Postgraduate Medical Journal

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ISSN / EISSN : 0032-5473 / 1469-0756
Published by: BMJ (10.1136)
Total articles ≅ 23,518
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Vusal Nacafaliyev, , Sevgi Sidika Sayin
Published: 28 September 2022
by BMJ
Postgraduate Medical Journal; https://doi.org/10.1136/pmj-2022-141911

Abstract:
Background The relationship between obstructive sleep apnea syndrome (OSAS) and ischaemic stroke is less known. Objectives This study aimed to investigate the relationship between OSAS and silent brain infarcts (SBI). Methods Patients who applied to our clinic with the complaint of snoring, respiratory arrest during sleep, that underwent polysomnography were included. All patients were undergone cranial magnetic resonance imaging to detect SBI. Results SBI was found in 176 (51.5%) of 270 patients in the group with OSAS and 94 (34.8%) patients without OSAS. The patients were evaluated according to their Apnea–Hypopnea Index(AHI) ratio, and those with were found to be significant in terms of SBI. SBI was detected in 56.56% in the moderate and severe (AHI ˃15) stage group and 39.94% in the normal and mild (AHI ≤15) OSAS group (p=0.009). Conclusions SBI was found to be significantly higher in patients with moderate and severe stage OSAS compared to the normal and mild OSAS group. Desaturations during sleep may influence the formation of these infarcts. Therefore, this study reported that patients with moderate and severe sleep apnea syndrome may have a higher risk of developing ischaemic cerebrovascular disease and that the treatment of these patients should be planned in this respect.
Linlin Liu, Jun Qian, Wenwen Yan, Xuebo Liu, Ya Zhao, Lin Che
Published: 20 September 2022
by BMJ
Postgraduate Medical Journal; https://doi.org/10.1136/pmj-2021-141454

Abstract:
Background The optimal threshold of hyperglycaemia at admission for identifying high-risk individuals in patients with acute myocardial infarction (AMI) and its impact on clinical prognosis are still unclear. Methods We retrospectively reviewed 2027 patients with AMI admitted from June 2001 to December 2012 in the ‘Medical Information Mart for Intensive Care III’ database. The significant cut-off values of admission blood glucose (Glucose_0) for predicting hospital mortality in patients with AMI with and without diabetes were obtained from the receiver operating characteristic (ROC) curve, then patients were assigned to hyperglycaemia and non-hyperglycaemia groups based on corresponding cut-off values. The primary endpoints were the hospital and 1-year mortality. Results Among 2027 patients, death occurred in 311 patients (15.3%). According to the ROC curve, the significant cut-off values of Glucose_0 to predict hospital mortality were 224.5 and 139.5 mg/dL in patients with diabetes and without diabetes, respectively. The crude hospital and 1-year mortality of the hyperglycaemia subgroup were higher than the corresponding non-hyperglycaemia group (p< 0.01). After adjustment, regardless of the state of diabetes, hyperglycaemia at admission was related to significantly increased hospital mortality in patients with AMI. For patients with AMI without diabetes, hyperglycaemia at admission was positively correlated with the increase of 1-year mortality (HR, 1.47; 95% CI 1.18 to 1.82; p=0.001). Nevertheless, this trend disappeared in those with diabetes (HR, 1.35; 95% CI 0.93 to 1.95; p=0.113). Conclusion Hyperglycaemia at admission was an independent predictor for mortality during hospitalisation and at 1-year in patients with AMI, especially in patients without diabetes.
Olivier Uwishema, Stanley Chinedu Eneh, Elissa El Jurdi, Omotayo Faith Olanrewaju, Zahraa Abbass, Mubarak Mustapha Jolayemi, Nour Mina, Lea Kseiry, Irem Adanur, Helen Onyeaka, et al.
Published: 19 September 2022
by BMJ
Postgraduate Medical Journal; https://doi.org/10.1136/pmj-2022-142103

Abstract:
On 22 June 2022, the UK Health Security Agency declared a ‘rare national incidence’ after finding poliovirus in sewage in London for the first time in nearly 40 years. Although no cases of the disease or accompanying paralysis have been documented, the general public’s risk is considered minimal. However, public health experts recommend that families are up to date on their polio vaccines to decrease the chance of harm. This article discusses the epidemiology of poliovirus by examining the aetiology of the disease and current mitigation policies implemented to prevent the spread of type 2 vaccine-deceived poliovirus in the UK. Finally, by examining the clinical features of polio, which range from mild gastroenteritis episodes, respiratory sickness, malaise and severe paralysis type, this article offers an advice on particular therapies and tactics to avoid poliovirus outbreaks and other future outbreaks.
Syifa Azhar, Le Roy Chong
Published: 19 September 2022
by BMJ
Postgraduate Medical Journal; https://doi.org/10.1136/pmj-2022-141998

