Australasian Medical Journal
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Assessing the mental health of medical students
Get PDFBackgroundOver the past years there has been a growing interest in investigating and studying the levels and causes of anxiety, depression and psychological deficits among medical students. Although there are numerous studies, there does not appear to be a comparative review of the reported results.AimsTo identify key stressors for medical students and investigate if there are any significant events that are more likely to evoke a stressful response. Also, to investigate if there are any groups of medical students, more prone to be negatively affected.Methods This was a Retrospective Cohort Study, analysing data that was collected from students in a wide range of medical schools.Results Medical students are far more significantly affected by perceived stress than other university students; there are specific events in their course of study and lifestyle that have been identified as likely triggering events.ConclusionAll medical students are at significantly higher risk of perceived stress, depression, anxiety, suicide ideation and risk of depression and psychological distress.Specific gender and ethnic groups appear to be in the higher risk groups, as well as specific stressors, that would appear to be the main contributors to these mental health problems. If universities and medical schools consider these key points, they should be able to plan processes to develop greater resiliency in their students
Is antecedent D-Dimer testing prior to compression ultrasonography likely to be helpful for evaluating deep vein thrombosis in acute medical inpatients?
Get PDFBackgroundVenous thromboembolism is a preventable cause of death in hospital, D-Dimer assays are highly sensitive for detecting VTE but have not been validated in inpatients. Acute medical inpatients frequently have comorbid conditions that may limit the value of this test.AimWe aim to review the evidence regarding D-Dimer use and apply it to an acute medical inpatient cohort to determine its potential applicability in this setting.MethodsA retrospective review of acute medical inpatients (within 48h of admission) was performed over a two year period who had compression ultrasonography. For patients without antecedent D-Dimer testing, medical records were reviewed to determine if a comorbid illness was present that would limit D-Dimer value. Pregnancy, active malignancy, significant infection, known arterial thrombus, VTE already detected, stage 4 CKD, age >80, exacerbation of moderate to severe COPD and clinical question of collection, not DVT, were accepted reasons that justified no D-Dimer.ResultsThree hundred and forty eight acute medical inpatients underwent DVT ultrasonography in this timeframe, 60 had confirmed DVT. 10.6 per cent of cases underwent antecedent D-Dimer testing, and a valid medical reason was identified in 84.9 per cent of cases who did not. Elderly age, significant infection and admission with active malignancy were the most common reasons to not proceed with D-Dimer testing.ConclusionMost acute medical inpatients proceeded straight to ultrasonography to evaluate for DVT which is largely supported by available literature. This study supports the limited, if any, role for antecedent D-Dimer use in acute medical inpatients due to their comorbid conditions
Mild cognitive impairment among patients with diabetes in Tabuk City, the Kingdom of Saudi Arabia and its relation to glycaemic control
Get PDFBackgroundThere is an increasing awareness regarding the interaction between diabetes mellitus and mild cognitive impairment (MCI), no researchers have assessed mild cognitive impairment among patients with diabetes in Saudi Arabia.AimsThe current study aimed to assess mild cognitive impairment among patients with diabetes mellitus in Tabuk, Saudi Arabia.Methods A case-control study was conducted among 106 patients with diabetes mellitus, and 96 control subjects attending a diabetes center in Tabuk City, Saudi Arabia during the period from December 2018 to September 2019. The participants were invited to sign a written informed consent and then interviewed using a questionnaire based on the Montreal Cognitive assessment, demographic data, and cardiovascular risk factors. The ethical committee of the University of Tabuk approved the research and the Statistical Package for Social Sciences was used for data analysis. A P-value of < 0.05 was considered significant.Results There were 106 patients with diabetes mellitus and 96 control subjects matched for age and sex. MCI was evident in 50.9 per cent of patients with diabetes vs. 8.9 per cent of control subjects with a highly significant statistical difference (P < 001, 95CI, 3.33–33.93), hypertension, overweight/obesity, coronary artery disease, and dyslipidaemia were commoner among patient with diabetes compared to their counterparts. A positive correlation was observed between mild cognitive impairment and hypertension (P < 0.05, Wald, 7.649, 95 per cent CI, 018-.506). No correlation was found between MCI, duration of diabetes, and other cardiovascular risk factors.ConclusionMore than half of patients with diabetes in Tabuk City had MCI and is correlated with hypertension. Raising awareness about the effects of high blood pressure on cognitive function is needed
Endogenous vascular repair system in cardiovascular disease: The role of endothelial progenitor cells
