Internal Medicine Journal最新文献

{"title":"Discordance between ICD-10-AM coding and confirmed prevalence of MASLD in a quaternary diabetes service.","authors":"Janakan Selvarajah, Maddison Terlato, Weilun Gao, Omar Salehi, Christine Lu, Faris Gondal, Karen Lu, Angela Zhu, Spiros Fourlanos, Ashok S Raj","doi":"10.1111/imj.70587","DOIUrl":"https://doi.org/10.1111/imj.70587","url":null,"abstract":"<p><strong>Background: </strong>Metabolic dysfunction-associated steatotic liver disease (MASLD), previously termed non-alcoholic fatty liver disease, affects an estimated 30%-70% of people with type 2 diabetes (T2D), with prevalence likely to be higher in quaternary diabetes clinics. Documentation using the International Classification of Diseases, Tenth Revision, Australian Modification (ICD-10-AM) may substantially underestimate disease burden.</p><p><strong>Aims: </strong>To compare the prevalence of MASLD identified by ICD-10-AM coding with imaging-based diagnosis using transient elastography (FibroScan®) and determine disease severity and clinical characteristics associated with significant fibrosis.</p><p><strong>Methods: </strong>Adults attending a quaternary diabetes clinic underwent retrospective review of electronic health records (August 2020-December 2023) for ICD-10-AM-coded MASLD, excluding other chronic liver diseases. A prospective cohort of consecutive clinic attendees underwent FibroScan® assessment for imaging-based diagnosis of MASLD and fibrosis staging. Clinical characteristics associated with significant fibrosis were analysed.</p><p><strong>Results: </strong>ICD-10-AM coding identified MASLD in 3% (85/2589) of patients, compared with 83% (81/103) diagnosed by FibroScan®. Significant fibrosis was present in 45% (46/103). Patients with significant fibrosis had higher body mass index (34 vs 28 kg/m², P < 0.01), alanine aminotransferase (40 vs 26 U/L, P < 0.001), gamma-glutamyl transferase (54 vs 30 U/L, P < 0.001), lower high-density lipoprotein cholesterol (1.03 vs 1.15 mmol/L, P = 0.04), younger age (62 vs 67 years, P = 0.05) and shorter diabetes duration (11 vs 18 years, P = 0.02).</p><p><strong>Conclusions: </strong>In this quaternary diabetes clinic, ICD-10-AM coding substantially under-recognised MASLD compared with FibroScan®, which identified a high prevalence of MASLD and significant fibrosis. These findings highlight important gaps in diagnostic coding and clinical awareness of MASLD in T2D.</p>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149012156","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":"Author reply.","authors":"Dipti Talaulikar, Jun Yen Ng, Adam Bryant, Annmarie Bosco, Hugh C Caterson, Pratyush Giri, Pravin Hissaria, Simon J Harrison, Stephen Lade, Connull Leslie, Jacinta Perram, H Miles Prince, Dejan Radeski, Maureen Rischmueller, Craig Wallington-Gates, Nicholas Weber, Alberta Hoi","doi":"10.1111/imj.70641","DOIUrl":"https://doi.org/10.1111/imj.70641","url":null,"abstract":"","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149001751","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":"Dengue@Home: evaluation of a hospital in the home pathway for management of adults with dengue fever.","authors":"Georgina Oakman, Seok M Lim, Elin Wee, Irani Thevarajan, Karin Leder, Kirsty L Buising, James S McCarthy, Stephen Muhi","doi":"10.1111/imj.70635","DOIUrl":"https://doi.org/10.1111/imj.70635","url":null,"abstract":"<p><strong>Background: </strong>The rising incidence of dengue in popular travel destinations for Australians is increasing the burden on local healthcare systems. Since hospital-based monitoring consumes significant resources, alternative models of care are needed.</p><p><strong>Aim: </strong>To evaluate a hospital-in-the-home (HITH) monitoring pathway for dengue ('Dengue@Home') at a quaternary hospital in Melbourne, Australia.</p><p><strong>Methods: </strong>Adults with confirmed acute dengue (positive NS1 antigen, PCR or IgG seroconversion) were considered for HITH if aged <65 years. Patients with dengue warning signs, severe dengue, significant comorbidities, co-infection, pregnancy, an unsafe home environment, poor oral intake or platelet count <100 × 10⁹/L within 72 h of fever onset were generally managed as inpatients. The pathway provided daily nursing visits, serial pathology and telehealth medical reviews. A retrospective review of all dengue cases during the programme's first 19 months (June 2024-January 2026) was undertaken to assess utilisation and safety.