St. James's Hospital
http://hdl.handle.net/10147/128169
2024-03-27T07:57:26ZDriving and Psychotropic Medications: What Do Psychiatrists and Service Users Really Know?
http://hdl.handle.net/10147/640764
Driving and Psychotropic Medications: What Do Psychiatrists and Service Users Really Know?
Vartukapteine, S; O'Connell, H
Aims We ascertained the level of psychotropic medication use among drivers from a sample population and examined whether psychiatrists and mental health service users are sufficiently informed about the effects of medications on driving ability and about drug-driving legislation and guidelines in Ireland. Methods This cross-sectional survey included a convenience sample of 50 service users aged 18 and over who presented to the acute psychiatric unit in Portlaoise, Laois-Offaly Mental Health Services (LOMHS) for urgent psychiatric assessment, along with a survey of 37 doctors working with LOMHS. Results Almost half of surveyed service users (46%) reported that they currently drive, with the majority of these (78%) driving most days. Sixty-one percent (61%) of drivers reported taking psychotropic medication, with 64% of these taking more than one medication. Of 17 doctors who returned questionnaires, 8 (47%) reported that driving and medication use is a common concern in their practice, while only 1 (6%) had received training in relation to assessing medical fitness to drive. Overall, 94% (16) of clinicians and 54% of service users (rising to 71% for service users who drive and take medication) expressed a need for more information about this topic. Conclusion In this sample, the majority of mental health service users who drive do so while taking prescribed medications and they are unclear on the implications. Furthermore, there are significant deficits in training for psychiatrists in the area of assessing medical fitness to drive. Therefore, considering the potential serious risks involved, there is a clear need for more information and training about this topic for both clinicians and service users alike.
2020-01-16T00:00:00ZThe Omentum in Obesity-Associated Cancer: A Hindrance to Effective Natural Killer Cell Migration towards Tumour Which Can Be Overcome by CX3CR1 Antagonism.
http://hdl.handle.net/10147/638219
The Omentum in Obesity-Associated Cancer: A Hindrance to Effective Natural Killer Cell Migration towards Tumour Which Can Be Overcome by CX3CR1 Antagonism.
Mylod, Eimear; O'Connell, Fiona; Donlon, Noel E; Butler, Christine; Reynolds, John V; Lysaght, Joanne; Conroy, Melissa J
Oesophagogastric adenocarcinomas (OAC) are obesity-associated malignancies, underpinned by severe immune dysregulation. We have previously shown that natural killer (NK) cells preferentially migrate to OAC omentum, where they undergo phenotypic and functional alterations and apoptosis. Furthermore, we have identified the CX3CR1:fractalkine (CX3CL1) pathway as pivotal in their recruitment to omentum. Here, we elucidate whether exposure to the soluble microenvironment of OAC omentum, and in particular fractalkine and IL-15 affects NK cell homing capacity towards oesophageal tumour. Our data uncover diminished NK cell migration towards OAC tumour tissue conditioned media (TCM) following exposure to omental adipose tissue conditioned media (ACM) and reveal that this migration can be rescued with CX3CR1 antagonist E6130. Furthermore, we show that fractalkine has opposing effects on NK cell migration towards TCM, when used alone or in combination with IL-15 and uncover its inhibitory effects on IL-15-mediated stimulation of death receptor ligand expression. Interestingly, treatment with fractalkine and/or IL-15 do not significantly affect NK cell adhesion to MAdCAM-1, despite changes they elicit to the expression of integrin α4β7. This study provides further evidence that CX3CR1 antagonism has therapeutic utility in rescuing NK cells from the deleterious effects of the omentum and fractalkine in OAC, thus limiting their dysfunction.
2021-12-23T00:00:00ZTitle: Understanding a Low Vitamin D State in the Context of COVID-19.
http://hdl.handle.net/10147/635909
Title: Understanding a Low Vitamin D State in the Context of COVID-19.
