Internal Medicine Journal最新文献

Multiparametric flow cytometry (MFC) enables rapid and sensitive quantification of measurable residual disease (MRD) in patients with acute myeloid leukaemia (AML), providing valuable prognostic information and guiding post-remission therapeutic strategies. Given the clinical utility of MFC AML MRD assessment and its inherent technical and analytical complexity, inter-laboratory standardisation is essential to ensure consistency of practice, diagnostic accuracy and reproducibility of results. However, limited options for external quality assessment exist. Representatives from all diagnostic laboratories in Australia and New Zealand currently performing AML MRD testing were invited to attend an in-person workshop to review site-specific practices and develop harmonisation processes. All six participating laboratories demonstrated a high level of concordance with respect to pre-analytical testing; however, greater variation was observed in post-analytical reporting, and a number of consensus recommendations were formulated for harmonisation. Ongoing meetings have also been established to promote continued sharing of expertise between AML MRD laboratories, align analytical strategies and enhance assay validation in accordance with regulatory requirements. These collaborative efforts provide guidance to existing MRD laboratories and those seeking to establish a new MRD service, facilitating sustainable provision of a high-quality regional MFC AML MRD testing network to meet current and anticipated increases in clinical demand.

Schnitzler syndrome is a rare autoinflammatory syndrome caused by a dysregulation of the interleukin-1β signalling pathway. Symptoms tend to appear in middle age and include urticariform skin lesions, fever, bone pain, lymphadenopathy and IgM monoclonal gammopathy. Interleukin-1 (IL-1) targeted therapy constitutes the basis for treatment and can lead to complete resolution of symptoms. We report a case of Schnitzler syndrome in a 49-year-old man refractory to anakinra and subsequently treated successfully with canakinumab.

Background: Guideline-directed medical therapy (GDMT) has significantly improved outcomes of patients with heart failure with reduced ejection fraction (HFrEF). However, the presence of hypotension often limits GDMT up-titration. Midodrine is a peripheral vasoconstrictor that may improve blood pressure in select patients with HFrEF and enable the optimisation of medical therapy.

Aims: This systematic review aimed to evaluate the safety and efficacy of midodrine in the treatment of HFrEF.

Method: A systematic review was registered (CRD42024594291) and conducted in accordance with PRISMA guidelines. A search was completed on 29 September 2024 among PubMed, Medline, EMBASE, Cochrane and SCOPUS databases. Primary outcome measures included tolerance of GDMT, left ventricular ejection fraction (LVEF) recovery, heart failure hospitalisations and all-cause mortality.

Results: Five studies were included (12 063 HFrEF patients). A meta-analysis was precluded due to heterogeneity in study design, population and reported outcomes. Two studies suggested that midodrine was associated with an increase in the prevalence of patients prescribed GDMT and improvements in LVEF. Two studies concluded that midodrine use was associated with increased hospitalisations, intensive care visits and mortality. One study suggested midodrine use was safe in patients with cancer and heart failure.

Conclusion: There is a lack of high-quality evidence to support the use of midodrine to facilitate GDMT up-titration in HFrEF. Supporting evidence of improving GDMT tolerance and LVEF stems from observational studies without comparator groups. Randomised trials are urgently needed to determine whether midodrine safely facilitates GDMT in HFrEF patients.

Prolonged waiting times for respiratory and sleep care can cause mortality and morbidity. Our audit of the Northern Adelaide Local Health Network (NALHN) Respiratory Unit showed delays in outpatient assessment and failure to meet guideline-based recommendations, with potentially associated harm including emergency department presentations and mortality. Improvements are needed to reduce waiting times, especially for conditions with poorer prognoses and to address health inequity in lower socioeconomic populations.

Background: Voluntary assisted dying (VAD) is an evolving area of end-of-life care in Australia. Internationally, over 300 individuals have donated organs after accessing VAD.

Aims: To explore Australian VAD clinicians' attitudes, knowledge and experiences regarding organ and tissue donation and to identify barriers and enablers to integrating donation into VAD practice.

Methods: We conducted a cross-sectional, mixed-methods online survey from September 2024 to April 2025 across Victoria, New South Wales, Queensland and South Australia. Participants included 244 health professionals involved in VAD care -- coordinating and consulting practitioners, nurses, and support staff -- recruited via state-based VAD navigation services, professional networks and registries.

