Internal medicine journal
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Internal medicine journal · Sep 2023
Case ReportsAssociation of monoclonal gammopathy of undetermined significance and C3 glomerulopathy.
Monoclonal gammopathy of undetermined significance (MGUS) is usually an asymptomatic pre-malignant condition caused by the proliferation of clonal plasma cells. Often considered a benign condition, it has the potential to progress to malignant plasma cell or lymphoproliferative disorders. Moreover, MGUS can rarely cause glomerular disease by activating the alternative complement pathway resulting in immunoglobulin-negative C3-positive glomerulonephritis called C3 glomerulopathy. ⋯ Untreated C3 glomerulopathy can lead to irreversible glomerular damage and end-stage renal failure, and a high index of suspicion is essential for timely diagnosis and management. Here, we present the case of a patient with a prior diagnosis of MGUS who presented with proteinuria and microscopic haematuria and was diagnosed with C3 glomerulopathy. The patient had complete resolution of the disease after receiving treatment with a combination of dexamethasone, lenalidomide and bortezomib for the underlying MGUS.
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Internal medicine journal · Sep 2023
Provision of continuous subcutaneous insulin infusion to type 1 diabetes 'frequent flyers'.
A few people with type 1 diabetes undergo multiple hospital admissions for acute glycaemic events. We report on a series of five such 'frequent flyers' who were provided with continuous subcutaneous insulin infusion (CSII) therapy. ⋯ Total insulin dose and body mass index decreased in some patients and satisfaction was anecdotally higher. Some, but not all, 'frequent flyers' benefited from a trial of CSII.
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Internal medicine journal · Sep 2023
Supporting home-based meal preparation improves lunchtime habits and self-assessed work performance of interns at a tertiary hospital.
There is ample evidence that doctors frequently miss meals at work, which negatively impacts concentration, decision-making and overall patient care. Junior doctors are particularly vulnerable given their heavy workload. We report on the impact of a pilot programme supporting home-based meal preparation on the dietary habits and energy levels of interns at a tertiary hospital and demonstrate this is one strategy healthcare organisations can adopt to promote a healthier workforce.