Irish Journal of Medical Science最新文献

Background/aims: During the COVID-19 pandemic, the Health Service Executive (HSE) and Royal College of Obstetricians and Gynaecologists (RCOG) recommended fasting and random plasma glucose (FPG/RPG) alongside glycated haemoglobin (HbA_1c) to replace the oral glucose tolerance test (OGTT) for diagnosing Gestational Diabetes Mellitus (GDM).

Methods: The study compared testing patterns and diagnostic rates for GDM before and after implementing the RCOG guidelines (01/05/2020) in pregnancies beginning 01/11/2018 to 31/03/2021. Trends were inspected using Cochrane-Armitage tests. Differences between General Practice (GP) and Secondary Care (SCare) were assessed by chi-square analysis. A significance level of p < 0.05 was used for all analyses. Information on maternal and pregnancy characteristics was accessed where available.

Results: Data indicated a significant reduction in OGTTs requested by GPs and SCare. Conversely, HbA_1c, FPG and RPG test requests increased significantly in both locations. The overall GDM positivity rate increased significantly from 7.4% to 22.0% in GP and 16.9% to 39.0% in SCare following RCOG guideline implementation.

Conclusions: The RCOG guidelines appear to have been well adopted by GPs and SCare, with greater adherence in SCare. Using FPG, RPG and HbA_1c to a greater extent than the OGTT corresponded with increased GDM diagnostic rates. Given the difficulties with interpreting HbA_1c in pregnancy, its routine use in diagnosing GDM requires further careful consideration. Relaying changes in diagnostic protocol during pandemics requires strong communication with all requesting clinicians, including GPs. Comparisons between GP and SCare indicated significant differences in test-requesting practices and GDM positivity rates.

Background: Malignant melanoma is an aggressive tumor with high resistance to therapy. The emergence of RAS-driven secondary cancers and BRAF-inhibitor resistance has led to the development of combination therapies targeting both BRAF and MEK.

Aims: This study explored the mechanisms underlying the synergistic effects of dabrafenib (DAB) and trametinib (TM) in drug-resistant A375 and RPMI 7951 melanoma cells.

Methods: Cytotoxicity was assessed via MTT assay and combination effects were evaluated via combination index analysis. Apoptosis was analyzed by DNA fragmentation ELISA, while ectopic let-7a miRNA expression and inhibition were performed using lipofection. Gene expression levels were quantified by qRT-PCR, and protein expression was assessed via Western blot.

Results: The combination of 0.7 μM DAB and 5.0 μM TM exhibited synergistic cytotoxicity by inhibiting the pERK1/2 signaling pathway and inducing MITF expression. This resulted in mitochondria-mediated apoptosis, characterized by a decrease in anti-apoptotic Bcl-2 and an increase in pro-apoptotic Bax, caspase-9, and caspase-3 levels. Additionally, Let-7a was identified as a crucial regulator of apoptosis sensitivity by targeting caspase-3, the key executor of apoptosis.

Conclusions: These findings provide new insights into overcoming melanoma drug resistance through combined BRAF/MEK inhibition.

Objective: Understanding the sealing ability of restorative materials to prevent microleakage and its consequent complications-such as secondary caries, postoperative sensitivity, and restoration failure-is imperative in clinical dentistry. This study aims to compare the microleakage performance of four restorative materials-bioactive composite resin (Activa Pronto), alkasite restorative (Cention N), compomer (Dyract Flow), and glass ionomer cement (Type 2 GIC)-in Class V cavities of extracted premolar teeth.

Materials and methods: Forty non-carious, intact premolar teeth were selected and prepared with standardized Class V cavities. The teeth were randomly assigned to one of four groups (n = 10) and restored with the respective materials. The restorations underwent thermocycling, followed by microleakage testing using rhodamine dye. Confocal laser scanning microscopy (CLSM), a technique that provides superior depth resolution and three-dimensional visualization of microleakage, was used to assess dye penetration at the tooth-restoration interface. Microleakage was then scored using a standardized grading system.

Results: Significant differences in microleakage were observed among the groups (χ² = 45.69; p < 0.001). Group 1 (bioactive composite resin) demonstrated the lowest microleakage, with predominantly Grade 0 and Grade 1 scores, while Group 4 (GIC) exhibited the highest microleakage, characterized mainly by Grade 3 scores. Bioactive composite resin exhibited significantly lower microleakage than alkasite, compomer, and GIC (p < 0.05). No significant difference was observed between alkasite and compomer.

