Unique T-cell phenotypes and articular involvement in sarcoidosis.
Authors: Tripathi D PMID: 32936091 [PubMed - as supplied by publisher] (Source: Journal of the Royal College of Physicians of Edinburgh)
Source: Journal of the Royal College of Physicians of Edinburgh - September 17, 2020 Category: General Medicine Tags: J R Coll Physicians Edinb Source Type: research

Travelling with heart disease: restricted choice and restrictive cost.
Authors: Wilkinson C, Ripley DP PMID: 32936092 [PubMed - as supplied by publisher] (Source: Journal of the Royal College of Physicians of Edinburgh)
Source: Journal of the Royal College of Physicians of Edinburgh - September 17, 2020 Category: General Medicine Tags: J R Coll Physicians Edinb Source Type: research

Current perspectives on predatory or low-quality journals.
Authors: Misra DP, Ravindran V PMID: 32936093 [PubMed - as supplied by publisher] (Source: Journal of the Royal College of Physicians of Edinburgh)
Source: Journal of the Royal College of Physicians of Edinburgh - September 17, 2020 Category: General Medicine Tags: J R Coll Physicians Edinb Source Type: research

Distinct T-cell immunophenotypic signature in a subset of sarcoidosis patients with arthritis.
The objective of the study was to assess T-cell subsets in sarcoidosis patients with or without articular involvement. METHODS: Treatment-naïve patients were divided into Group A (articular) and Group B (non-articular) based on joint involvement. Flow cytometric analysis of T-cell subsets and pro-in˜flammatory cytokines were carried out in the peripheral blood. RESULTS: Patients in group A (n = 29, mean age 40 ± 10.1 years) were compared with group B (n = 18, 43 ± 12.2 years). T-cell subsets: the CD4/CD8 ratio was abnormal in two groups but had no significant difference (p = 0.63). Ratios o...
Source: Journal of the Royal College of Physicians of Edinburgh - September 17, 2020 Category: General Medicine Tags: J R Coll Physicians Edinb Source Type: research

Factors affecting cost and patient choice of travel insurance in cardiac disease: a web-based case-control study.
Authors: Bennett M, Joshi SS, Denvir M Abstract BACKGROUND: The aim of this study was to explore variations in cost and choice of travel insurance in patients with cardiac disease. METHODS: Clinical data from patients with myocardial infarction (MI, n = 20), Marfan syndrome (MFS, n = 10) and dilated cardiomyopathy (DCM, n = 10) were input to insurance websites for a proposed ten-day holiday and data for premium cost (£) and choice of quotes (n) collated for each condition. Age-matched healthy individuals were used as controls. RESULTS: Median cost of insurance was significantly higher for MI (£2...
Source: Journal of the Royal College of Physicians of Edinburgh - September 17, 2020 Category: General Medicine Tags: J R Coll Physicians Edinb Source Type: research

Diabetes mellitus and prediabetes among patients with tuberculosis in a single north Indian tertiary care centre.
CONCLUSION: This study found high prevalence of prediabetes and diabetes among patients with TB. This underscores the need for a bidirectional screening strategy to improve diagnosis and outcome of both TB and DM. PMID: 32936096 [PubMed - as supplied by publisher] (Source: Journal of the Royal College of Physicians of Edinburgh)
Source: Journal of the Royal College of Physicians of Edinburgh - September 17, 2020 Category: General Medicine Tags: J R Coll Physicians Edinb Source Type: research

Interstitial pneumonia with autoimmune features.
Authors: Santhanam S, Mohanasundaram K, Krishnan S Abstract Interstitial lung disease (ILD) is an umbrella term for lung disease characterised by inflammation and fibrosis of the interstitium. ILD can be idiopathic or secondary to connective tissue disorders, drugs or environmental exposures. Before labelling it as idiopathic we have to rule out secondary causes. ILD is one of the most common extra-articular manifestations of connective tissue diseases (CTDs), causing significant morbidity and mortality. Patients with pre-existing CTD can develop ILD; some patients develop ILD against the background of either one o...
Source: Journal of the Royal College of Physicians of Edinburgh - September 17, 2020 Category: General Medicine Tags: J R Coll Physicians Edinb Source Type: research

