JRSM Open最新文献

{"title":"Hemi-paraplegia and hemi-anaesthesia in the inflammatory bowel disease clinic.","authors":"Hesam Ahmadi Nooredinvand, Anu Vallipuram, Alice Dawson, Jaymin Patel, Waqar Rashid, Andrew Poullis","doi":"10.1177/20542704211035987","DOIUrl":"https://doi.org/10.1177/20542704211035987","url":null,"abstract":"In this case report, we present a rare case of central nervous system demyelination secondary to infliximab therapy. A 47-year-old gentleman with a 15-year history of left sided ulcerative colitis presented to the gastroenterology clinic with a 1-month history of bloody diarrhoea associated with a significantly elevated faecal calprotectin. A trial of oral and rectal mesalazine as well as oral steroids proved ineffective. He had previously been intolerant to both Azathioprine and 6-mercaptopurine. Decision was made to escalate his treatment to methotrexate and infliximab 5 mg/kg (originator). He was managed in the outpatient setting and did not require hospitalization. First infliximab infusion was given on 14 May 2020. Second and third infusion were given two and six weeks after respectively. One week prior to the third infusion, he began to develop tingling and numbness down the right side of his body and he felt his right foot was more sensitive to changes in temperature. His Methotrexate was stopped but it was decided to proceed with giving the third infusion of infliximab. In the following two weeks he then developed weakness in the left leg and reported urinary hesitancy. He was reviewed in the ambulatory unit by the neurologist twelve days following the start of his neurological symptoms. On clinical examination, cranial nerves were intact. He had good muscle bulk and no focal wasting. Tone was normal bilaterally, but power was mildly reduced on the left, 4/5 in wrist, digits, hip flexion and knee extension. Reflexes were present bilaterally, but the supinator, knee and ankle reflexes were brisk on the left. Coordination was intact. There was reduced proprioception and temperature sensation on the right side, with a sensory level just below the clavicle, whilst touch, vibration and two-point discrimination were preserved bilaterally. Plantars were downgoing bilaterally. An urgent MRI of the spine was subsequently arranged which revealed a right sided intramedullary cord lesion at C4 with some focal eccentric enhancement (Figure 1). A subsequent MRI of his head revealed white matter plaques in the cerebral hemisphere and corpus callosum (Figure 2). The post contrast sequences (not shown) showed no features of active demyelination. CSF analysis was positive for IgG oligoclonal bands. Serum oligoclonal band testing revealed no abnormalities. These findings supported a diagnosis of Brown-Sequard syndrome secondary to a cord lesion due to multiple sclerosis (MS). The diagnosis of MS was based on evidence of widespread inflammation in the brain and the spinal cord in addition to positive oligoclonal bands in the CSF, which can be used as criteria for dissemination in time (2017 revised McDonald criteria). His infliximab was discontinued after his third infusion with no deterioration to his colitis and his neurology gradually started to improve two weeks later. He had a further flare of his MS a few months later manifesting as diplopia. Repeat MR","PeriodicalId":17674,"journal":{"name":"JRSM Open","volume":"12 9","pages":"20542704211035987"},"PeriodicalIF":0.0,"publicationDate":"2021-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/66/4a/10.1177_20542704211035987.PMC8411633.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39386186","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":"Hansen's disease - a forgotten disease?","authors":"Paula Marques Ferreira,&nbsp;Inês Rueff Rato,&nbsp;Joana Rigor,&nbsp;Margarida Mota","doi":"10.1177/20542704211035995","DOIUrl":"https://doi.org/10.1177/20542704211035995","url":null,"abstract":"<p><p>Hansen's disease, also known as leprosy, is an infection caused by the bacteria Mycobacterium leprae. The authors present the case of a 52-year-old man, born in Tondela and living in Espinho, with no pathological antecedents. The clinical picture began in April 2017, when macular lesions appeared in the lower limbs and rapidly progressed to the trunk and upper limbs, associated with complaints of pruritus but without alterations in the analytical study. After several topical and systemic treatments with glucocorticoids, antifungals, antibacterials and unsuccessful antihistamines, he was referred to an external consultation of Dermatology. He performed a biopsy of one of the lesions that revealed the definitive diagnosis: \"Lepromatous Leprosy\". After the biopsy result, he started triple treatment with rifampicin, clofazimine and dapsone with improvement of the condition.