Professor Brian Andrews NEJM Recommendations
Week of August 6th 2015 (#2)
University of Notre Dame Australia Fremantle
Idarucizumab for Dabigatran Reversal
Editorial: Targeted Anti-Anticoagulants
This is an extremely important article and Editorial as the direct oral
anticoagulants (or previously called NOACs- new oral anticoagulants) herald the
death knell for warfarin, currently the most frequently prescribed oral
anticoagulant for DVT and PE prophylaxis and for atrial fibrillation.
This is the first published cohort study using a very effective
inhibitor of dabigatran. I am sure studies on reversal agents of other direct
oral anticoagulants will be published very soon as there are tens of billions
of dollars for big Pharma at the end of this rainbow. If compared with the introduction of TNF
inhibitors used in RA, all reversal agents will achieve a therapeutic niche at
similar prices which will continue to increase annually.
However with the introduction of the Trans-Pacific Partnership, who
knows what rates PBS will be able to negotiate and thus how expensive will
these drugs will be to the Australian public.
Highly recommended for all years.
Pregnancy Complicated by Venous Thrombosis
Excellent Clinical Practice
article for MED300 and MED400. In addition to discussing venous thrombosis in
pregnancy, there is a good comparison with the non-pregnant state and a good
discussion of current investigations and management.
Electrolyte and Acid–Base Disturbances in
Patients with Diabetes Mellitus
An excellent in-depth review of electrolyte and acid-base disturbances
in diabetes mellitus. It may be a better reference article for some students,
used when a specific management problem develops in DM. In MED200, it may be useful
when learning renal physiology.
A Giant Aneurysm of the Anterior Communicating
Artery
Interesting CT angiogram of a huge calcified
intracerebral aneurysm
Tenofovir Gel for the Prevention of Herpes
Simplex Virus Type http://www.nejm.org/doi/full/10.1056/NEJMcps1303787 2
Infection
A very interesting spinoff public health article of HSV 2 prevention
using tenofovir gel (a nucleoside reverse transcriptase inhibitor) in a South
African population originally studied for HIV prevention. Recommended for those
particularly interested in public health and third world medicine.
A Surprising Cause of Chronic Cough
An interesting article in Clinical
problem Solving and describing an uncommon infection due to a very
interesting organism. This organism was originally thought to reside only in
Baltimore and only be recognised at Johns Hopkins. However soon after its
original description, it became apparent that the organism can occur in all
areas of the world.
An interesting exercise in clinical reasoning. Consider this entity in
middle age white males with fatigue, arthritis and malabsorption.
Public Health in the Precision-Medicine Era
http://www.nejm.org/doi/full/10.1056/NEJMp1506241
A public health Perspective
article on individualized and Precision Medicine which discusses the future
potential problems. An interesting read for those interested in this area.
Australian Health Care — The Challenge of Reform in a Fragmented System
A rather long and somewhat convoluted Perspective article on the Australian
Health Care System. This article should be stored for relevant reading in the
future for most students, but is a particularly interesting read for those
interested in this area. When you finish
reading this with all of the problems we have, you will wonder how the
Australian Health Care System is one of the best in the Western World. The
discussion of the System and the roles of political parties is illuminating.
