Internal Medicine Journal最新文献

{"title":"Central nervous system tuberculosis in Western Sydney: a 10-year retrospective cohort study.","authors":"Hayden Zhang, Tasnim Hasan, Ravindra Dotel, Evan Ulbricht, Nicole Gilroy, Susan Maddocks","doi":"10.1111/imj.70017","DOIUrl":"https://doi.org/10.1111/imj.70017","url":null,"abstract":"<p><strong>Background: </strong>Central nervous system tuberculosis (CNS-TB) is a rare complication of tuberculosis. There is a lack of data surrounding investigation and management of this in Australia.</p><p><strong>Aim: </strong>To review CNS-TB cases in Western Sydney, Australia, and understand the epidemiology, investigation, diagnosis, management and outcomes in a low-prevalence setting.</p><p><strong>Methods: </strong>Retrospective cohort study of all CNS-TB patients managed in Western Sydney from 2013 to 2022. Demographics, risk factors, clinical presentation, investigations and management were reviewed. Clinical outcomes like hospital length-of-stay, adverse drug reactions, paradoxical reactions, functional disability and treatment outcomes, including cure, treatment failure, loss to follow-up and death, were also measured.</p><p><strong>Results: </strong>Thirty-nine CNS-TB cases were identified, with 16 (41%) confirmed by nucleic acid amplification test or culture of CNS specimens and 23 (59%) diagnosed presumptively without CNS microbiological confirmation. The median age was 32 years. Thirty-seven (95%) were overseas-born; 27 (69%) had no comorbidities. Presenting symptoms included fever (82%), headache (64%) and weight loss (51%). Twenty-five (64%) used fluoroquinolones and nine (23%) used high-dose rifampicin. Steroids were used in all patients. Six (15%) were prescribed aspirin for primary stroke prevention. Twenty-eight (73%) completed treatment, with one requiring re-treatment for presumed treatment failure. Six (15%) were lost to follow-up, and five (13%) died during their treatment course. Twenty-one (54%) experienced an adverse drug reaction.</p><p><strong>Conclusion: </strong>Tuberculosis is an ongoing public health issue in Australia, with CNS-TB being its most devastating form, and all clinicians to be aware of this rare complication. The efficacy of newer treatment options requires further study.</p>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143657184","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":"TSANZ Abstract","authors":"","doi":"10.1111/imj.70003","DOIUrl":"10.1111/imj.70003","url":null,"abstract":"","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":"55 S1","pages":"4-193"},"PeriodicalIF":1.8,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/imj.70003","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143663175","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevalence of autoimmune diabetes among Aboriginal Australians: the Fremantle Diabetes Study Phase II.","authors":"Timothy M E Davis, Christine S Bundell, Stephen A Paul Chubb, Daniel McAullay, Wendy A Davis","doi":"10.1111/imj.70029","DOIUrl":"https://doi.org/10.1111/imj.70029","url":null,"abstract":"<p><p>The prevalence of autoimmune diabetes was assessed in 113 indigenous and 1555 non-indigenous participants in the Fremantle Diabetes Study Phase II. Both type 1 diabetes (3.5% vs. 8.2%) and latent autoimmune diabetes of adults diagnosed based on glutamic acid decarboxylase antibody (GADA) positivity (1.0% vs. 5.7%) were lower in Aboriginal participants (P = 0.101 and 0.039 respectively). Six Aboriginals with GADA-negative type 2 diabetes were positive for tyrosine phosphatase-related islet antigen 2 antibodies but did not exhibit relative insulin deficiency.</p>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143657188","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":"Trends in diabetes-related foot disease in a tertiary health service in Australia: a 10-year retrospective study.","authors":"Huy H Do, Tanita Botha, Eleanor Garnys, Casie Barrette, Hanh H Nguyen","doi":"10.1111/imj.70036","DOIUrl":"https://doi.org/10.1111/imj.70036","url":null,"abstract":"<p><strong>Background and aims: </strong>Despite being a major cause of hospitalisations, there is limited literature on the trends in diabetes-related foot disease (DFD) in Victoria, Australia. The aim of this study was to assess the incidence of DFD admissions and outcomes in inpatients with DM at a major Victorian health service.