UCC Student Medical Journal Vol. 4 (2024)
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Item Bed Numbers(UCC Medical Research and Technology Society, 2024) Dart O'Flynn, SineadItem A biopsychosocial approach to 6-year-old patient with impetiginized atopic dermatitis: a case report(UCC Medical Research and Technology Society, 2024) Goodings, Anthony James; Kajitani, Sten H.Introduction: This case report examines a 6-year-old male patient, NN, with a complex presentation of impetiginized atopic dermatitis. The report adopts a biopsychosocial approach, considering the interplay of biological, psychological, and social factors influencing the patient's condition and management. Methods: The case study methodology involved a comprehensive review of NN's medical history, family background, and current clinical presentation. A multidisciplinary approach was employed, integrating insights from dermatology, pediatrics, psychology, and social work to holistically address the patient's needs. Results: Biologically, NN's condition was characterized by severe exacerbation of atopic dermatitis, likely triggered by environmental pathogens and compounded by iron-deficiency anemia. Psychologically, the severity of his skin condition led to increased irritability and social withdrawal, a notable deviation from his previously cheerful temperament. Social considerations highlighted the supportive family environment and the challenges posed by the visible nature of his skin lesions, affecting his school attendance and potential social stigma. Discussion: The case underscores the intricate relationship between biological predispositions, psychological resilience, and social environmental factors in managing pediatric atopic dermatitis. It highlights the importance of a multidisciplinary approach in treating such complex cases, considering not only the physical but also the emotional and social wellbeing of the patient. Conclusion: NN's case demonstrates the critical need for an integrated biopsychosocial approach in pediatric dermatology, particularly in complex cases like impetiginized atopic dermatitis. Tailoring treatment to address the multifaceted aspects of the patient's condition can lead to more effective management and improved quality of life for both the patient and their family.Item Cancer cachexia and dysphagia: a systematic literature review(UCC Medical Research and Technology Society, 2024) Leahy, MarkBackground: Dysphagia is a difficulty in swallowing. Cancer cachexia is a generalised muscle loss disorder common in patients with late-stage disease. The prevalence of dysphagia in patients with head and neck cancer is well documented. However, it is postulated that cancer cachexia can, through systemic muscle loss, cause weakening of swallowing muscles and dysphagia. This review aimed to evaluate the scope of the association between cancer cachexia (excluding head and neck cancer) and dysphagia. Methods: A systematic review was conducted using the PRISMA P guidelines. PubMed and Embase databases were searched for papers including terms related to (1) cancer, (2) cachexia and (3) dysphagia. Results were imported to Zotero software manager, where duplicates were removed. The remaining articles were screened using pre-determined eligibility criteria. Eligible papers were retained for data extraction, data synthesis and narrative synthesis. Risk of bias was evaluated using the CASP cohort and case control tools. Results: Four studies met the eligibility criteria. These papers reported an association between cancer cachexia and dysphagia, with odds ratios of 2.1 [P=0.033] and 1.8 [P=0.018]. Prevalence of dysphagia was 16% higher in cancer patients with cachexia. Conclusion: These findings suggest a positive association between cancer cachexia and dysphagia. However, due to the limited number of papers included, their heterogeneity and their limitations, it is difficult to draw a robust conclusion. Sarcopenia or neurodegenerative disease may have contributed to these results. Regardless, these four studies support the requirement for dysphagia assessment in patients with cancers outside swallow regions.Item Aortic valve replacement via mini-sternotomy: Results of a single centre analysis(UCC Medical Research and Technology Society, 2024) Harrington, Joey; Barrett, Seán; Duggan, Eileen; Doddakula, KishoreBackground: The traditional method of Aortic Valve Replacement (AVR) is via full sternotomy. However, this incision may not heal properly and cause significant pain. Minimally-invasive approaches have been adopted, including mini-sternotomy. These have gained popularity due to smaller incision, reducing surgical trauma. The hypothesis is that AVR via mini-sternotomy is a safe alternative to full sternotomy. The objective was to analyse and describe