Irish Journal of Medical Science最新文献

Background: Methicillin-resistant Staphylococcus aureus (MRSA) strains are a major cause of hospital-acquired infections, exacerbated by increasing antibiotic resistance.

Aim: This study aimed to isolate bacteriophages targeting MRSA and evaluate their antimicrobial activity in combination with antibiotics.

Methods: Nasal samples from hospital staff (n = 50) were used to isolate MRSA strains, and sewage samples were processed for phage isolation using the double agar overlay technique. The microtitration plate method evaluated the synergistic effects of isolated phages and antibiotics.

Results: Out of 50 samples, 11 MRSA strains were positive, showing high resistance to multiple antibiotics, including oxacillin (95%), and vancomycin (85%). Phage zP-1, belonging to the Myoviridae family, exhibited > 90% lytic activity, stable across temperatures (20-50 °C) and pH (6-8). A statistically significant synergistic effect was observed at a MIC of 0.137 μg/ml for gentamicin (p-value 0.02).

Conclusion: These findings suggest that phage-antibiotic synergy may offer a promising strategy to combat MRSA infections, warranting further in vivo studies to assess its clinical potential.

Background: The prevalence of peripheral arterial disease (PAD) is increasing globally. An increase in PAD in an ageing population inevitably results in an increase in incidence of Chronic Limb Threatening Ischemia (CLTI). Loss of a limb is a life-changing event with immeasurable cost to the individual, while the potential financial benefit of saving a limb is not well documented.

Aims: The focus of this study was to estimate the cost associated with surgical interventions used in the treatment of CLTI compared with amputation.

Methods: The cost to treat a CLTI diagnosis in 124 patients was analysed in an acute tertiary referral hospital over a 13-month study period. The analysis included staffing, medical devices used, number of blood components used and the length of stay. Statistical methods included descriptive statistical data and the Mann-Whitney U test.

Results: The median cost, associated with length of stay, post-amputation and post-revascularisation (hybrid) was €61,313 [IQR = €44,417, €83,331] and €46,573 [IQR = €25,687, €58,554] respectively, p < 0.001. The total median cost for length of stay for amputees in an acute hospital, rehabilitation and a prosthetic limb was €88,820 [IQR = €74,486, €110,248]. The median surgical cost of an amputation was €2,064 [IQR = €1,342, €2,866], whilst the median surgical cost of a revascularisation procedure (hybrid) was €5,966 [IQR = €4,380, €7,723], p < 0.001, inclusive of total blood components transfused.

Conclusion: Revascularisation surgical interventions are more expensive than amputation, however, the length of stay, rehabilitation and prosthetic limb costs, for a patient undergoing a major limb amputation, is significantly more costly.

Background: Diabetes mellitus is one of the systemic diseases affecting the kidneys that eventually develop end-stage kidney disease. Shear wave elastography (SWE) is a reliable and non-invasive ultrasonography test used to determine tissue elasticity. The aim of this study is to detect early diabetic nephropathy by measuring renal stiffness using shear wave elastography (SWE), renal resistivity indices, and laboratory findings in DN patients.

Methods: Shear wave elastography and color duplex sonography assessments were performed in 60 diabetic nephropathy patients (divided according to eGFR into 3 stages: stage I-II-III diabetic nephropathy with equal groups of 20 patients in each stage) and 20 healthy age-matched control subjects. The SWE-derived mean value of the tissue stiffness, given in kilopascals (kPa), was correlated to patients' clinico-laboratory data (serum creatinine and eGFR) and resistive index.

Results: There is a statistically significant increase in SWE and RI in the diabetic group than control group and a statistically significant increase in SWE (mean) in CKD stage II and III when compared with CKD stage I, SWE can be used to discriminate between diabetic groups and control group at a cutoff level of > 10.5 (kPa), and also, SWE (mean) can be used to discriminate between CKD stage II and III patients at a cutoff level of > 41 (kPa), with 66.7% sensitivity and 64.9% specificity.

Conclusion: Shear wave elastography is a sensitive, non-invasive, and specific diagnostic tool for the detection of diabetic nephropathy and differentiation between different stages of DN.

Background: Advancements continue to be made in the development of medicines containing components of the Cannabis sativa L. plant. Consultants can prescribe specific cannabis-based products for a restricted set of indications in Ireland, with neurologists being at the forefront of therapy. Much debate on the therapeutic potential/efficacy of such cannabis-based products exists.

Aim: The objective of this study was to conduct a national survey to determine the perspectives/views of Irish neurologists regarding the use of cannabis-based medicines.

Methods: An online anonymous survey was conducted to capture the perspectives and experiences of neurologists in Ireland regarding cannabis-based therapeutics.

