Irish journal of medical science
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Sepsis is a leading cause of death in the critically ill patient. It is a heterogeneous disease and it is frequently difficult to make an unequivocal and expeditious diagnosis. The current 'gold standard' in diagnosing sepsis is the blood culture but this is only available after a significant time delay. Mortality rates from sepsis remain high, however, the introduction of sepsis care bundles in its management has produced significant improvements in patient outcomes. Central to goal-directed resuscitation is the timely and accurate diagnosis of sepsis. The rapid diagnosis and commencement of the appropriate therapies has been shown to reduce the mortality. ⋯ The biomarkers described reflect the difficulties in making evidence-based recommendations particularly when interpreting studies where the methodology is of poor quality and the results are conflicting. We are reminded of our responsibilities to ensure high quality and standardised study design as articulated by the STAndards for the Reporting of Diagnostic accuracy studies (STARD) initiative.
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Both central and peripheral opioid receptors activation produce cardioprotection. This study investigates the role of central and peripheral opioid receptors in intravenous morphine preconditioning (MPC) and ischemic preconditioning (IPC). ⋯ MPC could mimic IPC, produce a similar cardioprotective effect. Both central and peripheral opioid receptors mediate in the cardioprotection of MPC, however, only peripheral opioid receptors in IPC.
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Acute pharyngitis is a common presentation to Emergency Departments (EDs) and although most patients experience mild-to-moderate discomfort, severe pharyngitis can be incapacitating and painful. There have been recent trends in prescribing steroids to provide pain relief for patients with acute pharyngitis. ⋯ Steroids may provide a useful adjunct in the management of acute pharyngitis, but there is currently insufficient evidence to endorse routine use.
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The overall seroprevalence of toxoplasma antibodies in women of childbearing age in Ireland is 25% [1]. Hence, 75% of women remain susceptible to primary toxoplasma infection during pregnancy, which if transmitted to the foetus can cause ocular, neurological and other sequelae. Toxoplasma exposure during pregnancy can be avoided if there is an awareness of the potential sources of infection, mainly contaminated food, water, soil and cat faeces. ⋯ Most women were uneducated about the risks posed by Toxoplasma gondii exposure during pregnancy. There is a clear need for better educational programmes regarding primary prevention of congenital toxoplasmosis if neonatal infection is to be avoided.
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Epidemiologic and genetic studies have suggested a bidirectional association between breast carcinoma (BC) and malignant melanoma (MM). ⋯ The national figures provide evidence of a link between BC and MM. We recommend increased awareness among clinicians leading to more detailed surveillance of both second primary tumours. All MM patients with a family history of BC should be referred to a breast clinic. Women above the age of 40 with MM should undergo annual mammography and those less than 40 may be better evaluated with a breast MRI. All breast cancer patients should be made aware of the significance of changing moles and those with suspicious lesions referred to a dermatologist for evaluation.