Australasian Medical Journal
Not a member yet
1482 research outputs found
Sort by
Multi-drug resistant Acinetobacter species from various clinical samples in a tertiary care hospital from South India
Get PDFBackgroundAcinetobacter species are gram-negative coccobacilli belonging to the group of Non-Fermenting Gram-Negative Bacilli, which are ubiquitous in nature. They cause outbreaks in intensive care units and healthcare settings, and are becoming increasingly drug resistant.AimsTo determine the prevalence of multi-drug resistant Acinetobacter species from various clinical samples.Method Clinical samples were processed as per standard microbiological techniques. Antibiotic susceptibility testing was carried out on all the Acinetobacter isolates by Kirby-Bauer disc diffusion method as per CLSI guidelines.ResultsA total of 122 Acinetobacter spp. were isolated. 110 (90.16 per cent) were from in-patients, and 12 (9.83 per cent) were from out-patients. Out of 122 isolates, 44 (36.06 per cent) were from ICU. The majority of the isolates, 47 (38.52 per cent), were from pus samples followed by 25 (20.49 per cent) from endotracheal tube aspirate. Out of 122 isolates, 87 (71.31 per cent) were multi-drug resistant of which 15 (12.29 per cent) were resistant to all drugs tested.ConclusionAcinetobacter infections associated with multi-drug resistant and pan-resistant strains have emerged as important nosocomial pathogens in our setting
Medicine an evolving profession
Get PDFThe number of medical practitioners in the developed world has increased but in relative terms their incomes have decreased. Published comments suggest that some doctors are dissatisfied with what they earn. However doctors are still perceived as having a high status in society. Publicly available data suggests that doctors chose to live and work in affluent suburbs where arguably the need for their skills is less than that in neighbouring deprived areas. The gender balance in medicine is also changing with more women entering the workforce and a greater acceptance of part-time working arrangements. In some countries doctors have relinquished the responsibility for emergency out of hours care in general practice and personal continuity of care is no longer on offer. The profession is also challenged by policy makers’ enthusiasm for guidelines while the focus on multidisciplinary teamwork makes it more likely that patients will routinely be able to consult professionals other than medical practitioners. At the same time the internet has changed patient expectations so that health care providers will be expected to deploy information technology to satisfy patients. Medicine still has a great deal to offer. Information may be readily available on the internet, but it is not an independently sufficient, prerequisite for people to contend with the physical and psychological distress associated with disease and disability. We need to understand and promote the crucial role doctors play in society at a time of tremendous change in the attitudes to, and within, the profession
Electronic discharge summary driving advice: current practice and future directions
Get PDFBackgroundDriving is a complex task. Many older drivers are unaware of their obligation to inform authorities of conditions which may impact upon their driving safety. AimsThis study sought to establish the adequacy of driving advice in electronic discharge summaries from an Australian stroke unit.MethodOne month of in-patient electronic discharge summaries were reviewed. A predetermined list of items was used to assess each electronic discharge summary: age; gender; diagnosis; relevant co-morbidities; deficit at time of discharge; driving advice; length of stay; and discharge destination.ResultsOf 41 participants, the mean age was 72 years. Twenty patients had a discharge diagnosis of stroke, nine of transient ischaemic attack, four of seizure and one of encephalitis. Of these, only eight discharge summaries included driving advice.ConclusionThe documentation of driving advice in electronic discharge summaries is poor. This has important public health, ethical and medico-legal implications. Avenues for future research are explore
Lepromatous leprosy: An incidental diagnosis of a chronic untreated case
No full textLeprosy (Hansen’s disease) is caused by the obligate intracellular organism Mycobacterium leprae. It is an infectious, chronic granulomatous disease transmitted through close contact. The latest current data shows that in 2010, eleven new cases of leprosy were reported to the National Notifiable Diseases Surveillance System in Australia. We report the case of a patient with untreated chronic lepromatous leprosy diagnosed in Queensland, 2012. Delay in diagnosis may have been due to the rarity of this condition
Forgotten but not gone - Scrofuloderma in a migrant student from India
Get PDFA 34-year-old Indian student who immigrated to Australia five years ago presented with a four-week history of neck pain. Physical examination revealed two firm fixed cervical lymph nodes in the anterior triangle and midline region which were tender on palpation and erythematous on inspection. Cording phenomenon was found on ZN staining of FNA sample and mycobacterium tuberculosis (M.tb) PCR confirmed the diagnosis with incomplete resistance to isoniazid. Patient was treated with other three first line anti-tuberculosis medications for nine months with an excellent outcome. Prednisolone was also used as adjunctive therapy and tapered during the course of treatment
Primary non alcoholic fatty liver disease in hypertensive patients
