Irish medical journal最新文献

Presentation: We describe a 16-year-old girl presenting with four days of nausea, vomiting, malaise, and macular rash affecting the vulva and perineum during menstruation, following tampon use. She was febrile, hypotensive, tachycardic, and confused, with multi-organ dysfunction.

Diagnosis: Laboratory findings revealed leukocytosis, thrombocytopenia, renal impairment, markedly elevated CRP, and procalcitonin. Perineal swabs grew methicillin-sensitive Staphylococcus aureus resistant to clindamycin. Blood cultures were negative. The isolate was later confirmed to carry the tst gene encoding toxic shock syndrome toxin-1 (TSST-1).

Treatment: Broad-spectrum antibiotics were started, later rationalised to IV flucloxacillin after isolation of methicillin-susceptible S. aureus. The patient required critical care admission for monitoring and vasopressors but recovered quickly and was discharged well. Skin desquamation across neck, vulva, and perineum was noted during recovery.

Discussion: This case illustrates menstrual toxic shock syndrome due to TSST-1-producing S. aureus, occurring without evidence of prolonged tampon retention. Early recognition and management with microbiological testing are essential. Public education on safe tampon use remains vital to prevent this rare but life-threatening condition.

Aim: To estimate the direct economic burden of surgical site infections (SSIs) following hip fracture surgery within the Irish healthcare system.

Methods: A micro-costing analysis using clinical audit data was undertaken to estimate the direct in-patient costs of treating SSIs after hip fracture surgery. Costs were calculated for the acute episode of care and stratified by demographic and clinical characteristics, allowing for a more detailed assessment of potential disparities in healthcare outcomes and associated expenditure across different patient groups.

Results: Over 12 months, 16 (0.4%) hip fracture patients developed an SSI. The total cost was €712,898, with a mean of €44,556 per patient. Differences by subgroup were noted: males €35,418, females €50,039, aged ≥80 €49,712 and <80 years €33,213.

Discussion: These findings indicate that disease-specific surveillance programmes can generate valuable health economic and epidemiological evidence. As the older population continues to grow, the incidence of SSIs and their associated costs are likely to rise. Ongoing analysis and systematic monitoring through clinical audit are crucial for refining cost estimates, informing evidence-based policies, and optimising resource allocation to enhance the quality of care in the acute hospital setting.

Presentation: A 50-year-old obese male with non-insulin dependent diabetes mellitus (NIDDM) taking Semaglutide, a glucagon-like peptide-1 receptor agonist (GLP-1RA) presented with sudden, painless vision-loss from his right eye.

Diagnosis: Right eye visual acuity was 6/24. There was Frisen grade IV optic nerve head (ONH) oedema. This was confirmed at imaging with ocular coherence tomography (OCT). The patient was diagnosed with non-arteritic anterior ischaemic optic neuropathy.

Treatment: Semaglutide was ceased.

Discussion: GLP-1RAs such as Semaglutide are being increasingly recognised as a potential risk factor for NAION. A case such as this has not yet been reported in Ireland.

Aim: Helicopter Emergency Medical Services (HEMS) provide rapid aeromedical transport for critically ill or injured patients. Tallaght University Hospital (TUH) has accepted HEMS patients since 2012. This study aimed to characterise the demographics, clinical management and outcomes of patients presenting to TUH Emergency Department (ED) via HEMS.

Methods: A retrospective chart review of all adult HEMS presentations to TUH ED between January 2016 and December 2021 was conducted.

Results: A total of 192 HEMS patients presented to TUH ED from 16 counties. The mean age was 46.8 years, and 151 (78.6%) were male. Traumatic injuries in 177 patients accounted for 92% of the HEMS presentations, with road traffic accidents (63/192, 32%) the most common mechanism of injury. 152 patients (81%) required admission to TUH. Fourteen patients (7.2%) required interhospital transfer for specialist care. The average ED stay was 10.66 hours, and the mean hospital length of stay was 10 days, with longer stays observed in patients aged ≥65 years (12 days vs. 9.6 days, p < 0.01).

Discussion: TUH ED is a trauma HEMS receiving hospital for a wide geographical area. HEMS patients are typically high acuity with high admission rates and requirement for surgical interventions.

Aim: To assess the effectiveness of pigmented lesion referral pathways, particularly the National Cancer Control Programme (NCCP) pathway, in reducing waiting times and improving melanoma detection rates.

Methods: We analysed 2 cohort studies encompassing a prospective 3-month analysis (n=362) and a retrospective 6-month analysis (n=43) of melanoma detection at a tertiary dermatology centre in Ireland. Referral source, reason for referral, waiting times, and histopathological outcomes were evaluated via descriptive analysis.

Results: Referrals through the NCCP pathway were associated with shorter waiting times, with 300 (83%) of melanoma patients seen within 12 weeks. Delays in melanoma diagnosis were linked to incidental pickups or incomplete referral information. Outcomes following dermatology review showed that 89 (24.6%) of primary lesions referred required biopsies, however only 11 (3%) were clinically suspicious for melanoma. Histopathological analysis showed a portion of benign lesions or keratinocyte cancers were referred inappropriately through the NCCP pathway.

Conclusion: Improving diagnostic confidence in primary care through education, standardized referral criteria, and tele-dermatology tools may help optimize referral quality and reduce waiting times for patients with suspected melanomas.