Irish Journal of Medical Science最新文献

Background: Primary malignant chest wall tumors, originating from the bones, are infrequent neoplasms. Given its heterogeneity, further research is needed to understand the implications of recurrence and related factors in patients undergoing chest wall resection.

Aims: We analyzed the association between the clinicopathological characteristics of these patients and their overall-survival (OS) and disease-free-survival (DFS).

Methods:  In this study, we conducted a retrospective analysis on patients who underwent chest wall resection for primary malignant bony chest wall tumors between 2000-2023.

Results: Fifty-one patients were included. The presence of Ewing tumor, prior adjuvant therapy, postoperative complications, and reduced surgical margin were significantly associated with DFS and OS in both survival and univariate analyses. The optimal surgical margin threshold was identified as greater than 3 cm. Multivariate analysis revealed that only histopathological diagnosis of Ewing tumor and an insufficient margin remained significant for worse DFS and OS (p = 0.041 and 0.024, respectively). The 5-year overall survival (OS) and disease-free survival (DFS) rates were 53.6% and 50.8%, respectively.

Conclusion: Ensuring effective surgery of chest wall tumors necessitates a surgical margin greater than 3 cm. Furthermore, the histopathologic classification of Ewing carcinoma emerges as another determinant impacting DFS and OS.

Purpose: To retrospectively evaluate the efficacy and safety of Micropulse Transscleral Cyclophotocoagulation (MP-TSCPC) in reducing intraocular pressure (IOP) and the number of glaucoma medications in patients with different types of glaucoma over a two-year period.

Methods: This retrospective audit included 52 eyes from 32 patients treated with MP-TSCPC at Mountainhall Treatment Centre, Dumfries, UK, between August 2021 and September 2023. Standard treatment parameters included 2500 mW power applied for 10 s per quadrant across 9 cycles. Primary outcomes were changes in IOP and the number of glaucoma medications. Secondary outcomes included postoperative complications and changes in the mean deviation of the visual field (MD).

Results: The mean preoperative IOP was 21.4 mmHg, which significantly decreased postoperatively to 11.9 mmHg at 4 weeks, 12.75 mmHg at 3 months, 13.4 mmHg at 1 year, and 14.03 mmHg at 2 years. The median IOP reduction at 1 year was 5.0 mmHg with statistical significance (p < 0.0001). The average number of topical medications declined from 2.21 eye drops to 1.58 eye drops. No statistically significant change was observed in visual field MD (p = 0.4838), though disease progression appeared to stabilize (mean MD: -7.1 dB). Complications were infrequent and included mild anterior uveitis (n = 12), cystoid macular edema, recurrence of herpetic keratitis and severe ocular inflammation (n = 1).

Conclusion: MP-TSCPC is a safe and effective procedure for medium-term IOP control, particularly in patients with primary open-angle glaucoma. It significantly reduces IOP and medication dependency, with a low complication profile. However, outcomes are more variable in secondary glaucoma, especially uveitic cases. These findings support the growing role of MP-TSCPC as a minimally invasive treatment option for glaucoma.

Salmonella enterica serovar Paratyphi A is a significant pathogen responsible for enteric fever, particularly in developing countries, contributing to high morbidity and mortality. Current vaccines predominantly target S. Typhi, leaving a critical gap in protection against Paratyphi A strains. The absence of an effective vaccine for Paratyphi A is a significant public health concern, given its potential for outbreaks and long-term healthcare burdens. Designing a targeted vaccine is essential to reduce the incidence of enteric fever and improve global health outcomes. This study focuses on developing a multi-epitope mRNA-based vaccine against S. enterica Paratyphi A using in silico approaches, which can provide a rapid, cost-effective solution for vaccine development. A comprehensive in silico approach was utilized to design a multi-epitope vaccine candidate. Epitopes for major histocompatibility complex (MHC) Class I and II were predicted using the Immune Epitope Database (IEDB), with population coverage analysis conducted to evaluate potential efficacy across diverse populations. The selected epitopes were combined into a chimeric construct, followed by 3D modeling and molecular docking studies with Toll-like receptors (TLR4 and TLR6) using ClusPro. The stability and interaction dynamics of the vaccine-receptor complexes were further assessed through molecular dynamics (MD) simulations using the iMODS server. The population coverage analysis indicated that the vaccine epitopes provided 86.62% coverage for MHC Class I, 82% for MHC Class II, and an impressive 97% combined coverage. Docking studies revealed strong binding affinities, with interaction energy scores of -1418.2 and - 1446.1 for TLR4 and TLR6, respectively. MD simulations confirmed the stability of the vaccine-receptor complexes, with favorable interaction profiles and low energy levels, suggesting strong potential for immune activation. The computational results indicate strong antigenicity and immunogenicity, providing a foundation for further experimental validation of an effective preventive strategy against enteric fever.

