Saturday, 28 April 2012

Colonic (Bowel) Polyps

I found an interesting video on YouTube and tried to find out what it was and ended up learning about polyps! Hope you enjoy. 

The "colon is also called the large intestine" ( and is responsible for the removal of "water, salt, and some nutrients forming a stool" (same website; where there is a good image of the colon and where it sits in the body). 

Polyps, generally speaking; "are small growths: some develop into cancer, but it takes a long time" ( More specifically; 'colonic polyps' are "benign (non-cancerous) tumors or growth which arises on the inner surface of the colon and; like a piece of pipe, the colon is hollow and the inner surface is normally smooth. The cause is not known, but the incidence of polyps increases with age" ( The risk of developing cancer from the polyps depends on "the type of cell that forms the polyp which varies and is important in determining its potential for developing into a cancer" (

Symptoms; "most colon polyps do not cause symptoms. If you have symptoms, they may include blood on your underwear or on toilet paper after a bowel movement, blood in your stool, or constipation or diarrhea lasting more than a week" (

You may be wondering then: 'how they are removed or even how they detect whether they are there or not if there aren't any symptoms?' There are certain groups of people who come under a 'larger risk' category; these people include "those over the age of 50, those who have had polyps before, have had a family member with polyps or have had family history of colonic cancer" ( This does not mean that younger people cannot develop colonic polyps, but the chance increases with age. Therefore; to prevent the development of colonic polyps and then colonic cancer, "experts recommend routine colon cancer testing for everyone age 50 and older who has a normal risk for colon cancer. People with a higher risk, such as African Americans and people with a strong family history of colon cancer, may need to be tested sooner" ( There has been research carried out into the idea that African Americans hold a higher risk of developing colonic cancer from colonic polyps as shown in a huge study at this website:

Location and removal of the colonic polyps can be carried out though a procedure known as a "colonoscopy (telescope examination of the whole large bowel starting at the rectum)" (  "a thin, flexible, telescope. It is about as thick as a little finger. It is passed through the anus and into the colon" ( and this is what the video that I found on YouTube shows ( with an informative voice over of the whole procedure, starting with the location of the polyp then the 'snaring'. The second polyp removal shows a better picture of what is left afterwards 'a clean base'.

Sunday, 15 April 2012

Genetic Disorders and Prenatal Testing

There are hundreds of genetic disorders that have been diagnosed and have also been linked to specific mutations in the DNA. There are some common genetic disorders that occur more frequently than others; for example because "people in an ethnic group often share certain versions of their genes, which have been passed down from common ancestors; therefore if one of these shared genes contains a disease-causing mutation, a particular genetic disorder may be more frequently seen in the group" ( This can be seen in genetic disorders such as "sickle cell anaemia, which is more common in people of African, African-American, or Mediterranean heritage" ( There are also other common disorders such as cystic fibrosis, Down's syndrome, haemophilia and colour blindness.

I will do short introductions on what down 's syndrome, haemophilia and cystic fibrosis are, and then discuss the ethical sides of  the diagnostic testing that is available to pregnant women and also the ethics of abortion.

Down's Syndrome: "someone with Down's syndrome has an extra copy of chromosome 21 in the cells of their body. This is known as trisomy 21 (trisomy means there are three copies of a chromosome - in this case, chromosome 21). Because there is an extra chromosome 21, there is extra genetic material in the body" (''s-Syndrome.htm). It also explains on that website the typical features of down's syndrome, but also explains that "anyone can have a baby with Down's syndrome but a woman's risk increases as she gets older" (same website).

Cystic Fibrosis: occurs in places where mucus is produced and is caused by a mutation in the CFTR gene, which codes for the CFTR protein. The CFTR protein performs in a complicated mechanism that regulates the movement of chloride ions, sodium ions and water movement in and out of the mucus. When the mucus becomes too sticky for the cilia (hairs on epithelial cells) to move the mucus to where it needs to be (i.e. in the bronchus up to the mouth) the water needs to be drawn into the mucus to make it less viscous but when the CFTR is no longer present the chloride ions cannot get into the mucus to draw the water in via osmosis. This leads to blockages and damage to the lungs, reproductive system and other mucus dependent areas of the body. Sadly, because of the bacterium getting caught in the mucus, it is then dragged down into the lungs and destroys the alveoli and bronchioles, reducing the surface area and eventually suffocating the sufferer. For a more detailed explanation see which explains the effects on the other parts of the body as well, very interesting genetic disorder.

