SARS-CoV-2 Testing and Patient Waiting Times in the Emergency Department.

Aim Emergency Departments (EDs) were impacted early in the coronavirus disease 2019 (COVID-19) pandemic, with high attendance numbers. EDs relied upon SARS-CoV-2 reverse-transcriptase polymerase chain reaction (RT-PCR) tests to triage patients and facilitate admission to appropriate wards, meaning positive patients were isolated as early as possible. In October 2020, we introduced a 24-hour SARS-CoV-2 testing service. We examined the impact of this on patient experience times (PETs) in the ED, and on healthcare-associated (HA) COVID-19 infections. Methods Data on PETs before and after the introduction of 24-hour testing were available from the ED. HA COVID-19 infections were reported weekly to the Health Services Executive as a key performance indicator. Results Mean PET prior to the pandemic was 20 hours and dropped to 10 and 13 hours respectively in the first and second wave. A surge in case numbers and ED attendances during the third wave was not reflected in a rise in PETs, with a mean PET of 11 hours, significantly below pre-pandemic levels. HA-COVID-19 infections remained stable between wave one and three (83 v 92). Conclusion The introduction of 24-hour SARS-CoV-2 testing in our ED contributed to a reduction in PETs, facilitated appropriate patient placement at ward level, and kept HA-COVID-19 infections at acceptably low levels.

Thrombolysis for stroke in Ireland: increasing access and maintaining safety in a challenging environment.

BACKGROUND: In the setting of a national audit of acute stroke services, we examined the delivery of thrombolytic therapy for ischaemic stroke and whether current practice was achieving safe outcomes and consistent delivery for patients. METHOD: Data obtained from the recent national stroke audit was compared against previous Irish audit, the most recent SSNAP UK stroke audit and the Safe Implementation of Thrombolysis in Stroke-Monitoring Study (SITS-MOST) study. RESULTS: Thrombolysis was provided in 27 acute hospitals throughout Ireland during the period assessed with 82% (22/27) providing 24/7 access, the remaining sites using redirect policies. Decision to thrombolyse was made by stroke trained consultants in 63% (17/27) of units, with general physicians and emergency medicine consultants covering the other units. Thrombolysis rate for non-haemorrhagic stroke was 11% (n = 80/742, CI 95% ±2.23) versus a 1% rate in the 2008 audit. Sites receiving patients through a redirect policy had the highest thrombolysis rate, an average of 24%. Nearly 30% of cases were thrombolysed on the weekend. Eighty-three percent of cases were managed in a stroke unit at some time during admission versus 54% of the national total cases. Thirty-seven percent of patients were ≥80 years old. The mortality rate was 11.3% versus the national mortality rate for non-thrombolysed ischaemic strokes of 10% (p > 0.5), and this is comparable to the SITS-MOST 2007 study 3-month mortality rate of 11.3% (p > 0.5). CONCLUSION: Stroke thrombolysis is being effectively and safely provided in acute stroke services in Ireland despite regular involvement of non-specialist staff. There is still potential to improve thrombolysis rate.

Lecithin:cholesterol acyltransferase activity and high-density lipoprotein subfraction composition in type 1 diabetic patients with improving metabolic control.