Conclusions: Bioactive composite resin (Activa Pronto) provided the most effective seal against microleakage, followed by alkasite and compomer, with glass ionomer cement showing the least effective sealing properties.

Background and objectives: Post-traumatic stress disorder (PTSD) is a common psychological condition following traumatic events, including physical trauma. In this study, we aimed to determine the prevalence and demographic correlates of PTSD among orthopedic trauma patients.

Methods: We used a cross-sectional survey design and assessed 200 orthopedic trauma patients, using a self-administered questionnaire. The questionnaire consisted of demographic information and the PTSD Checklist-Civilian Version to determine the prevalence of PTSD.

Results: The results showed that the prevalence of PTSD was 39%. Females had a higher incidence rate (63%) than males (26%). Females were 1.16 times more likely to suffer from PTSD following trauma as compared to males, with a statistically significant association found between PTSD and female gender. However, the study found no significant association between PTSD and age. Additionally, a high proportion of PTSD participants had comorbid depression.

Conclusion: Future studies should further explore the demographic and psychological risk factors associated with PTSD following physical trauma.

John Stearne was the first Regius Professor of Medicine in Trinity College Dublin and founded the Fraternity of Physicians of Trinity Hall that later became the Royal College of Physicians in Ireland. He was born in Ardbraccan, County Meath in 1624 and was a great nephew of the Archbishop of Armagh and renowned scholar James Ussher who was his patron. He entered Trinity College in 1639 and was elected Scholar in 1641, before fleeing Dublin at the outbreak of the Confederate Wars later that year. He moved to Cambridge and studied medicine in Sidney Sussex College. After a short period practicing medicine in Bedfordshire, he returned to Trinity in 1651 and was appointed Professor of Medicine and College medicus. He later also became Professor of Hebrew and Professor of Law. He wrote six books and became a Senior Fellow of the College. In 1654, he established the Fraternity of Physicians with some other Dublin physicians in a disused building on Trinity Street. Stearne resigned his Fellowship and Professorship in 1659 but had them restored by 1662 following the Restoration of the King Charles II. The Royal College of Physicians of Ireland received its first royal charter in 1667. Stearne died in 1669 at the age of 44. This paper, written to celebrate the quatercentenary of his birth, discusses Stearne's life and achievements in more detail particularly in the context of the political turmoil of the age and the important role of his extended family in the important events that occurred.

Introduction: Diabetic retinopathy is a common complication of diabetes and a leading cause of vision loss. The prevalence of DR increases with the duration of diabetes, poor glycemic control, and the presence of other systemic conditions such as hypertension and dyslipidemia. Serum C-peptide is a marker of endogenous insulin production and is commonly used to assess residual beta-cell function in patients with type 2 diabetes (T2D).

Objectives: To examine the relationship between serum C-peptide levels and diabetic retinopathy in patients with type 2 diabetes, categorized according to their estimated glomerular filtration rate.

Methods: A cross-sectional study was conducted in VINAYAKA MISSION'S KIRUPANANDA VARIYAR MEDICAL COLLEGE AND HOSPITALS, VINAYAKA MISSION'S RESEARCH FOUNDATION, (DU), in the Department of General Medicine. The study was performed between September 2023 and July 2024. A total of 120 patients who had diabetes mellitus attending the OPD were included in the study. Blood samples were taken to measure serum C-peptide levels, fasting plasma glucose (FPG), and glycated hemoglobin (HbA1c). Serum C-peptide levels were measured using an electrochemiluminescence immunoassay. Also, eGFR was calculated using the CKD-EPI equation based on serum creatinine levels.

Results: The majority of the participants had more than 10 years of diabetes (51.7%), while 48.3% had less than 10 years of diabetes. The mean HbA1c value was 8.2 ± 1.5, and the mean Serum C-peptide was 2.3 ± 1.1 ng/mL. The prevalence of diabetic retinopathy among the study participants was 45.0%.

Conclusion: Serum C-peptide levels are significantly correlated with both diabetic retinopathy and kidney function. Lower C-peptide levels (reflecting worse beta-cell function) are associated with a higher risk of retinopathy and worse kidney function.

Background: Abdominal aortic calcification (AAC) is closely related to cardiovascular disease. Although its clinical significances have primarily been investigated in patients with chronic kidney disease, its association with cardio-cerebrovascular mortality in the general middle-aged and elderly population has not been sufficiently investigated.

