Journal of the Royal College of Physicians of Edinburgh最新文献

{"title":"The reversible absence of brainstem reflexes does not mimic death by neurological criteria.","authors":"Sophie Robinson, Mark A Henderson","doi":"10.1177/14782715241308924","DOIUrl":"https://doi.org/10.1177/14782715241308924","url":null,"abstract":"","PeriodicalId":46606,"journal":{"name":"Journal of the Royal College of Physicians of Edinburgh","volume":" ","pages":"14782715241308924"},"PeriodicalIF":1.1,"publicationDate":"2024-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142839954","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":"Why do doctors use AI in healthcare?","authors":"Abeera Junaid, Tamsin Adhiyaman, Nithin Fernando Edwin, Vedamurthy Adhiyaman","doi":"10.1177/14782715241306146","DOIUrl":"https://doi.org/10.1177/14782715241306146","url":null,"abstract":"","PeriodicalId":46606,"journal":{"name":"Journal of the Royal College of Physicians of Edinburgh","volume":" ","pages":"14782715241306146"},"PeriodicalIF":1.1,"publicationDate":"2024-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142808183","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":"Avascular necrosis of the hip post radioactive Palladium-103 seed implantation in a patient with prostate cancer.","authors":"Shivanee Vigneswaran, Ali S Jawad","doi":"10.1177/14782715241304450","DOIUrl":"https://doi.org/10.1177/14782715241304450","url":null,"abstract":"","PeriodicalId":46606,"journal":{"name":"Journal of the Royal College of Physicians of Edinburgh","volume":" ","pages":"14782715241304450"},"PeriodicalIF":1.1,"publicationDate":"2024-12-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142796402","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":"Secondary haemophagocytic lymphohistiocytosis associated with scrub typhus: A case report with a brief review of literature.","authors":"Rupak Chatterjee, Atanu Chandra, Sumana Mukherjee, Nandini Chatterjee, Sugata Dasgupta","doi":"10.1177/14782715241303969","DOIUrl":"https://doi.org/10.1177/14782715241303969","url":null,"abstract":"<p><p>Scrub typhus is a very important cause of acute undifferentiated febrile illness in the Asia-Pacific region. Haemophagocytic lymphohistiocytosis (HLH) is a rare and life-threatening condition characterised by widespread immune system activation, resulting in tissue damage throughout multiple organ systems. HLH is categorised into primary HLH, arising from intrinsic defects in lymphocytes and macrophages, and secondary HLH, primarily triggered by infections or connective tissue disorders. HLH is one of the rarest complications of scrub typhus. We present the case of a previously healthy young man who presented to our facility with a history of acute febrile illness. Clinical examination revealed an eschar and subsequent laboratory investigations confirmed the diagnosis of scrub typhus. The patient's haematological parameters showed pancytopenia, raising suspicion of this rare association. Confirmatory tests established the diagnosis of HLH, and the patient achieved an uneventful recovery following treatment for the underlying illness and supportive care.</p>","PeriodicalId":46606,"journal":{"name":"Journal of the Royal College of Physicians of Edinburgh","volume":" ","pages":"14782715241303969"},"PeriodicalIF":1.1,"publicationDate":"2024-12-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142796404","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":"Medical emergencies in hospital: The role of treatment escalation plans in out-of-hours decision-making.","authors":"Tze Yi Gan, Roy Harris, D Robin Taylor","doi":"10.1177/14782715241298525","DOIUrl":"10.1177/14782715241298525","url":null,"abstract":"<p><strong>Background: </strong>Out-of-hours medical emergencies are common in acute hospitals, and are often attended by staff who are unfamiliar with the patient's clinical background. Information in the hospital notes may or may not include guidance about how best to deal with clinical deterioration. The use of Treatment Escalation Plans (TEPs) attempts to address these deficiencies.</p><p><strong>Methods: </strong>This was an observational, questionnaire-based evaluation of the experience of trainee hospital doctors who attended out-of-hours medical emergencies.