Wilson Disease: A Case Report of Psychosis Preceding Parkinsonism.

BACKGROUND A first psychotic episode requires the exclusion of toxic-metabolic, inflammatory, infective, and neoplastic causes. Wilson disease is a rare, autosomal recessive disorder of copper metabolism and can present with neuropsychiatric symptoms secondary to copper accumulation in the brain. CASE REPORT We describe the case of a 48-year-old man with parkinsonism on a background of longstanding schizophrenia and psychotic depression in the setting of previously undiagnosed Wilson disease. The common history of neuropsychiatric disturbance and neuroleptic use complicated the assessment of parkinsonism. However, close attention to the temporal appearance of symptoms and signs differentiated his case from drug-induced parkinsonism, which commonly develops hours to weeks after commencement or uptitration of antipsychotic medication. The early features of sialorrhea and dysarthria were also atypical for idiopathic Parkinson disease. The diagnosis was confirmed by serum copper testing and supported by Kayser-Fleischer rings on bedside ophthalmological examination. Magnetic resonance imaging (MRI) of the brain demonstrated copper accumulation in the basal ganglia and pons, contributing to the characteristic neurological manifestations of an akinetic-rigid syndrome with dysarthria. CONCLUSIONS Serum copper testing is easily obtained and should be considered as part of the first-line investigations for new neuropsychiatric disturbances. Although rare, Wilson disease, if diagnosed early, is a potentially treatable and reversible cause of psychosis. With advanced disease, extrapyramidal findings on examination correlate with MRI brain changes, aiding the clinical assessment in differentiating the disease from drug-induced parkinsonism.

Pearls & Oy-sters: Huntington Disease Presenting as Primary Progressive Aphasia: A Case of Semantics.

We present a case of semantic variant primary progressive aphasia as the presenting feature in a patient with Huntington disease (HD). The patient initially developed progressive language impairment including impaired naming and object knowledge and single-word comprehension and then developed chorea and behavioral changes. An MRI of the brain showed left anterior temporal lobe and hippocampal atrophy. A neurologic FDG PET/CT showed reduced metabolism in the head of the left caudate nucleus. Huntingtin gene testing revealed an expansion of 39 CAG repeats in 1 allele. This case outlines the substantial overlap between the clinical presentation of HD and frontotemporal lobar degeneration syndromes and provides commentary on the investigation of these neurodegenerative diseases.

Truncal sensory polyneuropathy in light-chain amyloidosis.

We describe a case of truncal sensory polyneuropathy in a patient with light-chain amyloidosis. We highlight the clinical signs and differential diagnoses related to the presentation.

The role of reverse mentoring in medical education: current insights.

Reverse mentoring is a relatively contemporary concept that relies on the reversal of the traditional roles of mentor and mentee and the abolition of the mentorship model as an apprenticeship or hierarchy. Typically, a younger specialist takes on the role of mentor and an older, more experienced specialist the role of mentee. Reverse mentoring is founded in learning and social theories of mentorship and has been practically applied in information technology, business and education fields. However, there is a role for reverse mentoring in medical education and the health sciences, particularly with the inclusion of new technologies in a changing health landscape, and the emphasis on interdisciplinary teamwork and improved workplace culture. Further investigation and analysis of reverse mentoring is warranted, with a particular focus on the implementation of the reverse mentor model in the field of medical education and the health sciences. To assist those considering implementation of mentorship programs in their workplace, this article provides an overview of recent literature, with suggested applications of "reverse mentoring" in the medical education context.

Peer tutoring in a medical school: perceptions of tutors and tutees.

BACKGROUND: Peer tutoring has been described as "people from similar social groupings who are not professional teachers helping each other to learn and learning themselves by teaching". Peer tutoring is well accepted as a source of support in many medical curricula, where participation and learning involve a process of socialisation. Peer tutoring can ease the transition of the junior students from the university class environment to the hospital workplace. In this paper, we apply the Experienced Based Learning (ExBL) model to explore medical students' perceptions of their experience of taking part in a newly established peer tutoring program at a hospital based clinical school. METHODS: In 2014, all students at Sydney Medical School - Central, located at Royal Prince Alfred Hospital were invited to voluntarily participate in the peer tutoring program. Year 3 students (n = 46) were invited to act as tutors for Year 1 students (n = 50), and Year 4 students (n = 60) were invited to act as tutors for Year 2 students (n = 51). Similarly, the 'tutees' were invited to take part on a voluntary basis. Students were invited to attend focus groups, which were held at the end of the program. Framework analysis was used to code and categorise data into themes. RESULTS: In total, 108/207 (52 %) students participated in the program. A total of 42/106 (40 %) of Year 3 and 4 students took part as tutors; and of 66/101 (65 %) of Year 1 and 2 students took part as tutees. Five focus groups were held, with 50/108 (46 %) of students voluntarily participating. Senior students (tutors) valued the opportunity to practice and improve their medical knowledge and teaching skills. Junior students (tutees) valued the opportunity for additional practice and patient interaction, within a relaxed, small group learning environment. CONCLUSION: Students perceived the peer tutoring program as affording opportunities not otherwise available within the curriculum. The peer teaching program provided a framework within the medical curriculum for senior students to practice and improve their medical knowledge and teaching skills. Concurrently, junior students were provided with a valuable learning experience that they reported as being qualitatively different to traditional teaching by faculty.

