Nine years ago today, 26th December 2004, the Indian Ocean Tsunami brought serious damage and health disasters to fourteen countries boarding the Indian ocean. Natural disasters such as the Tsunami cause a huge number casualties, but further health issues are generated from starvation, lack of shelter and the quick spread of infectious diseases. It was expected that there would be a huge rise in waterborne diseases, for example cholera and malaria. However the major issue affected the people swept by the tsunami, which caused high levels of 'tsunami lung.'
Tsunami Lung is caused due to inhalation of mud and polluted water, containing several infecting microbes, it is thought that B. pseudomallei is one which is found within asian soil and water, however it is not certain as no laboratory was available to investigate the culture causing the illness. The symptoms of tsunami lung include bacterial lung infection, similar to pneumonia. Therefore it can treated by a strict course of antibiotics, however due to the lack of preparedness and slow response, the medical infrastructure was overwhelmed and there were lack of antibiotics available. This meant that many 'victims' could not be treated, and further neurological problems were created, leading to problems such as paralysis. These neurological problems are a result of infection spreading into the brain via the blood stream, resulting in abscesses. The brain swells in response to abscesses which can result in pressure on delicate brain tissue, or cutting off blood vessels supplying the brain. This is considered a medical emergency, as high pressure in the brain can be life threatening.
The lack of equipment available needed to diagnose tsunami lung, caused an increase in problems developed. A chest radiograph is required to identify lung infection and further computed tomography scan of the brain to confirm abscesses. The amount of trauma patients means there is a lack of staff and time to examine patients suspected with chest infections, furthermore many of the fourteen landmasses boarding the Indian ocean had little or no access at all to this type of equipment, therefore most was supplied by international relief, such as the US navy hospital ship which was docked off the coast of Banda Aceh, Sumatra.
Resources:
http://en.wikipedia.org/wiki/2004_Indian_Ocean_earthquake_and_tsunami
http://rense.com/general66/tsu.htm
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1310941/
http://www.nlm.nih.gov/medlineplus/ency/article/000783.htm
Thursday, 26 December 2013
Friday, 20 December 2013
Scotland phases out Liverpool care pathway
The Liverpool care
pathway was established at the Royal Liverpool University Hospital in
conjunction with the Marie Curie Palliative Care Institute. Palliative care is
a medical treatment designed to make people with terminal illness feel as
comfortable as possible- both physically and emotionally. It can be used to
relieve symptoms but not cure the conditions. The LCP was recommended as a
model of best practise by the department of health, and was therefore been adopted
by many UK hospitals and other health care settings. However there have been
many controversial issues with the pathway, and so Scotland have decided to
phase out this type of treatment.
When used correctly
the LCP was very successful in Scotland and had supported good quality of care
in the last hours and days of life. However it has been recognised that
inappropriate use of the pathway, such as patients being denied rights of food
and water. Furthermore another example is, when patients are not being removed
from the pathway if signs of improvement were shown. Therefore there were high
levels of complaints from relatives, and the high proportion of misuse has led
to the phasing out of the Liverpool Care Pathway in Scotland within the next 12
months.
The review of the LCP
pathway earlier this year recognised this misuse and so the report published on
the use and experiences of the Liverpool care pathway recommends phasing out of
the LCP to be replaced with individual end of life care plans for each patient. The report also provides methods of
improving the care pathway:
1. A general principle that a patient should only be placed on the
LCP or a similar approach by a senior responsible clinician in consultation
with the healthcare team.
2. Unless there is a very good reason, a decision to withdraw or
not to start a life-prolonging treatment should not be taken during any ‘out of
hours’ period.
3. An urgent call for the Nursing and Midwifery Council to issue
guidance on end of life care
4. An end to incentive payments for use of the LCP and similar
approaches
5. A new system-wide approach to improving the quality of care for
the dying
Wednesday, 11 December 2013
Obesity: social choice or a disease?
Obesity is defined as someone who is overweight with a high
proportion of body fat; the body mass index of an obese person would be between
30 and40 and above 40 would be classified as morbidly obese. A disease is a disorder
of structure or function and produces specific signs or symptoms or that
affects a specific location and is not simply a direct result of physical
injury.
