Professor Brian Andrews
NEJM Recommendations
Week of the 3rd
September 2015 (#6)
University of Notre Dame
Australia
(Fremantle campus)
Articles Recommended for
Medical Students
ORIGINAL
ARTICLE
Clinical Features and Outcomes of Takotsubo
(Stress) Cardiomyopathy
http://www.nejm.org/doi/full/10.1056/NEJMoa1406761
This is an important study on Takotsubo cardiomyopathy
(“broken heart syndrome”). Several features should be noted: i) should be
considered in the DD of acute coronary syndrome and/or acute heart failure, ii)
the disorder has a previously unrecognised significant morbidity and mortality
and iii) physical triggers may be more common than emotional triggers. This
entity is probably much more common than appreciated and is undoubtedly
underdiagnosed. The exact cause is still unclear. Recommended for MED300 and
MED400.
REVIEW
ARTICLE
Prenatal Factors in Singletons with Cerebral
Palsy Born at or near Term
http://www.nejm.org/doi/full/10.1056/NEJMra1505261
This review article should be read by MED300 (especially
during the O&G rotation) and MED400 students. It considers the possible
pathological causes of cerebral palsy but, in particular, notes how little is
really known about causation.
REVIEW
ARTICLE
In-Flight Medical Emergencies during Commercial
Travel
From a personal perspective, medical “emergencies” occur
more frequently than 1:640 as quoted and undoubtedly is due to the lack of reporting
of many incidents, frequently well managed in a “hostile environment.” Also of
interest, when travelling on Australian carriers, a physician has a legal
obligation to assist in a medical emergency, not just an ethical obligation as
required by US carriers. This is an interesting and revealing read.
CLINICAL
PROBLEM-SOLVING
On the Nose
This is a fun
exercise in problem solving and clinical reasoning. The treating physician
should have been more forceful with the patient in recommending earlier
investigations (lung and nose biopsy) which would have resulted in fewer
investigations, reduced morbidity, less cost and earlier diagnosis and treatment.
You go ‘where the money is.”
Important Articles Related to
Mechanisms of Disease and Translational Research
EDITORIAL
Unraveling the Function of FTO Variants
http://www.nejm.org/doi/full/10.1056/NEJMe1508683
ORIGINAL
ARTICLE
FTO Obesity
Variant Circuitry and Adipocyte Browning in Humans
For those with any serious interest in the biology of
obesity, the editorial and the study provide an update on the genetics of
obesity; the role of adipocytes, especially the inducible “beige” adipocyte;
the possible role of the “non-coding” intron in gene function and mechanisms by
which gene manipulation could lead to heat dissipation and weight loss via
depolarization of the inner mitochondrial membrane and proton transfer in the
beige and brown adipocyte.
At least try to read the editorial which summarises this
extensive study. Recommended for MED200
for basic science and genetics.
EDITORIAL
Treating Myeloproliferation — On Target or Off?
ORIGINAL
ARTICLE
A Pilot Study of the Telomerase Inhibitor
Imetelstat for Myelofibrosis
ORIGINAL
ARTICLE
Telomerase Inhibitor Imetelstat in Patients
with Essential Thrombocythemia
At last, a new approach to the management of
myeloproliferative disorders in addition to allogeneic stem cell
transplantation and JAK inhibitors (ruxolitinib).
Read at least the Editorial which provides an overview of
the two studies. There is a review of the telomere and telomerase for MED100
and MED200.
Further, while the drug imetelstat (a 13-mer lipid-conjugated
antisense oligonucleotide which binds to and inactivates human telomerase
reverse transcriptase) inhibits telomerase, there is no documented change in
telomere length in the patients (possibly method related) suggesting that the
drug exhibits a separate mechanism of action in these disorders. The results
were extremely promising, particularly in patients with primary thrombocytosis.
Imetelstat reduced the JAK mutant allele burden by 71%, inhibited the
megakaryocyte CFU assay by up to 92% and
patients obtained a complete clinical and haematological response in 94% (17 of
18 patients). The results in patients with myelofibrosis, while less dramatic,
were still impressive. This type of study provides an insight into where
medicine is heading in the future.
Perspective
INTERNATIONAL
HEALTH CARE SYSTEMS
Perennial Health Care Reform — The Long Dutch
Quest for Cost Control and Quality Improvement
This is a
perspective article reviewing Health Care Reform in the Netherlands. The concept of “cradle to grave”
comprehensive medical care has been changed because of the- cost of the ageing
population. This change in Health Care is now closer to the US system of the
Affordable Care Act introduced under extreme duress by the Democratic Obama
administration. Only time will tell as to the outcomes.
Other areas not reviewed but
of interest
CLINICAL
IMPLICATIONS OF BASIC RESEARCH