Diagnosis and management of fatty liver.
Authors: Tan PO, Mustaffa N, Tan SS, Lee YY Abstract Globally, the prevalence of non-alcoholic fatty liver disease (NAFLD) is increasing rapidly and constitutes a significant healthcare burden due to associated complications including hepatic (cirrhosis and hepatocellular cancer) and non-hepatic (cardiovascular deaths) disorders. It is closely linked to insulin resistance and metabolic syndrome but moderate alcohol consumption frequently coexists. Recently, genetic polymorphisms were implicated in the development of non-obese NAFLD. Apart from liver biopsy, in order to assess for steatosis, fibrosis and non-alcohol...
Source: Journal of the Royal College of Physicians of Edinburgh - September 17, 2020 Category: General Medicine Tags: J R Coll Physicians Edinb Source Type: research

Electronic health records: a critical appraisal of strengths and limitations.
Authors: Kataria S, Ravindran V Abstract Electronic health record (EHR) was hailed as a major step towards making healthcare more transparent and accountable. All the developed nations digitised their health records which were meant to be safe, secure and could be accessed on demand. This was intended to benefit all stakeholders. However, the jury is still out if the EHR has been worth it. There have been incidences of data breaches despite cybersecurity checks and of manipulation compromising clinicians' integrity and patients' safety. EHRs have also been blamed for doctor burnout in overloading them with a largel...
Source: Journal of the Royal College of Physicians of Edinburgh - September 17, 2020 Category: General Medicine Tags: J R Coll Physicians Edinb Source Type: research

Diabetic autonomic neuropathy: a clinical update.
Authors: Sharma JK, Rohatgi A, Sharma D Abstract Diabetic autonomic neuropathy is an under-recognised complication of diabetes and the prediabetic state. A wide range of manifestations can be seen due to involvement of cardiovascular, gastrointestinal, genitourinary, sudomotor and neuroendocrine systems. Cardiac autonomic neuropathy is the most dreaded complication carrying significant mortality and morbidity. Early detection and control of diabetes and other cardiovascular risk factors is the key to treat and prevent progression of autonomic neuropathy. Recently, a new entity of treatment-induced neuropathy (TIND)...
Source: Journal of the Royal College of Physicians of Edinburgh - September 17, 2020 Category: General Medicine Tags: J R Coll Physicians Edinb Source Type: research

COVID-19 at the intersections of science, morality and practice - reflections of the physician's soul.
Authors: Gupta L, Goel A PMID: 32936101 [PubMed - as supplied by publisher] (Source: Journal of the Royal College of Physicians of Edinburgh)
Source: Journal of the Royal College of Physicians of Edinburgh - September 17, 2020 Category: General Medicine Tags: J R Coll Physicians Edinb Source Type: research

Syndrome of inappropriate antidiuretic hormone release as the initial presentation of adenocarcinoma of the colon.
We describe a rare case of a patient with colonic adenocarcinoma presenting initially as SIADH. A 60-year-old man presented with confusion and vomiting. Over the previous month he had fatigue and loss of weight. Baseline investigations showed a low serum sodium level of 108mmol/l. He was euvolaemic on examination and fulfilled the criteria for SIADH. Further evaluation and imaging tests revealed that the patient had adenocarcinoma of the colon. It is remarkable that our patient did not present with any of the cardinal symptoms/signs suggestive of colorectal carcinoma including haematochezia, change in bowel habits or iron-...
Source: Journal of the Royal College of Physicians of Edinburgh - September 17, 2020 Category: General Medicine Tags: J R Coll Physicians Edinb Source Type: research

Progressive ataxia and cognitive decline in a 67-year-old male: a diagnostic challenge.
We report the case of a 67-year-old male who presented with a six-week history of progressive unsteadiness, cognitive impairment and weight loss, in the context of a recent bereavement. Magnetic resonance imaging (MRI) performed several weeks earlier excluded acute stroke. Examination revealed gross bilateral ataxia, bradyphrenia and physical manifestations of depression. Collateral history suggested rapidly progressing symptoms over three months. Repeat MRI head showed features suggestive of Creutzfeldt-Jakob disease (CJD) including T2 hyperintensities in the basal ganglia. Cerebrospinal ˜fluid (CSF) samples were po...
Source: Journal of the Royal College of Physicians of Edinburgh - September 17, 2020 Category: General Medicine Tags: J R Coll Physicians Edinb Source Type: research

