Tolland J.P.,Ulster Hospital Dundonald |
Murphy B.P.,Ulster Hospital Dundonald |
Boyle J.,Belfast City Hospital |
Hall V.,Belfast City Hospital |
And 3 more authors.
Photodermatology Photoimmunology and Photomedicine | Year: 2012
The incidence of phototoxicity as a side effect of ciprofloxacin appears to be increased in patients with cystic fibrosis compared to the general population (approximately 2.4%). We used an interview-based questionnaire to determine the incidence of such phototoxic skin reactions in cystic fibrosis patients. Results from 105 respondents revealed the incidence of ciprofloxacin-induced phototoxicity in the adult cystic fibrosis population in Northern Ireland to be 48.4% with only 66% of the patients recalling being given sun care information beforehand. We concluded that the incidence of phototoxicity is increased in patients with cystic fibrosis and that it is important for all to receive good sun care information prior to taking ciprofloxacin given the high risk of developing phototoxic rash. © 2012 John Wiley & Sons A/S.
PubMed | Ulster Hospital Dundonald and Belfast City Hospital
Type: | Journal: Case reports in gastrointestinal medicine | Year: 2016
Patients with Crohns disease often require the use of immunosuppressant drugs to control disease activity. Such medication includes steroids, azathioprine, and biologic therapy. These suppress the immune response, and the patient is more susceptible to infection. We present a case of a 69-year-old gentleman with a history of Crohns colitis who had ongoing symptoms of diarrhoea in spite of standard treatment. Biologic therapy was considered to be the next step, and screening for infection was undertaken prior to use. Three days following anti-TNF treatment, he became drowsy, and examination revealed pyrexia, slurred speech, and nystagmus. Investigation revealed presence of Listeria rhombencephalitis. He demonstrated poor neurological recovery. Listeria monocytogenes is an infection commonly associated with food sources. Some patients develop a self-limiting diarrhoeal illness, but in the immunosuppressed population, the clinical features may be more sinister. Cotrimoxazole prophylaxis is already recommended for those on triple immunosuppression. We propose the early initiation of this treatment, including where biologic use is anticipated. In those on multiple immunosuppressants, a diet similar to that followed in pregnancy may minimise risk of acquiring this infection. Clinicians must always have a high index of suspicion for opportunistic infection in such immunocompromised patients.
Eastwood M.P.,Ulster Hospital Dundonald |
Hoo K.H.,Ulster Hospital Dundonald |
Adams D.,Royal Victoria Hospital |
Hill C.,Ulster Hospital Dundonald
Cleft Palate-Craniofacial Journal | Year: 2014
Objective: To determine uptake and outcome of hearing screening in the cleft palate population in Northern Ireland (NI) and the rate of ventilation tube (VT) insertion over a 3-year period. Design: In NI, hearing screening is offered in the neonatal period, at 9 months in the community, and at 2.5 years in the joint cleft clinic. Patients: Eighty-five children with cleft palate born between 2006 and 2008 in NI were eligible for all three screenings. Methods: A retrospective case note review was performed of tympanograms, audiometry, and VT insertion rates at each of the three time points. Results: In the neonatal period, all patients eligible were screened; 66 (77.6%) patients passed the screening, with 19 patients (22.4%) failing, resulting in direct referral to ENT for consideration of VT. Results of the 9-month community screening were not made routinely available to the regional cleft service. At the 2.5-year clinic screening, all attending patients (n = 80) had documented screening. Fifty-two (65%) patients passed screening, with 28 patients (35%) failing screening. Forty-six patients (57.5%) had documented VT, and 9 (11.25%) were awaiting ENT review for consideration of VT. Conclusion: Ventilation tubes are not routinely inserted at the time of cleft repair in the NI population, and 57.5% of our cleft population has ventilation tubes inserted by 2.5 years. Cleft patients in NI have regular routine hearing assessments, and our current practice avoids universal ventilation tube insertion while identifying those who need further hearing management. Further research is needed to reach an international consensus on the insertion of VT in cleft patients. © Copyright 2014 American Cleft Palate-Craniofacial Association.
Smyth J.,Queen's University of Belfast |
Smyth J.,Ulster Hospital Dundonald |
Marley J.,Queen's University of Belfast |
Marley J.,Royal Victoria Hospital
British Journal of Oral and Maxillofacial Surgery | Year: 2010
Systemic and localised complications after administration of local anaesthetic for dental procedures are well recognised. We present two cases of patients with trismus and sensory deficit that arose during resolution of trismus as a delayed complication of inferior alveolar nerve block. © 2009 The British Association of Oral and Maxillofacial Surgeons.
