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Internal Medicine Journal

Gary N McAuliffe, Fransisca De Silva, Arlo Upton, George Chan
BACKGROUND: Warfarin remains a commonly used anticoagulant for the treatment and prevention of thrombosis. To balance the risks and benefits of therapy monitoring of the International Normalised Ratio (INR) is necessary. Patients derive most benefit from warfarin when they spend ≥65% of time in the therapeutic range (INR 2-3). AIMS: We performed an analysis of INR monitoring for the Auckland and Northland regions of New Zealand in order to estimate anticoagulation control and appropriateness of testing at the population level...
July 10, 2018: Internal Medicine Journal
Irene Ruderman, Stephen G Holt, Geoffrey S Kirkland, Sophie Maslen, Carmel M Hawley, Veronica Oliver, Rathika Krishnasamy, Nicholas A Gray, Girish S Talaulikar, Craig L Nelson, Yogeshwar Rajaram, Hilton Gock, Eric Au, Grahame J Elder, Rahul Mainra, Nigel D Toussaint
BACKGROUND: Secondary hyperparathyroidism (SHPT) in chronic kidney disease is associated with cardiovascular and bone pathology. Measures to achieve parathyroid hormone (PTH) target values and control biochemical abnormalities associated with SHPT require complex therapies, and severe SHPT often requires parathyroidectomy or the calcimimetic cinacalcet. In Australia, cinacalcet was publicly funded for dialysis patients from 2009 to 2015 when funding was withdrawn following publication of the EVOLVE study, which resulted in most patients on cinacalcet ceasing therapy...
July 10, 2018: Internal Medicine Journal
Kenneth Yong, Trevor Mori, Gerard Chew, Lawrence J Beilin, Ian Puddey, Gerald Watts, Gursharan Dogra, Neil Boudville, Wai Lim
INTRODUCTION: Diastolic dysfunction (DD) is an important cause of cardiovascular disease (CVD) mortality in chronic kidney disease (CKD) patients. Non-traditional risk factors such as arterial stiffness and inflammation are implicated in the pathogenesis of DD in CKD patients. AIM: To determine the association between inflammatory markers [interleukin(IL)-12, IL-18, highly sensitive C-reactive protein (hsCRP)] and non-invasive markers of arterial stiffness [24-hour pulse pressure (PP)] with DD in stage 3-4 CKD patients...
July 10, 2018: Internal Medicine Journal
Ingrid Bretherton, Emily Thrower, Mathis Grossmann, Jeffrey D Zajac, Ada S Cheung
BACKGROUND: Despite increasing demand for transgender healthcare, guidelines for cross-sex hormone therapy are based on low-level evidence only. As most data are based on international expert opinions, interpretations and practices vary significantly. AIMS: To aid the development of Australian clinical guidelines, we aimed to identify cross-sex hormone therapy prescribing patterns amongst medical practitioners experienced in adult transgender healthcare. METHODS: We conducted an anonymous online survey of experienced hormone prescribers who were members of the Australian and New Zealand Professional Association for Transgender Health...
July 10, 2018: Internal Medicine Journal
Laurens Manning, Jeffrey Cannon, John Dyer, Jonathan Carapetis
INTRODUCTION: Lower leg cellulitis (LLC) is a common infection that is usually caused by Streptococcus pyogenes or other β-haemolytic streptococci. We hypothesised that in Western Australia (WA), LLC is a summer disease and would be more common in the northern, tropical regions. METHODS: We conducted a state-wide data linkage of adult patients presenting to WA hospitals with a first ever diagnosis of LLC, from January 2002 through December 2013 according to region and season...
July 9, 2018: Internal Medicine Journal
John Zalcberg
Biosimilars have had a sizeable impact on the availability and use of biologic medicines in Australia, particularly those prescribed for supportive care in oncology or to treat inflammatory diseases. Biosimilars of oncology drugs that modify disease processes are likely to be the next 'wave' of biosimilars to receive regulatory approval, both internationally and in Australia. Given their more tailored development pathway relative to reference biologics, biosimilar versions of these drugs have the potential to substantially reduce the burden on the healthcare system and increase patient access to treatment...
July 9, 2018: Internal Medicine Journal
Yogesh Sharma, Michelle Miller, Rashmi Shahi, Adrienne Doyle, Chris Horwood, Paul Hakendorf, Campbell Thompson
BACKGROUND: Vitamin C has anti-oxidant properties and acts as a co-factor for a number of enzymes. Hypovitaminosis C has been associated with bleeding, endothelial dysfunction and death. The prevalence of hypovitaminosis C is unknown in Australian hospitalized patients and its clinical relevance is uncertain. AIMS: To determine prevalence, characteristics and clinical outcomes of hospitalized patients with hypovitaminosis C. METHODS: This observational study included general-medical inpatients in a tertiary-level hospital in Australia...
