Showing papers in "Irish Journal of Medical Science in 2015"

Ceramic and non-ceramic hydroxyapatite as a bone graft material: a brief review

Abstract: Treatment of dental, craniofacial and orthopedic defects with bone graft substitutes has shown promising result achieving almost complete bone regeneration depending on product resorption similar to human bone’s physicochemical and crystallographic characteristics. Among these, non-ceramic and ceramic hydroxyapatite being the main inorganic salt of bone is the most studied calcium phosphate material in clinical practices ever since 1970s and non-ceramic since 1985. Its “chemical similarity” with the mineralized phase of biologic bone makes it unique. Hydroxyapatite as an excellent carrier of osteoinductive growth factors and osteogenic cell populations is also useful as drug delivery vehicle regardless of its density. Porous ceramic and non-ceramic hydroxyapatite is osteoconductive, biocompatible and very inert. The need for bone graft material keeps on increasing with increased age of the population and the increased conditions of trauma. Recent advances in genetic engineering and doping techniques have made it possible to use non-ceramic hydroxyapatite in larger non-ceramic crystals and cluster forms as a successful bone graft substitute to treat various types of bone defects. In this paper we have mentioned some recently studied properties of hydroxyapatite and its various uses through a brief review of the literatures available to date.

Methodologies to assess paediatric adiposity.

Abstract: Childhood obesity is associated with increased risk of adult obesity, cardiovascular disease, diabetes and cancer. Appropriate techniques for assessment of childhood adiposity are required to identify children at risk. The aim of this review was to examine core clinical measurements and more technical tools to assess paediatric adiposity. The online databases PubMed, CINALH and EMBASE were searched and the abstracts identified were reviewed to determine appropriate studies. Their reference lists were also searched to identify further eligible studies. Publications were included if they described childhood measurement techniques or involved validation. There are many body composition assessment tools available, none of which are direct. Each technique has limitations and a combination of methods may be used. The main clinical techniques are weight, height, body mass index (BMI) and circumferences which provide sufficient information to enable classification of overweight or obesity when growth centile charts and ratios are employed. Further investigation depends on resources available and examiner skill. Skinfold thicknesses are cost-effective but require technical training and only measure subcutaneous fat. Dual energy X-ray absorptiometry (DEXA), air displacement plethysmography (ADP), magnetic resonance imaging (MRI) and computed tomography (CT) are more costly and intensive, requiring the child to remain still for longer periods. DEXA and ADP are capable of accurately measuring adiposity but are unable to distinguish between fat depots. MRI and CT can distinguish intra-abdominal from subcutaneous adiposity and are considered gold standards, but CT is unsuitable for adiposity measurement in children due to high levels of radiation exposure. Ultrasound is a promising technique capable of measuring intra-abdominal adiposity in children but requires further validation. The core clinical measurements of weight, height, BMI and circumferences are sufficient to enable diagnosis of paediatric overweight and obesity while more technical tools provide further insight.

The 100 most cited publications in cardiac surgery: a bibliometric analysis

Abstract: This study is a citation analysis of the top 100 most cited papers in adult cardiac surgery. Bibliometric analyses are viewed as a proxy marker of a paper’s influence and, therefore, an analysis of the most influential papers published in recent decades. Impact factor ranking as of 2012 was used to decide which journals to include in our searches. The Thompson Reuters Web of Knowledge was used to search for citations of all papers relevant to cardiac surgery within selected journals. Journals in the areas of surgery, cardiothoracic surgery, general medicine, anaesthesia, perfusion and pathology were included. The most frequently cited paper was found to be that of Nashef et al. (Eur J Cardiothorac Surg 16(1):9–13, 1999) introducing the EuroSCORE operative risk evaluation system. A number of authors including Alderman, Carpentier and Cox had more than one paper in the top 100. Despite the potential flaws with bibliometric analysis, and its application to cardiac surgery, there is inherent merit in an analysis of this type.

Anatomic study of infrapatellar branch of saphenous nerve in male cadavers

Abstract: Infrapatellar branch of saphenous nerve (IPBSN) is more prone for injuries during various surgical interventions of the knee. The aim of this study was to know the course and branching pattern of the IPBSN and describe its anatomical variations. To achieve these objectives, we dissected 32 male cadaveric knees. Origin of the nerve was traced in relation with the sartorius muscle; course and terminal branches of the nerve were noted. In majority of the cases (68.7 %), the nerve was found to emerge near the anterior border of sartorius muscle, distance between the medial margin of the patella and the nerve trunk was ranging between 4 and 7 mm. In majority of the cases (65.6 %), division of the nerve trunk was located between the apex of patella and tibial tuberosity. In majority of the cases, single branch was observed (40.6 %). By enriching the knowledge of these variable anatomical position of the IPBSN, surgeon can try to minimize the risk of nerve damage by avoiding the high risk zones while performing medial knee incision, blind puncture or an arthrotomy thus avoiding the unwanted complications.

