Internal Medicine Journal最新文献

英文中文

Infective endocarditis outcomes at a tertiary hospital in Western Australia: a retrospective cohort study from 2016 to 2021. 西澳大利亚一家三级医院感染性心内膜炎的治疗结果：2016 年至 2021 年的回顾性队列研究。

IF 1.8 4区医学 Q2 MEDICINE, GENERAL & INTERNAL

Internal Medicine Journal

Pub Date : 2024-08-28 DOI: 10.1111/imj.16508

Eli Lawson, Angela Jacques, Claire Italiano, James O Robinson

Background: Infective endocarditis (IE) is a severe infection with considerable mortality. It is associated with geographical variation, complicating diagnosis and treatment of patients in a standardised manner.

Aim: To evaluate the characteristics and management outcomes of patients with IE in Royal Perth Hospital (RPH).

Methods: A single-centre, retrospective cohort study. Data were collected from medical records of 131 patients with a diagnosis of IE admitted to RPH between 2016 and 2021.

Results: Eighty-four patients with definite IE were included for analysis. The median age of patients was 51.5 years and 77.4% were male. Compared to the general Australian population, there was disproportionately greater representation of Indigenous Australians (21.4%), those with a history of injecting drug use (IDU) (27.4%), rheumatic heart disease (14.3%) and previous IE (13.1%). The most commonly affected valve was the mitral valve in 46.4% of patients, and the most common pathogen was Staphylococcus aureus in 47.6% of patients. Twelve-month mortality was 16.7%, with significantly increased mortality in those treated non-surgically (25.6% vs 7.3%, P = 0.025). Factors associated with undergoing surgery included the presence of aortic valve disease, perivalvular extension of infection and infection with Enterococcus faecalis, whereas IDU, tricuspid valve disease and S. aureus infection were associated with non-surgical management. Adherence to multidisciplinary team review was 75.0%, and surgical management was performed in 70.7% of patients meeting an indication for surgery.

Conclusion: IE mortality rates remain high, particularly in patients who do not undergo surgical management. Streamlined MDT assessment and referral for surgical management where appropriate is necessary to improve outcomes.

背景：感染性心内膜炎（IE）是一种严重感染，死亡率相当高。目的：评估珀斯皇家医院（RPH）感染性心内膜炎患者的特征和治疗效果：方法：单中心回顾性队列研究。从2016年至2021年期间皇家珀斯医院收治的131名确诊为IE患者的病历中收集数据：84名确诊为IE的患者被纳入分析。患者的中位年龄为51.5岁，77.4%为男性。与澳大利亚总人口相比，澳大利亚原住民（21.4%）、有注射吸毒史者（27.4%）、风湿性心脏病患者（14.3%）和既往IE患者（13.1%）的比例过高。46.4%的患者最常受影响的瓣膜是二尖瓣，47.6%的患者最常感染的病原体是金黄色葡萄球菌。12个月的死亡率为16.7%，非手术治疗患者的死亡率明显增加（25.6% vs 7.3%，P = 0.025）。接受手术治疗的相关因素包括主动脉瓣疾病、瓣周感染扩展和粪肠球菌感染，而 IDU、三尖瓣疾病和金黄色葡萄球菌感染与非手术治疗相关。75.0%的患者接受了多学科团队审查，70.7%符合手术指征的患者接受了手术治疗：结论：IE死亡率仍然很高，尤其是未接受手术治疗的患者。为改善治疗效果，有必要简化多学科团队评估，并在适当情况下转诊进行手术治疗。

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引用次数: 0

Prevalence of pulmonary nodules detected incidentally on noncancer-related imaging: a review 在非癌症相关成像中偶然发现的肺结节的发病率：综述。

IF 1.8 4区医学 Q2 MEDICINE, GENERAL & INTERNAL

Internal Medicine Journal

Pub Date : 2024-08-28 DOI: 10.1111/imj.16502

Ankush Das, Asha Bonney, Renee Manser

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. We conducted a systematic search of literature and screened texts for eligibility. Clinically significant nodules were noncalcified nodules >4–6 mm. Prevalence estimates were calculated for all studies and risk of bias was assessed by one reviewer. Twenty-four studies were included, with a total of 30 887 participants, and 21 studies were cross-sectional in design. Twenty-two studies used computed tomography (CT) imaging with cardiac-related CT being the most frequent. Prevalence of significant nodules was highest in studies with large field of view of the chest and low size thresholds for reporting nodules. The prevalence of part-solid and ground-glass nodules was only described in two cardiac-related CT studies. 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.

