Research by staff affiliated to the University Hopsitals in Limerick, comprising Univeristy Hospital Limerick,Dooradoyle, Croom Orthopaedic Hospital, University Maternity Hospital, Ennis Road, Limerick

Recent Submissions

  • A Dedicated Perineal Clinic – An Audit in Support

    Corry, E; O’Connor, E; Eogan, M; Fitzpatrick, M; O’Sullivan, S; Imcha, M (Irish Medical Journal, 2019-04)
    To assess the quality of care in both the initial management of obstetric anal sphincter injury (OASI) and subsequent follow up postnatally in a tertiary maternity hospital without direct access to a perineal clinic.
  • Estimated Weight of Paediatric Patients versus Measured Weight – A Prospective Comparison

    Lineen, C; O’Donnell, S; Birrane, K; O’Riordan, A; Twomey, J; Murphy, A.M; O’Gorman, C (Irish Medical Journal, 2019-04)
    Weight measurement is fundamental in the management of paediatric patients. Many methods have been described for estimating a patient’s weight. The aim of this study was to assess the accuracy of the APLS 2017 estimated weight guidelines.
  • Bereavement Counselling for Healthcare Workers in the Aftermath of Child Death

    O’Sullivan, D; Stone, G; Mahomed, H; O’Reilly, P; Stewart, P; Noonan, H; Murphy, A.M (Irish Medical Journal, 2019-05)
    To assess the views and experiences of bereavement counselling services among healthcare staff dealing with paediatric ward death at UHL.
  • The Human Mesenteric Lymph Node Microbiome Differentiates Between Crohn's Disease and Ulcerative Colitis.

    Kiernan, Miranda G; Coffey, J Calvin; McDermott, Kieran; Cotter, Paul D; Cabrera-Rubio, Raul; Kiely, Patrick A; Dunne, Colum P (Journal of Crohn's and Colitis, 2019-01-01)
    Mesenteric lymph nodes are sites in which translocated bacteria incite and progress immunological responses. For this reason, understanding the microbiome of mesenteric lymph nodes in inflammatory bowel disease is important. The bacterial profile of Crohn’s disease mesenteric lymph nodes has been analysed using culture-independent methods in only one previous study. This study aimed to investigate the mesenteric lymph node microbiota from both Crohn’s disease and ulcerative colitis patients.
  • Ustekinumab-induced subacute cutaneous lupus.

    Tierney, Emma; Kirthi, Shivashini; Ramsay, Bart; Ahmad, Kashif (JAAD Case Reports, 2019-03-01)
    Drug-induced lupus erythematosus (DILE) is a lupus-like syndrome temporally related to continuous drug exposure. DILE can be divided into systemic lupus erythematosus (SLE), subacute cutaneous lupus erythematosus (SCLE) and chronic cutaneous lupus.1 Hydrochlorothiazide was the first drug associated with SCLE in 1985,2 but at least 100 other agents have since been reported to induce/exacerbate SCLE, with terbinafine, tumor necrosis factor (TNF)-α inhibitors, antiepileptics, and proton pump inhibitors, the most frequently associated medications. We present a case of ustekinumab-induced SCLE in a patient being treated for psoriasis.
  • Erectile Dysfunction and Ischaemic Heart Disease.

    Ibrahim, Abdalla; Ali, Mohamed; Kiernan, Thomas J; Stack, Austin G (European Cardiology Review, 2018-12-01)
    Erectile dysfunction (ED) is a common disorder that affects the quality of life of many patients. It is prevalent in more than half of males aged over 60 years. Increasing evidence suggests that ED is predominantly a vascular disorder. Endothelial dysfunction seems to be the common pathological process causing ED. Many common risk factors for atherosclerosis such as diabetes, hypertension, smoking, obesity and hyperlipidaemia are prevalent in patients with ED and so management of these common cardiovascular risk factors can potentially prevent ED. Phosphodiesterase type 5 inhibitors provide short-term change of haemodynamic factors to help initiate and maintain penile erection. They have been shown to be an effective and safe treatment strategy for ED in patients with heart disease, including those with ischaemic heart disease and hypertension.
  • Pulmonary aspiration in preschool children with cystic fibrosis.

