Professor Brian Andrews NEJM Recommendations
Week of the 20th August 2015 (#4)
University of Notre Dame Australia Fremantle
Perspective
GMOs, Herbicides, and Public Health
Very important article discussing genetically
engineered crops which can withstand an array of carcinogens sprayed on the
crops and when consumed will play a significant role in future human and animal
carcinogenesis. This is a potential major public health issue. We must all be
aware of what government and multinationals are inflicting on our environment
for the generation of short term profits for a few. The medical profession must
be proactive in this area and not act like ostriches.
EDITORIAL
Cancer
Workup after Unprovoked Clot — Less Is More
http://www.nejm.org/doi/full/10.1056/NEJMe1507506
ORIGINAL
ARTICLE
Screening for Occult Cancer in Unprovoked
Venous Thromboembolism
http://www.nejm.org/doi/full/10.1056/NEJMoa1506623
An Editorial and an Article discussing the
frequency of primary malignancy within the first 12 months after an unprovoked
DVT and how extensive an investigation the DVT patient should receive at onset.
The main problem is the age group of the
patients studied with a mean age of 50 years.
REVIEW
ARTICLE
Palliative Care for the Seriously Ill
An excellent overall review of palliative care. Make
sure you review the Supplemental index for the management of specific problems
encountered by the patient. Do not spend time considering the funding of
palliative care in the US, as it differs from the Australian system.
This is more suited to MED400 students or MED300
students encountering this situation on the wards or in GP.
CASE
RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL
Case 26-2015 — A 9-Month-Old Girl with
Recurrent Fevers
MED300 and MED400 students should read this article
about fever in a child, presumed infectious in origin, but with no apparent
site. Should a LP have been performed?
VIDEOS
IN CLINICAL MEDICINE
Examination of the Retina
http://www.nejm.org/doi/full/10.1056/NEJMvcm1308125#t=article
An absolute requirement for all medical students. This
is an area poorly performed by all students and interns, even if an
ophthalmoscope is available.
This is a reminder that Videos in Clinical Medicine cover an extensive range of procedures
and should be the “first port of call” for knowledge about any procedures.
IMAGES
IN CLINICAL MEDICINE
Electrical Alternans with Pericardial Tamponade
After reviewing the case, the ECG and the
echocardiogram, I now understand electrical
alternans better than I had before. Should be reviewed by all medical
students.
Perspective
Testosterone and “Age-Related Hypogonadism” —
FDA Concerns
http://www.nejm.org/doi/full/10.1056/NEJMp1506632?query=featured_home
Discusses the indications of androgen
replacement therapy in older males and how this is being misused in the US.
Note, in the US, the average duration of use for “hypogonadism” is around 6
months!
Articles
not considered to be of the highest value by the reviewing MED300 students, but
which I feel may interest some students with a particular interest in basic
research and its application to the future practice of clinical medicine
Perspective
FOCUS
ON RESEARCH
Let's Not Put All Our Eggs in One Basket
http://www.nejm.org/doi/full/10.1056/NEJMp1508144
ORIGINAL
ARTICLE
Vemurafenib in Multiple Nonmelanoma Cancers
with BRAFV600 Mutations
http://www.nejm.org/doi/full/10.1056/NEJMoa1502309
Patients with metastatic melanoma and a BRAF
activating mutation (a “driver” mutation) have a moderately increased survival
rate if treated with a BRAF inhibitor, and slightly longer if a MEK inhibitor
is also added (specific studies using advanced search in the journal for BRAF and melanoma). The obvious question
is what happens to patients with other types of malignancies which also have a
similar BRAF mutation when treated with specific inhibitors (in this case
vemurafenib). The Perspective discusses “basket research” and the possible
direction of research in an area which will become increasingly more common and
controversial in future patient care, particularly in those patients who can
afford very expensive, experimental treatment with a medication being used off-label.
CLINICAL
IMPLICATIONS OF BASIC RESEARCH
