Irish Journal of Medical Science最新文献

{"title":"Addressing the undergraduate airway \"Preparedness Gap\": a matched-pairs analysis of a trainee-led, scaffolding-based simulation curriculum.","authors":"Alice Meagher, Peter Burke, Dara Breslin","doi":"10.1007/s11845-026-04663-x","DOIUrl":"https://doi.org/10.1007/s11845-026-04663-x","url":null,"abstract":"<p><strong>Background: </strong>Traditional undergraduate airway training in Ireland relies heavily on passive and unstructured theatre-based observation. We hypothesised that this model may result in a \"preparedness gap\", where students lack safety-critical knowledge regarding airway management skills.</p><p><strong>Aims: </strong>Our study aimed to evaluate whether a Non Consultant Hospital Doctor (NCHD) led airway simulation circuit effectively remediates safety-focused knowledge deficits in airway management amongst medical students.</p><p><strong>Methods: </strong>A prospective pre-post study (n = 18) evaluated a four-station simulation circuit for medical students (Equipment, Bag-valve-mask (BVM), Endotracheal Tube Intubation (ETI), Supraglottic Airway Insertion (SGA)), designed and delivered by Anaesthesia NCHDs at St Vincent's University Hospital. Data were analysed using matched-pairs to evaluate objective knowledge and self-reported confidence among participants.</p><p><strong>Results: </strong>Objective safety knowledge improved from 2.72 to 4.83/5 (p < 0.001) among participants. Baseline recognition of nasopharyngeal airway contraindications rose from 38.9% to 100% (p = 0.001). Procedural confidence scores increased significantly across all domains (p < 0.001). Interestingly, fourteen of 18 participants (78%) reported increased interest in a career in anaesthesia after the workshop.</p><p><strong>Conclusion: </strong>NCHD-led simulation was associated with improved safety-focused knowledge and increased interest in anaesthesia as a career. Larger-scale evaluation is warranted.</p>","PeriodicalId":14507,"journal":{"name":"Irish Journal of Medical Science","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149165815","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":"A pilot of a non-consultant hospital doctor pay estimator.","authors":"James Morgan, Claudia Condon, Colin McGrath, Joe Newell, Jennifer Donnelly, Aisling Smith","doi":"10.1007/s11845-026-04671-x","DOIUrl":"https://doi.org/10.1007/s11845-026-04671-x","url":null,"abstract":"","PeriodicalId":14507,"journal":{"name":"Irish Journal of Medical Science","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149169462","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":"Association of pericoronary and epicardial adipose tissue thickness with coronary artery calcium score using cardiac computed tomography.","authors":"Yekbun Şanlı, Fatma Durmaz, İlyas Dündar, Mesut Özgökçe, Sercan Özkaçmaz, Muhammed Bilal Akıncı, Amed Çekdar Altındağ, Cemil Göya","doi":"10.1007/s11845-026-04674-8","DOIUrl":"https://doi.org/10.1007/s11845-026-04674-8","url":null,"abstract":"<p><strong>Purpose: </strong>To compare the associations of pericoronary (PCAT) and epicardial adipose tissue (EAT) thickness with coronary artery calcium score (CACS) using cardiac computed tomography.</p><p><strong>Materials and methods: </strong>This retrospective study included 1,032 patients (516 women, 516 men; median age, 54 years) who underwent coronary CT angiography. CACS was quantified using the Agatston method. Mean PCAT thickness was measured at predefined anatomical landmarks along the major coronary arteries, while mean EAT thickness was assessed at the right ventricular free wall. Associations with CACS were evaluated using correlation, multivariable linear and logistic regression, and receiver operating characteristic (ROC) analysis.</p><p><strong>Results: </strong>Detectable coronary artery calcification was observed in 432 patients (41.9%). Although both PCAT (r = 0.461, p < 0.001) and EAT thickness (r = 0.375, p < 0.001) correlated with CACS, PCAT thickness remained significantly associated with higher CACS after adjustment for age, sex, and EAT thickness. In logistic regression, each 1-mm increase in PCAT thickness was associated with 43% higher odds of coronary calcification (OR, 1.436; 95% CI: 1.298-1.588; p < 0.001). PCAT showed greater discriminatory performance than EAT (AUC, 0.736 vs. 0.695; DeLong p = 0.010), and adding PCAT to an age-and-sex model increased the AUC from 0.744 to 0.795 (DeLong p < 0.001).</p><p><strong>Conclusions: </strong>PCAT thickness was associated with CACS after adjustment for age, sex, and EAT thickness and showed greater discriminatory performance than EAT thickness for the presence of coronary calcification. PCAT thickness may provide additional imaging information from CCTA, although its incremental clinical value requires prospective validation.