Letteratura scientifica selezionata sul tema "Dublin. Rotunda Hospital"

With a population of some 140,000 in 1760, Dublin was the second largest city in the British Isles. Although small in comparison to London, it had a thriving musical community which attracted the likes of George Frideric Handel (1685–1759), Thomas Arne (1710–1778), Niccolo Pasquali (c. 1718–1757) and the oboist Johann Fischer (1733–1800). Concerts took place at various venues across the city including Dublin Castle, Christ Church Cathedral and Fishamble Street Musick Hall. In addition, societies such as the Musical Academy (an aristocratic music society founded by the Earl of Mornington in 1757) supported charitable concerts such as those at the Rotunda, the concert venue attached to the Lying-in Hospital. Although instruments were imported from London throughout the century (John Snetzler, for example, supplied the organ for the Rotunda in 1767), there was a knot of local instrument builders working in the vicinity of Trinity College. However, in contrast to the concentration of keyboard instrument builders in the Soho area of London in the eighteenth century, the distribution of harpsichord makers in Dublin was more diffuse.

ABSTRACT A retrospective audit was conducted at the Rotunda hospital, Dublin to assess the incidence of partial molar pregnancies and complete molar pregnancies over a 10-year period from the 1st of January 1997 to 31 of December 2006. Methods Records from the pathology department were accessed for the number of molar pregnancies from 1997 to 2006. Each pathology result was then retrieved to differentiate between complete moles and partial moles. The annual reports published by the hospital were used to obtain the number of deliveries and live births per year. Results The incidence of partial molar pregnancies at the Rotunda Hospital from 1997 to 2006 was 1 in 328 live births. The incidence of complete molar pregnancies from 1997 to 2006 was 1 in 1105 live births. The incidence of a molar pregnancy in the study period was 1:253. Conclusion The incidence of a molar pregnancy was estimated to be 1: 512 in 1993 and was 1: 253 in this study, indicating a significant rise. The incidence of complete and partial molar pregnancies has also doubled. The Rotunda hospital caters to a large proportion of Dublin's noncaucasian population which might account for an increase. But it is still possible that there is an over diagnosis of cases as diagnosis is only by histology and flow cytometry is not routinely performed in all cases.

BackgroundInfluenza during pregnancy is a potentially life threatening illness. There are limited data on influenza vaccination uptake and determinants of uptake in Irish obstetric populations.AimTo determine the uptake of influenza vaccination during pregnancy; determinants of vaccination uptake; knowledge, attitudes, and concerns of postnatal women; and knowledge and attitudes of healthcare professionals (HCPs) surrounding vaccination.Design & settingA quantitative study of postnatal women attending the Rotunda Hospital, a tertiary referral maternity hospital in Dublin, Ireland. A separate quantitative study conducted by the North Dublin City GP Training Programme surveyed GPs, pharmacists, and Rotunda Hospital clinical staff.MethodA paper-based survey was distributed to postnatal women. HCPs completed the survey via the online tool Survey Monkey.Results330 patient surveys were disseminated, with a 60.0% response rate. Of 198 responders, 109 (55.1%) were vaccinated against influenza. Non-professionals were less likely to be vaccinated (adjusted odds ratio [aOR] 0.29, 95% confidence interval [CI] = 0.09 to 0.89). Vaccination in previous pregnancy (aOR 5.2, 95% CI = 1.69 to 15.62) and information from an HCP were strongly associated with vaccination (aOR 12.8, 95% CI = 2.65 to 62.5). There was a 20.2% (n = 1180) response rate among HCPs. More GPs felt that it was their role to discuss vaccination (92.9%; n = 676), and offer to vaccinate women (91.7%; n = 666) than any other HCP.ConclusionProvision of information about the importance of vaccination against influenza and pertussis during pregnancy by HCPs and their consistent recommendations in support of vaccination were key determinants of vaccine uptake during pregnancy. The sociodemographic determinants of a woman’s vaccination status should be addressed in health promotion campaigns. Education of HCPs may address knowledge gaps surrounding vaccination.

