At what point does HIV become AIDS?

 

One question that has always intrigued me is why not everyone who carries HIV goes onto developing AIDS? I decided to research into this, and found that the contraction of HIV was the onset of the destruction of CD4+ cells, a type of white blood cells (also known as T-helper) that are an integral part of our immune system.

Most healthy people have a CD4+ cell count of approximately 800-1,200 per mm3 of blood. This high cell count is important as CD4+ have the vital role of instructing other cells to carry out their duties within the immune system; they also alert CD8 cells of any foreign pathogens, so that they can destroy these harmful particles. Without these cells, it would be difficult to maintain the human body’s health, leaving it vulnerable to even the simplest of infections.

HIV causes the gradual reduction of CD4+ cells over a long period of time, and it can take as long as 10-12 years for the cell count to fall to below 200, a point at which the carrier is defined as having AIDS. The immune system will be severely weakened, opening up its doorway to life-threatening diseases, such as neurological complications and cancer. It is therefore the vulnerability to other infections, not AIDS itself, that causes death. However, this time span can vary, dependant on the lifestyle of the carrier, and whether or not he receives treatment (in the form of antiretroviral medications, which are designed to preserve CD4 cells). Nevertheless, due to malnutrition and the unavailability of these drugs in poorer countries, AIDS can be triggered a lot more quickly in these areas, reducing life expectancy.

Now going back to the question of why not everyone with HIV develops AIDS, we can look into what prevents the CD4+ cell count from reducing in the first place. People who are fortunate enough to be ‘long-term nonprogessors’ are those who either have a slow decline of CD4 (Viremic Controllers), or those who don’t even experience a decline of CD4 (elite controllers) – even after 10 years, they will have less than 50 HIV particles within 1ml of their blood. This is surprising, since a typical person would’ve had hundreds of thousands of HIV in a single ml. So what makes those few individuals lucky?

Perhaps the explanation for this lies in genetics – these elite controllers are fortunate enough to have immune systems that modify the HIV into a ‘less fit’ variant, preventing it from reproducing rapidly (as they are unable to drive themselves into cells and integrate within their DNA). This results in lower levels of immune activation, reducing HIV replication, and hence the depletion of CD4 cells. Protective alleles, such as HLA B*5701, are found within 90% of elite controllers, proving that it is down to our genetics as to how our immune systems respond to the development of AIDS, not the virus itself.

Despite that, the ability to control HIV results from a combination of both genetic and environmental factors – this single explanation is only an “important clue”, according to Stephen Migueles, a National Institutes of Health researcher.

Hopefully with further research and studies we will be able to understand how certain immune systems control HIV better than others. I hope this was an enjoyable read, and if so, please rate and comment your ideas about this interesting topic!

Isra Ahmed

Sources:

http://www.news-medical.net/health/When-Does-HIV-Become-AIDS.aspx

https://www.scientificamerican.com/article/hiv-aids-controllers/

Volunteering in lessons

 

A few months back, I started to help out Year 8s in their maths lessons at my school, once a week. Though it wasn’t very medical-related, I decided to give it a shot because I knew the skills gained from this experience would be beneficial for my personal statement, and ultimate goal of becoming a doctor!

Interestingly, I found that assisting children with their work mirrored the duties doctors had to undertake, and the attributes required to accomplish them successfully. Some of the skills gained from this were:

  • Decision-making skills – Though Year 8 Maths may seem easy, I haven’t touched upon some of the topics in years so to work out answers for the students, whilst explaining how it works, was often quite a task for me. There was even an instance where me and a Maths Graduate helper were confused on a question, so we both worked together to find a solution. In terms of being a doctor, it’s a lot like working on your feet to make a quick diagnosis!
  • Confidence – I was taken out of my comfort zone, having to go up to pupils and check if they were ok, whilst answering any questions. Even though this task may seem easy, it was quite nerve-wracking at first, especially since I am quite a shy person. I felt this experience helped to boost my confidence, which is a vital attribute of a doctor who needs to communicate with strangers
  • Responsibility – As the Maths set I was working with required special attention, the teacher trusted me to help them by providing the children with sufficient support and correct advice. Working with a teacher meant that I was treated like an adult, giving me independence but also enforcing the responsibility of many children who were reliant on any help
  • Dealing with difficult situations – There were many scenarios of children being extremely disruptive and unwilling to learn, but as cheesy as it sounds, a doctor never gives up on his patient! Resilience is often required in these situations, as there is always a temptation to surrender to their bad attitudes, and stop trying. Therefore, to resolve these situations, I would often try out a different technique, or resort for help by another volunteer/teacher; however, I would never shout at them as this could aggravate their behaviour. This is a good representation of the struggles doctors have to deal with when working with non-cooperative patients!
  • Empathy – One particular student was getting bullied by the whole class, so I decided to step in by informing the teacher, who suggested I could be her point of contact if she ever needed advice and support. I happily agreed to this as I understood how difficult it was for her; and it is important, not just for doctors, but for any human being, to help those in need.

