Irish Journal of Medical Science最新文献

{"title":"Incidence and risk factors for chronic pain following primary total knee arthroplasty in an irish surgical population.","authors":"Aoife O'Brien-Horgan, Emma Woodhouse, Stephen Mannion","doi":"10.1007/s11845-024-03817-z","DOIUrl":"10.1007/s11845-024-03817-z","url":null,"abstract":"<p><strong>Objectives: </strong>To identify the incidence and characteristics of chronic post-surgical pain (CPSP) following total knee arthroplasty and determine peri-operative influencing factors.</p><p><strong>Methods: </strong>A representative, retrospective random sample was taken of patients who underwent total knee arthroplasty in the South Infirmary University Hospital Cork for an 18-month period. Two hundred fourteen patient charts were reviewed out of a total of 507 charts for that period to provide a 90% confidence interval.</p><p><strong>Results: </strong>The incidence of CPSP in an Irish population 6 months after total knee arthroplasty was found to be 36.5%. The following factors were found to be statistically significant with respect to the incidence of CPSP: female sex, lack of multimodal analgesia (consisting of paracetamol, NSAID, and opioids), general anaesthesia, and lower Oxford Knee Scores at 6 months post-surgery. Age, the knee operated on, ASA grade, or greatest acuity pain, were not found to be statistically significant factors in the development of CPSP.</p><p><strong>Conclusions: </strong>CPSP is common after total knee arthroplasty with an incidence of 36.5% at 6 months post procedure. Female sex, lack of multimodal analgesia, and lower Oxford Knee Scores were associated with increased CPSP.</p>","PeriodicalId":14507,"journal":{"name":"Irish Journal of Medical Science","volume":" ","pages":"2983-2988"},"PeriodicalIF":1.7,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142365230","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Optimal weight-based epinephrine dosing for patients with a low likelihood of survival following out-of-hospital cardiac arrest.","authors":"Michael W Hubble, Stephen Taylor, Melisa Martin, Sara Houston, Ginny R Kaplan","doi":"10.1007/s11845-024-03797-0","DOIUrl":"10.1007/s11845-024-03797-0","url":null,"abstract":"<p><strong>Introduction: </strong>Cardiac arrest patients presenting with non-shockable rhythms have a low probability of survival, and epinephrine is one of the few pharmaceutical options for this group. The recommended 1.0 mg adult dose is extrapolated from early animal studies and lacks adjustment for patient weight. Although several prior studies have investigated \"low-\" and \"high-\" dose epinephrine, none have identified a benefit to either strategy.</p><p><strong>Aims: </strong>To identify an optimal weight-based epinephrine dose for return-of-spontaneous-circulation (ROSC) after a single bolus among patients with low likelihood of survival.</p><p><strong>Methods: </strong>Included were adult patients who experienced a witnessed, non-traumatic out-of-hospital cardiac arrest prior to EMS arrival. Patients with shockable presenting rhythms or receiving bystander CPR were excluded. The AUROC was used to assess the predictive value of epinephrine dose (mg/kg) for ROSC following a single bolus. From the ROC curve, the optimal threshold dosage (OTD) was determined using the Youden Index. A logistic regression model calculated the adjusted odds ratio of OTD on ROSC.</p><p><strong>Results: </strong>A total of 2,463 patients met inclusion criteria, of which 190 (7.7%) attained ROSC after the first epinephrine administration. The dosage AUROC for ROSC was 0.603 (p < 0.01). As calculated by the Youden index, the OTD was 0.013 mg/kg. Patients receiving ≥ OTD were more likely to attain ROSC after a single epinephrine bolus (OR = 2.25,p < 0.001).</p><p><strong>Conclusions: </strong>Among patients with a low likelihood of survival, the optimal dose of epinephrine for attaining ROSC with a single bolus of epinephrine was 0.013 mg/kg. These findings should inspire further investigation into optimal dosing strategies for epinephrine.</p>","PeriodicalId":14507,"journal":{"name":"Irish Journal of Medical Science","volume":" ","pages":"2713-2721"},"PeriodicalIF":1.7,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142072761","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Molecular diagnosis of Alpha-sarcoglycanopathies by NGS in seven Moroccan families and report of two novel variants.","authors":"Yasmina Rahmuni, Youssef El Kadiri, Jaber Lyahyai, Abdelaziz Sefiani, Ilham Ratbi","doi":"10.1007/s11845-024-03792-5","DOIUrl":"10.1007/s11845-024-03792-5","url":null,"abstract":"<p><strong>Background: </strong>Limb-girdle muscular dystrophies constitute a heterogeneous group of neuromuscular diseases, both clinically and genetically. Limb-girdle muscular dystrophy by alpha-sarcoglycan deficiency or LGMD R3 α-sarcoglycan-related is a subtype of the autosomal recessive sarcoglycanopathies caused by variants in the alpha-sarcoglycan gene (SGCA) at 17q21.33. It appears in childhood by progressive weakness of pelvic and/or scapular girdle muscles and calf hypertrophy, with a wide range of clinical inter- and intra-familial clinical variability.