Internal medicine journal
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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.
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Internal medicine journal · Jan 2021
Unexpected high frequency of early mortality in COVID-19: a single-centre experience during the first wave of the pandemic.
We report the high frequency of early mortality in COVID-19 patients (48.6% of 72 deaths). Early deaths were not explained by differences in age, sex and comorbidities, but they had a more severe disease at hospital admission compared with late deaths. These data highlight the importance of outpatient monitoring for the early identification of COVID-19 patients who require hospital admission.
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Internal medicine journal · Jan 2021
Residential aged care facility COVID-19 outbreaks and magnitude of spread among residents: observations from a Victorian residential in-reach service.
There is a paucity of Australian literature exploring the spread of COVID-19 among residents living in residential aged care facilities (RACF). In this case series of COVID-19 outbreaks in six RACF, we collected data on the cumulative proportion of residents who tested positive for COVID-19 within 21 days of the index case being identified. We describe the observations of a Residential In-Reach service within these six RACF and found that rapid cohorting strategies, personal protective equipment availability and adequacy of use, embedded infection control staff, and adequate outbreak preparedness plans may have influenced the differences observed between RACF in the containment and minimisation of the spread of COVID-19 amongst residents.