Imelda P Hannigan, Sally M Rosengren, Gian L Di Tanna, Shaun R D Watson, Miriam S Welgampola
BACKGROUND: Vestibular migraine (VM) is a common cause of recurrent vertigo. Migraine headache preventative therapies are currently prescribed to control vertigo symptoms in VM. Clinical trials of nutraceuticals for migraine headache prevention have shown positive outcomes, but, to date, there have been no studies to assess their effectiveness in the management of VM. AIMS: To report the effects of nonprescription therapy management on VM symptoms. METHODS: We undertook a prospective, questionnaire-based assessment of patients diagnosed with VM between November 2019 and August 2021 at two Sydney tertiary referral clinics...
January 10, 2024: Internal Medicine Journal
Alexander Murray-Douglass, Jason Papacostas, Anne Ovington, Isaac Wensley, Robert Campbell, Lisa Gillinder
BACKGROUND: Surgical management of refractory focal epilepsy requires preoperative localisation of the epileptogenic zone (EZ). To augment noninvasive studies, stereoelectroencephalography (SEEG) is being increasingly adopted as a form of intracranial monitoring. AIMS: This study aimed to determine the rate of complications for patients undergoing SEEG and to report the success of SEEG with regard to EZ detection and seizure outcome following definitive surgery...
January 2, 2024: Internal Medicine Journal
Reinhardt Dreyer, James Gome
BACKGROUND: Clinicians and funders continue to search for ways to reduce costs without sacrificing quality of care. Ongoing research should focus on innovative care models that identify patients at high-risk for hospitalisation and thereby reduce healthcare costs. AIMS AND OBJECTIVES: This study examined readmission rates, comorbidity profiles and the performance of the LACEi (Length of stay, Acuity of admission, Charlson Comorbidity Index, ED admissions in the previous 6 months index) to predict the risk of 30-day readmissions in a regional population...
January 2, 2024: Internal Medicine Journal
Marycarol Holdaway, Zoë Hyde, Jo-Anne Hughson, Roslyn Malay, Andrew Stafford, Kate Fulford, Kylie Radford, Leon Flicker, Kate Smith, Dimity Pond, Sarah Russell, David Atkinson, Irene Blackberry, Dina LoGiudice
BACKGROUND: Aboriginal and Torres Strait Islander people are ageing with high rates of comorbidity, yet little is known about suboptimal prescribing in this population. AIM: The prevalence of potentially suboptimal prescribing and associated risk factors were investigated among older patients attending primary care through Aboriginal Community Controlled Health Services (ACCHSs). METHODS: Medical records of 420 systematically selected patients aged ≥50 years attending urban, rural and remote health services were audited...
December 30, 2023: Internal Medicine Journal
Patrice Forner, Jennifer Snaith, Jerry Greenfield
BACKGROUND: Many people living with type 1 diabetes (type 1 diabetes mellitus (T1DM)) do not meet glycaemic targets. Adjunctive therapies have both risks and metabolic benefits and may have a role in selected patients. AIM: To review the prescribing patterns of adjunctive therapy for the treatment of T1DM diabetes in Australia. METHODS: We conducted an online survey of Australian endocrinologists and endocrinology registrars. We surveyed the frequency of, motivations and concerns regarding the prescription of metformin, dipeptidyl peptidase-4 (DPP-IV) inhibitors, sodium-glucose transport protein 2 (SGLT-2) inhibitors and glucagon-like peptide 1 receptor agonist (GLP1RA) in T1DM...
December 29, 2023: Internal Medicine Journal
Christian M Girgis, Yoonah Choi, Peter R Ebeling
BACKGROUND: International osteoporosis guidelines have recommended treatment approaches based on fracture risk stratification, in particular, anabolic therapy for patients with very high risk (VHR) of fragility fracture. AIM: To summarise Australian clinicians' perceptions of patients at VHR of fracture. METHODS: Australian clinicians invited to educational webinars on anabolic treatments for osteoporosis were surveyed in March and April 2021 about a typical patient they had most recently seen and identified as at VHR of fracture...
December 29, 2023: Internal Medicine Journal
Kate Collins, Irene Lu, Jer Fuu Ng, Connor Stevenson, Damian Dowling
BACKGROUND: Eosinophilic oesophagitis (EOE) is a known cause of food bolus obstruction (FBO) with rising incidence and prevalence. AIMS: To assess the rates of EOE in adult cases presenting with an FBO via prospective biopsy collection during index endoscopy. METHODS: Oesophageal FBO cases requiring gastroscopy between February 2014 and January 2021 at a single institution with a unified policy to perform biopsies on FBO cases were analysed using medical records, endoscopy and histology...