A patient with atrioventricular block and ventricular tachycardia: think sarcoid!
We report the case of a 45-year-old Indian woman with an implanted permanent pacemaker for atrioventricular block, who presented with haemodynamically stable ventricular tachycardia and was found to have impaired left ventricular function. Subsequent investigations established the diagnosis of cardiac sarcoidosis. The patient was treated with prednisolone initially at 40 mg a day for 3 months. Left ventricular function improved over 3 months of treatment and there was no further recurrence of ventricular tachycardia. Screening for cardiac sarcoidosis should be considered in a patient with unexplained atrioventricular block...
Source: Journal of the Royal College of Physicians of Edinburgh - September 17, 2020 Category: General Medicine Tags: J R Coll Physicians Edinb Source Type: research

Hypophysitis in granulomatosis with polyangiitis: rare presentation of a multisystem disease.
Authors: Ramakrishna MP, Arun CS, Pavithran PV, Bhagavaldas MC, Kumar H Abstract Granulomatosis with polyangiitis (GPA) is a type of granulomatous vasculitis that can involve any organ in the body. The pituitary gland is one of the uncommon sites to be involved in this condition, with only a few cases reported in the literature. Our patient initially presented with central diabetes insipidus, epistaxis and haematuria. Diagnosis was established by antineutrophil cytoplasmic antibodies (cANCA) positivity against a background of typical clinical features and a bulky pituitary on magnetic resonance imaging (MRI) scan. ...
Source: Journal of the Royal College of Physicians of Edinburgh - September 17, 2020 Category: General Medicine Tags: J R Coll Physicians Edinb Source Type: research

Tenofovir-induced delayed nephro-osteo toxicity.
Authors: Kumar B, Prabhakar R, Thangavelu S Abstract Tenofovir disoproxil fumarate (TDF) is the foundation nucleotide reverse-transcriptase inhibitor in the recommended first-line regimen for all naive human immunodeficciency virus-1 (HIV-1) patients whose age is more than 10 years and body weight is more than 30 kg. Although it has a good safety profile overall, nephrotoxicity is a concern and its overall incidence is 1-6% with a long period of clinical latency. Nephrotoxicity may manifest as either proximal renal tubule dysfunction in the form of a partial or complete Fanconi syndrome or as decreased renal functi...
Source: Journal of the Royal College of Physicians of Edinburgh - September 17, 2020 Category: General Medicine Tags: J R Coll Physicians Edinb Source Type: research

Winslow pathway collaterals: an unusual arterial network in Takayasu arteritis.
We present a case of a young male with Takayasu arteritis with middle aortic syndrome and Winslow pathway collaterals with lower limb ischaemia, hypertension, coronary occlusion and stroke. The extensive collateral formation was visible as a clinical finding over the abdominal wall. The identification of these collateral pathways is essential in understanding the extent of haemodynamically significant disease and it alerts to the possibility of surgical injury during procedures like laparotomy or harvesting of internal thoracic artery for coronary artery bypass graft. PMID: 32936107 [PubMed - as supplied by publisher] ...
Source: Journal of the Royal College of Physicians of Edinburgh - September 17, 2020 Category: General Medicine Tags: J R Coll Physicians Edinb Source Type: research

Staring at an abscess, but lupus stares back ….
We report a case of a 12-year-old male who initially presented with active systemic lupus erythematosus (SLE) with lupus nephritis and secondary macrophage activation syndrome (MAS). He went on to develop left-sided upper motor neuron (UMN) facial palsy secondary to lupus-related tumefactive demyelination. Tumefactive lesions secondary to demyelination are a very rare manifestation in neuropsychiatric SLE. This child responded to aggressive immunosuppression with steroids and cyclophosphamide. PMID: 32936108 [PubMed - as supplied by publisher] (Source: Journal of the Royal College of Physicians of Edinburgh)
Source: Journal of the Royal College of Physicians of Edinburgh - September 17, 2020 Category: General Medicine Tags: J R Coll Physicians Edinb Source Type: research

