• DALI: Vitamin D and lifestyle intervention for gestational diabetes mellitus (GDM) prevention: an European multicentre, randomised trial ¿ study protocol

      Jelsma, Judith GM; van Poppel, Mireille NM; Galjaard, Sander; Desoye, Gernot; Corcoy, Rosa; Devlieger, Roland; van Assche, Andre; Timmerman, Dirk; Jans, Goele; Harreiter, Jurgen; Kautzky-Willer, Alexandra; Damm, Peter; Mathiesen, Elisabeth R; Jensen, Dorte M; Andersen, Liselotte; Dunne, Fidelma; Lapolla, Annunziata; Di Cianni, Graziano; Bertolotto, Alessandra; Wender-Oegowska, Ewa; Zawiejska, Agnieszka; Blumska, Kinga; Hill, David; Rebollo, Pablo; Snoek, Frank J; Simmons, David (2013-07-05)
      Abstract Background Gestational diabetes mellitus (GDM) is an increasing problem world-wide. Lifestyle interventions and/or vitamin D supplementation might help prevent GDM in some women. Methods/design Pregnant women at risk of GDM (BMI≥29 (kg/m2)) from 9 European countries will be invited to participate and consent obtained before 19+6 weeks of gestation. After giving informed consent, women without GDM will be included (based on IADPSG criteria: fasting glucose<5.1mmol; 1 hour glucose <10.0 mmol; 2 hour glucose <8.5 mmol) and randomized to one of the 8 intervention arms using a 2×(2×2) factorial design: (1) healthy eating (HE), 2) physical activity (PA), 3) HE+PA, 4) control, 5) HE+PA+vitamin D, 6) HE+PA+placebo, 7) vitamin D alone, 8) placebo alone), pre-stratified for each site. In total, 880 women will be included with 110 women allocated to each arm. Between entry and 35 weeks of gestation, women allocated to a lifestyle intervention will receive 5 face-to-face, and 4 telephone coaching sessions, based on the principles of motivational interviewing. The lifestyle intervention includes a discussion about the risks of GDM, a weight gain target <5kg and either 7 healthy eating ‘messages’ and/or 5 physical activity ‘messages’ depending on randomization. Fidelity is monitored by the use of a personal digital assistance (PDA) system. Participants randomized to the vitamin D intervention receive either 1600 IU vitamin D or placebo for daily intake until delivery. Data is collected at baseline measurement, at 24–28 weeks, 35–37 weeks of gestation and after delivery. Primary outcome measures are gestational weight gain, fasting glucose and insulin sensitivity, with a range of obstetric secondary outcome measures including birth weight. Discussion DALI is a unique Europe-wide randomised controlled trial, which will gain insight into preventive measures against the development of GDM in overweight and obese women. Trial registration ISRCTN70595832
    • Debt crisis ahead for Irish medical students

      Haugh, C; Doyle, B; O’Flynn, S (Irish Medical Journal, 2014-06)
    • A decade of non-cystic fibrosis bronchiectasis 1996-2006.

      Zaid, A A; Elnazir, B; Greally, P; Department of Paediatric Respiratory Medicine, National Children's Hospital, Tallaght, Dublin 24. (2010-03)
      This study aimed to determine the aetiology, clinical presentation, co-morbidity, severity and the lobar distribution of non cystic fibrosis bronchiectasis (NCFB). We performed a retrospective review of clinical, radiological, immunological and microbiological data from 92 non-CF patients with a High resolution thoracic CT (HRCT) diagnosis of bronchiectasis in the three Dublin Children's referral Hospitals for the period 1996-2006. Of 92 patients (50 female), the median age at diagnosis was 6.4 years. The aetiology of bronchiectasis was as follows; idiopathic 29 (32%), post-pneumonia 16 (17%), immune deficiency 15 (16%), recurrent aspiration 15 (16%), primary ciliary dyskinesia 8 (9%), chronic aspiration with immune deficiency 5 (5%), post foreign body inhalation 2 (2%), tracheomalacia 1 (1%) and Obliterative bronchiolitis 1 (1%). Bronchial asthma and gastroesophageal reflux disease (GORD) were concurrently present in 18 (20%) and 10 (11%) respectively. Left lower lobe was commonly involved followed next by the right middle lobe. The common isolates were Haemophilus influenza (50), Streptococcus pneumoniae (34) and Staphylococcus aureus (14), Moraxella catarrhalis (9) and Pseudomonas auerginosa (8). Surgical interventions were performed in 23 (25%) of patients, lobectomy 11 (12%), pneumectomy 2 (2%), laryngeal cleft repair 4 (5%), rigid bronchoscopy for foreign body removal 2 (2%), Nissan's fundoplication 2 (2%), tracheoesophageal fistula repair 2 (2%). We conclude NCFB is under-recognised in Irish children and diagnosis is often delayed and Bronchial Asthma and GORD are common co morbidity. A high index of suspicion and early HRCT can expedite the diagnosis.
    • Decreased myometrial p160 ROCK-1 expression in obese women at term pregnancy