To sum up, I have actually found this to be more helpful than any other work experience because not only did it kick me out my comfort zone, but it accurately represented life at a hospital.

I have also been told by many medical application advisors that if it is difficult to organise any work experience, or find somewhere to volunteer, things like these also carry some weight in the personal statement as they will often provide you with real-life skills.

Isra Ahmed

First Human Head Transplant

 

This year in December, they are aiming to undergo the first ever human head transplant (project HEAVEN), which in medical terms is known as cephalosomatic anastomosis, with a 90% chance success rate.

The Italian surgeon hoping to accomplish this is Sergio Canavero, who has even found a volunteer: 31 year old Russian Valery Spiridonov, who has spinal muscular atrophy, causing him to be bound to a wheelchair and limiting basic activities such as eating or even breathing.

Image result for valery spiridonov and sergio

The surgeon will have to cut off his head, and then attach it to a healthy body, which would have come from a newly brain-dead person. The whole procedure could take 36-72 hours and will cost around £11 million.

After taking anaesthesia, the patient’s body will be cooled to 10°C; this is stop all bodily functions and to allow cells to last for this long without oxygen.

In order to carry out the procedure, a team of 150, 80 of them surgeons, will severe his head from his spinal cord, between the C5 and C6 vertebrae (which have a key role in neck mobility) using a diamond blade.

The frames clamping the two bodies together will separate, and the heads will be lifted, with Spiridonov’s head literally being deposited on top of the donor’s body.

The first thing that will be joined together are the head-body arteries, so that blood can recirculate the brain again. After that, the windpipe, gullet, spine, gastrointestinal tract and muscles will be reattached – all of which have been successfully operated before, so most of this will be basic surgery knowledge.

He will then fuse the two spinal cords together, using electric shocks and a glue-like substance called polyethylene glycol (which has previously been tested on animals to grow spinal cord nerves). However, only around 10-20% of the nerves will be reconnected, only giving the patient basic movement if the transplant is successful. Another option is to use olfactory ensheathing cells, which enclose the axons (the inner section of a nerve cell that carries the electrical impulse) of olfactory receptor neurons (sensory cells that specialise in smell), supporting the process of neurogenesis and reconstructing synapses.

When the patient’s head has been stitched onto his new body, he’ll be put in a coma for 4 weeks, to allow healing; electrodes will be used throughout, accelerating the regrowth of the dendrons and axons. And then obviously he will be given strong immunosuppressant drugs, to prevent rejection.

If it’s successful, after waking up, he should be able speak with their old voice, and even move.

He’ll have to spend some months in rehab, using a virtual-reality simulator, or hypnosis, so that he gets used to his new unfamiliar body.

However, obviously there’s doubts – puppies, monkeys and rats have all been tested on – and the longest they’ve ever survived is a week. Many say that the surgeon has simplified fusing the spinal cords together – and should be charged with murder if the operation fails.

What do you think about this exciting new development in science? Is it ethical, and do you think it will succeed? Please rate and comment your opinions below!

Isra Ahmed

Image result for head transplant

 

Sixth Form Medical Work Experience

 

Taking bloodBetween Monday, 19th to Thursday, 22nd December 2016, I undertook some exciting work experience at Lincoln County Hospital. After only just coming back from Medlink, I was buzzing to get a first-hand experience of life as a doctor.

Specifically designed for lower sixth form students, this 3.5 day course intended to help us gain an insight into the work a doctor does on a daily basis, and the skills required to undertake challenging tasks. We were also given helpful sessions in small groups on how to perfect our personal statements, and ace the UKCAT/BMAT and interview process; a clinical skills workshop got us taking blood and suturing skin (from fake skin of course!).

Application Process

On the first day, whilst being given advice on the application process, I found that like Medlink, the idea of empathy and resilience was highly emphasised.  It is vital for any potential medical student to understand the ability to have confidence, even when things get difficult, whilst maintaining a healthy work-life balance. Also, don’t be afraid to point out your weaknesses, just be prepared to talk about how you overcame them.

