Internal medicine journal
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Internal medicine journal · Oct 2024
Predictive value of urine microscopy and urine culture in bacteraemic adults without localising urinary features.
Urine microscopy (UM) and urine culture (UC) are used in bacteraemic patients to identify a urinary focus of infection. However, their positive and negative predictive values (PPV and NPV) in patients without localising urinary features are uncertain. ⋯ bUTI without localising urinary features is common. In bacteraemia of unclear focus, UM/UC has a high NPV for excluding bUTI, although PPV is limited and non-urinary foci require consideration despite a positive result. UM/UC is low yield in those with a suspected non-urinary focus of infection.
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Granulomatous amoebic encephalitis is a rare but likely under-recognised form of subacute, usually fatal, encephalitis. We present an illustrative case report and literature review of Australian cases, summarising clinical features, diagnostic methods, treatment and outcomes.
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Internal medicine journal · Oct 2024
Phenotype of patients with late diagnosis of 22q11 deletion: a review and retrospective study.
Chromosome 22q11.2 deletion syndrome (22q11DS) is the most common microdeletion syndrome, typically presenting in neonates with congenital cardiac anomalies, hypocalcaemia and thymic hypoplasia. Some patients are diagnosed later in adolescence and adulthood, with less known about the clinical phenotype of these patients. ⋯ Chromosome 22q11DS has diverse clinical features and a highly variable phenotype, likely contributing to underdiagnosis and later diagnoses.
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Internal medicine journal · Oct 2024
Epidemiology and outcome of medical emergency team calls within 48 hours of intensive care unit discharge.
Some patients experience early (within 48 h) clinical deterioration and medical emergency team (MET) review following intensive care unit (ICU) discharge. Few studies have explored early MET review, despite it being a recognised quality and safety indicator. ⋯ One in 12 patients received post-ICU early MET review. This was more likely in patients who were invasively ventilated, had higher illness severity and had certain admission diagnoses. Such patients were at risk for worse outcomes. There is a need to identify reversible factors contributing to such increased risk.
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Internal medicine journal · Oct 2024
Treatment outcomes of mild to moderate Clostridioides difficile infection in inflammatory bowel disease: an Australian experience.
The incidence of Clostridioides difficile infection (CDI) in inflammatory bowel disease (IBD) is rising and associated with adverse outcomes. Optimal treatment for CDI in IBD remains unknown, with various organisations suggesting vancomycin as first-line therapy. ⋯ Metronidazole compared to vancomycin for treatment of mild to moderate CDI in IBD is effective however may be associated with higher rates of treatment failure.