Irish Journal of Medical Science最新文献

Glomerular filtration rate (GFR) as a marker of kidney function is important in health and disease management because decreased kidney function is associated with all-cause and cardiovascular mortality, progression of kidney disease, predisposition to acute kidney injury (AKI), and for drug dosage modification. While measured glomerular filtration rate (mGFR) is acknowledged as the most accurate method for evaluating kidney function, it is at present not feasible to be applied in the clinical arena. Estimated glomerular filtration rate (eGFR) is preferred due to its convenience, cost-effectiveness, and seamless integration into standard clinical practice for kidney function evaluation. The presence of multiple equations for eGFR with applications to differing populations makes their use challenging for clinicians. We reviewed available estimated glomerular filtration rate (GFR) equations and their application in different clinical settings both in normal and chronic kidney disease (CKD) patients. These formulae incorporate serum creatinine and/or serum cystatin C levels and correlate them with measured kidney function. Among the many available equations, the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation is the most recommended due to its robustness and accuracy across diverse patient populations. Strengths and limitations of different eGFR equations are discussed emphasizing the importance of selecting the appropriate equation based on specific patient demographics and clinical scenarios. There is need for regional validation studies to ensure the global applicability of these equations, considering the variations in population characteristics.

Background: Medical indemnity (MI) has become an important topic in the era of increasing number of medico-legal cases in Ireland. However, there is a sensible difference in understanding and usage of medical indemnity between Irish and international medical graduates.

Aim: This study aimed to investigate the knowledge and awareness of medical indemnity among international medical graduates in Ireland.

Methods: This was a descriptive study with an anonymous online survey including 19 questions about various aspects of MI. Analysis of the data was done using Microsoft Excel statistical analysis pack.

Results: One hundred eighty-six doctors participated in the study, 34 (18.2%) consultants, 74 (39.8%) registrars, 72 (38.7%) Senior House Officers (SHOs) and 6 (3.2%) General Practitioners (GPs). Their knowledge and insurance coverage were deficient before working in Ireland. The majority did not have any educational session about clinical indemnity insurance when starting work in Ireland. While most consultants (88.2%) had supplemental MI (SMI) at the time of the study, only 41.9% of registrars and 38.9% of SHOs had SMI. In addition, there was a difference between consultants and Non-consultant Hospital Doctors (NCHDs) involvement in medico-legal cases. 32.2% of consultants were involved in medico-legal cases compared to 19% of registrars and 18% of SHOs.

Conclusion: There is a need to address clinical indemnity and supplemental clinical indemnity topics on induction days for international medical graduates working in Ireland, including clear information about professional protection arrangements with refresher meetings every six months especially during rotational placements.

Background: Inflammatory bowel disease (IBD) is a chronic disease that includes Crohn's disease and ulcerative colitis. Studies found that 40-60% of women diagnosed with IBD have sexual dysfunction (SD).

Aims: To determine SD and associated factors in women with IBD.

Methods: Female patients diagnosed with IBD in the Gastroenterology Department who volunteered and healthy volunteers who were examined by a general practitioner were included in the study as the control group. After appropriate training was provided by the researcher, patients and volunteers were asked to fill out the Clinical and Sociodemographic Questionnaire, Hospital Anxiety Depression Scale and Female Sexual Function Index.

Results: There were 255 patients in the patient group and 240 patients in the control group. The mean ages of the patient and control groups were 40 ± 12 and 38 ± 11 years, respectively. Mean disease duration in IBD patients was 9 ± 5.6 years. The SD rate in the patient group (63.5%) was higher than in the control group (23.8%) (p < 0.01). The prevalence of SD was significantly lower in mildly active IBD patients than in moderate and severe IBD patients (p < 0.05). Active disease (OR: 3.82), active perianal disease (OR: 2.15), and severe depression (OR: 3.19) were predictive factors for SD in univariate logistic regression analysis. Previous abdominal surgery was found to be predictive for SD in multivariate analysis (OR: 5.13).

