0.05 ). However, there was a correlation between EF at peak exercise 27%?11% and maximal exercise capacity ( r = 0.42 , P

RHINOPHYMA NOSE SKIN DISEASES

In 2014, influenza activity was high in New South Wales (NSW), Australia, and 21 443 people were hospitalized with a diagnosis of influenza-associated pneumonia. This translates to a rate of 252.4 cases per 100 000 population. More than 18 000 cases of laboratory-confirmed influenza were reported in NSW. The majority were influenza A, dominated by A/H3N2 subtype. There were also 111 influenza outbreaks in aged care facilities (ACFs) reported in NSW in 2014, the highest number on record.

Elderly residents in ACFs experience high rates of morbidity and mortality during influenza outbreaks. They are at increased risk of developing complications due to underlying diseases. These residents also have an increased risk of infection because of the institutional environment they share with many other residents and staff. Furthermore, impaired oral intake, limited dexterity and altered consciousness may limit treatment options when they are infected.

In Chinese traditional culture,there are the concepts “Dao” and “Shu”.“Dao” means basic concept,basic principle,rule and regulation.“Shu” on the other hand means the application of “Dao” into daily use.If we apply these concepts of “Dao” and “Shu” into clinical medicine,“Dao” becomes the basic principle and rule that every good clinician should follow.This requires every clinician to have good medical ethics,sound medical knowledge,technical skills and the ability to apply the knowledge and skills into patient management.Furthermore,each clinician should submit himself to life-long continuing medical education and auditing.For a good surgeon,there is the additional requirement that he should have a pair of good hands.In other words,“Shu” is required in a good surgeon so that he can apply his medical knowledge and skills through operating with his hands.A good balance in the development of “Dao” and “Shu” is the basic requirement to become a good surgeon.Thus,a balance in “Dao” and “Shu” forms the launching platform for future development of a good surgeon.Clinical research in surgery is based on good clinical works and results.Without good clinical works and results,there is no good clinical research.On the other hand,good clinical research helps to improve clinical works and results.Thus,the two forms a virtuous cycle.In other words,clinical research and innovation in surgery are the final product of a balanced development of “Dao” and “Shu” in surgery.

Neurocutaneous melanosis (NCM) is a rare congenital syndrome characterized by the development of congenital melanocytic nevi and benign or malignant melanocytic tumors of the central nervous system. Neurologic symptoms usually manifest during the first two years of life with a high mortality rate.
This is a case of a 3-year-old girl presenting with generalized large and multiple hyperpigmented macules and patches, some with hair, over the scalp, face, trunk, and extremities, present since birth. Histologic findings of a nodule within a nevus include nested melanocytes at the epidermis, cords and strands of melanocytes extending to the deep reticular dermis showing maturation with descent and lack of mitosis consistent with melanocytic nevi. The cranial magnetic resonance imaging contrast study revealed melanocytic deposits on the cerebellum and amygdala. She has regular follow-up with her dermatologist, pediatrician, and neurologist. The patient has remained asymptomatic of neurological symptoms despite the melanocytic deposits in the central nervous system.

Human ; Female ; Child ; Amygdala ; Cerebellum ; Dermatologists ; Dermis ; Epidermis ; Hair ; Melanocytes ; Melanosis ; Mitosis ; Neurocutaneous Syndromes ; Neurologists ; Nevus ; Nevus, Pigmented ; Scalp ; Skin Neoplasms

This report describes a 20 year old student who presented with rapidly progressing respiratory dysfunction of one year duration, treated as a case of asthmatic bronchitis. Pulmonary alveolar proteinosis was diagnosed by open lung biopsy and she eventually underwent large volume whole lung lavage under general anesthesia.
Human ; Young Adult ; BRONCHOALVEOLAR LAVAGE ; PULMONARY ALVEOLAR PROTEINOSIS

