Survival of indigenous and non-Indigenous Queenslanders after a diagnosis of lung cancer: a matched cohort study

Objective: To compare survival of Indigenous and non-Indigenous lung cancer patients and to investigate any corresponding differences in stage, treatment and comorbidities.Design and setting: Cohort study of 158 Indigenous and 152 non-Indigenous patients (frequency-matched on age, sex and rurality) diagnosed with lung cancer between 1996 and 2002 and treated in Queensland public hospitals.Main outcome measures: Survival after diagnosis of lung cancer; effects of stage at diagnosis, treatment, comorbidities and histological subtype on lung cancer-specific survival.Results: Survival of Indigenous lung cancer patients was significantly lower than that of non-Indigenous patients (median survival, 4.3 v 10.3 months; hazard ratio, 1.48; 95% CI, 1.14–1.92). Of 158 Indigenous patients, 72 (46%) received active treatment with chemotherapy, radiotherapy or surgery compared with 109 (72%) of the 152 non-Indigenous patients, and this treatment disparity remained after adjusting for histological subtype, stage at diagnosis, and comorbidities (adjusted risk ratio, 0.65; 95% CI, 0.53–0.73). The treatment disparity explained most of the survival deficit: the hazard ratio reduced to 1.10 (95% CI, 0.83–1.44) after inclusion of treatment variables in the proportional hazards survival model. The remaining survival deficit was explained by the higher prevalence of comorbidities among Indigenous cancer patients, mainly diabetes.Conclusion: Survival after a diagnosis of lung cancer is worse for Indigenous patients than for non-Indigenous patients, and differences in treatment between the two groups are mainly responsible

Advances in the diagnosis and management of allergic disease : applications to South African practice

There have been a number of advances in the diagnosis and management of allergic diseases that are relevant to South African (SA) circumstances. These are all published or about to be published in new guidelines that provide practical advice to guide SA doctors who treat patients with these conditions. The guidelines include those for atopic dermatitis, allergic rhinitis and food allergy. This article reflects the most pertinent aspects of the guidelines. It also provides a short summary of a new allergy diagnostic test available in SA, the multiplex microarray chip, known as the immuno-solid-phase allergen chip (ISAC) test. It provides component-resolved allergy testing for special circumstances and complex allergic problems and is certainly not required as a screening allergy test. Finally, this article gives an update on allergen immunotherapy – some patients with allergic conditions may benefit from immunotherapy. In SA, some forms of immunotherapy for allergic rhinitis and mild asthma may currently include sublingual immunotherapy.http://www.samj.org.zaam201

Atopic dermatitis - prevention and education of patients

Why an article on prevention of atopic dermatitis and education of patients and their families? Well one might consider these two topics the two extremes of management of patients at risk from, or with, the condition. A physician might be called to intervene when families with risk factors for atopy consult at a very early stage (possibly even in pregnancy), and then again when a child has the disease expression. Without education in the management plan, all therapies for skin care are doomed to fail. Therefore, both these steps might be considered educational principles – education to avoid the condition if possible, and education to prevent flares of the condition. We are firm believers that the management of atopic and chronic conditions is centered on patient education.http://www.allergysa.org/journal.htm OR http://reference.sabinet.co.za/sa_epublication/cacitm201

Fever in children : how to minimise risk and provide appropriate therapy

The management of fever in children is a subject that garners many different opinions and interventions. Various approaches seem to be acceptable, from the physician who never uses antipyretic medication, to the use of multiple combination therapies. Following the recent publication of guidelines for the management of acute fever in children, there is now a standard against which fever in children should be managed. These guidelines aim to standardise the process of examining pyrexial children, elicit a reasonable history and then investigate the likely illnesses, so as to justify appropriate therapy.http://www.safpj.co.zahb201

The united airway - allergy and beyond

The concept of a 'united airway' became popular to link allergic rhinitis and asthma in many individuals who had symptoms of both upper and lower airway disease. Because of the common epithelium that runs all the way down the airway it is not surprising that in many individuals allergens trigger inflammation in both sites. However, the mere fact that some individuals have both symptoms of rhinitis and lower airway pathology does not mean the condition has an atopic basis. Since the airway has a limited number of ways of expressing symptoms, namely runny, sneezy, itchy and blocked nose, as well as cough or wheeze, these symptoms may also be produced in individuals who have quite a long list of other disease states. Although these are less common, healthcare workers will have to consider at some time that symptoms may be from primary ciliary dyskinesia, immune deficiency (primary or secondary), cystic fibrosis, Samter's triad or even recurrent viral airway infections. This article explores these conditions, suggesting their pathophysiology and symptom base. A clear message, to think of one of these conditions if symptoms do not have an allergy base and do not respond to first-line therapy, is expressed.http://www.allergysa.org/journal.htmam2013ay201

