Significant healthcare resource utilisation in the management of skin and soft tissue infections in the Torres Strait, Australia.

Introduction: Aboriginal and Torres Strait Islander Peoples (First Nations Australians) living in remote communities are hospitalised with skin and soft tissue infections (SSTIs) at three times the rate of non-First Nations Australians. The Torres Strait in tropical northern Australia has a highly dispersed population mainly comprising First Nations Australians. This study aimed to define the health service utilisation and health system costs associated with SSTIs in the Torres Strait and to improve the quality of regional healthcare delivery.

Serum Levels of Vitamin C and Thiamin in Children With Suspected Sepsis: A Prospective Observational Cohort Study.

Objectives: Vitamin C and thiamin have been trialed as adjunctive therapies in adults with septic shock but their role in critically ill children is unclear. We assessed serum levels of vitamin C and thiamin in children evaluated for sepsis.

Design: Single-center prospective observational study.

The effect of cardiopulmonary bypass on blood thiamine concentration and its association with post-operative lactate concentration.

Objective: Cardiothoracic surgery is a large field in Australia, and evidence suggests post-cardiopulmonary bypass (CPB) hyperlactataemia is associated with higher morbidity and mortality. Low thiamine levels are a potentially common yet treatable cause of hyperlactataemia and may occur in the setting of exposure to CPB non-biological material. We hypothesized that cardiopulmonary bypass would result in decreased whole-blood thiamine levels, which may therefore result in increased whole-blood lactate levels in the post-operative period.

Chronic hepatitis B in remote, tropical Australia; successes and challenges.

Introduction: Aboriginal and Torres Strait Islander Australians living in remote locations suffer disproportionately from chronic hepatitis B (CHB). Defining the temporospatial epidemiology of the disease-and assessing the ability of local clinicians to deliver optimal care-is crucial to improving patient outcomes in these settings.

Methods: The demographic, laboratory and radiology findings in all patients diagnosed with CHB after 1990, and presently residing in remote Far North Queensland (FNQ), tropical Australia, were correlated with their management and clinical course.

"We are everything to everyone": a systematic review of factors influencing the accountability relationships of Aboriginal and Torres Strait Islander health workers (AHWs) in the Australian health system.

Background: Health policy in Australia positions Aboriginal and Torres Strait Islander Health Workers (AHWs) as central to improving Aboriginal and Torres Strait Islander peoples' health, with high expectations of their contribution to closing the gap between Indigenous and non-Indigenous health outcomes. Understanding how AHWs' governance and accountability relationships influence their ability to address such health inequities has policy, programme and ethical significance. We sought to map the evidence of AHWs' experiences of accountability in the Australian health system.

Acute ST-elevation myocardial infarction in a 24-year-old woman with atheromatous coronary artery disease.

We report the case of a 24-year-old Torres Strait Islander woman who presented to a rural hospital ED with chest pain suspicious for myocardial ischaemia and was found to have an anterior ST-elevation myocardial infarction. She was thrombolysed and transferred to a tertiary centre where subsequent angiography revealed atheromatous disease of the left anterior descending coronary artery. We believe this to be one of the youngest reported cases of myocardial infarction due to atheromatous coronary artery disease, and demonstrates important learning points regarding the demographics and risk factors of indigenous patients with chest pain.

Irukandji sydrome in the Torres Strait: a series of 8 cases.

Objective: To review the presentations of a series of patients with suspected Irukandji syndrome in the Torres Strait, where the syndrome has hitherto been unknown or undocumented, in order to identify at-risk groups and improve the management of this condition in the region.

Methods: A mixed retrospective-prospective review of eight cases of patients with suspected Irukandji syndrome in the Torres Strait, with a focus on the differences between the clinical presentations and patient outcomes.

Results: Irukandji syndrome is the most likely explanation, based on current knowledge, of this series of marine envenomation syndromes in the Torres Strait.

Acute glomerulonephritis in a child with multidrug-resistant tuberculosis and multibacillary leprosy.

A 10-year-old boy from Papua New Guinea with multidrug-resistant tuberculosis and multibacillary leprosy developed acute glomerulonephritis while being treated as an inpatient at Thursday Island Hospital in the Torres Strait, Queensland. This is the first such case to be reported in Australia, where these diseases are uncommon and the combination is extremely rare, and it outlines important learning points regarding the aetiology of renal disease among patients with tuberculosis and leprosy.

HIV, malaria and pneumonia in a Torres Strait Islander male--a case report.

This report presents the case of a middle-aged Torres Strait Islander male with HIV who contracted Plasmodium vivax malaria in Papua New Guinea. His presentation included clinical and radiological features of pneumonia and he required inpatient treatment for 13 days. This study reviews the literature concerning co-infection with HIV and malaria, which is an uncommon combination in Australia, discusses the public health risks posed by patients with malaria in the Torres Strait, given the presence of a known vector, and suggests strategies to reduce the disease burden posed by malaria in this patient and other Torres Strait Islanders travelling to Papua New Guinea under the terms of the Torres Strait Treaty.

Scrub typhus in the Torres Strait islands of north Queensland, Australia.

Scrub typhus, caused by Orientia tsutsugamushi, occurs throughout Southeast Asia. We descript ten cases that occurred in the Torres Strait islands of northern Australia during 2000 and 2001. Preceding heavy rain may have contributed to the outbreak.

Melioidosis in the Torres Strait islands of far North Queensland.

During the six-year period from 1995 to 2000, 23 cases of melioidosis were diagnosed from the Torres Strait islands that lie between northern Queensland and Papua New Guinea. This represents an average annual incidence of 42.7 per 100,000 population, the highest documented to date in this region.

Hansen's disease. Practice tips for management.

The author highlights some of the critical features of general practice diagnosis and management of Hansen's disease in First World primary care practice. These features are often not obvious or emphasised in most texts because they are designed for a Third World scenario, where primary care is delivered without the luxury of medically trained practitioners and therefore without the option of emergency steroid therapy.