Twitter expands the reach and engagement of a national scientific meeting: the Irish Society of Urology

Abstract: Social media is the interaction among people in which they create, share or exchange information and ideas in virtual communities and web-based networks. This year, the Irish Society of Urology (ISU) expanded its involvement in social media with a preregistered Twitter hashtag (#ISU14) for the annual meeting. The aim of this study was to highlight the use of Twitter at an annual national meeting held in 2014. The Symplur healthcare analytics website was used to prospectively examine traffic related to the 2014 ISU Annual Meeting. This feature was used to generate statistics for the number of impressions, unique tweets (excluding retweets) and distinct contributors who used the indexing hashtag #ISU14. Individual tweets were assessed using the conference hashtag on the Twitter website. The total number of attendees at the conference was 119, and 99 individuals participated in Twitter using the conference hashtag (#ISU14). 31 % of attendees participated in tweeting at the conference. Over the course of the conference, a total of 798 unique tweets were generated, creating over 665,000 impressions in cyberspace. 590 (73.9 %) tweets were generated from attendees at the conference, while 26.1 % of tweets were from virtual followers. 702 (87.9 %) tweets were from urologists and 439 (55 %) tweets were of scientific nature. Tweet activity peaked during the guest lectures on both days. Twitter use at the ISU has been shown to facilitate interaction between delegates and allows users to follow as well as participate from afar.

Trends in socio-economic inequalities in mortality by sex in Ireland from the 1980s to the 2000s.

Abstract: It has been recognised for some time that mortality rates vary across social class groups, with lower rates in the higher social classes. Internationally, but particularly in Ireland, many studies on the topic of inequalities in mortality have been confined to men, partly because the most frequently used socioeconomic classification, that based on occupation, can less easily be applied to women. Where research does exist, studies indicate that health inequalities are greater for men than for women. Given the issues around classification, there remains however, little knowledge of the socio-economic inequalities in female mortality in Ireland. Using annual mortality data from the Irish Central Statistics Office over the period 1984–2008 this paper calculates crude and standardised mortality rates per 100,000 population for men and women in different socio-economic groups (SEG) and examines trends in these over time. This means that for the first time, longitudinal comparisons can be made between men and women across an important period of recent Irish history. There is a significant gradient in mortality rates across SEG for both men and women with the absolute and relative differential between professional and manual occupational groups increasing between the 1980s and 2000s even though the mortality rates were falling over time for all SEG groups for both sexes. The results confirm international findings that women generally have smaller gradients than men across SEG with the ratio of male/female differentials (i.e. the ratio of the male SEG rate ratio to the female SEG rate ratio) decreasing between the 1980s and 2000s from 1.25 to 1.07.

Radiation safety knowledge and practices among Irish orthopaedic trainees

Abstract: Fluoroscopy is frequently used in orthopaedic surgery, particularly in a trauma setting. Exposure of patients and staff to ionising radiation has been studied extensively; however, little work has been done to evaluate current knowledge and practices among orthopaedic trainees. This study aimed to investigate the knowledge and practices of Irish orthopaedic trainees regarding use of ionising radiation. A confidential internet-based survey on workplace radiation safety practices was distributed via email to 40 higher specialist trainees. Questions included related to radiation safety training and regular work practices. A total of 26 trainees completed the questionnaire (65 % response rate). All reported regular exposure to ionising radiation. Compliance with body shields was high (25, 96 %), however, other protective measures such as thyroid shields were less frequently employed. The ‘as low as reasonably achievable principle’ was practised regularly by 14 (54 %). Radiation safety training was variable—while just over half (14) respondents felt adequately trained in radiation safety, 17 (65 %) had attended a radiation protection course. Use of dosimeters was particularly poor, with only 4 (15 %) using them regularly and most citing lack of availability as the main barrier. Although most Irish orthopaedic trainees have some knowledge regarding radiation safety, many do not regularly use all available measures to reduce exposure to ionising radiation. Barriers to use of protective mechanisms include lack of availability and perceived impracticality.

