Mater Misericordiae University Hospital

Background: Fibrotic remodelling of the lamina cribrosa (LC) is a defining pathological feature of glaucomatous optic neuropathy and contributes to progressive optic nerve head deformation and axonal vulnerability. LC cells from glaucomatous donors exhibit a myofibroblast-like phenotype characterised by excessive extracellular matrix (ECM) production, a process associated with chronic cellular stress. cAMP responsive element-binding protein 3-like 1 (CREB3L1) is an endoplasmic reticulum-resident transcription factor implicated in stress-responsive regulation of collagen synthesis and matrix homeostasis. The role of CREB3L1 in glaucomatous LC cells, however, remains poorly defined. Methods: Primary human LC cells derived from donors with confirmed glaucoma (GLC; n = 3) and age-matched non-glaucomatous controls (NLC; n = 3) were examined. CREB3L1 expression was assessed at the mRNA and protein levels using quantitative RT-PCR and Western immunoblotting. The functional effects of CREB3L1 suppression were evaluated using siRNA-mediated knockdown in GLC cells, followed by analysis of ECM gene transcription (α-smooth muscle actin, collagen type I alpha 1, fibronectin) and cellular metabolic activity using an MTS assay. Results: CREB3L1 mRNA and protein expression were significantly elevated in GLC cells compared with NLC cells. siRNA-mediated knockdown of CREB3L1 effectively reduced its expression in GLC cells and was associated with significant suppression of profibrotic ECM gene transcription. In addition, CREB3L1 knockdown resulted in a marked reduction in cellular metabolic activity in glaucomatous LC cells. Conclusions: These findings identify CREB3L1 as a regulator of ECM-associated gene expression and cellular behaviour in glaucomatous lamina cribrosa cells. While preliminary, the data suggest that CREB3L1 may contribute to pathological fibrotic remodelling at the optic nerve head. Further mechanistic and in vivo studies will be required to determine whether modulation of CREB3L1-mediated pathways represents a viable therapeutic strategy in glaucoma.

<h3>Background and Importance</h3> The European Statements of Hospital Pharmacy recommend <i>‘A European-wide framework for initial post graduate education and training in hospital pharmacy with an assessment of individual competence is essential’</i>.¹ To facilitate the development of evidence-informed recommendations for improving hospital pharmacist education, national data outlining current practice were required. <h3>Aim and Objectives</h3> Evaluate current standards of practice relating to education within hospital pharmacy. Outline perceived barriers to pharmacist engagement in education. <h3>Material and Methods</h3> A national online survey was developed and distributed to hospital pharmacy managers between May and August 2025 inclusive. The survey was distributed via various methods, including central emailing lists and contacts of the research team. Survey questions addressed Staffing structures. Current levels of education provided. Types of educational activities conducted. Perceived gaps in hospital pharmacist education. Barriers to engagement in pharmacist education. Responses results were analysed descriptively. <h3>Results</h3> Fifty-five (65%) pharmacy managers responded. Key findings included: Only 27% of participants reported having a pharmacist responsible for education. Almost two–thirds (63%) reported having a structured induction for pharmacists. Pharmacist induction included dispensary training (91%), clinical training (85%), and corporate induction (79%). Over three–quarters (79%) of inductions lasted &lt;6 weeks. Seventy percent (70%) provided ongoing departmental education, most through journal clubs (77%), case presentations (60%), and near–miss/error meetings (57%). Over two–thirds (69%) of institutions currently support pharmacists on postgraduate courses, mostly in clinical pharmacy (86%) Formal education was provided by pharmacy to nursing (88%), medical (76%) and allied health professionals (33%), as well as undergraduate (47%) and postgraduate (27%) pharmacy students. Perceived gaps in hospital pharmacy education included advanced practice, inpatient and outpatient medication reviews, and clinical skills. Reported barriers to hospital pharmacy education include lack of funding, time constraints, workload and lack of a structured competency framework specific to hospital pharmacy practice. <h3>Conclusion and Relevance</h3> Hospital pharmacy departments display significant commitment to, and engagement with, education activities nationally. Efforts to introduce a standardised hospital-specific competency framework for new-to-hospital pharmacists, and validated accreditation for advanced practice will help further facilitate this. <h3>References and/or Acknowledgements</h3> 1. The European Statements of Hospital Pharmacy. <i>European Journal of Hospital Pharmacy</i> 2014;<b>21</b>:256–258. <h3>Conflict of Interest</h3> Conflict of interest Corporate sponsored research or other substantive relationships: No conflicts of interest