</p><p><strong>Results: </strong>Of 39 patients with dengue, 12 (31%) were admitted to HITH, 15 (38%) to an inpatient ward and 12 (31%) were discharged home. The average HITH length of stay was 4.3 days. Of the HITH patients, 92% (n = 11) had a complete assessment of dengue warning signs, and none received NSAIDs after admission template completion. One patient (3%) was readmitted from HITH with epistaxis and transaminitis. The programme saved an estimated 64 799 Australian dollars (AUD) in the 2024-2025 financial year, assuming each HITH admission represented an avoided inpatient admission of equivalent duration.</p><p><strong>Conclusion: </strong>Home-based management of returned travellers with dengue is feasible and safe and reduces unnecessary hospital admissions.</p>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148982213","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":"Survival among patients with systemic sclerosis-associated pulmonary arterial hypertension in the Australian scleroderma cohort study.","authors":"Zoe Brown, Dylan Hansen, Kathleen Morrisroe, Nava Ferdowsi, Laura Ross, Wendy Stevens, Maryam Tabesh, Joanne Sahhar, Gene-Siew Ngian, Diane Apostolopoulos, Kimti Kumar, Jennifer G Walker, Susanna Proudman, Mandana Nikpour","doi":"10.1111/imj.70567","DOIUrl":"https://doi.org/10.1111/imj.70567","url":null,"abstract":"<p><strong>Background and aims: </strong>Systemic sclerosis (scleroderma; SSc) patients can develop pulmonary arterial hypertension (PAH), which is a leading cause of death. We sought to evaluate severity, therapeutic strategy and survival of SSc-PAH in the Australian Scleroderma Cohort Study (ASCS).</p><p><strong>Methods: </strong>Among patients with 2013 American College of Rheumatology/European League Against Rheumatism-defined SSc, PAH was defined as mean pulmonary artery pressure (mPAP) ≥20 mmHg, pulmonary arterial wedge pressure (PAWP) ≤15 mmHg and pulmonary vascular resistance (PVR) >2 WU. Characteristics of those with and without PAH and those with incident PAH in 2014-2020 versus 2007-2013 were compared using descriptive statistics. Survival was evaluated using the Kaplan-Meier method and a multivariable Cox regression model.</p><p><strong>Results: </strong>Among 1612 patients, 71 (4.4%) had incident PAH prior to censoring on 13 February 2024. Significantly more patients received PDE5i monotherapy in the first 12 months after PAH diagnosis in the later epoch (30 (63.8%) vs 6 (25.0%), P = 0.002). Dual therapy (any endothelin reception antagonist (ERA) and any PDE5i) was more common in the later epoch (26 (55.3%) vs 4 (16.7%), P = 0.002). Overall survival of those diagnosed with PAH between 2007 and 2013 was 91.67%, 87.50% and 56.88% at 1, 3 and 5 years. Overall survival of those diagnosed between 2014 and 2020 was 100.00%, 77.62% and 48.98% at 1, 3 and 5 years (P = 0.414).</p><p><strong>Conclusions: </strong>Despite increased use of dual therapy in the more recent epoch, we observed no significant improvement in overall survival in SSc-PAH in our cohort. Our cohort's 1-, 3- and 5-year mortality is comparable to those reported for other contemporary SSc-PAH cohorts.</p>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148982227","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":"Transient global aphasia associated with daratumumab in monoclonal immunoglobulin light chain deposition disease.","authors":"Zachary Tuttle, Samantha Gardiner, Nicholas Trost, Robin Filshie","doi":"10.1111/imj.70643","DOIUrl":"https://doi.org/10.1111/imj.70643","url":null,"abstract":"","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148989868","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":"Integrating a sleep apnoea assessment into an anaesthetic pre-admission clinic.","authors":"Gayan Kathriachchige, Elizabeth Cawson, Eli Dabscheck, Belinda R Miller, Glenn Downey, Matthew T Naughton","doi":"10.1111/imj.70639","DOIUrl":"https://doi.org/10.1111/imj.70639","url":null,"abstract":"<p><strong>Background: </strong>Untreated obstructive sleep apnoea (OSA) is associated with increased post-operative complications.