Irish medical journal最新文献_第8页

A National Experience in Paediatric Achalasia: Symptom Recurrence, Reintervention, and Transition Challenges. 儿童失弛缓症的国家经验：症状复发、再干预和过渡挑战。

Irish medical journal Pub Date : 2026-06-18

M Elifranji, W Fadel, M E A Ahmed, J Gillick

{"title":"A National Experience in Paediatric Achalasia: Symptom Recurrence, Reintervention, and Transition Challenges.","authors":"M Elifranji, W Fadel, M E A Ahmed, J Gillick","doi":"","DOIUrl":"","url":null,"abstract":"Aims: To assess the long-term outcomes and quality of life (QOL) of patients who underwent intervention for esophageal achalasia in a national Paediatric centre over an 18-year period.Methods: All patients who underwent surgical or radiological intervention after a diagnosis of achalasia between 2006 and 2024 were identified. A retrospective review of patient demographics, operative technique and Eckardt score before intervention was undertaken. Patients were contacted via telephone to re-assess QOL using Eckardt and Achalasia Scoring Questionnaire (ASQ) scoring systems.Results: In total, 31 patients were identified and 28 were included in the analysis (15 female and 13 male). The majority 21(75%) underwent laparoscopic Heller Myotomy. The mean age at intervention was 11.6 years. The mean duration of follow-up was 7.6 years. The mean pre-operative Eckardt score was 6.9. The mean post-operative Eckardt score was 2.9. Twenty-one patients (75%) were initially symptom free for an average of 17.4 months and 7 (25%) remain symptom free to this day. Eleven (39%) required further interventions. In terms of quality of life, the current mean ASQ score is 19.4 (scoring system 10-31, with 10 representing symptom free). Of the patients who are now adults, 12 (57%) had a formal transition of care to adult services.Conclusion: Although surgery may initially improve achalasia symptoms, it is not curative. Patients require lifelong follow-up and support to manage this challenging chronic condition. Ensuring patients are transitioned from Paediatric to adult services could help improve future QOL and tools such as ASQ could help monitor this in an outpatient setting.","PeriodicalId":14713,"journal":{"name":"Irish medical journal","volume":"119 6","pages":"111"},"PeriodicalIF":0.0,"publicationDate":"2026-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148317080","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

When Sepsis Kills: A Fatal Cascade of Invasive Group A Streptococcal Sepsis. 当脓毒症致死：侵袭性A组链球菌脓毒症的致命级联。

Irish medical journal Pub Date : 2026-06-18

N K Brulinska, M Harb, P Kiely

引用次数: 0

Fulminant Thrombotic Thrombocytopenic Purpura presenting through the FAST Stroke Pathway. 暴发性血栓性血小板减少性紫癜通过FAST卒中途径呈现。

Irish medical journal Pub Date : 2026-06-18

A Maroof, H Y R Huang, H Elsadig, S Maharaj, D Elderderi, N A B Ibrahim, T Ayeni, L Murray, P Kiely, F Malik

{"title":"Fulminant Thrombotic Thrombocytopenic Purpura presenting through the FAST Stroke Pathway.","authors":"A Maroof, H Y R Huang, H Elsadig, S Maharaj, D Elderderi, N A B Ibrahim, T Ayeni, L Murray, P Kiely, F Malik","doi":"","DOIUrl":"","url":null,"abstract":"Presentation: A previously healthy woman in her mid-40s of African ancestry presented with sudden-onset left-sided weakness, aphasia, and collapse. On arrival, she was disoriented with a fluctuating GCS of 9-11. Neurological assessment revealed speech impairment and limb weakness.Diagnosis: CT brain showed multifocal parietal and cerebellar infarctions. Laboratory tests revealed severe thrombocytopenia (20 × 10³/mm³), anaemia (Hb 9 g/dL), elevated creatinine (180 μmol/L), and high troponins (1139 ng/L). Peripheral smear confirmed red cell fragmentation, and ADAMTS13 activity was <10%, confirming fulminant Thrombotic Thrombocytopenic Purpura (TTP).Treatment: Thrombolysis was contraindicated due to profound thrombocytopenia, and intensive supportive care was initiated, including vasopressors, transfusions, and planned plasma exchange. Despite aggressive management, she developed hemodynamic collapse and died within 24 hours.Discussion: This case highlights fulminant TTP mimicking acute stroke, emphasizing the importance of early recognition in patients with severe thrombocytopenia. Prompt multidisciplinary intervention and TTP-specific therapy are essential to improve survival outcomes.","PeriodicalId":14713,"journal":{"name":"Irish medical journal","volume":"119 6","pages":"113"},"PeriodicalIF":0.0,"publicationDate":"2026-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148317154","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Long-term impact of haemorrhoidal artery ligation on anal function and continence. 痔动脉结扎术对肛门功能及尿失禁的长期影响。

