Professor Brian Andrews
NEJM Recommendations for Medical Students and Tutors
Week of the 17th September
2015 (#8)
University of Notre Dame
Australia
(Fremantle campus)
Articles Recommended by and for
Medical Students
Perspective
Civil Rights and Health — Beyond Same-Sex
Marriage
Students found this to be an interesting discussion, not
only regarding same sex marriage and the legal ramifications in the US (similar
discussions will occur in Australia in the future), but also discrimination in
the LGBT community (particularly employment), the “bathroom bill” for
transgender individuals and particularly mental health issues in bisexual
patients.
CASE
RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL
Case 29-2015 — A 38-Year-Old Pregnant Woman
with Headache and Visual Symptom
http://www.nejm.org/doi/full/10.1056/NEJMcpc1404335
Students were not very interested in this
article.
It reviews causes of small vessel disease
during pregnancy with a wide range of interesting diagnoses.
Recommended learning: Causes of eosinophilia
ORIGINAL
ARTICLE
A Randomized Trial of Phototherapy with
Filtered Sunlight in African Neonates
http://www.nejm.org/doi/full/10.1056/NEJMoa1501074
Students were very interested in this important
article.
This is a very significant article which
demonstrates a simple and cost effective therapeutic procedure to provide
filtered sunlight in the treatment of hyperbilirubinemia of the newborn.
Filtered sunlight in Nigeria was as effective as and cheaper than standard
phototherapy.
IMAGES
IN CLINICAL MEDICINE
Ptosis after Swimming in the Red Sea
http://www.nejm.org/doi/full/10.1056/NEJMicm1411119
An
unusual, reversible cause of partial ptosis and inability to elevate the eye.
Moral
of the story: Don’t swim in the Red Sea without wearing a facemask.
Important Articles Related to
Mechanisms of Disease and Translational Research
ORIGINAL
ARTICLE
Therapeutic Clearance of Amyloid by Antibodies
to Serum Amyloid P Component
http://www.nejm.org/doi/full/10.1056/NEJMoa1504942
EDITORIAL
Out, Out — Making Amyloid’s Candle Briefer
http://www.nejm.org/doi/full/10.1056/NEJMe1508746
This is a fascinating study demonstrating that
depletion of amyloid P protein (SAP) from serum (specific drug) and from tissue
amyloid deposits (by a monoclonal antibody) resulted in presumed partial
clearance of liver amyloid as demonstrated by such techniques as transient
elastography (used to assess fibrosis in early cirrhosis and to assess the
effects of therapy in patients treated for hepatitis C). An animal model has
demonstrated that removal of SAP from amyloid tissue deposits (binds
reversibly) results in clearance of the amyloid deposit by the MPS. This appears
to debunk the concept that macrophages are unable to remove amyloid because of
its tertiary amyloid protein structure e.g. cross-beta pleating, but rather
suggests that binding of SAP to the amyloid protein, regardless of the protein
origin of the amyloid (50% of the patients in this study had light chain
amyloid, AL) is the cause. This type of
therapeutic intervention, in a disease that up until now has been extremely
difficult to treat, provides hope for the future and may be an interesting area
of clinical research in the future for young investigators. Of note, patients
with cardiac amyloid were excluded from this study and results in this area are
anxiously awaited.
REVIEW
ARTICLE
Acute Myeloid Leukemia
http://www.nejm.org/doi/full/10.1056/NEJMra1406184
This is a formidable academic review on acute
myeloid leukaemia and is not for the faint of heart. This would be a challenge
for the senior hematology-oncology registrar. It discusses the extensive cytogenetic
heterogeneity of AML (new classifications proposed by the WHO) and the ramifications
for the known biologic heterogeneity of AML. The article discusses current and
future therapies, based on this large body of exploding translational research.
The
hyperlink should be stored for the future for an article that will be current
for many years to come.
Other areas which may be of
interest to medical students
Perspective
Caring for Our Transgender Troops — The
Negligible Cost of Transition-Related Care
http://www.nejm.org/doi/full/10.1056/NEJMp1509230
ORIGINAL
ARTICLE
Adaptive Servo-Ventilation for Central Sleep
Apnea in Systolic Heart Failure
EDITORIAL
Heart Failure and Sleep-Disordered Breathing —
The Plot Thickens
http://www.nejm.org/doi/full/10.1056/NEJMe1510397
The article and review discuss central sleep
apnoea in patients with heart failure, manifesting as Cheyne-Stokes
respiration.
Recommended learning: Review other causes
of Cheyne-Stokes respiration, especially in the elderly
ORIGINAL
ARTICLE
Percutaneous Implantation of an Entirely
Intracardiac Leadless Pacemaker
An interesting picture showing how the leadless right
ventricular pacemaker works. However, while the authors laud the advantages of
the device, no mention is made of cost! Is it really any better or just an
academic exercise in bioengineering. Only time will tell.
CLINICAL
IMPLICATIONS OF BASIC RESEARCH
On Synaptic Circuits, Memory, and Kumquats
A fascinating, but complex
review, of a study on neural circuits and synapses in murine brain using
electron microscopy. For those who are budding neuroanatomists and
physiologists
