Toxoplasmosis

Toxoplasmosis is a parasitic disease caused by Toxoplasma gondii. There are only about 350 reported cases in the UK per year although it is thought there is probably up to 350,000 cases as it often goes unnoticed. In fact 1 in 3 people have been infected at some point in their lives, usually becoming immune after the first time. As it has very few damaging symptoms it is usually left untreated as the immune system is able to fight it. Only when it affects ‘at risk’ patients, such as those who are HIV positive or pregnant, would treatment be administered.

Congenital toxoplasmosis is far more dangerous and often leads to miscarridge. Given only 1 in 30,000 babies are born with the condition, I was privileged to be able to follow a case during my time on the paediatric ward in Warsaw, Poland. When the baby and mother were first admitted, the baby had a stereotypical smaller head and a visibly swollen abdomen. One of the main concerns was that the baby was feeding up to 30 times a day but had gained little weight since birth, despite being born prematurely. Not only was this bad for the baby, but it was also putting a great deal of strain on the mother who had to produce such large amounts of milk whilst also trying to recover for the disease as well.

I was able to witness early neurological tests and discuss some of the possible future implications for the child-the most worrying being Seizures and intellectual disability. Following my return I was able to look further into the disease.Most common treatement given to babies born with toxoplasmosis is pyrimethamine and sulfadiazine as they reduce the risk of serious or long term issues. They may need to be taken for up to a year, which can be a problem in countries where healthcare is not free. However there is not currently any medication or treatment available to reverse damage that has already been done, so recurrent or long-term problems may still occur despite treatment.

This suggests treatment is more targeted to mild cases where symptoms don’t appear for many months or even years, as there is often very little lasting damage done prior to birth. The most common manifestation of mild congenital toxoplasmosis being vision problems during teenage development. However those who don’t develop symptoms during childhood or as adolescents are usually be immune for life, as there is low chance of mutation in this disease, so memory cells produced during the first infection of the disease will remain effective to prevent future infection. This is also usually true for anyone who is infected with toxoplasmosis at any point after birth. 

From seeing the emotional and physical strain this easily preventable disease had on the mother and baby, I believe more effort should be made to increased mothers awareness so as to reduce risk of diseases such as toxoplasmosis. For toxoplasmosis there are very easy ways for expectant mothers to avoid possible infections; Wearing gloves when gardening to aviod contact with soil, washing hands and surfaces before and after handling raw meat, washing fruit before eating, avoiding coming into contact with cat litter and feeding your cats dried or canned cat food rather than raw meat.

 

 

Cudleadle a day keeps the doctor away

It is part of human psychology to thrive in social environments, thanks to our heritage of living in interdependent groups. However, increasing time spent alone, thought to be due to development of technology such as the mobile phone and Television, means that many people are not getting the face time and human contact they need for a happy and healthy life. The phenomenon known as ‘skin hunger’ or ‘touch-starvation’ suggest that this has contributed to an increased mood disorders such as depression and anxiety as well as having physical health impacts comparable to smoking or obesity.

It is becoming increasingly apparent that those between 16 and 25 are most susceptible to this disorder as it is an age where we begin to pull away from parents to become independent. There is often a large change in social environment such as a move to university or further education that results in many people feeling isolated and seeking comfort. They feel this is more difficult to find

 as they are in the process of creating new relationships that they do not yet enough trust in to make themselves ‘vulnerable’.

The majority of evidence around ‘skin hunger’ is based on its affects on early development and growth. Harry Harlow’s experiments with new-born monkeys demonstrated that infants will naturally choose the comfort of something soft above proper nourishment when selecting a surrogate mother. This suggests that they are naturally wired to seek out affection as a method of survival. Similarly, it is evident that infants in orphanages have a lower rate of survival, which is amplified during times of war due to increases in loss of parents and high stress.

Additionally, there is a known rela

tionship for children who experience a lack of attention from caregivers or spend extended periods in care to have poor ability to trust. However, this is not the only thing that has an increased risk for these children, there are also problems relating to attention span and logical thinking often leading to a confused thought process. Also recent evidence is revealing more physical constraints such as poor balance, hand-ey

e coordination, posture and fine motor skills, thus often leading them to being incorrectly pla

ced on the a

Given this information, it is clear that the world would benefit from a more interactive society. Not only could this lea

d to a decrease in health problems but also an increase in productivity and happy workers are more effective workers. Decreasing stress and anxiety will also have a 

positive impact on education and learning as people are more likely to retain information when they are more emotionally stable. 

utistic spectrum. This may lead to them being approached more cautiously thus being further deprived of the affection the need. The results of this lack of attention may then be brought into adulthood and lead to further problems.

