Internal medicine journal
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Internal medicine journal · Jan 2025
Comparative study of management strategies for immune checkpoint inhibitor-induced inflammatory arthritis: rheumatologists versus oncologists.
Immune checkpoint inhibitors (ICIs) have significantly improved cancer treatment outcomes but are associated with immune-related adverse events (irAEs), such as inflammatory arthritis (ir-IA). Management of ir-IA is evolving, with corticosteroids as the primary treatment, though some cases require steroid-sparing agents. ⋯ RA-like ir-IA comprised 8% of ICI-related irAEs. During the study period, patients managed by rheumatologists received lower initial prednisolone doses and more frequent csDMARD than oncologists. A multidisciplinary involvement between rheumatologists and oncologists in the event of ir-IA is crucial.
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Internal medicine journal · Jan 2025
Invasive group B streptococcal infections in Western Australia, 2000-2018.
Neonatal and puerperal sepsis are major manifestations of invasive group B streptococcal (Streptococcus agalactiae; iGBS) infections. International data indicate the importance of iGBS infections among non-pregnant adults. ⋯ iGBS cases increased across the period 2000-2018 in WA, with older adults making up a higher proportion of cases over time. Preventive efforts among older patients, including potentially through vaccination, may reverse this increase.
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Internal medicine journal · Jan 2025
Subjective and objectives measures of frailty among adults with advanced chronic kidney disease: a cross-sectional analysis of clinician misclassification.
Frailty is a recognisable clinical measure of impaired physiological reserve and vulnerability to adverse outcomes that is validated among patients with kidney disease. Practice patterns reveal inconsistent use of objective frailty measures by nephrologists, with clinicians prioritising subjective clinical impressions, possibly risking misclassification and discrimination. ⋯ Nephrologists' reliance on subjective clinical impressions that overlook or misclassify prefrailty offers incomplete prognostic assessment and potentially misses opportunities for early intervention.
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Internal medicine journal · Jan 2025
A retrospective analysis of cardiovascular outcomes of clozapine treated individuals within Hunter New England.
Clozapine has demonstrated superiority in improving both positive and negative symptoms of treatment-resistant schizophrenia; however, there are associated treatment-limiting side effects, including myocarditis, cardiomyopathy and agranulocytosis. ⋯ The overall incidence of myocarditis and HF during follow-up was low, with surveillance echocardiography offering limited predictive value. Patients maintained on clozapine are at risk of significant cardiovascular sequelae, likely reflecting an adverse risk factor profile.
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Internal medicine journal · Jan 2025
Appropriateness of lumbar spine imaging in patients presenting to the emergency department with low back pain in a Western Australian tertiary hospital.
The Australian Rheumatology Association identified the use of imaging in patients with low back pain without indication of serious pathology as a low-value practice. ⋯ Four in five lumbar spine imaging requests for investigating low back pain were appropriate. Of the inappropriate requests, the most common reason was the absence of alerting features, while a small number were the incorrect imaging modality.