Predicting mortality following hip fracture: an analysis of comorbidities and complications

Abstract: Hip fracture is common in the geriatric population. These patients have multiple comorbidities that complicate treatment and recovery such that poor functional outcomes often result. Since functional outcomes are associated with comorbidities and complications it is important to define the contributing factors. To describe comorbidities common to geriatric hip fracture patients and determine predictability of complications and mortality based on comorbidities. Data in this study were sourced from information prospectively collected for evaluation of a new orthogeriatric service established at a University Teaching Hospital over the period of 1 year. The median age was 82 years (range 54–100) and 73 % were female (N = 206). Common comorbidities included hypertension (51 %), dementia (28 %), osteoporosis (19 %), ischaemic heart disease (IHD) (15 %) and chronic obstructive pulmonary disease (15 %). In predicting 1-year mortality based on comorbidities, the final model included age, IHD, delay to surgery and explained 26 % of the variability in mortality. Predicting 1-year mortality based on complications, the final model included age and respiratory complications and explained 26 % of the variability in mortality. There was a significant association between having respiratory complications and chronic obstructive pulmonary disease (p < 0.001) with 63 % of those with respiratory complications having chronic obstructive pulmonary disease. This study highlights specific patient comorbidities and medical complications that could be used to guide clinical assessment, management and targeted interventions that improve outcomes in this patient group.

Impact of intracameral cefuroxime on the incidence of postoperative endophthalmitis following cataract surgery in Ireland.

Abstract: Postoperative endophthalmitis (PE) is a rare complication of cataract surgery, but carries a significant risk of blindness. The European Society of Cataract and Refractive Surgeons published a landmark study in 2007 that revealed the use of intracameral cefuroxime as prophylaxis against endophthalmitis reduced its incidence by fivefold. Since the publication of these results, the use of intracameral cefuroxime in cataract surgery has become a standard practice in many institutions, including our own. To identify the incidence rate of PE among patients undergoing cataract surgery over the 4-year period following the introduction of prophylactic intracameral cefuroxime for cataract surgery. A retrospective case note review of all cases of postoperative endophthalmitis that occurred between 2007 and 2011 was performed. Our results were compared with an earlier report on PE incidence rates from our institution that was conducted prior to the introduction of intracameral cefuroxime and published in 2001. There were five reported cases of endophthalmitis from 2007 to 2011 from a total of 8,239 cataract procedures, giving an incidence rate of 0.06 %. This compares with an incidence rate of 0.49 % in the earlier study prior to the introduction of intracameral cefuroxime and represents an eightfold reduction in the incidence of PE at our hospital. Of the five cases, three were confirmed on culture and sensitivity (two of which were due to Coagulase negative staphylococci and one due to Pseudomonas aeruginosa). The incidence of postoperative endophthalmitis has reduced by approximately eightfold since the introduction of intracameral cefuroxime following cataract surgery at our hospital in 2007. This study strongly supports the use of intracameral cefuroxime as prophylaxis against endophthalmitis in all cataract surgical cases.

Food and beverage advertising during children’s television programming

Abstract: Increasing prevalence of overweight and obese children in developed countries poses a substantial threat to long-term health. One well-described factor is the amount of time spent watching television, with exposure to food advertising a known influence on food preferences and consumption patterns. Following recent formulation of new rules regarding advertising of food during children’s programming, we sought to examine the advertising content in children-specific television broadcasts on Irish television. Advertisement content analysis for 5 weekdays of children-specific television broadcasting from 0700 to 1700 hours on Irish television was performed. Data were coded and transferred to SPSS for analyses. Food and beverage advertisements were coded based on type of product, nutritional content, intended age group and outcome. 322 advertisements were broadcast during the recording period. 31 % (n = 101) of advertisements related to food or beverage products with 66.3 % (n = 68) of food advertisements being for foods that should be eaten in moderation. The most frequently recorded food advertisement was for fast food products (27.3 %, n = 24), followed by sweets/candy (21.6 %, n = 19) and dairy products (17.0 %, n = 15). The most frequently recorded beverage advertisement was for natural orange juices (46.2 %, n = 6). 54.7 % (n = 176) of advertisements were adult specific with 27.3 % (n = 88) being children specific. All food and beverage advertisements were associated with a positive outcome (n = 322). These results demonstrate that food and beverages depicted in advertisements during children’s programming are predominantly unhealthy foods with high salt and sugar contents. The findings from this study again highlight the ongoing need for new rules regarding food advertising in children’s programming.

Comorbidity, health-related quality of life and self-care in type 2 diabetes: a cross-sectional study in an outpatient population

