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26.  The current state of diabetes mellitus in India 
doi:10.4066/AMJ.2013.1979
PMCID: PMC3920109  PMID: 24567766
27.  Clinical profile of urinary tract infections in diabetics and non-diabetics 
Background
The risk of urinary tract infection (UTI) is higher in diabetics compared to non-diabetics. The aetiology and the antibiotic resistance of uropathogens have been changing over the past years. Hence the study was undertaken to determine if there are differences in clinical and microbiological features of UTI between diabetic and non-diabetic subjects, to study the influence of diabetes mellitus on the uropathogens and antibiotic sensitivity pattern in patients with UTI.
Method
A total of 181 diabetics (83 males and 98 females) and 124 non-diabetic subjects (52 males and 72 females) with culture positive UTI were studied. Patients with negative urine culture (n= 64), those diagnosed and treated outside (n= 83) and not willing to participate in the study (n= 24) were excluded.
Results
Almost 30 per cent of the patients (both diabetics and nondiabetics) presented with asymptomatic bacteriuria and the prevalence of pyelonephritis was significantly higher (p= 0.04) in diabetics compared to non-diabetic patients. The majority of the diabetics with UTI (87.14 per cent) had glycosylated haemoglobin (HbA1c) > 6.5 per cent with p < 0.001. The isolation rate of Escherichia coli (E. coli) from urine culture was higher (64.6 per cent) among diabetic patients followed by Klebsiella (12.1 per cent) and Enterococcus (9.9 per cent). The prevalence of extendedspectrum beta-lactamase (ESBL) producing E.coli was significantly higher in diabetics (p= 0.001) compared to nondiabetics. E.coli showed maximum sensitivity to carbapenems in both diabetic and non-diabetic subjects and least susceptibility to ampicillin.
Conclusion
The prevalence of pyelonephritis is significantly higher in diabetics than in non-diabetic subjects, with E. coli being the most common isolate. Elevated glycosylated hemoglobin (HbA1c) predisposes diabetics to UTI. Investigation of bacteriuria in diabetic patients for urinary tract infection is important for treatment and prevention of renal complications.
doi:10.4066/AMJ.2014.1906
PMCID: PMC3920469  PMID: 24567764
Urinary tract infection; Asymptomatic bacteriuria; Uropathogens; Diabetic patients; E. coli
28.  Pharmacy practice and its challenges in Yemen 
Background
Pharmacy practice in Yemen was established in 1875 in Aden.
Objectives
To describe pharmacy practice as it currently exists in Yemen, the challenges the profession faces, and to recommend changes that will improve pharmaceutical care services.
Methods
This study has two parts. Part 1 comprised a literature search performed between May and July 2011 to identify published studies on pharmacy practice in Yemen. Full text papers, abstracts, and reports in Arabic or English between 1970 and 2011 were reviewed. Part 2 consisted of a qualitative study with face-to-face interviews with a representative sample of pharmacists, staff from the Ministry of Public Health and Population (MoPHP), and patients.
Results
The analysis revealed several issues that plague pharmacy practice in Yemen:
Fewer than 10 per cent of pharmacists working in pharmacies and drug stores are graduates of governmentrecognised colleges.
Most Yemeni pharmacists are dissatisfied with their work conditions and opportunities.
Medicines are expensive and hard to access in Yemen, and counterfeit medicines are a serious problem.
Few regulations and standards exist for pharmacists and pharmaceutical care.
Pharmaceutical marketing plays an important role in marketing and selling products in Yemen.
A dearth of standards, regulations, and laws are hurting pharmacy practice in the country and potentially endangering peoples’ lives.
Conclusion
In order to improve pharmacy practice in Yemen, many changes are needed, including updating the pharmacy curriculum taught, implementing industry standards for pharmacy practice, implementing and reinforcing laws, and integrating pharmacists more fully in the healthcare industry. Additionally, the quality of the pharmacy workforce needs to be improved, and there needs to be increased awareness by the public, physicians, other healthcare professionals, and policy makers about the value of pharmacists.
doi:10.4066/AMJ.2014.1890
PMCID: PMC3920470  PMID: 24567762
Pharmacy practice; workforce; satisfaction; challenges; recommendations and Yemen
29.  Hepatitis C, a silent threat to the community of Haryana, India: a community-based study 
Background
Hepatitis C is a global public health problem. As many as 12 million people may be chronically infected in India and most are unaware of it.
