Hawai'i journal of medicine & public health : a journal of Asia Pacific Medicine & Public Health
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Hawaii J Med Public Health · Nov 2014
Case ReportsCentipede envenomation: bringing the pain to Hawai'i and Pacific Islands.
Scolopendra subspinipes is the only clinically significant centipede found in Hawai'i. Envenomation typically leads to extreme localized pain, erythema, induration, and tissue necrosis and possible lymphedema or lymphangitis. Mortality is uncommon and results from secondary infection or anaphylaxis. Management is supportive and includes wound care, pain control, and treatment with topical or oral antihistamines and anti-inflammatory medications.
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Hawaii J Med Public Health · Sep 2014
Hospital visits due to domestic violence from 1994 to 2011 in the Solomon Islands: a descriptive case series.
The Solomon Islands has one of the highest rates of domestic violence in the world. This paper is a descriptive case series of all cases of domestic violence presenting to the Solomon Islands National Referral Hospital (NRH) over 18 years. Data were routinely collected from a database of all patients who were treated by NRH general surgery and orthopedic clinicians between 1994 and 2011, inclusive. ⋯ Only 5% (5 of 111) of cases in females were inflicted by another female. This analysis provides the best available information on domestic violence cases requiring a visit to a tertiary hospital in a Pacific Island in the specified time period and is undoubtedly an under-estimate of the total cases of domestic violence. Preventing and treating domestic violence in the Solomon Islands and in the Pacific is an important challenge and there is a significant role for secondary and tertiary health services in screening for and preventing domestic violence.
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Hawaii J Med Public Health · Aug 2014
Optic nerve sheath diameter measurements by CT scan in ventriculoperitoneal shunt obstruction.
The objective of the study was to determine differences in optic nerve sheath diameter (ONSD) measurements taken from computed tomography (CT) scans of patients with ventriculoperitoneal shunt (VPS) obstruction versus controls. Inpatients 0-15 years with confirmed VPS obstruction requiring neurosurgical intervention were identified using ICD9 codes. ONSDs, orbit, cranium, and foramen magnum sizes were measured on their pre-surgical CT. ⋯ The same measurements for the VPS obstruction versus age and gender matched controls were 0.22 and 0.21 for the VPS obstruction cases, respectively, compared to 0.17 and 0.16, respectively for the age and gender matched controls (P < .001 and P < .001, respectively). This data confirms that the optic nerve diameter increases during a VPS obstruction. ONSD measurements by ultrasound could add to the evaluation for VPS obstruction.
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Hawaii J Med Public Health · Jul 2014
Willingness to favor aggressive care and live with disability following severe traumatic brain injury: a survey of healthy young adults in Hawai'i.
Traumatic brain injury (TBI) is a major public health problem that significantly impacts young adults. Since severe TBI patients lack decision-making capacity, the providers and patient surrogates are often faced with the challenging task of deciding whether to continue with aggressive life-prolonging care or to transition to comfort-focused care with an expected outcome of natural death. The assumption is often made that aggressive care is appropriate for young patients who suffer severe TBI despite the high likelihood of a poor outcome. ⋯ Despite being presented with a high likelihood of long-term moderately severe-to-severe disability, 65 of the 115 respondents (57%) favored aggressive care. A willingness to live with receptive aphasia was the only independent factor that predicted aggressive care (OR 2.50, 95% CI: 1.15 to 5.46). Even among the young adults, preference of care was divided between aggressive and conservative approaches when presented with a hypothetical case of severe TBI.
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Hawaii J Med Public Health · Jun 2014
Case ReportsCongestive heart failure: a case of protein misfolding.
This article describes an interesting case of a patient presenting with congestive heart failure found to have restrictive cardiomyopathy with initial laboratory evaluation showing hypogammaglobuminemia without a monoclonal band on serum and urine electrophoresis. This case highlights the clinically significant cardiac manifestation caused by protein misfolding, a defect in protein homeostasis. In addition, the utility of a relatively newer laboratory test, serum free light chains as well as the importance of clinical and pathophysiologic correlation is also discussed. We present a relatively uncommon cause of heart disease, cardiac amyloidosis in a patient with a systemic plasma cell dyscrasia, and multiple myeloma.