The Covid-19 pandemic of 2020 reminds us that the advent of infectious diseases into a non-immune, though medically sophisticated community is an ever-present threat to life and health from the dawn of recorded history to the current year. There are numerous examples of endemic diseases in one community being introduced into another often remote and isolated non-immune population with disastrous results. However the converse effect of removing a whole yet small isolated community from a remote location and placing them in a more populous setting is less well analysed. Instead of the infection being taken to the vulnerable non-immune, the vulnerable non-immune are taken to the infection. The occurrence of Mycobacterium tuberculosis (MTB) amongst the evacuees from the remote Hebridean island of St Kilda in the decade after they were transported to the Scottish mainland in 1930 is examined

A 19-year-old immunocompetent male presented with severe headache and blurred vision in his left eye. Ophthalmic examination revealed reduced visual acuity and relative afferent pupillary defect in the left eye, increased intraocular pressure bilaterally, and bilateral neuroretinitis. Serology results revealed positive immunoglobulin G titres of Bartonella henselae (cat scratch disease). Magnetic resonance imaging of the head showed venous sinus thrombosis. The patient's bilateral neuroretinitis and venous sinus thrombosis is postulated to be caused by Bartonella henselae. This is the first known case demonstrating venous sinus thrombosis caused by Bartonella henselae.

Osteoporosis is a common bone disorder found predominantly in women in every corner of the globe both in the living and in skeletons of the last seven millennia found in global archaeological excavations, except Polynesia. The Pacific Islands, or South Sea Islands, Polynesian people have an instantly recognisable phenotype characterised by a large bone and muscle mass frequently found in the front row of the rugby union scrum, or as security ‘bouncers’ on the door of night clubs. They are rarely seen in the orthopaedic wards of Australasia in spite of increasing migrant numbers and their passion for the two rugby football codes. This poses the questions of are their bones stronger and if that is the case, why is that? Information directly from the islands is restricted by limited life expectancy, greater health priorities such as diabetes, limited diagnostic facilities and the lack of sophisticated computerised health information collection. However; this paper finds supportive data for the first question and identifies genetic and lifestyle factors as the possible answer to the second question.

The Japanese Hospital in Broome remains the only hospital in Australia's history predominantly staffed, controlled and funded by a linguistically, culturally and geographically alien nation. Initially the proposal, challenging prevailing attitudes, was bitterly opposed by the white community, but the hospital became respected thanks to Dr Tadashi Suzuki, the hospital's first doctor, and his successors' clinical skills and compassion.

Paleopathologists have identified osteoporosis in ancient skeletons and modern physicians and scientists have identified risk factors for osteoporosis today, but they are not clearly linked, making it more difficult to clarify the causes of osteoporosis in the past. The evidence for osteoporosis in the remote past, its causes, and the management of this disease is reviewed in the light of evolving and improving diagnostic modalities, more precise definitions, and the recent rapid expansion of therapeutic options. While the specific effects of parity and lactation on the development of osteoporosis are still not entirely clear, duration of reproductive span and age at first pregnancy appear to be significant predisposing factors.

The mental decline of King Henry VIII from being a jovial, charismatic and athletic young man into an increasingly paranoid, brutal tyrant in later life, ever more concerned at his lack of one or more male heirs, has attracted many medical diagnostic theories. Previous hypotheses have included diabetes, syphilis and hypothyroidism, among others. However, these inadequately explain Henry's failure to produce a male heir, despite multiple pairings. The latest postulated diagnoses for Henry are the coexistence of both Kell blood group antigenicity (possibly inherited from Jacquetta Woodville, Henry's maternal great grandmother) causing related impaired fertility, and McLeod syndrome, causing psychotic changes. As the mutated McLeod protein of the syndrome significantly reduces the expression, effectively inactivating the Kell antigen, we critically review this theory, examining in detail the pathophysiology of these conditions and assessing the genealogy of Henry VIII and its effect in subsequent generations.

We report the case of an immunocompetent 83-year-old man with metastatic neoplastic infiltration of the heart from primary squamous cell carcinoma (SCC) of the skin. Death was from cardiopulmonary collapse due to left ventricular failure with features of right ventricular inflow tract obstruction. Metastatic tumours involving the heart rarely originate from cutaneous SCC though have been reported in the literature in both immunocompetent and postrenal-transplant recipient patients. Most involve the pericardium and only rarely the endocardium or the myocardium. While the prognosis is generally poor, palliative radiotherapy may provide significant symptom relief. Cardiac metastases should be considered in patients with advanced cancer, especially when they show cardiac symptoms and signs.

An 80 year old female was admitted with an eight week history of fever associated with painful swelling of her right thigh, and a long history of poor dentition. Culture of blood stained fluid aspirated from the abscess grew Aggregatibacter actinomycetemcomitans (Aa) sensitive to ampicillin and cephalosporins. Transoesophageal echocardiography indicated endocarditis. Four weeks treatment with intravenous ceftriaxone and appropriate dental care was followed by full recovery.

