JRSM Open最新文献

{"title":"Life-Threatening Bronchospasm","authors":"J. La-Crette, A. Abdelhamid, A. Chadwick, A. Chakraborty","doi":"10.1177/20542704221086165","DOIUrl":"https://doi.org/10.1177/20542704221086165","url":null,"abstract":"Summary While Eosinophilic Asthma is frequently underdiagnosed, COPD is often misdiagnosed. This case focusses on a COPD misdiagnosis that had life-threatening consequences. The patient was a 59-year-old, male smoker, who presented to the Emergency Department with a week's history of increasing shortness of breath. On presentation, severe respiratory acidosis persisted acidotic despite Nebulisers, Oxygen, Steroids, and Magnesium. He was intubated for two weeks and had severe bronchospasm associated with type 2 respiratory failure. Eosinophils on admission were markedly elevated and remained so despite a week of intravenous steroids. As he missed the window for ECMO, we were advised to look at his diagnostic spirometry. Surprisingly, the spirometry done by his general practitioner, two years prior, showed Asthma not COPD. His blood eosinophils were elevated then, too. A revised diagnosis of Eosinophilic Asthma was given. Intravenous steroids were increased, and nebulised steroids were started. Soon thereafter, his condition improved, and he was stepped down from Intensive care. Hopefully, this case report increases physician knowledge of the different Asthma phenotypes and reduces incidences where correct treatment is only started during an avoidable life-threatening exacerbation.","PeriodicalId":17674,"journal":{"name":"JRSM Open","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49617169","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pneumomediastinum and subcutaneous emphysema post cocaine and amphetamine insufflation.","authors":"Leah Hawkins,&nbsp;Mohammed Ayaz Khalid,&nbsp;Alan Barton","doi":"10.1177/20542704221079120","DOIUrl":"https://doi.org/10.1177/20542704221079120","url":null,"abstract":"<p><p>A 20-year-old gentleman presented with blood-streaked vomitus after insufflation of an unknown amount of powder cocaine and amphetamine. This was taken with an unspecified amount of alcohol. Other notable symptoms were dysphagia, chest pain, palpitations and the patient reported a 'crunchy' sensation in his chest. A chest x-ray revealed pneumomediastinum and a computerised tomography (CT) trauma confirmed these findings with associated subcutaneous emphysema without an identifiable cause. Follow up investigations included a barium swallow and gastroscopy which showed no obvious perforation but mild gastritis and duodenitis. He was managed conservatively with proton pump inhibitor cover and his symptoms resolved.</p>","PeriodicalId":17674,"journal":{"name":"JRSM Open","volume":"13 2","pages":"20542704221079120"},"PeriodicalIF":0.0,"publicationDate":"2022-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/3c/8f/10.1177_20542704221079120.PMC8855391.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39939754","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Laparoscopic diagnosis of idiopathic left ovarian vein thrombosis in a 27-year-old woman.","authors":"Jasper Markus,&nbsp;Robin M F van der Weiden","doi":"10.1177/20542704221074150","DOIUrl":"https://doi.org/10.1177/20542704221074150","url":null,"abstract":"<p><p>Idiopathic left ovarian vein thrombosis was diagnosed in a 27-year-old woman at the time of a diagnostic laparoscopy performed because of a suspected ovarian torsion. The diagnosis was confirmed by abdominal computed tomography scanning. Subsequent magnetic resonance imaging showed no signs of an abdominal or pelvic mass nor enlarged lymph nodes. The patient was treated with systemic anticoagulation therapy for 3 months and made a good recovery. During follow-up it became clear that the patient was already diagnosed with familial hypercholesterolemia before the occurrence of the ovarian vein thrombosis. It remains unclear if familial hypercholesterolemia played a role in the occurrence of ovarian vein thrombosis in our patient.</p>","PeriodicalId":17674,"journal":{"name":"JRSM Open","volume":"13 1","pages":"20542704221074150"},"PeriodicalIF":0.0,"publicationDate":"2022-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/a0/51/10.1177_20542704221074150.PMC8793118.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39734696","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Smartwatch helps detects lung cancer: Using personal technology to advance healthcare.","authors":"Andrew Paul Charles Cole,&nbsp;Ashok Kar,&nbsp;Kofi Nimako,&nbsp;Jeremy Smelt","doi":"10.1177/20542704211068651","DOIUrl":"https://doi.org/10.1177/20542704211068651","url":null,"abstract":"<p><p>The prevalence of smartwatches and other wearable medical technology has been increasing yearly. These watches offer a sensitive tool for capturing cardiac dysrhythmias and can lead to patients seeking earlier medical advice. This case report highlights the importance of clinicians seeking and using the information provided by wearable medical technology which in this case resulted in both the timely treatment of non-sustained ventricular tachycardia and lung adenocarcinoma.