All articles

Fatigue: let's talk about it

doi:10.7244/cmj.2015.06.002
RL Lambson

Chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) is a debilitating condition characterised by intense long-lasting fatigue and affects 0.2-2% UK population. In addition, a more significant burden to UK health is the fatigue is commonly associated with many chronic diseases. Over 17.5 million people within the UK currently suffer with a chronic disease (1), a figure which is set to rise with the aging population. Those with an attributable cause for their fatigue, such as chronic diseases, are unable to access NHS CFS services. Despite this, NHS services dedicated to the fatigue occurring outside CFS/ME are lacking. This leaves many people without the support and access to the multidisciplinary team that they need.

Bilateral spontaneous rectus sheath haematoma complicating dengue haemorrhagic fever: a case report.

doi:10.7244/cmj.2015.06.001
KJ Bhat MD, HJ Samoon and R Shovkat

The clinical course of dengue haemorrhagic fever in the elderly is rather atypical and it is imperative to be aware of the protean manifestations and complications of dengue febrile illness in this age group. Rectus sheath haematoma, in the context of acute emergency presentations is uncommon, especially in the patients on anti-coagulation therapy. Bilateral  rectus sheath haematoma is rarely seen.

We present the first case of spontaneous and bilateral rectus sheath haematoma complicating dengue haemorrhagic fever in an elderly male. This case emphasizes the fact that serious complications can occur during the defervescence phase, especially in the elderly, and that a high index of supervision and suspicion should be maintained by the clincians.

Optogenetics: A vision of the future of Neurology?

doi:10.7244/cmj.2015.03.001
F Brown

In 1979, Nobel laureate Francis Crick published a paper discussing progress in neuroscience. Describing the subject as “profoundly mysterious”, he speculated on new methods of investigating the brain, including the ability to inactivate one type of neuron whilst leaving the others “more or less unaltered” [1]. Crick is not alone; for years the mammalian brain has dumbfounded researchers [1,2]. In the human, a hundred billion neuronal parts and myriad connections lead to an interconnected system of a level of unparalleled complexity [3]. This system is responsible for poetry, music and art and gives rise to consciousness, memory and countless other phenomena. It is also the victim of a vast array of devastating pathologies [4].

Polygeia: students shaping global health

doi:10.7244/cmj.2014.12.001
R Heywood, D Neal

On 15th November a new Cambridge-based organisation, Polygeia, held their inaugural conference on global health policy. Polygeia’s mission is to empower students to participate in global health discussions through policy research and discussion. Already, work has been produced on neglected tropical diseases, mental health, global health partnerships, sexual and reproductive health and pharmaceuticals. The type of work done ranges from literature reviews to opinion pieces to project evaluations. Through undertaking a wide range of work with support from academics and professionals from around the world, the second aspect to Polygeia’s mission is to develop the skills of those students involved.

3rd EUNS National Conference 2015; From Neuroscience to Neurology

Image credit: aboutmodafinil.com

doi:10.7244/cmj.2014.11.001
R Heywood

We are happy to once again be supporting the Edinburgh University Neurological Society (EUNS) for their 3rd Annual conference, to be held on Saturday 7th February, 2015. The conference will involve keynote speakers specialising in ageing, CJD and paediatric neurosurgery, along with workshops on Surgery and Neurotrauma, Careers in Neurology and Neurosurgery, Neuroscience Lab Skills and Science Communication. There is also a poster and oral presentation session

The Future of Neurology: Announcing the winning essay of the 2014 “Neuroscience to Neurology” essay competition

Image credit: ZEISS Microscopy

doi:10.7244/cmj.2014.03.001
F Begeti

The World Health Organization estimates that neurological disorders currently affect one billion people worldwide, a number which is predicted to increase considerably as a result of an ageing population. The need to further understand the brain and make progress in the field of neurology has therefore never been greater. However, with over 100 million neurons each making over 1000 synapses, the human brain is undoubtedly the most complex organ in the human body, and it is this complexity that has meant that advances in neuroscience have been comparatively slow.

The Medicalisation of Criminal Behaviour: A Unifying Approach

doi:10.7244/cmj.2013.12.001
J Rogers

Phèdre is a tragedy which explores the relationship between moral culpability and responsibility for one’s actions by examining the incestuous love of a queen for her step-son, a passion that is apparently imputed to her by a vengeful deity. What is fascinating for the purposes of our discussion is the dynamic interplay between the portrayals of Phèdre’s infatuation both as an illness and simultaneously as a crime, for this is essentially the same question we must consider in deciding to what extent a malady excuses behaviour that contravenes society’s judicial expectations. While this was doubtless an intriguing consideration for a seventeenth century French dramatist, it is all the more pertinent for us today given the extent of medicalisation that has occurred in recent decades across many spheres of society.

Case Report: Left knee pain in a young female athlete

doi:10.7244/cmj.2013.11.002
Jonathan Packer

A 14 year old girl was seen in clinic after an injury whilst playing rugby. Although her description was vague, she intimated that a valgus stress had been put on her left leg and described being tackled in rugby practice. She fell on her left knee and heard an audible cracking or ‘pop’ sound, experiencing immediate pain and swelling of the joint. She had no significant past medical history and was taking no regular medication.

Detection of Coeliac Patients at Risk of an Osteoporotic Fracture: A Two-Cycle Clinical Audit

doi:10.7244/cmj.2013.11.001
A Nunn, D Patterson

Patients diagnosed with Coeliac disease are known to be at higher risk of suffering a low-impact fracture, and even as children it is important to detect and correct malabsorption due to Coeliac since this may have a lasting impact on their lifelong fracture risk. The British Society of Gastroenterologists recommends that those Coeliac patients with two or more additional risk factors for osteoporotic fracture undergo a dual X-ray absorptiometry (DEXA) scan to determine their bone density. This audit addressed the question of whether this standard was being adhered to in a general practice setting in the south-east of England. The capture of cases represented a prevalence of 1:275 (similar to previously reported figures for the prevalence of this condition). The rate of DEXA scanning in this population was disappointingly low (only 37%), and since many of those Coeliac patients who should have been scanned, and were not, possessed ‘minor’ risk factors such as smoking or female gender, the low pick-up rate may be attributable to a lack of awareness of the small but significant risk that these factors pose. Of those DEXA scans performed, the bone mineral densities of the patients concerned was inversely proportional to the number of risk factors they possessed, supporting the stance of the BSG. Practitioner education alone was not sufficient to improve the rate of scanning, which actually declined following a period of raising awareness of the need for such scans.

Review: Complete Revision Notes for Medical And Surgical Finals (2nd edition)

doi:10.7244/cmj.2013.10.002
Charleen Chan Wah Hak

Initially, I had my doubts on the ambitious title of this book, which made it sound as if it were going to be an incredible task to read. Instead, it was pleasantly surprising to find it very readable with a simple layout, readable typeface, simple illustrations and a smattering of key radiographs throughout. All specialities are covered comprehensively in a system-based format, including a Public Health chapter and a Symptom control / palliative care section under Oncology.

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