Multifocal nodular steatosis mimicking malignancy
A previously fit man presented with breathlessness. Chest radiography showed right lower lobe density. Liver function tests, coagulation studies and alphafetoprotein levels were unremarkable. The patient’s breathlessness self-resolved, but chest–abdomen–pelvis CT performed to exclude malignancy revealed multiple hypodense liver lesions concerning for metastases (figure 1). Ultrasound-guided percutaneous liver biopsy targeting these lesions was successfully carried out. Histology showed fatty change but no evidence of malignancy. To avoid the possibility of sampling error, a second ultrasound-guided biopsy...
Source: Postgraduate Medical Journal - November 22, 2022 Category: General Medicine Authors: Kang, J. H.-E., Wong, J. S.-Y., Williams, M. Tags: Images Source Type: research
Non-alcoholic steatohepatitis in a Japanese obese child
A 10-year-old boy was referred to our hospital because of liver dysfunction. His body mass index was 29.7; however, other physical findings were normal. He did not have any history of illness and was not taking any medication. His parents were obese and had fatty liver disease, but no hypertension or diabetes. His laboratory data were as follows: total bilirubin, 0.6 (normal range (NR) 0.3–1.2) mg/dL; aspartate aminotransferase, 253 (NR 14–33) IU/L; alanine aminotransferase, 588 (NR 3–20) IU/L; -glutamyl transferase, 186 (NR 7–23) IU/L; total cholesterol, 222 (NR 140–199) mg/dL; low-density li...
Source: Postgraduate Medical Journal - November 22, 2022 Category: General Medicine Authors: Kakiuchi, T., Sakata, Y. Tags: Images Source Type: research
Muscle involvement in sarcoidosis
A 31-year-old man presented with dry cough of 2 months duration. He was detected to have mediastinal adenopathy, raised serum calcium and ACE levels. He underwent endoscopic ultrasound-guided biopsy from subcarinal and peripancreatic nodes, which showed discrete non-caseating granulomas. A diagnosis of sarcoidosis was made and he underwent a whole-body fluorodeoxyglucose-positron emission tomography (FDG PET) scan to assess disease activity elsewhere. It revealed the presence of FDG avid right cervical, mediastinal and retroperitoneal lymphadenopathy (figure 1 green arrows). Poorly defined hypoenhancing multiple intramuscu...
Source: Postgraduate Medical Journal - November 22, 2022 Category: General Medicine Authors: Arjun, P., Gopinath, R., Mahendran, B., Balan, G. Tags: Images Source Type: research
Fitz-Hugh-Curtis syndrome with right shoulder pain
A 24-year-old woman presented with right shoulder pain that started 6 days prior. Three days ago, she developed right upper quadrant abdominal pain. These pains worsened during deep inspiration and right lateral recumbent position. The right shoulder pain was localised to the trapezius ridge. Her last menstrual period was 14 days ago, and her last sexual intercourse was 6 weeks prior to the symptom onset. Physical examination revealed tenderness in the right upper abdominal quadrant with neither rebound tenderness nor pain in her right shoulder joint on passive motion. Hepatic capsular enhancement was seen in the early pha...
Source: Postgraduate Medical Journal - November 22, 2022 Category: General Medicine Authors: Tada, N., Ishizuka, K., Yokokawa, D., Ikusaka, M. Tags: Images Source Type: research
Lady Windermere syndrome
An 81-year-old woman, with hypertension and dyslipidaemia, was admitted with an 8-month history of intermittent episodes of persistent cough, occasionally productive of yellowish sputum, and mild exertional dyspnoea, associated with malaise and 10 kg weight loss, but no fever or night sweats related. She was diagnosed as having chronic bronchitis and community-acquired pneumonia, receiving several courses of different empiric antibiotics, like amoxicillin and azithromycin with little improvement. On admission, she looks malnourished, weight 47 kg, body mass index 17 kg/m2, arterial pression 126/60 mm Hg, heart rate 78 per ...
