Books from an ex-medical student...

With no medics in my family, I had been searching for a mentor that could give me advice on the entire process of becoming a doctor. Thankfully, I came into communication with a student that had dropped out of medical school a year ago; this was after realising that her parents wanted her to follow that career, but it was not something that she wanted to pursue. I became increasingly aware of what a major commitment studying medicine is, and that you need to make sure that your decision is thoroughly thought through.
I was delighted to be given many of her books from the period she was studying medicine. Anatomy has fascinated me since childhood, and now I had detailed textbooks of human anatomy! In my spare time I use these books for pleasure reading, but also helping my A level subjects by providing a deeper knowledge base for subjects like biology. The books included: Vanders Human Physiology, Human Anatomy, One stop doc- Cell and Molecular Biology and Clinically Orientated Anatomy. I have now grown to realise the sheer academic rigour required for studying the subject, and this continues to inspire me.

Photos from my trip to India

 I was invited to give a speech at a local school, talking about exercise's beneficial effects on the body. As I've played regionally, the students were very interested in my hockey playing. I was, however, surprised to hear that there was no female hockey team there (only male). After my speech, one of the school's governors announced that 'a female hockey team would be set up in my honour. Interacting in lessons and talking to teachers gave me insight into Indian culture a lot further.

 There were obvious differences between the hospital in Jodhpur and NHS hospitals in the UK.

 Me and a few of the doctors from the accident and emergency equivalent.

Adventure To India

I was on the train- destination Heathrow- and it finally dawned on me: I was going to India alone. The previous year I had researched medical intern-ships abroad, I was desperate to see healthcare in a developing country after completing some experience in the UK. I found a place for this; based in Jodhpur in the Royal state of Rajasthan, and I was not hesitant to book a month there (the chance to observe live surgeries was just to tempting!).

Upon my arrival, in contrast to the culture shock I was warned of, I fell in love with India. I was, however, dubious about the hospital I was staying and working in as the tuk tuk pulled up. It looked nothing like the generic western hospitals I was used to, it looked more like housing! But as I walked in with my supervisor, I was reassured by the friendly doctors and familiar equipment that, I would not feel entirely alien here. My room was at the top of Raj Hospital (A/C, thankfully); I was told about the outline of my work days here and soon felt quite at home. Shortly after my orientation around the town, I collapsed to sleep; the time, travelling, and especially the long changeover in Delhi,  had got to me.

My first day was the most difficult. It was frustrating not being able to understand Hindi (the language spoken in Jodhpur) although the staff did exercise their varying levels of English gladly on me. As I spent an hour or two on the wards, I couldn't help but compare the practice of medicine to that of London. The standards of hygiene were the most shocking; a very lax attitude relative to what I was made accustom to at home. However, the quality of the practice seemed equal- minus the fancy equipment and strict regulations- patient records format was very similar. Raj was a private hospital, as all but one government hospital in Jodhpur were; you had to pay for your own treatment etc, but had a lot more power over when you wanted to receive it. You could chose when you wanted your surgery, it was not dictated and with a sometimes horrendously long waiting time as in the NHS system. I was eager to make it into theatre that day, to see my first ever live surgery. This happened to be a hysterectomy, which turned out to be the most common one performed in my time at the hospital. (I will complete further posts giving detail of the surgeries).

I think that the greatest culture shock I experienced was the relaxed attitude of the staff. Team surgery only got going once a patient arrived after their game of cards was complete. Mobile phones were never turned off; in fact, they answer them during the surgery. By the end of my time I was fully trained at answering surgeons' mobiles and holding it to their ear as an unconscious body lay before them. Saying this, I must reiterate the shear skill of the people in theatre in that hospital. I adored surgery as a speciality-the results before you were shown, hence making the job very satisfying.

My time there was somewhat disrupted by illness. I ended up being treated in the the same hospital that I was working in, by the same staff that I was shadowing. Although only semi-conscious at the time, I remember being put on drips on three different occasions; but thankfully my new friends were on hand to take photos so I can look back now at myself on hospital beds there! I now have experience of healthcare in India from both sides, this can only be taken as benefit in my mind...

The experience I gained was near incomprehensible. I saw 24 surgeries all-in-all, including 2 impressively quick cataract surgeries and one electric burn case. The breadth of my observations highlighted the awe- inducing skill of the individual surgeons, as well as giving me insight into different procedures. Living in India for a month taught me some valuable life skills; I was in an alien country, with an alien language, working and exploring an alien area. I picked up very strongly the 'I know a man' attitude, with people going to specific doctors as well as other things; but also the strong business mindset of practically everyone there. Poverty was prominent, with many people living on the street and begging as well as the need for more orphanages.

I saw two caesarean sections! Births right before my eyes. And it was truly awe- inspiring...if a bit too similar to the 'Alien' films...Now I was never warned of what specific operation would be carried out whilst I was there; so, as you can probably imagine, seeing a woman being cut and ripped open and baby roughly pulled out came as a bit of a shock after witnessing numerous commonplace hysterectomies. I have to say, that the usual vague romance to what childbirth may seem, was completely unfounded in my personal experience. But nonetheless, I felt very privileged to be present as a proud woman entered into the role of mother.

The electric burn case: a boy aged 8 with burns on his head, abdomen and left leg. This was the only surgery I saw where the anaesthesia suppressed respiration, so intubation was needed to pump air into the patient's lungs manually. In preparation for operating, the staff- as usual- covered the body to expose only the areas needed; but by the time this was completed, I must say that the entire operating theatre looked like a scene from 'Saw'...very cool but odd. I noticed the head injury which left the skull exposed, as well as the right thigh also left exposed- I guessed that a skin graft was going to be performed. And I was correct, after wounds were cleaned a split thickness skin graft took place; this involved shaving a thin layer of skin from the thigh to use on the skull. I was shocked by the use of hammer and chisel on the skull before this happened...and I still have no idea why that was necessary. I was particularly inspired by this surgery as there was such a large team involved in this one patient- everyone had their own roles to ensure the best care.

