Objective: To determine the relationship between baseline indices of iron load and severity of arthropathy in C282Y homozygous HFE haemochromatosis (HH).
Method: Genetically proven HH participants from a previous community-based study who had clinical and radiologically confirmed arthropathy compatible with HH were included. The most recent joint imaging and blood tests available up to November 2021 were used to assess the summative joint damage score (SJDS), which comprises the sum of radiological grades in all clinically affected joints and all joints in the hands. Relevant x-rays were examined by both a rheumatologist and musculoskeletal radiologist. Joint scores were assigned in keeping with published systems of classification. Discrepancies were resolved by consensus.
Results: Nineteen participants with HH and arthropathy (median age 55 years) were analysed. Statistically significant correlations were observed between SJDS and serum ferritin at diagnosis of HH and between SJDS and the red cell mean corpuscular volume (MCV) at diagnosis of HH, [r = 0.58, p = 0.01 and r = 0.474, p = 0.04, respectively]. There was no statistically significant correlation between transferrin saturation at diagnosis and SJDS. Neither current ferritin nor current transferrin saturation were found to correlate with SJDS.
Conclusion: Indices of iron metabolism at the time of HH diagnosis and, in particular, serum ferritin concentrations and elevation of the MCV were found to be associated with the radiological severity of HH arthropathy. This finding suggests that baseline iron load is a prognostic marker for joint disease severity and that ferritin concentration at diagnosis is likely to be mechanistically important in the development of chondral damage.
Tasman Medical Journal 2022: 4(1); 1-5
This article describes early researcher experience with applying the Guardianship and Administration Amendment (Medical Research) Act 2020 (GAA) in Western Australia. The Act provides legislative authority for health research involving adults unable to make reasonable judgements about their participation in research (“incapacitated candidates”). The GAA is undergoing statutory review of its operation and effectiveness. Early researcher experience and stakeholder feedback were the focus of a panel discussion organised by the St John of God Health Care (SJGHC) Human Research Ethics Committee (HREC) held on 9 September 2021. The Panel comprised nine participants including a chairman. It represented a cross-section of key personnel working in health care research across the Western Australian private and public health care hospitals and academic institutions. This article provides an overview of the content and discussion points of the Panel which highlighted the perceived strengths of, and challenges in, implementation of the GAA, and which concluded with some suggested improvements. We elaborate on the discussion points raised by the Panel and comment broadly on wider implications of issues related to consent by incapacitated research candidates.
Tasman Medical Journal 2022; 4(2): 6-11
Introduction: Coded cause of death data from death certificates is important for estimating mortality related to cancers and their treatments. However, coding may be inaccurate or complicated by variation in mode of diagnosis (for example, radiology versus pathology, or in methodology between government agencies). This may have important reporting and funding implications.
Aims: (1) To investigate the level of agreement for cause of death data between the Australian Bureau of Statistics (ABS) and Tasmanian Cancer Registry (TCR), and to compare these with independent, blinded medical practitioner opinions on cause of death. (2) To estimate the impact of different coding practices and resulting cause of death data on cause-specific survival.
Methods: Causes of death were compared between the ABS and TCR, and discrepancies were independently reviewed by specialist medical practitioners. Cohen’s Kappa statistics were applied to evaluate the degree of concordance between the ABS, TCR and medical practitioner opinions regarding cause of death. The cumulative incidence function was used to estimate cause-specific survival time in the presence of a competing risk framework according to sex, place of residence, country of birth, and type of PLC.
Results: A minimal level of agreement (Kappa=0.35) was observed when comparing the TCR and ABS cause of death data. Agreement between the TCR and medical practitioners was weak (Kappa=0.51), moderate between the ABS and medical practitioners (Kappa=0.61), strong (Kappa=0.87) between the medical practitioners. These results reflect a greater level of agreement between medical practitioners than between coding agencies. Overall, cause-specific survival time was similar across the TCR, ABS and medical practitioners by sex, place of residence and country of birth, however, regarding type of PLC, only a small difference was observed.
Conclusions: Reporting of mortality data can vary substantially between agencies/institutions. Utilisation of specialist clinician oversight might improve data cohesion and fidelity. Overall, cause-specific survival time was similar across the TCR, ABS and medical practitioners, but a small difference was observed for the type of PLC. As PLC is a low survival cancer, these results may not apply to cancers with better survival such as breast cancer.
Tasman Medical Journal 2022: 4(2); 12-20
Background: Resistance and side effects encountered with use of common topical and systemic antifungal drugs for dermatophyte infections highlights the need for novel therapies. Medicinal plants, which have been traditionally utilised for their antimicrobial properties to treat superficial skin infections, serve as an abundant source for the identification of new antifungal compounds.
Aim: To summarise the current evidence for plant-based natural therapies for dermatophytic infections.
Methods: A comprehensive literature search was performed across databases PubMed, Embase and ScienceDirect using keywords ‘dermatophyte’ or ‘anti-dermatophytic’ or ‘antifungal’, combined with ‘natural, ‘ethnomedical’, ‘plant’, ‘botanical’, ‘treatment’ or ‘remedy’. Additional studies specific to the plant extract were searched using genus and species.
Results/ Discussion: Seventy plant extracts demonstrating in vitro anti-dermatophytic properties are summarised in this review. Among these, common antifungal phytochemicals found include phenolic compounds, terpenoids, terpenes, alkaloids, xanthones and glycosides including saponins. Only 21 plant extracts or their active components have been evaluated in in vivo bioassays in clinical trials and animal studies. Multiple mechanisms of action have been elucidated, including disruption to cell wall and cell membranes, inhibition of cell wall synthesis, hyphal growth, and spore germination, as well as possible in vivo anti-inflammatory and immunomodulatory effects.
Conclusion: Based on in vitro studies, numerous plant extracts show significant therapeutic potential for the treatment of dermatophyte infections. However, more in vivo studies are required to assess the clinical effectiveness of plant extracts.
Tasman Med J 2022: 3; 21-37
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