results of patients who underwent the procedure, including post-operative outcomes. Methods: A retrospective database review was performed on patients who underwent AVR via mini-sternotomy between September 2016 and December 2022 in Cork University Hospital (CUH). Exclusion criteria included patients who had an aortic procedure concurrently, such as ascending aorta replacement, and those under 18 years. Results for variables, such as age, were expressed as a mean. Results: 93 patients were included; the average age was 68. Average bypass and cross-clamp times were 92 and 73 minutes respectively. Median post-operative length of stay was 8 days and median ICU length of stay was 3 days. There were no in-hospital mortalities. Conclusion: AVR via mini-sternotomy has cosmetic advantages and is particularly useful in frail patients who may suffer from a conventional sternotomy and associated morbidities. It is shown to be a safe alternative with comparable intra- and post-operative outcomes to those described internationally.Item A two-dimensional cellular automaton model of parasystole(UCC Medical Research and Technology Society, 2024) Kodancha, MeghaUnder normal cardiac conditions, the sinoatrial node is the pacemaking region which initiates depolarization in the heart; in parasystole, there also exists an ectopic pacemaker which may initiate depolarization waves. Parasystole is a form of arrhythmia caused by the influence of the secondary pacemaker on cardiac behaviour. Specifically, we consider cases of pure parasystole, where the two pacemakers are protected from each other. Previous theoretical models of pure parasystole consider the interaction of two pacemakers without incorporating physical space. The objective here is to create a simple, theoretical, two-dimensional model of pure parasystole where the distance between the pacemakers may be adjusted. A cellular automaton model was created using Python 3.8.3 and associated packages. The model was used to evaluate how changes in space influenced cell activation cycles and the number of intervening sinus beats (the number of times cells were activated by the sinus node versus being activated by the ectopic pacemaker). The model dynamics were further compared to experiments using optogenetic methods to stimulate a cardiac monolayer from two sites. This model provides insight into the physical dynamics of parasystole in its most basic form so that it may be built upon to eventually be used in a clinical context.Item A snapshot of personalized medicine in palliative care(UCC Medical Research and Technology Society, 2024) Behmanesh, HakhamaneshPalliative care is an interdisciplinary care system that addresses the physical, emotional, social, and spiritual needs of patients and their families facing serious illness. It includes a team of medical professionals who work together to improve patient overall quality of life. While almost half of those who die in the US receive hospice services, many hesitate to enrol early due to the requirement to forgo curative treatment. To meet this challenge, unlike hospice care which may require forgoing curative treatment, palliative care services can be provided alongside curative treatments. When disease-modifying treatments are no longer an option, the traditional roles of medical team members change, with palliative medicine experts taking on a larger role in patient care. This comprehensive care can include managing pain and symptoms, providing social services and counselling, and assisting with daily living activities and spiritual support, among other services. Overall, palliative care services aim to enhance existing care services and involve additional support from family and community groups.Item Review of the dietetic and MDT management of Cystic Fibrosis(UCC Medical Research and Technology Society, 2024) Twomey, AoifeINTRODUCTION: Cystic Fibrosis (CF) is an autosomal recessive disorder due to mutations in the Cystic Fibrosis Transmembrane Conductance Regulator (CFTR) gene leading to abnormality of chloride channels in mucus and sweat producing cells. The respiratorysystem (lungs) and digestive system (GIT) are primarily impacted, leading to life threatening complications (Rafeeq and Murad, 2017). Ireland has the highest incidence of CF in the world. Approximately 1 in 19 Irish people are said to 'carry' one copy of the altered gene that causes CF (Cystic Fibrosis Ireland, 2023). More than 1900 mutations of CF have been identified (Rafeeq and Murad, 2017). METHODS: Articles for review were sourced from the academic database PubMed. Results were screened using PICOS criteria, focusing on dietetic management of CF. Papers dating back as far as the 1980’s were included in the review due to their continuing relevance in CF treatment today. RESULTS: Initial database