I managed to get in contact with the most well- known eye surgeons in the area, and went to shadow him whenever I could. I saw cataract operations, using microscopes the surgeon himself was using to operate. These surgeries could be done under only local anaesthetic, and no stitches were needed. This was precise surgery on a minute scale. Lignocaine was used as local anaesthetic injection and once in theatre, the cataract was broken up and removed before a new lens replaced the old. What was even more impressive, was the time in which these were performed- always under 10 minutes. This type of operation is particularly important in third world countries, where cataracts are common- but the poverty means that many can't afford treatment. Luckily, I discovered that there are charities to help with those problems and that the surgeon I was with  worked with them to provide care.

When my position of regional hockey player became known, I was invited to a local school to give a speech on sports and exercise. I was greeted traditional, by the end of the welcoming ceremony I was fashioning a bindi and feeling sufficiently special. As an experienced public speaker, I don't usually get too nervous in that kind of situation, but the fact that I needed a translator meant that I was unaware of what was actually being communicated to the students. For some reason, I think my explanation of exercise's effect on the brain involving nurerogenesis and BDMF was missed out. The hall was decorated with welcome greetings to a 'Miss Catriona Ailsa Osborn Moar', with photographers and various important people (the chairman for Mayo etc). Flowers and a trophy were presented to me after I was shown around the school, oh and of course after being near force fed various goodies as with anywhere I went. Autographs were wanted by the students, which was challenging in itself! After I left, I was informed that an all girls' hockey team was to be set up in my honour, and that I would be welcomed back to the  school any time.

I managed to fit in some travelling and site seeing, too, but this is a little irrelevant to this blog...although amazing too!

Work Experience, QE Hospital

I have grown up with many joint problems, encountering numerous rheumatologists and physiotherapists. It was natural, therefore, to be curious about rheumatology as a subject area. I managed to secure a week of work experience with my grandmother's rheumatologist (I am a carer for her) at Queen Elizabeth hospital. I was fortunate enough to be in contact with the doctor in question via email beforehand, so that I could arrange to visit other departments, too.

Rheumatology
It did not take me long to realise the systematic approach to clinics run there. I was struck at how repetitive the work seemed at times, but also at how grateful patients were to receive this kind of specialist help. The patients' desires were fully taken into account: if treatment was uncomfortable, it would be changed; if they suspected a problem, tests would be done. Trust is key from both sides. After every consultation a voice recording was made about it, verifying information and suggesting treatments- this would then by typed up and sent to those concerned (namely the patients, GPs, etc). After only about half an hour on my first day, I was made aware on the hierarchy at the hospital. Every senior member of staff was also overseeing juniors, providing advice and support. I like the learning-teaching aspect.
I found out about the intertwining of social services; most common was the unemployed that were 'looking for a reason not to get back to work by coming here', wanting to be deemed not capable- even though they may well be. I found this very interesting, my mother being a social worker herself, I have an interest in this mixing with medicine. 'Saying work is harmful has no evidence, but unemployment is bad for your health...you can see that' I was told. I was made to reflect on a wider societal contact with medicine.
Most commonly occurring cases I saw, were: vitamin D deficiency (I have this, too- supplements are prescribed) and osteoporosis- I was given information handouts that patients were also given, which proved to be very insightful. I knew that I wanted to pursue medicine as a career.

Ultrasound
I was lucky enough to be taught how to use an ultrasound machine, as well as shadowing a specialist in radiology. I was enthralled by the application of physics in this specialism; able to use my A level knowledge to explain the image produced. Depo- Mendrone was used- this injection contains methylprednisolone as the active ingredient, and is a corticosteroid; it was a number of uses. Upon arrival here, I was told the reasons for using ultrasound- it is: cheap, dynamic, and live. It was also emphasised to me the importance of sharing knowledge and understanding in a hospital setting; there is a 'complex multidisciplinary team' and  many junior doctors were about and senior staff helping where possible.
Using a small (transportable) ultrasound machine was great fun; I was able to look at my own joints and was taught how to look for inflammation as a marker of rheumatoid arthritis. Fortunately, no arthritis for me!

Dermatology
The morning I spent in a children's allergy clinic here, showed me quite a different practise of medicine. I was made aware of the pressures of managerial and administrative responsibilities of senior members of staff; sitting in on a meeting about funding opened my eyes to the NHS as a business as well as a service.
On thing that particularly concerned me, was the use of paper work instead of using computer systems...'it's 2013, why can't we use computers like everywhere else?' one of the doctors remarked; I agree entirely, but this just showed me that there is always room for change. I did, also, find the constant referrals quite frustrating, as you would never see one patient though the entire process- however I realised that it was this teamwork that lead to effective management and treatment for the patients.
Witnessing consultations with children present was interesting, to say the least. It was a more complex procedure due to the number of people responsible for making decisions about the child... as well as the noise levels of certain individuals in the room. But it was obvious how much the doctors enjoyed working in paediatrics. I was left alone on a mnuber of occassions to speak to the famiies, getting to know personal stories and accounts of allergies and their lives; this was very enjoyable.
Ordering tests was a major component in this clinic. HISS (hospital information support system) and WinPath (laboratory information management system) were used frequently. But these old computer systems seemed to me, over-complicated when one universal system could be used for the entire NHS... But funding, of course, is an issue.

Fracture Clinic
My time spent here, was my favourite of the entire work experience.This was probably thanks to the incredibly enthusiastic senior orthopaedic surgeon that I was shadowing. He taught me so much anatomy and background information of patient's conditions in between consultations- I spent the whole day frantically making notes on everything I could. The passion shown was truly inspirational to me. I was shown how to interpret basic x-rays and spoke to patients about their various conditions. He was giving me a day in the life of a medical student- lectures and shadowing and tutorials all in one. This day alone assured me that studying medicine would be the best choice of my life.
Here, I was also displayed the gratitude of the doctors toward the nurses; they seem to be an irreplaceable part of the team, doing so much of the groundwork.  It was highlighted to me, the new pressures that an ageing population is putting on the NHS- would more doctors need to go into fields such as geriatrics and in the future? There is a 25% chance of me living to 100. And 20 000 neurones are lost per day after the age of 25!

