Chronic asymptomatic hyponatraemia following angiotensin receptor blocker-neprilysin inhibitor (ARNi) therapy: a case report
Introduction Sacubitril/valsartan is a fixed dose combination of a neprilysin inhibitor (sacubitril) and an AT1 receptor blocker (valsartan), referred to as an angiotensin receptor-neprilysin inhibitor (ARNi). Its indication is in the treatment of heart failure with reduced ejection fraction (HFrEF).1 Hyponatraemia has only been reported once2 as an adverse drug reaction. We here contribute what we believe is the first reported case of ARNi induced chronic asymptomatic severe hyponatraemia, discovered incidentally by routine laboratory testing. Case presentation A middle-aged woman with a medical history of Cushing’s...
Source: Postgraduate Medical Journal - February 18, 2022 Category: General Medicine Authors: Mohammed, S. R., Pinto Pereira, L. M., Hanoman, H., Teelucksingh, S. Tags: Adverse drug reactions Source Type: research
Cheese, ketchup and grapes: a 10-step protocol on how to teach medical students and junior doctors cataract surgery in a simulated environment using household items
Cataract surgery is one of the most common surgical procedures performed worldwide, yet many medical students and doctors remain uncertain as to what a cataract is or what the operation involves. This protocol provides a simple 10-step approach on how to teach medical students and non-specialist doctors the stages involved in cataract surgery, in a low cost wet lab-based environment, without the need for expensive surgical simulators or operating microscopes. (Source: Postgraduate Medical Journal)
Source: Postgraduate Medical Journal - February 18, 2022 Category: General Medicine Authors: Norbury, C. Tags: Education and learning Source Type: research
Deconstructing language barriers in healthcare: where are we going wrong?
The COVID-19 pandemic has sharply brought to light the need to address inequalities in health. Language barriers have been demonstrated to be a major determinant in the inequality in healthcare received by Black, Asian and Minority Ethnic (BAME) and migrant patients.1–3 While working in a busy, multicultural London hospital, bridging language barriers have been one of the biggest challenges to delivering healthcare in this setting. In this short article, we wish to deconstruct what we believe to be the fundamental practical challenges to successfully communicating with Limited-English-Proficient (LEP) patients. We id...
Source: Postgraduate Medical Journal - February 18, 2022 Category: General Medicine Authors: Venkatesan, T., Naqvi, D., Patel, B. Tags: Editorials Source Type: research
Dr Ernesto 'Che Guevara: a study in moral ambiguity
There are few doctors in history whose image is recognisable almost everywhere in the world. Dr Ernesto Guevara, known universally as ‘Che’, is one of them. In his most famous photo, he exudes an air of glowering passion and self-conscious ‘machismo’, as if he already knew he would become an enduring icon. (see figure 1) If you ask most people about him, they are likely to describe him as a revolutionary hero, although others may call him a ruthless executioner, depending on their political beliefs. Both accounts are true. His life raises important moral issues, not only for doctors who aspire to be...
Source: Postgraduate Medical Journal - January 20, 2022 Category: General Medicine Authors: Launer, J. Tags: On reflection Source Type: research
How to manage a MFFD patient in the acute hospital settings?
This article is mainly geared towards junior doctors under training. Anyone who is working in the NHS(National Health Service)hospitals will resonate with this word MFFD1—it is the mantra everyone in the NHS hospitals understand. The senior nurse can assess one’s ward round and criticise that there was no plan if one has not mentioned the magic word MFFD (or... (Source: Postgraduate Medical Journal)
Source: Postgraduate Medical Journal - January 20, 2022 Category: General Medicine Authors: Kumar, A., Sinha, P. Tags: Letter Source Type: research
Gestational gigantomastia with massively haemorrhagic ulcers
A 26-year-old newlywed woman attended our clinic with gigantic breasts associated with neck and back pain, and severe bleeding from breast ulcers. Her breasts had enlarged rapidly within the first 2 months of her first pregnancy, causing approximately 25 kg of weight gain and later, swelling over both the lower limbs. Medical therapy was instituted, but failed to halt breast tissue growth or relieve symptoms. Ultimately, she underwent an abortion at the end of the first trimester of pregnancy, which finally stopped breast enlargement. However, bleeding breast ulcers were problematic. Once, profuse bleeding caused haemorrha...
Source: Postgraduate Medical Journal - January 20, 2022 Category: General Medicine Authors: Saha, S. Tags: Images Source Type: research
Quaternion of paraquat poisoning: icterus, oral ulceration, acute respiratory and renal failure
A 63-year-old man presented at emergency for shortness of breath associated with jaundice, oral ulceration, odynophagia and oliguria following accidental ingestion of paraquat 7 days prior. He had no previously known comorbidities. Clinically he had tachycardia (114/min), tachypnoea (34/min), low oxygen saturation (SpO2 66%), icterus and ulceration over the tongue (figure 1). On evaluation, he had acute hepatitis (SGOT 120 U/L, SGPT 252 U/L, bilirubin 18.9 mg/dL), renal failure (urea 224 mg/dL, creatinine 4.4 mg/dL) and acute respiratory distress syndrome (PaO2/FiO2 0.15) with chest X-ray and high-resolution CT scan showin...