searches identified 61 results, which were then screened for relevance to the objectives of this review. Treatment of CF requires a multi-disciplinary team approach, for which Nutrition and Dietetic management is integral. Lifelong management of CF includes pharmaceutical treatment to manage symptoms, case specific diet and lifestyletherapy, management of complications and co-morbidities, and novel therapies such as CFTR modulators. CONCLUSION: The identification of the faulty CFTR gene that causes CF was an important step in managing the disorder, yet has not led to a cure for the condition. Life expectancy for patients with CF has steadily improved during the last three decades, with medicalmanagement of symptoms and advances in CF therapies. Complications associated with the condition are treated on a case-by-case basis due to complexity of symptoms and individuality of the condition. Dietetic management includes a high calorie, high salt, and high protein diet and routine monitoring for changes in symptoms and nutritional deficiencies.Item Unraveling paediatric constipation: a biopsychosocial approach toward a 2-year-old’s chronic gastrointestinal quandary(UCC Medical Research and Technology Society, 2024) Kajitani, Sten; Goodings, Anthony James; Mthethwa, Mpho; Kang, Munsa; Enright, Frances; Albakri, Ahmad; Dunn, SophieIntroduction: This case report unfolds the diagnostic and therapeutic journey of a 2-year-old girl with chronic constipation unresponsive to conventional laxatives, hinting at a possible underlying organic pathology amidst a complex familial and personal medical background. Methods: Utilizing a biopsychosocial model, a comprehensive assessment was conducted to delineate the predisposing, precipitating, perpetuating, and protective factors affecting the patient’s gastrointestinal health. A multidisciplinary approach was employed to craft a tailored management plan involving the patient and her parents. Results: The application of the biopsychosocial model unveiled an intricate interplay of biological, psychological, and social factors contributing to the patient’s persistent constipation. The multidisciplinary approach fostered a nuanced understanding and a patient-centered management plan, addressing not only the gastrointestinal symptoms but also the broader health and well-being of the child and her family. Discussion: The case accentuates the essentiality of transcending traditional biological examinations, embracing a holistic, patient-centered, biopsychosocial model, especially in pediatric patients with complex medical and familial backgrounds. It also underscores the need for an integrated, multidisciplinary approach for effective diagnosis and management in complex pediatric gastroenterological cases. Conclusion: The case elucidates the paramountcy of a multidisciplinary, biopsychosocial approach in navigating complex pediatric gastroenterological cases, fostering an enriched discourse on patient-centered care and enhancing long-term health outcomes.Item Psychedelic-assisted therapy: Magical thinking or a meaningful treatment for mental illness(UCC Medical Research and Technology Society, 2024) Kodancha, MeghaPsychedelics are psychoactive substances that are known to alter perception, alter mood, and affect numerous cognitive processes. Throughout history, psychedelics were utilized in ceremonies and rituals, and in the 20th century, their utilization in psychiatry began. In the 1960s they became a banned substance and are only recently being revisited for their benefits. The main forms of psychedelic substances being studied today are Lysergic acid diethylamide (LSD) for addiction therapy, Psilocybin for palliative care, and 3,4-Methylenedioxymethamphetamine (MDMA) for post-traumatic stress disorder (PTSD). This paper focuses on the benefits of utilizing psychedelics for specific psychiatric conditions and is meant to encourage further research into this domain of Psychiatry.Item Emerging areas of personalized medicine in Obstetrics and Gynaecology: a narrative review(UCC Medical Research and Technology Society, 2024) Leung, Roxanne H.; Belfiore, Alyssa; Whibbs, Hannah; Wilson, Emma; Seo, Hoyang; Rotman, SydneyImportance: Obstetrics and gynaecology (OBGYN) focuses on women’s reproductive health. Many significant challenges in the field of OBGYN stem from limitations in screening, diagnostic, or treatment options. Conditions that are poorly understood, such as pre-eclampsia or endometriosis offer few management options or prevention strategies. In recent years, growing interest and advancements in personalized medicine have led to a deeper understanding of the aetiology and pathophysiology of OBGYN conditions, potential targets for intervention, and novel approaches to management. The aim of this review is to briefly