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 · Oct 2022
Observational StudyElevated renal resistive index is independently predicted by older age, but not by the presence of chronic kidney disease: A retrospective cohort study.
Renal resistive index (RRI), which reflects intrarenal arterial impedance, is routinely measured when undertaking renal Doppler ultrasonography (RDU). Increased RRI has been suggested to reflect renal parenchymal disease and imply risk of kidney disease progression. But this has been disputed and extra-renal haemodynamic factors rather than intra-renal factors have been proposed to determine RRI. ⋯ Elevated RRI was predicted by older age and diabetes, but not by the presence of CKD. Baseline RRI was not associated with eGFR decline.
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Internal medicine journal · Oct 2022
The Clinical and Financial Burden of Spinal Infections in People who Inject Drugs.
People who inject drugs (PWID) are known to be at increased risk of infectious diseases including bacterial and blood-borne viral infections. However, there is limited literature surrounding the burden of spinal infections as a complication of injecting drug use (IDU). ⋯ Spinal infections in PWID are an underreported serious medical complication of IDU. Although mortality is low, there is significant morbidity with prolonged admissions, large antimicrobial requirements and surgical interventions generating a substantial cost to the health system.
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Internal medicine journal · Oct 2022
Development of a risk score to predict peripherally inserted central catheter thrombosis in active cancer.
Peripherally inserted central catheter (PICC) thrombosis is common. ⋯ Cancer patients had longer PICC durations and higher PICC thrombosis rates than those without (7% vs 0.7%). mMRS more accurately classified low PICC thrombosis risk than KRS <1(47% vs 22%). Prospective validation of mMRS is warranted.
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Internal medicine journal · Oct 2022
A novel non-invasive index of oxygenation and prediction of outcomes for patients on high-flow nasal cannula: a pilot study.
Predicting success of a therapy in acute respiratory failure is clinically important. The FOx index (high-flow rate × FiO2 )/SpO2 was retrospectively applied to 70 patients who required high-flow nasal prongs for hypoxaemic and hypercapnic respiratory failure. The FOx index could predict between success and failure of high-flow nasal prongs at 6 hours, using non-invasive markers. This adds to the clinician's toolbox in managing respiratory failure and represents important proof of concept for a prospective study.