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A 5 year old boy presented to the Emergency Department with a 1 day history of evolving right sided hemiparesis and drooling on a background of primary varicella infection 3 months previously. No other significant medical history. No significant family history.On examination GSC 15/15, vitals were stable. Cardiovascular, respiratory, gastrointestinal, ENT examinations were unremarkable. Neurological examination; speech was normal, on mobilizing hisright leg dragged along floor. No ataxia or foot drop were noted. Cranial nerves II – XII grossly intact. Muscle bulk, tone and reflexes all normal. Reduced power 3/5 in the right upper and lower limbs.InvestigationsFBC, U+E, LFT, Coagulation all normal. CSF VZA DNA detected, VZV IgG>100 mIU/ml.CT and MRA brainNo abnormality identified. MRI Brain: Acute Left sided ischemic stroke – affecting the left subinsular region and the posterior limb ofthe left internal capsule.DiagnosisArterial ischaemic stoke secondary to varicella vasculitis

Objective Skin tags are associated with an insulin resistant phenotype but studies in White Europeans with morbid obesity are lacking. We sought to determine whether the presence of cervical or axillary skin tags was associated with increased cardiovascular risk in Irish adults with morbid obesity. We conducted a cross-sectional study of patients attending our Irish regional bariatric centre with a BMI ≥ 40 kg m −2 (or ≥ 35 kg m −2 with co-morbidities). We compared anthropometric and metabolic characteristics in those with versus without skin tags. Results Of 164 patients, 100 (31 male, 37 with type 2 diabetes, 36 on lipid lowering therapy, 41 on antihypertensive therapy) participated. Mean age was 53.7 ± 11.3 (range 31.1–80) years. Cervical or axillary tags were present in 85 patients. Those with tags had higher systolic blood pressure 138.0 ± 16.0 versus 125.1 ± 8.3 mmHg, p = 0.003) and HbA1c (46.5 ± 13.2 versus 36.8 ± 3.5 mmol/mol, p = 0.017). Tags were present in 94.6% of patients with diabetes, compared to 79.4% of those without diabetes (p = 0.039). Antihypertensive therapy was used by 45.8% of patients with skin tags compared to 13.3% without tags (p = 0.018). In bariatric clinic attenders skin tags were associated with higher SBP and HbA1c and a higher prevalence of diabetes and hypertension, consistent with increased vascular risk, but lipid profiles were similar.

IntroductionPaediatric ECG interpretation is a core clinical competence in postgraduate paediatric specialist training. Doctors treating paediatric patients with potential cardiac conditions should be familiar with the principles of ECG interpretation and the diagnoses requiring emergency treatment. Research has shown that paediatric ECG interpretation amongst doctors may be suboptimal and that the most effective method of teaching ECG interpretation is unclear.1 AimsThis study aims to establish the accuracy of paediatric ECG interpretation by NCHDs working in an Irish Tertiary Paediatric Hospital and to measure the impact of a teaching intervention.MethodologyNCHDs working in acute clinical areas in an Irish tertiary paediatric hospital were invited to participate (n=45). Participants were asked to report three ECGs (long QT, Wolf Parkinson White and normal). This was followed by a 40 minutes lecture. Participants were then asked to re-report the same 3 ECGs. Participants also completed questionnaires pre and post the study, including self-rating their ability to report paediatric ECGs on a Likert Scale from 1(poor) to 6 (expert).Results25 NCHDs completed the study. The pre-teaching accuracy for ECG1 (long QT), ECG 2 (Wolf Parkinson White) and ECG 3 (normal) was 37%, 32% and 24% respectively. Following the teaching intervention these figures rose to 76%, 40% and 44%. There was a statistically significant improvement in the combined before and after accuracy of ECG interpretation (31% v 53%) (p=0.02). There was also an improvement in participant self-rated ability to report paediatric ECG following the study. The mean pre-lecture score on the 1 (Poor)-6(Expert) Likert Scale was 2.84, the mean post lecture score on was 3.8 with the same scale. All participants found the teaching intervention helpful and reported that they would like further teaching on the topic.DiscussionThe initial accuracy of paediatric ECG interpretation amongst participants was lower than reported in the literature.2 Lectures were shown to be an effective teaching method to improve short-term ECG accuracy rates among participants.ConclusionThere is currently no structured post-graduate teaching for paediatric ECG interpretation resulting in a varied knowledge base. This study shows that further education on ECG’s is required.ReferencesJheeta J, et al. Accuracy in interpreting the paediatric ECG: a UK-wide study and the need for improvement. Arch Dis Child 2014;99:646–.Auseon AJ, et al. Methods of teaching and evaluating electrocardiogram interpretation skills among cardiology fellowship programs in the United States. J Electrocardiol 2009;42(4):339–44.