describe some of these emerging areas of research and clinical use. Observations: Personalized medicine in obstetrics is a foundational concept underlying routine prenatal care and also drives ongoing research in areas such as advanced assisted reproductive technology, screening for medical complications during pregnancy, and fetal treatment in utero of congenital diseases. In gynaecology, developments in our understanding of determinants and mechanisms of common conditions have illuminated potential avenues for improved diagnosis and more individualized approaches to treatment of endometriosis and postmenopausal symptoms. Conclusions and Relevance: Personalized medicine is a flourishing area of research and clinical application with the potential for significant benefits to OBGYN patients. This concept has driven research interest and advancement in OBGYN disease processes that are poorly understood and offers potential novel diagnostic and treatment options for the future. With endless potential to improve the health outcomes of women and children, personalized approaches to screening, diagnosis, and management are worthwhile investments.Item Elective experience - Summer Erasmus Madrid 2022(UCC Medical Research and Technology Society, 2024) Zagoneanu, Adina ElenaIn the blink of an eye I was on my flight home, wondering how two months, which felt like two years, could pass as quickly as two weeks. During the summer of 2022 I was lucky enough to be one of the three DEM3/GEM2 students to participate in an erasmus exchange in Madrid, Spain. This was the first year this programme was launched and I was one very happy ‘guinea pig’. There’s not a day that goes by where I don’t wish I could be back in La Latina, in the heart of Madrid, basking in the scorching heat. Although, on that note, the scorching heat I could do without…Item Exploring the biopsychosocial model for evaluation of an acutely suicidal patient with co-occurring borderline personality disorder and substance misuse: a case study(UCC Medical Research and Technology Society, 2024) Kajitani, Sten; Kodancha, Megha; Anderson, Hannah; Smith, Kayla; Goodings, Anthony James; Siddaiah, Dayananda; Mthethwa, MphoBackground: Borderline Personality Disorder (BPD) is a significant public health concern, affecting an estimated 28,725 individuals in Ireland with considerable associated costs. Despite its complexity, the biopsychosocial model offers a comprehensive approach, enabling clinicians to integrate predisposing, precipitating, perpetuating, and protective factors when understanding and managing BPD. Objective: This report presents a case study of a 35-year-old woman with a background of BPD and substance abuse, detailing her biopsychosocial formulation during an episode of acute suicidal ideation. Methods: The case entailed a thorough history and clinical examination, focusing on the biopsychosocial model's 4P causal framework: predisposing, precipitating, perpetuating, and protective factors. Results: Predisposing factors were abundant, including family history of mental health disorders and personal history of trauma. Precipitating factors were multi-faceted, encompassing biological vulnerabilities from alcohol abuse and significant recent social stressors, such as unemployment, eviction, custody battles, and bereavement. Perpetuating elements revolved around ongoing legal challenges and deep-seated feelings of guilt. However, protective factors were also present: no co-existing medical conditions, an eventual stable mood post-treatment, and engagement in therapeutic activities, including mindfulness interventions. Conclusion: This case underscores the value of the biopsychosocial model in psychiatric patient care, highlighting its potential to uncover individualized nuances in classic presentations. Embracing this model can optimize holistic care, underscoring its imperative utility in clinical practice.Item UCC Student Medical Journal 4th Edition(UCC Medical Research and Technology Society, 2024) Cronin, Padraig; Mehta, ShobhaThe 4th Edition of the UCC Student Medical Journal.Item Harmonizing the healing of hand trauma in a piano teacher: a case report on pain management in Ireland and utilizing butterfly ultrasound for a brachial plexus nerve block(UCC Medical Research and Technology Society, 2024) Kajitani, Sten; Kramer, Andrew; Albakri, Ahmad; O'Donnell , Brian; Jeantet, QuentinBackground: This case report outlined a specialized surgical technique designed for the restoration of intricate hand functionality after a complex hand injury. It also highlighted the use of Butterfly iQ+ and its integration with iOS devices for teaching ultrasound techniques during the administration of a brachial plexus nerve block. Finally, concerns regarding pain management protocols in Ireland were