Australasian Medical Journal
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A Critical review of surgical logbook applications for the android and iOS platforms in the Australian setting
Get PDFBackgroundSmartphones have become pervasive in all aspects of modern life and the health care industry is not immune. Currently smartphone applications (apps) are used by 85–87 per cent of physicians. Surgical logbooks are a mandatory part of training and time consuming to maintain.AimsWe conducted a critical review of available logbooks apps in the Australian market for Android and iPhone and reported our findings.Methods A critical search through the Google Play Store's (Android) and Apple’s App Store's (iOS) Australian marketplace was conducted with keywords of “logbook” and other suitable variations in January 2017. Apps were critically reviewed and against the Royal Australasian College of Surgeons’ Minimum Dataset (MDS) and Extended Dataset (EDS). Apps were included if they could be utilised to record clinical procedures.Results Seven apps were available and fit the criteria of our search: Surgeons Logbook, eLogbook, LogBox Academic, SurgCase, T-Res 2, Surgeon Log Book Free, and SurgiLog. None of the apps completely satisfied the requirements of maintaining a surgical logbook as stipulated by RACS. However, Surgeon’s Logbook provided ability to customise the logbook fields, which allows users to modify their logbook app to meet the requirements. Furthermore, the lack of connection to hospital electronic medical records, or RACS, limits the usability of these apps for Australian trainees.ConclusionThe current apps available in the market do not meet the requirements of Australian trainees. However, with the advancing technology and rapid progress of smartphones and their apps, this is likely to change in the future
Imaging salivary glands post external radiation beam therapy of head and neck tumours
Get PDFBackgroundRadiation therapy using external radiation beam is an established treatment for head and neck cancers. However, salivary glands are exposed leading to severe impairment of oral health. In order to devise patient care strategies, clinicians can measure the degree of salivary gland impairment using various imaging modalities.AimsThe study aimed determining the best imaging modality for measuring salivary glands impairment post external radiation beam therapy of head and neck tumours.Methods A systematic literature review, performed using Google and Science Direct.com search engines. Publications in English on salivary gland imaging modalities post external radiation beam therapy of head and neck cancers were selected. Information on advantages and disadvantages of the imaging modalities was documented.Results The study established that the Magnetic Resonance Imaging (MRI), Computer Tomography (CT), Ultra Sound (US) depict structural changes while salivary gland scintigraphy provides functional information. It was also established that the obstruction of the salivary glands can be measured using Magnetic Resonance – Sialography. ConclusionThe salivary gland scintigraphy technique is the most sensitive of all salivary gland imaging modalities with the ability to detect slight parenchymal injuries well before structural changes can be seen using the MRI, CT and US. However, when evaluating the obstruction of the salivary glands ducts, the Magnetic Resonance-Sialography modality offers the best option
Complexity problem in immunology
Get PDFThe article discusses the problem of immune response complexity, found in functional unity of regulatory systems, cooperation of immunocompetent cells, connection and regulation of specific and non-specific defence mechanisms, association of immune, routine laboratory and clinical parameters under normal and pathological conditions. The article reviews the influence of disease combinations, their comprehensive treatment on immunopathology, and the corrector effects. To reproduce natural mechanisms of homeostasis regulation, complex, blocking immunotherapy of diseases is suggested
Stromal graft rejection after uneventful deep anterior lamellar keratoplasty with a misleading manifestation similar to viral endotheliitis
Get PDFWe describe an unusual and misleading manifestation of stromal graft rejection after uneventful deep anterior lamellar keratoplasty (DALK). A 25-year-old healthy man with advanced keratoconus underwent uneventful DALK. After a few months, developed recurrent graft oedema, acute and diffuse epithelial and stromal oedema, few very fine keratic precipitates (KPs) in the allograft and not seen in the recipient bed, anterior chamber (AC) inflammation with cells and flair, without any vascularization in the graft and recipient bed, and without any infiltration or loosening of the sutures. Polymerase chain reaction (PCR) analysis was performed on an aqueous sample, which was negative for herpes simplex virus (HSV) and cytomegalovirus (CMV). Management with topical and systemic steroids led to complete resolution of the problem. Although there is no endothelial immune reaction after uneventful DALK, stromal graft rejection after DALK can present with the same features as endothelial graft rejection and should be differentiated from other similar demonstrations such as viral induced endotheliitis
Primary malignant melanoma of the vagina in a postmenopausal woman
Get PDFPrimary malignant melanoma of the vagina, a very rare malignancy, is very aggressive and highly metastatic. Primary vaginal melanoma usually has a poor clinical prognosis, because it is often diagnosed at an advanced stage. We present a case of an 80-year-old postmenopausal woman with pigmented lesion of the vagina. The histopathology of the lesion revealed malignant melanoma. The patient was treated surgically, with wide local excision of the vaginal lesion. Left inguinal lymphadenectomy, based on the positron emission tomography-computed tomography (PET-CT) images, found metastatic melanoma. We present a case report of postmenopausal woman with primary vaginal melanoma
A case of very delayed surgical site infection after instrumented spine surgery
