Irish Journal of Medical Science最新文献

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'.

Objective: This study is a retrospective evaluation of a new outpatient flexible cystoscopy service in a tertiary care hospital in Dublin, Ireland.

Design: This is a retrospective observational study.

Setting: This study has been held at the Department of Gynaecology, Rotunda Hospital, Dublin.

Population: This included all women who underwent outpatient flexible cystoscopy in Rotunda Hospital between May 2023 to October 2024.

Materials and methods: Retrospective data collection included patient demographics, indications for referrals, cystoscopic findings, post-procedural complications, and cost-benefit analysis.

Results: A total of 77 women underwent flexible cystoscopy. The mean age was 52.5 years ranging from 20 to 85 years. Flexible cystoscopy was successfully completed in all patients, and there were no post procedure complications. The most common indications were as follows: recurrent urinary tract infections (36%) and bladder pain syndrome (36%), followed by overactive bladder symptoms (14%). Fifty-five percent of patients had no abnormal findings. The most common abnormality found was trabeculations (39%), followed by glomerulations (9%). A cost-benefit analysis showed an approximate saving of € 1211 per patient leading to a saving of over € 93,000 over a period of 18 months.

Conclusion: Outpatient cystoscopy is a low-risk, feasible, well tolerated, and safe diagnostic procedure, with no post-procedure complications observed in this study. It avoids the risks of general anaesthesia and is associated with lower procedural costs.

Background: Aerobic exercise is recommended to alleviate pain and protect the joint for patients with advanced knee osteoarthritis, however, its clinical implementation is challenging due to the potential for exacerbating pain.

Aims: The study aimed to compare the effects of anti-gravity treadmill training with traditional treadmill training in patients with advanced knee osteoarthritis.

Methods: This single-blinded randomized-controlled trial included 30 women with knee osteoarthritis. All participants received hotpack, transcutaneous electrical nerve stimulation, and therapeutic ultrasound. Additionally, group 1 received anti-gravity treadmill, while group 2 received traditional treadmill training. Group 3 served as the control. The interventions were administered three-times a week for eight-weeks. The visual analogue scale (VAS) pain, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), six-minute-walk-test distance (6MWD), and femoral cartilage thickness were evaluated at baseline and weeks 4 and 8.

Results: VAS-pain significantly reduced over time in both anti-gravity (P < 0.001) and control (P = 0.004) groups. The anti-gravity group also showed significant improvements in WOMAC-pain (P = 0.008), WOMAC-total (P = 0.048), and 6MWD (P < 0.001). Post-hoc analysis indicated significant time (P < 0.001, effect size, ηp2 = 0.682) and interaction (P = 0.006, ηp2 = 0.271) effects on VAS, with no significant between-group differences. Femoral cartilage thickness showed no significant between-group differences, except within-group differences in the treadmill group (P = 0.037).

Conclusions: Anti-gravity treadmill training significantly improved pain, functionality, and functional capacity in patients with knee osteoarthritis, while traditional treadmill resulted in a reduction in femoral cartilage thickness. Further research should investigate long-term outcomes and more diverse populations.

Clinical trials identifier: NCT05319964.

Background: Emergency colorectal surgery carries a high risk of morbidity and mortality. Subspecialisation and split-site geographically distinct services may lead to critically unwell patients presenting to a non-colorectal specialist centre requiring urgent on-site intervention.

Aims: This study aims to determine outcomes of this high-risk patient cohort.

Methods: An observational retrospective study of emergency colorectal laparotomies at the Royal Infirmary of Edinburgh (RIE) between January 2016 and August 2020 was performed. The primary outcome was 30-day mortality. Secondary outcomes included rate of primary anastomosis, complications and overall mortality. Subgroup analysis of the vascular ischaemia cohort and colorectal surgeon involvement was performed.

Results: One hundred and eighteen patients were included. The median NELA (National Emergency Laparotomy Audit) score was 6.4% (IQR 2.5%-16.7%) and the 30-day mortality rate was 22% (26/118). The rate of primary anastomosis was 24.6%. Twenty-five patients had a vascular ischaemic pathology demonstrating a higher median NELA score (14.3%, IQR 5-22.4% vs. non-ischaemic group 5.7%, IQR 1.7-14.2%, p = 0.013) and thirty-day mortality (44%, 11/25 vs. 16.1%, 15/93, p = 0.006) than those without ischaemic pathology. Colorectal surgeon involvement in cases without ischaemia (23/93) was associated with a similar 30-day mortality (13.1% colorectal surgeon vs. 17.1% non-colorectal specialist surgeon, p = 0.755) and rate of primary anastomosis (30.4% colorectal surgeon vs. 31.8% non-colorectal specialist surgeon, p = 1).

