Res Medica (E-Journal)
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Preliminary assessment of the value of computer-assisted learning (CAL) in undergraduate endocrine medical education
Full text linkRecurrent Aspergillus endocarditis in an immunocompetent patient: challenges in diagnosis and management
Full text linkWe describe an unusual case of recurrent Aspergillus endocarditis in an immunocompetent 64-year-old lady. Four weeks after aortic valve replacement surgery, she presented with an inferior ST elevation myocardial infarction. Coronary angiography demonstrated compromise of the ostium of the right coronary artery, which was successfully treated by primary angioplasty and stenting. Six weeks later, she suffered from a subarachnoid haemorrhage secondary to a mycotic aneurysm. A transoesphageal echocardiogram suggested a large aortic root vegetation. She underwent urgent aortic root replacement with removal of the vegetation, which was subsequently confirmed to be caused by Aspergillus. She was discharged on long term anti-fungal medication (Voriconazole), which she discontinued after seventeen weeks. Several years later, she presented with non-specific symptoms and was ultimately diagnosed with a recurrence of Aspergillus endocarditis. This case illustrates one of the many non-specific ways Aspergillus endocarditis can present. A high index of suspicion can prevent significant life-threatening complications.
Henry Gray and John Fraser: Scottish surgeons of the Great War
Full text linkBetween 1914 and 1918, the British Expeditionary Force fighting in France and Flanders sustained 2.7 million battle casualties. Just over one quarter (26.1%) were never seen by the medical services. These were men who had been killed (14.2%), were missing (5.4%), or were prisoners of war (6.5%). Most of those who were missing had been killed and their bodies never recovered. Just under three-quarters of the wounded (73.9% or 1 988 969) were seen and treated by the medical services and 151 356 died.[i] The worst single day in British military history was Saturday 1 July 1916, the first day of the Battle of the Somme, when there were 57 470 casualties, of whom 20 000 were killed or died from their wounds. In nearly a quarter of a million admissions dealt with by the medical services, 58.5% of wounds were caused by high-explosive shellfire, 39% by bullets (mostly from machine guns), 2% were caused by grenades, and 0.5% from bayonets.
 
A Comparison of the Early Responses to AIDS in the UK and the US
Full text linkUpon its emergence in the western world in the early 1980s, AIDS marked the beginning of a new chapter in the history of communicable disease. In the early stages of the epidemic there was a distinct lack of knowledge about the causation or transmission of the disease, rendering control of the situation a practical impossibility. It was clear that AIDS necessitated a definitive response from several sectors of society. With its apparent associations with then largely marginalised groups of society, namely homosexuals and injecting drug users, virtually no aspects of the response to AIDS were free from the influence of social and political perceptions of the disease and its victims. The US and the UK have strong political and cultural links and in this essay I will compare the responses of these two nations to the AIDS epidemic at a scientific, political and community level and explore the interactions which occurred therein
Salmonella Typhi Leg Abscess in a Patient with Myelodysplastic Syndrome
No full textWe describe a 59-year-old Filipino male patient with myelodysplastic syndrome (MDS) who developed a Salmonella typhi leg abscess, presenting with a two-week history of right leg swelling and fever. The infection was treated successfully with a combination of surgical drainage and a three-week course of intravenous antibiotics. MDS predisposes patients to severe Salmonella infections ranging from infected subdural empyema to aortitis, empyema thoracis and splenic abscesses. To our knowledge, this is the first reported case of S. typhi soft tissue abscess in MDS. Salmonella infections should be considered in the differential diagnosis of soft tissue abscesses, especially among immunocompromised patients such as patients with MDS
Should patients with low-moderate surgical risk be offered TAVI instead of conventional aortic valve replacement in the management of symptomatic aortic stenosis?
Full text linkIntroduction: Surgical aortic valve replacement (AVR) is the current gold standard treatment for symptomatic aortic stenosis. Without surgical intervention, patients experience a period of rapid clinical worsening, with 50% mortality within two years. However AVR in itself carries considerable risk and many patients may be considered too high risk and therefore not candidates for surgery. Transcatheter Aortic Valve implantation (TAVI) was conceived in 2002 which showed comparable results to AVR in patient are at high surgical risk. TAVI is indicated for high risk patients and in patients that are contraindicated to surgery. Due to increasing public interest there is demand for TAVI tobe used within lower risk patients. This is currently being assessed through the large SURTAVI and PARTNER A trials.Aim: The aim of this review is to appraise the current indications surrounding the use of TAVI in potentially low-moderate surgical risk patients and inform its readers about the history of TAVI and its future direction. This paper also addresses the pathogenesis, epidemiology, management and prognosis of aortic stenosis from the most upto date research studies. Methods: A systematic review was conducted. Databases searched included MEDLINE, Embase, AMED, Science Direct, UPTODATE and the British Journal of Cardiology for papers published from the period of January 1990-present. Combinations of the following terms were used: ‘tavi, ‘transcatheter aortic valve implantation’, ‘aortic stenosis’, ‘treatment of aortic stenosis’, ‘aortic valve replacement’ ‘avr’ ‘Medtronic core valve’ ‘bioprosthetic heartvalves’, ‘edward sapien bioprostheis’ and ‘treatment of aortic stenosis’. All papers were from the most up to date sources and all information was cross referenced with NICE guidelines and the UPTODATE database.Results: 37 papers were selected for review. The main findings included: the incidence of aortic stenosis is rising due to advances in medical treatment resulting in an aging population; AVR is the current gold standard treatment for aortic stenosis; TAVI is superior to medical therapy alone; TAVI is indicated in high surgical risk patients and those that are contraindicated to surgery; TAVI is comparable to AVR in high risk patients; studies have shown comparable result comparing TAVI with AVR in low- moderate risk pateints; the wide SURTAVI and PARTNER A trials are currently assessing the use of TAVI in low-moderate risk patients.Conclusions: TAVI has revolutionized an alternative way of thinking towards the management of symptomatic aortic stenosis. TAVI is indicated in patient whom are at high surgical risk and in cases where surgery is contraindicated. AVR remains the gold standard treatment in low-moderate surgical risk patients. TAVI may be considered as an alternative method to surgical AVR following the results of the PARTNER 2 and SURTAVI trials
Flipped Publishing: A New Paradigm for Medical Textbooks
Full text linkMedical textbooks remain an integral component of the undergraduate education pathway. These texts are traditionally prepared by senior clinicians or academics, based on their long experience of the subject matter. Medical students and junior doctors are commonly asked to review these books, but often have little role in influencing the content. This article will discuss the opening of a new paradigm in medical publishing, whereby students and junior doctors (juniors) take the lead in planning and producing the content of their textbooks with senior clinicians taking the role of reviewer.