Harrington J.M.,University College Cork |
Fitzgerald A.P.,University College Cork |
Kearney P.M.,University College Cork |
McCarthy V.J.,University College Cork |
And 4 more authors.
American journal of hypertension | Year: 2013
BACKGROUND: The Dietary Approaches to Stop Hypertension (DASH) Trial provides critical data on the impact of a specific diet pattern (low in salt, fat, and processed foods and high in fruit and vegetables) on blood pressure (BP). The effect of compliance with a DASH-type diet on BP in a general population sample is less well defined. We studied associations between a DASH style diet and BP.METHODS: We used cross-sectional data from a study of men and women aged 47-73 years (n = 2,047). Participants completed a physical examination that included 3 standardized clinical BP recordings. A subsample (n = 1,187) had ambulatory BP measurements (ABPM) taken. Diet was assessed using a DASH dietary score constructed from a standard Food Frequency Questionnaire. Lower scores indicated less healthy diets. Hypertension was defined as clinic BP ≥ 140/90 mm Hg on medication or as 24-hour ABPM ≥ 130/80 mmHg.RESULTS: Inverse associations were evident between DASH and systolic BP (SBP). There was a difference in clinic SBP of 7.5 mm Hg and 5.1 mm Hg and a difference in ABPM SBP of 6.3mm Hg and 5.4mm Hg in men and women, respectively, between the highest and lowest DASH quintiles. In fully adjusted multivariable regression analysis, DASH score was inversely associated with SBP. Clear population differences in SBP were evident across DASH quintiles.CONCLUSIONS: The observed associations indicate that the findings are consistent with the hypothesis that adherence to DASH-equivalent diet can reduce BP at the population level. Public policy promoting a DASH-style healthy diet could have a significant impact on population health by reducing average BP in the population. © American Journal of Hypertension, Ltd 2013. All rights reserved. For Permissions, please email: email@example.com.
Nugent M.,Connolly Hospital Blanchardstown
Osteoarthritis and Cartilage | Year: 2016
Introduction: Osteoarthritis (OA) is a common disease worldwide leading to significant morbidity. The underlying disease process is multifactorial however there is increasing focus on molecular mechanisms. MicroRNAs are small non-coding segments of RNA that have important regulatory functions at a cellular level. These molecules are readily detectable in human tissues and circulation. They are increasingly recognised as having a major role in many disease processes - including malignancy and inflammatory processes. Objective: This review paper aims to provide a comprehensive update on the evidence for miRNA roles in OA. Design: A comprehensive literature search was performed using key medical subject headings (MeSH) terms 'microRNA' and 'osteoarthritis'. Results: Several miRNAs have been identified as having aberrant expression levels in OA. Some of these include miR-9, miR-27, miR-34a, miR-140, miR-146a, miR-558 and miR-602. Many of the dysregulated miRNAs have been shown to regulate expression of inflammatory pathways such as interleukin-mediated or matrix metalloproteinase-13 (MMP-13)-mediated degradation of the articular cartilage extracellular matrix (ECM). MiRNAs may also play a role in pain pathways and hence expression of clinical symptoms. Conclusions: Recent evidence has shown that miRNAs in the circulation may reflect underlying disease states and hence serve as potential markers for disease activity. These findings may represent possible future therapeutic applications in the management of OA. © 2015 Osteoarthritis Research Society International.
Moroney P.J.,Connolly Hospital Blanchardstown |
O'Neill B.J.,Connolly Hospital Blanchardstown |
Khan-Bhambro K.,Connolly Hospital Blanchardstown |
O'Flanagan S.J.,Connolly Hospital Blanchardstown |
And 2 more authors.
