Review of medical advancements in 2015

2015 has been an exciting year and has seen many breakthroughs in medicine. Here are some of my favourites from this year:

1. Gene editing

Layla Richards, a one year old girl, had incurable aggressive leukaemia in June (when she was three months old). Chemotherapy and a bone marrow transplant didn’t work but because of advances in gene editing she’s alive and has no trace of leukaemia in her body.

Doctors used microscopic scissors (Talens) were used to engineer the DNA inside the donor’s immune cells. These immune cells were designed to kill only leukaemia cells. They were then injected into Layla and she then had a second bone marrow transplant to restore her immune system.

It’s too early to know if she has been cured or if the technique used to save her will work for other patients with cancer but this case clearly shows that gene editing could be used to treat cancer and also genetic diseases. As well as this, gene editing can have many other uses such as breeding genetically modified mosquitoes that are resistant to malaria and tweaking genes in human embryos before implanting them in a woman’s womb using the CRISPR method. This method is now easy, cheap and effective and works well in almost all animals, which means that next year will bring more gene-edited organisms and that the method will be used more often to change existing genes in animals and humans. Debates are still going on about the use of gene editing but if it is allowed, it would certainly change medicine and the way we live.

2. The discovery of new antibiotics

Antibiotic resistance has been a huge problem recently and scientists fear that the whole world is heading into a post-antibiotic era. Bacteria that are resistant to all drugs, including colistin, used when other treatments have failed have been found. This means that more infections would become untreatable and that we can’t do surgery, chemotherapy, etc. because we need antibiotics to treat infections and for certain operations.

However, this problem can be avoided as long as antibiotics aren’t overused/prescribed inappropriately in the future. This January, a team of researchers at the Northeastern University have discovered 25 new antibiotics, including teixobactin, by growing bacteria from the soil in a laboratory. These drugs have to be tested first to see if they are suitable for medical use but if they are suitable, then more antibiotics could be discovered in the same way and antibiotic resistance can be prevented or at least delayed.

3. Alzheimer’s disease

It has been suggested that solanezumab can reduce the rate of the dementia’s progression by around 34%. Right now, the death of brain cells in Alzheimer’s is unstoppable but the drug might be able to keep them alive. The drug works by attacking the deformed proteins (amyloid) that build up in the brain of people with Alzheimer’s. This prevents the formation of sticky plaques of amyloid between nerve cells and therefore prevents brain cells from being damaged and from dying. A large trial will be conducted next year to collect more evidence and to find out the drug’s impact on Alzheimer’s symptoms. Other drugs that could slow down the progression of Alzheimer’s (e.g. azeliragon, which works by reducing brain inflammation) are also promising.

But drugs aren’t the only way the symptoms of Alzheimer’s can be improved. Next year the results from a trial where people with mild to moderate Alzheimer’s were given blood donated by volunteers aged 30 or younger to try to improve their symptoms. When young human blood was injected into old mice, their cognition, physical endurance and the health of their organs improved. Hopefully, the results of this trial will be good but we don’t know what will happen until next year.

4. Creating biolimbs and vocal cords from living cells

Harald Ott and his team at Massachusetts General Hospital in Boston grew a rat forelimb from living cells for the first time using the “decel/recel” (decellularisation and recellularisation) technique in June. Click here to find out more about this.

The same team then grew the world’s first vocal cords from scratch using cells from human donors last month. They then made the cells form tissue that was just like vocal fold mucosa (the flaps in the larynx that vibrate to create the sounds of the human voice when we speak). This could allow people who are unable to speak as a result of losing their vocal cords due to surgery or disease to speak again and would significantly improve their quality of life.

These are only a few of my favourites and there are many more breakthroughs that have fascinated me this year and that will have a significant impact on our lifestyles and on treatments for patients. As well as this, there are lots of things to look forward to next year, for example, some volunteers who have lost their sight due to injury will receive bionic eyes (a device with a camera mounted to a pair of glasses) that bypass most of the visual system and that should restore vision in people without a retina. If the bionic eye works properly, the volunteers will have a crude sense of vision.

Parasitic worms can increase women’s fertility

I recently read this article on the BBC News website and was quite surprised to find that parasites can be good for women. There is evidence from a nine-year study that women infected with roundworm (Ascaris lumbricoides) would have 2 more children over a lifetime than uninfected women. This seems to be the case in the Bolivian Amazon, where women have 9 children on average and 70% of the population are infected by parasitic worms. However, it was also found that hookworms had the opposite effect and often lead to 3 fewer children in a lifetime.