Therefore the symptoms of obesity are weigh gain, with combined increase risk of other illnesses such as type 2 diabetes, colon cancer and heart disease, as well as further social issues such as depression. These symptoms can arise due to an underactive thyroid gland, also known as hypothyroidism, where a lack of thyroxine means the patient has a lower metabolic rate, therefore more food is stored as fat. Furthermore weight gain can be a secondary impact of reduces physical exercise due to fatigue which is also a symptom of hypothyroidism. Another example of obesity not being a social choice is due to excess levels of cortisol secreted from the adrenal cortex, diagnosed as Cushing’s syndrome. There is a build-up of fat stores on the abdomen, face, neck and upper back, because the excess cortisol does not increase the metabolism of protein and carbohydrates. Instead it slows down or disables metabolic reactions inside the body.
However on the other hand, the majority of the obese patients, have a high proportion of fat, and a high BMI due to eating more calories than are burnt, and the excess is stored as fat. This would be described as a social choice, although there are many influencing factors such as access to cheap, high energy foods, the increased use of cars or public transport and also less active jobs. Nevertheless it is a social choice on the food consumed, and the lack of exercise and individual does.
Although obesity is considered a social choice, on the other end of the spectrum, anorexia nervosa is a condition when someone is severely underweight with a BMI of less than 17.5. Unlike obesity anorexia is a mental health condition, and therefore not defined as a social choice. This gives the perception that obesity is easily curable through change in lifestyle, whereas anorexia is harder to cure and needs medical intervention. However should obesity not need medical intervention when it causes increased health risks?
http://www.nhs.uk/conditions/Anorexia-nervosa/Pages/Introduction.aspx
http://www.medscape.com/viewarticle/778000_1
Therefore the symptoms of obesity are weigh gain, with combined increase risk of other illnesses such as type 2 diabetes, colon cancer and heart disease, as well as further social issues such as depression. These symptoms can arise due to an underactive thyroid gland, also known as hypothyroidism, where a lack of thyroxine means the patient has a lower metabolic rate, therefore more food is stored as fat. Furthermore weight gain can be a secondary impact of reduces physical exercise due to fatigue which is also a symptom of hypothyroidism. Another example of obesity not being a social choice is due to excess levels of cortisol secreted from the adrenal cortex, diagnosed as Cushing’s syndrome. There is a build-up of fat stores on the abdomen, face, neck and upper back, because the excess cortisol does not increase the metabolism of protein and carbohydrates. Instead it slows down or disables metabolic reactions inside the body.
However on the other hand, the majority of the obese patients, have a high proportion of fat, and a high BMI due to eating more calories than are burnt, and the excess is stored as fat. This would be described as a social choice, although there are many influencing factors such as access to cheap, high energy foods, the increased use of cars or public transport and also less active jobs. Nevertheless it is a social choice on the food consumed, and the lack of exercise and individual does.
Although obesity is considered a social choice, on the other end of the spectrum, anorexia nervosa is a condition when someone is severely underweight with a BMI of less than 17.5. Unlike obesity anorexia is a mental health condition, and therefore not defined as a social choice. This gives the perception that obesity is easily curable through change in lifestyle, whereas anorexia is harder to cure and needs medical intervention. However should obesity not need medical intervention when it causes increased health risks?
Finally recently on the news, was a story of a five year old
girl who was ten stone and taken in to care. Although this is due to excessive
consumption of food and lack of physical exercise, it cannot be considered a
social choice. Parents have primary control on raising a child, therefore the
type and amount of food consumption is provided by parents or guardians and at
a young age there is vulnerable knowledge to the need of exercise. There are
many social and medical problems associated especially with childhood obesity.
The medical condition consists of type 2 diabetes; high blood pressure, high
cholesterol and asthma, but the more concerning are the social impacts of
depression, teasing, discrimination and low self-esteem. For both the medical
and social reasons lowering the quality of life for the child, it can be
defined as a type of child abuse.
References:
http://www.nhs.uk/conditions/Obesity/Pages/Introduction.aspxhttp://www.nhs.uk/conditions/Anorexia-nervosa/Pages/Introduction.aspx
http://www.medscape.com/viewarticle/778000_1
Monday, 2 December 2013
Epidermolysis bullosa (EB)
Epidermolysis bullosa is
a group of inherited skin conditions; researchers have classified 27 variants
of the condition however there are 3 main types of EB:
·
Epidermolysis bullosa simplex is a dominantly
inherited condition therefore a child has a 1 in 2 chance of inheriting it if
one of the parents is affected. EBS can also be a result of a ‘new mutation’
within cell division. This is the most common t type of EB, accounting for 70%
of cases. There are three types of EBS:
1. Weber
Cockayne EBS- which is the most common type of EBS and the blistering symptoms
are localised on hands and feet and often do not become obvious until the child
begins to walk. Other friction such as riding a bike can cause blisters to
develop on the inner thighs or the buttocks. Generally blisters are made worse
by excessive sweating.
