Tallaght University Hospital

Lung cancer is the leading cause of cancer-related mortality worldwide, accounting for more deaths than any other malignancy. Despite advances in treatment, it remains highly lethal, with 5-year survival rates showing minimal improvement over the past several decades, highlighting a critical unmet clinical need. Macrophage Migration Inhibitory Factor (MIF) is a multifunctional cytokine that contributes to inflammation and cancer, promoting tumor growth, progression, and metastasis through modulation of the tumor microenvironment, stimulation of angiogenesis, and regulation of immune responses. Polymorphisms in the promoter region of MIF, such as high-expression CATT repeats, influence MIF expression and susceptibility to a range of inflammatory, autoimmune, and malignant disorders, yet their role in lung cancer remains largely unexplored. Therapeutic strategies targeting MIF, including small-molecule inhibitors, antibodies, and peptide-based agents, have shown promise in preclinical models, although their clinical translation is still limited. This review discusses the dual role of MIF in inflammation and oncology, summarizes current therapeutic developments, and emphasizes the potential of MIF-targeted interventions in lung cancer. It discusses the significance of genetic predisposition, particularly high-expression MIF alleles, in guiding personalized treatment strategies for lung cancer and identifying patients who may derive benefit from MIF inhibition.

Background: Laryngospasm is defined as glottis closure due to reflex constriction of the laryngeal muscles. It is one of the most common complications following pediatric anesthesia that can lead to hypoxemia, bradycardia, or aspiration. Laryngospasm following tracheal extubation has different reasons: presence of secretions, foreign body in the airway, or pain at the site of surgery. Propofol is usually used as an induction or maintenance agent. However, its use with the subhypnotic dose (0.5 mg/kg) is increasing nowadays for reducing the incidence of laryngospasm. This systematic review and meta-analysis aim to assess the efficacy of subhypnotic propofol in reducing the incidence of laryngospasm and respiratory complications in children following tonsillectomy or adenotonsillectomy and before extubation. Methods: We systematically searched the following databases: PubMed, Cochrane Library, Scopus, and Web of Science. Studies were included if they used propofol with a low dose (0.5 mg/kg) following tonsillectomy and before extubation. Both Randomized Controlled Trials (RCTs) and cohort studies published up until 27 December 2025 were included. We used the R software for statistical analysis. We employed a random-effects model for the analysis. Continuous outcomes were analyzed as mean differences (MD) and dichotomous data as risk ratios (RR), with 95% confidence intervals (CI). Heterogeneity was assessed using I2 statistics. Results: Our review included four RCTs and one prospective cohort study with 593 participants. Our analysis showed that propofol was significantly associated with a low incidence of laryngospasm (RR = 0.25, 95% CI 0.13-0.49), cough (RR = 0.08, 95% CI 0.01-0.62), and agitation (RR = 0.15, 95% CI 0.03-0.72) compared with the control group. However, there were no significant differences regarding laryngeal occlusion (RR = 0.70, 95% CI 0.20-2.46), cyanosis (RR = 1.13, 95% CI 0.14-9.43), stridor (RR = 1.38, 95% CI 0.76-2.50), and the duration of surgery (MD = 1.81, 95% CI -0.74 to 4.36). Conclusions: Our findings state that propofol had a lower significant incidence of laryngospasm than the control. Trial sequential analysis for laryngospasm indicated that evidence is conclusive. However, regarding the other outcomes, the evidence is still inconclusive, which suggests the need for future large-scale RCTs with larger sample sizes to validate these findings.

<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

Both low-grade systemic inflammation and acute inflammatory events may contribute to Alzheimer Disease (AD) progression. However, studies examining the prognostic utility of systemic inflammatory biomarkers in AD, and how systemic inflammatory events may contribute to clinical trajectories in AD, have yielded conflicting results. We quantified plasma cytokines/chemokines in 333 individuals with mild-moderate AD at baseline, 12 and 18 months alongside baseline neurodegenerative biomarkers. AD severity was assessed using the Alzheimer Disease Assessment Scale (ADAS-Cog), Clinical Dementia Rating Scale (CDR-Sb) and Disability Assessment for Dementia (DAD). Systemic inflammatory biomarkers were primarily associated with age/socio-demographic characteristics, remained strikingly stable over time, and were not associated with AD progression. Rather, higher baseline plasma p-tau217 was associated with greater yearly progression on both the ADAS-Cog (β: 2.82; 95% CI: 1.12, 4.52; nominal p = 0.001) and DAD (β: -2.34; 95% CI: -3.86, -0.82; nominal p = 0.003). Higher baseline GFAP was also associated with subsequent decline on both the CDR-Sb (β: 1.02; 95% CI: 0.38, 1.67; nominal p = 0.002) and DAD (β: 1.91; 95% CI: -3.45, -0.37; nominal p = 0.02). Experiencing one or more episodes of delirium was associated with accelerated decline on the CDR-Sb at 18-months (β: 2.63; 95% CI: 1.55, 3.71; adjusted p < 0.001). Biomarkers of neuroinflammation (GFAP), neurodegeneration (p-tau217) and incident delirium, rather than systemic inflammatory biomarkers, were associated with clinically-significant decline in mild-moderate AD. European Commission (FP7 grant; 279093); Meath Foundation (MFRG 121/2021); Wellcome Trust (227946/Z/23/Z & 203930/B/16/Z); Health Research Board (203930/B/16/Z; ECSA-2024-003).

