Australasian Medical Journal
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Low Utilization of Thrombolysis in Stroke in Australia
No full textBackgroundThrombolysis remains the only approved therapy for acute ischaemic stroke (AIS); however, its utilisation is reported to be low.AimsThis study aimed to determine the reasons for the low utilisation of thrombolysis in clinical practice.Method Five metropolitan hospitals comprising two tertiary referral centres and three district hospitals conducted a retrospective, cross-sectional study. Researchers identified patients discharged with a principal diagnosis of AIS over a 12-month time period (July 2009–July 2010), and reviewed the medical record of systematically chosen samples.ResultsThe research team reviewed a total of 521 records (48.8% females, mean age 74.4 ±14 years, age range 5-102 years) from the 1261 AIS patients. Sixty-nine per cent of AIS patients failed to meet eligibility criteria to receive thrombolysis because individuals arrived at the hospital later than 4.5 hours after the onset of symptoms. The factors found to be positively associated with late arrival included confusion at onset, absence of a witness at onset and waiting for improvement of symptoms. However, factors negatively associated with late arrival encompassed facial droop, slurred speech and immediately calling an ambulance. Only 14.7% of the patients arriving within 4.5 hours received thrombolysis. The main reasons for exclusion included such factors as rapidly improving symptoms (28.2%), minor symptoms (17.2%), patient receiving therapeutic anticoagulation (6.7%) and severe stroke (5.5%).ConclusionA late patient presentation represents the most significant barrier to utilising thrombolysis in the acute stroke setting. Thrombolysis continues to be currently underutilised in potentially eligible patients, and additional research is needed to identify more precise criteria for selecting patients for thrombolysis
Magnesium sulphate versus Phenytoin in eclampsia - Maternal and Foetal outcome – A comparative study
Get PDFBackgroundEclampsia manifests as seizures and is unique to the pregnant state. It remains an important cause of maternal mortality especially in resource-challenged countries that lack access to prenatal care. AimsThe aim of our study was to compare maternal and foetal outcomes in mothers with eclampsia with the administration of either magnesium sulphate or phenytoin in a resource- challenged situation. MethodThe work was conducted from January 2012 to December 2012. A total of 80 patients were assigned alternately to two groups – one group was treated with magnesium sulphate (Group-M; n=40), and the other treated with phenytoin (Group-P; n=40) (Figure 1). The magnesium sulphate was administered according to the Pritchard’s regimen; phenytoin administered according to Ryan’s regimen. With either regimen, anticonvulsant therapy was continued for 24 hours postpartum or 24 hours after the last convulsion, whichever was later.ResultsFifty-four percent of patients regained consciousness within 8 hours of treatment onsetin Group-P compared to 5.3 percent in Group-M (p=0.0001, χ2=19.24). Seven patients in Group-P had recurrence of convulsions as compared to none of the 40 women assigned to Group-M (p=0.032, χ2=4.62). The incidence of Caesarean section was greater (62.5 per cent) in Group-M compared to Group-P (25 per cent; p=0.001, χ2= 9.96). No statistically significant differences were found in the foetal outcomes between the two groups.ConclusionPhenytoin use may be reconsidered in selective cases in low and middle income countries (LMIC) as it has been found simpler to use, has several benefits and also curtails treatment cost. Magnesium sulphate is substantially more effective than phenytoin with regard to recurrence of convulsions. Proper training in the management of eclampsia should be given to all health care workers to ensure appropriate management of eclamptic mothers. Thus, the treatment of this disease calls for more research work especially in the resource challenged settings
Why drug shortages are an ethical issue
Get PDFDrug shortages are a growing problem in developed countries. To some extent they are the result of technical and organisational failures, but to view drug shortages simply as technical and economic phenomena is to miss the fact that they are also ethical and political issues. This observation is important because it highlights both the moral and political imperative to respond to drug shortages as vigorously as possible, and the need for those addressing shortages to do so in ethically and politically sophisticated ways. This brief article outlines the ethical issues that need to be considered by anyone attempting to understand or address drug shortages
Relevance of pharmacoepidemiology to Nepal
Get PDFDrug-related problems such as overuse of injectable drug products and antimicrobials, increased cost of drug therapy, polypharmacy, and adverse drug reactions (ADRs) are prevalent in the healthcare settings of Nepal. To date, no new drug development processes or clinical trials have been conducted in Nepal, despite the fact that studies of real life situations are an essential tool for monitoring medicine use. Pharmacoepidemiology (PE) is an important area that evaluates the effects of drug use in large populations.Data obtained from pharmacoepidemiological studies may highlight ways to reduce certain drug-related problems and provide reliable information on the safety profile of a drug. Moreover, clinicians and regulatory authorities may also use the data to make drug therapy decisions, drug regulation and policy development. Therefore, there is a great need to conduct appropriate pharmacoepidemiological studies that involve multiple regions and in various groups of the population of Nepal, to collect unbiased and reliable information on drug use
Neonatal sepsis and multiple skin abscess in newborn with Down’s syndrome
Get PDFNeonatal sepsis is a leading cause of neonatal mortality. Congenital heart disease accounts for additional risk of sepsis in neonate. Here we report a case of Down’s syndrome with late onset neonatal sepsis associated with multiple superficial skin abscesses simulating staphylococcal infection. The baby was empirically treated with vancomycin. Subsequently, multidrug resistant Klebsiella pneumoniae was detected from both pus and blood culture. Change to appropriate antibiotic resulted in clinical recovery. Although sepsis is one of the major ailments in neonates, atypical presentations of neonatal sepsis in Down’s syndrome patients are underreported. Here we highlight the atypical presentation of Klebsiella sepsis and the importance of early antibiogram in such cases
A Case of Kingella Kingae Endocarditis Complicated by Native Mitral Valve Rupture
Get PDFWe report a case of Kingella kingae endocarditis in a patient with a history of recent respiratory tract infection and dental extraction. This case is remarkable for embolic and vasculitic phenomena in association with a large valve vegetation and valve perforation. Kingella kingae is an organism known to cause endocarditis, however early major complications are uncommon. Our case of Kingella endocarditis behaved in a virulent fashion necessitating a combined approach of intravenous antibiotic therapy and a valve replacement. It highlights the importance of expedited investigation for endocarditis in patients with Kingella bacteraemia
Endophthalmitis due to Brevibacterium Casei
Get PDFEndophthalmitis is a serious post-traumatic ocular complication that can lead to loss of vision. We report a case of acute post-traumatic endophthalmitis following a penetrating injury caused by an unusual organism, Brevibacterium casei. The patient was successfully treated with intravitreal antibiotics like ceftazidime and vancomycin, along with topical cefazolin and tobramycin. Brevibacterium casei can be added to the list of rare bacteria causing endophthalmitis and should be kept in mind by clinicians as a potential source of pathology