My time at the hospital did nothing but confirm my passion for medicine as a vocation. I gained so much knowledge of day-to-day life as a doctor and met real patients to discover their own stories. I am just so looking forward to studying at university! (Hopefully).

The Rise and Fall of Modern Medicine

This book really set-in-stone my desire to study medicine. Providing much information on the major surge in medical achievement in the post-war years, it provided a perspective to view the practice of medicine today. Not only the achievements themselves, but also how they came about, such as by chance or drug screening. The latter part of the book focused on the possible limitations of medicine in modern society, and that it's future cannot be certain. And that the perpetual advance of medicine, that many believed would continue in the 'age of optimism', has come to barriers more recently. Resulting in a changing subject of both social and intellectual integrity.

Playing Hide and Seek with Tumour Cells

Immunotherapies in cancer treatment attempt to stimulate the body's own immune system to reject and destroy tumours.

Tumours in some people with advanced melanoma have disappeared after treatment with drugs that force the cells out of hiding. With this done, the patient's immune system can act to destroy the tumour, as it can now recognise the cancer.
Tumour cells tend to outfox the immune system as they find ways to camouflage themselves; they grow a ligand- a surface molecule that activates the PD-1 receptor on the T-cell, this fools the immune system to think that tumours are normal tissue.
The drugs used were one of three types of antibodies.T-cells (playing a key role in the immune response, matured in the thymus) should be able to spot these cancer cells as foreign and therefore destroy them. They act by blocking the interaction between the PD-1 receptor and the ligand.; thus allowing the immune system to recognise the tumour as cancer cells.
Another immunotherapy is to genetically engineer a patient's T-cells to recognise and destroy cancer cells. These engineered cells attack any cell with a CD19, which is a unique surface molecule to cancer cells.

Epilepsy's Unpredictability End?

This story now has a personal interest to me- I have recently been suffering from seizures and have now been referred to a neurologist to investigate the possibility of having epilepsy.

A new implant in the brain can warn of seizures minutes before they occur. Without this, epilepsy is incredibly unpredictable- putting people with the condition at risk, it is hazardous and disruptive. The warning of an imminent seizure helps sufferers stay safe.
Seizures can be described like earthquakes: you can't prevent them from happening, but if you predict them you can prepare to mitigate the effects. The implant is a patch of electrodes that measure brainwaves- it learns patterns of activity that indicate a seizure is about to happen. As this happens, the implant signals to a receiver implanted under the collarbone; alerting the person activating a handheld device with warning lights.
This means an enormous change in the independence and confidence of sufferers.

'A revolution in mental health'

Upon reading the NewScientist today, I was drawn to one particular article. This outlined the change of diagnosis procedure of mental health away from a symptom based diagnosis, and toward biomarkers and brain scans. This stood out to me as an issue, not only because I suffer from mental health problems myself, but also because such a huge sector of healthcare has been seemingly left behind research wise. You wouldn't diagnose cancer on the basis of a lump- the tissue would be tested- so why have we been diagnosing mental health issues differently, purely based on on symptoms and not on any objective laboratory measure? This would give rise to more accurate diagnoses, and hence improved help for the patient- that is, if the underlying science is reliable. This shift in technique is desirable, but 'to understand the neuroscience in sufficient depth to build a diagnosis would take time'.

Possible Drug for Autism

Currently, there are no medicines to treat autism's core symptoms.
A meeting in Massachusetts presented the results of the largest clinical trial of a drug for autism. The drug is called arbaclofen- it works by damping down the excessive brain activity. It derives from the already approved drug- baclofen (used to treat spastic muscles); this means that this class of drugs has already undergone safety testing.
150 people with autism either received a placebo or arbaclofen for 12 weeks. Although this drug did not change social withdrawal of the participants, it did make recipients more able to respond appropriate to other people.
Read in more depth: http://www.autismspeaks.org/science/science-news/top-ten-lists/2012/arbaclofen-shows-promise-treating-core-symptoms-autism

Hypothalamus: the Timer of Life

By manipulating the hypothalamus- a small almond shaped part of the brain that controls most of the basic life functions- in mice, researchers have managed to lengthen and shorten the lifespan of mice. This reveals new drug targets that may delay the onset of age-related disease.
 Mice were given gene therapy: one group to inhibit NF-kB- a protein complex that becomes more active in older mice (these lived to 1100 days); one group to activate NF-kB (these lived to 900 days); one group to age naturally (these lived to 600-1000 days). The mice that lived the longest also maintained mentally and physically fit for longer- the mice were given cognitive tests against a control and the longest lived mice performed best.
Post-mortem examinations in the longest living mice (with inhibited NF-kB) showed that they had many chemical and physical qualities of younger mice. Further investigations showed that NF-kB reduces the level of GnRH ( a chemical produced in the hypothalamus) which regulates puberty and fertility. Mice injected with GnRH resulted in new neurones in the brain and they lived longer too, with similar lifespans to that of mice with inhibited NF-kB. When injected directly into the hypothalamus, it influenced other brain regions.

Adults 'cured' after HIV baby

Following the apparent cure of the HIV baby (see previous post) reports suggest that therapy similar to that of the baby works on adults too. 70 people that were treated with three antiretroviral drugs (ARVs) a lot earlier than people are normally treated: 35 days-10 weeks after infection. The majority relapsed after their treatment was halted, but 14 of them, 10 out of that being male, were able to stay off the ARVs without relapsing like the others. These 14 still have HIV traces in their blood but only levels that their immune system can keep at bay.
This is not total eradication of the virus, but it does enable them to live a a substantial amount of time without drugs (no ARVs etc). It has been made clear tat early treatment is very important- however, this rapid treatment doesn't work for everyone (56 of the 70 relapsed). The 14 adults were also confirmed not to be 'super controllers' (population, 1%, of people with a natural resistance to HIV)- and researchers are now attempting to identify why it only works on some people, which may expand the future for further functional cures.
The senior advisor on HIV/AIDS strategy at the WHO (World Health Organisation) says 'The big challenge is identifying people early in their infection' and also pointing out that the stigma and potential discrimination means that people are reluctant to have a test for it.

