Irish journal of medical science
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Professor Davis Coakley (1946-2022) was an outstanding physician, historian, and leader of reform in medical services and education. This inaugural Davis Coakley Memorial Lecture, delivered in The Edward Worth Library at Dr Steevens' Hospital, Dublin, Ireland, on 28 September 2023, focuses on 'Medicine in History & History in Medicine'. It explores the position of the physician-historian in medical historiography, discusses Coakley's extensive historical work (especially his many books about the history of medicine), and concludes with comments about one of Coakley's great interests: the work of Sir William Wilde (1815-1876). ⋯ Sir William's comments about patterns of epidemics are especially arresting and relevant today in the immediate wake of COVID-19. Coakley's interest in Sir William echoed Coakley's broader commitment to medical care, progressive education, and genuine scholarship that shed light on suffering, illness, healing, and recovery. The fields of both medicine and history are greatly enriched by Coakley's life and work.
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Refeeding syndrome is characterized by metabolic and electrolyte alterations that result from the initiation of feeding after a period of inadequate caloric intake. Especially, in the elderly with acute and/or chronic illness, nutritional deficiencies are common, and diminished oral intake with effects of catabolic status yields malnutrition. This study was conducted to evaluate refeeding hypophosphatemia and its consequences on outcomes in the oldest old critically ill patients. ⋯ Refeeding hypophosphatemia incidence was similar to previous studies, although study patients were the highest risk group. Outcome parameters including mortality rate and length of ICU stay were not different between patients with or without refeeding hypophosphatemia.
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The study aimed to determine the variability in the stages of diabetic nephropathy by examining specific biochemical functions associated with the target organ. As a result, various biochemical parameters were assessed in all of the groups under investigation. ⋯ Soluble α-Klotho levels in the sera of diabetic patients were shown to be lower and significantly linked to patients with diabetic nephropathy. This implies that klotho levels may be influenced by ACR in addition to playing a significant role in insulin resistance.
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Women vaccinated through the initial catch-up HPV vaccination programme (2011/12 to 2013/14) first became eligible for cervical screening in 2019 at age 25. This study aims to examine the changes in detection of HG cytology outcomes in 25-year-olds screened from 2010 to 2022 compared to population data on HPV vaccination in this group. ⋯ This study provides early evidence of the potential impact of HPV vaccination on cervical disease in the Republic of Ireland. Despite lower vaccination uptake in the initial catch-up group, we are seeing early signs of the positive protective effect of HPV vaccination in women at the time of their first cervical screening test. Plans to incorporate individual-level HPV vaccination status for women on the cervical screening register will allow more detailed assessment of the impact of HPV vaccination.
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Neoadjuvant therapy is an essential component of multimodality therapy for locally advanced breast adenocarcinoma (BC). Complete pathologic response (pCR) is a useful surrogate for long-term oncologic outcome. ⋯ pCR was more likely in patients with less advanced disease in BC. The presence of HER2 + or TNBC in BC also increases the likelihood of pCR. Neoadjuvant therapy stimulates the systemic inflammatory response; however, a reduced baseline NLR may be associated with increased pCR. Confirmation with larger datasets is required.