ABSTRACT
Background ACE is a potent pro-inflammatory modulator that controls chemokines and adhesion molecules, and elevated ACE activity associated with immunoinflammatory conditions, including cardiovascular diseases (CVD) and diabetes. The ACE inhibitors are recommended as primary treatment for these illnesses. ACE is a peptidyl-dipeptidase that catalyses Angiotensin I to Angiotensin II, whilst inactivating bradykinin during blood pressure regulation via the Renin-Angiotensin System. The purpose of this study is to establish a reference interval (RI) for ACE in the Irish population after COVID, and to examine if there is an underlying correlation between ACE concentrations and a range of biomarkers. Methods Serum samples of 200 randomly selected patients were obtained from several Irish hospitals in March 2022 (in compliance withGuidance on Anonymisation and Pseudonymisation, June 2019). We analysed for ACE (Buhlmann reagents), HBA1C, 25OHD and other biomarkers on the Abbott Architect ci8200. Full Blood Count was measured on Sysmex CS-2500. The statistical analysis used the EP Evaluator 11.3.0.23 and SPSS 22.0 software. Results The RI based on the central 95% of data was 8-78 U/L. This is higher than the RI proposed by the manufacturer (20-70 U/L) but is very close to our RI (5-79 U/L) from 2019. We found a significant positive correlation between ACE concentration and HBA1c, Urea, Creatinine, White Blood Cells (p<0.0001), Glucose (p=0.02), LDL (p=0.03), Neutrophils (p=0.003), Lymphocytes (p=0.001). A significant negative correlation was observed with 25OHD (p<0.0001). Conclusions This study did not show any notable change in the RI for ACE after COVID in Ireland. The significant positive correlations with HBA1c and other biomarkers may indicate the importance for ACE testing for diabetic management and progression, but further studies will be needed. Patients' overall health and medical history should always be considered when evaluating ACE results, including Vitamin D levels.
ABSTRACT
The incidence of melanoma and nonmelanoma skin cancer continues to rise in Ireland. This study aimed to explore the tanning and sun-protection behaviour and attitudes, as well as awareness of signs of melanoma, of the Irish population. A cross-sectional study was performed in December 2020 via an online questionnaire. Respondents were recruited according to gender, age and geographical region. In total, 1043 respondents (49% female) completed the questionnaire (mean age 41 years;range 20-72). In total, 443 sunbathe when there is sunny weather in Ireland, with 245 wearing suncream less than half of the time. Thirty-eight per cent (n = 399) have used sunbeds in the last 12 months, despite the global COVID-19 pandemic. Almost half (49%) did not believe getting a sunburn was serious. Most (87%) were aware melanoma would have serious consequences for them and 91% believed it was important to protect themselves from getting melanoma. In total, 839 know that wearing sunscreen can prevent sunburn. However, the main reasons they do not apply it include just forgetting (n = 207), to get a tan (n = 177) and they just don't like putting it on (n = 359). The main reason for limiting sunbathing was to avoid wrinkles/ skin pigmentation (n = 356), followed by a fear of getting skin cancer (n = 334). The primary reason people sunbathed was to top up their supply of vitamin D (n = 336), which was closely followed by getting a tan. Eighty-five per cent reported feeling and looking better with a tan. Despite knowledge of the risks of sunburn, 208 respondents felt it was worth getting slightly sunburnt to get a tan. Most respondents were aware of sun-protection measures (n = 729), but 484 people were not confident about what to look for when performing a self-skin examination and only 410 know the signs of a melanoma. This study found that although the majority of people are aware of the risks of sunbathing, many are happy to take these risks in order to get a tan. Tans are still considered to be attractive by the majority of respondents. Although there are high levels of awareness regarding sun protection, knowledge regarding skin self-examination and the signs of melanoma is lacking. Our results indicate that health promotion interventions for skin cancer may need to focus on education regarding the signs of melanoma and consider strategies to alter the perceptions of the beneficial factors of tanning.
ABSTRACT
Introduction: Ireland has been one of the worst affected countries affected by COVID-19 in Europe. Many primary studies from Ireland have documented prevalence of anxiety and depressive disorders during the pandemic and their correlates. Objective(s): To study the prevalence range of anxiety and depression in Ireland, and their correlates during the pandemic. Method(s): We systematically searched Pubmed, PsycInfo and the WHO COVID-19 global research database using key words ( January 2020 - September 2021). We removed duplicates and extracted data into an excel database and carried out a narrative synthesis of the extracted data. Result(s): From a total 127 studies, we included 22 studies that met our criteria in our narrative review. Depending on the tool used and the type of population studied, the prevalence of general anxiety disorders varied between 20% and 49.5% while prevalence of depressive disorders ranged between 20.4% and 53.8%. Younger people, health care workers, those who had to give up physical activity, people who had lost income, those who lived alone, infected by COVID-19, or had a higher perceived risk of the disease had a higher prevalence of both anxiety and depression disorders during the pandemic. There was conflicting evidence on prevalence levels among men and women and on whether they had children or not. Conclusion(s): COVID-19 has had a profound effect on the mental health of the Irish population. Some population groups are more affected than the others. Addressing mental health concerns of Irish population during and post pandemic should remain as one of the top public health priorities.