Haemophilia: (2 types; A and B, which only vary due to "problems with different clotting factors) is a genetic (inherited) condition that affects the blood’s ability to clot, normally, if you cut yourself, proteins called clotting factors combine with blood cells called platelets to make the blood sticky. This makes the bleeding stop eventually. However, in haemophilia, there are not as many clotting factors in the blood as there should be. Therefore, someone with the condition will bleed for a longer time than usual" ( This means that people with haemophilia can be subjected to a greater volume of blood loss (both internal and external) than should normally occur which can be dangerous for the person with the disorder. It is also interesting that it "almost always occurs in males" (

There are a number of  tests that can be carried out to ascertain whether your child will have a genetic disorder; "prenatal testing provides information about your baby's health before he or she is born and, based on screening test results, your doctor might suggest diagnostic tests. Diagnostic tests confirm or rule out health problems in you or your baby" (

1) Amniocentesis: carried out at 15-17 weeks of pregnancy where a needle is inserted into the amniotic fluid to collect cells that have fallen off the embryo which are then tested for known genetic disorders. It is "usually only offered to women when there is a significant risk that their baby will develop a serious condition or abnormality. This is because the procedure is quite invasive and has a small associated risks of miscarriage; estimated to be 1 in 100" (

2) Chorionic Villus Sampling: this is where placental tissue is removed (around 8-12 weeks) via "transabdominal CVS-a needle is inserted through the abdomen, or, transcervical CVS – a tube is inserted through the cervix (the neck of the womb)" ( "The risk of CVS causing complications, such as miscarriage or birth defects in the baby, is higher if it is carried out before week 10 of the pregnancy" (as above).

So what are the implications of getting results from these tests? Well, if the results are negative then the family will probably decide to continue with the pregnancy as intended, but what if they come back positive?

1) The couple will receive guidance from their GP and will be given access to a whole host of people who can help them to make their decision and prepare for the child or to have an abortion, but either way, it will be an informed decision, that is best for everyone involved.
2) An argument that is often used is from those who believe in life beginning at conception, so they would say that an abortion is not the correct option, since that child now has a life ahead of him.
3) Others would say that life begins at birth and that the child is not conscious in the womb, so would argue against number three, but both arguing about human rights and when they are granted.
4) It also depends on the severity of the genetic disorder because if it is haemophilia then there is a good chance that the child will have a long life ahead of him that he can prosper in. But with cystic fibrosis it is very difficult for the child because of the treatments they must undergo regularly and also the suffering that they go through.

Please feel free to add to the list by leaving a comment and starting a discussion!

Friday, 13 April 2012

Hillview Medical Practice W/E

I have just finished three days of work experience at a General Practice in Hartcliffe (South Bristol) called Hillview Family Practice. It has been a very interesting and informative few days because of the huge variation in what I have seen, and it is hard to think about how varied a GP's day is when you just visit for a 10 minute appointment.

There were a number of things that made the days so good, as well as the diversity of cases that the patients brought in, such as being able to sit in with one of the GP's and observing the way that she carried out an examination on patients and realising the small amount of time in which a GP has so many things to carry out. They have to receive the patient and try to get down to the problem as quickly as possible, trying to get past the things in the patients story that don't actually have any relevance and get to the things that need to be dealt with. For example if a patient comes in with leg pain and a cold, the GP has to get past the fact that they have a cold, even though the patient talks about it as tha main part of the story (thinking that they are linked), and needs to focus on the leg pain, which could be a development of arthritis or a pulled muscle...

What I also noticed was the sheer volume of people that come through the door of the practice every day. There isn't much time in the day and all the free areas on the timetable at the beginning of the day for 'on call', quickly become filled with home visits or more appointments for people who need to be seen. There is also a large amount of 'admin' that needs to be performed to do with prescriptions for patients and so on which means that timings can become quite irregular.

