‘This calamitous year: plague, doctors and death’

On Monday 29th June, I traveled to London to the Royal College of Physicians to hear a public lecture on the ‘This calamitous year: plague, doctors and death’. The evening marked 350 years since the Great Plague of 1665, the event was split into three separate lectures. The first by Dr. Stephen Porter introduced us to the plague and three pandemics. He highlighted the extraordinary loss of life and widespread nature of the plague, at one point the pestilence reached nearly every parish of London. What I learnt was that the peasants of London were pretty much abandoned by the rich and most the physicians of London avoided the city, for which they gained much resentment. The care of the sick- which was quite limited- was many left to the apothecaries of the time, who may have worn the iconic beaked plague doctor costume. Whilst other theories such as the Great Fire of London have been suggested, the speaker proposed that the most credible explanation for the end of the plague was the introduction of stricter trading regulations preventing the flea-carrying rats from reaching the British Isle again.
The second speaker, Katie Birkwood gave an introduction to the role of the physician during the plague. Her talk was based upon a small rare book which was published in 1665 on request of the government to the college of physicians to advise methods of prevention and treatment of the Bubonic plague. The book gave a brief reference to herbal and medicinal remedies, these were displayed by the museum for public viewing. In addition, she presented some of the more quirky treatments such as using a suffocated chicken to burst the characteristic buboes, if one could not afford the surgeon.
The final talk was given by the curator of the Museum of London Human Osteology, Jelena Bekvalac. In this talk we were given an insight into the work carried out by the archaeologists on burial sites to reveal the lives of Londoners over the centuries. She indicated some of the ways to analyse and in conjunction with contextual information suggest the causes of deaths of human remains found all over the city. Methods of analysis included bone examinations and DNA testing of teeth. I found it interesting to hear about different pathologies presented by different time periods. It is clear that the museum is looking forward to filling the gap in their timeline with the upcoming Bedlam excavation with the aid of Crossrail. I was intrigued by the images displayed of curved spines and fused vertebra. I was amazed by the story of one man who survived being shot in the back with a projectile by living with it lodged in his back, but fell victim to the infamous pestilence. As I left, I enjoyed the display of flowers and herbs used to prevent or treat the plague and now feel inspired to go to the Museum of London.

Hemochromatosis and its victory over natural selection

Hemochromatosis is a hereditary disease, where the body builds up excessive levels of iron. The condition affects 1:200 people and 1:4 are carriers of the allele in the UK. The condition has been described as ‘the Celtic curse’, due to the increased frequency of the disorder within the white, western Europeans. Symptoms include: fatigue, joint pain, erectile dysfunction, amenorrhea and arrhythmia. It is generally diagnosed between the ages of 30-50. The possible consequences if left untreated include: damage to organs including Cirrhosis, Liver cancer and heart failure. The typical treatment involves regular phlebotomy, historically known as bloodletting. Avoiding iron or vitamin C supplements and alcohol is recommended. [1]

How has the gene been able to overcome natural selection?

Iron is needed by the body to form haem groups, which is essential for the transport of oxygen to respiring cells. Iron forms the cofactor of many metabolic enzymes and many dieticians originally took the opinion the more iron the better. However, extreme iron concentrations enhance the functioning of parasites. The body uses Chelators as the first line of defence to counteract the ability of parasites to use our iron stores.

It is thought that the survival of hemochromatosis allele dates back to the era of the bubonic plague. Those people with iron rich diets were particularly susceptible to the disease as the bacterium thrived off their iron in the macrophages. Hemochromatosis disrupts the distribution of iron and starves macrophages. Therefore, this long term life threatening illness became a short term advantageous adaption against bubonic plague.2

A study from the New England Journal of Medicine has linked hemochromatosis with being taller. For example, Swiss males with hemochromatosis have been found to be approximately 4.3 cm taller. In the past, added height has been a selective pressure which allowed the mutated gene to persevere through generations of natural selection. [2]

People with hemochromatosis are better able to survive on low iron diets. This would have benefitted, Hunter-Gatherers who had irregular and unpredictable sources of iron. People who had severe blood losses such as women in childbirth and young warrior males, had better chances of surviving, which made hemochromatosis a positive selection factor. Due to menstruation, women experience the effects of hemochromatosis later in life, particularly after menopause. Therefore, this would not affect genetic selection, as the woman no longer reproduced.