2. Kobner
EBS- Symptoms are similar to EBS however within hot conditions they usually
become more affected. There may be mild blistering of the mucus membranes such
as inside the nose, mouth or throat. Scarring and milia may occur on the skin,
but this is uncommon.
3. Dowling
Meara EBS – very severe case, where in some circumstances children develop over
200 blisters a day. The widespread blistering can make the skin vulnerable to
infection and affect an infant’s normal feeding pattern which means they may
not develop at expected rate.
Blisters may also develop inside the mouth and throat making eating and
speaking painful.
·
Dystrophic epidermolysis bullosa can exist in
two forms, recessive dystrophic EB (RDEB) therefore unless both defective
genes, the patient is just a carrier of the disorder and doesn’t show any
symptoms. However on the other hand Dystrophic EB (DDEB) causes fragile skin
and blistering inherited by a dominant gene.
·
Junctional Empidermolysis bullosa (JEB) although
only 5% of cases are infected, its considered the most severe form. Blistering
occurs at the junction between the epidermis and dermis within the basement
membrane. Hair loss is a common symptom due to blistering of the scalp. Further
problems arise because tooth enamel is not properly formed which means teeth
may be discoloured, fragile, and prone to tooth decay. Regular review by a
dermatologist is needed, as severe issues can arise such as cancer.
The defected genes affect
protein production in the upmost layer of the skin, there is a tendency for the
skin and mucous membranes to blister and break down in response to minimal
friction and trauma because the layers of skin do not ‘stick’ to each other.
The treatment available
is to relive symptoms but no cure the condition, by avoiding skin damage,
improve quality of life, and improve quality of life and preventing
complications occurring such as infected blisters or malnutrition.
References:
http://www.nhs.uk/conditions/Epidermolysis-bullosa/pages/introduction.aspx
Sunday, 24 November 2013
Second Impact Syndrome
SIS is caused by a second physical impact, in a close period
of time (minutes, days, weeks) after
the symptoms from prior concussion have subsided. It is caused by rapid
and extreme swelling in the brain, which can often be fatal, lead to severe
disability or coma. The patient feels signs of concussion after the first head
injury such as headaches, visual, sensory or motor changes and especially
recognised is effect on memory. Although the symptoms may subside quickly, the
effect of swelling on the brain takes a long time to reduce.
If the athlete continues playing, and experiences a second impact they appear
stunned but do not have loss of consciousness, however after seconds to minutes
the athlete collapses, semi-conscious with dilating pupils, loss eye movement
and stops breathing.
The cause is thought to be due to the brain’s arterioles
losing their ability to regulate the diameter, therefore lose control over
cerebral blood flow, causing massive cerebral edema. Cerebral edema is when
there is an excess accumulation of fluid within the intracellular or
extracellular brain spaces. With an increase in water content in the brain, the
pressure within the skull rises . For this reason it is considered an medical
emergency because blood vessels can become compacted, and hence oxygen supply
limited. In serious cases
herniation is thought to occur, which is leads to decreased blood flow in the
brain because with an increase in pressure the brain is squeezed through small
holes within the skull.
The vast majority of cases occur within males under the age
of eighteen, because their brains are still developing so the symptoms of
concussion take longer to subside. Two years ago, Benjamin Robinson, 14 died
during a rugby match from Second Impact Syndrome. His parents are campaigning
to have new legislation put in place to protect further incidences occurring in
Ireland and the UK. For Example in
the National Football League in America, players diagnosed with concussion
during the game were not allowed to continue playing and are subjected to
testing over the following days to determine if the player is fit to play the
next match.
References:
Friday, 8 November 2013
Francis Report
In February of this year, the final report of the Mid
Staffordshire NHS Foundation Trust Public Inquiry was published after Andrew
Lansley; the secretary of state for health announced the need for a full public
inquiry in June 2010. The full public
inquiry investigates the role of the commissioning, supervisory and regulatory
bodies in the monitoring of Mid Staffordshire Foundation NHS Trust. The inquiry
is chaired by Robert Francis, who will make recommendations to the secretary of
state for health. It will consider why the serious problems between January
2005 and March 2009 at the Trust were not identified and acted on sooner, and
will identify important lessons to be learnt for the future of patient care.