Abstract: Comorbid conditions may be related (concordant) or unrelated (discordant) to diabetes. Comorbidity in patients with type 2 diabetes (T2DM) is associated with reduced health-related quality of life (HRQoL) and self-care. To examine the impact of comorbidity on HRQoL and self-care in T2DM patients attending an outpatient setting. A cross-sectional questionnaire was sent to 498 patients with T2DM, aged 25–80 years, previously attending (August 2011–July 2012) an outpatient diabetes service in a Dublin hospital. The EuroQoL-5 Dimension (EQ-5D) and a modified summary of diabetes self-care activities scale were used to assess HRQoL and self-care, respectively. Comorbidity was assessed using a simplified version of the self-administered comorbidity Questionnaire. Mann–Whitney and Kruskal–Wallis tests were used to examine the association between EQ-5D index scores or self-care, and the number and type of comorbidities. Multiple linear regression, adjusting for age and sex, was used to examine the association between EQ-5D score, comorbidity score and type. EQ-5D scores decreased with an increasing number of comorbidities and with discordant comorbidity (P = 0.0001). Comorbidity type was associated with physical activity. The highest level of physical activity was reported in respondents with no comorbidity (median 4.5 IQR 3-6), while the lowest was in patients with both concordant and discordant comorbidity (median 2.5 IQR 0–5). Health professionals should be aware of the fall in HRQoL associated with comorbidity. This should be taken into account in the management of patients. Patients with discordant comorbidity should be advised and supported to maintain levels of physical activity.

Education, learning and assessment: current trends and best practice for medical educators.

Abstract: IntroductionMethods of teaching and assessment in medical schools have transformed over the recent past. Accreditation of medical schools through national licensing bodies and removal of bias at examinations is the norm. This review is intended to inform senior doctors who are peripherally involved in training at speciality or general professional level.Materials and methodsFrom the summative assessment of learning, the uses of assessment for learning and formative assessment have transformed the process of education. Student feedback has moved centre stage. The criteria used to rate questions and abilities are made explicit and there is accountability for student and examiner performances. Standard setting for medical professional examinations is formalised through norm or criteria referencing. Objective methods to determine the pass/fail border including Angoff, Ebel, Nedelsky, Bookmark, Hofstee, borderline group and contrast by group are described. There is some evidence for grade inflation over time at universities. Blueprinting by setting test questions to learning objectives is now standard. The Objective Structured Clinical Examination uses a wide variety of case tasks at different stations. Miller’s pyramid is the road map for professional competence indication where ‘doing’ becomes the benchmark standard. Item response theory and computer adaptive testing are available through the Concerto testing platform which is an open resource.ConclusionExamining the performance of examiners as well as that of students is a necessary part of good examination practice. The World Federation for Medical Education with the World Health Organisation has developed nine standards with two categories of basic and quality for the accreditation of medical education.

Developmental dysplasia of the hip: incidence and treatment outcomes in the Southeast of Ireland

Abstract: The incidence of developmental dysplasia of the hip (DDH) in the Republic of Ireland is unknown. It has been shown by previous Irish studies that effective screening methods for DDH are not widely practiced. The effect of this on treatment outcomes is unknown. The aim of this study was to estimate the incidence and treatment outcomes of DDH in the Southeast of Ireland. In a retrospective study, all cases of DDH in children born in 2009 were identified using the outpatient clinic database. We defined an early and late diagnosis as those treated before and after three months, respectively. We defined the operative incidence as those who required open surgery. Fifty-six cases of DDH were diagnosed giving an incidence of 6.73 per 1,000 live births. 58.9 % (n = 33) were referred to the clinic and began treatment early, while 41.1 % (n = 23) presented late. The incidence of operative procedures was 1.08 per 1,000 live births. The incidence of those requiring surgery was higher in the late diagnosis group. Our overall incidence rate of 6.73 per 1,000 live births in 2009 is similar to other international studies. Worryingly our incidence of 2.77 per 1,000 having late diagnosis and 1.08 per 1,000 live births requiring open surgery was higher. Despite screening with clinical examination, the percentage of late diagnosis remains high. There is a need for the development of a national screening policy with greater use of ultrasound screening to improve current practices.

Percutaneous balloon compression (PBC) of trigeminal ganglion for recurrent trigeminal neuralgia after microvascular decompression (MVD)

Abstract: Although microvascular decompression (MVD) has become the best surgical treatment for trigeminal neuralgia, it does not achieve 100 % cure rate. Re-exploration of the posterior fossa may carry increased risk over first-time MVD and is not always successful, so other treatments are needed. In this study, we evaluate the effectiveness of the patients with recurrent trigeminal neuralgia after MVD treated with percutaneous balloon compression (PBC). The clinical data of 52 recurrent trigeminal neuralgia patients after MVD who underwent PBC between November 2007 and March 2012 were retrospectively reviewed and analyzed. After the PBC, 50 patients (96.2 %) experienced immediate pain relief; 1 patient had occasional pain, and did not require medication; and 1 patient had no pain relief. The total efficiency was 98.1 %. With a mean length of follow-up of 37.6 months, ranging from 12 to 64 months after surgery, 43 (82.7 %) patients remained pain-free, 4 patients (7.7 %) had mild recurrence, and 3 patients (5.8 %) had severe recurrence. The mean time to recurrence was 25.1 months (5–60 months). PBC was repeated a second time in three patients, a third time in one patient. Postoperative complications included facial numbness in 51 patients (98.1 %), masseter muscle weakness in 31 patients (59.6 %), paresthesia in 5 patients (9.6 %), and diplopia secondary to abducens nerve palsy in 1 patient (1.9 %). None of the patients had serious surgical morbidities. PBC is a minimally invasive, safe and effective procedure which can be regarded as an optimized choice for recurrent trigeminal neuralgia after MVD.

