Diagnosis and management of pelvic inflammatory disease at an outpatient sexual health clinic: a chart audit

Background/Aims: To compare the management of pelvic inflammatory disease (PID) at the Townsville Sexual Health Services (TNSHS) with the Queensland Sexual Health Clinical Management Guidelines (QSHCMG), and identify areas of discrepancy. Methods: A retrospective chart audit of patients diagnosed with PID between January 2012 and December 2013 was conducted. Information from patient charts on the diagnostic criteria, investigations performed and management was retrieved and compared with the QSHCMG. Results: A total of 47 charts was identified with patient age range of 16-48 years. There was insufficient documentation of many features that were deemed as risk factors for PID by the QSHCMG, such as having multiple partners, concurrent bacterial vaginosis, previous sexually transmitted disease, vaginal douching, post-partum endometriosis and recent uterine instrumentation. Minimal diagnostic criteria were met by 37 (79%) patients. Documentation of investigations and management plan was complete in all patients. The antibiotic regimen prescribed (ceftriaxone 500 mg IMI stat, metronidazole 400 mg BD for two weeks and azithromycin 1 g stat (plus repeat in one week) matched that in the QSHCMG in all patients. Symptom improvement was documented in 33 of 40 patients (83%). Seven patients (15%) were lost to follow-up. Conclusion: Improvements could be made in the documentation of important parts of the history and clinical features that identify those patients diagnosed with PID

Emerging role of iron oxide nanoparticles in the diagnostic imaging of pancreatic cancer: a systematic review

Background/Aims: Pancreatic cancer is the fourth most common cause of cancer associated death worldwide with a five year survival rate less than 5%. The poor prognosis is mainly due to late presentation in 80% of patients and its drug resistant nature. Most diagnoses are made using contrast-enhanced computed-tomography (CT) or magnetic-resonance-imaging (MRI) which have a limited sensitivity between 76-86%. Iron oxide nanoparticles are increasingly used in the diagnostic imaging of pancreatic cancer, due their ability to selectively target tumour cells thereby increasing image resolution. The aim of this study is to identify studies investigating the use of iron oxide nanoparticles in the diagnostic imaging of pancreatic cancer. Methods: A systematic review was performed using PubMed for records up to 2015. Search terms used included "iron oxide nanoparticles", "pancreatic cancer" and "imaging". Results: A total of 16 studies were identified evaluating the use of iron oxide nanoparticles in the imaging of pancreatic cancer in-vitro and in in-vivo animal models. Eight of the studies evaluated the use of superparamagnetic-iron-oxide-nanoparticles (SPION), they showed SPION significantly decrease the T2 and T2* relaxation times of tumour tissue, providing a high sensitivity for MRI. Similar results were seen in eight studies that investigated the use of iron oxide nanoparticles conjugated to other molecules including gelatin, survivin, chemokine-receptor-4, silica-gold, endothelial-growth-factor-receptor, urokinase-receptor activator, Clostridium and a sonic-hedgehog target. Conclusion: Iron oxide nanoparticles in the form of SPION or conjugates are biocompatible and effective at targeting tumour cells and significantly attenuate MRI signals in T2-weighted images of pancreatic cancers from a range of cell lines

Emerging therapeutic potential of nanoparticles in pancreatic cancer: a systematic review of clinical trials

Pancreatic cancer is an aggressive disease with a five year survival rate of less than 5%, which is associated with late presentation. In recent years, research into nanomedicine and the use of nanoparticles as therapeutic agents for cancers has increased. This article describes the latest developments in the use of nanoparticles, and evaluates the risks and benefits of nanoparticles as an emerging therapy for pancreatic cancer. The Preferred Reporting Items of Systematic Reviews and Meta-Analyses checklist was used. Studies were extracted by searching the Embase, MEDLINE, SCOPUS, Web of Science, and Cochrane Library databases from inception to 18 March 2016 with no language restrictions. Clinical trials involving the use of nanoparticles as a therapeutic or prognostic option in patients with pancreatic cancer were considered. Selected studies were evaluated using the Jadad score for randomised control trials and the Therapy CA Worksheet for intervention studies. Of the 210 articles found, 10 clinical trials including one randomised control trial and nine phase I/II clinical trials met the inclusion criteria and were analysed. These studies demonstrated that nanoparticles can be used in conjunction with chemotherapeutic agents increasing their efficacy whilst reducing their toxicity. Increased efficacy of treatment with nanoparticles may improve the clinical outcomes and quality of life in patients with pancreatic cancer, although the long-term side effects are yet to be defined. The study registration number is CRD42015020009

Proton pump inhibitor use and vitamin B12 deficiency: a problem in the future

Background: Proton pump inhibitors (PPIs) are commonly prescribed in the clinical setting and are known to have a safe side effect profile and high efficacy. Recent\ud literature reviews showed a positive correlation between their long term use and adverse effects such as fractures, pneumonia and enteric infections. However these studies have inconclusive findings on PPI use leading to vitamin B12 deficiency.\ud \ud Aim: To determine whether there is an association between PPI use and vitamin B12 deficiency.\ud \ud Method: A systematic review was conducted using PubMed, Embase and the Cochrane Library for records between 1988-2012. Reference lists of review articles\ud were scanned to identify studies not found in the database search.\ud \ud Results: Studies meeting inclusion criteria consisted of two clinical trials, 13 observational studies, two case reports and seven review articles. The clinical trials suggested that vitamin B12 absorption is impaired during PPI therapy. Observational studies showed a reduction in serum vitamin B12 levels in participants on long term PPI therapy. Whether this led to vitamin B12 deficiency with a significant clinical impact remains unanswered.\ud \ud Conclusion: Certain groups of the population were at risk of developing vitamin B12 deficiency whilst on long term PPI therapy; this included the elderly, individuals with Zollinger Ellison syndrome, those on concurrent metformin and slow metabolisers of PPIs. Serum vitamin B12 levels should be monitored to minimise the haematological, gastrointestinal and neuropsychiatric manifestations of vitamin B12 deficiency

Barriers to the Management of Diabetes Mellitus - is there a Role for Laser Doppler Flowmetry?

