MyMedR

The silver lining: pleural calcification in an end-stage renal disease patient with tertiary hyperparathyroidism

Chiew KS, Cheng YF

J R Coll Physicians Edinb, 2020 Jun;50(2):164-165.

PMID: 32568291 DOI: 10.4997/JRCPE.2020.219

Bilateral medial medullary stroke: A rare stroke syndrome masquerading as myasthenia crisis in a young diabetic lady

Benjamin NHS, Gin TH, Ling Elora OY, Yung Kelly WK

J R Coll Physicians Edinb, 2022 Mar;52(1):30-33.

PMID: 36146975 DOI: 10.1177/14782715221088914

Bilateral medial medullary stroke is a rare stroke syndrome. The clinical presentation of bilateral medial medullary stroke is heterogenous and often overlaps with other non-stroke neurology emergencies such as Guillain-Barrésyndrome, myasthenic crisis and acute vestibular syndrome, leading to misdiagnosis. We wish to present a case of a young lady with type 1 diabetes mellitus, who had presented with subacute neuromuscular weakness which was erroneously treated as myasthenic crisis. Her case was subsequently diagnosed as bilateral medial medullary stroke, following evolving clinical signs and magnetic resonance imaging (MRI) findings of a heart-shaped abnormality at the rostral medulla. This rare stroke syndrome represented a diagnostic challenge which necessitated a strong clinical suspicion and an urgent MRI scan of the brain for prompt diagnosis to enable appropriate treatment initiation.

A rare case of a mother with gestational diabetes complicated with fulminant type 1 diabetes mellitus post-delivery

Ting Tai Y, Mohd Noor N

J R Coll Physicians Edinb, 2022 Jun;52(2):120-123.

PMID: 36147001 DOI: 10.1177/14782715221103668

Fulminant type 1 diabetes mellitus (FT1DM) is recognised as a novel subtype of type 1 diabetes mellitus characterised by the abrupt onset of insulin-deficient hyperglycaemia and ketoacidosis. Fulminant type 1 diabetes mellitus is known to be associated with pregnancy and had been associated with high fetal mortality. We report a case of a gestational diabetes mellitus (GDM) mother complicated with FT1DM immediately post-delivery. A 29-year-old Malay lady who was diagnosed with GDM at 19 weeks of pregnancy, underwent emergency lower segment caesarean section (EMLSCS) due to fetal distress at 36 weeks of gestation; 18 h post-EMLSCS, she developed abrupt onset Diabetic ketoacidosis (DKA) (blood glucose 33.5 mmol/L, pH 6.99, bicarbonate 3.6 mmol/L, ketone 4.4 mmol/L and HbA1c 6.1%). She received standard DKA treatment and discharged well. Her plasma C-peptide level 3 weeks later showed that she has no insulin reserve (C-peptide <33 pmol/L, fasting blood glucose (FBS) 28 mmol/L). Her pancreatic autoantibodies were negative. This case highlights that FT1DM not only can occur in pregnancy with normal glucose tolerance but can also complicate mother with GDM.

A probable case of vaccine-induced immune thrombotic thrombocytopenia secondary to Pfizer Comirnaty COVID-19 vaccine

Goh Cy C, Teng Keat C, Su Kien C, Ai Sim G

J R Coll Physicians Edinb, 2022 Jun;52(2):113-116.

PMID: 36146992 DOI: 10.1177/14782715221103660

The accelerated development of various vaccines against COVID-19 was a global effort to curb the COVID-19 pandemic. As a result, several unique vaccine-related adverse events were observed. Vaccine-induced immune thrombotic thrombocytopenia (VITT) has been recognised as a clinically distinct entity with a predisposition for thrombosis at unusual sites with laboratory features of consumptive coagulopathy in addition to anti-PF4 assay seropositivity. The majority of cases reported were associated with adenoviral-based vectors such as ChAdOx1 nCoV-19 (Oxford-AstraZeneca) and Janssen Ad26.COV2.S (Johnson & Johnson). In our online search, we have not found any reports to date of VITT associated with Pfizer-BioNTech Comirnaty mRNA vaccine. We report a case of a previously healthy 76-year-old man who received his first-dose Pfizer Comirnaty vaccine on 11 October 2021 who developed left upper limb swelling on day 2 post-vaccination, which progressively worsened on day 4 post-vaccination. He was confirmed to have left axillary vein thrombosis on computer tomography arteriography/computed tomography venography of left upper limb on day 5 post-vaccination with new onset aphasia with unilateral limb weakness on day 8 post-vaccination. Magnetic resonance imaging/magnetic resonance angiography of the brain confirmed acute left middle cerebral artery thrombosis with infarction. Blood investigations showed thrombocytopenia, elevated D-dimer, hypofibrinogenemia in addition to his unusual sites of thrombosis involving both arterial and venous circulation. His IgG ELISA assay for anti-PF4 antibody was positive.

