Sokay A, Crupper J, Doolan A
… +15 more, Burke S, Iatan M, Halpenny L, Giva S, Joyce R, Byrne S, Verdon S, Hanoudi J, Miramontes IM, Dimakos M, Bout N, White M, Curley A, McCallion N, Hourihane J
Slowey J, Geraghty K, Killeen E
… +3 more, Akhtar A, Farrell T, Williams D
Ir Med J
· 2026 May · PMID 42181978
PRESENTATION: A 41-year-old male patient presented to the emergency department (ED) with left sided headache, radiating to the left ear while also complaining of dizziness. A non-contrast CT brain, performed during a pre...PRESENTATION: A 41-year-old male patient presented to the emergency department (ED) with left sided headache, radiating to the left ear while also complaining of dizziness. A non-contrast CT brain, performed during a previous presentation five days earlier, was normal. On his second presentation, the patient displayed clinical signs of carotid artery dissection including left sided partial Horner's syndrome. DIAGNOSIS: A CT Intracranial angiogram revealed a likely left internal carotid artery (ICA) dissection. TREATMENT: The patient was commenced on dual antiplatelet therapy. DISCUSSION: As the headache caused by dissection has no specific features, it can resemble that of cluster headache or migraine, which may mislead clinicians. However, the presence of ipsilateral neck pain or headache and a partial Horner's syndrome followed by retinal or cerebral ischaemic are indicative of carotid artery dissection. Due to the bleeding risks of anticoagulation versus antiplatelet therapy, an individualised therapeutic approach is recommended.
PRESENTATION: A 29-year-old primigravida woman (G1P0) with a BMI of 35.2 presented at 38+3 weeks with severe edema extending from lower abdomen to her thighs, and vulval edema predominantly right-sided, and associated wi...PRESENTATION: A 29-year-old primigravida woman (G1P0) with a BMI of 35.2 presented at 38+3 weeks with severe edema extending from lower abdomen to her thighs, and vulval edema predominantly right-sided, and associated with difficulty mobilizing. Her BP was 160/94 mmHg. She had a prior diagnosis of gestational hypertension that progressed to preeclampsia. DIAGNOSIS: Investigations revealed an elevated urine protein-creatinine ratio (PCR 103 mg/Mmol), elevated serum uric acid (399), and thrombocytosis (platelet count 447). Serial PET screening confirmed a diagnosis of preeclampsia. TREATMENT: Labetalol was increased to 200 mg TDS. Due to worsening edema and functional impairment, an elective Caesarean section was performed, resulting in the delivery of a healthy 4 kg baby girl. Postoperatively, the patient developed an enlarging vulval swelling (15×10 cm) and her pain unrelenting to pain relief and impaired mobility hence it was drained under local anaesthesia yielding 250 mL of serous fluid. She was treated with oral antibiotics and discharged with improved condition. DISCUSSION: Massive vulval edema is a rare but distressing complication of preeclampsia, reported in very few global cases. This is the first documented case in Ireland, highlighting the importance of recognizing atypical presentations in hypertensive disorders of pregnancy. Timely intervention led to favourable maternal and foetal outcomes.
PRESENTATION: A previously healthy, 42-year-old female patient presented to the Emergency Department with a five-day history of widespread urticarial rash. The patient complained of widespread joint pain with bilateral u...PRESENTATION: A previously healthy, 42-year-old female patient presented to the Emergency Department with a five-day history of widespread urticarial rash. The patient complained of widespread joint pain with bilateral upper limb oedema noted on clinical examination. DIAGNOSIS: Core bloods revealed raised WCC and CRP. CT chest and neck were performed which revealed an 8mm left supraclavicular node with haziness of the surrounding fat along with low attenuation extending between the left deltoid and infraspinatus muscles (Figure 1). The CT radiological findings were atypical and MRI with Gadolinium contrast was recommended which confirmed the diagnosis of myositis and fasciitis. TREATMENT: Intravenous glucocorticoid therapy along with broad spectrum antimicrobial treatment were provided with clinical improvement over a six-day period. DISCUSSION: This case highlights both the limitations of radiological imaging in isolation and the importance of interdisciplinary collaboration to provide an appropriate diagnosis and management plan. This patient improved clinically following combined treatment for both inflammatory and infectious aetiology while more advanced diagnostics were performed over a protracted time period.
