Irish Journal of Medical Science最新文献

{"title":"Subclinical inflammation and early pathogenesis of rheumatic diseases: mechanistic insights relevant to primary care.","authors":"Wentong Wu, Yajing Liu, Xiaodong Wang, Jinxin Liu, Yuhua Su","doi":"10.1007/s11845-026-04590-x","DOIUrl":"https://doi.org/10.1007/s11845-026-04590-x","url":null,"abstract":"<p><p>Rheumatic diseases exhibit insidious onset and non-specific early manifestations, causing substantial diagnostic delays in primary care. This delay is closely linked to a prolonged subclinical inflammation phase, where pathogenic immune processes are active yet clinically inapparent. The mechanistic basis of this early disease concealment remains incompletely synthesized. Subclinical inflammation represents a state of persistent, low-grade immune activation in the absence of overt clinical signs, structural damage, or marked laboratory abnormalities. This phase is driven primarily by innate immune priming, sterile inflammation, and low-intensity cytokine signaling, which together sustain immune dysregulation below conventional diagnostic thresholds. Key processes include pattern recognition receptor activation, inflammasome signaling, modest but chronic cytokine production, and gradual erosion of immune tolerance. These mechanisms precede adaptive immune engagement, autoantibody maturation, and tissue-specific inflammation, thereby creating a temporal dissociation between molecular pathology and clinical expression. Disease-specific evidence from rheumatoid arthritis and systemic lupus erythematosus how subclinical inflammation constitutes a common early pathogenic state across diverse rheumatic conditions. Importantly, the heterogeneity and compartmentalization of early immune activation explain why routine clinical assessment and standard inflammatory markers frequently fail to detect active disease in primary care. By integrating current mechanistic insights, this review reframes diagnostic delay as a biologically driven phenomenon rather than a limitation of clinical practice. Understanding the mechanisms of subclinical inflammation provides a rational framework for risk-informed recognition and timely referral in primary care, with potential implications for improving long-term outcomes in rheumatic diseases.</p>","PeriodicalId":14507,"journal":{"name":"Irish Journal of Medical Science","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149074755","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":"Trends in mortality among patients with Rheumatoid arthritis and interstitial lung disease in the United States, 1999-2020, a population-based retrospective study.","authors":"Hrithik Mohan, Shagnik Ghosh, Siddharth Palanivel, Paul C Tom, John J Tina, Bestin M Mathew","doi":"10.1007/s11845-026-04649-9","DOIUrl":"https://doi.org/10.1007/s11845-026-04649-9","url":null,"abstract":"<p><strong>Background: </strong>Rheumatoid arthritis (RA) is a systemic autoimmune disorder that commonly involves the lungs, leading to interstitial lung disease (ILD). RA-associated ILD (RA-ILD) contributes substantially to morbidity and mortality.</p><p><strong>Aims: </strong>To examine long-term national trends and demographic patterns in mortality related to RA-ILD in the United States over a 22-year period.</p><p><strong>Methods: </strong>We performed a retrospective analysis using data from the Centers for Disease Control and Prevention Multiple Cause of Death database. Mortality records for adults aged ≥ 25 years were reviewed, identifying cases in which both RA and ILD were listed. RA was defined using ICD-10 codes M05-M06, and ILD using code J84. Age-adjusted mortality rates (AAMRs) per million populations were calculated.</p><p><strong>Results: </strong>A total of 7,435 deaths met inclusion criteria, yielding a crude mortality rate of 1.7 per 1,000,000 populations. Females accounted for most deaths (n = 4,730, 63.6%). White individuals represented 88.8% (n = 6,601) of deaths, followed by Black or African American individuals (7.2%). Most deaths occurred in metropolitan areas (n = 5956, 80.1%) and within medical facilities (n = 4455, 59.97%). AAMRs initially increased from 1999 to 2002 (annual percent change [APC] + 6.34%, p < 0.05), stabilized thereafter, and declined from 2008 to 2020 (APC - 1.34%, p < 0.05).</p><p><strong>Conclusions: </strong>RA-ILD mortality has demonstrated notable temporal changes in the U.S., with substantial demographic disparities. Despite therapeutic progress, pulmonary complications remain a significant cause of death in RA, underscoring the need for early ILD detection, coordinated rheumatology-pulmonology care, and improved access to specialized services.