McCain S.,Ulster Hospital Dundonald
BMJ case reports | Year: 2014
A 41-year-old woman developed severe abdominal pain, distension and faeculent vomiting. CT of abdomen and pelvis revealed small bowel malrotation with a right paraduodenal hernia. At emergency laparotomy, a right paraduodenal hernia containing jejunum and ileum was identified. She had a viable duodenum with 50 cm of ischaemic proximal jejunum which was exteriorised as an end jejunostomy; 180 cm of infarcted jejunum and ileum was resected. The proximal end of 150 cm of healthy ileum was exteriorised as a closed mucous fistula and 50 cm distally a feeding ileostomy was constructed. On day 5 postoperatively, jejunal effluent began to be recycled via her feeding ileostomy and she never required parenteral nutrition. Despite having only 50 cm of jejunum proximal to her stoma, recycling of effluent enabled her electrolytes to remain normal. She put on weight postoperatively and proceeded to closure of her stomas at 6 months, not requiring laparotomy. 2014 BMJ Publishing Group Ltd.
McCain S.,Ulster Hospital Dundonald |
Harris A.,Ulster Hospital Dundonald |
McCallion K.,Ulster Hospital Dundonald
BMJ Case Reports | Year: 2014
A 41-year-old woman developed severe abdominal pain, distension and faeculent vomiting. CT of abdomen and pelvis revealed small bowel malrotation with a right paraduodenal hernia. At emergency laparotomy, a right paraduodenal hernia containing jejunum and ileum was identi fied. She had a viable duodenum with 50 cm of ischaemic proximal jejunum which was exteriorised as an end jejunostomy; 180 cm of infarcted jejunum and ileum was resected. The proximal end of 150 cm of healthy ileum was exteriorised as a closed mucous fistula and 50 cm distally a feeding ileostomy was constructed. On day 5 postoperatively, jejunal effluent began to be recycled via her feeding ileostomy and she never required parenteral nutrition. Despite having only 50 cm of jejunum proximal to her stoma, recycling of effluent enabled her electrolytes to remain normal. She put on weight postoperatively and proceeded to closure of her stomas at 6 months, not requiring laparotomy. Copyright 2014 BMJ Publishing Group. All rights reserved.
Ong Y.L.,Ulster Hospital Dundonald |
Deore R.,Ulster Hospital Dundonald |
Rl-Agnaf M.,Ulster Hospital Dundonald
International Journal of Laboratory Hematology | Year: 2010
Pseudohyperkalaemia in conditions with increased platelet counts is caused by an in vitro rise of the serum potassium concentration during whole blood coagulation and the lysis of the platelets and other cellular components, in the presence of normal renal function and normal plasma potassium levels. The association between pseudohyperkala- emia and aetiology of thrombocytosis was studied in a 6-year retrospective audit on 90 patients with thrombocytosis referred to the Haematology Department in Ulster Hospital Dundonald, a large district general hospital. Over two-thirds of this study population had myeloproliferative disorders, and the most common diagnosis was primary thrombocythaemia (41%, n = 37). Reactive thrombocytosis was observed in approximately one-third of the cases (32%, n =29). Pseudohyperkalaemia with apparent potassium level above the upper limit of the normal range (reference range K 3.5-5.1 mmol/l) was observed in the majority of patients with thrombocytosis from any aetiology (60%, n = 54). The likelihood of finding pseudohyperkalaemia was highest among patients with primary thrombocythaemia (75.7%, n = 28/37) and polythaemia rubra vera (75%, n = 12/16), followed by myelofibrosis (50%, 4/8) and reactive thrombocytosis (34.5%, n = 10/29). A highly significant positive correlation was observed between the platelet counts and the serum potassium level (Spearman's correlation coefficient, R = 0.998, P = 0.01). Awareness of pseudohyperkalemia in disease conditions with increased platelet counts will lead to the withholding of potentially harmful treatment. © 2008 Blackwell Publishing Ltd.
