Australasian Medical Journal
Not a member yet
1482 research outputs found
Sort by
Splenectomy in non-traumatic diseases
Get PDFSplenectomy represents the first choice for treatment of spontaneous splenic rupture, abscesses, cysts, tumours, and an alternative for control of hereditary, autoimmune, and myeloproliferative disorders. However, its relative indications have been reviewed for better understanding of both the primary affections and of splenectomy per se, particularly with regard to the immune system. The emergence of minimally invasive surgery, the possibility of splenic preservation, and availability of biological therapy has shown that the procedure has often been referred to as salvage therapy upon failure of other therapeutic propositions. On the other hand, patients have their general health status compromised by the underlying disease, by the use corticosteroids or biologic therapy, immunosuppressed, coagulation disorders, which contribute to the incidence of postoperative complications, such as infections, bleeding and venous thrombosis. Therefore, this scenario favours higher morbidity and mortality rates than those of other intra-abdominal surgical procedures. Thus, this review has the primary and comprehensive objective of purpose the best moment for splenectomy, when surgeons can interfere in the natural course of the disease increasing patients’ quality of life and survival. In short, it is desired that the surgeon has complete knowledge of the profound physiological changes imposed on the host. In addition, to distinguish when it is curative and mandatory from when it must be put on hold due to other non-operative treatments with similar outcomes and, lastly, when it is not recommended for not aggregating survival
Facilitators and barriers to the privacy of Iranian hospitalized patients in government hospitals
Get PDFBackgroundPrivacy is one of the essential needs of humans, and is therefore crucial in effective healthcare systems. There is limited research clearly addressing the facilitators and barriers underpinning privacy for hospitalized patients.AimsThis study aimed to explore Iranian patients' perceptions of and experiences with the facilitators and barriers of privacy of in government hospital in-patients.Methods This qualitative study was conducted on 22 patients admitted to the in-patient departments of government hospitals in Tehran, Iran, in 2016. The study population was selected through purposive sampling technique. The data were collected using individualized semi- structured interviews, which were recorded and transcribed. Data analysis was performed by means of an inductive content analysis approach.Results The analysis of the experiences of the hospitalized patient's extraction of six themes. These themes included the ethical and legal backgrounds of privacy, multi-dimensional design of privacy, perceived vulnerability, patriarchal care, conflict between privacy and care, individual backgrounds, nature of disease, and informed consent.ConclusionThe privacy of the hospitalized patient is affected by complicated factors. These factors are facilitators and barriers and should be considered in the design of care
Prevalence of asthma-triggering drug use in adults and its impact on asthma control
Get PDFBackgroundThe use of asthma-triggering drugs (ATDs) is a major factor in poor asthma control (PAC), which can be either uncontrolled or partially controlled. ATDs include angiotensin-converting enzyme (ACE) inhibitors, β-blockers, aspirin, and nonsteroidal anti-inflammatory drugs (NSAIDs).AimsTo measure the prevalence of ATD use in adult asthmatics and their control levels.MethodsThis is a one-year cross-sectional study (starting March 2016). A sample of 173 adult asthmatics (mean age: 44±16 years) was enrolled from five primary care centres in Jeddah city (Saudi Arabia). Asthmatics were clinically diagnosed according to the British Thoracic Society’s asthma guidelines. Chronic obstructive pulmonary disease was excluded by reversibility (i.e., symptom improvement after using asthma drugs). The four questions about asthma control from the Global Initiative for Asthma’s 2016 guidelines were translated to Arabic, photos and names of ATDs available in local pharmacies were collected, and a questionnaire was drafted. The questionnaire was presented to adult asthmatics by medical students during a personal interview. Data were statistically analysed using SPSS.ResultsFifty percent of the adult asthmatics who used ATDs had badly controlled asthma: 31 per cent uncontrolled and 19 per cent partially controlled. Of the patients who took ATDs, 97 per cent had used several ATDs for extended periods of time without any warnings from health professionals. In order of prevalence, aspirin, ACE inhibitors, other NSAIDs, and β-blockers were the most common ATDs used.ConclusionATDs are a major cause of PAC. ATD use is extensive and often goes unnoticed. The present findings highlight the low awareness of health professionals about the undesirable effects of ATDs on asthma control. This problem needs to be resolved by regular and continuous asthma health educational courses. During clinic visits, health professionals should inquire about ATD use, discontinue them, and offer an alternative. This simple action could markedly improve asthma control