</p><p><strong>Aims: </strong>Our report extends the molecular spectrum of SGCA gene with the identification of variant disease causing and will help for better management of patients and genetic counseling of families.</p><p><strong>Methods: </strong>In our study, seven unrelated families presented a clinical and paraclinical picture consistent with alpha-sarcoglycanopathy. A molecular study using Next-Generation Sequencing (NGS) was carried out on them.</p><p><strong>Results: </strong>Six different homozygous variants of the SGCA gene were identified in the patients analyzed, including four previously reported variants and two novel variants predicted to be deleterious by the prediction tools.</p><p><strong>Conclusions: </strong>Our results expand the spectrum of variants in Moroccan patients with sarcoglycanopathy, specifically LGMDR3, most importantly as this form is not common in the Moroccan population.</p>","PeriodicalId":14507,"journal":{"name":"Irish Journal of Medical Science","volume":" ","pages":"3071-3076"},"PeriodicalIF":1.7,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142035846","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Injury incidence in golf-a systematic review and meta-analysis.","authors":"Ilari Kuitunen, Ville T Ponkilainen","doi":"10.1007/s11845-024-03759-6","DOIUrl":"10.1007/s11845-024-03759-6","url":null,"abstract":"<p><strong>Objective: </strong>There is a lack of comprehensive analysis of injuries in golf per exposure time. Thus, the aim was to report the pooled incidence of injuries in golf.</p><p><strong>Methods: </strong>We searched PubMed, Scopus, SPORTDiscus, and Web of Science databases in March 2024 for this systematic review and meta-analysis. We included observational studies reporting the number of injuries per exposure time. A random-effects model was used to calculate the pooled injury incidence per 1000 athlete exposures (18 holes of golf) with 95% confidence intervals (CI). Incidences were separately analyzed for men, women, amateurs, professionals, and special athletes.</p><p><strong>Results: </strong>A total of 999 studies were screened, 29 full texts were assessed, and 7 studies with 269,754 athlete exposures were included. Seven studies assessed the overall incidence of injury, and the pooled estimate was 2.5 per 1000 athlete exposures (CI 0.9-7.5). The incidence was higher in special athletes (21.0, CI 7.7-45.1; one study) than among professionals (8.5, CI 7.6-9.4; one study), or in amateurs (1.3, CI 0.5-4.0; five studies). The injury incidence was 2.6 per 1000 athlete exposures (CI 0.7-9.6; four studies) in women and 1.4 per 1000 athlete exposures (CI 0.4-5.2; three studies) in men. A sensitivity analysis without special athletes had an incidence of 1.9 (CI 0.7-4.9; six studies).</p><p><strong>Conclusion: </strong>The injury incidence in golf is 2.5 injuries per 1000 athlete exposures (18 holes of golf). Reporting was limited as only one study reported injuries per exposure time in professionals, and in total, only seven studies were found. More research is needed in all levels and age groups to better estimate the injury incidence and associated risk factors in golf.</p>","PeriodicalId":14507,"journal":{"name":"Irish Journal of Medical Science","volume":" ","pages":"2803-2811"},"PeriodicalIF":1.7,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11666794/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141723652","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The impact of glenohumeral bone loss on range of motion in patients with anterior shoulder instability.","authors":"Mohamed Gaafar, Tom R Doyle, Julia K Frank, Eoghan T Hurley, Martin S Davey, Ailbhe White-Gibson, Sami Khan, Hannan Mullett","doi":"10.1007/s11845-024-03765-8","DOIUrl":"10.1007/s11845-024-03765-8","url":null,"abstract":"<p><strong>Background: </strong>Loss of shoulder range of motion (ROM) is common after surgical management of anterior shoulder instability; however, it remains unclear to what degree this is related to their injury.</p><p><strong>Aim: </strong>The purpose of this study was to compare passive shoulder ROM in patients with ASI to a normal contralateral shoulder.</p><p><strong>Methods: </strong>A total of 121 patients undergoing stabilization surgery were prospectively enrolled. Preoperative advanced imaging was used to assess for glenoid bone loss and the presence of off-track Hill-Sachs lesions. Passive ROM was measured in both shoulders while under anaesthesia prior to surgery.</p><p><strong>Results: </strong>In all directions, there was a significant loss of ROM in shoulders with instability. Regression analysis showed that neither a glenoid bone defect nor greater glenoid bone loss were associated with a loss of ROM in any plane. The presence of a Hill-Sachs lesion was significantly associated with a loss of external rotation, while off-track lesions were associated with a loss of ROM in all planes (p < 0.05).