Australasian Medical Journal
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Entrapment of the Martin-Gruber branch of median nerve in the forearm
Get PDFWe report a rare case of a dual neuro-vascular variation, which was observed in the right extremity of male cadaver. About an inch inferior to the elbow joint, three branches arose from the median nerve. These were the anterior interosseous branch, a Martin-Gruber branch (MGB) and a muscular branch. The MGB coursed infero-medially to join with the ulnar nerve by running posterior to the ulnar artery. It was surprising to observe that the MGB passed between the ulnar artery and its venae comitantes. There was an acute angulation of the MGB here, suggesting entrapment at this site
Newborn bloodspot screening in Australia
No full textBackground The aim of newborn bloodspot screening (NBS) is to identify rare genetic and non-genetic conditions in children soon after birth in order to commence therapies that prevent the development of progressive, serious, and irreversible disabilities. Universal NBS programmes have been implemented in most countries, with minor adaptations to target conditions most relevant to the local healthcare environment. Aims In this article, we describe the initiatives of international and Australian governments to develop policies to address the expansion of NBS in their healthcare systems. Methods We have reviewed published public policies and literature to formulate recommendations based on clinical, social, legal, and ethical principles to inform a national governance and policy framework for Australia. Results Australian policy makers have been slow to develop a coordinated plan. While the experience from other governments can guide our national policy, there are specific areas that require further consideration by Australian health experts. Key reforms involve the separation of policy and operational activities, multidisciplinary decision-making and oversight by the Australian Health Ministers’ Advisory Council for policy direction. Conclusion A formal national policy framework will guide the coordination of NBS services that can adapt to the needs of Australian children and families
Do interpersonal problems catalyse experimentation of substance use among adolescents?
Get PDFBackgroundThe upbringing and sociocultural factors determine the initial stages of habit formation in a child. Type of family, peer company, environment at school, and surroundings tend to influence adolescent’s tendency for substance experimentation and use.AimOur aim was to identify the extent of experimental substance use and catalytic effect of interpersonal relational problems among adolescents.MethodsA self-administered health risk screening questionnaire was used. The questionnaire focused on problems related to substance use; type of substances experimented with; and interpersonal problems with parents, peers, at school, and in the neighbourhood. A cross-sectional study design was adopted (n=1770, age 16–19 years). Data obtained was entered and analysed using SPSS 15.ResultsThe proportion of experimentation with substance was found out to be more in boys as compared to girls. Alcohol was mostly consumed by them followed by cigarettes, pan masala and other substances. Interpersonal issues with mothers, fathers, at home, school and residing town were found to be significant factors that influenced adolescents for substance experimentation and use. Higher age group among adolescents sex (male) were strong socio demographic predictors of adolescent substance use.ConclusionCordial environment at home especially with parents, age, sex (male), residing town/neighbourhood were found to be very significant predictors of substance use by adolescents
A descriptive study of patients with Guillain-Barré syndrome
Get PDFBackgroundGuillain-Barré syndrome (GBS) is an immune-mediated polyneuropathy characterised by progressive, symmetric muscle weakness with depressed or absent deep tendon reflexes. This is a relatively rare disorder. The long term outcomes in Australasian populations are not well described.AimsTo describe the epidemiology of patients with GBS attending an Australian metropolitan hospital over a 10-year period, including long-term (12 months) functional outcomes.Methods Review of medical records of GBS patients admitted to Frankston Hospital over a ten year period (June 2004 to July 2014).Results Thirty seven patients were identified. Median (IQR) age of onset was 60 years (51.5–73), with a M:F ratio of 1.06:1. A seasonal trend was noted, with one-third of cases occurring in winter, and another third in spring. An antecedent event was identified in many patients, with 17 patients having a preceding viral illness, and 10 having diarrhoea. Symptoms started in the legs in the majority of patients (67.5 per cent). Peak disability occurred at admission, with only 34.3 per cent able to mobilise independently at this time. This improved to 70.8 per cent of patients by 12 months. Eleven patients required ICU admission; six of whom required mechanical ventilation, with 50 per cent of them (N=3) requiring tracheostomy. 67.6 per cent of patients required inpatient rehabilitation prior to returning home.ConclusionThe findings are consistent with previous epidemiologic studies. The vast majority of patients were independent at 12-month follow-up
Basic life support through early clinical exposure: Students’ perspective
Get PDFBackgroundPreclinical students in Indian medical colleges, who are fresh from their secondary schooling, are required to accumulate facts in basic sciences without any practical reference. Growing awareness of the significance of early clinical exposure (ECE) has prompted many institutions worldwide to start programs to introduce preclinical students to clinical medicine early. Following the Medical Council of India (MCI), PSG Institute of Medical Sciences and Research (PSG IMSR), Coimbatore has introduced this program for first-year students.AimsIn this study, an attempt is made to analyse the students’ perspective on ECE. The effectiveness of this program and the extent to which the students are benefitted is being evaluated.MethodsThis study focuses on the experience of the students who rotated through Clinical Simulation Laboratory, where they had training in Basic Life Support (BLS) under the program of ECE. The pre-post survey conducted through a questionnaire was analysed.ResultsThe survey showed improvement in students’ knowledge and attitudes regarding BLS. Students recorded positive attributes regarding the session and found it “interesting” and “interactive.” They felt that the session motivated them to learn in an analytical way as opposed to the traditional learning style. The sessions were extremely rewarding.ConclusionThe BLS program was successful as many students felt that it instilled confidence in them and they were prepared for their future profession. ECE should be continued in the following years and other institutions should consider starting a similar program
Diagnosing intravascular large B cell lymphoma
No full textIntravascular large B cell lymphoma (IVLBCL) is a rare condition with a predilection for central nervous system involvement and is often misdiagnosed. This case report describes a 58-year-old gentleman who presented with paraparesis and subsequent dramatic neurological deterioration initially attributed to acute disseminated encephalomyelitis. Upon post-mortem examination, the correct diagnosis of intravascular large B cell lymphoma was reached. This condition has a poor prognosis but can be chemotherapy responsive. It is hoped that this case report will raise awareness of a rare and diagnostically challenging illness
A novel variant of the AGPAT2 mutation in generalized congenital lipodystrophy
Get PDFInherited lipodystrophies are rare causes of young onset diabetes characterised by abnormal fat distribution with unique set of clinical features. We present a case of 24 year old lady with young onset diabetes mellitus, acromegaloid features, virilisation, hepatomegaly, hypertriglyceridemia with almost complete absence of subcutaneous and visceral adipose tissue as assessed by DXA scan body composition and MRI abdomen. Based on the clinical presentation, a diagnosis of Berardinelli–Seip generalized lipodystrophy was considered. Genetic analysis using next generation sequencing identified a novel homozygous insertion mutation in 1-acylglycerol-3-phosphate O-acyltransferase 2(AGPAT2) gene which was further confirmed with Sanger sequencing
Wilson’s disease: Atypical Imaging features
No full textWilson’s disease is a genetic movement disorder with characteristic clinical and imaging features. We report a 17-year-old boy who presented with sialorrhea, hypophonic speech, paraparesis with repeated falls and recurrent seizures along with cognitive decline. He had bilateral Kayser Flescher rings. Other than the typical features of Wilson’s disease in cranial MRI, there were extensive white matter signal abnormalities (T2 and FLAIR hyperintensities) and gyriform contrast enhancement which are rare imaging features in Wilson's disease. A high index of suspicion is required to diagnose Wilson’s disease when atypical imaging features are present