Aims
To determine the incidence of hepatitis C in the Ratia block of the Fatehabad district, Haryana, India.
Method
This cross-sectional study was carried out by house-tohouse visits over 2 weeks. After obtaining written consent, a blood sample was drawn from suspected cases by a laboratory technician maintaining all necessary safety precautions and sterilization.
Results
Of the samples, 1,630 (22.3 per cent) were found to be positive for hepatitis C by ELISA, 253 (15.5 per cent) patients were previously hepatitis C positive, and adults (21–60 years) were affected maximally (70.0 per cent).
Conclusion
The study emphasises the need for public awareness campaigns at various levels and prevention of HCV infection. It also suggests the need to develop and strengthen evaluation methodology for the Integrated Disease Surveillance Project (IDSP).
doi:10.4066/AMJ.2014.1883
PMCID: PMC3920471  PMID: 24567761
Hepatitis C; HCV; community
30.  An uncommon cause of ascites: spontaneous rupture of biliary cystadenoma 
Biliary cystadenomas are cystic hepatic tumours of biliary origin. Cystadenomas are often slow-growing benign tumours, but always harbour the risk of malignant transformation. Cystadenomas are often asymptomatic, but may present with abdominal pain and distension. Though suspected with cross-sectional abdominal imaging, definitive diagnosis almost always requires histology. Spontaneous rupture of cystadenoma had been reported three times in the medical literature to date, all presenting with peritonitis. Here we report a case of spontaneous intraperitoneal rupture of biliary cystadenoma presenting as ascites without peritonitis.
doi:10.4066/AMJ.2014.1875
PMCID: PMC3920472  PMID: 24567760
Nonparasitic hepatic cyst; abdominal pain; cystic neoplasm; leaking cyst
31.  Quality of patient health information on the Internet: reviewing a complex and evolving landscape 
Background
The popularity of the Internet has enabled unprecedented access to health information. As a largely unregulated source, there is potential for inconsistency in the quality of information that reaches the patient.
Aims
To review the literature relating to the quality indicators of health information for patients on the Internet.
Method
A search of English language literature was conducted using PubMed, Google Scholar and EMBASE databases.
Results
Many articles have been published which assess the quality of information relating to specific medical conditions. Indicators of quality have been defined in an attempt to predict higher quality health information on the Internet. Quality evaluation tools are scoring systems based on indicators of quality. Established tools such as the HONcode may help patients navigate to more reliable information. Google and Wikipedia are important emerging sources of patient health information.
Conclusion
The Internet is crucial for modern dissemination of health information, but it is clear that quality varies significantly between sources. Quality indicators for web-information have been developed but there is no agreed standard yet. We envisage that reliable rating tools, effective search engine ranking and progress in crowd-edited websites will enhance patient access to health information on the Internet.
doi:10.4066/AMJ.2014.1900
PMCID: PMC3920473  PMID: 24567763
Internet; health; patient information; quality evaluation
32.  Assessment of general public satisfaction with public healthcare services in Kedah, Malaysia 
Background
Patient satisfaction is considered an essential component of healthcare services evaluation and an additional indicator of the quality of healthcare. Moreover, patient satisfaction may also predict health-related behaviours of patients such as adherence to treatment and recommendations.
Aims
The study aimed to assess patients’ level of satisfaction with public healthcare services and to explore the association between socio-demographic and other study variables and patient satisfaction level.
Method
A cross-sectional study was conducted using selfadministered questionnaires distributed to a convenience sample of the general public in Kedah, Malaysia.