肺结节是常见的偶然发现，需要进行监测。随访建议因风险因素、大小、实性或亚实性特征而异。本综述旨在评估在非癌症专用成像中发现的具有临床意义的结节的患病率，以及部分实性结节和磨玻璃结节的患病率。我们对文献进行了系统性检索，并筛选了符合条件的文本。有临床意义的结节是指大于 4-6 毫米的非钙化结节。我们计算了所有研究的患病率估计值，并由一名审稿人对偏倚风险进行了评估。共纳入了 24 项研究，共有 30 887 人参与，其中 21 项研究为横断面设计。22项研究使用了计算机断层扫描（CT）成像，其中与心脏相关的CT最为常见。胸部视野大、报告结节大小阈值低的研究中，明显结节的发生率最高。只有两项与心脏相关的 CT 研究描述了部分实性结节和磨玻璃结节的发生率。7 项研究的总体偏倚风险较低，17 项研究的偏倚风险中等。虽然目前的文献经常报告心血管相关 CT 上的偶发结节，但关于亚实性特征的报告却很少。吸烟史量化不明确和成像方案的异质性也限制了对非筛查队列中结节患病率的可靠评估。

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引用次数: 0

Examining capillary ketone testing in hospitalised patients: indications and outcomes 研究住院病人的毛细血管酮检测：适应症和结果。

IF 1.8 4区医学 Q2 MEDICINE, GENERAL & INTERNAL

Internal Medicine Journal

Pub Date : 2024-08-28 DOI: 10.1111/imj.16490

Thomas Kent, Julie Loughran, Bella Halim, Spiros Fourlanos, Lachlan Hayes, Mervyn Kyi

Elevated blood ketone levels (ketosis) in inpatients with diabetes can herald diabetic ketoacidosis (DKA). However, ketosis can also occur in individuals without diabetes in certain settings. It is unclear what proportion of inpatients with ketosis are in DKA and which patients are at the highest risk of DKA. This study determined that many ketone tests are performed in individuals at low risk of DKA, and a β-hydroxybutyrate <1.0 mmol/L had a low incidence of DKA and less need for escalation in their management.

糖尿病患者血酮水平升高（酮病）可能预示着糖尿病酮症酸中毒（DKA）。不过，在某些情况下，非糖尿病患者也会出现酮症。目前还不清楚出现酮症酸中毒的住院患者中有多大比例处于 DKA 状态，也不清楚哪些患者患 DKA 的风险最高。本研究确定，许多酮体检测都是针对 DKA 低风险患者进行的，而 β-羟丁酸

引用次数: 0

The natural history of Gaucher disease type 1 in 31 patients over a median of 15 years: a retrospective study 一项回顾性研究：31 名戈谢病 1 型患者中位 15 年的自然病史。

IF 1.8 4区医学 Q2 MEDICINE, GENERAL & INTERNAL

Internal Medicine Journal

Pub Date : 2024-08-27 DOI: 10.1111/imj.16503

Siavash Piran, Graeme A. M. Nimmo, Amélie Chaboureau, Rakesh Mohankumar, Lorraine V. Kalia, Dominick Amato

Background and Aims

The natural history of untreated patients with type 1 Gaucher disease (GD1) is not well documented, and there is controversy over when and how to treat such patients, especially if they are only mildly symptomatic. Treatment of GD1 is inconvenient, very costly, and may result in undesirable side effects. We documented the clinical history of 31 untreated patients with GD1 followed in our clinic for 4–26 (median 15) years.

Methods

This was a retrospective, observational study of the progress of untreated adult patients with GD1 followed by blood tests (haemoglobin, platelet counts, ferritin and chitotriosidase), organ volumes (spleen and liver), bone manifestations (through magnetic resonance imaging and dual X-ray absorptiometry scans) and neurological and quality of life issues. Statistical analyses were performed with the use of the Student paired t test and the modified Wald test for 95% confidence intervals.