McCarroll, Kevin; Healy, Martin; O'Shea, Paula M; Kenny, Rose Anne; Faul, John L; Walsh, James Bernard; McCartney, Daniel; Laird, Eamon; Byrne, Declan
While a low vitamin D state has been associated with an increased risk of infection by SARS-CoV-2 in addition to an increased severity of COVID-19 disease, a causal role is not yet established. Here, we review the evidence relating to i) vitamin D and its role in SARS-CoV-2 infection and COVID-19 disease ii) the vitamin D status in the Irish adult population iii) the use of supplemental vitamin D to treat a deficient status and iv) the application of the Bradford-Hill causation criteria. We conclude that reverse causality probably makes a minimal contribution to the presence of low vitamin D states in the setting of COVID-19. Applying the Bradford-Hill criteria, however, the collective literature supports a causal association between low vitamin D status, SARS-CoV-2 infection, and severe COVID-19 (respiratory failure, requirement for ventilation and mortality). A biologically plausible rationale exists for these findings, given vitamin D's role in immune regulation. The thresholds which define low, deficient, and replete vitamin D states vary according to the disease studied, underscoring the complexities for determining the goals for supplementation. All are currently unknown in the setting of COVID-19. The design of vitamin D randomised controlled trials is notoriously problematic and these trials commonly fail for a number of behavioural and methodological reasons. In Ireland, as in most other countries, low vitamin D status is common in older adults, adults in institutions, and with obesity, dark skin, low UVB exposure, diabetes and low socio-economic status. Physiological vitamin D levels for optimal immune function are considerably higher than those that can be achieved from food and sunlight exposure alone in Ireland. A window exists in which a significant number of adults could benefit from vitamin D supplementation, not least because of recent data demonstrating an association between vitamin D status and COVID-19. During the COVID pandemic, we believe that supplementation with 20-25ug (800-1000 IU)/day or more may be required for adults with apparently normal immune systems to improve immunity against SARS-CoV-2. We expect that higher monitored doses of 37.5-50 ug (1,500-2,000)/day may be needed for vulnerable groups (e.g., those with obesity, darker skin, diabetes mellitus and older adults). Such doses are within the safe daily intakes cited by international advisory agencies.
2022-03-04T00:00:00ZShould MRI Be the Imaging Modality of Choice in Suspected Appendicitis During Pregnancy?
http://hdl.handle.net/10147/635883
Should MRI Be the Imaging Modality of Choice in Suspected Appendicitis During Pregnancy?
Donlon, N E; Kelly, M E; Davern, M; Sheppard, A; Nugent, T; Durand, M; Mehigan, B J; Larkin, J O; McCormick, P H
Aim
The aim of this review was to evaluate the efficacy of magnetic resonance imaging (MRI) in determining appendicitis
during pregnancy.
Methods
We retrospectively reviewed the clinical course for all pregnant patients with suspected appendicitis from 2013-2018.
We evaluated the efficacy of MRI and Alvarado scoring and its impact on management.
Results
Twenty-nine pregnant patients with suspected appendicitis had an MRI. The majority (90%, n=26/29) had normal
diagnostics with two patients (10.3%) having findings consistent with acute appendicitis. Two other patients proceeded
to laparoscopy, one with an inconclusive MRI, and one patient with clinical appendicitis. We found no accurate
correlation between pregnancy and Alvarado scoring.
Conclusion
MRI is a safe adjunct in accurately diagnosing appendicitis in pregnancy. Its routine use could help reduce rates of
negative appendectomies and the potential risk to maternal and fetal health.
2019-12-16T00:00:00ZLeptomeningeal Relapse of Embryonal Rhabdomyosarcoma after 15 years.
http://hdl.handle.net/10147/635859
Leptomeningeal Relapse of Embryonal Rhabdomyosarcoma after 15 years.
Chew, S; Gleeson, J P; McCarthy, A; Watson, G A; O'Dwyer, R; Nicholson, S; Capra, M; Owens, C; McDermott, M; Daly, P; Grant, C
Rhabdomyosarcoma (RMS) is the most common malignant soft tissue tumour of childhood, albeit accounting for only 3-4% of all childhood cancers. Embryonal RMS accounts for around 60% of all RMS cases, usually occurs in children less than 5 years of age and commonly originates from the head, neck or urogenital system. Alveolar RMS is responsible for about 21% of cases and tends to affect the trunk and limbs. Other less common subtypes include botyroid and spindle cell RMS.1
The introduction of a combined modality treatment approach has resulted in improved patient outcomes, with over 70% of patients with localised RMS cured of their disease. Disease relapse tends to happen early and is associated with a poor prognosis, but late relapse is poorly studied and understood. We present the case of a very late relapse of RMS in an unusual location.
2020-12-16T00:00:00ZCase Report: Acquired collagenoma on the dorsum of the foot.
http://hdl.handle.net/10147/635509
Case Report: Acquired collagenoma on the dorsum of the foot.
