Professor Brian Andrews
NEJM Recommendations for Medical Students and Tutors
Week of the 10th September
2015 (#7)
University of Notre Dame
Australia
(Fremantle campus)
Articles Recommended for
Medical Students
REVIEW
ARTICLE
Cannabinoids in the Treatment of Epilepsy
This is a review of the CNS receptor binding by
cannabinoids and possible role in seizure prevention. No real data from RCT to
indicate they are effective in seizure prevention but may play a limited role
in children with subgroups of severe epilepsy, not responsive to standard
therapies. With increasing legal use of cannabis in the US (really a means for
states to raise taxes for health care and infrastructure), the authors lament
the “use of medical cannabis could go the way of vitamin and nutritional
supplements, for which the science never caught up to the hype and was drowned
out by unverified claims, sensational testimonials and clever marketing.” Store
the link for future reference.
Recommended
learning: Biology of epilepsy, clinical types and management
CASE
RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL
Case 28-2015 — A 32-Year-Old Man with Fever,
Headache, and Myalgias after Traveling from Liberia
A very interesting public health and ID read about the
precautions taken where a haemorrhagic disease virus, such as Ebola, is
suspected within the community. In Perth, the designated quarantine hospital is
SCGH.
Recommended
learning: Fever in the
returning traveller and the causes (MED300 clinical case)
IMAGES
IN CLINICAL MEDICINE
A Viper Bite
This was regarded by the MED300 medical groups as the
most significant article in this week’s journal!!
Recommended
learning: Male reproductive health and envenomation
Important Articles Related to
Mechanisms of Disease and Translational Research
ORIGINAL
ARTICLE
BRIEF
REPORT
Chimeric Antigen Receptor T Cells against CD19
for Multiple Myeloma
An interesting article describing the use of autologous T
cells that had been transduced with an anti-CD19 chimeric antigen receptor in a
patient with refractory IgA myeloma with excellent response at 12 months. The
authors speculate as to how this might work, given that only 0.05% of the
plasma cells in the marrow were CD19 positive.
Recommended
learning: Multiple
myeloma and MGUS; cell biology of
the proteasome; how do alkylating
agents work? cytokine release syndrome; principles
and indications for autologous stem cell transplantation
ORIGINAL
ARTICLE
Eculizumab in Pregnant Patients with Paroxysmal
Nocturnal Hemoglobinuria
The anti-C5 monoclonal antibody in pregnant patients with
PNH resulted in a marked reduction in maternal complications, including
mortality, and a high rate of fetal survival.
Recommended
learning: The complement system in biology, in particular the
inhibitors of complement activation and their associated with cell membranes,
particularly in PNH; causes of intravascular haemolysis and how this differs
from extravascular haemolysis; causes of “thrombophilia” which result in both
venous and arterial thrombosis.
ORIGINAL
ARTICLE
Cyclosporine before PCI in Patients with Acute
Myocardial Infarction
EDITORIAL
Targeting Myocardial Reperfusion Injury — The
Search Continues
This article and editorial show that pre-treating
patients with STEMI (within 6 hours) with cyclosporine prior to PCI did not
improve the 12 month primary outcomes over the cyclosporine untreated group
(the hypothesis was that cyclosporine would stabilize the inner mitochondrial
membrane pores by inhibiting cyclophilin D and would reduce reperfusion
injury). This is an interesting study considering that the same group were the
only ones that had previously demonstrated a cardioprotective effect of
cyclosporine in this setting (published also in the NEJM). However, in this
study, the authors changed the formulation of the cyclosporine to reduce the
risk of anaphylaxis, but at the same time possibly invalidating this very
expensive current study??
Recommended
learning: The biology of reperfusion injury; biology of the
mitochondrion; MOA, indications and side effects of cyclosporine and tacrolimus
Other areas which may be of
interest to medical students
Perspective
Medicine's
Wild West — Unlicensed Stem-Cell Clinics in the United States
http://www.nejm.org/doi/full/10.1056/NEJMp1504560
ORIGINAL
ARTICLE