Background In Ireland, a ‘COVID-19 death’ is defined as any death in which the decedent was COVID-19 positive and had no clear alternative cause of death unrelated to COVID-19, a definition based on World Health Organization guidance. Aims The objectives of this audit were to determine the proportion of COVID-19 deaths notified in the Cork/Kerry region of Ireland during winter 2021–2022 which adhered to this national definition, and to determine whether COVID-19 was deemed to be the primary cause of death, or a contributory or incidental factor. Methods A review of all deaths in individuals who were COVID-19 positive at the time of death notified to the Department of Public Health for Cork and Kerry between 22 November 2021 and 31 January 2022 was conducted to determine whether each death adhered to the national COVID-19 death definition. The clinical opinion on cause of death was obtained by contacting decedents’ clinicians. Results Sixty deaths in individuals who were COVID-19 positive at the time of death were notified to the Department in the study period. Of deaths notified as being due to COVID-19, COVID-19 was deemed the primary cause of death, a contributory factor or an incidental factor in 72.7%, 21.8%, and 5.5% of cases, respectively. Most (93.3%) notified deaths adhered to the national COVID-19 death definition. Conclusions The COVID-19 death definition in Ireland may require revision so it can distinguish between deaths caused by COVID-19 and those in which COVID-19 played a less direct role. The current COVID-19 mortality reporting system may also need updating to capture more clinical nuance.

Women with previous gestational diabetes (GDM) are a high-risk group for future development of diabetes, metabolic syndrome, and cardiovascular disease. The new International Association of Diabetes in Pregnancy Study Groups (IADPSG) criteria significantly increase the number of women diagnosed with GDM. The long-term metabolic outcome in these women is unknown. We set out to determine the prevalence of metabolic syndrome, using adult treatment panel-III criteria; and insulin resistance, using HOMA2-IR, in white European women with previous GDM. Using a cohort design, we invited women meeting IADPSG GDM criteria across four Irish antenatal centres between 2007 and 2010 to participate. Two hundred and sixty-five women with previous values meeting IADPSG criteria for GDM participated (44 % of the population eligible for participation). Mean age was 36.7 years (SD 5.0). These women were compared with a randomly selected control group of 378 women (mean age 37.6 years, SD 5.1) known to have normal glucose tolerance (NGT) in pregnancy during the same period. A total of 25.3 % of women with previous IADPSG-defined GDM met metabolic syndrome criteria, compared to 6.6 % of women with NGT [at 2.6 (SD 1.0) vs. 3.3 years (SD 0.7) post-partum]. The prevalence of HOMA2-IR >1.8 was higher in women with previous IADPSG-defined GDM (33.6 vs. 9.1 % with NGT, p  < 0.001). Women with previous GDM by IADPSG criteria demonstrate a greater than threefold prevalence of metabolic syndrome compared to women with NGT in pregnancy. Efforts to prevent projected long-term consequences of this should focus on interventions both in the preconception and post-partum periods.