Concussion knowledge and management practices among coaches and medical staff in Irish professional rugby teams.

Abstract: Self-reported concussion rates among U-20 and elite rugby union players in Ireland are 45–48 %. Half of these injuries go unreported. Accurate knowledge of concussion signs and symptoms and appropriate management practices among coaches and medical staff is important to improve the welfare of players. Examine concussion knowledge among coaches, and management techniques among medical staff of professional Irish rugby teams. Surveys were administered to 11 coaches and 12 medical staff at the end of the 2010–2011 season. Coaches demonstrated an accurate knowledge of concussion with a good understanding of concussion-related symptoms. Medical staff reported using a variety of methods for assessing concussion and making return-to-play decisions. Reliance on subjective clinical methods was evident, with less reliance on objective postural stability performance. Overall, the coaches in this investigation have accurate knowledge of concussion and medical staff use effective techniques for managing this injury. On-going education is needed to assist coaches in identifying concussion signs and symptoms. It is recommended that medical staff increase their reliance on objective methods for assessment and return-to-play decision making.

Awareness of sexually transmitted infection and protection methods among university students in Ireland

Abstract: Sexually transmitted infections (STIs) are a major public health challenge. In 2012, young people (20–29 years) represented 59.1 % of STI notifications in Ireland. In studying awareness and knowledge of STIs, methods of protection, and sexual practices of young people, many researchers have accessed university students. Survey of 419 university students, investigating awareness and knowledge of sexual health and STIs, and risky sexual behaviour as a surrogate indicator of sexual activity in that age group. Self-administered questionnaire on students’ demographics, sexual activity, knowledge, attitude and awareness of sexual health and STIs. 419 students responded: 56.1 % female and 78.1 % undergraduate students. 74.2 % remembered receiving sexual education in secondary school and 84 % of those found it useful, but only 51.8 % remembered education regarding STIs. 44.4 % believed that STIs do not pose a long-term health risk. 90.7 % of respondents were sexually active, and 10.3 % had contracted STIs. 94.7 % of sexually active students used contraception, with condoms most frequently used. 69.1 % of those active had experienced penetrative vaginal sex, 86.4 % oral sex and 19.2 % anal sex without a condom in the prior 2 years. Condom usage initiated by women was primarily for STI prevention. Young people do not always have the information needed for them to take responsibility for their sexual health. In this study, university-provided medical and information resources were available, but large numbers of students were unaware or uncomfortable accessing them. Future work is needed to determine factors contributing to effective communication of sexual health information to young people.

Ongoing challenges in the treatment of adenoid cystic carcinoma of the head and neck

Abstract: Adenoid cystic carcinoma is a malignant tumour of major and minor salivary glands. Distant metastasis and poor survival are persistent in the literature, with recent publications aimed at understanding molecular pathogenesis and development of pharmaceutical therapeutic options. Provide an update of recent studies in the management of adenoid cystic carcinoma of the head and neck. Literature search using Medline, Scopus, Google Scholar, the Cochrane Database of Systematic Reviews and the Cochrane central register of controlled trials for articles on adenoid cystic carcinoma from January 2005 to January 2015. Adenoid cystic carcinoma is characterized by a slow growing mass, with distant metastasis independent of local or regional control. Primary tumour resection remains the preferred option with radiotherapy having an adjuvant role. Recent advances have been made with novel targeted therapies however, limited to clinical trials and advanced disease.

Pregnancy outcome in chronic myeloid leukemia patients on imatinib therapy

Abstract: Introduction Imatinib is a first-line therapy to treat chronic myeloid leukemia (CML) patients.

Procalcitonin: present and future.

Abstract: Critically ill patients are frequently at risk of sepsis or inflammatory conditions. Procalcitonin (PCT) is a biomarker for critically ill patients to differentiate sepsis from non-infectious triggers of the systemic inflammatory response syndrome. It has been recently shown that PCT is a valuable tool to guide antibiotic treatment in patients with bacteria infections. However, PCT is also less than a universal and perfect biomarker, and its physiologic role remains unknown. An increase in PCT is associated not only with localized bacterial infection, but also with non-infectious disease or other microbial infections. Numerous studies have suggested that use of PCT would reduce patients’ exposure to antibiotics; however, the use of PCT-guided management of antibiotics strategy needs further study to validate their safety in daily practice in ICU settings. Data supporting this concept from randomized trials are still required. Future studies should focus on PCT kinetics. On the other hand, the need for biologic role of PCT shall be highlighted. Immunoneutralization of PCT will likely be a therapeutic approach for human sepsis only if its physiologic effects are elaborated. The aim of this review is to summarize and discuss the current evidence for PCT in a series of clinical settings.

