• A Comparison of Perceived and Measured Paternal Weight and BMI, and Relationship to Weight and BMI of his Children

      Power, RF; Power, B; O’Gorman, CS (Irish Medical Journal, 2018-02)
      Nineteen percent of 9 years old Irish children are overweight; seven percent are obese. Our aims were: to examine whether differences exist between paternal self-reported and measured height, weight and BMI in a population representative sample; and to explore paternal perceptions of their own weight status. Measures of height and weight for fathers and for their children from the National Longitudinal Study of Children Growing Up in Ireland were obtained using validated methods. Three quarters of fathers (6,263 of 8,568 study children) with a mean age of 42 years (SD 5.04) responded. The mean difference between self-reported and measured weight was -1.03kg (SD=4.52), indicating that weight was underestimated. Obese fathers were more likely to have an obese son (9.4% compared to 5.3% for the full cohort) and an obese daughter (12.4% compared to 7.7%). These data suggest that there is a strong relationship between fathers' weights and his childrens’ weights. A leading factor in the development of childhood obesity is parental obesity. Targeting overweight and obesity in the child should occur simultaneously with tackling overweight and obesity in the parents; in this study, the fathers
    • 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.
    • Hemorrhagic lesion on the chest wall after trauma.

      Roche, Lisa; Wall, Dmitri; Hackett, Catriona (JAAD case reports, 2018-01)
      A 59-year-old woman presented with a burning, rapidly progressive mass on the midchest, occurring after a fall, 4 months prior. Examination found a large well-circumscribed mass over the lower xiphisternum (Figs 1 and 2). Results of baseline investigations were normal apart from mildly elevated liver function values. A computerized tomography scan confirmed a 6.4- x 4.9-cm lobulated soft tissue heterogeneous-density mass located in the subcutaneous fat with ill-defined borders and no obvious infiltration of the chest wall. A single focal abnormality was noted in the liver. Several incision/drainage procedures were complicated by difficulty achieving hemostasis. Ellipse incisional biopsy was performed (Figs 3 and 4).
    • Determination of the Lung Clearance Index (LCI) in a Paediatric Cystic Fibrosis Cohort

      Mulligan, M; Collins, L; Dunne, CP; Keane, L; Linnane, B (Irish Medical Journal, 2017-10)
      The pathogenesis of CF lung disease may start in infancy. Therefore, it is important to monitor the early stages of its progress. The Exhalyzer D is the first commercially available device designed to measure lung ventilation inhomogeneity at any age. This study was conducted to assess the performance and feasibility of using the Exhalyzer D in a paediatric CF clinic. A total of 91 subjects were recruited (23 controls, and 68 patients with CF). The majority of CF patients (79%) and controls (78%) completed at least two successful washouts. A strong linear correlation was noted between LCI and FEV1. Children with CF under six years of age struggled to perform the washout in a technically correct manner. A clear learning effect was observed, with improved technique and shorter testing times on repeated visits.
    • An unusual case of recurrent chest infections.

      Dahab, Taqua; Saleem, Shahzaib; Gumani, Dikshaini; Casserly, Brian; Sharkey, Claire; Laghi, Frank; Newmarch, William (2017-08)
      This case presentation relates to a 53 year old male, cachectic in appearance, who presented with progressively worsening dyspnoea, cough, intermittent haemoptysis and a history of nasal dryness ongoing over five months. The patient had received multiple courses of oral antibiotics for suspected community acquired pneumonia with no significant improvement. He was referred to our Respiratory Department for further evaluation of his symptoms. His HRCT showed right middle lobe consolidation with central cavitations. Furthermore, the transbronchial biopsy had been performed and the cytological examination revealed lipid laden macrophage with interstitial inflammatory changes. With return to the patient over the counter drug history, he described the frequent use of petroleum jelly to alleviate the symptoms of nasal dryness. This is the first report case of exogenous lipoid pneumonia presented with haemoptysis and cavitations in the HRCT.
    • Comparing cardiovascular risk factors, disease and treatment in participants with rheumatoid arthritis and without arthritis in a population based study

      O’Driscoll, N; Kennedy, N; Anjum, S; Fraser, A; Hannigan, A (Irish Medical Journal, 2017-05)
      Rheumatoid Arthritis (RA) is associated with a significant increase in mortality compared to the general population, with cardiovascular disease (CVD) the leading cause of death. The aim of this study is to compare the prevalence and treatment of modifiable CV risk factors and history of CVD in those with RA and those without arthritis in Ireland. Data from the Irish Longitudinal Study on Ageing (TILDA), a population-representative cohort study of people in Ireland aged 50 or over, was used. Participants with RA (n=457) were twice as likely to be obese (OR 2.02, 95% CI 1.99 to 2.06) compared to those without arthritis (n=4,063). Participants with RA were also more likely to be physically inactive (OR 1.73, 95% CI 1.69 to 1.76) and taking antihypertensive medication than those without arthritis. Exercise can have a beneficial impact on CVD and specific interventions to increase physical activity in those with RA may be warranted
    • Peritoneal tuberculosis in the setting of ustekinumab treatment for psoriasis.

