Internal medicine journal
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Internal medicine journal · Aug 2023
A Retrospective Comparison of Ultrasound Guided Percutaneous and Open Skeletal Muscle Biopsies.
Open skeletal muscle biopsy has been the mainstay of sample retrieval in patients with suspected muscle diseases. However, this technique is limited by surgeon and theatre availability, potentially resulting in delayed diagnosis and increasing hospital stay. ⋯ Ultrasound guided percutaneous muscle biopsies were performed faster and a wider range of muscles were targeted. However, this technique yielded smaller samples, which were non-diagnostic in 26% of cases. Increasing the needle gauge or number of passes may improve the diagnostic yield of this technique.
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Internal medicine journal · Aug 2023
The Disproportionately Large Contribution of the Māori and Pacific Islander Community to the Healthcare Burden of Gout in Western Sydney.
Gout is a common chronic inflammatory disorder due to monosodium urate deposition, which results in severe inflammatory arthritis. It is particularly common in those of Māori or Pacific Islander heritage. There is a significant number of this at-risk ethnic group in western Sydney. ⋯ The disproportionately large healthcare burden of gout in Western Sydney from the relatively small Māori and Pacific Islander population needs attention. Urgent culturally appropriate interventions to address gout are required to address this inequality.
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Internal medicine journal · Aug 2023
Outcomes out to 12 months after sequential use of high-dose tofacitinib following infliximab in acute severe ulcerative colitis.
Acute severe colitis (ASUC) remains a significant cause of morbidity in up to 25% of patients with ulcerative colitis during their disease course. We present the outcomes out to 12 months following the use of high-dose tofacitinib, 10 mg three times daily (TDS), in patients with steroid and infliximab refractory ASUC. A total of 11 patients with ASUC who were treated with high-dose tofacitinib after failing sequential infliximab therapy between 2019 and 2021 were identified at an Australian tertiary centre. ⋯ Neither venous thromboembolic events nor major infective complications were observed. Tofacitinib may be a safe and effective induction and maintenance agent in the treatment of steroid and infliximab refractory ASUC. Prospective studies with long-term follow-up are required to explore the use of tofacitinib in ASUC before it can be routinely recommended as salvage therapy.
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Internal medicine journal · Aug 2023
Subsegmental Pulmonary Embolism and Anticoagulant Therapy: The Impact of Clinical Context.
Anticoagulation for subsegmental pulmonary embolism (SSPE) is controversial. ⋯ SSPE is diagnosed in almost 3% of pulmonary angiograms and is associated with high mortality, regardless of anticoagulation, due to coexistent disease processes rather than SSPE. Anticoagulation appears dominant but markedly affected by the clinical context of risk factors, alternative indications and illness severity. Thus, the controversy is partly artificial because anticoagulation after SSPE is clinically contextual with SSPE as only one of several factors.
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Internal medicine journal · Aug 2023
Clinical assessment for pulmonary hypertension in interstitial lung disease.
Pulmonary hypertension (PH) is an important complication of interstitial lung disease (ILD), as its development confers a poor prognosis. There are no specific recommendations for methods of assessment for PH in ILD populations. ⋯ Our institutional PH assessment practice in ILD demonstrates a substantial prevalence of probable PH at baseline. As new therapies emerge for the treatment of PH in ILD, well-defined screening practices are important in this population for early identification and optimal management.