The link between Hemochromatosis and colon cancer

Hemochromatosis is caused by a recessive allele on the gene HFE, which codes for a transmembrane protein which has a role in iron homeostasis. Although the condition was first identified in 1865, the HFE gene was not identified until 1996.[3] The association between liver cancer and hemochromatosis has previously been well documented. In a recent study, scientists concluded that those with the HFE mutation have an increased colon cancer risk and is greater in carriers who are older or consume high quantities of iron. The study factored in other environmental influences such as age, race, sex, red meat consumption, previous family history of colon cancer. The mechanism for this association is unclear, but it’s suggested that excess iron ‘may promote increased oxidative stress and induce DNA damage’ but also, that iron allows the proliferation of tumor growth.[4]

 

 

[1] NHS. Hemochromatosis. http://www.nhs.uk/conditions/Haemochromatosis/Pages/Introduction.aspx

2Stephen Cobb. Hemochromatosis tall tales and the HFE gene. http://celticcurse.org/hemochromatosis-tall-tales-and-the-hfe-gene/

3 Dr. Sharon Moalem. Survival of the Sickest. Chapter 1: Ironing it out.

4 http://jnci.oxfordjournals.org/content/95/2/154.full

 

 

 

Work experience placement: Epsom General Hospital

Over Easter, 2015 I spent four days on a Stroke Care Unit at Epsom Hospital, under the supervision of consultant Doctor Jha. The ward consisted of 19 beds: 15 of which were occupied by stroke patients and 3 medical patients who presented the most complex cases with multiple diseases and symptoms. Although, the majority of the work I encountered was observational-which is appropriate due to my lack of qualifications-I gained a significant insight into working in a hospital. The main thing that I noticed was the high amount of cooperation and teamwork needed in this setting. If you want a solitary job, this is definitely not the one for you. I was also surprised to find that by the end of the week, many acronyms and medical jargon had become so familiar to me.

The routine

The typical day in the ward for the junior doctors consisted of an early start to update medical notes on all the patients on the wards, in preparation for a departmental meeting and a review of each patient. The discussion involves a progress update from the night before and any changes to the social circumstances of the patients. After the departmental meeting, the hectic and busy ward round could begin. I was kindly advised by the junior doctors to have a large breakfast as this process can go on until 1pm.

Although the mental state of most of the patients on the ward was impaired due to conditions such as Dementia and Alzheimer’s, the consultant would try to communicate with them to assess their pain levels. The consultant would listen to the breathing of the patients and tap their back to assess their respiratory functioning and predict possible infections. For new patients a more thorough investigation must take place. For example, to identify whether a stroke has taken place the consultant may request CT scans or for more refined search, an MRI. They may also look into their cognitive functioning by asking simple questions such as “who is the Queen?”, “Who is the current British Prime Minister?” , and cross checking date of births with the age the patients claim they are. This was all done to help assess the damage to memory from a stroke. In order to identify tremors, which can indicate damage to the cerebellum, the consultant would get the patient to touch their nose and his finger. Junior doctors would rapidly assess the vital signs of the patient. These included the blood pressure, heart rate, body temperature, respiratory rate and oxygen saturation. I learnt that vital signs are a good indicator of the ‘wellness’ of the patients, especially for those who were unable to convey this verbally. Notes were profusely scribbled down in a characteristic doctor’s handwriting during the ward round. Junior doctors noted down the alterations to drugs and the scans to be ordered.

