Vibrio cholerae, typically associated with cholera, rarely causes invasive disease. This case report describes a 59-year-old man with pancreatectomy, splenectomy and diabetes, admitted with nontoxigenic V. cholerae O1 bacteraemia after returning from Sri Lanka, with suspected exposure, including contaminated well water. He presented with fever, upper abdominal pain, and elevated inflammatory, liver, and biliary markers. CT findings and clinical history raised suspicion of cholangitis. Targeted ciprofloxacin led to full recovery. This case highlights the invasive potential of nontoxigenic V. cholerae O1.
The treatment of bilateral recurrent laryngeal paralysis is usually tracheotomy or various forms of irreversible surgery with removal of parts of the larynx. Since recurrent laryngeal paralysis is reversible in 33% of cases, tracheotomy is usually the treatment of choice. Here, in this case, we present an alternative reversible solution in a patient where a tracheostomy tube was a suboptimal solution.
Transcranial magnetic stimulation is a non-invasive brain stimulation technique which generates an electrical current in the cerebral cortex and alters excitability. This review focuses on repetitive transcranial magnetic stimulation and its use in therapy. It describes which stimulation parameters and localisation are used in rehabilitation after brain injury, neuropathic pain, complex pain disorders and depression. While current results are promising, there is still a need to uncover stimulation parameters and localisation for optimal treatment.
Coronary artery calcium (CAC) scoring is a widely available method for detecting subclinical atherosclerosis. This review finds CAC scoring strongly predicts future cardiovascular events and may refine risk assessment beyond traditional factors. Guidelines recommend CAC scoring mainly for low-intermediate-risk patients, while evidence for treatment decisions based solely on CAC is limited. Broader use of CAC, including standardized reporting of routine chest CT, holds promise and may enable earlier prevention, but requires randomized trials.
Advanced therapy medicinal products are a rapidly expanding drug class based on genes, cells, and tissues, transforming the treatment of diseases, including haematologic cancers and genetic disorders, such as sickle cell disease and haemophilia. This review highlights that successful clinical implementation requires coordinated national strategies, regulatory support, sustainable funding, robust clinical and production infrastructure, and trained specialised personnel to ensure timely, safe, and equitable patient access.
Human and animal data show that youth nicotine exposure causes permanent brain changes and raises mental illness risk, including addiction to nicotine and other drugs. E-cigarettes (EC) and nicotine pouches (NP) are associated with subsequent tobacco smoking, and vice versa, but whether these links are mainly causal or due to common liability remains debated. Use of EC and NP is negatively correlated with tobacco use. Some studies suggest EC and NP add harm; others suggest they reduce harm. This review finds that misinterpreting data can lead to regulations that fail to improve public health.
Severe obesity is a growing health challenge, and some experience disabling functional problems despite major weight loss. In this case report, we present two male patients with giant pannus, resulting in limited mobility, recurrent infections, and social restrictions. Both underwent giant panniculectomy, removing 34.6 kg and 18.9 kg of tissue, respectively. Postoperative results included regaining the ability to walk without mobility aids, resuming physical activity, and increasing social interaction. Giant panniculectomy can provide substantial quality-of-life improvement in selected patients.
This review highlights perineural spread, an important yet diagnostically challenging route of metastatic dissemination that significantly affects prognosis and often remains underrecognized. We discuss common clinical signs and symptoms, key imaging features, and the diagnostic approach, emphasising the diagnostic challenges and the critical roles of MRI and ¹⁸F-FDG PET/CT in PNS. Greater awareness of these diagnostic challenges is essential to improve accuracy and ultimately patient outcomes.
This case report describes a cesarean delivery in a woman with a BMI of 52.5 kg/m² performed through a supraumbilical transverse incision due to a substantial abdominal pannus and favorable preoperative ultrasound findings. The approach provided direct access to the lower uterine segment, good surgical exposure, and an uncomplicated peri- and postoperative course.
The maternal mortality rate in Denmark has decreased over the last few decades and is currently at its lowest with a stable rate of 3.3 per 100,000 live births (2012-2022). Nevertheless, some maternal deaths are still preventable, underlining the importance of recognising risk factors and symptoms that may predispose to known causes of maternal death, including cardiovascular disease, thromboembolism and suicide. Though the maternal mortality rate is low, this review finds that analysis of severe maternal morbidities is essential to identify areas for improvement in obstetric care.
Menopause is often associated with cutaneous complaints. These changes may involve the oral and genital mucosa as well as skin and hair. Some alterations are physiological consequences of hormonal decline; others represent distinct dermatologic conditions. This review investigates the most common menopausal cutaneous changes, including their clinical presentation, diagnosis and management. It highlights the limited consideration of menopausal hormone therapy in current guidelines and underscores the need for further research, particularly to inform evidence-based therapeutic strategies.
