4 NEWS
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4 NEWS
4 AUGUST 2023 ausdoc . com . au
Garlic crush linked to man ’ s haematuria
Kemal Atlay DOCTORS have reported how one unlucky patient ’ s use of garlic supplements and love of the pungent bulb led to severe haematuria following an otherwise safe and minimally invasive procedure .
The 65-year-old man underwent an elective green-light laser photovaporisation of the prostate after cystoscopy detected signs of bladder outlet occlusion .
Apart from occasional alcohol intake , the team from St George ’ s University Hospitals in London noted no other relevant medical history in the pre-procedure workup .
The day-surgery procedure was successful , and there were no initial concerns during theatre recovery : the patient passed good volumes of urine with limited rose tinting through a two-way catheter .
But this quickly changed with onset of severe haematuria and clots , which resulted in an overnight stay for monitoring .
A new three-way catheter was also inserted to allow continuous slow irrigation , the doctors wrote in Urology Case Reports .
They said this was “ unusual ” for patients undergoing the minimally invasive procedure at
their clinic — even among those taking regular antithrombotic medication . It was at this point that the
‘ He was taking between one and six garlic capsules a day .’
patient revealed his “ significant intake ” of garlic supplements over the past few years , right up until the day of his surgery .
“ His intake of supplements varied widely depending on the supply he could find , ranging between 300mg and 900mg per capsule in strength and taking between one and six capsules a day in quantity ,” the doctors wrote .
“ The patient was quoted to also be consuming large amounts of raw and cooked garlic as part of his regular Mediterranean diet .”
Although the specific mechanism was unclear , they said the active ingredient found in garlic — a thiosulfinate called allicin — had known antiplatelet and anticoagulant properties .
The haematuria resolved with irrigation , and the patient went home the next day after a successful trial without a catheter .
They did not state whether the patient had stopped taking garlic supplements , but no further significant bleeding episodes were reported except for rectal bleeding a year later due to a new diverticular disease .
“ At time of writing , this represents a novel case of unexpected bleeding in a patient strongly attributed to dietary or herbal supplements for a supposed less invasive technique with a better haemostatic profile ,” the doctors wrote . Urol Case Rep 2023 ; 4 Jul .
Abortion drug rules changed
Sarah Simpkins THE rule that GPs must retake a threehour training course every three years to prescribe abortion drugs is being scrapped , along with mandatory registration for prescribers and dispensers .
Around 10 % of GPs have been certified as medical abortion prescribers .
But the TGA says any health practitioner with “ appropriate ” skills and training will be allowed to prescribe MS-2 Step ( mifepristone and misoprostol ) from 1 August without drug sponsor MS Health certifying their training every three years .
This could include nurse practitioners , although the rules on who can prescribe or assist abortion procedures vary between jurisdictions and will potentially require states or territories to change legislation .
The PBAC has also recommended moving the drugs from telephone authority listing to streamlined authority listing .
Under the changes , GPs will no longer have to ask Services Australia staff over the phone to verify their registration and also that the patient is within the nine-week gestational limit .
Instead , prescribers will be responsible for ensuring patients meet gestational limit criteria .
MS-2 Step has been prescribed around 30,000 times each year under the PBS since 2019 .
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References : 1 . Cipriani C , et al . International J Nucl Med . 2017 ; July : 114 – 112 . 2 . Cipriani C , et al . J Dermatol Treat . 2020 ; DOI : 10.1080 / 09546634.2020.1793890 . 3 . Castellucci P , et al . Eur J Nucl Med Mol Imaging . 2021 ; 48 ( 5 ): 1511 – 1521 . 4 . Cipriani C , et al . In Therapeutic Nuclear Medicine . 2014 . RP Baum ( Ed ), New York : Springer . 5 . Australian Therapeutic Goods Administration . ARTG Public summary 400142 .
Please review the Product and User information before use . This can be accessed at www . oncobeta . com . Indication : Rhenium-188 paste for the treatment of skin cancer lesions and skin tumours . Currently not MBS funded . OncoBeta ® GmbH , Schleißheimer Str . 91 , 85748 Garching near Munich , GERMANY . SHOW4045 . B . Date of preparation : May 2023