Internal medicine journal
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Internal medicine journal · Jan 2021
Multicenter StudyCOVID-19 in Australia: Our national response to the first cases of SARS-CoV-2 infection during the early biocontainment phase.
On 31 December 2019, the World Health Organization recognised clusters of pneumonia-like cases due to a novel coronavirus disease (COVID-19). COVID-19 became a pandemic 71 days later. ⋯ This is a historical record of the first COVID-19 cases in Australia during the early biocontainment phase of the national response. These findings were invaluable for establishing early inpatient and outpatient COVID-19 models of care and informing the management of COVID-19 over time as the outbreak evolved. Future research should extend this Australian case series to examine global epidemiological variation of this novel infection.
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Internal medicine journal · Jan 2021
Randomized Controlled TrialResults from a double blinded, randomised, placebo-controlled, feasibility trial of melatonin for the treatment of delirium in older medical inpatients.
Delirium is common in elderly inpatients, causing distress, cognitive decline and death. No known intervention improves the course of delirium; current treatments are symptomatic, and limited by lack of efficacy and adverse effects. There is an urgent need to find an effective treatment for delirium. ⋯ A trial of the hypothesis that 5 mg melatonin nightly for five nights reduces delirium severity in older medical inpatients would require 120 patients, and is feasible.
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Internal medicine journal · Jan 2021
ReviewTracking of brachial and central aortic systolic pressure over the normal human lifespan: insight from the arterial pulse waveforms.
Despite multiple studies, it has not been possible to account for the normal changes of blood pressure that occur from infancy to old age. We sought a comprehensive explanation, by linking brachial pressure with the well documented changes in the arterial pulse waveform, whose peak and nadir determine systolic, diastolic and pulse pressure in brachial arteries. Changes in humans arterial pulse wave contour from birth to old age can be readily explained on (i) growth, with increasing length of the body from birth to adolescence, and adult height maintained thereafter, and (ii) degeneration and dilation of the aorta from elastic fibre fracture throughout life, causing progressive increase in aortic pressure wave amplitude from early return of wave reflection, and summation of incident with reflected waves in systole. These changes throughout life complement arterial pulse waveform analysis and explain brachial cuff pressure values, with optimal pulse wave pattern for cardiac interaction apparent in adolescence.
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Previous studies have found an increase in mortality among patients with worsening degrees of hyponatraemia. There is limited evidence on the impact of dysnatraemia on outcomes such as length of stay (LOS) and intensive care unit (ICU) admission. ⋯ An abnormal serum sodium level is a strong marker of poor outcome in acute hospital illness.
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Internal medicine journal · Jan 2021
Observational StudyRelationship between residual kidney function and symptom burden in haemodialysis patients.
Residual kidney function (RKF) has been associated with improved solute clearance and survival in haemodialysis (HD) patients. However, whether RKF impacts symptom burden in HD patients is unknown. ⋯ Higher RKF was significantly associated with fewer symptoms, and lower serum β2 -microglobulin and potassium, suggesting that strategies to preserve RKF may be beneficial.