Peer-assisted learning in medical school: tutees' perspective.

PURPOSE: Peer tutoring offers a valuable method of enhancing students' learning experience in medical school. Junior students learn from senior peers to reinforce curriculum content in an engaging community environment. The aim of our study was to assess tutees' perceptions of a formal peer tutoring program at the Central Clinical School of Sydney Medical School. We used the learning theory of the community of practice in order to understand tutees' perspectives. PATIENTS AND METHODS: All Year 1 and Year 2 students within the Central Clinical School were invited to be tutored by Year 3 and Year 4 students, respectively. Tutor pairs taught a group of three to four tutees fortnightly, and the tutorials were largely clinically based. A questionnaire containing 13 closed items and four open-ended questions regarding their experiences in the program was distributed to the tutees. Descriptive statistics were used to analyze the data. RESULTS: A total of 66 of 101 (65%) Year 1 and Year 2 students took part as tutees and 42 of 106 (40%) students as tutors. The tutees' response rate was 53% (35/66). Results were largely positive, with 97% of the tutees enjoying the program, 90% showing interest in tutorial topics, 91% feeling a sense of community, 100% wanting to take part next year, 97% finding small groups effective, and 97% and 91% feeling an improved understanding of medical concepts and clinical skills, respectively. Tutees perceived the most useful aspects to be learning and revision and advice from experienced peers. The most frequent suggestion for improvement was to resolve scheduling conflicts. CONCLUSION: Tutees found the peer tutoring program to be valuable in learning and revision, establishing a community, and gaining practical skills and advice through a small-group format. The community of practice framework was useful in identifying these areas of benefit, demonstrating that a peer tutoring program such as this can provide an enhanced learning environment for tutees.

Senior students' experience as tutors of their junior peers in the hospital setting.

BACKGROUND: Student-led teaching has long been regarded as a useful ancillary educational method. It is also a valuable tool in the development of aspects of professionalism in student tutors and contributes to a sense of community within the student body. In 2014, a peer-assisted learning (PAL) program, organised by students at Sydney Medical School (Central), explored students' experience of tutoring their junior peers. METHODS: Year 3 and 4 students within Central Clinical School (CCS) were invited to be tutors for Year 1 and 2 students respectively. Tutorials centered on the application of clinical skills. All tutors were asked to complete an end of year questionnaire. RESULTS: A total of 40% of senior students participated as tutors and 65% of junior students as tutees. The end of year questionnaire response rate was 48% (20/42). Most tutors (19/20, 95%) felt confident to teach tutorials although one-third (6/20, 30%) would have preferred more training in teaching. Tutors felt that the program better prepared them for their exams. Almost all tutors (19/20, 95%) enjoyed teaching and felt it fostered a sense of community at CCS (17/20, 85%). Tutors stated they were likely to be involved in teaching in the future (17/20, 85%). CONCLUSION: This student initiated PAL program provided tutors with the opportunity for content and clinical skills revision and assisted in the development of professional competencies required on entering the medical workforce. The resultant sense of community at CCS will aid the expansion of the program in 2015 with an aim to review quality assurance measures.

Iron(III) complexes of fluorescent hydroxamate ligands: preparation, properties, and cellular processing.

Iron(III) complexes containing hydroxamic acid fluorophores were investigated as models of hypoxia selective prodrugs in vitro. Two complexes were synthesised, [Fe(c343haH)(3)] and [Fe(salen)(c343haH)]. The fluorescence of the hydroxamate coumarin fluorophore was almost completely quenched on coordination to the iron(III) centre in [Fe(c343haH)(3)]. However, quenching was minimal for [Fe(c343haH)(salen)] in aqueous media and we propose that the fluorescence results from structural rearrangements that occur because of the inherent strain in the iron-salen structure. Fluorescence was also measured in the presence of the cellular reductants ascorbic acid and cysteine. Fluorescence intensity increased over time, with the most rapid return of fluorescence occurring over a two hr period. The rapid fluorescence return indicates that the complexes undergo ligand release, either via reduction followed by aquation, or via direct ligand exchange with the reductants. Electrochemical studies demonstrated that both complexes have very negative reduction potentials. Furthermore, [Fe(c343haH)(salen)] was shown to exhibit quasi-reversibility of reduction. The distribution of the free hydroxamate ligand and the complexes were monitored in A2780 cells. The free ligand displayed non-specific distribution, which differed from the nucleolar distribution of [Fe(c343haH)(3)] and the lysosomal accumulation of [Fe(c343haH)(salen)] over time. Thus the results of the present study show that iron(III) complexes present a viable model for monitoring hydroxamate fluorophore displacement in vitro to determine the fate of prodrugs.