</p><p><strong>Conclusion: </strong>Patients with anterior shoulder instability lost motion in all directions, with a profound loss of external rotation. The presence of a glenoid bone defect nor greater bone loss did not reliably predict a loss of range of motion. A Hill-Sachs lesion was predictive of a loss of external rotation, while an off-track lesion was predictive of a loss of range in all directions.</p>","PeriodicalId":14507,"journal":{"name":"Irish Journal of Medical Science","volume":" ","pages":"2813-2818"},"PeriodicalIF":1.7,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11666619/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141971103","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Management of patients with adrenal myelolipoma: experience from a tertiary referral centre.","authors":"Anant Paul, Conor Toale, Marie Egan, Maria Whelan, John Feeney, Stephen Crowther, James Gibney, Kevin Conlon","doi":"10.1007/s11845-024-03779-2","DOIUrl":"10.1007/s11845-024-03779-2","url":null,"abstract":"<p><strong>Background: </strong>Adrenal myelolipomas are rare, benign, tumours of the adrenal cortex.</p><p><strong>Aims: </strong>This study reports the experience of a tertiary adrenal surgery referral centre's approach to the management of patients with adrenal myelolipoma.</p><p><strong>Methods: </strong>A retrospective observational cohort study was conducted on all adult patients (> 18 years age) diagnosed with adrenal myelolipoma from January 1, 2014, to December 30, 2022. Demographics, imaging characteristics, histological diagnosis (where applicable) and follow-up data were compared between patients undergoing surgery and those referred to surveillance. Indications for operative intervention were recorded at the time of multidisciplinary team discussion, consisting of surgeons, endocrinology physicians, radiologists, pathologists and specialist nursing representatives.</p><p><strong>Results: </strong>Of the 522 patients with an adrenal lesion discussed in adrenal tumour meeting between 2014 and 2022, n = 15 (2.8%) were diagnosed with adrenal myelolipoma. Of the 15 patients, 4 underwent adrenalectomy at first presentation (27%), while 1 patient underwent adrenalectomy after interval follow-up. Indications for operative intervention were as follows: 'indeterminate lesion' (n = 3), 'abdominal pain and size (> 4 cm)' (n = 1) and 'mass effect on adjacent organs' (n = 1). The mean rate of lesion growth in patients referred for surveillance (n = 10) was 0.13 cm/year. Histology confirmed adrenal myelolipoma as the diagnosis in all resected tumours.</p><p><strong>Conclusions: </strong>For patients with adrenal myelolipoma, the presence of symptoms and/or indeterminate features on imaging may be more clinically useful indications for operative intervention over size alone. The surveillance of adrenal myelolipomas, even in patients with adrenal lesions > 4 cm, is a safe clinical strategy, provided the imaging characteristics are benign and patients remain asymptomatic.</p>","PeriodicalId":14507,"journal":{"name":"Irish Journal of Medical Science","volume":" ","pages":"2941-2947"},"PeriodicalIF":1.7,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11666644/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142125709","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Letter to the Editor: Enhancing palliative care education in graduate medical curriculum.","authors":"Pincheng Luo, Yanxue Lian","doi":"10.1007/s11845-024-03808-0","DOIUrl":"10.1007/s11845-024-03808-0","url":null,"abstract":"","PeriodicalId":14507,"journal":{"name":"Irish Journal of Medical Science","volume":" ","pages":"3069"},"PeriodicalIF":1.7,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142307716","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The impact of the COVID-19 pandemic on the performance of the Rapid Access Lung Cancer Clinic.","authors":"Mohammad J Ghassemi-Rad, Colum Dennehy, Noreen Lyons, Michael T Henry, Marcus P Kennedy, Éilis J O'Reilly, Roisin M Connolly","doi":"10.1007/s11845-024-03749-8","DOIUrl":"10.1007/s11845-024-03749-8","url":null,"abstract":"<p><strong>Background: </strong>The Rapid Access Lung Cancer Clinic (RALC) experienced fewer referrals during the COVID-19 pandemic in Ireland.</p><p><strong>Aims: </strong>Our aim was to determine the impact of the pandemic on the key performance indicators (KPIs) of the Cork University Hospital (CUH) RALC, using a retrospective chart review of the referrals and attendances.</p><p><strong>Methods: </strong>The medical charts of patients referred to CUH-RALC from 03/2019 to 02/2020 (period I), and from 03/2020 to 02/2021 (period II) were reviewed. Performance of the RALC was determined based on average wait time from referral to 1] acquisition of the first CT scan, 2] consultation, and 3] receiving a cancer diagnosis, and compared between periods I and II.