Get PDFBackgroundCardiovascular (CV) disease has been considered as the first global leading cause of premature death in last decades. Vascular complications close correspond to development of endothelial dysfunction, microvascular inflammation, accelerating atherosclerosis, coagulopathy, and thrombosis, in pathogenesis of which altered vascular reparation is core player and possible target for further treatment strategy.AimsThe aim of the review is: to summarize knowledge regarding the role of endothelial progenitor cells (EPCs) as a core component of endogenous vascular repair system in CV disease.MethodsThis is a descriptive review based on evidence of pre-clinical and clinical studies published within last decade.ResultsThe review is reported that developing of CV disease associates with lowered number and impaired function of circulating EPCs, which play a pivotal role in endogenous reparation of vasculature and restore endothelial function after various injuries on the vessels. EPCs could be modified by several stimuli including epigenetic factors and thereby they are failed completely restoring vascular structure and endothelial function. However, there is unclear whether EPC dysfunction is just a whiteness of the evolution of CV disease or it could be a trigger of CV disease manifestation in the vulnerable population.ConclusionEPCs are novel biological marker of impaired vascular reparation and CV risk with predictive value. Large clinical trials are required to justify number and function of EPCs as independent prognosticator of CV risk
The future of gallstone treatment in Australia
Get PDFBackgroundThe standard treatment for gallstones to avoid risk of gallbladder attacks or other complications is to remove the gallbladder. The removal of gallstones is deemed futile because gallstones just return (if there is no change in diet).AimsTo remove the gallstones and not the gallbladder to avoid possible side effects or ongoing discomfort from gallbladder removal.MethodsAn alternative surgical procedure exists to just remove the gallstones which have been proven clinically which, despite being of a higher degree of difficulty, can produce superior results if it is combined with a strict change in diet by the patient to avoid the return of gallstones after their removal.ResultsA previous paper concludes: ‘Gallstones were completely cleared in 66 (81 percent) patients and complete symptom relief was obtained in more than 95 percent of these patients. There were no deaths or serious complications.’ConclusionA viable pathway to removal of gallstones using a modified cholecystoscope exists rather than removal of the gallbladder providing that a strict diet change (possibly aided by medication) is implemented to avoid recurrence of gallstones
The current state of knowledge regarding thyroid-stimulating hormone lowering/suppressive therapy and its cardiovascular risks in differentiated thyroid carcinoma
Get PDFBackgroundThyroid-stimulating hormone acts as a growth factor for thyroid follicular cells, so some patients with differentiated thyroid carcinoma (DTC) are placed on thyroid hormone suppressive therapy. However, (TSH) suppression is not without risks.AimsWe thought to assess the potential benefits and cardiovascular risks among patients on TSH suppressive therapy following thyroid surgery for DTC.Methods A systematic electronic search was conducted in PubMed, MEDLINE, and Google Scholar for relevant articles. All human and cell lines studies published during the period 2009-October 2019 were eligible. The keywords TSH suppression, differentiated thyroid carcinoma, TSH level, cardiovascular risk, cardiovascular morbidity, cardiovascular mortality, atrial fibrillation, and left ventricular volume were used One hundred and eighty-five articles were retrieved and only eighteen met the inclusion and exclusion criteria.Results Out of 185 articles, eighteen studies were included, more than half (55.6 per cent)were published in Europe, 22.2 per cent were from Asia,11.1 per cent from Latin America and one study was from the USA, the majority (72.2 per cent were observational studies),. Patients on TSH suppression were at a high risk of cardiovascular morbidity and mortality that increases at lower TSH levels. Levels < .1mU/L are beneficial in patients with micro or macroscopic disease. However it may induce tumour growth among patients with aggressive recurrent disease, no benefit was observed in low-intermediate DTC.ConclusionPhysicians may need to suppress TSH in patients with micro or macroscopic DTC. However, caution is needed in aggressive recurrent disease. The available level of evidence showed no benefit of TSH lowering therapy in low-intermediate disease
Hemophagocytic syndrome due to infection by H1N1 influenza virus
Get PDFA 31-year-old man presenting a dyspnoea, persistent fever, haemoptysis, a Leishmaniasis cutaneous record and recent close contact with a person diagnosed with influenza virus (H1N1). During admission to the emergency department, the patient rapidly progressed to respiratory failure requiring invasive mechanical ventilation and antibiotics because of suspected bacterial pneumonia. During his stay at the intensive care unit, he progressively developed bycytopenia, splenomegaly and reticulonodular lung opacities. Moreover, the bone marrow biopsy evidenced hemophagocytosis of lymphocytes and detection of H1N1 by Reverse Transcription Polymerase Chain Reaction (RT – PCR). Hence, the case of hemophagocytic syndrome secondary to influenza virus H1N1, which was rapidly resolved after initiation of antiviral therapy, is presented hereof
