Internal medicine journal
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Internal medicine journal · Sep 2024
Diagnostic accuracy of ANCA serology in ANCA-associated vasculitis with renal involvement.
Pauci-immune glomerulonephritis (GN) due to antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) is a common cause of crescentic GN. Despite advances in treatment, rates of mortality and progression to end-stage kidney disease remain high. Renal involvement is diagnosed by histological examination of kidney tissue. Serum ANCAs play a significant role in AAV; however, the value of serum ANCA quantification to predict renal involvement is not well-established. ⋯ ANCA titres are highly predictive of pauci-immune GN in the appropriate context. While serum ANCA quantitation may not replace renal biopsy, reporting will assist in the decision to start treatment early for patients with organ or life-threatening disease.
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Internal medicine journal · Sep 2024
ReviewANZTCT practice statement: sinusoidal obstruction syndrome/veno-occlusive disease diagnosis and management.
Sinusoidal obstruction syndrome/veno-occlusive disease (SOS/VOD) is a life-threatening complication which can develop after haemopoietic stem cell transplantation (HSCT) and some antibody-drug conjugates. Several SOS/VOD diagnostic and management guidelines exist, with the most recent and refined being the European Society for Blood and Marrow Transplantation adult and paediatric guidelines. ⋯ In Australia and New Zealand, there is variability in clinical practice and access to SOS/VOD therapies. This review aims to summarise the current evidence for SOS/VOD diagnosis, prevention and treatment and to provide recommendations for SOS/VOD in the context of contemporary Australasian HSCT clinical practice.
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Internal medicine journal · Sep 2024
ReviewPrevalence of pulmonary nodules detected incidentally on noncancer-related imaging: a review.
Pulmonary nodules are common incidental findings requiring surveillance. Follow-up recommendations vary depending on risk factors, size and solid or subsolid characteristics. This review aimed to evaluate the prevalence of clinically significant nodules detected on noncancer-dedicated imaging and the prevalence of part-solid and ground-glass nodules. ⋯ The overall risk of bias was low in seven studies and moderate in 17 studies. While current literature frequently reports incidental nodules on cardiovascular-related CT, there is minimal reporting of subsolid characteristics. Unclear quantification of smoking history and heterogeneity of imaging protocol also limits reliable evaluation of nodule prevalence in nonscreening cohorts.
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Internal medicine journal · Sep 2024
ReviewGender-affirming hormone therapy for transgender and gender-diverse adults in Australia.
Gender-affirming hormone therapy (GAHT) is used by many transgender and gender-diverse adults to align physical characteristics with their gender identity, reduce gender incongruence and improve psychological functioning. This narrative review provides an overview of the initiation and monitoring of GAHT in an Australian context. Trans individuals treated with testosterone typically receive standard testosterone doses and formulations recommended for cisgender men, whereas those receiving estradiol GAHT are typically treated with estradiol in combination with an anti-androgen in those without orchidectomy. Proactive monitoring and mitigation of cardiovascular risk factors is pertinent in all transgender and gender-diverse adults and bone health is an important consideration in those using estradiol GAHT.
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Internal medicine journal · Sep 2024
Predictive accuracy of the ASIG algorithm in a prospective systemic sclerosis cohort undergoing annual screening for pulmonary arterial hypertension.
The Australian Scleroderma Interest Group (ASIG) algorithm for screening pulmonary arterial hypertension (PAH) in systemic sclerosis (SSc) requires only respiratory function tests and serum N-terminal pro-brain natriuretic peptide as first-tier tests, and is recommended in international guidelines. In this communication, we present the findings of the application of the ASIG screening algorithm to a Singaporean cohort undergoing prospective annual screening for PAH, which shows a high negative predictive value. The ASIG algorithm may offer an alternative to more complex and costly SSc-PAH screening algorithms.