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Sydney, Australia

Two patients were admitted sequentially to a rural emergency department, then transferred to a tertiary intensive care unit, both with serious methanol poisoning from home-brewed alcohol. They were intubated, mechanically ventilated, and treated with intravenous and nasogastric ethanol and continuous venovenous haemodiafiltration. Although quite similar in presentation, metabolic complications and therapy, one patient became brain dead due to severe cerebral oedema, while the other was discharged without any significant complications. Their course highlights the importance of early treatment of non-ethanol alcohol poisoning. Source

Objective: To examine the effect of an education campaign based around a gold coin fine on ordering of C-reactive protein (CRP) tests. Design and setting: A retrospective analysis of CRP test ordering before and after the intervention in the emergency department (ED) of a tertiary referral hospital in metropolitan Sydney that sees about 60 000 patients per annum. The date of the intervention - 2 August 2013 - corresponded with Jeans for Genes Day. Main outcome measures: Number of CRP tests ordered in the ED. Results: 1290 CRP tests were ordered before the intervention (1-31 July), and 394 were ordered after the intervention (2-31 August). This decrease in CRP test ordering was despite an increased number of ED presentations in August compared with July (5219 v 5497 presentations). This represented an absolute reduction in the rate of CRP test ordering of 17.6% (95% CI, 16.2%-18.9%; P< 0.001). Conclusion: The threat of a gold coin fine for ordering a CRP test, as part of a broader education campaign, significantly reduced the number of CRP tests ordered in a tertiary referral ED. Source

Wang C.-C.,Nepean Hospital
Cancer Biology and Medicine

The association between cerebellar medulloblastoma and syringomyelia is uncommon and only found in pediatric patients. To date, adult medulloblastoma associated with syringomyelia has not been reported in the literature. Paroxysmal bradycardia is an uncommon clinical manifestation in posterior fossa tumors and likely to be vagally mediated via brainstem preganglionic cardiac motor neurons. This report introduces the diagnosis and treatment of a case of adult medulloblastoma associated with syringomyelia, which presented with paroxysmal bradycardia. © 2012 by Cancer Biology & Medicine. Source

Objective To describe the epidemiology of 2009 A/H1N1 influenza in critically ill pregnant women. Design Population based cohort study. Setting All intensive care units in Australia and New Zealand. Participants All women with 2009 H1N1 influenza who were pregnant or recently post partum and admitted to an intensive care unit in Australia or New Zealand between 1 June and 31 August 2009. Main outcome measures Maternal and neonatal mortality and morbidity. Results 64 pregnant or postpartum women admitted to an intensive care unit had confirmed 2009 H1N1 influenza. Compared with non-pregnant women of childbearing age, pregnant or postpartum women with 2009 H1N1 influenza were at increased risk of admission to an intensive care unit (relative risk 7.4, 95% confidence interval 5.5 to 10.0). This risk was 13-fold greater (13.2, 9.6 to 18.3) for women at 20 or more weeks' gestation. At the time of admission to an intensive care unit, 22 women (34%) were post partum and two had miscarried. 14 women (22%) gave birth during their stay in intensive care and 26 (41%) were discharged from an intensive care unit with ongoing pregnancy. All subsequently delivered. 44 women (69%) were mechanically ventilated. Of these, nine (14%) were treated with extracorporeal membrane oxygenation. Seven women (11%) died. Of 60 births after 20 weeks' gestation, four were stillbirths and three were infant deaths. 22 (39%) of the livebom babies were preterm and 32 (57%) were admitted to a neonatal intensive care unit. Of 20 babies tested, two were positive for the 2009 H1N1 virus. Conclusions Pregnancy is a risk factor for critical illness related to 2009 H1N1 influenza, which causes maternal and neonatal morbidity and mortality. Source

Objective: This article provides a brief review of the practical implications of the current diagnostic conceptualisation of generalised anxiety disorder (GAD) and an update on its pharmacotherapy. Conclusions: The diagnostic criteria for GAD need to be refined, to better reflect its clinical features and to make GAD more clinically useful. Various pharmacological agents are effective for GAD and to some extent, allow a tailored treatment approach. In addition to effectiveness, the choice of medication is influenced by the speed of therapeutic action, tolerability and habit-forming properties. Source

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