Showing papers by "Connolly Hospital Blanchardstown published in 2012"

Incidence, Event Rates, and Early Outcome of Stroke in Dublin, Ireland The North Dublin Population Stroke Study

Abstract: Background and Purpose— The World Health Organization has emphasized the importance of international population-based data for unbiased surveillance of stroke incidence and outcome. To date, few such studies have been conducted using recommended gold-standard ascertainment methods. We conducted a large, population-based stroke study in Dublin, Ireland. Methods— Using gold-standard ascertainment methods, individuals with stroke and transient ischemic attack occurring over a 12-month period (December 1, 2005–November 30, 2006) in North Dublin were identified. Disability was assessed using the modified Rankin score and stroke severity ( Results— Seven hundred one patients with new stroke or transient ischemic attack were ascertained (485 first-ever stroke patients, 83 recurrent stroke patients, 133 first-ever transient ischemic attack patients). Crude frequency rates (all rates per 1000 person-years) were: 1.65 (95% CI, 1.5–1.79; first-ever stroke), 0.28 (95% CI, 0.22–0.35; recurrent stroke), and 0.45 (95% CI, 0.37–0.53; first-ever transient ischemic attack). Age-adjusted stroke rates were higher than those in 9 other recent population-based samples from high-income countries. High rates of subtype-specific risk factors were observed (atrial fibrillation, 31.3% and smoking, 29.1% in ischemic stroke; warfarin use, 21.2% in primary intracerebral hemorrhage; smoking, 53.9% in subarachnoid hemorrhage; P Conclusions— Using gold-standard methods for case ascertainment, we found high incidence rates of stroke in Dublin compared with those in similar high-income countries; this is likely explained in part by high rates of subtype-specific risk factors.

Are we prepared for a growing population? Morbid obesity and its implications in Irish emergency departments.

Abstract: Two percent of the Irish population is morbidly obese with this figure expected to rise significantly. This survey aimed to establish the present logistical capacity of Irish emergency departments (EDs) to adequately cater for the bariatric patients. A telephone survey was carried out of 37 health service executive EDs over a 5-day period in October 2008. Questions were posed to the departmental lead nurse regarding facilities (Supplemental digital content 1). No ED had adequate facilities. Two of 37 units questioned had on-site hoists designed to lift patients of more than 170 kg. Four departments had rapid access to mattresses within the hospital and three of these four had access to beds and trolleys for weighing patients. Two percent of the Irish population is morbidly obese with this figure expected to rise significantly to more than 150 kg. One department had access to commodes, chairs, wheelchairs and trolleys from inpatient services. All departments had extra-wide blood pressure cuffs and 12 had a difficult airways trolley. Necessary infrastructure and equipment for bariatric patients is deficient in the majority of Irish EDs.

Non-operative management of acute cholecystitis in the elderly (Br J Surg 2012; 99: 1254-1261).

Abstract: The Editors welcome topical correspondence from readers relating to articles published in the Journal. Responses should be sent electronically via the BJS website (www.bjs.co.uk). All letters will be reviewed and, if approved, appear on the website. A selection of these will be edited and published in the Journal. Letters must be no more than 250 words in length. Copyright © 2012 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.

Serum vitamin D and its association with lung function and inflammation in subjects with respiratory symptoms

Abstract: The prevalence and severity of asthma has been linked to hypovitaminosis D. Hypovitaminosis D is common in countries at high latitudes, such as Ireland (53 N). The aim of this study was to measure serum vitamin D levels in consecutive patients (both asthmatic and non-asthmatic) with respiratory symptoms. Body mass index (BMI) was calculated following standard protocols. Blood samples were obtained and serum was tested for total immunoglobulin E (IgE), high sensitive C-reactive protein (hsCRP), 25-hydroxyvitamin D (25(OH)D) levels and eosinophil cationic protein (ECP). Serum total IgE and hsCRP were measured on the Abbott Architect ci8200 analyser. Total 25(OH)D was analyzed using the DiaSorin LIAISON. ECP was tested by ImmunoCAP Technology using fluorescent enzyme immunoassays on the IDM Phadia 250. Additionally, to evaluate the severity of airway disease; spirometry was performed to ascertain the Forced Expiratory Volume (FEV1) – a measure of lung function. All statistical analyses were performed using SigmaStat 3.0(SPSS) software. We examined 42 Caucasian adults (mean age 50.9 17.2; mean BMI 27.4 kg/m 5.9) with respiratory symptoms of more than 4 weeks (FEV1, 89 24% predicted. The average serum vitamin D level was 38.3 21.3 nmol/L. Vitamin D levels were positively associated with FEV1 (r = 0.33, p = 0.018). Moreover, all patients with airway obstruction (FEV1 less than 80% predicted) had vitamin D insufficiency (<80 nmol/L) and 50% were vitamin D deficient (<25 nmol/L). Markers of inflammation (ECP, hsCRP) and allergic immunity (IgE) were elevated in the vitamin D deficient state compared to sufficiency, but these differences were non-significant. All patients with IgE>500 IU/mL had deficient levels of 25(OH). We conclude that vitamin D deficiency is common in Irish patients with airway disease. Using the recently revised Institute of Medicine’s criterion for vitamin D deficiency of total 25(OH)D (<50 nmol/L), approximately 80% of the patients in the study had evidence of vitamin D deficiency. Vitamin D has emerged as an important immunomodulator with diverse benefits in respiratory disorders, for example antimicrobial peptide production. In addition, corticosteroid therapy is commonly prescribed for respiratory disorders, including asthma and chronic bronchitis, thus careful consideration should be made regarding bone health in patients with symptomatic airway obstruction. Our findings add to the growing evidence suggesting vitamin D may play an important role in airway disease.