Foot and Ankle Specialist | Year: 2014
Background: Chronic plantar heel pain is a common and potentially debilitating condition, often caused by plantar fasciitis. Plantar calcaneal spurs were originally considered the cause of plantar fasciitis but are now regarded as an incidental finding by most authors. We aimed to test this hypothesis and to investigate predisposing factors for the development of spurs. Methods: We reviewed all lateral ankle X rays taken in our institution over a 6-month period and identified all X rays demonstrating calcaneal spurs. Then, we identified a similar number of age- and sex-matched controls without spurs. We contacted both groups by telephone and compared symptoms of heel pain, plantar fasciitis, associated comorbidities, and foot and ankle outcome scores (FAOSs). Results: We reviewed the X rays of 1103 consecutive patients and found a spur prevalence of 12.4%, more common in women and older patients. Questioning of the spur group and control group found a higher body mass index in the spur group. Patients with spurs were 4 times more likely to have diabetes mellitus and 10 times more likely to have lower-limb osteoarthritis. Patients with spurs had more foot pain and poorer FAOS than the control group, even when patients with plantar fasciitis were excluded. Conclusion: Our results demonstrate that the presence of a plantar calcaneal spur may be an indicator of foot pain independent of plantar fasciitis. Although spurs may not cause foot pain themselves, they may be an indication of other associated conditions. Clinical relevance: We have demonstrated the relevance of a radiographic finding once considered irrelevant.Level of Evidence: Prognostic, Level III: Case-control study © 2013 The Author(s).
Hensey M.,Connolly Hospital Blanchardstown |
O'Neill J.,Connolly Hospital Blanchardstown
Current Cardiology Reports | Year: 2016
There has been an increased focus on heart rate as a target in the management of cardiovascular disease and more specifically in heart failure with preserved ejection fraction in recent years with several studies showing the benefit of a lower resting heart rate on outcomes. This review paper examines the pathophysiology behind the benefits of lowering heart rate in heart failure and also the evidence for and against the pharmacological agents available to achieve this. © 2016, Springer Science+Business Media New York.
Parati G.,San Luca Hospital |
Parati G.,University of Milan Bicocca |
Dolan E.,Connolly Hospital Blanchardstown |
Ley L.,Boehringer Ingelheim |
Schumacher H.,Boehringer Ingelheim
Journal of Hypertension | Year: 2014
Objectives: High 24-h ambulatory blood pressure (ABP) variability is associated with poor cardiovascular outcomes. We analysed a large ABP monitoring database containing data from hypertensive patients treated with telmisartan/amlodipine combination or various monotherapies with the aim of quantifying the 24-h distribution of blood pressure (BP) reduction by treatment through the smoothness index and of developing and testing a new treatment-on-variability index (TOVI) to quantify the effects of treatment on both mean BP and BP variability. Methods: ABP data were pooled from 10 studies (N=4294) with a median follow-up of 60 days. Smoothness index was calculated by dividing the mean of treatment-induced hourly BP reductions by its SD. TOVI was calculated as the ratio of the mean of hourly BP reductions to weighted 24-h BP SD (weighted mean of daytime and night-time SDs) under treatment. Results: The SBP/DBP smoothness index and TOVI values of telmisartan/amlodipine combination were significantly (P<0.0001) higher (smoothness index: 1.81/1.51; TOVI: 2.71/2.13) compared with telmisartan 80mg (smoothness index: 1.12/0.90; TOVI: 1.55/1.23), amlodipine 10mg (smoothness index: 1.33/1.09; TOVI: 2.09/1.58), valsartan 160mg (smoothness index: 1.01/0.81; TOVI: 1.35/1.07), ramipril 10mg (smoothness index: 0.83/0.63; TOVI: 1.11/0.87) and placebo (smoothness index: 0.23/0.18; TOVI: 0.34/0.30), indicating a smoother 24-h BP reduction profile (higher smoothness index) as well as the achievement of significantly lower and smoother BP levels over 24h (higher TOVI) with the combination. Conclusion: As compared with various monotherapies, the telmisartan/amlodipine combination was associated with a smoother BP reduction over 24h and with a more favourable balance between mean 24-h BP reduction and the degree of BP variability on treatment, reflecting both its effectiveness in lowering BP levels and its longer duration of action the agreement between smoothness index and TOVI demonstrates that they are similarly effective in the differentiation of antihypertensive treatments, although providing conceptually different information, the clinical relevance of which needs to be tested by ad-hoc outcome studies. © 2014 Wolters Kluwer Health | Lippincott Williams Wilkins.
