Narrative reviews

Australian clinicians need to be able to recognise, diagnose, manage and appropriately refer patients affected by COVID-19

Irani Thevarajan · Kirsty L Buising · Benjamin C Cowie

Since COVID-19 emerged in December 2019, over 1100 clinical studies have been registered globally, including over 500 RCTs

Joshua S Davis · David Ferreira · Justin T Denholm · Steven YC Tong

Psoriasis is a chronic inflammatory disease that is commonly encountered in primary care and is associated with significant morbidity that extends beyond the skin manifestations. Psoriasis is associated with an elevated risk of psoriatic arthritis, cardiovascular disease, obesity, insulin resistance, mental health disorders, certain types of malignancy, inflammatory bowel disease and other immune‐related disorders, and hepatic and renal disease. Enhanced recognition of these comorbidities may lead to earlier diagnosis and potentially better overall health outcomes. Psoriatic nail involvement, severe skin disease and obesity are associated with a greater risk of psoriatic arthritis. Individuals with psoriasis should be routinely screened for psoriatic arthritis to allow for early intervention to improve long term prognosis. Life expectancy is reduced in people with psoriasis due to a variety of causes, with cardiovascular disease and malignancy being the most common aetiologies. Psoriasis affects several factors that contribute to worsened quality of life and increased risk of depression and anxiety. Effective therapies are now available that have been shown to concurrently improve skin disease, quality of life and psychiatric symptoms. As the concordance between psychosocial impact and objective disease severity does not always correlate, it is essential to tailor management strategies specifically to the needs of each individual. Cigarette smoking and excess alcohol consumption are among the most important modifiable risk factors that increase the likelihood of psoriasis development and severity of skin disease. This provides a compelling rationale for smoking cessation and limiting alcohol intake in people with psoriasis beyond their traditional harmful health consequences.

Tom Kovitwanichkanont · Alvin H Chong · Peter Foley

Chronic fatigue syndrome (CFS) is a prevalent condition affecting about one in 100 patients attending primary care. There is no diagnostic test, validated biomarker, clear pathophysiology or curative treatment. The core symptom of fatigue affects both physical and cognitive activities, and features a prolonged post‐activity exacerbation triggered by tasks previously achieved without difficulty. Although several different diagnostic criteria are proposed, for clinical purposes only three elements are required: recognition of the typical fatigue; history and physical examination to exclude other medical or psychiatric conditions which may explain the symptoms; and a restricted set of laboratory investigations. Studies of the underlying pathophysiology clearly implicate a range of different acute infections as a trigger for onset in a significant minority of cases, but no other medical or psychological factor has been reproducibly implicated. There have been numerous small case–control studies seeking to identify the biological basis of the condition. These studies have largely resolved what the condition is not: ongoing infection, immunological disorder, endocrine disorder, primary sleep disorder, or simply attributable to a psychiatric condition. A growing body of evidence suggests CFS arises from functional (non‐structural) changes in the brain, but of uncertain character and location. Further functional neuroimaging studies are needed. There is clear evidence for a genetic contribution to CFS from family and twin studies, suggesting that a large scale genome‐wide association study is warranted. Despite the many unknowns in relation to CFS, there is significant room for improvement in provision of the diagnosis and supportive care. This may be facilitated via clinician education.

Carolina X Sandler · Andrew R Lloyd

Sexual dysfunction is a frequent, potentially distressing, adverse effect of antidepressants and a leading cause of medication non‐adherence. Sexual function should be actively assessed at baseline, at regular intervals during treatment, and after treatment cessation. Trials comparing the risk of sexual dysfunction with individual antidepressants are inadequate, but it is reasonable to conclude that the risk is greatest with selective serotonin reuptake inhibitors (SSRIs) and serotonin and noradrenaline reuptake inhibitors (SNRIs), less with tricyclic antidepressants (except clomipramine) and mirtazapine, and least with moclobemide, agomelatine, reboxetine and bupropion. Management of antidepressant‐induced sexual dysfunction requires an individualised approach (eg, considering other causes, dose reduction, addition of medication to treat the adverse effect, switching to a different antidepressant). Post‐SSRI sexual dysfunction has been recently identified as a potential, although rare, adverse effect of SSRIs and SNRIs. Consider the possibility of post‐SSRI sexual dysfunction in patients in whom sexual dysfunction was absent before starting antidepressants but develops during or soon after antidepressant treatment and still persists after remission from depression and discontinuation of the drug.

