Blood Groups

Stemming from the post 'Blood Donation'; this post looks at the different blood groups that are present in human bodies and also some UK statistics. There are four different blood groups in the ABO blood system (A, B, AB and O (originally C)) which are each split into two groups via the Rhesus system where Rhesus is positive and without is negative i.e. A Rhesus (+) and A-.

A slice of history: "early attempts at blood transfusions, as far back as 1666, seemed to have been very successful, but when a French patient died unexpectedly during a procedure in 1668 all efforts were halted" (NHS Blood and Transplant: Blood Groups Leaflet).

But what segregates these different groups from each other? It is all down to the antigens (markers on the surface of red blood cells) and the antibodies (part of the specific immune response secreted by B effector cells to cluster 'foreign material' to be destroyed by macrophages) present in the blood. Between the blood types there are three types of antigens (A antigens, B antigens and Rhesus antigens) and two types of antigens (anti-A and anti-B).

A+ blood contains anti-B antibodies and red blood cells with A antigens and Rhesus antigens.
A- blood contains anti-B antibodies and red blood cells with A antigens but no Rhesus antigens.
B+ blood contains anti-A antibodies and red blood cells with B and Rhesus antigens.
B- blood contains anti-A antibodies and red blood cells with B but no Rhesus antigens.
AB+ blood contains no antibodies and red blood cells with A antigens, B antigens plus Rhesus antigens.
AB- blood contains no antibodies and red blood cells with A antigens, B antigens but no Rhesus antigens.
O+ blood contains anti-B and anti-A antibodies but red blood cells with no A or B antigens, just Rhesus antigens.
O- blood contains anti-B and anti-A antibodies with no antigens on the surface of the red blood cells.

These properties of the different blood groups are responsible for how they can be used and to whom they can be used by. If anti-A antibodies come into contact with A antigens they will attack the red blood cells and destroy them. This is the same reaction if anti-B antibodies come into contact with B antigens. If the blood groups are mixed then the results can be life threatening as we saw earlier with the French patient who died in 1668. This is because they did not know about the different blood groups, with the "ABO groups only discovered in 1901/1902 by Karl Landsteiner" (NHS Blood and Transplant: Blood Groups Leaflet) and the Rhesus groups discovered in 1937. Below is a bar chart of the percentages of each blood group present in the UK population with the most common being A+ and O+ and the rarest being AB-.

But what are the uses for each of the groups. Because of O- not having any antigens on its red blood cells it is known as the 'universal donor' as it can be given to anyone. This is because it cannot be targeted by any antibodies in the 'foreign' blood. At the other end: AB+ is the 'universal recipient' as a person with this blood group can receive any blood type due to having no anti-A or anti-B antibodies . However AB cannot be donated to people with either A or B blood types due to having both of these antigens on the surface of its red blood cells. Below is a table illustrating who can and can't receive each blood type. See if you can use the information provided above (about the antibodies and antigens with each blood group) to give reasons for why the recipient cannot receive certain blood groups.

How do you become a certain blood type? "ABO blood types are inherited through genes on chromosome 9 and they do not change as a result of environmental influences during life" (http://anthro.palomar.edu/blood/ABO_system.htm). "A and B are co-dominant alleles over O thus if a genotype of one parent is AO then its genotype is A" (as above). The table below shows the possible outcomes:

Parent Alleles	A	B	O
A	AA (A)	AB (AB)	AO (A)
B	AB (AB)	BB (B)	BO (B)
O	AO (A)	BO (B)	OO (O)

Although in some cases it does not work like this and is known as the Bombay phenotype (http://anthro.palomar.edu/blood/Bombay_pheno.htm). 

90-seconds of exercise (HIIT)

The WEEK reported (a few weeks ago) an article on the "90-second exercise routine". As with The WEEK it pulls on all the different British newspapers for its stories, I couldn't find the exact story which it had drawn upon or even find, by searching through PubMed, the original study or even the abstract but I did find a similar article from MNT (Medical News Today) (albeit slightly outdated and which may represent ideas which have since been investigated further and maybe even improved on/discarded so please take the dates of these articles into account when reading them)(http://www.medicalnewstoday.com/articles/242498.php).

The WEEK (Issue 902) (loosely taken from the Daily Mail)
"Scientists from the universities of Bath, Nottingham and Birmingham say that having warmed up for two minutes, people should engage in three, 30-second bursts of really intense exercise with 60-second rest periods in between. Results from an ongoing study involving hundreds of middle-aged people indicates that HIIT (High Intensity Interval Training) is just as effective as long sessions in the gym. The team isn't sure why this should be so, but notes that one advantage of HIIT is that it seems to suppress appetite; by contrast, longer workouts tend to leave people hungry."

However although this form of exercise known as HIIT sounds easily carried out, it has to be done properly for it to be effective. The 30-second bursts of high intensity workout should be something like "running up a flight of stairs or pedalling furiously on an exercise bike" (The WEEK (as above)) at almost maximum intensity.