SummaryEarly onset preeclampsia (EOP) is a pregnancy-specific proinflammatory disorder that is characterised by competing thrombotic and bleeding risks. It was the aim of this study to characterise thrombin generation, a major determinant of thrombotic and bleeding risk, in order to better understand the haemostatic balance in patients with EOP. Patients with EOP were recruited at the Rotunda Hospital, Dublin. Twenty-six cases of EOP were recruited over a 21-month period, out of 15,299 deliveries at the Rotunda. Blood samples were collected into sodium citrate plus corn trypsin inhibitor anticoagulated vacutainers, platelet-poor plasma was prepared, and calibrated automated thrombography was used to assess thrombin generation. Results were compared to age and sex-matched non-pregnant controls (n=13) and age-and gestation-matched pregnant controls (n=20). The rate and extent of thrombin generation triggered by low-dose tissue factor (TF) was significantly reduced in patients with EOP compared to pregnant controls, most significantly in cases of severe EOP. EOP patients displayed a trend towards an increased response to endogenous activated protein C and thrombomodulin relative to pregnant controls. Plasma tissue factor pathway inhibitor (TFPI) activity was increased in EOP patients. Inhibition of TFPI abolished the attenuation of thrombin generation stimulated by low-dose TF. In conclusion, patients with EOP are characterised by an attenuated coagulation response characterised by reduced thrombin generation stimulated by low-dose TF and elevated plasma TFPI activity. These changes in coagulation may modulate thrombotic risk and bleeding risk in patients with EOP.

A patent ductus arteriosus (PDA) in preterm infants is associated with increased ventilator dependence and chronic lung disease, necrotizing enterocolitis, intraventricular haemorrhage, and poor neurodevelopmental outcome. Randomised controlled trials of early PDA treatment have not established a drop in the aforementioned morbidities. Those trials did not physiologically categorise PDA severity. Incorporating the specific physiological features of a haemodynamic significant PDA may evolve our understanding of this phenomenon, allowing accurate triaging using echocardiography and targeted treatment. Our group has recently demonstrated that a PDA severity score (PDAsc) derived at 36-48 hours of age can accurately predict the later occurrence of chronic lung disease or death (CLD/Death). Using echocardiography, we assessed PDA characteristics, as well as left ventricular diastolic function and markers of pulmonary overcirculation, and from this formulated a PDAsc. Gestation was also incorporated into the score. We hypothesise that in preterm infants at high risk of developing CLD/Death based on a PDAsc, early treatment with Ibuprofen compared with placebo will result in a reduction in CLD/Death. This is a single centre double-blind two arm randomised controlled trial conducted in the neonatal intensive care unit in the Rotunda Hospital, Dublin. Echocardiogram is carried out in the first 36-48 hours of life to identify preterm infants with a PDAsc ≥ 5.0 and these infants are randomised to Ibuprofen or placebo. Primary outcomes are assessed at 36 weeks post menstrual age. This pilot study’s purpose is to assess the feasibility of performing the trial and to obtain preliminary data to calculate a sample size for a definitive multi-centre trial of early PDA treatment using a PDAsc. We aim to recruit a total of 60 infants with a high risk PDA over three years. Trial Registration: ISRCTN ISRCTN13281214 (26/07/2016) and the European Union Drug Regulating Authorities Clinical Trials Database 2015-004526-33 (03/12/2015).

