UCC Journals (Univ. College Cork)
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Aortic valve replacement via mini-sternotomy: Results of a single centre analysis
Get PDFBackground: The traditional method of Aortic Valve Replacement (AVR) is via full sternotomy. However, this incision may not heal properly and cause significant pain. Minimally-invasive approaches have been adopted, including mini-sternotomy. These have gained popularity due to smaller incision, reducing surgical trauma. The hypothesis is that AVR via mini-sternotomy is a safe alternative to full sternotomy. The objective was to analyse and describe results of patients who underwent the procedure, including post-operative outcomes.
Methods: A retrospective database review was performed on patients who underwent AVR via mini-sternotomy between September 2016 and December 2022 in Cork University Hospital (CUH). Exclusion criteria included patients who had an aortic procedure concurrently, such as ascending aorta replacement, and those under 18 years. Results for variables, such as age, were expressed as a mean.
Results: 93 patients were included; the average age was 68. Average bypass and cross-clamp times were 92 and 73 minutes respectively. Median post-operative length of stay was 8 days and median ICU length of stay was 3 days. There were no in-hospital mortalities.
Conclusion: AVR via mini-sternotomy has cosmetic advantages and is particularly useful in frail patients who may suffer from a conventional sternotomy and associated morbidities. It is shown to be a safe alternative with comparable intra- and post-operative outcomes to those described internationally
Exploring the biopsychosocial model for evaluation of an acutely suicidal patient with co-occurring borderline personality disorder and substance misuse: a case study
No full textBackground: Borderline Personality Disorder (BPD) is a significant public health concern, affecting an estimated 28,725 individuals in Ireland with considerable associated costs. Despite its complexity, the biopsychosocial model offers a comprehensive approach, enabling clinicians to integrate predisposing, precipitating, perpetuating, and protective factors when understanding and managing BPD.
Objective: This report presents a case study of a 35-year-old woman with a background of BPD and substance abuse, detailing her biopsychosocial formulation during an episode of acute suicidal ideation.
Methods: The case entailed a thorough history and clinical examination, focusing on the biopsychosocial model\u27s 4P causal framework: predisposing, precipitating, perpetuating, and protective factors.
Results: Predisposing factors were abundant, including family history of mental health disorders and personal history of trauma. Precipitating factors were multi-faceted, encompassing biological vulnerabilities from alcohol abuse and significant recent social stressors, such as unemployment, eviction, custody battles, and bereavement. Perpetuating elements revolved around ongoing legal challenges and deep-seated feelings of guilt. However, protective factors were also present: no co-existing medical conditions, an eventual stable mood post-treatment, and engagement in therapeutic activities, including mindfulness interventions.
Conclusion: This case underscores the value of the biopsychosocial model in psychiatric patient care, highlighting its potential to uncover individualized nuances in classic presentations. Embracing this model can optimize holistic care, underscoring its imperative utility in clinical practice
Unraveling paediatric constipation: a biopsychosocial approach toward a 2-year-old’s chronic gastrointestinal quandary
Get PDFIntroduction:
This case report unfolds the diagnostic and therapeutic journey of a 2-year-old girl with chronic constipation unresponsive to conventional laxatives, hinting at a possible underlying organic pathology amidst a complex familial and personal medical background.
Methods:
Utilizing a biopsychosocial model, a comprehensive assessment was conducted to delineate the predisposing, precipitating, perpetuating, and protective factors affecting the patient’s gastrointestinal health. A multidisciplinary approach was employed to craft a tailored management plan involving the patient and her parents.
Results:
The application of the biopsychosocial model unveiled an intricate interplay of biological,
psychological, and social factors contributing to the patient’s persistent constipation. The multidisciplinary approach fostered a nuanced understanding and a patient-centered management plan, addressing not only the gastrointestinal symptoms but also the broader health and well-being of the child and her family.
Discussion:
The case accentuates the essentiality of transcending traditional biological examinations, embracing a holistic, patient-centered, biopsychosocial model, especially in pediatric patients with complex medical and familial backgrounds. It also underscores the need for an integrated, multidisciplinary approach for effective diagnosis and management in complex pediatric gastroenterological cases.