Irish medical journal Pub Date : 2026-06-18

A Anwar, S Abushara, M Naseem, C Rampersad, S Casey, A Arif

{"title":"Long-term impact of haemorrhoidal artery ligation on anal function and continence.","authors":"A Anwar, S Abushara, M Naseem, C Rampersad, S Casey, A Arif","doi":"","DOIUrl":"","url":null,"abstract":"Aims: Haemorrhoidal artery ligation (HALO) and variants including Doppler-guided HAL (DG-HAL), HAL with rectoanal repair (HAL-RAR), and transanal haemorrhoidal dearterialisation (THD) serve as minimally invasive alternatives to excisional haemorrhoidectomy, reducing pain while preserving sphincter function. Long-term faecal incontinence remains a concern due to its quality-of-life impact. This systematic review assessed prevalence, severity, and patterns of incontinence beyond six months post-procedure across HAL techniques.Methods: PRISMA 2020 guidelines directed searches of PROSPERO, MEDLINE, PubMed, Scopus, Cochrane Library, and ScienceDirect for 2015-2024 studies reporting continence >6 months after HAL-based procedures. Six studies (3 RCTs, 1 prospective, 2 retrospective cohorts; total n=671 patients) met PICOS criteria, with Wexner Incontinence Scores reported or retrospectively mapped. Quality appraisal used CASP Cohort Checklist.Results: Seventeen (2.5%) of 671 patients developed postoperative faecal incontinence. Of these, 14 (82%) cases were mild (Wexner 1-4) and transient, resolving within 3-6 months; 3 (18%) were moderate (Wexner 5-8), primarily in HAL-RAR (9/158 [5.7%]). Standard HAL showed 0/76 (0%) cases; THD had 1/104 (1.0%); DG-HAL had 7/293 (2.4%). No severe incontinence occurred.Discussion: HALO techniques demonstrate excellent long-term continence safety (overall 2.5% low-grade incontinence). HAL-RAR's higher risk (5.7%) warrants counselling. Standardised scoring and multicentre trials are recommended.","PeriodicalId":14713,"journal":{"name":"Irish medical journal","volume":"119 6","pages":"109"},"PeriodicalIF":0.0,"publicationDate":"2026-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148316963","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

The Sugar-Sweetened Beverage Tax (Sugar Tax): Innovation and Stasis. 含糖饮料税（糖税）：创新与停滞。

Irish medical journal Pub Date : 2026-06-18

F Houghton, J M Stritch, J Auerbach, D Houghton, M Daly

引用次数: 0

Reducing Anaesthesia's Carbon Footprint: A Survey of Awareness and Attitudes. 减少麻醉的碳足迹：意识和态度的调查。

Irish medical journal Pub Date : 2026-06-18

H Anderson, A Goodings, O Nordrum, G Iohom

{"title":"Reducing Anaesthesia's Carbon Footprint: A Survey of Awareness and Attitudes.","authors":"H Anderson, A Goodings, O Nordrum, G Iohom","doi":"","DOIUrl":"","url":null,"abstract":"Aims: This study aimed to explore Irish anaesthesiologists' attitudes toward environmentally sustainable anaesthesia, including perceptions of safety, efficacy, and policy influences on anaesthetic choice.Methods: A cross-sectional online survey was distributed to anaesthesiologists across Ireland between March and June 2025. The questionnaire assessed demographic factors, preferences for intravenous versus inhalational anaesthesia, environmental awareness, and institutional support. Descriptive and comparative statistical analyses were performed.Results: A total of 98 responses were received. Patient factors and ease of administration were the primary determinants of anaesthetic choice, while cost was less influential. Environmental considerations were common, with 71 (72%) reporting they consider environmental impact when selecting an anaesthetic technique. Most respondents (n=86, 88%) were willing to modify their practice to reduce environmental harm, yet 55 (56%) felt their institution did not provide adequate environmental education or guidance.Discussion: Irish anaesthesiologists demonstrate strong awareness and willingness to engage in sustainable practice, but institutional training and policy support remain limited. Targeted education and system-level initiatives may enhance environmentally responsible anaesthetic care.","PeriodicalId":14713,"journal":{"name":"Irish medical journal","volume":"119 6","pages":"110"},"PeriodicalIF":0.0,"publicationDate":"2026-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148316876","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Regional Anaesthesia for Tibial Fracture Surgery in the Third Trimester of Pregnancy. 妊娠晚期胫骨骨折手术的区域麻醉。