Results
A total of 435 out of 500 people invited to participate in the study agreed to take part, giving a response rate of 87 per cent. In this study, only approximately half of the participants (n=198, 45.5 per cent) were fully satisfied with the current healthcare services. The majority of the participants agreed that doctors had given enough information about their state of health (n=222, 51 per cent) and were competent and sympathetic (n=231, 53.1 per cent). Almost half of the participants (n=215, 49.5 per cent) agreed that the doctors took their problems seriously. Only 174 (40 per cent) participants agreed that doctors had spent enough time on their consultation session. Some respondents (n=266, 61.2 per cent) agreed that healthcare professionals in the public health sector were highly skilled. The majority of the respondents described amenities, accessibility and facilities available in the public healthcare sector as good or better. In this study, waiting time was significantly associated with patient satisfaction as the results showed that those who waited longer than two hours were less satisfied with the services than those who waited under two hours.
Conclusion
The study findings showed that approximately half of the respondents were fully satisfied with current healthcare services. In this study, waiting time was the main factor that affected patient satisfaction level. Other factors that influenced satisfaction level included the length of consultation sessions and the process of patient registration. Hence, improvement in the health services that leads to a shorter waiting time may increase the satisfaction level of patients.
doi:10.4066/AMJ.2014.1936
PMCID: PMC3920474  PMID: 24567765
Patient satisfaction; quality of service; healthcare services; Malaysia
33.  Repeatable antibiotic prescriptions: an assessment of patient attitudes, knowledge and advice from health professionals 
Background
Previous Australian research has identified that general practice software systems appear to be associated with an increase in repeatable antibiotic prescriptions. Such prescriptions potentially facilitate the use of antibiotics without medical consultation and may be inconsistent with attempts to promote prudent use of antimicrobials.
Aims
We sought to assess knowledge and attitudes to antibiotics amongst patients presenting with a repeatable prescription; and the provision of supporting advice from healthcare professionals regarding use of these repeats.
Method
Six community pharmacies across Tasmania invited patients presenting with a repeatable antibiotic prescription to participate in the study. Participants were asked to complete a questionnaire and return this to the research team in a pre-paid envelope.
Results
Fifty-seven of 244 (23 per cent) surveys were returned. Regarding provision of advice on use of the repeat, 14 (25 per cent) of respondents stated that they were given no advice by the prescriber and 19 (30 per cent) no advice from the pharmacist. Five (9 per cent) were given no advice from either prescriber or pharmacist. One-third of respondents indicated that they would keep the repeat for future use and around three-quarters perceived no major safety concerns with antibiotics.
Conclusion
Further research is needed, however, this small study suggests that provision of information to patients regarding appropriate use of repeatable antibiotic prescriptions is suboptimal. This coupled with existing patient knowledge and attitudes may contribute to inappropriate use of antibiotics.
doi:10.4066/AMJ.2014.1871
PMCID: PMC3920475  PMID: 24567759
Antibiotic; prescription; repeat; patient; knowledge; attitude
34.  Detection of metallo-beta-lactamase producing Pseudomonas aeruginosa in intensive care units 
The Australasian Medical Journal  2013;6(12):686-693.
Background
Metallo-beta-lactamase (MBL) producing Pseudomonas aeruginosa has emerged as a threat to hospital infection control, due to its multi-drug resistance, especially in intensive care units (ICUs).
Aims
This study was carried out to detect MBL producing P. aeruginosa isolates from medical and surgical ICUs, to compare and evaluate different phenotypic methods currently in use and to determine antibiograms.
Method
A prospective study was undertaken to detect MBLs in P. aeruginosa isolates obtained from various clinical samples. A total of 49 strains were recovered from patients admitted in inpatient wards and ICUs, and screened for imipenem resistance by Kirby Bauer disk diffusion method. Detection of MBLs was further done by imipenem-EDTA disk synergy test and combined disk test.
Results
Out of 49 isolates, 11 isolates (22.4 per cent) were imipenem resistant. All 11 imipenem resistant P. aeruginosa strains, when further tested, were positive for MBL production by combined disk test, but, only eight showed positive results by imipenem-EDTA disk synergy test.