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Background: Febrile neutropenia in patients receiving chemotherapy is a life-threatening condition requiring prompt attention. This condition may also result in dose reductions, delays, or discontinuations of chemotherapy which compromise patient outcomes. This study seeks to evaluate the impact of COVID19 “lockdown” public health measures in Ireland on the incidence of febrile neutropenia in patients who were receiving cytotoxic chemotherapy regimens. Methods: All patients receiving chemotherapy at the Bon Secours Hospital Cork who were admitted with neutropenia and fever during two separate time periods were included in the study: 1st April 2018 to 31st March 2019 (“pre-pandemic year”) and 1st April 2020 to 31st March 2021 (“pandemic year”). The pandemic year selected equates to a period of heightened infection control measures in Irish society, featuring public health advice re social distancing, routine mask wearing in public and successive lockdown waves. Retrospective chart review was performed on all patients admitted to the oncology inpatient ward who had blood cultures on admission to determine the number of these patients who were neutropenic at the time of blood culture draw. Similarly, pharmacy records were accessed to determine the number of unique chemotherapy items dispensed in each year in order to establish a rate of febrile neutropenia episodes per 100 chemotherapy items dispensed for each period. The incident rate ratio was calculated using the Exact Poisson Test. Results: During the pre-pandemic year there were 57 individual admissions with febrile neutropenia compared with 32 admissions during the pandemic year. There were 4581 chemotherapy units dispensed during the pre-pandemic year compared to 4628 during the pandemic year. The rate of febrile neutropenia episodes per 100 chemotherapy units dispensed was 1.24 (95% CI 0.94, 1.61) in the pre-pandemic year and 0.69 (95% CI 0.47, 0.98) in the pandemic year. The incident rate ratio is 1.80 (95% CI 1.14, 2.87, two-sided P = 0.007). 9 of 57 (16%) admissions in the pre-pandemic year were associated with positive blood cultures compared with 4 of 32 (13%) in the pandemic year (not significant by Fisher's exact test). Conclusions: Increased precautionary infection control measures during the COVID19 pandemic public health restrictions correlated with a significant reduction in the rate of febrile neutropenia amongst patients receiving cytotoxic chemotherapy. This suggests that there may be a role for similar measures for this patient cohort in the post-pandemic period. Options which patients may consider to employ include social distancing, wearing face-coverings and restricting social contacts while at risk of neutropenia from cytotoxic chemotherapy regimens.
ABSTRACT
Rationale: It has been suggested that individuals with ZZ alpha-1 antitrypsin deficiency (AATD) might suffer from more severe and prolonged pulmonary exacerbations compared to their MM counterparts due to the loss of immunomodulatory AAT protein. During the COVID-19 pandemic it was advised that individuals with ZZ AATD should, where practicable, cocoon to avoid contracting COVID-19. Methods: A survey of ZZ AATD individuals attending the Irish National Centre for Expertise for AATD was conducted 1 year into the COVID-19 pandemic. It evaluated the effects of cocooning on patient-reported exacerbation frequency during the 1-year COVID-19 period versus the 2 years prior to COVID-19. 184 individuals were contacted by phone, mail, or email. Results: 114 (62%) individuals successfully completed the survey. 73 (64%) cocooned during the pandemic, with men (39) and women (34) almost equally likely to cocoon. Those who cocooned tended to have a lower baseline FEV1 (% predicted). Women who cocooned had a mean FEV1 of 73.5% compared to a mean of 97.5% for women who did not cocoon. Men who cocooned had a mean FEV1 of 52.8% compared to a mean of 78.9% for men who did not cocoon. Men benefited from lower rates of exacerbation due to cocooning. They suffered an average of 0.92 exacerbations during the cocooning period versus 1.56 exacerbations per year prior to the pandemic (P = 0.0298). Women, regardless of cocooning status and non-cocooning men also demonstrated a trend towards fewer exacerbations but these were not statistically significant. In terms of hospitalisations, there were no differences observed between men or women based on cocooning status. This was likely due to the low rate of hospital admissions during the 3-year period. 14 (12%) of 114 respondents contracted COVID-19, 7 (50%) of whom were hospitalised. There was a single fatality from COVID-19. Conclusion: Further work needs to be done to establish the effects of risk reduction behaviours such as cocooning on exacerbation frequency and which groups may benefit most from this strategy. Our survey suggests that men with more advanced respiratory disease were most likely to benefit from a cocooning strategy and this may be applicable to non-COVID threats in the future.