Varghese S, Cinnamond K, Malek B
… +2 more, McMonagle E, Casserly L
Ir Med J
· 2026 May · PMID 42180434
PRESENTATION: A 42-year-old man presented with a four-week history of nausea, vomiting, and abdominal pain, ultimately attributed to chronic overuse of calcium carbonate tablets for gastroesophageal reflux disease (GORD)...PRESENTATION: A 42-year-old man presented with a four-week history of nausea, vomiting, and abdominal pain, ultimately attributed to chronic overuse of calcium carbonate tablets for gastroesophageal reflux disease (GORD). DIAGNOSIS: Diagnostic evaluation revealed hypercalcaemia, metabolic alkalosis, and acute kidney injury, necessitating intravenous fluid administration and cessation of calcium carbonate tablet consumption. Comprehensive investigations excluded alternative aetiologies, confirming Milk-Alkali Syndrome (MAS). TREATMENT: Management involved cessation of calcium carbonate intake, aggressive intravenous fluid administration, and a single 4 mg dose of zoledronic acid. The patient was discharged with esomeprazole. His serum calcium normalised within six days, and creatinine showed further improvement at the 18-month follow-up, underscoring the importance of prompt recognition and intervention. DISCUSSION: This case emphasizes the need for awareness among healthcare providers regarding MAS as a potential consequence of over-the-counter antacid use and underscores the importance of vigilant medication history review and patient education to prevent MAS-related complications.
O'Brien J, McCarthy K, Corcoran R
… +4 more, Roberts C, O'Hanrahan N, McConnell R, Carr P
Ir Med J
· 2026 May · PMID 42179974
AIMS: There is limited understanding of the impact of parenthood on doctors in medical training in Ireland. We aimed to identify key challenges faced by trainees focusing on childcare, breast-feeding, the return to work,...AIMS: There is limited understanding of the impact of parenthood on doctors in medical training in Ireland. We aimed to identify key challenges faced by trainees focusing on childcare, breast-feeding, the return to work, and the impact of parenthood on medical careers and training. METHODS: This study was a multi-centre, cross-sectional survey of parents in medical training in a national medical training body. All 1,849 trainees were invited to participate through email. A survey was created and distributed using the online survey platform Qualtrics. Descriptive statistical analysis was performed using the survey platform. RESULTS: Two hundred five trainees met the inclusion criteria of being a parent whilst in medical training. 131/205 (63%) were required to live away from their families during their training. 178/191 (93%) reported that childcare limitations impact their training and 186/187 (99%) felt that parenthood influences their training, research, and career opportunities. 104/187 (56%) had considered leaving their specialty and 97(52%) considered leaving their career in medicine due to family commitments. DISCUSSION: Being a parent during medical training presents unique challenges that impact both personal and family life. There is a need to explore how we can best support our trainees who are parents and enable them to lead both fulfilling personal and professional lives.
McCarthy T, Cagney P, Gleeson C
… +2 more, Kelly M, Timlin M
Ir Med J
· 2026 May · PMID 42179432
AIMS: Excessive preoperative cross-matching can waste resources and shorten blood product shelf-life. The purpose of this study was to evaluate compliance with the Maximum Surgical Blood Order Schedule (MSBOS) in spinal...AIMS: Excessive preoperative cross-matching can waste resources and shorten blood product shelf-life. The purpose of this study was to evaluate compliance with the Maximum Surgical Blood Order Schedule (MSBOS) in spinal surgery at NSIU and to quantify the impact of deviations on red cell utilisation and cost, before and after implementation of a revised departmental guideline. METHODS: A two-cycle, closed-loop audit at NSIU comparing how practice before and after a revised, spine-specific departmental transfusion guideline aligned with Maximum Surgical Blood Order Schedules was performed. Outcomes included MSBOS compliance, Red Cell Concentrate (RCC) utilisation, and estimated cost impact; two-sided tests were used. RESULTS: Comparing October 2024 (63 surgeries) and May 2025 (50 surgeries), MSBOS compliance improved (33/63 [52%] to 36/50 [72%]; p=0.03), over-crossmatching decreased (27/63 [43%] to 6/50 [12%]; p<0.001), and estimated overspend fell (€19,662 to €6,780). Neither cycle required intra-operative ordering beyond preoperative plans. DISCUSSION: Implementation of a revised, spine-focused transfusion guideline improved compliance and reduced unnecessary cross-matching at NSIU without compromising peri-operative safety.