Other researchers are working on a way to eradicate HIV from the body completely- by using drugs that  'flushes out' dormant HIV out of its hiding places in the host. This was supported by the trebled levels of dormant HIV in the blood following taking the drug (vorinostat) as this shows that the virus is being removed from cells. And now, an attempt to find a way to kill the HIV which would now be in the blood after use of drugs flushing it out- and so getting rid of the virus from the body completely. Theoretically, HIV can be 'moped up' if it is released form the plasma in cells (if HIV is unlocked from resisting CD4 memory T-cells).

Vorinostat is histone deacetylase (HDAC)  inhibitor- used for treatment of cutaneous lymphoma (brand name- Zolinza). HDAC is an enzyme that contributes to maintaining latency of the genetic material, that is integrated in human cells, of HIV. The idea is to break this HIV latency, thus 'turning on' the HIV genes and the virus to replicate. Vironostat shows the ability to cause mutations (mutangenisis, AMES positive)), which could potentially leads to cancer- although, there were no such events in the study into the drug. This study is hoped to chow that HDAC drugs can be effective and that other less toxic (not AMES positive) can be used to move the 'cure' forward.

Electronic Cigarettes- The Debate

Throughout our lives we are told about the effects of smoking, how bad it is to hour health including increased cancer risk, and yet many still do it. Upon reading my NewScientist, I was drawn to one particular article on electronic cigarettes  I have a particular interest in such due to family members using them on-and-off in a desperate attempt to quit for good. However, are they really any help, or just a menace? Some people think that the wide use of e-cigarettes could save many lives, the number of people using them in the UK is thought to reach a million this year (Acting on Smoking and Health, charity, claimed 700 000 people were using them last year); but some people believe that they are doing harm in normalizing smoking.

These 'cigarettes' vaporise solution (including propylene glycol and vegetable glycerine) into aerosol mist, which simulates the act of smoking. They contain nicotine, just like normal cigarettes- which might be around the same amount of a normal one, but the quantity of nicotine can be chosen by the user, with some opting for none at all. The huge attraction for smokers the these devices is that they look and feel just like the real thing- unlike nicotine patches or gum. They are, however, more pleasant for non-smokers around the people using the e-cigarettes as opposed to real ones; they do not produce toxic gas or smell. A 2012 study showed that carcinogens were typically 1000 higher in smoke from standard cigarettes compared to the vapour from electronic ones.
There is uncertainty around the effects of inhaling of nicotine vapour into the lungs; but there are no combustion products to be inhaled, so no tobacco toxins inhaled which could cause lung disease and cancer.

Are e-cigarettes medicines, or simply a form of cigarette to be on general sale? There is a great disparity when it comes to the view of this across countries, for example in Canada and Australia they are not on shop shelves and people can only buy them on-line for their personal use; whereas, in the US e-cigarettes are classifies as tobacco products so they can be sold legally as consumer products. In the next few months, UK regulators could 'provide a model for which way to go'- the MHRA (Medicines and Healthcare products Regulatory Agency) proposed regulating them as medicines- but would allow them to be continued in retail sale, so that smokers who have already turned to them do not go back to smoking.

Smoking is the world's second biggest avoidable killer (following high blood pressure)- killing 6 million a year. 35% of smokers try to quit each year in the UK, but only around 5% succeed unaided. From a study of of 300 smokers for evidence for whether e-cigarettes help people stop smoking, 9 % quit and a further 20-25% cut intake of real cigarettes by at least half. But how safe are these e-cigarettes? The WHO in 2008 warned that the safety of e-cigarettes had yet to be established.
Action on Smoking and Health (a UK anti-smoking charity) said the use of electronic cigarettes was a 'harm reduction' approach. But they can legally be sold to children, and there are few advertising restrictions- could they be seen as glamorising smoking? They are not regulated medicines like patches or gum, so there are no rules about the purity of nicotine in them. Should the smoking of e-cigarettes be allowed in a public place? The BMA has called for a ban for their use in public places, so there is smaller risk of normalising something that looks like smoking.

How will the regulation change? We can only wait and see...

Speaking for Charity

A short while ago, I was invited to speak at the Bexley Women’s Aid annual conference, and accepted without hesitation. After preparing and presenting a 10 minute talk about the charity’s work in schools and its impact- to a hall of officials- I received useful, supportive and encouraging feedback. The coordinator was so pleased with my work that she contacted my head teacher and I received the Head Teacher’s Award for representing the school in an outstanding way. 

I kept in contact with the women working for the charity, and was invited for a meeting to discuss the possibility of volunteering at one of their refuges. I hope to start soon, on a weekly basis to hopefully gain some valuable experience and help BWA offer their support.

School Medical Club

I have been running a thriving club for aspiring medics for approximately two years. 
There was a small medical club in place, which I attended throughout my GCSE years. As soon as I entered the sixth form, I set out with the aid of certain teachers to reform the group. I aimed for a place where anyone can come to learn and discuss scientific news and breakthroughs and issues relating to medicine and medical ethics, all of which would aid applying for university. I have also managed to use my resources to secure medical students and graduates to join the club to speak to us about their experiences and advice. The club is running and successful to date.

I am now aiming to expand the club, get the lower school interested and passionate about medicine- as well as encouraging peers to come along.

HIV Cure?

Watching BBC news this morning, when admittedly I should have been on my way to school, I was fascinated by the story of a HIV baby in the US being 'cured' by use of very early treatment with drug therapy. This fitted in all too perfectly with my Biology As at the moment, learning about the transmission, global spread, effect and prevention of HIV/AIDS.

What is HIV?

HIV stands for Human Immunodeficiency Virus. The virus enters the body- in this case, across the placenta or during childbirth- and may remain inactive (this is known as being HIV-positive). AIDS is the disease caused by the HIV virus; once the virus is active it attacks and destroys T helper cells in the immune system- these cells normally help to prevent infection. If destroyed, you will be unable to defend yourself against any pathogen that enters your body and you may  contract a range of opportunistic infections. It is the effect of these diseases which eventually kill a person with HIV. AIDS stands for Acquired Immune Deficiency Syndrome. 

