Australasian Medical Journal
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Disseminated nocardiosis in a female patient with idiopathic thrombocytopenic purpura: A case report
Get PDFNocardiosis is a life-threatening disease if unrecognized and maltreated. We describe a case of disseminated nocardiosis in a patient with idiopathic thrombocytopenic purpura under steroid therapy. She presented with a 2-week history of progressive symmetrical limb weakness, fatigue, and profuse sweating. Brain MRI revealed ring-enhanced lesions at the cerebellum and left parietal lobe with brain oedema. Chest CT revealed a left upper lobe nodule. Aspirate culture confirmed the diagnosis of nocardiosis. We administered antibiotics and dexamethasone to ameliorate the brain oedema. The patient improved clinically after 2 weeks. Follow-up brain MRI showed improvement. Clinicians should consider nocardiosis in immunocompromised patients with non-specific symptoms
The relationship between periodontitis and diabetic retinopathy: A cross-sectional longitudinal study
Get PDFBackgroundPeriodontal disease is regarded as the sixth complication of diabetes mellitus. The association of periodontitis with diabetic retinopathy is controversial.AimsThe study aimed to assess the association of periodontitis with diabetic retinopathy.Methods This is a cross-sectional descriptive study conducted at a diabetes centre in Omdurman, Sudan during the period from July to September 2018. One hundred and fifty-nine patients with type 2 diabetes were interviewed using a structured checklist. The demographic data and diabetes complications including retinopathy were recorded. An experienced dentist assessed the participants for periodontitis. The Statistical Package for Social Sciences (SPSS, version 20, New York) was used for data analysis. A P-value of > 0.05 was considered significant.Results Out of 159 patients with type 2 diabetes mellitus (65.4 per cent females), their age mean±SD was 58.13±9.96, periodontal diseases were found in 22.0 per cent of patients, and retinopathy was present in 34.6 per cent, while the number of lost teeth was 3.86±3.05. Between patients, periodontal disease (+) vs. (-), the incidence rate of the followings did not differ retinopathy, neuropathy, nephropathy, and coronary history. However, those with periodontal disease, compared with those without, had significantly more lost teeth P-value < 0.05.ConclusionThe number of lost teeth was higher among patients with diabetic retinopathy. However, a cause and effect cannot be withdrawn. Further larger multi-centre studies assessing the association of retinopathy with the severity of periodontal disease and controlling for other causes of teeth loss are needed
The role of Candida species in peri-implant diseases
Get PDFBackgroundPeri-implantitis is a chronic, marginal and progressive infection of soft and hard tissue that surrounds dental implants, which results in the loss of the supporting bone, caused by similar microbes as adult periodontitis. Staphylococcus aureus and Candida albicans are microorganisms that are not primarily associated with periodontitis, but certain studies identified them in peri-implant pockets.AimsThe current review aimed to assess the role of Candida species in peri-implant diseases.MethodsThis review has been carried out in accordance with the question: ";;;What is the role of Candida albicans in peri-implant diseases?";;;. To answer this, a bibliographic search was carried out using PubMed, Scopus and Medline and it was limited to works published during 2009-2019.Results Candida albicans appears to play an important role in the formation and stabilization of biofilm on the titanium surfaces and in the implant itself, which subsequently allows the growth of periodontal pathogenic bacteria involved in the development of inflammatory response resulting in the loss of bone supporting the dental implant.ConclusionFurther research is needed to shed more light on the pathophysiology of peri-implant inflammation and to find more effective ways to treat it
Role of L- glutamine and crizanlizumab in sickle cell anaemia painful crisis reduction
Get PDFBackgroundPatients with sickle cell disease, frequently suffer from intense painful episodes. Till recently hydroxyurea was the only available medical therapy that approved for reduction of painful episodes.AimsTo summarize the available data from randomized controlled trials that aim to evaluate the efficacy of newly approved L-glutamine (alters redox state of red blood cells [RBCs]) and crizanlizumab ((anti-P-selectin)) on vaso-occlusive episodes in Sickle cell disease patients.Methods PubMed, Google Scholar, and EBSCO databases were systematically search for relevant articles. The terms L-glutamine, sickle cell disease, sickle cell anaemia, crizanlizumab and vaso-occlusive episodes were used.Results Out of Four-hundred seventy-two records, only three fulfilled the inclusion criteria. Two trials were aimed to evaluate the efficacy of L-glutamine therapy on the frequency of painful crises in sickle cell anaemia patients. Both studies showed that L-glutamine therapy significantly reduce the frequency of VOEs. Only one trial examined the ability of crizanlizumab on VOEs reduction, and showed crizanlizumab successful reduce the occurrence of VOEs.ConclusionNewer agent with different mechanism of action, such as L-glutamine, and crizanlizumab may consider if hydroxyurea not effective or not tolerable