</p><p><strong>Aims: </strong>To assess the impact of integrating a sleep physician into an anaesthetic pre-admission clinic (PAC) on the identification of patients at high risk of OSA, wait times to OSA management and to surgery.</p><p><strong>Methods: </strong>An interrupted time series of a PAC service was conducted at a tertiary hospital, before and after integration of a sleep physician into PAC. Before integration, anaesthetists who identified patients at risk of OSA were referred to the sleep clinic on a future date. After integration, such patients were referred to the sleep physician in PAC on the same day. Number of referrals for OSA assessment, time to: sleep physician assessment, sleep study, OSA management and surgery, were compared.</p><p><strong>Results: </strong>Three hundred eighty-two patients were reviewed in PAC before integration (26% bariatric, 31% orthopaedic, 43% other surgery) and 355 after integration (16% bariatric, 39% orthopaedic, 45% other). The introduction of a sleep physician into PAC resulted in a 10-fold increase in patients being referred for assessment by a sleep physician (2% vs 20%) (P = <0.001) and was associated with a reduction in time to surgery (261 ± 93 vs 38 ± 32 days, P = 0.015). However, in both groups (before and after integration), 30-day mortality and unplanned non-invasive ventilation (NIV) did not differ.</p><p><strong>Conclusions: </strong>Integration of a sleep physician into PAC resulted in a 10-fold increase in patients identified at high risk of OSA, a same-day sleep physician assessment, 91% reduction in time to OSA management and 85% reduction in surgical wait time.</p>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148976891","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":"Periodontitis and adverse outcomes in atrial fibrillation: prospective evidence from the UK Biobank.","authors":"Hongdao Li, Yixing Huang, Jiajie Li, Jianhua Wu, Weicheng Chen, Airong Liang, Ruixi Zhang, Meixia Kang, Wei Tang, Yuan Chen, Yuyang Chen, Yong Xie, Haifeng Zhang, Jingfeng Wang, Shuanglun Xie","doi":"10.1111/imj.70640","DOIUrl":"https://doi.org/10.1111/imj.70640","url":null,"abstract":"<p><strong>Background: </strong>Periodontitis (PD), a prevalent chronic inflammatory disease, has been implicated in the pathogenesis of various cardiovascular conditions. Although prior evidence suggests an association between PD and incident atrial fibrillation (AF), its influence on the clinical outcomes in patients with established AF remains poorly understood.</p><p><strong>Objective: </strong>This prospective cohort study aimed to explore the associations of PD with all-cause mortality, cardiovascular mortality, incident heart failure (HF) and incident stroke among individuals with AF based on the data from the UK Biobank.</p><p><strong>Methods: </strong>A total of 3707 AF patients without prior HF or stroke were included. PD was identified by self-reported symptoms of loose teeth or painful gums, an approach validated in prior epidemiological studies. The primary outcome was all-cause mortality; secondary outcomes included cardiovascular mortality, incident HF and incident stroke. Multivariable Cox models were adjusted for demographic factors, lifestyle behaviours and clinical comorbidities.</p><p><strong>Results: </strong>Over a median follow-up of 15.5 years, PD was significantly associated with increased risks of all-cause mortality (adjusted HR: 1.59, 95% CI: 1.26-2.00), cardiovascular mortality (adjusted HR: 1.73, 95% CI: 1.18-2.54) and incident stroke (adjusted HR: 1.60, 95% CI: 1.11-2.30). Although a trend towards higher HF incidence was observed in PD, the association was not statistically significant after full adjustment (adjusted HR: 1.19, 95% CI: 0.92-1.55).</p><p><strong>Conclusion: </strong>Among patients with AF, PD is independently associated with higher risks of death and stroke. These results underscore the potential value of integrated periodontal care in the comprehensive management of AF, a hypothesis that merits testing in future randomised controlled trials.