</p><p><strong>Methods: </strong>Inpatients aged >18 years with DM and DFD between 2013 and 2022 were identified using International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Australian Modification (ICD-10-AM) codes. Admission, demographic and mortality data were extracted from the hospital electronic database. Prevalence and incidence of DM, DFD and amputations were analysed. Independent t tests, Mann-Whitney U tests and χ² tests were used to compare groups. Linear regression models were used to explore trends, with logistic and Poisson regression for analysis of 5-year mortality and length of stay.</p><p><strong>Results: </strong>Over 10 years, 37 561 patients with DM required 110 736 admissions at Western Health. DFD prevalence was 17% (n = 6397). An increasing burden of annual DM admissions was observed (6855 to 12 182), with increased rates of DFD admissions (β = 0.480, P < 0.001). Minor amputation rates increased (β = 0.028, P = 0.001), whilst major amputation rates remained stable. DFD cohorts experienced longer admissions (median 4.11 (interquartile range 1.74-9.06) vs 1.83 (interquartile range 0.28-4.50) days, P < 0.001), higher re-admissions (76% vs 47%, P < 0.001) and 5-year mortality (23.4% vs 12.7%, P < 0.001).</p><p><strong>Conclusion: </strong>This large retrospective audit demonstrated an increasing burden of inpatient DM and DFD at Western Health, Victoria in Australia, with greater morbidity and mortality in DFD patients. Health networks need to be prepared for greater health service utilisation required by DFD cohorts, and further funding to prevent DFD is of particular importance to avoid overwhelming health services.</p>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143624422","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 outcomes of subcutaneous implantable cardioverter-defibrillators: a single-centre Australian experience.","authors":"Ehsan Mahmoodi, Xiang Wen Lee, Blake M Freeman, Meghan A Webster, John R Betts, Haris M Haqqani, Russell A Denman","doi":"10.1111/imj.70014","DOIUrl":"https://doi.org/10.1111/imj.70014","url":null,"abstract":"<p><strong>Background: </strong>The subcutaneous implantable cardioverter-defibrillator (S-ICD) has become an established alternative to overcome conventional transvenous ICD (TV-ICD) lead-related complications.</p><p><strong>Aims: </strong>To describe the long-term outcomes of S-ICD implantation at a single Australian institution.</p><p><strong>Methods: </strong>We retrospectively reviewed the clinical outcomes of consecutive patients who underwent S-ICD implantation from 2015 to 2019.</p><p><strong>Results: </strong>In total, 128 patients (median age 52.5 years, 70% male) underwent S-ICD implantation. The indication was primary prevention in 86 patients (66%), and 22 patients (17%) had a previous transvenous device. Seventy-seven patients (60%) had heart failure, and the median left ventricular ejection fraction was 36% (29%-60%). The procedure was performed under general anaesthesia in 124 patients (97%), and the median procedure time was 105 min (interquartile range (IQR) 90-120). During a median follow-up of 4.7 years (IQR 3.8-5.8), 15 patients (12%) died, none of which were due to sudden death or device-related complications. Inappropriate shocks occurred in 17 patients (13.3%), predominantly due to T-wave oversensing (4.7%) and supraventricular arrhythmias (4.7%), and 15 patients (11.7%) received appropriate shocks. During the follow-up period, the S-ICD system was revised to TV-ICD in 10 patients (8%), and 24 patients (19%) required S-ICD generator change. Four patients (3%) underwent surgical intervention due to lead (two) or pocket-related (two) complications, and two patients (1.5%) developed pocket infection without systemic sepsis.</p><p><strong>Conclusion: </strong>In this single-centre study, S-ICDs were implanted safely with acceptable device performance and clinical outcomes over long-term follow-up.