For example "recent [be aware this report is from the 6th of March 2012] HIT research shows, that doing ten one-minute sprints on a stationary exercise bike with about one minute of rest in between, three times a week, is as good for improving muscle as many hours of less strenuous conventional long-term biking" (http://tinyurl.com/87mutke).

In a study a few years ago (by Gibala around 2010) "participants had to pedal at their maximum possible effort level on a specially adapted lab bike. The thinking then was that 'all out' was an important part of the HIT [High Interval Training (referring to the same style of training as HIIT)] method.

But then, in 2010, Gibala and colleagues published another study in The Journal of Physiology, where they showed how a less extreme form of HIT worked just as well for people whose doctors might be a bit worried about them adopting the 'all out' method, for instance those who might be older, less fit and overweight.

In that form of HIT, the workout was still beyond the comfort zone of most people (about 95% of maximal heart rate), but was only half of what might be regarded as an 'all out' sprint" (http://tinyurl.com/87mutke).

The BBC ran a Horizon episode on HIIT with someone (known as Mosley) doing a HIIT programme for 4 weeks to observe the health effects. His programme ran like this (from http://tinyurl.com/87mutke):
 

1.    First, you warm up for a couple of minutes with some gentle cycling: then you cycle as fast as you possibly can for 20 seconds.

2.    Cycle gently again for a couple of minutes while you catch your breath, then do another 20 seconds 'flat out'.

3.    Then, for a final time, two minutes gentle cycling to catch your breath, followed the third period of 20 seconds at 'full throttle'.

 

One of the health effects that the HIIT/HIT had on Mosley was on his insulin sensitivity...

 

"The researcher (Timmons) had tested Mosley for a number of health indices before he started, and then, after his 4 weeks of HIT, Mosley went back to the lab to be re-tested. A main test was for insulin sensitivity. When they measured Mosley's insulin sensitivity before he started his HIT exercise regime, the result showed he was just inside what would be regarded as healthy tolerance. Timmons told Mosley that research from a number of centers shows that doing 3 minutes HIT a week can improve insulin sensitivity by 24%. And this is exactly the amount by which Mosley's own index improved.

But bigger improvements than this have also been recorded, albeit with a slightly different HIT regime. A 2011 study by Gibala's group at McMaster published in Medicine & Science in Sports & Exercise found a 35% improvement in insulin sensitivity after only two weeks.

Insulin sensitivity is important for keeping blood sugar/glucose stable. It is not clear how HIT affects insulin sensitivity, but Timmons, and some other scientists that Mosley spoke to, suggest it could be because HIT uses many more muscles than conventional aerobic training. HIT engages 80% of the muscles of the body, compared to up to 40% during moderate jogging or cycling. HIT engages not only leg muscles, but also the muscles in the upper body, such as the arms and shoulders.

One of the effects of exercise is to break down glycogen in muscles. Glycogen is a stored form of glucose. The theory is that removing stores of glycogen makes way for fresh glucose to be deposited from the bloodstream. So the more muscle tissue that come under this influence, the more space that is available for new glucose deposits.
 
However there are some things that HIT will not necessarily do for you. For example, in Mosley's case, it didn't improve his aerobic fitness, the other main health index that Timmons and colleagues tested.

The evidence that ties aerobic fitness to health shows that one of the best predictors of a healthy long life is the body's ability to take in and use oxygen while we are exercising maximally. The more blood the heart pumps around the body, the more oxygen our muscles use and the lower our risk of disease and early death.

This idea stresses the idea that the more you do, does not necessarily mean the more you benefit.

What we are learning is that the link between exercise and health is an individual thing. Methods like HIT are useful, because very quickly, without spending a lot of time and effort, you can find out what works for you, and what doesn't, and fine-tune a program that you can fit more easily into your lifestyle." (http://tinyurl.com/87mutke).

For further information and the full stories visit:
http://www.medicalnewstoday.com/articles/242498.php
http://www.medicalnewstoday.com/articles/182165.php

Norovirus

Onto one of the biggest media stories that was reported on around Christmas time. Norovirus or the 'winter vomiting bug' was responsible for a large number of dramatic media headlines over the winter period with a BBC headline entitled "winter vomiting cases at 1.1 million", described by some as an outbreak, others as a superbug...but really? I for one don't know anyone who contracted norovirus this year yet the stats presented by the media corporations are very dramatic as if no-one is untouched by it?

The Health Protection Agency (HPA) (http://tinyurl.com/b9xw4gb) has up to date information on the number of laboratory cases reported of norovirus in England and Wales in each year from the year 2000 up to 2012 (but the 2012 data is at the moment provisional).

 

 

This graph, from the HPA website, shows the number of laboratory reports in each year (for precise figures see the URL above). Between 2000 and 2005 the levels fluctuated but rose steadily from 2005 to 2009 and then steeply in 2010. Since 2010 there have been large fluctuations in the number of reports and it will be interesting to see the levels in 2013.