Conclusions: The high mortality rate described highlights a specific group of unwell patients unfit for transfer. Research registration number: researchregistry7101.

Background: Studies evaluating lower urinary tract symptoms (LUTS) and sexual functions after holmium laser enucleation of prostate (HoLEP) are very limited.

Aims: To evaluate both the LUTS voiding and storage functions of patients after HoLEP operation and to examine its effect on postoperative sexual functions.

Methods: The data of male patients who underwent HoLEP for benign prostatic hyperplasia (BPH) between May 2019 and February 2022 were evaluated. The International Prostate Symptom Index (IPSS) was used for questioning LUTS. The International Erectile Function Index-Erectile Function (IIEF-EF) section was completed to evaluate erectile functions and Male Sexual Health Questionnaire-Ejaculation function (MSHQ-EjD) was completed to evaluate ejaculation functions.

Results: A total of 427 patients were included in the study. A significant improvement was found in IPSS total, storage, and voiding scores at the 3rd month follow-ups of the patients after HoLEP. While improvement was detected in the erectile functions of the patients (p < 0.001), a significant decrease was found in MSHQ-EjD scores (15.97 ± 2.26 vs. 11.02 ± 3.69; p = 0.002). More than 50% reduction in IPSS scores was found in 85.48% (365/427) of the patients. It was determined that the patients who did not benefit from the treatment had higher preoperative IPSS-storage symptoms (p = 0.001), lower IIEF-EF scores (p < 0.001), and higher PVRs (p = 0.001).

Conclusions: HoLEP is an effective method that can be used safely and effectively in the treatment of LUTS due to BPH. While both storage and voiding functions of the patients improve, there is no worsening in erectile functions, but deterioration in ejaculation functions can be observed.

Background: Sirtuins and FoxO1 are reported to be important in the pathophysiology of preeclampsia. This study aimed to investigate whether serum FoxO1 and SIRT2 concentrations differ between preeclampsia and normal pregnancy and also to compare these markers in early- and late-onset preeclampsia.

Methods: This cross-sectional study was conducted on 27 women with early-onset preeclampsia, 27 women with late-onset preeclampsia, and 26 healthy normotensive pregnant controls. Maternal serum levels of FoxO1 and SIRT2 were measured with the use of an enzyme-linked immunosorbent assay kit.

Results: The mean maternal serum FoxO1 levels were significantly lower both in early-onset (9.1 ± 3.8 vs. 29.1 ± 3.2, p < 0.001) and late-onset preeclampsia (2.6 ± 1.6 vs. 29.1 ± 3.2, p < 0.001) than the normotensive pregnancies. The mean maternal serum FoxO1 level of late-onset preeclampsia was significantly lower than the early-onset preeclampsia group (2.6 ± 1.6 vs. 9.1 ± 3.8, p < 0.001). The mean maternal serum SIRT2 levels were significantly lower both in early-onset (4.5 ± 2.1 vs. 6.3 ± 0.9, p < 0.001) and late-onset preeclampsia (2.1 ± 0.6 vs. 6.3 ± 0.9, p < 0.001) than the healthy pregnancies.

Conclusions: FoxO1 and SIRT2 may be biomarkers for early detection of preeclampsia and potential therapeutic targets in the pathophysiology of preeclampsia.

Background: Alcohol, a significant public health concern, contributes to a substantial burden on emergency services. Identifying avoidable causes of Emergency Department (ED) presentations may reduce hospital overcrowding and benefit public health.

Aims: This prevalence study aims to provide a detailed analysis of patients presenting to the ED at Mercy University Hospital (MUH) as "Apparently Drunk" in 2022 and 2023.

Methods: Data were sourced from the Integrated Patient Management Information System at MUH. All patients recorded as "Apparently Drunk" were included. Data collected included demographics, associated injuries or complaints, mode of arrival, admission status, and discharge status. Descriptive statistics were used to summarise the data and trends were examined by comparing 2022 and 2023 data.