It can also be transmitted by: exchange of bodily fluids, unprotected sex, use of unsterilised surgical equipment, sharing needles etc.

HIV/AIDS is a worldwide disease, and is still spreading in pandemic proportions. The majority of people living with it are living in sub-Saharan Africa. 

Latest case

The child in question is now 2 1/2 years old, now off of medication for over a year without infection. Dr Deborah Persaud presented her findings at a conference for retroviruses and opportunistic infections, she said 'This is a proof of concept that HIV can be potentially curable in infants'.

The first person believed to be recovered from HIV, Timothy Ray Brown had his infection eradicated with leukaemia treatment and stem cell transplant from a donor with a genetic mutation that resists HIV- very rare. On the contrary, this case involved a mix of drugs (antiviral therapy) already used to treat infant HIV. 

This suggests that the quick treatment meant that the virus did not have chance to form hideouts in the body. HIV specialist Dr Hannah Gay put the baby on a cocktail of 3 standard HIV fighting drugs at  30 hours old- before the lab tests came back from confirming infection (high risk of the baby to have HIV as the mother recently found out she was carrying the virus and had no treatment). The treatment continued for 18 months, then the child disappeared from the system and 5 months later it was a surprise to find the virus had not returned.

Does this mean a cure?

In the above case, there are very special circumstances: the HIV battled hard and fast just after birth. This worked, meaning that the infant can grow up without having to worry about the implications of HIV- however, the same approach could not be applied to adult cases, with people finding oiut they have the virus a long time (months, years) after acquiring HIV. 

High risk groups in the UK are offered regular testing for the virus, free- however, 25% of people with HIV are unaware of it. This gap in acquiring and finding out that HIV has been acquired gives time for the virus to hide away in the immune system, so no therapy can touch it. 

This approach is definitely not going to provide a cure for the majority affected by the virus. Antiretroviral therapies in the 90s had a great impact on the number of deaths- HIV is not the great killer it once was. But the hunt for a 'cure' is still on.

Opening my latest NewScientist magazine, I was immediately drawn to its covering of the HIV case. Beside stating the majority of things I could learn via the news, this went into more depth of the sceptical response and future for this kind of treatment.
Mario Stevenson said 'At present, this can best be described as a functional rather than a sterilising cure' although also says that every baby of HIV positive mothers should receive 'triple-drug treatments'.Other beliefs, of Davis Margolis, are that the baby could have been a 'super-controller'- this means that the baby had a natural resistance to the virus, due to a fault in the gene that manufactures CCR5 receptors on white blood cells. HIV needs to attach to these receptors to successfully invade cells, meaning super-controllers are protected from infection from this nasty virus. This same mutation was involved in the only other 'cure' case for HIV- Timothy Ray Brown, mentioned above; the stem cells involved in his treatment were from the bone marrow from a super-controller.
Now, therapies are being developed that focus on these CCR5 receptors. Another hope for treatment is vorinostat- a drug that can 'flush out' HIV from its hiding places in cells and ARVs (antiretroviral drugs) can then be used to keep the virus at bay. Several countries are now giving ARVs to all HIV positive mothers rather than only with a CD4 (type of white blood cell) cell count has fallen below a certain amount as a result of the infection. 

Triple Helix Conference

Science in society, Cambridge conference

On the 13th and 14th of February, I attended the Triple Helix conference 2013 at Newnham College, Cambridge. Website for the conference- http://tthssc2013.weebly.com/.

I found out about the conference from a pupil at my school in the year above, whom attended the previous year and was enthusiastic to encourage me to go...I can see why she was so eager after attending, myself! Science has always been my greatest passion, so it was an obvious decision to register asap- and, of course, encourage my peers to look into it. 

As I arrived in Cambridge, I was gazed awe at the wonderful architecture and was delighted to see so many bikes about- a keen cyclist myself, and most interested in Cambridge for my studies. The town centre was a near perfect size: not too big, not too small; although my friend and I did manage to get quite lost in our desperation to find a chip shop, typical. 

Day 1- Technology
On arrival at Newnham hall, we were handed our conference packs: editions of the Triple Helix magazine, quick-fire questions and a name tag. I was pleasantly surprised, I must admit, that there were not that many people in total attending- a select bunch of teenagers equally as 'geeky' as myself. We discussed in small groups a selection of the questions handed to us upon arrival before joining with the other groups as a whole to report back; it was then I realised that I would enjoy the days there- discussions are one of my favourite activities.
Chris Mannerings: 'Technology in education/development' was our first talk- where we were encouraged to remember our ability as humans to think, our "best ability". The main focus was on mobile phones and other types of technology and their effect on development (e.g. activism like the Arab Spring, education like MoMaths, and economics like M-PESA). We also touched on healthcare, sanitation, disease, and how technology can help. This was certainly an eye-opener.
Prof Peter Gruthie gave the next talk, explaining sustainable development and how needs are different in difference places (e.g. in developing countries). This really did make me realise how subjective technologies are in aiding development.
Krishna Mahbubani: 'Biotechnology in genetic modification and human enhancement' was our last talk before lunch, so the majority were losing concentration - but this speaker really stood out to me, helped greatly by her contagious enthusiasm. We followed her path in developing an oral vaccine; of particular interest to me, wanting to study Medicine. It was refreshing to see a problem identified, worked on as a team and eventually sold on as an idea.
After lunch and the 'poster session', we were informed of the careers in science- I myself, greatly surprised with the range of career prospects post-doc. Although this did just confirm my desire to study medicine- I concluded that I belonged not with test tubes, but with people!
The challenge of a debate was thrown at us next- a challenge because we were fighting our side as a group, and not necessarily the side that we agreed with personally.It was quite heated, but nevertheless enjoyable.
Day 2- Mental Health
Following the discussion ice-breaker (same to previous day) to include the people who had not attended the first day, we were made audience to a panel discussion.
Student mental health was the topic of one speaker- my friend frequently looking accusingly over at me at any mention of stress, anxiety or depression. Jokes aside, I did ponder at whether I would be mentally stable enough to survive the pressures of studying at Cambridge...Of course, not enough to put me off. I was very impressed with the support system that the university had in place for students- something I count quite highly in reasons to apply to Cambridge now. We were left with the message of "expect change" for university.
Next, we learned about learning difficulties- or as possibly concluded, learning differences. The education system is built with one ideal learning style in mind, purely for the ease of it. However there is great variation, and Cambridge has a wide range of services to provide for anyone struggling or with a specific learning disability.
Anthropology was the topic of the next speaker- looking into Alzheimer's. I found this entirely fascinating, a brilliant speaker. I will not go into detail for fear that I cannot put over the desired information. It was food for thought- how has modern society meant that more elderly people have the disease than earlier? This was of particular interest as I am currently writing a research paper on exercise's effect on the brain and how it can be used to help with dementia.
After lunch and the poster session, we were given a talk on applying to Cambridge- certainly the most informative activity of the conference for me. I will not try to recreate or summarise my notes as I got rather excited when scribbling down every word. All I can say is that Cambridge seems like the perfect option for me and I honestly cannot wait to apply.
An interesting activity followed- developing a policy for ADHD in schools. We were divided into groups such as teachers, parents, scientists etc and had to outline a policy for tackling the problems that can arise from ADHD children. I enjoyed this, but realised how complicated things like this get when looked at in depth.