Uncommon simultaneous diagnosis of multiple myeloma and chronic myeloid leukaemia.
Authors: Mangal V, Paresh S, Adwait S, Nachiketa D Abstract Chronic myeloid leukaemia (CML) is a clonal hematopoietic stem cell disorder. The annual incidence of CML is 1.5 cases per 100,000 individuals. Multiple myeloma (MM) represents a malignant proliferation of plasma cells derived from a single clone. The co-occurrence of two rare malignancies CML and MM in the same patient is an extremely rare incident, and simultaneous diagnosis of CML and MM is reported in only five cases in the literature. A 75-year-old male presented with complaints of easy fatigability, loss of appetite and unquantifed weight loss of fou...
Source: Journal of the Royal College of Physicians of Edinburgh - September 17, 2020 Category: General Medicine Tags: J R Coll Physicians Edinb Source Type: research

Neuromyelitis optica spectrum disorder mimicking Wernicke's encephalopathy.
Authors: Karri M, Ramasamy B, Perumal S, Kannan KT PMID: 32936110 [PubMed - as supplied by publisher] (Source: Journal of the Royal College of Physicians of Edinburgh)
Source: Journal of the Royal College of Physicians of Edinburgh - September 17, 2020 Category: General Medicine Tags: J R Coll Physicians Edinb Source Type: research

Rheumatoid arthritis with necrotic lung nodules.
We present a 74-year-old male with long-standing rheumatoid arthritis who had multiple cavitating lung nodules. Biopsy from the lung nodule could not be performed as the patient refused to consent. However, infection, malignancy and granulomatosis with polyangiitis were ruled out on the basis of blood investigations and bronchoscopy. He was empirically treated with a moderate dose of glucocorticoid along with conventional synthetic disease-modifying antirheumatic drugs. After three months of treatment, the lung nodules disappeared completely and his articular symptoms showed marked improvement. PMID: 32936111 [PubMed -...
Source: Journal of the Royal College of Physicians of Edinburgh - September 17, 2020 Category: General Medicine Tags: J R Coll Physicians Edinb Source Type: research

Inclusion of medical fitness to drive in medical postgraduate training curricula.
CONCLUSION: There are notable deficits in MFTD training for specialists in Ireland and the UK. Common conditions which can significantly impair MFTD such as stroke, diabetes and alcohol use disorders are severely underrepresented and curricula should be revisited to include relevant training and guidance on MFTD for trainees. PMID: 32936112 [PubMed - as supplied by publisher] (Source: Journal of the Royal College of Physicians of Edinburgh)
Source: Journal of the Royal College of Physicians of Edinburgh - September 17, 2020 Category: General Medicine Tags: J R Coll Physicians Edinb Source Type: research

Usefulness of a workshop on scientific writing and publication in improving the baseline knowledge deficit among postgraduates.
CONCLUSION: This survey underscores the need for structured training in scientific writing. Its inclusion in the medical postgraduate curriculum appears desirable. PMID: 32936113 [PubMed - as supplied by publisher] (Source: Journal of the Royal College of Physicians of Edinburgh)
Source: Journal of the Royal College of Physicians of Edinburgh - September 17, 2020 Category: General Medicine Tags: J R Coll Physicians Edinb Source Type: research

Pulmonary sarcoidosis: a clinical update
Authors: Hu MK, Mathur A, Dempsey OJ Abstract Sarcoidosis remains difficult to diagnose, assess and treat. The last decade has brought significant diagnostic and therapeutic advances in the field of sarcoidosis including endobronchial ultrasound, F-fluorodeoxyglucose positron emission tomography and biologics. In this article we use clinical vignettes to discuss commonly encountered cases to illustrate and explain the application of these, and other advances. PMID: 32936114 [PubMed - as supplied by publisher] (Source: Journal of the Royal College of Physicians of Edinburgh)
Source: Journal of the Royal College of Physicians of Edinburgh - September 17, 2020 Category: General Medicine Tags: J R Coll Physicians Edinb Source Type: research

History of the West of Scotland Haemophilia Centre, Glasgow, 1950-2019.
Authors: Lowe G, Walker I, Gibson B, Tait C, Bagot C Abstract Over 70 years, the West of Scotland Haemophilia Centre in the UK has played a leading role in research, education and training. Its staff studied the natural history of haemophilias, their complications, and their treatment complications, pioneered the use of fibrinolytic inhibitors to reduce the risk of receiving a blood transfusion and developed national audit. Collaborations across Scotland with other haemophilia centres and the Scottish National Blood Transfusion Service progressed self-suffi ciency in NHS-produced factor concentrates, heat treatment...
Source: Journal of the Royal College of Physicians of Edinburgh - September 17, 2020 Category: General Medicine Tags: J R Coll Physicians Edinb Source Type: research