</p>","PeriodicalId":17674,"journal":{"name":"JRSM Open","volume":"12 8","pages":"20542704211035995"},"PeriodicalIF":0.0,"publicationDate":"2021-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/c6/ea/10.1177_20542704211035995.PMC8411470.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39386185","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":"Myocardial infarction post COVID-19 vaccine - coincidence, Kounis syndrome or other explanation - time will tell.","authors":"Ossama Maadarani,&nbsp;Zouheir Bitar,&nbsp;Mahmoud Elzoueiry,&nbsp;Mohammad Nader,&nbsp;Mohamad Abdelfatah,&nbsp;Tamer Zaalouk,&nbsp;Mohamad Mohsen,&nbsp;Mohamad Elhabibi","doi":"10.1177/20542704211025259","DOIUrl":"https://doi.org/10.1177/20542704211025259","url":null,"abstract":"<p><p>A case of ST elevation myocardial infarction reported post Coronavirus disease 2019 (COVID-19) vaccine. Probably premature to draw a link between COVID-19 vaccine and myocardial infarction.</p>","PeriodicalId":17674,"journal":{"name":"JRSM Open","volume":"12 8","pages":"20542704211025259"},"PeriodicalIF":0.0,"publicationDate":"2021-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/d7/e5/10.1177_20542704211025259.PMC8361528.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39313210","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":"Double heart - chronic large missed pseudoaneurysm of left ventricle.","authors":"Ossama Maadarani,&nbsp;Zouheir Bitar,&nbsp;Ragab Elshabasy,&nbsp;Tamer Zaalouk,&nbsp;Mohamad Mohsen,&nbsp;Mahmoud Elzoueiry,&nbsp;Mohamad Abdelfatah,&nbsp;Mohamad Elhabibi,&nbsp;Mohamad Gohar","doi":"10.1177/20542704211025258","DOIUrl":"https://doi.org/10.1177/20542704211025258","url":null,"abstract":"<p><p>Myocardial infarction is considered the most common cause of left ventricular pseudoaneurysm. Large missed pseudoaneurysm of the left ventricle incidentally diagnosed and treated conservatively.</p>","PeriodicalId":17674,"journal":{"name":"JRSM Open","volume":"12 7","pages":"20542704211025258"},"PeriodicalIF":0.0,"publicationDate":"2021-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/20542704211025258","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39207504","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 hand and digital paroxysmal haematomas: a possible association with joint hypermobility syndrome in two sibling cases.","authors":"Robert Anthony Clive Chate","doi":"10.1177/20542704211023162","DOIUrl":"https://doi.org/10.1177/20542704211023162","url":null,"abstract":"<p><p>A pair of middle-aged sisters is presented who experienced episodes of spontaneous, relatively atraumatic, acute onset, painful sub-cutaneous bleeding into the digits of their hands over a number of preceding years. A literature search revealed they had Achenbach's syndrome, which is a benign and self-limiting condition that resolves completely within 2-4 days. However, a hitherto unreported association between Achenbach's syndrome and joint hypermobility with its abnormal collagen is made, along with a tentative causality hypothesis that perhaps in the presence of atypical connective tissue, the architecture and integrity of the peripheral capillary bed of the hand could be adversely affected and therefore predispose towards paroxysmal palm and/or finger bleeds.</p>","PeriodicalId":17674,"journal":{"name":"JRSM Open","volume":"12 6","pages":"20542704211023162"},"PeriodicalIF":0.0,"publicationDate":"2021-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/20542704211023162","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39334812","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":"Efficacy and safety of non-vitamin K antagonist oral anticoagulants for venous thromboembolism: a meta-analysis.","authors":"Yan Zhuang,&nbsp;Lin-Feng Dai,&nbsp;Ming-Qi Chen","doi":"10.1177/20542704211010686","DOIUrl":"https://doi.org/10.1177/20542704211010686","url":null,"abstract":"<p><strong>Objective: </strong>Several trials had compared the efficacy and safety between non-vitamin K antagonist oral anticoagulants and warfarin for acute venous thromboembolism, but the results were incomplete. This updated review comprehensively assessed the efficacy and safety of non-vitamin K antagonist oral anticoagulants for venous thromboembolism.