Conway R.,Galway University Hospitals |
Conway R.,National University of Ireland |
Conway R.,Park University |
Low C.,Connolly Hospital Blanchardstown |
And 4 more authors.
BMJ (Online) | Year: 2015
Objective To evaluate the relative risk of pulmonary disease among patients with psoriasis, psoriatic arthritis, and inflammatory bowel disease treated with methotrexate. Data sources PubMed, Cochrane central register of controlled trials, and Embase to 9 January 2014. Study selection Double blind randomised controlled trials of methotrexate versus placebo or active comparator agents in adults with psoriatic arthritis, psoriasis, or inflammatory bowel disease. Studies with fewer than 50 participants or of less than 12 weeks' duration were excluded. Data synthesis Two investigators independently searched both databases. All authors reviewed selected studies. We compared relative risk differences using the Mantel-Haenszel random effects method to assess total respiratory adverse events, infectious respiratory adverse events, non-infectious respiratory adverse events, interstitial lung disease, and death. Results Seven studies met our inclusion criteria, six with placebo as the comparator. Heterogeneity across the studies was not significant (I2=0%), allowing combination of trial results. 504 respiratory adverse events were documented in 1630 participants. Methotrexate was not associated with an increased risk of adverse respiratory events (relative risk 1.03, 95% confidence interval 0.90 to 1.17), respiratory infections (1.02, 0.88 to 1.19), or non-infectious respiratory events (1.07, 0.58 to 1.96). No pulmonary deaths occurred. Conclusions Findings suggested that there was no increased risk of lung disease in methotrexate treated patients with non-malignant inflammatory diseases. Given the limitations of the study, however, we cannot exclude a small but clinically important risk. © BMJ Publishing Group Ltd 2015.
PubMed | Connolly Hospital Blanchardstown, Lancaster University and Trinity College Dublin
Type: | Journal: Journal of clinical nursing | Year: 2016
To evaluate the efficacy of action learning for improving cancer related pain management in the acute healthcare settings. Despite the prevalent use of action learning in private, public, clinical and non-clinical settings, no studies were found in the literature that either examined cancer pain management or used action learning as an approach to improve patient care in acute healthcare settings.An intervention pre - posttest design was adopted using an action learning programme (ALP) as the intervention. Healthcare professionals knowledge, attitudes and practice were assessed and evaluated before and after the implementation of the six-month ALP. A pre and post audit and survey were conducted for data collection. The data were collected from the entire population of 170 healthcare professionals in one healthcare organisation.The management of cancer related pain improved significantly following the intervention. Significant improvement were also seen in healthcare professionals knowledge, attitudes with improved cancer related pain management as a consequence of this.Despite many organisational challenges to practice development and collaborative working in healthcare settings there is evidence that action learning can achieve positive outcomes for improving CRP and supporting collaborative working. Action learning needs to be considered as a strategy for achieving high quality standards. This article is protected by copyright. All rights reserved.
PubMed | Connolly Hospital Blanchardstown and Connolly Hospital
Type: | Journal: Irish journal of medical science | Year: 2017
Dietary nitrate has been shown to increase nitrate/nitrite levels in multiple populations, with potential blood pressure lowering effects. However, there are few reports among hypertensives.We aimed to assess the effect of daily nitrate in subjects with controlled hypertension vs. uncontrolled hypertension.On day 0, hypertensives wore an ambulatory BP monitor (ABPM) for 24h and fasting blood was taken. Subjects then consumed concentrated beetroot juice (12.9mmol nitrate) for 14 consecutive days. On day 14 subjects consumed their last nitrate dose after fasting blood was drawn and again had an ABPM for 24h.According to baseline ABPM, 11 subjects had controlled BP while 8 had uncontrolled BP. There were similar, significant increases in serum nitrate/nitrite in both groups. We observed little change in BP variables among controlled hypertensives. However, there were reductions in BP variables in uncontrolled hypertensives where decreases in nighttime DBP (-64.8mmHg), arterial stiffness (-0.080.03 ambulatory arterial stiffness index) and LDL (-0.360.42mmol/L) reached significance (p=003, 0.05 and 0.046, respectively).Our results support the existing data suggesting an anti-hypertensive effect of nitrate-containing beetroot juice, but only among those with uncontrolled hypertension.