Background Lifestyle modification is fundamental to obesity treatment, but few studies have described the effects of structured lifestyle programmes specifically in bariatric patients. We sought to describe changes in anthropometric and metabolic characteristics in a cohort of bariatric patients after participation in a nurse-led, structured lifestyle programme. Methods We conducted a retrospective, observational cohort study of adults with a body mass index (BMI) ≥40 kgm −2 (or ≥35 kgm −2 with significant co-morbidity) who were attending a regional bariatric service and who completed a single centre, 8-week, nurse-led multidisciplinary lifestyle modification programme. Weight, height, waist circumference, blood pressure, HbA1c, fasting glucose and lipid profiles as well as functional capacity (Incremental Shuttle Walk Test) and questionnaire-based anxiety and depression scores before and after the programme were compared in per-protocol analyses. Results Of 183 bariatric patients enrolled, 150 (81.9 %) completed the programme. Mean age of completers was 47.9 ± 11.2 years. 34.7 % were male. There were statistically significant reductions in weight (129.6 ± 25.9 v 126.9 ± 26.1 kg, p  < 0.001), BMI (46.3 ± 8.3 v 44.9 ± 9.0 kgm −2 , p  < 0.001), waist circumference (133.0 ± 17.1 v 129.3 ± 17.5 cm in women and 143.8 ± 19.0 v 135.1 ± 17.9 cm in men, both p  < 0.001) as well as anxiety and depression scores, total- and LDL-cholesterol and triglyceride levels, with an increase in functional capacity (5.9 ± 1.7 v 6.8 ± 2.1 metabolic equivalents of thermogenesis (METS), p  < 0.001) in completers at the end of the programme compared to the start. Blood pressure improved, with reductions in systolic and diastolic blood pressure from 135 ± 16.2 to 131.6 ± 17.1 ( p  = 0.009) and 84.7 ± 10.2 to 81.4 ± 10.9 mmHg ( p  < 0.001), respectively. The proportion of patients achieving target blood pressure increased from 50.3 to 59.3 % ( p  = 0.04). The proportion of patients with diabetes achieving HbA1c <53 mmol/mol increased from 28.6 to 42.9 %, p  = 0.02. Conclusions Bariatric patients completing an 8 week, nurse-led structured lifestyle programme had improved adiposity, fitness, lipid profiles, psychosocial health, blood pressure and glycaemia. Further assessment of this programme in a pragmatic randomised controlled trial seems warranted.

I became involved in the Irish community, volunteering at the Irish Centre, and working with the Toronto Irish Players. I started singing professionally with Toronto's community of traditional Irish musicians. Later, I spent two months in Ireland where I took singing workshops and visited museums and libraries. Here I made the painful discovery that in spite of my intense love for the culture, Ireland was not my home. I had dreamed of going back to Ireland for so many years, and yet when I got there, I experienced a sense of isolation, of being cut off in a very real way from the living experience of my culture. I still struggle with this dilemma. From 300 BC to 300 AD the Celts of Ireland produced some of the most unique art. At this time the continental Celts were feeling the pressure of other civilizations: Etruscan, Roman, and Greek and this was reflected in their designs. Irish Celts were isolated by the sea from these influences. It was during this period that the Irish developed their unique enamelling style called champleve which is derived from the French \"raised\" (leve) and \"field\" (champ) as the design is created with a raised field of metal. This technique is different from the more well-known cloisonne, which is derived from the French \"cell\" (cloison) as the design is created with cells of wire. Champleve is the technique that I use for all of my work. The early Celts gouged out the metal with engraving tools. They then melted the glass (enamel) in clay crucibles and poured it into the depressions. [Macha] was said to have entered the household of a wealthy widower named Crunnchu, wordlessly taking the place of his wife who had died. Because she was beautiful and useful, Crunnchu accepted her and she became pregnant. When Crunnchu asked if he could attend an assembly of the men of Ulster, Macha agreed, stipulating only that he should not mention her. At the assembly, no one could talk of anything but the swiftness of the King's horses, so that Crunnchu could not help boasting \"My wife is swifter.\" Instantly he was arrested by the King and told to produce his wife and prove his statement. When Macha arrived at the race, nine months pregnant, she asked leave to wait until after her delivery, but was told that her husband would be killed if she did not run. She raced and won, giving birth to twins as she crossed the finish line in front of the king's chariot. She then cursed the men of Ulster unto the ninth generation, and this was her curse: that all who had heard her cries, would themselves suffer the pains of labour whenever they were in most need of strength. That place was ever after called Emain Macha (that is: the twins \"emain\" of Macha)