O'Donohoe, Patrick; Theopold, Christoph; McMenamin, Mairin
Collagenoma is a rare benign skin lesion classified as a hamartomatous proliferation of normal collagen fibres and varying amounts of elastic fibres. They most frequently occur on the arms or trunk and may present as solitary or multiple lesions, as part of a syndrome (such as Cowden Syndrome, Tuberous Sclerosis, or MEN1) or sporadic and of varying sizes. Herein, we report on a case of large acquired collagenomas found in an unusual location on the dorsum of both feet.
2022-03-10T00:00:00ZChanging demographics and immunity to vaccine preventable diseases in people with HIV in Ireland.
http://hdl.handle.net/10147/635075
Changing demographics and immunity to vaccine preventable diseases in people with HIV in Ireland.
Kelleher, M; Coughlan, S; Crowley, B; O'Reilly, E J; Bergin, C; Kerr, Colm
Background: HIV infection is associated with an increased risk of morbidity and mortality from vaccine preventable infections. This research describes, in the context of changing patient demographics, the seroprevalence of vaccine preventable viral infections among attendees of the largest centre for HIV positive patients in Ireland.
Methods: Baseline serum IgG results for measles, mumps, rubella, varicella zoster virus (VZV) & hepatitis A, as well as hepatitis B sAg, cAb and sAb results, were retrieved for 2534 clinic attendees attending in 2018. Results were available for between 990 and 2363 attendees (39-93%), depending on the test, and were compared with 2013 clinic data.
Results: There was a 35% increase in attendees in 2018 when compared to 2013. The largest increase was in attendees of South American origin. In 2018, males accounted for 73% of the entire cohort and the HIV acquisition risk for 48% of attendees was MSM. 47% of attendees were originally from Ireland. Among those tested, 33% were susceptible to at least one component of the MMR vaccine. 5% were VZV non-immune (significantly associated with younger age and the acquisition risk status of injection drug use). 21% were hepatitis A non-immune (significantly associated with younger age and being of European or South American origin). 32% were hepatitis B cAb seropositive (significantly associated with older age, injection drug use status and being originally from Africa). 3% demonstrated hepatitis B sAg positivity. 64% had hepatitis B sAb ≥ 10mIU.
Conclusion: In a cohort of attendees to an HIV clinic in a large urban setting, the susceptibility to several common vaccine preventable viral infections, in particular MMR and hepatitis A and B, was high. These results highlight the importance of proactive screening and immunisation to help protect this high risk patient group against vaccine preventable diseases.
2022-06-29T00:00:00ZThe Incidence of Venous Thromboembolism in Critically Ill Patients with SARS-CoV-2 Infection Compared with Critically Ill Influenza and Community-Acquired Pneumonia Patients: A Retrospective Chart Review.
http://hdl.handle.net/10147/635059
The Incidence of Venous Thromboembolism in Critically Ill Patients with SARS-CoV-2 Infection Compared with Critically Ill Influenza and Community-Acquired Pneumonia Patients: A Retrospective Chart Review.
Boyd, Sean; Sheng Loh, Kai; Lynch, Jessie; Muzzammil, Saad; Marsh, Hannah; Masoud, Mustafa; Bin Ihsan, Salman; martin-loeches, Prof. Ignacio; Alrashed, Dhari
The rate of venous thromboembolism in COVID-19 patients has been reported to be 30% (deep vein thrombosis 20% and pulmonary embolism 18%). This has been shown to be higher in COVID-19 patients admitted to the ICU. Prophylactic anticoagulation may be sufficient at ward level, but not in intensive care. A retrospective chart review was undertaken in a large university hospital. The review included 276 patients from COVID-19 Wave 1, COVID-19 Wave 2, influenza, and community-acquired pneumonia groups. The timeframe included patients admitted between 23 February 2014 and 12 May 2021. Clinical characteristics, outcomes, blood results, rates of venous thromboembolism, and anticoagulation status were recorded. The incidence of venous thromboembolism in COVID-19 Wave 1, COVID-19 Wave 2, influenza, and community-acquired pneumonia was 10.91%, 13.69%, 13.33%, and 6.81%, respectively (p = 0.481). The incidence of pulmonary embolism was 7.27%, 10.95%, 3.33%, and 5.68%, respectively (p = 0.350). The incidence of deep vein thrombosis was 5.45%, 5.48%, 10.00%, and 1.14%, respectively (p = 0.117). Although most patients were prophylactically anticoagulated, venous thromboembolism still occurred. Venous thromboembolism remains an important differential to consider in critically ill COVID-19 patients. The current literature does not advise therapeutic anticoagulation for thromboprophylaxis in the ICU.