</p><p><strong>Design: </strong>Meta-analysis of randomised control trials. Six databases were searched from January 2000 to December 2018.</p><p><strong>Setting: </strong>Adult patients had got non-vitamin K antagonist oral anticoagulants or warfarin for venous thromboembolism.</p><p><strong>Participants: </strong>Randomised control trials that compared the efficacy and safety between non-vitamin K antagonist oral anticoagulants and warfarin.</p><p><strong>Main outcome measures: </strong>The efficacy and safety of non-vitamin K antagonist oral anticoagulants .</p><p><strong>Results: </strong>Seven studies involving 29,879 cases were included, among which 14,943 cases were assigned to non-vitamin K antagonist oral anticoagulants group and 14,936 cases to warfarin group. Meta-analysis showed that compared with warfarin, recurrent venous thromboembolism (odds ratio 0.94 [95% confidence interval 0.81 to 1.11]), death related to venous thromboembolism or fatal pulmonary embolism (odds ratio 1.00 [95% confidence interval 0.63 to 1.60]), symptomatic deep-vein thrombosis (odds ratio 0.88 [95% confidence interval 0.72 to 1.09]), symptomatic nonfatal pulmonary embolism (odds ratio 1.03 [(95% confidence interval 0.82 to 1.30]) and all deaths (odds ratio 0.92 [95% confidence interval 0.76 to 1.12]) are similar in non-vitamin K antagonist oral anticoagulants group, but major bleeding event (odds ratio 0.61 [95% confidence interval 0.50 to 0.75]) and clinically relevant non-major bleeding event (odds ratio [95% confidence interval 0.53 to 0.85]) are less in non-vitamin K antagonist oral anticoagulants group. .</p><p><strong>Conclusions: </strong>For the treatment of venous thromboembolism, non-vitamin K antagonist oral anticoagulants is as effective as warfarin, and has a better safety profile than warfarin.</p>","PeriodicalId":17674,"journal":{"name":"JRSM Open","volume":"12 6","pages":"20542704211010686"},"PeriodicalIF":0.0,"publicationDate":"2021-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/20542704211010686","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39111001","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":"Femoral venous aneurysms are rare, yet confer significant mortality risk due to venous thromboembolism; consider in venous thromboembolism of unknown aetiology.","authors":"Bence Csongor Baljer,&nbsp;Lauren Shelmerdine,&nbsp;Gerard Stansby","doi":"10.1177/20542704211001220","DOIUrl":"https://doi.org/10.1177/20542704211001220","url":null,"abstract":"<p><p>Femoral venous aneurysms are a rare disease entity, yet they carry the risk of significant mortality due to venous thromboembolism, as demonstrated by a case report of an otherwise fit and well 74-year-old gentleman.</p>","PeriodicalId":17674,"journal":{"name":"JRSM Open","volume":"12 5","pages":"20542704211001220"},"PeriodicalIF":0.0,"publicationDate":"2021-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/20542704211001220","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39075759","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":"Chest CT versus RT-PCR for the detection of COVID-19: systematic review and meta-analysis of comparative studies.","authors":"Mohammad Karam, Sulaiman Althuwaikh, Mohammad Alazemi, Ahmad Abul, Amrit Hayre, Abdulmalik Alsaif, Gavin Barlow","doi":"10.1177/20542704211011837","DOIUrl":"10.1177/20542704211011837","url":null,"abstract":"<p><strong>Objectives: </strong>To compare the performance of chest computed tomography (CT) scan versus reverse transcription polymerase chain reaction (RT-PCR) as the reference standard in the initial diagnostic assessment of coronavirus disease 2019 (COVID-19) patients.</p><p><strong>Design: </strong>A systematic review and meta-analysis were performed as per the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. A search of electronic information was conducted using the following databases: MEDLINE, EMBASE, EMCARE, CINAHL and the Cochrane Central Register of Controlled Trials.</p><p><strong>Setting: </strong>Studies that compared the diagnostic performance within the same patient cohort of chest CT scan versus RT-PCR in COVID-19 suspected patients.