Internal Medicine Journal最新文献

{"title":"Immune checkpoint inhibitor cardiomyotoxicity: a case series of five patients and development of a clinical management algorithm.","authors":"S Z Xie, J E Salem, A Nagrial, A Menzies, L Thomas, S Ramanathan, L J Berglund, S C Sasson, A C Grey, R Habib, M Wong, M S Carlino, B Jeffrey, J Mo, M W Lin","doi":"10.1111/imj.70368","DOIUrl":"https://doi.org/10.1111/imj.70368","url":null,"abstract":"<p><p>Immune checkpoint inhibitor (ICI) therapies have revolutionised the management of a range of malignancies. However, the syndrome of ICI induced cardiomyotoxicity, also reported as triple \"M\" syndrome (myasthenia gravis, myositis and myocarditis) is an unfortunate severe consequence in up to 1%-2% of patients receiving ICI, with an associated mortality of up to 50%. Based on international evidence and local experience, we have developed a clinical pathway in our institution as a guide to the early identification and targeted management of this condition.</p>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147770303","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ketogenic diet therapy for epilepsy in Australia: insights from the Pharmaceutical Benefits Scheme.","authors":"Neha Kaul, Lillian King, Susanna Chen, Patrick Kwan, Terence J O'Brien","doi":"10.1111/imj.70445","DOIUrl":"https://doi.org/10.1111/imj.70445","url":null,"abstract":"<p><p>Ketogenic diet therapy is an effective non-pharmacological treatment for drug-resistant epilepsy. Since the first item was listed on the Pharmaceutical Benefits Scheme (PBS) in 2009, we report a 21.6-fold increase in annual PBS expenditure on items related to ketogenic diet therapy. This may reflect an increasing utilisation of ketogenic diet therapy for epilepsy nationally.</p>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147770253","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"When macrophages malfunction: ileal and psoas muscle malakoplakia in a patient with VEXAS syndrome.","authors":"Isaac K S Ng, Wilson G W Goh, Kong Bing Tan, Cheryl K T Chua","doi":"10.1111/imj.70439","DOIUrl":"https://doi.org/10.1111/imj.70439","url":null,"abstract":"","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147770357","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Implications of race-neutral equations on interpretation of lung function in Australia.","authors":"Helen Luo, Paul Finlay, Amanda Cestnik, Kanishka Nirmalan, Lauren Moncrieff, Garun S Hamilton, Paul T King, Daniel J Tan","doi":"10.1111/imj.70429","DOIUrl":"https://doi.org/10.1111/imj.70429","url":null,"abstract":"<p><strong>Background and objective: </strong>In 2022, the American Thoracic and European Respiratory Societies recommended a shift to race-neutral equations for reporting and interpreting lung function tests. The impact of this change in the Australian population has not been comprehensively evaluated.</p><p><strong>Methods: </strong>We conducted a cross-sectional study of adults evaluated at a multi-centre lung function laboratory in Australia between 2014 and 2024. Adults aged 40-70 years referred with respiratory symptoms or suspected obstructive airways disease were included (n = 6109). We compared the classification and severity of obstructive, restrictive, and mixed ventilatory defects using the race-neutral versus race-specific Global Lung Initiative reference equations.</p><p><strong>Results: </strong>Lung function tests from 6109 individuals with a mean (SD) age of 51.0 (13.7) years were evaluated (71% Caucasian, 9% South East (SE) Asian, 19% Other). Using race-neutral instead of race-specific equations resulted in 93% (5702 of 6109) remaining in the same classification. Among Caucasians, race-neutral equations increased the prevalence of obstruction (11%-13%), decreased restriction (8%-4%), and decreased mixed (4%-3%). Among SE Asians, race-neutral equations decreased the prevalence of obstruction (15%-10%) and increased restriction (6%-8%), and mixed was unchanged (2%). Among Others, race-neutral equations decreased the prevalence of obstruction (8%-7%), decreased restriction (21% to 17%) and decreased mixed (6% to 5%).</p><p><strong>Conclusion: </strong>While race-neutral and race-specific equations had concordant classifications for most individuals, the change resulted in a relative decrease in the prevalence of restriction in Caucasians by 53% and obstruction in SE Asians by 35%.