Internal medicine journal
-
Internal medicine journal · Mar 2019
Multicenter StudyOutcomes of endovascular thrombectomy with and without bridging thrombolysis for acute large vessel occlusion ischaemic stroke.
Endovascular thrombectomy (EVT) for management of large vessel occlusion (LVO) acute ischaemic stroke is now current best practice. ⋯ Our study supports the current practice of administering i.v. alteplase before endovascular therapy.
-
The solitary pulmonary nodule represents a common diagnostic challenge for clinicians. While most are benign, a significant number represent early, potentially curable lung cancers. ⋯ This article provides an up to date review of the imaging features of both benign and malignant solitary pulmonary nodules to assist in the identification of nodules that require histological confirmation or ongoing surveillance. In addition, we summarise the newly updated Fleischner Society Guidelines that provide clinicians with a framework for the evaluation and management of solitary pulmonary nodules.
-
Severe aortic stenosis (AS) is the most common form of valvular heart disease in the developed world, with a rising prevalence due to an ageing Australian population. Transcatheter aortic valve implantation (TAVI) offers a less invasive option for the treatment of severe AS, with evidence supporting TAVI compared with medical therapy in inoperable patients and superior with surgical aortic valve replacement (SAVR) in high-risk patients. Equal outcomes have been observed in all-comer intermediate-risk populations. ⋯ In 2018, TAVI is a well-established procedure in Australia that has revolutionised the management of severe AS. In the future, with an expanding elderly population, the number of patients to benefit from transcatheter therapies for severe AS is hypothesised to increase 4-10-fold. Heart Team assessment is crucial in patients with severe AS to direct appropriate management.
-
Internal medicine journal · Mar 2019
Multicenter StudyBurden of skin disease in two remote primary healthcare centres in northern and central Australia.
The burden of skin infections across all age groups in remote Australian Indigenous communities is currently unknown. In a retrospective audit of 439 residents from two remote communities presenting to health clinics, skin conditions were the most common reason for presentation (1603/7392, 22%) and 330/439 (75%) residents presented at least once with a skin infection. Skin infections are an under-appreciated and dominant reason for presentation to primary healthcare centres in these indigenous communities and public health campaigns to address this should incorporate all age groups.
-
Internal medicine journal · Mar 2019
Tuberculosis in Far North Queensland, Australia: a retrospective clinical audit.
Compared with global numbers, Australia has enjoyed relatively good tuberculosis control over the past 30 years, with an annual incidence of 5.7 per 100 000 population. Thanks to its unique geography and proximity to high-burden countries, such as Papua New Guinea (PNG), Far North Queensland (FNQ) has previously been shown to have higher rates of tuberculosis compared with both the state and national average. ⋯ Tuberculosis remains a significant problem in FNQ. Case numbers have increased threefold since the 1990s. Much of the increase comes from the overseas-born population. Although PNG accounts for the majority, the number of positive notifications among those born abroad has increased fivefold since 2010. Tuberculosis among Aboriginal Australians has decreased following policy changes in response to previous audits. However, tuberculosis in Torres Strait residents has increased from 12 cases (1993-2002) to 40 cases (2006-2016).