Addressing unmet needs for patients with previous upper gastrointestinal bleed requiring concomitant aspirin and non-steroidal anti-inflammatory drugs

Jayaraman T, Wong MS, Mustaffa N, Lee YY

J R Coll Physicians Edinb, 2017 12;47(4):356-358.

PMID: 29537408 DOI: 10.4997/JRCPE.2017.411

Disseminated tuberculosis - diagnostic challenges of atrial tuberculoma masquerading as atrial myxoma

Alaga A, Yew YX, Razul MK

J R Coll Physicians Edinb, 2017 Dec;47(4):353-355.

PMID: 29537407 DOI: 10.4997/JRCPE.2017.410

A 47-year-old female, with multiple comorbidities, presented with a cough of two months, loss of weight and appetite. She was treated for pneumonia. A chest X-ray showed bilateral reticulonodular opacities. She was noted to have a vague central abdominal mass and a systolic murmur over the mitral region. Ultrasonography and computed tomography of the abdomen showed an omental mass and loculated ascites. Oesophagoduedenoscopy showed antral gastritis and during colonoscopy the surgical team was unable to advance the scope beyond 40 cm due to external compression. An echocardiogram showed a right atrial mass and a pericardial effusion over the posterior wall. A possible diagnosis of atrial myxoma was made. Sputum acid-fast bacillus was negative. The patient was treated empirically for disseminated tuberculosis and scheduled for bronchoscopy by the pulmonology team. The patient showed remarkable improvement after day 7 of anti-tuberculosis medication. GeneXpert study came back as positive. CT abdomen and echocardiogram repeated after 2 weeks of treatment showed reduction in the mass.

Successful treatment of confluent and reticulated papillomatosis with a combination of doxycycline and topical tretinoin

Ting IPL, Kiing JW

J R Coll Physicians Edinb, 2024 Mar;54(1):59-61.

PMID: 38357752 DOI: 10.1177/14782715241227468

The epidemiological characteristics of sleep disordered breathing in congestive heart failure: A prospective, single centre study in Southeast Asia

Lourdesamy Anthony AI, Abdul Rani R

J R Coll Physicians Edinb, 2024 Mar;54(1):18-25.

PMID: 38509698 DOI: 10.1177/14782715241239704

BACKGROUND: The presence of sleep-disordered breathing (SDB) in congestive heart failure (CHF) is associated with poor prognosis and is underdiagnosed despite advances in CHF management. The prevalence of SDB in CHF remains understudied in South East Asia.

METHODS: A prospective, observational single-centre study was conducted where 116 consecutive patients in a specialised heart failure clinic underwent level 1, attended polysomnography (PSG).

RESULTS: The prevalence of SDB was 78% using the apnoea-hypopnea index (AHI), AHI ⩾ 5/h threshold, and 59% with the AHI ⩾ 15/h threshold. Obstructive sleep apnoea (OSA) was the predominant type of SDB and was associated with increased body mass index and neck circumference. STOP-BANG was predictive of SDB, especially in men. Central sleep apnoea (CSA) patients had worse sleep indexes and lower awake arterial carbon dioxide. SDB was also homogenously present in preserved ejection fraction (EF) CHF.

CONCLUSION: Most of the CHF patients were found to have SDB with the utility of PSG. Local CHF guidelines should include sleep testing for all patients with CHF.The study is registered on ClinicalTrials.gov (NCT05332223) as 'The Epidemiological Characteristics of SDB in Patients with Reduced or Preserved EF CHF'.

Calcinosis universalis and breast cancer: A distinctive association

Nor Hashimah AMM, Kan SL, Raymond AA

J R Coll Physicians Edinb, 2022 Jun;52(2):134-137.