After the inquiry, the report was published on 6 February 2013 and makes 290 recommendations, including:
•openness, transparency and candour throughout the healthcare system (including a statutory duty of candour), fundamental standards for healthcare providers
•improved support for compassionate caring and committed nursing and stronger healthcare leadership.
Structure of the inquiry
The Inquiry follows the requirements of the Inquiries Act
2005 and the Inquiry Rules 2006. Key
tasks are:
- Gathering and
reviewing evidence, including the taking of witness statements – this began in
July 2010; following the conclusion of the hearings, new evidence is now only
accepted on an exceptional basis
- Oral hearings – these began on 8 November 2010 in Stafford
and concluded on 1 December 2011
- Writing the final report
In addition, the Inquiry held a series of seven seminars in
October and November 2011, to explore the 'forward-looking' part of the
Inquiry's terms of reference. The Inquiry's hearings were held at Stafford
Borough Council's offices, at the Riverside in Stafford. This is because they aimed
to hold them as close to the people affected most, but also allowing them to be
carried out efficiently and effectively, considering the cost and meet the
needs of other interested parties. The Chairman has also undertaken a number of
visits to observe and identify examples of good practice and provide him with
some context in relation to NHS healthcare provision.
This public inquiry differs from the previous independent
inquiry set up under the NHS Act 2006. The
Chairman is required to take such steps as he thinks reasonable to secure
public access to the hearings and evidence taken by the Inquiry. He may also compel people to give evidence
and has powers to require production of evidence to the Inquiry. However the
focus of the first inquiry was to look at individual cases of patient care, or
specifically at the internal operation of the Trust. 
After the inquiry, the report was published on 6 February 2013 and makes 290 recommendations, including:
•openness, transparency and candour throughout the healthcare system (including a statutory duty of candour), fundamental standards for healthcare providers
•improved support for compassionate caring and committed nursing and stronger healthcare leadership.
References:
http://www.midstaffspublicinquiry.com/
Wednesday, 30 October 2013
Polio outbreaks in Syria
Recently on the news there has been many
reports on the recent outbreak of Polio within Syria, which thought to have
originated in Pakistan. So far there has
been twenty-two children recorded paralysed, ten of these have be confirmed to
infected with the polio virus and the further twelve victims are being
investigated. The origin of Pakistan indicated a high risk for the virus to
have spread over a broad area, not just the Deir al-Zol region where those
infected live. Although vaccinations have decreased the rates of polio, the
spread of polio has never stopped in Afghanistan, Nigeria and Pakistan.
Polio is a highly infectious disease, where
transmission is via the mouth by infected food or water. It is usually in areas with poor sanitation
due to infection of the food or water by feces of a polio victim. Furthermore
the virus can be transmitted by direct contact with the infected person. Certain
categories of people are most vulnerable to infection, such as pregnant women,
very young children (often younger than five) and those with a weak immune
system. The virus causes many symptoms,the worst being paralysis invading the
nervous system and infecting the brain and spinal cord, and can be fatal due to
immobilizing breathing muscles. Other symptoms include flu-like symptoms that last for a few days or
weeks, such as fever,
sore throat,
headache,
vomiting, fatigue,
back and neck pain, arm and leg stiffness, muscle tenderness, muscle spasms,
and meningitis.
These symptoms tend to be those of nonparalytic polio or the beginning symptoms
of the paralytic polio. Paralytic polio however advances onto harsher symptoms
such as severe muscle pain, loose or floppy limbs or in the worst case as
previously described paralysis of different parts of the body.
The Polio outbreak within Syria refers to
symptomatic polio, which accounts for 4-8% of all cases. Polio can be defined
as either symptomatic or asymptomatic. Symptomatic polio can be broken down
further into a mild form called nonparalytic (where many patients can make a
full recovery) or abortive polio and a severe form called paralytic polio
(occurring in 0.1% to 2% of cases). Paralytic polio (as mentioned above) also
may be classified as:
Spinal polio
- attacks motor neurons in the spinal cord and causes paralysis in arms and
legs and breathing problems
Bulbar polio
- affects neurons responsible for sight, vision, taste, swallowing, and
breathing
Bulbospinal polio - both spinal and bulbar polio
There is no cure for Polio, so in more
economically developed countries polio is cut out my vaccinations given at
birth. Therefore the best form of treatment is prevention in the form of immunisation,
however medication can be given to ease the symptoms of those infected. These
treatments can include antibiotics to treat consequent infections, pain
killers, and ventilators for those with lung paralysis.