</p><p><strong>Results: </strong>Average monthly referrals (57.3 vs 42.1, p = 0.0078) and RALC reviews (24.3 vs 22, p = 0.0310) were lower in period II compared to period I. However, no difference was seen in the length of time from referral to review at RALC or time to receive cancer diagnosis. There were shorter wait times from referral to CT scan (11.2 vs. 8.7 days, p = 0.0011) and to surgery (109.0 vs 79.3 days, p = 0.0236) in period II.</p><p><strong>Conclusions: </strong>The COVID-19 pandemic had minimal impact on the performance of RALC at our institution. Fewer referrals to RALC in period II may relate to hesitancy in attending general practitioner (GP) and/or GPs raising the thresholds for referrals to RALC during the early lockdown period of the pandemic. A national evaluation will be required to fully determine the impact of this pandemic on lung cancer in Ireland.</p>","PeriodicalId":14507,"journal":{"name":"Irish Journal of Medical Science","volume":" ","pages":"2625-2634"},"PeriodicalIF":1.7,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11666672/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141734141","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An investigation into General Practitioners' experience with Long Covid.","authors":"Aisling Farrell, James O'Flynn, Aisling Jennings","doi":"10.1007/s11845-024-03782-7","DOIUrl":"10.1007/s11845-024-03782-7","url":null,"abstract":"<p><strong>Background: </strong>Long Covid (LC) is the continuation or development of new symptoms after initial COVID-19 infection. Little is known about General Practitioners' (GP) experience of managing patients with LC.</p><p><strong>Aims: </strong>The aim of this study is to establish GP experiences with LC.</p><p><strong>Methods: </strong>A survey was designed and piloted in three training practices prior to distribution. The survey was completed by doctors working in GP training scheme practices in Cork, Ireland.</p><p><strong>Results: </strong>Fifty-three of one hundred and sixty invited GPs completed the survey, indicating a 33% response rate. 8% (4/53) of participants agreed and 0% (0/53) strongly agreed with the statement they were \"confident in diagnosing Long Covid\". 81% (43/53) were not confident in treating patients with LC. 70% (37/53) were unaware of indications for referral to secondary care. 38% (20/53) were aware of the referral pathways to local LC clinics. 93% (49/53) agreed there were educational deficits regarding LC.</p><p><strong>Conclusions: </strong>There was a lack of confidence in the diagnosis and management of LC, and in the interface with secondary care. There is demand for educational interventions to assist GPs with their care of patients with this emerging condition.</p>","PeriodicalId":14507,"journal":{"name":"Irish Journal of Medical Science","volume":" ","pages":"2869-2873"},"PeriodicalIF":1.7,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11666628/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142004232","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of neutrophil activation marker in patients with vitiligo.","authors":"Hala M El-Sadek, Asmaa A Elmadbouly, Basma E M Risha","doi":"10.1007/s11845-024-03777-4","DOIUrl":"10.1007/s11845-024-03777-4","url":null,"abstract":"<p><strong>Background: </strong>Vitiligo is an inflammatory, autoimmune disorder. Its pathogenesis is unclear. A neutrophil activation marker (calprotectin) is a protein complex present in many different types of cells and may be used as an indicator of inflammation.</p><p><strong>Aims: </strong>This study is to assess calprotectin levels in non-segmental vitiligo patients and compare them to the severity of the illness to identify potential associations.</p><p><strong>Methods: </strong>The present inquiry was conducted on thirty non-segmental vitiligo patients and thirty healthy volunteers matched in terms of age and gender. The Vitiligo Area Scoring Index was used to assess the vitiligo severity. Calprotectin levels were measured in serum samples obtained from all participants by Enzyme Linked Immunosorbent Assay.</p><p><strong>Results: </strong>Compared to controls, non-segmental vitiligo patients had considerably elevated serum calprotectin levels. Additionally, calprotectin levels were shown to have a significant positive association with disease severity (r = 0.833, P = 0.000).</p><p><strong>Conclusions: </strong>Elevated levels of serum calprotectin in non-segmental vitiligo patients relative to healthy individuals with high sensitivity indicated that it may have a role in the vitiligo pathophysiology and can act as a marker for disease monitoring.</p>","PeriodicalId":14507,"journal":{"name":"Irish Journal of Medical Science","volume":" ","pages":"2797-2802"},"PeriodicalIF":1.7,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11666612/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142055580","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}