</p><p><strong>Participants: </strong>Thirteen non-randomised studies enrolling 4092 patients were identified.</p><p><strong>Main outcome measures: </strong>Sensitivity, specificity and accuracy were primary outcome measures. Secondary outcomes included other test performance characteristics and discrepant findings between both investigations.</p><p><strong>Results: </strong>Chest CT had a median sensitivity, specificity and accuracy of 0.91 (range 0.82-0.98), 0.775 (0.25-1.00) and 0.87 (0.68-0.99), respectively, with RT-PCR as the reference. Importantly, early small, China-based studies tended to favour chest CT versus later larger, non-China studies.</p><p><strong>Conclusions: </strong>A relatively high false positive rate can be expected with chest CT. It is possible it may still be useful to provide circumstantial evidence, however, in some patients with a suspicious clinical presentation of COVID-19 and negative initial Severe Acute Respiratory Syndrome Coronavirus 2 RT-PCR tests, but more evidence is required in this context. In acute cardiorespiratory presentations, negative CT scan and RT-PCR tests is likely to be reassuring.</p>","PeriodicalId":17674,"journal":{"name":"JRSM Open","volume":"12 5","pages":"20542704211011837"},"PeriodicalIF":0.0,"publicationDate":"2021-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/20542704211011837","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39018403","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":"Folates, folic acid and preconception care - a review.","authors":"Simon H House,&nbsp;John Aa Nichols,&nbsp;Sarah Rae","doi":"10.1177/2054270420980875","DOIUrl":"https://doi.org/10.1177/2054270420980875","url":null,"abstract":"<p><p>The link between folate deficiency and congenital spina bifida defects was first suggested in the 1960s. Although the prevention of these defects by preconception folic acid supplementation was confirmed in a large multi-centre controlled trial in 1991, its subsequent implementation as health education advice has made very little difference. North America's policy of folic acid fortification of flour and bread has had a beneficial impact. No European country has implemented fortification due to concern over possible adverse effects on older subjects, but a recent review shows these to be largely hypothetical and far outweighed by beneficial effects. Recent research by Menezo et al. has, however, shown that folic acid is ineffective for some women with severe fertility problems including recurrent miscarriage and failed in vitro fertilisation. There is a genetically determined bottleneck (677TT) in their folate metabolism that can be successfully overridden by going straight to the next step in the metabolic pathway and taking 5-methylytetrahydrofolate, as a preconception supplement. Menezo suggests that all women with fertility problems should be tested for 677TT. If fortification of flour and bread is to be implemented in the UK, there should be monitoring for possible adverse effects including the incidence of colorectal cancers and cognitive decline. In conclusion, whilst there are concerns that fortification could have a detrimental effect on these conditions, there is sound evidence that it would have much greater beneficial effects.</p>","PeriodicalId":17674,"journal":{"name":"JRSM Open","volume":"12 5","pages":"2054270420980875"},"PeriodicalIF":0.0,"publicationDate":"2021-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/2054270420980875","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39018401","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":"An unusual case of neutrocytic, culture-negative meningitis in an immunocompetent adult.","authors":"Kundoly V Suseela,&nbsp;Firosh Khan,&nbsp;Santhosh J Kottoor","doi":"10.1177/20542704211009354","DOIUrl":"https://doi.org/10.1177/20542704211009354","url":null,"abstract":"<p><p>Patient presenting with fever, acute onset seizure and neck stiffness on examination; deteriorating despite initiation of early treatment for meningitis.</p>","PeriodicalId":17674,"journal":{"name":"JRSM Open","volume":"12 5","pages":"20542704211009354"},"PeriodicalIF":0.0,"publicationDate":"2021-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/20542704211009354","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39018402","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}