      O’Brien, Margaret; Carbin, Shawna; Morrison, John J; Smith, Terry J (2013-08-15)
      Abstract Background Obesity is becoming an increasing problem in obstetric practice; it has led to an increase in the risk of caesarean delivery, prolonged pregnancy and dysfunctional labour. It has been postulated that many of these problems are as a result of abnormal myometrial contractility. The RhoA/Rho kinase pathway is involved in calcium sensitisation in the myometrium during labour and contributes to the phosphorylation of myosin phosphatase and thus continued myosin light chain activity, during uterine contractility. The aim of this study therefore, was to investigate the effect of obesity on the expression of various components of the RhoA/ROCK pathway in human myometrium at term pregnancy. Methods Protein was isolated from myometrial biopsies obtained at elective caesarean section, at term pregnancy from obese women and from those with a normal body mass index. Western blotting was performed using specific primary antibodies to RhoA/ Rho kinase associated proteins. Results The protein expression of p160 ROCK-1 was significantly decreased (P < 0.001) in the myometrium from women in the obese cohort (n = 22) at term pregnancy, compared to women of those of normal body mass index (n = 15). No alteration in expression of the other proteins investigated was noted. Conclusions The significant decrease in p160 ROCK-1 protein expression observed in the myometrium of obese women at late gestation may contribute to an inhibitory effect on contractility at labour, due to its contribution to calcium sensitisation and possibly other signalling pathways. These findings are relevant to the concept of compromised myometrial function in obese parturients.
    • A degenerate PCR-based strategy as a means of identifying homologues of aminoglycoside and ß-lactam resistance genes in the gut microbiota

      Fouhy, Fiona; Ross, R P; Fitzgerald, Gerald F; Stanton, Catherine; Cotter, Paul D (2014-02-05)
      Abstract Background The potential for the human gut microbiota to serve as a reservoir for antibiotic resistance genes has been the subject of recent discussion. However, this has yet to be investigated using a rapid PCR-based approach. In light of this, here we aim to determine if degenerate PCR primers can detect aminoglycoside and β-lactam resistance genes in the gut microbiota of healthy adults, without the need for an initial culture-based screen for resistant isolates. In doing so, we would determine if the gut microbiota of healthy adults, lacking recent antibiotic exposure, is a reservoir for resistance genes. Results The strategy employed resulted in the identification of numerous aminoglycoside (acetylation, adenylation and phosphorylation) and β-lactam (including bla OXA, bla TEM, bla SHV and bla CTX-M) resistance gene homologues. On the basis of homology, it would appear that these genes originated from different bacterial taxa, with members of the Enterobacteriaceae being a particularly rich source. The results demonstrate that, even in the absence of recent antibiotic exposure, the human gut microbiota is a considerable reservoir for antibiotic resistance genes. Conclusions This study has demonstrated that the gut can be a significant source of aminoglycoside and β-lactam resistance genes, even in the absence of recent antibiotic exposure. The results also demonstrate that PCR-based approaches can be successfully applied to detect antibiotic resistance genes in the human gut microbiota, without the need to isolate resistant strains. This approach could also be used to rapidly screen other complex environments for target genes.
    • Delayed cystic fibrosis presentation in children in the absence of newborn screening.