After a brief lunch break, it was the duty of the junior doctors to compile and complete the jobs for the day. The doctors would check the blood counts that had been taken by a phlebotomist on a previous day to examine kidney and liver functioning. Inflammatory markers such as the level of C-reactive proteins and white blood cells can indicate infection. The level of C-reactive protein should be less than 5 in a normal well person; however, as most the patients on the ward had multiple complications, often including cancer, it is essential for the doctors to work within their abilities to fight the constant infection. These infections could be verified by microbiological tests such as mid-stream urinalysis which can be cultured and identify the specific bacterial pathogen. Therefore, the infection can be targeted with specific antibiotics more effectively. Likewise, when we encountered a patient with very low haemoglobin levels in the red blood cell, blood transfusions could be requested to help reduce the patient’s fatigue. Whilst the majority of the doctors’ tasks consisted of paperwork there were occasional practical elements such as inserting cannulas and taking blood with an arterial stab. I observed that an arterial stab is a harder procedure than simply taking blood from the veins. As the arteries are located deeper within the body the doctors work from touch rather than visible directions. However, due to the pain caused and importance of the major blood vessels, it is usually less advocated by doctors.

What became apparent very quickly to me is the mountain of forms and paperwork which the doctors had to rapidly complete and that the actual everyday care of the patients was largely under the control of the nursing staff.

The support team

As I said before, the work experience highlighted to me the necessity for cooperation between professionals in this busy environment.  I would describe the nursing staff as the backbone of the hospital, getting to know the patients better than the doctors. They play an essential role in minor practical tasks and deal with the patients immediate requirements.

The role of the occupational therapist is to restore the patient’s functional ability according to their varying levels of capability and required independence. On the stroke ward at Epsom hospital the patients are encouraged to make their own breakfast when capable. This is so that the journey from a passive GM tube to making and eating their own breakfast in the common room is a recognisable improvement in their functioning and increases the morale of patients.  I attended a swallowing tutorial lead by an occupational therapist and I hadn’t appreciated that swallowing is one of the most complex tasks performed by the nervous system.

The junior doctors emphasized the importance of maintaining a good relationship with the Ward Clark. This essential communicator for the ward liaises with different parts of the hospital, often to chase up those critical scans or test results.

I thoroughly enjoyed my session with the speech therapist. We met with an old lady who was trying to regain her speech. I couldn’t help being amused when testing her cognitive functioning, she mistook a banana for a telephone. However, it was impossible not to feel sympathy towards the woman, as she was obviously frustrated by her inability to produce coherent words. The speech therapist tried many techniques such as singing ‘Happy Birthday’ and showing the woman photos of her family and loved ones to help trigger memories.

The other professionals I met included Physiotherapists, Pharmacists, Stroke care coordinators, Dieticians and a Discharge manager.

The challenges

I encountered several thought-provoking events during my visit. Firstly, the ward was confronted with an issue where a man with dementia couldn’t be discharged because he had been rejected by several nursing homes, due to his aggressive behaviour and poor prognosis. This meant that he was taking up valuable room in stroke care unit. The question that arose is: should nursing homes be able to reject patients and exert further pressure on a strained NHS? Understandably the nursing homes wished to avoid taking in patients with a bad prognosis as it can demoralize staff and possibly lead to investigations into death records of patients. However, this delay in discharge presented a crisis in the understaffed hospital stroke ward.

Secondly, the most emotionally challenging encounter I witnessed during my work experience, was the death of a cancer patient. As a result of the circumstances, I was the only person available to console her only living relative, a spinster older sister. On my first day, the doctors explained to the patient’s sister that it was the ‘end of the road’ and that they were moving into a more palliative care plan. On the third day when I returned to the ward, there was an empty bed and a distraught sister. Although it was difficult to console her, I identified with her, as I myself am the oldest of three sisters. A cup of tea and someone holding her hand seemed futile when I knew she would have to return to her home that she had shared with her dead sister. The doctor’s detached approach seemed harsh but I realised that it was important for him to remain professional in order to deal effectively with such draining events on an everyday basis.

