Res Medica (E-Journal)
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The New Dual Antiplatelet Therapy Agents And Their Role in Acute Coronary Syndrome
Get PDFBackground: Prasugrel and ticagrelor are two novel antiplatelet agents, which have been subject to large randomized trials to compare their efficacy with clopidogrel for patients with acute coronary syndrome (ACS).Aim: To conduct a systematic review of prasugrel and ticagrelor as alternative therapy to clopidogrel in patients who present with ACS undergoing PCI.Methods: The articles cited in this paper were searched on PubMed, MEDLINE, and Plymouth University’s Metalib database. The search terms used included “dual antiplatelet therapy”, “prasugrel”, “ticagrelor”, and “clopidogrel resistance”. Discussion: The main indications for the use of prasugrel based on current understanding are patients presenting with acute STEMI referred for primary PCI, ACS patients with DM, or those who have a high risk of stent thrombosis. Ticagrelor, on the other hand, may provide optimal benefit for patients with NSTEMI treated with conservative or invasive therapy, those with previous TIA or stroke, advanced age, or small body surface. Conclusion: Prasugrel and ticagrelor have been shown to be adequate P2Y12 antiplatelet therapy alternatives to clopidogrel in the management of patients with ACS. While prasugrel and ticagrelor have both been shown to clinically improve platelet inhibition and significantly reduce the incidence of stent thrombosis compared with clopidogrel therapy, both increase the risk of a significant bleeding incident. Both ticagrelor and prasugrel have been shown to be appropriate and effective treatment alternatives for ACS patients who display clopidogrel treatment resistance or failure
Supraventricular tachycardia and catheter ablation: Anxiety levels and patient perceptions
Get PDFAim: To investigate anxiety levels and patient perception associated with supraventricular tachycardia (SVT); investigate anxiety levels and patient perception pre- and post- radiofrequency catheter ablation (RFCA); and explore any association between anxiety and patient perception with patient age and gender.Design: Follow-up quantitative and qualitative cohort study. 141 patients in a tertiary centre in Scotland who underwent an electrophysiological study and RFCA for atrioventricular nodal re-entrant tachycardia, atrioventricular re-entrant tachycardia or atrial tachycardia between 2009 and 2012 were enrolled. 59 (41.8%) were male; mean age at follow-up was 50 years.Interventions: Follow-up by structured phone questionnaire; mean follow-up period was 14 months. Main outcome measures: Anxiety level and patient perception during index episode, and anxiety level before and after RFCA.Results: During index episode, median patient anxiety, on a scale of 0–10, was 8. Anxiety was not associated with gender (p = 0.07). Patients in the lowest and highest anxiety groups tended to be older (mean 54.5 and 44.4 years respectively) compared with those in the middle 2 groups (mean 34.1 and 35.6 years). There was an association between anxiety and age (p = 0.039). 45 (32.0%) participants thought they were having a heart attack or dying. Before RFCA, median anxiety level was 7. 55 (39.0%) patients were afraid of complications, 21 (14.9%) patients feared being awake during RFCA. After RFCA, median anxiety was 2.5.Conclusions: Anxiety is a common accompaniment to SVT that may lead to greater pre-procedural anxiety. Exploring this link may allow reduction of anxiety via better psychopharmacological intervention, education, and preprocedural counselling
A Biochemical Approach to Depressive Illness
Get PDFWe also have a fourth possibility, namely that the changes in metabolism may be taking place only in the brain although the same metabolic process is to be found also in other tissues. If this situation exists it may be impossibleto infer changes in cerebral tissue from changes in metabolites in blood and urine. Studies of cerebral metabolism in depressive illness are necessary in each of the above situations. In 1, 2 and 3 above they are necessaryto justify the assumptions relating general and cerebral metabolism, whilst in case 4 the information is not obtainable by any other technique
Medical Pudder
Get PDFIvor Brown first used the term pudder to describe writing which has a tendency to say what has to be said in as complicated a way as possible. Here is a well known piece of medical pudder:“Experiments are described which demonstrate that in normal individuals the lowest concentration in which sucrose can be detected by means of gustation differs from the lowest concentration in which sucrose (in the amount employed) has to be ingested in order to produce a demonstrable decrease in olfactory acuity and a noteworthy conversion of sensations interpreted as a desire for food into sensations interpreted as satiety associated with ingestion of food.
