Irish Journal of Medical Science最新文献

Background: Postoperative pain following laparoscopic cholecystectomy (LC) is a major concern. The transversus abdominis plane block (TAPB) is one of the anesthetic techniques that has been developed to address this issue. The TAPB can be delivered by the guidance of either ultrasound (UTAPB) or laparoscopic (LTAPB). Our aim is to compare the efficacy of these guidance methods in reducing postoperative pain after LC.

Methods: A systematic search was performed in PubMed, Scopus, Cochrane, and Web of Science databases from inception to June 2024 for randomized studies comparing the delivery of TAPB under ultrasound and laparoscopic guidance. Data analysis was conducted using Review Manager V5.4.

Results: Five randomized studies were included in our study. UTAPB was significantly more effective in reducing postoperative pain after 6 h compared to LTAPB (MD =  - 0.38, 95% CI, - 0.67 to 0.09, p = 0.01). However, UTAPB was insignificantly more effective than LTAPB in reducing postoperative pain after 12 h (MD =  - 0.14, 95% CI, - 0.44 to 0.17, p = 0.39), 24 h (MD =  - 0.09, 95% CI, - 0.41 to 0.23, p = 0.60), and 48 h (MD =  - 0.12, 95% CI, - 0.44 to 0.19, p = 0.44). UTAPB insignificantly resulted in decreased opioid consumption (SMD: - 0.09; 95% CI: - 0.42, 0.25; p = 0.62) and less postoperative nausea and vomiting (OR = 0.73, 95% CI, 0.21 to 2.51, p = 0.62) in comparison with LTAPB.

Conclusion: Ultrasound guidance of TAPB offers superior pain relief in the setting of LC, especially in the early postoperative period. Further trials are needed to prove and support the results.

Background: Cancer has adverse consequences for mental health, especially in women. Lack of awareness of services and stigma diminish access to psycho-oncology services.

Aims: To assess psychological distress and willingness to engage in multidisciplinary psycho-oncological services among cancer patients.

Methods: Cross-sectional survey of attitudes towards psycho-oncology services in 142 cancer patients.

Results: Women experienced more extreme distress than men, with 46.4% of females and 17.8% of males reporting "extreme" distress. Under one third of cancer patients (30.3%) knew the meaning of 'psycho-oncology'; one quarter (25.6%) knew of the psycho-oncology service, and two thirds (67.2%) were unsure if referral would be beneficial. One fifth (21.0%) would be somewhat/extremely uncomfortable disclosing attending palliative care, compared to 17.9% for psychiatry, 14.4% for psychology, and 5.8% for cardiology. On multivariable analysis, pre-existing psychiatric/psychological difficulty was the only variable independently associated with belief that a psycho-oncology referral would be beneficial.

Conclusions: Limited awareness of psycho-oncology services exist despite high rates of extreme distress among women with cancer.. Given that women have higher levels of extreme distress, it would be prudent to offer them enhanced psycho-oncological care.

Aim: This study aimed to investigate the effect of the COVID-19 pandemic on the clinical and pathological stages of patients diagnosed with breast cancer.

Method: In this retrospective study, a total of 298 male and female patients over the age of 18 who were diagnosed with breast cancer and who were continuing surgical and oncologic treatment were included.

Results: Of the 298 patients diagnosed with breast cancer, 186 (62.4%) belonged to the pre-COVID period and 112 (37.6%) to the COVID period, and there was a 39.7% decrease in the number of diagnosed patients. Statistical analyzes revealed significant differences in family history, smoking, histopathologic grade, disease stage, type of surgery performed and Cerb-B2 ovarian expression (p = 0.005, p = 0.001, p = 0.018, p = 0.035, p < 0.001, p = 0.047). During the pandemic period, tumor size (T), axillary lymph node metastasis rate, neoadjuvant chemotherapy rate, and distant metastasis rate increased, but there was no statistically significant difference (p = 0.535, p = 0.070, p = 0.148, p = 0.153, respectively).

