Eyebrow loss and the Queen Anne sign in hypothyroidism
An 85-year-old woman was transferred to our hospital after a 2-day history of difficulty in getting out of bed and eating. She also experienced edema in the limbs for several years and was taking furosemide, but it was ineffective. She did not have any other medical history. Physical examination revealed a blood pressure of 134/61  mmHg, pulse rate of 62 beats/min, respiratory rate of 10 beats/min and body temperature of 35.7°C. The patient’s Glasgow Coma Scale score was 14 (E4V4M6). We observed limb and periorbital edema, as well as loss of the outer third of the eyebrows (Figure  1) and dry skin. Laboratory finding...
Source: QJM - July 14, 2023 Category: Internal Medicine Source Type: research

Deep and long myocardial bridge
A 67-year-old man presented to the emergency department with left-sided chest pain that occurred while he was sleeping. He had experienced similar symptoms once a month for the past 3 years but did not experience any chest pain during physical activity. He did not have any risk factors for coronary heart disease, such as hypertension, obesity, dyslipidemia, cigarette smoking or diabetes mellitus. Electrocardiogram and echocardiography revealed no abnormality. Laboratory tests including serum creatine kinase and troponin levels were normal. Variant angina pectoris was suspected based on clinical manifestations, and an elect...
Source: QJM - July 6, 2023 Category: Internal Medicine Source Type: research

Mondor ’s disease: an overlooked clinical entity
A 50-year-old gentleman with hypertension presented with sudden onset, dull, aching pain on the left side of the chest for 3 days. The pain was persistent throughout the day and was not typical of angina. He denied any history of trauma or discharge from the nipple. Systemic symptoms including fever and cough were absent. There was no history of similar type of lesions in the past. On examination, a tender cord-like lesion was palpated on the anterolateral aspect of the left chest wall (Figure  1A). Routine laboratory investigations were unremarkable. Tests for anticardiolipin antibodies and lupus anticoagulant were negat...
Source: QJM - July 6, 2023 Category: Internal Medicine Source Type: research

Psychological stress, the central nervous system and arrhythmias
SummaryThis review highlights the links between psychological stress and the neurocircuitry of cardiac –brain interactions leading to arrhythmias. The role of efferent and afferent connections in the heart–brain axis is considered, with the mechanisms by which emotional responses promote arrhythmias illustrated by inherited cardiac conditions. Novel therapeutic targets for intervention in the aut onomic nervous system are considered. (Source: QJM)
Source: QJM - July 5, 2023 Category: Internal Medicine Source Type: research

Low incidence of neurological recurrent side effects following COVID-19 reimmunization
We thank Leeet al. who suggested that confounding may be present and proposed that we perform propensity score methods,1,2 traditionally used to address non-random allocation to treatment and control groups to overcome selection effects. We were careful to avoid the language of causality in our paper3 as we completely agree that confounding is a possibility. In the cases presented in our paper, we do not present any variable resembling a treatment or control arm. Both reimmunization and timeliness of reimmunization are, implicitly, end points of the analyses. Nevertheless, we are grateful for the chance to further explore ...
Source: QJM - June 26, 2023 Category: Internal Medicine Source Type: research

Response to: Low incidence of neurological recurrence after two-dose COVID-19 vaccination
We read with great interest a 4-month observational study by Kohet al.1 that investigated the recurrent frequency of neurological side effects after reimmunization with COVID-19. The authors found a low incidence of neurological recurrence after COVID-19 reimmunization. However, we are concerned that some confounders of the results of interest between groups will not be adequately addressed, which could make the research results unreliable. Tables 1 and 2 show that some variables were not balanced at baseline (demographic data and pre-existing comorbidities), especially the age between the reimmunization and non-reimmuniza...
Source: QJM - June 26, 2023 Category: Internal Medicine Source Type: research

Peripartum thrombotic microangiopathy —a enigma
The report by Horinoet al.1 nicely demonstrates a case of renal and systemic thrombotic microangiopathy in a pregnant lady with a background history of systemic sclerosis. The authors also lucidly explain the differentiating features between scleroderma renal crisis (SRC) and thrombotic thrombocytopenic purpura (TTP). However, apart from SRC and TTP, two other differentials should also be considered in a peripartum lady with Thrombotic microangiopathy (TMA), i.e. severe preeclampsia with HELLP and atypical hemolytic uremic syndrome (aHUS). Severe preeclampsis can be differentiated from other hypertensive disorders in pregn...
Source: QJM - June 24, 2023 Category: Internal Medicine Source Type: research