Conclusion
MBL production was the main resistance mechanism in the 11 carbapenem resistant P. aeruginosa isolates collected, with multidrug resistance associating significantly with MBL production in P. aeruginosa from our institution.
doi:10.4066/AMJ.2013.1824
PMCID: PMC3877850  PMID: 24391679
Metallo-beta-lactamases; infection control; Pseudomonas aeruginosa; Multidrug resistance
35.  Spontaneous coronary artery dissection causing myocardial infarction in an 18-year-old man: A case report 
The Australasian Medical Journal  2013;6(12):694-696.
Spontaneous coronary artery dissection (SCAD), an uncommon cause of myocardial infarction, typically affects a younger, otherwise healthy population. There are currently no known direct causes of this condition, although some correlations have been noted. Commonly found in women, the asymptomatic presentation in men is very rare. Herein, we report the case of an 18-year-old man who presented to our institution with asymptomatic myocardial infarction secondary to a spontaneous dissection of the left anterior descending coronary artery. Until now, there is no specific guideline for SCAD. Choice of treatment should be tailored to the clinical condition of each individual patient.
doi:10.4066/AMJ.2013.1897
PMCID: PMC3877851  PMID: 24391680
spontaneous coronary artery dissection; myocardial infarction; young age; asymptomatic
36.  Multi-drug resistant Acinetobacter species from various clinical samples in a tertiary care hospital from South India 
The Australasian Medical Journal  2013;6(12):697-700.
Background
Acinetobacter species are gram-negative coccobacilli belonging to the group of Non-Fermenting Gram-Negative Bacilli, which are ubiquitous in nature. They cause outbreaks in intensive care units and healthcare settings, and are becoming increasingly drug resistant.
Aims
To determine the prevalence of multi-drug resistant Acinetobacter species from various clinical samples.
Method
Clinical samples were processed as per standard microbiological techniques. Antibiotic susceptibility testing was carried out on all the Acinetobacter isolates by Kirby- Bauer disc diffusion method as per CLSI guidelines.
Results
A total of 122 Acinetobacter spp. were isolated. 110 (90.16 per cent) were from inpatients, and 12 (9.83 per cent) were from outpatients. Out of 122 isolates, 44 (36.06 per cent) were from the ICU. The majority of the isolates, 47 (38.52 per cent), were from pus samples followed by 25 (20.49 per cent) from endotracheal tube aspirate. Out of 122 isolates, 87 (71.31 per cent) were multi-drug resistant of which 15 (12.29 per cent) were resistant to all drugs tested.
Conclusion
Acinetobacter infections associated with multi-drug resistant and pan-resistant strains have emerged as important nosocomial pathogens in our setting.
doi:10.4066/AMJ.2013.1901
PMCID: PMC3877852  PMID: 24391681
Acinetobacter; multi-drug resistance; clinical samples
37.  Comparing performance of Tabriz obstetrics and gynaecology hospitals managed as autonomous and budgetary units using Pabon Lasso method 
The Australasian Medical Journal  2013;6(12):701-707.
Background
Considering governmental scrutiny and financial constraints in medicine, the need for improved performance, which can provide acceptable care for medical consumers, leads to the conduct of new managerial methods to improve effectiveness.
Aims
This study aimed to compare performance indicators of obstetrics and gynaecology teaching hospitals in Tabriz.
Method
A longitudinal, retrospective study was conducted to compare performance indexes of Tabriz obstetrics and gynaecology teaching hospitals during 2010-2012. Al-Zahra is Tabriz’s central teaching hospital in obstetrics and gynaecology that is authorised under a board of trustees as an autonomous hospital and Taleghani hospital is managed under centralised administration. Study variables included: Average Length of Stay (ALOS), Bed Occupancy Rate (BOR), and Bed Turnover Ratio (BTR). The data was extracted via the Hospital Information Systems (HIS) within the hospitals' admission and discharge units. Pabon Lasso model was used to assess hospital performance. Data was analysed and graphs were plotted using the SPSS-17 software package.