RCPE Medical Trainees' Annual Conference 2020: The On-call Handbook.
Authors: Lynch R PMID: 32936116 [PubMed - as supplied by publisher] (Source: Journal of the Royal College of Physicians of Edinburgh)
Source: Journal of the Royal College of Physicians of Edinburgh - September 17, 2020 Category: General Medicine Tags: J R Coll Physicians Edinb Source Type: research

RCPE symposium - Medicine of the Older Person.
Authors: Jayasuriya P PMID: 32936117 [PubMed - as supplied by publisher] (Source: Journal of the Royal College of Physicians of Edinburgh)
Source: Journal of the Royal College of Physicians of Edinburgh - September 17, 2020 Category: General Medicine Tags: J R Coll Physicians Edinb Source Type: research

COVID-19: an opportune period to reform the medical curriculum.
Authors: Christopher E PMID: 32936118 [PubMed - as supplied by publisher] (Source: Journal of the Royal College of Physicians of Edinburgh)
Source: Journal of the Royal College of Physicians of Edinburgh - September 17, 2020 Category: General Medicine Tags: J R Coll Physicians Edinb Source Type: research

Aequanimitas in a pandemic: a personal viewpoint.
Authors: Khan I PMID: 32936119 [PubMed - as supplied by publisher] (Source: Journal of the Royal College of Physicians of Edinburgh)
Source: Journal of the Royal College of Physicians of Edinburgh - September 17, 2020 Category: General Medicine Tags: J R Coll Physicians Edinb Source Type: research

Has the use of hand sanitiser substituted hand hygiene in the current COVID-19 pandemic? A perilous path.
Authors: Kalidoss VK, Bakshi SS PMID: 32936120 [PubMed - as supplied by publisher] (Source: Journal of the Royal College of Physicians of Edinburgh)
Source: Journal of the Royal College of Physicians of Edinburgh - September 17, 2020 Category: General Medicine Tags: J R Coll Physicians Edinb Source Type: research

Prevalent fears and inadequate understanding of COVID-19 among medical undergraduates in India: results of a web-based survey.
Authors: Agarwal V, Gupta L, Davalbhakta S, Misra DP, Agarwal V, Goel A PMID: 32936121 [PubMed - as supplied by publisher] (Source: Journal of the Royal College of Physicians of Edinburgh)
Source: Journal of the Royal College of Physicians of Edinburgh - September 17, 2020 Category: General Medicine Tags: J R Coll Physicians Edinb Source Type: research

Impact of COVID-19 on the 'art' of physical examination: a sincere concern.
Authors: Naik BS, M C PMID: 32936122 [PubMed - as supplied by publisher] (Source: Journal of the Royal College of Physicians of Edinburgh)
Source: Journal of the Royal College of Physicians of Edinburgh - September 17, 2020 Category: General Medicine Tags: J R Coll Physicians Edinb Source Type: research

Declaration to improve biomedical and health research.
Authors: J Graham CJ, Bradley SH PMID: 32936123 [PubMed - as supplied by publisher] (Source: Journal of the Royal College of Physicians of Edinburgh)
Source: Journal of the Royal College of Physicians of Edinburgh - September 17, 2020 Category: General Medicine Tags: J R Coll Physicians Edinb Source Type: research

Why is knowledge about fluid prescribing so poor?
Authors: Drummond G PMID: 32936124 [PubMed - as supplied by publisher] (Source: Journal of the Royal College of Physicians of Edinburgh)
Source: Journal of the Royal College of Physicians of Edinburgh - September 17, 2020 Category: General Medicine Tags: J R Coll Physicians Edinb Source Type: research

Authors' reply.
Authors: Mathur A, Johnston G, Clark L PMID: 32936125 [PubMed - as supplied by publisher] (Source: Journal of the Royal College of Physicians of Edinburgh)
Source: Journal of the Royal College of Physicians of Edinburgh - September 17, 2020 Category: General Medicine Tags: J R Coll Physicians Edinb Source Type: research