Quintyne KI, Parlour R, Williams M
… +3 more, Gilbourne C, Andersen K, McCrystal Z
Ir Med J
· 2026 May · PMID 42179337
AIMS: The global public health landscape is rapidly evolving, driven by emerging infectious diseases, shifting vaccination priorities, and climate-related health risks. The WES Synthesis 2025 project aimed to consolidate...AIMS: The global public health landscape is rapidly evolving, driven by emerging infectious diseases, shifting vaccination priorities, and climate-related health risks. The WES Synthesis 2025 project aimed to consolidate and analyse recent intelligence from international and national sources to inform strategic planning, policy development, and workforce preparedness. METHODS: Outputs generated between January and September 2025 were systematically reviewed from WHO, ECDC, UKHSA, CDC, ProMED, and national public health bodies. A thematic analysis identified trends across six domains: emerging infectious diseases, vaccination guidance, antimicrobial resistance, sexual health, environment and health, and public health systems. Items were categorised by theme, action type, and relevance. RESULTS: Over 1,000 intelligence items were reviewed. Key findings included measles and mpox resurgence, expanded avian influenza surveillance, and updated vaccination guidance for COVID-19, RSV, and influenza. Other priorities included antimicrobial resistance monitoring, rising STI rates among young adults in Ireland, climate-sensitive disease patterns, and strengthened digital preparedness frameworks. DISCUSSION: The WES Synthesis 2025 underscores the value of integrated horizon scanning and thematic evidence review in strengthening public health intelligence. Findings provide actionable insights to support timely decision-making, targeted interventions, and enhanced situational awareness. This approach offers a replicable model for multidisciplinary evidence integration to address evolving health threats.
AIM: To evaluate pathological response and safety outcomes of neoadjuvant immunotherapy in a real-world cohort of patients with locally advanced resectable melanoma. METHODS: A retrospective chart review was conducted on...AIM: To evaluate pathological response and safety outcomes of neoadjuvant immunotherapy in a real-world cohort of patients with locally advanced resectable melanoma. METHODS: A retrospective chart review was conducted on 24 consecutive patients treated between 2023-2025. Most patients had Stage IIIC disease (14/24, 58%). Treatment comprised pembrolizumab monotherapy (19/24, 79%) or ipilimumab/nivolumab (5/24, 21%). Pathological response was assessed using the International Neoadjuvant Melanoma Consortium criteria, and categorised as complete (pCR), partial (pPR) or no pathological response (pNR). RESULTS: Overall, 4/24 (16.7%) achieved pCR and 8/24 (33.3%) achieved pPR. In the pembrolizumab subgroup, 4/19 (21%) achieved pCR. NRAS codon 61 mutations were present in 10/24 (42%); among these, 5/10 (50%) achieved pPR and 2/10 (20%) progressed pre-operatively. Adverse events occurred in 11/24 (46%), including 8/19 (42%) on pembrolizumab and 3/5 (60%) on ipilimumab/nivolumab. Colitis occurred in 2/5 (40%) receiving combination therapy. Four patients (4/24, 16.7%) died due to disease progression. DISCUSSION: Observed pCR rates with pembrolizumab align with controlled trial data, supporting the applicability of neoadjuvant therapy. The high prevalence of NRAS mutations and associated pPR is notable, though progression in a subset underscores the need for improved biomarker-guided treatment selection. Toxicity, particularly colitis with combination therapy, remains a significant clinical challenge.