Book Reviews
Get PDFA Practical Guide To The Care of the Injured by P. S. London. E. & S. Livingstone. ￡7 10/-.Treatment of Common Acute Poisonings. Henry Matthew and A. A. H. Lawson. E. & S. Livingstone Ltd. 1967. 16/.Basic Anatomy (2nd. Edition) by G. A. G. Mitchell and E. L. Patterson. E. & S. Livingstone. ￡5 5/-.Introduction to Medical Laboratory Technology (4th Edition) by F. J. Baker, R. E. Silverton and E. D. Luckcock. Butterworth & Co. 62/6.Exercises In Neurological Diagnosis by J. H. Tyrer and J. M. Sutherland. E. & S. Livingstone Ltd. 42/-.Nervous Inhibition. Ed. E. Florey. Pergamon Press. £5.Outline Of Fractures (8th Edition) by J. Crawford Adams. E. & S. Livingstone. 32/6.Principles Of Gynaecology (3rd. Edition) by T. N. A. Jeffcoate. Butterworth & Co. £6 10/-.Introduction To Gastrointestinal Physiology by George B. Jerzy Glass. Prentice-Hall, Inc.74/6.Techniques In Blood Grouping. Vols. I and II, by I. Dunsford and C. C. Bowley. (2nd. Edition). Oliver & Boyd Ltd. £5 5/-.Research In Burns. Ed. A. B. Wallace and A. W. Wilkinson. E. & S. Livingstone. 90/-.Symptoms And Signs In Clinical Medicine (8th. Edition) by E. Noble Chamberlain and Colin Ogilvie. John Wright & Sons Ltd. 55/-.Principles of Head and Neck Surgery by H. Robert Freund. Butterworth & Co. £6 5/-.Exercise in Neurological Diagnosis. John H. Tyrer and John M. Sutherland. E. & S. Livingstone Ltd. 1967. 42/-.A System of Orthopaedics and Fractures—Third Edition by A. Graham Apley, MB, BS, FRCS.Surgery of the Alimentary Tract by John H. Garlock, M.D.Labor-Clinical Evaluation and Management by Emanuel A. Friedman, M.D
Graphology
Get PDFPersonality assessment is serious business. It goes on all the time and involves everybody from the Prime Minister to modern Miss Telephonists of 1969. Because of its intangible nature people search for tangible systems to define it. The way a woman wears her face, a man his laugh, the way we act, talk and write, help to form some sort of register, permanent or hopefully immutable. People like to know most things about most other people. I just don’t understand you, sighs a puzzled lover; a disillusioned contemporary looks to the bottom of his beer mug for support. Both clutch at any technique that offers to crack the code of those that matter to them.Graphology has struggled hard with its metamorphosis from art to science. If the ecdysis is not yet complete it is not for want of trying. The approach in graphology has been modified from an artifical and laboured point by point analysis of handwriting, the "school of fixed signs” of Michon , to a wider assessment of the traits and general forms inherent in writing. Pulver, Kraeplin and Klages, Allport, Vernon and Saudek, Roman, Lewinson and Zubin, these are the names that have introduced a commonsense, rhythmical and balanced line to handwriting analysis. While not entirely acceptable, it is intriguing and full of promise. Inevitably the subject finds itself variously ascribed to a booth along with Mme . Lizandra and her magic ball, phrenologists, homeopaths and cocktail party astrologers, or to the laboratory with psychometrists, forensic scientists and employers. It is not an entirely happy resonance
Review
Get PDFFor many years, the R.M.S. has attracted a membership of only 10 % of medical students between 2nd and 6th years in this University, and has had very variable (and often disappointing) turn-outs at both public and private -meetings. A questionnaire was put out to students last Summer Term to determine what proportion of medical students might be attracted to joining the Society.This showed that 30% of students were ‘regular’ attenders at extracurricular lectures, societies, symposia, etc., i.e. attended more than twice per term; 30% did not attend any such meetings, the remainder (40%) being ‘occasional\u27 attenders. Comparison showed that twice as many students attended Edinburgh Medical Group meetings as R.M.S. meetings; why this should be we could not definitely ascertain, but it is significant that 72% of medical students felt that they were insufficiently informed about R.M.S. activities
Books
Get PDFAuscultation of the Heart (3rd. Edition) by R. W. D. Turner. E. & S. Livingstone Ltd. 6 /- .A Dictionary of Microbial Taxonomic Usage by S. T. Cowan. Oliver & Boyd. 4 2 /-.Acute Myocardial Infarction . Eds. D. G. Julian and M. F. Oliver. E. & S. Livingstone Ltd. 50 /-.Textbook of Medical Treatment. Eds. Dunlop and Alstead. E. & S. Livingstone Ltd. 75/-.Medical Aspects of F itne ss to Drive Vehicles. A Report by the Medical Commission on AccidentPrevention. 5/-.Modern Trends in Toxicology I. Eds. Boyland and Goulding. Butterworth & Co. 75/-.Vascular Diseases by M. J. Tsapogas, V. V. Kakkar & E. N. Gleave. H. K. Lewis & Co. £2 10/-.Principles of X-Ray Diagnosis by D. H. Trapnell. Butterworth & Co. £6 10/-.Elements of Medical Genetics by Alan E. H. Emery. E. & S. Livingstone. 35/-.The Principles and Practice of Medicine (9th.Edition) by Sir Stanley Davidson. E. & S. Livingstone Ltd. 45/-.Develpoment of the Brain by W. A. Marshall. Oliver & Boyd Ltd. 7/6d.Speech and Hearing Science by W. Zemlin. Prentice Hall International. 102/6d.Industrial Dermatoses and The Industrial Injuries Act by J. T. Ingram. J. & A. Churchill Ltd. 10/-.Scoliosis by J. I. P. James. E. & S. Livingstone Ltd. 55 /-
Editorial
Get PDFDespite the many exciting discoveries in scientific medicine which fill the medical journals at present, one senses that patients are growing disillusioned with their doctors ability to help them. The staggering increase in litigation cases against doctors and the slowly advancing growth of "alternative medicine" are symptoms of a growing rejection by some of the public of the standard type of medical care they are presently offered. Interestingly, these alternatives are invariably less scientific than the medicine we practice; if we are to recover the trust of our patients and restore a healthy relationship with them we must relearn to value our patients as people and not as objects for our scientific appraisal.It is hoped that this second issue of “Res Medica" will stimulate its readers to think harder on medical issues, and encourage a more balanced practice of medicine. Hamish Maclaren opens with his criticism of the new Edinburgh medical curriculum and makes observations on medical education generally. Dr. Jack Cormack gives his views on the role of obstetrics in general practice, and to conclude the "Comments and Reflections" section of the magazine Dr. Edward Duvall (Olim Praeses) contributes a fascinating account of the control of infectious diseases
A short history of Obstetric Anaesthesia
Get PDFThe pain of childbirth has afflicted women for generations and the quest to relieve such pain has been pursued throughout history. Dr Ann Whitfield relates the story of obstetric anaesthesia from its early beginnings in ancient times, the introduction of chloroform by Sir James Young Simpson in the 1800s, through to the present day and the controversy over natural childbirth