2022-06-08T00:00:00ZThe Incidence of Venous Thromboembolism in Critically Ill Patients with SARS-CoV-2 Infection Compared with Critically Ill Influenza and Community-Acquired Pneumonia Patients: A Retrospective Chart Review.
http://hdl.handle.net/10147/634900
The Incidence of Venous Thromboembolism in Critically Ill Patients with SARS-CoV-2 Infection Compared with Critically Ill Influenza and Community-Acquired Pneumonia Patients: A Retrospective Chart Review.
Boyd, Sean; Sheng Loh, Kai; Lynch, Jessie; Muzzammil, Saad; Marsh, Hannah; Masoud, Mustafa; Bin Ihsan, Salman; martin-loeches, Prof. Ignacio; Alrashed, Dhari
The rate of venous thromboembolism in COVID-19 patients has been reported to be 30% (deep vein thrombosis 20% and pulmonary embolism 18%). This has been shown to be higher in COVID-19 patients admitted to the ICU. Prophylactic anticoagulation may be sufficient at ward level, but not in intensive care. A retrospective chart review was undertaken in a large university hospital. The review included 276 patients from COVID-19 Wave 1, COVID-19 Wave 2, influenza, and community-acquired pneumonia groups. The timeframe included patients admitted between 23 February 2014 and 12 May 2021. Clinical characteristics, outcomes, blood results, rates of venous thromboembolism, and anticoagulation status were recorded. The incidence of venous thromboembolism in COVID-19 Wave 1, COVID-19 Wave 2, influenza, and community-acquired pneumonia was 10.91%, 13.69%, 13.33%, and 6.81%, respectively (p = 0.481). The incidence of pulmonary embolism was 7.27%, 10.95%, 3.33%, and 5.68%, respectively (p = 0.350). The incidence of deep vein thrombosis was 5.45%, 5.48%, 10.00%, and 1.14%, respectively (p = 0.117). Although most patients were prophylactically anticoagulated, venous thromboembolism still occurred. Venous thromboembolism remains an important differential to consider in critically ill COVID-19 patients. The current literature does not advise therapeutic anticoagulation for thromboprophylaxis in the ICU.
2022-06-08T00:00:00ZScoring the Clinical Frailty Scale in the Emergency Department: The Home FIRsT Experience.
http://hdl.handle.net/10147/634868
Scoring the Clinical Frailty Scale in the Emergency Department: The Home FIRsT Experience.
Thorpe, Owen; McCabe, Elva; Herrero, Elena Marie; Doyle, William Ormiston; Dillon, Aoife; Edge, Lucinda; Flynn, Sinéad; Mullen, Anna; Davis, Aisling; Molamphy, Aoife; Kirwan, Anna; Briggs, Robert; Lavan, Amanda H; Shields, Darragh; McMahon, Geraldine; Hennessy, Arthur; Kennedy, Una; Staunton, Paul; Kidney, Emer; Yeung, Sarah-Jane; Glynn, Deirdre; Horgan, Frances; Cunningham, Conal; Romero-Ortuno, Roman
We evaluated predictors of the Clinical Frailty Scale (CFS) scored by an interdisciplinary team (Home FIRsT) performing comprehensive geriatric assessment (CGA) in our Emergency Department (ED). This was a retrospective observational study (service evaluation) utilising ED-based CGA data routinely collected by Home FIRsT between January and October 2020. A linear regression model was computed to establish independent predictors of CFS. This was complemented by a classification and regression tree (CRT) to evaluate the main predictors. There were 799 Home FIRsT episodes, of which 740 were unique patients. The CFS was scored on 658 (89%) (median 4, range 1-8; mean age 81 years, 61% women). Independent predictors of higher CFS were older age (p<0.001), history of dementia (p<0.001), mobility (p≤0.007), disability (p<0.001), and higher acuity of illness (p=0.009). Disability and mobility were the main classifiers in the CRT. Results suggest appropriate CFS scoring informed by functional baseline.
2022-06-01T00:00:00Z