Internal medicine journal
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Internal medicine journal · Oct 2022
ReviewEpstein-Barr virus -related lymphoma in rheumatoid arthritis: Implications for long-term usage of immunosuppressive drugs and review of the literature.
Rheumatoid arthritis (RA) is a common autoimmune disease where methotrexate (MTX) is widely used as the first-line therapy. The combination of RA and MTX is associated with lymphoproliferative disorders (LPD). RA patients with Epstein-Barr virus (EBV) have impaired T-lymphocyte function, thus allowing an overgrowth of EBV-positive lymphoblastoid cells. We examined the association of EBV with LPD in immunosuppressed RA patients, particularly those treated with MTX. ⋯ The association between EBV, lymphoma and MTX highlights the need to consider reducing or stopping MTX in patients who have had stable RA for many years.
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Internal medicine journal · Sep 2022
ReviewDiagnosis and management of primary central nervous system lymphoma: a Consensus Practice Statement from the Australasian Lymphoma Alliance.
Primary central nervous system lymphoma is a clinicopathological disease entity that accounts for 1% of all non-Hodgkin lymphoma (NHL). Advanced patient age, adverse disease biology and complexities of diagnosis and treatment render outcomes markedly inferior to systemic NHL. Despite this, an increasing evidence base, including limited randomised controlled clinical trial data, is informing optimal therapeutic strategies with methotrexate-based induction chemotherapy schedules and intensified consolidation in selected patients. This practice statement represents an evidence-based review of the literature and has been devised to assist healthcare professionals in the diagnosis and management of this disease.
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Internal medicine journal · Sep 2022
Solid pancreas transplant outcomes with increased donor and recipient ages compared to reference ages: A systematic review.
Increased recipient and donor age are associated with worse solid organ pancreas transplant outcomes. However, donor and recipient age criteria vary between jurisdictions. We systematically reviewed studies reporting the association between transplanting older recipients and donors beyond current Transplantation Society of Australia and New Zealand (TSANZ) limits with solid pancreas transplant outcomes. ⋯ Increased donor or recipient age alone should not absolutely contraindicate solid pancreas transplantation, especially if other risk predictors are minimised.
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Internal medicine journal · Sep 2022
ReviewCannabis, cannabidiol and tetrahydrocannabinol in sport: An overview.
The World Anti-Doping Agency now allows cannabidiol (CBD) to be taken in elite sport, but has retained all other cannabinoids on its banned list. This, together with liberalisation of cannabis laws, has led to an increasing interest in its use in sport. ⋯ CBD possesses anti-inflammatory and analgesic properties that have not been adequately evaluated in the area of sport. Some formulations of CBD contain THC or other cannabinoids that may result in a positive drug test.
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Internal medicine journal · Aug 2022
ReviewEvidence to guide ethical decision-making in the management of older people living in squalor: a narrative review.
Older people living in squalor present healthcare providers with a set of complex issues because squalor occurs alongside a variety of medical and psychiatric conditions, and older people living in squalor frequently decline intervention. To synthesise empirical evidence on squalor to inform ethical decision-making in the management of squalor using the bioethical framework of principlism. A systematic literature search was conducted using Medline, Embase, PsycINFO and CINAHL databases for empirical research on squalor in older people. ⋯ The harm associated with squalid living for the older person, and for others around them, means a non-interventional approach is likely to contravene the principles of non-maleficence, beneficence and justice. Adequate assessment of decision-making capacity is of particular importance. To be ethical, any intervention undertaken must balance benefits, harms, resource utilisation and impact on others.