Irish Journal of Medical Science最新文献

Background: Both macroscopic and histological lesions are frequently detected at upper endoscopy in elderly patients. We assessed the prevalence of main endoscopic and histological alterations in elderly (> 65 years old) patients.

Methods: In this study, clinical, endoscopic and histological features of patients referred for upper endoscopy in clinical practice were retrieved. Both univariate and multivariate analyses were executed. Comparisons with previous data were performed.

Results: A total of 1336 underwent upper endoscopy in the 28 participating centres. At endoscopy, at least one macroscopic lesion was present in overall 420 (31.4%) patients. Erosive gastritis (13.3%) and erosive oesophagitis (9.8%) were the most prevalent lesions, whilst Barrett's oesophagus, gastric ulcer, duodenal ulcer and erosive duodenitis were observed in 1.8%, 2%, 1.4% and 3.1% patients, respectively. Nine (0.6%) cases of oesophageal, 25 (1.8%) gastric and 2 (0.1%) duodenal neoplasia were detected. At histology, Helicobacter pylori infection was diagnosed in 99 (15.9%) patients, and extensive precancerous lesions on gastric mucosa were detected in 80 (14.5%) patients. Endoscopic lesions were more frequent in males, at first endoscopy and in those with alarm symptoms and lower during PPI therapy. At multivariate analysis, PPI therapy significantly reduced the probability of finding endoscopic lesions (OR: 0.68, 95% CI: 0.46-0.99; P = 0.04), whilst neoplastic lesions were associated with presence of alarm symptoms (OR: 1.5, 95% CI: 1.1-2.1; P = 0.005).

Conclusions: We found that the frequency of erosive and neoplastic lesions remained high in elderly patients, whilst the prevalence of both H. pylori infection and peptic ulcer was decreased.

Background: Radio frequency catheter ablation (RFCA), a treatment for arrhythmia, requires a long fluoroscopy time that increases the radiation exposure dose to the physician, particularly to the lens of the eye. It is recommended that a lens-specific dosimeter such as DOSIRIS® is used to measure the dose to the lens.

Aims: In this study, we investigated whether conventional glass badges can be used as an alternative to lens dosimeters.

Methods: The doses to the lenses of two physicians (physician A, main operator; physician B, assistant; physician B was further away from the patient than physician A) were measured for 126 RFCA procedures performed over a 6-month period (fluoroscopy rate of 3.0 p/s with use of a ceiling-hanging shield).

Results: The cumulative value measured by a lens dosimeter attached to the inside of Pb glasses (0.07-mm dose equivalent) next to the left eye was 4.7 mSv for physician A, and 0.8 mSv for physician B. The reading on the glass badge worn on the left side of the neck was 4.7 mSv for physician A and 1.3 mSv for physician B. Lens dosimeter and glass badge values showed a good correlation for the left eye and left neck (r = 0.86, p < 0.01).

Conclusions: We show that glass badges may be a viable alternative to lens-equivalent dosimetry when using low-pulse fluoroscopy and a ceiling-hanging shield.

Background: Osteoarthritis is a chronic degenerative disorder with rising prevalence. Early detection of structural damage is difficult. Consequently, there is a pressing demand for reliable biomarkers that enable an earlier diagnosis of osteoarthritis. The aim is to investigate the level of serum fibulin-3 in patients with primary knee osteoarthritis and its correlation with disease severity.

Subjects and methods: A case-control study was conducted at the Baqubah Teaching Hospital from November 2023 to January 2024. One hundred twenty persons participated in this study (eighty females with the diagnosis of knee osteoarthritis in its early and late stages, and forty age-matched, apparently healthy control. Serum fibulin-3, ESR, CRP, and calcium levels were measured for all participants. Ethical approval was obtained. SPSS was used for data analysis.

Results: Patients with osteoarthritis had considerably higher serum levels of fibulin-3. In patients with late-stage knee osteoarthritis, this rise was greater than in earlier stages. Serum fibulin and ESR are positively correlated. Fibulin's area under the curve is 0.830 for diagnosis and 0.709 for differentiating between osteoarthritis's early and late stages.

Conclusion: Serum levels of fibulin-3 can act as diagnostic markers for OA and may be useful in determining the severity of knee osteoarthritis.

Background: Bowel dysfunction can significantly impair quality of life. Adequate fibre intake is associated with good bowel health but intakes have been reported to be low in Ireland.

Aim: This study aimed to gather data on fibre intake and bowel habits in a cohort of adults at a university campus in Dublin, Ireland.

Methods: An online questionnaire was developed by adapting validated tools to assess habitual fibre intake and bowel function. The questionnaire was circulated through mailing lists and advertised via QR codes on campus in February/March 2023. Data was analysed using SPSS, p < 0.05 was considered statistically significant.

