Journal of the New Zealand Medical Association Vol 128 | No 1416 | 12 June 2015 Barriers to successful cessation among young late-onset smokers An important investment to control Acute Rheumatic Fever needs to run its course Whooping Karyotypes, confined blood HIV-associated tuberculosis in chimerism, and confusion: a Auckland cough—where case of genetic sex mislabelling Direct access GP referral for are we now? and its potential consequences ETT functions as a virtual clinic Publication Information published by the New Zealand Medical Association NZMA Chairman To contribute to the NZMJ, first read: Dr Stephen Child www.nzma.org.nz/journal/contribute NZMJ Editor Other enquiries to: Professor Frank Frizelle NZMA PO Box 156 NZMA Communications Manager The Terrace Sharon Cuzens Wellington 6140 Phone: (04) 472 4741 NZMJ Production Jeremiah Boniface © NZMA 2015 To subscribe to the NZMJ, email [email protected] Subscription to the New Zealand Medical Journal is free and automatic to NZMA members. 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Individual articles are available for purchase by emailing [email protected] NZMJ 12 June 2015, Vol 128 No 1416 ISSN 1175-8716 © NZMA 2 www.nzma.org.nz/journal CONTENTS EDITORIAL 62 6 Karyotypes, confined blood An important investment to control chimerism, and confusion: a case Acute Rheumatic Fever needs to run of genetic sex mislabelling and its its course potential consequences Diana Lennon, Joanna Stewart Aarthi Ravishankar, José G B Derraik, Sarah Mathai, Wayne S Cutfield, Paul L Hofman ARTICLES VIEWPOINT 10 Ethnic differences in acute 66 hospitalisations for otitis media Domperidone safety: a mini-review and elective hospitalisations for of the science of QT prolongation and ventilation tubes in New Zealand clinical implications of recent global children aged 0–14 years regulatory recommendations Justine McCallum, Liz Craig, Ian Whittaker, Pamela J Buffery, R. Matthew Strother Joanne Baxter CLINICAL CORRESPONDENCE 21 75 Whooping cough—where are we now? Not a simple back pain A review Jen-Li Looi, Ruvin Gabriel Tomasz Kiedrzynski, Ange Bissielo, Mishra Suryaprakash, Don Bandaranayake 77 Recalcitrant peripheral spondyloarthritis 28 treated with radiotherapy The role of echocardiography in Nur Azri Bin Haji Mohd Yasin, Shaun Anthony Staphylococcus aureus bacteraemia at Costello Auckland City Hospital Nicholas Gow, Boris S. Lowe, LETTERS Joshua Freeman, Sally Roberts 79 36 Direct access GP referral for ETT HIV-associated tuberculosis functions as a virtual clinic in Auckland Jessica H Greaves, Joan D Leighton, John G Christopher Luey, David Milne, Simon Briggs, Lainchbury, Paul G Bridgman Mark Thomas, Rupert Handy, Mitzi Nisbet. 81 44 Uptake of new medicines: the Efficacy of intralesional triamcinolone Pharmaceutical Management Agency injections for benign refractory of New Zealand (PHARMAC) in the oesophageal strictures at Counties international context Manukau Health, New Zealand Rajan Ragupathy, Zaheer-Ud-Din Babar Yeri Ahn, Christin Coomarasamy, Ravinder Ogra 84 Improving our strategy to prevent and 51 control measles outbreaks Barriers to successful cessation Lance Gravatt among young late-onset smokers Hayley Guiney, Judy Li, Darren Walton 87 Methuselah 88 100 Years Ago: The War, the Birth Rate, and Strong Drink NZMJ 12 June 2015, Vol 128 No 1416 ISSN 1175-8716 © NZMA 3 www.nzma.org.nz/journal SUMMARIES An important investment to control Acute Rheumatic Fever needs to run its course Diana Lennon, Joanna Stewart Rheumatic Fever reduces life spans by 10 years, but is preventable. Current school programmes to prevent it in high-risk areas are promising, but numbers are needed to prove it is working to prevent rheumatic fever. The Ministry of Health has co-funded the school programmes with DHBs, but is handing over to the DHBs before there is proof that the programme is effective (numbers need to accrue to prove statistical significance). DHBs may not continue to fund and have no evidence to inform their funding choices. This is a short-term wasted investment. Whooping cough—where are we now? Tomasz Kiedrzynski, Ange Bissielo, Mishra Suryaprakash, Don Bandaranayake This paper describes the recent trends of pertussis and vaccine uptake in New Zealand based on notifications and immunisation registration information since 2011. It highlights the current risk for the infant in the first months after birth and the crucial role a pertussis booster in pregnancy could play. It also aims to show