UCC Journals (Univ. College Cork)
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Proton Pump Inhibitors as chemoprophylaxis against the progression of Barrett’s Esophagus: a literature review
No full textBackground: Barrett’s Esophagus (BE) is a premalignant condition with a strong association with an increased risk of Esophageal Adenocarcinoma (EAC). Due to this established progression, management strategies focus on symptom control with acid suppression therapy via proton pump inhibitors (PPIs), and endoscopic surveillance using advanced imaging techniques to detect neoplastic progression early, despite its small association with decreased mortality. These approaches emphasize early detection rather than preventing malignant transformation. A case described in The New England Journal of Medicine highlights a 56-year-old obese man with a 4-cm segment of non-dysplastic BE who was managed with PPIs for reflux control and endoscopic surveillance. This case exemplifies a key gap in standard clinical practice - BE management relies on PPIs and surveillance rather than chemoprevention. Given this, optimizing PPI dosage as a targeted pharmacological intervention could offer a minimally invasive alternative to more resource-intensive endoscopic interventions, reducing procedural burden on healthcare systems. However, the role of PPIs in chemoprophylaxis remains unclear, necessitating further investigation into their efficacy in preventing neoplastic progression.
Objectives: Evaluate the efficacy of PPIs as a chemopreventive strategy by establishing the optimal dosage and duration required and assess whether PPIs, either alone or in combination with other pharmacological agents will effectively interrupt the progression of BEs from high-grade dysplasia to EAC.
Methods: To address this gap, a systematic search was performed using PubMed with MeSH terms. Exclusion and inclusion filters were applied, yielding 49 articles. Studies focusing on PPI use alone or with other pharmacological agents were prioritised with title/abstract screening conducted to assess eligibility. This generated the 14 articles used in this review.
Results: The literature review found strong evidence supporting the chemopreventive role of PPIs in the neoplastic progression of Barrett’s esophagus (BE). Long-term PPI use has been shown to reduce the risk of high-grade dysplasia and esophageal adenocarcinoma (EAC), with some studies even demonstrating a significant reduction in all-cause mortality and neoplastic progression in BE patients. The greatest benefit was observed at higher PPI doses, and this was further enhanced combined with NSAIDs or statins, suggesting potential synergistic chemopreventive properties. Despite these promising findings, variability in individual patient responses, coupled with concerns regarding the long term risk of PPI therapy, has fueled ongoing debate about the safety and efficacy of prolonged use. This confers the need for a tailored, individualized approach to BE chemoprophylaxis strategies. These findings highlight the necessity for updated clinical guidelines to optimize PPI dosing, treatment duration and potential adjunctive therapies in the prevention of BE progression.
Conclusion: The available evidence suggests that while long-term, high-dose PPI therapy may be an effective chemopreventive strategy, its ability to completely prevent neoplastic progression remains uncertain. Future research should focus on determining the optimal PPI dosage, duration, and potential synergistic effects with other chemopreventive agents. Simultaneously, standardizing these approaches through refined treatment protocols could improve clinical practice and help reduce the burden of EAC
Automated Protocolling in Radiology: Enhancing Efficiency and Reducing Workload
No full textThe increasing demand for medical imaging has placed a heavy workload on radiologists, leading to fatigue and potential errors. For example, the volume of medical imaging studies has been increasing annually in various regions. Automated protocoling (AP) using artificial intelligence (AI) promises to reduce this burden by automating routine tasks. Protocoling in radiology involves selecting the best imaging study for a patient based on their history and symptoms. AI can automate this process, ensuring consistent decisions and freeing radiologists to handle more complex cases. This article reviews the impact of AP in radiology, highlighting its benefits in improving workflow efficiency
Transnational voluntary standards’ role in global governance
No full textTransnational voluntary standards, as a form of legal pluralism in global governance, are gaining increasing recognition for their ability to bridge the regulatory gaps between domestic and international law. This article provides an introductory exploration of the contextual and theoretical foundations underpinning the rise of standards as instruments of global governance. It critically examines their necessity in promoting international regulatory coherence, the challenges posed by their non-binding and voluntary nature, and the principal legal and institutional obstacles they encounter as regulatory frameworks. Through this analysis, the article tries to brief the efficacy and limitations of standards in addressing contemporary legal and governance challenges
How Miscentring in CT Scans Affects Radiation Patient Dose and Image Quality
No full textComputed tomography (CT) imaging is a cornerstone of modern medical diagnostics, yet patient miscentring remains a persistent issue affecting both radiation dose and image quality. Proper patient positioning is critical to optimising scan parameters, reducing unnecessary radiation exposure, and ensuring diagnostic accuracy. Miscentring of patients during CT scanning can result in increased radiation dose, image noise, and potential diagnostic errors. This article explores the impact of patient miscentring on CT imaging, discusses contributing factors, and highlights strategies for mitigation
Cultural neuroscience and its implications in healthcare - a narrative review
No full textCultural influences, including language, shared values and social structures, play a critical role in shaping neural organization and brain development. This narrative review from UCC\u27s Neuroscience and Neurology Society aims to explore new findings in the emerging field of cultural neuroscience, focusing on how an individual’s culture and environment influences their neurocognitive processes, and how this understanding can be applied to advance community-based, inclusive research
Breaking Barriers: Addressing stigma and cultural taboos in global health initiatives by Médecins Sans Frontières (MSF)
No full textMédecins Sans Frontières (MSF) addresses the impact of cultural stigma and taboos on mental health, sexual and reproductive health (SRH), and vaccine hesitancy, amongst other global health initiatives. Stigma and taboos, rooted in cultural and societal norms, hinder equitable access to care, erode trust in healthcare, and perpetuate misinformation. To combat these barriers, MSF employs culturally sensitive, community-centred strategies, including education campaigns, local partnerships, and psychosocial support. Initiatives such as tele-Mental Health services, Teen Mums’ Clubs, and vaccine education programs foster awareness, normalize care, and dismantle misconceptions. By integrating advocacy and research, MSF champions global health equity and drives sustainable progress in humanitarian healthcare
Visualizing facial distortions In Prospometamorphopsia
No full textBackground: Prosopometamorphopsia is a specific type of visual distortion where patients perceive distortions when viewing the faces of others. It is an extremely rare condition, with less than 100 cases being reported since 1904. Not to be confused with prosopagnosia which is a condition in which patients cannot recognize faces, in prosopometamorphopsia patients can still identify faces even while being distorted. The cause of this is unknown, however this case in particular sheds more light on the condition and the potential aetiology behind this condition. Lesions in the posterior section of the corpus callosum, specifically the splenium have been linked to visual distortions (prosopometamorphopsia) and reading difficulties such as alexia.
