Australasian Medical Journal
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Additively manufactured custom load-bearing implantable devices
Get PDFBackgroundAdditive manufacturing technologies are being enthusiastically adopted by the orthopaedic community since they are providing new perspectives and new possibilities. First applications were finalised for educational purposes, pre-operative planning, and design of surgical guides; recent applications also encompass the production of implantable devices where 3D printing can bring substantial benefits such as customization, optimization, and manufacturing of very complex geometries. The conceptual smoothness of the whole process may lead to the idea that any medical practitioner can use a 3D printer and her/his imagination to design and produce novel products for personal or commercial use.AimsOutlining how the whole process presents more than one critical aspects, still demanding further research in order to allow a safe application of this technology for fully-custom design, in particular confining attention to orthopaedic/orthodontic prostheses defined as components responding mainly to a structural function.Methods Current knowledge of mechanical properties of additively manufactured components has been examined along with reasons why the behaviour of these components might differ from traditionally manufactured components. The structural information still missing for mechanical design is outlined.Results Mechanical properties of additively manufactured components are not completely known, and especially fatigue limit needs to be examined further.ConclusionAt the present stage, with reference to load-bearing implants subjected to many loading cycles, the indication of custom-made additively manufactured medical devices should be restricted to the cases with no viable alternative
Population pharmacokinetics of amikacin in neonatal intensive care unit patients
No full textBackgroundAmikacin treatment requires close monitoring of blood concentrations to increase the probability that levels achieved are both effective and safe.AimsWe described population pharmacokinetics parameters of amikacin in newborns from a Neonatal Intensive Care Unit with suspected or documented sepsis.Methods A nonlinear mixed-effect model approach was used to analyse the data.Results Twenty seven neonates were enrolled. Final parameter estimates were: Ke(h-1)=0.232x(CR) Exp-0.85; V(mL/kg)=497.ConclusionWeight and serum creatinine are associated with neonatal amikacin volume of distribution and elimination constant rate, respectively. The presence of sepsis may decrease amikacin elimination, although this observation should be further explored. These results could help to individualize amikacin dosage for neonates
Clinical profile of severe generalised tetanus patients
No full textBackgroundTetanus, a rare disease in today’s world, when occurs, takes a devastating course. However, with proper treatment and ventilatory support, patients with tetanus can survive and lead a healthy event-free life.AimsTo describe the clinical features, course, complications, treatment and outcomes in patients admitted to the medical intensive care unit (MICU) with severe generalised tetanus requiring mechanical ventilation. Methods A prospective study was conducted between September 2014 to February 2016, on 40 patients who had severe generalised tetanus. Adult patients (above 12 years age) who required mechanical ventilatory support were included. A detailed history, laboratory parameters, medications, supportive medical care, duration of mechanical ventilation and outcome were studied. Outcomes were defined as complete recovery or death. Results This study showed male to female ratio of 3:1, with 67.5 per cent patients under the age of 40 years. Most of the patients (95 per cent) were from rural population and all patients were unimmunized. Mortality was 82.6 per cent, when period of onset was less than two days. Autonomic dysfunction was the attributed cause of death in first seven days of hospital stay, while from second week onwards death was due to secondary complications (sepsis, ventilator associated pneumonia, etc.). Overall mortality rate was 52.5 per cent.ConclusionShorter the period of onset, more severe the disease, and high the mortality. Early mortality was attributed to autonomic dysfunction, while late mortality is attributed to secondary complications. These results matched with the existing literature and historical studies
Determining the true prevalence rate of Hepatitis-C in Pakistan
No full textBackgroundHepatitis-C is a serious public health concern in Pakistan, with an average prevalence rate of 8.7 per cent, has been reported.AimsThe objectives of this study are multifold: to comprehensively review the published reports, determine positive predictive value (PPV) of Hepatitis-C using Bayes’ Theorem and to perform meta-analysis using both raw prevalence rates and PPV rates.Methods Using available search engines and databases, a comprehensive literature search was performed on Hepatitis-C in Pakistan. Positive predictive values for the reported prevalence rates were calculated using Bayes’ Theorem. Results Average PPV value found to be 33 per cent of the prevalence rate indicating that even after high prevalence reports, the chance of actual disease is still low to moderate, necessitating further confirmatory diagnosis. This discrepancy may be attributed to several factors, including the highly varying rates of prevalence; and test sensitivity and test specificity.ConclusionRandom samples from various geographical locations and population segments are required to determine a realistic Hepatitis-C prevalence in Pakistan; in the absence of such representative samples, novel analytical and modeling approaches may offer a viable alternative to determine the actual prevalence rate and help devise better public health policy to combat the disease
Ankle-brachial index by automated method and renal function