The medical dictionary ‘tongue-in-cheek' edition

Medical communication is often so formal, and one can't help thinking that sometimes a more light-hearted approach would be nice. We recently attended an advanced paediatric life support course in Pretoria (may we suggest that all doctors treating children should think of doing this course?), and on one of the days our group was in a silly mood. Attempting to describe perfusion in a child who isn't shocked but also doesn't have perfect perfusion, we came up with the term 'good-ish'. It felt so right, and everybody could identify with what we meant - '-ish': something that falls outside a medical tick-box; 'normal-ish': something's not quite right but one won't put one's medical head on the block; 'ok-ish': better, but who knows what will happen?http://www.samj.org.zaam2014ay201

An ideal children's chest and allergy clinic

The practice of Allergology has reached great heights in the last 2 years. South Africa has progressed from having Diplomates in Allergology to the recognition of sub-specialist Allergologists in Paediatrics, Internal Medicine and Family Practice. This is a new era for those of us interested in bringing the science of Allergology to our patients and already there is a sense that Allergology has joined other subspecialities in our country, to advance this aspect of science and medicine. However, the number of subspecialists in Allergology will remain small for many years and in the mean time, we will need our Allergy Diplomates, and other interested clinicians, to uphold the practice of Allergology in their own practices. This article is intended to provide a useful philosophical guide to what would make the general allergy clinic better able to meet the needs of patients. In this article we provide some ideas firstly for the ideal Children’s Chest and Allergy Clinic. We believe that allergic children and their parents want three things. They want an answer (a diagnosis), then they want a treatment (a therapeutic strategy) and lastly they want a therapeutic strategy that works or leads to a solution (improved quality of life). This article will suggest ways to achieve this in your own clinic.http://www.allergysa.org/journal.htmam201

A multicenter, prospective cohort study

Organ transplant recipients (OTRs) have a 100‐fold increased risk of cutaneous squamous cell carcinoma (cSCC). We prospectively evaluated the association between β genus human papillomaviruses (βPV) and keratinocyte carcinoma in OTRs. Two OTR cohorts without cSCC were assembled: cohort 1 was transplanted in 2003‐2006 (n = 274) and cohort 2 was transplanted in 1986‐2002 (n = 352). Participants were followed until death or cessation of follow‐up in 2016. βPV infection was assessed in eyebrow hair by using polymerase chain reaction–based methods. βPV IgG seroresponses were determined with multiplex serology. A competing risk model with delayed entry was used to estimate cumulative incidence of histologically proven cSCC and the effect of βPV by using a multivariable Cox regression model. Results are reported as adjusted hazard ratios (HRs). OTRs with 5 or more different βPV types in eyebrow hair had 1.7 times the risk of cSCC vs OTRs with 0 to 4 different types (HR 1.7, 95% confidence interval 1.1‐2.6). A similar risk was seen with high βPV loads (HR 1.8, 95% confidence interval 1.2‐2.8). No significant associations were seen between serum antibodies and cSCC or between βPV and basal cell carcinoma. The diversity and load of βPV types in eyebrow hair are associated with cSCC risk in OTRs, providing evidence that βPV is associated with cSCC carcinogenesis and may present a target for future preventive strategies

TRA-928: FISH BARRIER MITIGATION OF AN OVERSTEEPENED CULVERT WITHIN SAUGEEN FIRST NATION RESERVE

A deteriorated concrete box culvert conveying a tributary of the Saugeen River under Highway 21 in Ontario had reached the end of its lifespan and was in need of replacement. The tributary supports a diverse range of coldwater fish species such as Rainbow Trout; however, fish passage, particularly upstream migration, has been cut off since the culvert and highway were constructed over seventy-five years ago. Specifically, fish passage has been hindered by shallow sheet flow along the sixty metre flat bottom, excessive velocities associated with the smooth, seven percent gradient, and a perched barrier at the downstream outlet. A key component of the culvert replacement was an effort to improve the overall condition of the tributary’s natural environment, including the promotion of fish passage and migration opportunities. The culvert replacement project undertaken by the Ontario Ministry of Transportation (MTO) and MMM Group, coupled resources with the Saugeen Ojibway Nation (SON) Environment office, Parsons biologists, and Aquafor geomorphologists. The most ecologically sensitive replacement methodology of an open bottom structure was not viable for this project as it would have required a full closure of the Highway for approximately four months. A circular steel pipe culvert installed through tunneling was designed to by-pass and replace the existing concrete box culvert. In an effort to mitigate the current barriers to fish with the new pipe culvert, a prefabricated corrugated steel slip liner with engineered baffle arrangement was integrated into the design. The baffle configuration and geometry was designed by Jason Duguay (Université de Sherbrooke) and Ken Hannaford (Gov. NFLD), and the slip liner construction by the Corrugated Steel Pipe Institute. Construction of the new culvert and slip liner was completed in December, 2015, and a two year monitoring program will be undertaken to assess the effectiveness of barrier mitigation and geomorphic stability of the tributary