Sweeney P, McKevitt K, Ní Mhuircheartaigh J
… +1 more, Abdeldaim Y
Ir Med J
· 2026 Feb · PMID 41729038
PRESENTATION: A healthy 23-year-old man developed sore throat and fever with positive EBV Infectious Mononucleosis test, followed by abdominal pain, vomiting, and haemodynamic collapse, without trauma. DIAGNOSIS: Bedside...PRESENTATION: A healthy 23-year-old man developed sore throat and fever with positive EBV Infectious Mononucleosis test, followed by abdominal pain, vomiting, and haemodynamic collapse, without trauma. DIAGNOSIS: Bedside ultrasound suggested intraperitoneal free fluid. Urgent contrast-enhanced CT demonstrated large haemoperitoneum, perisplenic and subcapsular haematoma, and active splenic contrast extravasation. TREATMENT: Emergency laparotomy revealed massive haemoperitoneum, and confirmed splenic bleeding; splenectomy was performed. Recovery was uncomplicated, with post-splenectomy antibiotics and vaccinations. He was well at three-month follow-up. DISCUSSION: EBV-associated atraumatic splenic rupture is rare yet life-threatening. CT imaging confirms injury and bleeding. Management depends on physiology; unstable patients require prompt surgical management, whereas stable cases may merit spleen-preserving strategies and close monitoring.
PRESENTATION: A rare case of pancreaticopleural fistula in a 53-year-old female patient who presented with unsteady gait and shortness of breath on the background of chronic pancreatitis. DIAGNOSIS: Diagnosis was confirm...PRESENTATION: A rare case of pancreaticopleural fistula in a 53-year-old female patient who presented with unsteady gait and shortness of breath on the background of chronic pancreatitis. DIAGNOSIS: Diagnosis was confirmed through MRI, MRCP, and analysis of pleural fluid obtained via thoracentesis. TREATMENT: Diagnosis was confirmed through MRI, MRCP, and analysis of pleural fluid obtained via thoracentesis. DISCUSSION: This case highlights a rare complication of acute pancreatitis that requires a high index of clinical suspicion for timely diagnosis. Pancreaticopleural fistulas should be considered an important differential diagnosis for pleural effusions, particularly in patients with chronic pancreatitis. Optimal management involves a multidisciplinary team, including gastroenterologists, surgeons, radiologists, and dieticians.
PRESENTATION: Patients with Fontan circulation are at increased risk of thromboembolism. We report a case of multifocal stroke caused by thrombus in a rudimentary right ventricle and highlight the need to consider stroke...PRESENTATION: Patients with Fontan circulation are at increased risk of thromboembolism. We report a case of multifocal stroke caused by thrombus in a rudimentary right ventricle and highlight the need to consider stroke in Fontan patients with neurological symptoms. DIAGNOSIS: A CT brain which presented normal. MRI/MRA brain performed demonstrating multifocal shower of infarcts consistent with an acute embolic cerebrovascular event. Transthoracic echo was normal. Transoesophageal echo located a thrombus within the trabeculations of the rudimentary right ventricle, confirming a diagnosis of thromboembolic stroke secondary to RV thrombus. TREATMENT: Multidisciplinary care including cardiology, neurology, and haematology. Commenced on anticoagulation with an INR target range of 2-3. Possible future catheter procedure to occlude right ventricle. DISCUSSION: This case highlights the persistent risk of thromboembolic events in Fontan patients in whom residual cardiac structures such as a rudimentary ventricle can serve as a source of thrombus. Multimodal imaging is critical for diagnosis. Optimal thromboprophylaxis remains uncertain.