Results

We found that the above parameters remained stable in most patients over a period of 4–26 (median 15) years. Five patients progressed from normal bone density to osteopenia and two from osteopenia to osteofibrosis; six were peri- or post-menopausal females. The DS-3 was stable over time. Only four of the 31 patients were started on enzyme or substrate reduction therapy.

Conclusions

Our results demonstrate that many patients with GD1, provided with close follow-up by a specialist centre, can be followed for many years without requiring treatment and with no or minimal worsening of their GD1 manifestations.

背景和目的：未经治疗的 1 型戈谢病（GD1）患者的自然病史没有得到很好的记录，对于何时以及如何治疗此类患者，尤其是仅有轻微症状的患者，存在争议。治疗 GD1 既不方便，费用又高，还可能产生不良副作用。我们记录了 31 名未经治疗的 GD1 患者的临床病史，这些患者在我们的诊所接受了 4-26 年（中位数为 15 年）的随访：这是一项回顾性观察研究，对未经治疗的成年 GD1 患者的病情进展进行了跟踪调查，包括血液检测（血红蛋白、血小板计数、铁蛋白和壳三糖苷酶）、器官体积（脾脏和肝脏）、骨骼表现（通过磁共振成像和双 X 射线吸收扫描）以及神经系统和生活质量问题。统计分析采用学生配对 t 检验和 95% 置信区间的改良 Wald 检验：我们发现，在 4-26 年（中位数为 15 年）的时间里，大多数患者的上述参数保持稳定。五名患者从骨密度正常发展为骨质疏松，两名患者从骨质疏松发展为骨纤维化；六名患者为绝经前后的女性。随着时间的推移，DS-3 保持稳定。31 名患者中只有 4 人开始接受酶或底物减少疗法：我们的研究结果表明，许多 GD1 患者在专科中心的密切随访下，可以随访多年而无需治疗，其 GD1 表现也不会恶化或恶化程度极小。

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引用次数: 0

Initiating or switching to insulin degludec/insulin aspart in a real-world population of adults with type 2 diabetes in Australia: results from a prospective, non-interventional study 澳大利亚 2 型糖尿病成年患者开始或转用德鲁达胰岛素/阿斯巴特胰岛素的实际情况：一项前瞻性非干预研究的结果。

IF 1.8 4区医学 Q2 MEDICINE, GENERAL & INTERNAL

Internal Medicine Journal

Pub Date : 2024-08-22 DOI: 10.1111/imj.16492

Gregory R. Fulcher, Neale D. Cohen, Katherine Davies, Michael d'Emden, Sarah J. Glastras, Peak M. Mah, Roland W. McCallum, Robert Moses, Ken Y. Thong, Anthony Roberts

Background

Insulin degludec/insulin aspart (IDegAsp) is a fixed-ratio co-formulation of insulin degludec and insulin aspart for the treatment of people with diabetes and suboptimal glycaemic control. Few real-world studies of IDegAsp treatment have been conducted. Here, we report results from the Australian cohort of the global ARISE study of real-world IDegAsp use.

Aims

To investigate glycaemic control and other clinical outcomes in people with type 2 diabetes (T2D) treated with IDegAsp in a real-world setting in Australia.

Methods

A total of 183 adults with T2D initiating or switching to IDegAsp in the Australian cohort of the open-label, non-interventional ARISE study were followed for 26–36 weeks from August 2019 to December 2020.

Results

IDegAsp was associated with significant reductions from baseline to end of study (EOS) in mean glycated haemoglobin (estimated change −0.8% (95% confidence interval (CI): −1.05 to −0.56; P < 0.0001)), fasting plasma glucose (−1.6 mmol/L (95% CI: −2.49 to −0.63; P = 0.0017)) and body weight (−2.6 kg (95% CI: −3.68 to −1.55; P < 0.0001)). In insulin-experienced patients, the mean total daily insulin dose did not change significantly (estimated change from baseline to EOS 3.8 (95% CI: –3.70 to 11.21; P = 0.3202)). The proportion of patients experiencing hypoglycaemia numerically decreased during the study (non-severe: 14.2–10.9%; nocturnal non-severe: 4.9–2.2%; and severe: 2.2–0%).

Conclusions

Initiating or switching to IDegAsp in a real-world population of people with T2D in Australia was associated with significant improvements in glycaemic control and body weight, and numerically lower levels of hypoglycaemia compared with baseline.