I also took the chance to talk to some patients of the practice and I asked them what they thought of the service that the practice prosuces; one man replyed that the service has been fantastic and that he could not have asked for more. I have also furthered my understanding that some people choose to take free healthcare for granted, after observing a statistic on reception that over 300 people did not attend their appointments in a month and also the reluctance of some patients to comply with the best advice that they could be offered (from someone in the medical profession).

I spent some time in the treatment room in the practice where they take blood samples, analyse urine samples and administer vaccinations for babies; among other things. The blood that they take is sent off and can be tested for a number of different things, while the urine is also tested for a number of things such as glucose levels, pH etc. which can lead to further examinations.

On Thursday I went on a visit with one of the GP's to the MHA care home based in Hartcliffe, which is the older of the two MHA care homes in Bristol. It was very interesting to see the differences between the MHA care home that I volunteer at and the Hartcliffe MHA. What I noticed most of all was the extra floor space of this care home, set up in a different style to Horfield Lodge and seemed to make the place feel bigger. However the colours of the corridors were a lot darker (purples and creams) compared to Horfield Lodge (whites and reds). This made it feel as if there was no natural light and a bit enclosed from the outside world, even though more spacious.

On the whole I enjoyed my time at Hillview Family Practice, it was a great opportunity to observe how a General Practice works and how intense it can be at times; but it will also be interesting to see how it differs from another General Practice placement that I have planned for in August, based in Easton, which has a very different socio-economic standing to Hartcliffe.

Monday, 9 April 2012

Malaria RTS,S Vaccine

I recently did some private study on malaria and the development of the RTS,S vaccine which is "the first malaria vaccine candidate to ever reach large-scale Phase III clinical testing"  ( You can find about the outline of clinical trials on the 'Clinical Trials' page.

What I found was that although there are currently ways of preventing malaria or treatments that are available once malaria is contracted, a lot of them take time to teach people how to use them and other solutions have to be replaced after a certain time period. For example; I looked at LLIN's and ITN's and the comparison between them. I found that LLIN's (long-lasting insecticide-treated mosquito nets) were of a better standard than ITN's (insecticide-treated mosquito nets) because they last around 3 years opposed to 12-18 months. This means that the distributor (mainly the WHO) does not have to go back to the same place every year but can distribute further afield or spend time funding other projects.

Another solution are antimalarial drugs, but mosquitoes are becoming/have become resistant to certain drugs; as was reported today; "scientists have found new evidence that resistance to the front-line treatments for malaria is increasing" (

IRS (indoor residual spray) is another option but there are issues to do with the component of the spray; DDT (Dichlorodiphenyltrichloroethane) which is thought by many to have environmental impacts and also health impacts, although the WHO disagrees and; "announced that this intervention will once again play a major role in its efforts to fight the disease; Dr Anarfi Asamoa-Baah, WHO Assistant Director-General for HIV/AIDS, TB and Malaria said; DDT presents no health risk when used properly” (

Therefore, the newest development in the fight against malaria to prevent the disease that affects millions of people every year is the RTS,S vaccine. It has been under development for 25 years and is the most clinically advanced malaria vaccine there has ever been and there has been a huge amount of investment in the development by a number of huge companies.

Results from the Phase III trials were released in 2009 by the "New England Journal of Medicine". On their website there are a number of interesting tables and graphs to show the effectiveness/efficacy of the vaccine and the methods of trialling it, who they administered it too and the effects that the vaccine had. One table that I found very interesting was to do with 'serious adverse effects' (7th table on the right hand side ( The results look shocking when you see how many more adverse effects there were in the malaria group than the control drug, but then I noticed that the group that it was administered was double that of the control in both the '6-12 week' and '5-17 month' test groups. This seems to point towards the age groups that this drug will be administered in and leads to the question of safety for the children that it is being tested in; but as the tables data shows (and the other data), it appears to be a very safe vaccine.  