I met some amazing people: speakers and my peers from the UK and USA. I learned a great deal. And I developed many skills. Overall, an invaluable experience for me.

HIV Increase

Researchers say the rise in HIV is due to the lack of condom use in the male gay/bisexual community.

The HPA and some universities found a 26% rise in the number of men having sex with men without the use of condoms from 1990 to 2010; although this was thought to be a less sharp rise due a wider use in anti-retroviral drugs- thought to be 68% higher without this use. HIV rates in MSM (men having sex with men) have reached an all time high- figures show: nearly half of the 6 280 diagnosed in 2011 were MSM. 1 in 20 MSM have HIV.

http://www.bbc.co.uk/news/health-21474066

This links in quite nicely with an article in the NewScientist I read last week, about making condoms a more desirable approach. Researchers were finding ways to make use of condoms more pleasurable- the main idea was an origami-style condom, which received very good feedback from both partners in having intercourse. Might an entirely new condom style contraceptive be more attractive, more pleasurable, be more popular?

Paracetamol: Small Change, Big Impact

I was reading this article on the BBC website, and it made for very interesting reading:
http://www.bbc.co.uk/news/health-21370910
After 11 years the law on size of paracetamol packets changed- although the number of people taking overdoses had not declined-the deaths from overdoses dropped by 43%. In 1998, the packets were restricted to 32 in pharmacies and 16 in other shops. This long-term impact was not anticipated by previous studies.
An Oxford study not only showed fewer deaths, but also that people registering for liver transplants from overdose (frequent cause of liver damage) was reduced by 61%.

I think this just goes to show that the small differences that can be made really do help people. Paracetamol is an easily accessible way to attempt suicide, so at the point of mental instability and crisis it is too easy to overdose as a means of escape. Even thought the number of people overdosing has not decreased due to the smaller packs, there is a significantly greater chance of survival due to the smaller quantity taken and less risk of liver damage.

Obesity to lack of Vitamin D?

Genetic data from 21 studies was analysed in a report in the journal PLOS Medicine. There was a 4% drop in the vitamin D available in the body for every 10% of BMI increase.
The vitamin is stored in fatty tissue, so why is less available in people with more of it? It was suggested that the larger storage capacity in obese people (BMI > 30) may prevent vitamin D from circulating the bloodstream.

What is Vitamin D?

It helps regulate the amount of calcium and phosphate in the body. 

Sources of vitamin D include: oily fish, eggs, fortified fat spreads, fortified cereals. But the body can also synthesise it when sun exposure is adequate, and so cannot be strictly scientifically called a vitamin (as the body can produce it in sufficient amounts normally, without including it in diet).

Healthy levels are about 50 nanomoles litre. Less than 30 can cause softening and weakening of bones- leading to rickets and osteomalacia.

Obese groups are not acknowledged normally as being at risk of vitamin D deficiency, those that are include: pregnant women, age under 5, aged 65 and over, people with darker skin and people who are not exposed to much sunlight. These groups are recommended to take vitamin D supplements. 

Stafford Hospital

The report

290 recommendations in total. Overall, the hospital's board should take ultimate responsibility- they took the decision to peruse a cost-cutting drive to achieve foundation trust status, and which refused to listen to complaints.

There was a lack of clarity about the role of the regional health authority in monitoring. The Department of Health was also being criticised for being to not always putting patients first and being too remote.

The scandal should not be seen as a one-off; change is needed- to put patients first.

More hospitals?

The public inquiry into failings at Stafford hospital has lead to investigations at five other hospitals.

There were many, many unnecessary deaths at the hospital between 2005 and 2008, now David Cameron has announced that these other hospital- of which have had high death rates for two years- to be investigated.

Namely: Colchester Hospital University NHS Foundation Trust, Tameside Hospital NHS Foundation Trust, Blackpool Teaching Hospitals NHS Foundation Trust, Basildon and Thurrock University Hospitals NHS Foundation Trust and East Lancashire Hospitals NHS Trust

All UK medical students to be provided with a Junior Doctor job

A post a while back explained about the issue of unemployment and that the intake to medical schools will drop by 2% in 2013 to tackle this.
Now, the Government have pledged to provide all UK medical students with a junior doctor job for the 2013 application cycle. The BMA responded positively... with this new guarantee, lots of tax-payers' money will be saved- not wasting on the training of students who would be unemployed.
Great news for me!

High Court ruled that sperm donors can seek access to their offspring

It is now possible for males that donate sperm to apply to seek a role in the lives of their biological children.