Conclusions: In pandemic situations such as COVID-19, restrictions in social life and fear of contamination can prolong the time of admission to the hospital. This may cause delays in the diagnosis of malignant diseases such as breast cancer and progression in the disease stage. In these and similar outbreaks, public awareness should be raised, and the public should be encouraged to comply with screening and follow-up programs in order to continue outpatient clinic activities and screening programs without interruption by taking contamination measures.

From'grave diggers' to a 'Trauma System for Ireland', the history of Irish orthopaedics is a unique and fascinating story. This story has developed over decades and centuries, with many late and great surgeons and trainers playing major roles in developing our orthopaedic services nationally, as we know them today. The authors acknowledge that it would be wrong to think that a 1500-word review could provide an in-depth, yet comprehensive, discussion of all topics past and present of celebration, deliberation and further debate, related to orthopaedic surgery in Ireland. However, this article sought to provide a brief account of some of the key, landmark moments of orthopaedics over the last 3 centuries in Ireland, many of which are responsible for shaping the landscape of the outpatient rooms, orthopaedic wards and theatre suites, in which we provide high standard orthopaedic care to the people of our island today.

Background: Knee injuries are common among elite intercounty Gaelic games players (collectively GAA players).

Aims: The primary aim was to examine knee pain, function, and quality of life in retired elite male GAA players. Secondary objectives were to (i) report the incidence of previous knee surgery and total knee replacement, (ii) assess medication usage, and (iii) investigate any associations between a history of knee injury and/or knee surgery and knee pain, function, and quality of life among retired elite male GAA players.

Methods: One hundred retired male senior intercounty GAA players were surveyed on their history of severe knee injury and previous knee surgery (68 completed survey; 47 Gaelic football, 20 hurling, 1 dual player). The Knee Injury and Osteoarthritis Outcome Score Physical Function Short Form (KOOS-PS) and the Patient-Reported Outcomes Measurement Information System Global Health (PROMIS-GH) were used to assess level of function and pain.

Results: Forty-seven (69%) of the retired players described experiencing at least one severe knee injury during their intercounty career. Fourteen (21%) participants retired due to a significant knee injury. Mean KOOS-SP score was 75.5 (SD 17). The Global Physical Health and Global Mental Health mean scores were 44 and 51. There was a low negative correlation between KOOS-SP scores and a history of severe knee injury (r = -0.35, p = 0.001). Moderate negative correlation between Global Mental Health scores and a history of severe knee injuries (r = -0.36, p = 0.386) and a very weak negative correlation between the number of surgeries during a participant's intercounty career and Global Mental Health score (r = -0.089, p = 0.234).

Discussion: Severe knee injuries and knee surgery are common among male intercounty GAA players. These injuries lead to self-reported reduced performance and retirement and are potentially associated with worse health-related outcomes post-intercounty career. Further well-designed studies, including among retired women GAA players, are required to assess the relationship between knee injuries and long-term athlete outcomes. Improved injury prevention efforts, enhanced rehabilitation of knee injuries, and post-retirement care may mitigate the adverse effects associated with severe knee injuries among male GAA players.

Background: The majority of thyroid nodules are benign; however current guidelines suggest that thyroid incidentalomas should be appropriately evaluated to rule out malignancy.

Aims: This study aims to determine the incidence of thyroid incidentalomas and the likelihood that they harbour sinister pathology in the largest Irish cohort studied to-date.

Methods: A retrospective observational chart review was conducted using data from July 2018 to December 2018 using the Radiology Database in use at Cork University Hospital. The text of 1000 imaging reports (500 carotid Doppler and 500 computed tomography thorax) was manually screened for phrases such as "thyroid mass" or "thyroid nodule".

Results: On 1000 scans, 14 (1.4%) thyroid incidentalomas were discovered. The occurrence of incidentalomas by imaging was 2/500 (0.4%) for ultrasound and 12/500 (2.4%) for computed tomography. Three of these nodules (21.4%) were further evaluated with a subsequent ultrasound and due to a size of more than 1 cm underwent fine needle aspiration. Using the Thy classification, all three were given a Thy 2 (non-neoplastic) grading.

