Internal Medicine Journal最新文献

{"title":"Narcolepsy 2025 (with an Australasian perspective).","authors":"Amelia Lin, Brendon J Yee, Jian Eu Tai, Sheila Sivam","doi":"10.1111/imj.70186","DOIUrl":"https://doi.org/10.1111/imj.70186","url":null,"abstract":"<p><p>Narcolepsy is a disorder of central hypersomnolence, which, while uncommon, can carry profound implications for affected individuals. Despite this, it remains under-recognised within the medical community and presents frequent diagnostic and treatment challenges in the Australasian setting. Narcolepsy is subdivided into narcolepsy type 1, characterised by cataplexy and deficiency of the neuropeptide orexin, and narcolepsy type 2, a distinct entity. The latter can be further difficult to distinguish from the separate central hypersomnolence disorder idiopathic hypersomnia. Implementation of diagnostic criteria to distinguish these conditions is not always straightforward, however, with consideration of comorbidities and test conditions required to avoid misdiagnoses. Within Australia and New Zealand, narcolepsy remains relatively ill-defined on a population level compared to other developed nations, and greater challenges exist in access to diagnostic testing and therapeutic options. Internationally, orexin receptor 2 agonists have displayed promise as oral therapy to target the neurobiological basis of narcolepsy, particularly narcolepsy type 1, with further testing underway. We discuss practical challenges and updates in narcolepsy from an Australasian perspective, with a view to improve awareness of narcolepsy in both primary and specialty medicine to support access to care for individuals with the condition.</p>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144952703","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":"Geographical trends in National Health and Medical Research Council grants: A 12-year descriptive analysis.","authors":"Joshua Kovoor, Brandon Stretton, Benjamin Cook, Aashray Gupta, Weng Onn Chan, Stephen Bacchi","doi":"10.1111/imj.70182","DOIUrl":"https://doi.org/10.1111/imj.70182","url":null,"abstract":"","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144952675","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":"An endoscopic strategy for oesophageal food bolus impactions: a multicentre retrospective study of 750 patients over a decade.","authors":"Hardesh Dhillon, Irene Lu, Phillip Te, Elaine Koh, Jesselyn Sin, Neel Heerasing, Damian Dowling, Marcus Robertson","doi":"10.1111/imj.70185","DOIUrl":"https://doi.org/10.1111/imj.70185","url":null,"abstract":"<p><strong>Background: </strong>The management of oesophageal food bolus impactions (OFBIs) has seen a growing preference for the use of distal attachment caps over traditional devices such as nets, snares and grasping forceps.</p><p><strong>Aim: </strong>Our aim was to evaluate the outcomes of procedural efficiency and cost implications of different endoscopic strategies.</p><p><strong>Methods: </strong>This was a retrospective multicentre review of all adults with soft OFBIs between 2011 and 2021. Data were collected using patient medical records, with 750 patients meeting the inclusion criteria.</p><p><strong>Results: </strong>The mean age was 56 years, with a predominance of males (72.3%). Eosinophilic esophagitis (EoE) was the primary cause of OFBI from 2019 onwards, replacing reflux esophagitis. Medical management was attempted in 75.2% of patients. The 'push' technique showed significantly shorter procedure durations compared to 'pull' strategies (25.2 ± 19.6 vs 37.0 ± 24.7 min; P < 0.001). Cap-based pull strategies resulted in shorter procedure times (30.7 ± 16.0 vs 40.2 ± 28.0 min; P = 0.002), higher en-bloc removal rates (80.4% vs 19.8%; P < 0.001) and fewer instruments used (1.0 vs 1.5; P < 0.001) compared to conventional strategies without a difference in adverse events. Multivariable regression confirmed cap-assisted techniques, push strategy, and sedation (vs intubation) were independently associated with significantly shorter intervention times. Cost modelling estimated a per-case saving of $439.98 with cap use.</p><p><strong>Conclusion: </strong>Cap-assisted endoscopy offers superior clinical efficacy and cost-effectiveness compared to conventional methods. These findings support the routine use of cap-assisted techniques and suggest that a push-based strategy could be considered as the initial approach in the endoscopic management of food bolus impactions.</p>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144952389","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":"Immune-related adverse events in immune checkpoint inhibitor therapy for cancer.","authors":"Katie Liao, Emily Martin, Amy Body, Ai Li Yeo","doi":"10.1111/imj.70183","DOIUrl":"https://doi.org/10.1111/imj.70183","url":null,"abstract":"<p><p>Immunotherapy has changed the oncology landscape over the last decade. However, as survival rates for cancer improve, a new class of treatment complications, immune-related adverse events (irAEs), has emerged, affecting up to 71.5% of patients. These events result in significant morbidity, with mortality rates ranging from 0.36% to 1.23%; they lead to permanent discontinuation of cancer treatment in 10%-20% of patients receiving checkpoint monotherapy or combination therapy. Despite their substantial impact, there remains a paucity of evidence regarding identification and optimal management, with current treatment guidelines based on case reports and expert consensus. This review article aims to summarise the current literature on incidence, pathophysiology, diagnosis and management of irAEs, with a focus on rheumatic manifestations.