raised. Case Details: A 58-year-old piano teacher presented with a significant hand trauma. The restoration of intricate hand functionality essential for her profession as a piano teacher was a central concern. Her treatment included surgical exploration and wire fixation of the fractures. The application of Butterfly Ultrasound played an interesting role as an educational tool in anesthetic administration. Discussion: The case presented significant challenges in postoperative rehabilitation, necessitating an adjustment to a more conservative approach due to the patient's high pain levels. This adjustment highlighted gaps in pain management and anesthetic care, especially during the transition from hospital to home care, revealing broader issues in Ireland's rehabilitation systems. The postoperative prescription of Oxycontin was inconsistent with established guidelines, pointing to a need for improved integration between primary and tertiary care. Conclusion: This case underscored the importance of patient-specific, adaptable management strategies in trauma recovery. It showcased the potential role of Butterfly Ultrasound in clinical settings for anesthetic guidance and educational purposes. Finally, the report further prompted a broader dialogue on the improvement of pain management practices, particularly concerning the rise in opioid prescriptions in Ireland.Item Ethical dilemma in dietetics: Should dieticians engage in paid partnerships?(UCC Medical Research and Technology Society, 2024) Twomey, AoifeWith global shifts towards social media as a new way of communicating and receiving information, medical fields must adapt to trends, to maximise reach for providing accurate, evidence-based advice to the general public and call out or clarify mis-information that can be potentially harmful. We have seen instances of mis-information causing harm in the past. Wellness influencers like Belle Gibson promote dangerous pseudoscience as a cure for disease, where an Australian cookbook author faked having cancer to convince her followers that she cured it through healthy eating habits and exercise. Similarly, in Ireland we have seen The Happy Pear influencers making factually incorrect claims on reducing breast cancer risk. Scandals like these confirm the need for healthcare services and professionals to have a strong social media presence, to monitor and counter unqualified, inaccurate health advice that is rampant throughout the internet. It is critical that social media is used ethically and professionally, to represent dietetics as a profession and field of scientific study.Item An exploration of gut hormone therapy to treat infertility caused by Type 2 Diabetes(UCC Medical Research and Technology Society, 2024) Belle Martin, Alison; Duggan, EileenBackground: Type II Diabetes Mellitus is a common disease associated with multiple debilitating symptoms, including reduced fertility in women of reproductive age. Gut hormone therapies have shown promise in improving fertility in these patients. Objectives: To identify the relationship between the human gut microbiota and the successful functioning of the female reproductive system. To explore treatments to improve bacteria culture in the gut, and to examine if these improvements affect fertility in female patients with Type II Diabetes. Method: A systematic search was undertaken; studies were collected from PubMed and The Diabetology and Metabolic Syndrome Journal. Searches were performed between January, 2023 and March, 2023. Studies focused on female patients suffering simultaneously from Type II Diabetes Mellitus and fertility complications. Ten papers that met criteria were appraised and included. Results: There is evidence to suggest a causative relationship between the gut microbiome and reproductive functioning. Infertile patients had increased abundance of the phylum Verrucomicrobia and Phascolarctobacterium in the gastrointestinal tract, and decreased amounts of genera Stenotrophomonas, Streptococcus, and Roseburia. These abnormalities were associated with depleted circulating oestrogen concentrations, irregular menstrual cycling, and hyperandrogenism. Evidence authenticates the use of probiotics and hormone therapy in treatment of Type II Diabetes and its associated symptoms. Supplements studied included metformin, GIP agonists, and GLP-1 receptors. Across studies, patients showed significant improvements in Type II Diabetes management following treatment. Conclusion: Alterations to the composition of the gut microbiome are associated with improvements in glycemic control as well as improvements in fertility in female patients with Type II Diabetes Mellitus.Item Post-partum psychosis: a case report(UCC Medical Research and Technology Society, 2024) Deonarine, FeliciaThe patient (NS) is a 5 month