References:
Tuesday, 22 October 2013
Ebola Virus
The transmission of the virus is first from animals to humans by direct contact with blood, secretions, organs or bodily fluids of the infected animal. It is secondly past from human to human by similar contact of blood, secretions and bodily fluid of the infected human. People can cause transmission as long as their blood or secretions are infected with the Ebola Virus. Within Africa it is believed transmission from animals to humans is due to close contact with monkeys, antelopes, chimpanzees, fruit bats or porcupines. Furthermore the direct contact transmission from person to person can be due to infected semen, close contact with infected deceased during burial. Another example is in the healthcare industry because within less economically developed countries, such as those in Africa there are not sufficient sterile precautions and an inadequate protection barrier. Examples of these include lack of gloves or goggles which can lead to direct exposure with the infected patient’s blood.
Many patients infected with the Ebola virus can be diagnosed with malaria, typhoid fever, shigellosis, cholera, leptospirosis, plague, rickettsiosis, relapsing fever, meningitis, hepatitis and other VHFs. Although the Ebola virus can be distinguished with further blood tests, due to it causing elevated liver enzymes, henceforth an enzyme-linked immunosorbent assay (ELISA) can be carried out. However There is currently no treatment or vaccine available to treat humans or animal, therefore unfortunately it cannot be cured or prevented. The Lack of cure drives fatality rates up to 90% of those infected with the virus. The healthcare provided is often intensive rehydration with fluids containing electrolytes.
References:
Friday, 18 October 2013
Tourette's Syndrome
Tourette’s syndrome is a life long neurological condition
(affecting the brain and nervous system) that is characterised by a combination
of involuntary noises and movements called tics. The full name is Gilles de la
Tourette’s syndrome, which originates from the 19th Century when
firsts signs of tics were identified by a French doctor named Georges de Gilles
de la Tourette. Tics can be vocal-phonic or motor, and are repetitive, fast
involuntary contractions of muscles. Examples of vocal movements can be simple
such as saying a word or grunting, or more complex such as phrasing a whole
sentence. Involuntary swearing is a socially disabling tic symptom which is
present in 10-30% of people diagnosed with Tourette’s. Physical movements can
also be simple or complex, such as jerking or making a series of movements. Names
of complex tics include echolalia, which is a vocal tic where the patient
repeats other people’s words, or coprolalia (swearing.) Furthermore a motor tic
known as copropraxia, is where involuntary production of rude gestures occurs.
The presence of comorbid behavioural symptoms often makes
diagnosis a lot harder, but a key feature of diagnosis can be at least two
motor tics and one vocal tic present since childhood. Tics relating to
Tourette’s syndrome usually develop at a young age, the average being six years
old, and rarely develop in adulthood. Although tics do develop in men and
women, men are four times more likely to develop them than women. Tics can also
be caused by other medical conditions such as Huntington’s disease and
physiological effects of substances such as stimulants. Quite often Tourette’s
syndrome occurs with other disorders for example Obsessive-compulsive
disorders, attention-deficit disorders and hyperactivity disorders, in which
60% of diagnosed patients also have these disorders.
Why do tics occur? The main explanation for the involuntary reactions is
due to genetically inherited genes; however tics tend to be intensified by
anxiety and stress. This therefore explains the peak in severity during teenage
years and on the other hand tics are eased by mental and physical
concentration. This therefore
supports the need for schools and workplaces to take into account the
implications of tics, but still provide education and jobs so that the
severities of tics for the patients are reduced. Nevertheless there is a
disabling of social capabilities with the disorder, finding it hard to face
daily activities. This is hugely unfortunate because research shows that the
syndrome is compatible with success at school and in the workplaces and it has
no effect on intellectual disability. Moreover patients can voluntarily supress
their tics for a short period of time, although this is researched to cause
inner tension and subsequent rebound in tic severity.
Finally the treatment available involves behavioural
treatments and prescription of drugs. Behavioural training involves practices
such as habit reversal training which influences tic expressions to be delayed
or abolished because patients can recognise the prior urge associated with the
involuntary movement. This method has proved to be very successful in about
half of patients treated; unfortunately access to this type of treatment is
currently limited in many countries.