Whilst discussing, we found that there were many different reasons people wanted to apply – the variety in the career, the prospect of discovering new things that may have an impact, the life-long learning process, and having a chance to undertake research and reaching the pinnacle of cutting-edge technology – all these ideas are very good examples to include in your personal statement, as long as you don’t mention the cliché phrase: “I love science and helping people!”.

Infection Control

After this engaging session, we learnt a bit about infection control, by isolating patients to either protect other patients from getting infected (ie. diarrhoea spreading from faeces’ sprays) or to protect the patient from infection (eg. chemotherapy). At the current moment, Clostridium Difficile is roaming around hospitals, which lives in the human bowel and can cause diarrhoea if the ‘good bacteria’ that usually keep it in check are killed off (by antibiotics). It is important, therefore, to observe good hand hygiene by thoroughly washing your hands, to prevent infection spread.

Watching Surgery

Later on in the afternoon, we visited the operation theatre and got to watch two orthopaedic surgeries!  Experiencing the process of anaesthesia and watching the surgeons operate was an amazing first-hand experience to actually learn how doctors manage to stay calm in intense situations, using social interaction, scientific knowledge and practical skills (surgery is a lot like carpentry – the use of drills, saws, hammers and cauters to burn tissue were frequent). One thing that surprised me was the huge role the anaesthetist had to undertake – as well as injecting the patient with the chemicals and muscle relaxants to make them unconscious, their blood pressure (which gets very low), oxygen, CO2 and breathing rate was constantly monitored and recorded throughout. Even though the actual operations were relatively small, with a girl’s toe bones being straightened and a nail being removed from a man’s leg, it was interesting to learn about the standard procedures undertaken – such as using iodine (which immobilises bacteria and viruses on skin) to clean the limb, a tight band to restrict blood flow and hence prevent excessive bleeding during the surgery, and finally making sure I stood behind the a line where dirty air was getting filtered out.

Wearing my scrubs, all ready for surgery!

However, the main thing I learnt from this was the idea of having a ‘multidisciplinary team’; I cannot stress enough the significance teamwork had in surgery, whether you were a surgeon or scrub nurse – being able to communicate effectively and having chemistry with your teammates could be between a matter of life and death. Also, as an anaesthetist, empathy is needed as you need to comfort the patient, and act as human as possible! They must let the patient know what they are doing (never take them on by surprise), and if there are any difficulties. Once again, the role of communication will help put the patient at ease, relaxing them and speeding up the process – it also allows you to undertake the procedure safely, and makes sure they’re not in excessive pain or allergic to any damaging substances.

Personal statement and interview

I won’t go into detail here but some tips for the statement (which we learnt on the 2nd day) is to get it checked by people you don’t know on ‘The Student Room’ and use the ‘Medic Portal’ for more advice. Another thing, that some people may overlook, is to have an extra-curricular element just to add interest, and perhaps show off some other unique skills.

For the interview, one thing I would recommend is to familiarise yourself with the ‘Four Pillars of Ethics’ and to look into the idea of ‘capacity’ – whether or not a patient can make decisions. You will be tested on these things, and the interviewer will assess your reasoning for your arguments so perhaps challenge yourself with a few scenarios at home!

Doctor Shadowing

Later on in the day, I was assigned to a foundation doctor (F2) in the Medical Assessment Unit (MAU) – an area designated for patients after A&E. From the start of placement, I sensed the stressful and busy atmosphere, with doctors quickly moving from one patient to the next. Quite surprisingly, the F2 I was shadowing had to get through so much paperwork, something that required organisational and management skills to make sure the correct forms were filled in for the patients (listing their medication), ready for their transfer to another ward. Patience and tolerance was a virtue my doctor seemed to have – at one point, she lost all her patient’s details so had to remain calm and resolve the issue. However, it is important  to have effective communication and good ICT skills because at one point, due to a senior not informing her of his absence, she ended up having to go around the hospital trying to find someone to sort out a paperwork issue – this unnecessarily lengthened up the process and a patient, who had severe asthma, was forced to wait for her even though she was in considerable pain. When we finally got to this patient, I found that as well as the necessity to consider patient history, you should also have empathy; the husband of the patient was clearly distressed so by making conversation, it was a way of relaxing him, preventing him from panicking his wife. Everything you do as a doctor has a chain reaction – even if it is something little, it could lead to a (hopefully!) positive outcome.

