Prof. Peter Doherty won the Nobel Prize in Medicine in 1996 with his colleague Rolf Zinkernagel for the discovery of the interaction between T cells and the major histocompatibility complex (MHC). He was named Australian of the Year in 1997. He continues to make major contributions to immunology research, specifically in the area of influenza. The editors of the AMSJ asked Prof. Doherty to share some of the details of his journey leading up to his renowned immunological discoveries.
This case report describes a lady who presented with abdominal pain, hypotension and multiple ovarian follicles following egg collection and embryo transfer. She was provisionally diagnosed with Ovarian Hyperstimulation Syndrome (OHSS) and managed accordingly. This case study describes her clinical presentation, investigations, progress, management and outcome. No current laboratory diagnostic/prognostic markers are available for OHSS; the condition is currently diagnosed clinically. The subsequent discussion elaborates on the epidemiology, pathophysiology, clinical features, assessment, management and risk factors of OHSS, and aims to increase awareness of this important complication of infertility treatment to assist diagnosis, prevention and early institution of treatment.
Introduction: This case report aims to address the ethical issues and obligations of enforcing medical care onto psychiatric patients under the Queensland Mental Health Act 2000 Involuntary Treatment Order (ITO), and will also present Queensland’s legal standpoint and limitations on providing this care under the Act. Case Presentation: PF, a 47 year old male with a history of depression and recent diagnosis of Gleason 7 prostate cancer was admitted to the acute mental health unit following an intentional overdose of alprazolam. His risk to himself prompted the application of an ITO. Although PF was due for investigation of his recently diagnosed prostate cancer, he refused following his suicide attempt. Conclusion: Although an ITO allows for enforcement of psychiatric treatment, no legal allowances exist for enforcement of medical care. In situations where medical conditions may be indirectly detrimental to a person’s mental health, ethicallyappropriate techniques should be employed.
Background: Duchenne muscular dystrophy (DMD) is an X-linked recessive disease which causes skeletal muscle wasting in males, resulting in premature death during their early to mid 20s. Males with DMD carry defects in the gene encoding for dystrophin, a protein important in ensuring sarcolemmal stability. Dystrophin has also been implicated in disruption to Purkinje cells in the cerebellum. This disruption to cerebellar Purkinje cells has been proposed to be involved in reducing the IQ of affected boys. Aim: To compare Purkinje cell number and distribution in mutant mdx and normal mice. Methods: Cerebellar slices from both mutant (n=4) and normal (n=4) mice were prepared and stained. The number of Purkinje cells in each slice was estimated by three different cell counting techniques. Counting methods were as follows: firstly, the actual number of Purkinje cells per lobe; secondly, a randomised estimate where five random sections of the Purkinje cells layer were selected, counted and averaged; thirdly, an estimated maximum possible count, where three segments from the Purkinje cell layer with the highest density of cells were used to estimate Purkinje cell population. Results: No statistical significance in Purkinje cell numbers between the two groups was found. However, there was a trend towards a decrease in the median number of Purkinje cells in the mutant group, particularly in lobules 3, 4/5, 6 and 10. Conclusion: The study findings suggest a decrease in Purkinje cell number in mdx mice. The small sample size of this study precludes definitive statistical analysis of Purkinje cell numbers in either group. These findings demonstrate a need for larger mouse-model studies to accurately assess differences in cell numbers between the two groups. Given that the greatest difference in cell numbers was demonstrated in lobules 3 and 4/5, the authors suggest that DMD may affect the cerebellum during the maturation of these lobules. Importantly, a reduced Purkinje cell population may be implicated in the intellectual morbidity in boys with DMD.
In 2009, a woman pleaded guilty to reckless homicide and faces up to five years in prison for exercising her husband to death in a swimming pool. He suffered a ‘heart attack.’ [1] We cannot know, however, whether this was an ischaemic event or an arrhythmia. Exercise is promoted and encouraged in society; it is considered a healthy pursuit with benefits to the heart and mind. We know that certain heart diseases make exercising dangerous, but what risk is exercise to a healthy person without known heart disease?
Ancient history records the death of the Greek messenger Phidippides who ran 26 miles from Marathon to Athens to deliver the news of the victory over Persian invaders, only to collapse and die soon after his arrival.
