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Review Articles

Early impact of rotavirus vaccination

Background: Rotavirus is the most common cause of severe gastroenteritis in children and two vaccines to prevent rotavirus infection have been licensed since 2006. The World Health Organisation recommends the inclusion of rotavirus vaccination of infants in all national immunisation programs. Aim: To review current literature evaluating the global impact of rotavirus immunisation programs over the first two years of their implementation. Methods: A MEDLINE search was undertaken to identify relevant observational studies. Results: Eighteen relevant studies were identified which had been carried out in eight countries. Introduction of the vaccine was associated with a reduction in all-cause gastroenteritis hospitalisation rates of 12- 78% in the target group and up to 43% in older groups ineligible for the vaccine. Hospitalisation rates for confirmed rotavirus cases ranged between 46-87% in the target group. Mortality from all-cause gastroenteritis was reduced by 41% and 45% in two countries studied. Conclusions: Early research evaluating rotavirus immunisation programs suggests significant decreases in diarrhoeal disease rates extending beyond the immunised group. Further monitoring will allow vaccine performance to be optimised and for the long-term effect of vaccination programs to be assessed.

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Review Articles

Balance and gait stability following sports-related concussion

Background: Concussion is an injury that is associated with many sports, in particular ice hockey, martial arts and the various codes of football. Concussion alters the stability of a person and as stability is vital when playing sports, the consequences of undiagnosed and untreated concussions are enormous. Aim: To look at various methods used to assess posture and stability in athletes, and their use in making safe return to play decisions after a sport-induced concussion. Methods: A search was conducted through PubMed, using the terms ‘concussion’ and ‘sport.’ Article titles were initially screened by the author and if the title seemed to be relevant to the purpose of the review, the abstract of the article was then screened for relevance. Results: Concussion negatively impacts upon an athlete’s cognitive and motor functioning. Cognitive testing has previously been assessed and is currently used; however it has been shown that cognitive function may return before motor functioning. The time taken to recover the motor component is usually between three to ten days; however, this varies considerably between athletes. Balance and gait testing are a means of objectively assessing the stability of an athlete and have proved to be particularly useful in monitoring the recovery of an athlete after suffering concussion. Conclusion: Balance and gait testing are means of objectively assessing the stability of an athlete. Although their use is applicable to many situations, they have proved to be of particular usefulness in monitoring the recovery of an athlete after suffering concussion. Through their use, the subjectivity of the assessment is being eliminated, ensuring informed and supported decision-making regarding the safe return to play.

 

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Review Articles

Acute blood loss in children

Hypovolaemia is the leading cause of circulatory failure in children. Effective fluid resuscitation is a mainstay of patient management and is dependent on accurate detection of blood loss or volume depletion. Calculation of blood volume in children is based on age, weight and clinical physiology and the estimation of the volume of blood lost requires interpretation of the history and orthostatic vital signs, especially heart rates. Administration of fluids following these calculations will also be discussed.

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Review Articles

Management of infertility in the setting of polycystic ovary syndrome

Polycystic ovary syndrome (PCOS) is a common endocrine disorder which affects a significant number of premenopausal women in Australia. PCOS has long-term clinical implications which can lead to decreased quality of life and psychological morbidity. A major contributing factor to this is the impact of PCOS on a woman’s fertility. However, there are a number of treatment modalities that may be used to treat PCOS-related infertility and with appropriate treatment, a woman’s prognosis with regards to PCOS-related infertility can be excellent.

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Review Articles

Prevention of rheumatic heart disease: Potential for change

Rheumatic heart disease (RHD), an autoimmune reaction to an infection of rheumatogenic group A streptococcus bacteria, is characterised primarily by progressive and permanent heart valvular lesions, although other parts of the heart may be affected. Despite an overall decrease in the incidence of RHD in developed countries, it remains a pertinent health issue with high rates in developing countries and amongst certain Indigenous populations in industrialised countries. Primary, secondary and tertiary strategies for the prevention of rheumatic heart disease exist, as do numerous barriers to such strategies. A review of the literature, incorporating its epidemiology and pathophysiology, demonstrates that interventions at various stages of the disease may reduce the collective burden of disease.

