Australasian Medical Journal
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Is there a seasonal variation in HbA1c in Australia?
Get PDFBackgroundA recent publication has shown that the prevalence of gestational diabetes mellitus (GDM) diagnosed with a glucose tolerance test (GTT) has a significant seasonal variation. The HbA1c has been proposed as an alternate method for testing of GDM.AimsNumerous reports indicate that in the Northern Hemisphere the HbA1c is higher in winter. The aim of this study was to assess if there was a seasonal variation in the HbA1c in a temperate climate.Methods Southern IML Pathology (SIML) is the major provider of pathology services in Wollongong and surrounding areas. De-identified data were obtained from SIML from January 2011 to December 2015. The data included the date of collection, date of birth, gender and HbA1c.Results A total of 203,170 HbA1c results were available for analysis. The median HbA1c was 6.6 per cent (48mmol/mol) for each season. While these differences were statistically significant (due to the large numbers used for analysis), it was felt unlikely to be of clinical significance. There was also no difference in the median HbA1c in females with HbA1c ≤6.0 per cent; the probable range during pregnancy.ConclusionWhereas in the Northern hemisphere the HbA1c does exhibit seasonal variation, this was not apparent in a temperate climate. Specific data are required during pregnancy. HbA1c could be considered as an alternative diagnostic test during pregnancy to potentially overcome the changes in prevalence with seasons with GTT
Prevalence of obesity in Kazakhstan
Get PDFBackgroundObesity is a growing problem throughout the world, including Kazakhstan. However, the obesity rate in interconnection with diabetes and geographical features of the Kazakhstan, has not been investigated yet.AimsTo scrutinize the spatial rates of obesity in various regions of Kazakhstan. Methods Investigations are epidemiological, continuous (covering the entire territory of the state). They are carried out by means of mass medical examination. In addition, the studies are descriptive (descriptive-evaluative) and analytical. Statistic data have been selected in accordance with the following criteria: the diagnosed cases of obesity, diabetes, the demographic survey in the country during the last 5 years; the morbidity rate per 100,000 population.Results The population increase over 5 years of the research turned out to be over 1.3 million people or 7.97 per cent. The annual growth rate, on average, amounted to 1.59 per cent. The total morbidity for all classes of diseases listed in “ICD-10” over the five-year period increased only by 1 per cent. However, morbidity related to endocrinological disorders, malnutrition and metabolic disorders (E00-E89) increased significantly by 19.7 per cent. ConclusionThe investigation revealed a stable growth in obesity, diabetes, metabolic and nutritional disorders. The annual increase in obesity rates during the study period amounted to 3.9 per cent. The highest correlation (Pearson) of obesity value and diabetes is (r, 0.96). South-Kazakhstan, Astana city and Almaty city were identified as the regions with the highest obesity rates.The identified regional features of obesity should help the healthcare system of Kazakhstan organize targeted arrangements to reduce the growth of this pathology
The insufficient formulation and vagueness of the definition ‘Traditional Health Practitioner’ as included in the Traditional Health Practitioners Act (Act No 22, 2007) of South Africa
No full textBackgroundThe main focus of the Traditional Health Practitioners Act No 22 (2007) is the regulation of traditional healing in South Africa. The role player who has to deliver this traditional health service to the public is the statutorily recognized traditional health practitioner. However, thus far the precise health practice offered, training and the practitioner’s role as a healer in the society, have not been clearly defined. The various definitions and descriptions in the literature of the identity of the traditional healer are contradictory, making the formulation of a single definition and meaning impossible.AimsThe study aimed to determine a definition for traditional health practitioner.Methods This is an exploratory and descriptive study in line with the modern historical approach of the investigation and review of the available research. The emphasis is on using documentation like articles, books and newspapers as primary resources to reflect on everyday thinking and opinions around the identity of the traditional healer. The findings are represented in narrative format.Results The Traditional Health Practitioners Act’s regulations, as embedded in its 52 Sections, create a legal framework of definitions. One specific definition outlines what is meant by the traditional health practitioner. This definition includes four sub-types of healers, namely the diviner, herbalist, traditional birth attendant and traditional surgeon. Various other names for and types of traditional healers seem to exists outside the Act’s statutory definitions. It also seems as if the practice scopes, training and methods of diagnosis and treatments of these different healers are not uniform.ConclusionIt seems that the legal definition of a traditional health practitioner, as offered by the Traditional Health Practitioners Act No 22, is vague and insufficiently formulated. This shortcoming frustrates the intention of the Act to make the traditional health practitioner the exclusive role player who has to deliver a traditional health service to the public
Will the Traditional Health Practitioners Act (Act No 22, 2007) challenge the holy grails of South African medical doctors?
