Alcohol attributable hospitalisations and costs in Ireland, 2000-2004

The aim of this study was to calculate the number and costs of hospital bed-days due to alcohol use in Ireland over the five year period 2000 to 2004. Age and sex specific Irish alcohol-attributable-fractions (AAFs) were developed by combining international risk estimates with Irish consumption data where available; where not available international AAFs were used. These were applied to national datasets to count the number and costs of bed-days wholly caused and prevented by alcohol and that proportion of bed-days that were partially caused and prevented by alcohol. Between 2000 and 2004, alcohol was estimated to have caused 3,428,973 (10.3%) and prevented 529,239 (1.6%) of hospital bed-days, giving a net number of bed-days due to alcohol of 2,899,734 (8.7%). Over this period the hospital inpatient costs attributed to the negative effects of alcohol were 953,126,381 euros, the costs attributed to hospitalisations prevented were 147,968,164 euros; giving net costs of alcohol-attributed bed-days of 805,158,217 euros. Chronic conditions accounted for 3,262,408 (95%) hospital bed-days due to the harmful effects of alcohol. Conditions not wholly due to alcohol accounted for 2,297,412 (67%) hospital bed-days due to the harmful effects of alcohol. The negative impacts of alcohol were greater than previously thought and spread across the whole population.

Outcome of laparoscopic duodenal switch for morbid obesity

Background

The aim of this study was to determine the safety and efficacy of laparoscopic duodenal switch (LDS) as a treatment option in a selected group of patients with morbid obesity.

Methods

This retrospective analysis of a prospective database assessed the frequency of all complications and alterations in weight, body mass index (BMI), co-morbidity and quality of life.

Results

One hundred and twenty-one patients underwent LDS between April 2003 and March 2009. Median preoperative weight was 160 kg and median BMI 55 kg/m2. All procedures were performed laparoscopically. The in-hospital mortality rate was zero. No ileoduodenal anastomotic stenosis was encountered. There were four clinical leaks (3·3 per cent) managed by laparoscopic drainage and placement of a feeding jejunostomy. Median percentage excess weight loss was 75 per cent at 12 months and 90 per cent at 24 months. Thirty-six of 40 diabetic patients had complete resolution of diabetes within 1 year. There were significant improvements in other obesity-related co-morbidity. Only a few patients developed postoperative protein deficiency, and fat-soluble vitamin deficiencies were easily managed with oral supplementation.

Conclusion

The LDS procedure is a safe and effective treatment for morbid obesity and its associated co-morbidity in selected patients.

Macrofaunal recolonisation following the intertidal placement of fine-grained dredged material

Dredged material is increasingly being regarded as a potential resource, and one of its many uses is to create and/or improve intertidal habitats (i.e. beneficial use). However, uncertainties over the longer-term environmental consequences of such schemes have, to date, limited the practice to small-scale applications in UK waters. This paper studies the macrofaunal recolonisation of fine-grained dredged material recharged concurrently at four adjacent recharge areas along the south-east coast of the UK in order to facilitate predictions regarding the recolonisation of comparable schemes and, thereby, to promote effective environmental management. During the 2-year study period, the four recharge areas were distinctly different in terms of their environmental characteristics, primarily wave exposure and bed level. These conditions resulted in different macrofaunal recolonisation rates and community structures. While the low-level, wave-sheltered area experienced rapid recolonisation, the process was delayed until 12 months post-recharge at the relatively wave-exposed areas. Bed level differences resulted in distinctly different communities in wave-sheltered areas but not under wave-exposed conditions. While we are unable to separate the effects of individual environmental variables on recolonisation, these results provide general conclusions as to the importance of environmental conditions on resulting macrofaunal communities.

Levels and trends of brominated diphenyl ethers in blubber of harbor porpoises (Phocoena phocoena) from the U.K., 1992-2008

Controls were placed on the production and use of the penta-mix polybrominated diphenyl ether (PBDE) formulation within the European Union in 2004. In porpoises stranded or bycaught around the U.K., BDE congeners from this product predominate. Lipid-normalized concentrations of 9 (summed) BDE congeners in the blubber of 415 porpoises sampled during the period 1992-2008 have been investigated for possible time trends resulting from the regulatory action. Our analysis suggests that, overall, median Sigma9BDE concentrations peaked around 1998 and have since reduced by between 53.8% and 73.5% to 2008. Our best point estimate is that the reduction has been 67.6%. This decline was highly statistically significant (p < 0.001) and was not confounded by a range of other factors which were also considered (area, season, nutritional status, bycaught/stranded, and age class).