December 27, 2023: Internal Medicine Journal
Sueh-Li Lim, Cameron Wellard, Elizabeth Moore, Simon J Harrison, Quach Hang, Joy Ho, Rajeev Rajagopal, Andrew Spencer
BACKGROUND: There is no currently available standard of care for triple-class exposed, relapsed refractory myeloma (RRMM) patients in Australia. CARTITUDE-1 (CART-1) was a single-arm, phase 1b/2 study of 97 triple-class exposed RRMM patients, who received BCMA-CAR-T cell therapy with ciltacabtagene autocel. Overall response rate (ORR) was 98%. Median progression free survival (PFS) and overall survival (OS) had not been reached at a median follow-up of 28 months. METHODS: We performed a retrospective analysis on a cohort of CART-1 comparable RRMM patients participating in the Australian and New Zealand Myeloma and Related Diseases Registry (MRDR), to compare outcomes in triple-class exposed MM patients treated with currently available therapies, in a real-world context...
December 27, 2023: Internal Medicine Journal
Ashlea Campbell, Benjamin Teh, Stephen Mulligan, David M Ross, Robert Weinkove, Nicole Gilroy, Shane Gangatharan, Henry Miles Prince, Jeff Szer, Judith Trotman, Steven Lane, Michael Dickinson, Hang Quach, Anoop K Enjeti, Matthew Ku, Gareth Gregory, Gregory Hapgood, Phoebe Joy Ho, Tara Cochrane, Chan Cheah, Matthew Greenwood, Maya Latimer, Leanne Berkahn, Joel Wight, Tasman Armytage, Peter Diamond, Constantine S Tam, Nada Hamad
Despite widespread vaccination rates, we are living with high transmission rates of SARS-CoV-2. Although overall hospitalisation rates are falling, the risk of serious infection remains high for patients who are immunocompromised because of haematological malignancies. In light of the ongoing pandemic and the development of multiple agents for treatment, representatives from the Haematology Society of Australia and New Zealand and infectious diseases specialists have collaborated on this consensus position statement regarding COVID-19 management in patients with haematological disorders...
December 25, 2023: Internal Medicine Journal
Trung Q Ngo, Matthew W Scott, Shreerang Sirdesai, Jennifer L Hempton, Georgina S Hodges, Philip J Campbell
BACKGROUND: JAK2-mutated polycythaemia vera (PV) is associated with reduced survival because of thrombotic events and haematological disease transformation. Therapeutic venesection has traditionally been used to lower haematocrit, but the technique of erythrocytapheresis has emerged over the last decade. AIM: To compare erythrocytapheresis with venesection as treatment for PV by assessing medical efficacy and financial viability. METHODS: One hundred sixteen patients with PV who received red cell depletion therapy at Barwon Health between 2014 and 2021 were identified...
December 25, 2023: Internal Medicine Journal
Paul Lilburn, Jonathan P Williamson, Martin Phillips, Nikela Tillekeratne, Alvin Ing, Allan Glanville, Tajalli Saghaie
The first dedicated tracheobronchial silicone stent was designed by the French pulmonologist Jean-Paul Dumon. The most common indications for stenting are to minimise extrinsic airway compression from mass effect, maintain airway patency due to intrinsic obstruction or treat significant nonmalignant airway narrowing or fistulae. Silicone stents require rigid bronchoscopy for insertion; however, they are more readily repositioned and removed compared with metallic stents. Metallic stents demonstrate luminal narrowing when loads are applied to their ends, therefore stents should either be reinforced at the ends or exceed the area of stenosis by a minimum of 5 mm...
December 22, 2023: Internal Medicine Journal
Christian Hamilton-Craig, Karam Kostner, David Colquhoun, Stephen J Nicholls
The cardiovascular benefits of omega-3 polyunsaturated fatty acids (O3FA) remain a point of confusion in clinical medicine. Recently two large, randomised trials were published with discordant findings regarding the overall benefits of omega-3 supplementation, resulting in unnecessary confusion and therapeutic nihilism. Epidemiological studies clearly show high intake of fish and measured O3FA (mainly eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA)) in tissues are inversely associated with cardiovascular events and total mortality...
December 17, 2023: Internal Medicine Journal
Claire Tucak, HuiJun Chih, Frank Mastaglia, Julian Rodrigues
BACKGROUND: 'PD Warrior' (PDW) is a popular exercise program for Parkinson's disease; however, there are no published studies on the outcomes of the program. AIMS: To investigate short-term functional and quality of life (QoL) outcomes after the PDW 10-week program in a pilot study of individuals with early Parkinson's Disease (PD). METHODS: Twenty individuals with PD (Hoehn & Yahr 1-3) attending a hospital outpatient clinic were recruited into the PDW 10-week program, comprising a weekly 1-h supervised class complemented by an individualised daily home exercise program...