</p>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147770342","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rethinking inpatient diabetes care: innovative strategies for outcome equity.","authors":"Qiuyu Wang, Yu Geng","doi":"10.1111/imj.70400","DOIUrl":"https://doi.org/10.1111/imj.70400","url":null,"abstract":"","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147770294","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correction to \"Clinical utility of ¹⁸F-fluorodopa positron emission tomography in the movement disorder clinic: an Australian experience\".","authors":"","doi":"10.1111/imj.70417","DOIUrl":"https://doi.org/10.1111/imj.70417","url":null,"abstract":"","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-04-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147770634","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long-term echocardiographic findings in patients with idiopathic recurrent pericarditis treated with anakinra.","authors":"Zeynep Toker Dincer, Damla Raimoglou, Erkin Yilmaz, Ayten Dag, Melike Melikoglu, Serdal Ugurlu","doi":"10.1111/imj.70452","DOIUrl":"https://doi.org/10.1111/imj.70452","url":null,"abstract":"<p><strong>Aim: </strong>Idiopathic recurrent pericarditis (IRP) is considered an autoinflammatory disease, and interleukin 1 inhibitors, such as anakinra, are used to treat resistant cases. Constrictive pericarditis, a feared complication, continues to be a critical concern. In the biologic era, evidence on long-term transthoracic echocardiographic (TTE) findings following anakinra treatment remains limited.</p><p><strong>Methods: </strong>We conducted a cross-sectional study that included 18 patients with IRP treated with anakinra who had been attack-free for at least 3 months. TTE was performed on all patients and 21 healthy controls, and findings were compared between the groups.</p><p><strong>Results: </strong>Pericardial thickness was significantly increased in patients compared with controls (3.1 mm (interquartile range (IQR): 3.0-3.4) vs 2.1 mm (IQR: 1.9-2.4), P < 0.001). None of the patients exhibited echocardiographic signs of constrictive pericarditis. Mild pericardial effusion was present in nine patients (50%) despite being attack-free. Pericardial hyperechogenicity was observed in 61.1% of the patient group and 23.8% of the control group (P = 0.018). In the subgroup analysis of patients receiving ongoing anakinra treatment and those who had discontinued, there were no significant differences in pericardial thickness (P = 0.573), pericardial effusion (P = 0.637) or pericardial hyperechogenicity (P = 0.066).</p><p><strong>Conclusion: </strong>In conclusion, despite the refractory course of the disease, no cases of constrictive pericarditis were identified. TTE evaluation revealed increased pericardial thickness in patients who received anakinra compared with healthy controls, despite being attack-free. Further studies are needed to clarify whether the presence of pericardial thickening or ongoing pericardial effusion should influence treatment planning.</p>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147770326","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evolving treatments for Sjögren disease: current approaches and emerging targets.","authors":"Mansi Bhurani, Adrian Y S Lee, Maureen Rischmueller, Alberta Hoi","doi":"10.1111/imj.70322","DOIUrl":"https://doi.org/10.1111/imj.70322","url":null,"abstract":"<p><p>Sjögren disease (SjD) is a prevalent systemic autoimmune condition characterised by exocrine gland dysfunction, systemic inflammation and heterogeneous organ involvement. Current management remains largely symptomatic, with no approved disease-modifying therapies available and substantial unmet clinical need. However, advances in understanding immunopathogenesis have accelerated the development of targeted treatments. Ianalumab, a dual-acting B cell-activating factor receptor (BAFF) receptor inhibitor with B cell-depleting activity, is the first agent to report positive phase 3 results, showing significant improvements in systemic disease activity. Other investigational approaches include BAFF/APRIL pathway inhibition, T-cell-B-cell costimulation inhibition, type I interferon blockade, JAK-STAT, TYK2 and BTK inhibition, neonatal Fc receptor antagonist and endosomal Toll-like receptor inhibition, with exploratory modalities such as RNA-targeted agents and cellular immunotherapy (including Chimeric antigen receptor T therapy) under evaluation for severe or refractory disease. Outcome assessment has also evolved, with European Alliance of Associations for Rheumatology (EULAR) Sjögren Syndrome Disease Activity Index and EULAR Sjögren Syndrome Patient Reported Index providing validated physician- and patient-centred measures. Composite endpoints such as the Composite of Relevant Endpoints for Sjögren Syndromeand the Sjögren Tool for Assessing Response now integrate systemic, symptomatic and functional domains, improving sensitivity and feasibility in trials. Together, these tools support more rigorous evaluation of novel therapies. Overall, therapy in SjD is shifting towards precision, phenotype-informed strategies. Priorities now are confirming long-term safety and durability of response, and demonstrating patient-important benefit. In Australia, the impact of new therapies for SjD will hinge on clear diagnostic pathways, routine use of validated disease activity measures and multidisciplinary care models.