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The first time a doctor or medical student watches a patient go from being fully alert and talking to apnoeic and pulseless in a matter of minutes, the event is likely to stay with them for the rest of their life. Two accounts of such experiences by junior doctors are movingly described in Academic Emergency Medicine (2007;14:825-6 doi: 10.1197/j.aem.2007.03.1352). Sometimes this may happen in the middle of nowhere, where medical facilities and resources are scarce—but it can also happen in a centre of excellence where, despite everything that is available to save lives, a life is lost.
Most vaccines act by neutralising viral antibodies, thereby reducing viral entry into target cells. Monkey models have shown that this protects against HIV. New animal research shows this protective effect comes not just from neutralised antibodies but also from activated cell mediated “effector” cells (Nature 2007;449:101-4 doi:10.1038/nature06106). The effector cells act against free viral cells as well as targeting infected cells, suggesting that an HIV vaccine should tackle both cell mediated immunity and antibody immunity.
Another dimension of the suitability of doctors for their intended career is discussed in the Annals of the Royal College of Surgeons of England (2007;89:591-5 doi: 10.1308/003588407x187702). Dexterity and technical skills are fundamental to surgery but aren't assessed during selection. A survey of nine surgical training programmes in the London Deanery found that candidates' practical skills were assessed in three specialties (ENT, plastic surgery, and general surgery)—but once trainees were selected, no specialty tested for visuospatial or technical ability.
The 2007 Medsin National Conference for about 400 UK based medical students will be held in Dundee on 26-28 October. With a theme of “lots of people, lots of problems,” it will be covering topics such as migration, urbanisation, development, and population. Dundee University is looking for sponsorship from companies, organisations, and individuals. If you can help please email Emma Baird (firstname.lastname@example.org).
In Australia, pharmacists can “hand make” compounds of drugs in novel delivery systems that are not regulated by the Therapeutic Goods Administration. Compounded hormone replacement therapy (“bioidentical” HRT) is commonly made up into tablets or creams. Three cases of endometrial cancer occurred in women taking bioidentical HRT (Medical Journal of Australia 2007;187:244-5), suggesting that some of these handmade compounds contain insufficient progesterone to prevent endometrial hyperplasia.
The recipient of the UK's first canine knee replacement is Grace, a 7 year old bearded collie with severe arthritis (Veterinary Record 2007;161:284). Euthanasia had been considered because she didn't tolerate non-steroidal anti-inflammatory drugs. The femoral component of the replacement knee is made of cobalt chrome and is not cemented; long term stability comes from the bone growing into tiny beads on the surface of the prosthesis. The polyethylene tibial component is cemented, and there's no patellar component.
The first issue of the Journal of Infection in Developing Countries is now available online. (www.oloep.org/jidc/content.asp?id=958). The editor in chief describes it as an “open laboratory” and welcomes suggestions and comments. The idea for the journal came from a forum on the open learning website www.oloep.org, which is hosting this first issue.
“Irritable male syndrome” is what a writer in Fighters Only (October 2007:66-8) calls covert depression in men. Instead of becoming clingy and needy, depressed men tend to isolate themselves socially and struggle to keep their negative feelings inside. They may experience more unexplained physical symptoms than women, and undiagnosed depression can help destroy relationships. In many men, the midlife crisis is a euphemism for depression.
A systematic review suggests we still don't know whether delayed onset post-traumatic stress disorder exists. The diagnosis was introduced in DSM-III in 1980, and the data show that it's rare. Discrepancies in data on prevalence may be explained by problems in definition. Researchers say studying delayed onset post-traumatic stress disorder would be easier if the definition included the likelihood of previous symptoms becoming exacerbated or reactivated (American Journal of Psychiatry 2007;14:1319-26 doi: 10.1176/appi.ajp.2007.06091491).