Antimalarial use in managing COVID-19 in the context of Glucose-6-Phosphate-Dehydrogenase G6PD deficiency
Get PDFBackgroundThe use of certain medications in G6PD deficient patients can trigger an oxidative stress which can lead to haemolytic anaemia. Recently, in a few countries, Chloroquine and Hydroxychloroquine; drugs that are indicated for prevention and treating malaria have been used in the management of COVID-19 patients. Evidently, the use of chloroquine and hydroxychloroquine can cause negative impact to the haemolytic status of COVID-19 G6PD deficient patients.AimsThe aim of this mini review was to provide an overview of the use of antimalarial agents in the management of COVID-19 G6PD deficient patients.Methods We conducted a review of the literature that has examined the use of antimalarial agents in the management of COVID-19 G6PD deficient patients.Results Chloroquine and hydroxychloroquine have been found to exhibits an antiviral activity against several viral infections including human coronaviruses. Many countries have implemented the use of Chloroquine and Hydroxychloroquine in managing COVID-19 patients. However, according to published case reports, the use of Chloroquine and hydroxychloroquine have been shown to worsen the haemolytic status in G6PD deficient patients.ConclusionCOVID‐19 infection can trigger severe acute haemolytic crisis in G6PD‐deficient patients which can be worsened by chloroquine and hydroxychloroquine. Thus, physicians should be aware to this possible adverse event particularly in countries with high prevalence of G6PD deficiency
Clinical application of three-dimensional printed models in preoperative planning of pancoast tumour resection
Get PDFBackgroundThe resection of pancoast tumours is a highly challenging procedure for cardiothoracic surgeons. A patient-specific 3D printed model of the tumour may be useful as an adjunct to standard preoperative planning procedures.AimsThis study aims to assess the clinical value of a 3D printed pancoast tumour model as a preoperative planning tool.MethodsTwo anonymised cases of pancoast tumours were obtained and one was chosen to be 3D printed. The model was presented to two cardiothoracic surgeons with more than 10 years of experience. Interview and questionnaire sessions were conducted to sought expert opinions about the clinical value of the model as a preoperative planning tool. ResultsThe participants agreed that the 3D printed model provides an accurate representation of the exact location of the tumour in relation to surrounding structures. The hand-held model also offers a tactile approach to preoperative planning, facilitating the planning of ports placement. The model is also potentially useful in team communication and patient education, leading to improved surgical outcomes. ConclusionThis study has demonstrated the clinical value of a patient-specific 3D printed model of pancoast tumour in preoperative planning. Apart from enhancing the surgeons’ understanding of the anatomical location of the tumour, the model is also easily manipulated. Future research could investigate the impact of 3D printed model on short to mid-term clinical outcomes
Australian orthopaedic surgeons and social media: The future of education and communication?
Get PDFBackgroundFor health care professionals, utilisation of social media provides numerous potentially useful opportunities. To the author’s knowledge, no study to date has quantified the use of social media among orthopaedic surgeons in Australia.AimsTo assess the use of popular social media platforms by all practicing orthopaedic surgeons in Australia and determine other potential correlations.Methods Orthopaedic surgeons currently practicing in Australia as of November 2019 were identified using the Australia Orthopaedic Association (AOA) surgeon directory. A comprehensive search of websites and social media platforms including Facebook, Twitter, LinkedIn, ResearchGate, Instagram and YouTube was undertaken to assess the level of uptake of these platforms for each surgeon. Further analysis in relation to surgeon gender, geographical location, and ‘years in practice’ was also undertaken.Results A total of 1039 Australian orthopaedic surgeons were included in the study, of which 776 (74.4 per cent) had at least one type of social media account. Overall, 10 surgeons (0.96 per cent) were found to have accounts on all six social media platforms investigated. LinkedIn proved the most popular platform, with a total of 637 (60.3 per cent) surgeons having accounts on the platform, followed by Facebook (463 (44.5 per cent)) and Twitter (210 (20.2 per cent)). There was no statistically significant correlation between surgeon gender and uptake of social media platforms.ConclusionThe uptake of social media platforms by Australian orthopaedic surgeons is varied. As the role of these platforms becomes increasingly relevant years to come, it is important for surgeons to remain aware of the guidelines governing the utilisation of these platforms
The relationship of somatization with fatigue and exhaustion as chief complaints