</p>","PeriodicalId":14507,"journal":{"name":"Irish Journal of Medical Science","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149074841","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":"Should we use the SARC-F score in sarcopenia screening in kidney transplant patients?","authors":"Mahmut Armagan, Nazife Nur Ozer Sensoy, Fatma Betul Guzel, Murat Sahin, Orcun Altunoren, Ozkan Gungor","doi":"10.1007/s11845-026-04648-w","DOIUrl":"https://doi.org/10.1007/s11845-026-04648-w","url":null,"abstract":"<p><strong>Background: </strong>The risk of sarcopenia is increased in kidney transplant (KT) patients. The SARC-F score is a reliable tool used for sarcopenia screening; however, it has not been tested in KT patients.</p><p><strong>Objective: </strong>The aim of our study is to assess the prevalence of sarcopenia in KT recipients and to investigate the relationship between the SARC-F score and sarcopenia parameters.</p><p><strong>Methods: </strong>The study included 150 KT patients. Body muscle mass was measured using the Tanita DC 360 ST device. Before these measurements, patients were scored using the five-question SARC-F assessment, and their scores were recorded.</p><p><strong>Results: </strong>28 patients were diagnosed with sarcopenia, yielding a sarcopenia prevalence of 18.7%. The mean age of the patients was 42.1 ± 13.5 years. Correlation analysis of SARC-F scoring results revealed a negative correlation between SARC-F and total muscle mass, muscle percentage, skeletal muscle mass, skeletal muscle index, grip strength, and walking speed parameters, as expected. Analysis of SARC-F scores showed that only 12 of the 150 patients had a SARC-F score greater than 4. Patients with a SARC-F score ≥ 4 had lower muscle percentage, total muscle mass, skeletal muscle mass, handgrip strength, and walking speed than those with a score < 4. However, only one of these patients met the criteria for sarcopenia.</p><p><strong>Conclusion: </strong>The findings of this study indicate that the SARC-F score is associated with muscle mass and strength parameters in KT patients and may be used as a screening tool. However, it is not sufficient as a standalone diagnostic tool for sarcopenia.</p>","PeriodicalId":14507,"journal":{"name":"Irish Journal of Medical Science","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149061351","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":"Hands on or held back? Procedural experience during a neonatal rotation in Ireland.","authors":"Hassan Shahid, Jan Miletin","doi":"10.1007/s11845-026-04628-0","DOIUrl":"https://doi.org/10.1007/s11845-026-04628-0","url":null,"abstract":"<p><strong>Background/ aims: </strong>Neonatology is a core component of paediatric training in Ireland and Europe. However, the procedural experience of Senior House Officers (SHOs) during neonatal rotations in Ireland has not previously been formally reported. Concerns have been raised regarding the impact of the European Working Time Directive (EWTD) on postgraduate medical training. At the Coombe Hospital, implementation of an EWTD-compliant rota reduced SHO on-call duties from 16 to 12 hours. This study aimed to describe the procedural experience of a Senior House Officer during a six-month neonatal rotation under a 12-hour EWTD-compliant rota.</p><p><strong>Methods: </strong>We retrospectively audited the clinical logbook of an SHO during a six month rotation (July-December 2024) at the Coombe Hospital, a Level III perinatal centre in Dublin.</p><p><strong>Results: </strong>The SHO attended 120 deliveries; 91% were term births and the remainder preterm, including four extremely preterm infants, with the earliest gestation attended being 22+5 weeks. The SHO participated in 12 neonatal resuscitations, acted as first responder on seven, and independently delivered intermittent positive pressure ventilation on four occasions. They completed 218 routine neonatal discharge examinations, identifying significant findings. Procedural exposure comprised six intravenous cannulations, 40 phlebotomies and one assisted umbilical line insertion. No opportunities arose for lumbar puncture, central line insertion or endotracheal intubation.</p><p><strong>Discussion/ conclusion: </strong>Although exposure to deliveries, neonatal resuscitation and newborn examinations was adequate, hands-on procedural experience was limited. As this rotation is often the only neonatal exposure before progressing to registrar level, reduced shift length may adversely affect training and the acquisition of core competencies.</p>","PeriodicalId":14507,"journal":{"name":"Irish Journal of Medical Science","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149061353","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":"Correction to: Why and how the long case became the OSLER-the sum of the parts.","authors":"Fergus Gleeson","doi":"10.1007/s11845-026-04615-5","DOIUrl":"https://doi.org/10.1007/s11845-026-04615-5","url":null,"abstract":"","PeriodicalId":14507,"journal":{"name":"Irish Journal of Medical Science","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149061288","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":"Teach-back versus video-assisted instruction for improving nursing students' knowledge, self-efficacy and skills in safe medical device use.","authors":"Züleyha Gürdap, Zeliha Cengiz","doi":"10.1007/s11845-026-04640-4","DOIUrl":"https://doi.org/10.1007/s11845-026-04640-4","url":null,"abstract":"<p><strong>Background: </strong>Nursing students' proficiency in medical device use is critical for patient safety. However, this training is often unstructured in nursing curricula, necessitating evidence-based practice.