All articles

Rapidly deteriorating mobility in a young man: Case description and possible differential diagnoses

doi:10.7244/cmj.2016.06.001
V Srirangam

A 32 year old gentleman, presenting initially with a ‘dragging’ foot, rapidly progressed to become paraplegic within a year. Here, a case summary is presented initially, followed by the differential diagnosis for the clinical presentation. Investigations primarily showed combined central and peripheral demyelination which could have been secondary to the anti-CRMP5 antibodies found in his serum. Such antibodies are highly associated with malignancy and, as a consequence, our patient was extensively investigated for an occult neoplasm (which was not found). While the central and peripheral demyelination may have been secondary to an antibody-mediated paraneoplastic syndrome, other differentials such as autoimmune combined demyelination must also be considered.

Integrating Care for Communicable Disease and Non-Communicable Disease

Credit: Penn State, flickr

doi:10.7244/cmj.2016.05.002
A Yang

Although communicable disease (CD) and non-communicable disease (NCD) are often thought of as separate, competing entities particularly when it comes to funding pipelines and interventions, the two classes of disease are in fact intimately related. Medical anthropologists and sociologists have long recognized that social determinants such as poverty serve as a common breeding ground for CDs and NCDs, but the relationship between the two kinds of diseases can be even more direct. This article explores the intimate symbiosis between CDs and NCDs through a range of illustrative examples. In some CD-NCD pairs, the CD causes or is etiologically associated with an NCD, illustrating that NCD interventions are sometimes more effective when coupled with CD interventions, such as vaccination programs. In others, the relationship is better characterized as bidirectional, each worsening the outcomes of the other. From a broader perspective, these relationships also connect with each other in a larger web of various CD-NCD interactions. Because of these reinforcing relationships, screening for and treating CDs and related NCDs together rather than separately can more effectively reduce the suffering they cause. Hence, integrating interventions against CDs and NCDs can produce better clinical results than addressing them separately, and given the increasing overlap between the burdens of NCDs and CDs across the world, integration is now as crucial as ever.

Dengue in India: The importance of child education

doi:10.7244/cmj.2016.05.001
M Roshen

Dengue is an important mosquito-borne viral disease and constitutes a major public health concern throughout tropical and subtropical regions. Its global incidence has increased 30-fold in the past half century and the World Health Organisation (WHO) estimates that there are up to 100 million new infections annually, with 40% of the world’s population at risk.

Historical Figures in Neuroscience: Donald Hebb

Image Credit: Raymond M. Klein

doi:10.7244/cmj.2016.02.002
J Kang

Donald Olding Hebb is truly a historical figure in the field of neuroscience, neurology and psychology. Hebb’s work, in particular his monograph The Organization of Behavior: A Neuropsychological Theory, provided a biological explanation for numerous psychological phenomena and revolutionized the aforementioned fields, a feat emphasized by his consequent nomination for the 1965 Nobel Prize for Physiology or Medicine. However, what distinguishes Hebb from other exceptional scientists is that his influence is not solely limited to his research. His work as an educator inspired many prominent psychologists, including Brenda Milner, Ronald Melzack and Michael Posner, and stimulated changes in educational approaches, most notably in the childhood education of the underprivileged.

Antimicrobial resistance: A major threat to public health

Credit: Wellcome Images

doi:10.7244/cmj.2016.01.001
WL Hamilton and R Wenlock

Antimicrobial Resistance (AMR) is an increasing problem in the treatment of many pathogenic microorganisms, and can be intrinsic to the pathogen or acquired. Here, we provide an overview of the causes and consequences of AMR using illustrations from bacterial species that have a major impact on UK healthcare, such as Methicillin-Resistant Staphylococcus aureus (MRSA), Extended-Spectrum β-lactamase (ESBL)-producing organisms, and Carbapenemase-Producing Enterobacteriaceae (CPE). Bacteria can quickly evolve AMR due to short generation times allowing rapid evolutionary change, and horizontal transfer of genetic material between strains. The resulting arms race between bacterial evolution and human pharmaceuticals is one that modern medicine is currently losing, with potentially disastrous consequences for patient outcomes, public health, and healthcare macroeconomics.

CMJ Photo Competition - Winner announced!

I miss the NHS

The CMJ are pleased to annouce the winner of the 2015 photo competition as Roisin O'Dea. We had a high number of excellent entries and it was difficult to pick just the one. We will be uploading the runner up images shortly. Click to view the winning entry.

Acute skin toxicities in patients receiving adjuvant breast radiotherapy

Credit: IAEA Imagebank

doi:10.7244/cmj.2015.08.002
P Boothroyd, E Lee , E Sweet, A Stillie, E Cameron, Y Cao, A MacArthur, H Zakaria, J Cameron

Adjuvant breast radiotherapy (RT) is associated with acute skin toxicities including erythema and desquamation that may be associated with a detrimental impact on patients’ quality of life. Management of radiation-induced skin reactions (RISR) is contentious due to conflicting literature. There is a lack of evidence for the use of aqueous cream although this is commonly used in UK cancer centres. Alternative preparations such as Moogoo udder cream® are more expensive and may be more efficacious. The aim of this study was to investigate patient experience of RISRs and determine whether they would be willing to purchase a cream not provided on the NHS, should one be demonstrated to be more efficacious.

Patient Information: One Approach Fits All?

doi:10.7244/cmj.2015.08.001
R Price, R Gilhespy, K Hartop, S Jack, E Simpson, A Stillie

The evolution of healthcare spans centuries and reflects the way in which new knowledge has been applied and subsequently integrated into medical practice. There has been a distinct shift towards a mutualistic approach to delivering healthcare. Physicians must address increasingly complex patient expectations and ensure that patients understand their medical conditions. Providing solely verbal information has long been recognised to result in poor patient recall1, however identifying and developing a model to ensure the effective delivery of medical information is proving more challenging. Can one approach fit all?

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