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Item Embolisation of an acquired uterine arteriovenous malformation(BMJ Publishing Group, 2024-12-15) Coffey, Aidan John; Galvin, Daniel; Power, Stephen; Hayes-Ryan, DeirdreA G5P2+2 woman in her 30s presented to hospital with per vaginum (PV) bleeding, approximately 2 weeks post electric vacuum aspiration (EVA) for retained products of conception. Ultrasound and MRI demonstrated a large vascular myometrial lesion, suggestive of a uterine arteriovenous malformation (UAVM). She underwent digital subtraction angiography (DSA) with interventional radiology and simultaneous uterine artery embolisation (UAE). She represented 2 weeks later with recurrent PV bleeding and anaemia. She underwent repeat DSA, demonstrating persistent UAVM, and a repeat embolisation was performed. Symptoms resolved following the second embolisation, and a repeat MRI performed 12 weeks later demonstrated complete resolution of the UAVM. Although UAVMs are rare lesions, they can cause significant haemorrhage and morbidity. The presence of UAVM should particularly be considered after uterine intervention such as EVA or caesarean section. UAE is a safe and effective therapy, which preserves fertility.Item Radiographers’ knowledge, clinical expertise and application of pain management strategies in the radiology department – results from a qualitative focus group(Elsevier Ltd., 2024-12-24) O’ Regan, Róisín; Rawashdeh, Mohammad; McEntee, Mark F.; Moore, Niamh; Treanor, Ben; Ali, Magdi; England, AndrewBackground: Radiographers are frequently involved in imaging patients in pain thus requiring a heightened awareness and focus on this crucial issue. Purpose: To explore the challenges radiographers encounter when imaging patients in pain and to identify strategies that could be implemented to improve overall patient-centered care. Methods: A qualitative research study with a single focus group (FG) was conducted using six radiographers working within Irish hospitals. The research questions focused on pain management challenges in the radiology department, particularly identifying radiographers' current practices and strategies to address these challenges. The FG was moderated and video-recorded to facilitate comprehensive analysis. The audio obtained from the FG was transcribed and then analyzed thematically. Results: Data from the FG identified four main themes: 1) consequences of pain management, 2) communication, 3) professional experience, and 4) barriers. In addition, the study highlighted the absence of current protocols, policies, and guidelines in practice for the effective management of challenges associated with imaging patients in pain within the radiology department. Conclusion: The primary challenges identified include the stress experienced by both staff and patients, the potential for obtaining suboptimal images, concerns regarding patient safety, and adverse effects on image quality. This study elucidates the manner in which patient discomfort adversely impacts the imaging process and delineates the potential implications for radiographers aiming to achieve optimal image quality. At present, there are no established policies or procedures within the radiology department to direct the imaging of patients in pain.Item Computed tomography morphomics and antifibrotic therapy in idiopathic pulmonary fibrosis(Elsevier Ltd., 2024-11-29) O'Mahony, A. T.; Waldron, M. G.; Henry, P. J.; Shet, Sahil; O'Regan, P. W.; Bennett, D. M.; Ryan, D. J.; Maher, M. M.; Henry, M. T.AIM: Idiopathic pulmonary fibrosis (IPF) is a debilitating and fatal lung disease. Changes in body composition potentially correlate with outcomes in patients with IPF. MATERIALS AND METHODS: Patients with IPF on antifibrotic treatment attending a single institution were identified and retrospectively evaluated (n=84). Three groups were formed based on antifibrotic treatment: pirfenidone group, nintedanib group and pirfenidone-nintedanib switch group. Morphomic analysis of muscle quantity (cross-sectional area in cm2) and quality (density in Hounsfield Units) on thoracic computed tomography (CT) was performed using a web-based morphomic segmentation tool. Bilateral erector spinae and pectoralis muscles were measured at pre-defined vertebral levels. RESULTS: All three treatment groups showed a statistically significant decline in forced vital capacity (FVC), diffusion capacity of the lung for carbon monoxide (DLCO), pectoral muscle cross sectional area (PMA), and erector spinae muscle cross-sectional area (ESMA). Muscle density did not change significantly. Differences existed in analytic morphomics between treatment groups. Patients with a pretreatment body mass index (BMI) below 30 were found to have a significantly greater loss of PMA when treated with nintedanib instead of pirfenidone. FVC and DLCO did not differ between treatment groups. CONCLUSION: There were no direct correlations between pulmonary function and morphomic parameters in our entire group of IPF patients. However, between different treatment groups, the rate of muscle bulk loss differed. This is an important consideration for clinicians when deciding on an antifibrotic agent of choice.Item The clinical significance and burden of thyroid nodules discovered incidentally(Springer Nature, 2024-12-26) Dureja, Rohil F.; Casey, Caoimhe; Barry, Josephine; Tuthill, Antoinette; Irish Endocrine SocietyBackground: The majority of thyroid nodules are benign; however current guidelines suggest that thyroid incidentalomas should be appropriately evaluated to rule out malignancy. Aims: This study aims to determine the incidence of thyroid incidentalomas and the likelihood that they harbour sinister pathology in the largest Irish cohort studied to-date. Methods: A retrospective observational chart review was conducted using data from July 2018 to December 2018 using the Radiology Database in use at Cork University Hospital. The text of 1000 imaging reports (500 carotid Doppler and 500 computed tomography thorax) was manually screened for phrases such as “thyroid mass” or “thyroid nodule”. Results: On 1000 scans, 14 (1.4%) thyroid incidentalomas were discovered. The occurrence of incidentalomas by imaging was 2/500 (0.4%) for ultrasound and 12/500 (2.4%) for computed tomography. Three of these nodules (21.4%) were further evaluated with a subsequent ultrasound and due to a size of more than 1 cm underwent fine needle aspiration. Using the Thy classification, all three were given a Thy 2 (non-neoplastic) grading. Conclusion: This study found that there was no clinical benefit to reporting the presence of thyroid incidentalomas incidentally noted on radiology investigations. Although the overall percentage of thyroid incidentalomas is low, this number may be enough to cause unnecessary strain on the healthcare system and burden patients with invasive investigations in addition to causing unnecessary anxiety.Item T lymphocyte plasticity in chronic inflammatory diseases: The emerging role of the Ikaros family as a key Th17-Treg switch(Elsevier B.V., 2024-12-30) Ramón-Vázquez, Ana; Flood, Peter; Cashman, Thuy Linh; P. Patil; Ghosh, Subrata; Science Foundation IrelandT helper (Th) 17 and regulatory T (Treg) cells are highly plastic CD4+ Th cell subsets, being able not only to actively adapt to their microenvironment, but also to interconvert, acquiring mixed identity markers. These phenotypic changes are underpinned by transcriptional control mechanisms, chromatin reorganization events and epigenetic modifications, that can be hereditable and stable over time. The Ikaros family of transcription factors have a predominant role in T cell subset specification through mechanisms of transcriptional program regulation that enable phenotypical diversification. They are crucial factors in maintaining Th17/Treg balance and therefore, homeostatic conditions in the tissues. However, they are also implicated in pathogenic processes, where their transcriptional repression contributes to the control of autoimmune processes. In this review, we discuss how T cell fate, specifically in humans, is regulated by the Ikaros family and its interplay with additional factors like the Notch signaling pathway, gut microbiota and myeloid-T cell interactions. Further, we highlight how the transcriptional activity of the Ikaros family impacts the course of T cell mediated chronic inflammatory diseases like rheumatoid and psoriatic arthritis, inflammatory bowel disease, systemic lupus erythematosus and multiple sclerosis. We conclude by discussing recently developed therapeutics designed to target Ikaros family members.