</p>","PeriodicalId":17674,"journal":{"name":"JRSM Open","volume":"13 1","pages":"20542704211068651"},"PeriodicalIF":0.0,"publicationDate":"2022-01-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/b1/0e/10.1177_20542704211068651.PMC8733372.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39662359","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"“All things must pass” - Cutaneous migration of an endobronchial valve","authors":"Michelle Lee, R. Baranowski, David Gammon, J. Hargrave, D. Waller","doi":"10.1177/20542704221074148","DOIUrl":"https://doi.org/10.1177/20542704221074148","url":null,"abstract":"Summary The Zephyr (PulmonX Inc., Redwood, CA) endobronchial valve (EBV), predominantly designed for lung volume reduction in emphysema, can also be used to close a spontaneous or post-operative prolonged air leak (PAL). We describe a previously unreported complication of cutaneous migration of an EBV, inserted for management of a PAL from a postoperative bronchopleural fistula (BPF), in a 62-year-old male following a right upper lobe posterior-apical (S1,2) segmentectomy. His PAL resulted in a chronic empyema which failed to respond to surgical debridement, anterior cavernostomy and pectoral myoplasty. Bronchoscopic closure of the air leak by EBV insertion resulted in clinical improvement but there was a residual chronic wound sinus through which the patient reported protrusion of a foreign body that was causing irritation. It was the EBV. We hypothesise that the BPF healed beneath the EBV causing it to dislodge but its route to the skin remains a mystery.","PeriodicalId":17674,"journal":{"name":"JRSM Open","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43895215","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Benign metastasizing leiomyoma - a case of benign metastasis.","authors":"Diogo André, Fabiana Gouveia, Helena Luís, Mónica Caldeira, Filipe Perneta, Marília Jeanette Gonçalves, António José Chaves","doi":"10.1177/20542704211064482","DOIUrl":"10.1177/20542704211064482","url":null,"abstract":"<p><p>Leiomyomas are benign tumours of smooth muscle cells that most often affect the female genital tract, but their metastasis to extra-uterine locations represent rare, yet misunderstood phenomena. The authors present a clinical case of a 42-year-old woman, who underwent a hysterectomy 15 years ago due to myomas, admitted with multiple pulmonary nodules and abdominal mass, diagnosed by imaging tests, in the context of haemoptysis. The anatomopathological exams of the pulmonary and abdominal lesions were compatible with the diagnosis of benign metastatic leiomyoma. Benign metastatic leiomyoma is a rare condition that particularly affects women of childbearing age, with a history of hysterectomy for uterine fibroids. Hence, this entity must be considered in the differential diagnosis of women with pulmonary nodules of uncertain aetiology.</p>","PeriodicalId":17674,"journal":{"name":"JRSM Open","volume":"12 12","pages":"20542704211064482"},"PeriodicalIF":0.0,"publicationDate":"2021-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/18/ca/10.1177_20542704211064482.PMC8674719.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39827544","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Massive haemorrhage: an unusual presentation of systemic lupus erythematosus.","authors":"Wajeeha Qayyum,&nbsp;Sohail Khan,&nbsp;Muhammad Shahid Iqbal,&nbsp;Muhammad Fozan Khan,&nbsp;Zaland Ahmed Yousafzai,&nbsp;Saima Afaq","doi":"10.1177/20542704211062041","DOIUrl":"https://doi.org/10.1177/20542704211062041","url":null,"abstract":"<p><p>Systemic lupus erythematosus (SLE) usually affects young females and its presentation with haemorrhage is unusual. Intracerebral bleed (ICB) has been described in a few case reports, but massive haematuria has not been reported in the literature so far. Here, we present a case of a 56 year-old-lady who presented with expanding lobar bleed and massive haematuria as the first presentation of SLE secondary to vasculitis. Lupus vasculitis usually presents with thrombosis-related complications and although bleeding in this context is rare, it can lead to catastrophic consequences. Hence, vasculitis-related bleeding should be taken under consideration in a challenging situation like ours.</p>","PeriodicalId":17674,"journal":{"name":"JRSM Open","volume":"12 11","pages":"20542704211062041"},"PeriodicalIF":0.0,"publicationDate":"2021-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/dd/d0/10.1177_20542704211062041.PMC8638069.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39694531","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The neurological risks of playing association football.","authors":"Oliver C Cockerell,&nbsp;Natalie Iino Hayes,&nbsp;Richard Sylvester","doi":"10.1177/20542704211055558","DOIUrl":"https://doi.org/10.1177/20542704211055558","url":null,"abstract":"<p><strong>Aims: </strong>The present study aims to provide a narrative review of the literature surrounding concussion and head injury in football and its clarity in evaluating the risk of long-term neurological disease.