Results
According to study findings, overall ALOS in Al-Zahra hospital is 3.15 (2.15) days (1.88 (0.97) days for prenatal wards and 6.13 (0.97) days for neonatal wards) and ALOS in Taleghani Hospital is 3.37 (3.09) days (1.74 (0.14) days for perinatal wards and 5.96 (3.55) days for neonatal wards). In this regard, Al-Zahra hospital holds the maximum BOR with 86.92 per cent and the minimum BOR was attributed to Taleghani hospital at 68.44 per cent (P<0.001). Study findings indicate that BOR in neonatal wards is greater than prenatal wards. On the other hand, BOR in Al-Zahra is greater than Taleghani (P<0.001), whereas BOR trend shows an increasing pattern in both hospitals.
Conclusion
Results of this study showed that the performance of Al- Zahra Hospital is better than Taleghani Hospital. These two hospitals are similar in different aspects except Al-Zahra is under a board of trustees and Taleghani is not. We should also consider that Al-Zahra Hospital has more facilities than Taleghani.
doi:10.4066/AMJ.2013.1903
PMCID: PMC3877853  PMID: 24391682
Performance; Obstetrics and Gynaecology hospital; Pabon Lasso; Administration Models; Autonomisation
39.  The use of anaesthetic agents to provide anxiolysis and sedation in dentistry and oral surgery 
The Australasian Medical Journal  2013;6(12):713-718.
Throughout the world there is considerable variation in the techniques used to manage anxious dental patients requiring treatment. Traditionally anxious or phobic dental patients may have been sent for general anaesthesia to allow dental treatment be undertaken. While this is still the case for the more invasive oral surgical procedures, such as wisdom teeth extraction, sedation in general dentistry is becoming more popular.
Various sedation techniques using many different anaesthetic agents have gained considerable popularity over the past 30 years. While the practice of sedating patients for dental procedures is invaluable in the management of suitably assessed patients, patient safety must always be the primary concern. Medical, dental and psychosocial considerations must be taken into account when evaluating the patient need and the patient suitability for sedation or general anaesthesia.
The regulations that govern the practice of dental sedation vary throughout the world, in particular regarding the techniques used and the training necessary for dental practitioners to sedate patients. It is necessary for medical and dental practitioners to be up to date on current practice to ensure standards of practice, competence and safety throughout our profession.
This article, the first in a two-part series, will provide information to practitioners on the practice of sedation in dentistry, the circumstances where it may be appropriate instead of general anaesthesia and the risks involved with sedation. It will also discuss the specific training and qualifications required for dental practitioners to provide sedation. The second article in this series will outline the different techniques used to administer inhalation, oral and intravenous sedation in dentistry and will focus on specific methods that are practiced.
doi:10.4066/AMJ.2013.1836
PMCID: PMC3877855  PMID: 24391684
Conscious sedation; sedation; dentistry; anaesthetic agents; fear; dental phobia; anxiolysis; access to treatment
40.  Education for practitioners and patients 
The Australasian Medical Journal  2013;6(12):724-726.
doi:10.4066/AMJ.2013.1952
PMCID: PMC3877856  PMID: 24391685
41.  Predicting ICU admissions from attempted suicide presentations at an Emergency Department in Central Queensland 
The Australasian Medical Journal  2013;6(11):536-541.
Background
Emergency medicine physicians and psychiatric staff face a challenging job in risk stratifying patients presenting with suicide attempts to predict which patients need intensive care unit admission, hospital admission or can be discharged with psychiatry follow up.
Aims
This study aims to analyse patients who were admitted to the intensive care unit or regular ward for suicide attempt, and the methods they employed in a rural Australian base hospital.
Method
We conducted a retrospective analysis of patients who presented with suicide attempts to the Rockhampton Base Hospital Emergency Department, Queensland Australia from 1 September 2007 to 31 August 2009. Multivariate logistic regression was undertaken to identify risk factors for ICU and regular ward admission, and predictors of suicide method.
