Internal medicine journal
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Internal medicine journal · Aug 2023
Review Meta AnalysisWeight Loss With Subcutaneous Semaglutide Versus Other Glucagon Like Peptide-1 Receptor Agonists In Type 2 Diabetes: A Systematic Review.
Glucagon-like peptide 1 receptor agonists (GLP-1 RAs) reduce elevated blood glucose levels and induce weight loss. Multiple GLP-1 RAs and one combined GLP-1/glucose-dependent insulinotropic polypeptide agonist are currently available. This review was conducted with the aim of summarising direct comparisons between subcutaneous semaglutide and other GLP-1 RAs in individuals with type 2 diabetes (T2D), particularly with respect to efficacy for inducing weight loss and improving other markers of metabolic health. ⋯ Comparators included liraglutide, exenatide, dulaglutide and tirzepatide. In the identified studies, multiple dosing regimens were utilised for semaglutide. Randomised trials support the superior efficacy of semaglutide over other GLP-1 RAs with respect to weight loss in T2D, but tirzepatide is more effective than semaglutide.
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Internal medicine journal · Aug 2023
Practice GuidelineExecutive summary of consensus clinical practice guidelines for the prevention of infection in patients with multiple myeloma.
Infection remains a significant contributor to morbidity and mortality in patients with myeloma. This guideline was developed by a multidisciplinary group of clinicians who specialise in the management of patients with myeloma and infection from the medical and scientific advisory group from Myeloma Australia and the National Centre for Infections in Cancer. In addition to summarising the current epidemiology and risk factors for infection in patients with myeloma, this guideline provides recommendations that address three key areas in the prevention of infection: screening for latent infection, use of antimicrobial prophylaxis and immunoglobulin replacement and vaccination against leading respiratory infections (severe acute respiratory syndrome coronavirus 2, influenza and Streptococcus pneumoniae) and other preventable infections. This guideline provides a practical approach to the prevention of infection in patients with myeloma and harmonises the clinical approach to screening for infection, use of prophylaxis and vaccination to prevent infectious complications.
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Internal medicine journal · Aug 2023
The Disproportionately Large Contribution of the Māori and Pacific Islander Community to the Healthcare Burden of Gout in Western Sydney.
Gout is a common chronic inflammatory disorder due to monosodium urate deposition, which results in severe inflammatory arthritis. It is particularly common in those of Māori or Pacific Islander heritage. There is a significant number of this at-risk ethnic group in western Sydney. ⋯ The disproportionately large healthcare burden of gout in Western Sydney from the relatively small Māori and Pacific Islander population needs attention. Urgent culturally appropriate interventions to address gout are required to address this inequality.
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Internal medicine journal · Aug 2023
Subsegmental Pulmonary Embolism and Anticoagulant Therapy: The Impact of Clinical Context.
Anticoagulation for subsegmental pulmonary embolism (SSPE) is controversial. ⋯ SSPE is diagnosed in almost 3% of pulmonary angiograms and is associated with high mortality, regardless of anticoagulation, due to coexistent disease processes rather than SSPE. Anticoagulation appears dominant but markedly affected by the clinical context of risk factors, alternative indications and illness severity. Thus, the controversy is partly artificial because anticoagulation after SSPE is clinically contextual with SSPE as only one of several factors.