December 15, 2023: Internal Medicine Journal
Edwina Light, Ian Kerridge, George Skowronski, Venkatesha Venkatesha, Aravind Krishnamurthy, Suzanne Kuper, Kerrie Noonan, Philip Hoyle, Mark Arnold, Stephen Manley, Wade Stedman, Linda Sheahan
BACKGROUND: In the context of nationwide law reform, New South Wales (NSW) became the last state in Australia to legalise voluntary assisted dying (VAD) - commencing 28 November 2023. Clinicians have divergent views regarding VAD, with varying levels of understanding, support, and willingness to be involved, and these may have a significant impact on the successful implementation. AIMS: To understand levels of support, understanding and willingness to be involved in VAD among clinical staff across NSW during implementation of VAD...
December 14, 2023: Internal Medicine Journal
Kyle Crassini, John Gibson
Malignancies of the B-lymphocyte lineage are among the most diagnosed haematological malignancies in clinical practice. In our community, multiple myeloma (MM) and its precursor condition monoclonal gammopathy of undetermined significance are the commonest, accounting for ~12% of diagnoses, followed by chronic lymphocytic leukaemia (CLL) and its precursor condition monoclonal B lymphocytosis, ~9%. Along with diffuse large B cell lymphoma, follicular lymphoma and marginal zone lymphoma, these conditions comprise around a third of all haematological malignancies diagnosed...
December 8, 2023: Internal Medicine Journal
Anna Nelson, P Joy Ho, Helen Haysom, Neil Waters, Cameron Wellard, Melissa Chee, Juliana Teo, Anthea Greenway, Kylie Mason, Giselle Kidson-Gerber, Zane Kaplan, Tina Carter, Merrole F Cole-Sinclair, Pasquale Barbaro, Erica M Wood
BACKGROUND: Sickle cell disease (SCD) is the most common monogenic disorder worldwide. In deoxygenated conditions, the altered beta chain (haemoglobin S [HbS]) polymerises and distorts the erythrocyte, resulting in pain crises, vasculopathy and end-organ damage. Clinical complications of SCD cause substantial morbidity, and therapy demands expertise and resources. Optimising care for patients and planning resource allocation for the future requires an understanding of the disease in the Australian population...
December 8, 2023: Internal Medicine Journal
Marie Robert, Arthur Mageau, Augustin Gaudemer, Michael Thy, Nathan Peiffer Smadja, Victoire de Lastours, Thomas De Broucker, Thomas Papo, Tiphaine Goulenok, Karim Sacré
BACKGROUND: Immune reconstitution inflammatory syndrome (IRIS) affecting the central nervous system (CNS) is associated with poor outcomes. AIMS: To report on risk factors for CNS-IRIS following tuberculous meningitis (TBM) in HIV-negative patients. METHODS: In this retrospective multicentre study, all HIV-negative adult patients admitted between 2003 and 2021 with microbiologically proven TBM were included. The primary outcome measure was IRIS onset over follow-up...
December 8, 2023: Internal Medicine Journal
Drew Farquhar, Keat Choong, James Anderson, Sandra Peters, Shradha Subedi
BACKGROUND: Virtual ward (VW) models of care established during the coronavirus disease 2019 (COVID-19) pandemic provided safe and equitable provision of ambulatory care for low-risk patients; however, little is known about patients who require escalation of care to hospitals from VWs. AIM: To assess our VW model of care and describe the characteristics of patients admitted to the hospital from the VW. METHODS: Observational study of all patients admitted to a tertiary hospital COVID-19 VW between 1 December 2021 and 30 June 2022...
December 8, 2023: Internal Medicine Journal
Lynden Law, Wei Juen Lo, Caris House, Matthew Rawlins, Peter Boan, Michael Musk
BACKGROUND: Western Australia (WA) serves as a unique global case study on the impact of coronavirus disease 2019 (COVID-19) on an isolated, prepared and highly vaccinated population. This study builds upon the study performed by House et al. through an extended data set. AIM: To examine the impact of COVID-19 at the only quaternary hospital in WA following the border opening from 3 March to 17 July 2022. PARTICIPANTS: A total of 257 adults were admitted with COVID-19 under either respiratory or the intensive care unit (ICU)...
December 8, 2023: Internal Medicine Journal
Jennifer H Martin
There is a paucity of public discussion of costs spent on drug trials during coronavirus disease 2019 (COVID-19) and their value, and of large public outlay on research funding for vaccine and drug development that did not deliver medicines nor vaccines for Australians. This oversight left us at the behest of global supply chains, politics and commercial cost-plus pricing for vaccines. It is possible that these outcomes were the result of some major cognitive biases and the failure of a clinical pharmacologist's voice in the leadership teams...
December 5, 2023: Internal Medicine Journal
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