      Jackson, A; Foley, L; Daly, L; Fitzpatrick, P; Harrington, M; Zhou, S; Kelleher, C; UCD School of Public Health, Physiotherapy and Population Science, Woodview Hse, UCD, Belfield, Dublin 4. abaigeal.jackson@ucd.ie (2010-04)
      Newborn cystic fibrosis (CF) screening facilitates early diagnosis and nutritional intervention, which prevents malnourishment and improves growth in childhood. To provide baseline information on the natural history of CF in the Republic of Ireland, where newborn screening has not yet been introduced and CF incidence is high (1:1353 live births), we examined the effect of presentation mode, symptom type and gender on age at diagnosis. Median age at diagnosis was calculated by gender and for presentation mode/symptom type for 601 CF registry children diagnosed 1986-2007. Modes of presentation were each significantly associated with delayed presentation. An adjusted odds ratio of 4.5 (95% CI: 1.8, 11.1) was determined for presentation with family history, 43.1 for gastrointestinal symptoms presentation (95% CI: 18.3, 101.4), 96.9 for both respiratory and gastrointestinal symptoms (95% CI: 38.6, 243,4), and 115.4 for respiratory symptoms (95% CI: 45.2, 294.7). Children with respiratory symptoms had the greatest likelihood of delayed diagnosis (median age: 20.4 months), followed by those with respiratory and gastrointestinal symptoms (9.2 months). Gender was not significantly associated with a delayed presentation when presentation mode was taken into account.
    • Delayed prescribing of antibiotics for respiratory tract infections: Use of information leaflets

      Agnew, J; Taaffe, M; Darker, C; O’Shea, B; Clarke, J (irish Medical Journal, 2013-09)
    • Delayed prescriptions: attitudes and experiences of General Practitioners in the Midwest

      Hayes, M; Faherty, A; Hannon, D (Irish Medical Journal, 2013-06)
    • Delayed presentation of a traumatic brachial artery pseudoaneurysm.

      Forde, James C; Conneely, John B; Aly, Sayed; Department of Vascular Surgery, Mater Misericordiae Univeristy Hospital, Dublin, Ireland. fordejames@yahoo.com (2009-09)
      Delayed presentation of a brachial artery pseudoaneurysm following penetrating trauma is infrequently reported. We report the case of a 23-year-old male who presented three months following a penetrating trauma to his antecubital fossa with a sudden exacerbation of swelling and tenderness of his elbow. Doppler ultrasound and computed tomography arteriography confirmed the presence of a large pseudoaneurysm. Surgical reconstruction was performed using the long saphenous vein as an interposition vein graft, restoring normal arterial circulation.
    • Deletion of Irs2 causes reduced kidney size in mice: role for inhibition of GSK3beta?

      Carew, Rosemarie M.; Sadagurski, Marianna; Goldschmeding, Roel; Martin, Finian; White, Morris F.; Brazil, Derek P. (2010-07-06)
      Abstract Background Male Irs2-/- mice develop fatal type 2 diabetes at 13-14 weeks. Defects in neuronal proliferation, pituitary development and photoreceptor cell survival manifest in Irs2-/- mice. We identify retarded renal growth in male and female Irs2-/- mice, independent of diabetes. Results Kidney size and kidney:body weight ratio were reduced by approximately 20% in Irs2-/- mice at postnatal day 5 and was maintained in maturity. Reduced glomerular number but similar glomerular density was detected in Irs2-/- kidney compared to wild-type, suggesting intact global kidney structure. Analysis of insulin signalling revealed renal-specific upregulation of PKBβ/Akt2, hyperphosphorylation of GSK3β and concomitant accumulation of β-catenin in Irs2-/- kidney. Despite this, no significant upregulation of β-catenin targets was detected. Kidney-specific increases in Yes-associated protein (YAP), a key driver of organ size were also detected in the absence of Irs2. YAP phosphorylation on its inhibitory site Ser127 was also increased, with no change in the levels of YAP-regulated genes, suggesting that overall YAP activity was not increased in Irs2-/- kidney. Conclusions In summary, deletion of Irs2 causes reduced kidney size early in mouse development. Compensatory mechanisms such as increased β-catenin and YAP levels failed to overcome this developmental defect. These data point to Irs2 as an important novel mediator of kidney size.
    • Delirium and the acute hospital system of the Republic of Ireland: Challenges, solutions and opportunities