Case Description: This case explores a 62 year old right handed Caucasian male presenting with alexia and prosopometaphoprasia affecting the lower part of the face after suffering an infarction in the left splenium of the corpus collosum. The patient reported distorted perception specifically of people’s mouths while other facial features appeared normal, he also reported difficulty in reading but his writing remained unaffected. The patient’s opthalmic examination revealed normal visual acuity, color vision and ocular motility with no apparent abnormalities on retinal examination. Neuroimaging disclosed a late subacute infarction in the left splenium which is crucial for the interhemispheric transfer of visual information and is a part of the Papez circuit involved in memory function.
Conclusion: The findings from this case emphasize the importance of comprehensive neuroimaging in patients who present with unusual combinations of visual and cognitive disturbances
Amusement park rides and cardiac devices: heart dropper or device stopper?
No full textBackground: Cardiac implantable electronic devices (CIEDs) are essential for managing cardiac conditions, but may malfunction due to magnetic fields >10,000mG. Roller coasters using linear induction motors (LIMs) generate magnetic fields, yet their potential for electromagnetic interference (EMI) with CIEDs is unclear. This study assesses magnetic field exposure on amusement rides and examines healthcare provider recommendations.
Methods: Magnetic field strength was measured using gaussmeters placed at shoulder and abdomen levels, representing pediatric CIED sites. Rides at an amusement park were tested at least four times, recording median and maximum magnetic field strengths per second throughout the ride. Magnetic field strengths were compared between rides with health advisory messages (HAMs) and without (NHAMs). A survey was distributed to the Pediatric and Congenital Electrophysiology Society (PACES) and the Canadian Council of Cardiovascular Nurses to assess healthcare provider recommendations.
Results: A total of 15 rides were sampled: 11 with HAMs and 4 with NHAM. The median magnetic field strength was higher for HAM rides (2.9mG) than NHAM rides (1.6mG; p=0.05). Maximum field strength was also greater in HAM rides (46.4mG vs. 6.5mG; p<0.001), and in rides using LIMs (n=2) compared to those using other mechanisms (211.7mG vs. 7.8mG; p<0.001). Only 18.1% (n=13) of healthcare providers relied on published resources for amusement park ride recommendations, while 58.3% (n=42) advised patients to consider HAMs.
Conclusion: Magnetic field strengths on all rides were clinically insignificant, posing minimal EMI risk for CIED patients. Further validation and standardized guidelines are needed to inform healthcare recommendations for patients with CIEDs
Impact of opioid-free anaesthesia on postoperative opioid consumption: a systematic review and meta-analysis
No full textBackground: The main objective was to assess the effects of opioid-free versus opioid-based anaesthesia on postoperative opioid use.
Methods: A systematic review and meta-analysis were conducted using MEDLINE, SCOPUS, Cochrane Library, Web of Science, and Embase. Inclusion criteria consisted of randomised control trials published from 2004–2024 on adult surgical patients undergoing opioid-free or opioid-based general anaesthesia. Studies with regional anaesthesia, ICU, or pregnant patients were excluded. The primary outcome measure was postoperative opioid consumption at 24 hours. Subgroup analysis was performed on studies measuring the postoperative period as 1-3 hours, 12 hours, 24 hours, and 48 hours. Secondary outcome measures were postoperative nausea and vomiting, Post-Anaesthesia Care Unit discharge time, and pain scores. The Cochrane Risk of Bias (RoB-2) tool assessed the risk of bias, and a meta-analysis was performed using Cochrane RevMan software.
Results: The search included 26 RCTs with 2,370 patients undergoing various surgeries, predominantly gastric bypasses, and cholecystectomies. The patients varied in age, BMI, and ASA grade. Opioid-free anaesthesia was associated with a decrease of 11.55 [18.91, 4.20] mg oral morphine equivalents postoperatively. There was also a statistically significant decrease in postoperative nausea and vomiting (RR=0.62 [0.55, 0.71]), and pain scores (0.49 [0.83, 0.15]) in the opioid free anaesthesia group. PACU discharge time was slightly longer in the opioid free group (5.32 [0.11, 10.53] minutes).
Discussion: Our systematic review and meta-analysis found a decrease in postoperative opioid consumption in those receiving opioid-free anaesthesia versus opioid-based anaesthesia. We also found that opioid-free anaesthesia can decrease postoperative nausea and vomiting and pain scores. These findings suggest that opioid-free anaesthesia can improve patient outcomes. Limitations include variability in opioids between studies, extrapolated dosage conversions, and non-opioid analgesic use. High heterogeneity across analyses reflects these differences