So if you’re having a bad day, don’t be afraid to get your cuddle on!

Drug Dangers for Pregnant Women

This piece was prompted by an Article in the student BMJ.

Are-Pregnancy-Multivitamins-A-Waste-Of-Money-454x255

Paediatric and maternal research have always been associated with major ethical dilemmas. It is almost universally agreed that harming children, foetuses or mothers, whether intentional or not, is unethical. Critics agree that exposing children and foetuses to the risks of research for the benefit of others is not justifiable and that we should not exploit those who are unable to comprehend the risks they are being placed under. This leads to a seemingly irresolvable dilemma meaning that during pregnancy and post-partum, the drugs available to treat mothers is limited, as many are left untested due to research cost and ethics.

During my time in Poland with Gap Medics I witnessed a mother and baby suffering from the parasitic disease Toxoplasmosis. The congenital disease had been picked up during pregnancy leading to the baby had been born prematurely. Despite feeding 20 times a day the baby was still far below its expected weight and this was also putting a strain on the mother who was also attempting to recover from the disease. The doctor I was shadowing prescribed a treatment of antibiotics, however he told me that because of ethics council ruling he was unable to give the patient the newer, more effective drugs as they had not been tested on pregnant women or those who were breastfeeding. This is an example of how the limits of ethical testing can compromise patient health and recovery.

Alternatively, some mothers may need to change current treatments all together when they discover they are pregnant, as their medications may have detrimental foetal effects. This can be very stressful for the mothers, especially those who have had a long term use of particular medication or past problems, as it may make them wary of trying alternatives. Also for undiscovered or unexpected pregnancies it may be into the third trimester before any treatment changes are made, at which point it may be too late. Some may have to weigh a balance between the benefit to the mother and risk damage to the baby whilst others may be told that, during treatment all possible effort should be put into avoiding pregnancy. An example of this would be Isotretinoin, more commonly known as Roaccutane- a treatment for severe acne. The medication is known to cause major birth defects and malformation in development, meaning it poses an extremely high risk to unexpected pregnancies. To even be prescribed 30 days of medication women have to first have spent at least a month using a minimum of one, but usually two, effective methods of contraception, for example the pill and condoms. They are also put under strict monthly monitoring not only to look out for any pregnancies but also to ensure liver function and lipid levels are not being compromised.

I spoke to a 17 year old who was currently receiving the medication, to discover their views on the treatment and its associated risks. Having previously used the pill, antibiotics and benzoyl peroxide they found roaccutane to be by far the most effective, especially as their condition developed. Their biggest concern was the actual idea of taking a dug with so many side effects, with the most worrying for them being effects on the liver and cholesterol levels as the risk of pregnancy in this case was extremely low. The patient said that the effect they felt most conscious of was the achiness of their body and that the regular pregnancy testing was not an influencing factor for them as they had chosen to opt out in favour of monthly blood tests.

The BMJ article that prompted this piece spoke about a study carried out in Denmark into whether or not ‘Antiepileptic drugs lead to an increased risk of spontaneous abortion (miscarriage)’. The paper based on numbers from 1st February 1997 to 31st December 2008 and included a cohort of 983305 recorded pregnancies. However, it was only in 0.5% of cases that antiepileptic drugs were being used.16% of women using a form of antiepileptic drug, compared to 13% of women who were not using any, suffered miscarriages. There was no increase for women with an epilepsy diagnosis that used the drugs; however there was an increase for those who did NOT have a diagnosis. In cases where drugs were used in the first pregnancy but not the second, the hazard ratio was 0.83 for exposed pregnancies compared to unexposed, as identified by 18 women. The overall conclusion was that there was no relationship however it was noted that the statistical precision for the experiment was low.