Results: A total of 1662 presentations were categorised as "Apparently Drunk," representing 3% of all ED visits. There was an 18% increase in such presentations from 2022 to 2023. The majority of patients were male (72%). The median age was 39 years. Notably, 23% of the presentations involved people experiencing homelessness, and 81% were conveyed by ambulance. Significant associated injuries included head injuries (7%), falls/collapses (6%), mental health issues (5%), and assaults (4%).

Conclusion: The findings indicate a growing trend in patients presenting to the ED as "Apparently Drunk". The high incidence among people experiencing homelessness and the substantial resource utilisation underscores the need for targeted public health interventions and integrated services. Policymakers should consider these findings in the context of potential legislative changes that may impact alcohol availability.

Background: The anterior cruciate ligament (ACL) is a strip of dense connective tissue that runs from the femur to the tibia with a relatively poor blood supply. It prevents the femoral condyles from rolling posteriorly. ACL is commonly injured in any knee trauma, ranging from a little sprain to a total rupture. The arthroscope is the gold standard approach for identifying ACL tears, which may be treated conservatively or surgically.

Aim of the study: To assess the efficiency of immediate and delayed weight bearing after arthroscopic ACL reconstruction.

Material and methods: Cohort longitudinal study carried through 6 years from 2017 to 2023 et al.-kindy Teaching, Ulamaa, and Almuktar hospitals 186 patients, the patients were divided randomly into 2 groups, group A (n = 93) with immediate (after 10 days) weight bearing and group B (n = 93) with delayed (after 1 month) weight bearing following ACL reconstruction. any patients with chondral lesions, aged less than 19 or more than 40 years, knee osteoarthritis, ligament damage, and deformity in lower extremities were excluded. Patients from both groups A and B had complete ACL tears and underwent arthroscopic ACL reconstruction follow-up for 6 months duration regarding stiffness, infection, giving up pain, swelling, and quadriceps muscle atrophy.

Results: In group A, there were 93 patients,70 male and 23 female, and meniscal injury was 89 patients. While in group B (93 patients) 57 male and 36 female, meniscal injury in group B was 91. There is a statistically significant difference regarding knee swelling. (80.6% in group A, and 10.8% in group B), and knee pain in which (79.6% in group A patients and only 7.5% in group B). There is no significant value between the two groups about the knee getting given up, infection, stiffness, and quadriceps muscle atrophy.

Conclusion: Delay weight bearing after ACL reconstruction makes the patients less prone to knee pain and effusion but more prone to quadriceps muscle atrophy.

Background: COVID-19 pandemic and mental health of people are related to each other.

Aims: To assess the relationship between fear of COVID-19 (FCOV) and the psychological status of medical students of Bangladesh.

Methods: A total of 967 medical students and intern doctors of Sher-E-Bangla Medical College participated in this cross-sectional study. FCOV was measured using the Fear of COVID-19 Scale (FCV-19S). Mental health status was assessed using the Depression Anxiety Stress Scale (DASS-21). Correlation between these two variables was done followed by general linear model to assess the relationship of other covariates with mental health.

Results: FCOV had a highly significant relationship with mental health (DASS-21 and all its components, p < 0.001 for all). Females suffered more from fear than males except the interns. Clinical students, students with middle income groups, students residing with the families, and students having family members in health services exhibited more FCOV compared to their counterparts. When we looked at the DASS-21 and its components, females suffered more from stress. Having family members in health services was related to higher anxiety and stress with higher DASS-21 scores as well. Students who expressed their lives to be affected by COVID-19 had higher DASS-21 and its components compared to those whose lives were not affected as such. Students residing with their families revealed increased stress. FCOV and life affected by COVID-19 were constantly related to DASS-21 and its components (p < 0.001), adjusted for other variables.

Conclusions: Fear of COVID-19 is associated with poor mental health of medical students.

This narrative review provides a comprehensive overview of complications in interventional radiology (IR), focusing on their aetiology, recognition, and management. As IR procedures continue to evolve and expand, understanding potential adverse events is crucial for improving patient safety and outcomes. The review will summarise various common complications associated with IR-based procedures, including their presentation, aetiology, and management. By consolidating current knowledge on these issues, the review offers valuable insights into minimising risks and enhancing procedural success. This synthesis will aid practitioners' knowledge and ultimately try and ensure safer IR practices and aftercare of patients.