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Archive for April, 2009

Human syngamosis: an unusual cause of chronic cough in travellers

29 Apr, 09 | by Emilia Demetriou

“Sometimes it takes a great deal of investigations before the correct diagnosis is made. In this case the authors describe a rare cause of cough due to a parasite in a recent traveller. They point out that the travel and the rapid onset of cough were key factors pointing to an infective / parasitic cause.”

Human syngamosis: an unusual cause of chronic cough in travellers

Everyone is “swine flu” case reports mad!

29 Apr, 09 | by Dr Dean Jenkins

It is great to see that the whole world is discussing case reports! Led by the World Health Organisation we are constantly being kept up to date with a growing case series of swine influenza.

http://www.who.int/csr/disease/swineflu/en/index.html

The BBC news this morning reported that they are awaiting the outcome of tests on relatives and friends of the first couple to catch the new flu in Scotland. This will help confirm if human to human transmission has occurred in the UK.

http://news.bbc.co.uk/1/hi/scotland/8023515.stm

It is clear that case reports and case series are most useful in hypothesis generation and the early reporting of new diseases / adverse reactions.

Should anyone want to publish a case report in a peer-reviewed and dedicated case reports journal then please consider BMJ Case Reports … after you have called the BBC of course.

Internet diagnosis of digitalis toxicity

15 Apr, 09 | by Emilia Demetriou

As electronic connectivity improves so the opportunity of correct and timely diagnosis is made possible. In this example the authors describe how a web-connection helped identify digitalis toxicity and the diagnosis was made whilst the patient was still at home.

Internet diagnosis of digitalis toxicity

Case series: Alzheimers treatment with CPHPC

14 Apr, 09 | by Dr Dean Jenkins

A case series of 5 people with Alzheimers disease given CPHPC for 3 months which led to depletion of Serum Amyloid P component (SAP) in the blood and brain1 is reported widely in the news.

http://www.sciencedaily.com/releases/2009/04/090413180706.htm

It is good that CPHPC, a small molecule developed in conjunction with Roche and now owned by Pentraxin, is usually abbreviated as its long name is R-1-[6-[R-2-carboxy-pyrrolidin-1-yl]-6-oxo-hexanoyl]pyrrolidine-2-carboxylic acid.

Whilst an interesting observation of safety and efficacy this short case series is very early in the development of this interesting new compound and requires further research. The story however has been taken up by several news sources as a possible breakthrough in the treatment of Alzheimers.

1) Simon E. Kolstoea SE, Basil H. Ridhab, Vittorio Bellottia, Nan Wangd, Carol V. Robinsond, Sebastian J. Crutchb, Geoffrey Keirc, Riitta Kukkastenvehmasb,, J. Ruth Gallimorea, Winston L. Hutchinsona, Philip N. Hawkinsa, Stephen P. Wooda, Martin N. Rossorb, Mark B. Pepysa. Molecular dissection of Alzheimer disease neuropathology by depletion of serum amyloid P component. PNAS, (in press)

Fundoplication: cases vs. RCT

13 Apr, 09 | by Dr Dean Jenkins

The Health Technology Assessment Programme published its findings on laparoscopic fundoplication for chronic gastroeaophageal reflux disease in September 20081. “The results showed that surgical treatment was more effective than long-term drug therapy, especially in patients with the most troublesome symptoms, certainly up to one year after the procedure. A surgical policy is, however, more costly than medical management and it is uncertain whether it would be cost-effective in the long-term.”

http://www.ncchta.org/news/newsitem061108.shtml

The BBC, in a recent news article2, cite a case where a young woman’s quality of life was greatly improved by the operation.

http://news.bbc.co.uk/1/hi/health/7753066.stm

There is clearly enthusiasm for the long term success (and therefore cost-effectiveness) of this procedure from the authors of the study and other experts cited by the BBC. The use of a case report here is trying to push forward the debate ahead of results from the extended follow-up from the trial.

I don’t think the case reports are going to change clinical practice more than the final results of the RCT in this battle but they can certainly keep the message of the benefit for severe cases alive in the meantime.

1) Grant A. The effectiveness and cost-effectiveness of minimal access surgery amongst people with gastro-oesophageal reflux disease – a UK collaborative study. The REFLUX trial. Health Technol Assess 2008;12(31):1–214

2) Elliot J. ‘I can eat pizza again after 10 years’. BBC News: Health. Available online at http://news.bbc.co.uk/1/hi/health/7753066.stm (accessed 13 April 2009)

Scurvy induced by obsessive–compulsive disorder

1 Apr, 09 | by Emilia Demetriou

This case highlights how old diseases may present in new ways. Fad diets or grossly abnormal diets due to behavioural and psychological illness may induce nutritional deficiencies and these can be a challenge for the clinician.

Scurvy induced by obsessive–compulsive disorder

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