Despite that lack of definitive result within the paper, the importance of research of this type remains. Identifying possible drug effects as soon as possible is paramount to preventing any mass generation wide effects occurring such as those in the past. The most memorable being the thalidomide cases of the late 50s where the unknown relationship between the drug and foetal development lead to over 10,000 known cases of deformity as the drug was prescribed to treat morning sickness in the early stages of pregnancy. In this cases, like many others, despite being aimed at pregnant women, there had been little testing done on pregnant subjects due to ethical complications and following the events there was a significant increase in standards for testing and licensing drugs. In the rules regarding disclosure of all side effects discovered during testing were more strongly enforced and documents such as The Kefauver Harris Amendment and Directive 65/65/EEC laid down the some of the early steps to our modern drug licensing processes.

Concussion Vs Exams

With the British populations increasing involvement in organised sports, the occurrence of head injury and concussion is on the rise.

Concussion comes from the Latin word concutere meaning to shake and is defined as ‘Any transient neurological dysfunction as a result of biochemical force’ or in more simple terms- a sudden, short-lived loss of mental function occurring after a blow or injury to the head. It is the most common but least serious type of brain injury.

Symptoms of concussion can include loss of consciousness, loss of memory or no recollection of events before or after the trauma occurred, headaches, vomiting, loss of balance, trouble reading, and writing, listening or speaking leading to confusion. In younger children changes in behaviour may be noticeable and clear fluid leaving nose and ears-this could be cerebrospinal fluid which usually acts as a cushion and immunological protector for the brain, although this could be confused with regular mucus leaving the nose.

During a concussion there are biochemical changes within the brain such as the release of neurotransmitters and unchecked ionic fluxes. Further neuronal depolarization with efflux of potassium and influx of calcium (ionic shifts) leads to rapid changes to cellular physiology. The Increased action of the sodium-potassium pump increases glucose metabolism, leading to disparity between glucose supply and demand which results in a cellular energy crisis. This can be measure using a positron emission tomography, a method also used to diagnose Alzheimer’s. The deficit means there is a period of depressed metabolism where the patient is more vulnerable due to slower reaction to a second concussion which may lead to longer-lasting deficits.

General effects to the brain and central nervous system as bruising or cuts to the brain after it is pushed up against the skull, less oxygen being delivered to the brain and poor communication with cells showing in weakening muscles.

Although long-term effects of concussion or post-concussion syndrome is rare, due to the increasing occurrence of concussion it is becoming a more serious pediatric health problem. Moderate to severe traumatic brain injuries (TBI’s) have symptoms similar to those of concussion but have more long term health risks, with particular problems in concentration, processing information, solving problems and decision making. Despite the brain having the best ability to re-organise its self and make new connections during childhood, research shows they usually take longer to recover that adults with a similarly imparting injury. This can by an issue as children can often understate symptoms, especially in sports, so as to continue playing as soon as possible. On the opposite end of the scale some may exaggerate so as to avoid things such as school. Hence why doctors must be wary during examinations and parents are recommended that complete inactivity isn’t often advisable.

Despite female involvement becoming increasingly popular, the most dangerous sports in the UK in terms of concussion are football and rugby which are historically male dominated. Although female gymnasts frequently obtain minor head traumas due to sheer impact of their landings. I believe that involvement in more ‘aggressive’ sports and lower teenage dropout rates could be a contributing factor as to why male exam results are often lower than females of the same year, as they are more susceptible to brain traumas. The 2014 GCSE results showed a 8.8% difference between proportion of girls getting grades A*-C compared to boys, the largest difference in 11 years, although the gap is greater at Grade C and above then at A*

In most UK secondary schools, both rugby and football are large contributors to the boys PE course throughout the Autumn, Winter and leading into Spring. Given that exams take place in the Summer term, the majority of the course is taught in conjunction with these ‘more dangerous’ sports before the focus is shifted towards revision later in the year. This means that the initial intake and retention of knowledge when a topic is first introduced has a greater chance of being compromised due to an increased risk of unidentified head injuries.

This leads me to question many things:

*Is this the reason that boys are often seen as ‘last-minute merchants’ when it comes to exams, by out-performing their predicted grades following intense last minute revision?

*Is this why boys are only matching or out achieving girls in subjects that involve less factual knowledge and more mathematical problem solving?

*Do boys just experience later cognitive development naturally?

*Is changing exam structure to decrease gender gap unfair to girls who often need to out shine their male counterparts to achieve jobs later in life?

What are we doing prevent long term damage?

