Internal medicine journal
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Internal medicine journal · Apr 2020
U-shaped association of vigorous physical activity with risk of metabolic syndrome in men with low lean mass, and no interaction of physical activity and serum 25-hydroxyvitamin D with metabolic syndrome risk.
There is uncertainty over how lean mass, physical activity (PA) and 25-hydroxyvitamin D (25-OH-D) status interact on metabolic syndrome (MetS) risk in adults. ⋯ Men and women with high lean mass have low risk of MetS regardless of PA. Low lean mass identifies men who may benefit most from increasing PA, with an optimal level associated with lowest risk. 25-OH-D and PA do not interact on MetS risk.
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Internal medicine journal · Apr 2020
Enterococcal bacteraemia 'silent but deadly': a population-based cohort study.
The high mortality rate of patients with enterococcal infections has been shown to be associated with the severity of underlying comorbidities. ⋯ Microbiological cure was inversely associated with 30-day mortality. The presence of underlying urological and colorectal malignancy was a predictor of 1-year mortality. We identified the importance of evaluating patients with Enterococcus faecalis bacteraemia for underlying colorectal neoplasia. Routine colonoscopy is recommended in patients with E. faecalis bacteraemia or infective endocarditis with an unclear source of infection.
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Internal medicine journal · Apr 2020
Performance of risk models predicting cardiac complications in pregnant women with congenital heart disease: a meta-analysis.
Accurate risk stratification is important in pregnant women including the growing population with congenital heart disease (CHD). We meta-analysed the performance of risk models for CHD women. ⋯ Pooled c-statistics (95% confidence interval) for scores were mWHO 0.71 (0.65-0.76), CARPREG 0.66 (0.61-0.71) and ZAHARA 0.71 (0.65-0.76). Current risk models had at best moderate discrimination for CHD women with significant room for improvement.
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Internal medicine journal · Apr 2020
Hospitalised exacerbations of chronic obstructive pulmonary disease: adherence to guideline recommendations in an Australian teaching hospital.
Optimal management of exacerbations of chronic obstructive pulmonary disease (COPD) reduces patient morbidity and healthcare system burden. COPD guidelines, including the Global Initiative for Chronic Obstructive Lung Disease (GOLD) and the COPD-X Plan, provide evidence-based recommendations, but adherence in hospital practice is variable. ⋯ Level of adherence to guideline recommendations in the management of COPD exacerbations is inadequate and further strategies are required to elevate standards of practice.
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Lithium-induced neurotoxicity typically occurs with chronic accumulation rather than following acute overdose. There is little emphasis in the literature on the protracted nature of lithium neurotoxicity long after the lithium concentration returns to the therapeutic range. ⋯ Lithium neurotoxicity has a prolonged course. Its severity correlates poorly with lithium concentrations, which normalise quickly. Most poisonings occur in elderly patients with acute kidney injury. Prolonged delirium often prompts multiple unnecessary investigations. Rationalisation of lithium therapy is important in elderly patients.