Internal medicine journal
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Internal medicine journal · Mar 2024
Diagnosis and subtyping of idiopathic inflammatory myopathies: caution required in the use of myositis autoantibodies.
Detection of myositis autoantibodies (MAs) has utility in both the diagnosis and subtyping of idiopathic inflammatory myopathies (IIMs). Multiplex assays such as the Euroimmun line immunoassay (LIA) have significant limitations in rare diseases like IIM. A retrospective cohort study was performed on positive MA detected on LIA in 171 patients using the manufacturer's recommended cut-off. ⋯ Positive predictive value (PPV) improved, but there was variable increase in false negatives. False positive MA results are common using LIA, but locally derived cut-offs can improve performance. Clinicians must be aware of the limitations of LIA, which is the commonest method for MA detection in Australasia.
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Internal medicine journal · Mar 2024
Risk factors for malignancy and serious infection in patients with Inflammatory Bowel Disease: a retrospective analysis.
Patients with inflammatory bowel disease (IBD) are at increased risk of malignancy and infection compared to the general population. ⋯ Factors including ileocolonic CD and increasing IBD duration were associated with higher malignancy risk in this cohort. Compared with non-exposure, patients exposed to thiopurines were not at increased risk of malignancy or serious infection. Similarly, patients exposed to anti-TNF treatment did not experience increased rates of malignancy or serious infection compared to patients not exposed to this treatment.
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Internal medicine journal · Mar 2024
Left ventricular assist devices for treatment of refractory advanced heart failure: the Western Australian experience.
Left ventricular (LV) assist devices (LVADs) can prolong survival and improve quality of life in end-stage heart failure. ⋯ Excellent outcomes can be achieved with LVADs in appropriately selected patients.
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Internal medicine journal · Mar 2024
Reporting hypoglycaemia as a hospital-acquired complication (HAC): assessing biochemical and clinical validity.
Given treatment-related hypoglycaemia in hospitals can lead to adverse outcomes, the Australian Commission on Safety and Quality in Health Care has included hypoglycaemia as a reportable hospital-acquired complication (HAC) with financial disincentives. However, the designation of a hypoglycaemia HAC relies on clinical coding without a defined glucose threshold or clinical context. We assessed the biochemical validity and clinical relevance of a hypoglycaemia HAC. ⋯ Given safety and cost implications, the designation of hypoglycaemia HAC requires a standardised definition incorporating a biochemical threshold and clinical context. We propose a clinically relevant definition of hypoglycaemia HAC to promote safe diabetes care.
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Internal medicine journal · Mar 2024
Mitochondrial disease in New Zealand: a nationwide prevalence study.
The complexities of mitochondrial disease make epidemiological studies challenging, yet this information is important in understanding the healthcare burden and addressing service and educational needs. Existing studies are limited to quaternary centres or focus on a single genotype or phenotype and estimate disease prevalence at 12.5 per 100 000. New Zealand's (NZ) size and partially integrated national healthcare system make it amenable to a nationwide prevalence study. ⋯ Within the limitations of this study, comparison to similar prevalence studies performed by specialist referral centres suggests mitochondrial disease is underdiagnosed in NZ. This highlights a need for improved education and referral pathways for mitochondrial disease in NZ.