Disturbing sounds were everyday occurrence on the ward. For example, a woman was continually crying out in German and was not being understood as she had forgotten all her English due to her stroke.  

My final impression

After talking with the consultant I have gathered that whilst there are long, hard hours working in a hospital and it seems there are a lot less emotionally challenging routes to gaining the same economic rewards, this altruistic profession can be incredibly fulfilling. That is, there are a lot easier ways to earn a living! Also, although not every case ends in success you get to deal with people on a daily basis and the job has a social and practical application of science, that can really make a difference to people’s lives.  

Stroke information summary:

There are two types of strokes:

1) Ischemic. These are due to a blood clot, which causes a loss of blood supply to the brain. Without oxygen the death of cerebral cells occurs at a rate of 2 million per minute. This is the type of stroke most commonly encountered (85% of stroke patients). Blood clots are formed from the build-up of an atheroma, in a disease known as atherosclerosis. The atheroma can block an artery or break down producing fragments, causing a thrombus. If the clot develops in the heart it is known as an embolus. The brain cells could also be deprived of oxygen from an extremely low blood pressure.

2) Haemorrhagic. This type of stroke is also known as a brain bleed, and the symptoms presented can be more complex. The arteries near the brain burst causing an aneurysm , the leakage of blood into the brain. Bleeds are caused from the build-up of too much pressure in the blood vessels. High pressure can be a result of inflammation or infection and certain drugs that narrow the lumen of the heart.

During the time I spent with the consultant he discussed the potential risk factors for strokes which we can identify within the community. Number one, (no surprises here) was smoking, but also too high levels of red meat containing cholesterol and high blood pressure also have been recognised as a risk factor. After further research I found that genetic factors such as being male, over 55 years old, of African-American ethnicity and having a family history can also increase the risk.

The symptoms of strokes include: Loss of sensation, weakness, impaired vision, slurred speech, imbalance, loss of recognition and cognitive functioning. Damage from a stroke is viewed physically on the opposite side of the body to the location within the brain, apart from a stroke that has occurred in the cerebellum, where the symptoms would present on the same side as the infarction.

The diagnosis of a stroke can be confirmed usually from a CT or more sensitive MRI scan. The prognosis for stroke sufferers is not overwhelmingly positive, as around 20% of patient die in hospital. However, many patients can be rehabilitated at least to a level where they can regain the independence to live in a nursing home or with a full time carer. Some of the luckier ones return to their previous job.  In Epsom hospital there is no onsite rehabilitation centre however, the patients are often referred to a smaller NEECH hospital once they are stable for transfer.  The main role of the hospital is to provide medical assistance in life functions such as feeding through a GM tube and supplying oxygen to patients. Stroke care is a slow and gradual process, and it focuses on small improvements such as an increase in the thickness of the food a patient can tolerate.

Terms I have learnt:

  • Hyperkalaemia: a too high potassium level, which can have an effect on the heart rate.
  • Hypokalaemia: a too low potassium level. This may be due to loss of potassium from bodily fluids especially if the patient is being treated with diuretics. Potassium is essential for correct functioning of nerve and muscle cells.
  • Atrial fibrillation: an irregular or too fast heartbeat due to a lack of coordination of the ventricles of the heart, and can cause poor blood flow around the body.
  • Tachycardia: a fast heart rate more than 100bpm
  • Bradycardia: a slow heart rate less than 60bpm
  • Dysphasia: difficulty or discomfort in swallowing.
  • Endocarditis: swelling of the inner heart, or inflammation of the endocardium.
  • Ascites: excess fluid in the abdomen, due to the accumulation of fluid in the peritoneal cavity.
  • Pleural effusion: an infection in the pleural cavity, the space around the lungs. This build-up of fluid can impair breathing by limiting the expansion of the thorax.
  • Refeeding Syndrome: Potentially fatal shifts in fluids and electrolytes that can occur in malnourished patients after receiving artificial refeeding.
  • Thrombolysis: The treatment following a stroke to dissolve dangerous clots in the blood vessels to improve blood flow and prevent further damage to organs.
  • Emetic: the adjective of causing vomiting.
  • Beta blocker: a class of drugs which can control heart rhythm and reduce high blood pressure.