Some potential unintended consequences from open access publication.
Authors: Humphreys H PMID: 32936126 [PubMed - as supplied by publisher] (Source: Journal of the Royal College of Physicians of Edinburgh)
Source: Journal of the Royal College of Physicians of Edinburgh - September 17, 2020 Category: General Medicine Tags: J R Coll Physicians Edinb Source Type: research

Awareness and attitude regarding the COVID-19 outbreak among newly quali fied medical students prior to starting internships in Kerala, India.
Awareness and attitude regarding the COVID-19 outbreak among newly qualified medical students prior to starting internships in Kerala, India. J R Coll Physicians Edinb. 2020 09;50(3):343-350 Authors: Vijay A, Somnath P, Radhakrishnan S PMID: 32936127 [PubMed - as supplied by publisher] (Source: Journal of the Royal College of Physicians of Edinburgh)
Source: Journal of the Royal College of Physicians of Edinburgh - September 17, 2020 Category: General Medicine Tags: J R Coll Physicians Edinb Source Type: research

Supporting our Fellows and Members through COVID-19.
Authors: Pound S, Bhandari S, Maguire C, Elder A PMID: 32568273 [PubMed - in process] (Source: Journal of the Royal College of Physicians of Edinburgh)
Source: Journal of the Royal College of Physicians of Edinburgh - June 24, 2020 Category: General Medicine Tags: J R Coll Physicians Edinb Source Type: research

Hydroxychloroquine and coronavirus disease 2019.
Authors: Mukhtyar C PMID: 32568274 [PubMed - in process] (Source: Journal of the Royal College of Physicians of Edinburgh)
Source: Journal of the Royal College of Physicians of Edinburgh - June 24, 2020 Category: General Medicine Tags: J R Coll Physicians Edinb Source Type: research

Compassion, resilience and COVID-19.
Authors: Gillies A PMID: 32568275 [PubMed - in process] (Source: Journal of the Royal College of Physicians of Edinburgh)
Source: Journal of the Royal College of Physicians of Edinburgh - June 24, 2020 Category: General Medicine Tags: J R Coll Physicians Edinb Source Type: research

COVID-19: An initial view from the Scottish critical care frontline.
Authors: Fleming G, McNeill G PMID: 32568276 [PubMed - in process] (Source: Journal of the Royal College of Physicians of Edinburgh)
Source: Journal of the Royal College of Physicians of Edinburgh - June 24, 2020 Category: General Medicine Tags: J R Coll Physicians Edinb Source Type: research

SARS-CoV-2 pandemic in the western world: the lessons learned.
Authors: Castelli F PMID: 32568277 [PubMed - in process] (Source: Journal of the Royal College of Physicians of Edinburgh)
Source: Journal of the Royal College of Physicians of Edinburgh - June 24, 2020 Category: General Medicine Tags: J R Coll Physicians Edinb Source Type: research

Publication models in scientific publishing: to open or not?
Authors: Misra DP, Ravindran V PMID: 32568278 [PubMed - in process] (Source: Journal of the Royal College of Physicians of Edinburgh)
Source: Journal of the Royal College of Physicians of Edinburgh - June 24, 2020 Category: General Medicine Tags: J R Coll Physicians Edinb Source Type: research

Is the Medicines and Healthcare products Regulator Agency (MHRA) guidance on sodium valproate acceptable to women of childbearing age?
CONCLUSION: Our study suggests that patients and carers do not wish to stop valproate or engage in PPP despite being made aware of MHRA guidance. PMID: 32568279 [PubMed - in process] (Source: Journal of the Royal College of Physicians of Edinburgh)
Source: Journal of the Royal College of Physicians of Edinburgh - June 24, 2020 Category: General Medicine Tags: J R Coll Physicians Edinb Source Type: research

Epidemiological, clinical and laboratory features of leptospirosis compared to other acute febrile illnesses.
CONCLUSION: Our study suggests that certain epidemiological, clinical and laboratory features in patients with leptospirosis may allow an early diagnosis. Our study also underscores the usefulness of confirming the leptospiral serology by enzyme-linked immunosorbent assay (ELISA) in combination with relevant epidemiological and clinical features in diagnosing leptospirosis using the modified Faine's criteria. PMID: 32568280 [PubMed - in process] (Source: Journal of the Royal College of Physicians of Edinburgh)
Source: Journal of the Royal College of Physicians of Edinburgh - June 24, 2020 Category: General Medicine Tags: J R Coll Physicians Edinb Source Type: research