post-partum 32 year old woman, G2P2, who presented to the Cork University Hospital (CUH) Emergency Department by ambulance. She presented to the ED distressed, anxious and confused. Her family history is significant for depression. Her personal history is significant for long periods of separation from her spouse and an increased workload and chores list at home, leading to high levels of stress and anxiety. Her past medical history includes two births, both caesarean and non-complicated. However, she contracted a SARS-CoV-2 infection prior to her most recent delivery. Her eldest child is 6 years old and her most recent is 5 months. Prior to NS’s deterioration, she was described as level-headed, dependable, quiet, and overall an extremely competent mother. Her physical examination was non-contributory. Finally, on December 5th 2022, her condition improved. Her MSE showed a tidy appearance, non-paranoid body language, sequential speech, reactive mood, logical and non-paranoid thoughts, good insight about psychosis, excellent cognition, and low risk for harm to herself or others. In this case report, the biopsychosocial aspects of the patient’s recovery are discussed.Item The use of Artificial Intelligence in clinical diagnostics: Challenges to consider for implementation(UCC Medical Research and Technology Society, 2024) Cronin, PadraigWhilst many technological advancements have revolutionised healthcare throughout the 21st century, one of the most significant is Artificial Intelligence (AI). AI is generally regarded as the capability to imitate intelligent human behaviour using machines, and is based on computer science, statistics, algorithms, machine learning, information retrieval, and data science1. AI has permeated into many domains of healthcare including Clinical Diagnostics. While AI chatbots (such as those used in Babylon and Ada) are being used by patients to identify symptoms and recommend further actions in community and primary care settings, more recent advances in the technology with larger datasets have provided users access to a more extensive array of clinical conditions2. However, as these tools are constantly being developed with an ever-increasing dataset of clinical cases, certain challenges threaten the implementation of an accurate and effective model. In this article, the issue of Data Bias, and Data Handling will be examined within the context of Clinical Diagnostics, and how these factors threaten the development of such AI Healthcare tools.Item HELLP Syndrome: a biopsychosocial case report(UCC Medical Research and Technology Society, 2024) Deonarine, FeliciaThis case concerns a 30 year old female patient (HS), G2P1 (2 gravidity, 1 parity), who was admitted to the high dependency unit at Cork University Maternity Hospital in Cork, Ireland at 37 weeks and 1 days’ gestation. She was admitted after experiencing a 5 minute tonic-clonic seizure at home with no obvious relieving factors. Relevant positive symptoms included nausea, headache, and right hypochondrial pain. Relevant negative symptoms included denying tongue biting, incontinence, speech or visual disturbances, sensory or mental aura, vomiting and cyanosis. There were no drugs, trauma, recent illness or history of previous seizures. On examination, HS was confused and displayed signs consistent with pregnancy. In addition, a focused examination revealed hypertension, hyperreflexia, right hypochondrial pain, and lower limb oedema. The investigations included a urine dipstick, CT scan and blood tests which showed anaemia, low platelets and proteinuria. The history, examination and investigations in this case were consistent with a presentation of HELLP (haemolysis, elevated liver enzymes and low platelets) syndrome. In this case report, the biopsychosocial aspects of the patient’s recovery are discussed.Item Future frontiers in paediatric oncology(UCC Medical Research and Technology Society, 2024) Beleutz, Danielle; Brannen, Sydney; Cronin, Pádraig; Haughey, ColleenPaediatric oncology is the field of medicine relating to the care and treatment of childhood cancers. Over the past two decades, the remission rate has been increasing due to improved treatment methods; however, a number of aggressive forms of malignancy still affect this cohort. These rarer forms of cancer do not respond well to conventional treatment, presenting a significant challenge for paediatric oncologists due to their unique genetic profile and rapid progression. This paper seeks to explore two new frontiers in paediatric cancer treatment: the fields of genetic testing and targeted treatment strategies. Combined, both of these domains not only present a promising approach toward treating childhood cancers through personalised medicine, but also earlier detection leading to improved survival rates