None available.

Scabies presents as an intensely pruritic rash that predominantly involves hairless and thin skin such as web spaces of the hands and skin creases. Sensitization to mite products is responsible for the itch and therefore symptom onset is usually delayed by weeks in the first infection. Secondary bacterial infection with Staphylococcus aureus and Streptococcus pyogenes is responsible for significant morbidity. Crusted scabies, the most severe form of scabies, presents as a hyperkeratotic rash. Lesions are loaded with mites and such patients are highly infectious. Direct skin-to-skin contact is the most important mode of transmission. Parasitological diagnosis is difficult and therefore clinical diagnosis is usually relied upon, although new diagnostic methods are under development. The most commonly used treatment of choice is topical permethrin cream applied to the whole body. Ivermectin, administered orally, is increasingly being used, including for mass drug administration.

“Drs. Genevieve Martin, Catherine Marshall, and Bart Currie from the Royal Darwin Hospital share their approach to Burkholderia pseudomallei aka melioidosis!”

"This chapter is divided into three sections. The first provides the reader with a historical perspective of Australian Aboriginal and Torres Strait islander peoples, the impact of colonisation and contemporary access to mental health care. The second section is written from a remote rural mental health nurse perspective, providing insight into some of the concerns and challenges of working in often far distant places, away from acute care services, to provide mental health care to Indigenous people within Australia. The last section comes from our colleagues in New Zealand, exploring the bi-cultural nature of mental health care in that country. This section offers insights into how care can be provided within a culturally safe and inclusive manner. " -- taken from the introduction to the chapter.

Back Ground: Bronchiectasis is a commonly seen chronic lung disease in our inpatient and outpatient services of QCH. The unmet needs of people with bonchiectasis are hug, with realitvely few randomised controlled trials (RCT's) and evidence-based interventions. This randomised-controlled-trial (RCT) aims to imporve the outcomes of these children. It will examine the benefits (or otherwise) of a novel medication, erosteine. Erosteine's effects include (a) mucolytic action modulation of mucus production and increasing muco-cilary transport; with (b) antioxidant; (c) airway anit inflmaatory and; (d) bacterial anit-adhesion properties. This RCT will answer: In children with bronchiectasis, does 12 months treatment with erosteine, compared to the placebo, (i) reduce acute respiratory exacerbations and/or (II) improve quality of life (QoL). The RCT will also determine the cost-effectiveness of the treatment. The findings of this RCT may alter routine clinical proactive if eroosteine is shown to improve the lives of children with bronchiectasis.

Episodes of acute adrenal insufficiency (AI)/adrenal crises (AC) are a serious consequence of congenital adrenal hyperplasia (CAH). This study aimed to assess morbidity from acute illness in CAH and identify factors associated with use of IV hydrocortisone, admission and diagnosis of an AC. An audit of acute illness presentations among children with CAH to paediatric hospitals in New South Wales, Australia, between 2000 and 2015. There were 321 acute presentations among 75 children with CAH. Two-thirds (66.7%, n = 214) of these resulted in admission and 49.2% (n = 158) of the patients received intravenous (IV) hydrocortisone. An AC was diagnosed in (9.0%). Prior to presentation, 64.2% (n = 206) had used oral stress dosing and 22.1% (n = 71) had been given intramuscular (IM) hydrocortisone. Vomiting was recorded in 61.1% (n = 196), 32.7% (n = 64) of whom had used IM hydrocortisone. Admission, AC diagnosis and use of stress dosing varied significantly between hospitals. IM use varied from 7.0% in one metropolitan hospital to 45.8% in the regional hospital. Children aged up to 12 months had the lowest levels of stress dosing and IV hydrocortisone administration. Higher numbers of prior hospital attendances for acute illness were associated with increased use of IM hydrocortisone. Prehospital and in-hospital management of children with CAH can vary between health services. Children under 12 months have lower levels of stress dosing prior to hospital than other age groups. Experience with acute episodes improves self-management of CAH in the context of acute illness in educated patient populations.

Pictorial guide to safe food handling.

The effect of socioeconomic status (SES) on rates of sports specialization and injury among youth athletes has not been described previously. Young athletes from lower socioeconomic status will have lower rates of sports specialization and subsequently lower risk of overuse injuries. Cohort study. Level 3. Injured athletes aged 7 to 18 years were recruited from 2 hospital-based sports medicine clinics and compared with uninjured athletes presenting for sports physicals at primary care clinics between 2010 and 2013. Participants completed surveys on training patterns. Electronic medical records provided injury details as well as patient zip code, race, and health insurance type. SES was estimated from zip codes. The sample was divided into SES tertiles. Analysis of variance and multivariate regression were used for continuous variables, and multivariate logistic regression analyses were conducted to explore relationships between risk factors and injury. Of 1190 athletes surveyed, 1139 (96%) had satisfactory SES data. Compared with low-SES athletes, high-SES athletes reported more hours per week spent playing organized sports (11.2 ± 6.0 vs 10.0 ± 6.5; P = 0.02), trained more months per year in their main sport (9.7 ± 3.1 vs 7.6 ± 3.7; P < 0.01), were more often highly specialized (38.9% vs 16.6%; P < 0.01), and had increased participation in individual sports (64.8% vs 40.0%; P < 0.01). The proportion of athletes with a greater than 2:1 ratio of weekly hours in organized sports to free play increased with SES. Accounting for age and weekly organized sports hours, the odds of reporting a serious overuse injury increased with SES (odds ratio, 1.5; P < 0.01). High-SES athletes reported more serious overuse injuries than low-SES athletes, potentially due to higher rates of sports specialization, more hours per week playing organized sports, higher ratio of weekly hours in organized sports to free play, and greater participation in individual sports. As SES increases, young athletes report higher degrees of sports specialization, greater participation in individual sports, and more serious overuse injuries.