Results
There were 570 patients presenting with suicide attempts, 74 of which were repeat suicide attempts. There was a 10- fold increase in the odds of intensive care unit or ICU admission (CI 1.45-81.9, p=0.02) for patients who presented with drug overdose. Increased age (OR=1.02, 95 per cent CI 1.00-1.03, p=0.05), drug overdose (OR=2.69, 95 per cent CI 1.37-5.29, p=0.004), and previous suicide attempt (OR=1.53, 95 per cent CI 1.03-2.28, p=0.03) were significantly correlated with hospital admission. Male patients (OR=2.76, 95 per cent CI 1.43-5.30, p=0.002) and Aboriginal patients (OR=3.38, 95 per cent CI 1.42-8.05, p=0.006) were more likely to choose hanging as a suicide method.
Conclusion
We identified drug overdose as a strong predictor of ICU admission, while age, drug overdose and history of previous suicide attempts predict hospital admission. We recommend reviewing physician practices, especially safe medication, in suicide risk patients. Our study also highlights the need for continued close collaboration by acute care and community mental health providers for quality improvement.
doi:10.4066/AMJ.2013.1730
PMCID: PMC3858606  PMID: 24348869
Suicide, Attempted; Drug Overdose; Emergency Care; Intensive Care; Utilisation
42.  Why are organisations that provide healthcare services fuzzy? 
The Australasian Medical Journal  2013;6(11):542-548.
Background
Healthcare organisations are an enigma to many people inand outside the service. Organisational fuzziness is a common state, characterised by a lack of clarity, lack of awareness, lack of organisational knowledge, and the reliance on practice and custom instead of transparency.
Aims
The objective of this study was to obtain a better understanding of what causes this fuzziness and provide an actionable description of fuzzy organisations. Such a description is essential to managing and preventing organisational fuzziness.
Method
We used a longitudinal case study in an integrated healthand social care organisation to obtain a thorough understanding of how the organisation functions. These indepth insights allowed the identification of three generators of fuzziness.
Results
We found that the three main generators of organisational fuzziness are change, informal organisation and complexity. Organisational fuzziness is thus partly due to the inherent complexities of human systems. However, also continuous change and the inability of the system to adapt its formal structures resulted in structures deteriorating or no longer being appropriate.
Conclusion
Existing approaches to explain unclear or absent structures in healthcare organisations by describing these organisations as complex adaptive systems (CAS) are too simplistic. While aspects relating to people and their interactions are indeed complex, fuzziness of structural aspects are often the result of continuous change and insufficient organisational capacity to adapt to it.
doi:10.4066/AMJ.2013.1857
PMCID: PMC3858607  PMID: 24348870
Complexity; change; healthcare services; complex adaptive systems; healthcare organisations; service design
43.  Why drug shortages are an ethical issue 
The Australasian Medical Journal  2013;6(11):556-559.
Drug shortages are a growing problem in developed countries. To some extent they are the result of technical and organisational failures, but to view drug shortages simply as technical and economic phenomena is to miss the fact that they are also ethical and political issues. This observation is important because it highlights both the moral and political imperative to respond to drug shortages as vigorously as possible, and the need for those addressing shortages to do so in ethically and politically sophisticated ways. This brief article outlines the ethical issues that need to be considered by anyone attempting to understand or address drug shortages.
doi:10.4066/AMJ.2013.1869
PMCID: PMC3858608  PMID: 24348871
Drug shortages; ethics; society; social consequence
44.  Clinical profile and visual outcome of ocular injuries in a rural area of western India 
The Australasian Medical Journal  2013;6(11):560-564.
Background
Ocular trauma is a major cause of visual impairment and morbidity worldwide.
Aims
To identify the various type of ocular injury in a rural area, determine the presence of any associated visual damage and assess the final visual outcome after treatment.
Method
Hospital-based, prospective study conducted over a period of two years. A total of 60 patients of ocular trauma were included.
Results
Ocular injuries were more commonly seen in adult (55 per cent) patients who were associated with agricultural work (43.33 per cent). They were more common in male patients (71.67 per cent). Closed globe injury (68.33 per cent) was more common than open globe injury (31.67 per cent). Both in open and closed globe injuries, the commonest object causing injury was a wooden stick. Just 26.7 per cent of the patients had a visual acuity better than 6/60 at presentation; while after completed treatment at two months follow-up, 68.3 per cent had best corrected visual acuity better than 6/60.