Conclusion:
The case elucidates the paramountcy of a multidisciplinary, biopsychosocial approach in navigating complex pediatric gastroenterological cases, fostering an enriched discourse on patient-centered care and enhancing long-term health outcomes
The use of Artificial Intelligence in clinical diagnostics: Challenges to consider for implementation
Get PDFWhilst many technological advancements have revolutionised healthcare throughout the 21st century, one of the most significant is Artificial Intelligence (AI). AI is generally regarded as the capability to imitate intelligent human behaviour using machines, and is based on computer science, statistics, algorithms, machine learning, information retrieval, and data science1. AI has permeated into many domains of healthcare including Clinical Diagnostics. While AI chatbots (such as those used in Babylon and Ada) are being used by patients to identify symptoms and recommend further actions in community and primary care settings, more recent advances in the technology with larger datasets have provided users access to a more extensive array of clinical conditions2. However, as these tools are constantly being developed with an ever-increasing dataset of clinical cases, certain challenges threaten the implementation of an accurate and effective model. In this article, the issue of Data Bias, and Data Handling will be examined within the context of Clinical Diagnostics, and how these factors threaten the development of such AI Healthcare tools
Evaluation of the relationship between thyroid cancer and the concurrent detection of thyroid nodules on the background of primary hyperparathyroidism
Get PDFIntroduction: Primary Hyperparathyroidism (PHPT) is commonly caused by a benign parathyroid adenoma that results in overactivity of the gland and subsequent hypercalcemia due to elevated parathyroid hormone (PTH). This endocrine pathology is associated with thyroid cancer, specifically Papillary Thyroid Cancer (PTC). However, the explanation for their synchronous presentation is unknown. Moreover, it causes diagnostic and treatment challenges that impact patient outcomes.
Aims and Objectives: To critically analyze published research to address the relationship between PHPT and thyroid cancer, the role of ultrasound imaging in detecting sinister thyroid nodules in PHPT patients and the features of PHPT that predispose the risk of thyroid malignancy.
Study Design: Literature Review
Methodology: Electronic database searches of PubMed and CINAHL Plus through EBSCOhost were conducted using the keywords "primary hyperparathyroidism", "thyroid nodules" and "thyroid cancer". Following application of filters and removal of duplicates, 627 relevant results remained. Articles were screened for eligibility based on predetermined selection criteria. Following a review of titles and abstracts, 10 peer-reviewed articles were chosen for further analysis. The studies included were critically appraised using the EBL Critical Appraisal Checklist.
Results: 10 articles were examined, 2 were prospective cohort studies and 8 were retrospective cohort studies. All studies involved exhaustive medical chart reviews of patients with PHPT, to investigate the concomitance of thyroid malignancy. Six studies established cervical ultrasound as the optimal method of recognition and preoperative localization of thyroid and parathyroid lesions. Overall, the incidence of thyroid cancer among PHPT patients ranged between 2.9% to 32.9%. Four studies established age, gender and PTH levels as risk factors.
Conclusion: The existing literature is consistent with previous studies and purports that individuals with a background fo PHPT are at an increased risk of thyroid cancer. Furthermore the highest likelihood of identifying thyroid cancer is through preoperative localization of parathyroid adenomas by cervical ultrasound, in female patients over the age of 50.
Key Findings: Further research is needed to understand the underlying pathogenesis and genetic mechanisms that encompass the relationship between PHPT and thyroid cancer.
The state of malaria in a rural-mission hospital in Nkhoma, Malawi
Get PDFIntroduction: In recent times, malaria has fallen out of the limelight due to an economical migration of populations into medium and higher income settings. Despite this, it remains endemic in 31 countries with 228 million cases per annum. In Malawi, the WHO have reported that all of its citizens are at risk of contracting the disease. In this study we hope to expand on the clinical data available at a rural mission hospital in Malawi, as well as highlight some of the external global health factors in such environments.
Methods: An observational retrospective cohort study looking at severe malaria admission in a paediatric population was conducted. The Nkhoma hospital Paediatric department was the centre of the data collection which focused on the diagnosis of severe malaria, as well as the signs and symptoms and treatment regimens of same.