Source: Postgraduate Medical Journal - November 22, 2022 Category: General Medicine Authors: Catano, J. C., Porras Mancilla, J. P. Tags: Images Source Type: research
Multiple fibroadenomas of the breasts: a cause of monthly chest pain
Clinical image A 35-year-old woman reported of continuous bilateral chest pain lasting several years, aggravated by vibration or shaking and most intense during menstruation. The pain limited her daily activities. Physical examination revealed masses resembling rugged rocks in both breasts. Her medical and family histories were unremarkable, and she received no medication. Ultrasonography revealed more than 100 oval-shaped, well-circumscribed tumours, each 5–30 mm. Each breast was 200x200x60 mm. Contrast-enhanced MRI revealed multiple tumours throughout the breasts on dynamic gradual enhancement and no early washout ...
Source: Postgraduate Medical Journal - November 22, 2022 Category: General Medicine Authors: Shibata, J., Fujii, M., Kato, T. Tags: Images Source Type: research
Diffusely increased 18F-FDG thyroid radionuclide uptake is not always hyperthyroidism
Introduction In the routine evaluation of the thyroid, imaging is often a useful modality, which gives anatomical and functional characteristics that can aid diagnosis. Thyroid ultrasonography is the principal imaging modality in this regard, whereas CT, MRI and PET scanning are much less frequently ordered for thyroid assessment through thyroid lesions are often discovered via such advanced imaging modalities as incidental findings.1 Unlike radiologists, most physicians tend to be unfamiliar with radiological features of thyroid disorders detected via these latter forms of scanning.2 Case description A 25-year-old woman w...
Source: Postgraduate Medical Journal - November 22, 2022 Category: General Medicine Authors: Sun, L., Goh, H. J., Wang, N. X., Verma, S. K., Velan, S. S., Leow, M. K. S. Tags: Open access Images Source Type: research
Revealing image of arterial spin labelling in posterior reversible encephalopathy syndrome
A 31-year-old postpartum woman presented with a generalised tonic–clonic seizure on the seventh day of delivery. The antepartum period was uneventful, and there was no significant medical history. Examination showed elevated blood pressure (160/100) and a disoriented patient. MRI of the brain showed hyperintensities in bilateral parieto-occipital areas (figure 1A–E) suggestive of posterior reversible encephalopathy syndrome (PRES). Pulsed arterial spin labelling (ASL) showed hyperperfusion in corresponding areas (figure 1F,G). Electroencephalography showed delta range slowing in the left parieto-occipital leads...
Source: Postgraduate Medical Journal - November 22, 2022 Category: General Medicine Authors: Reddy, Y. M., Parida, S., Chavan, R., Murthy, J. Tags: Images Source Type: research
Symmetrical white matter lesions in a patient with systemic lupus erythematosus
A 16-year-old girl presented with two episodes of headache, neck pain and vomiting in the last 4 months. In the first episode, she was treated with antibiotics for 5 days following which steroids were added, as her symptoms did not resolve. She had aggravation of symptoms when steroids were tapered with additional right lateral rectus palsy and left knee joint swelling. She had intermittent exertional dyspnoea, photosensitive rashes on cheeks, weight loss, pallor and clubbing. She had 4/5 power at bilateral hip joints. MRI brain showed confluent bilaterally symmetrical T2 hyperintensities in periventricular, subcortical an...
Source: Postgraduate Medical Journal - November 22, 2022 Category: General Medicine Authors: Radhakrishna, P., Das, A., Srivastava, A. K. Tags: Images Source Type: research
Claustrum hyperintensity as a marker of anti-NMDAR encephalitis
A young adult male patient presented with subacute onset, rapidly progressive cognitive impairment and refractory seizures and was diagnosed as definite anti N-methyl D-aspartate receptor (anti-NMDAR) antibody encephalitis as per criteria by Graus et al. (2016), following detection of culprit autoantibodies in serum.1 MRI of brain revealed bilateral T2-weighted image (T2WI)/fluid-attenuated inversion recovery (FLAIR) claustrum hyperintensities (figure 1). Previously, in a cohort of 34 patients,2 presenting with new-onset refractory epilepsy, 4 out of 34 patients showed bilateral claustrum FLAIR hyperintensities on MRI imag...