</p><p><strong>Findings: </strong>Epidemiological studies have shown correlations between participation in professional football and increased incidence of neurodegenerative disease and there have been reports of chronic traumatic encephalopathy (CTE) in the brains of former players in autopsy. These findings have been assumed by some to be the result of repetitive brain injury from head injuries and/or from heading the ball over a player's career. Data linking increased heading exposure with dementia is conflicting, and studies are limited by the reliance on retrospection and undocumented reports of concussion. It remains unclear whether CTE is unique to sportsmen or a variant of dementia pathology endemic in the population.</p><p><strong>Conclusions: </strong>Although logically appealing, there is no current evidence that heading is the cause of neurodegeneration amongst footballers and risks should be balanced by the protective mental and physical benefits of the sport. Physicians have an important role in providing balanced views in this emotive and controversial area.</p>","PeriodicalId":17674,"journal":{"name":"JRSM Open","volume":"12 11","pages":"20542704211055558"},"PeriodicalIF":0.0,"publicationDate":"2021-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/7a/5b/10.1177_20542704211055558.PMC8609100.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39749169","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical frailty as a key characteristic of the patient population of the NHS Nightingale North West COVID-19 temporary emergency field hospital: cohort study April to June 2020.","authors":"M Trent Herdman,&nbsp;Tim Seers,&nbsp;Cassandra Ng,&nbsp;Rebecca Davenport,&nbsp;Sarah Sibley,&nbsp;Steve Mannion,&nbsp;Sooria Balasegaram,&nbsp;Anthony D Redmond","doi":"10.1177/20542704211046435","DOIUrl":"https://doi.org/10.1177/20542704211046435","url":null,"abstract":"<p><strong>Objectives: </strong>COVID-19 temporary emergency 'field' hospitals have been established in the UK to support the surge capacity of the National Health Service while protecting the community from onward infection. We described the population of one such hospital and investigated the impact of frailty on clinical outcomes.</p><p><strong>Design: </strong>Cohort study.</p><p><strong>Setting: </strong>NHS Nightingale Hospital North West, April-June 2020.</p><p><strong>Participants: </strong>All in-patients with COVID-19.</p><p><strong>Main outcome measures: </strong>Mortality and duration of admission.</p><p><strong>Methods: </strong>We analysed factors associated with mortality using logistic regression and admission duration using Cox's regression, and described trends in frailty prevalence over time using linear regression.</p><p><strong>Results: </strong>A total of 104 COVID-19 patients were admitted, 74% with moderate-to-severe frailty (clinical frailty score, CFS > 5). A total of 84 were discharged, 14 transferred to other hospitals, and six died on site. High C-reactive protein (CRP) > 50 mg/dL predicted 30-day mortality (adjusted odds ratio 11.9, 95%CI 3.2-51.5, <i>p</i> < 0.001). Patients with CFS > 5 had a 10-day median admission, versus 7-day for CFS ≤ 5 and half the likelihood of discharge on a given day (adjusted hazard ratio 0.51, 95%CI 0.29-0.92, <i>p</i>  =  0.024). CRP > 50 mg/dL and hospital-associated COVID-19 also predicted admission duration. As more frail patients had a lower rate of discharge, prevalence of CFS > 5 increased from 64% initially to 90% in the final week (non-zero slope <i>p</i> < 0.001). <b>Conclusions:</b> The NNW population was characterized by high levels of frailty, which increased over the course of the hospital's operation, with subsequent operational implications. Identifying and responding to the needs of this population, and acknowledging the risks of this unusual clinical context, helped the hospital to keep patients safe.</p>","PeriodicalId":17674,"journal":{"name":"JRSM Open","volume":"12 10","pages":"20542704211046435"},"PeriodicalIF":0.0,"publicationDate":"2021-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/c7/86/10.1177_20542704211046435.PMC8832049.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39611743","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Achenbach's syndrome: a rare condition.","authors":"Carlos I Higuera-Cetina,&nbsp;Lina M Montaña-Gómez,&nbsp;Yelson A Picón-Jaimes,&nbsp;Javier E Orozco-Chinome,&nbsp;Iván Lozada-Martínez,&nbsp;Luis R Moscote-Salazar","doi":"10.1177/20542704211047121","DOIUrl":"https://doi.org/10.1177/20542704211047121","url":null,"abstract":"<p><p>Achenbach's syndrome corresponds to a pathology characterized by the appearance of ecchymoses and bruises on the fingers of the hands and eventually on the feet. It is a benign and self-limited disease, which is accompanied by pain. It generates great concern because its sudden appearance leads women who are the most affected to consult the emergency services. At present, its pathophysiology is unknown and requires knowledge of the disease to diagnose it. It is a must for poorly trained professionals.</p>","PeriodicalId":17674,"journal":{"name":"JRSM Open","volume":"12 9","pages":"20542704211047121"},"PeriodicalIF":0.0,"publicationDate":"2021-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/bb/01/10.1177_20542704211047121.PMC8458660.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39452250","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}