Jody Rothmore

The treatment options for type 2 diabetes have expanded significantly in the past decade, with new classes of agents demonstrating superiority for cardiovascular outcomes

Renata Libianto · Timothy ME Davis · Elif I Ekinci

Evidence for implementing the first funded meningococcal B vaccine program in infants, children and adolescents

Helen S Marshall · Noel Lally · Louise Flood · Paddy Phillips

Compared with age-matched men, women tend to have poorer health status but longer life expectancy

Emily H Gordon · Ruth E Hubbard

Migraine affects over a billion people worldwide in any year and is the second most common cause of years lost due to disability

Michael Eller · Peter J Goadsby

Infants with GORD should first be distinguished from those with physiological GOR and then be managed in a step-wise fashion, using non-pharmacological measures where possible and pharmacological measures where necessary

Robert N Lopez · Daniel A Lemberg

The evidence suggests that calcium and vitamin D supplements should not be provided routinely to healthy older individuals

Ian R Reid · Mark J Bolland

Despite the immense economic burden of the growing number of people with chronic and end-stage kidney disease, it is still not recognised as one of the five national priority areas in Australia

Wai H Lim · David W Johnson · Stephen P McDonald · Carmel Hawley · Philip A Clayton · Matthew D Jose · Germaine Wong

Addressing the social determinants of health is ultimately needed for skin infections in Aboriginal and Torres Strait Islander children to have disease rates similar to their non-Aboriginal peers

Lucy Davidson · Jessica Knight · Asha C Bowen

Activity against antibiotic-resistant pathogens and a lack of serious side effects make phage therapy an attractive treatment option to combat refractory bacterial infections

Aleksandra Petrovic Fabijan · Ali Khalid · Susan Maddocks · Josephine Ho · Timothy Gilbey · Indy Sandaradura · Ruby CY Lin · Nouri Ben Zakour · Carola Venturini · Bethany Bowring · Jonathan R Iredell

The lung will tolerate the challenges of low gravity and decompression stress during lunar exploration, but dust may be the major challenge

G Kim Prisk

The increasing age and obesity rates of the Australian population are contributing to the higher prevalence of patients with obstructive sleep apnoea presenting for surgery

Nicolette R Holt · Glenn Downey · Matthew T Naughton

Antithrombotic treatment is gold standard and effective

Veronica Mezhov · Julian D Segan · Huyen Tran · Flavia M Cicuttini

Routine and risk-based antenatal screening identifies some vertically transmissible infections that can be prevented or treated in pregnancy

Caitlin L Keighley · Hannah JM Skrzypek · Angela Wilson · Michael A Bonning · Gwendolyn L Gilbert

Diverticular disease is a common gastrointestinal disorder with significant health burden; recent evidence is changing practice

Hayley You · Amy Sweeny · Michelle L Cooper · Michael Von Papen · James Innes

Pulmonary embolism is a potentially life-threatening condition, mandating urgent diagnosis and treatment

Paul C Kruger · John W Eikelboom · James D Douketis · Graeme J Hankey

Lactic acidosis associated with metformin use is a complex issue and the causal relationship remains open to debate

Cara Tanner · Gayathiri Wang · Nancy Liu · Sofianos Andrikopoulos · Jeffrey D Zajac · Elif I Ekinci

New therapies show promise, but effective treatment of non-motor, non-dopaminergic symptoms remains a major challenge

Michael W Hayes · Victor SC Fung · Thomas E Kimber · John D O'Sullivan

The diagnosis of DVT requires a high index of suspicion because symptoms and signs are often non-specific

Paul C Kruger · John W Eikelboom · James D Douketis · Graeme J Hankey

Treatment of erectile dysfunction with pharmacotherapy alone or in combination with graded psychosexual therapy is effective in improving and/or restoring sexual function in most men

Christopher G McMahon

With the advent of better biomarkers and disease-modifying therapeutics in the near future, the era of precision health is coming of age in COPD

Ma'en Obeidat · Mohsen Sadatsafavi · Don D Sin