INTRODUCTION:This study aimed to quantify wait times for adjuvant breast radiotherapy at Christchurch Hospital following surgery or completion of chemotherapy, with specific attention to the impact of COVID-19 lockdowns on service delivery. METHODS:A retrospective review was conducted of patients with breast cancer who initiated adjuvant radiotherapy between 1 January 2018 and 31 December 2022 at Christchurch Hospital. Wait times were defined as the interval (in days) from final surgery or chemotherapy to the first fraction of radiotherapy. Median wait times were tabulated and graphed to determine trend lines accounting for the COVID-19 lockdown periods affecting Canterbury, New Zealand. RESULTS:The cohort included 682 patients. Median wait time to radiotherapy from surgery was 72 days and from adjuvant chemotherapy was 36 days. A statistically significant increase in wait times was observed from surgery to radiotherapy of 7.2 days per annum (95% confidence interval 6.84-7.65 days, p<0.001). An initial increase in wait times was followed by a comparative reduction during the COVID-19 lockdown period. CONCLUSION:Wait times for adjuvant breast radiotherapy have increased at Christchurch Hospital from 2018 to 2022. Although COVID-19 restrictions temporarily reduced delays, sustained increases suggest multifactorial pressures. Excessive delays to commencing radiation should be minimised to reduce the risk of locoregional recurrence.
AIM:The Deterioration Early Warning System (DEWS) is a unique process, co-designed and developed in New Zealand, to support residential aged care (RAC) staff in the timely identification of, and response to, acute deterioration. This study aimed to test the effectiveness of DEWS and the feasibility of its implementation within the RAC sector. METHOD:This type 2 feasibility-implementation study was planned and evaluated in line with the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework. Focus group semi-structured interviews were conducted and template thematic analysis was undertaken to provide descriptive and interpretive data themes. RESULTS:Findings from this study support DEWS as an effective process for the timely identification of, and response to, acute deterioration in people living in care. Implementation was found to be feasible, with participants recommending the system's adoption across the RAC sector. CONCLUSION:Participants recommended DEWS to the RAC sector for its capacity to support the multidisciplinary team with the timely identification of and response to acute deterioration. However, future implementation of DEWS is contingent on digitalisation and integration within existing information technology infrastructure.
AIM:Acute rheumatic fever (ARF) is an autoimmune response to group A Streptococcus (Strep A) infection that can lead to rheumatic heart disease (RHD). To prevent Strep A infection for people with ARF or RHD, clinical guidelines recommend monthly intramuscular penicillin (Bicillin L-A®) injections for at least 10 years. However, multiple barriers to accessing healthcare affect adherence. This research aimed to improve adherence by developing a Māori and Pacific-centred model of care. METHODS:Qualitative, Kaupapa Māori and Kakala methodology underpinned the research. Data collection from people in the Waikato region with ARF, their whānau and healthcare providers included interviews, wānanga and fono. Data were analysed using a general inductive approach. RESULTS:Forty-seven participants were included: nine people with ARF, 10 whānau, eight health professionals and 21 whānau navigators. Three themes were identified: impacts of a colonial health system on Indigenous whānau; life defined by a disease status; and catalysts of healthcare engagement. A community informed, Whānau Ora model of care was also developed. CONCLUSION:Indigenous methodologies are effective methods to develop community informed, culturally responsive models of care. Although designed for ARF in Waikato, there is potential to adapt this approach for other health conditions and different regions of Aotearoa New Zealand.
AIM:Acknowledging the risks of passive exposure to methamphetamine, New Zealand started testing residential properties in 2010 and set a national standard and guidelines in 2016. However, in May 2018, the requirement to test for methamphetamine was eased unless there was a suspicion of a methamphetamine laboratory or high contamination levels. Owing to this policy change, methamphetamine testing drastically reduced. This study examines the impact of the policy change on residential methamphetamine contamination levels in New Zealand. METHODS:Using longitudinal data from 423 residential properties that were tested before and after the policy change, we applied a fixed effects model to examine the impact of the policy change on methamphetamine contamination at residential properties in New Zealand. RESULTS:We found that the policy change is associated with 1.92mcg/100cm2 higher methamphetamine contamination at residential properties in New Zealand, which will likely increase future healthcare costs. CONCLUSIONS:Given the ongoing escalation in methamphetamine usage, the government should revisit the policy change for controlling the passive exposure of methamphetamine to inhabitants of residential properties so that the associated premature deaths, child maltreatment and healthcare cost can be reduced.
