Internal medicine journal
-
Nailfold capillaroscopy (NFC) is a simple noninvasive microscopic technique used to identify characteristic morphological abnormalities in the nailfold capillaries. The presence of this microvasculopathy appears to be of fundamental importance in the pathological processes that underlie the scleroderma spectrum disorders (including dermatomyositis and antisynthetase myositis). This review discusses the different methodologies and techniques in performing NFC and stresses the diagnostic utility achieved with simple 'bedside' techniques utilising the ophthalmoscope, dermatoscope or smart phone. ⋯ The aetiopathogenesis of the microvasculopathy is currently unknown but its close association with Raynaud Phenomena and specific autoantibodies together with recent observations from sequential NFC allows speculations on its possible mechanism. Finally, future developments in the use of NFC as a possible biomarker in the management of the scleroderma spectrum disorders are discussed, with a recommendation that NFC becomes more widely available, particularly in rheumatological, immunological and dermatological practice. NFC provides a clinically accessible window on the pathologic process fundamental to scleroderma-related disease.
-
Internal medicine journal · May 2023
Consultation with patients for whom English is not their native language.
Good communication with the patient is the cornerstone of effective and efficient consultation. The absence of a common language between the patient and physician negatively impacts the consultation outcome. ⋯ While involving an interpreter may help, it has its downsides and may not be ideal in all situations. Here, we discuss the experiences of various medical practitioners from different cultural and linguistic backgrounds (from Middle Eastern and Asian Countries) in managing non-English-speaking patients with a focus on the impacts of linguistic/cultural barriers in delivering optimal healthcare services and possible solutions to them.
-
Internal medicine journal · May 2023
Dose-Adjusted-EPOCH-R is a safe and well tolerated outpatient treatment regimen in double-hit lymphoma.
Double-hit lymphoma (DHL) is an aggressive subtype of high-grade B-cell lymphoma with inferior prognosis using standard dose chemotherapy. Controversy remains whether more intensive chemotherapy regimens such as dose-adjusted etoposide, prednisolone, vincristine, cyclophosphamide, doxorubicin and rituximab (DA-EPOCH-R) provide better outcomes in this cohort. ⋯ This study suggests that DA-EPOCH-R is a well tolerated outpatient regimen for DHL and should be considered for initial treatment in medically fit patients. Further prospective studies are warranted to confirm these findings.