PRESENTATION: We report a case of a 20-month-old who presented with a 3-week history of non-bilious vomiting and metabolic alkalosis. DIAGNOSIS: Serology demonstrated a hypokalaemic, hypochloraemic metabolic alkalosis. A...PRESENTATION: We report a case of a 20-month-old who presented with a 3-week history of non-bilious vomiting and metabolic alkalosis. DIAGNOSIS: Serology demonstrated a hypokalaemic, hypochloraemic metabolic alkalosis. Abdominal ultrasonography and barium studies confirmed the diagnosis of gastric outlet obstruction. TREATMENT: Oesophago-gastro-duodenoscopy identified a hypertrophied closed pylorus with evidence of pyloric muscular hypertrophy. A laparoscopic pyloroplasty was performed. DISCUSSION: Hypertrophic pyloric stenosis is the most common cause of gastric outlet obstruction in children. It typically occurs between 2 and 12 weeks of age and is very rarely found in older children. Primary acquired gastric outlet obstruction in late infancy and childhood is a rare cause of gastric outlet obstruction. Few cases have been reported in the literature outside of northern India. We present this case to highlight the need to consider this diagnosis in the older child.
PRESENTATION: A 77-year-old man with type 2 diabetes, presented to the Emergency Department with an acute onset of confusion for 24 hours. He was on Metformin but due to nausea, this was switched to Linagliptan two days...PRESENTATION: A 77-year-old man with type 2 diabetes, presented to the Emergency Department with an acute onset of confusion for 24 hours. He was on Metformin but due to nausea, this was switched to Linagliptan two days prior to his presentation. All vital signs were stable including blood sugar. Clinical examination was normal. DIAGNOSIS: Full blood count, renal, liver and C-reactive protein were all normal. CT brain revealed age-related involutional changes, while Chest X-ray and MRI brain was normal. His 4AT score was ten and together with his acute change from baseline, a diagnosis of delirium was made. TREATMENT: Linagliptan was discontinued and Empagliflozin was commenced with full recovery of the delirium gradually. DISCUSSION: Linagliptan and delirium may be due to changes to the gut microbiome, disturbing the gut-brain axis increasing inflammation1. Linagliptan associated delirium has not been previously reported, although with effects of delayed gastric emptying and reduced gut motility, more studies are needed.
AIM: Lack of transport has been shown to be a key barrier to accessing healthcare, with poorer associated health outcomes in those experiencing transport poverty. Our health survey aimed to assess the transportation need...AIM: Lack of transport has been shown to be a key barrier to accessing healthcare, with poorer associated health outcomes in those experiencing transport poverty. Our health survey aimed to assess the transportation needs of a population attending a geriatric ambulatory care unit and the role of transport as a barrier to healthcare attainment. METHODS: Data collection was via survey; the survey used was adapted from the Irish Translational Study on Aging (TILDA) and the questionnaire devised by Locatelli, Sharp, Syed, Bhansari, and Gerber in their research on urban transport barriers to healthcare. Results were compiled and analysed using descriptive statistics. RESULTS: In total 52 participants with a mean age of 81 years were included, of which 48 (92%) were accompanied to clinic by a caregiver. The most common mode of transport was being driven by an accompanying driver (43 [83%]), with the majority of these (43 [94%]) being driven by family members. Public transport was deemed unfeasible/highly unfeasible for attending clinic by 38 (73%) respondents. Only ten of the respondents were still currently driving (19%). Common indications for attending clinic included Alzheimer's dementia, Parkinson's disease, and orthostatic hypotension. DISCUSSION: Patients were largely reliant on family for transport to ambulatory care appointments, and public transport was seen as inaccessible for the majority; overall transport was cited as a cause of stress in attending clinic. Facilitating transport that maintains patient autonomy and dignity is an area of public interest requiring further study.
Selvajothi J, Hewitt M, de Haan A
… +3 more, Ting S, Philpott D, Hayes-Ryan D
Ir Med J
· 2026 Jan · PMID 41589599
AIM: Women with symptoms suggestive of cervical cancer require prompt specialist gynaecological review with access to diagnostic testing. A Cervical One-Stop Assessment Clinic (COSAC) was established at Cork University M...AIM: Women with symptoms suggestive of cervical cancer require prompt specialist gynaecological review with access to diagnostic testing. A Cervical One-Stop Assessment Clinic (COSAC) was established at Cork University Maternity Hospital in 2021. This retrospective review evaluates the first three years of this service. METHODS: Anonymised data from all attendees of the between September 2021 and September 2024 were collected, including referral indication, cervical cancer risk factors, examination findings, investigations, and onward referrals. Descriptive analysis was performed using Microsoft Excel. RESULTS: During the review period, 1714 COSAC appointments were offered based on referral details and 1522 of these women attended (88.9%). The mean age was 39 years. Most referrals were for abnormal cervical appearance (812, 53.5%) or post-coital bleeding (408, 26.8%). The majority of attendees were up to date with HPV screening and had tested negative (1238, 90.7%). Most attendees had a normal examination and did not require biopsy (1155, 76.2%). Of the 185 (12.2%) biopsied, most results were benign, including metaplasia (133, 71.9%) and cervicitis (42, 22.7%). Pre-cancer cervical intraepithelial neoplasia was identified in three women (3/1522), two with low grade changes. Advanced squamous cell carcinoma was confirmed in two women. Both were over 35, multiparous and overdue for screening with no prior colposcopy. DISCUSSION: COSAC clinics provide specialist care for symptomatic women and help maintain colposcopy capacity for those with an abnormal screening result. They are low resource, high impact services which could be considered a useful adjunct for implementation in gynaecology units nationally and internationally.