Get PDFBackgroundText Somatization is the expression of mental distress and psychosocial stress with physical symptoms. Medically Unexplained Symptoms (MUS) are defined as symptoms like fatigue, exhaustion and general body pain that causes patients to apply to a doctor repeatedly, without the presence of an underlying organic disease, and lasts more than three months. Its’ frequency in primary care is 20–30 per cent.AimsThe aim of this study is to determine the underlying psychiatric comorbidity in patients that apply to Family Medicine clinic with the mentioned complaints using the PHQ-SADS scale.Methods From the patients that applied to Marmara University Pendik Research and Teaching Hospital Family Medicine clinic with complaints of fatigue and exhaustion between January 2019 and May 2019, those that were between 18-65 years of age and did not have any diagnosed, chronic psychiatric disease, cancer, uncontrolled diabetes, hypothyroidism, and rheumatological diseases were included in the study. A questionnaire including demographic characteristics and the PHQ-SADS scale was applied to the participants.Results The number of participants was 65, the mean age was 36±10.5 years, 84.6 per cent were women, and the level of education was mainly high school and higher. The presence of chronic disease increased with age. The most frequent chief complaint was fatigue and the most ordered test was a complete blood count (92.2 per cent). The most common diagnosis was iron and vitamin D deficiency together (n=22).The most frequent score level of the applied PHQ-SADS scale was moderate-severe (66.2 per cent) in the subscale PHQ-15 which screens somatization symptoms. Patients with chronic diseases had higher PHQ-15 and PHQ-9 scores (p=0.025 and p=0.22 respectively).ConclusionPatients’ visiting primary care physicians with recurrent and undifferentiated complaints is a frequently encountered situation. Somatization levels are found to be high in these patients. Physicians recognizing and managing this situation appropriately may help to reduce these multiple doctor visits
Oral semaglutide adequate glycaemia control with safe cardiovascular profile
Get PDFBackgroundType 2 diabetes is a chronic and progressive disease that associated with series complication such as major adverse cardiovascular events. Adequate glycaemic control proven to reduce this risk. Orally administered semaglutide promising medication in managing patient with type 2 diabetes.AimsTo assess the cardiovascular safety and efficacy of semaglutide, a recently approved glucagon-like peptide 1 receptor agonist (GLP-1 RA) for type 2 diabetes.Methods Pub Med, Google Scholar, and EBSCO databases were systematically search for relevant articles. The terms diabetes, Glucagon-like peptide, semaglutide were used. Out of hundred twenty-two records, only four fulfilled the inclusion criteria.Results Four placebo-controlled studies with oral semaglutide were included. Single study concern about the cardiovascular safety of oral semaglutide and showed that, compared with placebo, semaglutide was not associated with increased in the cardiovascular events. On the other hand, the remaining trials shown that, semaglutide can effectively control the blood glucose as evident by reduction in HA1c.ConclusionOral semaglutide can effectively and safely lower blood glucose without increase in the major adverse cardiovascular events (MACE).
The impact of childhood atopic dermatitis on quality of life of the paediatric population
Get PDFBackgroundAtopic Dermatitis (AD) is a chronic skin condition characterized by pruritis which presents with xerosis, lichenification, and the eruption of eczematous lesions.AimsTo measure the quality of life in the paediatric population with atopic dermatitis at King Abdulaziz Medical City in Jeddah, Saudi Arabia.Methods The assessment tool utilized was the Infants' Dermatitis Quality of Life Index (IDQOL) questionnaire which is validated and available in Arabic. The sample size is 80 participants. Demographics, history of atopy, current treatment, and the percentage of body involved were described as frequencies. Chi-square test was performed to determine if there was a significant difference between gender, age group and the presence of other atopic disease in comparison to percentages of body involved. The analysis of the questionnaire’s items was done by One-way ANOVA to determine where significant impact on quality of life was present.Results There was a significant difference in overall IDQOL score between patient who had asthma with AD and those who did not (p=0.016). Significantly, the higher the percentage of body area affected by AD, the higher IDQOL score (p < 0.0001). No significant difference was identified for the chi-square test. Among questionnaire’s items sleep disturbance was affected the most among patients in relation to increase in distribution of disease along the body (p < 0.0001).ConclusionThe study concluded that the IDQoL among paediatric population with Atopic Dermatitis was significantly impaired, and it showed that the disease severity was proportionally related to the impairment of patients’ quality of life. Therefore, we highly recommend further studies in the same field to be able to generalize the results in the Saudi paediatric population