 

An introduction to Radiology

On the 10th October 2014, our school took our ‘Thank Science It’s Friday’ club on tour to the National History Museum. As part of a research project, I presented a brief insight into the world of medical imaging.

The four mains types of medical imaging used today are X-Ray, PET scan, MRI scan and ultrasound. For each technique I looked into: how they work; the history of the technique; its current medical application and the potential risks, limitations and advantages. My talk prompted a question from the audience about the role of ultrasound in sport, to which I responded with the obvious use of skeletal imaging for fractures. After the presentation I researched further and found that there is also an unproven therapeutic application. Some practitioners harness the thermal effect of the vibrations to try to increase flexibility in muscles, ligaments and tendons, but also to try to increase blood flow to certain areas to reduce healing time.

Below is the information I collated, and on which I based my presentation.

In the year 1892, Sir William Osler wrote the Textbook of Medicine where the scientific community marvelled at new diagnosis techniques such as Haemoglobin estimation, red and white blood cell counts, and simple urinalysis. Today, stimulated by advances in technology, diagnosis has become largely computer based.

Radiology: the use of medical imaging for diagnosis or treatment.

1. X-ray (radiography)

Although X-rays were discovered in 1895, their vast medical application became apparent during the 1960s. A body is exposed to x-rays, which are high energy electromagnetic radiation and the resulting remnant beam is captured. Higher density solids absorb more X-ray photons and through contrasting shades of light, they reveal the internal structure.

The types of X-ray imaging include:

– Projection radiography, where X-rays are mainly used to examine the skeletal system to look for fractures, to take dental x-rays, as a guide for an orthopaedic surgeon in bone replacement and to assist diagnosis of bone cancer. Mammography is a specialised low dose x-ray to detect potentially cancerous tissues in the breast.

– Computed tomography, also known as CT scanning, where high amounts of radiation are used in conjunction with computing algorithms to give a higher definition image.

– Fluoroscopy, where using liquid barium real-time imaging of organ functioning can be observed such as swallowing.

– Dual x-ray absorptiometry or bone densitometry which is primarily used for osteoporosis testing.  

It has been proven that too frequent exposure to x-ray radiation can cause cancer. Furthermore, when examining soft tissue, the interpretations can be very challenging. Therefore, they are mainly used as an initial means of diagnosis as there are usually no side effects with occasional use.

2. Ultrasound (sonography)

Ultrasound is used to detect changes in appearance, size, and the contour of organs. A probe called a traducer sends and receives high frequency sound waves which bounce off tissues and the returning pitch and direction produce a real-time image. There are 3 main types of ultrasound: external (through the skin); internal (through the vagina or rectum) and endoscopic (through the mouth or throat). Likewise, a specialised area of ultrasound known as Doppler ultrasound measures the speed of blood cells through vessels.

Ultrasonic energy was first applied to the human body in the US in the 1940s, to assess the thickness of bowel tissue. Nowadays, it is used as a means of diagnosis in organs such as: the Heart (known as an echocardiogram), Liver, Spleen, Pancreas, Kidneys, Bladder and Thyroid. Furthermore, ultrasound has been used to break up gall stones using high frequency waves in the gall bladder. The most ubiquitous use of ultrasound is for monitoring an unborn foetus. Imaging in obstetrics enables a medical professional to determine the sex, location, gestational age, movement and heartbeat, existence of any physical abnormalities in the foetus. In addition, ultrasound is used alongside surgery to guide the needle using real-time imaging.