Aims: To study the association of AAC and cardio-cerebrovascular mortality in both the entire general middle-aged and elderly populations and age subgroups.

Methods: Data of participants of the National Health and Nutrition Examination Survey (NHANES) 2013-2014 were analyzed. This study included middle-aged and elderly (≥ 40 years old) individuals who underwent dual-energy X-ray absorptiometry. The severity of AAC was assessed by an AAC scoring system (AAC score) with a maximum possible value of 24. Participants were tracked for survival status and major cause of death till 31st December 2019. This study utilized AAC score = 6 as the optimal cut-off according to Harrell's c statistic. Based on AAC scores, participants were trichotomized (0, 0-6, and ≥ 6). Groupwise survival curves and cumulative incidence functions were plotted to reveal the association of AAC and cardio-cerebrovascular mortality. Given results under trichotomization, combination of participants with AAC scores 0 and 0-6 was conducted to reaffirm the association of AAC and adverse prognosis.

Results: Correlation between increased AAC score and poorer survival, higher cumulative incidence of events was revealed. Cox models identified AAC score ≥ 6 as an independent risk factor of cardio-cerebrovascular mortality (AAC score ≥ 6 vs. AAC score = 0: Hazard ratio: 2.38, P = 0.008) after adjusting for cardiovascular risk factors. Results remained significant after regrouping (AAC score ≥ 6 vs. AAC score < 6: Hazard ratio: 2.06, P = 0.016). Subgroup analysis provided no evidence of unparallel change in hazard for the same amount of increase in AAC score among middle-aged (40-65 years old) and elderly (≥ 65 years old) individuals.

Conclusions: AAC score ≥ 6 independently indicate increased risk of cardio-cerebrovascular death and would be effective in risk stratification among the general middle-aged and elderly population in clinical practice.

Objectives: Evaluating photodynamic therapy's efficacy and suitability for treating periodontal disease is the main goal of this review. What are the best conditions for using photodynamic therapy, and how can it improve conventional periodontal treatments?.

Materials and methods: A comprehensive literature search has been conducted to identify peer-reviewed research published up until August 2024. This search utilized reputable databases, including PubMed, Scopus, and Google Scholar, ensuring a robust selection of relevant studies. Selected studies were meticulously analyzed to their methodologies, types of photosensitizers employed, light intensity levels applied, as well as the resultant clinical outcomes observed. Additionally, a comparative analysis has been performed between photodynamic therapy and traditional periodontal therapy as documented in numerous clinical studies.

Results: Results show that photodynamic therapy considerably lowers the number of microorganisms present in periodontal pockets, which in turn reduces inflammation and improves healing responses. According to studies, photodynamic therapy is an efficient way to break up the biofilms that of harmful bacteria that cause periodontal disease produce.

Conclusions: Photodynamic therapy is an intriguing alternative treatment option for periodontal disease. Because photodynamic therapy reduces biofilm resistance, improves blood flow, and promotes healing through anti-inflammatory effects, it may yield better clinical results when used in conjunction with conventional periodontal therapies. More research is required to create consistent guidelines for light dosage and photosensitizer selection in order to maximize therapeutic outcomes.

Background: To date, there is one university offering the Physician Associate (PA) Studies programme in Ireland. Responding to a demand for PAs outside of Dublin, a hybrid model was introduced, allowing students undertake the didactic phase of the programme online for synchronous instruction, attending campus twice a month for anatomy learning, clinical skills, and integration sessions.

Aims: The aim of this study was to evaluate the hybrid model from the perspectives of students and their teachers, including the external examiner.

Methods: This was a mixed methods study, using surveys (n = 15), focus groups with students (n = 10), teaching staff (n = 4), and a one-to-one interview with an external examiner. Action points of programme board meetings were also analysed.

Results: While attitudes to online learning were positive, the need for improvements was highlighted. During online teaching sessions, the students expressed the need to feel more a part of the traditional classroom experience. Even though lecturers were aware of students online, some found it difficult to engage with these students. Clinical teachers did not detect any differences between hybrid and on-campus students on their clinical application to practice.

Conclusion: Findings suggest that hybrid learning is influenced by previous online learning experiences. Students admitted to a feeling of social isolation at times and the reminder for faculty to support an inclusive environment. Student performance showed that hybrid students did as well or better across both years of the programme, and this translated into clinical practice too.