Source: Postgraduate Medical Journal - November 22, 2022 Category: General Medicine Authors: Datta, A. K., Chakraborty, U., Dutta, A., Malakar, S., Pandit, A. Tags: Images Source Type: research
Learning from the black death
In the space of three or 4 years in the fourteenth century, around half the population of Europe died of plague. So did around a third of people in the Middle East and North Africa, as well as countless victims in central Asia – where the pandemic originated – and in China. Total deaths were probably around 75 million, only exceeded in history by the Second World War. Because the population of the world in the Middle Ages was far smaller than now, this meant that there was a direct impact on almost every town, village and family.1 For comparison, the current pandemic of COVID-19 has so far claimed around a tent...
Source: Postgraduate Medical Journal - October 21, 2022 Category: General Medicine Authors: Launer, J. Tags: On reflection Source Type: research
Review of the published literature to characterise clinical excellence in COVID-19 care
COVID-19 continues to be a major source of global morbidity and mortality. It abruptly stressed healthcare systems early in 2020 and the pressures continue. Devastating hardships have been endured by individuals, families and communities; the losses will be felt for years to come. As healthcare professionals and organisations stepped up to respond to the overwhelming number of cases, it is understandable that the focus has been primarily on coping with the quantity of the demand. During a pandemic, it is not surprising that few papers have drawn attention to the quality of the care delivered to those afflicted with illness...
Source: Postgraduate Medical Journal - October 21, 2022 Category: General Medicine Authors: Garibaldi, B. T., Chisolm, M. S., Berkenblit, G. V., Feller-Kopman, D., Stephens, R. S., Stewart, R. W., Wright, S. M. Tags: COVID-19 Reviews Source Type: research
Association between IL-6 and severe disease and mortality in COVID-19 disease: a systematic review and meta-analysis
Conclusion
IL-6 is an adequate predictor of severe disease in patients infected with the COVID-19. The finding of current study may guide clinicians and healthcare providers in identifying potentially severe or critical patients with COVID-19 at the initial stage of the disease. Moreover, we found that only monitoring IL-6 levels does not seem to predict mortality and was not associated with COVID-19’s mortality.
PROSPERO registration number
CRD42021233649. (Source: Postgraduate Medical Journal)
Source: Postgraduate Medical Journal - October 21, 2022 Category: General Medicine Authors: Liu, X., Wang, H., Shi, S., Xiao, J. Tags: COVID-19 Reviews Source Type: research
Is metformin use associated with a reduced risk of oesophageal cancer? A systematic review and meta-analysis
Conclusion
Metformin is associated with a reduced risk of OC. More well-designed studies are still needed to further elaborate on these associations.
PROSPERO registration number
CRD42021237127. (Source: Postgraduate Medical Journal)
Source: Postgraduate Medical Journal - October 21, 2022 Category: General Medicine Authors: Chen, Y., Cheng, X., Sun, C., Kim, N. H., Kailas, S., Qureshi, F., Karadsheh, Z., Wu, Y., Hu, L., Zhou, Z., Bhan, C., Kim, K. Y., Manem, R., Cheng, C., Zhou, Q. Tags: Editor's choice Original research Source Type: research
Predominant learning approaches of medical students in Saudi Arabia
Conclusion
The findings from this study show that medical students predominantly favour the deep learning approach. Results from this study encourage the continuous adaptation of clinical teaching in medical schools to optimise students’ learning experiences. (Source: Postgraduate Medical Journal)
Source: Postgraduate Medical Journal - October 21, 2022 Category: General Medicine Authors: AlOmar, R. S., AlShamlan, N. A., AlAmer, N. A., Albrahim, N. I., Alshulah, Z. Z., Kalalah, Z. A., Almoaibed, D. M., Alshulah, H. Z., AlRashid, M. R., Althumairi, A. A., Althunyan, A. K. Tags: Original research Source Type: research