Results: Respondents represented ~23% of the VAD workforce in the participating states. Most supported organ (98%) and tissue (98%) donation, with 91% personally willing to donate. Only 39% had received prior donation training, and 37% were aware of existing donation-after-VAD guidelines. While 90% agreed donation should be discussed when clinically appropriate, only 63% supported routinely raising the topic in VAD contexts. Key barriers included limited training, time constraints, ethical concerns (e.g. coercion, conflicts of interest) and assumptions about donation feasibility. Most respondents (84%) expressed interest in further education, particularly on eligibility criteria and navigating donation conversations.

Conclusions: Australian VAD clinicians strongly support organ and tissue donation but face significant knowledge, logistical and ethical challenges. Targeted education, clear clinical guidance, structural supports and the development of national guidelines bridging both VAD and organ donation sectors are essential to ensure safe, ethical and patient-centred donation practices.

Human albumin (HA) infusion has demonstrated benefits for patients with uncomplicated ascites, but implementation of this evidence is limited by critical logistical and budget issues relating to long-term HA infusion. In this pilot feasibility study of 14 hospital patients with uncomplicated ascites, participants were administered weekly HA by home-based nursing staff. Results suggest that home-based HA infusions are safe and feasible, effective and associated with high levels of patient satisfaction and lower relative cost.

Background: Contrast-induced encephalopathy (CIE) is an acute neurotoxic syndrome that can complicate iodinated contrast use, particularly in neurointerventional settings and among patients with renal vulnerability. Precise, indication-specific burden estimates are needed to inform counselling and contrast stewardship and post-procedure surveillance.

Aims: This review was done to determine the burden of CIE amongst patients with renal or neurological disorders.

Methods: Following Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) 2020, we searched major databases and grey sources through 24 October 2025 for observational and interventional studies reporting CIE with a definable denominator. Two reviewers independently screened, extracted data and assessed risk of bias. The primary outcome was the incidence of CIE per procedure or per patient. We synthesised proportions using random-effects meta-analysis, examined heterogeneity (τ², I²), explored clinical subgroups (acute ischemic stroke, aneurysm) and assessed small-study effects with a Doi plot and Luis Furuya-Kanamori (LFK)Preferred Reporting Items for Systematic reviews and Meta-Analyses index.

Results: Eight neurological cohorts yielded a pooled CIE incidence of ~2% (95% CI: 1-4), with wide dispersion across settings; heterogeneity was high (I² ≈ 91%). In prespecified subgroups, pooled incidence was ~3% (95% CI: 2-4) among acute ischaemic stroke patients undergoing endovascular therapy and ~2% (95% CI: 1-4) among intracranial/extracranial aneurysm cohorts. In patients with renal disorders (end-stage renal disease/haemodialysis), three studies showed a pooled incidence of ~1% (95% CI: 0-5) with moderate heterogeneity. The Doi plot demonstrated major asymmetry (LFK >2), consistent with small-study effects and underlying clinical heterogeneity.

Conclusion: CIE is uncommon but clinically relevant, with a higher burden in acute neurovascular procedures and a non-negligible risk in advanced renal disease despite stewardship practices. Given substantial heterogeneity and small-study effects, incidence should be contextualised to procedure mix and surveillance intensity.

Giant cell arteritis (GCA) is the most common systemic vasculitis in older adults and is a medical emergency due to the potential for irreversible visual loss and stroke in the acute phase and aortic complications in the longer term. Prompt recognition of the condition and immediate initiation of glucocorticoids remain central to management and advances in therapy, particularly with tocilizumab in the first 12 months, have reduced glucocorticoid-related morbidity. Upadacitinib has recently been shown in phase 3 trials to be effective, and its place in the Australasian therapeutic landscape will evolve in the coming years. Management also focusses on assessing for and reducing disease and treatment-related complications, including relapse, aortic aneurysm, infection, diabetes and osteoporosis. The optimal treatment strategy beyond the initial 12 months of therapy remains undefined and is typically individualised and informed by comorbidities, patient preference, clinician familiarity, cost and regulatory access. This review outlines current best practice for the management of GCA in Australia with a focus on recent therapeutic advances and strategies for longer-term patient care.