</p>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143604795","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":"Results of rapid plasma direct oral anticoagulant levels greatly expand stroke thrombolysis eligibility: evidence from real-world implementation.","authors":"Edward Callaly, Jason Tjahyadi, Vicky Yin, Ben Holland, Helen Dewey, Marija Borosak, Philip M C Choi","doi":"10.1111/imj.70012","DOIUrl":"https://doi.org/10.1111/imj.70012","url":null,"abstract":"<p><p>Direct oral anticoagulants (DOACs) are used for stroke prevention in atrial fibrillation, but their presence can limit thrombolysis eligibility in acute stroke. This retrospective study examined whether rapid plasma DOAC testing expanded eligibility for thrombolysis. Among ischaemic stroke patients taking DOACs who were otherwise eligible for thrombolysis, 40% had low DOAC levels (<50 ng/mL). This led to the use of potentially life- and disability-saving thrombolysis in patients who would otherwise have been ineligible.</p>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143604796","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":"Sputum microbiology data and related clinical outcomes among adult Aboriginal Australians with bronchiectasis.","authors":"Claire Gibbs, Timothy Howarth, Sudharsan Venkatesan, Sanjana S Heraganahally, Asanga Abeyaratne, Subash S Heraganahally","doi":"10.1111/imj.70020","DOIUrl":"https://doi.org/10.1111/imj.70020","url":null,"abstract":"<p><strong>Background: </strong>Sputum microbiology is an integral aspect of managing patients with bronchiectasis. Adult Aboriginal Australians have a high bronchiectasis disease burden; however, as yet there is sparce literature detailing the sputum microbiology profile in this population.</p><p><strong>Aims: </strong>To assess the sputum microbiology profile among Aboriginal patients aged ≥18 years with chest computed tomography-confirmed bronchiectasis in the Top End Northern Territory of Australia.</p><p><strong>Method: </strong>All available sputum samples processed in a single laboratory service with established protocols for examining and reporting sputum microbiology results between 2011 through 2020 were assessed in relation to demographics, lung function parameters, chest radiology, inhaled pharmacotherapy, hospital admissions restricted to respiratory conditions and all-cause mortality.</p><p><strong>Results: </strong>Four hundred twenty-eight patients (median age 47 years, 56% female) had sputum cultures available to assess. Haemophilus spp. was the most common (64%), followed by yeast/Candida spp. (53%) and Pseudomonas spp. (36%). Polymicrobial cultures were noted in 92% of patients. There were significant geographic differences on a region-wise and community-wise basis. Patients with yeast/Candida spp. and Pseudomonas spp. recorded more hospitalisations (median 7 (interquartile range (IQR) 3-14) and 8 (IQR 4-16)). In multivariate models, both yeast/Candida spp. (odds ratio (OR) 2.63 (95% confidence interval (CI) 1.68-4.14)) and Pseudomonas spp. (OR 1.95 (95% CI 1.25-3.04)) were associated with increased odds for mortality. Other than higher Pseudomonas spp. isolated with the use of inhaled corticosteroids, no significant association was observed either with lung function or chest radiology.</p><p><strong>Conclusion: </strong>Adult Aboriginal Australians with bronchiectasis harbour a significant microorganism load that may play a role in overall morbidity and mortality.</p>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143604798","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":"Performance and opportunity: retrospective cohort study of general medicine heart failure management.","authors":"Noor Lammoza, Lung En Teng, Gail Edwards, Maria Hormiz, Matthew Morton, Harry Gibbs, Ingrid Hopper, Ar Kar Aung, Archana Thayaparan","doi":"10.1111/imj.70016","DOIUrl":"https://doi.org/10.1111/imj.70016","url":null,"abstract":"<p><strong>Background: </strong>Heart failure (HF) is increasingly prevalent, with growing patient complexity. Understanding the quality of care delivered is key to optimising management.</p><p><strong>Aims: </strong>To characterise HF care by a general medicine service compared to established quality indicators.</p><p><strong>Methods: </strong>A retrospective cohort review was conducted over a 7-month period. Consecutive general medicine patients admitted with a primary diagnosis of HF were included. Main outcomes measures were baseline guideline-directed medical therapy (GDMT) and index admission medication modifications, planned medical follow-up and 30- and 180-day readmission rates. Comparison to National Heart Foundation quality indicators was undertaken.