Australasian Medical Journal
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Which one is reasonable option for necrosectomy of biliary-origin necrotizing pancreatitis immediate or late cholecystectomy?
Get PDFMetastatic cutaneous melanoma associated with vitreous seeding
Get PDFBackgroundOcular metastases of cutaneous melanoma exclusive to the vitreous are a rare presentation and usually represent disseminated disease. Although traditionally associated with poor outcomes, recent developments in melanoma treatment have vastly improved prognosis.AimsTo review new targeted therapies for metastatic-melanoma.MethodsLiterature review of current clinical guidelines, systematic reviews and case series surrounding current recommended targeted therapies for metastatic-melanoma.ResultsNew targeted therapeutic agents offer improved treatment response, progression free survival, overall survival and have a better side-effect profile than traditional chemotherapy agents for metastatic melanoma.ConclusionTargeted agents for melanoma have improved patient prognosis and life expectancy, likely leading to reduced need for surgical intervention
Healthcare meets Aesthetics: New approaches to the complex oral rehabilitations with implant-supported dental prostheses
No full textEdentulism can lead to significant functional impairment as well as unfavourable aesthetic and psychological changes in patients. Main problems include restrictions in diet, speech impairment and loss of bone tissue in the zone where the teeth are missing. Many patients choose to retard the replacement of missing teeth for economic reasons, as they believe that overdenture prosthesis can mean poor quality or poor aesthetics.The modern dentistry has greatly improved the quality of overdenture prosthesis on dental implants. Nowadays, such rehabilitative solution is considered as a fair compromise between economic and biological factors, without renouncing to top-quality aesthetics; but today we still need to stress the concept of good aesthetics as key-factor in improving the overall quality of life of our patients. The implant-supported overdenture can solve complex rehabilitative cases with a pretty easy prosthetic planning, ensuring highly-conservative surgery and great aesthetics, also thanks to the most advanced implants technologies and components. In this clinical case, we will improve the function and aesthetics in a patient that will benefit from a clinical and psychological point of view
A case of spuriously high CK-MB: Contemplate beyond cardiac
Get PDFCreatine kinase-MB (CK-MB) is a widely tested enzyme in cardiac disease and thus has important clinical implications. We relate the scenario of a young patient presenting with chest pain whose CK-MB levels remained inordinately elevated despite a normal total CK level, resolution of symptoms and exclusion of coronary artery disease. Further analysis by electrophoresis revealed the presence of a rare molecular variant of creatine kinase: macro-CK type 1. While this may be a benign finding, there are sparse data demonstrating an association with non-cardiac pathologies such as malignancy, endocrinopathies, connective tissue and autoimmune diseases.Thus, after further exclusion of these associated conditions, the patient was reassured on the likely benign nature of macro-CK in this case
Vitiligo: A new side effect of everolimus therapy for metastatic renal cell carcinoma
Get PDFPatients with metastatic renal cell carcinoma (mRCC) have always had a poor prognosis. Recently new targeted drugs were developed. A 73-year-old female patient affected from mRCC was assessed at our Department. She underwent before a multitargeted tyrosine kinase inhibitor (TKI) therapy, but she developed progressive liver metastases so she was treated after with everolimus, an allosteric inhibitor of the mammalian target of rapamycin (mTOR), but started developing depigmented lesions over the neck. Vitiligo is a common cutaneous disorder and drug-induced vitiligo is reported. Our case can suggest a new type of drug-induced vitiligo, caused by a melanocyte-specific mechanism of toxicity
Does the traditional healer have a modern medical identity in South Africa?
No full textBackgroundResearch supports the view that the South African traditional healer does not hold a modern medical identity, but developed from the traditional African religions and cultural environment as a kind of caregiver. The name healer with a medical connotation arose from early colonists and missionaries misunderstanding the role of a traditional healer in Africa, especially in early South Africa. There is even a misunderstanding today about the African meaning of spiritual healing. As such, the traditional healer is a remnant from a previous, pre-modern time.Traditional healers were forced to the foreground recently in South Africa by the Traditional Health Practitioners Act No 22 (2007). This act makes the traditional healer an exclusive healthcare practitioner with statutory status under the name traditional health practitioner. Such a healer can practice in the formal healthcare sector, including the public hospitals. The Act gives the healer the right to diagnose, treat and make, and prescribe pre-modern health products to his/hers clients unhindered. It is clear that the various resolutions and implementations of the Traditional Health Practitioners Act No 22 (2007) intend to bring the South African traditional healer into the practice domain of the South African medical doctor. AimsThe study aimed to determine if the traditional healer has a medical identity in modern South Africa.Methods This is an exploratory and descriptive study that makes use of an historical approach by means of investigation and a literature review. The emphasis is on using current documentation like articles, books and newspapers as primary sources to reflect on the traditional healer’s medical identity in modern South Africa. The findings are offered in narrative form.Results The New South Africa did not start changing socially, economically and politically after 1994. They have started to move into new cultural and life domains centuries ago. Some left behind many of the pre-modern beliefs, like the traditional healer and his supernatural activities and practices. The present-day political and cultural pressure from politicians (with outdated thoughts) by means of things like the Traditional Health Practitioners Act No 22 (2007), are being met more and more with resistance by the broad population. It is therefore important to research on the changes in cultural values and styles, economical positions and the medical needs of the country’s population to understand if the traditional healer has a truly medical identity in modern South Africa.ConclusionThe Traditional Health Practitioners Act (No 22, 2007) has failed to include the outdated traditional healer into the modern South African society and formal healthcare sector as a specific medical entity. The foundations of South African society had changed too dramatically to allow space for a pre-modern cult practitioner
Are the fees that the traditional health practitioner charges generally lower than that of the medical practitioner?