Conclusion
Agricultural trauma is an important cause of monocular blindness in rural India. The visual outcome depends upon the site and size of the injury and the extent of the ocular damage.
doi:10.4066/AMJ.2013.1876
PMCID: PMC3858609  PMID: 24348872
Closed globe injury; open globe injury; rural India; visual outcome
45.  Enablers of and barriers to making healthy change during pregnancy in overweight and obese women 
The Australasian Medical Journal  2013;6(11):565-577.
Background
High Body Mass Index (BMI) during pregnancy is associated with an increased risk of adverse health outcomes. Making healthy change during pregnancy is beneficial, especially for overweight and obese women.
Aims
The aim of this study was to explore the barriers and enablers identified by overweight and obese women that preclude and facilitate making healthy change during pregnancy.
Method
We conducted a retrospective analysis of patients who presented with suicide attempts to the Rockhampton Base Hospital Emergency Department, Queensland Australia from 1 September 2007 to 31 August 2009. Multivariate logistic regression was undertaken to identify risk factors for ICU and regular ward admission, and predictors of suicide method.
Results
The core concept of “being pregnant” indicated women consider this specific time as both a reason not to make healthy change as well as a motivation for change. Overweight and obese women cited the following barriers to making healthy change during pregnancy: physiological (e.g. pregnancy complications and tiredness); emotional (e.g. preference and mood); cognitive (e.g. lack knowledge); interpersonal (e.g. lack support); and environmental (e.g. availability of healthy choice). Similar enablers were identified by overweight and obese women: physiological (e.g. relief of pregnancy symptoms); emotional (e.g. approval and commitment); cognitive (e.g. knowledge and belief); interpersonal (e.g. family support); and environmental (e.g. help from others). More barriers than enablers were given, indicating that women were more sensitive to barriers than the enablers for making healthy change. Factors viewed by some women as barriers were viewed as enablers by others.
Conclusion
When designing interventions to promote healthy eating and physical activity during pregnancy, individually focused interventions must be implemented in conjunction with environmental-level interventions to facilitate behaviour change.
doi:10.4066/AMJ.2013.1881
PMCID: PMC3858610  PMID: 24348873
Pregnancy; overweight; healthy change
46.  Bacteriophage types of methicillin-resistant Staphylococcus aureus in a tertiary care hospital 
The Australasian Medical Journal  2013;6(10):496-503.
Background
Phage typing had been utilised extensively to characterise methicillin-resistant Staphylococcus aureus (MRSA) outbreak strains in the past. It is an invaluable tool even today to monitor emergence and dissemination of MRSA strains.
Aims
The aim of this study was to determine the prevalent phage types of MRSA in south India and the association between phage types, antibiotic resistance pattern and risk factors.
Method
A total of 48 non-duplicate MRSA strains recovered from various clinical samples during January to December, 2010 were tested against a panel of anti-staphylococcal antibiotics. Phage typing was carried out at the National Staphylococcal Phage Typing Centre, New Delhi. Out of 48, 32 hospitalised patients were followed up for risk factors and response to empirical and post sensitivity antibiotic therapy. The risk factors were compared with a control group of 30 patients with methicillin sensitive Staphylococcus aureus (MSSA) infection.
Results
Amongst the five prevalent phage types, 42E was most common (52%), followed by a non-typable variant (22.9%), 42E/47/54/75 (16.6%), 42E/47 (6.2%) and 47 (2%). Phage type 42E was the predominant strain in all wards and OPDs except in the ICU where 42E/47/54/75 was most common. Although not statistically significant, strain 42E/47/54/75 (n=8) showed higher resistance to all drugs, except ciprofloxacin and amikacin, and were mostly D-test positive (87.5%) compared to the 42E strain (32%). Duration of hospital stay, intravenous catheterisation and breach in skin were the most significant risk factors for MRSA infection.