</p><p><strong>Aims: </strong>To compare the effects of teach-back and video-assisted instruction on nursing students' knowledge, self-efficacy, and skills in safe medical device use.</p><p><strong>Methods: </strong>A randomized controlled trial with a repeated-measures design was conducted among 91 final-year nursing students (teach-back = 31, video = 30, control = 30). Training focused on bedside monitors, infusion pumps, and suction devices. Knowledge, self-efficacy, and skills were assessed.</p><p><strong>Results: </strong>The findings indicated that the teach-back and video-assisted teaching groups had significantly higher average scores in knowledge, self-efficacy, and skills than the control group (p < 0.001). Although no statistically significant difference was found between the teach-back and video-assisted teaching groups regarding knowledge and skills scores (p > 0.05), the self-efficacy scores were significantly higher in the teach-back group (p < 0.05).</p><p><strong>Conclusions: </strong>Both teach-back and video-assisted instruction significantly improved nursing students' knowledge, self-efficacy, and psychomotor skills in safe medical device use compared to the control group. While both methods were equally effective in knowledge and skill acquisition, teach-back demonstrated a superior effect in enhancing self-efficacy. Given their complementary strengths, future educational strategies could explore integrating video-assisted instruction with teach-back to optimize both skill competency and self-efficacy.</p><p><strong>Trial registration: </strong>NCT05354687.</p>","PeriodicalId":14507,"journal":{"name":"Irish Journal of Medical Science","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149038647","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":"NMR-based metabolic profiling in urine for bipolar disorder manic episode.","authors":"Talha Ağaç, Fatmanur Köktaşoğlu, Halime Dulun Ağaç, Metin Demirel, Şahabettin Selek, Somer Bekiroğlu, Mustafa Solmaz","doi":"10.1007/s11845-026-04632-4","DOIUrl":"https://doi.org/10.1007/s11845-026-04632-4","url":null,"abstract":"<p><strong>Background: </strong>Bipolar disorder is a chronic psychiatric condition characterised by recurrent manic, hypomanic, and depressive episodes. Despite its substantial burden, Bipolar disorder lacks validated biological biomarkers, and diagnosis continues to rely on subjective clinical assessment. Urinary metabolomics-based nuclear magnetic resonance spectroscopy offers a non-invasive approach to characterising systemic metabolic alterations associated with psychiatric illness.</p><p><strong>Aims: </strong>This study aimed to annotate urinary metabolic alterations and dysregulated metabolic pathways in patients with Bipolar disorder during a manic episode, compared with healthy controls, using an untargeted H1NMR metabolomics approach.</p><p><strong>Methods: </strong>First-morning urine samples were collected from 19 patients experiencing a manic episode and 27 healthy controls. Metabolite annotation was supported by one- and two-dimensional NMR spectroscopy and database matching. Between-group differences were assessed using the limma moderated t-test with Benjamini-Hochberg false discovery rate correction. Multivariate analyses included principal component analysis, PERMANOVA, and exploratory orthogonal partial least-squares discriminant analysis. Pathway enrichment and topology analysis were performed using MetaboAnalyst 6.0.</p><p><strong>Results: </strong>After FDR correction, uracil and taurine were significantly decreased in the manic episode group. Pathway analysis annotated five significantly enriched pathways: taurine and hypotaurine metabolism, primary bile acid biosynthesis, pyrimidine metabolism, pantothenate and CoA biosynthesis, and β-alanine metabolism. Multivariate analyses revealed a statistically significant but modest group-related metabolic difference, with limited discriminatory performance in OPLS-DA modelling.</p><p><strong>Conclusion: </strong>This pilot study annotated exploratory urinary metabolic alterations in treated patients with BD during a manic episode. These findings are hypothesis-generating and require validation in larger, longitudinal, independent cohorts.</p>","PeriodicalId":14507,"journal":{"name":"Irish Journal of Medical Science","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149038730","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 relationship between maternal c-type natriuretic peptide levels and fetal growth restriction.","authors":"Sercan Serin, Emine Ahu Koç, Sakine Merve Aydın, Gökhan Ünver, Bahattin Avcı","doi":"10.1007/s11845-026-04645-z","DOIUrl":"https://doi.org/10.1007/s11845-026-04645-z","url":null,"abstract":"<p><strong>Objective: </strong>To investigate maternal serum C-type natriuretic peptide (CNP) levels in pregnancies with different fetal growth patterns and to evaluate the ability of CNP to discriminate pathological fetal growth restriction (FGR) from non-pathological fetal smallness.