July 3, 2018: Internal Medicine Journal
Dave Nicholls, Rina Barrett, Peter Button, Matt Truman, Paul Bird, Lynden Roberts, Kathleen Tymms, Geoffrey Littlejohn, Hedley Griffiths
AIMS: To assess the effectiveness of biologic disease-modifying anti-rheumatic drugs (bDMARDs) as monotherapy or in combination with methotrexate and/or other conventional DMARDs (cDMARDs) for treatment of rheumatoid arthritis (RA). METHODS: A retrospective, non-interventional study which investigated the use of bDMARDs in adult patients with RA in routine clinical practice. Data was extracted from the OPAL-QUMI database. Real-world effectiveness was measured using the 28-joint disease activity score (DAS28) and clinical disease activity index (CDAI) by treatment group at baseline, week 12 and week 24...
July 3, 2018: Internal Medicine Journal
Satwik Motaganahalli, Lauren Beswick, Danny Con, Daniel R van Langenberg
BACKGROUND: Faecal calprotectin (FC) is an accurate biomarker of disease activity in inflammatory bowel disease (IBD), yet the cost/resource implications of incorporating FC into 'real world' practice remain uncertain. AIM: To evaluate the utility of FC in clinical decision-making and on healthcare costs in IBD. METHODS: Retrospective data including colonoscopy/ other investigations, medication, admission and surgical data were collected from hospital records and compared between two groups: (1) pre-FC historical cohort (2005-09) where colonoscopy was used to assess IBD activity versus (2) FC was used first instead (2010-14)...
July 2, 2018: Internal Medicine Journal
Masaki Shimizu, Munechika Misumi, Michiko Yamada, Waka Ohishi, Hideya Yamamoto, Yasuki Kihara
BACKGROUND/AMIS: Cognitive function and physical function are important predictors of mortality. We investigated whether or not reaction time (RT) as a cognitive function and grip strength (GS) as a physical function were associated, alone or in combination, with mortality from heart disease or stroke. METHODS: The subjects consisted of 4,901 Adult Health Study participants in Hiroshima who had undergone RT and GS measurements, were 35-74 years old at baseline (1970-1972), and were followed to the end of 2007...
June 20, 2018: Internal Medicine Journal
Sarbroop Dhillon, Elizabeth McKinnon, Jeremy Wrobel, Melanie Lavender, Sharon Lawrence, Eli Gabbay, Michael Musk
BACKGROUND: The Western Australian lung transplant program commenced in 2004 to serve the growing demand of patients with end-stage lung disease. AIM: This report summarises our eleven-year experience in lung transplantation. METHODS: Data on 115 consecutive patients and their respective donors transplanted between 2004 and 2015 was collected. Kaplan-Meier method was used to estimate survival. Cox regression was used to analyse impact of donor and recipient characteristics on survival...
June 19, 2018: Internal Medicine Journal
Surein Arulananda, James Lynam, Mun Sem Liew, Morikatsu Wada, Lawrence Cher, Hui K Gan
INTRODUCTION: This study was done retrospectively to evaluate rates of thrombocytopenia and their clinical impact during chemo-radiotherapy for glioblastomas and to elucidate associated clinical factors. METHODS: Sixty-four patients who received temozolomide chemotherapy at our institution were included. Thirty-five patients received full dose chemo-radiotherapy as per the STUPP protocol (Group A) and nine patients received abbreviated radiotherapy with concurrent chemotherapy (Group B)...
June 19, 2018: Internal Medicine Journal
D J Meiklejohn, L J Ridley, M C Ngu, J L Cowlishaw, A Duller, W Ridley
Colorectal cancers result in substantial morbidity and mortality to Australian society each year. The usual investigation for bowel malignancyis optical colonoscopy (OC), withcomputed tomographic colonography (CTC) used as an alternative investigation. The catharsis and colon insufflation associated with these investigations pose a higher risk in the elderly and frail. Risks include perforation, serum electrolyte disturbance, and anaesthesia/sedation risks.Minimal preparation computed tomographic colonography (MPCTC) eliminates these risks...
