Australasian Medical Journal
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Systemic Mastocytosis associated with Minimal Change Disease
Get PDFSystemic Mastocytosis (SM) has not previously been reported in association with minimal change disease (MCD). Mastocytosis is a rare myeloproliferative disease that is characterised by uncontrolled proliferation of aberrant mast cells. This can lead to a wide variety of symptoms and can present as either a cutaneous or a systemic disease. Systemic manifestations usually include bone marrow, intestine, liver and splenic infiltration of mast cells, with reports of renal manifestations being rare. This is a case report of a 70-year-old man who was known to have Systemic Mastocytosis and who presented with nephrotic range proteinuria. Renal biopsy diagnosed Minimal Change Disease with mast cell infiltration being an identified by C-kit staining. The patient was treated with steroids and is currently in remission of the proteinuria
Half and half nail or Lindsay’s nail
Get PDFA 62-year-old diabetic patient came to the outpatient department due to increasing tiredness in the past few months. On examination, his distal half of fingernails revealed pinkish red transverse band which is sharply demarcated by a dull white band proximally, consistent with half and half nail. Further evaluation showed evidence of chronic kidney disease due to long standing poorly controlled diabetes. Although half and half nail is seen in many conditions, it is relatively a specific clinical marker of end stage kidney disease and hence serves as an important diagnostic clue
Microbiological burden in Nepalese hospital air culture
No full textBackground The environmental matrices (water, air, and surfaces) play a vital role as reservoirs of Legionella spp. and Pseudomonas aeruginosa (Pseudomonas spp.). Hence, hospital environment control procedures are effective measures for reducing nosocomial infections. Aims This study was carried out to explore the profiles of microorganisms in air culture at various wards/units of a tertiary care hospital in Nepal. Methods A descriptive cross-sectional study was carried out at various wards/units of a tertiary care hospital in Nepal between January and September 2015 to explore the microbiological burden in inanimate objects. Each week one ward or unit was selected for the study. Bed, tap, the entire room, trolley, computer, phone, rack handles, table, chair, door, stethoscope, oxygen mask, gown, cupboard handles, and wash basins were selected for air culture testing. Ten different wards/units and 77 locations/pieces of equipment were selected for air culture by employing a simple random sampling technique. Information about the organisms was entered into the Statistical Package for the Social Sciences (SPSS) Version 22 (IBM: Armonk, NY) and descriptive analyses were carried out. Results Staphylococcus aureus (S. aureus), Micrococcus, coagulase negative staphylococcus (CONS), Bacillus, Pseudomonas aeruginosa, yeast, and Acinetobacter were the most commonly detected organisms. In the postoperative ward, S. aureus was the most frequently detected microorganism. Micrococcus was detected in four out of 10 locations. In the x-ray unit, S. aureus was detected in three out of four locations. Conclusion S. aureus, Micrococcus, CONS, Bacillus, Pseudomonas, yeast, and Acinetobacter were the most common organisms detected
Childhood hospitalisation for otitis media
Get PDFBackground The aim of this study was to assess the prevalence of hospitalisation for otitis media across the different risk indicators for Western Australian children (less than 15 years old) over a 10-year period. Method This retrospective population-based study used the de-identified detailed data of children under the age of 15 years, hospitalised for otitis media (OM), as determined by principal diagnosis (ICD-10AM) and obtained from the Western Australian (WA) Hospital Morbidity Dataset for 10 financial years from 1999–2000 to 2008–2009. Various risk indicators, including age, gender, Indigenous status, insurance status, hospital area, hospital type, and length of stay were also analysed. Results Out of 26,294 cases of in-hospital care, Indigenous children comprised 4.7 per cent (n=1,226), while the non-Indigenous children comprised 95.3 per cent (n=25,068). The majority of the children, nearly 98.8 per cent, were admitted for chronic OM. The children were grouped into three age groups, namely, 0–4 years, 5–9 years, and 10–14 years. Nearly two-thirds of all cases were in the 0–4-year age group. Significantly more non-Indigenous (51 per cent) than Indigenous children (2 per cent) had private health insurance. The hospitalisation rates were directly proportional between the number of Indigenous children living in the area and the increasing remoteness of the area along with greater socioeconomic disadvantage. There were 24 per cent more cases from very remote areas compared to highly accessible areas, and there were 60 per cent more cases from the most disadvantaged socioeconomic category, compared with the least disadvantaged category, for Indigenous children. Conclusion These data depict the variations in prevalence of otitis media hospitalisations within the community, as affected by various risk indicators
Enhancing cultural awareness education for undergraduate medical students
Get PDFBackgroundCultural awareness education is mandatory for medical programs, with particular emphasis on Aboriginal and Torres Strait Islander health. However, there is limited evidence to measure the impact of such education has on medical students.AimsThis paper presents the development and delivery of a cultural immersion activity for first year undergraduate medical students. Additionally we explore how this type of activity may improve attitudes, comprehension and perceived competence relating to working with and understanding people of different cultures.Methods A pre- and post-survey design was utilised in connection with a cultural immersion activity. First year medical students (N=284, responses 196, 69 per cent) from three cohorts (2012–2014 inclusive) voluntarily completed a cultural awareness questionnaire, which contained items that related to perceptions, personal characteristics and educational competence. The main outcome measures were changes in perceived cultural knowledge, awareness, beliefs and attitudes. Data were analysed using principal component analysis and obtained means comparison.Results Principal component analysis revealed five dimensions for pre-post comparison: Knowledge Acquisition, Perceptions of Role Modelling, Internal Beliefs and Reflections, Personality Variables and Institutional Influences. Non-parametric means comparison showed increased ratings for knowledge acquisition and institutional influences (p < 0.001), whilst a decline was noted for the personality variables (p < 0.05).ConclusionCultural immersion has great potential to elicit positive shifts in attitudinal and knowledge related aspects of cultural awareness at early stages in medical curricula. Negative directions also suggest that students question their beliefs and behaviours relating to cultural knowledge
The Traditional Health Practitioners Act No 22 (2007) of South Africa (Part 3: Implementations)
No full textBackgroundThe registration of an alleged 200,000 or more unregulated traditional healers in terms of the Traditional Health Practitioners Act (Act No 22, 2007) seems a challenging task. Section 1 of the Act prescribes clear legal guidelines for the registration of traditional healers on completion of a prescribed learning and training programme at an approved institution. The section also offers stipulations to acknowledge prior learning.AimsThis study aimed to determine the various options open to traditional healers to obtain formal registration as traditional health practitioners.Methods This is an exploratory and descriptive study that follows the modern historical approach of investigation by means of a literature review. The emphasis is on using current documentation, like articles, books and news papers, as primary resources to reflect on the options available for the registration of traditional healers. It also puts the options for future registration of traditional healers in perspective. The findings are offered in narrative form. Results An inquiry into the Traditional Health Practitioners Act No 22 seems to reveal that its prescribed legal guidelines are too strict and too comprehensive to allow all ±200,000 traditional healers who are practising at present into the system. However, Act No 22 does make provision for other less rigid options, like acknowledging prior learning. This can allow the aspiring traditional health practitioner to obtain full or provincial registration.ConclusionThere are implementation options available to accommodate a large number of unregistered healers into the system. The grandfather clause for instance recognizes prior learning and training. Another possibility is special entrance examinations
