Internal medicine journal
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Thyroid eye disease is an autoimmune inflammatory disease strongly associated with thyroid disease, principally Graves disease. It can range from mild disease requiring observation or symptomatic treatments only, through to sight-threatening disease requiring major drug therapy and orbital surgery. Severity is graded by the NOSPECS system and activity by the clinical activity score (CAS) to assist in treatment selection. ⋯ High-dose intravenous methylprednisolone therapy is used in active vision-threatening disease with early use of tarsorrhaphy and orbital decompression. Inactive but moderate to severe disease may be treated by orbital decompression, strabismus and eyelid surgery. Systematic assessment and management by both an endocrinologist and ophthalmologist to achieve and maintain euthyroidism and select and sequence treatments according to activity and severity of thyroid eye disease gives the best results for quality of life and vision.
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Internal medicine journal · Jan 2022
ReviewMobile applications for the management of chronic physical conditions: A systematic review.
Chronic physical conditions (CPC) decrease the quality of life of millions of people. In the absence of curative treatments, maintaining healthy lifestyle habits is one of the main pillars in their clinical management. Mobile-based interventions may help patients take care of their health and follow medical recommendations. The purpose of this review is to summarise the latest evidence about mobile telephone applications (apps) for the management of CPC. ⋯ Mobile apps are promising tools for the management of CPC. Some apps have been sufficiently tested to propose their implementation in clinical practice. However, several barriers exist that can slow down the routine use of new technologies in healthcare settings.
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Internal medicine journal · Jan 2022
Basal serum cortisol levels predict a normal response to the Synacthen stimulation test in hospitalized patients.
The short Synacthen test (SST) is widely used to assess the hypothalamus-pituitary-adrenal axis in the outpatient setting. However, in the inpatient setting, technical difficulties to adhere to the protocol may pose a challenge for using this test. ⋯ In this study, we found two suitable BSC cut-offs for predicting an adequate response to the SST in hospitalised patients. We suggest using the lower cut-off (280 nmol/L) for patients with a low level of suspicion for AI and using the higher cut-off (380 nmol/L) for patients with a higher level of suspicion. A BSC above this cut-off makes the diagnosis of AI very unlikely and precludes the need for a Synacthen test.
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Internal medicine journal · Jan 2022
ReviewUpdate on echocardiography: do we still need a stethoscope?
The focus of this article is to review point-of-care ultrasound (POCUS) of the chest as an adjunct to use of the stethoscope and physical examination. We consider selected evidence supporting POCUS for evaluation of acute dyspnoea and focussed cardiac assessment, explore current and the future directions in POCUS for the generalist physician and review some historical notes on auscultation of the chest and parallels to the evolution of POCUS.