Research by staff affiliated to the Midland Regional Hospital Mullingar

Recent Submissions

  • Analysis of inflammatory cytokine and TLR expression levels in Type 2 Diabetes with complications.

    Gupta, Saket; Maratha, Ashwini; Siednienko, Jakub; Natarajan, Anandan; Gajanayake, Thusitha; Hoashi, Shu; Miggin, Sinéad (Scientific Reports, 2017-08-09)
    The pathogenesis and complications of type 2 diabetes (T2DM) are closely linked with defective glucose metabolism, obesity, cardiovascular disease and an inability to mount an effective immune response to certain pathogenic organisms. Perturbations in key innate immune receptors known as Toll-like receptors (TLRs) and inflammatory mediators such as IL-6, TNFα and IL-1β have been linked with T2DM. Herein, we sought to establish whether patients with T2DM and underlying complications exhibit perturbations in cytokine and TLR expression. Serum cytokine and mRNA levels of cytokines/TLRs in monocytes (M) and neutrophils (N) were measured in a cohort of 112 diabetic patients: good glycaemic control without complications (GC), good glycaemic control with complications (GCC), poor glycaemic control without complications (PC) and poor glycaemic control with complications (PCC) and compared them with 34 non-diabetic volunteers (NGT). Serum cytokine levels were normal in all study participants. In the GC group, cytokine and TLR gene expression were enhanced compared to NGT. In contrast, suppressed cytokine and TLR gene expression were evident in PC, GCC & PCC groups when compared to the GC. In conclusion, whereas serum pro-inflammatory cytokine levels are unaltered in T2DM patients, differences in inflammatory gene profiles exist among the T2DM patient groups.
  • Scope and Safety of Paediatric Surgery in a Model III Hospital

    Joyce, P.D; Craig, R; Dakin, A.; Elsheik, E.; Ejaz, T.; Mansoor, S.; Toomey, D.P. (Irish Medical Journal, 2019-03)
    In 2016 the Faculty of Paediatrics in the Royal College of Physicians of Ireland, in conjunction with the Royal College of in Surgeons Ireland and the Health Service Executive, published the National Clinical Programme for Paediatrics and Neonatology: improving services for general paediatric surgery1. The purpose of these guidelines was to ensure the provision of safe and efficient paediatric general surgery outside of specialist paediatric hospitals in both local and regional paediatric surgical facilities. These guidelines were necessitated by a variety of factors including the retirement of a generation of consultant surgeons with paediatric surgical skills, a lack of paediatric surgical training for core trainees, increasing sub-specialisation within the field of general surgery with the resultant de-skilling of supporting anaesthetic, radiology and nursing colleagues, and inadequate funding of paediatric surgical services. These challenges are compounded by Ireland having the lowest number of paediatric surgeons per capita when compared to other European countries, despite having the highest birth rate in Western Europe1.
  • Caecal Epiploic Appendagitis Masquerading Clinically as an Acute Appendicitis: A Case Report and Brief Literature Review.

    Ejaz, Tallat; Saad, Eltaib; Nabil, Andik; Slattery, James (Case Reports in Surgery, 2019-01-01)
    A 46-year-old female presented to our emergency department (ED) with a 2-day history of right lower abdominal pain which was associated with nausea and anorexia. Abdominal examination revealed tenderness in the right iliac fossa (RIF) with rebound tenderness and a localized guarding. Urine dipstick was normal, and the pregnancy test was negative. Her laboratory investigations were significant only for a CRP of 16.6. A presumptive clinical diagnosis of acute appendicitis was suggested based on the given history and relevant physical signs. However, an abdominal computed tomography (CT) scan revealed an epiploic appendagitis of the caecum with a normal-looking appendix. She was managed conservatively and responded well and was discharged after 2 days in good health. Though being a relatively rare case of acute localized right-sided lower abdominal pain, caecal epiploic appendagitis should be considered as one of the differential diagnoses with the final diagnosis reached usually by the radiological findings due to the nonspecific nature of clinical and laboratory features.
  • A Case of Postpartum HELLP Syndrome

    Langhe, R; Shah, U F; Almshwt, M (Irish Medical Journal, 2017-11)
    A 37-year-old primigravida was referred from the antenatal clinic with a provisional diagnosis of pre-eclampsia in view of severe frontal headache, high blood pressure and proteinuria. There was no history of visual disturbance or epigastric pain. The woman was at 30 weeks gestation.
  • Westermark's sign of pulmonary embolism--well known but frequently overlooked.