 

In 2010 there was also a media storm about norovirus, once again being described as a pandemic and a superbug (this would presumably be down to the increase that can be observed in the graph above). The big issue in 2011 was to do with "norovirus being found in 76% of British oysters" (http://tinyurl.com/c5rb6ns).

Information at http://www.patient.co.uk/doctor/Norovirus.htm tells you all you need to know about norovirus but I will pick out the useful parts;

"Noroviruses (NVs) are a genus of the Caliciviridae family of viruses found in 'used' water. They are concentrated in shellfish, oysters and plankton."

"The numbers [of cases] seem to have risen since about 1993 and this may in part be spurious due to the introduction of a commercially available enzyme-linked immunosorbent assay (ELISA) test that made diagnosis much easier. However, it may also be due to the emergence of a new strain of NV which is even more virulent [infectious] than the original strain."

"Outbreaks tend to affect no more than about 50% within a community. Outbreaks tend to be within November to April when pressures on hospitals are at their greatest." This therefore indicates an issue with infection control within hospitals when there is great pressure/the capacities are high; such as the use of alcohol gels and the ability to isolate those with the virus.
  

"There is a risk of mortality especially in the frail, immunocompromised [where the immune system is unable to respond effectively] and at the extremes of age."

A headline reading "winter vomiting cases at 1.1 million" is definitely an alarming headline to read. But as we can see from the data in the above graph and the detailed values on the HPA website their cases are nowhere near the 1 million mark (only just reaching 10,000).

The 1.1 million value has therefore been quoted on the basis that "for each confirmed case, there are a further 288 unreported cases, as the vast majority of those affected do not seek healthcare services in response to their illness" (http://tinyurl.com/ae3a4xa). So based on the current 4,407 number of laboratory cases reported (as of yesterday rather than the BBC's report on the 2 January) the total number of cases is at 1,273,623 across England and Wales. So maybe the ground shaking figures on the BBC news website are relevant but still may not be completely accurate as 288 is only a rough guide to the levels of undiagnosed norovirus.

"John Harris, an expert in norovirus from the HPA said: “Norovirus activity always varies from year to year and although we might have expected cases to rise again now we have passed the New Year period this hasn’t been the case. We can’t read anything into this fall and don’t know how busy the rest of the season will be. The busiest months are normally from December to April, so further cases will occur but we can’t say if there will be further significant increases in the number of laboratory reports.

“There have been reports in the media of people with symptoms of norovirus attending their local hospital but we would urge people not to do this. If you think you may have the illness then it is important to stay away from any healthcare facility and care homes to avoid spreading it to people who may have underlying health conditions and already be vulnerable” (http://tinyurl.com/ae3a4xa).

But there is no need to worry, not as the NHS was  provided with "additional funding to help it cope with the added pressure that the winter brought" but also the statement from the Department of Health in England who "said 2.4% of beds were closed in the NHS due to norovirus symptoms compared with a peak of 2.9% last year." (http://www.bbc.co.uk/news/health-20889382)

Maybe we should just follow Charlie Brooker in his suggestion?
"If things go disastrously wrong, and you've shaken someone's revolting disease-sodden hand and you don't have immediate access to hot water and a sink, it's imperative to remember your hand is "evil" until you've had a chance to wash it. Don't eat with it, and don't pick your nose or rub your eye with it either or you will die. Keep it in a pocket. Or sit on it... Just don't use it. Now wash your hands." (http://tinyurl.com/bccsg7t) 

Start to 2013

As it's recently been New Year and Christmas (and I haven't posted for a while!) I thought I'd do a story based on alcohol, and whilst we are having a post about alcohol, why not tie in smoking too.

The BBC reported on January 2nd that "alcohol calories 'too often ignored'"...."people watching their weight should pay closer attention to how much alcohol they drink since it is second only to fat in terms of calorie content [reported by World Cancer Research Fund (WCRF)]. Eating or drinking too many calories on a regular basis can lead to weight gain. Unlike food, alcoholic drinks have very little or no nutritional value" (http://www.bbc.co.uk/news/health-20874204).

An interesting calorie calculator was embedded in the report (http://tinyurl.com/aswlqvf) showing the number of calories consumed with certain drinks, how many chocolate digestive biscuits that equated to and then how many minutes of brisk walking it would take to walk off that number of calories. As an example 2 standard glasses of wine equates to 3 chocolate biscuits in terms of calorie content and 52 minutes of brisk walking to burn those 248 calories off.

I also found an abstract for a study entitled "Alcohol consumption, nutrient intake and relative body weight among US adults" at (http://ajcn.nutrition.org/content/42/2/289.abstract). The study showed that  "drinkers had significantly higher intakes of total calories than non-drinkers, but only because of their intakes of alcoholic calories. Among drinkers, the intakes of non-alcoholic calories decreased as alcohol intakes increased, and it was estimated that between 15 and 41% of the alcoholic calories replaced non-alcoholic calories. Despite their higher caloric intakes, drinkers were not more obese than non-drinkers." It was therefore "suggested that alcoholic calories may be less efficiently utilized than non-alcoholic calories, or may interfere with utilization of non-alcoholic calories."

