Professor
Brian Andrews NEJM Recommendations for Medical Students and Tutors
Week
of 8th December 2016 (#72)
University
of Notre Dame Australia (Fremantle Campus)
Occasional Editorial Comment
None
Must Read Articles
None
Articles Recommended for Medical Students
Perspective
Neglected
— Cancer Care and Mental Health in Rural America
The
woman had neglected breast cancer, but the root of her problem was bipolar
disorder, for which her family, feeling guilty about committing her in the
past, would no longer compel treatment. Moreover, much of rural America has
less than 1 psychiatrist per 30,000 people.
IMAGES IN CLINICAL MEDICINE
Tinea
Imbricata
An
18-year-old woman presented with a concentric, scaly rash on her arms, trunk,
and legs that involved approximately 70% of the body-surface area. Her brother
had similar skin findings.
IMAGES IN CLINICAL MEDICINE
Tongue
Fasciculations in Organophosphate Poisoning
A
15-year-old boy who lived with his family on a farm presented to the ED with
vomiting, diarrhea, and altered sensorium. During insertion of a feeding tube,
diffuse tongue fasciculations, shown in a video, were noted.
Important Articles Related to Mechanisms of Disease and
Translational Research
CLINICAL IMPLICATIONS OF BASIC RESEARCH
Wasting
Energy to Treat Obesity
A
means of “burning fat” — shunting protons to a thermogenic pathway rather than
an energy-producing one — is mediated by UCP1, which is expressed in the
mitochondria of brown fat. A study in mice has uncovered a similar mechanism in
skeletal muscle and white adipose tissue.
Other Articles which should interest medical students
Perspective
Cost
Containment and the Tale of Care Coordination
The
notion that care coordination not only improves outcomes but also lowers costs
is not evidence-based, and it poses many potential dangers, beginning with the
diminution of the importance of coordinated care itself as a worthy goal.
EDITORIAL
Treatment
of Left Main Coronary Artery Disease
Eugene
Braunwald, M.D
ORIGINAL ARTICLE
Everolimus-Eluting
Stents or Bypass Surgery for Left Main Coronary Artery Disease
In
a randomized trial, over 1900 patients with left main coronary artery disease
were assigned to percutaneous coronary intervention or coronary-artery bypass
grafting. At 3 years, PCI was noninferior to CABG with respect to the rate of
death, stroke, or myocardial infarction.
CLINICAL DECISIONS
Implantable
Cardioverter–Defibrillators in Nonischemic Cardiomyopathy
This
interactive feature on treatment for nonischemic cardiomyopathy in patients who
are receiving medical therapy offers a case vignette accompanied by essays that
support either implantation of an ICD or no implantation. Share your comments
and vote at NEJM.org.
CASE RECORDS OF THE
MASSACHUSETTS GENERAL HOSPITAL
Case
37-2016 — An 86-Year-Old Woman with Leukocytosis and Splenomegaly
An
86-year-old woman was seen at this hospital because of fatigue, night sweats,
leukocytosis, and splenomegaly. Review of the peripheral-blood smear revealed
neutrophilia without dysplastic features, immature forms, or monocytosis. A
diagnostic procedure was performed.
New Pharmacological Therapies
EDITORIAL
Drugging
the Undruggable Ras — Immunotherapy to the Rescue?
ORIGINAL ARTICLE
BRIEF REPORT
T-Cell
Transfer Therapy Targeting Mutant KRAS in Cancer
A
woman with KRAS-mutated colon cancer had a response to T cells derived
from her tumor that were specific for mutant KRAS. A lesion recurring 9 months
later had lost expression of the class I major histocompatibility complex
molecule recognized by the T cells.
Other articles which may be of interest to certain students
ORIGINAL ARTICLE
Adjuvant
Sunitinib in High-Risk Renal-Cell Carcinoma after Nephrectomy
In
patients with renal-cell carcinoma at high risk for relapse after nephrectomy,
the rate of disease-free survival was significantly higher among those
receiving sunitinib than among those receiving placebo, at the cost of a higher
rate of toxic events.