Spence M.,Queen's University of Belfast |
Alderdice F.A.,Queen's University of Belfast |
Harper R.,Ulster Hospital Dundonald |
McCance D.R.,Royal Victoria Hospital |
Holmes V.A.,Queen's University of Belfast
Diabetic Medicine | Year: 2010
Aims Pre-pregnancy care optimizes pregnancy outcome in women with pre-gestational diabetes, yet most women enter pregnancy unprepared. We sought to determine knowledge and attitudes of women with Type 1 and Type 2 diabetes of childbearing age towards pre-pregnancy care. Methods Twenty-four women (18 with Type 1 diabetes and six with Type 2 diabetes) aged 17-40 years took part in one of four focus group sessions: young nulliparous women with Type 1 diabetes (Group A), older nulliparous women with Type 1 diabetes (Group B), parous women with Type 1 diabetes (Group C) and women with Type 2 diabetes of mixed parity (Group D). Results Content analysis of transcribed focus groups revealed that, while women were well informed about the need to plan pregnancy, awareness of the rationale for planning was only evident in parous women or those who had actively sought prepregnancy advice. Within each group, there was uncertainty about what pre-pregnancy advice entailed. Despite many women reporting positive healthcare experiences, frequently cited barriers to discussing issues around family planning included unsupportive staff, busy clinics and perceived social stereotypes held by health professionals. Conclusions Knowledge and attitudes reported in this study highlight the need for women with diabetes, regardless of age, marital statusor type of diabetes, to receive guidance about planningpregnancy in amotivating, positive and supportive manner. The important patient viewpoints expressed in this studymayhelp health professionals determine howbest to encourage women to avail of pre-pregnancy care.
Wallace R.G.H.,Musgrave Park Hospital |
Wallace R.G.H.,Ulster Hospital Dundonald |
Heyes G.J.,Musgrave Park Hospital |
Heyes G.J.,Ulster Hospital Dundonald |
And 2 more authors.
Journal of Bone and Joint Surgery - Series B | Year: 2011
Controversy surrounds the most appropriate treatment method for patients with a rupture of the tendo Achillis. The aim of this study was to assess the long term rate of re-rupture following management with a non-operative functional protocol. We report the outcome of 945 consecutive patients (949 tendons) diagnosed with a rupture of the tendo Achillis managed between 1996 and 2008. There were 255 female and 690 male patients with a mean age of 48.97 years (12 to 86). Delayed presentation was defined as establishing the diagnosis and commencing treatment more than two weeks after injury. The overall rate of re-rupture was 2.8% (27 re-ruptures), with a rate of 2.9% (25 re-ruptures) for those with an acute presentation and 2.7% (two re-ruptures) for those with delayed presentation. This study of non-operative functional management of rupture of the tendo Achillis is the largest of its kind in the literature. Our rates of re-rupture are similar to, or better than, those published for operative treatment. We recommend our regime for patients of all ages and sporting demands, but it is essential that they adhere to the protocol. © 2011 British Editorial Society of Bone and Joint Surgery.
PubMed | Northern Ireland Clinical Trial Unit, Queen's University of Belfast, Ulster Hospital Dundonald and Royal Belfast Hospital for Sick Children
Type: Journal Article | Journal: PloS one | Year: 2015
Despite vaccines and improved medical intensive care, clinicians must continue to be vigilant of possible Meningococcal Disease in children. The objective was to establish if the procalcitonin test was a cost-effective adjunct for prodromal Meningococcal Disease in children presenting at emergency department with fever without source.Data to evaluate procalcitonin, C-reactive protein and white cell count tests as indicators of Meningococcal Disease were collected from six independent studies identified through a systematic literature search, applying PRISMA guidelines. The data included 881 children with fever without source in developed countries.The optimal cut-off value for the procalcitonin, C-reactive protein and white cell count tests, each as an indicator of Meningococcal Disease, was determined. Summary Receiver Operator Curve analysis determined the overall diagnostic performance of each test with 95% confidence intervals. A decision analytic model was designed to reflect realistic clinical pathways for a child presenting with fever without source by comparing two diagnostic strategies: standard testing using combined C-reactive protein and white cell count tests compared to standard testing plus procalcitonin test. The costs of each of the four diagnosis groups (true positive, false negative, true negative and false positive) were assessed from a National Health Service payer perspective. The procalcitonin test was more accurate (sensitivity=0.89, 95%CI=0.76-0.96; specificity=0.74, 95%CI=0.4-0.92) for early Meningococcal Disease compared to standard testing alone (sensitivity=0.47, 95%CI=0.32-0.62; specificity=0.8, 95% CI=0.64-0.9). Decision analytic model outcomes indicated that the incremental cost effectiveness ratio for the base case was -8,137.25 (US $ -13,371.94) per correctly treated patient.Procalcitonin plus standard recommended tests, improved the discriminatory ability for fatal Meningococcal Disease and was more cost-effective; it was also a superior biomarker in infants. Further research is recommended for point-of-care procalcitonin testing and Markov modelling to incorporate cost per QALY with a life-time model.