Malaria is suspected in pregnant women with fever of unknown origin who come from areas with high transmission of the disease. Pregnant women are at greater risk of infection due to a weakened immune response and higher parasite burden because of placental sequestration. A 26-year-old Sudanese primigravid 23 6/7 weeks of gestation presented at our institution with mixed infection of malaria, with severe features (hypotension and anemia). Malaria was highly suspected due to her country of origin, which was highly endemic and has high transmission of the disease. Fetal surveillance to monitor fetal well-being was done since malaria is known to cause perinatal adverse outcomes. Intrauterine growth restriction, preterm labor and stillbirth are the most common perinatal morbidity from malaria. These are not present in the patient due to the prompt initiation of artemisinin-based combination therapy, which significantly decreased the parasite load, leading to successful outcome.

Human ; Female ; Adult (a Person 19-44 Years Of Age) ; Pregnancy ; Artemisinine ; Artemisinins ; Parasites ; Coinfection ; Malaria ; Prenatal Care ; Parasite Load ; Gravidity ; Obstetric Labor, Premature ; Anemia ; Hypotension

Introduction：Staphylococcus aureus is a common cause of staphylococcal food poisoning in Australia with several outbreaks associated with foods prepared by commercial caterers. Laboratory testing on cases of gastrointestinal illness caused by enterotoxin-producing S. aureus is not routinely done as this condition is self-limiting. Hence outbreaks of such illness may go undetected.Methods：A retrospective cohort study was conducted among a group of tourists who were hospitalized in Sydney shortly after flying from Queensland. The group had consumed food prepared by a restaurant on the Gold Coast before transit. Laboratory analyses on stool specimens were conducted in Sydney. An environmental assessment of the restaurant in the Gold Coast was conducted, and environmental specimens were assessed for contamination.Results：Epidemiological investigations linked the outbreak to a restaurant in the Gold Coast where the suspected food was produced. Stool samples from two of the hospitalized cases were confirmed to have enterotoxin-producing S. aureus, and several environmental samples were found to be contaminated with S. aureus as well. Investigations suggested that absence of hand washing and other unhygienic food handling at the implicated restaurant was the likely cause of this outbreak.Conclusion：Food poisoning due to toxin-mediated S. aureus is frequently undetected and underreported. Public health units should consider toxin-producing pathogens such as S. aureus when investigating outbreaks where vomiting is the predominant symptom and occurs rapidly after consuming food.

Objective:The Australian Capital Territory Health Directorate was notified of a food handler with hepatitis E virus (HEV) infection. To guide the public health response, a rapid risk assessment was undertaken to determine the risk of transmission of HEV from the infected food handler to restaurant patrons.Method:The literature on HEV was reviewed and expert advice sought from clinical and public health specialists. This was supplemented by results of a site investigation and a case interview. The risk rating was determined to be the product of the likelihood of transmission and the consequence of the infection.Results:The food handler was likely to have been infectious at the time he was working at the restaurant. He had handled high-risk foods, and the site inspection revealed potential opportunities for transmission. HEV is not common in Australia and it was assumed that the population was non-immune and hence susceptible to the disease. Therefore, there was a low but possible likelihood of transmission of HEV. If infected, HEV has the potential for major consequences in vulnerable populations especially among women who are pregnant. The overall level of risk was considered to be very high.Discussion:The general public and health practitioners were alerted to enable early identification of symptoms and prompt disease management. There were no secondary cases of HEV associated with this event. In the absence of published guidelines and limited evidence, a risk assessment framework was a useful tool to inform public health decision-making.

Various techniques of liver parenchymal transection have been introduced,including the finger fracture technique,clamp-crush method,Cavitron ultrasonic surgical aspirator,waterjet,TissueLink,Ligasure,harmonic scalpel,vascular stapler,radiofrequency dissection sealer and the Peng's multifunction operative dissector.All these techniques have the common goals of achieving rapid liver parenchymal transection,minimizing blood loss and preventing bile leak or fistula.It is still unclear which technique is the best.The technique of choice for any individual surgeon would depend on the condition of patients,surgeon's experience and the resources available.This article reviewed the current development and role of the various techniques.