PubMed | Materials Misericordiae University Hospital, Connolly Hospital Blanchardstown, The Adelaide and Meath Hospital, National University of Ireland and 2 more.
Type: | Journal: Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association | Year: 2017
Celiac disease is an immune-mediated enteropathy characterized with high heterogeneity in presentation among genetically predisposed individuals. In recent years, a change in the phenotypic presentation of celiac disease has been reported. We studied clinical presentation, from 1960 through 2015, in Ireland, which has a high incidence of celiac disease.We performed a retrospective analysis of medical charts from patients diagnosed with celiac disease at 5 secondary referral centers in Ireland from 1960 through 2015 (n=749; median age, 56 years; age range 18-91 years). The cohort was divided into 5 groups based on year of diagnosis (1985, 1986-1995, 1996-2005, 2006-2010, or 2011 and later). We collected findings from clinical presentation at diagnosis, serology tests and small intestinal biopsy analyses, as well as patients demographic, clinical, and family data. Presentations at diagnosis were classified according to the Oslo criteria as follows: classical (patients presenting with malabsorption), non-classical (no signs or symptoms of malabsorption at presentation), or subclinical (below the threshold of clinical detection). The primary outcome was change in clinical presentation of celiac disease over time.Of the 749 patients studied, 512 were female and 237 were male (ratio of 2.2:1). Female patients were diagnosed at younger ages than male patients (42 vs 47 years respectively, P=.004), and had more immune-mediated conditions than male patients (35.7% for female patients vs 21.5% for male patients, P<.001). For patients diagnosed as adults (after the age of 18 years), the median age of diagnosis increased from 34.0 years during the period 1985 to median ages of 44-46 years after 1985 (P<.002). A smaller proportion of patients presented with classical features of celiac disease after 2010 (48.4%) than 1985 (85.2%); the proportion of patients with non-classical or subclinical celiac disease increased from 14.8% 1985 to 51.6% after 2010 (P=.006 for each). Biopsies categorized as Marsh 3c decreased, from 52.2% in the period 1996-2005 to 22.5% in the period after 2010 (P=0.003). The prevalence of associated thyroid disease has decreased during the study period, from 36.6% 1985 to 17.1% after 2010 (P=.039), whereas body mass index at diagnosis increased from 21.5 kg/m2 1985 to 24.8 kg/m2 after 2010 (P<.001).We found the clinical presentation of celiac disease changed significantly in Ireland from 1960 through 2015. The age of presentation in adulthood increased over this time period, as did the proportions of patients with non-classical or subclinical disease.
PubMed | Connolly Hospital Blanchardstown
Type: | Journal: International journal of surgery case reports | Year: 2017
Synovial chrondomatosis is a rare disorder characterised by the development of hyaline cartilage from the synovial membrane. Large isolated lesions in the Hoffas fat pad are an uncommon entity.A 33 year old gentleman presented complaining of progressive knee pain associated with an enlarging lesion on the anterior aspect of the right knee, with associated locking and giving way. Examination revealed a firm 45cm lesion adjacent to the patellar tendon. Subsequent CT and MRI demonstrated a lesion in the inferior aspect of Hoffas fat pad, with a second lesion adjacent to the proximal tibiofibular joint, in addition to advanced degenerative changes and a meniscal tear. He proceeded to excisional biopsy. Histological analysis was consistent with a solitary synovial osteochondroma. There were no atypical features suggestive of malignancy.Synovial chondromatosis is a rare disorder affecting the synovial joints. The underlying pathophysiology is thought to be metaplastic change of the synovium to hyaline cartilaginous tissue. Transformation to malignancy has been described but is uncommon with an estimated risk of 5%. It is 1.5-2 times as prevalent in males versus females. Symptoms which patients may complain of include pain;locking and giving way; and palpable masses. The management usually entails removal of the mass lesion with or without accompanying synovectomy. Recurrence of disease may occur in up to 15-23% of patients.Synovial chrondromatosis is a rare but well recognised condition. Long term follow up is advised in view of the risk of recurrence and malignant transformation.