Primhak R.,Taranaki Base Hospital
Paediatrics and Child Health (United Kingdom) | Year: 2013
This review provides an overview of acute and chronic upper airway obstruction. Glottic or subglottic obstruction affects the airway when it is a single channel. This is potentially life-threatening and presents with stridor and/or respiratory distress. Supraglottic airway obstruction generally affects the nasal or nasopharyngeal airway and tends to predominantly affect breathing during sleep. There are a number of different causes for each of these clinical problems.In acute glottic or subglottic obstruction, management consists of a rapid assessment and the establishment of a secure airway when the obstruction is life-threatening. Thereafter the management will be targeted on the underlying condition. In supraglottic airway obstruction it is important to recognize that symptoms may be subtle and a high index of suspicion is needed, particularly when there are co-morbidities which make sleep-disordered breathing more likely. In severe supraglottic obstruction causing significant sleep-disordered breathing adenotonsillectomy is usually the treatment of choice, but other measures including non-invasive continuous positive airway pressure (CPAP) or ventilation may be necessary if this is unhelpful. © 2012 Elsevier Ltd.
Zhanje F.T.,Taranaki Base Hospital
New Zealand Medical Journal | Year: 2013
Peripartum cardiomyopathy (PPCM) is a dilated cardiomyopathy in which left ventricular systolic dysfunction and symptoms of heart failure occur between the late stages of pregnancy and the early postpartum period. It is relatively uncommon. In this case report I describe the development of PPCM in the first pregnancy of a woman of older maternal age. © NZMA.
Lance S.,Taranaki Base Hospital |
White C.,General Medicine and Gastroenterology
New Zealand Medical Journal | Year: 2015
AIMS: Faecal calprotectin (FC) is a recognised marker for excluding inflammatory bowel disease (IBD). However, it is often not used appropriately. This audit aimed to identify the rate of its use of in Taranaki, along with attempting to assess how appropriately it is used and overall utility. METHODS: A list of FCs performed in Taranaki from July 2013 to December 2013 was obtained. Notes were examined, identifying the indication, its outcome, and a decision made whether or not the test added any benefit. RESULTS: 206 patients were identified. A large number (n=75) were excluded due to inadequate clinical information. Of the remaining 131 patients, 37% (n=49) did not benefit. 22% (n=29) avoided further investigation with a negative result. 91% of patients with previously known IBD avoided invasive investigation with a negative result. There was a strong correlation between very high levels (>500mg/g) and a diagnosis of IBD (88%), as well as a strong correlation between lower levels (<200mg/g) and excluding IBD (86%). CONCLUSIONS: FC remains useful to exclude IBD, and can assist in patients with established disease. However, in a significant percentage, the test adds no value. The absolute level of FC may also assist diagnosis. More research is needed, and more education is recommended. © 2015 NZMA.
Hayat A.,Taranaki Base Hospital
The New Zealand medical journal | Year: 2013
We report a peritoneal dialysis-related peritonitis infection with Rothia mucilaginosa (R. mucilaginosa), a Gram-positive germ belonging to the normal flora of the human oral cavity. Successful treatment was achieved by intraperitoneal administration of cephazolin. This case report illustrates the potential virulence of R. mucilaginosa in patients on peritoneal dialysis. We propose to routinely perform specific staining and prolonged culturing techniques for unusual germs such as R. mucilaginosa in patients with peritoneal dialysis-related peritonitis.
Hopkins C.J.,Taranaki Base Hospital
Internal Medicine Journal | Year: 2014
Background: Reporting of antibiotic consumption in hospitals is a crucial component of antibiotic stewardship, but data from Australasian secondary hospitals are scarce. The hypothesis of this audit is that antibiotic consumption in secondary hospitals would be lower than in tertiary centres. Aims: The study aims to present the first published audit of antibiotic consumption from a secondary hospital in New Zealand compared with two tertiary centres. Methods: Hospital population-level data were retrospectively accessed to identify all systemic antibiotics dispensed to adult inpatients at Taranaki District Health Board during 2011. Consumption was calculated in defined daily doses per 100 inpatient-days and per 100 admissions, stratified by drug class. Comparison was against published data from two tertiary centres. Results: Total consumption was lower, but that of high-risk antibiotic classes was higher than both tertiary centres. The relative consumption of lincosamides was 4.0 and 2.6 times higher than the two tertiary centres, with an associated 14% incidence of Clostridium difficile associated diarrhoea within 3 months. Conclusion: Our secondary hospital appears to consume the wrong types of antibiotic rather than too much. Data from all Australasian hospitals, stratified by clinical service area and hospital level, are required for clinically relevant benchmarking. © 2014 Royal Australasian College of Physicians.