PicSafe App of the Week
IT’ S one of healthcare’ s more irritating problems: doctors would love to send clinical photographs to other doctors, but are repeatedly told that emails are too vulnerable to hacking or intercepting.
From 2012-2015, an app called PicSafe Medi allowed doctors to securely upload clinical photographs from their smartphone
to a server. But overheads were too high and the app folded.
Now it’ s back with the snappier name of PicSafe. Instead of using a central server, doctors can now send photographs to other PicSafe users, in the same way as encrypted text messages.
The developers, based in Melbourne, hope this cheaper( and
mycin 1g stat and 97 % for doxycycline 100mg bd for seven days. 2
In contrast, doxycycline appears superior to azithromycin for anorectal( non-lymphogranuloma venereum) chlamydia infection, with treatment efficacy rates of almost 100 % for doxycycline versus just over 80 % for azithromycin. 1
Rectal chlamydia infection is common in women— even in the absence of a history of anal sex. That said, it is important to ask about anal sexual history. Most rectal chlamydia infection is asymptomatic and may serve as a reservoir for auto-inoculation of the cervix.
Lymphogranuloma venereum requires a 21-day course of doxycycline.
Men who have sex with men who have rectal chlamydia identified should have rectal PCR samples
sent for genotyping to identify the specific chlamydial serovar responsible.
As true treatment resistance is rare in urogenital infections, a test of cure is not routinely recommended. Instead, a test of reinfection is recommended at three months. However, a test of cure remains indicated in pregnant women and cases of rectal chlamydia. ●
References
1. Kong FYS, Hocking JS. Treatment challenges for urogenital and anorectal Chlamydia trachomatis. BMC Infectious Diseases 2015; 15:293.
2. Kong FYS, et al. Azithromycin versus doxycycline for the treatment of genital chlamydia infection: A meta-analysis of randomized controlled trials. Clinical Infectious Diseases 2014; 59:193-205.
simpler) model will take off among Australian doctors and solve this irritating problem for good.
Specifications
COST: Standard version free; pro version $ 9.99 monthly; $ 99.99 yearly; $ 599.99 lifetime. COMPATIBLE WITH: iOS 9 or Android 4.1.
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Q. Which is the least likely presenting complaint for this condition? a. Pain b. Irritation c. Epiphora d. Chronic erythema e. Discharge A. The answer is a. Lower lid ectropion may present with a variety of symptoms but pain is rarely a feature. Epiphora is common given that the punctum is not within the tear lake. Ocular irritation, erythema and chronic discharge mimicking infective conjunctivitis may also occur.
Q. What would you expect on external examination with this condition? a. Follicular conjunctival reaction b. Keratinisation of tarsal conjunctiva c. Papillary conjunctival reaction d. Punctal stenosis e. Lateral canthal tendon laxity A. The answers are b, c, d and e. Longstanding exposure of the tarsal conjunctiva results in metaplasia of the conjunctiva and keratinisation with an associated papillary reaction. Keratinisation and meibomian gland
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dysfunction contribute to punctal stenosis. Anatomically horizontal lid laxity is one of the most important contributing factors. The lateral canthal tendon is generally most affected. Follicular reaction is not generally a feature.
Q. What are the subtypes of ectropion? a. Involutional b. Congenital c. Cicatricial d. Paralytic e. All of the above A. The answer is e. All types of ectropion have an element of horizontal eyelid laxity and instability or dehiscence of lower lid retractors resulting in outward rotation of the eyelid margin. Involutional ectropion arise secondary to ageingrelated laxity. Cicatricial ectropion occurs when there is traction on the anterior lamella( skin and muscle) of the eyelid mechanically pulling the lid away from the globe. Paralytic ectropion occurs in seventh nerve palsies where there is a loss of eyelid tone which, in conjunction with midface descent, causes laxity of the lower lid. Congenital ectropion is particularly rare but may occur in trisomy 21.
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Q. What is the definitive management of this condition? a. Topical steroids b. Topical antibiotics c. Topical lubricants d. Lateral lid shortening A. The answers are c and d. Initial management is usually conservative. Lubricants help with conjunctival exposure. Surgery to address lid laxity and retractor dehiscence is the definitive treatment. As the lateral canthal tendon is usually the main culprit, lateral lid shortening with medial retractor plication generally suffices.
If there is a cicatricial element, the anterior lamella scarring must be released and lengthened via a full thickness skin graft. The eyelid skin is very thin and matching skin may be difficult to find, particularly in patients with severe actinic change. Donor sites include the upper lid, pre / post auricular, inner arm and supraclavicular region. Steroids may be considered, but only prior to surgery. Topical antibiotics should only be used if there is clear evidence of associated bacterial conjunctivitis.
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Bear necessities Medical history
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THE cure for scurvy has been discovered, lost, found again and forgotten ad nauseam throughout history.
Despite learning, although not completely understanding, the benefits of citrus fruit in combating the sailors’ scourge in 1747, humanity seemed to be suffering from some sort of‘ scurvy-cure amnesia’ for centuries.
Perhaps it was all that salty sea air, but by the turn of the 20th century, explorers were once again oblivious to the simple remedy of lemons and other fresh fruit. During a voyage to the North Pole, where the ship became frozen in pack
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ice for three years, the on-board doctor discovered, quite rightly, that his men could stave off scurvy by eating fresh polar bear meat, especially the organs.
Unsurprisingly, most of the crew weren’ t keen and instead chose to just grin( with their toothless, scurvy-ridden mouths) and bear it. The whole ship’ s company came down with scurvy, and two men died.
On his infamous Antarctic expeditions, polar explorer Captain Robert Falcon Scott attempted to follow a similar diet, substituting penguin and seal for polar bear.
But his team made one fatal mistake:
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they boiled the meat, destroying most of the vitamin C in the process.
Cooking their food made it lighter and thus easier to transport on sledge journeys, but it was this space-saving measure that at least partly contributed to the deaths of every man, including Scott, on their doomed march to the South Pole.
So, if you ever find yourself feeling a little worse for wear on an Arctic adventure, just remember the old proverb: when life gives you scurvy, eat lemons— not boiled polar bears.
Sophie Attwood
References on request.
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