The Princess of Wales Hospital (Welsh: Ysbyty Tywysoges Cymru) is a district general hospital in Bridgend, Wales. It is managed by Cwm Taf Morgannwg University Health Board.
Polyarteritis nodosa (PAN) is an uncommon systemic vasculitis involving predominantly medium-sized arteries. Its heterogeneous presentation and relapsing-remitting course often lead to diagnostic delay. We report a 68-year-old male with a 15-month history of progressive peripheral neuropathy, recurrent vasculitic rash, renal impairment, and testicular pain. Laboratory investigations revealed elevated inflammatory markers, positive rheumatoid factor, type II cryoglobulins, and negative antineutrophil cytoplasmic antibody (ANCA). Complement levels were normal on repeated testing, and urinalysis showed isolated proteinuria without red blood cells or casts, arguing against other differentials like cryoglobulinemic vasculitis and glomerulonephritis. Skin biopsy demonstrated leukocytoclastic vasculitis. After excluding secondary causes, including hepatitis B, ANCA-associated vasculitis (granulomatosis with polyangiitis and microscopic polyangiitis), IgA vasculitis, and cryoglobulinemic vasculitis, a diagnosis of systemic idiopathic PAN was established. Cyclophosphamide was considered but avoided due to pre-existing renal impairment. The patient was treated with high-dose prednisolone for induction, followed by low-dose azathioprine as a steroid-sparing agent, with subsequent clinical improvement. This case illustrates the diagnostic difficulty of distinguishing PAN from cryoglobulinemic vasculitis when overlapping serological features are present, and the consequences of delayed recognition on organ function.
Background Trauma and orthopedics remains a desirable career choice for many medical students and postgraduate doctors. Multiple factors influence a resident doctor's future career choice, including mentorship, work-life balance, culture, and clinical interest. However, regular teaching on orthopedic topics to junior resident doctors can greatly influence their desire to pursue this specialty as a career. The ability to understand orthopedic pathologies beyond those taught in medical school can significantly boost a resident doctor's interest in the specialty. Aims and objectives The aim of this study was to assess whether regular teaching in orthopedics to junior resident doctors (foundation year doctors and trust grade senior house officers (SHOs)) would positively influence their desire to pursue this specialty. The objective was to monitor a change in interest in orthopedics using a 5-point Likert scale pre- and postintervention. Methods A survey was sent to junior resident doctors at a district general hospital, asking questions to determine factors influencing their career choice. This was followed by weekly teaching sessions on a different orthopedic topic. A subsequent survey was sent to the same junior doctors asking about the impact of the teaching on their decision to pursue orthopedics as a career. Furthermore, the resident doctors were asked whether they now considered orthopedics as a career. Results were collected using SurveyMonkey (SurveyMonkey Inc., San Mateo, CA, USA), and qualitative and quantitative analyses were performed. Results Six junior resident doctors completed the survey and participated in the study. There were three foundation year doctors and three SHOs. Of the participants, one wished to pursue a career in orthopedics, one in emergency medicine, one in internal medicine, and the others were undecided. Among multiple factors influencing their career choice, participants rated "Culture of the specialty," "Role models," and "Mentorship" as the most important. The participants also rated teaching and training as being very important in their decision to pursue a career. Teaching sessions were held on four different topics over a period of four weeks. All participants attended at least two teaching sessions. On average, three junior doctors attended each teaching session. The average interest in orthopedics prior to the teaching sessions was 2.83 (scale of 1-5; 1 = very low; 5 = very high). Following the teaching sessions, the average interest in orthopedics improved to 4.17. The effect of the teaching sessions in increasing the participants' interest in orthopedics was rated as "extremely effective" (five of six responses) and "very effective" (one of six responses). Conclusions This study demonstrates the significant impact of regular teaching on the self-reported interest of junior team members in orthopedics. Orthopedic residents and consultants have the significant ability to powerfully motivate junior colleagues through enthusiastic teaching. We recommend regular teaching for junior members of an orthopedic department as an essential tool to maintain morale and bolster enthusiasm for this specialty.
