醫教週報第五十二期

2023年9月24日出刊

這裡是第52區第五十二期內科週報👽
轉眼間就進入九月最後一週
不曉得大家有沒有漸漸抓到新崗位上的步調呢？
小編入職也即將滿兩個月
中間受到許多老師與學長姐的指導與照顧
真的很謝謝他們
希望未來也能跟他們一樣厲害！
祝這些前輩教師節快樂！
各位讀者也中秋愉快～🌕🥮

本週學術活動

時間/地點	主題/主講/主持	會議網址與備註
9/28(四) 07:30-08:30 第二會議廳	Grand Rounds: What do we do next after early diagnosis of AF by screening? OAC or not? 心臟內科詹益欣醫師/ 謝宜璋主任田亞中部長	https://cgmh.webex.com/cgmh/j.php?MTID=m56b4c5730dab3e06ee40f198a049f348
9/28(四) 12:00-13:30 5AB內科會議室	CXR reading R2 李英誠 R2 林唯尹/ 黃建達副主席	https://cgmh.webex.com/cgmh/j.php?MTID=me52b4ea6ffa2d6d8c7060c2d17559ac7

2023/9/28 (四) Grand Rounds

學術活動回顧

2023/9/19 (二) Morbidity and Mortality Conference

R3 吳聲旻醫師

這個病人是我二月在腎臟科跟洪振傑醫師及張明揚醫師的團隊時所遇到的。平常照顧病人時，很常遇到病人說全身無力、很虛弱等等的主訴，因此下意識的很容易忽略，尤其在腎臟科更是如此。近兩三年來，新冠肺炎幾乎改變了所有人的生活，隨之而來的更造成了許多新的共病及新的診斷，剛好遇到了這個case，也就藉這個機會查閱了許多跟新冠肺炎有關的神經學疾病。

這位病患有末期腎病變，長期洗腎的病史，這次住院的主訴是肚子痛及全身無力。或許是平常在醫學中心待習慣了，急診都會幫我們分好病人，所以有些掉以輕心。在病人病情惡化、覺得很喘時，思考不夠全面，只侷限在內科的疾病上，沒有更仔細的對病人做理學檢查以及評估。所以本次報告的投影片在前半部分主要呈現的是思考流程以及鑑別診斷的辨別。

在後半部分，主要介紹了GBS這個疾病在EMG及NCV的結果，還有一些致病機轉、診斷及治療流程。也整理了目前有關新冠肺炎造成的GBS的所有治療方式及預後因子。藉由這個報告，也能仔細的審視自己平常照顧病人時是否都有照著guideline，而不是”經驗性”療法。

最後，報告完了總算是鬆了一口氣，畢竟也很少在這麼多人的面前演講。要特別感謝洪振傑醫師抽空指導我及整理PPT，感謝張明揚醫師百忙之中願意參加這次的會議給予我一些建議，感謝神經內科張君瑋學長，願意幫我修改PPT，給我許多神經內科的思考角度。小時候當clerk時就覺得那時還是神經內科總醫師的學長的神經傳導速度異於常人，若干年後，還是如此。常常飛快的給我許多機轉及鑑別診斷，而我卻連第一個鑑別診斷都還沒聽清楚，希望大家都能因此有些收穫！

感謝吳醫師提拱以下重點簡報：

新年度的內科MM-C，部長請主報者要出一題會後有獎徵答，學弟妹們答題非常踴躍。醫學五林揚修同學在當天答對有獎徵答，以下為他的與會心得：

During the Mortality, Morbidity, and Improvement Conference held on September 19, 2023, a compelling case took the spotlight. The subject was a 65-year-old female patient with a multifaceted medical history, encompassing End-Stage Renal Disease (ESRD), IgA nephropathy, and a recent bout of COVID-19. Her initial presentation was marked by epigastric pain, general weakness, and a fall incident, prompting her admission under the suspicion of acute pancreatitis. However, the situation grew increasingly perplexing as her condition deteriorated, characterized by symptoms such as dyspnea, intermittent diarrhea, and progressive muscle weakness. Following a comprehensive examination, a significant point of focus during the conference was the medical team’s consideration of Guillain-Barre syndrome (GBS) as a potential complication linked to her recent COVID-19 infection.

So, what exactly is Guillain-Barre syndrome? It’s an autoimmune disorder that primarily affects the peripheral nervous system, leading to ascending muscle weakness, which can eventually progress to paralysis. During the conference, one of the emphasis was placed on the recognition of specific laboratory findings associated with GBS. A pivotal indicator in the diagnosis of GBS is what’s known as “albuminocytologic dissociation" in the cerebrospinal fluid (CSF). This term denotes an elevated protein level in the CSF, while the white blood cell count remains within normal parameters. This distinctive CSF profile serves as a critical diagnostic hallmark for GBS. The root cause of GBS is believed to lie in the immune system’s response to a preceding infection, as in the case of COVID-19. Nevertheless, the precise mechanism through which the immune response leads to peripheral nerve demyelination is an area of ongoing investigation. The conference discussions emphasized the crucial need for early GBS recognition due to its potential for severe outcomes. Furthermore, there was debate on the importance of promptly implementing appropriate interventions, considering the complexity of the case.

Reflecting on the conference, I’m struck by the ever-evolving medical knowledge and the unwavering dedication of healthcare professionals when addressing complex cases. As a medical student, I’ve been fortunate to witness the collective expertise and effort devoted to patient care. This case discussion underscores the significance of interdisciplinary collaboration, prompt diagnosis, and appropriate treatments in the face of challenging medical scenarios. Drawing inspiration from the experienced professionals who shared their insights during this enlightening conference, I’m committed to continuous learning and growth in my medical journey, aiming to positively contribute to patient well-being and the advancement of medical science.