Predicting the probability of mortality of gastric cancer patients using decision tree.

Abstract: Gastric cancer is the fourth most common cancer worldwide. This reason motivated us to investigate and introduce gastric cancer risk factors utilizing statistical methods. The aim of this study was to identify the most important factors influencing the mortality of patients who suffer from gastric cancer disease and to introduce a classification approach according to decision tree model for predicting the probability of mortality from this disease. Data on 216 patients with gastric cancer, who were registered in Taleghani hospital in Tehran,Iran, were analyzed. At first, patients were divided into two groups: the dead and alive. Then, to fit decision tree model to our data, we randomly selected 20 % of dataset to the test sample and remaining dataset considered as the training sample. Finally, the validity of the model examined with sensitivity, specificity, diagnosis accuracy and the area under the receiver operating characteristic curve. The CART® version 6.0 and SPSS version 19.0 softwares were used for the analysis of the data. Diabetes, ethnicity, tobacco, tumor size, surgery, pathologic stage, age at diagnosis, exposure to chemical weapons and alcohol consumption were determined as effective factors on mortality of gastric cancer. The sensitivity, specificity and accuracy of decision tree were 0.72, 0.75 and 0.74 respectively. The indices of sensitivity, specificity and accuracy represented that the decision tree model has acceptable accuracy to prediction the probability of mortality in gastric cancer patients. So a simple decision tree consisted of factors affecting on mortality of gastric cancer may help clinicians as a reliable and practical tool to predict the probability of mortality in these patients.

The paradox of Wolff’s theories

Abstract: The upper femur has long held a fascination for both clinicians and bioengineers as it contains two trabecular columns obviously related to its function In this respect two theories as to the formation of these columns have developed, both associated with Wolff: the Trajectorial Theory, which relates mainly to the passage of forces through the cancellous bone of the upper femur, and Wolff's Law of bone formation, which describes the bone's reaction to these forces and relates to bone in general The two concepts nevertheless are often used synonymously The Trajectorial Theory propounds that these cancellous structures in the femoral neck are due to both tension and compression forces, while modern day concepts of Wolff's Law only acknowledge the action of compression forces: and herein lies the paradox The Trajectorial Theory and Wolff's Law, when applied to the upper femur, are mutually exclusive The evidence, anatomical and physiological, indicates that bone forms within the femoral neck solely under the influence of compression forces This would indicate that the Trajectorial Theory is not appropriate for this region An alternative conceptual way of looking at this region is presented which eliminates this theory and resolves the paradox

Dietary contributors to hypertension in adults reviewed.

Abstract: Recent national surveys which measured respondents’ blood pressure (BP) levels have shown a high prevalence of hypertension amongst the Irish population, with approximately two-thirds of men and over half of women aged 45 years and over affected. Higher prevalence rates are observed with advancing age. Established diet- and lifestyle-related risk factors for hypertension such as high salt intake, high alcohol consumption and physical inactivity are pervasive in Ireland and are believed to contribute significantly to the high national prevalence of this condition. Additional dietary deficits have been implicated in the development of hypertension, however, including low fruit and vegetable intake, low dairy food consumption and low intake of oily fish. Deficiencies of single micro-nutrients such as folate, riboflavin, vitamin C and vitamin D have also been recently recognised as risk factors for hypertension. For each of these factors, there is evidence that the food and nutrient intakes of many Irish adults fall short of the ideal. These dietary and nutritional deficits, when superimposed on Ireland’s existing health-subversive behaviours and escalating rates of obesity, constitute a potent constellation of risk factors for hypertension. However, they also represent viable and potentially effective targets for health promotion initiatives. This review aims to describe the main nutritional, dietary and lifestyle contributors to hypertension in Ireland with a view to informing future interventions aimed at alleviating Ireland’s burden of hypertensive disease.