Results: In total, 275 valid responses were received. Low fibre intakes (< 19 g/day) were found in 50.5% of participants. A significantly higher proportion of males had low fibre intake compared to females (62.2% vs 44.8%, p = 0.039). Nearly a third (30.2%) of respondents experienced mild symptoms of bowel dysfunction, and 13.1% experienced moderate to severe symptoms. An inverse relationship was observed between fibre intake (g/day) and bowel dysfunction (p = 0.033).

Conclusions: In this cohort, low fibre intakes and some degree of bowel dysfunction were prevalent. Public health campaigns to increase fibre intake could prove to be a cost-effective way to improve bowel function and health amongst adults in Ireland.

Background: Rectal cancer is one of the most common cancers worldwide that imposes high costs on patients and the healthcare system while also having a significant impact on the patient's quality of life (QoL).

Aim: We aimed to assess the QoL of rectal cancer patients undergoing lower anterior resection (LAR) and evaluate potential confounding factors.

Methods: In this cross-sectional study, we included patients undergoing neo-adjuvant chemotherapy followed by LAR, diverting ileostomy, and adjuvant chemotherapy. Six months after stoma reversal, QoL was assessed using a cancer-specific core questionnaire EORTC QLQ-C30 and also a colorectal cancer module EORTC QLQ-CR29. Linear and quantile regression models were used to examine associations of QoL and patients' demographical and clinical features.

Results: The study population comprised 210 patients with an average age of 61.9 ± 11.0 (range: 37-85) and 112 (53.3%) male patients. The higher tumor stage increases the QoL of patients by reducing diarrhea, loss of appetite, defecation problems, and stool frequency. Based on the linear regression analysis, a farther distance of the anastomosis from the anal verge (AV) was correlated with lower symptom scores and higher QoL. Also, at the 75th percentile cut-off of the QLQ-CR29 scores, a higher N stage of the tumor was correlated with higher QoL based on functional subscale (coefficient = 3.032, P = 0.016).

Conclusions: QoL of patients after LAR for rectal cancer is significantly associated with the distance of the anastomosis site from the AV.

Background: Double diabetes is a term used to describe people with type 1 diabetes who are overweight, show signs of insulin resistance, or have a family history of type 2 diabetes. Asprosin is a novel glucogenic adipokine; Asprosin regulates appetite and glucose metabolism. The study aimed to investigate the level of asprosin in people with double diabetes with and without hypothyroidism and its association with markers of insulin resistance.

Subjects and methods: This case-control study was conducted in Iraq between March 2022 and January 2023. One hundred sixty participants were enrolled; the selected participants were classified into three age and sex-matched groups. The first group consisted of eighty healthy controls served as the control group. Of eighty participants with newly discovered DD, half (40) have DD alone, and 40 have both DD and hypothyroidism. Serum asprosin, insulin, thyroid, lipid profile, glucose, and glycated hemoglobin were measured. The estimated glucose disposal rate, triglyceride-glucose index, and HOMA-IR were calculated.

Results: Participants with double diabetes had significantly (p ≤ 0.001) greater circulation asprosin levels than subjects in the control group. Comparatively, to double diabetes participants without hypothyroidism, asprosin levels were also higher in double diabetes subjects with hypothyroidism (p ≤ 0.001), and the insulin resistance markers increased in a stepwise way across the asprosin quartiles (p ≤ 0.001). Asprosin significantly correlated with insulin resistance markers, eGDR, plasma glucose, HbA1C, triglycerides, HDL-C, and LDL-C.

Conclusion: Elevated asprosin levels might be a potential biomarker for the alteration in glucose metabolism, insulin resistance, and double diabetes. It may be the missing link between metabolic and endocrine disorders.

Objective: Metformin reduces incidences of miscarriage and preterm delivery in polycystic ovary syndrome (PCOS) women, but its impact on gestational diabetes mellitus (GDM) is conflicting. Hence, this study set up selection criteria to include previously infertile women with PCOS but without pre-existing DM who became pregnant, aiming to minimize confounders and investigate the influence of metformin on GDM, miscarriage, and preterm delivery.

Methods: This study included 195 previously infertile women with PCOS who became pregnant. They were divided into metformin (receiving metformin during pregnancy) and control (not receiving metformin) groups without intervention.

Results: Metformin group tended to have a lower incidence of GDM versus control group (13.3% versus 23.3%, P = 0.070). A logistic regression model adjusted for all baseline characteristics (demographics, infertile duration, and diabetes mellitus-related features) showed that metformin was associated with a decreased probability of GDM (odds ratio (OR): 0.426, P = 0.037). Metformin group showed a similar incidence of miscarriage (6.7% versus 11.1%, P = 0.273), but decreased incidences of preterm delivery (not statistically significant) (6.7% versus 13.3%, P = 0.091) and miscarriage or preterm delivery (13.3% versus 24.4%, P = 0.046) versus control group. A logistic regression model adjusted for all the aforementioned features revealed that metformin was related to a lower risk of miscarriage or preterm delivery (OR: 0.417, P = 0.040). Fetal outcomes, including birth weight (P = 0.245) and the incidence of 5 min-Apgar score ≤ 7 (P = 0.702), were similar between groups.