Drug prescription is not given to every patient with Tourette’s
syndrome, its usually provided to patients who do not respond to behavioural
training or alternatively if the tics provide injury or pain or furthermore
social discomfort such as bullying. Haloperidol and pimozide are examples of
neuroleptics which are prescribed to patients with Tourette’s as the most
effective medication, despite the metabolic side effects. More recent
antipsychotics have been researched to provide the same benefits but without
side effects. For young patients with other conditions such as ADHD, clonidine
and guanfacine examples of a2 adrenergic agonists can be used as treatment due
to the fewer adverse effects than other drugs. On the
other hand Benzodiazepines should be avoided as long term treatment for tics
due to tolerance and addiction. The final types of treatment are Botulinum
toxic injections or surgery such as functional neurological procedure.
References:
Tuesday, 8 October 2013
Political drive to screen for Pre-Dementia
Dementia is a progressive and largely irreversible clinical
syndrome that is characterised by a widespread impairment of mental function.
This includes problems with memory loss, thinking speed, mental agility,
language, understanding and judgement.
Dementia is a common condition that affects about 800,000 people in the
UK. The risk of developing dementia increases as you get older, and the
condition usually occurs in people over the age of 65.
Throughout the world there has been a ‘political drive’ to
assess elderly patients for Dementia, due to the large amount diagnosed and past
neglect of services and research in dementia has fuelled international calls
for action and earlier treatment. The Alzheimer’s Society estimated that in
2005 there were 574,717 people in England with dementia. In addition the
Society estimated that the total cost of dementia in the wider UK population
totalled £17.03 billion, or an average of£25,472 per person with late-onset
dementia. The NHS bears 8% £1.36 billion or £2.69 million per 100,000
population) of this total cost, as shown below.
The cost of £25,475 per person with late-onset dementia is
the primary reason for the demand for screening or case finding of mild
cognitive impairment and dementia, in aim to reduce NHS costs. In England, the
government has announced that it will reward GP’s around £3600 annually, per
practice for assessing patients aged over 75.This also includes those in a
‘at-risk group’ which is those patients with established diabetes or vascular
disease. People with diabetes have an increased risk of developing dementia,
due to high blood glucose concentrations which damage blood vessels, and the
risk of vascular dementia increases with blood vessel damage. This is also
being enforced in other places around the world such as in the United States,
under the new Affordable Care Act which is a recent new health reform, the
Medicare insurance programme will cover an annual wellness visit with a
physician. This wellness visit will include detection of cognitive impairment
or any measurable change in thinking abilities.
This screening process aiming to diagnose patients early
will beneficial so healthcare assistants can give counselling and provides an
opportunity for patients to organise financial affairs and future guardianship
whilst they are still competent.
However the ‘political drive’ is controversial, because
screening is not recommended by the UK National Screening Committee, Royal
Australian College of General Practitioners guidelines or the US Preventative
Services Task Force. This is
because there is no evidence for the usefulness or curative pharmacological
intervention. A further reason is that only 5-10% of people with mild cognitive
impairment progress to Dementia, therefore costs of screening may not outweigh
the costs of early diagnosis. Furthermore many people who develop dementia do
not meet the definitions of mild cognitive impairment before diagnosis. Also
very interestingly, research has shown that the development of people with
dementia is higher in people who don’t have symptoms of mild cognitive
impairment than in those who do. A major issue created by screening, is adding
increase risks to the patients: this is because there is no drugs to prevent
the progression, many patients turn to therapies such as Vitamin E,
cholinesterase inhibitors or memantine. These can increase damage to a
patient’s health rather than improve it, for example cholinesterase inhibitors
increase of hip fractures, syncope and pacemaker insertion.
It is difficult to assess whether the beneficial advantages
of screening patients for cognitive impairment outweighs the negative risks and
effects of the treatment. Nevertheless, within the UK and the US and many other
places around the world they think it’s extremely worthwhile.
Reference:
http://www.mayoclinic.com/health/vascular-dementia/DS00934/DSECTION=risk-factors
Tuesday, 1 October 2013
The Return of the Black Death
Last month within
Kyrgyzstani, a fifteen-year-old boy died of bubonic plague after being bitten
by an infected flea. This is of huge interest because naively I thought the
bubonic plague had died out, but today 1000-3000 cases occur globally each
year. Although 90% of infections occur in Africa, by contrast in the US
annually on average seven people catch the plague. In July this year, camping
sites around Los Angeles were closed because a squirrel tested positive for
plague.
The bubonic plague is
caused by a bacterium, Yersinia pestis
and transmission of the infection occurs by rats, squirrels and other rodents.