Abstract Background Novel prognostic biomarkers are urgently needed in older adults with Alzheimer Disease (AD). Peripheral inflammation, systemic inflammatory events (SIEs) and delirium are increasingly recognised as AD risk factors, but their impact on progression in established AD and temporal relationships with AD progression remains unclear. Further, whether SIEs, adverse events and delirium interact with peripheral inflammation to accelerate AD is unknown. Methods We analysed &amp;gt;1,000 plasma/cerebrospinal fluid samples from 333 patients with mild to moderate dementia due to AD with 18-months of follow-up. Ten cytokines/chemokines (IFN-γ, IL-6, IL-10, IL-12p70, IL-17A, TNF-α, Eotaxin, IP-10, MCP-1, MIP-1β) were quantified at baseline, 12, and 18-months using ultra-sensitive immunoassays. Baseline neurodegenerative biomarkers (p-tau217, p-tau181, t-tau, Neurofilament Light [NfL], Glial Fibrillary Acidic Protein [GFAP]) were measured using validated immunoassays. Clinical progression was assessed using Clinical Dementia Rating Scale (CDR-Sb). Results of linear and logistic regression models are reported as Beta Coefficients (B) and Odds Ratios (OR), respectively, with 95% Confidence Intervals and p-values and adjustment for important clinical confounders. Results Baseline peripheral inflammatory biomarkers (particularly IL-6 and IP-10) correlated significantly with age and sociodemographic factors but not AD severity. Peripheral inflammatory biomarkers remained remarkably stable over 18-months despite clinical-significant decline. Conversely, plasma biomarkers of AD pathophysiology (p-tau217) and neuro-inflammation (GFAP) at baseline strongly predicted accelerated AD progression (p-tau217: B:0.54, 0.18-1.08, p=0.02; GFAP: B:0.53, 0.18-0.90, p=0.002). Single (OR:2.63, 1.55-3.71, p&amp;lt;0.001) or multiple episodes of delirium (OR:3.45, 1.77-5.13, p&amp;lt;0.001), but not SIEs or adverse events, predicted greater progression on the CDR-Sb. Conclusion Biomarkers specific to AD pathology (p-tau217, GFAP) rather than peripheral inflammation had robust prognostic value in established AD. Delirium was consistently associated with clinically-meaningful decline, highlighting the importance of delirium prevention efforts in older adults with AD. Our findings add strong evidence supporting the prognostic utility of p-tau217 and GFAP in older adults with established AD.

Abstract Background Dementia is preventable and deferrable yet remains a major cause of disability and dependency and the seventh leading cause of death worldwide. The Lancet Commission on dementia published a report in July 2024, identifying 14 modifiable dementia risk factors and estimating a 45% reduction in dementia cases with risk factor elimination. The aim of this study is to assess the prevalence of modifiable dementia risk factors, providing crucial context for the delivery of dementia prevention in Ireland. Methods This is a longitudinal study using data from three waves of the Irish Longitudinal Study on Ageing (TILDA) to quantify the prevalence of modifiable dementia risk factors in Ireland over a 10·93 (±0·37) year follow-up. TILDA is a population-based prospective cohort study, representative of community-dwelling adults aged 50 years and older, living in Ireland. Data were analysed using Stata 15·1 applying inverse probability weighting. Results 8,171, 6,615 and 4,318 participants were included in wave one, three and six analyses. 70·6%, 61·1% and 54·2% of the population had 4 or more modifiable risk factors for dementia at consecutive waves amounting to over 500,000 people with 4 or more modifiable risk factors for dementia on weighted population analysis at wave six.77% of those with severe decline in cognitive performance during follow-up had 4 or more risk factors at baseline. An estimated 32,480 cases of severe decline in cognitive performance during follow-up were potentially preventable if risk factors were eliminated. Conclusion This study identifies a high prevalence of modifiable dementia risk factors in Ireland and highlights the need for public education on the concept of brain health and the development of a clinical framework focused on delivering on the opportunity of dementia prevention. Preventing and delaying dementia onset has the potential to compress morbidity and increase healthy lifespan in older age.