As a fan of rugby it would be hard not to notice the increased caution surrounding head injuries in recent times, especially at the higher levels. Changes in head injury protocol include incorporating the removal of players seen to be involved in head collisions, or injuries from the field of play to partake in head injury assessment. This has reduced the occurrence of multiple concussions hence reducing long term effects. Returning to the sport at all, following multiple concussions within a period of a few seasons is also being handled with upmost caution. Notably with George North, following multiple collisions and knockouts within the same season that lead to significant discussions about the continuation of his career.

Israel Folau, a household name of Australian and international rugby, recently advertised the use of a wearable tracker to monitor head impacts throughout a game. The brainBAND is a product of the work of Dr. Alan Pearce and Braden Wilson, currently being trialled as a prototype. Using sensors at the back of the head, impacts are measured in real-time with information being shared with medical teams, Coaches and referees so they can carry out the appropriate action, as well as being logged so that over time each player can see a more complete picture of their individual head-injury profile.

At younger ages there is talk of adoption the New Zealand approach of creating weigh bands within age groups to minimise size difference and subsequently the difference in force between players during tackles. This occurs within some U18 school teams already when talented younger players (U16) who wish to contest at higher age groups must have sufficient levels for grip strength and height to match that of the top year within the age group. The current proposed age-weight grouping used in New Zealand are similar to the following based on national percentiles.

weight-chart-a

The Worlds Population In Just One Village

After an extremely hectic month on Dofe, revision, tests and competitions I’ve finally managed to find time to sit and write a blog post so here it is!

images

Videos and posters depicting the world as 100 people have recently become a popular and engaging way to share current population statistics, some of which are more surprising than others. For example if the world was a town of 100 people the population would be almost evenly split with 51 living in ‘urban’ areas and 49 in ‘rural’ areas. The range of nationalities would be less diverse than you’d think with; 61 Asians, 13 of each for both African and American (including both north and south) nationalities, 12 Europeans and only 1 Oceanian. And of those people; 17 would speak Chinese, 9 English, 8 Hindi, 6 Spanish, 6 Russian, 4 Arabic and 50 would speak other languages as there are far too many to name.

These ‘infographics’ are so popular because almost 90% of our brain is said to be visual, meaning we can process images far faster than text. Not only are people 60% more likely to remember something they’ve seen over something they’ve read, but they’re also more likely to believe it and can then discuss it with friends and peers. For example in just two years, one graphics website (KISSmetrics INFOGRAPHICS GENERATED)  had over 2.5 million visitors, and almost 1 million tweets and other links to it from those sharing what they’d seen. Hence why infographics are being used more often in business and advertising.

The infographics that inspired this article are by a designer called Toby Ng, who uses relatively simple images to express information. My favourites are the ones depicting Food, Births/Deaths and HIV. I find them the most intriguing as although the numbers seem relatively small for things such as HIV and Starvation, each person in the village corresponds to about 74,158,000 people. This means it often difficult for people viewing these images to understand the scale of those problems. For example I asked both my mother (a nurse) and my younger brother (13) how many people in the village they thought would be affected by certain factors and compared their answers to the actual values given. I believe that the values shown reflect the information they are exposed to.

HIV Malnourished Dying of Starvation Overweight Births (deaths) per year
Mother

2

4

2

30

2 (1)

Brother  12

29

3

15

6 (3)

Actual

1

20

1

15

2 (1)

My brother, who spends a lot more time online, watching TV and Hanging out with friends has a greater understanding of the proportions of those who are overweight as he has more exposure to fast food advertisement which is often aimed at younger people. He also surprised me by suggesting that he thought about obese people as well as very underweight people  and those with eating disorders when estimating his malnourishment value as “none of those people would have a very balanced diet”, which I thought was a positive reflection on the way children are being educated about food.

My mother on the other hand was far more accurate on medical factors given her history in the field as both a midwife and gynaecology nurse, but struggled to conceptualise the world as a whole when estimating values for food related issues. Instead she used what she would see day to day in the UK and on charity advertisements thus supporting my theory of people struggling to connect the scale of the world to the scale of the hypothetical village.

In the field of medicine I believe it is important that we can visualise and share information and statistics as clearly as possible while still showing the scale of the problems. Henceforth allowing us to both focus more on large scale problems as well as being able to compare and combat those that are having the most effect. Also, public sharing of a wider range of information through more visual campaigns would improve overall public understanding of our position as citizens of a more ‘privileged’ country especially in the context of wars, refugee crisis and food shortages.

 

Interesting Links:

The Collection

More World statistics – International – LIVE