Irish Journal of Medical Science最新文献

{"title":"Role of shearing wave elastography in detecting early diabetic nephropathy.","authors":"Amr M Shaker, Shaza Y Sleem, Mayssa I Aly, Asmaa H Habib, Mona G Hassan","doi":"10.1007/s11845-025-03897-5","DOIUrl":"https://doi.org/10.1007/s11845-025-03897-5","url":null,"abstract":"<p><strong>Background: </strong>Diabetes mellitus is one of the systemic diseases affecting the kidneys that eventually develop end-stage kidney disease. Shear wave elastography (SWE) is a reliable and non-invasive ultrasonography test used to determine tissue elasticity. The aim of this study is to detect early diabetic nephropathy by measuring renal stiffness using shear wave elastography (SWE), renal resistivity indices, and laboratory findings in DN patients.</p><p><strong>Methods: </strong>Shear wave elastography and color duplex sonography assessments were performed in 60 diabetic nephropathy patients (divided according to eGFR into 3 stages: stage I-II-III diabetic nephropathy with equal groups of 20 patients in each stage) and 20 healthy age-matched control subjects. The SWE-derived mean value of the tissue stiffness, given in kilopascals (kPa), was correlated to patients' clinico-laboratory data (serum creatinine and eGFR) and resistive index.</p><p><strong>Results: </strong>There is a statistically significant increase in SWE and RI in the diabetic group than control group and a statistically significant increase in SWE (mean) in CKD stage II and III when compared with CKD stage I, SWE can be used to discriminate between diabetic groups and control group at a cutoff level of > 10.5 (kPa), and also, SWE (mean) can be used to discriminate between CKD stage II and III patients at a cutoff level of > 41 (kPa), with 66.7% sensitivity and 64.9% specificity.</p><p><strong>Conclusion: </strong>Shear wave elastography is a sensitive, non-invasive, and specific diagnostic tool for the detection of diabetic nephropathy and differentiation between different stages of DN.</p>","PeriodicalId":14507,"journal":{"name":"Irish Journal of Medical Science","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143255317","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":"Neurologists' perspectives of cannabis-based medicines: results from an all-Ireland survey.","authors":"Michael Savio, Hugh Kearney, Eric J Downer","doi":"10.1007/s11845-025-03880-0","DOIUrl":"https://doi.org/10.1007/s11845-025-03880-0","url":null,"abstract":"<p><strong>Background: </strong>Advancements continue to be made in the development of medicines containing components of the Cannabis sativa L. plant. Consultants can prescribe specific cannabis-based products for a restricted set of indications in Ireland, with neurologists being at the forefront of therapy. Much debate on the therapeutic potential/efficacy of such cannabis-based products exists.</p><p><strong>Aim: </strong>The objective of this study was to conduct a national survey to determine the perspectives/views of Irish neurologists regarding the use of cannabis-based medicines.</p><p><strong>Methods: </strong>An online anonymous survey was conducted to capture the perspectives and experiences of neurologists in Ireland regarding cannabis-based therapeutics.</p><p><strong>Results: </strong>Thirty-four neurologists completed the survey in full, with study participants rating their knowledge of cannabis-based medicines as average. Data presented herein indicate that there is a need for educational programmes on the cannabinoid system and cannabinoid-based medicines, and the findings indicate that neurologists are interested in the use of cannabinoid-based medicines in their practice. Study participants were more divided with regard to the clarity of the process for accessing cannabis-based medicines, and the consensus is that the application process is unclear. Approximately one-third of participants have made an application to access medicinal cannabis-based products on behalf of a patient.</p><p><strong>Conclusions: </strong>Data presented herein indicates that the majority of neurologists surveyed are aware of the current systems in place to access cannabis-based products for medicinal use in Ireland and that some engagement with these systems has taken place. A key finding is that educational programmes on the cannabinoid system and cannabis-based medicines are required.</p>","PeriodicalId":14507,"journal":{"name":"Irish Journal of Medical Science","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143079975","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":"Functional outcomes of inspiratory muscle training in elderly with intensive care unit-acquired weakness and severe walking disability.","authors":"Mushabbab Alahmari, Hany Farid Elsisi, Ali Mohamed Ali Ismail","doi":"10.1007/s11845-025-03876-w","DOIUrl":"https://doi.org/10.1007/s11845-025-03876-w","url":null,"abstract":"<p><strong>Background: </strong>Intensive care unit acquired-weakness syndrome (ICUAWS) leaves several complications in functional movements of patients such as severe walking disability.