</p><p><strong>Results: </strong>Sixty-five medical emergencies were evaluated by a total of 38 doctors. Thirty patients had a TEP, attended by 20 doctors, and 35 without a TEP were attended by 27 doctors. Information from medical notes to facilitate decision-making was deemed sufficient by the attending doctor in 77% of patients with a TEP, compared to 54% of patients with no TEP. Only 10% of patients with a TEP had their treatment escalated at the time of the call, whereas this occurred in 20% of patients without a TEP (NS). A TEP was deemed 'somewhat' or 'very' helpful by trainees in 21/30 of the cases who had one. In 27/35 cases who did <i>not</i> have a TEP, trainees deemed that it would have been helpful to have had one. Twelve of 38 participants (32%) considered that there was a discrepancy between what was 'expected' and what they considered to be 'right' when managing out-of-hours emergencies.</p><p><strong>Conclusion: </strong>TEPs have an important role in delivering key information that shapes out-of-hours decision-making in deteriorating patients. Both objective outcomes and the subjective quality of medical decision-making are enhanced when a TEP is available.</p>","PeriodicalId":46606,"journal":{"name":"Journal of the Royal College of Physicians of Edinburgh","volume":" ","pages":"284-289"},"PeriodicalIF":1.1,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142773634","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":"A physical directory.","authors":"","doi":"10.1177/14782715241307790","DOIUrl":"10.1177/14782715241307790","url":null,"abstract":"","PeriodicalId":46606,"journal":{"name":"Journal of the Royal College of Physicians of Edinburgh","volume":" ","pages":"348"},"PeriodicalIF":1.1,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142808178","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":"Hereditary haemochromatosis: A review.","authors":"Prabhsimran Singh, Charles Millson, Robert Driver","doi":"10.1177/14782715241298724","DOIUrl":"10.1177/14782715241298724","url":null,"abstract":"<p><p>Hereditary haemochromatosis (HH) is the commonest genetic condition among populations of Northern European ancestry. Mutations to the <i>HFE</i> gene leads to uninhibited intestinal iron absorption followed by excess iron deposition in various organs such as the liver, pituitary gland, pancreas and heart. Due to variable biochemical and clinical penetrance, not all individuals with C282Y homozygosity will develop HH. Early diagnosis is crucial to prevent morbidity and mortality but is challenging with most patients not exhibiting any symptoms. Patients with HH should undergo clinical assessment to evaluate their symptoms, presence of organ damage and hepatic fibrosis using transient elastography. Patients who are negative for the <i>HFE</i> mutations but have significant liver iron loading seen on magnetic resonance imaging should be reviewed by a specialist and considered for genetic tests looking for the rarer non-<i>HFE</i> mutations. HH patients are predominantly treated with venesection which can improve symptoms, hepatic fibrosis and mortality.</p>","PeriodicalId":46606,"journal":{"name":"Journal of the Royal College of Physicians of Edinburgh","volume":" ","pages":"340-347"},"PeriodicalIF":1.1,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142629904","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":"James (Carrick) Moore (1763-1860): Another (Scottish) Local Anaesthetic Hero.","authors":"Jaw Tony Wildsmith","doi":"10.1177/14782715241298138","DOIUrl":"10.1177/14782715241298138","url":null,"abstract":"<p><p>Modern technology has provided the author with access to a previously unobtainable publication, John Moore's 1784 work, '<i>A Method of Preventing or diminishing Pain in Several Operations of Surgery</i>'. Not only did this allow direct consideration of his technique of nerve compression (which has been described briefly by many others since), but also showed that Moore had very advanced humane views on the need to try and produce pain relief for surgery. It also became possible to obtain far more information on the author, notably that although he worked in London he was born and educated in Glasgow, and did his initial medical training in Edinburgh. He thus is one of a group, all of whom were Scots, who did preliminary work on local anaesthesia before the recognition of the local action of cocaine. His technique was tried, apparently successfully, for a below-knee amputation by John Hunter, and while both the technique and his humane approach were noted by others, the method does not seem to have found wider favour. He continued working as a surgeon in London until he inherited an estate in south-west Scotland, this allowing him to give up clinical practice and focus on writing and campaigning. He wrote the definitive biography of his brother (Sir John Moore of Corunna fame) and was a leading advocate of vaccination, leading the organisation after Jenner's death. These activities meant that he was well known in his lifetime, but he deserves to be better known today as being the first person to promote the need for pain relief during surgery.