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CMJ competition 2013


The Cambridge Medicine Journal are proud to announce the 2013 Case Report and Medical Imaging Competition, open to all UK medical students. We are on the hunt for the best clinical case reports and picture articles for publication in one of Cambridge’s leading medical journals.


Safety of SSRIs in Pregnancy

Dr Sian-Lee Ewan, GPST2, Northern Ireland Deanery

Mental health in pregnancy remains a significant issue, with 7-13% [1] of women experiencing depressive symptoms during pregnancy. ‘Confidential Enquiries into Maternal Deaths in the United Kingdom’ [2] have highlighted suicide in pregnancy and during the first postnatal year as a leading cause of maternal death. SSRIs are known to cross the placental barrier, however the safety of these drugs in pregnancy is not well understood [3].


1. Jensen HM, Randi G, Lidegaard O, Pedersen LH, Andersen PK, Kessing LV. Maternal depression, antidepressant use in pregnancy and Apgar scores in infants. The British Journal of Psychiatry. 2013; 202:347-351 doi:10.1192/bjp.bp.112.115931
2. Centre for Maternal and Child Enquires (CMACE). Saving Mothers’ Lives: reviewing maternal deaths to make motherhood safer:2006-2008. The Eighth Report on Confidential Enquires into Maternal Deaths in the United Kingdom. BJOG. 2011; 118(Suppl. 1):1-203. doi:10.1111/j.1471-0528.2010.02847.x
3. NICE. Antenatal and Postnatal Mental Health. NICE 2007; clinical guideline 45. Available at

Story image taken from Wikimedia Commons

‘To Give or Not To Give’

Shannon Leckey, Cardiff University School of Medicine, Heath Park, Cardiff, CF14 4YU, UK
Thomas Lemon, Cardiff University School of Medicine, Heath Park, Cardiff, CF14 4YU, UK

As medical students, we should all know about the legal regulations surrounding key aspects of medicine, The Welsh Government published the Draft Human Transplantation Act in June 2012 [1]. It proposes that Welsh residents give presumed consent for organ donation unless they ‘opt out’ of the system.

In order to be passed, the draft bill must first be introduced into the assembly, go through all 4 stages of scrutiny and then be presented for Royal Assent. Ministers aim for the law to be in place by 2015.

Short-term vs Conventional Glucocorticoid Therapy in Acute Exacerbations of COPD

Christine Ma, Faculty of Medicine, University of New South Wales, Sydney Australia

Chronic obstructive pulmonary disease (COPD) is a common respiratory condition with a high level of resource utilisation through hospital admissions, specialist visits and chronicity of disease [1]. The WHO defines an exacerbation as an acute increase in symptoms beyond the normal daily variation, especially with an increase in cardinal symptoms of cough, sputum production and dyspnoea [2]. Current international guidelines advocate glucocorticoid use in acute exacerbations, with a 10-14 day course of oral prednisolone commonly utilised [3].


1. Buist AS, McBurnie MA, Vollmer WM, et al. International variation in the prevalence of COPD (the BOLD Study): a population-based prevalence study. Lancet 2007; 370:741. doi: 10.1016/S0140-6736(07)61377-4
2. Global strategy for the diagnosis, management, and prevention of COPD: Revised 2011. Global initiative for Chronic obstructive lung disease (GOLD). file:// (Accessed on April 30, 2012).
3. Wouters EF. Management of severe COPD. Lancet. 2004; 364(9437):883-895. doi: 10.1016/S0140-6736(04)16984-5
4. Leuppi JD, Schuetz P, Bingisser R, Bodmer M, et al; Short-term vs ConventionalGlucocorticoid Therapy in Acute Exacerbations of Chronic Obstructive Pulmonary Disease. JAMA 2013; 309 (21): doi:10.1001/jama.2013.5023
5. Niewoehner DE, Erbland ML, Deupree RH, et al; Department of Veterans Affairs Cooperative Study Group. Effect of systemic glucocorticoids on exacerbations of chronic obstructive pulmonary disease. N Engl J Med. 1999; 340(25):1941-1947. doi:10.1056/NEJM19990624340250

Story image taken from Wikimedia Commons

CABG superior to PCI for diabetic patients with multi-vessel CAD

Clement Loh Chee Hoou, Faculty of Medicine, University of New South Wales, St George Hospital, Sydney, Australia

Coronary artery disease (CAD) affects millions worldwide. In North America, nearly 700,000 people are diagnosed with multi-vessel CAD and require immediate revascularisation and of these, 200,000 are diabetic. Coronary artery bypass graft (CABG) surgery or percutaneous coronary intervention (PCI) are the two main modalities of revascularisation. The previous BARI, CARDia, TAXUS and SYNTAX randomised clinical trials offered conclusive evidence favouring CABG over PCI as the preferred method of revascularisation (1).


1. Farkouh ME, Domanski M, Sleeper LA, Siami FS, Dangas G, Mack M, et al. Strategies for multivessel revascularization in patients with diabetes. The New England journal of medicine. 2012;367(25):2375-84. Epub 2012/11/06. doi: 10.1056/NEJMoa1211585 PubMed PMID: 23121323.

Story image taken from Wikimedia Commons

First Wales Medical Undergraduate Conference

Ashley Yarrow-Jenkins, Cardiff University, United Kingdom
Rupali Shah, Cardiff University, United Kingdom
Rhiannon Lampard, Cardiff University, United Kingdom
Ben Stone, Cardiff University, United Kingdom
Felicity Cooksey, Cardiff University, United Kingdom

Friday 23rd November saw the First Wales Medical Undergraduate Conference take place at the Michael Griffiths Building, University Hospital of Wales. Jointly organised by Cardiff University and Meducation – a community of over 23,000 medical students and doctors, who by sharing their knowledge, ideas and experiences, endeavour to facilitate learning medicine.