that protection of infants by the current vaccine can be improved by timely immunisation even in a situation of improving overall uptake rates that are nearing the national target of 95%. The role of echocardiography in Staphylococcus aureus bacteraemia at Auckland City Hospital Nicholas Gow, Boris S. Lowe, Joshua Freeman, Sally Roberts Staphylococcus aureus blood stream infection (SAB) is a major cause of morbidity and mortality in New Zealand. When it is diagnosed, it is important to exclude endocarditis (infection affecting predominantly the heart valves) as this condition is associated with a 20% risk of death. Therefore international and local guidelines suggest all cases of SAB should be investigated with a cardiac ultrasound study known as an echocardiogram. This study of the use of echocardiography in SAB at Auckland City Hospital has revealed that some patients are at particularly low risk of endocarditis; in this group it may be possible to avoid doing an echocardiogram, therefore making more valuable use of this resource. Efficacy of intralesional triamcinolone injections for benign refractory oesophageal strictures at Counties Manukau Health, New Zealand Yeri Ahn, Christin Coomarasamy, Ravinder Ogra Some benign strictures in the food pipe can be very difficult to manage and require endoscopy and stretching every few weeks and can severely affect the quality of life of such patients. This paper describes a simple steroid injection into the scar tissue at the time of endoscopy that reduces the number of procedures and allows patients to swallow better. NZMJ 12 June 2015, Vol 128 No 1416 ISSN 1175-8716 © NZMA 4 www.nzma.org.nz/journal SUMMARIES Karyotypes, confined blood chimerism, and confusion: a case of genetic sex mislabelling and its potential consequences Aarthi Ravishankar, José G B Derraik, Sarah Mathai, Wayne S Cutfield, Paul L Hofman Disorders of sex development (DSD) encompass a range of conditions which at their extreme can present as boys appearing like normal girls and girls appearing like normal boys. The management of infants with DSD can be extremely complex, requiring the long-term involvement of a multidisciplinary team working alongside the family. However, in some cases a normal infant may be wrongly labelled as having DSD, which may lead to irreversible consequences such as inappropriate surgery. This case illustrates how easily this can occur. The infant’s blood had a normal male 46 XY karyotype due to bone marrow transplant from the male twin while the other tissues were a normal female 46XX karyotype. This led to an incorrect sex determination at birth and almost to the potentially disastrous surgical removal of normal ovaries. NZMJ 12 June 2015, Vol 128 No 1416 ISSN 1175-8716 © NZMA 5 www.nzma.org.nz/journal EDITORIAL An important investment to control Acute Rheumatic Fever needs to run its course Diana Lennon, Joanna Stewart ew Zealand has been applauded The age group at greatest risk for ARF is publically at the World Health primary-school-aged children (range 5–12 NAssembly, Geneva for the commit- years) and is the best group for investment ment of the New Zealand Government in an effective prevention programme. moving towards control of Acute Rheumatic The government has wisely focused on Fever (ARF).1 Our primary prevention strat- this age group, investing in an innovative egy for control of first episodes of ARF is primary health care delivery model through innovative. Other countries seek guidance schools. Nurses, under delegated authority from these programmes. This investment for treatments, work in partnership with is an important step forward for the health community health workers, with the of New Zealand children and adults. The potential to prevent the most ARF cases life long shadow of the sequela of ARF, per health dollar invested. School clinics Rheumatic Heart Disease (RHD) can reduce are operating in focused areas of high ARF longevity by up to 10 years.2 endemicity throughout the North Island. ARF is an important child health indicator Many studies have highlighted the poor in New Zealand with wide socio-economic access for children in low socio-economic and ethnic disparities. Poor children groups, particularly Māori and Pasifika residing in decile 10 (using the New Zealand children.7 Children in families with limited Deprivation Score) have been shown to be transport and time during surgery hours nearly 30 times more likely to have ARF are less likely to access medical care.