Australasian Medical Journal
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Impact of migraine headaches and depression/anxiety on the incidence of post-dural puncture headache during postpartum course
Get PDFBackgroundMigraine headaches, anxiety disorder and depression have not been studied to determine if parturients are at risk for developing a PDPH.AimsThis retrospective analysis is to identify and assess the risk of developing a post-dural puncture headache (PDPH) in parturients with a documented history of primary migraines and anxiety/depression.MethodsThe parturients who had accidental dural puncture (ADP) during labour epidural placement were included and further analysed for the development of a post-dural puncture headache (PDPH). We compared patient demographics and the history of depression/anxiety, as well as evaluated the patient for a history of migraine headaches and depression/anxiety.ResultsOne hundred seventy-five parturients met our criteria for ADP, from which 92 (52.6 per cent) developed PDPH. A history of migraines was present in 7 of 10 (70 per cent) of patients with a PDPH, from which 4 of 7 (57.1 per cent) required an epidural blood patch treatment. A history of depression/anxiety was found in 7 of 12 (58.3 per cent) with a PDPH of which 2 of 7 (28.6 per cent) required an epidural blood patch treatment. Data analysis showed no significant difference between a history of migraines or depression/anxiety and the incidence of dural puncture headache (P=0.26 and P=0.68, respectively), nor was there an association between a history of migraines or depression/anxiety and the intensity of dural puncture headache (P=0.25 and P=0.63, respectively).ConclusionThe results of this study indicate that in postpartum patients neither the presence of a history of migraines nor a history of depression/anxiety was associated with an increased risk of the development of PDPH or an increase in its intensity
A multibody model for the optimization of hip arthroplasty in relation to range of movement
Get PDFBackgroundThe dislocation of the prosthesized hip is a relevant post-operative complication; this adverse outcome is dependent on the specific patient anatomy and on the artificial joint design. The geometry of the reconstructed hip is one of the key factors and it is usually designed at the time of pre-operative planning when the stem model and size, the head diameter and its offset, and the acetabular cup orientation are selected.AimsIn this work, the authors have developed a numerical model to support to pre-operative planning, allowing assessing the allowed range of motion, once the geometry of the implant has been defined.Methods A multi-body model of a prosthesized hip has been developed, and a dislocating movement has been applied; the software is able to assess the entity of displacements and of applied forces which can produce hip dislocation.Results As a proof of concept, multiple combinations of geometric factors have been examined that are the head diameter, the acetabular cup anteversion and its inclination, reaching a total number of 675 configurations. This software is able to analyse and compare all configurations in few minutes.ConclusionThe developed numerical model can be a support to quickly compare a great number of solutions from the point of view of hip stability, reaching a comprehensive view of all possibilities, and giving a contribute to the final aim that is surgery optimization, in relation to each specific patient
John Billings, an Australian medical pioneer in research on fertility and contraception
Get PDFBackgroundContemporary rankings and ratings of contraceptive options frequently neglect the Billings’ ovulation method or cite inaccurate failure rates for this method.AimsThe aim of the review is to clarify inaccurate data and to shed light on the role Billings’ discoveries play in contemporary research on contraception.Methods Systematic analysis of the failure rates of the most widely used ratings and rankings offered by influential research institutes and government agencies.Results Contemporary research uses Billings’ insights for stipulating new characterizations of contraceptive methods and fails to agree on estimates for these methods.ConclusionNew data are needed to accurately assess the efficacy of the Billings’ ovulation method and to determine its place in international rankings
Effect of hyperemesis gravidarum on child neurodevelopment
Get PDFBackgroundPregnancy outcome following hyperemesis gravidarum (HG) has been sparsely reported. This review article aims at critically reviewing the first prospective study of foetal long-term neurodevelopment after maternal HG.AimsThis review aimed at critically appraising the first prospective human study that aimed at investigating long term child neurodevelopment after exposure to maternal HG.MethodsIn this study, women with nausea and vomiting of pregnancy treated with doxylamine–pyridoxine (Diclectin) or with no pharmacotherapy were prospectively recruited. Their children (ages 3 6/12 to 6 11/12 years) were assessed for development using standardized psychological tests. The study cohort was divided into 2 groups: 1) severe NVP necessitating hospitalization of the woman for rehydration and electrolyte corrections (n=22) and 2) all other cases of nausea and vomiting of pregnancy (n=197). ResultsChildren of hospitalized mothers achieved significantly lower IQ scores than the rest of the children on verbal, performance and full scale IQ. In multivariable linear regression duration of hospitalization, maternal depression and maternal IQ were significant predictors for these outcomes. ConclusionThis first prospective human study documented that HG is associated with an increased risk for lower cognitive outcome among HG- exposed offspring. More research is needed to examine whether early use of anti-emetics may prevent hospitalization, leading to favourable child neurodevelopment