Background: Precious imaging tools like computed tomography (CT) are high-demand, time-limited resources that must serve both inpatients and outpatients. It is therefore essential to use them efficiently and accurately. We aimed to enhance accuracy, reduce administrative burden, and expedite patient care - while ensuring rigorous clinical oversight through human review of artificial intelligence (AI) outputs, including optical character recognition (OCR) and natural language processing (NLP).

Methods: At Tzafon Medical Center, we implemented a hybrid AI workflow consisting of: (1) optical character recognition (OCR) with provider-specific pattern matching for automated extraction of patient and referral data; (2) natural language processing (NLP) via the DigitalOwl service for structured clinical concept extraction (diagnoses, comorbidities, negated findings) with human-in-the-loop validation; (3) a deterministic rule-based engine that matched clinical requirements with scanner availability to recommend CT protocols, schedule appointments, and generate patient preparation instructions.

Results: Integration of AI-powered document analysis using OCR, NLP, and a statistical decision engine increased annual CT examinations by 20% (from 10,000 to 12,000), saved approximately 10 staff hours per week, reduced patient waiting times by 30%, and improved patient satisfaction by 12%. Complaint rates fell from 5% in 2022 to 1% in 2024.

Discussion: AI-assisted workflow integration proved to be a cost-effective and efficient approach that improved safety, reduced staff workload, and enhanced satisfaction for both to patients and medical staff.

Objective: Our goal is to conduct an investigation into the safety and efficacy of 𝛽3 agonist (Mirabegron) in patients with heart failure (HF) comparing it to placebo.

Methods: We searched internet databases for eligible randomized controlled trials (RCTs) up to April 1st, 2024. Heart rate, stroke volume, systolic blood pressure, cardiac index, and adverse events were the primary outcomes that were analyzed. Inverse variance was used to compute the risk ratio (RR) and pooled mean differences (MD), along with their 95% CI.

Results: Four studies were included in our paper with a total of 454 patients. The mirabegron group showed a statistically significant improvement compared to the placebo group in Cardiac index (MD: 0.28, [95% CI: 0.02 , 0.53], P = 0.03), but pooled analysis did not favor either of the two arms in heart rate, ejection fraction, stroke volume and systolic blood pressure (MD: 2.54, [95% CI: -1.05 , 6.13]), (MD: 2.40, [95% CI: -2.51 , 7.3]), (MD: 0.56, [95% CI: -2.45 , 3.56]), and (MD: 0.11, [95% CI:-0.15 , 0.38]) respectively. Furthermore, there were not significant variations between the two groups in adverse events, and serious adverse events (RR: 1.06, [95% CI: 0.87, 1.29]), and (RR: 1.06, [95% CI: 0.70, 1.60], p = 0.80) respectively.

Conclusion: The Cardiac index was considerably enhanced with Mirabegron, but all other effectiveness and safety outcomes were unchanged. Further RCTs for longer durations and on more diverse populations still need to be conducted.

Background: Obesity is a prevalent health problem in both developed and developing countries. There is no consensus on the incidence of gastro-oesophageal reflux following MGB, and the underlying factors affecting reflux remain unclear.

Aim: This study aimed to investigate factors that may influence the development of gastro-oesophageal and biliary reflux after MGB surgery.

