ORCID Profile
0000-0002-5842-6173
Current Organisations
Northern Health
,
Austin Hospital
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Publisher: Wiley
Date: 04-2020
DOI: 10.1111/IMJ.14796
Publisher: Wiley
Date: 30-10-2017
DOI: 10.1111/JPC.13743
Abstract: To assess adherence to the Iocal guideline (LG) for the management of fever in infants under 3 months and whether the application of a risk-stratified protocol (RSP) to this population would miss any serious bacterial infections (SBI) compared to current practice (CP) and LG. All presentations to the authors' Emergency Department of infants 0-3 months with fever from 1 July 2015 to 28 April 2016 were included (n = 219), along with a detailed analysis of CP. The initial history, examination and pathology results were applied to the LG and RSP to assess what changes in management would occur. The primary end point was a missed SBI, with secondary outcomes measuring the number of invasive procedures performed, antibiotics prescribed and admissions. Adherence to the LG was 83% with three missed SBIs. Strict adherence would have resulted in eight missed SBIs. This indicates that both warranted and unwarranted variation exists in current clinical practice. Application of the RSP showed no missed SBIs but, compared to CP, indicates a statistically significant increase in admissions and full septic screens (admissions 95% vs. 83%, P < 0.05 full septic screens 82% vs. 72%, P < 0.05). Chest X-rays were infrequently requested (10%) and the validity of use in this group warrants further study. An ad hoc risk-stratified practice already exists at the authors' institution, and application of an RSP did not miss any SBIs. Adoption and implementation of a formal RSP is currently being formulated.
Publisher: Informa UK Limited
Date: 11-03-2023
Publisher: Bioscientifica
Date: 07-2019
DOI: 10.1530/EC-19-0272
Abstract: Oestradiol with or without an anti-androgen (cyproterone acetate or spironolactone) is commonly prescribed in transfeminine in iduals who have not had orchidectomy however, there is no evidence to guide optimal treatment choice. We aimed to compare add-on cyproterone acetate versus spironolactone in lowering endogenous testosterone concentrations in transfeminine in iduals. Retrospective cross-sectional study. We analysed 114 transfeminine in iduals who had been on oestradiol therapy for months in two gender clinics in Melbourne, Australia. Total testosterone concentrations were compared between three groups oestradiol alone ( n = 21), oestradiol plus cyproterone acetate ( n = 21) and oestradiol plus spironolactone ( n = 38). Secondary outcomes included serum oestradiol concentration, oestradiol valerate dose, blood pressure, serum potassium, urea and creatinine. Median age was 27.0 years (22.5–45.1) and median duration of hormone therapy was 1.5 years (0.9–2.6), which was not different between groups. On univariate analysis, the cyproterone group had significantly lower total testosterone concentrations (0.8 nmol/L (0.6–1.20)) compared with the spironolactone group (2.0 nmol/L (0.9–9.4), P = 0.037) and oestradiol alone group (10.5 nmol/L (4.9–17.2), P 0.001), which remained significant ( P = 0.005) after adjustments for oestradiol concentration, dose and age. Serum urea was higher in the spironolactone group compared with the cyproterone group. No differences were observed in total daily oestradiol dose, blood pressure, serum oestradiol, potassium or creatinine. The cyproterone group achieved serum total testosterone concentrations in the female reference range. As spironolactone may cause feminisation without inhibition of steroidogenesis, it is unclear which anti-androgen is more effective at feminisation. Further prospective studies are required.
Publisher: Mary Ann Liebert Inc
Date: 04-2023
Publisher: Wiley
Date: 05-10-2020
DOI: 10.1111/CEN.14329
Publisher: Bioscientifica
Date: 10-2021
DOI: 10.1530/EDM-21-0137
Abstract: Primary aldosteronism is one of the most common (affecting up to 10%) yet treatable causes of hypertension in our community, notable due to an associated elevated risk of atrial fibrillation, stroke and myocardial infarction compared to essential hypertension. Guidelines have focussed on improving case detection due to significant underdiagnosis in the community. While our case experienced significant delay in diagnosis, we highlight a state of protracted, persistent post-operative hypoaldosteronism which manifested with severe hyponatraemia and hyperkalaemia, necessitating long-term mineralocorticoid replacement. We discuss whether pre-operative mineralocorticoid receptor antagonists to stimulate aldosterone secretion from the contralateral gland may have prevented this complication. Hypoaldosteronism is an uncommon complication of adrenalectomy for primary aldosteronism, typically manifesting with hyperkalaemia and hyponatraemia. While most cases are transient, it may be persistent, necessitating ongoing mineralocorticoid replacement. Routine electrolyte monitoring is recommended post-adrenalectomy. Risk factors for hypoaldosteronism include age years, duration of hypertension years, pre-existing renal impairment and adrenal adenoma size cm. Mineralocorticoid receptor antagonists may assist in the management of hypokalaemia and hypertension pre-operatively. However, it is unclear whether this reduces the risk of post-operative hypoaldosteronism.
No related grants have been discovered for Lachlan Angus.