Kiran S, Mullan R, Cunningham P
… +1 more, Chavrimootoo S
Ir Med J
· 2026 Feb · PMID 41729015
PRESENTATION: We present a case of Hyperphosphataemic Familial Tumoral Calcification (HFTC). A 30-year-old Indian male patient presented to our Rheumatology clinic complaining of joint pains involving his left elbow, rig...PRESENTATION: We present a case of Hyperphosphataemic Familial Tumoral Calcification (HFTC). A 30-year-old Indian male patient presented to our Rheumatology clinic complaining of joint pains involving his left elbow, right hip, and ankle. Examination was normal apart from a tender left elbow with firm swelling on the extensor surface and Positive Faber's test at his right hip. Laboratory analysis showed negative HLA-B27, normal routine parameters except for raised phosphate level. X-rays showed soft tissue calcifications at left elbow and right hip with faint calcifications around right knee and ankle. Dermatomyositis and Heterotopic Calcification Screen were negative. DIAGNOSIS: Elbow swelling showed Calcium Phosphate crystals on histology. He was diagnosed with HFTC on the basis of positive genetic testing for homozygous GALNT3. His Fibroblast growth factor 23 (FGF-23) levels remained elevated. TREATMENT: He received dietary modifications with phosphate binders and referred to Endocrinology. DISCUSSION: HFTC is a rare condition to consider in patients presenting with features of tumoral calcinosis who also have unexplained hyperphosphataemia. It can be confirmed by genetic testing.
Ni Mhiochain de Grae M, Rigney B, Mahony R
… +3 more, Govender L, Quinlan JF, McGoldrick NP
Ir Med J
· 2026 Feb · PMID 41729002
AIM: Electric scooter (e-scooter) injuries represent an emerging challenge in Emergency Departments due to their rising incidence and associated resource demands. This study is a follow up from our previous study which d...AIM: Electric scooter (e-scooter) injuries represent an emerging challenge in Emergency Departments due to their rising incidence and associated resource demands. This study is a follow up from our previous study which demonstrated that 50% of e-scooter injuries required specialist orthopaedic referral 1. This study aims to analyse trends in e-scooter-related injuries presenting to a tertiary referral centre and to evaluate the clinical outcomes, management strategies, and compare service impact over a two-year period. METHODS: This is a retrospective analysis of all patients presenting to our hospital between 1st August 2023 and 31st July 2024. We compared our data to our previous study which analysed e-scooter presentations between 1st August 2021 and 31st July 2022. Datapoints measured included mechanism of injury, type of injury, use of safety equipment, outcome of emergency presentation, admission length, surgery performed, and follow-up. RESULTS: A total of 306 patients were included, increasing from 105 in Phase 1 (1st August 2021 - 31st July 2022) to 201 in Phase 2 (1st August 2023 - 31st July 2024) (p = 0.157). Fractures were identified in 134 e-scooter presentations (43%), and 27 patients (8.9%) required emergency fixation. Physiotherapy referrals rose from 4.8% to 34.3% (p = 0.001), and wound care needs increased from 6.7% to 14.4% (p = 0.07). Orthopaedic clinic visits rose (mean 1.96 to 3.1), while admission (13.3% vs. 13.4%, p = 1.0) and surgery rates (9.5% vs. 8.5%, p = 0.92) remained stable. DISCUSSION: This study highlights a significant increase in both the frequency and complexity of e-scooter-related trauma over two years, with rising rates of vertebral and hip fractures, wound care needs, and physiotherapy referrals. Despite stable admission and surgical rates, outpatient and allied health burdens have escalated. These findings underscore the need for targeted public health interventions to mitigate injury severity and reduce preventable harm.