Abstract:
MRI is an important and widely used imaging modality for clinical diagnosis. This article provides a concise discussion of the basic principles of MRI physics for non-radiology clinicians, with a general explanation of the fundamentals of signal generation and image contrast mechanisms. Common pulse sequences, tissue suppression techniques and use of gadolinium contrast with relevant clinical applications are presented. Knowledge of these concepts would provide an appreciation of how MR images are acquired and interpreted to facilitate interdisciplinary understanding between radiologists and referring clinicians.
Abhilasha Pankaj Boruah,
Published: 19 September 2022
by BMJ
Postgraduate Medical Journal; https://doi.org/10.1136/pmj-2022-142002

Abstract:
The rapid spread of arboviral infections in recent years has continually established arthropod-borne encephalitis to be a pressing global health concern. Causing a wide range of clinical presentations ranging from asymptomatic infection to fulminant neurological disease, the hallmark features of arboviral infection are important to clinically recognise. Arboviral infections may cause severe neurological presentations such as meningoencephalitis, epilepsy, acute flaccid paralysis and stroke. While the pathogenesis of arboviral infections is still being investigated, shared neuroanatomical pathways among these viruses may give insight into future therapeutic targets. The shifting infection transmission patterns and evolving distribution of arboviral vectors are heavily influenced by global climate change and human environmental disruption, therefore it is of utmost importance to consider this potential aetiology when assessing patients with encephalitic presentations.
, Stuart Maitland
Published: 19 September 2022
by BMJ
Postgraduate Medical Journal; https://doi.org/10.1136/pmj-2022-142080

Abstract:
Objectives To investigate whether sentiment analysis and topic modelling can be used to monitor the sentiment and opinions of junior doctors. Design Retrospective observational study based on comments on a social media website. Setting Every publicly available comment in r/JuniorDoctorsUK on Reddit from 1 January 2018 to 31 December 2021. Participants 7707 Reddit users who commented in the r/JuniorDoctorsUK subreddit. Main outcome measure Sentiment (scored −1 to +1) of comments compared with results of surveys conducted by the General Medical Council. Results Average comment sentiment was positive but varied significantly during the study period. Fourteen topics of discussion were identified, each associated with a different pattern of sentiment. The topic with the highest proportion of negative comments was the role of a doctor (38%), and the topic with the most positive sentiment was hospital reviews (72%). Conclusion Some topics discussed in social media are comparable to those queried in traditional questionnaires, whereas other topics are distinctive and offer insight into what themes junior doctors care about. Events during the coronavirus pandemic may explain the sentiment trends in the junior doctor community. Natural language processing shows significant potential in generating insights into junior doctors’ opinions and sentiment.
Manisha Arthur, Kishore Pichamuthu, Vijay Prakash Turaka, Tharani Putta, Mohammad Sadiq Jeeyavudeen, Anand Zachariah, Sowmya Sathyendra, Samuel George Hansdak, Ramya Iyadurai, Reka Karuppusami, et al.
Published: 14 September 2022
by BMJ
Postgraduate Medical Journal; https://doi.org/10.1136/pmj-2021-141343

Abstract:
Background This study determines the diagnostic utility of lung ultrasonography (LUS) in a medical ward in a developing country. In a low resource country like India, we hope that use of lung ultrasound in primary and secondary hospitals will assist in earlier and better bedside diagnosis. Methods This prospective diagnostic study was done to test the diagnostic accuracy of LUS against a composite reference standard, which included clinical history and examination, basic laboratory investigations, imaging and the diagnosis at discharge. We evaluated 321 consecutive patients, admitted in our medical wards with an LUS within 24 hours of the chest radiograph being done. Findings Between August 2016 and August 2017, we enrolled 321 patients. The sensitivity and specificity of the LUS for all pathologies were found to be 82.5% (76.50 to 87.20) and 78.2% (69.09 to 85.26) respectively. A subgroup analysis including the patients in whom CT was part of the composite reference standard showed sensitivity and specificity of 87.9% and 92.9% for all lung pathologies. It was found that there was superior sensitivity and specificity of LUS compared with chest radiograph in a subgroup analysis of pulmonary oedema and acute respiratory distress syndrome (ARDS). Interpretation We found that the LUS was better than chest radiograph and as good as CT in most pathologies, especially pulmonary oedema and ARDS. We believe that training in the basics of bedside LUS must be part of the medical curriculum and a low-cost ultrasound machine must be made available in medical wards, so that clinical diagnosis can be supplemented with this tool. In a low resource setting like India, where access to chest radiograph and CT may be difficult particularly in a rural setup, expertise in LUS would be helpful in easy bedside diagnosis and saving cost on a CT scan.
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