    Tsvetanova, Z; Logan, H (Irish Medical Journal, 2015-01)
    Pulmonary embolism (PE) is frequently a difficult diagnosis because of non-specific symptoms that can lead to misdiagnosis 1 . We report a patient with PE successfully diagnosed and treated, whose CXR showed Westermark’s sign of pulmonary embolism. Westermark’s sign is distal oligaemia in the affected area of the lung due to a reduction in size of vessels distal to a PE 2 . It has a low sensitivity (14%) and high specificity (92%) for the diagnosis of pulmonary embolism 3 . Its high specificity for PE makes it a sign well worth being aware of and in this case described its early recognition may led to early treatment and to prevention of cardiovascular insult.
  • Somatoform abdominal pain in surgery: is SD worthy of surgical attention? Case reports and literature review.

    Abd Elwahab, Sami Medani; Doherty, Eva; Elsheikh, Hashim; Department of Surgery, Midland Regional Hospital Mullingar, Mullingar, Westmeath, Ireland. sami_medani@hotmail.com (2012-08)
    Somatoform disorders (SD) or medically unexplained physical symptoms (MUPS) are a group of disorders that represent a group of symptoms that cannot be explained by an organic or physical pathology. These disorders are widely prevalent, and, if unrecognised, SD may lead medical professionals to embark on tests or procedures which may inflict unnecessary iatrogenic complications. Despite the high prevalence, they are only poorly included in medical training curricula, at both undergraduate and postgraduate levels. In this article, we review the literature and present two cases. The first one presented with a recurrent acute abdomen had an unnecessary CT abdomen. The second case had laparoscopy for acute right-sided abdominal pain which turned out to be normal, and was readmitted again after a short period with acute urine retention which resolved spontaneously following discussion with the patient and family. Both cases were referred for psychiatric assessment and their family doctors were informed.
  • "Cobra head" stone.

    Stafford, Aisling M; Logan, Hugh; O'Grady, Michael J; Department of Pediatrics, Midland Regional Hospital, Mullingar, Ireland. (2014-02)
  • Bloody nipple discharge in a 7-month-old boy.

    Zaid, Ahmed; Carolan, Eirin; Sharif, Farhana; Department of Paediatrics, Mullingar Regional Hospital, Mullingar, Ireland. (2011-10)
    Isolated bloody nipple discharge is rare in infancy and is usually idiopathic. Discharge commonly resolves spontaneously, and ultrasonography is a useful diagnostic technique to detect the cause of discharge. The authors report a 7-month-old boy who presented with unilateral spontaneous bloody nipple discharge for 1 month without signs of infection or mass.
  • A 'one in a million' case of pulsating thoracoabdominal mass.

    Tan, Lay Ong; Lim, Soo Yen; Sharif, Farhana; Paediatric Department, Midland Regional Hospital, Mullingar, Ireland. philiptan83@gmail.com (2012-11)
    Ectopia cordis is a rare congenital malformation in which the heart is located partially or totally outside the thoracic cavity. It comprises 0.1% of congenital heart diseases. The authors present a case of a male baby born at term by emergency caesarean section due to prolonged fetal bradycardia, who was noted to have a large pulsating mass in the thoracoabdominal area. In view of lower thoracolumbar abdominal defect, ectopic placement of the umbilicus, deficiency of the diaphragmatic pericardium, deficiency of anterior diaphragm and intracardiac abnormalities, a diagnosis of ectopia cordis-Pentalogy of Cantrell was made. He was transferred to a tertiary centre and required oxygen supplement initially. He was sent home after 1 week, on propanolol, with weekly oxygen saturation checks. He is awaiting further surgical intervention pending the required weight gain.
  • Stroke knowledge in an Irish semi-rural community-dwelling cohort and impact of a brief education session.

    O'Callaghan, Geraldine; Murphy, Sean; Loane, Dorothy; Farrelly, Evelyn; Horgan, Frances; Physiotherapy Department, Midland Regional Hospital, Mullingar, County Westmeath, Ireland. geraldineocallaghan@hotmail.com (Elsevier, 2012-11)
    Poor knowledge of stroke risk factors and failure to recognize and act on acute symptoms hinders efforts to prevent stroke and improve clinical outcomes. Levels of stroke knowledge are poorly established within Ireland. This study was conducted to establish levels of knowledge among men and women aged >40 years in an Irish community, and also to determine the impact of a single education session on stroke knowledge. Subjects from 2 separate geographical locations were allocated to an intervention group (n = 200), who received stroke information over a 90-minute session, or a control group (n = 200). Both groups completed a stroke knowledge questionnaire at baseline and at 4 weeks after the educational session. Overall, the initial response rate was 70% (280/400); 52% of the respondents knew that the brain is affected by stroke, 58% could list 2 or more risk factors but only 27% could list 2 or more warning signs, 50% would call 999 (emergency number in Ireland) in response to stroke, 17% had heard of thrombolytic therapy, but only 1% knew the time frame for receiving thrombolytics. The response rate to the resurvey following the educational session was 57%, with 47 of 117 subjects in the intervention group (40%) attending the session. Stroke knowledge scores improved by 50% in the intervention group (P < .001). Overall, the knowledge of stroke risk factors, warning signs, and thrombolytic therapy was poor in this Irish community-dwelling cohort. Our study demonstrates that a single educational session can improve short-term knowledge of stroke symptoms and thrombolytic therapy.
  • Linking audit and clinical effectiveness in the lung tumour service

