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Auckland, New Zealand

Williamson D.A.,Auckland District Health Board
The New Zealand medical journal | Year: 2011

Burkholderia cepacia complex organisms are environmental Gram-negative bacteria which rarely cause disease in otherwise immunocompetent individuals. We describe a case of tricuspid valve endocarditis secondary to B. cepacia complex in an injecting intravenous drug user in Auckland, New Zealand.

Reid I.R.,University of Auckland | Bolland M.J.,University of Auckland | Grey A.,Auckland District Health Board
The Lancet | Year: 2014

Background Findings from recent meta-analyses of vitamin D supplementation without co-administration of calcium have not shown fracture prevention, possibly because of insuffi cient power or inappropriate doses, or because the intervention was not targeted to defi cient populations. Despite these data, almost half of older adults (older than 50 years) continue to use these supplements. Bone mineral density can be used to detect biologically signifi cant eff ects in much smaller cohorts. We investigated whether vitamin D supplementation aff ects bone mineral density. Methods We searched Web of Science, Embase, and the Cochrane Database, from inception to July 8, 2012, for trials assessing the eff ects of vitamin D (D3 or D2, but not vitamin D metabolites) on bone mineral density. We included all randomised trials comparing interventions that diff ered only in vitamin D content, and which included adults(average age >20 years) without other metabolic bone diseases. We pooled data with a random eff ects meta-analysis with weighted mean diff erences and 95% CIs reported. To assess heterogeneity in results of individual studies, we used Cochran's Q statistic and the I2 statistic. The primary endpoint was the percentage change in bone mineral density from baseline. Findings Of 3930 citations identifi ed by the search strategy, 23 studies (mean duration 23.5 months, comprising 4082 participants, 92% women, average age 59 years) met the inclusion criteria. 19 studies had mainly white populations. Mean baseline serum 25-hydroxyvitamin D concentration was less than 50 nmol/L in eight studies (n=1791). In ten studies (n=2294), individuals were given vitamin D doses less than 800 IU per day. Bone mineraldensity was measured at one to fi ve sites (lumbar spine, femoral neck, total hip, trochanter, total body, or forearm) ineach study, so 70 tests of statistical signifi cance were done across the studies. There were six fi ndings of signifi cant benefi t, two of signifi cant detriment, and the rest were non-signifi cant. Only one study showed benefi t at more than one site. Results of our meta-analysis showed a small benefi t at the femoral neck (weighted mean diff erence 0.8%, 95% CI 0.2-1.4) with heterogeneity among trials (I2=67%, p<0.00027). No eff ect at any other site was reported, including the total hip. We recorded a bias toward positive results at the femoral neck and total hip. Interpretation Continuing widespread use of vitamin D for osteoporosis prevention in community-dwelling adults without specifi c risk factors for vitamin D defi ciency seems to be inappropriate. Funding Health Research Council of New Zealand.

Anderson N.E.,Auckland City Hospital | Chung K.,Auckland City Hospital | Willoughby E.,Auckland City Hospital | Croxson M.S.,Auckland District Health Board
Journal of Neurology, Neurosurgery and Psychiatry | Year: 2013

Objective To determine the frequency and range of neurological manifestations of phaeochromocytomas and secretory paragangliomas. Methods A retrospective review of case notes of patients admitted to Auckland Hospital from 1985 to 2011 with a discharge diagnosis of phaeochromocytoma or secretory paraganglioma. Results Ninety-three patients were admitted with a phaeochromocytoma or secretory paraganglioma. Sixtyeight patients (73%) had neurological symptoms, but only 15 patients (16%) received a neurological consultation. Neurological manifestations occurred in three main clinical contexts. First, paroxysmal symptoms occurred in 66 of 93 patients (71%). Neurological symptoms were common features of these attacks and included headache (47 patients), anxiety (24 patients), tremulousness (15 patients) and dizziness (12 patients). The headaches typically had an explosive onset. Delay in diagnosis was common. Second, 28 patients (30%) had an acute crisis, which was associated with neurological symptoms in 11 (39%) of the episodes: headache (10 patients); seizures (five patients); strokes (three patients); delirium (three patients) and subarachnoid haemorrhage (one patient). Third, five of six patients with a head and neck secretory paraganglioma had neurological symptoms related to infiltration of the middle ear or compression of cranial nerves. Reversible cerebral vasoconstriction syndrome (RCVS) was documented in three patients. Conclusions Neurological manifestations of phaeochromocytomas and secretory paragangliomas were common, and these tumours can present with various neurological manifestations. The paroxysmal symptoms can be incorrectly attributed to other headache syndromes, panic attacks or cerebral vasculitis. RCVS may play a role in the pathogenesis of the neurological symptoms associated with acute crises and paroxysmal attacks.