So far, we don’t know what is causing this but it could be due to the changes in women’s immune systems caused by these worms. Hookworms cause both type 1 T cells and type 2 T cells to be produced whereas roundworms tend to make the immune system produce more type 2 T cells, which make embryos more likely to survive. Type 1 T cells tell other cells to directly attack pathogens whereas type 2 T cells tell cells to produce antibodies. Hookworms could also cause anaemia, which then leads to infertility.

These findings could lead to drugs that can be used to increase women’s fertility in the future but there is a lot more work that has to be done before these roundworms can be used for women with fertility problems.

Hospital work experience

Yesterday I had some work experience in the physiotherapy department of Darent Valley Hospital in which I shadowed some physiotherapists and observed what they were doing. I really enjoyed this experience and I learned a lot from it. I went to a number of different departments and gained a better understanding of the role of doctors as well as physiotherapists in these departments.

Firstly, a senior physiotherapist explained to me and 2 other work experience students the main roles of physiotherapists and of what was going to happen throughout the day. He also showed us some x-rays of some surgery patients before and after surgery and then told us about the ways damaged/fractured bones can be repaired and about different joint replacements (e.g. hip replacement). I then went to the orthopaedics department, where I saw the physiotherapists talking to patients who have had knee/hip/other joint replacements in the last few days and helping these patients recover after their surgery. The physiotherapists did this by first checking if the patient does not have any other problems (e.g. low/high blood pressure) since the surgery and then telling them to do some exercises daily/regularly as part of the patient’s rehabilitation programme to strengthen their muscles and reduce any pain/swelling. As well as this, the patients were also told why it was important to do the exercises and what was going to happen next, which is important as the patients need to be aware of their health problems. Also, by doing this the patients would be more likely to do the exercises and cooperate with the physiotherapists as they would understand the point of doing their exercises and of following the physiotherapists’ instructions. Prior to this, the patient’s doctor(s) would have done some tests and talked to the patient to check if the patient has any other conditions that the physiotherapists should be aware of.

Next, I went around the A&E department and had a look at the different areas in A&E (Resus/ resuscitation area, minor and major injuries units, etc.). As I had expected, this department was very busy and I was told that it is sometimes hard to see 95% of all A&E patients within 4 hours as there are a large number of patients coming into A&E at once and as 4 hours is a short amount of time to see all of these patients. Afterwards, I went into the short stay unit, where patients with minor injuries were being looked after until they were well enough to go home. The physiotherapist then did an assessment on a patient to see if they can walk and do basic tasks such as getting on a bed and going up and down stairs without any problems. This was done to see if the patient is able to do everything independently and to prevent further problems when they are sent home. If a patient has had problems when cooking in the past that are putting them at risk, a kitchen assessment is also done to make sure that they can cook and use kitchen equipment (e.g. kettles) without putting themselves and others in danger. Social services referrals and referrals for problems such as falling are also sent when necessary to prevent further problems and so that the patient can get more help and support.

After going around A&E, I went to the physiotherapy outpatients department, where patients who needed treatment but did not have to stay overnight were being treated. The problems the patients had here were similar to the problems the patients in the orthopaedics department had. When the physiotherapist was with the first patient, he first discussed the patient’s problems and what happened during the previous appointment. He then assessed the mobility of the patient by telling him to do some exercises to see what had improved and the areas where the patient was still having pain in. When it came to the second patient, he also discussed the problem she had and what had happened during the previous appointment but he also knew that what he did for her would not make a difference in her health. This was because the cause of her leg pain makes it very hard to stop the pain, which shows that physiotherapists and even doctors are not always able to do something to treat a condition due to a lack of knowledge about it and that as a doctor I would have to work within my limits.

Lastly, I saw a CT scan of a patient’s brain before going to see him in the stroke ward. I noticed that when the physiotherapist was interacting with this patient she was patient and maintained a soft tone when talking to him despite the fact that he could not respond properly at times and that there was not much improvement in the movement of certain areas. The patient could say yes and no and was also able to respond using gestures and movements but he was unable to say anything when he wanted to speak. This can make it harder for other healthcare staff (e.g. nurses and doctors) as well as physiotherapists when interacting with patients but in these situations it is important to remain calm and not rush the patient/force them to do certain things.

Throughout the day, I came across a range of patients from patients with a knee replacement to patients with strokes that affected their mobility on one side of their bodies and with previous infections. Every patient was unique and their situations were all different from one another. By seeing the physiotherapists and other medical staff interacting with the patients I realised that it is important that the staff always spoke with the patients in a gentle manner and that they explained what was going on in terms of the patients’ care/treatment to the patients so that the staff are trusted and so that the relationship between the staff and patients is always good. This is also important for doctors as a doctor-patient relationship cannot exist if the patient does not trust the doctor and doesn’t believe that the doctor can treat their condition or at least make a significant improvement in their health.