On initial diagnosis or when metabolic control is poor, subjects with type 1 (insulin-dependent) diabetes mellitus often exhibit decreased high density lipoprotein (HDL) cholesterol levels, which have been associated in numerous studies in non-diabetic subjects with atherosclerosis and coronary artery disease. We measured the activities of plasma lecithin:cholesterol acyltransferase (LCAT), post-heparin lipoprotein lipase, and the composition of the HDL subfractions HDL2 and HDL3, in ten poorly controlled type 1 diabetic patients admitted to a metabolic ward (six women and four men, aged 18-37 years). The measurements were repeated after metabolic control had been optimised and again a week after discharge. The results were compared with those of ten healthy normolipidaemic subjects matched for age, sex and body mass. LCAT activity increased significantly (P < 0.05) with improved metabolic control in the diabetic patients, and showed positive within-person correlation with HDL2 cholesterol ester (r = 0.67; P < 0.01), HDL2 free cholesterol (r = 0.67; P < 0.01), phosphatidylcholine (r = 0.49; P < 0.05), total phospholipids (r = 0.50; P < 0.01) and apolipoprotein A-I (apo A-I: r = 0.72; P < 0.01). With improving metabolic control HDL2 lipid levels increased more than twofold and the compositional changes in HDL2 were reflected by an increased apo A-I:apo A-II ratio (P < 0.05) and a decreased triglyceride:apo A-I ratio (P < 0.05). Changes in HDL3 levels and composition were minor. The results of this study indicate that an increase in LCAT activity increases the concentration and changes the composition of HDL2 in type 1 diabetic patients with improved metabolic control.

A histocytochemical study of mucus glycoproteins or mucins in the intestinal tract of the African elephant (Loxodonta africana).

The distribution of neutral mucins, sialomucins and sulphomucins was determined histochemically in the duodenum, jejunum, ileum and colon of the African elephant (Loxodonta africana). The techniques used were periodic acid-Schiff (PAS), alcian blue/periodic acid-Schiff (AB-PAS), high-iron-diamine/alcian blue (HID-AB), alcian blue at varying pH solutions and alcian blue at high temperature after methylation and saponification. Acid mucins appear to dominate neutral mucins, the latter decreasing toward the large intestine. Sulphomucins and sialomucins occurred in almost equal amounts throughout the intestinal tract, with a slight decrease of sialomucins toward the colon.

Characterization of mucus glycoproteins in the intestinal mucosa of the African elephant (Loxodonta africana) following lectin histochemistry.

The glycoproteins of the small intestines, caecum and colon of three adult elephants and one recently weaned elephant calf were examined by means of lectin histochemistry. Tissue sections were histochemically stained with peroxidase-labelled concanavalin A (Con A), asparagus-pea (TPA), peanut (PNA) and wheat-germ (WGA) lectins. Con A and TPA showed no binding activity in the intestinal tract of the adult elephants or the duodenum and ileum of the elephant calf, but did show a small amount of binding activity in the caecum and colon of the calf. WGA bound very intensely throughout the intestinal tracts of the adults and of the calf--especially with the goblet cells located in the crypts of Lieberkuhn and the glands of Brunner--decreasing in intensity towards the luminal surface of the intestinal tract. PNA stained the glands of Brunner of the duodenum faintly and the goblet cells of the ileum moderately, with no staining of the caecum and faint staining of the colon. These results show the distribution of Con A-, WGA-, PNA- and TPA-binding sites, and the changes that take place in the type of glycoprotein secreted after a change in the diet of the animal.

Diagnosis of liver tapeworm, Stilesia hepatica, infection in sheep.

A practical method of diagnosing Stilesia hepatica in live sheep is described. Intestinal contents and faeces were sieved through a sieve with apertures of 1.0 mm onto a sieve with apertures of 100 microns to reduce volume and turbidity. The residue on the fine sieve was examined microscopically. Gravid proglottids passed through the intestine without being digested. Intact proglottids were recovered from the intestine and faeces of infected sheep. Used purely on faeces, the technique is simple and reliable as a diagnostic method. Its application could facilitate basic research into the biology and epidemiology of the parasite.

The optical microscope--en route to extinction?

Change in medical curricula is a worldwide trend. Concomitant with this is a change in the role of the microscope and its contribution to a student's career. In this questionnaire-based study the perceptions of medical, dental and veterinary students to microscopy and alternative forms of histology tuition, as well as the role of microscopy in their future careers, was assessed. Veterinary students indicate a strong preference for the microscope and microscopy training due to the importance of the microscope in their chosen career, whilst medical and dental students are somewhat ambivalent. However, the students would not choose to eliminate the microscope entirely from their studies.