Irish medical journal Pub Date : 2026-06-18

A Duncan, B O'Donnel

引用次数: 0

Establishing Ireland's Healthcare Greenhouse Gas Baseline: Key Findings, Implications, and Future Directions. 建立爱尔兰的医疗保健温室气体基线：主要发现，影响和未来的方向。

Irish medical journal Pub Date : 2026-06-18

O L Nordrum, T M O'Dowd, M M Brennan, B Bond, R Breen, N D McCarthy, M F Chersich, D O'Donovan, P Kavanagh

引用次数: 0

Children Admitted with Pertussis Over a One-Year Period. 一年内因百日咳住院的儿童。

Irish medical journal Pub Date : 2026-06-18

A Dore, P Valla, B Scanlan, E Kitt, R Cunney, A Habington, M O'Reilly, S Kelleher, S Harty

{"title":"Children Admitted with Pertussis Over a One-Year Period.","authors":"A Dore, P Valla, B Scanlan, E Kitt, R Cunney, A Habington, M O'Reilly, S Kelleher, S Harty","doi":"","DOIUrl":"","url":null,"abstract":"Aims: This study examines cases of Bordetella pertussis admitted to a tertiary hospital in Dublin, Ireland over a one-year period. Described are the demographics, clinical features, severity, morbidity, clinical course and vaccination status of patients.Methods: This retrospective cohort study included all children admitted with pertussis from January 2024 to December 2024 inclusive. Data were collected from patient records and analysed with descriptive statistics.Results: Of the 26 children admitted, 20 (76.9%) were <6 months of age. Median length of stay was 7 days and 3 (11.5%) required readmission. Oxygen supplementation was required in 10 (38.4%) cases and intravenous hydration for >48 hours in 11 (42.3%). The pertussis severity score (PSS) was >5 (severe) in 18 (69.2%). Vaccine eligible children comprised 16 of 26 cases (61.5%). Vaccination status was documented in 24 children; 13 (54.1%) were unvaccinated against pertussis, with 10 (76.9%) ineligible due to age. Vaccination was completed in 4 (16.7%), and 7 (29.1%) were partially vaccinated. Maternal vaccination status was documented in 15 cases, 3 (20.0%) received antenatal vaccination.Conclusion: Pertussis is associated with significant morbidity particularly in infants. Many children are admitted before full vaccination highlighting the importance of maternal antenatal pertussis vaccination.","PeriodicalId":14713,"journal":{"name":"Irish medical journal","volume":"119 6","pages":"105"},"PeriodicalIF":0.0,"publicationDate":"2026-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148317159","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

A review of a perinatal genetics and genomics service's role in prenatal diagnosis. 围产期遗传学和基因组学服务在产前诊断中的作用综述。

Irish medical journal Pub Date : 2026-06-18

G McMahon, T Rigney, S Doyle

{"title":"A review of a perinatal genetics and genomics service's role in prenatal diagnosis.","authors":"G McMahon, T Rigney, S Doyle","doi":"","DOIUrl":"","url":null,"abstract":"Aims: The aim of this study was to review prenatal anomaly cases referred to the Department of Perinatal Genetics and Genomics at the National Maternity Hospital.Methods: We conducted a retrospective review of all patients who were referred to the Department between August 2021 to April 2025. We included cases referred for consideration of further genetic testing because of a fetal anomaly where initial QF-PCR and chromosomal microarray studies did not reveal a genetic diagnosis.Results: There were 109 patients who met our inclusion criteria. A molecular diagnosis was made in 56 (51.4%) of this cohort. These diagnoses were apparently de novo in 35 cases (62.5%) and inherited in 21 (37.5%). Pregnancy outcomes showed 31 cases (28.4 %) had a livebirth surviving the neonatal period.Discussion: Our findings demonstrate the high diagnostic yield and clinical value of a dedicated Perinatal Genetics and Genomics service as part of the multi-disciplinary team for prenatal diagnosis. These cases all have a higher rate of recurrence in subsequent pregnancies compared to the empiric risk, indicating a need for ongoing genetics counselling in subsequent pregnancies. This data also indicates a high proportion of these patients experience a fetal or neonatal loss and that appropriate psychological input is needed.","PeriodicalId":14713,"journal":{"name":"Irish medical journal","volume":"119 6","pages":"107"},"PeriodicalIF":0.0,"publicationDate":"2026-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148317078","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0