PMID: 36147003 DOI: 10.1177/14782715221104860

Calcinosis universalis (CU) is characterised by diffuse deposition of insoluble calcium salt in the skin, subcutaneous tissue or organs. Calcium deposits in the breast may be associated with an increased risk for developing breast cancer. We present a case of a 65-year-old woman diagnosed with CU secondary to undifferentiated connective tissue disease. She developed progressive calcification of her skin, which did not improve with oral medications aimed at reducing the calcification. Investigations to look for possible causes of calcification were all unremarkable. During follow-up, calcification was also found in both her breasts. Initial mammography was reported as fibroadenoma. However, 3 years later, she returned with metastatic breast cancer which presented with a massive pleural effusion of the right lung. Calcinosis universalis should now be considered as a risk factor for breast cancer.

Effects of metformin on glycaemic variability in combination with insulin in overweight/obese patients with type 1 diabetes

Poh Shean W, Chin Voon T, Long Bidin MBB, Adam NLB

J R Coll Physicians Edinb, 2023 Jun;53(2):94-103.

PMID: 37154572 DOI: 10.1177/14782715231170958

BACKGROUND: The prevalence of overweight and obesity in type 1 diabetes mellitus (T1DM) individuals is increasing. Overweight people with T1DM may be insulin resistant. Glycaemic variability (GV) is an emerging measure of glycaemic control. The aim of this study is to investigate whether metformin, in adjunct to insulin, would have any favourable effect on GV.

METHODS: This was a multi-centre, open-label randomised crossover study. Twenty-four overweight/obese T1DM patients aged ⩾18 years old with HbA1c ⩾ 7.0% (53 mmol/mol) were recruited and randomised into two study arms. For first 6-week, one arm remained on standard of care (SOC), the other arm received metformin, adjunctive to SOC. After 2-week washout, patients crossed over and continued for another 6 weeks. Glycaemic variability, other glycaemic parameters and metabolic profile were monitored.

RESULTS: There were significant reduction in metformin group for GV: mean (0.18 ± 1.73 vs -0.95 ± 1.24, p = 0.014), %CV (-15.84 (18.92) vs -19.08 (24.53), p = 0.044), glycemic risk assessment of diabetes equation (-0.69 (3.83) vs -1.61 (3.61), p = 0.047), continuous overlapping net glycaemic action (0.25 ± 1.62 vs -0.85 ± 1.22, p = 0.013), J-index (-0.75 (21.91) vs -7.11 (13.86), p = 0.034), time in range (1.13 ± 14.12% vs 10.83 ± 15.47%, p = 0.032); changes of systolic blood pressure (2.78 ± 11.19 mmHg vs -4.30 ± 9.81 mmHg, p = 0.027) and total daily dose (TDD) insulin (0.0 (3.33) units vs -2.17 (11.45) units, p = 0.012). Hypoglycaemic episodes were not significant in between groups.

CONCLUSION: Metformin showed favourable effect on GV in overweight/obese T1DM patients and reduction in systolic blood pressure, TDD insulin, fasting venous glucose and fructosamine.

Clinical characteristic of cutaneous tuberculosis in a tertiary hospital in East Malaysia between January 2014 and September 2021

Hock Gin T, Jiu Wen K, Sze Ying F, Muniandy P

J R Coll Physicians Edinb, 2022 Dec;52(4):363-364.

PMID: 36533387 DOI: 10.1177/14782715221133077

Spontaneous resolution of primary hyperparathyroidism post-biopsy-related neck haematoma

Goh Q, Tong C

J R Coll Physicians Edinb, 2023 Dec;53(4):252-254.

PMID: 37642421 DOI: 10.1177/14782715231196602

Spontaneous or fine-needle aspiration (FNA)-induced remission of primary hyperparathyroidism (PHPT) is an extremely rare phenomenon with variable outcomes. We report a 75-year-old Male who initially presented with left ureteric calculi and was found to have PHPT. Imaging studies including ultrasound neck, parathyroid sestamibi scan and computed tomography of thorax, abdomen, and pelvis failed to identify the culprit lesion and exploratory parathyroidectomy was planned. Before surgery, he underwent FNA for cytology of a right cold thyroid nodule which was complicated with a large neck haematoma and dysphagia. The cytology of the aspirated fluid was consistent with a benign cyst. One month after the procedure, serum calcium and phosphate normalised along with resolution of haematoma. He remained in biochemical remission at 1-year follow-up with the latest ultrasound of neck showing resolution of a large colloid nodule that was previously seen occupying the right thyroid lobe.

Displaying publications 21 - 32 of 32 in total