For your library - interesting articles from this week journals

NEJM articles
Clinical images - Marjolin's Ulcer - this is an ulcer arising from scar tissue

Use of Electronic Medical Alerts to remind physicians to comply with the guidelines - in this case using DVT prophylaxis

New developments in the chemotherapy for brain tumors

Neurocardiogenic Syncope - a review. See how to use a tilt table.

Anemia of Chronic Disease (ACD) - a review. Check also our case about one patient with IDA and ACD. Use the search box at the top.

ACD is multifactorial and it can occur in both chronic and acute inflammation despite the name anemia of "chronic" disease. The pathogenesis is too multifactorial to remember but inflammatory substances like IL and TNF play crucial role, e.g. suppressing RBC precursors.

Often, ACD and IDA coexist, and that's why every patient with suspected ACD needs an iron profile and ferritin.

Epogen is not a panacea and may have its own problems, e.g. certain cancer cells have Epo receptors, and treating ACD with Epo may stimulate cancer growth. Some studies showed that patients with breast cancer and ACD had higher mortality when treated with Epo.

The best Hgb level is also controversial. It looks like Hgb 8 is not enough anymore because patients with Hgb >10 have better outcomes.

This NEJM article is definitely worth reading although it is a little heavy on pathogenesis but this is what NEJM is always like in its review articles. If you like practicality, read the American Family Physician.

JAMA articles
Computerized Physician Order Entry Increased the Medication Errors.
Paradoxically the computer system increased the errors. Was it the software design? Physicians had to click sometimes through 20 screen to get the job done - no wonder they made mistakes. Check the editorial.

Screening for Breast Cancer - a literature review

Overdosed America: The Broken Promise of American Medicine - a book review

BMJ
Recent developments in asthma management - a review