Overall, I thoroughly enjoyed this work experience and I now have a better understanding of how different departments of the hospital were run as well as a better understanding of the contribution of physiotherapists in the multidisciplinary team of a hospital.

What I have learned from my work experience so far

In Year 10, I got some work experience at a pharmacy (Jade Pharmacy) for 2 weeks and over the past year I have been getting more work experience in other places. In the pharmacy, serving customers of all ages helped me improve my communication skills and organising the stock improved my organisational skills. Through doing these duties and asking the staff questions about their job, I gained an insight into the role of pharmacists and pharmacy assistants when it comes to patient care. I also seized the opportunity to learn about common medicines such as codeine by reading their labels and asking questions to the staff about these medicines, which was useful for me. Personally, I thoroughly enjoyed this work experience and this experience was what gave me the platform to pursue a career in medicine.

Last December, I spent 2 weeks at a GP practice (Dr Gunasuntharam & Partners GP Surgery). During this time, I was mainly involved in dealing with patients who came to the practice, filing patients’ files, checking patients’ records, handling prescriptions, booking appointments using EMIS and calling patients regarding appointments. Doing these duties further honed my organisational skills and my ability to communicate professionally over the phone likewise improved. As well as this, I realised that the administrative tasks I was doing were important in order to prevent mishaps and to make sure that information about patients was accessible when it was needed. I also realised the importance of teamwork as a doctor and the different ways different health professionals (not just doctors and GPs) contribute to the care and treatment of patients.

During the Easter holidays, I worked as a care assistant at a care home (St Mary’s Care Home). My experiences there have shown me the more unpleasant side of medicine and have taught me a lot about the reality of a medical career. The problems and difficulties I encountered during this experience made me develop and understand the importance of the skills that are required when dealing with patients. An example of this was when an argument between two of the residents occurred due to hateful comments from one of them. With the help of the staff, I calmed them down and resolved their argument before they became violent. As a result of this situation, I learned to be more confident and to ask for help when needed. Spending time with residents who had dementia and/or other health problems also made me realise that understanding and patience were important to be able to communicate effectively and interact with them. During this experience, I also realised that being a doctor can be emotionally stressful, but despite this, the experience was very rewarding and conversing with the residents made me very glad to be helping them.

In the past year, I have also volunteered as a teaching assistant at Culvers House Primary School every Wednesday afternoon for 6 months. While I was there, I worked with a small group (3 or 4 children) of children, who were in Year 6, and went through their work and tests. Through doing this, I learned how to communicate so that they could understand what I was saying, which is crucial for doctors when discussing the patients’ conditions and possible treatment options. I was also unsupervised during this time, which allowed me to be more autonomous and helped me solve problems (e.g. children misbehaving and not focussing on their work) more effectively without help.

So far, I have really enjoyed my work experience and these experiences have given me a strong insight into the realities of medicine. Next month, I will be working in the physiotherapy department of a hospital, which I am looking forward to and should be useful even though I will be working with physiotherapists instead of doctors (I tried getting work experience at numerous hospitals last year but unfortunately I could not get a placement at any of these hospitals).

Could wasp venom be a cure for cancer?

Lab studies done by scientists in the University of Brazil suggest that the toxin (MP1) in the venom of a  Brazilian wasp (Polybia paulista) can kill cancer cells without harming normal cells.

The scientists found that MP1 interacts with fat molecules on the surface of cancer cells and creates wide holes that makes vital molecules leak out of the cells. Healthy cells would not be affected by this as the same molecules are hidden on the inside of these cells and so healthy cells are normally not affected by the toxin. Their findings are published in the Biophysical Journal.

The wasp venom could be used to develop new combination therapies, where the wasp venom and other drugs are used at the same time to treat a certain type of cancer by simultaneously attacking different parts of the cancer cells.

These findings do show that wasp venom could possibly be used to treat cancer in the future but this work is at an early stage and so more lab studies and clinical trials are needed to check if it will work safely in humans and if it will benefit cancer patients.