</p>","PeriodicalId":14507,"journal":{"name":"Irish Journal of Medical Science","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149166320","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":"Effects of tyrosine kinase inhibitors in treatment of non small cell lung cancer patients with brain metastases, real world experience.","authors":"Mehmet Akif Tükenmez, Gamze Emin, Süleyman Karakeçi, Esra Aşık, Zeynep Sağnak Yılmaz, Evren Kara","doi":"10.1007/s11845-026-04653-z","DOIUrl":"https://doi.org/10.1007/s11845-026-04653-z","url":null,"abstract":"<p><strong>Background: </strong>Lung cancer remains one of the leading causes of cancer-related mortality worldwide, and brain metastases are a common and serious complication of advanced disease. Early detection and effective management of brain metastases are essential for improving survival and maintaining quality of life. Recent advances in targeted therapies, particularly tyrosine kinase inhibitors (TKIs), have shown promising efficacy in controlling both systemic and intracranial disease. This study aimed to evaluate the efficacy of TKIs in patients with non-small cell lung cancer (NSCLC) harboring driver mutations and presenting with brain metastases.</p><p><strong>Materials and methods: </strong>We retrospectively analyzed 31 patients with NSCLC and brain metastases who received targeted therapy at Karadeniz Technical University Faculty of Medicine between January 1, 2010, and September 1, 2023. Clinical and demographic data, including age, sex, histological and molecular subtypes, metastatic sites, progression-free survival (PFS), overall survival (OS), and treatment modalities, were evaluated.</p><p><strong>Results: </strong>Median OS was 34.5 months in patients with PD-L1 expression < 50%, compared with 4.5 months in those with PD-L1 expression ≥ 50% (p = 0.004). Median OS was 36.1 months (range, 1.8-58.7) among never-smokers and 4.5 months (range, 2.2-18.5) among current or former smokers (p = 0.005).</p><p><strong>Conclusion: </strong>TKIs remain an effective treatment option for patients with NSCLC and brain metastases. PD-L1 expression and smoking status may influence clinical outcomes. Further studies are warranted to validate these findings and clarify the prognostic role of PD-L1 expression in NSCLC patients with brain metastases.</p>","PeriodicalId":14507,"journal":{"name":"Irish Journal of Medical Science","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149166441","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":"Methodological and clinical implications regarding the 12-year retrospective analysis of infectious keratitis profile in Cork, Ireland.","authors":"Shifa Maqbool, Aleezah Sameen","doi":"10.1007/s11845-026-04611-9","DOIUrl":"https://doi.org/10.1007/s11845-026-04611-9","url":null,"abstract":"","PeriodicalId":14507,"journal":{"name":"Irish Journal of Medical Science","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149172293","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":"Neonatal appendicitis with rectal bleeding: an unusual presentation.","authors":"Sinan Kılıç, Şenol Bozdağ, Murat Cengiz Aşıcıoğlu, B Haluk Güvenç","doi":"10.1007/s11845-026-04678-4","DOIUrl":"https://doi.org/10.1007/s11845-026-04678-4","url":null,"abstract":"<p><strong>Background: </strong>Neonatal appendicitis is an exceptionally rare condition with a high risk of delayed diagnosis and perforation. Its nonspecific clinical presentation may mimic other causes of acute abdomen and gastrointestinal bleeding in newborns, particularly necrotizing enterocolitis.</p><p><strong>Case presentation: </strong>A 36-week, 2500-g male neonate developed abdominal distension, irritability, decreased oral intake, and bright red rectal bleeding on the second day of life. Abdominal radiography demonstrated multiple air-fluid levels, while ultrasonography revealed dilated bowel loops and free intraperitoneal fluid. Exploratory laparotomy revealed a hyperaemic, oedematous, and indurated appendix with localized inflammatory changes, without perforation or gangrenous changes. Appendectomy was performed, and histopathological examination confirmed acute appendicitis with transmural inflammation and fibrinous exudates, without necrosis or histopathological findings suggestive of necrotizing enterocolitis. The patient recovered uneventfully, and no further rectal bleeding was observed after appendectomy.</p><p><strong>Conclusion: </strong>Neonatal appendicitis should be considered in the differential diagnosis of newborns presenting with hematochezia, particularly when rectal bleeding is accompanied by abdominal distension and signs of intestinal obstruction or ileus. Although the condition is rare and its clinical presentation is nonspecific, recognition of atypical presentations may facilitate timely surgical evaluation and treatment.