</p>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148968220","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":"Association between serum osmolality and delirium in critically ill patients: a retrospective cohort study.","authors":"Yu Fang, Tong Ni","doi":"10.1111/imj.70633","DOIUrl":"https://doi.org/10.1111/imj.70633","url":null,"abstract":"<p><strong>Background: </strong>Delirium is a common and serious neuropsychiatric disorder in intensive care unit patients. It is associated with adverse outcomes and long-term sequelae. Serum osmolality is a simple-to-calculate, readily available physiological parameter that may influence neurological function. Its relationship with delirium remains unclear.</p><p><strong>Aims: </strong>This retrospective study aimed to evaluate the association between serum osmolality and delirium in a critically ill population.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study of 30 073 patients screened from the Medical Information Mart for Intensive Care IV database. Serum osmolality was calculated and categorised into hypo-osmolality, normal osmolality and hyper-osmolality groups. The primary outcome was delirium. Kaplan-Meier curves, Cox proportional hazards models and restricted cubic splines were used to examine the association. Sensitivity analyses, competing risk models and subgroup analyses were performed.</p><p><strong>Results: </strong>Among 30 073 eligible patients, 2.9% had hypo-osmolality, 82.1% normal osmolality and 15.1% hyper-osmolality. In the fully adjusted model (Model III), hyper-osmolality was associated with a 35% increased risk of delirium (HR = 1.35, 95% CI: 1.27-1.45, P < 0.001). Hypo-osmolality was associated with a 24% increased risk of delirium (HR = 1.24, 95% CI: 1.05-1.46, P = 0.013). Restricted cubic spline analysis revealed a U-shaped relationship (P < 0.001), with the lowest risk at an osmolality of 293.2 mOsm/kg. Results remained robust in sensitivity and competing risk analyses. Subgroup analyses showed stronger associations in patients receiving mechanical ventilation or vasopressors.</p><p><strong>Conclusions: </strong>Both hyper-osmolality and hypo-osmolality are associated with an increased risk of delirium in critically ill patients. Maintaining osmolality homeostasis may be important for delirium prevention, especially in those receiving mechanical ventilation or vasopressors.</p>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148968274","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":"Hypophosphataemia in adults: approach to diagnosis and management.","authors":"Kajanan Parameshwaran, Mawson Wang, Kirtan Ganda","doi":"10.1111/imj.70645","DOIUrl":"https://doi.org/10.1111/imj.70645","url":null,"abstract":"<p><p>Hypophosphataemia is a common electrolyte disorder which can have clinically significant consequences for bone, muscle, neurological and haematological function. Its causes range from transient transcellular shifts in hospitalised patients to chronic renal phosphate-wasting disorders mediated by fibroblast growth factor 23 (FGF23). A stepwise diagnostic approach enables identification of the underlying aetiology and guides management. While most cases are managed with removal of causative factors and phosphate supplementation, burosumab has revolutionised the treatment of patients with chronic FGF23-mediated hypophosphataemia. This review provides a practical framework for the evaluation and management of hypophosphataemia in adults, with focussed discussion of iron infusion-associated hypophosphataemia, X-linked hypophosphataemia and tumour-induced osteomalacia.</p>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148963109","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":"Spontaneous Candida dubliniensis acromioclavicular joint septic arthritis in an immunosuppressed patient.","authors":"Jisha J Nair, Zhi Yi Wang, Gabriel Perkovic, Imal Hemachandra, Aiveen Bannan","doi":"10.1111/imj.70642","DOIUrl":"https://doi.org/10.1111/imj.70642","url":null,"abstract":"","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148963152","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}