</p><p><strong>Objective: </strong>Assessment of functional outcomes of 1-month inspiratory muscle training (IMT) in elderly with ICUAWS and severe walking disability was our aim. The design, setting, participants, and intervention. This study is a randomized controlled trial. ICUAWS patients who complained of severe walking disability on the Modified Functional Ambulatory Category Test (MFACT) were randomly assigned into the IMT group or control group, n = 20 for each group. Both groups received the traditional physical therapy program.</p><p><strong>Results: </strong>The results showed that the post-therapy between-group comparison of ICUAWS sufferers/groups' parameters showed a significant improvement toward the IMT group in six-minute walk test, inspiratory and expiratory muscle strength, forced vital capacity, time up and go test, 10-m walk test, forced expiratory volume in the first second, 30-s sit-to-stand test, partial pressure of arterial blood oxygen and carbon dioxide, MFACT, oxygen saturation of arterial blood, physical, and mental summary of short form 36.</p><p><strong>Conclusion: </strong>In conclusion, IMT improves functional outcomes in ICUAWS patients with walking disability.</p><p><strong>Trial registration number: </strong>The clinical trial ID of this ICUAWS trial is NCT06210763.</p>","PeriodicalId":14507,"journal":{"name":"Irish Journal of Medical Science","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143079971","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":"Hepatotoxicity in spaceflight: intrinsic and extrinsic risks for astronaut metabolic health.","authors":"Ethan Waisberg, Joshua Ong, Mouayad Masalkhi, Ben Cools, Ryung Lee, Mathieu Vinken, Andrew G Lee","doi":"10.1007/s11845-025-03884-w","DOIUrl":"https://doi.org/10.1007/s11845-025-03884-w","url":null,"abstract":"","PeriodicalId":14507,"journal":{"name":"Irish Journal of Medical Science","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143079972","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":"Determinants of acute psychiatric inpatient length of stay in Ireland.","authors":"Aoife Brick, Brendan Walsh, Leonie Hill, Caragh Behan, Antoinette Daly, Sarah Craig","doi":"10.1007/s11845-024-03819-x","DOIUrl":"10.1007/s11845-024-03819-x","url":null,"abstract":"<p><strong>Background: </strong>Ireland has had an historic over-reliance on inpatient mental health care accompanied by poorly resourced community provision. There has been an increasing policy focus on provision of mental health care in the community to facilitate diversion from, or shorten stays in, inpatient care. However, little is known about the determinants of psychiatric inpatient length of stay (LOS) to allow for the targeting of community services.</p><p><strong>Aim: </strong>To use a large cross-sectional national dataset to examine the determinants of psychiatric inpatient LOS in the Irish context.</p><p><strong>Methods: </strong>Using information on 60,607 discharges from adult acute psychiatric units in Ireland between 2015 and 2019, the study employs both descriptive and regression analysis. Using negative binomial regression models, we control for patient demographic, socioeconomic, and clinical characteristics. In addition, as LOS may be related to provision of non-acute services in the patient area of residence, the analysis also controls for aspects of community service provision.</p><p><strong>Results: </strong>The study finds that longer LOS is associated with older age, being female, and having an involuntary admission. Clinical diagnosis significantly impacts LOS, with diagnoses such as schizophrenia being associated with longer LOS. There is also significant variation in LOS across region of residence, with discharges from some regions staying up to 5 days longer.</p><p><strong>Conclusions: </strong>The regional variation observed in inpatient LOS supports the assumption that increased provision of community services diverts or reduces the quantum of care required in inpatient settings. However, without substantive improvement in the community data collected and reported, future planning of mental health services, both community and inpatient, will be substantially curtailed.</p>","PeriodicalId":14507,"journal":{"name":"Irish Journal of Medical Science","volume":" ","pages":"211-223"},"PeriodicalIF":1.7,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142465541","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":"Application of norepinephrine in the treatment of septic shock: a meta-analysis.","authors":"Qiu Ying Xu, Yan Hong Jin, Li Fu, Ying Ying Li","doi":"10.1007/s11845-024-03827-x","DOIUrl":"10.1007/s11845-024-03827-x","url":null,"abstract":"<p><strong>Objective: </strong>To systematically evaluate the efficacy and safety of norepinephrine in the treatment of septic shock.</p><p><strong>Methods: </strong>Literature retrieval of eligible randomized controlled trials (RCTs) on norepinephrine in the treatment of septic shock was performed in three English databases including PubMed, Web of Science, and Medline from database establishment to October 1, 2023. The Cochrane risk bias tool was used to evaluate the quality of the included literature. RevMan 5.3 software was used for meta-analysis.