ABSTRACT
Mental illness in young people is a growing concern, with an estimated 10-20% of adolescents suffering from mental illness worldwide.1 In Ireland, referrals to CAMHS (Child and Adolescent Mental Health Services) have increased by 26% in recent years.2 These services are already under-resourced leading to long waiting lists. The adverse psychological impact of Covid-19 has disproportionately affected youth and is likely to result in increased demand for CAMHS. Given these circumstances, an understanding of pre-Covid-19 prevalence of mental illness among youth in Ireland is imperative to help inform & plan services. The aim of this research is to report on prevalence of mental illness in youth (aged 0-18) in Ireland. A systematic review using pre-defined search terms in PubMed, PsycInfo, Embase and CINAHL was conducted. Studies included youth population health empirical studies conducted in Ireland, focusing on mental illness. From a total of 624 papers identified, 43 papers were selected by Title/ selection, and 38 following full paper review. 2 nationally representative studies (Growing Up in Ireland & My World Survey) identified 10-15% to be 'at risk' by one-stage screening. A two-stage study (Challenging Times) reported rates of 'any' mental health disorder in 15% of adolescents, with other studies reporting on specific disorders. Although data on mental illness among Irish youth is limited, available data of illness and risk suggest rates similar to international levels. Attention needs to be given post Covid-19 to regular reliable data collection, and dedicated CAMHS funding to allow best use of a scarce resource.
ABSTRACT
In an effort to limit physical contact during the COVID-19 pandemic, there has been rapid implementation of virtual cancer care clinics using messaging, audio, and video communication. This model has advantages, particularly in convenience for patients who do not have to travel to a distant centre for specialist care, but has the potential to limit communication and also omits physical examination. The aim of this survey study was to assess whether patients attending the oncology unit at a tertiary care academic cancer centre were satisfied with the virtual clinic model and explore challenges in the delivery of virtual care. We also surveyed medical oncology trainees and consultant oncologists in the centre on the use of virtual care. Methods: All patients attending St Vincent's University Hospital Oncology, Dublin, Ireland, who had received a virtual oncology clinic appointment were invited by text message to participate in a survey study analysing attitudes towards virtual oncology clinics. Medical oncology trainees and consultants working were also invited to give their opinions. Results: Between April and October 2020, 207 patients (of 600 invited) who had at least one virtual clinic consultation responded to the survey. 95% had their consultation via telephone, and 5% by email. 80% reported satisfaction with the experience. 85% received timely notice of their appointment, but 50% of patients did not receive a telephone call at the scheduled time. 80% of patients thought they had enough time with the doctor. Some patients who were travelling from outside Dublin found virtual clinics more convenient. 50% of patients want to continue virtual consultations post Covid-19;the main criticism was that patients want to receive the call at the appointed time. 14 medical oncology trainees (of 18 invited)and 6 consultants (of 8 invited) responded to the survey. 92% of trainees and 100% of consultants believed virtual care is inferior to face to face care. 85% of junior doctors and 100% of consultants surveyed found clinical assessment more difficult via virtual consultation, but 76% of trainees and 100% of consultants found virtual clinics more time efficient. 62% of trainees reported face to face clinics as better for education from consultants. 80% of consultants believed the education of trainees was inferior in virtual clinics. 62% of trainees and 100% of consultants would like to continue virtual care in some form post Covid -19. Conclusions: Irish patients attending a tertiary academic cancer centre were mostly satisfied with the telephone consultations they had with their oncology team. Satisfaction rates were lower among the doctors than patients, reflecting doctors' difficulties in clinical assessment and teaching opportunities using virtual care. This survey highlights the need for more advanced technical platforms (including video calling and real time messaging) to provide excellent virtual care, as well as the development of new strategies for medical education through virtual clinics.
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Background: COVID-19 has proved devastating in older persons. Previous studies reveal a mortality rate of 31% for hospitalised patients over 70.1 We examine outcomes for older COVID patients in our hospital. Methods: We conducted a Hospital In Patient Enquiry Scheme review for patients coded as COVID-19 between 19/03/2020-19/02/2021 (n=674). Older adults were defined as those aged over 65 years at time of admission. Age, sex, length of stay and survival were collected. Data was collated by 'wave': (Wave 1 n=294, 2 n=105, 3 n=275). We reviewed whether patients had a CT pulmonary angiogram (CTPA) on the National Integrated Medical Imaging System. Results: 42.3% of COVID patients in our hospital were older persons (n=285). This remained stable throughout the pandemic (Wave 1 44.2%,Wave 2 44.7%,Wave 3 39.3%). Mean length of stay was 19.7 days for older adults vs 7.4 for those under 65. Older persons had a higher mortality rate at 30.9% vs 3.6%. Overall incidence of PE was low at 1.9% (1.1% in older persons). However, the likelihood of a CTPA being positive for those over 65 was much higher at 42.9% vs 17.9%. While there was improvement in mortality rates in older persons from Wave 1 (31.5%) to 2 (19.1%), our data showed a significant rise in mortality inWave 3 (35.2%). This compares to a different pattern in younger people, with mortality rates by wave at 6.7%, 0% and 1.7%. Conclusion: In a large Irish cohort of patients hospitalised with COVID-19, 42.3% were older adults. Length of hospital stay was 3 times longer and mortality was 10 times higher than patients under 65.Older adults were alsomore likely to have a positive CTPA. Further study is needed to evaluate the long term effects of COVID-19 in our older population.