No full textBackgroundThe South African healthcare establishment is primarily managed and overseen by medical doctors. This powerbase was established over many years, especially after the early 1930s. World War II gave doctors the final approval to take this supervisory and sole decision-making role regarding healthcare training, practice models and other health workers in South Africa. This phenomenon led initially to doctors having a certain jurisdiction to set the pace and to make the rules.This jurisdiction became more comprehensive and extent with time in South Africa to include a collection of unique medical traditions, customs, privileges, habits, healthcare rights and empowerment as well as exclusive medical training and practice models to become known as the holy grails of the South African medical doctors. The power of these holy grails has become untouchable to anyone outside the medical domain. Since the 1980s, some powers vested in these holy grails have been lost to the allied health professions and to other insiders of the HPCSA brotherhood itself.The recognition of traditional healers by means of the Traditional Health Practitioners Act (Act No 22, 2007) seems to challenge these holy grails of medical doctors. This may also create internal conflict in the South African medical brotherhood that can cost medical doctors more ground.AimsThe study aimed to determine if the Traditional Health Practitioners Act No 22 (2007) challenges the holy grails of South African medical doctors, subsequently affecting the long-established management and guardian system of the medical field within South Africa or the practice rights of medical doctors.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 possible effect of the Traditional Health Practitioners Act No 22 (2007) and traditional healers on the holy grails of South African medical doctors. The findings are offered in narrative form.Results It is clear that South African medical doctors are still largely in charge of all healthcare management. This fraternity serves as gatekeepers in relation to what medical healers are allowed, the level of their training and even their future. Newcomers like the allied and traditional health practitioners are not easily allowed into the medical doctors’ domain.ConclusionThe South African medical doctors’ interests as a specific healthcare provider group seem to be so well established that they give no thought to making dramatic changes to the present-day medical models and systems that they manage. They are not keen to relinquish any significant power as a group within the healthcare domain. This attitude means that the Traditional Health Practitioners Act no 22 (2007) can create enormous problems for South African medical doctors in future
Ultrasound-guided percutaneous treatment of liver hydatid cysts using 3% hydrogen peroxide as a scolicidal agent
No full textBackgroundHydatid disease of the liver is endemic in cattle areas of the world. A variety of treatment options is available. The common treatment options are medical therapy, surgery and puncture-aspiration-injection-reaspiration (PAIR) therapy. AimsTo evaluate the clinical outcomes and effectiveness of PAIR therapy in the treatment of liver hydatid disease using 3 per cent hydrogen peroxide (HP) as a scolicidal agent.Methods Between October 2012 and October 2015, seventy hydatid cysts in 52 patients were treated by PAIR procedure using three per cent HP as a scolicidal agent. Pre-procedural clinical, radiological and laboratory characteristics and post-procedural morbidity, mortality and length of hospital stay were recorded.Results We performed PAIR of 70 hydatid cysts in 52 patients with a success rate of 95 per cent without any mortality. The mean length of hospital stay was three days (ranges 1–8). In our series, minor complications occurred in six patients and major complications in five patients. The follow-up period ranged from 12–18 months, with a mean of 15.3 months. Three patients developed recurrence.ConclusionPAIR therapy is a minimally invasive procedure for Gharbi type I-III hepatic hydatid cysts. It is a relatively safe procedure with a significant reduction in the duration of hospital stay. We believed that HP by itself plays a role in influencing the results and the outcomes of PAIR
Investigation of different types of carcinomas among differentiated thyroid cancer patients managed in the Department of Nuclear Medicine