So far, there have been no known harmful effects, however as waves are intercepted by gas, they are not effective for gas filled organs such as the bowels. Likewise, the waves cannot penetrate dense solids such as large quantities of fat or bones. Whilst there is quite a lot of skill needed to operate and acquire a quality image, ultrasound proves to be the cheapest and most widely available form of imaging which is non-invasive and painless.

3. PET/CT scans (positron emission tomography/computed tomography)

PET systems have been used since 1961 and nowadays over 400 systems have been installed worldwide. Patients take in very small amounts of a radiopharmaceutical which localises in the diseased tissues producing gamma emission. These areas of high metabolic activity in the diseased tissue indicate hotspots that can be represented as a 2D or 3D image of the tissues, which are superimposed on a CT scan. 90% of PET/CT scans worldwide are used to detect cancer, determine how far the cancer has spread and are also useful for studying tissue functioning, e.g. blood flow, oxygen usage and glucose metabolism. They can also be used to study blood flow to the heart muscle and identify whether certain areas would benefit from a coronary artery bypass. Likewise, they are also used to examine renal functioning and the effects of a heart attack. Other uses include evaluating brain abnormalities e.g. tumours, memory disorders and seizures.

PET scanning has a higher radiation risk due to the ionising effect it can have on cells, furthermore, there may be a risk of allergic reaction to the radiotracer. Other disadvantages are that it can be a very time consuming technique, whilst having a lower resolution in comparison with CT and MRI. As with most medical imaging techniques the equipment can be very expensive, although, they do provide unique, accurate and vast quantities of information on functioning. The information from PET scans can provide earlier diagnosis than MRI and CT alone. As with all medical imaging methods they are a less invasive treatment, which so far has produced no long term side effects.

4. MRI scans (magnetic resonance imaging)

To date there are over 25,000 MRI scanners worldwide since the first machine was clinically approved in 1980, at the University of Aberdeen. The technique is based on powerful magnets which are used to polarise hydrogen nuclei in water molecules of tissues. The MRI machine emits a radio frequency pulse and as the protons absorb the energy and spin at a specific frequency, in a specific direction, the energy signals given out by the hydrogen atoms as they try to return to their usual alignment can be imaged. MRIs are used for imaging the physiology of organs and blood vessels, in order to detect tumours, abnormalities, malformation and inflammations. They are an essential component of neuroimaging, and viewing the functioning of systems such as: Cardiovascular (for congenital heart disease); Musculoskeletal (spinal imaging); Liver and gastrointestinal (associated with Cirrhosis and Crohn’s disease) and Oncology (looking at cancerous tissue).

Functional MRI scanning (FMRI) is a technology which has specially been developed for detecting blood flow. When neurons become active, blood moves into the cell, and the levels of oxygen in the blood change.  As haemoglobin reacts differently in magnetic fields depending on whether it is bonded to oxygen or not (known as the hemodynamic response), this can be used as an indicator of neural activity. This newer technique plays a large role in research to associate parts of the brain with specific behaviour and can anatomically map the effects of tumours, strokes and neurological diseases such as Alzheimer’s.

As MRI is a relatively new technology there is still uncertainty around the long term effects. Whilst some studies suggest possible genotoxic effects it is deemed safer than x-rays and PET scanning as it doesn’t use ionizing radiation. The machinery is very expensive, loud and confining which can cause discomfort especially with claustrophobic patients. False artefacts can arise due to an irregular heartbeat, breathing and bowel movements.  The main advantage is the imaging is not obscured by bone, unlike X-ray, PET/CT and Ultrasound images.

So what is the future for medical imaging?

Even now there seem to be more future possibilities. To briefly outline a few:

  • Diffuse optical tomography. Using near-infrared light to monitor water and oxygenated or deoxygenated blood which could be extremely effective for detecting tumours.