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Review Articles

Human papillomavirus in head and neck squamous cell carcinoma

Background: Head and neck squamous cell carcinoma (HNSCC) is a significant global health burden. Approximately 25 percent of HNSCC cases are caused by human papillomavirus (HPV). These particular cancers of viral aetiology have been found to have distinct characteristics in regards to presentation, treatment and prognosis. Current advances in vaccinology have the capability to drastically decrease the incidence of HPV-positive HNSCC. Methods: A literature review was undertaken through MEDLINE/PubMED/Ovid databases. The terms “HPV,” “HNSCC,” “carcinogenesis,” “treatment,” “prognosis” and “vaccine” were searched. Only studies published in English were considered with 65 articles selected and analysed. Preference was given to studies published in the last ten years. Results: The incidence of HPV-positive HNSCC is increasing. Infection with HPV can result in cancer through the expression of oncogenic proteins which disrupt normal cellular turnover. Aggressive treatment is often undertaken causing significant morbidity in many patients. A proportion of patients die from this disease, suggesting that these cancers have a considerable impact on society. Conclusion: Human papillomavirus is an infectious agent that is likely transmitted through skin-to-skin contact. The virus integrates into the DNA of the host with the high oncogenic risk genotypes, HPV 16 and 18 being strongly linked to HPV-positive HNSCC development. Prevention through vaccination against these genotypes is currently an option for all individuals. The cervical cancer vaccines immunise non-exposed females against HPV 16 and 18. Vaccination of both males and females will prevent HPV-positive HNSCC.

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Case Reports

Intra-vitreal bevacizumab in patients with Juvenile Vitelliform Dystrophy (Best Disease)

Figure 1. Right fundus of Case One, eighteen months prior to the time of presentation with decreased left visual acuity. A vitelliform macular lesion typical of Best disease is present.

Juvenile Vitelliform Dystrophy (Best disease) is a degenerative macular condition that is genetically inherited. In recent years monoclonal antibodies have been employed to help prevent the decline in vision associated with macular fluid. This report documents the use of intra-vitreal bevacizumab in two siblings (aged thirteen and fifteen) with Best Disease. This work studies the changes observed in visual acuity and macular oedema over a 39 and nineteen week period respectively.

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Case Reports

IVC thrombosis: An unusual complication of metastatic prostate cancer

Figure 1. Contrast enhanced abdominal CT scan: coronal section. This image demonstrates the ovoid hypodense filling defect in the IVC distal to the renal veins. The thrombus is expanding the cava (red circle). Note also the hypodense metastatic deposit in the liver (green circle).

This case report identifies an IVC thrombosis in a patient with stage IV prostate cancer. The case demonstrates hypercoagulability as one of the many complications of malignancy. The patient presented clinically with bilateral pitting oedema to the groin and into the scrotum with dilated superficial abdominal veins. The prostate cancer was aggressive and unresponsive to anti-androgen therapy and brachytherapy. The latest staging CT and bone scans revealed diffuse disseminated disease and a caval thrombus. He is now receiving chemotherapy as an outpatient and unfortunately his prognosis is unfavourable.

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Guest Articles

Medical research at the cutting edge – Alan Trounson

Prof. Alan Trouson

Introduction

I have had the experience of working in two major areas of human medicine that have been challenging and rewarding, and have provided some of the most heated debate on medical ethics and disturbance of established social mores. In many respects this made the developments even more difficult because they were frequently and avidly opposed by entrenched religious, political and gender advocates. The medical developments have been extremely successful. In the first place, human in vitro fertilisation (IVF) whose genesis occurred in the 1970s and 1980s has resulted in more than five million births worldwide and can no longer be simply quantified. In some countries with liberal health support systems, more than 3% of all live births are by IVF. The second great quantum development resides in stem cell based therapies, whose influence will be even more pervasive and influential, and whose significance is only just being evaluated in preclinical and clinical trials. This work has evolved from discoveries in bone marrow transplantation in the 1980s and 1990s and embryonic stem cell discoveries between 1998 and 2000…

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Guest Articles

‘We want you to be our mother’ – Fiona Stanley

Figure 1. Population pyramid demonstrating the relative youth of Australia’s Indigenous population, 2009.

Surely we don’t need any more research? Surely we know what to do to improve Aboriginal health? Surely we know the best environments for healthy child development? In this article I provide a rationale for Aboriginal child health research, give a history of my own personal journey in Aboriginal child health from the 1970s to 2011, give examples of our research and its application to improve outcomes and how we have provided the environment to build the careers of Aboriginal researchers; and finally, end with several recommendations.

The aims of the Telethon Institute for Child Health Research (TICHR) are fourfold:

  1. To conduct high quality research;
  2. To apply research findings (not only our own) to improve the health and well being of children, adolescents and families;
  3. To teach the next generation of health researchers; and
  4. To be an advocate for children, for research and for social justice.

We do all this by…