      Fitzgerald, JM; Leeds General Infirmary, Leeds Teaching Hospital Trust, Leeds, UK (Irish Medical Journal, 2017-08)
    • Delivering painless and effective inferior alveolar nerve block anaesthesia

      Canavan, Dermot (Irish Dental Assocation (IDA), 2014-10)
    • Dementia Diagnosis and Referral in General Practice: A Representative Survey of Irish General Practitioners

      Dyer, AH; Foley, T; O’Shea, B; Kennelly, SP (Irish Medical Journal, 2018-04)
    • Dementia in Down's syndrome: an MRI comparison with Alzheimer's disease in the general population

      Mullins, Diane; Daly, Eileen; Simmons, Andrew; Beacher, Felix; Foy, Catherine ML; Lovestone, Simon; Hallahan, Brian; Murphy, Kieran C; Murphy, Declan G (2013-08-20)
      Abstract Background Down’s syndrome (DS) is the most common genetic cause of intellectual disability. People with DS are at an increased risk of Alzheimer’s disease (AD) compared to the general population. Neuroimaging studies of AD have focused on medial temporal structures; however, to our knowledge, no in vivo case–control study exists comparing the anatomy of dementia in DS to people with AD in the general population. We therefore compared the in vivo brain anatomy of people with DS and dementia (DS+) to those with AD in the general population. Method Using MRI in 192 adults, we compared the volume of whole brain matter, lateral ventricles, temporal lobes and hippocampus in DS subjects with and without dementia (DS+, DS-), to each other and to three non-DS groups. These included one group of individuals with AD and two groups of controls (each age-matched for their respective DS and general population AD cohorts). Results AD and DS+ subjects showed significant reductions in the volume of the whole brain, hippocampus and temporal lobes and a significant elevation in the volume of the lateral ventricle, compared to their non-demented counterparts. People with DS+ had a smaller reduction in temporal lobe volume compared to individuals with AD. Conclusions DS+ and AD subjects have a significant reduction in volume of the same brain regions. We found preliminary evidence that DS individuals may be more sensitive to tissue loss than others and have less ‘cognitive reserve’.
    • The demographic and academic profile of Irish dental school faculty members.

      O'Sullivan, Eleanor M; Cork University Dental School and Hospital, Wilton, Cork. eleanor.osullivan@ucc.ie (2010-04-23)
      AIM: This paper reviews the demographic, academic and professional profile of Irish dental school faculty members. Faculty duties are explored. METHODS AND MATERIALS: Custom-designed questionnaires were distributed to faculty members for self-completion, adopting a 'mixed-method' approach with quantitative and qualitative components. Response rate was 64.60%. RESULTS: Demographic profile reveals a male-dominated regime (64%). Males also occupy a disproportionate number of senior academic positions. The age profile mirrors international trends with 75% of staff over 40 and c.33% over 50, including 78% of professorial staff (p < 0.001). Dental school faculties are comprised of highly educated professionals with the following qualifications: 89% BDS, 43% FDS, 39% Masters, 16% Doctorates. Most (77%) have 10+ years of clinical experience, while 47% have over 20 years' experience. Clinical experience varied by age, rank (p < 0.001) and gender (p < 0.05). A review of contractual agreements and duties confirms the major role of part-time clinical staff in dental education, comprising the largest single group (48%) delivering the bulk of the clinical teaching. However, 54% of part-time clinical staff have less than five years teaching experience. This study also explores staff views of various faculty roles. CONCLUSIONS: This report provides a benchmark profile of Irish dental school faculty members. It reflects on the heavily skewed age groups of our current dental educators and the impending retirement of many senior academics. Educational organisations need to explore ways to make a career in dental education financially and sociologically attractive and provide adequate support for existing faculty to ensure their development during these challenging times.
    • Demographics of implant placement and complications of a patient subgroup in a dental hospital population

      Brennan, N; Houston, F; O'Sullivan, M; O'Connell, B; Department of Restorative Dentistry, University Dental School and Hospital, Wilton, Cork (Irish Dental Association, 2010-05)
    • Dental amalgam: is this the end?

      Taut, Cristina (Journal of Irish Dental Association, 2013-12)