</p>","PeriodicalId":46606,"journal":{"name":"Journal of the Royal College of Physicians of Edinburgh","volume":" ","pages":"335-339"},"PeriodicalIF":1.1,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142629907","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":"Findings on serial thigh MRI can identify individuals with inflammatory myositis who recover sub-optimally: A 6-month follow-up study.","authors":"Mamatha Gorijavolu, Chengappa G Kavadichanda, Aishwarya Gopal, Ramesh Ananthakrishnan, Dhukhabandhu Naik, Christina Mary Mariaselvam, Molly Mary Thabah, Vir Singh Negi","doi":"10.1177/14782715241300850","DOIUrl":"10.1177/14782715241300850","url":null,"abstract":"<p><strong>Background: </strong>Magnetic resonance imaging (MRI) of the thigh is used in diagnosis of idiopathic inflammatory myositis (IIM) diagnosis due to its high sensitivity in detecting muscle oedema and to localize the site for muscle biopsy. At the same time, dual energy absorptiometry (DXA) is an accepted method in clinical practice to measure muscle mass and change in body composition. In this longitudinal study of patients with active IIM we sought to correlate muscle findings on serial thigh MRI and body composition assessed using DXA with six-month clinical outcomes, we also studied correlation of thigh MRI scores with body composition parameters.</p><p><strong>Methods: </strong>A single-centre prospective study involving 20 active IIM patients. Clinical outcomes, muscle enzymes, MRI of the thigh scores and body composition were periodically assessed over 6 months.</p><p><strong>Results: </strong>Muscle oedema score significantly decreased from baseline (median 17.7) to 3 months (0.7) and 6 months (0) (<i>p</i> < 0.001). Fatty infiltration increased significantly from baseline (8.8) to 3 months (13.3; <i>p</i> < 0.001) and remained stable. Muscle atrophy score did not change significantly from baseline to 3 or 3 to 6 months. Body composition indices showed significant changes over 6 months, with increases in both lean mass indices and adiposity measures (<i>p</i> < 0.05). Muscle oedema score significantly correlated with manual muscle testing-8 (MMT-8) at baseline (<i>r</i> = -0.64). At 6 months MMT-8 showed a significant negative correlation with muscle atrophy (<i>r</i> = -0.562) and fatty infiltration (<i>r</i> = -0.478) but not with muscle oedema. Multivariate regression model revealed muscle oedema scores at 3 months (<i>p</i> = 0.03) and baseline muscle atrophy (<i>p</i> = 0.02) as significant predictors of MMT-8 at 6 months.</p><p><strong>Conclusion: </strong>Thigh MRI correlated with clinical outcomes both cross-sectionally and longitudinally. Higher baseline muscle atrophy and fatty infiltration, and higher muscle oedema at 3 months predict suboptimal clinical outcomes at 6 months. Intramuscular fatty infiltration scores on thigh MRI did not correlate with lower limb fat indices but correlated with overall fat indices on DXA scan.</p>","PeriodicalId":46606,"journal":{"name":"Journal of the Royal College of Physicians of Edinburgh","volume":" ","pages":"290-297"},"PeriodicalIF":1.1,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142695985","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":"Unlocking the diagnostic riddle: Beyond arthritis in DIP joint deception.","authors":"Saranya Chinnadurai, Sabarinath Mahadevan, PadamKumar Bhawarlal","doi":"10.1177/14782715241288903","DOIUrl":"10.1177/14782715241288903","url":null,"abstract":"<p><p>Glomus tumour is a rare benign neoplasm arising from specialized neuromyoarterial plexus situated in the subungual region. Here, we present a 36-year-old male who had severe pain in the distal part of left third finger mimicking distal interphalangeal joint arthritis (DIP). On evaluation, he was found to have severe tenderness just distal to the DIP joint line. Also, he had positive cold sensitivity test. MRI showed high-signal intensity lesion in the dorsal aspect of left third digit. Glomus tumour was suspected based on these findings. Surgical excision was done followed by histopathological examination, confirmed the diagnosis. We present this case to raise awareness about this rare condition and the possibility of misinterpreting distal pain as DIP arthritis.</p>","PeriodicalId":46606,"journal":{"name":"Journal of the Royal College of Physicians of Edinburgh","volume":" ","pages":"330-331"},"PeriodicalIF":1.1,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142356159","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}