The biggest problem for epidemics is when rodents begin to die, as the infected
fleas need a new host. Buboes within the lymph glands (in the groin) begin to
swell and cause immense pain; this is where the name ‘Bubonic’ plague comes
from.
An example of an
epidemic of the Bubonic plague was during the 1300’s when it was known as the
‘Black Death.’ At the time it wasn’t known what caused the blisters and
swellings, but recent work from archaeologists identified the bacterium Yersinia pestis within skeleton DNA. It
was known as the Black Death due to high death rates down to the lack of
medical advancement and antibiotics. It became fatal because it caused
haemorrhaging of blood vessels in the fingers and nose leading to gangrene.
This became infected and spread to the lungs causing pneumonic plague. This
increased the risk because pneumonic plague could be spread by droplet
infection such as coughs or sneezes.
Bubonic is only one
type of plague the infected bacterium can also cause pneumonic plague as I
previously mentioned and then the third one is septicemic plague. The
transmission is the same, however its symptoms such as weakness, abdominal pain
and bleeding beneath skin or other organs is caused by the multiplication of
the bacterium within the bloodstream. Skin and other tissues may turn black and die, especially on fingers,
toes, and the nose. Septicemic plague can occur as the first symptom of plague,
or may develop from untreated bubonic plague.
Reference:
THE WEEK/ISSUE 936/7th
September 2013
Thursday, 19 September 2013
Transplant
Currently in the UK, organ donation is voluntary and organ
donors carry a card stating which organs they are willing to donate after
death. However in Wales there is a new scheme proposed for 2015, where it will
be presumed that organs are for donation after death unless people have stated
otherwise. This is known as the ‘Human Transplantation Act 2013’ and it is
hoped it will raise the transplant donation by 25%.
There is a huge demand for organ donation, for example
within 2012, 7593 people were left on the waiting list despite 2413 people
having donated. There is a huge need for an increase in donators from certain
ethnicities, such as in Asian communities where kidney failure is three times
more likely therefore the need for donors is more. It is important is important
the organ is matched well to the recipient for the greatest chance of success,
and those from the same ethnic group are likely to be a close match. Those who
are rare tissue types may only be able to accept organ donations from someone in
the same ethnic origin.
Before organ transplant occurs, it has to be insured blood
type of donor and recipient is compatible, and that the organ is healthy.
Although the checking must be thorough, it has to happen quickly due to the
lifespan of organs outside the body. For example, thoracic organs such as the
heart and lungs can survive outside the body for only 4-6 hours while kidneys
can survive up to 36 hours and livers, up to 12. The proximity of the donor and
recipient is also an important factor and can be a main decider on whether the
transplant can occur.
Thursday, 5 September 2013
Abortion
Recently in the news there has been consistent criticism of two doctors who organised an abortion due to the gender of the unborn child. The recent headline ‘Hunt concerned by lack of prosecutions in gender abortion case’ encouraged me to research further into the ethics behind abortion.
Abortion is the termination of pregnancy through medical intervention (unlike a miscarriage) and is currently legal during the first 24 weeks of pregnancy in the UK. The Abortion Act makes it necessary that two doctors must confirm that the procedure would cause less damage to the female’s mental and physical health then carrying on with the pregnancy. The doctors in the recent news case abide the law by giving consent of two doctors however it is described as a ‘Selective Abortion’ where the foetus is described to have undesirable characteristics (in this case being the wrong sex). An alternative example of selective abortion would be when the pregnancy involves multiple foetuses. The abortions described in the Abortion Act are known as ‘therapeutic abortions’ which occur due to the health of the mother or child.
So should Selective Abortions be able to occur?
People believe therapeutic abortion is justified to a higher extent than selective abortion, despite the fact that abortion as a whole is despised by many people. There are many problems with selective abortion, it could lead to imbalance in the population and its described as unjustified to terminate a 'life' due to the gender.
The largest debate is whether abortions are 'right' or 'wrong' and whether they should be legal or illegal. Those against abortion describe the procedure as 'murder' because its destroying a life without the consent of that human being. On the other hand, those pro-abortion argue its the mothers choice, its unjustified to affect the health of the mother or the baby and finally in the first 24 weeks the foetus is not a 'human' so doesn't have the right to life. However those against it would argue life begins within those 24 weeks.