</p><p><strong>Methods: </strong>This prospective study included 180 singleton pregnancies classified as appropriate-for-gestational-age, constitutionally small with normal Doppler, or pathological FGR with abnormal Doppler. Maternal serum) levels were measured, and appropriate statistical methods were applied to evaluate their ability to distinguish pathological FGR from non-pathological smallness.</p><p><strong>Results: </strong>Maternal age, gravidity, and parity were similar across groups (p > 0.05), while BMI differed significantly (p < 0.001). Gestational age at delivery and birth weight decreased progressively from Group 1 to Group 3 (p < 0.001). Maternal serum CNP levels varied significantly (p < 0.001), being highest in pathological FGR. Post-hoc analysis confirmed higher CNP in Group 3 versus Groups 1 and 2 (p < 0.001), with a smaller difference between Groups 1 and 2 (p = 0.039). CNP correlated negatively with gestational age (r = - 0.277) and birth weight (r = - 0.466) (p < 0.001). ROC analysis showed excellent accuracy for detecting pathological FGR (AUC = 0.908, 95% CI: 0.857-0.959), with a cutoff of 644.3 pg/mL yielding 95% sensitivity and 80.8% specificity.</p><p><strong>Conclusion: </strong>Maternal serum CNP levels are significantly elevated in pregnancies with pathological fetal growth restriction but not in constitutionally small fetuses. This suggests that CNP reflects placental insufficiency rather than normal smallness and may serve as a useful biomarker to differentiate pathological from non-pathological fetal growth.</p>","PeriodicalId":14507,"journal":{"name":"Irish Journal of Medical Science","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149038835","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":"Correction to: Cocaine-induced pseudo-granulomatosis polyangiitis - Irish rhinologic society guidelines.","authors":"Niall McInerney, Shawkat Abdulrahman, Mark Little, Mona Thornton","doi":"10.1007/s11845-026-04616-4","DOIUrl":"https://doi.org/10.1007/s11845-026-04616-4","url":null,"abstract":"","PeriodicalId":14507,"journal":{"name":"Irish Journal of Medical Science","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149038736","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":"Effect of preoperative pain neuroscience education on pain catastrophizing and early recovery following upper extremity orthopaedic surgery: a randomized controlled trial.","authors":"Gamze Torun, Şüheda Özkan, Koray Şahin","doi":"10.1007/s11845-026-04629-z","DOIUrl":"https://doi.org/10.1007/s11845-026-04629-z","url":null,"abstract":"<p><strong>Background: </strong>Pain Neuroscience Education (PNE) aims to reconceptualize pain by addressing its neurophysiological and biopsychosocial dimensions to improve perioperative outcomes.</p><p><strong>Aim: </strong>To investigate the effect of preoperative PNE on postoperative pain catastrophizing in patients undergoing upper extremity orthopaedic surgery. Secondary outcomes included preoperative anxiety, pain intensity, central sensitization, upper extremity function, and health-related quality of life.</p><p><strong>Methods: </strong>Thirty-three patients were randomized to a PNE group (n = 17), receiving a single session supported by metaphors and visuals, or a control group (n = 16). Both groups received standard preoperative care. Pain catastrophizing was the predefined primary outcome. Anxiety was assessed before and after education, while pain intensity, pain catastrophizing, central sensitization, function, and quality of life were assessed preoperatively and four weeks postoperatively.</p><p><strong>Results: </strong>Groups were comparable at baseline. No significant between-group differences were observed in postoperative pain catastrophizing, although both groups demonstrated significant within-group improvements over time. Likewise, preoperative anxiety decreased significantly within the PNE group (p = 0.012), no significant between-group difference was observed. Compared with the control group, participants receiving PNE demonstrated significantly greater improvements in central sensitization (p = 0.004), upper extremity function (p = 0.008), and the physical component of health-related quality of life (p = 0.023) at four weeks after surgery.</p><p><strong>Conclusion: </strong>Although PNE did not improve pain catastrophizing, it was associated with greater improvements in central sensitization, function, and physical quality of life. These findings suggest that multi-session or more comprehensive PNE protocols may be needed to achieve meaningful psychological benefits.</p>","PeriodicalId":14507,"journal":{"name":"Irish Journal of Medical Science","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149030421","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}