    Clarke, D; Gorman, I; Ringholz, F; McDermott, M; Cox, D W; Greally, P; Linnane, B; Mc Nally, P (Respiratory Research, 2018-12-17)
    Pulmonary aspiration of gastric refluxate (PAGR) has been demonstrated in association with pulmonary inflammation in school aged children with Cystic Fibrosis (CF). We sought to determine if similar findings were present in preschool children. Pepsin was measured in Broncho-alveolar lavage (BAL) fluid collected from clinically stable preschool children with CF and controls. Elevated pepsin levels were found in a subgroup of children with CF, but this was not found to be associated with pulmonary infection, pulmonary inflammation or respiratory or gastrointestinal symptoms.
  • Prevalence and correlates of central venous catheter use among haemodialysis patients in the Irish health system - a national study.

    Hussein, Wael F; Mohammed, Husham; Browne, Leonard; Plant, Liam; Stack, Austin G (BMC Nephrology, 2018-04-02)
    Central venous catheters (CVC) are associated with substantial morbidity and mortality among patients undergoing haemodialysis (HD), yet they are frequently used as the primary vascular access for many patients on HD. The goal of this study was to determine the prevalence and variation in CVC use across centres in the Irish health system. Data from the National Kidney Disease Clinical Patient Management System (KDCPMS) was used to determine CVC use and patterns across centres. Data on demographic characteristics, primary cause of end-stage kidney disease (ESKD), comorbid conditions, laboratory values and centre affiliation were extracted for adult HD patients (n = 1, 196) who were on dialysis for at least three months up to end of December 2016. Correlates of CVC use were explored using multivariable logistic regression. Overall prevalence of CVC use was 54% and varied significantly across clinical sites from 43% to 73%, P < 0.001. In multivariate analysis, the likelihood of CVC use was lower with increasing dialysis vintage, OR 0.40 (0.26-0.60) for 4 years vs 1 year vintage, rising serum albumin, OR 0.73 (0.59-0.90) per 5 g/L), and with cystic disease as a cause of ESKD, OR 0.38 (95% CI 0.21-0.6). In contrast, catheter use was greater for women than men, OR 1.77 (1.34-2.34) and for 2 out of 10 regional dialysis centres, OR 1.98 (1.02-3.84) and OR 2.86 (1.67-4.90) respectively compared to referent group). Catheters are the predominant type of vascular access in patients undergoing HD in the Irish health system. Substantial centre variation exists which is not explained by patient-level characteristics.
  • Annular Rupture During Transcatheter Aortic Valve Implantation: Predictors, Management and Outcomes.

    Coughlan, J J; Kiernan, Thomas; Mylotte, Darren; Arnous, Samer (International Cardiology Review, 2018-09-01)
    Transcatheter aortic valve implantation (TAVI) is the treatment of choice in patients with symptomatic severe aortic stenosis who are either inoperable or at high risk for conventional surgical aortic valve replacement. Recent data have also shown favourable outcomes in patients deemed to be at intermediate operative risk, which expands the application of this novel technology. Despite its success, TAVI has been associated with rare life-threatening complications. Of these, aortic annular rupture is considered to be the most devastating. Advances in pre-procedural screening and patient selection have reduced the incidence of annular rupture. When this complication occurs, early recognition and prompt management are essential. This article is intended to provide a comprehensive review of the predictors, management and clinical outcomes of aortic annular rupture.
  • Temporal trends in hyperuricaemia in the Irish health system from 2006-2014: A cohort study.

