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Gold Coast, Australia

Robinson P.C.,University of Queensland | Robinson P.C.,Gold Coast University Hospital | Horsburgh S.,University of Otago
Maturitas | Year: 2014

Gout is a common inflammatory arthritis precipitated by an inflammatory reaction to urate crystals in the joint. Gout is increasingly being recognised as a disease primarily of urate overload with arthritis being a consequence of this pathological accumulation. It is associated with a number of important co-morbidities including chronic kidney disease, obesity, diabetes and cardiovascular disease. The prevalence of gout is increasing around the world. Significant progress has been made in determining the genetic basis for both gout and hyperuricaemia. Environmental risk factors for gout have been identified as certain foods, alcohol and several medications. There is, however, little evidence that changing these environmental risks improves gout on an individual level. Treatment of gout encompasses two strategies: firstly treatment of inflammatory arthritis with non-steroidal anti-inflammatories, corticosteroids, colchicine or interleukin-1 inhibitors. The second and most important strategy is urate lowering, to a target of 0.36 mmol/L (6 mg/dL) or potentially lower in those with tophi (collections of crystalline urate subcutaneously). Along with urate lowering, adequate and prolonged gout flare prophylaxis is required to prevent the precipitation of acute attacks. Newer urate lowering agents are in development and have the potential to significantly expand the potential treatment options. Education of patients regarding the importance of life long urate lowering therapy and prophylaxis of acute attacks is critical to treatment success as adherence with medication is low in chronic diseases in general but especially in gout. © 2014 Elsevier Ireland Ltd.

Alassaf M.,Gold Coast University Hospital
International Journal of Surgery Case Reports | Year: 2015

INTRODUCTION Pneumoperitoneum, observed by radiography, is typically associated with the perforation of hollow viscous. More than 90% of all cases of pneumoperitoneum are the result of a gastrointestinal tract perforation. These patients usually present with signs of acute peritonitis and require immediate surgical exploration and intervention. However, rare cases of idiopathic spontaneous pneumoperitoneum do occur without any indication of visceral perforation and other known causes of the free intraperitoneal gas. PRESENTATION OF CASE A 66-year-old male presented to the emergency department on three separate occasions with similar episodes six months apart. Upon physical examination and subsequent testing, chest radiography revealed the presence of free intraperitoneal gas. A computerized tomography (CT) was performed in which pneumatosis and pneumoperitoneum was reported with the first two admissions and both laparotomies were negative. This patient continues to be followed for prostate cancer and bony metastases. All subsequent CT scans (last performed 01/2014) have shown no acute or chronic abdominal pathology and no obstructions. He also had upper and lower endoscopies in 2011, which were negative. DISCUSSION This case revealed very different finding than anticipated. The patient presented to the emergency department with symptoms unrelated to the CT findings of free intraperitoneal gas. On two separate occasions, the patient underwent a laparotomy with negative findings. The conventional course of treatment for pneumoperitoneum was followed, but was it necessary? Though the presentation of pneumoperitoneum is most often associated with significant pathology requiring surgical intervention, a more conservative approach may be applicable in cases similar to the one presented here. © 2014 Published by Elsevier Ltd. on behalf of Surgical Associates Ltd. This is an openaccess article under the CC BY-NC-ND license.

Beckmann M.M.,Obstetrics and Gynaecology | Widmer T.,Gold Coast University Hospital | Bolton E.,Obstetrics and Gynaecology
Australian and New Zealand Journal of Obstetrics and Gynaecology | Year: 2014

Background To date, there is a lack of evidence to suggest that a systematic and coordinated approach to prepregnancy care might make a difference. Aims To evaluate whether women who receive preconception care through a structured approach will be more likely to be healthy around the time of conception compared with women who plan their pregnancy but have not been exposed to preconception care. Methods A case control study was undertaken of women who attended the preconception care service and subsequently conceived, received maternity care and gave birth at Mater Health Services Brisbane between January 2010 and January 2013. Pregnancy information and birth outcomes for each woman who attended the service were matched with those of three women who reported that they had planned their pregnancy but did not attend the service. Records were matched for prepregnancy BMI, age, parity, prepregnancy smoking status and number of health conditions. Results Pregnant women who attended preconception care were more likely to have received adequate peri-conceptual folate, to report being vaccinated against influenza and hepatitis B, to have consulted with a specialist with the specific aim of optimising a pre-existing health condition and to report less weight gain up until booking. Preterm birth and hypertensive disorders of pregnancy were less common amongst women who had attended preconception care, and there were trends towards a decreased incidence of gestational diabetes, LGA and fetal anomalies. Conclusion These preliminary data provide some optimism that a comprehensive preconception care service may positively influence maternal and neonatal outcomes. © 2014 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists.

Islam F.,Griffith University | Gopalan V.,Griffith University | Smith R.A.,Griffith University | Smith R.A.,Queensland University of Technology | And 2 more authors.
Experimental Cell Research | Year: 2015

Cancer stem cells (CSCs) are a subpopulation of cancer cells with many clinical implications in most cancer types. One important clinical implication of CSCs is their role in cancer metastases, as reflected by their ability to initiate and drive micro and macro-metastases. The other important contributing factor for CSCs in cancer management is their function in causing treatment resistance and recurrence in cancer via their activation of different signalling pathways such as Notch, Wnt/β-catenin, TGF-β, Hedgehog, PI3K/Akt/mTOR and JAK/STAT pathways. Thus, many different therapeutic approaches are being tested for prevention and treatment of cancer recurrence. These may include treatment strategies targeting altered genetic signalling pathways by blocking specific cell surface molecules, altering the cancer microenvironments that nurture cancer stem cells, inducing differentiation of CSCs, immunotherapy based on CSCs associated antigens, exploiting metabolites to kill CSCs, and designing small interfering RNA/DNA molecules that especially target CSCs. Because of the huge potential of these approaches to improve cancer management, it is important to identify and isolate cancer stem cells for precise study and application of prior the research on their role in cancer. Commonly used methodologies for detection and isolation of CSCs include functional, image-based, molecular, cytological sorting and filtration approaches, the use of different surface markers and xenotransplantation. Overall, given their significance in cancer biology, refining the isolation and targeting of CSCs will play an important role in future management of cancer. •Cancer stem cells play an important role in cancer metastases. © 2015 Elsevier Inc.

Franks Z.,Griffith University | Nightingale R.,Gold Coast University Hospital
Australian Family Physician | Year: 2014

Background The association between perceived decreased fetal movement (DFM) and adverse outcomes in pregnancy is widely acknowledged. However, in the general practice setting, a common first point-of-call for pregnant women, guidelines for appropriate management of DFM are lacking. Objective This article reviews the current evidence surrounding women presenting with DFM and suggests appropriate management in the community setting and the indications for hospital referral. Discussion Maternal perception of DFM is a common reason for women to make contact with their healthcare provider. Women presenting on multiple occasions with DFM are at increased risk of poor perinatal outcomes, including fetal death, intrauterine fetal growth restriction (IUFGR) or preterm birth. An evaluation of women presenting with DFM should involve a thorough history, examination and auscultation of fetal heart, cardiotocography (CTG) and ultrasound if indicated.

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