Career Archive – Dr Shay Keating

Post registration appointments: January 1997 – January 2009

General Practitioner in substance misuse for the HSE, Northern Area

In 1997 I established the ‘young persons programme’, a methadone maintenance and detoxification programme for the HSE, Northern Area in Ballymun. Prior to my departure there were 65 patients in my care for ongoing support in their addiction. I also piloted the use of lofexidine as a detoxification modality for opiate dependence in the community in 1998.

Post registration appointments: July 1997-June 2000

Associate Specialist in hepatitis C to the HIV and addiction service, EHB.

In July 1997, I began work with the then Eastern Health Board. I set up hepatitis C review clinics in the six main drug treatment clinics in the Dublin area. There I reviewed the patients, educated them about hepatitis C, its prevention and treatment and encouraged them to access treatment if drug and alcohol stable. I continued to provide primary care to the clients of the Drug Treatment Centre Board. During this time I continued endoscopy with Dr. PWN Keeling at St. James’s Hospital, Dublin.

Post registration appointments: July 1996-June 1997

Registrar in Substance Misuse, Drug Treatment Centre Board, Pearse Street.

In July 1996, I left hospital medicine to pursue a career in general practice. To this end, I accepted a post as registrar in substance misuse at the Drug Treatment Centre Board (DTCB). During this period, I developed a keen interest in substance misuse and the medical consequences of addiction, particularly infection with hepatitis C. I provided primary care to the clients attending the DTCB. I continued endoscopy with Dr. PWN Keeling at St. James’s hospital Dublin during this time.

Post registration appointments: July 1994-June 1996

Registrar in Genitourinary Medicine – St. James’s Hospital

Consultant: Prof. F. Mulcahy, MD, FRCPI

During this period, I was medical registrar with inpatient and outpatient patient clinical responsibility for patients infected with HIV or other sexually transmitted diseases. I acted as cardiac on-call registrar. I also had an extensive research commitment, was clinic tutor to the final year medical students and had a weekly endoscopy list under the guidance of Dr. PWN Keeling.

Post registration appointments: July 1993-June 1994

Registrar in gastroenterology – Meath and Adelaide Hospitals, Dublin.

Consultant: Prof. C. O’Morain, MSc, MD, FRCPI

During this period I was a medical registrar supervising the inpatient and outpatient management of patients with gastroenterological and general medical needs. I performed daily endoscopy lists including procedures such as gastroscopy, colonoscopy, PEG feeding tube insertion and banding of oesophageal varices. I also had a research commitment.

Post registration appointments: July 1991-June 1993

(Dublin Federated Hospitals Medical Rotation)

• July 1991 – Dec. 1991 – St. James’s Hospital, Dublin. (General Medicine/Genitourinary Medicine) Medical SHO
• Jan. 1992 – June 1992 – St. Lukes’s Hospital, Kilkenny. (General Medicine/Paediatrics) Medical SHO
• July 1992 – Dec. 1992 – Adelaide Hospital, Dublin (General Medicine/Gastroenterology) Medical SHO
• Jan. 1993 – July 1993 – Meath Hospital, Dublin. (General Medicine/Endochrinology) Medical SHO

Pre- Registration posts: July 1990 – June 1991

• July 1990 – Sep. 1990 –  Meath Hospital Dublin – Surgical intern
• Oct. 1990 – Dec. 1990 – Meath Hospital Dublin – Medical intern
• Jan. 1991 – Mar. 1991 – Adelaide Hospital Dublin – Surgical intern
• Apr. 1991 – June 1991 – Adelaide Hospital Dublin – Medical intern

Postdoctoral Biochemical Research

Oct. 1986 – July 1990

Employer: Trinity College Dublin.

Position: Postdoctoral research fellow (part-time)
In October 1985, I commenced the study of medicine at Trinity College Dublin. Because my primary degree was in biochemistry with physiology as my minor, I was offered an exemption in these subjects in my pre-clinical undergraduate medical career. This afforded me the opportunity to pursue my research interests under the guidance of Prof. John Scott and Prof Donald Weir in St. James’s hospital, Dublin. This research involved the development of a technique for the measurement of S-adsenosylmethionine and S-adenosylhomocysteine in the cerebrospinal fluid in patients infected with the immunoideficiency virus. This research was published in the Lancet in 1991.

Oct. 1984 – Oct. 1995 & June 1986 – Oct. 1986

Employer: Department of Nutrition, University College Berkeley, California.

Position: Postdoctoral Research Fellow

In October 1984, I travelled to Berkeley where I researched under the guidance of the late Prof. Robert Stokstad. There we investigated the effect of the hypothyroid and hyperthyroid states on the metabolism of folic acid. During this time we also investigated the effect of folic acid administration of folic acid consumption on zinc absorption. Having completed my year in Berkeley, I returned to Dublin to study medicine in Trinity College but spent a further five months in Berkeley during the summer recess (June 1986-Oct. 1986).

Jan.1984 – Oct. 1984

Employer: Department of Biochemistry, Trinity College Dublin

Position: Postdoctoral Research Fellow

Having completed my PhD in December 1983, under the guidance of Prof. John Scott and Prof Donald Weir, I was offered a research position in Trinity College Dublin. During this period I continued my doctoral research interest in the inter-relations between the vitamins folic acid and B12 and the amino acid, methionine.

PhD Thesis: October 1980-December 1983

Title:  Folate, Cobalamin and Methionine metabolism with particular reference to Methionine Synthase in normal and compromised metabolic states.

Supervisors: Prof JM Scott MA, PhD, DSc. Prof DG Weir MA, MD, FRCPI, FRCP, FTCD

Summary:

The folate and cobalamin dependent enzyme, methionine synthase had been shown to be present in every organ investigated in the rat with the exception of the intestinal mucosal cell. Using improved methodology to isolate intact villous and crypt cells of the small intestine, this enzyme was indeed found to be active. In addition, the enzyme was similar to the liver enzyme in its basic kinetic parameters and in its susceptibility to inactivation with nitrous oxide, which creates a pseudo cobalamin deficiency state. The enzyme was also found to be active in the intestinal mucosal cells of the monkey, pig, rabbit and guinea pig.

It was demonstrated that liver folate polyglutamate biosynthesis, which is depressed in rat liver by nitrous oxide is unaffected by simultaneous administration of formate or tryptophan. In addiction, the nature of in vivo substrate for folate polyglutamate biosynthesis both with and without concomitant nitrous oxide exposure was investigated. It was observed that in air, the range of folate derivatives studies appeared to have similar substrate specificities but in nitrous oxide, the formyl folates were more efficient substrates.

Folate polyglutamate biosynthesis and methionine synthase activity were also investigated following the administration of cycloleucine, a methionine structural analog and ethanol consumption. The incorporation of labelled folates into rat liver was found to be maximal seven days following cycloleucine administration. In addition, the liver enzyme, methionine synthase level was slightly elevated. Chronic alcohol consumption resulted in an increased liver methionine synthase level but unlabelled folate polyglutamate uptake was unaffected. The polyglutamate was also found to be unaffected.

Finally, the effect of a diet, deficient in methionine on folate polyglutamate biosynthesis and methionine synthase activity was investigated in the rat liver and brain, both with and without concomitant exposure to nitrous oxide. The uptake of labelled folate into the liver was found to decrease in such deficiency states. Following nitrous oxide exposure, the opposite was found. The uptake of labelled folate increased and the activity of methionine synthase decreased. The folate uptake and methionine synthase levels in the brain were found to be unaffected by dietary methionine deprivation in air or nitrous oxide.

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