Groin pain secondary to Femoral Acetabular Impingement- A case of mistaken identity
Get PDFGroin pain is a common presentation usually associated with inguinal hernias, thus a clinician will rarely consider hip pathology. We present the case of a 51-year-old man with right groin pain and imaging-confirmed right inguinal hernia. His atypical symptoms and signs however led to us pursuing other differentials; he was subsequently diagnosed with a Cam-type femoral acetabular impingement (FAI) syndrome. Through this case study and literature review, we aim to increase awareness amongst general surgeons regarding this uncommon differential of FAI syndrome- a painful condition associated with morphological characteristics of the proximal femur and/or acetabulum. A thorough history and examination in patients with groin pain is essential in the diagnostic algorithm to accurately diagnose FAI syndrome. This will facilitate orthopaedic referral, appropriately manage pain symptoms, as well as prevent unnecessary hernioplasties and possible complications
Intussuscepted caecal cancer in a patient with intestinal malrotation and agenesis of one kidney
Get PDFWe present the case of 60-year-old man (twin) with ileus cause by intussusception of the caecum adenocarcinoma and coexistence of intestinal malrotation (IM) and agenesis of one kidney. Intestinal malrotation with colon carcinoma is very rare in adult patients (only 14 cases have been described in the literature). Ileus cause by tumour intussusception has been previously reported in only one patient and the additional coexistence of agenesis of one kidney has not been reported in the available medical literature. However, coexistence of other anomalies was observed in 46 per cent of patients with IM. Therefore, in patients with ileus and coexisting congenital anomalies in other organs, the existence of intestinal malrotation should be considered. Furthermore, because of the unusual anatomy of the mesenteric vessels, right colon resection in patients with IM should be performed with special caution and the preoperative work-up should be extended to include visceral angiography
Coexisting complete hydatidiform mole and live foetus
Get PDFThe authors report a case of twin pregnancy with complete hydatidiform mole coexisting with a live foetus (CHMCF) that developed gestational trophoblastic neoplasia (GTN). The patient with metastatic low risk GTN that developed resistance to single-agent chemotherapy achieved remission with combination chemotherapy. The patient’s condition, management of complication and literature review of etoposide, MTX, Act-D, Cyclophosphamide, and vincristine (EMA-CO) are presented in the hope that great caution can be exercised in managing CHMCF
Rapidly growing vaginal mass: Benign or malignant?
Get PDFVaginal leiomyoma is a rare condition. Approximately 300 cases have been reported in the literature so far. We present a case of 47 years old patient with a rapidly growing vaginal myoma which was diagnosed three months after a supravaginal hysterectomy due to uterine myoma and was suspicious for malignancy
A comparative survey of the attitudes of nurses, nursing students, and patients as to the observance of the patients’ dignity in the psychiatric ward
Get PDFBackgroundPatients with mental health illness have a variety of physical, mental, social, and spiritual needs and respecting their dignity and status is of the most important. Nurses and nursing students might have different attitudes with regard to observation of status and dignity of mental patients.AimsThe present study is an attempt to comparatively survey nurses, nursing students, and patients’ attitudes about the observance of the patient’s dignity.Methods The study was carried out as a cross-sectional work on 300 participants in psychiatric wards of the selected hospitals of Kashan and Tehran cities in 2017. The participants were selected through purposeful sampling and data gathering was done using a demographics checklist and a researcher-designed patient’s dignity observance questionnaire. Data analyses were done in SPSS (V.19) using descriptive and inferential tests (P-value=0.05).Results The three groups of participants were homogenous in terms of gender. There was a significant difference between psychiatric wards of the Kashan-based and Tehran-based hospitals in terms of attitudes about dignity of patients (P=0.04). In addition, the results confirmed a significant difference among the study groups with regard to their attitudes about the dignity of patients (p=0.000).ConclusionThe nurses had better attitudes with regard to the observance of patient’s dignity in comparison with the patients and nursing students. There was also a difference between Kashan-based and Tehran-based hospitals as to the observance of patient’s dignity so that the attitudes in the former were better than that in the latter. It seems that holding moral training courses is essential