In this month's issue of QJM
As usual this month's edition offers a variety of articles that are not only interesting but which also have implications for clinical practice. The review paper by Beynon explores the important issue of cardiac pathology in muscular dystrophy. We are reminded of the importance of screening for cardiac disorders in both patients and carriers of this disorder. Furthermore, the need for effective team working between all clinicians (especially neurologists, cardiologists and geneticists) involved in the care of this patient group is stressed.MacDonald et al. have undertaken a survey of transthoracic echocardiography services across the UK. In their opinion, there is much scope for improvement. In many hospitals, echocardiography was performed by individuals whose competence had not been formally assessed and fewer than half of the units surveyed undertook regular audit of the services they provided.
We publish many papers on Type 2 Diabetes Mellitus (T2DM) but that written by Smith and colleagues is somewhat unusual. An attempt is made to define the usefulness of the trace element vanadium in the control of T2DM. There is a hypothesis that deficiency of certain micronutrients may play a role in glucose metabolism and vanadium has been demonstrated to have insulin-like properties in certain situations. However, in this critical review of the subject, no evidence was found for the effectiveness of vanadium in the treatment of T2DM.
There are two papers that deal with deliberate self-poisoning. The first of these by Waring et al. makes the observation that two of the accepted risk factors (alcohol abuse and malnutrition) for subsequent development of liver damage following paracetamol overdose are both associated with low serum urea concentrations. However, following their study of 1085 patients who presented with excessive paracetamol ingestion, their conclusion was that low serum urea concentration could not be conclusively considered to be an independent risk factor for hepatotoxicity. Davies et al. describe the occurrence of organophosphorus pesticide as form of self-harm in Sri Lanka where it represents a significant source of mortality and morbidity. They assess the effectiveness of two established scores (the International Program on Chemical Safety Poison Severity Score (IPCS PSS) and the Glasgow Coma Score (GCS) for the prediction of death in patients presenting with organophosphorus pesticide poisoning. Both scores were found to be effective in this respect but two important facts of clinical relevance were found: patients presenting with a low GCS should be considered as candidates for immediate intensive monitoring and those who had ingested the pesticide fenthion needed to be carefully watched as their initials symptoms could be mild.
Home Parenteral Nutrition (HPN) is an accepted treatment modality for those patients with intractable intestinal failure. Green describes 15 years experience of HPN at the John Radcliffe Hospital, Oxford. Eighty-eight patients received HPN for a total period of 121 patient years with acceptably low rates of complications that included line sepsis/occlusion, subacute bacterial endocarditis, cholestasis and central venous thrombosis. It is concluded that HPN can be safely and effectively delivered outside of a hospital setting but is highly dependent upon the input from a multidisciplinary team that includes nurse-lead vascular access.
In 2003, QJM published a paper by Akashi et al. that described the clinical features of takotsuba cardiomyopathy (TC), a disorder resulting from sudden weakening of the myocardium but where the coronary arteries are apparently normal. (A takotsuba is a Japanese pot used for fishing octopus and its shape resembles that of the left ventriculum in this disorder.) Haghi found the occurrence of left ventricular thrombus in 4 out of 52 patients with TC. As a result the use of anticoagulant therapy should be considered in patients with TC especially those with elevated CRP levels and thrombocytosis.
Continuing with a cardiology theme, the review conducted by Testa et al., compares the risk/benefit profile of repeat thrombolysis vs rescue primary percutaneous coronary intervention (PCI) in patients where thrombolysis has failed. Eight trials fulfilled their search criteria and included 1318 patients. It is argued that although the observed benefit is modest, the use of PCI after failed thrombolysis should be carefully considered.
Much has recently been written about the role of pentraxin PTX3 as a marker of inflammation in a variety of clinical settings. In particular, many consider it to be a useful early indicator of myocardial infarction. Suliman and colleagues examine the relationship between PTX-3 and clinical outcome in renal dialysis patients. PTX3 levels were found to be high in dialysis patients who also had cardiovascular disease; furthermore, high levels of PTX3 were independently associated with mortality of any cause in these patients.
There is also in this month's issue a paper that deals with a piece of medical history (a subject that is often related to infectious diseases). Leprosy was once endemic in all of Europe including the British Isles. Allegedly the last reported indigenously contracted case in Britain was in Scotland in the late 18th century. Cases subsequently seen in the UK were usually acquired abroad. A paper from the Liverpool School of Tropical Medicine describes what might well be the first documented cases of indigenous leprosy transmission in the UK. This is noteworthy in itself but what was more remarkable was the public reaction to what became known as the Wallasey Leprosy Scare in the 1940s. There are obvious similarities with more current media coverage of HIV, SARS and multi-drug resistant TB.
Finally, a general observation about the journal itself. The more observant reader may have noticed some changes in the editorial team. I took over as editor in chief from Chris Martyn for QJM some months ago. Wendy Moore has succeeded David Hackett as editorial assistant. I am very grateful to Chris for leaving me with a journal that is in such a healthy state. QJM continues to enjoy a well deserved reputation and attracts a loyal readership. The journal has been in circulation since 1907 and during that time it has seen many editors and change of format. The most recent significant change has been the introduction of the electronic submission system, Editorial Manager. This has vastly improved the manuscript processing system while at the same time ensuring a high quality of published papers. As your editor, I look forward to receiving your papers: original research, reviews, commentaries and personal views. We can not publish everything that we receive but will try and give you an early decision. Also please let me have any suggestions that you may wish to make about the journal (mjbannon{at}doctors.org.uk). I look forward to hearing from you
CiteULike 
Connotea 
Del.icio.us What's this?
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||