Maher L, McCarthy R, Helmi L
… +3 more, Byrne L, Kelly B, Walsh K
Ir Med J
· 2026 Jan · PMID 41589578
AIM: Radiofrequency pulmonary vein isolation is an established treatment for atrial fibrillation. Patients are administered either conscious sedation or general anaesthesia. The purpose of this study was to compare patie...AIM: Radiofrequency pulmonary vein isolation is an established treatment for atrial fibrillation. Patients are administered either conscious sedation or general anaesthesia. The purpose of this study was to compare patient experiences of conscious sedation versus general anaesthesia during pulmonary vein isolation. METHODS: A retrospective, observational, single-centre, single-operator study was performed, comparing patient experiences of pulmonary vein isolation performed under general anaesthesia versus conscious sedation. A Likert scale questionnaire was used to compare satisfaction with the different modes of anaesthesia, with score of 1 denoted for very dissatisfied and score of 5 for very satisfied. RESULTS: 41 patients were included - 20 (48.8%) in conscious sedation group, and 21 (51.2%) in general anaesthesia group. Groups were well-matched as regards age (mean 56.3 +/-13.7yrs), gender (71.4% male), percentage with paroxysmal atrial fibrillation (76.2%), and percentage re-do cases (28.6%). Patients in the general anaesthesia group experienced lower levels of pain/discomfort (mean score 2.90 +/- 1.77 vs 1.33+/-0.80) (p<0.001) and were more likely to recommend the mode of anaesthesia (mean score 4.90 +/- 0.44 vs. 3.40 +/- 1.70) (p<0.001), compared with those in conscious sedation group. There was no significant difference in anxiety/depression post-procedure (p= 0.057), satisfaction with recovery time post-procedure (p=0.175), likelihood to recommend the procedure (p= 0.103), and overall satisfaction with the ablation experience (p=0.089). DISCUSSION: Patients who had general anaesthesia for radiofrequency pulmonary vein isolation experienced less peri-procedural pain than patients who had conscious sedation and were more likely to recommend general anaesthesia as a mode of anaesthesia.
Lai FY, Yong JF, Al-Hosni F
… +2 more, Salim A, Hackett C
Ir Med J
· 2026 Jan · PMID 41589577
AIM: To assess the effectiveness of pigmented lesion referral pathways, particularly the National Cancer Control Programme (NCCP) pathway, in reducing waiting times and improving melanoma detection rates. METHODS: We ana...AIM: To assess the effectiveness of pigmented lesion referral pathways, particularly the National Cancer Control Programme (NCCP) pathway, in reducing waiting times and improving melanoma detection rates. METHODS: We analysed 2 cohort studies encompassing a prospective 3-month analysis (n=362) and a retrospective 6-month analysis (n=43) of melanoma detection at a tertiary dermatology centre in Ireland. Referral source, reason for referral, waiting times, and histopathological outcomes were evaluated via descriptive analysis. RESULTS: Referrals through the NCCP pathway were associated with shorter waiting times, with 300 (83%) of melanoma patients seen within 12 weeks. Delays in melanoma diagnosis were linked to incidental pickups or incomplete referral information. Outcomes following dermatology review showed that 89 (24.6%) of primary lesions referred required biopsies, however only 11 (3%) were clinically suspicious for melanoma. Histopathological analysis showed a portion of benign lesions or keratinocyte cancers were referred inappropriately through the NCCP pathway. CONCLUSION: Improving diagnostic confidence in primary care through education, standardized referral criteria, and tele-dermatology tools may help optimize referral quality and reduce waiting times for patients with suspected melanomas.
Govender L, Koopman A, Splinter TL
… +3 more, Grufferty A, Bennett M, McCabe A
Ir Med J
· 2026 Jan · PMID 41589558
AIM: Helicopter Emergency Medical Services (HEMS) provide rapid aeromedical transport for critically ill or injured patients. Tallaght University Hospital (TUH) has accepted HEMS patients since 2012. This study aimed to...AIM: Helicopter Emergency Medical Services (HEMS) provide rapid aeromedical transport for critically ill or injured patients. Tallaght University Hospital (TUH) has accepted HEMS patients since 2012. This study aimed to characterise the demographics, clinical management and outcomes of patients presenting to TUH Emergency Department (ED) via HEMS. METHODS: A retrospective chart review of all adult HEMS presentations to TUH ED between January 2016 and December 2021 was conducted. RESULTS: A total of 192 HEMS patients presented to TUH ED from 16 counties. The mean age was 46.8 years, and 151 (78.6%) were male. Traumatic injuries in 177 patients accounted for 92% of the HEMS presentations, with road traffic accidents (63/192, 32%) the most common mechanism of injury. 152 patients (81%) required admission to TUH. Fourteen patients (7.2%) required interhospital transfer for specialist care. The average ED stay was 10.66 hours, and the mean hospital length of stay was 10 days, with longer stays observed in patients aged ≥65 years (12 days vs. 9.6 days, p < 0.01). DISCUSSION: TUH ED is a trauma HEMS receiving hospital for a wide geographical area. HEMS patients are typically high acuity with high admission rates and requirement for surgical interventions.
