All articles

A case of a single coronary artery arising from the right coronary cusp

doi:10.7244/cmj-1379800800
Laura Skinner

Coronary artery anomalies (CAAs) are present in 1-1.96% of the population [1,2]. The clinical significance of single CAAs differs depending on the course of the artery. Those that take an inter-arterial (malignant) course, between the aorta and pulmonary artery, can present with syncope or sudden death [1,3]. This is attributed to the myocardial ischaemia that ensues when the single coronary artery is compressed between high-flow structures in systole. Whereas, those that traverse benign, inter-ventricular paths do not predispose to myocardial ischaemia, hence, patients are often asymptomatic [1,3]

It’s all in the Head?

doi:10.7244/cmj-1379800800-0
Lisa Sabir

Mr F, a Maltese 69 year old retired electrician living at home with his wife, presented to the Emergency Department with a referral from his ophthalmologist. Mr F presented with a two month history of headaches that had worsened the last two weeks accompanied by a deterioration in peripheral vision over the last week. The headache was described as continuous and generalised, had suddenly increased in severity from 2/10 to 7/10 over the last 2 weeks, and was not affected by posture, movement or time of day. Mr F denied any associated vomiting, drowsiness, neck stiffness, photophobia or rhinorrhoea. Other clinical features noted were fatigue, cold intolerance, decreased need for shaving and decreased libido for the past month. No other constitutional symptoms including weight loss, change in appetite, fevers, or night sweats were reported. No changes in bladder or bowel function.

The Unconsidered Differential Diagnosis of Recurrent Acute Abdomen

doi:10.7244/cmj-1379800800-1
Shirley Sze

A 32-year-old from Turkey (Kurdistan province) presented with a 4-year history of recurrent, severe, vague abdominal pain requiring numerous hospitalizations. The pain was non-radiating, dull and constricting in nature with acute onset. There were no associated symptoms apart from constipation. His C-reactive protein and white cell count were always raised during these acute episodes. The pain resolved spontaneously without any specific treatment. He was completely well in between these acute episodes. Investigations including diagnostic laparoscopy, endoscopy and colonoscopy, CT scans and porphyria and infection screens were performed and were found to be negative / normal. Subsequent analysis of the MEFV gene detected two pathogenic variants (Met680IGC and Glu148Gln) on exon 2 and 10 and a diagnosis of familial Mediterranean fever was made. He had no further acute episodes after colchicine treatment was initiated.

Safety of SSRIs in Pregnancy

Image credit: tipstimes.com/pregnancy

doi:10.7244/cmj.2013.07.003
Sian-Lee Ewan

A recent study, Jensen et al 2013 [1], sought to differentiate the effects of exposure to maternal depression from the effects of antidepressants in their contribution to a reduction of Apgar scores. They collected data regarding diagnosis of depression, use of antidepressants in pregnancy, and Apgar scores at 5 minutes from all pregnancies in Denmark from 1996 to 2006 using national databases. This gave information on 668,144 births. Pregnant women were divided into 8 risk groups depending on their exposure to antidepressants during pregnancy, their exposure to antidepressants before pregnancy, and a diagnosis of depression before the end of pregnancy. Logistic regression analyses were applied with Apgar score <7 as the outcome and risk group as the variable of interest. Apgar score of <7 at 5 minutes was used as the outcome because it has been associated with an increased risk of low IQ at age 18, individuals being less likely to have no income from work, and neurological disability [1]

Medical Students concerned regarding lack of research skill teaching

Image credit: Bryan Jones

doi:10.7244/cmj-1373989392
F Cooksey, R Smith, TI Lemon, R Sharm, A Yarrow Jenkins, P Winter, A Buick

Knowledge of research skills and methods, once an integral part of the academic process, has in recent times become neglected by medical schools. Anecdotal evidence suggests political pressures have prioritised communication skills training as the focus towards producing the best doctors for tomorrow. Consequently, the prioritisation of communication training in the UK undergraduate curriculum has caused a reduction in research methods training, despite Tomorrows Doctors (2009) [1] documenting research skills such as critical appraisal integral to the analytical armoury of the developing clinician. We decided to poll students as to whether they felt they are adequately taught research skills and methods in their undergraduate medical courses.

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

Image credit: Hey Paul Studios

doi:10.7244/cmj.2013.07.002
Christine Ma

Three hundred and fourteen patients >40 years old with >20 pack year history and diagnosed acute exacerbation of COPD in hospital were randomised to have either 5 or 14 days of systemic glucocorticoids. The primary end point of this study was the time to next exacerbation over a follow-up period of 6 months, and secondary end points examined all-cause mortality, changes in pulmonary function testing, clinical performance, glucocorticoid-associated adverse events. Apart from a higher cumulative glucocorticoid exposure in the 14 day therapy group, there were no statistical differences in primary or secondary outcome measures between the two groups.

'To Give or Not to Give'

Image credit: scribbletaylor

doi:10.7244/cmj.2013.07.001
Shannon Leckey, Thomas Lemon

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.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

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

Image credit: Charlie J

doi:10.7244/cmj.2013.06.001
Clement Loh Chee Hoou

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).

Review of the Oxford Handbook of Medical Sciences

doi:10.7244/cmj-1348049146
Angus J McKnight

The iconic Oxford Handbook of Clinical Medicine has long been a favourite of medical students and junior doctors alike from all over the country. It is used routinely for reference, revision and help on the wards. The Oxford Handbooks series has greatly expanded over the last few years, and there are now handbooks dedicated to a vast number of medical and surgical specialties and subspecialties targeted at all levels of medical training.

Review of Clinical Biochemistry

doi:10.7244/cmj-1334679407
Stephanie Smith

Clinical Biochemistry is taken from Oxford’s new “Fundamentals of Biomedical Science” range. The authors set out to bridge the gaps between basic science, disease processes and diagnostic medicine. The book would be particularly useful for preclinical students who wish to gain a better insight into the relevance of biochemistry in a clinical context.

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