    Kumar A U, Arun; Browne, Leonard D; Li, Xia; Adeeb, Fahd; Perez-Ruiz, Fernando; Fraser, Alexander D; Stack, Austin G; University Hospital Limerick (PLOS ONE, 2018-01-01)
    Elevated serum uric acid (sUA) concentrations are common in the general population and are associated with chronic metabolic conditions and adverse clinical outcomes. We evaluated secular trends in the burden of hyperuricaemia from 2006-2014 within the Irish health system. Data from the National Kidney Disease Surveillance Programme was used to determine the prevalence of elevated sUA in adults, age > 18 years, within the Irish health system. Hyperuricaemia was defined as sUA > 416.4 μmol/L in men and > 339.06 μmol/L in women, and prevalence was calculated as the proportion of patients per year with mean sUA levels above sex-specific thresholds. Temporal trends in prevalence were compared from 2006 to 2014 while general estimating equations (GEE) explored variation across calendar years expressed as odds ratios (OR) and 95% Confidence intervals (CI). From 2006 to 2014, prevalence of hyperuricaemia increased from 19.7% to 25.0% in men and from 20.5% to 24.1% in women, P<0.001. The corresponding sUA concentrations increased significantly from 314.6 (93.9) in 2006 to 325.6 (96.2) in 2014, P<0.001. Age-specific prevalence increased in all groups from 2006 to 2014, and the magnitude of increase was similar for each age category. Adjusting for baseline demographic characteristics and illness indicators, the likelihood of hyperuricemia was greatest for patients in 2014; OR 1.45 (1.26-1.65) for men and OR 1.47 (1.29-1.67) in women vs 2006 (referent). Factors associated with hyperuricaemia included: worsening kidney function, elevated white cell count, raised serum phosphate and calcium levels, elevated total protein and higher haemoglobin concentrations, all P<0.001. The burden of hyperuricaemia is substantial in the Irish health system and has increased in frequency over the past decade. Advancing age, poorer kidney function, measures of nutrition and inflammation, and regional variation all contribute to increasing prevalence, but these do not fully explain emerging trends.
  • Merkel Cell Carcinoma: A Case Series

    Zafar, S.A; O.M Ahmed, O.M; Boland, M.R; Aucharaz, N; Lal, A (Irish Medical Journal, 2018-10)
    Merkel cell carcinoma (MCC) is a rare cutaneous tumour that is clinically aggressive with a high local, regional, and distant metastatic potential.
  • Coming of Age in Ireland: the Twilight Zone!

    Power, B.D; Stewart, P; Stone, G; O’Reilly, P; Costigan, C; O’Gorman, C; Murphy, A.M; University Hospital Limerick (Irish Medical Journal, 2018-10)
    To describe the healthcare needs of adolescent patients inhabiting the ‘seventh age of childhood’ in our region with a view towards future workforce and infrastructure planning.
  • Report on the death of patients in whom CPE had been detected

    Spencer, Robert C.
    Following the first Irish outbreak of Carbapenemase Producing Enterobacteriaceae [CPE] at UHL in 2011, there has been an ongoing increased detection of CPE in the UL Hospitals Group (ULHG) with multiple associated outbreaks. An extensive screening programme is currently in place; in critical care and for newly admitted patients should they fulfil specific screening criteria [ULHG Guidelines for the Prevention, Control & Management of CRE including KPC. Document: QPRS-IPCH-10 Approved January 2016].
  • Caffeine Treatment for Apnea of Prematurity and the Influence on Dose-Dependent Postnatal Weight Gain Observed Over 15 Years.

    Philip, Roy K; Ismail, Abu; Murphy, Bernadette; Mirza, Adnan; Quinn, Collette; Dunworth, Margo; University Hospital Limerick (Journal of Caffeine and Adenosine Research, 2018-09-01)
    To analyze the influence on weight gain of infants exposed to two dosage regimens of oral caffeine citrate (CC) for apnea of prematurity.
  • Temporal trends in acute kidney injury across health care settings in the Irish health system: a cohort study.

