Monthly Archives: November 2015

The Consequences of Cholera

Cholera, a deadly, life-threatening disease that affects 3 to 5 million people worldwide. I previously did not know how widespread and lethal this disease was, but after reading a detailed article in this month’s Biological Sciences Review magazine I found out exactly how the toxin causes such devastating effects.

Having had the cholera vaccine in order to travel to the Dominican Republic and Ecuador, I did not realise the consequences that cholera could have. It is actually endemic in various parts of Asia and is responsible for 100,000 to 120,000 deaths annually. Essentially it is an infection of the small intestine by the bacterium Vibrio cholera which thrives in contaminated water. Hence, the disease occurs in areas of poor sanitation, particularly after natural disasters or war.

There is excessive transport of chloride ions and water into the small intestine as a result of the toxin being released. This leads to severe diarrhoea causing rapid dehydration. In 50% of cases, if untreated, it can cause death in just a few hours. Fortunately, there are new therapies to counteract dehydration by delivering a mixture of sugars and salts dissolved in water. Sufferers can therefore revive their immune system and recover. Nevertheless, the majority of people do not have access to such treatments as Figure 1 shows 70% of all cases occur in Southeastern Asia, Northern and Central Africa. The territory size on this map indicates the proportion of all cholera cases in that country. The United Kingdom (top centre) and United States (top left) are almost unnoticeable. Hence, most people infected are likely to live in poor conditions and so are likely to die if they become severely dehydrated.

Figure 1: territory size is in proportion to the number of cholera cases reported
Figure 1: Territory size is in proportion to the number of cholera cases reported

Indeed, there are no drugs currently which can specifically block the cholera toxin, and so even in economically advanced countries, recovery is only ensued by oral-rehydration therapy. Nevertheless there are a multitude of clinical trials being carried out in cholera-affected areas. To find out about specific clinical trials visit: http://www.nhs.uk/Conditions/Cholera/Pages/Clinical-trial.aspx?&Condition=Cholera&pn=1&CT=0&Rec=0 .

In conclusion, always check to see if you are travelling to a cholera-affected area to ensure you take the necessary precautions. A cholera vaccine is administered as a drink and it lasts for 2 years. While in the affected area you should also avoid ice cream and any ice in drinks, ensure you drink bottled water, avoid uncooked food unless you have washed it yourself and avoid seafood. While making sure that your health is protected from cholera, we also need to support those who are disadvantaged from such privileges. The most recent severe outbreak of cholera was in South Sudan and charity MSF has so far treated 46,900 people. They do this by simply replacing the fluids and salts the patient has lost having developed cholera treatment kits to provide rapid assistance. The MSF has managed to limit the case fatality in South Sudan to less than 1%. Working in Angola, Cameroon, Haiti, India, just to name a few more countries; the charity is hugely responsible to providing a future where cholera can be controlled and contained. Their website includes an interactive guide to how they treat cholera (http://www.msf.org.uk/cholera,) and you can also donate online.

Cholera is just one of the few diseases that effects less economically developed countries around the world. It is important to remember in the midst of wars and natural disasters, how such diseases can thrive and spread so quickly affecting millions who are deprived from medical facilities that we take for granted each day.

Biological Sciences Review, Volume 28, November 2015

Tourette’s Syndrome

While I was working at my local pharmacy a customer came in to collect their prescription and I noticed they were making abnormal physical movements; jerking their head up and down and they also spoke very loudly. They seemed unable to control such random movements.

Having witnessed such symptoms I decided to research into what the person could be suffering from. I discovered Tourette’s syndrome, which seemed to match the symptoms I had observed. It is a neurological condition; affecting the nervous system and brain, and it is commonly characterised by involuntary noises and movements called tics.

This condition normally starts in childhood and continues into adult life. Some children will develop tics, but they will grow out of them after several months- transient tics. Hence, to be classified as Tourette’s syndrome, these tics must have been present at least a year. Examples of vocal tics are grunting, coughing or shouting words, and physical movements include the jerking of the head or jumping up and down. Such tics can also be categorized as simple- small movements or uttering a single sound, or complex- making a series of movements or speaking a long phrase.