Conclusions: The prevalence of SD was high in female IBD patients and its prevalence increased as disease activity increased. History of abdominal surgery in IBD was found to be associated with SD.

Background: Chronic Obstructive Pulmonary Disease (COPD) is associated with physical limitations and significant social, psychological, and behavioral challenges. This study investigates the relationship between fatigue levels and psychosocial adjustment in COPD patients, considering their sociodemographic characteristics.

Methods: A descriptive study was conducted with 160 COPD patients hospitalized in the Pulmonology Department of a university hospital. Data were collected via face-to-face interviews using a patient information form, the COPD and Asthma Fatigue Scale (CAFS), and the Psychosocial Adjustment to Illness Scale-Self-Report (PAIS-SR). Statistical analyses included Independent Sample t-test, One-Way ANOVA, Mann-Whitney U test, Kruskal-Wallis test, and Spearman correlation analysis, with significance set at p < 0.05.

Results: The mean age of participants was 68.70 ± 9.41 years; 71.9% were male, and 67.9% had COPD for over six years. Most participants (74.4%) reported limitations in daily living activities due to the disease, and 91.9% reported having social support. Mean scores were 58.03 ± 15.80 on the CAFS and 64.19 ± 6.41 on the PAIS-SR. Significant differences were observed in fatigue and psychosocial adjustment scores based on gender, social support, and disease impact on daily activities (p < 0.05). A weak positive correlation was found between fatigue levels and psychosocial adjustment (p < 0.05).

Conclusions: COPD patients experience moderate-to-high fatigue levels and challenges in psychosocial adjustment, with fatigue negatively influencing adjustment. Interventions should focus on enhancing coping strategies, addressing psychosocial needs, and leveraging social support systems to improve patient outcomes.

Background: Hydronephrosis developing at the ureteropelvic junction due to obstruction poses clinical challenges as it has the potential to cause renal damage.

Aims: This study aims to evaluate how well machine learning models such, as XGBClassifier and Logistic Regression can be used to predict the need for treatment in patients, with hydronephrosis resulting from ureteropelvic junction obstruction.

Methods: Hydronephrosis was diagnosed in the medical records of patients from January 2015 to December 2020. These patients were classified into two groups: those who were not operated upon (n = 194) and those who had surgical procedures (n = 129). Details such as demographics, clinical presentations, and imaging findings were captured. XGBClassifier and Logistic Regression methods were employed to predict the requirement for an operation. The performance of the models was assessed based on ROC-AUC values, sensitivity, and specificity.

Results: The XGBClassifier algorithm gave the best prediction results with a ROC-AUC value of 0.977 and an accuracy rate of 95.4%. The Logistic Regression algorithm, on the other hand, offered the highest prediction during cross-validation. The presence of obstruction on scintigraphy, kidney size, anteroposterior diameter of the renal pelvic and parenchymal thickness observed in hydronephrotic kidney on USG have been identified as important predictive factors.

Conclusions: In predicting the requirement for surgery in cases of hydronephrosis due to obstruction, machine learning algorithms have shown high accuracy and sensitivity rates. Consequently, clinical decision support systems based on these algorithms may lead to better care management of patients and more accurate projections concerning the need for surgical intervention.

Trial registration number and date of registration: ESH/GOEK 2024/88-23/01/2024.

Background: It has been revealed that the potential utility of the triglycerides and glucose (TyG) index as an effective option for assessing glycemic control; however, evidence in this field is still scarce.

Aims: The goal of this study was to investigate the diagnostic accuracy of the TyG index, as an alternative option, to detect inadequate glycemic control in patients with type 2 diabetes (T2D).

Methods: Men and women between 30 and 60 years of age diagnosed with type 2 diabetes were included in a cross-sectional study. Exclusion criteria were smoking, alcohol intake, pregnancy, type 1 diabetes, cancer, autoimmune diseases, active infections, kidney disease, and incomplete data. According to the glycated hemoglobin (HbA1c) concentration, patients were allocated into the groups with optimal (< 7.0%) and deficient (≥ 7.0%) glycemic control.