Changing paradigms in the management of gout.
Authors: Nuki G, Riches P Abstract The incidence and prevalence of gout have increased, as have comorbid obesity, diabetes mellitus, hypertension, chronic kidney and cardiovascular disease. Gout is now the commonest type of inflammatory arthritis despite availability of safe, effective and potentially 'curative' urate-lowering drugs. Modern imaging studies show that gout is a chronic inflammatory crystal deposition disorder even at the first acute attack and they illuminate the need to eliminate urate crystals by continuing reduction of the serum urate below its solubility threshold. Clinical outcomes, adherence to...
Source: Journal of the Royal College of Physicians of Edinburgh - June 24, 2020 Category: General Medicine Tags: J R Coll Physicians Edinb Source Type: research

Emerging pharmacotherapy for COVID-19.
Authors: Lipworth B, Kuo CR, Chan R Abstract Broadly speaking, pharmacological treatments for COVID-19 can be divided into those acting on upstream pathways early on in the disease process via suppression of viral replication or by inhibiting cell entry, and those acting on downstream pathways later on via selective attenuation of the adaptive immune cytokine-mediated inflammatory response. The antiviral drug remdesivir has been shown to shorten duration of disease while interferon beta-1b may speed up viral clearance. The results with hydroxychloroquine have thus far been rather disappointing. Trials with selectiv...
Source: Journal of the Royal College of Physicians of Edinburgh - June 24, 2020 Category: General Medicine Tags: J R Coll Physicians Edinb Source Type: research

Talaromyces (Penicillium) species infection in the central nervous system.
Authors: Chuah CH, Ong YC, Kong BH, Woo YY, Wong PS, Leong KN, Chow TS Abstract Talaromycosis typically occurs as an opportunistic infection among immunocompromised individuals. Infection caused by species other than T. marneffei is uncommon. While most reported cases describe infection in the lungs, we report an extremely rare intracranial Talaromyces species infection. This 61-year-old with end-stage renal disease who was unwell for the previous two months, presented with fever and worsening confusion lasting for three days. Lumbar puncture was suggestive of meningitis. Cerebrospinal fluid (CSF) culture was later...
Source: Journal of the Royal College of Physicians of Edinburgh - June 24, 2020 Category: General Medicine Tags: J R Coll Physicians Edinb Source Type: research

Primary Ewing sarcoma of the lung: a challenging case.
We report the case of a 33-year old man with primary Ewing sarcoma of the lung diagnosed upon postsurgical histological examination. Initially presenting with unilateral pleural effusion, our patient underwent various investigations before final diagnosis. This case report reviews the available literature of similarly reported cases and discusses the current developments on managing this rare and aggressive disease. As a supplementary learning point, this case reminds us always to consider unusual possibilities and seek further sub-specialist opinion when presented with unresolved clinical and radiological abnormalities th...
Source: Journal of the Royal College of Physicians of Edinburgh - June 24, 2020 Category: General Medicine Tags: J R Coll Physicians Edinb Source Type: research

Microangiopathic haemolytic anaemia and thrombocytopenia due to combined vitamin B12 and folate deficiency masquerading as thrombotic thrombocytopenic purpura.
We present a case of a 47-year-old male with a history of diffuse large B-cell lymphoma (DLBCL) who was admitted for fatigue, persistent frontal headache and left upper-quadrant abdominal pain. Further investigation showed that he had pancytopenia with microangiopathic haemolytic anaemia (MAHA) and intracranial bleeding (ICB). Serum vitamin B12 and folate were later found to be low and a diagnosis of combined vitamin B12 and folate deficiency mimicking thrombotic thrombocytopenic purpura (TTP) was made. The patient responded well to vitamin B12 and folate replacement. PMID: 32568285 [PubMed - in process] (Source: Journ...
Source: Journal of the Royal College of Physicians of Edinburgh - June 24, 2020 Category: General Medicine Tags: J R Coll Physicians Edinb Source Type: research