The combination of letrozole and metformin has a better therapeutic effect on uterine and ovarian arteries in PCOS patients
Get PDFBackgroundPolycystic ovary syndrome (PCOS) is the most prevalence endocrine disorder in the reproductive age of women. In these patients, medications such as clomiphene citrate, letrozole and metformin are used to induce ovulation and overcome infertility.AimsThis study was done for comparing the findings of Color Doppler sonography of the uterine and ovarian arteries in women with PCOS under treatment of two drug groups of letrozole-metformin and clomiphene-metformin.Methods Intervention-applied study was performed on 108 women with secondary infertility due to PCOS in Imam Reza Hospital of Kermanshah in 2016. Women were divided in two groups of 54 people, for investigating the effect of letrozole-metformin and clomiphene-metformin on ovarian and uterine arteries.Results Blood flow in the uterus and ovaries significantly increased after treatment with letrozole-metformin and clomiphene-metformin (P < 0.05). However, the effect of letrozole-metformin was significantly higher than that of clomiphene-metformin on uterine and ovarian arteries Resistance Index (RI) (P < 0.05).ConclusionLetrozole-metformin as well as clomiphene-metformin have a significant effect on blood flow in the uterus and ovaries. The group which received letrozole-metformin had a better response in this regard
Workers´ health disorders: Burnout syndrome on public servers
Get PDFBackgroundBurnout syndrome encompasses emotional tiredness, depersonalization and the sense of low personal fulfilment.AimsThe aim of this study is to analyse Burnout syndrome on public servers. Methods Participants were 121 employees of public institutions, where 46 were females (38.02 per cent) and 75 males (61.98 per cent), aged between 24 and 58 years (Mage=36.21, SD=7.98). As measurement regent Maslach Burnout Inventory General Survey was applied. As statistical analyses descriptive techniques of central tendency and dispersion were conducted. Inferential analyses encompassed correlation techniques, variance comparison and risk factor prediction.Results There were found significant correlations among Burnout dimensions: (a) emotional tiredness, (b) depersonalization, and (c) low personal fulfilment (r=0.32–0.63). Between 5 per cent and 20 per cent of workers presented a high risk to present Burnout’s symptomatology. Male gender presented 1.39 (IC 0.61–3.15) and 1.12 (IC 0.48–2.60) times more probability to present low personal fulfilment and depersonalization respectively. Females presented 1.39 (IC 0.61–3.15) times more probability to present emotional tiredness. According to educational level, workers with secondary level presented lower personal fulfilment (F=4.33, p=0.002) than those with higher educational level.ConclusionAnalyses of data in relationship with previous studies are realized, highlighting the need to implement future interventions in order to diminish the risk for a public server to present the Burnout syndrome
Management for elevated serum Gamma Glutamyl Transpeptidase in primary care settings
Get PDFBackgroundOne of the most frequently encountered problems in outpatient and health screening centres is the elevation of Gamma Glutamyl Transpeptidase(y-GTP) levels. The measurement of y-GTP is a very sensitive indicator for screening for the presence of hepatobiliary disease. Especially, when alkaline phosphatase is elevated, it is a useful test to distinguish the presence of cholestasis. The diseases for which y-GTP can be elevated include diabetes, pancreatic disease, fatty liver, primary and metastatic liver cancer, cirrhosis, neuromuscular disease, myocardial infarction, hyperthyroidism, chronic obstructive pulmonary disease, chronic renal failure, prostate cancer, rheumatoid arthritis, Obesity, drugs, etc. Since y-GTP has a relatively high sensitivity and low specificity, it is preferable to perform it with other blood tests rather than performing it independently. The measurement of y-GTP is used as a test to diagnose alcohol abuse. AimsWhat is the meaning of y-GTP when it is raised independently or in relation to other liver function tests and how is it interpreted? In this article, we will examine the meaning of y-GTP elevation and its clinical application in primary care settings
Development of dengue vaccines