    Stack, Austin G; Li, Xia; Kaballo, Mohamed; Elsayed, Mohamed E; Johnson, Howard; Murray, Patrick T; Saran, Rajiv; Browne, Leonard D (Nephrology, dialysis, transplantation, 2018-08-07)
    Complete ascertainment of the true rates of acute kidney injury (AKI) and emerging trends are essential for planning of preventive strategies within health systems. We conducted a retrospective cohort study from 2005 to 2014 using data from regional laboratory information systems to determine incidence rates of AKI and severity Stages 1-3 in the Irish health system. Multivariable models were developed to explore annual trends and the contributions of demographic factors, clinical measures, geographic factors and location of medical supervision expressed as adjusted odds ratios (ORs) and 95% confidence intervals (CIs). From 2005 to 2014, incidence rates of AKI increased from 6.1% (5.8-6.3) to 13.2% (12.7-13.8) per 100 patient-years in men and from 5.0% (4.8-5.2) to 11.5% (11.0-12.0) in women, P < 0.001. Stage 1 AKI accounted for the greatest growth in incidence, from 4.4% (95% CI 4.3-4.6) in 2005 to 10.1% (95% CI 9.8-10.5) in 2014 (P < 0.001 for trend). Compared with 2005, patients in 2014 were more likely to experience AKI [OR 4.53 (95% CI 4.02-5.1) for Stage 1, OR 5.22 (4.16-6.55) for Stage 2 and OR 4.11 (3.05-5.54) for Stage 3], adjusting for changing demographic and clinical profiles. Incidence rates of AKI increased in all locations of medical supervision during the period of observation, but were greatest for inpatient [OR 19.11 (95% CI 17.69-20.64)] and emergency room settings [OR 5.97 (95% CI 5.56-6.42)] compared with a general practice setting (referent). Incidence rates of AKI have increased substantially in the Irish health system, which were not accounted for by changing demographic patterns, clinical profiles or location of medical supervision.
  • Sweat Testing in Ireland

    Blake; Tsang, V; Ghori, R; Whelan, S; Boran, G; Linnane, B; University Hospital Limerick (Irish Medical Journal, 2018-07)
    Quick, painless, cheap and reliable, the sweat test remains the gold standard diagnostic test for cystic fibrosis. We aimed to describe the pattern of testing in Ireland over a calendar year.
  • A cross sectional study of the relationship between self-reported levels of loneliness and the experience of Pastoral Care in an Older Adult Day-care Service

    Kiely, Elizabeth; Irish College of Humanities and Applied Sciences (2018-08-04)
    Thesis submitted for the Masters in Counselling and Pastoral Care At the Irish College of Humanities and Applied Sciences. The thesis seeks to establish if a correlation exists between self-reported levels of loneliness and the experience of pastoral care in Older Adult Daycare Services (OADS).
  • Revascularisation of left main stem disease: a prospective analysis of modern practice and outcomes in a non-surgical centre.

    Coughlan, J J; Blake, Nial; Chongprasertpon, Napohn; Ibrahim, Munir; Arnous, Samer; Kiernan, Thomas John; Department of Cardiology, University Hospital Limerick (2018-07)
    In this study, we sought to prospectively analyse the management and long term outcomes associated with revascularisation of left main stem disease via percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) in our centre.
  • Enhancing acute stroke services: a quality improvement project.

    McGrath, Keith; Cunningham, Nora; Moloney, Elizabeth; O'Connor, Margaret; McManus, John; Peters, Catherine; Lyons, Declan; University Hospital Limerick (BMJ open quality, 2018-07)
    In a busy stroke centre in Ireland, care for acute stroke was provided by a mixture of general physicians. In acute ischaemic stroke, speed is essential for good outcomes.
  • A core outcome set for studies evaluating the effectiveness of prepregnancy care for women with pregestational diabetes.

    Egan, Aoife M; Galjaard, Sander; Maresh, Michael J A; Loeken, Mary R; Napoli, Angela; Anastasiou, Eleni; Noctor, Eoin; de Valk, Harold W; van Poppel, Mireille; Todd, Marie; et al. (Diabetologia, 2017-04)
    The aim of this study was to develop a core outcome set (COS) for trials and other studies evaluating the effectiveness of prepregnancy care for women with pregestational (pre-existing) diabetes mellitus.

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