<title>Abstract</title> <italic>Mycobacterium tuberculosis</italic> is a significant opportunistic pathogen in solid organ transplant recipients, primarily due to the chronic immunosuppression. We present two cases of donor-derived tuberculosis from the same donor in the Irish national centre for heart and lung transplantation. Case 1, a woman in her 60s with a history of end-stage chronic obstructive pulmonary disease, underwent a left single-lung transplant. 5 months post-operatively, she presented with fever and dyspnoea. Bronchoalveolar lavage was positive for <italic>M. tuberculosis</italic> , type 223235331434425153334732, Haarlem lineage. Case 2 was a man in his 60s with history of idiopathic pulmonary fibrosis, who received a right single –lung transplant from the same donor. Following the diagnosis of the first case, he was placed under surveillance 7 months post-transplant. Although asymptomatic, his bronchoalveolar lavage culture was positive for <italic>M. tuberculosis</italic> 22 months post-surgery. Molecular analysis confirmed that his isolate was identical to that of case 1. Both patients received treatment consisting of rifabutin, isoniazid, ethambutol and pyrazinamide, and remained reasonably well at follow-up. The case of donor-derived tuberculosis is rare in our transplant centre. The described case was the only one in period 2015–2024. A literature review revealed that the problem of donor-derived TB has gained more attention in recent years, since organ transplantation occurs more frequently in TB-endemic regions. In addition, there is also an exponential rise in global mobility that has increased the diversity of the donor pool, even in non-endemic regions. The World Health Organization currently estimates that approximately one-third of the world's population is infected with TB.

Ronan Cahill is named on patents filed in relation to processes for visual determination of tissue biology with University College Dublin, receives speaker frees from Stryker Corp and Ethicon/J&J, consultancy fees from Arthrex, Astellas, Diagnostic Green, Intuitive and Touch Surgery (Medtronic) and has held research funding from the EU and Irish Government with Arctur, Palliare, Steripak and IBM Research in Ireland. Professor Ronan A. Cahill is named on patents filed by University College Dublin in relation to processes for visual determination of tissue biology, receives speaker fees from Stryker Corp and Ethicon/J&J, consultancy fees from Arthrex, Astellas, Diagnostic Green and Touch Surgery (Medtronic), research funding from Intuitive Corp and Medtronic as well as from the Irish Government (DTIF) in collaboration with IBM Research in Ireland, from EU Horizon 2020 in collaboration with Palliare and Horizon Europe in collaboration with Arctur. He is a member of the medical advisory board for Palliare and a trial advisory group for Hypervision. The data that support the findings of this study are available from the corresponding author upon reasonable request.

ObjectiveThis study aimed to develop a consensus of expert opinion on the quality standards of care and outline management best practices for pulmonary arterial hypertension (PAH) in SSc and other CTDs.MethodsTwenty physicians and four nurse practitioners (NPs) managing patients with CTD-PAH (including SSc-PAH) from six European countries participated in a modified Delphi panel. Consensus was defined as ≥80% agreement among the physicians.ResultsThe importance of a multimodal approach to screening and early detection of PAH through combining echocardiography, biomarker tests and symptom evaluation was emphasised. Consensus agreement was also reached on the usefulness and increased access of echocardiography for optimising screening and early detection processes, noting the importance of cardiology expertise for accurate assessment of right-heart variables. Panellists reached consensus agreement on the importance of a multidisciplinary approach to managing SSc- and other CTD-PAHs through collaboration between rheumatologists and pulmonary hypertension (PH) specialists, NPs and patients. Rheumatologists aligned on the usefulness of the DETECT screening algorithm, whereas cardiologists and pulmonologists remained divided, with consensus not being reached, thus highlighting the lack of agreement regarding the relevance of a stepwise approach. Similarly, no consensus was reached on the impact of the new haemodynamic definition of PH in CTD-PAH management, where greater evidence is required.ConclusionsConsensus was reached on key recommendations for optimising CTD-PAH management, including the standardisation of multimodal screening and promotion of closer collaboration between healthcare specialties and patients.