The smoking story was about research (carried out by the universities of Oxford, Cambridge and Kings College London) that challenged the "widely held belief that giving up smoking makes you more edgy and that smoking [itself] relieves stress". The story was run on the BBC, Medical News Today and also in The WEEK (Issue 902). On the Medical News Today website (http://www.medicalnewstoday.com/articles/254544.php) the following quote from researchers on the project was used. The researchers wrote:

 

"The belief that smoking is stress relieving is pervasive, but almost certainly wrong. The reverse is true: smoking is probably anxiogenic (causes anxiety) and smokers deserve to know this and understand how their own experience may be misleading."

 

"The researchers recruited 491 smokers who attended NHS smoking clinics, and tested their anxiety levels...when their anxiety levels were tested again, the quitters were found to have reduced their anxiety by nine points on average, whereas those who had failed to quit were feeling more anxious: their levels had increased three points" (The WEEK).

 

"The decrease in anxiety was particularly noticeable among the ex-smokers who used to smoke "to cope", compared to those who used to smoke "for pleasure" (Medical News Today article: above).

 

The researchers concluded saying "stopping smoking probably reduces anxiety and the effect is probably larger in those who have a psychiatric disorder and who smoke to cope with stress" (MNT article).




 

Organ Donation (Wales)

A BBC report last week (http://www.bbc.co.uk/news/uk-wales-politics-20583179) detailed the plans by the Welsh Assembly to bring in an opt-out scheme for organ donation instead of the current opt-in scheme. This means that if you die and you have not stated whether you would or would not like your organs to be donated then you will be taken to be a willing organ donor.

"If passed by the Welsh Assembly it could come into force by 2015" (as above). This move would mean that in the situation where your wishes have not been stated your family would not be able to decide against you having your organs donated as it was never changed in your lifetime.

"The main reason families stopped organs being taken was because they did not know what their relatives' wishes were." Therefore it has been encouraged that these conversations are had at home to discuss the idea of 'presumed consent' and come to a decision on whether to opt-out of the organ donation process.

However, although the general thought is that it will increase the numbers of organ donors in Wales; "there are lower rates of organ donation in some countries that have already implemented presumed consent so it's important that this scheme is not seen as the only way to increase donation rates." This enforces the argument that this issue needs to be openly talked about and publicity increased in Wales but also across the whole of the United Kingdom.

A BMJ article (http://www.bmj.com/content/340/bmj.c2188) published in 2010 says that "in practice, even when people have expressed their willingness to donate by either carrying a donor card or, since 1994, signing up to the computerised NHS Organ Donor Register, their relatives are always asked for consent and relatives’ refusal overrides the deceased would-be donor’s decision." This is clearly wrong as it goes against the wishes of the deceased person and it is the hope that this new law, as well as brining in a presumed consent scheme, will act to stop the overriding that occurs by the relatives of the deceased.

The BMJ article also says that "in 2008, Prime Minister Gordon Brown asked an Organ Donor Taskforce to consider the potential effect of an opt-out system for organ donation in the UK." The Taskforce then did research and collected data on "the effect of presumed consent on organ donation rates" but contrary to the data that they collected they "recommended no change to current policy but renewed effort to increase the number of donors opting in."

In their report (http://tinyurl.com/32y8ktp) they set out 14 recommendations that "taken together, would create a structured and systematic approach to organ donation in the UK" but they also state that "the wishes of the potential donor or their family are ascertained and respected." But as I mentioned earlier this is where the issues are coming in, the overriding by the family of the potential donor.

What really needs to be focussed on are checkpoints 4.47-4.50 of the report under the heading ('public recognition and promotion of donation'). These underline the issues of publicity of organ donation, the lack of donation amongst certain communities, the risks that some communities face and the necessity of people from that same community donating organs.

However the most shocking statistic (as of 2008 when this report was created) is that "it is still the case that nationally, the relatives of 40% of potential donors refuse consent for donation." Therefore this Bill tabled by the Welsh Assembly is trying to dramatically decrease this percentage and make sure that people think about the huge benefits to other people's lives (sometimes saving lives) by giving their organs after death.




 

ottobock.

"In developed nations, stroke is the most frequent cause of long-term disabilities. Each year 150,000 people in the UK suffer from a stroke; with a dramatic increase expected over the next few years due to current demographic developments and the ageing of the so-called baby boomers." (http://tinyurl.com/cxv878r)

Otto Bock was a man who "founded a company to supply thousands of war veterans with prostheses and orthopaedic products" (http://tinyurl.com/bmxt89e). His company now have a huge range of products aimed at those affected by strokes and aiding in "reintegrating patients into their professional and social environments" (http://tinyurl.com/cxv878r).
 