Dalbeth N.,University of Auckland | Milligan A.,Auckland District Health Board | Doyle A.J.,University of Auckland | Clark B.,Grafton Group | McQueen F.M.,University of Auckland
Arthritis Research and Therapy | Year: 2012

Introduction: Radiographic descriptions of gout have noted the tendency to hypertrophic bone changes. The aim of this study was to characterize the features of new bone formation (NBF) in gout, and to determine the relationship between NBF and other radiographic features of disease, particularly erosion and tophus.Methods: Paired plain radiographs (XR) and computed tomography (CT) scans of 798 individual hand and wrist joints from 20 patients with gout were analyzed. Following a structured review of a separate set of images, films were scored for the presence of the following features of NBF: spur, osteophyte, periosteal NBF, ankylosis and sclerosis. The relationship between NBF and other radiographic features was analyzed.Results: The most frequent forms of NBF were bone sclerosis and osteophyte. Spur and periosteal NBF were less common, and ankylosis was rare. On both XR and CT, joints with bone erosion were more likely to have NBF; for CT, if erosion was present, the odds ratios (OR) was 45.1 for spur, 3.3 for osteophyte, 16.6 for periosteal NBF, 26.6 for ankylosis and 32.3 for sclerosis, P for all < 0.01. Similarly, on CT, joints with intraosseous tophus were more likely to have NBF; if tophus was present, the OR was 48.4 for spur, 3.3 for osteophyte, 14.5 for periosteal NBF, 35.1 for ankylosis and 39.1 for sclerosis; P for all < 0.001.Conclusions: This detailed quantitative analysis has demonstrated that NBF occurs more frequently in joints affected by other features of gout. This work suggests a connection between bone loss, tophus, and formation of new bone during the process of joint remodelling in gout. © 2012 Dalbeth et al.; licensee BioMed Central Ltd.

Daleboudt G.M.N.,Leiden University | Broadbent E.,University of Auckland | McQueen F.,Auckland District Health Board | Kaptein A.A.,Leiden University
Journal of Psychosomatic Research | Year: 2013

Objective: Sexual problems are common in patients with chronic illnesses. However, few studies have investigated problems with sexual functioning in patients with systemic lupus erythematosus (SLE). The present cross-sectional study assessed the influence of SLE on sexual functioning and its associations with illness perceptions and medical and socio-demographic characteristics. Method: The study included 106 SLE patients who used at least one immunosuppressive agent to control their SLE. Sexual functioning was measured using the Physical Disability Sexual and Body Esteem and the Medical Impact Scale from the Sexual Functioning Questionnaire. Patients' illness perceptions were assessed using the Brief Illness Perception Questionnaire. Results: 49.1% of patients agreed that their SLE had a negative influence on their sexual functioning. In addition, treatment for SLE seemed to play an important role in the negative impact on sexual functioning. Patients' illness perceptions were more important predictors of sexual functioning than medical and socio-demographic characteristics. SLE patients appear to report a lower sexual functioning than patients with other chronic illnesses. Conclusion: SLE in general and immunosuppressive treatment for SLE specifically have a negative influence on sexual functioning. Patients' illness perceptions appear to play a more important role in the negative impact on sexual functioning than medical characteristics such as disease activity. The high prevalence of sexual problems highlights the need to more frequently address and aim to improve sexual functioning in patients with SLE. Patients may benefit from methods such as illness perception modification and coping style interventions to reduce their sexual problems. © 2012 Elsevier Inc.

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