An audit of drug shortages in a community pharmacy practice

Abstract: There are no firm data on drug shortages in Irish community pharmacy. This prospective observational study aimed to characterise the drug shortage problem in an Irish community pharmacy. The primary aim was to determine numbers and durations of drug shortages. Secondary aims included comparing these shortages with Irish Pharmacy Union (IPU) drug shortage lists and determining the frequency with which notifications were received prior to shortages. Further secondary aims were to examine relationships between causes of drug shortages and drug costs and between causes of drug shortages and shortage durations. The study took place in a community pharmacy in a Limerick City suburb between October 2012 and February 2013. Data were collected daily regarding drugs that were dispensed, but unavailable to purchase. Suppliers/manufacturers provided data on the reasons for shortages. 65/1,232 dispensed drugs (5.3 %) were in short supply over the study period. Median shortage duration was 13 days (interquartile range 4–32 days) and median cost was €8.10. Numbers of unavailable drugs by month varied from 13 to 38. Monthly IPU drug shortage lists identified between six and eight of these shortages depending on the month. Two notifications were received from suppliers/manufacturers regarding shortages. Parallel exports had the highest mean costs (mean €38.05) and manufacturing problems were associated with the longest durations (mean 57.44 days). This study highlights the drug shortage problem in an Irish community pharmacy. We propose that enhanced communication between all stakeholders is the most worthwhile solution. Further studies are needed.

Protective effects of three remote ischemic conditioning procedures against renal ischemic/reperfusion injury in rat kidneys: a comparative study.

Abstract: Remote ischemic perconditioning (RIPerC), remote ischemic postconditioning (RIPostC), and remote ischemic perconditioning + postconditioning (RIPerC + RIPostC) protect against renal ischemia reperfusion injury (IRI). However, the most beneficial approach among these is not known. To compare the protective effects and study the mechanisms of three different remote ischemic conditioning in preventing IRI in the rat kidney. Fifty healthy adult male Sprague–Dawley rats were randomly assigned to five groups: sham, IRI, RIPerC, RIPostC, and RIPerC + RIPostC. Right nephrectomy was performed initially in all rats. IRI was induced by occluding the left renal artery for 60 min, followed by reperfusion for 24 h. RIPerC, RIPostC, and RIPerC + RIPostC were induced with 5-min ischemia/reperfusion (I/R) cycles using a tourniquet on the right hind limb. The IRI group showed significant serologic evidence of renal injury compared to the sham group (P < 0.05). The RIPerC, RIPostC, and RIperC + RIpostC groups displayed significantly lower levels of renal dysfunction than the IRI group (P < 0.05). Superoxide dismutase (SOD) levels were significantly lower in the IRI group than in the sham group (P = 0.003), but were significantly less depressed in the RIPerC, RIPostC, and RIperC + RIpostC groups (P < 0.05). The IRI group displayed more severe renal tubular injury than the RIPerC, RIPostC, and RIPerC + RIPostC groups (P < 0.05). All three remote ischemic conditioning showed similar therapeutic potential for preventing renal IRI. The RIPerC + RIPostC protocol did not show an additive effect from the combination of preconditioning and postconditioning. The protective mechanism may be due to the stimulation of endogenous antioxidant activity by transient limb ischemia–reperfusion.

Long-term prognostic significance of living alone and other risk factors in patients with acute myocardial infarction

Abstract: Living alone has been associated with higher risk of acute coronary syndrome in general population, but there are no consistent findings about its effect on prognosis after acute myocardial infarction (AMI). To analyse the relationships between living alone and other risk factors at baseline and long-term survival after AMI. One hundred and thirty-five patients with confirmed myocardial infarction (MI) admitted to the coronary care unit of the Institute of Cardiovascular Diseases, Clinical Centre of Serbia in Belgrade, between June 2002 and April 2006, were followed up until September 2011. Survival time was estimated using the Kaplan–Meier method and Cox regression analysis. Patients with MI were followed up for a median of 77 months. The mean age of participants was 57.82 years (SD ± 10.8), and one quarter of them were women. According to the multivariate Cox regression analysis stratified on marital status, the model in which were included living alone, age, gender, education, obesity, smoking, hyperlipidaemia, hypertension, diabetes mellitus, previous cardiovascular and other disease, thrombolytic therapy and localisation of MI, the following variables were found to be independent predictors of death after AMI: living alone, with a hazard ratio (HR) of 7.60 [95 % confidence interval (CI) 1.99–29.08], diabetes mellitus (HR 3.31; 95 % CI 1.33–8.23), current smoking (HR 2.82; 95 % CI 1.03–7.71) and, older age (HR 1.13; 95 % CI 1.06–1.19). The results of this study support hypothesis that patients who live alone have higher long-term all-cause mortality following AMI.