      Lynch, Maeve; Roche, Lisa; Horgan, Mary; Ahmad, Kashif; Hackett, Caitriona; Ramsay, Bart (JAAD case reports, 2017-05)
      Biologics have revolutionized the treatment of moderate-to-severe psoriasis, but serious infection is a risk with these immunosuppressive agents.1 An increased risk of tuberculosis (TB) reactivation in patients with latent TB infection is well recognized with antietumor necrosis factor (TNF)-a agents, as TNF has a central role in TB immunity, and antieTNF-a agents interfere with innate and cellmediated immune responses.2 Testing for and treating latent TB before starting therapy reduces the risk of reactivation of TB on biologic agents
    • 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.
    • Does exercise impact on sleep for people who have rheumatoid arthritis?

      McKenna, Sean (Rheumatology International, 2017-03-01)
      Objectives: To systematically search for the availability of evidence for exercise impacting on sleep for people who have rheumatoid arthritis. Methods: Two reviewers independently searched seven electronic databases, identified and extracted relevant studies by applying eligibility criteria. Sources of bias were assessed independently by two reviewers using the Cochrane bias assessment tool for randomized controlled trials (RCTs) and Newcastle-Ottawa Quality Assessment Scale for non-RCT’s. Data were synthesized using a level of evidence approach. Meta-analyses were deemed to be inappropriate due to the heterogeneity of study designs, measurement tools and interventions. Results: Five studies were included: 1 RCT; 2 pilot RCT’s and 2 sample of convenience. A total of 262 people with RA were included. Interventions used were difficult to assess due to the heterogeneity of study designs and the inclusion of two using different types of Yoga as an intervention. Different sleep outcome measures were used thus, it was not feasible to pool results. Studies had a high risk of bias.
    • Ghana Health Services and the Irish health system – bridging the gap.

      Akaateba, D; Andan, M; Hadfield, K; Elmusharaf K; Leddin D; Murphy F; Ofosu W; Sheehan C; Finucane P (Irish Medical Journal, 2017-02)
      The University of Limerick Hospitals Group (ULHG), and the University of Limerick (UL), are committed to fostering links with the developing world and contributing to solutions of the challenges these countries face. In 2016 a group from UL and ULHG visited the Upper West Region of Ghana1 to explore the possibility of establishing a partnership with Ghana Health Services (GHS). In this article, we describe aspects of GHS and outline some of the challenges for Irish institutions trying to engage with the realties of the developing world.
    • Knitting the Threads of Silk through Time: Behçet's Disease-Past, Present, and Future.

      Adeeb, Fahd; Stack, Austin G; Fraser, Alexander D (International Journal of Rheumatology, 2017)
      Behçet's disease (BD) is a chronic relapsing vasculitis that affects vessels of all types and sizes with a broad spectrum of phenotypic heterogeneity and complex immunopathogenesis. Efforts by the scientific community to resolve the unmet needs of BD and gaps in our knowledge have been hampered by considerable challenges that primarily relate to the rare nature of the disease in many parts of the world and its heterogeneity. Controversies remain in many aspects of the disease including the diagnostic criteria, immunopathogenesis and biomarker discovery, geographical variation, and therapeutic considerations. In this review, we highlight recent advances in our scientific understanding of BD, shed new insights into diagnostic and treatment strategies, and discuss residual gaps in our knowledge that will serve as the basis for current and future research.
    • High Vitamin D Levels May Downregulate Inflammation in Patients with Behçet's Disease.