No full textBackgroundThe cost of healthcare is a matter of concern for the public and the authorities. When a new healthcare provider enters the healthcare market, specifically the private sector, it is crucial to know if the fees will be affordable, especially when that service provider claims to be able to offer a far less expensive service than his competitors. The newcomer, the traditional health practitioner, was awarded statutory status in South Africa in terms of the Traditional Health Practitioners Act No 22 (2007). Although the training and skills of the various types of health practitioners are central to their ability to deliver an effective health service and influence the specific fee that the practitioner will charge, the focus of this research is only the financial aspect. Factors such as the nature, complexity, risk and difficulty level of procedures influence fees. The question here is whether the traditional health practitioner’s fees are in general lower in comparison with that of the medical practitioner.AimsThe study aimed to determine if the fees of the traditional health practitioner are in general lower in comparison with that of the medical practitioner.Methods This is an exploratory and descriptive study that makes use of a historical approach by means of investigation and a literature review. The emphasis is on using current documentation like articles, books and newspapers as primary sources to reflect on whether the fees of the traditional health practitioner are generally lower than that of the medical practitioner. The findings are offered in narrative form.Results The research could not uncover any evidence to support the claim that the fees of the traditional health practitioner are lower in comparison with that of the medical practitioner.ConclusionThis research could not confirm that the fees of the traditional health practitioner are in general lower when compared with that of the medical practitioner
The future registration of the White traditional healer in terms of the Traditional Health Practitioners Act (Act No 22, 2007) in South Africa
No full textBackgroundThe dilemma of the White traditional healer is an unexpected outcome of the intent to use the Traditional Health Practitioners Act No 22 (2007) to adhere to the ANC’s cultural rights declaration of 1969, which stated that they aim to bring the indigenous traditional healer into the South African health care sector. The traditional philosophy of a ‘calling’ and the unique way of practice that life as a traditional healer entails, ask for guidelines to address the matter.AimsThe study aims to determine if a White person can be accommodated in terms of the Traditional Health Practitioners Act No 22 (2007) as a traditional healer in South Africa.Methods This is an exploratory and descriptive study that makes use of an historical approach by means of investigation and a literature review. The emphasis is on using current documentation like articles, books and newspapers as primary sources to reflect on the South African White traditional healer and his position in the traditional healing fraternity. The findings are offered in the narrative form.Results Various ways have been identified in which an individual, including Whites, can become a traditional healer other than that of the traditional ‘calling’ to be a traditional healer and the customs and ceremonies.ConclusionAlthough the Traditional Health Practitioners Act No 22 (2007) emphasizes a traditional philosophy and underwrites unique practice rules and customs for the traditional health practitioner, it harbours, although vaguely and unspecific, descriptions that point to the end of the exclusively holistic traditional approach to healing. It would be possible in future to insert medical science into the traditional healer’s healing principles. The White person, without the ‘calling’ and not necessarily underwriting the pre-modern traditional philosophy, its customs and habits, can surely be a traditional health practitioner under the auspices of the Traditional Health Practitioners Act No 22 of 2007 in South Africa
Intravenous immunoglobulin to treat hyperbilirubinemia in neonates with isolated glucose-6-phosphate dehydrogenase deficiency
No full textBackgroundGlucose-6-phosphate dehydrogenase deficiency alone or concomitant with ABO isoimmunisation is a widespread indication for neonatal exchange transfusion.AimsTo evaluate the effectiveness of Intravenous Immunoglobulin in the treatment of neonatal hyperbilirubinemia due to glucose-6-phosphate dehydrogenase deficiencyMethods A retrospective cohort study was conducted between 2006 and 2014 at the Jordan University of Science and technology. The medical records of 43 infants admitted to the neonatal intensive care unit for isolated glucose-6-phosphate dehydrogenase deficiency hemolytic disease of the newborns were reviewed.Patients were divided into two groups. Group I, a historical cohort, included newborns born between 2006 and 2010, Treatment included phototherapy and exchange transfusion. Group II included newborns born between 2011 and 2014, where, in addition to phototherapy, intravenous immunoglobulin was administered. The duration of phototherapy and number of exchange transfusions were evaluated.Results Of 412 newborns that were admitted with neonatal hyperbilirubinemia, Glucose-6-phosphate dehydrogenase deficiency was present in 43. Of these, 22, did not receive intravenous immunoglobulin and served as a control group. The other 21 newborns received intravenous immunoglobulin. There was no difference in the demographic characteristics between the two groups.Infants in the control group were significantly more likely to receive exchange blood transfusion than infants in the immunoglobulin treatment group, but were significantly less likely to need phototherapy.ConclusionIntravenous immunoglobulin is an effective alternative to exchange transfusion in infants with glucose-6-phosphate dehydrogenase deficiency hemolytic disease of the newborn. It is suggested that intravenous immunoglobulin may be beneficial as a prophylaxis for infants with hyperbilirubinemia