Irish medical journal最新文献

Aim: This retrospective study aimed to evaluate changes in body mass index (BMI) and haemoglobin A1c (HbA1c) levels among children and adolescents with type 1 diabetes mellitus (T1DM) transitioning from multiple daily injections (MDI) to insulin pump therapy over one year.

Methods: Data were collected from chart reviews of 33 T1DM patients. BMI z-scores were calculated using WHO charts, and HbA1c levels were recorded at pump initiation, 6 months, and 1 year thereafter.

Results: At pump initiation, mean HbA1c was 7.81% (95% CI: 7.49-8.12), improving to 7.41% (95% CI: 7.13-7.68) at 6 months (p=0.0068) and 7.42% (95% CI: 7.12-7.72) at 1 year (p=0.009). The initial BMI z-score was 0.65 (95% CI: 0.24-1.06), with a trend toward weight gain at 6 months (0.76, 95% CI: 0.45-1.26, p=0.097) but no significant change at 12 months (0.73, 95% CI: 0.34-1.12, p=0.377).

Conclusion: Insulin pump therapy significantly improved glycaemic control within 6 months and maintained it at 1 year, though BMI z-scores showed no significant change.

Presentation: A 77-year-old man with type 2 diabetes, presented to the Emergency Department with an acute onset of confusion for 24 hours. He was on Metformin but due to nausea, this was switched to Linagliptan two days prior to his presentation. All vital signs were stable including blood sugar. Clinical examination was normal.

Diagnosis: Full blood count, renal, liver and C-reactive protein were all normal. CT brain revealed age-related involutional changes, while Chest X-ray and MRI brain was normal. His 4AT score was ten and together with his acute change from baseline, a diagnosis of delirium was made.

Treatment: Linagliptan was discontinued and Empagliflozin was commenced with full recovery of the delirium gradually.

Discussion: Linagliptan and delirium may be due to changes to the gut microbiome, disturbing the gut-brain axis increasing inflammation1. Linagliptan associated delirium has not been previously reported, although with effects of delayed gastric emptying and reduced gut motility, more studies are needed.

Aim: Women with symptoms suggestive of cervical cancer require prompt specialist gynaecological review with access to diagnostic testing. A Cervical One-Stop Assessment Clinic (COSAC) was established at Cork University Maternity Hospital in 2021. This retrospective review evaluates the first three years of this service.

Methods: Anonymised data from all attendees of the between September 2021 and September 2024 were collected, including referral indication, cervical cancer risk factors, examination findings, investigations, and onward referrals. Descriptive analysis was performed using Microsoft Excel.

Results: During the review period, 1714 COSAC appointments were offered based on referral details and 1522 of these women attended (88.9%). The mean age was 39 years. Most referrals were for abnormal cervical appearance (812, 53.5%) or post-coital bleeding (408, 26.8%). The majority of attendees were up to date with HPV screening and had tested negative (1238, 90.7%). Most attendees had a normal examination and did not require biopsy (1155, 76.2%). Of the 185 (12.2%) biopsied, most results were benign, including metaplasia (133, 71.9%) and cervicitis (42, 22.7%). Pre-cancer cervical intraepithelial neoplasia was identified in three women (3/1522), two with low grade changes. Advanced squamous cell carcinoma was confirmed in two women. Both were over 35, multiparous and overdue for screening with no prior colposcopy.

Discussion: COSAC clinics provide specialist care for symptomatic women and help maintain colposcopy capacity for those with an abnormal screening result. They are low resource, high impact services which could be considered a useful adjunct for implementation in gynaecology units nationally and internationally.

Presentation: We report a case of a 20-month-old who presented with a 3-week history of non-bilious vomiting and metabolic alkalosis.

Diagnosis: Serology demonstrated a hypokalaemic, hypochloraemic metabolic alkalosis. Abdominal ultrasonography and barium studies confirmed the diagnosis of gastric outlet obstruction.

Treatment: Oesophago-gastro-duodenoscopy identified a hypertrophied closed pylorus with evidence of pyloric muscular hypertrophy. A laparoscopic pyloroplasty was performed.