Get PDFThis is a case of a 69-year-old obese woman treated with posterior spinal stabilization for lumbar degenerative stenosis who developed delayed and persistent surgical site infection sustained by Bacteriodes fragilis. This microorganism is characterized by slow growth and resistance to antimicrobial agents. The patient underwent a surgical treatment with debridement of the surgical wound without hardware removal. After fourteen months the patient had a recurrence of low back pain, low-grade fever and dehiscence of surgical wound with the need of hardware removal. The intra-operative culture was positive for the same microrganism, than she healed with target antibiotic therapy
Primary, nodal, marginal zone lymphoma of a woman’s left breast imitated fibroadenoma
Get PDFBackgroundPrimary breast lymphoma is a rare malignant neoplastic disease, accounting for around 0.5 per cent of all malignant diseases of that organ, and also 2.2 per cent of extranodal lymphomas. The most common histopathological types are: diffuse large B-cell lymphoma, extranodal B-cell marginal zone lymphoma and MALT lymphoma. The primary affected group is with median age between 55 and 62 years. The clinical manifestation is usually of a tumour process in the affected breast.Case presentationHere we present an extremely rare case of a 68 years old woman with primary, nodal, B-cell, marginal zone lymphoma of the left breast, presenting itself under the mask of a benign tumour process, found accidentally following a histopathological examination of excisional samples.ConclusionsPrimary, nodal, marginal zone, B-cell lymphoma of the breast is extremely rare. Its clinical and mammographic presentation completely overlaps with those of fibroadenoma, which makes diagnosing it preoperatively practically impossible. Main treatment method here is not surgical, but radiological and chemotherapeutic
Complicated giant perianal condylomata accuminata transforming into squamous cell carcinoma in a patient with latent syphilis
Get PDFGiant condylomata accuminata (CA) is a pre-malignant tumour, which commonly involves the genital area. Human papilloma virus (HPV) 6 and 11 are the most common causative pathogens for this rapidly growing tumour. (CA) has been also associated with human immunodeficiency virus (HIV) infection, 40 to 60 per cent of benign (CA) transforms to malignancy. The main risk factors for HPV infection and subsequently condylomata include risky sexual behaviours, early pregnancy and tobacco use.Here, we report a 55-year-old man who presented with complicated giant perianal (CA) that transformed into squamous cell carcinoma. His condition was complicated by recurrent infections and massive bleeding. The patient underwent end colostomy followed by surgical resection of the mass followed by palliative radiotherapy. Histopathological analysis of the resected mass confirmed transformation into squamous cell carcinoma. Malignant transformation of (CA) should be suspected in patients with rapidly enlarging perianal mass and progressively invasive disease
Kuwaiti parent's knowledge of their childern's fever and their patterns of use of over the counter antipyretics
Get PDFBackgroundMany parents consider fever a disease with the continuation of fever phobia and overuse of antipyretics to reduce it.AimsIdentifying Kuwaiti parent’s knowledge of their children’s fever and determining their patterns of use of Over-the-Counter- Antipyretics.Methods A descriptive cross-sectional study in which we have recruited 614 Kuwaiti mothers of well children aged between six months and five years. Data was collected over six-months from September 2015 to March 2016, using a self-administered questionnaire.Results A total of 614 mothers participated in the study, with a response rate of 94.5 per cent. Twenty-seven per cent (166) of them considered a temperature ≤38.5°C to be a high-grade fever, with the level of education significantly influenced mothers’ reports of high-grade fever (F=4.68, df.=4, P=0.001, n=207). Almost all the parents believed that heat could cause harm, and 48 per cent (294) of them stated that fever is very harmful. Fifty-three per cent of mothers (309) would give antipyretic medication when body temperature is ≤38°C. Sixty-one per cent (375) of the mothers had alternated antipyretic paracetamol and ibuprofen. Forty-five per cent (274) of parents think that antipyretics are without potential harm. Level of education had a positive impact on the perception of fever [χ2 (df=8)=70.68, p < 0.001]. Usual practices targeted temperature reduction using antipyretics by 53.7 per cent.ConclusionMothers have an imperfect knowledge of fever. Fever phobia is widespread, leading to an overuse of antipyretics
Serodiagnosis of Human Leptospirosis by Enzyme-Linked Immunosorbent Assay (ELISA)
No full textBackgroundLeptospirosis is a zoonotic bacterial disease that affects humans and animals. The disease occurs by contact direct or indirect with the urine of infected animal and common among agriculture workers, garbage collectors, sewage works, forestry and animal slaughtering. The disease also spreads in tropical regions where the conditions are favourable for leptospires. AimsThe purpose of this study is to determine human leptospirosis among suspected cases by ELISA IgM (a retrospective study on 50 cases from 2004 to 2010).MethodsSera from patients had fever and jaundice suspected clinically from leptospirosis, were referred to the National Institute of Hygiene in Rabat, Morocco. ELISA IgM and SAT were used for the diagnosis. Results While 33 serums were positive by Slide Agglutination Test (SAT), thirty one serums were positive by ELISA IgM. The sensitivity was 62 per cent and 66 per cent in ELISA and SAT respectively. ConclusionELISA IgM and SAT seem to be useful for human leptospirosis; they can detect the disease from the 5th day of the illness. They are easy, inexpensive and useful for developing countries and less equipped laboratories. However, if the first sera was negative, the second sera should obtained in the second week, or PCR used in combination with serological tests if it is available