背景：德谷胰岛素/天冬胰岛素（IDegAsp）是一种固定比例的德谷胰岛素和天冬胰岛素联合制剂，用于治疗血糖控制不理想的糖尿病患者。关于 IDegAsp 治疗的实际研究很少。在此，我们报告了全球 IDegAsp 真实世界使用情况 ARISE 研究中澳大利亚队列的研究结果：在2019年8月至2020年12月期间，对开放标签、非干预性ARISE研究澳大利亚队列中开始或转用IDegAsp的183名成年T2D患者进行了为期26-36周的随访：结果：IDegAsp与平均糖化血红蛋白从基线到研究结束（EOS）的显著降低有关（估计变化-0.8%（95% 置信区间（CI）：-1.05 至-0.56；P 结论：IDegAsp与平均糖化血红蛋白从基线到研究结束（EOS）的显著降低有关：在澳大利亚患有 T2D 的真实人群中开始或转用 IDegAsp 与血糖控制和体重的显著改善有关，与基线相比，低血糖的发生率在数量上有所降低。

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引用次数: 0

Characteristics of arthritis in patients with familial Mediterranean fever 家族性地中海热患者关节炎的特征。

IF 1.8 4区医学 Q2 MEDICINE, GENERAL & INTERNAL

Internal Medicine Journal

Pub Date : 2024-08-21 DOI: 10.1111/imj.16495

Selcan Yenigun, Ali Yagiz Ayla, Mebrure B. Yuzbasioglu, Sura N. Baspinar, Sercan Ergun, Ali Karabicek, Cagri Belli, Fatma Demirkol, Huri Ozdogan, Serdal Ugurlu

Background

Many of the familial Mediterranean fever (FMF) patients present with arthritis during attacks, which may vary in its characteristics.

Aims

In this study, we aimed to describe and characterise arthritis in FMF patients.

Methods

We used our hospital's record system to retrospectively identify FMF patients with arthritis who presented to our clinic between 2005 and 2020. The prevalence, laboratory results of attack, remission periods, genetic mutations, demographic data, characteristics of attacks, characteristics of arthritis, comorbidities, treatments and treatment responses were recorded.

Results

Nine hundred fifty-four patients from a cohort of 2350 FMF patients had arthritis (40%). The male/female ratio was 0.49 in patients with arthritis. The frequency of at least one exon 10 mutation was high. The age of onset of symptoms was earlier for patients with arthritis. Monoarticular pattern was more frequent compared to oligo- and polyarticular patterns. Colchicine resistance was higher; the required colchicine dose for disease control and the frequency of use of biological agents were higher compared to general FMF population.

Conclusion

Since M694V mutation is common and the colchicine dose required for disease control is high, we can conclude that the disease activity is high in FMF patients with arthritis. The frequency of sacroiliitis and spondyloarthropathy is significantly increased, especially in individuals with M694V mutation, suggesting that there may be a common pathway in their pathogenesis. FMF should be included in the differential diagnosis in patients presenting with arthritis in FMF endemic regions.

背景：目的：本研究旨在描述家族性地中海热（FMF）患者关节炎的特征：我们利用医院的记录系统回顾性地识别了 2005 年至 2020 年期间在我院就诊的患有关节炎的 FMF 患者。记录了发病率、发作的实验室结果、缓解期、基因突变、人口统计学数据、发作特点、关节炎特点、合并症、治疗方法和治疗反应：在2350名FMF患者中，有954名患者患有关节炎（占40%）。关节炎患者的男女比例为 0.49。至少一个外显子10突变的频率很高。关节炎患者的发病年龄较早。单关节型比少关节型和多关节型更常见。秋水仙碱耐药性较高；与普通 FMF 患者相比，控制疾病所需的秋水仙碱剂量和使用生物制剂的频率较高：结论：由于M694V突变很常见，且控制疾病所需的秋水仙碱剂量较高，因此我们可以得出结论，患有关节炎的FMF患者的疾病活动度较高。骶髂关节炎和脊柱关节病的发病率明显增加，尤其是在 M694V 突变的个体中，这表明它们的发病机制可能存在共同的途径。FMF流行地区的关节炎患者应将FMF纳入鉴别诊断。

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