Short term, high-dose vitamin D supplementation for COVID-19 disease: a randomised, placebo-controlled, study (SHADE study)
Conclusion
Greater proportion of vitamin D-deficient individuals with SARS-CoV-2 infection turned SARS-CoV-2 RNA negative with a significant decrease in fibrinogen on high-dose cholecalciferol supplementation.
Trial register number
NCT04459247. (Source: Postgraduate Medical Journal)
Source: Postgraduate Medical Journal - January 20, 2022 Category: General Medicine Authors: Rastogi, A., Bhansali, A., Khare, N., Suri, V., Yaddanapudi, N., Sachdeva, N., Puri, G. D., Malhotra, P. Tags: COVID-19 Original research Source Type: research
'Triple therapy (elexacaftor, tezacaftor, ivacaftor) skin rash in patients with cystic fibrosis
Cystic fibrosis transmembrane conductance regulator (CFTR) modulators such as ivacaftor (IVA), elexacaftor (ELX), lumacaftor (LUM) and tezacaftor (TEZ) are recently approved novel therapies for cystic fibrosis (CF) patients who have at least one ‘F508 del’ mutation. This mutation occurs in the majority of cystic fibrosis patients. Clinical trials with ‘triple therapy’ have demonstrated significantly improved lung function, sweat chloride and body mass index, with reduced pulmonary exacerbations.1 2 Our patient is a 24-year-old woman with cystic fibrosis (CF) with homozygous F508 del who received &ls...
Source: Postgraduate Medical Journal - January 20, 2022 Category: General Medicine Authors: Hu, M. K., Wood, G., Dempsey, O. Tags: Adverse drug reactions Source Type: research
Neighbourhood walking tours for physicians-in-training
Social and economic factors have a profound impact on patient health. However, education about these factors has been inconsistently incorporated into residency training. Neighbourhood walking tours may help physician-residents learn about the social determinants of health (SDoH). We assessed the impact of a neighbourhood walking tour on physician-residents’ perceptions of SDoH, plans for counselling patients and knowledge of community resources. Using a community-based participatory research approach, in 2017 we implemented a neighbourhood walking tour curriculum for physician-residents in internal medicine, interna...
Source: Postgraduate Medical Journal - January 20, 2022 Category: General Medicine Authors: Cross, J. J., Arora, A., Howell, B., Boatright, D., Vijayakumar, P., Cruz, L., Smart, J., Spell, V., Greene, A., Rosenthal, M. Tags: Education and learning Source Type: research
Educational benefits of writing multiple-choice questions (MCQs) with evidence-based explanation
Introduction Facilitating learning has been the focus of extensive research to identify efficient strategies and activities. Solving problems and learning through questions have been widely used to enhance active learning by exposure to inquiry or problem for which answers are needed. The process involves memory retrieval, understanding, application and critical thinking skills. However, writing questions involves all the above learning strategies at a deeper level and broader application. Writing is a commonly known tool of thinking and learning.1 2 Writing questions provides the additional learning skills of analysing, e...
Source: Postgraduate Medical Journal - January 20, 2022 Category: General Medicine Authors: Tuma, F. Tags: Editorials Source Type: research
Divine bodies: imagining the anatomy of God
In my office at home I have two statuettes of Hindu gods. One is a bronze I bought many years ago in Varanasi on the banks of the Ganges. It depicts Shiva the Destroyer with his three eyes and four arms. The other is a small marble image that one of my patients once gave me, to bring me good luck. It shows the elephant-headed god Ganesh, with his pot belly. I also currently have on my desk a catalogue from a recent exhibition at the British Museum. On its cover there is a photo of a scary but magnificent effigy of Kali, one of many forms of the mother goddess. In her left hand there is a severed head., and she has a garlan...