</p><p><strong>Results: </strong>A total of 14 RCTs were included in this study, and the risk of bias was low. Our meta-analysis showed that the norepinephrine group had significantly better outcomes in reducing the 28-day mortality rate (RR = 0.92; 95% CI, 0.86 ~ 0.99; P = 0.03), the incidence of arrhythmia (RR = 0.54; 95% CI, 0.45 ~ 0.64; P < 0.0001), and the length of stay in intensive care unit (ICU) (MD =  - 1.03; 95% CI, - 1.85 to approximately - 0.21; P = 0.01) than those of the control group. However, there were no statistically significant differences in in-hospital mortality rate (RR = 0.97; 95% CI, 0.90 ~ 1.04; P = 0.4), the 90-day mortality rate (RR = 1.07; 95% CI, 0.97 ~ 1.18; P = 0.15), length of hospital stay (MD = 0.03; 95% CI, - 1.13 ~ 1.18; P = 0.96), and the rate of achieving target MAP (RR = 1.27; 95% CI, 0.72 ~ 2.26; P = 0.41) between the norepinephrine group and the control group.</p><p><strong>Conclusion: </strong>Norepinephrine has the advantages of improving 28-day mortality, shortening ICU hospitalization time, and reducing the incidence of arrhythmia. It is a more effective choice for the treatment of septic shock than other vasopressors, and the incidence of arrhythmia is low.</p>","PeriodicalId":14507,"journal":{"name":"Irish Journal of Medical Science","volume":" ","pages":"361-369"},"PeriodicalIF":1.7,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11861117/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142620556","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":"Challenges for neurodiverse children in acute medical hospitals and opportunities for the new National Children's Hospital to be 'neurodiversity-friendly'.","authors":"Laura Bond, Timothy Frawley, Kieran Moore, Blánaid Gavin, Fiona McNicholas","doi":"10.1007/s11845-024-03850-y","DOIUrl":"10.1007/s11845-024-03850-y","url":null,"abstract":"<p><p>Neurodiversity refers to the variation in human cognitive, sensory, and communication experiences and reframes deficits as differences. Rates and duration of hospitalisation in neurodiverse children are higher compared to their neurotypical peers. Despite increased admissions, paediatric medical hospitals are poorly equipped to adequately support their unique cognitive, sensory, behavioural, and communication needs, which can have negative impacts on the experiences of patients, families, and staff. The literature supports several innovative and inclusive strategies, which present exciting opportunities for Ireland's new National Children's Hospital (NCH) to become a 'neurodiversity-friendly paediatric hospital'.</p>","PeriodicalId":14507,"journal":{"name":"Irish Journal of Medical Science","volume":" ","pages":"253-261"},"PeriodicalIF":1.7,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142836668","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":"Outpatient flexible cystoscopy in urogynaecology: a tertiary hospital's experience.","authors":"Parijot Kumar, Saboohi Tariq, Siji Philip, Caroline Hendricken, Fadi Salameh","doi":"10.1007/s11845-025-03891-x","DOIUrl":"https://doi.org/10.1007/s11845-025-03891-x","url":null,"abstract":"<p><strong>Objective: </strong>This study is a retrospective evaluation of a new outpatient flexible cystoscopy service in a tertiary care hospital in Dublin, Ireland.</p><p><strong>Design: </strong>This is a retrospective observational study.</p><p><strong>Setting: </strong>This study has been held at the Department of Gynaecology, Rotunda Hospital, Dublin.</p><p><strong>Population: </strong>This included all women who underwent outpatient flexible cystoscopy in Rotunda Hospital between May 2023 to October 2024.</p><p><strong>Materials and methods: </strong>Retrospective data collection included patient demographics, indications for referrals, cystoscopic findings, post-procedural complications, and cost-benefit analysis.</p><p><strong>Results: </strong>A total of 77 women underwent flexible cystoscopy. The mean age was 52.5 years ranging from 20 to 85 years. Flexible cystoscopy was successfully completed in all patients, and there were no post procedure complications. The most common indications were as follows: recurrent urinary tract infections (36%) and bladder pain syndrome (36%), followed by overactive bladder symptoms (14%). Fifty-five percent of patients had no abnormal findings. The most common abnormality found was trabeculations (39%), followed by glomerulations (9%). A cost-benefit analysis showed an approximate saving of € 1211 per patient leading to a saving of over € 93,000 over a period of 18 months.</p><p><strong>Conclusion: </strong>Outpatient cystoscopy is a low-risk, feasible, well tolerated, and safe diagnostic procedure, with no post-procedure complications observed in this study. It avoids the risks of general anaesthesia and is associated with lower procedural costs.