Conclusion: This study found that there was no clinical benefit to reporting the presence of thyroid incidentalomas incidentally noted on radiology investigations. Although the overall percentage of thyroid incidentalomas is low, this number may be enough to cause unnecessary strain on the healthcare system and burden patients with invasive investigations in addition to causing unnecessary anxiety.

Background: The role of NT-proBNP as a cardiac biomarker for predicting short-term major adverse cardiovascular events (MACEs) in acute coronary syndrome (ACS) remains unclear.

Aims: This study investigated the utility of the NT-proBNP level for predicting MACEs within a 6-month period in patients with ACS.

Methods: This prospective study included 241 consecutively enrolled adults with ACS between September 2023 and February 2024. Demographic data, clinical characteristics, GRACE score, and high-sensitivity cardiac troponin T (hs-cTnT) and NT-proBNP levels were compared between patients who were MACE-positive vs. MACE-negative within a 6-month period.

Results: The overall mortality rate was 8.7%, and the incidence of MACEs was 43.2%. The mean serum levels of hs-cTnT and NT-proBNP were significantly higher in the MACE-positive than in the MACE-negative group. Age, concomitant coronary artery disease, NT-proBNP, and GRACE score were independent predictors of MACEs in patients with ACS. An NT-proBNP level of 250 pg/mL had a sensitivity of 73.1% and a specificity of 88.3% for predicting MACEs, with an area under the curve of 0.847. The estimated risk of MACEs was 70% and 90% for NT-proBNP values of 600 pg/mL and 900 pg/mL, respectively.

Conclusion: The NT-proBNP level measured at ED admission was strongly associated with short-term MACEs in patients with all ACS subtypes and was an important prognostic biomarker. Therefore, combining the NT-proBNP level with the GRACE score in ACS patients may provide significant benefits in terms of predicting MACEs and obtaining a more accurate risk stratification.

Background: A pathological complete response (pCR) rate after neoadjuvant chemotherapy (NAC) is important for the prognosis of early-stage breast cancer. The prediction of an NAC response plays a key role in managing neoadjuvant treatment.

Aims: The aim of this study is to investigate the predictive value of the baseline PETCT FDG (F-18 fluoro-deoxy-glucose (FDG) positron emission tomography/computed tomography) SUVmax (the maximum standardized uptake value) for pCR after NAC in early-stage breast cancer.

Methods: The patients who performed PETCT before NAC were included in this retrospective study. The basal PETCT SUVmax values were divided into two categories based on the cutoff points of ≥ 8.77 or < 8.77, namely the low SUV max group and the high SUV max group. These two groups were compared according to the general characteristics. The impact of the PETCT SUVmax values on pCR was determined with logistic regression analyses.

Results: One hundred forty-eight patients who performed PETCT before NAC were included in this retrospective study. Eighty-one patients were in the low SUV max group and 67 patients were in the high SUVmax group. The pCR trended toward a higher rate in the high SUVmax group than in low SUVmax group but it was not statistically significant (p = 0.052). The baseline PETCT SUVmax value was an independent predictive factor for pCR. (p = 0.025).

Conclusion: PETCT SUVmax may be a factor for the predicting complete response to neoadjuvant treatment in early-stage breast cancer.

Neurodiversity refers to the variation in human cognitive, sensory, and communication experiences and reframes deficits as differences. Rates and duration of hospitalisation in neurodiverse children are higher compared to their neurotypical peers. Despite increased admissions, paediatric medical hospitals are poorly equipped to adequately support their unique cognitive, sensory, behavioural, and communication needs, which can have negative impacts on the experiences of patients, families, and staff. The literature supports several innovative and inclusive strategies, which present exciting opportunities for Ireland's new National Children's Hospital (NCH) to become a 'neurodiversity-friendly paediatric hospital'.