This Month’s IMJ

This Month March 2019, Vol 112, No. 3


JFA Murphy


Original Papers

Tatum et al report that the rate of polypharmacy among patients over 45 years receiving medication was 64.3%.  The authors recommend research into the mechanisms that drive polypharmacy.

Table 1: Polypharmacy in 2013 by age and sex
  Male Female 45-54 55-64 65-69 70-74 75 Total
Population (N) 355,992 438,635 181,175 161,310 95,355 166,810 239,183 794,628
% of study population 44.8 55.2 22.8 20.3 12.0 14.7 30.1 100
% with polypharmacy 60.8 67.0 38.6 58.1 68.2 71.8 82.6 64.3

Corcoran et al state that since the introduction of PCV7 and PCV13 into the childhood immunisation programme there has been a decline in these serotypes in adults aged 65 years and older.  PCV7 has decreased by 85%.  However the authors report that the number of PPV23-PCV13 and non-vaccine types are rapidly increasing.  Increasing PPV23 uptake could still reduce the burden of disease for this population.

Table 1: Incidence and number of serotypes from adults aged ≥65 years of age in Ireland with invasive pneumococcal disease, according to vaccine serotypes, 2007/08 to 2016/17.

Figure 1: Number of penicillin susceptible and non-susceptible isolates causing invasive pneumococcal disease from adults aged ≥65 years of age in Ireland, from 2007/08 to 2016/17

O’Brien et al report that in 2017 a total of 9,020 women attended the out of hours service.  The commonest reason was first trimester bleeding.  The current admission rate is 16%.

Table 1: Indications for women’s presentation to the Out of Hours Emergency Service in 1993 compared to February-April 2017. “Other” included vomiting, hypertension, suspected pre-eclampsia, an outside ultrasound suggestive of miscarriage or ectopic pregnancy

Scope and Safety of Paediatric Surgery in a Model III Hospital

 D.P. Joyce, R. Craig, A. Dakin, H. Elsheik, T. Ejaz, S. Mansoor, D.P. Toomey

Joyce et al report that in 2015-2016 there were 2,079 paediatric surgical admissions.  575 were elective and 1504 were emergencies.  Laparoscopic appendicectomy accounted for almost 25% of the procedures undertaken.  Male circumcision was the second commonest procedure, 15.5%.

Table 2. Most commonly performed procedures across 2015 and 2016

Continuous Glucose Monitoring in the Management of Neonatal Hypoglycaemia

S.M. McGlacken-Byrne, R. O’Neill, A. Jenkinson, J.F.A. Murphy

McGlacken-Byrne et al a quality initiative programme using continuous glucose monitoring in the newborn.  The process illustrates the efficacy of PDSA cycling in the introduction of new methodologies.

Graph 2: Project runchart

Finn et al report 133 cases of paediatric ketoacidosis over a 5 year period.  61% were new cases and 39% were known cases of diabetes.  The precipitating factors were suboptimal control, psychosocial factors, acute illness, and pump failure.

Occasional Pieces

Case Reports

Rana et al report on a 3 years old girl with a retropharyngeal abscess.  She presented with irritability and neck flexion.  A retropharyngeal abscess was diagnosed on MRI.  It was treated with incision and antibiotics. 

Arrow = Abscess

Smith et al describe 2 infants with meconium ileus.  Both were treated surgically.  A subsequent diagnosis of cystic fibrosis was made for both infants.  

O’Morain et al report a case of cardiac tamponade following infliximab induction therapy.  The patient had ulcerative colitis.  The tamponade was treated with pericardiocentesis.

Image 1: Chest X-Ray pre and post first dose infliximab infusion.

Letters to the Editor

Continual Professional Development

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