Mr Justice Baker ruled that two men (with a civil partnership) could apply through the courts for contact with a child of their sperm used by lesbian couples they are friends with. There were disagreements about the level of the men's involvement, despite the contact between the couples after birth- so they applied to the courts. He ruled that, in this case, it was appropriate for the biological fathers to apply for a contact order.

Should sperm donors have contact with their biological children? Of course, this could have implications on both the donor and the family involved. It would be a scary prospect for many parents, if the donors could apply for courts orders. Surely, it is most vital that plans are already in place prior to the use of fertility treatment.
http://www.bbc.co.uk/news/health-21296551

Stress

Could stress prolong your life? Good news for medics, I suppose.
Research at the University of California showed:- People that were most hard-working, involved, persistent, achieved most and had the most stress were those who stayed healthier and lived longest. People that take it easy, don't stress and retire early were those who tended to die at a younger age. Quite surprising, considering the general anti-stress advice.
Habits of those under more stress are likely to be healthier: less likely to smoke and drink to excess but also more conscientious people tended to succeed more in their careers. People with a socially responsible life, helping and being involved with others, live longer.

http://www.bbc.co.uk/news/magazine-21186757

Veggies have a lower heart risk

Vegetarians are 32% less likely to die or need hospital treatment as a result of heart disease- a study of 44 500 people showed. Behind this health boost are thought to be differences in cholesterol levels, body weight and blood pressure.

This story was of greater importance to me, seeing as I, myself, am a vegetarian- and have been since I can remember. 

Heart disease is a major problem, killing more than any other disease in the UK- killing 94 000 people a year, as well as 2.6 million people living with the condition.

Fatty deposits build up in the arteries that provide blood to the heart muscle, blocking the flow; this can cause angina (severe pain in the chest) and can lead to myocardial infarction (destruction of the heart tissue) if the vessels are entirely blocked. 

The vegetarian diet often results in consumption of a lot less saturated fats, cutting out all animal fats. However, it is important to remember that a meat-free diet is not always a healthy/balanced one, so it is important that sufficient vitamins and minerals are included.

http://www.bbc.co.uk/news/health-21258509

Cancer survival increasing

More people being diagnosed with cancer and yet fewer people dying as a result in the UK (according to figures from the Office of National Statistics).

http://www.bbc.co.uk/news/world-20624891

Quadruple helix? Cancer cell DNA

Commonly know to exist as as two intertwining DNA strands, the double helix- but also existing as four strands it now appears. 

Quadruple-stranded DNA helices have been identified in human cancer cells after being made previously in the lab; but this is the first evidence of it occurring naturally. These are called G-quadruplexes and are formed by the interaction of for G (guanine) bases that make a square- most abundant when cells are about to divide (transitory structures). They form in telomeres and chromosomes.

Cancer cells divide rapidly, and they commonly have defects in their telomeres (a region at each end of a chromosome, which protects the end from deterioration or from fusion with neighbouring chromosomes) so the quadruple helix may be a feature unique to cancer cells. This difference means that this could be the way forward in treating cancer as they could target only the cancer cells and not harm healthy cells. Could the G-quadruplexes be blocked? Are they present in healthy cells too? Are they present by design?
NewScicentist 26 January 2013

Putting St John's skills into practice

Upon returning home, I was delighted to hear that my father had sprained his thumb- I mean not thrilled by his distressed, but because my assistance was needed.
Fortunately, I am quite a skilled-hand when it comes to bandages: I have been attending St John's Ambulance Cadets for a couple of years now and have taught the younger learners how and when to apply bandages. Also, my practice has definitely stemmed from my various sporting injuries!
. I think that it was a torn ulnar collateral ligament:

A sprain can result from a sudden twist, fall or a blow to the body that forces a joint out of its normal position and stretches or tears the ligament supporting that joint.
Naturally, once I assessed my father's situation, I grabbed my good old friend the elastic support bandage. Practising my bedside manner and coping with the challenge of applying it to the difficult area of the hand, I provided a neat and comfortable result.
Feedback was that it was 'perfect- comfortable and supportive, just what I needed'. Happy day.

Work experience secured!

After a long struggle to find an opportunity, I have arranged work experience at Queen Elizabeth Hospital with a consultant rheumatologist.

Just a day after sending off my CV I received an email confirming 2 weeks in July. Now I just have the paperwork to fill out...But I am able to chose what I can see whilst there- other than the operating theatre etc.  unfortunately. 

Another problem is, that my school only allows time for one week's work experience- no where near enough for medicine, in my opinion! So I will be arguing my case to be excused from school for an extra week to take advantage of this opportunity.

Really looking forward to it and I will be reporting back after to give details of my experience. 

Drug funding decisions by NHS

MPs said a more streamlined, faster system of assessing drug treatments was needed; a Commons committee said NICE (National Institute for Health and Clinical Excellence) should have a more 'rough and ready' approach. NICE was set up to make recommendations to the NHS about which treatments should be made available by assessing their cost-effectiveness. NHS trusts were shown in a report to focus on the expensive treatments rather than cheaper, effective drugs that could be prescribed via GPs.
New treatments are generally only used if they are under £30 000 for each year of good health they provide (QALY)- no scientific basis to the threshold.
http://news.bbc.co.uk/1/hi/health/7179699.stm
Researchers say that the current method of deciding on which drugs should be funded, is 'flawed'.
Assumptions of the system used by NICE was tested by the a study funded by The European Commission.
NICE uses QALY (Quality-Adjusted Life Years) to assess the value of new drug treatments: this looks at the costs and how much someone's life would be improved and extended. After a questionnaire, the QALY system was criticised for grading different states of health- saying that people varied in their views about the impacts of different illnesses and disabilities as well as their approach to risk. 71% would prefer to live 15 years in a wheelchair than die after 5-10 years in a wheelchair, but the remaining 29% said they would rather die earlier than spending 15 years in a wheelchair.
There was a conclusion that the system failed to reflect varying views on disability and illness. However, NICE opposed the study by calling it limited and ensured that their system was the best.
http://www.bbc.co.uk/news/health-21170445

Laser to treat AMD

Age- related macular degeneration (AMD) affects millions of people- losing their sight without a way to prevent it. AMD corrodes the macula, leaving people with a gap in their vision; making recognising words and faces difficult/impossible. Most common in older white women, AMD affects about 1 in 15 people at some point in their lives.