</p><p><strong>Results: </strong>Two hundred and thirteen patients who survived the index admission were included (median age 86 years (interquartile range 82-89), 53.1% female). Comorbidities included hypertension (69.0%), atrial fibrillation (58.7%) and chronic kidney disease (28.2%). Echocardiography was available for 153 patients (72%), with 26.6% who had HF with reduced ejection fraction (HFrEF) and 62.2% who had HF with preserved ejection fraction (HFpEF). GDMT for HFrEF was 73.2% for beta-blockers, 41.5% for renin-angiotensin system inhibitors, 22.0% for mineralocorticoid antagonists and 9.8% for sodium glucose co-transporter-2 inhibitors (SGLT2i). SGLT2i was prescribed in 2.1% of HFpEF patients. Index admission medication modifications occurred for 40 patients, with 37 initiation/dose escalations and 13 cessation/dose de-escalations. Follow-up was planned in 69.0% patients across multiple services. All-cause readmission rates at 30 and 180 days were 19.2% and 45.5% respectively.</p><p><strong>Conclusions: </strong>Our HF cohort is elderly and comorbid with high readmission rates. We found low prescription and modification rates of GDMT and poor continuity of care, highlighting areas to improve care in both inpatient and outpatient settings.</p>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143585692","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":"Clinical presentations and outcomes of respiratory tract infections in an Australian cohort of centenarians.","authors":"Louise Mugridge, Lachlan Faktor, Christiaan Yu, Ar Kar Aung","doi":"10.1111/imj.70022","DOIUrl":"https://doi.org/10.1111/imj.70022","url":null,"abstract":"<p><p>Centenarians are a rapidly growing patient population. Little is known about their clinical responses to respiratory tract infections. This study examines a cohort of centenarians admitted to a tertiary centre with multiplex polymerase chain reaction-confirmed respiratory tract infections to characterise clinical characteristics and management outcomes better. Despite multiple comorbidities and frailty, the overall mortality rate and outcomes appeared favourable.</p>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143585678","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":"Incidence and predictors of transurethral resection of prostate in men with and without type 2 diabetes: the Fremantle Diabetes Study Phase I.","authors":"Timothy M E Davis, Wendy A Davis","doi":"10.1111/imj.70021","DOIUrl":"https://doi.org/10.1111/imj.70021","url":null,"abstract":"<p><strong>Background: </strong>The relationship between type 2 diabetes and the incidence of transurethral resection of the prostate (TURP) remains uncertain.</p><p><strong>Aims: </strong>To utilise data from the Fremantle Diabetes Study Phase I (FDS1) to examine the association between type 2 diabetes and incident TURP and investigate risk factors in men with type 2 diabetes.</p><p><strong>Methods: </strong>First TURP hospitalisations were ascertained for males from the Fremantle Diabetes Study Phase I (n = 581) and age- and postcode-matched men without diabetes (n = 2361) between entry (1993-1996) and end (2017). Incidence rate ratios (IRRs) were calculated. Cox proportional hazards and competing risk models generated cause-specific (cs) and subdistribution (sd) hazard ratios (HRs) for incident TURP.</p><p><strong>Results: </strong>There were 86 and 338 TURP hospitalisations in participants with and without type 2 diabetes, respectively, during 42 236 person-years of follow-up. The IRR (95% confidence interval) for diabetes versus no diabetes was 1.23 (0.96, 1.56). A 10-year age increase more than doubled the risk of incident TURP (csHR 2.51 (2.02, 3.12), sdHR 2.59 (2.11, 3.18)), but type 2 diabetes was not a significant predictor in multivariable models. In participants with type 2 diabetes, a 10-year age increase was predictive (csHR 2.94 (1.93, 4.47), sdHR 1.92 (1.51, 2.44)); Anglo-Celt versus other ethnic groups was significant in the Cox (csHR 1.87 (1.17, 3.00)) but not competing risk (sdHR 1.60 (0.99, 2.57)) models.</p><p><strong>Conclusions: </strong>Type 2 diabetes does not increase TURP risk in community-based Australians. There are no diabetes-specific variables associated with incident TURP.</p>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143585699","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}