Australasian Medical Journal
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Rasmussen's Encephalitis: A case report
Get PDFRasmussen’s encephalitis (RE) is a rare neurological disorder of inflammatory aetiology characterised by encephalitis, intractable seizures, hemiparesis, variable motor deficits, and dementia. It is not commonly considered in the clinical differential diagnosis of a patient with a past history of a stroke-like episode presenting with status epilepticus. It is suspected mainly in children in whom the disease is more common. Here we report a case of an adult man presenting with a common symptom of seizure caused by Rasmussen’s encephalitis
Medicines shortages in Australia–the reality
Get PDF Across Australia, there is a changing pattern of increasing medicine shortages, particularly affecting generic medications and injectables. Although shortages are happening for several reasons, the lack of national response from the Australian government and industry to mitigate these shortages and their impact on patient care is alarming. For this national issue, the federal government needs to be more proactive by preparing strategic policies to address this growing problem in clinical practice
Giant sigmoid diverticulum: A case report
Get PDFSigmoid colon diverticulosis is commonly seen in both the surgical outpatient and emergency departments. Rarely, these sigmoid diverticulum, which usually range from 2–3mm to 2cm in size, can enlarge to more than 10 times. This is due to a ball-valve type mechanism that traps colonic gas inside the sigmoid diverticulum causing it to gradually enlarge. Patients with a giant sigmoid diverticulum (GSD) must be investigated thoroughly as 2 per cent of patients will present with a colonic carcinoma either within or distal to the GSD. Clinical symptoms of a GSD can range from chronic abdominal pain, altered bowel habits, abdominal distention, weight loss, bleeding, perforation, fistula formation, or bowel obstruction. CT and plain abdominal x-ray is the investigation of choice for its diagnosis. Barium enema is useful to determine the presence of a carcinoma within the GSD. Sigmoidoscopy is useful to rule out a distal colonic carcinoma. This is the first published case where nocturnal diarrhoea is the primary differentiating symptom in the patient. The treatment of choice for a GSD is complete resection of the diverticulum and/or the adjacent sigmoid colon. This can be performed with a primary anastomosis or a double-stage procedure
Prevalence and patterns of hearing loss among chronic kidney disease patients undergoing haemodialysis
Get PDFBackground The prevalence, degree, and patterns of hearing loss associated with chronic kidney disease (CKD) reported by various studies differ significantly. The effects of haemodialysis and duration of disease on hearing loss remain unclear. Aims The aim of this study was to determine the prevalence and degree of hearing loss in CKD patients on haemodialysis. Methods This study included 120 CKD patients on haemodialysis. Information regarding age, gender, duration of disease, subjective hearing loss, exposure to ototoxic drugs, co- morbidities like diabetes, hypertension, and hypothyroidism, renal functions, electrolytes and number of haemodialysis sessions received were obtained. An equal number of age and sex matched controls were used to determine prevalence of hearing loss in CKD patients after subjecting both groups to pure tone audiometry. We compared CKD patients with and without hearing loss for association of hearing loss with disease duration, number of haemodialysis, and blood parameters. Results Hearing loss was present in 41.7 per cent of CKD patients, significantly higher than controls (p=0.001), and was mild in the majority of patients. Impairment was noted across high and low frequencies of audiometric testing. Median duration of disease was the same (18 months) among CKD patients with and without hearing loss (p=0.62). CKD patients with hearing loss received 72 haemodialysis compared to 122 sessions by those without hearing loss (p=0.04). Conclusion Mild sensorineural hearing loss is common in CKD. Hearing loss has no specific pattern as it prevails at high and low frequencies. Hearing loss may be inversely associated with the number of haemodialysis sessions but not with duration of disease
Obese Youth Can Benefit from Strength Training
No full textBackground Exercise has shown positive training effects on obesity-related inflammation, however, resistance training has shown mixed results concerning adipocytokine levels. Aims The purpose of this pilot study was to explore the effects of resistance training on blood adipocytokine concentrations in obese youth, with specific examination of the relationship between these biomarkers and improved fitness (i.e., aerobic capacity, muscular strength). Methods Fourteen obese adolescents (16.1 ± 1.6 y; BMI: 32.3 ± 3.9 kg/m2) participated in a 16-week resistance training intervention. Body composition, fasting blood concentrations of interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-α), adiponectin, and leptin were measured pre- and post-training. Aerobic capacity was assessed via a maximal discontinuous exercise test. The rate of gain in muscular strength was calculated as the slope of progression in 1-repetition maximum throughout the intervention. Results Resistance training increased lean mass (total, trunk) and decreased per cent body fat (total, trunk). The training also caused moderate clear decreases in IL-6 and TNF-α concentrations. A small increase in