In the past few years we have heard of professional athletes collapsing during soccer and basketball games and on the athletics track. These are graphically represented and frequently viewed on YouTube. In September last year, Evander Sno, a midfielder for Dutch soccer giants, Ajax, suffered a cardiac arrest during a match. He was successfully resuscitated after four shocks from an external defibrillator – an outcome unfortunately not shared by several athletes in recent years.
Not so long ago, there was evidence to suggest that marathon runners were immune to coronary artery disease, [2] and this idea has pervaded public perception. If someone can compete in countless marathons and triathlons, how could they possibly be at risk of dying from a heart attack? This has been debunked however, with the finding that coronary disease is the major cause of exercise related deaths in the over 35 age group; a phenomenon also seen in younger individuals. [3] To confuse matters more, there is evidence that strenuous activity kills patients with known heart disease but the risk is reduced if they exercise on a regular basis compared with those who are sedentary. [4] To top it off, recent Australian research shows evidence of damage to the right ventricle detected by MRI following a triathlon in normal hearts. [5]
One of the problems in identifying athletes at risk is the similar appearances of the athletic heart to abnormal pathological hearts. Physiologic changes can occur which mimic the appearance of these conditions (so-called ‘athlete’s heart’). They can manifest as morphologic changes (such as wall thickening mimicking hypertrophic cardiomyopathy), ECG changes (usually voltage changes, non-specific…
We all want to be remembered for something – a major contribution to science, or a political triumph bringing peace to a beleaguered world, or perhaps you would like to be honoured with an eponymous syndrome? Or, more modestly, as one committed housewife said, “I would like simply to be remembered for making good gravy.” She held on to this humble desire until it was pointed out to her by some wit, that such a wish was really taking cannibalism too far. So what do we boil down to? If not exactly gravy, then perhaps a juicy bundle of conflicting desires encased in a will for pleasure. No philosopher, artist or scientist has been able to come up with a better reason for doing something than pleasure (giving it, and receiving it).
A world without pleasure is pointless. We may sense this pointlessness on a bad day as we go out to work, fighting stolidly to save impossible lives. But if we accord taking pleasure in our patients as a primary aim, all may not be lost. Of course we know that patients’ welfare and the relief of suffering should be our first concern. But this wears thin after a decade or two (or a week or two) at unpromising bedsides. Pleasure is the only motivator that lasts a professional lifetime. Like it or not, there is no alternative to pleasure. Just as the sex therapist must “give permission” to inhibited clients to enable them to partake of the full range of sexual pleasures, so medical authors have to give permission to fellow doctors to sample clinical pleasures. We are so conditioned by our objective scientific training that we tend to put pleasure last in the list of tasks we must accomplish – if it ever gets onto the list at all.
So what are the pleasures we are talking about? I was once told by a connoisseur, who happens to be a judge, that all pleasures are sensory (as he refilled my glass with a sumptuous wine). So “enjoying our patients” does sound rather cannibalistic in this context. While we do not exactly endorse this approach, it reminds us that swallowing is the vital precursor of many pleasures. And in the clinical context, this means swallowing the whole patient – hook, line and sinker. For those who do not fish, it may be necessary to point out that the sinker is…
Aim: To conduct a review of the literature to evaluate whether stethoscopes constitute a clinically significant vector of healthcareassociated infection, and to explore the behaviour, attitudes and beliefs about stethoscope hygiene amongst medical students. Methods: Section one: PubMed was searched for empirical studies written in English, published before 1 May 2010, dealing with colonisation rates of stethoscopes and self-reported frequency of stethoscope cleaning by healthcare staff. Thirty-one articles were systematically reviewed. Section two: Qualitative and quantitative cross-sectional study of medical students. A convenience sample of seventeen undergraduate medical students in years two, three and four were asked a series of thirteen questions exploring their knowledge, practice of and attitudes towards stethoscope hygiene. Results: The diaphragm and bell of stethoscopes are colonised with micro-organisms on average 87.3% of the time. On average, 14% of stethoscopes carry MRSA, and 16.5% carry gram-negative species. On average, 58.8% of doctors clean their stethoscope annually or never. Fifty-nine percent of students surveyed had never cleaned their stethoscope. Only 29% of students had ever been advised about stethoscope hygiene. Eighty-two percent of students felt senior colleagues had influenced their attitude (positive or negative) toward stethoscope hygiene. Conclusions: Stethoscopes potentially represent a moderate-to-high risk of infection transmission, particularly in vulnerable settings, yet stethoscope hygiene is rarely considered or practiced by doctors and medical students. Improving stethoscope hygiene in practice requires addressing the lack of formal education on the subject and the shortage of positive role models.