  • Elastography. This involves examining the strain and elastin distribution in soft tissues. The underlying theory is that cancerous tumours will be harder than the surrounding tissue.

  • Electrical impedance tomography. This technique uses electrodes to measure the electrical conductivity of cells. As conductivity depends on the cells free ion content, patterns can be recorded and images developed.


 

 

 

Fear of Ebola: more fatal than the virus?

Malaria: a disease that was on the decline until the Ebola pandemic diverted healthcare efforts. Malaria is endemic in sub-saharan African countries, since the invasion of intimidating head-to-toe isolation suited medics, treatable malaria sufferers have avoided medical assistance, leaving the disease neglected.

Whilst widespread fear of Ebola has engulfed the western world, Malaria, a disease that was on its way to elimination has become ever more of a plague. The malaria mortality rate in Africa had decreased by 53% between 2000 and 2013, however, in Sierra Leone due to the 50% reduction of vaccinations, the ‘Ebola-time’ malaria mortality rate has become distressing. The frustrating fact is that the fragile gains on beating Malaria are slowly being overturned by the new disease in town.

Whilst Malaria killed 627,000 people last year, it does not pose as great a threat due to the hot climate needed for transmission of the disease by Anopheles Mosquito vectors, therefore the west remain blind and oblivious to its horrifying aftermath. Malaria, a disease which when caught early can be treated with simple drugs, prevented by cheap bed nets and eradicated by testing. The issue brought by Ebola is that although the initial symptoms are comparable to Malaria, the prognosis is less favourable. Therefore, Africa endures avoidable deaths as Malaria sufferers steer clear of treatment centres in order to prevent Ebola contamination, leaving ghost-like wards in its place.

Another challenge which confronts Malaria suppression is the emergence of Artisiminin resistance. Whilst I don’t want to regurgitate the current lectures given by the same fear of antibiotic resistance, the prospect of Malaria becoming uncontrollable and untreatable could lead to a medieval-like epidemic.

Paralysis – a condition of the past?

The BBC covered a ground breaking medical development as a previously paralysed, Polish firefighter has been enabled to walk again after a nasal cell transplant to his spinal chord. Due to 30 years of research into the regenerative properties of olfactory ensheathing cells (OECs) found in the nasal cavity, neuroscientist Professor Geoff Raisman has achieved partial success with the treatment; the main limitation of the therapy being the financial burden.
Being a sports enthusiast myself, the concept of paralysis seems devastating. This area of research is fascinating: a solution to injuries to the CNS without the risk of an immune response to an allograft or the ethical concerns of autologous embryo stem cell therapy. However, this is one case regarding this technique and whilst it was a huge success, the patient selection process is extensive and there is intensive post-treatment rehabilitation process. I understand that caution must be taken in order to prevent arising unrealistic expectations and whilst it seems to be an extraordinary achievement, it is far from being implemented in the NHS. Public fundraising has never been so essential and the story of a paraplegic Daniel Nicholls and his father who is the founder of the Nicholls Spinal Injuries Foundation, a charity which has contributed to research over £2.5 million, is truly inspirational.
Another line of inquiry taken at Newcastle university is Spinal Chord Stimulation, where an external electrical stimulation reconnects the brains voluntary intensions with the isolated limb. Yet again another encouraging prospect.
What grips me across this research topic is the potential techniques are so vast, from tissue transplants to electrical stimulation, and that is not even delving into the prospects of induced pluripotent cells; the solution seems so close.

sources:
http://www.culture-of-life.org/e-brief/nasal-cells-ips-cells-and-adult-stem-cells—-advance-regenerative-medicine

http://www.bbc.co.uk/news/health-29686709

http://www.medicaldaily.com/paralyzed-man-walks-after-spinal-cord-injury-repaired-nose-cells-end-paralysis-closer-ever-307562