Wales Medical Undergraduate Photo 1
Wales Medical Undergraduate Photo 2

The cardiac effects of curcumin

Mrinalini Dey, Murray Edwards College, New Hall, University of Cambridge, Cambridge CB3 0DF

A study published in the British Journal of Pharmacology [1] has found that curcumin, commonly found in curries, is effective at improving cardiac function and may have potential in treating patients who have had a heart attack.


1. Wang N-P., Wang Z-F., Tootle S., Philip T., Zhao Z-Q. Curcumin promotes cardiac repair and ameliorates cardiac dysfunction following myocardial infarction. British Journal of Pharmacology. 2012, 167: 1550-1562. doi:10.1111/j.1476-5381.2012.02109.x

Story image taken from Wikimedia Commons

Gut feeling – is the child sick?

Natasha Lee, University of Cambridge School of Clinical Medicine, Addenbrooke’s Hospital, Hills Road, Cambridge, CB2 0SP

A study was recently carried out across general practices in Belgium [1]. It aimed to evaluate the added value of gut feeling to diagnosing serious infections when clinical impression suggested otherwise. Out of 3369 clinically non-severe cases, six were eventually diagnosed with serious infections. In two of the six cases (33%) the clinicians had initially had a bad gut feeling. In the 3363 cases that were eventually diagnosed with non-serious illnesses, there were 44 (1.3%) false alarms from intuitive feelings.


1. Van den Bruel A, Thompson M, Buntinx F, Mant D. Clinicians’ gut feeling about serious infections in children: observational study. BMJ. 2012, epub ahead of print, available online doi:10.1136/bmj.e6144
2. Van den Bruel A, Aertgeerts B, Bruyninckx R, Aerts M, Buntinx F. Signs and symptoms for diagnosis of serious infections in children: a prospective study in primary care. Br J Gen Pract. 2007 Jul;57(540):538-46.
3. Briars G. Re: Clinicians’ gut feeling about serious infections in children: observational study. [updated 2012 Nov 7]; Available online
4. Gilleece L. Re: Clinicians’ gut feeling about serious infections in children: observational study. [updated 2012 Oct 10]; Available online
5. Cohen M. Re: Clinicians’ gut feeling about serious infections in children: observational study. [updated 2012 Nov 15]; Available online

Story image taken from Wikimedia Commons

Dalcetrapib for ischaemic heart disease?

Clement Loh Chee Hoou, Faculty of Medicine, University of New South Wales, Sydney, Australia

High density lipoprotein (HDL), or ‘good cholesterol’, is an apoprotein containing-lipid particle that plays a vital role in reverse cholesterol transport by removing cholesterol deposits from both intravascular and extravascular tissues and transporting it back to the liver for excretion or re-utilization(1, 2). In conventional medical wisdom, elevated levels of high-density lipoproteins (HDL) translate into lower risk of atherosclerosis and ischaemic heart disease.


1. Hall JE. Guyton’s Medical Physiology. 12th ed. New York: Saunder Elsevier; 2011.
2. Miller NE. HDL metabolism and its role in lipid transport. Eur Heart J. 1990;11 Suppl H:1-3. doi: 10.1093/eurheartj/11.suppl_H.1
3. Schwartz, G.G., Olsson, A.G., Abt, M., Ballantyne, C.M., Barter, P.J., Brumm, J., Chaitman, B.R., Holme, I.M., Kallend, D., Leiter, L.A., Leitersdorf, E., McMurray, J.J.V., Mundl, H., Nicholls, S.J., Shah, P.K., Tardif, J.-C., Wright, R.S. Effects of Dalcetrapib in Patients with a Recent Acute Coronary Syndrome. N. Engl. J. Med 2012. doi: 10.1056/NEJMoa1206797

Story image taken from Wikimedia Commons

High dose multivitamin supplementation as highly active antiretroviral therapy adjuvant

Christine Ma, 4th year medical student, University of New South Wales, Australia

Highly active antiretroviral therapy (HAART) has been shown to decrease morbidity and mortality from HIV infection, with a combination of these potent pharmacological agents being most effective and least likely to confer resistance [1]. The general therapeutic goals are to prolong and improve life, reduce viral load and promote immune reconstitution whilst minimising side effects [2]. Despite the revolutions HAART has provided, immune reconstitution is not complete or sustained in many patients, with opportunistic infection and death still relatively high [3].


1. Safrin S., 2012. Antiviral Agents. Basic & Clinical Pharmacology 12th ed, San Francisco: McGraw Hill Companies
2. Rothman RE, Marco CA, Yang S. 2011 Human Immunodeficiency Virus Infection and Acquired Immunodeficiency Syndrome. Tintinalli’s Emergency Medicine: A Comprehensive Study Guide. 7th ed, Chapel Hill North Carolina: McGraw Hill Companies
3. Isanaka S, Mugusi F, Hawkins C, Spiegelman D, Okuma J, Aboud S, Guerino C, Fawzi WW. Effect of High-Dose vs Standard-Dose Multivitamin Supplementation at the Initiation of HAART on HIV Disease Progression and Mortality in Tanzania. JAMA 2012; 308(15):1535-1544. doi: 10.1001/jama.2012.13083
4. Fawzi WW, Msmanga GI, Spiegelman D, Wei R, Kapiga S, Villamor E, Mwakagile D, Mugusi F, Hertzmark E, Essex M, Hunter DJ. A randomised trial of multivitamin supplements and HIV disease progression and mortality. NEJM 2004; 35(1):23-32. doi: 10.1056/NEJMoa040541

Story image taken from Wikimedia Commons

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