Source:  http://www.bbc.co.uk/news/health-34115112

 

Review of “Medical Ethics: A Very Short Introduction” by Tony Hope

Medical Ethics: A Very Short Introduction by Tony Hope is a very interesting read that covers a wide range of medical topics. It is also very accessible as it provides the legal and medical vocabulary needed to understand the content in each chapter. One of the best things about this book is that Hope discusses controversial questions (e.g. Should euthanasia be legalised?) using 5 tools in his tool-box for reasoning: logic, conceptual analysis, consistency and case comparison, and reasoning from principles. He also goes through how these tools should be used when making decisions and how to spot errors in reasoning. A range of case studies, most of which are based on real life events, are included in the book to help present his arguments for making decisions in medical cases and to give the reader a taste of the world of moral dilemmas in the medical profession. 

Another good thing about this book is that it makes you think again about what yous the thought was the right way of making moral and ethical decisions in certain circumstances and also challenges several moral principles that were well-established. As well as this, some logical fallacies were also identified in this book and the problems caused because of these logical fallacies are also discussed in this book. One point mentioned in the book is that it’s unacceptable to force a mentally-competent person into treatments for an illness but it’s acceptable to force those with mental illnesses into treatments they do not want, regardless of how competent they are, which he then says would be discriminating against people against mental illnesses as different standards are being set for those with mental illnesses compared to those without.

Overall, this book gives a very short introduction about medical ethics, which does mean that unfortunately it does not cover all ethical situations in medicine. However, I would still highly recommend this book as it does help the reader improve their ability to think critically and develop ethical reasoning as well as providing a good introduction to medical ethics.

Independent Research Project: stem cells and ALS 2

As I mentioned in my last post, this post will be about the stem cells that could be used to treat ALS. There are several types of stem cells that could be used to treat ALS but in this post I will be talking about the following types:

  • Embryonic stem cells
  • Induced pluripotent stem cells
  • Mesenchymal stem cells
  • Neural stem cells

Embryonic stem cells and induced pluripotent stem cells are pluripotent, which means that they can be developed into any type of cell, and can be injected into the spinal cord to become motor neurons. The main problem with using these types of stem cells is that nobody knows how to make them regrow and reconnect to the muscles to restore function. Another problem with using embryonic stem cells is that their use is controversial as the stem cells are taken from aborted fetuses, which are viable and have the potential to create new life. To avoid this problem, induced pluripotent stem cells are being used as a replacement for embryonic stem cells. These cells begin as adult cells that are reprogrammed to act like embryonic stem cells by injecting DNA/transcription factors into the cells. The DNA/transcription factors would then change the state of the chromosomes. However, some people say that induced pluripotent stem cells can still cause ethical issues as induced pluripotent stem cells can also contribute to a human embryo.

Mesenchymal stem cells derived from the bone marrow are said to be able to treat ALS when they are injected into the bloodstream. This is because the stem cells provide support for cells by releasing growth factors but no studies have shown that they replace neurons/astrocytes in the central nervous system. Neural stem cells can be used to make astrocytes, cells that support motor neurons, and to alter these astrocytes to make extra growth factors, which make the neurons remain healthy and grow.

Several clinical trials have been conducted and lots of clinical trials are currently being carried out to find out whether the different types of stem cells could be used as a cure for ALS. Most of these are in the early stages (phase 1 or phase 2) and are conducted to find out what the frequent and serious side effects are and the safety and efficacy of using these stem cells in stem cell therapy.

Can stem cells be used in the future to treat ALS in the future? I believe they can be used to treat ALS as the results of most clinical trials using stem cells show that stem cells can be used to treat ALS. Also, the ethical problems caused by the use of embryonic stem cells can be avoided as there are other types of stem cells (e.g. neural stem cells) that can be used instead. However, it will take a long time before stem cells can realistically be used to treat ALS as there are still many hurdles to overcome (e.g. getting the implanted stem cells to grow from the spinal cord out to the muscles).

References (this post and my last post):

  1. http://www.alsa.org/about-als/what-is-als.html
  2. http://www.nhs.uk/Conditions/Motor-neurone-disease/Pages/Introduction.aspx
  3. http://www.nhs.uk/Conditions/Motor-neurone-disease/Pages/Symptoms.aspx
  4. http://www.nhs.uk/Conditions/Motor-neurone-disease/Pages/Treatment.aspx
  5. http://www.alsa.org/assets/pdfs/svendsen-stem-cells-webinar-6-19-12.pdf
  6. http://www.eurostemcell.org/factsheet/stem-cell-research-therapy-types-stem-cells-and-their-current-uses
  7. http://www.eurostemcell.org/factsheet/ethics-and-reprogramming-ethical-questions-after-discovery-ips-cells
  8. Gillian Pocock, Christopher D. Richards, David A. Richards, Human Physiology, 4th ed. (Oxford, 2013) p. 55
  9. http://www.alsa.org/research/about-als-research/stem-cells.html?referrer=https://www.google.co.uk/

Independent Research Project: stem cells and ALS

For the past 4 weeks, I have been working on an independent research project in which I found out how different kinds of stem cells could be used to treat ALS and gave my opinion on whether stem cells could realistically be used to treat ALS in the future. I chose to do my research on this because stem cells are known to have the potential to treat a wide range of diseases and because ALS is an interesting condition to talk about. As this is my first post on this topic, I will mainly be talking about what ALS is in this post and in my next post I will be talking about the different types of stem cells that could be used to treat ALS.