Bell V, Pentony L, Mineva GM
… +9 more, Naidu SL, Rafaqat H, Cavallari S, Penrose P, Ahmed M, Altaf J, Roze I, Elsammak M, Corcoran JD
Ir Med J
· 2026 May · PMID 42179321
AIMS: To assess the accuracy of capillary gas bilirubin (Radiometer TBiL) compared to venous total plasma bilirubin (Roche TPB), and to evaluate the reliability of Radiometer TBiL in neonatal hyperbilirubinaemia treatmen...AIMS: To assess the accuracy of capillary gas bilirubin (Radiometer TBiL) compared to venous total plasma bilirubin (Roche TPB), and to evaluate the reliability of Radiometer TBiL in neonatal hyperbilirubinaemia treatment decisions. METHODS: A prospective study was conducted at a tertiary neonatal centre in Dublin, Ireland between December 2023 and May 2025. Paired Radiometer TBiL and Roche TPB measurements were obtained from 97 neonates requiring bilirubin assessment. RESULTS: Radiometer TBiL demonstrated high correlation with Roche TPB (r = 0.97, p < 0.0001), although Radiometer TBiL showed an overestimation, especially at bilirubin levels between 150 to 230 µmol/L. Bland-Altman analysis revealed a mean difference of -16.6 µmol/L with wide limits of agreement (-63.6 to 30.4 µmol/L). Kappa analysis (κ = 0.35, 95% CI: 0.14 - 0.55) showed fair agreement in treatment decisions, with a tendency for Radiometer TBiL to overestimate the need for treatment, but there was no significant underestimation. DISCUSSION: Radiometer TBiL offers a rapid and less invasive alternative for bilirubin screening and risk stratification in neonates, with high correlation to standard laboratory measurements. While a tendency to overestimate bilirubin levels may lead to overtreatment, the absence of significant underestimation suggests Radiometer TBiL is a safe tool for clinical decision-making. Larger studies are warranted to validate these findings and refine clinical thresholds.
Gillman R, Murphy E, Ó Catháin C
… +2 more, Brand C, Gilmartin S
Ir Med J
· 2026 May · PMID 42179312
AIM: Protocol 37 is the process in Ireland that facilitates emergency inter-hospital transfers. We performed a five-year retrospective review of emergency transfers from a Model 3 Emergency Department (ED). The aim of th...AIM: Protocol 37 is the process in Ireland that facilitates emergency inter-hospital transfers. We performed a five-year retrospective review of emergency transfers from a Model 3 Emergency Department (ED). The aim of the study was to identify delays and reasons for delays to transfer. METHODS: A retrospective review was completed on all Protocol 37 transfers from Sligo University Hospital (SUH) ED from 01/06/2019-01/06/2024. All data collected was analysed for documented reasons for transfer delays. RESULTS: There were 399 Protocol 37 transfers over the five-year period. The mean age was 56 years and 299 (75%) were triage category 2. The most common reasons for transfer were myocardial infarction (131, 33%) and ischaemic stroke (63, 16%). The local tertiary centre received 210 (53%) of the patients. 112 (28%) transfers required medical staff to travel. The mean time from ED arrival to transfer was 5 hours 5 minutes, and Protocol 37 activation to transfer was 56 minutes. 41 (10.3%) patients had documented transfer delays. DISCUSSION: This review identifies clear delays to emergency inter-hospital transfers from a model 3 hospital ED. This is secondary to the complexity involved in the diagnosis and management of these patients. We aim to implement a national transfer document to improve the efficiency of transfers.
Algahtani L, Richardson SC, Barrett E
… +1 more, Walsh O
Ir Med J
· 2026 May · PMID 42179295
AIMS: To evaluate trainees' knowledge and confidence in using the HEEADSSS psychosocial assessment tool and any training gaps, confidence using it when interviewing a young person in distress and attitude toward mental h...AIMS: To evaluate trainees' knowledge and confidence in using the HEEADSSS psychosocial assessment tool and any training gaps, confidence using it when interviewing a young person in distress and attitude toward mental health disorders in adolescents. METHODS: An electronic anonymous survey link was sent to trainees from two different specialties within the Royal College of Physicians of Ireland (RCPI) using a Qualtrics questionnaires tool. RESULTS: A total of 65 trainees' responses were recorded, 51 (78%) from Paediatrics and 14 (22%) from Obstetrics and Gynaecology. In total, 50 (77%) knew about the HEEADSSS assessment, but only 37 (57%) felt confident using it. Twenty-four (37%) report feeling uncomfortable when dealing with adolescent patients with behavioural or mental health disorders and 29 (44%) do not feel comfortable doing a psychosocial assessment in adolescents during times of emotional distress. Sixty-five (100%) of participants agreed on the fact that mental health knowledge is important in adolescent health care. DISCUSSION: This study reveals a significant gap between trainee awareness of the HEEADSSS psychosocial assessment tool and its clinical implementation. Despite high awareness, trainees reported low confidence and discomfort, particularly with adolescent mental health, indicating a clear need for enhanced training and structured support.