Results: Severe malaria accounted for over 40% of all paediatric admissions in the month of May 2019. Patients suffered from anaemia (80%) and cerebral malaria (41%), as well as a host of generalised symptoms such as fever (95%), vomiting (36%), malaise (30%), and diarrhoea (21%). Promisingly, a strict and comprehensive treatment regime for severe malaria was in practice with artesunate, Lumefantrine used in ~100% of cases.
Conclusion: Sadly, malaria continues to create horrendous amounts of morbidity and mortality, but our united commitment to eradicating malaria is stronger than ever.
Behavioral addictions and psychosis
Get PDFM.K* is a 27-year-old, single, unemployed male that was driven to the Emergency Department by his foster father, four weeks ago with first episode of psychiatric symptoms of tactile hallucinations, auditory hallucinations of male and female voices making inappropriate sexual comments about him, persecutory delusions and delusions of control for the past five days. M.K is a daily cannabis user of 0.5-1g use for the past 2 years and has 5.5 pack year smoking history. M.K also reports having a pornography and masturbation addiction for 2 years with marked intrusive thoughts of sexual nature the past week. M.K has no medical or psychiatric history. Recent stressor was moving out of foster father’s house 8 days ago. The symptoms led to significant impact at work which he has quit since then. On presentation, M. K showed partial insight into his third person running commentary hallucinations but believed adamantly that he was being watched, followed and controlled. He reported hearing his female neighbour stating that he has sexual interest in animals and later heard his manager making pedophilic allegations on him. M.K was so distressed, he quit work and isolated himself in his room. He reported poor concentration and lack of appetite for the past week. M.K describes his baseline mood to have “always been not the greatest” and denied anhedonia, fatigue, or sleep changes. He denied thoughts of self- harm, harm to others or suicidal ideation. Four weeks following inpatient, referral to HBCT and cannabis abstinence has shown improvement in psychiatric symptoms with absence of hallucinations, however, there has been increased symptoms of anxiety with “panic attacks”. M.K’s biological mother is reported to have history of substance misuse and sister with depressive symptoms. He continues to withdraw from society with increased time spent indoors gaming and shows emotional dependence on foster father
Corcaigh Ceann an Domhain
No full textThis map is entitled Corcaigh Ceann an Domhain (“Cork, the Head of the World”), which is inspired by the Latin phrase Roma caput mundi. It is painted with acrylics on canvas board, and finished with coffee stain and shellac, and the map is orientated to the east. The aim was to make a map from the perspective of Cork being at its centre and distort the world around it. The central landmass is Ireland with a disproportionately sized Cork: on the left is the Shannon estuary, and further above is Galway Bay and Lough Neagh. Surrounding Ireland is Iceland on the lower left, Iberia on the lower right, Norway and Britain to the top, and India and the Caspian Sea at the top right. The map is inspired by medieval world maps, or mappae mundi (in particular, the Cotton World Map found in a manuscript held in the British Library - Cotton MS Tiberius B. V, f. 56v) which were produced in what is now Britain, France and Germany from the eleventh to the fifteenth centuries
The time when the new light is born: Ewa Benesz\u27s Paratheatre as a collective and individual performative process
Get PDFThe subject of this report is the paratheatrical laboratory In the Act of Creating: Meeting with the Lentisk, led by Ewa Benesz. The contribution provides insight into this work, focusing on the key elements that characterise it as both an individual and collective artistic process. Benesz is one of the most important representatives of paratheatre, a participatory artistic practice initiated in 1969 by Jerzy Grotowski as part of the activities of the Wrocław Laboratory Theatre. In the article, I offer my own testimony of the workshop held at Ca’Colmello in Italy in January 2020, focusing on the analogy between the transformation of the lentisk plant and the inner process of the performer. Each paratheatrical encounter is unique and unrepeatable: through improvised actions, the participants give life to an extemporary theatrical creation in the absence of an audience. The purpose of the report is to provide an account of the work that highlights its particular dramaturgical dimension, which is not fixed and is capable of generating, welcoming, and integrating the proposals of both group and individual performers