The diagnosis and initial management of melanoma in Australia: findings from the prospective, population-based QSkin study.

Objectives: To determine the proportions of newly diagnosed melanomas treated by different medical specialist types, to describe the types of excisions performed, and to investigate factors associated with treating practitioner specialty and excision type.

Design, Setting: Prospective cohort study; analysis of linked data: baseline surveys, hospital, pathology, Queensland Cancer Register, and Medical Benefits Schedule databases.

Participants: Random sample of 43 764 Queensland residents aged 40-69 years recruited during 2011, with initial diagnoses of in situ or invasive melanoma diagnosed to 31 December 2019.

Familial Q fever clustering with variable manifestations imitating infectious and autoimmune disease.

Q fever, caused by Coxiella burnetii, can present as an outbreak of acute disease ranging from asymptomatic disease, pneumonia, hepatitis or fever of unknown origin, which can progress to a chronic disease, most frequently endocarditis. The occurrence of Q fever within families is rarely described, and in most cases presents with uniform acute disease manifestations. Here we present a familial cluster of Q fever presenting as highly variable synchronous manifestations in four of five family members, including prolonged fever of unknown origin, asymptomatic carrier state, hepatitis, and chronic endocarditis developing in the absence of previous symptoms.

A lightning multiple casualty incident in Sequoia and Kings Canyon National Parks.

Multiple casualty incidents (MCIs) are uncommon in remote wilderness settings. This is a case report of a lightning strike on a Boy Scout troop hiking through Sequoia and Kings Canyon National Parks (SEKI), in which the lightning storm hindered rescue efforts. The purpose of this study was to review the response to a lightning-caused MCI in a wilderness setting, address lightning injury as it relates to field management, and discuss evacuation options in inclement weather incidents occurring in remote locations.

Omalizumab therapy for chronic spontaneous urticaria: the Israeli experience.

Background: Chronic spontaneous urticaria (CSU) is a common, debilitating disease that is frequently resistant to standard therapy. Omalizumab, anti-immunoglobulin-E humanized monclonal antibody, was recently shown to be effective in treating resistant CSU.

Objectives: To investigated the treatment of CSU with omalizumab in Israel.

Evaluation of a prospectively administered written questionnaire to reduce the incidence of suspected latex anaphylaxis during elective cesarean delivery.

Background: Life-threatening anaphylaxis has been reported in women exposed to latex during surgery. We compared a written screening questionnaire to identify suspected latex sensitivity with a verbal inquiry used previously in a historical control group of women undergoing cesarean delivery to determine if the incidence of suspected latex anaphylaxis could be reduced.

Methods: To identify suspected latex sensitivity among women undergoing elective cesarean delivery in a single-site tertiary unit, a nine-item written screening questionnaire was compared to historical use of a standard verbal inquiry "Are you allergic to medications or latex?".

Azathioprine as a therapeutic alternative for refractory chronic urticaria.

Background: Chronic urticaria (CU) affects up to 1% of the general population. Its impact on quality of life is immense, and patients might require multiple drugs to control symptoms. The main therapeutic challenge in the treatment of CU is to maintain symptomatic control while minimizing the use of glucocorticosteroids and their plethora of side effects.

Azathioprine-induced fever in autoimmune hepatitis.

Underdiagnosis of drug-induced fever leads to extensive investigation and prolongation of hospitalization, and may lead to multiple unnecessary invasive procedures and a wrong diagnosis. Azathioprine is a widely used immunosuppressive drug. We report a case of a 53-year-old female patient diagnosed with autoimmune hepatitis treated with azathioprine, who presented to the emergency room with a 6-wk history of fever and chills without other associated symptoms.

Dapsone induced eosinophilic pneumonia.

Eosinophilic lung diseases (ELD) are a variety of several clinical entities, which may result from different etiologies, including drug treatment. Dapsone, a sulfone antibiotic widely used in leprosy (among other indications), has been described as a possible cause of ELD. We report a patient with leprosy who presented with respiratory symptoms and pulmonary infiltrates and was diagnosed as suffering from eosinophilic pneumonia.

Intranasal naloxone is a viable alternative to intravenous naloxone for prehospital narcotic overdose.

Objective: To compare the prehospital time intervals from patient contact and medication administration to clinical response for intranasal (IN) versus intravenous (IV) naloxone in patients with suspected narcotic overdose.

Methods: This was a retrospective review of emergency medical services (EMS) and hospital records, before and after implementation of a protocol for administration of intranasal naloxone by the Central California EMS Agency. We included patients with suspected narcotic overdose treated in the prehospital setting over 17 months, between March 2003 and July 2004.

Biphasic defibrillation does not improve outcomes compared to monophasic defibrillation in out-of-hospital cardiac arrest.

Study Objective: To compare the outcomes of out-of hospital cardiac arrest (OHCA) victims treated with monophasic truncated exponential (MTE) versus biphasic truncated exponential (BTE) defibrillation in an urban EMS system.

Methods: We conducted a retrospective review of electronic prehospital and hospital records for victims of OHCA between August 2000 and July 2004, including two years before and after implementation of biphasic defibrillators by the Fresno County EMS agency. Main outcome measures included: return of spontaneous circulation (ROSC), number of defibrillations required for ROSC, survival to hospital discharge, and discharge to home versus an extended care facility.

A novel approach to enhance visualization during drainage of peritonsillar abscess.

Routine emergency department care for uncomplicated peritonsillar abscess involves needle aspiration or incision and drainage. Standard technique involves use of a tongue blade and auxiliary light source. We describe the novel use of a disassembled disposable vaginal speculum with fiberoptic light, a device becoming commonplace in many emergency departments.

An experimental study of warming intravenous fluid in a cold environment.

Objective: Numerous studies support the use of warmed intravenous fluids in hypothermic patients. The most effective method to accomplish this goal in a cold prehospital, wilderness, or combat setting is unknown. We evaluated various methods of warming intravenous fluids for a bolus infusion in a cold remote environment.

Late-onset sarcoidosis after liver transplantation for primary biliary cirrhosis.

Primary biliary cirrhosis (PBC) and systemic sarcoidosis are granulomatous diseases of unknown etiology whose hepatic manifestations may infrequently be imitative of one another. Described herein is the first reported case in the medical literature of systemic sarcoidosis developing after liver transplantation for PBC. The presented patient, who suffered from typical clinical, laboratory, and pathologic manifestations of PBC, developed decompensated liver cirrhosis within a course of 8 years, necessitating orthotopic liver transplantation.

Saliva secretion in patients with allergic rhinitis.

Background: Allergic rhinitis is manifested by watery discharge; however its clinical effect on the watery volume in the oral cavity is unknown. In addition, the low incidence of dry mouth due to treatment with the new generation antihistamines is based on subjective patients' reports only. This study aimed to examine the effect of loratadine and fexofenadine on the salivary gland function in patients diagnosed with allergic rhinitis compared to untreated allergic patients and healthy individuals.