Rohan P, Singh S, Brosnan C
… +2 more, Healy N, Morrin M
Ir Med J
· 2026 May · PMID 42179294
AIM: Demand for acute radiology services has increased globally, including in Ireland. Radiology Specialist Registrars (SpRs) play a significant role in managing this workload. However, rising demand can influence workfl...AIM: Demand for acute radiology services has increased globally, including in Ireland. Radiology Specialist Registrars (SpRs) play a significant role in managing this workload. However, rising demand can influence workflow, performance, and service delivery. Understanding workload trends is essential to ensure high-quality care. This study evaluates trends in out-of-hours imaging workload for radiology SpRs in a tertiary referral centre over a five-year period. The analysis includes the volume of computed tomography (CT), magnetic resonance imaging (MRI), and ultrasound (US) studies, as well as the number of incoming phone calls. METHODS: A retrospective observational analysis of imaging studies performed out-of-hours between 2019 and 2023 was performed. The mean number of studies in representative months of January, June, and November was calculated. Phone call volumes during selected periods were also assessed. Paired t-tests were used, with significance set at p<0.05. RESULTS: Mean out-of-hours CT increased from 694 in 2019 to 962 in 2023, a 39% increase (p=0.003). Emergency department (ED) studies increased by 46% (p=0.002). Significant increases were observed in CT TAP (220%, p=0.049) and NCB (38%, p=0.007). Stroke protocol CTs increased by 41% (p = 0.056). Studies performed after midnight increased by 82% (p=0.055). Out-of-hours MRI increased by 7% (p=0.76). US decreased by 41% (p=0.21). Phone calls to SpRs remained stable over the study period, averaging 33 calls per shift. DISCUSSION: The findings demonstrate an increased demand in out-of-hours CT and MRI, driven by increasing ED demand. US trends were not statistically significant, which may suggest shifting imaging priorities. Workflow management, sufficient staffing, and adequate support are crucial to address rising demand and maintain high standards of care.
Coveney J, Bonsor R, Cohen A
… +4 more, Gonzalez-Lamberth A, Hopgood D, Thorpe R, Ledger E
Ir Med J
· 2026 May · PMID 42179280
AIMS: It is important to accurately measure a child's weight when they present to hospital. It is a task typically performed by health-care professionals but is time-consuming. The aim is to assess if weight measured by...AIMS: It is important to accurately measure a child's weight when they present to hospital. It is a task typically performed by health-care professionals but is time-consuming. The aim is to assess if weight measured by a carer (Carer-measured weight - CMW) is accurate when compared to when measured by a trained health-care professional (Health-care professional Measured Weight - HMW). METHODS: We prospectively compared CMW with HMW, in children presenting to a single paediatric emergency department (PED) in England. The strength of the association between both measurements was analysed using a Pearson Correlation coefficient. RESULTS: Over the period June to October 2024, 328 children and carers were assessed. 323 (98%) of all CMW were within 10% of the HMW. 318 (97%) of all CMW were within 5% of the HMW. The Pearson Correlation coefficient was 0.99. CONCLUSION: This service evaluation supports the theory that CMW is an accurate method of measuring children's weight in the CED setting.
AIM: To evaluate the frequency, turnaround time (TAT), and outcomes of Heparin-induced thrombocytopenia testing referrals from Cork University Hospital (CUH) and assess whether local specialised testing is justified. MET...AIM: To evaluate the frequency, turnaround time (TAT), and outcomes of Heparin-induced thrombocytopenia testing referrals from Cork University Hospital (CUH) and assess whether local specialised testing is justified. METHODS: Retrospective review of HIT referral forms and laboratory records (2021-2022). Data collected included demographics, referring specialty, platelet nadir, 4Ts score, HIT assay results, and TAT. RESULTS: Ninety-three patients were referred; 73 had complete data. Median TAT was 6 days (mean 31.9 days; adjusted mean 8.8 days after excluding six extreme outliers). Mean age was 66 years, 53% post-cardiothoracic surgery, mean 4Ts score 4.9. Three patients (4.1%) tested positive. Twenty-three (31.5%) had severe thrombocytopenia (<50 ×10⁹/L). CONCLUSION: HIT testing referrals are frequent but delayed. Local in-house testing could improve patient safety, reduce unnecessary use of costly anticoagulants, and support timely clinical decision-making.