Abstract Introduction Following birth, the transition from intrauterine to extrauterine life is associated with major physiological changes. Many pathological processes linked with mortality and morbidity in preterm infants start at this time. Extracellular vesicles (EVs) are subcellular particles released by all known cell types and readily detectable in large numbers in all biological fluids. EVs are heterogeneous in size and origin, consisting of exosomes (endosomal origin, 30-150 nm), microvesicles (plasma membrane-derived, 50-1000nm), and apoptotic bodies (500-2000 nm). They are linked with a wide variety of processes including coagulation and cell-cell communication, and it has been hypothesized that they may affect preterm morbidities. It is unknown whether circulating EVs can change during this extrauterine transition period. Aim Here we investigate if the population of circulating EVs is altered in premature neonates during the extrauterine transition period Patients and Methods Preterm neonates were recruited through the Department of Neonatology at the Rotunda Hospital, Dublin, Ireland. Written informed consent was obtained from the parents of all participants. Blood collection was performed during routine phlebotomy. Platelet free plasma was prepared by double centrifugation at 3000g for 10 minutes. 15x Day 1 of life and 14x days 3 of life plasma samples were available from preterm neonates, 8 of which were matched Day 1 and Day 3 samples. EVs were quantified and characterised by both nanoparticle tracking analysis (NTA with a Malvern NanoSight 3000) and flow cytometry (Beckman Coulter CytoFLEX LX). Results The extrauterine transition period is characterised by a shift in plasma EVs profile. Using NTA, we observed an increase in the levels of plasma EVs (0-200nm) from Day 1 to Day 3 (Day 1; 4.0 ± 2.5 x 107/µl vs. Day 3; 7.2 ± 4.4 x 107/µl; p = 0.03). This increase in EV levels (0-200nm) was supported by flow cytometry, which also demonstrated an increase in EVs (100-900nm) from day 1 to Day 3 (Day 1; 1.1 ± 0.3 X 106/µl vs. Day 3; 4.2 ± 3.2 x 106/µl, p = 0.0009). There was a highly significant correlation between EV levels measured by NTA and flow cytometry (Spearmann rank correlation coefficient, r = 0.69, p < 0.0001), suggesting simultaneous increases in small and large EVs during the extrauterine transition period. Using flow cytometry, we also observed a change in the composition of plasma EVs during the extrauterine transition period. Flow cytometry data from Day 3 samples were characterised by the presence of a homogenous population of EVs of ~100-300nm in size, which was not observed on Day 1. The presence of this population caused a significant increase in the median side scatter height (SSC-H) value of the plasma EV population (Day 1; 1800 ± 746 vs. Day 3; 3832 ± 1633, p = 0.0013), as well as reduction in the percentage of 100nm EVs (Day 1; 73.9 ± 9.2 % vs. Day 3; 57.4 ± 12.6 %, p = 0.0005) and an increase in the percentage of 100-300nm EVs (Day 1; 19.7 ± 7.7 % vs. Day 3; 38.0 ± 12.9%, p = 0.001). EVs from Day 3 samples were characterised by higher median Red SSC-H values (Day 1; 1688 ± 2902 vs. Day 3; 3641 ± 6247, p = 0.0004) and Violet SSC-H values (Day 1; 42641 ± 21131 vs. Day 3; 97133 ± 38311, p < 0.0001), suggesting a potential change in the membrane or internal composition of EVs in the extrauterine transition period. We also observed a change in protein expression on EVs during the extrauterine transition period. Platelets and platelet activation play a physiological role in the closure of the ductus arteriosus . As such, we assessed the levels of platelet EVs (CD41+/Annexin V+), an established marker of platelet activation in vivo. The percentage of CD41+/Annexin V-EVs significantly decreased from Day 1 to Day 3 (Day 1; 6.5 ± 4.9 % vs. Day 3; 2.4 ± 1.9 %, p = 0.007), suggestive of a platelet activation event early in the extrauterine transition period. Proteomic differences between day 1 and day 3 were analysed using mass spectrometry analysis Conclusion In this study, we clearly demonstrate that the extrauterine transition period is characterised by major changes in plasma EVs. These changes include an increase in the levels of EVs, a change in the composition of EVs, and a reduction in the percentage of platelet-derived EVs. The physiological or pathophysiological causes of the changes require further elucidation. In addition, the role of this change of EV profile in the pathogenesis of important preterm morbidities needs to be clarified. Disclosures Ni Ainle: Leo Pharma: Research Funding; Actelion: Research Funding; Bayer: Research Funding; Bayer: Membership on an entity's Board of Directors or advisory committees; BMS: Membership on an entity's Board of Directors or advisory committees; Daiichi Sankyo: Membership on an entity's Board of Directors or advisory committees; Boehringer: Membership on an entity's Board of Directors or advisory committees.

Abstract The reactivity of the pulmonary vascular bed to the administration of oxygen is well established in the post-natal circulation. The vasoreactivity demonstrated by the fetal pulmonary artery Doppler waveform in response to maternal hyperoxia has been investigated. We sought to investigate the relationship between the reactivity of the fetal pulmonary arteries to hyperoxia and subsequent neonatal cardiac function in the early newborn period. Methods This explorative study with convenience sampling measured pulsatility index (PI), resistance index (RI), acceleration time (AT), and ejection time (ET) from the fetal distal branch pulmonary artery (PA) at baseline and following maternal hyperoxygenation (MH). Oxygen was administered for 10 min at a rate of 12 L/min via a partial non-rebreather mask. A neonatal functional echocardiogram was performed within the first 24 h of life to assess ejection fraction (EF), left ventricular output (LVO), and neonatal pulmonary artery AT (nPAAT). This study was conducted in the Rotunda Hospital, Dublin, Ireland. Results Forty-six women with a singleton pregnancy greater than or equal to 31 weeks’ gestational age were prospectively recruited to the study. The median gestational age was 35 weeks. There was a decrease in fetal PAPI and PARI following MH and an increase in fetal PAAT, leading to an increase in PA AT:ET. Fetuses that responded to hyperoxygenation were more likely to have a higher LVO (135 ± 25 mL/kg/min vs 111 ± 21 mL/kg/min, p < 0.01) and EF (54 ± 9% vs 47 ± 7%,p = 0.03) in the early newborn period than those that did not respond to MH prenatally. These findings were not dependent on left ventricular size or mitral valve (MV) annular diameter but were related to an increased MV inflow. There was no difference in nPAAT. Conclusion These findings indicate a reduction in fetal pulmonary vascular resistance (PVR) and an increase in pulmonary blood flow and left atrial return following MH. The fetal response to hyperoxia reflected an optimal adaptation to postnatal life with rapid reduction in PVR increasing measured cardiac output.