Bolarinwa BV, McCormack E, Penny Z
… +2 more, Lennon D, Foley MP
Ir Med J
· 2026 Feb · PMID 41728935
AIM: To investigate how much impact targeted informal information days have on early-career doctors and the impact of these information days on their perception of surgical careers. METHODS: All attendees of the 2024 Iri...AIM: To investigate how much impact targeted informal information days have on early-career doctors and the impact of these information days on their perception of surgical careers. METHODS: All attendees of the 2024 Irish Surgical Training Group (ISTG) Careers' Day and Aspiring Surgeons Research Symposium were given a link to an online survey following the event. Their responses were aggregated and analysed using Microsoft Excel. RESULTS: 57% (n=47/82) of attendees submitted feedback forms. All respondents were considering a career in surgery prior to the event. After the event, 93.5% (n=44) attendees rated themselves more likely or much more likely to pursue a career in surgery, while none reported a new negative view on surgery. Additionally, prior to the event, 47% of attendees (n=22) were considering applying to Core Surgical Training, while a further 13% (n=6) were unsure. After the event, 76.5% (n=36) reported themselves to be more likely or much more likely to apply for CST at some point, and only 2 (4.3%) considered themselves somewhat less likely to apply. DISCUSSION: Our study has identified the positive influence that informal sessions can have in promoting interest in surgical specialities as well as providing networking opportunities amongst consultants and NCHDs that otherwise may not have been easily accessible.
AIM: Interventional Radiology (IR) is a rapidly evolving specialty with increasing global demand. While surveys of UK and international trainees report high satisfaction, gaps in training exposure, research support, and...AIM: Interventional Radiology (IR) is a rapidly evolving specialty with increasing global demand. While surveys of UK and international trainees report high satisfaction, gaps in training exposure, research support, and gender diversity persist. No national data exists for IR training in Ireland. This survey evaluates trainee satisfaction, identifies training deficiencies, and explores improvement strategies. METHODS: A 13-item electronic survey was distributed to radiology trainees in the Republic of Ireland, assessing demographics, IR exposure, involvement in clinical services, preparedness for fellowships, and views on a diagnostic/interventional radiology (DR/IR) split. Free-text questions explored departmental strengths, areas for improvement, and contributors to gender imbalance. RESULTS: Thirty-one trainees responded (68% male, 21/31), with a response rate of 22%. 71% (22/31) intended to incorporate IR in future practice. Overall, 48% (15/31) were satisfied with IR training, 36% (11/31) dissatisfied, and 16% (5/31) neutral. Rostering for IR training varied with only 23% (7/31) having a fixed IR day weekly. 16/31 (52%) did not support a DR/IR split, and 55% (17/31) felt prepared for fellowships abroad. Key areas for improvement included enhancing trainee autonomy, teaching, vascular and oncology case exposure, and infrastructure. Lifestyle concerns, radiation exposure, and lack of female mentors were identified as drivers of gender imbalance. DISCUSSION: While IR training satisfaction in Ireland is moderate, several actionable improvements have been identified to optimise training nationwide.
AIM: To analyse the prevalence of dermatophyte species from 2012 to 2024 in Cork, Ireland; and to assess regional trends. METHODS: A retrospective laboratory database analysis was conducted at Bon Secours Hospital, Co. C...AIM: To analyse the prevalence of dermatophyte species from 2012 to 2024 in Cork, Ireland; and to assess regional trends. METHODS: A retrospective laboratory database analysis was conducted at Bon Secours Hospital, Co. Cork. Following ethical approval in July 2023, all dermatological mycology samples referred from January 2012 to January 2024 were reviewed. Samples were analysed microscopically and macroscopically for fungal identification. All data was analysed using SPSS version 28. RESULTS: Of 2,270 samples, 723 (31.8%) were positive for fungal infection, with 623 (27.4%) identified as dermatophytes. Anthropophilic species predominated, representing 87% of dermatophyte cases (542 out of 623). Trichophyton rubrum showed a significant increase from 60 of 130 cases (46%) in 2012-2015 to 110 of 135 cases (81.5%) in 2020-2024 (p < 0.0001). Candida Species declined from 32 of 130 cases (25%) to 12 of 135 cases (9%) over the same period (p < 0.0001). DISCUSSION: Trichophyton rubrum is now the leading dermatophyte in Co. Cork. These trends align with global data and underscore the growing need for national fungal surveillance, treatment updates, and investigation into emerging antifungal resistance. Further regional comparisons and patient-level analyses are recommended.