Lapse and relapse following inpatient treatment of opiate dependence

We conducted a prospective follow-up study of consecutive opiate dependent patients admitted to a residential addiction treatment service for detoxification. We measured the rate of relapse following discharge, and sought to identify factors that were associated with early relapse (i.e., a return to daily opiate use). Follow-up interviews were conducted with 109 patients, of whom, 99 (91%) reported a relapse. The initial relapse occurred within one week in 64 (59%) cases. Multivariate survival analysis revealed that earlier relapse was significantly predicted by younger age, greater heroin use prior to treatment, history of injecting, and a failure to enter aftercare. Unexpectedly, those who were in a relationship with an opiate user had significantly delayed relapse. Those who completed the entire six-week inpatient treatment programme also had a significantly delayed relapse. In order to reduce relapse and the associated increased risk of fatal overdose, services providing residential opiate detoxification should prepare people for admission, strive to retain them in treatment for the full admission period and actively support their entry into planned aftercare in order to improve outcome.

A locus for an auditory processing deficit and language impairment in an extended pedigree maps to 12p13.31-q14.3

Despite the apparent robustness of language learning in humans, a large number of children still fail to develop appropriate language skills despite adequate means and opportunity. Most cases of language impairment have a complex etiology, with genetic and environmental influences. In contrast, we describe a three-generation German family who present with an apparently simple segregation of language impairment. Investigations of the family indicate auditory processing difficulties as a core deficit. Affected members performed poorly on a nonword repetition task and present with communication impairments. The brain activation pattern for syllable duration as measured by event-related brain potentials showed clear differences between affected family members and controls, with only affected members displaying a late discrimination negativity. In conjunction with psychoacoustic data showing deficiencies in auditory duration discrimination, the present results indicate increased processing demands in discriminating syllables of different duration. This, we argue, forms the cognitive basis of the observed language impairment in this family. Genome-wide linkage analysis showed a haplotype in the central region of chromosome 12 which reaches the maximum possible logarithm of odds ratio (LOD) score and fully co-segregates with the language impairment, consistent with an autosomal dominant, fully penetrant mode of inheritance. Whole genome analysis yielded no novel inherited copy number variants strengthening the case for a simple inheritance pattern. Several genes in this region of chromosome 12 which are potentially implicated in language impairment did not contain polymorphisms likely to be the causative mutation, which is as yet unknown.

Chlorobiphenyls in the blubber of harbour porpoises (Phocoena phocoena) from the UK: levels and trends 1991-2005

Harbour porpoises sampled within the UK Cetacean Strandings Investigation Programme have been analysed for 25 chlorobiphenyl congeners. In all, 440 porpoises stranded or bycaught during the period 1991-2005 were studied. There are regional differences in the trend in summed congener concentrations over time but, despite controls on PCBs having been in place for decades, they are declining only slowly. Their toxic impacts in UK porpoises - increased susceptibility to infectious disease mortality in the most contaminated individuals - looks likely to continue for some time yet. Further efforts to limit or eliminate PCB discharges to the marine environment are still needed.

Tracheo-oesophageal fistula diagnosed with multidetector computed tomography

This case highlights important issues in investigation of patients with suspected tracheo-oesophageal fistula including the value of multidetector computed tomography, the importance of thorough imaging evaluation when high clinical suspicion of tracheo-oesophageal fistula exists and the value of close interaction between radiologists and intensive care physicians in the investigation of these patients.

Botulism in injecting drug users, Dublin, Ireland, November-December 2008

In November and December 2008, six cases of suspect wound botulism were reported in heroin injecting drug users, all residents in Dublin, Ireland. Patients were aged between 23-42 years of age; four cases were male; one patient died shortly after admission. The patients presented to four different hospitals across the city. Botulism in injecting drug users in Ireland was last reported in 2002.

Botulism in injecting drug users, Dublin, Ireland, November-December 2008

In November and December 2008, six cases of suspect wound botulism were reported in heroin injecting drug users, all residents in Dublin, Ireland. Patients were aged between 23-42 years of age; four cases were male; one patient died shortly after admission. The patients presented to four different hospitals across the city. Botulism in injecting drug users in Ireland was last reported in 2002.

Acute aortic dissection mimicking an acute coronary syndrome through occlusion of the right coronary artery

Occlusion of the right coronary artery (RCA) is an uncommon complication of type A aortic dissection. Aortic dissection and acute coronary syndrome (ACS) share a similar pathogenesis in atherosclerosis and hypertension. Consequently a patient with ischaemic risk factors presenting with chest pain and dynamic ECG change may well be incorrectly treated for ACS if careful attention is not paid to the presenting symptoms and signs. This case report describes a 59-year-old man who presented with chest pain, confusion and an ischaemic ECG and was initially treated for ACS. He subsequently deteriorated clinically and imaging confirmed type A aortic dissection complicated by RCA occlusion. Following emergent surgery with aortic root replacement and coronary artery bypass grafting he later made a good recovery.