adiponectin was also observed before and after intervention. When the group was stratified by changes in aerobic capacity, there were substantially larger decreases in leptin levels for those with improved capacity. Correlation analyses also revealed a negative relationship between log-transformed leptin and aerobic capacity at rest. Improvement in quadriceps strength was positively correlated with IL-6 and TNF-α, while improvement in shoulder adductor strength was positively correlated with IL-6 only. Conclusion Resistance training improved adipocytokine markers, which were partially associated with improved physical fitness. Specifically, the relationship between strength improvements and IL-6 and TNF-α suggests an exercise-induced signalling pathway that results in overall adaptive decreases in systemic inflammation in obese youth
How nurses shape med students' identities
No full textBackground On their journey to “becoming” doctors, medical students encounter a range of health professionals who contribute to their socialisation into clinical practice. Amongst these individuals are registered nurses (RNs) in clinical practice who are often employed by medical schools as clinical tutors. These RNs will encounter medical students on campus and later in the clinical setting. Aims This qualitative study explored RNs’ perceptions of their contribution to medical students’ developing professional identities in order to provide a greater understanding of this process and ultimately inform future curriculum. Methods This qualitative study took place in 2012 at one Australian medical school as part of a broader study exploring medical students’ professional identity development from the perspectives of their teachers and trainers. Eight of the nine RNs involved in teaching procedural skills were interviewed. Recorded interviews were transcribed verbatim. Data were analysed inductively by the research team. Results Two major themes emerged: RNs as change agents and RNs as facilitators of medical students’ transition to the clinical environment. RNs as change agents related to their role modelling good practice, being patient-centred, and by emphasising factors contributing to good teamwork such as recognising and respecting individual professional roles. They facilitated students’ transition to the clinical environment often through personal narratives, by offering advice on how to behave and work with members of the healthcare team, and by being a point of contact in the hospital. Conclusion Based on their descriptions of how they role modelled good practice and how they facilitated students’ transition to clinical practice, we believe that RN clinical tutors do have the experience and expertise in clinical practice and a professional approach to patients to contribute to medical students’ developing professional identities as future doctors
Skull fractures: CT scans versus autopsies
No full textBackground Emergency departments rely on CT scans to manage trauma victims, especially for head injuries. Although the detection of an undisplaced fracture on a CT scan of the head without significant intracranial findings may be insignificant for a clinician, such cases are of paramount importance for medico-legal purposes because they help ascertain the nature, manner, and cause of the head injury. Aims The study was conducted with the objective of knowing the sensitivity and specificity of ante-mortem CT scan findings indicating the presence or absence of skull fractures. Methods Findings were confirmed during post-mortem examination of the subjects who had died during management but who had not had any surgical intervention. A comparative study of ante-mortem CT scan and autopsy findings with respect to fracture in traumatic head injuries was undertaken on 60 deceased individuals brought in for medico-legal post- mortem examination over a period of two years. Results Considering the autopsy findings as the gold standard, we have concluded that 14.6 per cent of the fractures were missed on CT scan findings compared to fractures found during autopsy. The sensitivity of CT scan for skull fractures was found to be 85.4 per cent and specificity was 100 per cent. Kappa was 0.787, which shows good agreement with
UCBC: A diagnostic test for early onset neonatal sepsis
No full textBackground Neonatal sepsis is a major cause of neonatal mortality. The clinical outcome mainly depends on the early diagnosis and peripheral venous blood culture (PVBC) is the most widely practiced diagnostic method. Aims This study aimed to evaluate the utility of umbilical cord blood culture (UCBC) in neonates at high risk of early onset neonatal sepsis (EONS) in comparison to peripheral venous blood culture. Methods A total of 40 neonates with two or more risk factors for EONS were included in the study. Umbilical cord blood was collected aseptically during delivery for blood culture and C-reactive protein (CRP). Peripheral venous blood was collected within 24 hours of birth for sepsis screen and PVBC. Results Although 11 babies were sepsis screen positive, cord blood CRP was negative in all cases. In comparison to PVBC, UCBC had 100 per cent sensitivity and 94.9 per cent specificity. The results of UCBC were consistent with PVBC. One neonate who was both UCBC and PVBC positive also had isolation of the same pathogen in both the cultures and 33 per cent PPV for UCBC. Conclusion UCBC is a simple convenient method, which ensures culture of adequate volume of blood from newborns allowing effective early isolation of bacterial pathogens, especially in EONS