      Adeeb, Fahd; Khan, Maria Usman; Li, Xia; Stack, Austin G; Devlin, Joseph; Fraser, Alexander D (International Journal of Inflammation, 2017)
      Vitamin D plays a significant role in the immune system modulation and may confer a protective role in autoimmune diseases. We conducted a case-control study to compare 25(OH)D levels in patients with BD who were managed at a regional rheumatology programme in the midwest region of Ireland compared to matched controls. Healthy controls were selected from the Irish health system and matched in 1 : 5 ratio for age, sex, and the month of the year. 25(OH)D levels <20 nmol/L were classified as deficient while levels between 20 and 40 nmol/L were classified as insufficient. Differences between groups were assessed using Mann-Whitney test and associations between cases and controls were expressed as odds ratios and 95% confidence intervals. Nineteen patients with BD were compared with 95 controls matched by age, sex, and month of blood draw. 25(OH)D levels were significantly higher in patients in BD than in matched controls (median values: 45 nmol/L versus 22 nmol/L, p < 0.005) and tended to be lower in patients with active disease than in those without (median values: 35 nmol/L (IQR: 22.75-47.25 nm/L) versus 50 nmol/L (IQR: 35-67 nmol/L), p = 0.11). Compared to controls, patients with BD were significantly less likely to have 25(OH)D deficiency or insufficiency (OR: 0.09, 95% CI: 0.03-0.28, p < 0.001). Our findings suggest a possible role for 25(OH)D in modifying the inflammatory response in BD and uncover a potential opportunity to assess whether correction of Vit D deficiency confers protective benefits.
    • UL Hospitals Group Healthy Ireland Implementation Plan 2016-2019

      UL Hospitals Group (Health Service Executive (HSE), 2016-06)
      This implementation plan builds on current health and wellbeing practices which are already underway across the UL Hospitals Group, including patient education programmes, staff stress management and leisure time opportunities. A comprehensive survey of staff physical activity was undertaken in 2015 with a 30% response rate (n=1003) and the results of this are reflected in the provision of environmental supports to promote physical activity and active commuting. The UL Hospitals Group has positioned health and wellbeing under the executive team’s governance to signpost the leadership’s commitment to the successful implementation of Healthy Ireland within the group.
    • Bed Utilisation in an Irish Regional Paediatric Unit A Cross-Sectional Study Using the Paediatric Appropriateness Evaluation Protocol (PAEP)

      Ó hAiseadha, Coilín; Mannix, Mai; Saunders, Jean; Philip, Roy K. (Int J Health Policy Manag, 2016-05)
      Increasing demand for limited healthcare resources raises questions about appropriate use of inpatient beds. In the first paediatric bed utilisation study at a regional university centre in Ireland, we conducted a cross-sectional study to audit the utilisation of inpatient beds at the Regional Paediatric Unit (RPU) in University Hospital Limerick (UHL), Limerick, Ireland and also examined hospital activity data, to make recommendations for optimal use of inpatient resources.
    • Car safety seat usage and selection among families attending University Hospital Limerick

      Scully, P; Finner, N; Letshwiti, JB; O’Gorman, C (Irish Medical Journal, 2016-05)
      The safest way for children to travel within a car is by provision of a weight-appropriate safety-seat. To investigate this, we conducted a cross-sectional study of adult parents who had children under 12 years, and collected information related to: car use, safety-seat legislation, and type of safety-seat employed. Data were reviewed on 120 children from 60 respondents. Ninety-eight (81.7%) children were transported daily by car. Forty-eight (81.4%) respondents were aware that current safety-seat legislation is based on the weight of the child. One hundred and seven (89.9%) children were restrained during travel using a car safety-seat. One hundred and two (96.2%) safety seats were newly purchased, installed in 82.3% (88) cases by family members with installation instructions fully read in 58 (55.2%) cases. Ninety-nine (83.2%) children were restrained using an appropriate safety-seat for their weight. The results show that four out of five families are employing the most appropriate safety-seat for their child, so providing an effective mechanism to reduce car-related injury. However, the majority of safety-seats are installed by family members, which may have child safety consequences.
    • Dedicated orthogeriatric service saves the HSE a million euro

      Shanahan, E; Henderson, C; Butler, A; Lenehan, B; Sheehy, T; Costelloe, A; Carew, S; Peters, C; O’Connor, M; Lyons, D; et al. (Irish Medical Journal, 2016-03)
      Hip fracture is common in older adults and is associated with high morbidity, mortality and significant health care costs. A pilot orthogeriatrics service was established in an acute hospital. We aimed to establish the cost effectiveness of this service. Length of hospital stay, discharge destination and rehabilitation requirements were analysed for a one year period and compared to patients who received usual care prior to the service. We calculated the costs incurred and savings produced by the orthogeriatric service. Median length of stay was reduced by 3 days (p=<0.001) saving €266,976. There was a 19% reduction in rehabilitation requirements saving €192,600. Median rehabilitation length of stay was reduced by 6.5 days saving €171,093. Reductions in long term care requirements led to savings of €10,934 per week. Costs to establish such a service amount to €171,564. The introduction of this service led to improved patient outcomes in a cost effective manner.
    • Irish medical students’ understanding of the intern year