Methods: This study was designed as a retrospective cohort study. Patients aged 18-65 years who underwent MGB surgery were included in the study. Reflux symptoms were assessed using the GerdQ questionnaire preoperatively and at 6 months and 1 year postoperatively, and the results were compared.

Results: A total of 256 patients were included in the study, with an average age of 44.51 ± 10.07 years. The mean preoperative body mass index (BMI) was 47.8 ± 8.32 kg/m², decreasing to 28.05 ± 5.44 kg/m² at the one-year postoperative mark. The proportion of patients experiencing severe reflux decreased significantly from 42.7% preoperatively to 7.8% at 1 year postoperatively (p < 0.001). However, reflux symptoms at six and twelve months postoperatively were significantly higher in patients with a preoperative hiatal hernia (p < 0.001).

Conclusion: Mini gastric bypass surgery is an effective option for managing reflux; however, as symptoms do not improve in patients with a preoperative hiatal hernia, this procedure should be avoided in patients with both gastro-oesophageal reflux and a hiatal hernia. Furthermore, the increased risk of biliary reflux should always be considered in patients with a hiatal hernia but without gastro-oesophageal reflux.

Introduction: One of the foremost problems in geriatric patients is the inappropriate medication use (IMU), and several national and international guidelines have been established to define inappropriate medications, including the Turkish Inappropriate Medication Use in the Elderly (TIME) Criteria. We aimed to evaluate the prevalence of IMU among older adults admitted to the emergency room (ER) and to examine its association with clinical outcomes.

Materials and methods: Patients aged 60 years and older admitted to the internal medicine and geriatric medicine outpatient clinics between January and December 2024 were retrospectively screened, and their emergency room admissions were recorded. The IMU was defined according to the TIME-to-STOP criteria.

Results: This study included 174 older patients, with a mean age of 76.8 ± 7.7 years and a female representation of 50%. IMU rate was 61.5%. The intensive care unit (ICU) indication was significantly higher in patients with IMU than in those without IMU, with 43.9% of patients with IMU being transferred to the ICU, compared to 28.4% in patients without IMU (p = 0.039). IMU was an independent risk factor for ICU admission among geriatric outpatients, regardless of age, sex, multimorbidity, or polypharmacy (OR: 2.463, 95% CI: 1.027-5.027, p = 0.013).

Conclusion: IMU was prevalent among older adults admitted to ER, and it was identified as an independent risk factor for ICU admission. These findings underscore the importance of optimizing medication use in geriatric populations to enhance clinical outcomes.

Background: Hyperemesis Gravidarum (HG) in pregnancy is a severe form of nausea and vomiting resulting in dehydration, weight loss and declining mental health. Research on the clinical characteristics and management of HG in Ireland is limited.

Aim: To describe a cohort of women with HG attending an Irish Maternity Hospital.

Methods: A retrospective chart review of 198 women referred for HG management in an urban stand-alone maternity hospital in Dublin between 2020-2023. Data included medical and obstetric history, management, symptoms and birth outcomes.

Results: Most (64.8%) were multiparous, with 77% reporting previous HG. The majority (76.3%) presented in the first trimester. PUQE scores indicated mild (3.4%), moderate (48.3%), or severe (48.3%) nausea and vomiting, and 72.1% rated their wellbeing 5 or lower (on a scale of 0-10). Mean weight loss from pre-pregnancy to first presentation was-2.64kg (SD 3.9), with 39% losing >5%. Dehydration (61.3%) and ketonuria (42.8%) were common. Mean duration of HG care was 11.04 (SD 8.4) weeks. Nearly half (49.5%) trialled 3-4 medications, with 87.9% prescribed Doxylamine/Pyridoxine and/or Prochlorperazine. Hospital resource use was high; 76% required day ward management, 78% attended A&E, and 36.9% needed overnight admission, at least once. Among 187 live births, 55.2% were male, 70% were vaginal deliveries, 9.1% were small for gestational age (<10^thcentile) and 13.4% were large for gestational age (>90^thcentile).

Conclusion: HG significantly impacts maternal health and places demands on hospital resources. While birthweight centiles were generally normal, HG's potential long-term effects on child health warrant further investigation.