Source: Postgraduate Medical Journal - December 15, 2021 Category: General Medicine Authors: Launer, J. Tags: On reflection Source Type: research
Mask as an aid in preventing photodermatosis
COVID-19 pandemic does not look it is going to end soon; the population is adapting and acclimatising to this new normal. In order to prevent the spread of virus, people are changing their daily habits, which include frequent washing of hands and wearing a mask. Masks are covering almost lower two-thirds of the face providing photoprotection to the nose, cheeks, lips, and perioral and mandibular regions. Masks are made of tightly woven fibres, which favour photoprotection. The combination of these masks and sunglasses covers almost the entirety of face. In this era of COVID-19 when everyone is donning a mask, patients with...
Source: Postgraduate Medical Journal - December 15, 2021 Category: General Medicine Authors: Aggarwal, K. Tags: COVID-19 Letter Source Type: research
Heerfordt-Waldenström Syndrome: an under-recognised form of sarcoidosis
I read with great interest the article entitled ‘Sarcoidosis with multiorgan involvement’ in the ‘Images’ section of the August 2020 print issue.1 The authors have detailed the diagnostic dilemma encountered as the patient was initially treated for tuberculosis without any improvement before further work-up eventually pointed to sarcoidosis. This quandary is often seen in world regions where tuberculosis (TB) is endemic and thus, TB often becomes the forefront diagnosis for clinicians. The myriad presentation of sarcoidosis that is shared by many other diseases further adds to the perplexing situati...
Source: Postgraduate Medical Journal - December 15, 2021 Category: General Medicine Authors: Ramasamy, K. Tags: Letter Source Type: research
Life-threatening corrosive injury with hepato-renal-pulmonary failure in boric acid poisoning
CASE A young female presented with burning sensation, ulceration of mouth and oral cavity following the intake of uncooked rice after a quarrel with her parents. Further enquiry revealed that they used boric acid powder as insecticide to preserve the rice. Clinically, she had extensive ulceration with congestion involving the buccal mucosa of lips, oral cavity and tongue (figure 1). Upper gastrointestinal endoscopy also revealed extensive corrosive injury with ulceration, mucosal hyperaemia and slough formation involving oropharynx, oesophagus and stomach, for which nasojejunal tube was placed for nutritional supplementati...
Source: Postgraduate Medical Journal - December 15, 2021 Category: General Medicine Authors: Singh, H., Dhibar, D. P., Naidu, G. S. R. S. N. K. Tags: Images Source Type: research
Haemolytic crisis of hereditary spherocytosis
A 23-year-old man presented to the emergency department with a 2-day history of fever, nausea, conjunctival pallor and new yellowing of the skin. His medical history was unremarkable. Physical examination demonstrated mild jaundice of the sclera and skin and a palpable spleen. Laboratory testing showed a haemoglobin of 6.6 g/L (reference range 13.7–16.8 g/L), total bilirubin of 7.03 mg/dL (0.4–1.5 mg/dL), direct bilirubin of 0.67 mg/dL (0–0.4 mg/dL) and a reticulocyte fraction of 2.8% (0.67–1.92%). Ultrasonography (US) and enhanced CT revealed splenomegaly and non-obstructing gallst...
Source: Postgraduate Medical Journal - December 15, 2021 Category: General Medicine Authors: Matsuura, H., Shiraishi, Y. Tags: Images Source Type: research
Cystinuria
The patient was an 8-year-old boy with flank pain and past medical history of more than 10 episodes of renal stone since the age of 18 months. Urine analysis revealed positive blood (20–25/HPF) and hexagonal crystals in the sediment (figure 1). The crystals had a negative birefringence with polarised microscopy. The cyanide nitroprusside test was positive (figure 2). The patient was under the treatment of potassium citrate, high fluid intake, low sodium, and low protein diet since the age of 18 months with the diagnosis of cystinuria. D-penicillamine (tiopronin which is a better choice is not available in I...