Waters I, Geoghegan L, Haupfear I
… +2 more, Cafferkey A, Sherwin A
Ir Med J
· 2026 Feb · PMID 41728899
AIM: IV paracetamol is approximately 10 times the cost and has 68 times higher carbon emissions compared to oral paracetamol (PO) however, it has been shown to be equally as effective. This paper aims to assess potential...AIM: IV paracetamol is approximately 10 times the cost and has 68 times higher carbon emissions compared to oral paracetamol (PO) however, it has been shown to be equally as effective. This paper aims to assess potential environmental and financial savings of an oral paracetamol switch in a large day surgery unit using a simple behaviour change intervention. METHODS: Charts were collected at random from the Day Surgery Unit over a four-week period. An education campaign was carried out aimed at Anaesthetic trainees and data was collected over a second four-week period. The proposed financial and carbon cost savings of the intervention were then calculated. RESULTS: The proportion of patients who received preoperative PO paracetamol significantly increased post-intervention, from 5% (2/40) to 24.4% (11/45) (p=0.014). Projected over a one-year period, we estimate that our intervention would save the hospital €188.04 and reduce carbon emissions by 54.53 kgCO₂e from elective day cases alone, without compromising patient safety. DISCUSSION: The education intervention led to a shift towards preoperative prescribing of oral paracetamol. The relatively simple intervention could be adapted and applied to other settings in order to yield further cost and carbon emission savings, such as the main theatre, surgical wards, and the emergency department.
Das T, Jones K, Crowley J
… +3 more, Du Plessis S, Mensch R, Deasy C
Ir Med J
· 2026 Feb · PMID 41728870
AIM: Urgent Virtual Care (UVC), launched by the Health Service Executive (HSE) South West aims to enhance patient care in General Practice and Emergency Department settings by seeking alternative care pathways to unsched...AIM: Urgent Virtual Care (UVC), launched by the Health Service Executive (HSE) South West aims to enhance patient care in General Practice and Emergency Department settings by seeking alternative care pathways to unscheduled ED visits at Cork University Hospital. This study aims to evaluate the impact of UVC on patient care pathways, unscheduled ED attendance, and GP referral outcomes. METHODS: A retrospective observational analysis was conducted using data from Salutem GP practice in Co. Cork, comparing two periods: a pre-UVC phase (August 4th to November 4th 2025) and a post-UVC phase (November 4th 2024 to February 4th 2025). During the pre-UVC period, all emergency referrals went to the ED. In the post-UVC period, patients were directed to either (1) ED or (2) UVC, including remote, onsite, or scheduled care. RESULTS: Post-UVC launch, 59 emergency referrals were made, with 17% (10/59) referred to UVC and 83% (49/59) to the ED. Pre-UVC launch, all 30 emergency referrals resulted in ED visits. Of UVC referrals, 40% (4/10) were resolved without ED attendance. 40% (4/10) led to additional scheduled care through UVC. DISCUSSION: Our findings demonstrate that UVC is a promising service that improves patient care, enhances healthcare resource efficiency, and provides GPs timely access to urgent consultant opinions.
INTRODUCTION: Sodium glucose co-transporter 2 (SGLT2) inhibitors were originally developed for the treatment of diabetes mellitus, however their approved use has expanded over recent years to include the treatment of hea...INTRODUCTION: Sodium glucose co-transporter 2 (SGLT2) inhibitors were originally developed for the treatment of diabetes mellitus, however their approved use has expanded over recent years to include the treatment of heart failure and chronic kidney disease. This case series illustrates a spectrum of perioperative SGLT2 inhibitor related diabetic ketoacidosis (DKA), both euglycaemic and hyperglycaemic. We hope to highlight the challenges of both diagnosis and management of this condition. CASES: Case 1: Euglycaemic DKA in a 54-year-old post-emergency laparotomy, which recurred following resumption of her SGLT2 inhibitor. Case 2: Euglycaemic DKA in an 82-year-old post-emergency laparotomy. Case 3: Hypergylcaemic DKA in a 52-year-old patient who underwent arthroscopic shoulder surgery as a day case. Case 4: Euglycaemic DKA in a 78-year-old post-emergency lower limb revascularisation. RESULTS: These cases highlight that the use of SLGT2 inhibitors carries the risk of perioperative DKA which can be difficult to diagnose and requires prompt management. DISCUSSION: As the indications for the use of these medications expand, we must maintain a high clinical suspicion for DKA with their perioperative use.
