Professor
Brian Andrews NEJM Recommendations for Medical Students and Tutors
Week
of 5th January 2017 (#76)
University
of Notre Dame Australia (Fremantle Campus)
Occasional Editorial Comment
None
Must Read Articles
Perspective
A
View from the Edge — Creating a Culture of Caring
When
a pregnant physician winds up in her own hospital with a ruptured occult
adenoma of the liver and barely survives, she learns that though medical
professionals do so many difficult, technical things so perfectly right, they
fail their patients in many ways.
Articles Recommended for Medical Students
EDITORIAL
Acute
Kidney Injury in Critically Ill Children — An Ominous Legacy
CLINICAL PROBLEM-SOLVING
After
the Party’s Over
While
driving home from a party, a 35-year-old previously healthy woman had a sudden
onset of chills, myalgias, nausea, and abdominal cramping. That night fever,
explosive nonbloody diarrhea, frequent vomiting, and abdominal and low back
pain developed.
IMAGES IN CLINICAL MEDICINE
Gastric
Cancer in Chest Radiograph
A
90-year-old man presented with progressive edema in both legs and malaise and
dizziness associated with hypoglycemia. On examination, a nontender epigastric
mass was palpated. A chest radiograph showed a round, irregular opacity inside
the gastric chamber.
IMAGES IN CLINICAL MEDICINE
Acromioclavicular
Joint Separation
A
30-year-old man presented after a recent fall that had resulted from a loss of
balance while he was walking. On examination, his vital signs were normal, but
a palpable posterior fullness with swelling was seen over his left shoulder.
REVIEW ARTICLE
Arrhythmogenic
Right Ventricular Cardiomyopathy
Arrhythmogenic
right ventricular cardiomyopathy is a heritable heart-muscle disorder that
causes progressive replacement of right ventricular myocardium by fibrofatty
tissue. Mutations in genes encoding desmosomal proteins play a key role in the
pathogenesis of the disease.
Important Articles Related to Mechanisms of Disease and
Translational Research
ORIGINAL ARTICLE
Resolution
of Disease Phenotypes Resulting from Multilocus Genomic Variation
Of
over 7000 patients referred to a diagnostic laboratory, 28% had diagnoses based
on DNA sequencing, 5% of whom had two or more diagnoses. Their phenotypes could
be better understood by considering whether the implicated genes affect
independent biologic processes or organ systems.
Other Articles which should interest medical students
ORIGINAL ARTICLE
Ticagrelor
versus Clopidogrel in Symptomatic Peripheral Artery Disease
In
this randomized trial involving 13,885 patients with symptomatic peripheral
artery disease (PAD), ticagrelor was not shown to be superior to clopidogrel
for the reduction of cardiovascular events. Major bleeding occurred at similar
rates with ticagrelor and clopidogrel.
Novel New Therapies
CLINICAL IMPLICATIONS OF BASIC RESEARCH
Targeting
Therapeutic Oligonucleotides
Two
recent studies test whether oligonucleotide drugs that are tailored to target
different cell types — the hepatocyte and the myocyte and cardiomyocyte —
actually target those cell types.
ORIGINAL ARTICLE
A Highly Durable RNAi Therapeutic
Inhibitor of PCSK9
In
a phase 1 trial, healthy volunteers were assigned to an RNAi therapeutic
inhibitor of PCSK9 or placebo. Single doses of 300 mg or more reduced LDL cholesterol
by up to 50%; multiple-dose regimens reduced LDL cholesterol by up to 59%. No
serious adverse events were reported.