In terms of issues of cost, organisation, transportation to the areas where the vaccine is needed i.e. sub-Saharan Africa and administering the vaccine to the patients; I think that these will all be overcome by the co-operation between GlaxoSmithKline Biologists and organisations such as the WHO but also through the governments of the countries that need the vaccine for their people. The amount of people that will be saved by this vaccine in the future is worth more than the effort that is needed for organisation of producing and distribution of the vaccine itself. 

I would say that the RTS,S vaccine is a very good solution to the issue of malaria control. I think that it would be very effective if used in combination with other alternative malaria controls such as LLIN’s (which I feel would be a lot more successful than ITN’s) and also IRS. I think that GlaxoSmithKline Biologicals and other biological companies should continue their work and strive to develop a second generation malaria vaccine that performs even better than the first generation RTS,S vaccine.

Monday, 2 April 2012

Hip Surgery and Prescriptions

Odd combination but I haven't done a post for a while, so I thought I would do a couple of topics together.

Earlier in the year it was reported that thousands of pounds were lost to the NHS due to prescriptions every year i.e. in Wales where prescriptions are free (as in Scotland and Northern Ireland) it was reported that "people in Wales received an average of 22 items on prescription last year, costing the NHS £594m" (

But the news is that the cost of the prescriptions have risen in England (while the other UK nations stay free). I'm not going to list figures because that would be boring and that's not what matters here really, it's still a fairly low price to pay; but yes, the price has has gone up and that may be an issue for some people i.e. those who have long term conditions who need constant prescriptions. Maybe there should be funding schemes set up to help these people, but then again there is so much funding being lost these days it would be hard to see that happen.

The question is, why can't England have free prescriptions like the rest of the United Kingdom? Well; "The government says abolishing prescription charges in England would leave the NHS £450m short each year" (, which is a fair argument but they aren't dealing with the losses they are making in Wales (as illustrated earlier). There were a number of opinions expressed in the comments on the BBC website. Some were for the rises but others were unhappy with the rises and thought that it was 'unfair' (a very common term used in the report). What I suggest is that we be thankful for the NHS and what they do for us for free and we just accept these extra payments. If you are in a critical condition and on the brink of death they will perform life saving surgery without asking any questions, how about that for healthcare. I've been to other countries and seen their standards of healthcare where they can barely put up all the people in a hospital who need treatment. What are people suggesting? That we go private? Then things will be ten times more expensive because healthcare will no longer be good practice, it will be a business, charging people to live because they know that people want one thing; and they will pay anything to keep their lives. Honestly, what do people think is the alternative to what services we have?!

In terms of the hip surgery story, it is much like the PIP breast implant story; "surgeons have been warned to stop using a particular type of metal-on-metal hip implant because it has an 'unacceptably' high failure rate" ( The BBC reported that over a 4 year period "10.7%" had to be replaced which is almost 29 out of the "270" who have been given the "Mitch TRC and Accolade" hip replacements. There is a lot of investment and research put into things like hip replacements and other structures that are put into the body. This is because it has to be accepted by the body and also try to act as if it is natural/meant to be there; for example making sure the bones can move with it in place or making sure the metal doesn't rust in the body.

One way of performing hip replacement surgery is to do 'anterior approach' which is said to be better because "rehabilitation is simplified and accelerated, dislocation risk is reduced, leg length is more accurately controlled, and the incision is small" ( It was interesting to find that (written in a report in 2007) it wasn't the preferable choice of hip surgery in the USA because apparently "there are several reasons: lack of familiarity, traditional teaching, and lack of the necessary instrumentation and equipment" (as above). However the techniques may have improved since the report was written.

Although this is a very long surgical video (almost 2 hours) detailing the whole procedure, if you flick through it you can see the basic outline of how the anterior approach surgery is carried out with a small incision.

To finish, back to the H5N1 story which is raging on in America at the moment; news is out that a "US panel has approved the publication of two controversial H5N1 bird flu studies, after they were revised" ( There was controversy over whether to release the publications in case bioterrorists got hold of them. But the "panel said the publications no longer revealed details that could lead to abuse by terrorists" (link as above).