</p>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144952691","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":"Addressing the 'python' crisis affecting medical specialist training programmes: organisational frameworks and interdisciplinary insights.","authors":"Louis William Wang","doi":"10.1111/imj.70169","DOIUrl":"https://doi.org/10.1111/imj.70169","url":null,"abstract":"<p><p>Medical education programmes constantly need to balance numerous and often competing demands of their stakeholders (i.e. trainees, educators, hospital administration, specialist colleges and accrediting bodies). Many of these issues are difficult to resolve; such challenges actually represent a special type of crisis - known as a 'python' crisis in scholarly organisational management literature. Basic physician training programmes are particularly susceptible to 'python'-like crises. These specialist vocational training programmes rely on the goodwill of experienced clinicians, who provide teaching and supervision to trainees on a voluntary basis and whose engagement in teaching activities is often limited because of other work and personal commitments. On top of this, expectations from important internal and external stakeholders collectively act as additional constraints, similar to the constricting coils of a python. Many of these issues remain unresolved over years and are likely to grow over time. Utilising the 'python' metaphor as an analogy, this review integrates interdisciplinary insights from the fields of educational leadership, organisational crisis management, developmental psychology, strategic finance and the natural sciences to offer a framework ('SCALE') that simultaneously aims to improve a training programme's resilience to short-term shocks while fostering long-term sustainability. This proposed framework may prove useful not only for hospital-based training programmes in internal medicine but also education programmes at all levels of medical training.</p>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-08-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144952452","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":"Immune thrombocytopenia in a patient treated with ravulizumab for classical paroxysmal nocturnal haemoglobinuria","authors":"Eugene Wang,&nbsp;Rithin Nedumannil,&nbsp;Kirsten Herbert","doi":"10.1111/imj.70190","DOIUrl":"10.1111/imj.70190","url":null,"abstract":"","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":"55 9","pages":"1593-1594"},"PeriodicalIF":1.5,"publicationDate":"2025-08-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144952738","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":"Embedding artificial intelligence competency in postgraduate training and assessment.","authors":"Isaac K S Ng, Desmond B Teo, Li Feng Tan","doi":"10.1111/imj.70177","DOIUrl":"https://doi.org/10.1111/imj.70177","url":null,"abstract":"","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144952641","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":"How may grant applications change in future because of artificial intelligence? An international and historical perspective.","authors":"Christina Gao, Benjamin Cook, Brandon Stretton, Aashray Gupta, Joshua Kovoor, Weng Onn Chan, Stephen Bacchi","doi":"10.1111/imj.70187","DOIUrl":"https://doi.org/10.1111/imj.70187","url":null,"abstract":"<p><p>Grant application processes fulfil a vital role by determining the allocation of resources to facilitate medical research. Existing grant application processes run by large governmental institutions have changed over time. Through examination of previous changes to grant application processes and the current challenges facing grant applicants and reviewers, including the increasing role of artificial intelligence, insights may be obtained into future modifications in grant application structures that require consideration.</p>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144952769","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":"Asthenozoospermia in a 51-year-old patient with cytochrome P450 oxidoreductase deficiency","authors":"Takeshi Sato,&nbsp;Tomohiro Ishii,&nbsp;Tomonobu Hasegawa","doi":"10.1111/imj.70188","DOIUrl":"10.1111/imj.70188","url":null,"abstract":"","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":"55 9","pages":"1600-1601"},"PeriodicalIF":1.5,"publicationDate":"2025-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144952614","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 outcomes of post-transplant lymphoproliferative disorder in the Western Australian liver transplant population: a 24-year retrospective study.","authors":"Rohita Reji, Gavin Cull, Julie Crawford, Leon Adams, George Garas, Gerry Macquillan, Briohny Smith, Michael Wallace, Luc Delriviere, Gary Jeffrey","doi":"10.1111/imj.70170","DOIUrl":"https://doi.org/10.1111/imj.70170","url":null,"abstract":"<p><strong>Background: </strong>Post-transplant lymphoproliferative disorder (PTLD) is the most common malignancy following solid organ transplants, affecting 1% to 4% of liver transplant recipients. Recent advancements have shifted the management of B-cell PTLD, with rituximab (a monoclonal anti-CD20 antibody) now used as the first-line treatment, while chemotherapy is reserved for patients with inadequate responses. Reducing immunosuppression remains a key aspect of management but can lead to organ rejection and even necessitate re-transplantation.</p><p><strong>Aims: </strong>This study aimed to assess the prevalence, characteristics and outcomes of PTLD in Western Australian liver transplant recipients over 24 years.</p><p><strong>Methods: </strong>We used hepatology and haematology databases to identify liver transplant recipients who developed PTLD from 1999 to 2023.</p><p><strong>Results: </strong>Among 476 liver transplants, 16 patients developed PTLD, an incidence of 3.4%. PTLD occurred at a median of 66.5 months post-transplant. Most cases were B-cell lymphomas, CD20-positive and associated with Epstein-Barr virus (EBV) infection. First-line treatments included rituximab with chemotherapy (n = 7) and rituximab monotherapy (n = 5). The overall response rate was 69%, with 11 patients achieving complete remission at 6 months. One-, three- and five-year survival rates were 75%, 50% and 50%, respectively. Factors such as EBV load, lactate dehydrogenase levels and age did not significantly impact remission. Seven patients (44%) experienced graft rejection. Three patients underwent repeat transplant during the study period and remained alive at the conclusion of the study period.</p><p><strong>Conclusion: </strong>Rituximab-based treatments demonstrated promising outcomes, though graft rejection remains a challenge. Further research is needed to optimise treatment and reduce rejection risks in PTLD patients.</p>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144952772","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}