Conclusion: Metformin administration during pregnancy may reduce GDM, miscarriage, and preterm delivery risks without adverse effects on fetal outcomes in previously infertile women with PCOS.

Purpose: Appendectomy is the standard treatment of acute appendicitis. However, recent advancements have introduced medical treatment as a potential alternative. Within this context, it's important to recognize the rare occurrence of appendiceal tumors, often incidentally discovered during histopathological examination following appendectomy. Consequently, there's a concern about the possibility of overlooking appendiceal neoplasms, particularly in cases where conservative treatment for acute appendicitis is considered.

Methods: The files of patients who underwent surgery for acute appendicitis between January 2015 and December 2023 and were diagnosed with neoplasia in their pathology reports were retrospectively registered. Demographic characteristics of the patients, laboratory and imaging features, details of the surgery performed, preoperative and intraoperative suspicion of neoplasm and data from pathology reports were collected and analyzed.

Results: A total of 6446 patients were operated for acute appendicitis. Neoplasia was detected in the histopathological examination of 93 patients (1.44%). Acute appendicitis was diagnosed in 51.6% of the patients by computed tomography. Neoplasm suspicion was present in 9.7% of patients in preoperative imaging methods and in 6.5% of patients intraoperatively. Only appendectomy was performed in 94.5% of patients. The most common appendiceal neoplasm is neuroendocrine tumors (40.9%), followed by appendiceal mucinous neoplasm (29%), sessile serrated adenoma (15%), and adenocarcinoma (6.5%).

Conclusion: Although appendiceal neoplasms are relatively rare in proportion, they represent a significant numerical value due to the density of cases. Therefore, this information should be taken into consideration when evaluating treatment options for acute appendicitis.

Aim of the study: To compare clinical findings with MRI findings and evaluate the role of physical examination in the diagnosis, localization of the level, site, size, and type of lumbosacral disc herniation.

Materials and methods: A prospective study of 104 patients with low back pain and/or sciatica was conducted et al.-Kindy Teaching Hospital between January to December 2022. All Participants were evaluated via history, clinical examination, and MRI. One hundred patients had a disc herniation in the lumbosacral region, which was confirmed by MRI assessment after clinical presentation and physical examination. The data were collected and analyzed by the chi-square test.

Results: Most of the patients (84%) experienced pain in the lower back that radiated to the lower limb or limbs, and nearly half of the patients experienced paresthesia (48%). Sixty-six percent of the patients had a scoliotic list; limitation of lumbar spine movements was common in 96%, and a decrease in the straight leg raising test (SLR) was detected in 98%. Cross SLR "Well test" was positive in 64% of patients. The femoral nerve stretch test was positive in 40% of patients. Sixty-four percent were presented with neurological deficits, 42% with affected L5 nerve roots, 22% with affected S1 nerve roots, and no patients with L4 affected. Twenty-two percent showed a positive SLR test with an angle between 41 and 70°.

Conclusion: Proper correlation between clinical and MRI will help determine the lesion's level, horizontal location, herniation type, and herniated disc size in the lumbosacral region and achieve a more accurate diagnosis.

Background: Pulmonary embolism requires careful differential diagnosis as it is associated with a wide range of symptoms that may suggest different diseases such as chest pain, shortness of breath and syncope. Since the disease can be fatal, especially in cases where right ventricular failure and hemodynamic instability develop, prognostic markers are great importance in terms of monitoring the patient during the treatment process.

Aim: We aimed in our study to compare the relationship between the ratio of D-dimer and High Sensitive Troponin T (HsTnT) values ​​with short-term mortality and to compare this relationship with Pulmonary Embolism Severity Index (PESI) scoring.

Method: Our study was conducted with patients who applied to the emergency department of our hospital between 01/01/2022 and 01/01/2023 and were definitively diagnosed with Pulmonary thromboembolism after their evaluation.

Findings: The success of D-dimer/HsTroponin, D-dimer/CK-MB and troponin/D-dimer indices calculated from the laboratory test results of the cases in predicting mortality was examined, and a comparison was made with the success of the PESI score in predicting mortality. Among these indices, D-dimer/CK-MB was found to be the most successful index in predicting 7-day mortality (AUC: 0.734; 95% CI: 0.653-0.815; p < 0.001). Additionally, the D-dimer/HsTroponin ratio was found to be statistically significant as a successful index in predicting 7-day mortality (AUC: 0.697; 95% CI: 0.621-0.774; p < 0.001).

Conclusion: FD-dimer/HsTroponin ratio, which is a powerful, fast, low-cost, easy and simple test, can be used especially in emergency services instead of the PESI score as a mortality marker in pulmonary embolism, which has a high mortality rate.