Results: In total, 129 patients aged 51.1 ± 6.6 years were included in this study. The logistic regression analysis adjusted by age, sex, body mass index, waist circumference, and time of diabetes diagnosis revealed that the TyG index is strongly associated with deficient glycemic control (OR = 86.6; 95% CI: 12.9 - 576.9). The best cut-off point of the TyG index for identifying inadequate glucose control was 4.93, which showed the highest sensitivity (80%) and specificity (67%) values. Additionally, the positive and negative predictive values were 71% and 74%, while the positive and negative likelihood ratios were 1.68 and 0.41, respectively.

Conclusion: The results of our study suggest that the TyG index may be used as an optional test for assessing glycemic control in patients with T2D.

Purpose: Retinal vein occlusion (RVO) is a prevalent retinal vascular disorder characterized by retinal haemorrhage, neovascularization, and macular edema This study aimed to assess the structural and functional effects of intravitreal implant (Ozurdex) treatment as a second-line for RVO-associated macular edema in patients who did not respond to first-line anti-VEGF therapy.

Materials and methods: We conducted a retrospective observational cohort study using electronic health records of RVO patients at Salisbury District Hospital between January 2014 and December 2019. Inclusion criteria included patients diagnosed with central or branch RVO. Patients underwent ophthalmic evaluations at baseline, including central retinal thickness (CRT) and best-corrected visual acuity (BCVA) assessments. Statistical analysis was performed using IBM SPSS Statistics, employing various tests to determine significance.

Results: Sixteen eyes of 16 White British patients were evaluated. Most patients had branch RVO (52.95%), and 47.05% had central RVO. While anti-VEGF treatment significantly improved BCVA (p = 0.0061), Ozurdex did not result in additional gain (p = 0.747). Both treatments significantly reduced CRT (p = 0.0055 for anti-VEGF; p = 0.0079 for Ozurdex). No significant differences were observed between diabetic and non-diabetic BCVA patients receiving either treatment.

Conclusion: Ozurdex emerges as a safe and effective option for persistent macular edema in RVO patients unresponsive to anti-VEGF therapy. Although structural improvements in CRT were observed following Ozurdex treatment, they did not correlate with additional gain in BCVA. Despite this, the reduced treatment frequency of Ozurdex compared to anti-VEGF injections may be advantageous, particularly for frail non-responding patients minimizing treatment burden.

Background: Chronic infection with hepatitis B virus and HIV causes significant morbidity and mortality. Effective antiviral treatment is available for both. Ireland has historically been considered a low prevalence country. However, with increasing inward migration and diversity, this may be changing.

Aims: The aim of this study was to measure the community prevalence of hepatitis B virus and HIV infections in Irish residents born between the years 1965 and 1985.

Methods: Anonymised residual serum samples from blood tests ordered by community general practitioners and tested in eight general hospital laboratories, spread across Ireland, were analysed for the presence of Hepatitis B surface antigen and antibodies to HIV.

Results: A total of 6080 samples were analysed for hepatitis B surface antigen including 2993 males, 2807 females and 280 samples for which gender was not recorded. HBsAg was detected in 28/6067 samples giving an estimated prevalence of 0.46% (95% CI 0.32-0.67%). Antibodies to HIV were identified in 18/6064 giving an estimated prevalence of 0.33% (95% CI 0.19-0.47%). The prevalence of both hepatitis B and HIV was significantly higher in Cork (Southwest Ireland) than other centres: hepatitis B (12/1050 vs 16/5017, p = 0.014) and HIV (11/1049 vs 7/5015, p < 0.001).

Conclusions: The prevalence of hepatitis B virus and HIV infections in this cohort appear to be higher than previously estimated. In addition, their prevalence in the Cork area appears particularly high. Whether this represents a true prevalence or a chance finding will require confirmatory studies.