      Gouda, P; Kitt, K; Evans, D.S; Goggin, D; McGrath, D; Last, J; Hennessy, M; Arnett, R; Dunne, F; O’Donovan, D; et al. (Irish Medical Journal, 2016-03)
      Upon completion of medical school in Ireland, graduates must make the transition to becoming interns. The transition into the intern year may be described as challenging as graduates assume clinical responsibilities. Historically, a survey of interns in 1996 found that 91% felt unprepared for their role. However, recent surveys in 2012 have demonstrated that this is changing with preparedness rates reaching 52%. This can be partially explained by multiple initiatives at the local and national level. Our study aimed evaluate medical student understanding of the intern year and associated factors. An online, cross-sectional survey was sent out to all Irish medical students in 2013 and included questions regarding their understanding of the intern year. Two thousand, two hundred and forty-eight students responded, with 1224 (55.4%) of students agreeing or strongly agreeing that they had a good understanding of what the intern year entails. This rose to 485 (73.7%) among senior medical students. Of junior medical students, 260 (42.8%) indicated they understood what the intern year, compared to 479 (48.7%) of intermediate medical students. Initiatives to continue improving preparedness for the intern year are essential in ensuring a smooth and less stressful transition into the medical workforce
    • Left atrial appendage thrombus with resulting stroke post-RF ablation for atrial fibrillation in a patient on dabigatran.

      Lobo, R; McCann, C; Hussaini, A; Meany, T B; Kiernan, T J (Irish Medical Journal, 2015-11)
      Dabigatran etexilate is licensed for use in prevention of deep venous thromboembolism and in prevention of stroke and systemic embolism in nonvalvular atrial fibrillation (AF). It has also been used in patients for other indications as a substitute for warfarin therapy because it requires no monitoring; one group being patients undergoing radiofrequency (RF), ablation for AF, although there have been no consensus guidelines with regards to dosage and timing of dose. We report the case of a patient with documentary evidence of left atrial appendage (LAA) thrombus formation and neurological sequelae post-RF ablation despite being on dabigatran. This case highlights the concern that periprocedural dabigatran may not provide adequate protection from development of LAA thrombus and that a standardised protocol will need to be developed and undergo large multicentre trials before dabigatran can be safely used for patients undergoing RF-ablation.
    • The establishment of a pilot paediatric obesity clinic at the University Hospital, Limerick

      Dowd, K; Murphy, AM; Scully, P; Letshwiti, JB; O Gorman, C (Irish Medical Journal (IMJ), 2015-10)
      This study describes the establishment of a pilot Paediatric Obesity Clinic (POC) in the University Hospital Limerick (UHL). Referrals were received from consultant paediatricians in the catchment areas of UHL for paediatric patients with high levels of excess adiposity. Fifteen patients and their families were invited to the POC in 2012. An initial medical assessment was conducted by 2 consultant paediatricians. Patients were also reviewed by a dietitian, a physiotherapist and physical activity experts from local Sports Partnerships. Twelve children and their families attended the POC (mean age=8.08 years; Range=3.6-13.6): 11/12 were overweight and 9/12 were obese. Abnormalities in blood work were detected as follows: 1/7 had elevated LDL-cholesterol; 2/8 had elevated triglyceride levels; 4/8 had elevated fasting insulin; 2/8 had elevated fasting glucose. With the current prevalence of obesity in paediatric populations, initiatives such as UHLâ s POC need to be established, funded and supported, to try to meet complex, multidisciplinary patient needs and to prevent future complex and expensive health complications.
    • Therapeutic hypothermia in ICUs

      O Connor, J; Doody, K; O’Dea, J (Irish Medical Journal, 2015-09)
      Recent research on Therapeutic Hypothermia (TH) post cardiac arrest has raised questions about its implementation and benefits. TH to 32-34oC is still included in international guidelines for post-cardiac arrest care. We investigated how Irish ICUs are utilising TH as part of their management of patients post cardiac arrest using a telephone survey of all Irish ICUs. All 25 ICUs in Ireland participated. As of quarter 2 2014, TH was part of post-cardiac arrest management in 20 ICUs(80%), which is similar to international figures. 2011 was the median year for units to start using TH in Ireland. Over half 13 (52%) of Irish ICUs have experience with cooling more than 10 patients. Despite lack of evidence for its benefit, 12 ICUs (48%) use TH for OHCA non VF-VT arrests. Lack of resources was cited by 2 ICUs (8%) as well as no local consensus by 1 ICU (4%) prevented a small minority adopting the protocol. Similar methods of inducing and maintaining TH were found in Ireland as with overseas. Interest was expressed in recent research on TH and in 2 ICUs local practice had changed because of it. An updated international resuscitation guideline is awaited.