A. Keith W. Brownell

Assessment of non-cognitive traits through the admissions multiple mini-interview.

Context  Contemporary studies have shown that traditional medical school admissions interviews have strong face validity but provide evidence for only low reliability and validity. As a result, they do not provide a standardised, defensible and fair process for all applicants.

Dilated cardiomyopathy in multicore myopathy

Abstract Multicore myopathy is a skeletal muscle disorder causing proximal skeletal muscle weakness. The typical feature on skeletal muscle biopsy is the presence of multiple small cores within muscle fibers from which mitochondrial enzymes are absent by enzyme histochemistry. The occurrence of cardiac disease in patients with multicore myopathy has only recently been described,1 and descriptions of the cardiac pathology are rare. We report the findings at necropsy in a man with multicore myopathy and a long history of biventricular congestive heart failure.

Homozygous Lamin A/C familial lipodystrophy R482Q mutation in autosomal recessive Emery Dreifuss muscular dystrophy

Autosomal recessive Emery Dreifuss muscular dystrophy (AR-EDMD) is rare, with few reports in the medical literature. We describe the first cases of AR-EDMD and autosomal dominant familial partial lipodystrophy (FPLD) in the Hutterite population resulting from homozygous or heterozygous R482Q mutations in the lamin A/C gene (LMNA). Heterozygosity for LMNA R482Q mutation causes FPLD, which is associated with increased risk of hyperlipidemia and hypertension. The overall carrier frequency of the R482Q mutation in Dariusleut and Leherleut Hutterites in Alberta was found to be 1.45%. Homozygosity for this mutation has not been previously reported and here resulted in a combination of generalized lipodystrophy and EDMD. Knowledge that the LMNA R482Q mutation is present in this population is important for genetic counseling, surveillance, and management of the associated disorders.

Reversible cerebellar syndrome caused by metronidazole

A 54-year-old man presented with a 3-day history of difficulty speaking and an unsteady gait after having a generalized tonic-clonic seizure. He had been taking oral metronidazole for bronchiectasis for 2 months before presentation (estimated cumulative dose of about 60 g). His medical history

Clinical practitioners’ views on the management of patients with medically unexplained physical symptoms (MUPS): a qualitative study

Objectives By identifying strategies that practicing physicians use in managing patients with medically unexplained physical symptoms (MUPS), we present an interim practical management guide (IPMG) that clinical practitioners may find useful in their clinical practices and that may help guide future research. Design A qualitative research study based on interview data from practicing physicians with experience in dealing with MUPS and known to the physician members of the research team. A parallel exploration of patient experiences was carried out simultaneously and is reported elsewhere. Setting 2 urban centres in 2 different Canadian provinces in a healthcare system where family physicians provide the majority of primary care and self-referral to specialists rarely occurs. Participants The physician members of the research team invited practicing family and specialty physicians to participate in the study. Results We characterise the care of patients with MUPS in terms of a 4-part framework: (1) the challenge of diagnosis; (2) the challenge of management/treatment; (3) the importance of communication and (4) the importance of the therapeutic relationship. Conclusions On the basis of the details in the different parts of the framework, we propose an IPMG that practitioners may find useful to facilitate the clinical care of patients with MUPS. The guide can be readily implemented into the practice of any physician who cares for patients with MUPS.