June 11, 2018: Internal Medicine Journal
Christopher John Kiely, Paul Pavli, Claire Louise O'Brien
BACKGROUND: Using culture-based methods, bacterial translocation from the gut to draining mesenteric lymph nodes (LNs) is seen in 5% of normal controls and up to 33% of patients with IBD. Many bacteria can't be cultured so these methods are unable to capture the full spectrum of bacteria present. AIMS: To detect viable bacteria in LNs of patients with IBD and non-IBD controls using bacterial RNA as a surrogate for viability and to compare them with the same patient's gut microbiome...
June 11, 2018: Internal Medicine Journal
Wee Jie Chee, Huda Abdullahi, Yolanda Chan, Amelia Rattle, Stephanie Snedden, Ralph Junckerstorff
BACKGROUND: Statins are one of the most commonly prescribed medications in Australia. Although the cardioprotective effects of statins are well documented, questions remain regarding their risk-benefit profile in elderly adults, especially those with limited life expectancies. AIM: To describe the prevalence and pattern of statin use in elderly patients admitted to a General Medicine Unit. METHODS: We retrospectively reviewed medical records of patients aged ≥80 years who were admitted under the General Medical Unit at Monash Medical Centre between 1st January 2015 and 30th June 2015...
June 5, 2018: Internal Medicine Journal
Malcolm Wilson, Jana Weston, Annette Mullen, Trevor Knight, Graham Simpson
BACKGROUND: Compared with global numbers, Australia has enjoyed relatively good tuberculosis control over the last thirty years with an annual incidence of 5.7 per 100,000 population.1 Thanks to its unique geography and proximity to high-burden countries, such as Papua New Guinea (PNG), Far North Queensland (FNQ) has previously been shown to have higher rates of tuberculosis compared with both the state and national average.2,3 AIMS: Document tuberculosis epidemiology in FNQ with comparison to two previous audits of the region...
June 5, 2018: Internal Medicine Journal
Aqilah Imtiaz, Robyn Toomath
The literature suggests that certain clinical criteria to determine raised intracranial pressure should be met if a patient suspected of meningitis is to undergo a computed tomography (CT) head scan prior to having a lumbar puncture (LP). The purpose of this audit was to evaluate whether these criteria were being used by the general medicine department of Auckland City Hospital when requesting CT scans prior to LPs in patients with suspected meningitis. A total of 37 patients admitted under general medicine with suspected meningitis from January 1st to July 31st 2016 were retrospectively audited based on the clinical evidence justifying the decision to do a CT scan prior to an LP...
June 5, 2018: Internal Medicine Journal
Paula Loveland, Micheal Christie, Gary Hammerschlag, Louis Irving, Daniel Steinfort
BACKGROUND: Timely diagnosis of malignant pleural effusions is critical to guide prognosis and management decisions. Cytologic analysis of pleural fluid has been the first-line diagnostic test for many decades, with highly variable reported sensitivities of 40 to 90%. Its diagnostic accuracy in modern practice in Australia needs to be understood. AIMS: To determine the diagnostic yield of pleural fluid cytology for the detection of malignant pleural effusions, and to determine the aetiologies of pleural effusions at our centre...
June 5, 2018: Internal Medicine Journal
Ming Sheng Lim, Ashwini Bennett, Sanjeev Chunilal
BACKGROUND: The ADJUST-PE study showed that an age adjusted D-dimer (AADD) (age years X 10ng/ml if >50 years) combined with an unlikely pre-test probability (PTP) can increase the proportion of older patients whom pulmonary embolism (PE) can be safely excluded but the IL D-dimer HS assay was not assessed. AIM: To assess the ability of the IL D-dimer HS assay to exclude PE using the AADD. METHODS: Retrospective analysis of consecutive patients presenting with symptoms of acute PE to one of three Monash Health Emergency Departments (January 2013-January 2014) who had Computer Tomography Pulmonary Angiography (CTPA)...
June 5, 2018: Internal Medicine Journal
Yvonne Brennan, Emmanuel J Favaloro, Leonardo Pasalic, Hayley Keenan, Jennifer Curnow
BACKGROUND: Idarucizumab is a specific antidote to the direct thrombin inhibitor oral anticoagulant, dabigatran etexilate. It has been used with increasing frequency in Australia since it was granted Therapeutic Goods Administration approval in October 2016. AIMS: To assess idarucizumab usage, effect on coagulation parameters and clinical outcomes in patients who received idarucizumab in Western Sydney Local Health District (WSLHD). METHODS: A retrospective audit was conducted of all patients who received idarucizumab in WSLHD between September 2015 and December 2017...
June 5, 2018: Internal Medicine Journal
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