Get PDFBackgroundNon-alcoholic fatty liver disease (NAFLD) is considered the most common liver disease affecting 15–25% of the general population.AimsThe aim of this study was to investigate the prevalence of NAFLD and the relationship between insulin sensitivity and NAFLD in grade III high and very high cardiovascular additional risk essential hypertensive patients according to the circadian blood pressure (BP) rhythm.Method This four-year prospective study was conducted at the Department of Internal Medicine at Cluj-Napoca’s Diagnosis and Treatment Centre in Romania. The study included grade III essential hypertensive patients. Hypertensive patients were divided into four groups according to the diurnal index (DI) from ABPM monitoring: dipper (D), non-dipper (ND), reverse-dipper (RD), and extreme-dipper (ED). All hypertensive patients underwent 24 ABPM, blood tests and abdominal ultrasonography for the diagnosis of fatty liver disease.ResultsThirty-five hypertensive patients were included in the study, with 31.42% ND, 11.43% RD, 8.57% ED and 48.57% D. The prevalence of NAFLD was significantly higher in ND, RD and ED when compared to D. When compared to the dipper group of hypertensive patients a statistically significantly higher level of plasma insulin was observed: in non-dipper [86.3±17.9pmol/l vs. 62.2±203pmol/l,
Predicting ICU Admissions from Attempted Suicide Presentations at an Emergency Department in Central Queensland, Australia
Get PDFBackgroundEmergency medicine physicians and psychiatric staff face a challenging job in risk stratifying patients presenting with suicide attempts to predict which patients need intensive care unit admission, hospital admission or can be discharged with psychiatry follow up.AimsThis study aims to analyse patients who were admitted to the intensive care unit or regular ward for suicide attempt, and the methods they employed in a rural Australian base hospital.MethodWe conducted a retrospective analysis of patients who presented with suicide attempts to the Rockhampton Base Hospital Emergency Department, Queensland Australia from 1 September 2007 to 31 August 2009. Multivariate logistic regression was undertaken to identify risk factors for ICU and regular ward admission, and predictors of suicide method.ResultsThere were 570 patients presenting with suicide attempts, 74 of which were repeat suicide attempts. There was a 10-fold increase in the odds of intensive care unit or ICU admission (CI 1.45-81.9, p=0.02) for patients who presented with drug overdose. Increased age (OR=1.02, 95 per cent CI 1.00-1.03, p=0.05), drug overdose (OR=2.69, 95 per cent CI 1.37-5.29, p=0.004), and previous suicide attempt (OR=1.53, 95 per cent CI 1.03-2.28, p=0.03) were significantly correlated with hospital admission. Male patients (OR=2.76, 95 per cent CI 1.43-5.30, p=0.002) and Aboriginal patients (OR=3.38, 95 per cent CI 1.42-8.05, p=0.006) were more likely to choose hanging as a suicide method.ConclusionWe identified drug overdose as a strong predictor of ICU admission, while age, drug overdose and history of previous suicide attempts predict hospital admission. We recommend reviewing physician practices, especially safe medication, in suicide risk patients. Our study also highlights the need for continued close collaboration by acute care and community mental health providers for quality improvement
The use of anaesthetic agents to provide anxiolysis and sedation in dentistry and oral surgery
Get PDFThroughout the world there is considerable variation in the techniques used to manage anxious dental patients requiring treatment. Traditionally anxious or phobic dental patients may have been sent for general anaesthesia to allow dental treatment be undertaken. While this is still the case for the more invasive oral surgical procedures, such as wisdom teeth extraction, sedation in general dentistry is becoming more popular. Various sedation techniques using many different anaesthetic agents have gained considerable popularity over the past 30 years. While the practice of sedating patients for dental procedures is invaluable in the management of suitably assessed patients, patient safety must always be the primary concern. Medical, dental and psychosocial considerations must be taken into account when evaluating the patient need and the patient suitability for sedation or general anaesthesia.The regulations that govern the practice of dental sedation vary throughout the world, in particular regarding the techniques used and the training necessary for dental practitioners to sedate patients. It is necessary for medical and dental practitioners to be up to date on current practice to ensure standards of practice, competence and safety throughout our profession.This article, the first in a two-part series, will provide information to practitioners on the practice of sedation in dentistry, the circumstances where it may be appropriate instead of general anaesthesia and the risks involved with sedation. It will also discuss the specific training and qualifications required for dental practitioners to provide sedation. The second article in this series will outline the different techniques used to administer inhalation, oral and intravenous sedation in dentistry and will focus on specific methods that are practiced
Vitamins are more Funky than Casimir thought
Get PDFWe celebrate; 2012, as the centenary of the discovery of the 'Vitamine'. Dr Casimir Funk first conceived the concept of ";;vital amines";;; essential nutrients with a specific action, requiring only minute quantities to cure a specific disease. Thus he is the godfather of the vitamin industry. His legacy is the heuristic that all vitamins are simple amines with one mode of action and thus effective in a single disease. Whilst this may be true for thiamine, it is not for other vitamins that have many modes of action and are implicated in many diseases. The limitations do not detract from the genius of his theory, its influence on medical thinking, and the founding the vitamin industry. However it is time to progress to a 21st Century understanding of vitamins.