A significant downturn in levels of hexabromocyclododecane in the blubber of harbor porpoises (Phocoena phocoena) stranded or bycaught in the UK: an update to 2006

In an earlier paper, we reported data indicating a sharp increase in hexabromocyclododecane concentrations in the blubber of 85 harbor porpoises from the UK, from about 2001 onward. That time trend was evaluated using data from 1994-2003, generated on a diastereoisomer basis using LC-MS. In this paper we report additional data for 138 animals collected during 2003-2006. SigmaHBCD concentrations ranged from <10 to 11,500 microg kg(-1) wet weight (up to 12,800 microg kg(-1) lipid weight) and TBBP-A was not detected in any samples. The maximum SigmaHBCD concentration observed in this study was about half that seen in the earlier study (21,400 microg kg(-1) lipid weight) and, in both studies, the highest concentration was for an animal stranded or bycaught in 2003. Investigation of time trends confirmed a statistically significant increase between 2000 and 2001 (p < 0.01) and a statistically significant decrease between 2003 and 2004 (p < 0.05). Neither trend was confounded by age, sex, nutritional status, or location. Possible contributory factors to the observed decrease include the closure in 2003 of an HBCD manufacturing plant in NE England which had considerable emissions up to 2003, and two voluntary schemes intended to reduce emissions of HBCD to the environment from industry which, however, did not formally begin until 2006.

Dissolved organic carbon reduces the toxicity of copper to germlings of the macroalgae, Fucus vesiculosus

This study investigates the effects of waterborne copper exposure on germling growth in chemically defined seawater. Germlings of the macroalgae, Fucus vesiculosus were exposed to a range of copper and dissolved organic carbon (DOC as humic acid) concentrations over 14 days. Germling growth was found to be a sensitive indicator of copper exposure with total copper (TCu) and labile copper (LCu) EC(50) values of approximately 40 and 20 microg/L, respectively, in the absence of added DOC. The addition of DOC into the exposure media provided germlings with protection against copper toxicity, with an increased TCu EC(50) value of 117.3 microg/L at a corrected DOC (cDOC from humic acid only) concentration of 2.03 mg/L. The LCu EC(50) was not affected by a cDOC concentration of 1.65 mg/L or less, suggesting that the LCu concentration not the TCu concentration was responsible for inhibiting germling growth. However, at a cDOC concentration of approximately 2mg/L an increase in the LCu EC(50) suggests that the LCu concentration may play a role in the overall toxicity to the germlings. This is contrary to current understanding of aquatic copper toxicity and possible explanations for this are discussed.

Effects of dissolved organic carbon on the toxicity of copper to the developing embryos of the Pacific oyster (Crassostrea gigas)

The effects of humic acid (HA) on copper speciation and its subsequent toxicity to the sensitive early life stages of the Pacific oyster (Crassostrea gigas) are presented. Differential pulse anodic stripping voltammetry with a hanging mercury drop electrode was used to measure the copper species as labile copper (LCu; free ion and inorganic copper complexes) and total copper (TCu) with respect to increasing HA concentration. The TCu and LCu 50% effect concentrations (EC50s) in the absence of HA were 20.77 microg/L (95% confidence interval [CI], 24.02-19.97 microg/L) and 8.05 microg/L (95% CI, 9.6-5.92 microg/L) respectively. A corrected dissolved organic carbon (DOC) concentration (HA only) of 1.02 mg/L was required to significantly increase the TCu EC50 to approximately 41.09 microg/L (95% CI, 44.27-37.52 microg/L; p < 0.05), almost doubling that recorded when DOC (as HA) was absent from the test media. In contrast, the LCu EC50 was unaffected by changes in DOC concentration and was stable throughout the corrected DOC concentration range. The absence of change in the LCu EC50, despite increased HA concentration, suggests that the LCu fraction, not TCu, was responsible for the observed toxicity to the oyster embryo. This corresponds with the current understanding of copper toxicity and supports the free-ion activity model for copper toxicity.

Epidemiology of hepetitis C infection, ERHA/HSE Eastern region

Hepatitis C became statutorily notifiable in Ireland on 1 January 2004. Prior to 2004, only hepatitis A and hepatitis B were notifiable as distinct types of hepatitis. A third category notifiable under the Infectious Diseases Regulations 1981 was "viral hepatitis unspecified". The majority of cases notified under this heading were thought to be due to infection with hepatitis C Virus (HCV). Between January 1 2004 and December 31 2005, the Department of Public Health HSE Eastern Region, received notification of 2,014 cases of HCV infection (2004, 941 cases, 2005 1,073 cases). This report outlines basic demographic details on cases notified and comments on missing data. Peak age band at notification for males and females is in the 25-29 year old age group where 538 (26.7%) were notified. Thirty cases notified (1.5%) were under 15 years of age. Drug misuse has been confirmed as a risk factor for 1247 (61.9%) of cases notified, and may be a risk factor in a large percentage of the reminder where risk factor data are unknown. Problems with completeness of notification have been identified. Enhanced surveillance of all hepatitis C infections is a prerequisite for future service planning.