Conclusion
We found MRSA strain diversity in hospital wards with differences in their antibiotic susceptibility pattern. The findings may impact infection control and antibiotic policy significantly.
doi:10.4066/AMJ.2013.1742
PMCID: PMC3821046  PMID: 24223065
MRSA; phage types; stairs; risk factors
47.  Orbital myiasis caused by green bottle fly 
The Australasian Medical Journal  2013;6(10):504-506.
An 80-year-old farmer, presented with large, maggot infested ulceration involving the medial part of the right upper lid. The left eye was phthisical. There was history of untreated traumatic laceration of the right upper lid. Mechanical removal of maggots was done under turpentine coverage with regular antibiotic dressing. Microbiological examination of maggots revealed the larvae to be of Lucilia sericata (green bottle fly). The ulceration completely healed in two weeks following manual removal of maggots and regular dressing. Orbital myiasis is an uncommon clinical condition, with isolated case reports in literature.
doi:10.4066/AMJ.2013.1848
PMCID: PMC3821047  PMID: 24223066
Green bottle fly; Lucilia sericata; maggots; orbital myiasis
48.  Tongue cleaner, an unusual foreign body in the urethra: A case report 
The Australasian Medical Journal  2013;6(10):508-510.
Introduction
Various cases of self-inflicted foreign body insertion into the urethra have been reported in adult males. The most common motive for such acts has been postulated as autoerotic stimulation, psychiatric illness or intoxication.
Case presentation
A 40-year-old male presented with a partially inserted tongue cleaner in his urethra with one end projecting from the urethral meatus and with a history of bleeding and pain. After a gentle attempt of removal using local anaesthetic gel the patient was scheduled for its surgical removal under anaesthesia.
Conclusion
Large complex foreign bodies may be not amenable to endoscopic removal and may warrant open surgical procedure. Urethral stricture should be suspected in such patients. A psychiatric visit should be recommended for all adult males with self-inflicted foreign body in the urethra.
doi:10.4066/AMJ.2013.1851
PMCID: PMC3821048  PMID: 24223067
Green bottle fly; tongue cleaner; urethral trauma; unusual foreign body
49.  Variation in the lobar pattern of the right and left lungs: A case report 
The Australasian Medical Journal  2013;6(10):511-514.
The right lung has three lobes and two fissures while the left lung has two lobes and one fissure. During a routine dissection we observed a variant complete fissure and three incomplete fissures in the right lung while the left lung presented with a variant transverse fissure separating the superior lingual and anterior bronchopulmonary segments. In the right lung, the incomplete fissures lie between the apical and posterior bronchopulmonary segments; medial and lateral bronchopulmonary segments; apical and basal bronchopulmonary segments. The complete variant fissure separates the medial basal bronchopulmonary segment from the remaining basal segments. Such variant fissures and lobes are clinically important in cases of lobotomy.
doi:10.4066/AMJ.2013.1856
PMCID: PMC3821049  PMID: 24223068
Bronchopulmonary segments; Lobotomies; Lung Fissure; Lung
50.  Compressive myeloradiculopathy from bony metastasis as the initial presentation of poorly differentiated adenocarcinoma stomach – a case report 
The Australasian Medical Journal  2013;6(10):515-519.
Carcinoma of the stomach rarely disseminates to bone. We report a case of compressive myeloradiculopathy from extensive metastases to the spine, which on evaluation originated from adenocarcinoma of the stomach. Magnetic resonance imaging of the spine showed osteolytic and osteosclerotic metastases. Gastrointestinal endoscopy revealed ulcerative growth in the stomach that on biopsy showed poorly differentiated adenocarcinoma. This case is unique in that the initial presentation of gastric cancer itself was bony metastases without any gastrointestinal symptoms or liver involvement. Moreover, metastases were osteosclerotic as well, which is against the general belief that gastric cancer produces only osteolytic secondaries.
doi:10.4066/AMJ.2013.1859
PMCID: PMC3821050  PMID: 24223069
Gastric cancer; adenocarcinoma; bone metastases; osteosclerotic; alkaline phosphatase

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