Results: Thirty-four neurologists completed the survey in full, with study participants rating their knowledge of cannabis-based medicines as average. Data presented herein indicate that there is a need for educational programmes on the cannabinoid system and cannabinoid-based medicines, and the findings indicate that neurologists are interested in the use of cannabinoid-based medicines in their practice. Study participants were more divided with regard to the clarity of the process for accessing cannabis-based medicines, and the consensus is that the application process is unclear. Approximately one-third of participants have made an application to access medicinal cannabis-based products on behalf of a patient.

Conclusions: Data presented herein indicates that the majority of neurologists surveyed are aware of the current systems in place to access cannabis-based products for medicinal use in Ireland and that some engagement with these systems has taken place. A key finding is that educational programmes on the cannabinoid system and cannabis-based medicines are required.

Background: Intensive care unit acquired-weakness syndrome (ICUAWS) leaves several complications in functional movements of patients such as severe walking disability.

Objective: Assessment of functional outcomes of 1-month inspiratory muscle training (IMT) in elderly with ICUAWS and severe walking disability was our aim. The design, setting, participants, and intervention. This study is a randomized controlled trial. ICUAWS patients who complained of severe walking disability on the Modified Functional Ambulatory Category Test (MFACT) were randomly assigned into the IMT group or control group, n = 20 for each group. Both groups received the traditional physical therapy program.

Results: The results showed that the post-therapy between-group comparison of ICUAWS sufferers/groups' parameters showed a significant improvement toward the IMT group in six-minute walk test, inspiratory and expiratory muscle strength, forced vital capacity, time up and go test, 10-m walk test, forced expiratory volume in the first second, 30-s sit-to-stand test, partial pressure of arterial blood oxygen and carbon dioxide, MFACT, oxygen saturation of arterial blood, physical, and mental summary of short form 36.

Conclusion: In conclusion, IMT improves functional outcomes in ICUAWS patients with walking disability.

Trial registration number: The clinical trial ID of this ICUAWS trial is NCT06210763.

Background: Ireland has had an historic over-reliance on inpatient mental health care accompanied by poorly resourced community provision. There has been an increasing policy focus on provision of mental health care in the community to facilitate diversion from, or shorten stays in, inpatient care. However, little is known about the determinants of psychiatric inpatient length of stay (LOS) to allow for the targeting of community services.

Aim: To use a large cross-sectional national dataset to examine the determinants of psychiatric inpatient LOS in the Irish context.

Methods: Using information on 60,607 discharges from adult acute psychiatric units in Ireland between 2015 and 2019, the study employs both descriptive and regression analysis. Using negative binomial regression models, we control for patient demographic, socioeconomic, and clinical characteristics. In addition, as LOS may be related to provision of non-acute services in the patient area of residence, the analysis also controls for aspects of community service provision.

Results: The study finds that longer LOS is associated with older age, being female, and having an involuntary admission. Clinical diagnosis significantly impacts LOS, with diagnoses such as schizophrenia being associated with longer LOS. There is also significant variation in LOS across region of residence, with discharges from some regions staying up to 5 days longer.

Conclusions: The regional variation observed in inpatient LOS supports the assumption that increased provision of community services diverts or reduces the quantum of care required in inpatient settings. However, without substantive improvement in the community data collected and reported, future planning of mental health services, both community and inpatient, will be substantially curtailed.

Objective: To systematically evaluate the efficacy and safety of norepinephrine in the treatment of septic shock.

Methods: Literature retrieval of eligible randomized controlled trials (RCTs) on norepinephrine in the treatment of septic shock was performed in three English databases including PubMed, Web of Science, and Medline from database establishment to October 1, 2023. The Cochrane risk bias tool was used to evaluate the quality of the included literature. RevMan 5.3 software was used for meta-analysis.

Results: A total of 14 RCTs were included in this study, and the risk of bias was low. Our meta-analysis showed that the norepinephrine group had significantly better outcomes in reducing the 28-day mortality rate (RR = 0.92; 95% CI, 0.86 ~ 0.99; P = 0.03), the incidence of arrhythmia (RR = 0.54; 95% CI, 0.45 ~ 0.64; P < 0.0001), and the length of stay in intensive care unit (ICU) (MD =  - 1.03; 95% CI, - 1.85 to approximately - 0.21; P = 0.01) than those of the control group. However, there were no statistically significant differences in in-hospital mortality rate (RR = 0.97; 95% CI, 0.90 ~ 1.04; P = 0.4), the 90-day mortality rate (RR = 1.07; 95% CI, 0.97 ~ 1.18; P = 0.15), length of hospital stay (MD = 0.03; 95% CI, - 1.13 ~ 1.18; P = 0.96), and the rate of achieving target MAP (RR = 1.27; 95% CI, 0.72 ~ 2.26; P = 0.41) between the norepinephrine group and the control group.

Conclusion: Norepinephrine has the advantages of improving 28-day mortality, shortening ICU hospitalization time, and reducing the incidence of arrhythmia. It is a more effective choice for the treatment of septic shock than other vasopressors, and the incidence of arrhythmia is low.

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'.