PurposeTo investigate the relationship between posterior vitreous detachment (PVD) status and fibrovascular membrane (FVM) angio-fibrotic transformation following anti-VEGF therapy in advanced proliferative diabetic retinopathy (PDR), and their combined impact on disease progression and visual outcomes.MethodsThis prospective real-world study enrolled 165 treatment-naïve PDR patients with vitreous hemorrhage (VH) and FVM who received intravitreal anti-VEGF injection followed by panretinal photocoagulation(PRP) when possible. PVD status and FVM characteristics were monitored during a median follow-up of 13.0 months. Cox proportional hazards and Kaplan-Meier analyses evaluated factors influencing visual prognosis and timing of surgical intervention.ResultsFVM fibrosis occurred in 43% of patients, with distinct PVD-dependent patterns: predominantly in complete PVD cases, moderately in partial PVD, and rarely without PVD. Multivariate analysis identified macular involvement as the strongest risk factor for poor visual outcomes (HR=3.65), while PVD (HR=0.37) and FVM fibrosis (HR=0.023) were strongly protective. Patients with both PVD and FVM fibrosis maintained stable vision longest (median 28.5 months) and demonstrated significantly longer surgery-free survival (28.3 months) compared to those without either condition (3.2 months, p<0.0001), who frequently presented with vitreoschisis and recurrent VH disproportionate to visible FVM grade.ConclusionPVD status critically determines the clinical manifestation and prognosis of post-anti-VEGF FVM fibrosis in PDR. This PVD-dependent pattern challenges the conventional view that FVM fibrosis inevitably leads to “Crunch syndrome” and creates a risk stratification framework that can guide individualized surgical timing decisions, potentially improving functional outcomes in advanced PDR.

The European Society of Gynaecological Oncology (ESGO) recognizes that poorly designed instruments and operating room environments contribute to musculoskeletal injuries, fatigue, and burnout, disproportionately affecting female and smaller-stature surgeons. Ergonomic equity is central to ensuring surgical precision, team well-being, and optimal patient outcomes. ESGO calls for close collaboration between surgeons, industry partners, and hospital systems to re-design surgical instruments and equipment. Adaptable grip sizes, adjustable weight distribution, and inclusive workstation designs must be prioritized to accommodate diverse anthropometric needs and improve comfort, dexterity, and performance. INCLUSIVE OPERATING ROOM DESIGN AND STANDARDIZED SUPPORT MEASURES: Operating rooms should be designed to support diverse surgical teams, including surgeons of different statures, hand sizes, and physical capacities. ESGO recommends adjustable tables, consoles, lighting, and pedals, alongside consistent policies for accommodating pregnant and postpartum surgeons through measures such as flexible seating and scheduled breaks. ESGO advocates for the integration of ergonomic training into surgical education and continuing professional development. Standardized guidelines, intraoperative microbreaks, and mentorship initiatives are key strategies to reduce injury risks, enhance surgical longevity, and foster equality, diversity, and inclusion within gynecological oncology.

SummaryActivating mutations in the ABCC8 gene are extremely rare and cause ABCC8-MODY. The phenotype is variable with onset of diabetes in childhood/early adulthood. Retinopathy is the most common reported complication. We describe a 31-year-old primigravida woman referred to and seen at our antenatal ambulatory diabetes clinic at 6 weeks plus 5 days gestation. She had a strong family history of diabetes and was diagnosed at the age of 11 years. Genetic testing revealed an activating pathogenic c.4139G>A variant in the ABCC8 gene. She was managed with glibenclamide, sitagliptin, and dapagliflozin. Her complications included mild bilateral non-proliferative retinopathy and necrobiosis lipoidica. Her BMI was 19 kg/m2, and HbA1c was 68 mmol/mol. Oral agents were discontinued, and insulin therapy was commenced. At 22 weeks gestation, routine retinal screening identified progression to bilateral active proliferative diabetic retinopathy (time in range for pregnancy (TIRp) 68%, HbA1c 39 mmol/mol). She received four sessions of panretinal photocoagulation (PRP) bilaterally between 22 and 33 weeks gestation. There was no associated loss of vision or nephropathy. TIRp was ≥70% for the remainder of the pregnancy. She delivered a 3.9 kg unaffected female infant at 38 weeks via elective caesarean section without maternal or neonatal complications. Bilateral active proliferative retinopathy persisted up to 61 weeks postnatally and required additional PRP. Forty-six weeks post-partum, after ceasing breastfeeding, insulin was switched to glibenclamide and dapagliflozin. This is the first case report of rapid progression of clinically significant diabetic retinopathy during pregnancy in a woman with ABCC8-MODY. This is an unusual finding as there is a relatively low risk of significant progression of diabetic retinopathy in women with type 2 diabetes during pregnancy.Learning pointsRapid progression of diabetic retinopathy during pregnancy is an uncommon complication in women with type 2 diabetes.This woman with ABCC8-MODY developed rapidly progressive clinically significant diabetic retinopathy without nephropathy during pregnancy.There is a paucity of literature regarding pregnancy-related complications of ABCC8-MODY.This case highlights the risks of end organ disease in a rare form of diabetes.