</p>","PeriodicalId":14507,"journal":{"name":"Irish Journal of Medical Science","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143074758","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":"Comparison of anti-gravity treadmill training and traditional treadmill training in patients with moderate to severe knee osteoarthritis: A randomized controlled trial.","authors":"Tuğba Atan, Yunus Emre Bildik, Yasin Demir, Ümüt Güzelküçük, Arif Kenan Tan","doi":"10.1007/s11845-024-03836-w","DOIUrl":"10.1007/s11845-024-03836-w","url":null,"abstract":"<p><strong>Background: </strong>Aerobic exercise is recommended to alleviate pain and protect the joint for patients with advanced knee osteoarthritis, however, its clinical implementation is challenging due to the potential for exacerbating pain.</p><p><strong>Aims: </strong>The study aimed to compare the effects of anti-gravity treadmill training with traditional treadmill training in patients with advanced knee osteoarthritis.</p><p><strong>Methods: </strong>This single-blinded randomized-controlled trial included 30 women with knee osteoarthritis. All participants received hotpack, transcutaneous electrical nerve stimulation, and therapeutic ultrasound. Additionally, group 1 received anti-gravity treadmill, while group 2 received traditional treadmill training. Group 3 served as the control. The interventions were administered three-times a week for eight-weeks. The visual analogue scale (VAS) pain, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), six-minute-walk-test distance (6MWD), and femoral cartilage thickness were evaluated at baseline and weeks 4 and 8.</p><p><strong>Results: </strong>VAS-pain significantly reduced over time in both anti-gravity (P < 0.001) and control (P = 0.004) groups. The anti-gravity group also showed significant improvements in WOMAC-pain (P = 0.008), WOMAC-total (P = 0.048), and 6MWD (P < 0.001). Post-hoc analysis indicated significant time (P < 0.001, effect size, ηp2 = 0.682) and interaction (P = 0.006, ηp2 = 0.271) effects on VAS, with no significant between-group differences. Femoral cartilage thickness showed no significant between-group differences, except within-group differences in the treadmill group (P = 0.037).</p><p><strong>Conclusions: </strong>Anti-gravity treadmill training significantly improved pain, functionality, and functional capacity in patients with knee osteoarthritis, while traditional treadmill resulted in a reduction in femoral cartilage thickness. Further research should investigate long-term outcomes and more diverse populations.</p><p><strong>Clinical trials identifier: </strong>NCT05319964.</p>","PeriodicalId":14507,"journal":{"name":"Irish Journal of Medical Science","volume":" ","pages":"125-136"},"PeriodicalIF":1.7,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142557841","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":"Outcomes of emergency colorectal surgery within a non-colorectal split site service-a retrospective cohort study.","authors":"Rebecca Swan, Emma MacVicar, Kate Carey, Dimitrios Damaskos, Nicholas Ventham","doi":"10.1007/s11845-024-03837-9","DOIUrl":"10.1007/s11845-024-03837-9","url":null,"abstract":"<p><strong>Background: </strong>Emergency colorectal surgery carries a high risk of morbidity and mortality. Subspecialisation and split-site geographically distinct services may lead to critically unwell patients presenting to a non-colorectal specialist centre requiring urgent on-site intervention.</p><p><strong>Aims: </strong>This study aims to determine outcomes of this high-risk patient cohort.</p><p><strong>Methods: </strong>An observational retrospective study of emergency colorectal laparotomies at the Royal Infirmary of Edinburgh (RIE) between January 2016 and August 2020 was performed. The primary outcome was 30-day mortality. Secondary outcomes included rate of primary anastomosis, complications and overall mortality. Subgroup analysis of the vascular ischaemia cohort and colorectal surgeon involvement was performed.</p><p><strong>Results: </strong>One hundred and eighteen patients were included. The median NELA (National Emergency Laparotomy Audit) score was 6.4% (IQR 2.5%-16.7%) and the 30-day mortality rate was 22% (26/118). The rate of primary anastomosis was 24.6%. Twenty-five patients had a vascular ischaemic pathology demonstrating a higher median NELA score (14.3%, IQR 5-22.4% vs. non-ischaemic group 5.7%, IQR 1.7-14.2%, p = 0.013) and thirty-day mortality (44%, 11/25 vs. 16.1%, 15/93, p = 0.006) than those without ischaemic pathology. Colorectal surgeon involvement in cases without ischaemia (23/93) was associated with a similar 30-day mortality (13.1% colorectal surgeon vs. 17.1% non-colorectal specialist surgeon, p = 0.755) and rate of primary anastomosis (30.4% colorectal surgeon vs. 31.8% non-colorectal specialist surgeon, p = 1).</p><p><strong>Conclusions: </strong>The high mortality rate described highlights a specific group of unwell patients unfit for transfer. Research registration number: researchregistry7101.</p>","PeriodicalId":14507,"journal":{"name":"Irish Journal of Medical Science","volume":" ","pages":"263-270"},"PeriodicalIF":1.7,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142604421","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}