</p>","PeriodicalId":14507,"journal":{"name":"Irish Journal of Medical Science","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149166301","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":"Paradoxical reactions during treatment of miliary tuberculosis: a 25-year single-centre case series and literature review.","authors":"Abdurrahman Kaya, Ali Mert","doi":"10.1007/s11845-026-04655-x","DOIUrl":"https://doi.org/10.1007/s11845-026-04655-x","url":null,"abstract":"<p><strong>Background: </strong>Paradoxical reactions during otherwise effective anti-tuberculosis treatment can resemble treatment failure or drug resistance. Their frequency and clinical spectrum in miliary tuberculosis are incompletely characterised.</p><p><strong>Aims: </strong>To describe the timing, manifestations, management and outcomes of paradoxical reactions identified in a defined cohort of patients with miliary tuberculosis and to place these events in the context of the published literature.</p><p><strong>Methods: </strong>We retrospectively reviewed the records of 63 patients with miliary tuberculosis managed at a single centre between 1981 and 2005. A paradoxical reaction was defined as clinical or radiological worsening of an initially improving lesion, or development of a new lesion during appropriate therapy, after reasonable exclusion of treatment failure, drug resistance and alternative diagnoses.</p><p><strong>Results: </strong>Five of 63 patients (7.9%) developed six paradoxical reaction episodes. Manifestations included multiple subcutaneous abscesses, two small-intestinal perforations, two spontaneous pneumothoraces and progression of miliary nodules with new cavitary lesions. Reactions occurred 10-240 days after treatment initiation (median, 108 days). Five episodes required surgical or interventional management. The anti-tuberculosis regimen was continued without modification in every episode. One patient developed two reactions despite corticosteroid treatment for systemic lupus erythematosus. All patients recovered, with no recurrence during 4-24 months of follow-up.</p><p><strong>Conclusions: </strong>Paradoxical reactions in miliary tuberculosis may be anatomically diverse and life-threatening. Recognition of this pattern, together with careful exclusion of microbiological failure, can prevent unnecessary alteration of effective treatment while ensuring timely management of site-specific complications.</p>","PeriodicalId":14507,"journal":{"name":"Irish Journal of Medical Science","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149166520","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":"Increased skeletal muscle loss as a predictor of recurrence in postoperative lung cancer patients.","authors":"Zeynep Nilufer Tekin, Zeynep Bilgi","doi":"10.1007/s11845-026-04656-w","DOIUrl":"https://doi.org/10.1007/s11845-026-04656-w","url":null,"abstract":"<p><strong>Background: </strong>Skeletal muscle loss and sarcopenia are associated with adverse outcomes in patients with non-small cell lung cancer (NSCLC). However, the relationship between longitudinal postoperative changes in CT-derived skeletal muscle mass and cancer recurrence remains insufficiently explored.</p><p><strong>Aims: </strong>To evaluate longitudinal changes in CT-derived skeletal muscle mass at the T4 vertebral level after curative-intent resection for NSCLC and investigate their association with cancer recurrence.</p><p><strong>Methods: </strong>Patients who underwent anatomic or non-anatomic lung resection for NSCLC between January 2016 and December 2019 and were followed at the same institution were included. Preoperative and recurrence or last follow-up CT images were evaluated for skeletal muscle mass at the T4 level using the open-source software 3D Slicer.</p><p><strong>Results: </strong>Sixty-three patients were evaluated, including 44 with recurrence and 19 without recurrence. Mean time to recurrence was 21.1 ± 17.6 months, and mean follow-up in controls was 41.5 ± 10.0 months. Initial and recurrence/last follow-up skeletal muscle mass measurements were comparable between groups. However, mean monthly total skeletal muscle mass loss was significantly greater in patients with recurrence than in controls (135.68 ± 285.52 vs. 16.31 ± 31.53, respectively; p = 0.015). A monthly back muscle mass loss cut-off of ≥ 250.29 showed 79.5% sensitivity, 84.2% specificity, and an area under the curve of 0.840 for detecting recurrence. Loss above this cut-off was independently associated with recurrence (odds ratio = 12.583; 95% confidence interval: 2.41-65.66).</p><p><strong>Conclusions: </strong>Accelerated postoperative skeletal muscle loss was associated with NSCLC recurrence. Serial T4-level muscle assessment on routine surveillance CT may provide a practical supplementary marker for identifying patients at increased risk of recurrence.</p>","PeriodicalId":14507,"journal":{"name":"Irish Journal of Medical Science","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149166869","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":"Floating knee injuries: a retrospective analysis of treatment outcomes and prognostic factors.","authors":"Murat Taşcı, Furkan Uçar, Mustafa Murat Hakyoldaş","doi":"10.1007/s11845-026-04679-3","DOIUrl":"https://doi.org/10.1007/s11845-026-04679-3","url":null,"abstract":"<p><strong>Background/ aims: </strong>Floating knee injury is a rare high-energy trauma pattern frequently associated with concomitant organ injuries. Optimal treatment timing and the role of external fixation remain subjects of ongoing debate.