Diabetes Mellitus (DM) is a chronic disease that carries a significant disease burden in Australia and worldwide. The aim of this paper is to identify current barriers in the management of diabetes, ascertain whether there is a benefit from early detection and determine whether LDF has the potential to reduce the disease burden of DM by reviewing the literature relating to its current uses and development. In this literature review search terms included; laser Doppler flowmetry, diabetes mellitus, barriers to management, uses, future, applications, vasomotion, subcutaneous, cost. Databases used included Google Scholar, Scopus, Science Direct and Medline. Publications from the Australian government and textbooks were also utilised. Articles reviewed had access to the full text and were in English

Spinal gout mimicking osteomyelitis

[Extract] A 41-year-old Australian man with a history of gout presented with severe thoracic back pain and fevers, causing him to be bed-bound for a week. There was no infectious or traumatic precipitating event. This magnetic resonance image of the spine showed a lytic lesion on the T1 spinous process with inflammatory changes in the adjacent soft tissues and surrounded by a small collection of fluid. There was no spinal cord involvement. The patient was treated for vertebral osteomyelitis and gout until a spinal aspirate showed monosodium urate crystals. He made a full recovery

Barriers to the management of diabetes mellitus - is there a future role for laser Doppler flowmetry?

Diabetes Mellitus (DM) is a chronic disease that carries a significant disease burden in Australia and worldwide. The aim of this paper is to identify current barriers in the management of diabetes, ascertain whether there is a benefit from early detection and determine whether LDF has the potential to reduce the disease burden of DM by reviewing the literature relating to its current uses and development. In this literature review search terms included; laser Doppler flowmetry, diabetes mellitus, barriers to management, uses, future, applications, vasomotion, subcutaneous, cost. Databases used included Google Scholar, Scopus, Science Direct and Medline. Publications from the Australian government and textbooks were also utilised. Articles reviewed had access to the full text and were in English

Proton pump inhibitors and vitamin B12 deficiency in older adults: a systematic review of clinical studies

Background/Aims: Proton pump inhibitors (PPIs) are commonly prescribed in the clinical setting worldwide. Current evidence shows an association between PPI use and fractures, pneumonia and enteric infections, with inconclusive findings on PPI use leading to vitamin B12 deficiency. This is particularly relevant in older adults as the physiological changes that occur with ageing predispose to illness and the occurrence of additional co-morbidities places them at a greater risk of vitamin B12 deficiency. The aim of this study is to determine whether the long term use of PPIs in the older adult population is related to vitamin B12 deficiency.\ud \ud Methods: A systematic review was conducted using Pubmed, Embase and the Cochrane library for records from 1988 up to 2015. Search terms used included: "proton pump inhibitors", "vitamin B12 deficiency", "cobalamin", "clinical studies", "elderly" and "older adults".\ud \ud Results: A total of seven studies were analysed, including one non-randomised-control- trial, one retrospective-cohort study, two retrospective-case-control studies, one cross-sectional study and two case reports. Four studies found an association between long term PPI use and vitamin B12 deficiency, a retrospective case-control study showed no association. Both the case reports show an association between long term PPI use and vitamin B12 deficiency. One case report demonstrated clinical manifestations of vitamin B12 deficiency.\ud \ud Conclusion: Small scale clinical studies suggest that vitamin B12 absorption is impaired in individuals on PPI therapy. This is supported by observational studies showing a reduction in vitamin B12 levels associated with long term PPI therapy in participants over 60 years, whether this association has a significant clinical impact remains unanswered

Diagnosis and management of pelvic inflammatory disease at an outpatient sexual health clinic: a chart audit

Background/Aims: To compare the management of pelvic inflammatory disease (PID) at the Townsville Sexual Health Services (TNSHS) with the Queensland Sexual Health Clinical Management Guidelines (QSHCMG), and identify areas of discrepancy. Methods: A retrospective chart audit of patients diagnosed with PID between January 2012 and December 2013 was conducted. Information from patient charts on the diagnostic criteria, investigations performed and management was retrieved and compared with the QSHCMG. Results: A total of 47 charts was identified with patient age range of 16-48 years. There was insufficient documentation of many features that were deemed as risk factors for PID by the QSHCMG, such as\ud having multiple partners, concurrent bacterial vaginosis, previous sexually transmitted disease, vaginal douching, post-partum endometriosis and recent uterine instrumentation. Minimal diagnostic criteria were met by 37 (79%) patients. Documentation of investigations and management plan was complete in all patients. The antibiotic regimen prescribed (ceftriaxone 500 mg IMI stat, metronidazole 400 mg BD for two weeks and azithromycin 1 g stat (plus repeat in one week) matched that in the QSHCMG in all patients. Symptom improvement was documented in 33 of 40 patients (83%). Seven\ud patients (15%) were lost to follow-up. Conclusion: Improvements could be made in the documentation of important parts of the history and clinical features that identify those patients diagnosed with PID