Clinical skills

On the 3rd day, as well as watching a GP presentation (did you know that 80% of GPs are female?), which expanded my medical knowledge, we got a taster session in clinical skills, by learning how to take blood from a plastic arm, inserting a cannulation (used to deliver fluids to veins), trying out a peak flow respiratory device and suturing (the art of stitching skin to close up wounds).

Taking Blood using a butterfly needle:

Using a butterfly needle to take blood

Suturing (Vertical and Horizontal line stitching):Vertical and horizontal line stitching

Medical Schools

On the 4th day, we discussed the types of medical schools (31 overall) – when deciding where you want to apply, consider the cost of living (London is more expensive), teaching style (PBL, Traditional or Integrated), the application process, the course structure (some universities offer intercalated degrees), location, student satisfication and perhaps even how they teach anatomy. A good website to use is medschools.ac.uk and remember, as a backup, a good option is to take a gap year or do biomedical sciences, as some universities automatically transfer the top students to medicine.

 

If you’ve managed to get to the end of this post, I hope it was an interesting and helpful read – please comment and rate! Also, if you’re interested in surgery, I will be writing another post about a work experience opportunity I undertook in orthopaedics, where I will go into more detail about the work they do, and the skills I’ve learnt.

Thank You

Isra Ahmed

Medlink Intensive Conference

 

On the 17-18th December 2016, I attended the highly-valuable Medlink Intensive Course in Nottingham University, an experience that confirmed my desires to study medicine and become a doctor.

Medlink Intensive

Throughout the two days, we were given extremely useful hints and tips, as well as advice on perfecting the basics of our application – the personal statement and interviews (Traditional and MMI). Throughout a series of lectures, interactive taster sessions and role play, the idea to ‘have a wide focus’ was drilled into our heads from the start, allowing us to think constructively so that when it came to the real thing, we could have an advantage over everyone else.

Master classes on how to boost our grades to an A* in every subject – including the all-important chemistry were delivered with enthusiasm and were jam-packed with information, such as being able to ‘understand, apply and develop’ our knowledge in order to increase our competence in the exam. Downloading apps (such as brain teasers and dingbats), role play and word puzzles are all activities designed to expand our perspective of the world, a skill a doctor needs to possess! Another key quality that was stressed was the idea of resilience – as one of the lecturers put it, it was:

“being able to bounce back when things get tough”

There were also other workshops such as the UKCAT and BMAT, and a chance to get all our burning questions answered by none other than those who know medicine inside out, and the perks of its lifestyle – medical students! (including some who study abroad). Though the highlight of conference had to be the auscultation practical – after being given our very own stethoscopes, we were given a lesson on its parts, and how to use them!

The Medlink Conference as a whole was an interesting and one-of-a-kind experience; for those aspiring medics, it is definitely something I recommend attending. Not only was the information provided useful, with organisations such as Kaplan (UKCAT and BMAT training) and even St. Georges University from Grenada, West Indies (one of the top unis for medicine) visiting, but it was a chance to meet like-minded individuals, all of different interests, and expand our social circles, allowing us to share ideas and be part of a bigger Medlink community. It’s in the name – what I obtained from this short but intense course was something that I wouldn’t be able to acquire from the basic sources around us; Medlink was a collection of the best all packaged into an innovative and exciting weekend. And it was worth every penny – because it wasn’t just a small conference, we were promised constant support all the way to our application. Opportunities like publishing our own GMO (Genetically Modified Organisms) report, using social media and experiencing virtual reality are things that are being offered to enhance our application.

So for those Medics and Vets looking for something original, and a taste of university life, I wholeheartedly recommend Medlink Intensive: http://medlink-uk.net/

Thank you for reading and please feel free to comment on your views of the Medlink Conference! Also, if anyone remembers the name of the man giving the ‘Social Media’ and ‘Achieving the Dream’ talk, please mention it!

Isra Ahmed

Lincoln Hall

Lincoln Hall (my accommodation during the stay)

Welcome to my Blog

 

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Hi, my name is Isra Ahmed, and I’m a 16 year old student in Year 12 who aspires to study medicine.

Inspired by the recent Medlink Intensive course I attended a few days ago, I decided to create this blog in order to document my journey to achieving my ultimate goal of becoming a doctor, whilst also giving other potential medical applicants somewhere to learn more about the career, and share ideas.

I hope to be updating this blog regularly to give people an insight into my application process, as well as providing my views on current medical affairs, and anything that interests me. Opportunities such as work experience and volunteering will also be reflected on in my posts.

Studying medicine is a lifelong learning process and I hope to start now! Enjoy and please keep reading and commenting!

Isra Ahmed