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

{"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}

{"title":"Storytelling: A learning tool to enhance medical students' empathy, attentive listening, clinical curiosity and reflection.","authors":"Dibyajyoti Pattanaik, Emma Purvis, David Jeffrey","doi":"10.1177/14782715241299839","DOIUrl":"10.1177/14782715241299839","url":null,"abstract":"<p><p>Listening to stories of sickness lies at the heart of the patient-doctor relationship. Storytelling serves as a powerful learning tool fostering empathy, attentive listening, clinical curiosity and reflection, key elements of narrative competence. The patient's story, their history, forms the fundamental core of diagnosis, and their emotions are central to crafting appropriate treatment plans that address their true concerns. This study reviews the benefits of storytelling as a learning tool, particularly in enhancing empathy, attentive listening, clinical curiosity and reflection within medical education. It also describes a practical workshop that demonstrates how storytelling can be utilised to inspire students to develop narrative competence in a supportive learning environment. Since the stories draw on participants' clinical experience, in both primary and secondary care, the article aims to engage clinicians involved in medical education and the teaching of communication skills.</p>","PeriodicalId":46606,"journal":{"name":"Journal of the Royal College of Physicians of Edinburgh","volume":" ","pages":"325-329"},"PeriodicalIF":1.1,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142629912","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":"Making the transition from medical student to junior doctor.","authors":"Isaac Ks Ng","doi":"10.1177/14782715241299837","DOIUrl":"10.1177/14782715241299837","url":null,"abstract":"<p><p>The transition between medical students and junior doctors is known to be a notoriously challenging period of time, contributed by heavy clinical responsibilities, steep learning curves, poor working conditions and various psychological stressors. In addition, there is often a significant lack of support at the organisational or health systems level for fledgling junior physicians in their transition to work life. In this article, I hope to offer several important guiding principles from the perspectives of a medical resident-in-training that I hope will be useful for graduating medical students to ease their transition into the foundational year of practice, such that they can optimise their training and work experience within what is in their control and maintain a sense of purpose even in difficult times.</p>","PeriodicalId":46606,"journal":{"name":"Journal of the Royal College of Physicians of Edinburgh","volume":" ","pages":"316-318"},"PeriodicalIF":1.1,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142649187","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":"Cough-induced vertebral artery dissection: A case report and literature review.","authors":"A Khalid, A Summerbell, P Jha, A H Abdelhafiz","doi":"10.1177/14782715241290309","DOIUrl":"10.1177/14782715241290309","url":null,"abstract":"<p><p>Spontaneous vertebral artery dissection (VAD) is common after minor neck trauma or abrupt neck manipulation, which may result in stroke. However, violent cough is a less recognised cause of VAD. Only a few cases are reported in the literature. We review the literature and report a case of a 62-year-old man who presented with a headache and neck pain following a period of intermittent coughing, which led to VAD and a cerebellar ischaemic stroke. He responded well to medical treatment and made a full recovery. Therefore, VAD should be considered in the differential diagnosis for patients presenting with neck pain and headache after episodes of violent coughing.</p>","PeriodicalId":46606,"journal":{"name":"Journal of the Royal College of Physicians of Edinburgh","volume":" ","pages":"298-303"},"PeriodicalIF":1.1,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142401598","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":"Revisiting the conceptualisation and implications of medicine's 'hidden curriculum'.","authors":"Isaac Ks Ng, Li Feng Tan, Wilson Gw Goh, Christopher Thong, Kevin Sh Teo, Desmond B Teo","doi":"10.1177/14782715241293814","DOIUrl":"10.1177/14782715241293814","url":null,"abstract":"<p><p>In medical training and practice, our professional attributes, attitudes, perceptions, character traits and identities are fundamentally shaped by our lived experiences and observations in clinical and para-clinical settings instead of being inculcated through formal curriculum or classroom teaching. For instance, clinical acumen, communication skills and bedside manners are learnt through role modelling and experiential learning in the course of clinical rotations. Likewise, one's attitudes, professional behaviours and inclinations are often also influenced by direct/indirect observations of the actions of others in the medical fraternity in various clinical and non-clinical settings. This is also what is often termed as the 'hidden curriculum' of medicine. In this article, we sought to provide a practical conceptualisation of the hidden curriculum in medical training, which we describe as lived experiences and personal observations of medical trainees and residents in clinical and para-clinical spaces, which shape their perceptions of the medical profession (vocational identity and purpose), patients (patient-physician relationship) and colleagues (intra- and inter-professional relationships), with downstream implications on physician well-being and clinical decision-making. Although this idea of a 'hidden curriculum' has conventionally carried predominantly negative connotations in medical literature, we suggest that it is an inevitable part of medical education and practice, which, through deliberate regulation, can potentially be shaped to create more positive and meaningful effects in the professional development of medical trainees.</p>","PeriodicalId":46606,"journal":{"name":"Journal of the Royal College of Physicians of Edinburgh","volume":" ","pages":"310-315"},"PeriodicalIF":1.1,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142510186","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":"Proactive frailty in primary care: A primary care system fit for frailty.","authors":"Lloyd D Hughes, Tara Verity, Liz Lawn, Deb Gompertz","doi":"10.1177/14782715241286918","DOIUrl":"10.1177/14782715241286918","url":null,"abstract":"<p><p>Older adults with frailty are at increased risk of premature death, and numerous negative sequalae including falls, disability, and dementia alongside increased healthcare costs. Most healthcare interactions for older people with frailty take place in primary care, and there is increasing interface working between primary and secondary care to manage this patient group including virtual wards, frailty management programmes and Hospital @ Home. This commentary aims to place proactive frailty into recent policy perspective, alongside highlighting some of the current challenges around the implementation of proactive frailty programmes.</p>","PeriodicalId":46606,"journal":{"name":"Journal of the Royal College of Physicians of Edinburgh","volume":" ","pages":"280-283"},"PeriodicalIF":1.1,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142378428","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":"Successful management of refractory Cushing's disease with severe hypercortisolemia using etomidate and temozolomide in post-surgical failure.","authors":"Neeti Agrawal, Debalina Sarkar, Subhankar Chatterjee, Pallab Sinha, Ranita Bhattacharya, Prabhat Ranjan, Partha Pratim Chakraborty, Rana Bhattacharjee","doi":"10.1177/14782715241293817","DOIUrl":"10.1177/14782715241293817","url":null,"abstract":"<p><p>Corticotropinomas account for 20% of all aggressive pituitary tumors and pituitary carcinomas and are associated with high mortality. These tumors not only cause neurovascular compromise but can also be fatal due to severe hypercortisolemia itself. Although surgery is considered the primary treatment modality, it is often partially successful or unsuccessful. Moreover, these tumors frequently recur and may be resistant to conventional treatments, including surgery and radiotherapy. Therefore, early multimodal treatment and regular follow-up are necessary. We present a case of aggressive Cushing's disease managed with combined temozolomide therapy and radiotherapy following an unsuccessful transsphenoidal surgery, resulting in significant long-term radiological and biochemical remission. In addition, etomidate infusion was administered to achieve rapid cortisol reduction, highlighting its role as a bridging therapy to other modalities in treating life-threatening and severe hypercortisolemia outside an intensive care setting.</p>","PeriodicalId":46606,"journal":{"name":"Journal of the Royal College of Physicians of Edinburgh","volume":" ","pages":"304-309"},"PeriodicalIF":1.1,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142548139","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}