Internal Medicine Journal最新文献

Background: Retinal vascular diseases (RVDs), including retinal vascular occlusion (RVO), diabetic retinopathy (DR) and retinal haemorrhage (RH), share pathophysiologic features with cerebral microvasculature and may serve as indicators of subsequent stroke risk.

Aims: This study aimed to evaluate the associations of RVDs with ischemic stroke (IS) and hemorrhagic stroke (HS) in a nationwide cohort.

Methods: Using data from the Korean National Health Insurance Service-National Sample Cohort (2002-2013), patients diagnosed with RVD were matched 1:10 with age- and sex-matched controls. Cox proportional hazards models were applied to estimate adjusted hazard ratios (aHRs) for IS and HS, adjusting for demographic, lifestyle and clinical covariates.

Results: A total of 1365 patients with RVO, 975 with DR and 836 with RH were included. Compared with controls, patients with RVO (aHR: 1.82; 95% CI: 1.45-2.28), DR (aHR: 1.70, 95% CI: 1.32-2.21) and RH (aHR: 1.55, 95% CI: 1.18-2.05) had significantly higher IS risk. RVO was also associated with increased HS risk (aHR: 2.44, 95% CI: 1.39-4.29). Stratified analyses demonstrated stronger relative risks in individuals younger than 60 years. Socioeconomic disadvantage, obesity, smoking and heavy alcohol consumption further modified the risk of stroke.

Conclusions: RVDs, particularly RVO, were significantly associated with elevated risks of both IS and HS. These findings highlight the potential value of retinal assessment in early identification of high-risk individuals and underscore the importance of tailored stroke prevention strategies, particularly in younger and socioeconomically vulnerable populations.

This study presents a retrospective audit of new referrals to three tertiary gender clinics in Victoria, Australia, from 2020 to 2024. It finds a plateau and slight reduction in referrals, in contrast to previous increases over the preceding decade. The reduction may stem from a shift to primary and community-based services. These findings suggest decentralising care could ease strain on tertiary clinics while maintaining access, informing models for the delivery of genderaffirming care in Australia.

Moderate to severe hepatic steatosis was detected on low-dose computed tomography (LDCT) in 15% of participants undergoing lung cancer screening in a retrospective observational study. Almost half of participants with hepatic steatosis (21/45) were at intermediate risk of liver fibrosis, with four participants (8.9%) at high risk based on Fibrosis-4 scores. Based on current guidelines, these participants would be recommended to undergo further evaluation for liver disease. The clinical impact of moderate to severe hepatic steatosis incidentally detected on lung cancer screening LDCT requires further consideration and evaluation.

To examine the relationship between alcohol intake and the risk of developing dementia, we conducted a comprehensive search of PubMed, Embase, Cochrane Library and Web of Science databases for relevant studies up to July 22, 2024. The quality of the original studies was appraised utilising the Newcastle-Ottawa Scale (NOS). The link between alcohol intake and the risk of dementia was presented using relative risks (RRs) and their corresponding 95% confidence intervals (CIs). Subgroup analyses were implemented based on the level of alcohol consumption, geographic region and age. All statistical analyses were executed utilising Stata 15.0. The meta-analysis unveiled no significant link between alcohol exposure and the risk of developing dementia, including all-cause dementia (ACD) (RR = 1.03, 95% CI: 0.84-1.27), Alzheimer disease (AD) (RR = 0.97, 95% CI: 0.86-1.08), vascular dementia (VD) (RR = 1.09, 95% CI: 0.95-1.26) and other dementia (RR = 0.62, 95% CI: 0.33-1.15). In the subgroup analysis by drinking levels, light to moderate alcohol intake was linked to a decreased risk of ACD and AD (RR = 0.88, 95% CI: 0.81-0.96; RR = 0.88, 95% CI: 0.79-0.97, respectively). Nonetheless, heavy alcohol consumption significantly increased the risk of developing all types of dementia (ACD, RR = 1.18, 95% CI: 1.02-1.36; AD, RR = 1.29, 95% CI: 1.21-1.36; VD, RR = 1.25, 95% CI: 1.11-1.40). Further subgroup analyses indicated that light to moderate drinking's protective effect was stronger in Europe and among individuals aged 60 to 69 years. Light to moderate drinking may protect against dementia, while heavy drinking or alcohol use disorders raises dementia risk.

Cognitive dissonance is a term coined by Festinger in the 1950s that describes an uncomfortable tension experienced whenever one simultaneously holds contradicting beliefs or finds that one's behaviour is inconsistent with inner beliefs. This phenomenon is unfortunately commonplace in medical training and practice, where many lived experiences in its 'hidden curriculum' reflect observations, attitudes and practices that run contrary to what is formally taught or one's personal values/beliefs. As medical professionals training and practising in modern healthcare settings, we herein share our perspectives on the key areas in which cognitive dissonance occurs in real-world clinical environments, and offer practical strategies at both individual and systemic levels to mitigate this issue.

This update of the Australasian consensus guidelines for the initial empiric management of neutropenic fever occurs in the context of major changes in cancer treatment paradigms, as well as advances in the management of sepsis and new models of care for infections since the last version of these guidelines in 2011. Acknowledging the important role of antimicrobials in the disruption of the gut microbiome and emerging antimicrobial resistance, as well as the changing epidemiology of antimicrobial resistance more broadly, these guidelines address current evidence for optimal empiric neutropenic fever therapy. A writing group - including adult and paediatric representatives across infectious diseases, microbiology, haematology, transplant and oncology, as well as across craft groups, including medicine, nursing and pharmacy - was developed to produce and address key management questions. This was overseen by a steering committee, which included consumer representation. Using an extensive review of the literature, these guidelines provide consensus recommendations with evidence grading for initial empiric management of neutropenic fever in adults and children, including recommended investigations, antimicrobial therapy and approach to patients with beta-lactam allergy or risk factors for multidrug-resistant infection. Management beyond the first 72 h is discussed in separate chapters of this issue: the Subsequent Management (for high-risk neutropenic fever) and Ambulatory Management (for low-risk neutropenic fever) chapters.