Statistics from the Otto Bock website state that after suffering a stroke "one quarter of all people are still bound to a wheelchair; two thirds of all people have restriction of the ability to walk. Approximately one-third of all people complain of a total loss of arm functionality, and daily dexterity is significantly impaired in a further 50% of cases" (http://tinyurl.com/cxv878r). These statistics show the huge effects on daily life of a stroke, which is itself a life threatening medical condition.

"Like all organs, the brain needs the oxygen and nutrients provided by blood to function properly. If the supply of blood is restricted or stopped, brain cells begin to die. This can lead to brain damage and possibly death" (http://tinyurl.com/3py5b32). Strokes can be caused by a blood clot in the brain which leads to the blood supply being stopped and thus oxygen supply being reduced. This is known as "ischaemic (accounting for over 80% of all cases)" (http://tinyurl.com/3py5b32). The other main cause of a stroke is "haemorrhagic: a weakened blood vessel supplying the brain bursts and causes brain damage" (http://tinyurl.com/3py5b32).

"There is also a related condition known as a 'transient ischaemic attack' (TIA), where the supply of blood to the brain is temporarily interrupted, causing a 'mini-stroke'" (http://tinyurl.com/3py5b32).

Ischaemic strokes are caused by the build up of deposits, plaques, on the blood vessel walls causing an increased blood pressure, reduced space in the vessel and also stiffening of the walls. These factors later result in a blockage when a plaque breaks off and gets stuck in the blood vessel becoming fully blocked and causing a loss of blood supply and thus oxygen supply to the brain.

The risk of a stroke occurring can however be reduced "through a healthy lifestyle [such as] consuming a healthy diet, taking regular exercise, drinking alcohol in moderation and not smoking. Lowering high blood pressure and cholesterol levels with medication also lowers the risk of stroke substantially" (http://tinyurl.com/3py5b32).

Treatment of a stroke most often comes in the form of medical drugs for example in the case of ischaemic strokes "using a 'clot-busting' medicine called alteplase, dissolves blood clots. A regular dose of aspirin (an anti-platelet medication) [will also be administered] as this makes the cells in the platelets in the blood, less sticky, reducing the chances of further blood clots occurring" (http://tinyurl.com/d25mo6l). Other drugs are used, known as anticoagulants which also reduce the chances of blood clots by thinning the blood.

Blood cholesterol levels may also be an issue, if the LDL (low-density lipoprotein) cholesterol ('bad cholesterol') count is high then this could be part of the cause of the stroke as they stick to the blood vessel wall and form the plaques (restricting blood flow and reducing the elasticity of the blood vessel walls). "Statins reduce the level of cholesterol in your blood by blocking an enzyme (chemical) in the liver that produces cholesterol" (http://tinyurl.com/d25mo6l).

In terms of treatment for haemorrhagic strokes "emergency surgery is often needed to remove any blood from the brain and repair any burst blood vessels. This is usually done using a surgical procedure known as a craniotomy.

During a craniotomy, a small section of the skull is cut away to allow the surgeon access to the cause of the bleeding. The surgeon will repair any damaged blood vessels and ensure there are no blood clots present that may restrict the blood flow to the brain. After the bleeding has been stopped, the piece of bone removed from the skull is replaced.

Following a craniotomy, the patient may have to be placed on a ventilator. A ventilator is a machine that assists someone with their breathing. It gives the body time to recover by taking over its normal responsibilities, such as breathing, and it will help control any swelling in the brain.

The patient will also be given medicines, such as ACE inhibitors, to lower blood pressure and prevent further strokes from occurring." (http://tinyurl.com/d25mo6l).

This type of surgery is extremely dangerous and the risks and benefits to the patient must be assessed before any surgery takes place.

THIS IS A SURGICAL VIDEO
This video shows a procedure not for a craniotomy for stroke but for a tumour. (http://www.youtube.com/watch?v=CoDT9o01L08)

This brochure shows the product range for Otto Bock healthcare and displays the huge innovation in their products. http://www.ottobock.co.uk/cps/rde/xbcr/ob_uk_en/799_Stroke_Product_brochure_A4_FINALJAN.pdf

More information on stroke and the heart can be found at the websites in this post but also on the British Heart Foundation website at http://www.bhf.org.uk/#&panel1-2.





 

The Thumb

Reason for this bizarre topic.....?! I may have cracked/damaged the ligaments in my thumb and was wondering what could be the consequence of dislocated/breaking my thumb!

-Thumb Dislocation
"A dislocation is a separation of two bones where they meet at a joint. Joints are areas where two bones come together" (http://www.nlm.nih.gov/medlineplus/ency/article/000014.htm). In terms of the anatomy of the thumb, look below.



http://www.ski-injury.com/specific-injuries/thumb
 

Therefore a dislocation in the case of a thumb concerns the metacarpal bone and the bone below it or the metacarpal with the proximal phalanx. "In the case of a serious dislocation, the joint becomes unstable, and the function of the thumb is definitely altered. The joint of the thumb, between the metacarpal and the first phalanx, has two major ligaments (ulnar collateral ligament and dorsal collateral ligament) which may suffer from trauma and even rupture" (http://www.hand-clinic.com/pop_emergency/thumb_dislocation.htm).