Get PDFBackgroundDifferentiated thyroid cancers (DTC) are abnormal tissues growing around the thyroid gland manifesting in various forms, they vary according to geographic locations and life style. Knowledge of different types of DTC is important in order to implement cost effective treatment strategies. AimsThis study was aimed at establishing the types of thyroid cancers among DTC patients managed with radioiodine post-surgery in the Department of Nuclear Medicine at Dr George Mukhari Academic Hospital (DGMAH) in South Africa. MethodsA retrospective five year (2007–2013) review of patient files managed post-surgery in the Nuclear Medicine Department for various thyroid diseases. A total of 51 patient files were examined. Males and females who received at least a single treatment dose of radioiodine (I-131) qualified for the study thus excluding 26 patients treated for grave’s disease and 9 DTC patients who did not receive a dose of radioiodine. A pie chart was used for categorical variables of the subtypes of carcinomas.ResultsThe follicular carcinoma was the leading malignancy: 8 /16; (50 per cent); followed by the papillary carcinomas amounting to 6/16; (37.5); only one patient was managed for the Hurtle cell carcinoma; 1/16 (6.25 per cent) and also one patient for poorly differentiated follicular carcinoma, 1/16; (6.25 per cent). ConclusionFollicular carcinoma was found to be the most common type of DTC managed at DGMAH followed by papillary carcinoma. However, the Hurtle cell carcinoma and the poorly differentiated follicular carcinomas were found to be rare
The evidence for biologic immunotherapy in Sarcoidosis: A systematic review
Get PDFBackgroundSarcoidosis is a chronic inflammatory disease with a myriad of clinical manifestations. Treatment involves immunosuppression with corticosteroids or steroid-sparing agents. A proportion of patients does not respond to or are intolerant to therapy. Targeted immunotherapy with biologic agents has emerged as a novel approach with plausible mechanistic reasons to warrant study. AimsThe aim of this review was to evaluate the evidence for the efficacy of biological therapy in sarcoidosis.Methods We conducted a systematic literature review and meta-analysis of all published randomised-controlled trials (RCT) evaluating biological therapy in sarcoidosis, using MEDLINE and Embase databases, through to September 2017. The search terms included sarcoidosis, infliximab, adalimumab, etanercept, golimumab, certolizumab, rituximab, abatacept, tocilizumab, anakinra, ustekinumab, secukinumab. Only articles reporting RCTs were selected. Improvements in respiratory disease were assessed by changes in forced vital capacity (FVC) by weighted mean difference (WMD). There were insufficient data on outcome measures in other organ systems to comparatively assess efficacy.Results The search identified 2,324 studies of which only 5 provided relevant and original data. This comprised a total of 364 patients, evaluating pulmonary, cutaneous and ocular sarcoidosis. One study in pulmonary disease and one study in cutaneous disease demonstrated improvements in the primary outcome. In pulmonary disease, meta-analysis of the treatment effect of anti-TNF therapy versus placebo on FVC revealed a WMD of 1.69 per cent (95 per cent confidence interval, 1.44–1.94). ConclusionThere are insufficient data to suggest the long-term efficacy of anti-TNFα inhibitors in the treatment of sarcoidosis. This may be due to heterogeneity, small sample sizes and the lack of consistent reporting of outcome measures
The highest realm of precision treatment of cancer – Extending from micro-level precision to holistic personalization
Get PDFBackgroundPrecision medicine opened the era of precision cancer treatment based on genetic variation, abnormal protein and other personalized factors. However, control of cancer cell proliferation and disease diffusion is not all we can do in cancer treatment. The strength of the human immune system, human basic physiological functions and normal metabolic activity, as well as the elimination of disease complications, these are the important aspects closely related to cancer lesions and therapeutic effect. Precision medicine is rapidly starting to build a micro-level personalized human pathological condition description system by the current results of genes, proteins, metabolites, and other genomics research. Chinese medicine (CM), which has a history of more than 2,000 years in China, is a mature medical system which describe and adjust-control the state of the human body from the overall level personally. The future precise treatment of cancer requires micro-level precision, and personalized holistic human status control. Thus, the introduction of the CM's system of syndrome differentiation and treatment, making micro-level precision treatment gradually extended to personalized holistic human status control of the patient, will be the highest attainment of precision medicine in the treatment of cancer.AimsFrom the perspectives of theoretical and clinical practice, in personalised cancer treatment, it’s need target therapy for cancer lesions as well as proliferation control. It’s also requiring symptomatic treatment for different dysfunctions and complications in organs and systems based on holistic status. By achieving an organic integration of the micro-level precision of treating local lesions and the holistic personalised recuperation, the highest realm of precision treatment of cancer can be achieved