Source: Postgraduate Medical Journal - January 20, 2022 Category: General Medicine Authors: Arora, N., Dhibar, D. P. Tags: Images Source Type: research
Guidance for providing effective feedback in clinical supervision in postgraduate medical education: a systematic review
The primary aim was to systematically review the empirical evidence relating to models and guidance for providing effective feedback in clinical supervision occurring in postgraduate medical education contexts. A secondary aim was to identify the common and differentiating components of models and guidance for providing effective feedback in this context. A systematic review was conducted. Fifty-one records met the inclusion criteria, including 12 empirical studies. Empirical records meeting inclusion criteria were critically appraised. Qualitative content analysis was applied to the guidance on effective and ineffective f...
Source: Postgraduate Medical Journal - January 20, 2022 Category: General Medicine Authors: Weallans, J., Roberts, C., Hamilton, S., Parker, S. Tags: Reviews Source Type: research
Healthcare worker protection against epidemic viral respiratory disease
Lower respiratory infections are often caused or precipitated by viruses and are a leading cause of global morbidity and mortality. Mutations in these viral genomes can produce highly infectious strains that transmit across species and have the potential to initiate epidemic, or pandemic, human viral respiratory disease. Transmission between humans primarily occurs via the airborne route and is accelerated by our increasingly interconnected and globalised society. To this date, there have been four major human viral respiratory outbreaks in the 21st century. Healthcare workers (HCWs) are at particular risk during respirato...
Source: Postgraduate Medical Journal - January 20, 2022 Category: General Medicine Authors: Scantling-Birch, Y., Newton, R., Naveed, H., Rajak, S., Bhutta, M. F. Tags: Reviews Source Type: research
Trainee burnout: when does the fire start?
Conclusion
Stress and burnout stimulus appear to start on day one of induction for susceptible PGY1 doctors, and continues into front-line clinical work irrespective of shift pattern. Short Grit Scale questionnaires appear an effective tool to facilitate targeted stress countermeasures. (Source: Postgraduate Medical Journal)
Source: Postgraduate Medical Journal - January 20, 2022 Category: General Medicine Authors: Robinson, D. B. T., James, O. P., Hopkins, L., Brown, C., Powell, A., Abdelrahman, T., Egan, R. J., Lewis, W. Tags: Original research Source Type: research
Opioid prescribing attitudes of palliative care physicians versus other specialists: a questionnaire-based survey
Conclusions
Continuous medical education on cancer pain treatment should be provided to all specialists to ensure optimal opioid pharmacotherapy and avoid overprescribing or underprescribing opioids. Administrative restrictions are the main barrier to optimal pain treatment. (Source: Postgraduate Medical Journal)
Source: Postgraduate Medical Journal - January 20, 2022 Category: General Medicine Authors: Dzierzanowski, T., Kozlowski, M. Tags: Original research Source Type: research
Diagnostic performance of morning serum cortisol as an alternative to short synacthen test for the assessment of adrenal reserve; a retrospective study
Conclusions
Basal morning serum cortisol can be safely used as a first step in the evaluation of patients with suspected AI. This will enhance the number of patients being screened for this condition. (Source: Postgraduate Medical Journal)
Source: Postgraduate Medical Journal - January 20, 2022 Category: General Medicine Authors: Kumar, R., Carr, P., Wassif, W. Tags: Original research Source Type: research
Bronchoscopic intratumoral injections of cisplatin and endostar as concomitants of standard chemotherapy to treat malignant central airway obstruction
Conclusions
We have shown that the intratumoral injection of cytotoxic cisplatin plus anti-angiogenic Endostar is an effective and safe adjuvant therapeutic option to treat malignant CAO in clinical practice. This time-staggered local and systemic treatment combination improves quality of life and clinical parameters, thus may provide a feasible therapeutic option for symptomatic CAO. (Source: Postgraduate Medical Journal)
Source: Postgraduate Medical Journal - January 20, 2022 Category: General Medicine Authors: Jiang, W., Yang, X., Wang, X., Li, Y., Yang, X., Wang, N., Yin, B. Tags: Original research Source Type: research
Antithrombotic therapy and the risk of new-onset dementia in elderly patients with atrial fibrillation
Conclusion
In elderly AF patients, warfarin therapy was associated with a significantly lower risk of new-onset dementia compared those with no therapy or aspirin. (Source: Postgraduate Medical Journal)
Source: Postgraduate Medical Journal - January 20, 2022 Category: General Medicine Authors: Wong, C. K., Huang, D., Zhou, M., Hai, J., Yue, W. S., Li, W.-h., Yin, L.-X., Zuo, M.-L., Feng, Y. Q., Tan, N., Chen, J. Y., Kwan, J., Siu, C. W. Tags: Editor's choice Original research Source Type: research
COVID-19 associated variations in liver function parameters: a retrospective study
Conclusions
More than half of patients admitted to the hospital with SARS-CoV-2 infection had an abnormal liver function which was found to be associated with raised levels of inflammatory markers. Significantly higher proportions of patients with abnormal liver function were elderly and males and were at higher risk of progressing to severe disease. (Source: Postgraduate Medical Journal)
Source: Postgraduate Medical Journal - January 20, 2022 Category: General Medicine Authors: Saini, R. K., Saini, N., Ram, S., Soni, S. L., Suri, V., Malhotra, P., Kaur, J., Verma, I., Sharma, S., Zohmangaihi, D. Tags: COVID-19 Original research Source Type: research