-Treatment of a thumb dislocation.
Non-surgical treatment such as "orthopaedic treatment: immobilisation with a fixed plaster cast or resin to block the metacarpophalangeal joint of the thumb, with the wrist released. This immobilisation should be kept for three weeks. After removal of the immobilisation, the patient will gradually regain thumb motion, and should take care for two months. A few rehabilitation sessions [may] be needed" (http://tinyurl.com/btmf36n).

However surgical treatment may be necessary depending on the extent of damage;

As can be seen from the diagram above (http://tinyurl.com/btmf36n) an incision can be made (on the inside of the thumb in this case) and a screw can be put in place to hold the two bones together.



-Broken Thumbs (Fracture)
"Broken thumb injuries are highly debilitating and a common cause of thumb pain and hand swelling" (http://www.orthoped.org/broken-thumb-injury-symptoms-and-treatment.html).

"The thumb, being a vital part of the hand, dictates the necessity to achieve a nearly perfect reconstruction of a broken thumb" (http://tinyurl.com/d5eod44).  The options involve  "thumb joint replacement, and artificial thumb reconstruction" (http://tinyurl.com/d5eod44) or as we saw above, using 'orthopaedic bone screws'. The impact of this surgery can be seen in the patient below.



However "the common protocol, is to bring the broken ends of the bones or ligaments to their natural alignment as much as possible, with or without surgery. The next step is to keep them immobilised in this position until the fusion of the broken ends" (http://tinyurl.com/d5eod44).

I am very glad that I have neither of these but I do have the pain symptoms and swelling usually associated with both. the swelling is a "delayed symptom of thumb injury due to insufficient space in the thumb to accommodate the inflammatory fluids" (http://tinyurl.com/d5eod44).
 

Polypill

Student BMJ- The polypill: a magic bullet against cardiovascular disease?(http://student.bmj.com/student/view-article.html?id=sbmj.e6386)

The polypill is "a pill containing a number of medicines that all treat the same condition" (Oxford Dictionary) from 'poly', meaning many.

 

"Cardiovascular disease remains the leading cause of mortality in developed countries, and has been described as a “global epidemic.” In 2003, Wald and Law proposed a new polypill: six drugs combined into one tablet that would work to reduce cardiovascular risk. They proposed the polypill as a way of targeting modifiable cardiovascular risk factors, both for adults with pre-existing cardiovascular disease (secondary prevention) and, more controversially, for adults over 55 years old without cardiovascular disease (primary prevention)."

"Wald and Law argued that over 80% of myocardial infarctions and strokes could be prevented if this strategy was adopted. The polypill would contain six ingredients: three blood pressure lowering drugs (a thiazide diuretic, a β blocker, and an angiotension converting enzyme (ACE) inhibitor), a statin, aspirin, and folic acid. Their idea ignited great debate in the medical community regarding its potential to reduce the global burden of cardiovascular disease" (BMJ reference above).

How well does the pill work?
"By using the right combination of active medicines, the Polypill can reduce the risk of a heart attack or stroke by two thirds. The key objectives of the medicines are to reduce blood pressure and cholesterol."

"In July 2012, the results of a Polypill trial conducted at the Wolfson Institute of Preventive Medicine, were published. The trial was conducted among individuals aged 50 and over without a history of cardiovascular disease and without selection on the basis of blood pressure or cholesterol. The reductions in blood pressure and cholesterol were recorded and compared with those predicted from published estimates of the effects of the individual components.
84 participants took a single Polypill (containing amlodipine, losartan, hydrochlorothiazide and simvastatin) each evening for 12 weeks and a placebo each evening for 12 weeks in random sequence (a randomised cross-over trial).

In this trial, participants and doctors did not know whether the Polypill or the placebo was taken during each period (double-blind). The reduction in blood pressure and cholesterol at the end of the Polypill period was compared with the levels at the end of the placebo period. The allocation of the placebo or the Polypill is coded, and is only revealed at the end of the study. This study design provides more precise and accurate estimates of the blood pressure and cholesterol lowering effects of the Polypill than other kinds of study. Systolic blood pressure was reduced by an average of 17.9 mmHg (12%) on the Polypill, diastolic blood pressure by 9.8 mmHg (11%), and LDL cholesterol by 1.4 mmol/L (39%). The results were almost identical to those predicted; 18.4 mmHg, 9.7 mmHg, and 1.4 mmol/L respectively" (https://www.polypill.com/evidence-for-polypill.html).

The two graphs below (https://www.polypill.com/evidence-for-polypill.html) show the effect that the polypill has on diastolic blood pressure and cholesterol respectively both lowering to almost the levl of a 20 year old.

 

Whilst showing a reduction in diastolic blood pressure and LDL (low density lipoproteins) cholesterol in the graphs, this considerably lowers the risk of coronary heart disease and also the risks of stroke (http://tinyurl.com/9ykwvnp and http://tinyurl.com/9uvkr6z).