Aim: The aim of this review is to emphasise the global significance of Hepatitis B (HBV) and its vertical transmission, and to summarise the current status of preventative strategies. Methods: A literature review was carried out. PubMed, The Cochrane Collaboration and Medline were searched for both primary studies and reviews pertaining to vertical HBV transmission, its prevention and barriers to prevention. Key words used included “HBV,” “Hepatitis B,” “vertical transmission,” “mother to child transmission,” “prevention” and “epidemiology.” Results: HBV is a major cause of death from liver cancer and liver failure. HBV is the ninth leading cause of death internationally and accounts for up to 80% of the world’s primary liver cancers. In highly endemic areas, 75% of chronic HBV is acquired by vertical transmission (mother to child transmission at birth), or by horizontal transmission in early childhood. The earlier in life the disease is acquired, the greater the adverse consequences. Available therapies for preventing mother to child transmission are very effective and include multiple doses of HBV vaccine and usually, HBV immunoglobulin. However, up to 10% of infants acquire HBV despite this standard prophylaxis. Whether anti-viral agents should be given to mothers with a high viral load to prevent transmission remains controversial. Conclusion: HBV is an extremely important global public health issue. Prevention of vertical transmission is the most important preventative strategy and current prophylactic therapies are highly effective. Emerging approaches for mothers with a high viral load require further investigation to determine whether they are effective and safe. Developing countries face the issues of cost, access and education to apply prevention strategies, while developed countries need processes to ensure adherence to established recommendations.
Introduction
Of the approximately 130 million babies born each year, an estimated four million babies die in the neonatal period. Globally, the main causes of death are estimated to be preterm birth (28%), severe infections (26%) and asphyxia (23%). [1] New South Wales (NSW) is the most populous state in Australia with approximately 86,000 births per year. In 2006, 6,044 babies in NSW were registered to neonatal intensive care units (NICUs), representing 2.3% of total live births in that year. [2] Gestational age is highly correlated with birth outcomes including mortality. Each extra week of time spent in utero increases an infant’s chances of survival significantly, and by 27 weeks of pregnancy, over 90% of infants will survive.
There are significant differences between common causes of death in the pre-term population (less than 37 weeks gestation) and the term population (37+ weeks gestation). The most notable difference is an approximate five-fold increase in deaths caused by congenital neurological malformations in the term population compared with the pre-term population [3]. Premature infants have a considerably higher chance of dying than full-term infants. However, improved neonatal care, particularly the widespread use of surfactant replacement and antenatal steroids, has almost halved neonatal mortality in many parts of the world. [1] Between 1985 and 1991 in the United States, the overall neonatal mortality rate declined from 5.4 to 4.0 per 1,000 live births. An understanding of causes of neonatal death and changes in mortality rates is critical for prenatal counselling, decision making, quality control and further improvement in management.
In NSW, newborn infants are admitted to NICUs under the following criteria: gestational age less than 32 weeks, birth weight less than 1,500 grams, need for mechanical ventilation for four hours or more, continuous positive airways pressure for four hours or more and/or major surgery, defined as opening of the body cavity.
Newborns admitted to NICUs are cared for by a highly specialised team of medical, nursing and allied health staff. Despite the level of sickness and intensity of morbidities of NICU patients, mortality rates are relatively low. Neonatal mortality rate is defined as the number of neonatal deaths per 1,000 live births and includes all deaths of infants within 28 days after birth. Each neonate who dies in the NICU represents not only a financial cost to the community but more importantly, a significant emotional stress and grief for the involved parents and staff…
Abstract
Hand hygiene (HH) is today recognised as being the most important factor in preventing the spread of infections; however, adequate compliance with this remains unacceptably low amongst healthcare workers (HCWs). One of the leading products in the push for successful HH is the alcohol-based hand rub (ABHR), which currently exists as a ubiquitous item in healthcare facilities. This review amalgamates the current understanding of ABHRs, presenting an overview of important issues including its correct usage and insights into HH. Aimed at Australian HCWs and students, a small yet significant amount of attention is devoted to Hand Hygiene Australia – one of the leading authorities in this subject area. It may be concluded that the ABHR is an effective hand disinfectant that also improves HH compliance, and is thus highly recommended for use in healthcare settings.