Codyre L, Brent L, Hickey P
… +4 more, Briody J, Kelly F, Murphy T, Valentelyte G
Ir Med J
· 2026 Jan · PMID 41589557
AIM: To estimate the direct economic burden of surgical site infections (SSIs) following hip fracture surgery within the Irish healthcare system. METHODS: A micro-costing analysis using clinical audit data was undertaken...AIM: To estimate the direct economic burden of surgical site infections (SSIs) following hip fracture surgery within the Irish healthcare system. METHODS: A micro-costing analysis using clinical audit data was undertaken to estimate the direct in-patient costs of treating SSIs after hip fracture surgery. Costs were calculated for the acute episode of care and stratified by demographic and clinical characteristics, allowing for a more detailed assessment of potential disparities in healthcare outcomes and associated expenditure across different patient groups. RESULTS: Over 12 months, 16 (0.4%) hip fracture patients developed an SSI. The total cost was €712,898, with a mean of €44,556 per patient. Differences by subgroup were noted: males €35,418, females €50,039, aged ≥80 €49,712 and <80 years €33,213. DISCUSSION: These findings indicate that disease-specific surveillance programmes can generate valuable health economic and epidemiological evidence. As the older population continues to grow, the incidence of SSIs and their associated costs are likely to rise. Ongoing analysis and systematic monitoring through clinical audit are crucial for refining cost estimates, informing evidence-based policies, and optimising resource allocation to enhance the quality of care in the acute hospital setting.
AIM: This retrospective study aimed to evaluate changes in body mass index (BMI) and haemoglobin A1c (HbA1c) levels among children and adolescents with type 1 diabetes mellitus (T1DM) transitioning from multiple daily in...AIM: This retrospective study aimed to evaluate changes in body mass index (BMI) and haemoglobin A1c (HbA1c) levels among children and adolescents with type 1 diabetes mellitus (T1DM) transitioning from multiple daily injections (MDI) to insulin pump therapy over one year. METHODS: Data were collected from chart reviews of 33 T1DM patients. BMI z-scores were calculated using WHO charts, and HbA1c levels were recorded at pump initiation, 6 months, and 1 year thereafter. RESULTS: At pump initiation, mean HbA1c was 7.81% (95% CI: 7.49-8.12), improving to 7.41% (95% CI: 7.13-7.68) at 6 months (p=0.0068) and 7.42% (95% CI: 7.12-7.72) at 1 year (p=0.009). The initial BMI z-score was 0.65 (95% CI: 0.24-1.06), with a trend toward weight gain at 6 months (0.76, 95% CI: 0.45-1.26, p=0.097) but no significant change at 12 months (0.73, 95% CI: 0.34-1.12, p=0.377). CONCLUSION: Insulin pump therapy significantly improved glycaemic control within 6 months and maintained it at 1 year, though BMI z-scores showed no significant change.
Devine M, Bourke M, Amoo M
… +4 more, Lynch N, Bennett B, McCourt M, Andrews E
Ir Med J
· 2026 Jan · PMID 41589533
AIMS: To determine the incidence of non-appendicitis pathology of the appendix in an Irish context. METHODS: A single institute review of 4,428 consecutive appendiceal resections was conducted independently by two resear...AIMS: To determine the incidence of non-appendicitis pathology of the appendix in an Irish context. METHODS: A single institute review of 4,428 consecutive appendiceal resections was conducted independently by two researchers. Clinical, radiological, intra-operative, and histological reports were reviewed. RESULTS: A total of four-thousand four-hundred and twenty-eight (4,428) appendicectomies including right hemicolectomies, subtotal colectomies, panproctocolectomies, ileocolic resections, and en-bloc resections were performed during the study period. Incidental malignancies occur in less than one per cent (<1%) of appendiceal resections. The mean age of incidental malignancies was 54.75 (range 11 - 79 years), and the mean age for non-incidental appendiceal malignancies was 62 (range 42 - 85 years). CONCLUSION: A wide array of neoplastic and inflammatory conditions' incidence in the Irish context is described for the first time.
Keenan K, McDonald S, Jones E
… +17 more, Walsh O, Richardson SC, Oketah N, Azam M, Glackin S, Onyekwere D, Gallagher P, Reade E, Roche E, Sharif F, Waldron D, Stokes H, Lucey J, Thomas M, McNicholas F, O'Gorman CS, Barrett E