 

"If people took the polypill from age 50, an estimated 28% would benefit by avoiding or delaying a heart attack or stroke during their lifetime" (http://www.bbc.co.uk/news/health-18883163).
 

However "The British Heart Foundation called for more research and said pills were not a substitute for a living a healthy life." (http://www.bbc.co.uk/news/health-18883163). This study was also a very small study of just "84" (BBC) over 50 year olds, a much larger study would have to be carried out to provide solid data and evidence to become valid and broadly used.



 

Medical Mash Up

BBC- NHS and US health system 'should share ideas' (http://www.bbc.co.uk/news/health-19913437)

Before reading the article you would think that it was a good suggestion to share ideas and learn from different mistakes made. However to compare the two nations proves difficult in the size of the population and also their distribution between built up and rural areas.

The Telegraph Online website shows the population densities of the UK: http://tinyurl.com/cq5gh2o and the USA: http://tinyurl.com/9a2xdf4 with the USA clearly showing that it has large areas of very low population density compard to the UK which has a very high population density across the whole country.

Specifics that one could learn for the other include "NHS, which is in the middle of a £20bn savings drive in England, could learn from the transparency and analytical rigour provided by bodies such as the Congressional Budget Office in the US. And lessons learned from the NHS's rollout of universal electronic health care records could prove helpful to the US, which is much further behind on the issue."

"But both countries are under pressure to get more value out of health care spending and reduce growth in expenditure to sustainable levels and are consequently experimenting with new ways to encourage clinicians, patients and institutions to help achieve this." But maybe not copying another system is the way to do this, maybe ingenuity is needed?

BBC-Kaylee Davidson-Olley marks 25 years with new heart (http://www.bbc.co.uk/news/uk-england-tyne-19915904)

"She said: 'I cannot believe that I am fit and healthy 25 years after my transplant. This was only made possible because of the generosity of a family who made that important decision about organ donation, a decision that saved my life. Without that family discussing organ donation, I simply would not be here.'"

"In total, 112 babies aged under a year have received new hearts in the UK during the past 25 years."

And...one of the most inpirational stories I have seen in a while! http://www.bbc.co.uk/news/world-middle-east-19914444...incredible!
 

Electronics for the Body

US scientists have created "ultra-thin electronics that dissolve inside the body" (http://www.bbc.co.uk/news/health-19737125). As can be seen from the video on the BBC website (link above), the electronic 'plate' appears to 'melt' away. "The components are made of silicon and magnesium oxide, and placed in a protective layer of silk. The speed of melting is controlled by the silk. The material is collected from silkworms, dissolved and then allowed to reform. Altering the way the dissolved silk crystallises changes its final properties - and how long the device will last" (http://tinyurl.com/cog5642).

These electronics are classed as "transient electronics" (http://tinyurl.com/cog5642). The aim is for the electronics to "function for medically useful time frames but then completely disappear via resorption [reabsorption] by the body" due to the "remarkable feature of modern silicon electronics  and its ability to remain physically invariant, almost indefinitely" (http://www.sciencemag.org/content/337/6102/1640.abstract).

In terms of medical uses the team of researchers are finding uses for the technology having testing in "rats a device that heats a wound to kill off bugs. There are also ideas around using the technology to slowly release drugs inside the body or to build sensors for the brain and heart. John Rogers, a mechanical science and engineering professor at the University of Illinois, said: 'Infection is a leading cause of readmission, a device could be put in to the body at the site of surgery just before it is closed up'" (http://tinyurl.com/cog5642). Another huge benefit is that "medical implants will never need to be surgically removed" (http://www.medicalnewstoday.com/articles/250791.php) meaning that surgery does not need to be repeated to remove what may have been out in place. So, the electronics can be programmed to completely disintegrate once they have performed their task.

"As for concerns of toxicity, they say the materials are non-toxic and that in one device they used less of the mineral magnesium than is found in a multivitamin" (http://tinyurl.com/cjyps88).


 

ME and CFS

ME and CFS "Myalgic Encephalopathy and Chronic Fatigue Syndrome" (http://www.meassociation.org.uk/?p=1001) respectively.

These are just two of the names assigned to an illness which affects a "currently estimated 250,000 people in Britain, but is an illness of uncertain cause. All types of people at all ages are affected" (as above) which means that it has a serious affect on people in all walks of life from young people in education or work to those who are beyond both education and work. "The predominant symptom of ME/CFS is usually severe fatigue" (http://www.meassociation.org.uk/?page_id=1685) and can occur with "painful muscles and joints, disordered sleep, gastric disturbances, poor memory and concentration" (first link). The illness therefore has a huge impact on people's day-to-day lives, as expressed by the writer of this blog (http://www.chronicfatiguesyndromesupport.me.uk/), a sufferer of CFS who says;

"Think back to the worst dose of flu you’ve ever had - not a bad cold but the real thing. I’m talking about the sort of flu that makes it almost impossible to get out of bed in the morning - sometimes it IS impossible. I’m talking about the sort of flu that leaves you totally exhausted and ill when all you’ve done is walk a few yards. I’m talking about the sort of flu that overwhelms your joints and muscles with excruciating pain, the sort that fills your head with cotton wool so that if you try to read a book, the words mingle confusingly then swim off the page, leaving you feeling dizzy and sick.