AIM: Martha's Rule is a patient safety initiative introduced in the NHS which provides patients and families with a way to seek an urgent review if they or their loved one's condition deteriorates. This study aimed to ca...AIM: Martha's Rule is a patient safety initiative introduced in the NHS which provides patients and families with a way to seek an urgent review if they or their loved one's condition deteriorates. This study aimed to capture staff opinions regarding the effect of the policy on staff workload and department flow. METHODS: Pre- and post-implementation questionnaires were circulated to CED senior staff members by e-mail. RESULTS: In the pre-implementation questionnaire (17 responses, 50% response rate), all senior staff surveyed believed the change would increase clinician workload and 88% believed it would negatively impact patient flow. At 6-months post-implementation, 87% of senior staff surveyed (15 responses, 44% response rate) believed that the change had not increased clinician workload or negatively impacted patient flow. DISCUSSION: These early results suggest that perceived worries about the impact of implementation of Martha's rule on workload and patient flow in the CED setting may not be seen in practice.
Dolan AM, Hoban J, Persad D
… +5 more, Low J, O'Kelly B, Mulholland J, Connolly R, Trzos-Grzybowska M
Ir Med J
· 2026 Jan · PMID 41589640
PRESENTATION: We describe a 16-year-old girl presenting with four days of nausea, vomiting, malaise, and macular rash affecting the vulva and perineum during menstruation, following tampon use. She was febrile, hypotensi...PRESENTATION: We describe a 16-year-old girl presenting with four days of nausea, vomiting, malaise, and macular rash affecting the vulva and perineum during menstruation, following tampon use. She was febrile, hypotensive, tachycardic, and confused, with multi-organ dysfunction. DIAGNOSIS: Laboratory findings revealed leukocytosis, thrombocytopenia, renal impairment, markedly elevated CRP, and procalcitonin. Perineal swabs grew methicillin-sensitive Staphylococcus aureus resistant to clindamycin. Blood cultures were negative. The isolate was later confirmed to carry the tst gene encoding toxic shock syndrome toxin-1 (TSST-1). TREATMENT: Broad-spectrum antibiotics were started, later rationalised to IV flucloxacillin after isolation of methicillin-susceptible S. aureus. The patient required critical care admission for monitoring and vasopressors but recovered quickly and was discharged well. Skin desquamation across neck, vulva, and perineum was noted during recovery. DISCUSSION: This case illustrates menstrual toxic shock syndrome due to TSST-1-producing S. aureus, occurring without evidence of prolonged tampon retention. Early recognition and management with microbiological testing are essential. Public education on safe tampon use remains vital to prevent this rare but life-threatening condition.
PRESENTATION: A 50-year-old obese male with non-insulin dependent diabetes mellitus (NIDDM) taking Semaglutide, a glucagon-like peptide-1 receptor agonist (GLP-1RA) presented with sudden, painless vision-loss from his ri...PRESENTATION: A 50-year-old obese male with non-insulin dependent diabetes mellitus (NIDDM) taking Semaglutide, a glucagon-like peptide-1 receptor agonist (GLP-1RA) presented with sudden, painless vision-loss from his right eye. DIAGNOSIS: Right eye visual acuity was 6/24. There was Frisen grade IV optic nerve head (ONH) oedema. This was confirmed at imaging with ocular coherence tomography (OCT). The patient was diagnosed with non-arteritic anterior ischaemic optic neuropathy. TREATMENT: Semaglutide was ceased. DISCUSSION: GLP-1RAs such as Semaglutide are being increasingly recognised as a potential risk factor for NAION. A case such as this has not yet been reported in Ireland.