Response to: Peripartum thrombotic microangiopathy: an enigma
We appreciate Dr Sethi insight on our original article titled ‘Postpartum scleroderma renal crisis with renal thrombotic microangiopathy’,1 focusing on differentiating thrombotic microangiopathy (TMA) in pregnant women with a history of systemic sclerosis, highlighting the significance of distinguishing scleroderma renal crisis (SRC). Dr Sethi mentioned severe preeclampsia with hemolysis, elevated liver enzymes, and low platelets (HELLP)  and atypical hemolytic uremic syndrome (aHUS) as differential conditions causing TMA in pregnant women. We sincerely value his contribution to this topic. (Source: QJM)
Source: QJM - June 24, 2023 Category: Internal Medicine Source Type: research

Investigation of liver-targeted peripheral focused ultrasound stimulation (pFUS) and its effect on glucose homeostasis and insulin resistance in type 2 diabetes mellitus: a proof of concept, phase 1 trial
We report the first safety and feasibility outcomes in subjects with type 2 diabetes (T2D) mellitus and discuss these outcomes in relation to previous pre-clinical results.DesignThe study was performed as an open label feasibility study to assess the effects of hepatic ultrasound (targeted to the porta hepatis) on glucometabolic parameters in subjects with T2D. Stimulation (peripheral focused ultrasound stimulation treatment) was performed for 3  days (i.e. 15 min per day), preceded by a baseline examination and followed by a 2-week observation period.MethodsMultiple metabolic assays were employed including measures of f...
Source: QJM - May 27, 2023 Category: Internal Medicine Source Type: research

Real-world implementation of non-endoscopic triage testing for Barrett ’s oesophagus during COVID-19
ConclusionsCytosponge-biomarker tests enabled targeting of endoscopy services to higher-risk individuals, whereas those with TFF3 negative ultra-short segments could be reconsidered regarding their Barrett ’s oesophagus status and surveillance requirements. Long-term follow-up will be important in these cohorts. (Source: QJM)
Source: QJM - May 23, 2023 Category: Internal Medicine Source Type: research

Prognostic factors in hospitalized HIV-positive patients with COVID-19: correspondence
We read with great interest the retrospective study by Moreno-Torreset al.1 on  predictors of in-hospital mortality in HIV-infected patients with COVID-19. The authors based on an analysis of the national public database draw a strong conclusion about risk, stating that COVID inpatients with HIV infection had better survival than those without HIV infection, most likely eluci dated by younger age and a lower frequency of comorbidities. Furthermore, advanced liver disease was associated with an increased risk of fatality in HIV-infected people with COVID-19. Their work is helpful in identifying those at high risk of wo...
Source: QJM - May 22, 2023 Category: Internal Medicine Source Type: research

Response to: Prognostic factors in hospitalized HIV-positive patients with COVID-19: correspondence
UNIR-CiteiIB-23-005 (Source: QJM)
Source: QJM - May 22, 2023 Category: Internal Medicine Source Type: research

Membrane-based cancer nanovaccines: the time is now
Beijing Municipal Health Commission10.13039/501100005088Beijing Demonstration ResearchBCRW20200303National Natural Science Foundation of China10.13039/501100001809Mechanism investigation of CAR- γδT82272951National Natural Science Foundation of China10.13039/50110000180982272953Chinese Academy of Medical Sciences10.13039/5011000051502022-I2M-C&T-B-070 (Source: QJM)
Source: QJM - May 17, 2023 Category: Internal Medicine Source Type: research

Role of optical coherence tomography imaging in treatment of diabetic macular oedema
Learning points for cliniciansTimely treatment of diabetic macular oedema helps restore retinal structure and thereby visual function. Optical coherence tomography is an indispensable tool in diagnosis and monitoring treatment of diabetic macular oedema. (Source: QJM)
Source: QJM - May 17, 2023 Category: Internal Medicine Source Type: research

Emergence of hybrid airway neutrophils with increased mitochondrial metabolism and low inflammatory response in neutrophilic asthma: evidence supporting targeting inhibition of neutrophil glycolysis in this asthma sub-group
Chinese Academy of Medical Sciences Innovation Fund for Medical SciencesCIFMS 2021-I2M-1-048CAMS Innovation Fund for Medical Sciences2021-I2M-1-062National High-Level Hospital Clinical Research Fouding2022-PUMCH-D-005 (Source: QJM)
Source: QJM - May 15, 2023 Category: Internal Medicine Source Type: research