Aust Fam Physician
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Traumatic head injury is a common occurrence in the paediatric population, with the majority of patients sustaining only mild head injury. ⋯ A careful history including time of injury, the mechanism of injury, and any loss of consciousness or seizure activity; a thorough examination including a Glascow Coma Scale (GCS) score; and observation should be appropriate for most patients. Only a small number of injuries require further examination/imaging with computerised tomography. Indicators for transfer to hospital include GCS equal to or less than 12, focal neurological deficit, clinical evidence of skull fracture, loss of consciousness for more than 30 seconds, ataxia, amnesia, abnormal drowsiness, persistent headache, seizure following initial normal behaviour or recurrent vomiting. Postconcussive symptoms frequently occur after minor head injuries and parents and other family members should be aware of what symptoms to expect, and possible duration. Regular follow up until all symptoms have resolved is mandatory, with clear guidelines for stepwise resumption of physical activity.
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Aggressive and violent behaviour by patients, or their relatives or friends, toward general practice staff is a matter of national concern. Forms of this behaviour include verbal and physical abuse, property damage, theft, stalking, sexual harassment and sexual abuse. ⋯ Australian data investigating patient initiated aggression and violence in general practice are limited. Findings should be interpreted with caution due to methodological limitations. The lack of national data needs to be addressed.
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Dengue virus infection is spread by the mosquito vector Aedes aegypti and causes significant morbidity and mortality worldwide. In Australia, it is an important cause of fever in the returned traveller and recent outbreaks have occurred in northern Queensland. A comprehensive understanding of the clinical and public health ramifications of dengue infection is essential for general practitioners. ⋯ Dengue should be considered as a differential diagnosis of fever in a returned traveller, including in patients who have travelled to northern Queensland within 3 months of an outbreak. Clinical manifestations vary from asymptomatic infection to serious disease. Typical symptoms last 7 days and may include: fever, headache, myalgia, fatigue, abnormal taste sensation, arthralgia, maculopapular rash and anorexia. Around 1% of patients will get the more severe form of the illness, dengue haemorrhagic fever. Recommended diagnostic tests depend on the time since the onset of symptoms. Management involves symptomatic treatment and monitoring for complications. Dengue haemorrhagic fever requires hospitalisation. Prompt notification to public health authorities and advice to patients about prevention of spread are a key role of the GP.
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Since the mid 1990s, there has been a global resurgence of bed bugs (Cimex spp.), which are blood feeding insects that readily bite humans. Patients suffering with bite reactions are increasingly presenting to medical practitioners. ⋯ Common dermatological responses include the early development of small macular spots that may later progress into prominent wheals accompanied by intense itching. Patients exposed to numerous bed bugs can present with a widespread erythematous rash or urticaria. Bullous eruptions are not uncommon and anaphylaxis has been reported, albeit rarely. There is no evidence that bed bugs transmit human pathogens, but they are responsible for significant psychological distress, can produce anaemia when abundant, and have been implicated in the triggering of asthmatic reactions. Symptomatic control involves treatment of the patient with antihistamines and corticosteroids, and ensuring that the infestation responsible for the problem is effectively eliminated.
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In recent years there has been a worldwide increase in the number of diagnoses of type 2 diabetes mellitus (T2DM) in children and adolescents. This has become a major focus for the work of the International Diabetes Federation. In Australia, most children and adolescents with diabetes have type 1 diabetes. However, more young Australians are developing T2DM. ⋯ Type 2 diabetes is the consequence of a complex interaction between genes and the environment in a susceptible individual. Children with T2DM are generally overweight, often with central adiposity. Having one or more parents with T2DM gives offspring up to an 80% chance of developing T2DM. At risk children and adolescents should be screened for T2DM. It is important to check the glutamic acid decarboxylase (GAD) antibody to exclude type 1 diabetes. Symptoms and signs of the metabolic syndrome should be sought. Child and adolescent patients with T2DM face the psychological burden of living a lifetime with a chronic disease. Management is team based and team members include the general practitioner, diabetes educator, dietician and endocrinologist. Goals include achieving and maintaining normoglycaemia, weight reduction and increased physical activity. Lifestyle modification alone may control minor hyperglycaemia and metformin can be added to control moderate hyperglycaemia. In severe hypoglycaemia, insulin may be required initially to achieve normoglycaemia and can be phased out and metformin phased in later. Insulin is likely to be required again later in the natural history of disease. Little is known about factors affecting complication risk in children and adolescents with T2DM but they essentially have a 'double whammy' of diabetes and the metabolic syndrome and are likely to develop macrovascular complications much earlier than adults who develop T2DM.