Discussion: Hypertrophic pyloric stenosis is the most common cause of gastric outlet obstruction in children. It typically occurs between 2 and 12 weeks of age and is very rarely found in older children. Primary acquired gastric outlet obstruction in late infancy and childhood is a rare cause of gastric outlet obstruction. Few cases have been reported in the literature outside of northern India. We present this case to highlight the need to consider this diagnosis in the older child.

Aim: Radiofrequency pulmonary vein isolation is an established treatment for atrial fibrillation. Patients are administered either conscious sedation or general anaesthesia. The purpose of this study was to compare patient experiences of conscious sedation versus general anaesthesia during pulmonary vein isolation.

Methods: A retrospective, observational, single-centre, single-operator study was performed, comparing patient experiences of pulmonary vein isolation performed under general anaesthesia versus conscious sedation. A Likert scale questionnaire was used to compare satisfaction with the different modes of anaesthesia, with score of 1 denoted for very dissatisfied and score of 5 for very satisfied.

Results: 41 patients were included - 20 (48.8%) in conscious sedation group, and 21 (51.2%) in general anaesthesia group. Groups were well-matched as regards age (mean 56.3 +/-13.7yrs), gender (71.4% male), percentage with paroxysmal atrial fibrillation (76.2%), and percentage re-do cases (28.6%). Patients in the general anaesthesia group experienced lower levels of pain/discomfort (mean score 2.90 +/- 1.77 vs 1.33+/-0.80) (p<0.001) and were more likely to recommend the mode of anaesthesia (mean score 4.90 +/- 0.44 vs. 3.40 +/- 1.70) (p<0.001), compared with those in conscious sedation group. There was no significant difference in anxiety/depression post-procedure (p= 0.057), satisfaction with recovery time post-procedure (p=0.175), likelihood to recommend the procedure (p= 0.103), and overall satisfaction with the ablation experience (p=0.089).

Discussion: Patients who had general anaesthesia for radiofrequency pulmonary vein isolation experienced less peri-procedural pain than patients who had conscious sedation and were more likely to recommend general anaesthesia as a mode of anaesthesia.

Aim: Lack of transport has been shown to be a key barrier to accessing healthcare, with poorer associated health outcomes in those experiencing transport poverty. Our health survey aimed to assess the transportation needs of a population attending a geriatric ambulatory care unit and the role of transport as a barrier to healthcare attainment.

Methods: Data collection was via survey; the survey used was adapted from the Irish Translational Study on Aging (TILDA) and the questionnaire devised by Locatelli, Sharp, Syed, Bhansari, and Gerber in their research on urban transport barriers to healthcare. Results were compiled and analysed using descriptive statistics.

Results: In total 52 participants with a mean age of 81 years were included, of which 48 (92%) were accompanied to clinic by a caregiver. The most common mode of transport was being driven by an accompanying driver (43 [83%]), with the majority of these (43 [94%]) being driven by family members. Public transport was deemed unfeasible/highly unfeasible for attending clinic by 38 (73%) respondents. Only ten of the respondents were still currently driving (19%). Common indications for attending clinic included Alzheimer's dementia, Parkinson's disease, and orthostatic hypotension.

Discussion: Patients were largely reliant on family for transport to ambulatory care appointments, and public transport was seen as inaccessible for the majority; overall transport was cited as a cause of stress in attending clinic. Facilitating transport that maintains patient autonomy and dignity is an area of public interest requiring further study.

Aims: To determine the incidence of non-appendicitis pathology of the appendix in an Irish context.

Methods: A single institute review of 4,428 consecutive appendiceal resections was conducted independently by two researchers. Clinical, radiological, intra-operative, and histological reports were reviewed.

Results: A total of four-thousand four-hundred and twenty-eight (4,428) appendicectomies including right hemicolectomies, subtotal colectomies, panproctocolectomies, ileocolic resections, and en-bloc resections were performed during the study period. Incidental malignancies occur in less than one per cent (<1%) of appendiceal resections. The mean age of incidental malignancies was 54.75 (range 11 - 79 years), and the mean age for non-incidental appendiceal malignancies was 62 (range 42 - 85 years).

Conclusion: A wide array of neoplastic and inflammatory conditions' incidence in the Irish context is described for the first time.