Internal Medicine JournalVolume 42, Issue 12 p. 1367-1367 Letter to the Editor The i-patient or the eyeball patient? P. J. O. Stride, P. J. O. Stride University of Queensland School of Medicine, Brisbane, Queensland, Australia Departments of Medicine, Redcliffe Hospital, Brisbane, Queensland, AustraliaSearch for more papers by this authorT. Wood, T. Wood Departments of Radiology, Redcliffe Hospital, Brisbane, Queensland, AustraliaSearch for more papers by this authorJ. M. Hunter, J. M. Hunter Departments of Medicine, Redcliffe Hospital, Brisbane, Queensland, AustraliaSearch for more papers by this authorA. L. Reid, A. L. Reid Departments of Medicine, Redcliffe Hospital, Brisbane, Queensland, AustraliaSearch for more papers by this authorS. Walsh, S. Walsh Departments of Medicine, Redcliffe Hospital, Brisbane, Queensland, AustraliaSearch for more papers by this author P. J. O. Stride, P. J. O. Stride University of Queensland School of Medicine, Brisbane, Queensland, Australia Departments of Medicine, Redcliffe Hospital, Brisbane, Queensland, AustraliaSearch for more papers by this authorT. Wood, T. Wood Departments of Radiology, Redcliffe Hospital, Brisbane, Queensland, AustraliaSearch for more papers by this authorJ. M. Hunter, J. M. Hunter Departments of Medicine, Redcliffe Hospital, Brisbane, Queensland, AustraliaSearch for more papers by this authorA. L. Reid, A. L. Reid Departments of Medicine, Redcliffe Hospital, Brisbane, Queensland, AustraliaSearch for more papers by this authorS. Walsh, S. Walsh Departments of Medicine, Redcliffe Hospital, Brisbane, Queensland, AustraliaSearch for more papers by this author First published: 18 December 2012 https://doi.org/10.1111/imj.12013Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article. Volume42, Issue12December 2012Pages 1367-1367 RelatedInformation

We present a case of chronic benign tracheo-oesophageal fistula in an immunologically competent elderly female, cured with a period of nasogastric feeding.

Public awareness of hospital misadventure is now common. In response, we describe our integrated hospital safety system, which is dependent on the linkage of multiple individual safety committees, and the presence on each committee of senior and junior multidisciplinary healthcare professionals to provide feedback to their peer groups on required improvements.

We report a case of staphylococcal sepsis with vascular complications including peripheral emboli and renal vein thrombosis. Bilateral renal vein thrombosis has not been reported as a complication of Staphylococcus aureus (SA) axillary abscess. Uncontrolled diabetes was the only detected predisposing medical condition. The patient was treated successfully with incision and drainage of soft-tissue abscesses and intravenous antibiotic for six weeks and with anticoagulation for renal vein thrombosis.

Hospitalised patients commonly experience adverse drug events (ADEs) and medication errors. Runciman reported that ADEs in hospitals account for 20% of reported adverse events and contribute to 27% of deaths where death followed an adverse event. Hughes recommends multidisciplinary hospital drug committees to assess performance and raise standards. The new Code of Conduct of the Medical Board of Australia recommends participation in systems for surveillance and monitoring of adverse events, and to improve patient safety. We describe the functions and role of a Drug Safety Working Group (DSWG) in a suburban hospital, which aims to audit and promote a culture of prescribing and medication administration that is prudent and cautious to minimise the risk of harm to patients. We believe that regular prescription monitoring and feedback to Resident Medical Officers (RMOs) improves medication management in our hospital.

ABSTRACTBackgroundThe antiplatelet drugs, aspirin and clopidogrel, are widely prescribed for cardiovascular and neurovascular diseases. It is recommended that these drugs should be ceased 5 days prior to elective surgery. If patients on these drugs require emergency non‐cardiac surgery, the peri‐operative risk of haemorrhage and thrombosis causes management dilemmas. Current guidelines are limited to the management of patients with coronary stents who are on antiplatelet drugs and require elective surgery. There is no universal evidence‐based consensus, for the indications, method, timing or endpoints of treatment to reverse the antiplatelet action of clopidogrel in patients requiring emergency non‐cardiac surgery.AimTo report two cases where emergency abdominal surgery was required in patients on concomitant clopidogrel and aspirin.Clinical details and outcomeTwo patients who were on concomitant aspirin and clopidogrel required urgent abdominal surgery. The two cases were managed differently. In the first case, no pre‐operative platelets or fresh frozen plasma were administered and surgery was complicated by major bleeding. The second patient received pre‐operative platelet transfusion and encountered no significant bleeding or thrombotic complications.ConclusionThere is an urgent need for the development of guidelines to manage patients receiving antiplatelet drugs requiring emergency non‐cardiac surgery.

We present the case of an 80-year old man with a Stanford Type A dissecting thoracic aortic aneurysm plus the unusual CT finding of extramural haemorrhage along the pulmonary vessels. The clinical and radiological picture has an extremely high mortality

Intra-species variations in Homo sapiens can contribute to health and resistance to infection, or alternatively to death and disease. The small isolated population of the St Kilda archipelago in the Scottish Hebrides suffered severely from many infectious diseases in the seventeenth to nineteenth centuries, with greater morbidity and mortality than the inhabitants of similar Scottish communities on other remote islands.