Postoperative adjuvant arterial chemoembolization improves the survival of hepatitis B virus-related hepatocellular carcinoma: a retrospective control study

Abstract: The survival benefit of postoperative adjuvant transcatheter arterial chemoembolization (TACE) remains controversial. We aim to investigate the survival effect of postoperative adjuvant TACE on the prognosis of hepatitis B virus (HBV)-related hepatocellular carcinoma (HCC) patients (stage B, the Barcelona Clinic Liver Cancer staging). Sixty consecutive HBV-related HCC patients (stage B) from February 2006 to May 2009 undergoing surgical resection were included in this study. Of these 60 patients, 34 patients underwent surgery only (Group A) and 26 patients underwent surgery plus TACE (Group B). We followed-up until May 2013. Overall survival rates as well as prognostic factors were analyzed by the Kaplan–Meier method, the log-rank test or Cox’s proportional hazard model. All patients’ data were collected from the hospital medical records, which were described precisely after accurate clinical samples detection. The 1-, 2-, and 3-year overall survival rates in surgery-only group were 58.8, 32.4 and 12.6 %, and the rates in surgery plus TACE group were 73.1, 61.5, and 48.9 %, respectively (P = 0.033). The median survival time of the two groups after surgery and surgery plus TACE was 15.0 months [95 % confidence interval (CI) 10.714–19.286] and 35.0 months (95 % CI 20.974–49.026). In multivariate analysis, hemoglobin, HBeAg, peripheral blood regulatory T cells and tumor size were independent prognostic elements for HBV-related HCC patients (stage B). Postoperative adjuvant TACE improves the survival of patients with HBV-related HCC (stage B) after curative resection compared to surgery only.

Experience with different techniques for the management of postpartum hemorrhage due to uterine atony: compression sutures, artery ligation and Bakri balloon.

Abstract: To report our experience with different management approaches to treat postpartum hemorrhage (PPH) due to uterine atony with reference to need for hysterectomy. A retrospective study of data of all women who delivered in Dr. Sami Ulus Medical and Research Hospital between April 2010 and April 2013 was collected from the department’s medical records, to identify patients who had undergone the compressive suture techniques, artery ligation, Bakri balloon application and hysterectomy operation because of PPH due to uterine atony. A total of 32 cases who had PPH due to uterine atony were identified. Bleeding was successfully treated without the need for hysterectomy in 25 patients. Compressive suture technique and artery ligation without Bakri balloon application were used in 22 patients with the success rate of 72.7 %. Bakri balloon was applied to ten patients, and there were three cases with failure: two patients needed an additional procedure (hypogastric artery ligation and B-Lynch suture) and one patient needed hysterectomy. The overall success rate of intrauterine balloon tamponade alone was 70 %. The success of Bakri balloons in combination with artery ligation and B-Lynch suture was promising. Our case series suggest that in the condition of PPH due to atony, both compression sutures and Bakri balloon tamponade are effective methods. In combination of uterine artery ligation and B-Lynch suture with Bakri balloon tamponade might be the best surgical approach due to its higher success according to our results. To obtain more information further studies with large case series are important.

Blood lipid profile and BMI-Z-score in adolescents with hyperuricemia

Abstract: Numerous studies have demonstrated that elevated serum uric acid concentration (SUA) is correlated with lipid profile in hypertensive or obese patients. However, the relationship between serum uric acid levels and lipid profile in non-obese late adolescent population was not examined before. In this study we decided to assess the potential relationship between SUA and lipid profile, according to gender in adolescents with HU. The study group comprises 607 Polish adolescents (474 males, 133 females) with HU. Retrospective analysis included demographic, clinical, and laboratory data. Lipid profile was assessed including total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), triglycerides (TG), total cholesterol to HDL-C ratio (TC/HDL-C). In the examined group 187/607 (31 %) of teenagers were diagnosed with metabolic syndrome (MetS). Median BMI-Z-score was 1.11 Q1–Q3: (−0.02–2.03) and both females and males in the upper tertile of SUA had statistically significant higher BMI-Z-score. The males in the upper tertile of serum uric acid levels also had higher values of TG and lower of HDL-C. In females, we have not found significant differences in lipid profile. Multiple regression analyses indicated that male gender, BMI-Z-score, and presence of hypertension correlated significantly with serum uric acid concentration. In summary, the results of our study confirm higher prevalence of hyperuricemia in males when compared to females and a stronger association of HU with BMI-Z-score and lipid profile in male adolescents. Nevertheless, multiple regression does not confirm the independent association of SUA with lipid profile.

Validation of a nomogram predicting sentinel lymph node status in melanoma in an Irish population

Abstract: Background Sentinel lymph node (SLN) positivity is an important prognostic factor in cutaneous melanoma. A nomogram has been developed at Memorial Sloan-Kettering Cancer Centre (MSKCC) to predict SLN positivity and this may be useful to select patients for SLN biopsy.

Utility of CT head in the acute setting: value of contrast and non-contrast studies.

Abstract: Introduction To examine the added diagnostic value of emergent contrast enhanced CT head (CECTH) in patients who present to the emergency department (ED) with acute non-traumatic symptoms referable to the brain, and to assess the financial implications of CECTH in the emergent setting.