</p><p><strong>Methods: </strong>Twenty-one patients who underwent surgery for ipsilateral femoral and tibial fractures were retrospectively reviewed. Fractures were classified using the Fraser and Gustilo-Anderson systems. Functional outcomes were assessed using the Karlström-Olerud criteria.</p><p><strong>Results: </strong>The mean age was 31 ± 12.1 years; 85% of patients were male. The mean follow-up was 66.6 months. The most common injury mechanism was motorcycle accident (71.4%). According to Karlström criteria, 76.1% of patients achieved excellent or good functional outcomes. External fixation was associated with significantly longer total hospital stay (p = 0.003) and higher superficial infection rates (60.0% vs. 6.3%, p = 0.028) however, this likely reflects greater initial injury severity in patients selected for this approach rather than a direct effect of the device. Patients requiring postoperative ICU admission had significantly higher complication rates (75% vs. 23.1%, p = 0.032). The Injury Severity Score (ISS) correlated significantly with operative time (rs = 0.549, p = 0.010). Delayed definitive surgery was associated with longer total hospital stay (rs = 0.492, p = 0.024) but had no effect on functional outcomes or complication rates. Fraser classification and Gustilo-Anderson grade did not significantly influence functional outcomes.</p><p><strong>Conclusion: </strong>Floating knee injuries carry significant morbidity despite favourable functional outcomes in the majority of patients. External fixation prolongs hospitalisation and increases infection risk, highlighting the importance of early conversion to definitive fixation in eligible patients. Postoperative ICU admission may serve as a useful indicator for heightened complication risk.</p>","PeriodicalId":14507,"journal":{"name":"Irish Journal of Medical Science","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149167571","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":"Multimorbidity patterns and outcomes among adults (non-maternity) with community-onset sepsis in Ireland: a retrospective national analysis of acute hospital data, 2020-2025.","authors":"Nandakumar Ravichandran, Diarmuid Quinlan, Patricia Fitzpatrick, Ellen Hayes, Mick Molloy, Etimbuk Umana, Tomas Breslin, Aoife Cotter, Walter Cullen","doi":"10.1007/s11845-026-04662-y","DOIUrl":"https://doi.org/10.1007/s11845-026-04662-y","url":null,"abstract":"<p><strong>Background: </strong>Community-onset sepsis accounts for most sepsis cases and frequently occurs in individuals with underlying comorbidity. While national analyses in Ireland have described its epidemiology, impact of multimorbidity and how comorbidities co-exist to form patterns remain poorly characterised.</p><p><strong>Objectives: </strong>To identify multimorbidity patterns among adult (non-maternity) episodes with community-onset sepsis and examine their association with critical care admission and in-hospital mortality.</p><p><strong>Methods: </strong>We conducted a secondary analysis of Hospital In-Patient Enquiry data from all acute public hospitals in Ireland from January 2020 to December 2025. Community-onset sepsis was defined using the present-on-admission flag. The sample comprised adult episodes aged ≥ 16 years excluding maternal admissions from conception to 6 weeks postpartum. K-means clustering identified patterns of co-occurring diseases. Multivariable logistic and negative binomial regression examined associations between patterns and outcomes.</p><p><strong>Results: </strong>Of 80,628 sepsis admissions, 58,101 (72.0%) were community-onset. Of these, 53,812 (93.0%) were adult (non-maternity); of these, 35,316 (65.6%) had at least one Charlson comorbidity. Five data-derived multimorbidity patterns were identified: metabolic-multimorbid (31%), oncological-dominant (29%), renal-metabolic (15%), progressive metabolic (13%) and cardiopulmonary (12%). Outcomes varied across patterns, with differences in critical care admission and in-hospital mortality. Cardiopulmonary pattern had the highest odds of in-hospital mortality (adjusted-OR 2.01, 95% CI 1.86-2.17).</p><p><strong>Conclusions: </strong>Charlson comorbidity was recorded in approximately two-thirds of adult community-onset sepsis episodes and formed data-derived patterns associated with differences in critical care admission and in-hospital mortality. Multimorbidity clustering may support future risk stratification research and targeted clinical vigilance for episodes at highest risk of adverse outcomes.</p>","PeriodicalId":14507,"journal":{"name":"Irish Journal of Medical Science","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149172286","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}