Vaginal myoma – A rare type of vaginal tumor
Get PDFVaginal myoma is an extremely rare benign tumour. Its clinical picture is multiform, core being the presence of pain symptom. This diagnosis is not that easy and malignant tumour should always be considered. We present three clinical cases, where the formations differ in their dimensions, localizations and clinical pictures. We used one and the same method in their surgery and there was no recurrence during the follow up period. We cannot rely on clinical symptoms or gynaecological examination to diagnose vaginal leiomyoma. The ultrasonography is only of orientational character. Therefore, each formation originating vaginally should be treated as malignant – it should be removed intact, without disrupting its entirety
Early endoscopic intervention in acute gastrointestinal bleeding may reduce the need for blood transfusion
Get PDFBackgroundAcute gastrointestinal bleeding (GIB) is a common gastroenterological emergency worldwide with significant morbidity and mortality of 6 per cent–14 per cent. The main causes of death in patients with GIB include shock, aspiration, and therapeutic procedure carried out for the management of the GIB. Thus, the resuscitation strategy of blood transfusion plays a very important role in these patients before any other specific treatment. Currently, endoscopy is considered the mainstay of diagnosis and treatment for patients with GIB.AimsTo assess the effect of an early endoscopic intervention on the need for blood transfusion in patients presented with GIB.MethodsWe retrospectively analysed the data for patients presented with hematemesis, melena, or hematochezia, from July 2015 to July 2016, in Ballarat Base Hospital (BHS) in Victoria, Australia. Data were extracted from the hospital coding system related to patient’s demographic history, alcohol intake, comorbidity, procedure details including the timing and the type of procedure performed, and the number of units of blood transfused. Additionally, the laboratory blood test results for each patient were examined through the electronic records to assess the haemoglobin level before and after the blood transfusion.Results A total of 92 eligible patients with GIB during the 12 months study period, were included in this observational study. The median age of the study population was 67 years (range 24-96) at the time of admission. A total of 67 patients (73 per cent) underwent inpatient endoscopic procedure with gastroscopy performed in 52 patients, colonoscopy in 5 patients, flexible sigmoidoscopy in 3 patients, and combined gastroscopy and colonoscopy in 7 patients. In the enrolled population (n=92), at time of presentation, 11 patients (12 per cent) had the haemoglobin level below 7grams per decilitre (g/dL), 17 patients (18 per cent) had haemoglobin level between 7 and 8g/dL, and 64 patients (70 per cent) had haemoglobin level greater than 8g/dL. Out of the 67 patients who had inpatient endoscopy, 12 patients underwent endoscopic procedure within 12 hours of admission ( 12 hours group), including 31 patients who received blood transfusion. Among participants who received a blood transfusion in the two groups, 1 out of 5 patients in the 12 hours group had haemoglobin level below 8g/dL at the time of transfusion.ConclusionTrends of greater blood transfusion in patients with delayed (> 12 hours) endoscopic procedure and administering blood transfusion at haemoglobin level >8g/dL in patients with early (< 12 hours) endoscopic procedure were observed without achieving statistical significance. The results obtained from this study indicate that more saving in terms of cost of treatment from blood transfusion can be achieved by adopting an optimized restrictive transfusion strategy
Local anti-inflammatory effect of vitamin D in acute and chronic gouty arthritis
Get PDFBackgroundVitamin D has immunomodulatory, anti-inflammatory properties and important role in bone metabolism. Effects of vitamin D supplementation in musculoskeletal diseases are well known, but it is unknown if local application of vitamin D can have an anti-inflammatory potential.AimsThe aim of this study was to investigate local influence of vitamin D on inflammation, pain, redness and swelling of the affected joint in acute and chronic gouty arthritis. 40 patients with acute gouty arthritis and 40 patients with chronic gouty arthritis were included in study.Methods We did topical application of cholecalciferol in a dose of 180,000 IU daily through seven days on the affected joint for one hour. Local changes of the affected joint such as swelling and redness were observed. Also, serum samples were taken on a 1st, 3rd and 7th day of application in order to measure levels of vitamin D, urates, calcium and C reactive protein.Results We found that local application of vitamin D increased its serum levels in both groups of patients while urates level, swelling, redness and pain was reduced. Effect of vitamin D on pain, redness and inflammation was stronger in a group with acute inflammation.ConclusionLocal application of vitamin D may be linked to the reduction of acute and chronic inflammation in gouty arthritis. Relationship between vitamin D and urates in inflammatory process should be investigated further