    Gorman, S; Doyle, C; O’Brien, A; Midlands Regional Hospital Mullingar (MRHM). (International Society for Quality in Health Care, 2009)
    The aim of the audit is to capture the lung cancer patient’s care pathway, to improve clinical effectiveness, advance service quality and improve standards of care by reducing diagnosis and treatment time delays.
  • A disjointed effort: paediatric musculoskeletal examination.

    Gill, Irwin; Sharif, Farhana; Department of Paediatrics, Midlands Regional Hospital, Mullingar, Co. Westmeath, Ireland. irwingill@gmail.com (2012-07)
    Musculoskeletal (MSK) symptoms are a frequent cause of emergency department attendance for children, and while most often indicative of benign or self-limiting disease, such symptoms can occasionally be the first presentation of serious illness such as leukaemia or juvenile idiopathic arthritis. MSK examination, however, is often not included as part of the routine paediatric examination. The authors aimed to evaluate how often and how thoroughly MSK examination was performed during admissions to the paediatric ward and to compare it with the examination of other symptoms in relation to the presenting complaint and eventual diagnosis.
  • Linking audit and clinical effectiveness in the lung tumour service

    Gorman, Sharon; Kelly, Jacinta; Midland Regional Hospital, Mullingar (Midland Regional Hospital, Mullingar, 2009-05-28)
    Clinical Audit plays an important role in the evaluation of care and clinical outcomes for all patients. In conjunction with the respiratory nurse specialist a retrospective chart audit of the regional lung cancer service was undertaken at the Midlands Regional Hospital Mullingar (MRHM). The lung cancer service has been established for four years and has set its standards in line with NICE guidelines and Irish guidelines for the clinical management of lung cancer. An audit tool was developed by the audit facilitator in conjunction with the respiratory nurse specialist and key department personnel. The tool aimed to measure length of time taken for key steps in the patients care pathway. A pilot audit was carried out and the tool was evaluated. The audit tool provided accurate recording of information at key points in the patient’s care which allows for a thorough service evaluation. The data collected and analysed gives vital information on the quality of service, and showed where there are deficits in service provision that need to be addressed.
  • Atypical fractures on long term bisphosphonates therapy.

    Hussein, W; Cunningham, C; Logan, H; Fallon, C; Murphy, S; Midland Regional Hospital, Mullingar, Co Westmeath. waelhussein@physicians.ie (2011)
    Bisphosphonates reduce fractures risk in patients with osteoporosis. A new pattern of fractures is now being noted in patients on prolonged bisphosphonate therapy. We report a case of an atypical femoral fracture with preceding pain and highlight the characteristics of these fractures.
  • Behavioural and emotional outcome of very low birth weight infants--literature review.

    Hayes, Breda; Sharif, Farhana; Department of Paediatrics, Midland Regional Hospital, Mullingar, Ireland. bredahayes@hotmail.com (2009-10)
    VLBW or very preterm infants are at significant risk of behavioural and emotional problems. The risk is further increased when cognitive or motor difficulties are present or when social circumstances are poor.
  • A comparison of antibiotic point prevalence survey data from four Irish regional/general hospitals.

    Naughton, C; Hennessy, Y; Mannion, C; Philbin, M; Quality, Audit and Risk Management Team, HSE-Dublin Mid Leinster, Midlands Regional Hospital Mullingar, Mullingar, Westhmeath, Ireland. corina.naughton@ucd.ie (2011-06)
    Point prevalence survey data using a standardised methodology could facilitate both local audit and national benchmarking to monitor antibiotic use.
  • Time from hospital admission to CT brain in acute ischaemic stroke

    Mulroy, Martin; Murphy, Blathnaid; Murphy Sean PT (Irish Medical Journal, 2011-06)