There is not defined answer to when a life is created. The first theory is it begins at fertilisation of the sperm and the egg inside the womb, because this is the point when DNA is selected with the potential for a human to exist. It is this theory that most of those against abortion believe. The next stage considered to be the beginning of life occurs three weeks after contraception when the brain, spinal cord, heart and other organs begin to form. It is a week later that the heart begins to pump blood, this is a major argument in the debate against abortion because someone is determined dead when their heart stops beating. Therefore in using the same theory, the foetus pumping blood must be determined as 'living.' Alternatively if life is defined when the foetus begins to breathe, it can be considered 'alive' much later at around 30 weeks after contraception.
To conclude due to there being no clarity when a foetus becomes 'living' it is impossible to decide how far along it can be justified as not destroying a life. In the UK it is decided on Fetus viability, around 24 weeks which is the age that the foetus can survive outside the uterus.
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Tuesday, 20 August 2013
This Perfect World
On my recent holiday I was reading a novel named 'This perfect world' by Suzanne Bugler and despite the fact it was fictional, it was about young experiences effecting a persons later life. It encouraged me to put in some research about this because I think many health issues dealt with my a doctor can involve social aspects currently and in the past.
The first thing I came across was on the recent news, with the headline 'school bullying 'affects adult life.' The reports seemed to be a reliable resource because 1400 people were tracked, between the ages of 9 and 26 (also reliable because a large age gap.) The trial also incorporated victims of bullying, people who bullied and others who were both bullies and victims.
The thing I found most interesting was the fact in which, the people who had the most negative effect, were people who were bullied and bullied others. This was very interesting to me because I thought the victims would be the most negatively effected people. These people were six times more likely 'to have a serious illness, smoke regularly or develop a psychiatric disorder.' A further health issue developed more likely by these people are obesity and further social issues include lack of qualifications and less likely to have friends. The reason I believe these people are the worse effected are due to the distinctive characteristics of a victim such as low self esteem, unpopular with peers or poor at understanding social cues. They also have the characteristics of a bully such as easily provoked.
The studies showed people who are singly victims or bullies still have a negative outcome than those isolated completely.
The victims of bullying show higher rates of mental health, serious illnesses and greater likelihood of poverty. Where they differ from people who bully aswell, is they generally are more capable of making friends or succeeding through education. Where as the result for bullies is opposite to victims, in the way that they have low rates of health issues, but problems socially. The social problems include inability to remain employed, violent relationships and are much more likely to be involved in crime or illegal occupation.
Although this research isn't directly medically related, I find it hugely interesting and is closely related to the psychological side of medicine.
Saturday, 10 August 2013
Malaria Vaccine
My recent exploring of the BBC news health page spurred my interest to research further on the Malaria vaccine, after ‘Malaria vaccine shows promise in recent clinical trials.’
Malaria is a disease caused by a protozoan called plasmodium (of which there are four different species which cause malaria and only two are common; Pvixax and P.falciparum.) The plasmodium causes illness when it reproduces inside red blood cells, and then burst out releasing chemicals, which cause fever. A female mosquito of Genus Anopheles transfers it from person to person. It takes in the plasmodium bacterium when obtaining protein from blood to make its eggs. The plasmodium is then injected into another person, where it multiplies in the liver.
Although there are drugs available for malaria, such as prophylactics that are taken prior to being infected. However the largest area affected is Africa, where there is lack of access to drugs and medical expertises and due to poor diet and high HIV rates. Therefore The African Region accounts for 85% of malaria cases and 90% of malaria deaths worldwide. Malaria causes avoidable and often catastrophic spending for households and is an obstacle to the development of affected African communities and nation.
It is clear the malaria vaccine would be so beneficial, it would save one child every 30 seconds from dying from malaria. So what he the advancement so far?
The vaccine contains weakened form of malaria, which is injected into the patient and allows the patient to evolve immunity to the disease. ‘Sanaria has taken lab-grown mosquitoes, irradiated them and then extracted the malaria-causing parasite (Plasmodium falciparum), all under sterile conditions.’ The weakened form are transferred to vials prior to injection into the patients blood stream.
The pre-clinical research was successful and so the next step was to determine appropriate doses of the medication to give the patients. There were 57 volunteers, it was important that none of these patients had been infected before. 17 of the volunteers did not receive any dose, and the other 40 were given different strengths. Once exposed to malaria-infected mosquitoes, it was discovered no vaccine or small doses resulted in infection. The huge advancement for the vaccine was the of the 15 people given high dosage, only 3 became infected after exposure.
Most drugs don’t pass the pre-clinical trials, so this is a huge advancement to be successful on phase one of the clinical trials. I will post any further news on the vaccine!
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