Source: Postgraduate Medical Journal - December 15, 2021 Category: General Medicine Authors: Nozarian, Z., Safavi, M. Tags: Images Source Type: research
Recent advances in the aetiology of recurrent aphthous stomatitis (RAS)
Recurrent aphthous stomatitis (RAS) is the most common disease of oral mucosa, which almost attacks each individual once in their lifespan. Although plenty of factors have been suggested to play a role in the pathogenesis of RAS, the aetiology of RAS is still controversial, which might lead to limited clinical therapies in accordance with each RAS patient. This review mainly illustrates recent advances in potential causes associated with RAS in detail. Deeper comprehension of the aetiology of RAS will support doctors and researchers to make a better management of RAS patients and to discover new treatments. The aetiology o...
Source: Postgraduate Medical Journal - December 15, 2021 Category: General Medicine Authors: Wang, Z., Cao, H., Xiong, J., Lu, Y., Deng, Y., Nan, H., Zheng, S., Ye, H., Cao, Z. Tags: Reviews Source Type: research
What do beta-lactams add to vancomycin or daptomycin in the treatment of patients with methicillin-resistant Staphylococcus aureus bacteraemia? A review
Several studies have documented the synergy between vancomycin/daptomycin and various beta-lactams, and clinical studies have studied this combination therapy in humans. We review the published literature on this topic to know the utility of the combined treatment with beta-lactams in treating bacteraemia methicillin-resistant Staphylococcus aureus (MRSA) infections. Fifteen observational studies, three randomised clinical trials and three systematics reviews are analysed in this article. Observational studies used ceftaroline, cefazolin, piperacillin/tazobactam or cefepime among the beta-lactams. Clinical trials used clox...
Source: Postgraduate Medical Journal - December 15, 2021 Category: General Medicine Authors: Garcia Aragones, L., Blanch Sancho, J. J., Segura Luque, J. C., Mateos Rodriguez, F., Martinez Alfaro, E., Solis Garcia del Pozo, J. Tags: Reviews Source Type: research
Hospital-acquired serum phosphate derangements and their associated in-hospital mortality
Conclusion
Hospital-acquired serum phosphate derangements affect approximately half of the hospitalised patients and are associated with increased in-hospital mortality rate. (Source: Postgraduate Medical Journal)
Source: Postgraduate Medical Journal - December 15, 2021 Category: General Medicine Authors: Thongprayoon, C., Cheungpasitporn, W., Chewcharat, A., Petnak, T., Mao, M. A., Srivali, N., Bathini, T., Vallabhajosyula, S., Qureshi, F., Kashani, K. Tags: Original research Source Type: research
Experiences, patient interactions and knowledge regarding the use of cannabis as a medicine in a cohort of New Zealand doctors in an oncology setting
Conclusion
In the oncology setting, patients are asking doctors about symptomatic and curative treatment with cannabis-based products. Doctors are not biased against the use of products showing medical provenance; however, NZ-specific clinical and regulatory guidelines are essential to support patient discussions and appropriate prescribing. (Source: Postgraduate Medical Journal)
Source: Postgraduate Medical Journal - December 15, 2021 Category: General Medicine Authors: Oldfield, K., Eathorne, A., Tewhaiti-Smith, J., Beasley, R., Semprini, A., Braithwaite, I. Tags: Original research Source Type: research
Strategic organisational skills predict surgical training success
Conclusions
Better-prepared trainees achieved 25% more operative experience, were four-fold more likely to publish and pass MRCS, which aligned with consistent desirable ARCP outcome. Timely arrival at training events represents a skills-composite of travel planning and is a useful marker of strategic organisational skills. (Source: Postgraduate Medical Journal)
Source: Postgraduate Medical Journal - December 15, 2021 Category: General Medicine Authors: James, O. P., Robinson, D. B. T., Hopkins, L., Bowman, C., Powell, A., Brown, C., Hemington-Gorse, S., Egan, R. J., Lewis, W. G. Tags: Original research Source Type: research