So what is ALS? ALS, which stands for amyotrophic lateral sclerosis but is also known as motor neurone disease (MND)/Lou Gehrig’s disease, is a rare neurodegenerative disease that affects the motor neurons in the brain and spinal cord that provide voluntary movements and muscle control. It can affect adults of all ages but it is usually diagnosed in people over 40 and most people develop early symptoms in their 60s. In the UK, about 2 in every 100,000 people are affected each year. The motor neurons become unable to function and as a result they eventually die. This causes the brain to be unable to initiate and control muscle movement. Voluntary muscle action is progressively affected, which makes it harder to do common activities such as speaking, eating, moving and breathing.

Types of ALS:

  • Sporadic- this is the most common type of ALS
  • Familial- this is when the gene mutation for ALS is inherited.

There are several symptoms, which usually follow a pattern with 3 stages:

  • the initial stage: limb-onset disease, bulbar-onset disease and respiratory-onset disease
  • the advanced stage: symptoms such as muscular symptoms and excessive yawning
  • the end stage: increasing body paralysis and shortness of breath

Secondary symptoms such as insomnia and depression can also occur as a result of the stress of living with ALS.

At the moment, there is no cure for ALS but treatment can help relieve symptoms and help slow down the disease’s progression.

World’s first biolimb grown in a lab

blog pic

Harald Ott and his team at Massachusetts General Hospital in Boston have successfully grown a rat forelimb from living cells for the first time (see image above). This breakthrough offers hope that one day in the future, amputees will be able to receive biological replacement limbs that function properly instead of artificial limbs. The main problem with artificial limbs is that they don’t work as well as real limbs. Another common problem is that the recipient has to take immunosuppressive drugs for their whole life to prevent their immune system from attacking the hand (the transplanted hand is recognised as a foreign mass by the immune system). This problem wouldn’t occur with biolimbs as they only consist of the recipient’s cells and so they won’t be rejected by the recipient’s immune system.

But how did the team manage to do this? The did this using a technique called “decel/recel” (short for decellularisation and recellularisation). In the first step (decel), the soft tissue of organs of dead donors is stripped off using detergents, leaving the collagen “scaffold” of the organ, which in this case includes the collagen structures that make up the blood vessels, muscles, bones and tendons. In the second step (recel), the flesh of the organ is recellularised by seeding cells from the recipient into the scaffold, which is then grown in a bioreactor and provided with nutrients and oxygen so that new tissue can be grown.

To create a forearm, human endothelial cells were then injected into the collagen structures of blood vessels to make the vessels stronger. Myoblasts, the cells that grow to form muscles, were then injected in the areas of the scaffold that were normally occupied by muscles. In just two to three weeks, the blood vessels and muscles had successfully been rebuilt. Next, the team used electrical impulses to activate the muscles and found that the limb’s muscles were working properly.

However, there’s still a lot of work to do as there are still many hurdles to overcome. Ott and his team still have to test if the cartilage, bone and other cells in limbs can be regenerated and if a nervous system will develop in the biolimbs. Although the team have shown that primate forearms can be decellularised in the same way, we’ll have to wait for at least 10 years before the first biolimbs for amputees can be tested on humans.

There is also a short video about this on YouTube: https://www.youtube.com/watch?v=SSLijQUNUz8

Source (information and image): http://www.newscientist.com/article/mg22630243.300-worlds-first-biolimb-rat-forelimb-grown-in-the-lab.html#.VXGwmdJVhBd

 

Hello world!

Hello everyone! I’m Tharshiya and I’m currently in Year 12 studying Maths, Biology, Chemistry and French. Last month, I attended Medlink at Nottingham University, which was an amazing and useful experience; the lectures and sessions were really interesting and I gained a lot from the whole experience, especially in terms of getting into medical school and making my dream of becoming a doctor a reality.

In this blog, I will include stuff about work experience and volunteer work as well as interesting things related to medicine.