Drusen- consisting of proteins and lipids- should normally be cleared by RPE (retinal pigment epithelium) but as they age they become less effective in doing so, resulting in large deposits which litter the retina. 

However, the cause of the affect on vision is not entirely understood. It could be because of: 

1) RPE cells dying off as they become starved of oxygen, and stop providing the photoreceptors with energy- they die too. As the density of photoreceptors is greatest in the macula, vision is worse;

2) The deposits of drusen itself.

In 2010 there was a trial for a laser that indicated the clearing of drusen (in the 70s). 50 people with the disease (with a drusen build up) were treated with a specially designed laser in one eye. The majority saw benefits: reduced drusen and/or improvement in sight. There was indication that the retina had regained some of its function. 

The laser could kill some of the cells and reduce the bonds between tightly bound cells, and so allow new RPE cells to regenerate (of which they could not before). The laser is not a uniform beam , but a 'beam of spikes'.

But some of the participants experienced they effect in both eyes...seemingly something else was triggering a response in both eyes. It is suggested that the immune system may be responsible: when the laser kills the RPE cells it alerts the immune system to the presence of drusen and so triggering a double clean-up of the drusen by immune system as well as the new RPE cells. However, this is not yet proven- just a hypothesis. 

Could this be the future for preventing AMD with people at risk? The laser could effectively work as a vaccination.

 

Why do your fingers wrinkle in water?

They wrinkle after about 5 minutes in water due to constriction of the blood vessels- pulling the skin inward.

In 2011, a study showed that the wrinkles form channels that divert water away from the fingertips. A team in Newcastle thought this might aid grip; they deduced that with wrinkles wet objects were moved 12% faster than with unwrinkled fingers.

It is suggested that our fingers aren't always like this as the wrinkles would affect the sensitivity of the fingertips- due to reduced surface area that touches the object.

Interesting, huh?

Medical student intake cut by 2%?

A government backed report recommends reducing the medical student intake by 2%. This will start in 2013- affecting me.

This is apparently to ensure that there is no money wasted in training more doctors than required by the NHS- not sustainable. Current medical school graduates are faced with medical unemployment due to the lack of junior doctor jobs to the number of qualified doctors leaving medical school.

Models show that demand for GPs would increase, and supply would fall short (supply increase by 29% by 2040) but the demand for hospital doctors will be too low for the increasing supply (supply increase by 64% by 2040)- according to a HENSE (Health and Education National Strategic Exchange) review and model Recent developments may mean all doctors working for two years longer and the aim for a 50:50 ratio of GP:hospital speciality entry level training posts- according to the HENSE model. 

First Injection!

Just gave a subcutaneous injection of insulin to my diabetic father- achievement. 

It was really satisfying and enjoyable...Without sounding too strange I hope...

Hope to use him as a practise subject again in the future.

MEDICAL INTERNSHIP- India

http://www.pulse-asia.com/

Very excited! Just secured 3 weeks of work experience in India for this summer- perfect. 

I will have the opportunity to shadow doctors, help on ward rounds, volunteer in an orphanage and even observe surgery! 

Quite nervous about going to a foreign country alone, but I am looking forward to the challenge it presents. I hope I can get a lot out of this experience, learn more about being a medic and lots to talk about in interview.

Wish me luck!

Non-Fiction>Fiction

According to my parents, I have never enjoyed reading fiction particularly- only really enjoying stories that were told verbally, I don't know why...To a certain extent, this is true to this day, although I have thoroughly enjoyed reading books such as: Dracula, A Brave New World, Frankenstein and the works of PJ Wodehouse.

Weekly visits to the local Library provided me with a fresh set of either anatomy or medical books throughout primary school...I was a bit of a weird child! I set myself challenges like memorising the major bones in the body, names of muscles and how organ systems function- instead of reading about magical worlds like my peers at the time. I suppose I didn't see the point in fiction when there were so many things to learn about, fascinating things that are part of us- the human body.

My enthusiasm to learn about science lead me to collect the 'Horrible Science' books- of which I would recommend to anyone, including adults. As well as diving into such books as 'Why Do Men Have Nipples' and other popular science books, whilst still in primary education. 

Now, as- what I would like to consider- a mature teenager, I read around the subject of medicine whenever there is a pare moment: the bus being a chosen favourite, with in front of the TV being a close second. 

At the age of 14 I subscribed to the NewScientist magazine, and consistently read it- cutting out particularly interesting articles around medical issues. Now I am older, the ethics of medicine has become more appealing  and I have started reading into it more.

Who needs a made-up story when you have a much better story right in front of you? (Life itself).

Book- Elephants On Acid

Re-discovered this old friend- I remember holding hands with my dad going into the book shop in search for some new reading material at the age of about 13 and the playful cover attracted my attention...They say never judge a book by it's cover, but in this case I was right!
I started to relish the challenge of reading above my level, picking up new vocabulary and learning fascinating facts. And of course, I felt the need to share my new information with my closest friends continuously, reading them passages and forcing the book upon them after finishing.

Book- Bad Science

I read this book when I was 12 years old- initially just to show off how grown up I was by quoting insightful comments, but I was captivated by how subjective science can be. 

The satire and humorous tone tickled my pre-teen fancy of popular science books- especially medical related ones.

Book- Medical Ethics

I have just completed this book...For the second time...After my head teacher lent his copy to me after discovering my determination to study medicine. I found this to be an incredibly useful tool to explore my views and challenge them.

At first, it was difficult for me to get my head around the philosophical jargon and unfamiliar concepts, but the clear structure aided this- at first explaining the principles behind the later discussions. 

Relaxing into the challenging reading, I became enthralled by ethics- I wanted to read into it more. Although the book gave me a good overview of medical ethics, I was aware of the obvious biased in the writing- cannot be avoided- but I now seek to find out more.