No full textBackgroundThe ankle-brachial index (ABI) is a non-invasive method used for the diagnosis of peripheral arterial occlusive disease (PAOD).AimsTo determine the clinical features of patients submitted to ABI measurement by automatic method. To investigate association between ABI and renal function. Methods The present is a cross-sectional study. The study was performed in a private clinic in the city of Fortaleza (Ce)-Brazil. For ABI analysis, we utilized automatic methodology using a Microlife device. Data collection took place from March 2012 to January 2016. During this period, ABI was measured in 375 patients aged >50 years, who had a diagnosis of hypertension, diabetes or vascular disease. Results Of the 375 patients, 18 were categorized as having abnormal ABI (4.8 per cent) and 357 were normal ABI (95.2 per cent). Patients with abnormal ABI showed older mean age when compared to patients with normal ABI. Among patients with normal renal function, only 0.95 per cent showed abnormal ABI; among patients with abnormal renal function, 6 per cent showed abnormal ABI.ConclusionNo differences were observed when comparing the groups regarding gender or the prevalence of hypertension, diabetes, dyslipidaemia or CAD. Group with abnormal ABI had renal function greater impairment
CA 19-9 is more useful than CA 125 in the diagnosis of ovarian malignancy, and can truly differentiate the histological subtypes of the ovarian tumours
No full textBackgroundCA 125 is a tumour marker; commonly, used for screening ovarian malignancy. However, recent studies have proven a limited role for CA 125 as a diagnostic marker for ovarian cancer. Nevertheless; recently, a limited number of studies have demonstrated a role for CA 19-9 in the diagnosis and prognosis of malignant ovarian tumours.AimsTo evaluate the utility of CA 19-9 in the workup of suspected ovarian malignancy.Methods In this observational study, on the basis of histopathology reports of ovarian tumours, 45 patients were equally divided into three different groups namely; benign, borderline and malignant. All the patients had their serum CA 125 and CA 19-9 measured preoperatively. The data was analysed using SPSS version 16. One-way ANOVA with Turkey HSD, independent sample t-test and chi squared tests were run for the statistical analysis.Results Serum CA 125 does not predict the type of ovarian histopathology in a suspected ovarian malignancy, p>0.05. However, CA 19-9 is the highest in malignant (M=168.27±48.78,
Improving Chances? A design strategy to improve health and wellbeing for marginalised people
No full textBackgroundThere is a call for architects and designers to rethink what is meant by design for health. Therapeutic design in everyday settings is a growing area of concern AimsThe authors aim to provide alternative ways of approaching the design of facilities or places that integrate the end-user as a collaborator in the evolution of design ideas in order to create places, which will support their wellbeing. Methods The research integrated a theoretical Model with creative practice as research before gaining insights from the end-users and provider of a case study, a day facility for people who are homeless. Results The results are twofold. Firstly a Socio-Ecological Design Model (SEDM) and secondly, insights into a designing supportive environments for people who are homeless as an example of a marginalised group. ConclusionIt is possible to undertake a collaborative and informed process, which can act as a catalyst for positive change and challenge the current common processes to date
Importance of university teacher behaviour in the faculty of health science
Get PDFBackgroundWe describe the results from the questionnaire of Tuncel concerning the behaviour of university teachers, since university students believe they have influenced their academic achievement.AimsThe objective of this study was to reveal which behaviours of university teachers were most appreciated by the students in the first year of the studies taught at the Faculty of Health Sciences of Universidad Rey Juan Carlos in Madrid (Degrees in Medicine, Nursing, Physiotherapy, Dentistry, Psychology and Occupational Therapy).Methods 540 first-year students from the Health Sciences degree participated. An exploratory factor analysis of the items was performed and the internal consistency was studied using Cronbach’s alpha.ResultsStudents placed the most importance on the following areas: “Emotional aptitude of the university teacher”, “University teacher-student interaction”, “Achievement of teaching objectives”, “Connection between the teaching of theory and practical components”, “Organization and planning of teaching” and “Correct students and providing them with information on their progress and evolution”. It should be noted that affective factors and the relationship and close interaction with students were the areas most demanded and valued by the students.ConclusionMaking the teaching process more effective is an important goal of educational research. But few researchers take into account the point of view of the students and are primarily involved in determining the behaviour of university teachers. Therefore our aim in this study was to find out their opinions. We wanted to know which attitudes are the most valued by students of the Rey Juan Carlos University (Madrid, Spain) studying for degrees in the health sciences program. Once identified, we will be able to use this information to identify teaching strategies that could improve the minimum academic requirements of the university
Methods of Tick Removal: A Systematic Review of the Literature
No full textBackgroundAn increase in tick borne diseases in Australia has seen an interest in appropriate removal of ticks (order Ixodida) in order to prevent anaphylaxis, allergy and transmission of tick borne diseases.AimsA systematic review of peer-reviewed literature to determine what method of tick removal should be promoted in terms of preventing future health complications.Methods Thematic synthesis was used in two stages: – tick removal studies conducted on animals and humans were examined and the conclusions from all of these studies were compared, in order to ascertain the best tick removal method in relation to prevention of future medical problems (including tick bite allergy and transmission of infection).ConclusionThis systematic review documents the best method of tick removal based on scientific and medical studies between 1985 and 2016. It concludes that the best method is to remove the tick as soon as possible after it is detected, using either fine-tipped tweezers or a reputable commercially produced tick removal tool to pull the tick away from the site of attachment. Some methods of removal, such as applying chemicals like petroleum jelly, alcohol, or nail polish to the tick, have been discredited. Other methods of removal, such as freezing, while promising, have not yet been scientifically validated