Get PDFBackgroundDengue virus (DENV) causes up to 390 million infections yearly, of which 96 million are clinically manifested. Approximately 500,000 people with severe dengue require hospitalization each year and there are at least 25,000 deaths among children from Asian and Latin American countries. DENV is endemic in more than 100 countries. Chemical and biological controls have been implemented in targeting Aedes aegypti and Aedes albopictus mosquitoes, but these control practices failed to stem the dengue transmission. As a result, dengue vaccine has become a potential option recommended by WHO to be implemented in dengue endemic regions. Currently, several vaccine candidates are being evaluated in clinical studies. Amongst the vaccine candidates, live attenuated vaccines (LAV) are the furthest along the development pipeline. The most advanced vaccine, CYD-TDV (Dengvaxia) has been licensed in 19 countries. Several other live attenuated vaccines, as well as DNA, subunit, inactivated virus, viral-vectored and subunit-based vaccines, are under development and evaluation in preclinical or clinical studies. Each of the live-attenuated vaccine candidates targets on molecular determinants of virulence in DENV, with the emphasis on attenuating the DENV and inducing a balanced tetravalent immune response against all the four dengue serotypes.AimsThis review presents several different vaccine approaches and their construction strategies, providing an insight into the development of future dengue vaccines such as live attenuated vaccines, DNA vaccines, sub-unit protein vaccines and viral vectored vaccines. Methods Recent development status of dengue vaccine candidates was reviewed based on the published data and an online registry for clinical trials (ClinicalTrials.gov) which is run by the U.S. National Library of Medicine, National Institutes of Health. ResultsIncreasing burden of dengue necessitates the development of a safe and efficacious tetravalent dengue vaccine. Various vaccine strategies are being developed for disease prevention, each has its own strengths and limitations. Dengvaxia is a licensed dengue vaccine in 19 countries but it has been suspended in the Philippines in December 2017 due to its potential risks in children < 9 years of age and seronegative vaccinees. TDV was able to elicit neutralizing antibodies as well as cross protective T cell responses against all four dengue serotypes and protected mice and nonhuman primates against challenge with wild type DENV. Seroconversion was achieved in both seronegative and seropositive adults and children < 1.5 years of age with a single dose. TV003/TV005 was able to elicit multifunctional T cell response in addition to the humoral response. Seroconversion in 90 per cent of seronegative adults was observed with a single dose of TV005. However, eliciting a balanced immune response against all the four dengue serotypes remained the major impediment. ConclusionDengvaxia has been launched in 11 countries but it has been withdrawn in the Philippines due to adverse effects in young children. Experimental vaccines such as TDV and TV003/TV005 are live attenuated vaccines which are currently in phase III clinical trials. Continued field trials will further our understanding of immune correlates of protection or risk
Three-dimensional printing in medicine: Opportunities for development of optimal CT scanning protocols
Get PDFThree-dimensional (3D) printing has shown great promise with increased applications in the medical field. 3D printed models are reported to accurately replicate normal anatomy and pathology, assist pre-surgical planning and simulation, serve as a useful tool for medical education and improve patient-doctor communication. Another unique application of 3D printed realistic models is to develop optimal computed tomography (CT) scanning protocols for investigation of scanning parameters with low radiation dose while still achieving diagnostic images. This editorial highlights the application of using patient-specific 3D printed pulmonary artery model for investigation of optimal CT pulmonary angiography protocols for detection of pulmonary embolism
A surgeon, a rabbi and a lawyer walk in to an OR… Absorbable haemostatic agents and the dangers of product evolution – clinical, religious and legal implications
Get PDFAdjunctive haemostatic agents have been used in surgery for over 70 years. What surgeons may not know is that products intended for similar applications may have very different biological properties and that occasionally product upgrades may introduce a change in the material’s behaviour. Many of the agents employed to assist in haemostasis may have a biological (animal) origin. A recent case brought to light the need to recognise the possibility of biological interactions. As consideration into this surgical problem unfolded, religious and legal questions began to arise