</p>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147770631","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Virtual multidisciplinary thiopurine monitoring: experiences from an Australian tertiary inflammatory bowel disease service.","authors":"Vinny Ea, Jacqueline Fraser, Alexander Mitropoulos, Atul Shrestha, Sheridan Rodda, Megan Burns, Sally Bell, Gregory Moore, Rimma Goldberg","doi":"10.1111/imj.70419","DOIUrl":"https://doi.org/10.1111/imj.70419","url":null,"abstract":"<p><strong>Background: </strong>Thiopurines remain key immunomodulators for inflammatory bowel disease (IBD) but require close safety monitoring for adverse effects.</p><p><strong>Aims: </strong>We evaluated a virtual multidisciplinary team (MDT) thiopurine monitoring service and compared it to standard care and a pharmacy-led monitoring service.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study at an Australian tertiary health service, comparing IBD patients initiated on thiopurines across three study periods: (i) prior to any thiopurine monitoring service; (ii) pharmacy-led thiopurine monitoring service; and (iii) virtual MDT thiopurine monitoring service. The MDT model involved telehealth case reviews by IBD clinicians, pharmacists and nurse consultants. Outcomes included frequency of early clinical reviews, thiopurine methyltransferase (TPMT) phenotype screening, dose optimisation, adverse effects, medication persistence and the promotion of IBD preventive care.</p><p><strong>Results: </strong>A total of 285 patients were included. TPMT phenotype assessment improved across periods (80.3%, 92.5%, 95.6%; P = 0.007). Dose optimisation by 4 months was similar across cohorts (28.8%, 40.2%, 37.8%; P = 0.107). Adverse effect rates, including myelosuppression (4.9%), were comparable. Thiopurine persistence during the MDT monitoring service decreased, potentially due to increased de-escalation of combination therapy to biologic monotherapy. Promotion of cervical screening, skin checks and vaccination improved with the MDT monitoring service. Monitoring services improved the proportion of clinical reviews within 2 weeks of thiopurine initiation, although increased the total number of reviews in the first 3 months.</p><p><strong>Conclusion: </strong>A virtual multidisciplinary thiopurine monitoring service supported more timely clinical review, pharmacogenomic screening and systematic promotion of IBD preventive care. Adverse effect rates were similar across monitoring models. The MDT monitoring model may also facilitate recognition of patients suitable for treatment de-escalation. These findings highlight the potential of structured monitoring approaches to support safe and proactive thiopurine use in IBD, though further research is needed to assess long-term outcomes and sustainability.</p>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147770390","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A multi-centre retrospective review of the bronchoscopic management of upper tracheal stenosis: An Australian perspective.","authors":"Nathan Harb, David K E Chan, Eugenie Dale, Tsu-Hui Hubert Low, Tajalli Saghaie, Alvin J Ing, Jonathan Williamson","doi":"10.1111/imj.70434","DOIUrl":"https://doi.org/10.1111/imj.70434","url":null,"abstract":"<p><strong>Background: </strong>Upper tracheal stenosis (UTS) is a rare process with multiple causes and variable approaches to treatment. Australian data on management patterns are lacking and patient resources reflecting local practices are scarce.</p><p><strong>Aims: </strong>To describe the management strategies of UTS over 12 years among three teaching hospitals in New South Wales, Australia. A secondary aim is to formulate an evidence-based patient information sheet for this condition and its management.</p><p><strong>Methods: </strong>Retrospective descriptive case series. Demographic, procedural and spirometric data were obtained from the medical records of patients undergoing bronchoscopy for UTS between March 2012 and February 2024.</p><p><strong>Results: </strong>A total of 31 patients (81% female) underwent 120 procedures (median: 3; interquartile range: 1-5) with a median procedure interval of 134 days. The interventions included 82 balloon dilatations, 37 steroid injections, 54 radial incisions (28 endoscopic scissors, 26 laser) and seven stent insertions. Following serial procedures, there were improvements in mean maximum forced expiratory flow (FEF_max) by 1.62 L/s (95% CI: 1.05-2.15, P < 0.001) and FEF_max percent predicted by 27% (95% CI: 18-36, P < 0.001). The mean FEV₁ improved by 0.36 L (95% CI: 0.15-0.54, P = 0.002) and 14% predicted. There was a documented improvement in symptoms in 80% of therapeutic procedures. Complications were infrequent and higher in procedures involving stents. Based on these findings, a patient information sheet has been developed.</p><p><strong>Conclusions: </strong>Patients with UTS undergo several bronchoscopies that result in improvements in symptoms and function with relatively low rates of complications.</p>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147770622","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}