Before experiencing a tic, most people have unusual and uncomfortable feelings before so- premonitory sensations. These sensations are relieved after a tic. Tics will often follow a pattern and can be worsened by factors such as stress, anxiety and tiredness. Conversely, doing an enjoyable activity will reduce tics.

What are the causes of Tourette’s syndrome?

Diagram to show the area of the brain which causes Tourette's syndrome
Diagram to show the area of the brain which causes Tourette’s syndrome

 

The actual cause of this condition remains unknown, although it is believed to be linked to problems in the basal ganglia; an area of the brain. This is a group of specialised brain cells inside the brain that aid the regulation of the body’s movements. Tics are therefore the result of a temporary problem in this area which disrupts the decision-making process. A tic is effectively an unconscious urge to perform an action that the actual conscious mind regards as unwanted. What causes this to happen is still unknown, though dopamine is a naturally occurring chemical in the brain which can have powerful affects and so could be responsible.  

 

 

How can it be treated?

Fortunately there are treatments for Tourette’s syndrome and these may be classified as treatments without medication (behavioural therapy for example), medication (muscle relaxants, dopamine antagonists) and surgery (only in severe cases and so is extremely rare; it is a last resort).

This condition is also associated with Obsessive Compulsive disorder, ADHD and learning difficulties which are all psychological and behavioural problems which affect children in particular. Fortunately, this syndrome does not commonly affect a person’s intelligence.

To find out more about Tourette’s syndrome go to http://www.netdoctor.co.uk/conditions/adhd/a5227/tourettes-syndrome/.

Realising Reality in the Dominician Republic

Recently I travelled to the Dominican Republic with my grandmother. We stayed in a beautiful resort on the coast where everything was all inclusive, luxurious and ultimately a paradise.

However, when we decided to venture out into the real country we were hit with a harsh reality. The resort had been designed so that you would not to have to explore outside, with a street full of shops with all the facilities you could ever need. Stepping out of the complex felt like the Truman Show. From the perfect tarmac streets to dusty dirt roads, the cleanliness turned to ubiquitous litter and the houses were little more than shacks.

This picture is unedited and depicts how close rich and poor worlds meet
This picture is unedited and depicts how close rich and poor worlds meet

Although this experience may not be completely relevant to medicine, it was an extremely eye-opening visit that has changed my perception on life. Memories of when I witnessed such poverty in Ecuador during my month long aid-working expedition came rushing back to me. Indeed, I have been reminded about the harsh consequences that the majority suffer for the small elite to indulge.

Arriving home I researched and found that 34% of the Dominican Republic’s population is below the poverty line and 20% live in extreme poverty. Moreover I was astonished to learn that the staffs at our hotel only earn $100 dollars per fortnight, with more than a third of the country living on less than $1.25 a day. The economy has been growing since 1996, though economic inequality still poses a major problem as no more than 4% of the GDP is spent on education so that only 30% finish primary school.

Map showing the number of people below the poverty line in the Dominican Republic
Map showing the number of people below the poverty line in the Dominican Republic

Tourism is the main industry of the Dominican Republic, so effectively by staying in the country I did contribute to their economy. Nevertheless it is hard not to feel guilty when a few meters separate a perfect resort world from such inadequate conditions. Yet something that was pleasing was the fact that everyone I met was joyful, smiling and friendly. They have nothing yet embrace in happiness within family life and with friends.

Certainly this is just one example of poverty; there are 1 billion suffering from poverty across the world which is every second child. Nevertheless tourism is aiding to alleviate this as it is responsible for 235 million jobs, and is either the 1st or 2nd source of export in 20 out of the 48 least developed countries.

I hope to contribute to helping relieve poverty during my future career. Protecting the health of the world’s poorest people is a major goal for me. I would like to aid communities that have been cut off from the outside world that are medically disadvantaged and have almost been forgotten. We definitely need to strengthen our health services worldwide to promote good health practice as well as tackling diseases that are a consequence of poverty.