Australasian Medical Journal
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Follicular Bronchiolitis in Primary Ciliary Dyskinesia
Get PDFCiliary dysfunction in primary ciliary dyskinesia (PCD) may be associated with bronchiolitis. Diffuse bronchiolitis has been reported in a subset of PCD patients having Kartagener's syndrome in Japan. We report the first case of follicular variant of bronchiolitis in a case of PCD presenting as recurrent episodes of cough, dyspnea and bronchiectasis
Catheter-directed thrombolysis for acute limb ischaemia: An audit
Get PDFBackground Acute limb ischaemia (ALI) is commonly managed with surgical intervention but catheter-directed thrombolysis (CDT) is a proven treatment alternative. CDT as a treatment for ALI is not common and is dependent on local practice. All patients receiving urokinase infusions at our institution currently require a bed in the high-dependency unit (HDU). Administering the infusion requires significant nursing time and this can be accommodated in HDU where the nurse-to-patient ratio is higher than it is on general wards. Aims To report the outcomes of the initial admission of patients who received CDT to manage ALI, and to give a cost estimate of their care. Method A retrospective audit was undertaken of all patients who received CDT with urokinase for the management of ALI over a four-year period. Success of thrombolysis was defined as a patient’s survival with no need for any surgical intervention prior to discharge. Outcome measures included the requirement for further vascular procedures in the same admission, the complication rate, and the median urokinase dose and duration. Cost estimates were based on hospital pharmacy and administration data. Results Seventy-three patients (median age 66 years, range 27–93 years) were included in the audit. The median urokinase dose was 2.3 million units (range 0.9–5.0 million units) with a median duration of treatment of 26 hours (range 3–96 hours). Fifty-seven patients did not require any further intervention prior to discharge, 14 had further intervention, and two died (one from a brainstem haemorrhage and one who deteriorated despite thrombolysis). The total cost per CDT case at our institution is currently approximately AUD 6,700 for a patient being treated in HDU for one and two days, respectively. If patients were treated on a general ward, the cost would be approximately AUD 3,000, respectively. Conclusion Rates of clinically acceptable clot lysis were high for patients treated with urokinase for ALI. Complication rates were comparable with published studies. Infusions can be required for prolonged periods of time and given the low complication rate, managing patients on a general ward rather than in the HDU is a feasible alternative and would reduce costs substantially
Potential cost to Western Australia of proposed patient co-payments according to healthcare organisational structure: A preliminary analysis
Get PDFBackgroundThe Australian federal government has proposed an AUD 6.3 million, 87.4 million at 1, 5, and 10 per cent diversion, respectively. Commonwealth receipts increase and expenditure on Medicare benefits declines.ConclusionA diversion of patients from GP surgeries to ED in WA caused by the co-payment will result in increased costs to the state, which may be substantial, and will reduce net costs to the Commonwealth
Team-based learning as a teaching strategy for first-year medical students
Get PDFBackgroundTeaching programmes in medical education are now routinely employing active learning strategies to enhance the learning process and engage students in higher levels of learning. Team-based learning (TBL) is one active learning strategy that builds on individuals’ strengths by allowing them to collaborate and work as a team to achieve a common learning objective.AimsThe present study aims to evaluate the impact of TBL on student performance. It also aims to assess students' attitudes towards TBL and the feasibility of its incorporation into the course curriculum.Methods From a class of 241 students, 128 who agreed to participate in the study underwent two sessions of TBL each consisting of Individual and Group Readiness Assurance Tests (IRATs and GRATs). The readiness assurance tests each had 13 multiple choice questions (MCQ). To analyse the impact of TBL supplementation, the median sessional MCQ scores of students who underwent TBL supplementation (group 1) were compared with those who did not undergo the session (group 2). Students' experiences with TBL and their attitudes towards incorporation of TBL into the course curriculum were analysed using a feedback questionnaire that was given to students who underwent TBL. Results Students belonging to the TBL group performed significantly better than the students who did not undergo TBL (
SGLT2 inhibitors: New medicines for addressing unmet therapeutic needs in type 2 diabetes
No full textThe prevalence of type 2 diabetes mellitus (T2DM) is rising in Australia. Sodium glucose co-transporter 2 (SGLT2) inhibitors are an emerging treatment for T2DM. SGLT2 inhibitors offer a novel approach to lowering hyperglycaemia by suppressing renal glucose reabsorption and increasing urinary glucose excretion. The increased urinary glucose excretion has also been associated with caloric loss and osmotic diuresis. Dapagliflozin and canagliflozin are the SGLT2 inhibitors that are approved for clinical use in the US, the European Union (EU), and Australia. Their use results in reductions in HbA1c and body weight across a broad range of patient populations ranging from drug-naive patients to those who require additional therapy due to inadequate glycaemic control on their existing treatment. In addition, reductions in blood pressure (BP), particularly systolic BP, have also been noted. SGLT2 inhibitors are generally well tolerated with low rates of adverse events. Episodes of hypoglycaemia were mostly classified as minor, with low and balanced rates of severe hypoglycaemia across studies. The proportions of patients with genital infections and urinary tract infections were higher with dapagliflozin and canagliflozin versus their comparators. However, these infections were generally mild-to-moderate in intensity, treated with standard antimicrobial therapies, and rarely led to discontinuation. No dosage adjustments for dapagliflozin and canagliflozin are recommended for normal-to-mild renal impairment. Dapagliflozin and canagliflozin are not recommended for use in patients with eGF
Bilateral Schizencephaly Type II
Get PDFBackgroundSchizencephaly is one of the most severe forms of neuronal migration defects and is an extremely rare cause of seizure disorder. Case detailsWe report a case of bilateral schizencephaly (Type II) presenting as seizure disorder since birth. DiscussionThis case is rare because of the relatively benign features compared to other reported cases. ConclusionCompared to other cases, this patient has normal cognitive and motor functioning. Given the scant literature on schizencephaly in India’s paediatric population, this case highlights the possibility of a very rare entity associated with seizures. MRI can detect this condition.
Miliary Tuberculosis with Left Brachial Monoplegia: A case report
Get PDFTuberculoma of the brain is a major neurological problem in developing countries accounting for 12 to 30 per cent of all intracranial masses. It often presents with focal neurological symptoms or seizures. Simultaneous occurrence of brain tuberculoma with miliary mottling in the lungs is uncommon in the immunocompetent patient. We report only the second case of monoplegia and miliary tuberculosis, wherein the patient presented with acute onset left brachial monoplegia, upper motor neuron facial palsy, and fever with an MRI of the brain showing multiple granulomas and chest x-ray showing miliary mottling. The patient’s neurological deficit started to resolve with corticosteroids and anti-tubercular treatment