Imagine these symptoms not lasting seven or ten days as with the flu, but for year after miserable year."

  

People try to adapt to the illness to minimise the effect that it has on their lifestyle and relationships. People who wish to carry on with work or with education are generally advised to "apply the principles of pacing" (http://www.meassociation.org.uk/?page_id=1693). This is so as not to put a huge demand or stressful workload on the sufferer. Others "find a relaxation technique of benefit and try to couple this with a form of gentle exercise" (http://tinyurl.com/ceh63e3).

 

Having given a very brief overview of the illness and a few treatments to do with therapy and active management, drug treatments (although not specialist for curing the illness) are also available, varying by case. It is clear to see that it affects the life of the sufferer very severely. As well as the diffuclties faced by the sufferers there are complications that arise in diagnosis due to there being "no examination findings which can confirm the diagnosis. There has to be a process of elimination (the exclusion of other conditions) before a diagnosis of ME/CFS can be made" (http://tinyurl.com/cjuo8v9). This therefore makes it very difficult for doctors in terms of action plans/active management and may rely on taking time and trying different methods to understand what actually is wrong. This could be a very stressful and worrying time for those who are suffering from the illness but have no diagnosis or plan to deal with the symptoms. 

Singing for Dementia

Reading an out of date New Scientist (22 May 2010) I found a story about dementia saying that "singing to elderly people with dementia helps them form new memories" (22 May 2010 pg12 by Nora Schultz). It has also been proved that "people with Alzheimer's disease are better at remembering events from their past when music is played" (same reference).

The breakthrough in this story (or was a breakthrough back in 2010!!) is that sufferers of dementia find it extremely difficult to remember things that have happened very recently i.e. what they have had for lunch, but can remember past events that mean a lot to them/ well in the past when stimulated.

A trial was carried out by "Brandon Ally and his team at Boston University" who were "inspired inspired by the report of a man with Alzheimer's who could recall current events if his daughter sang the news to him to the tune of familiar pop songs" (same reference).

What they found from their trial of "13 people with Alzheimer's" that by giving "the lyrics from 40 unfamiliar children's song to read, half accompanied by the actual song and half by spoken word" and the results showed that "those with Alzheimer's were able to recognise 40% of the original lyrics that had been accompanied by song but only 28% of those read to them."

Granted that this isn't a huge increase in the percentages it is a significant difference of 12%. But it was also reported that "we don't yet know why singing should help, but Ally said that music engages areas of the brain, including subcortical regions, that are typically spared until later on in dementia."

But singing has also been used in other ways for dementia sufferers such as in getting patients to "cope better with their symptoms and improve their quality of life" (http://tinyurl.com/cem7tpc).

Tendinopathy

"Tendonitis is a term often used to describe an inflamed and painful tendon. However, tendon pain can also be caused by small tears in the surrounding tissue or the gradual deterioration of a tendon where it connects to the bone. This type of tendon pain is often referred to as 'tendinopathy'." (http://www.nhs.uk/conditions/Tendonitis/Pages/Introduction.aspx) where the term tendinopathy is used to describe "tendon injuries collectively" (as above). These injuries can include tendonitis, tenosynovitis and deterioration of the tendon.

Tendosynovitis is a condition where "the sheath surrounding the tendon, rather than the tendon itself, becomes inflamed" (http://tinyurl.com/97qozs9).

Specifically one of the types of tendonitis that can occur is "Achilles tendonitis (heel)" (http://tinyurl.com/97qozs9) and is "commonly caused by a sports injury" such as walking or running where you may be "wearing shoes that do not fit or support the foot properly" (http://tinyurl.com/97qozs9).

To minimise the damage that could be caused "you should stop doing the exercise or activity that caused your symptoms. Self-help techniques, such as rest, painkillers and ice packs, can often help relieve tendonitis. More persistent cases of tendonitis may need to be treated with physiotherapy, corticosteroid injections or shock wave therapy." (http://tinyurl.com/yjz3rjh)

And to ease the pain of tendonitis whilst doing sport if you already have it "you should warm up properly before you start to prepare your body for more vigorous activity and help avoid injury. It is also important you cool down and stretch after you finish." (http://tinyurl.com/yjz3rjh).

There is a short video and a lot more information on the NHS website http://tinyurl.com/yjz3rjh which also gives an informative animation of tendonitis and gives a good overview of inflammation and the difference between tendocynovitis and tendonitis.



 

Sports Drinks

I found an article about sports drinks in THE WEEK 4th August 2012.

The article ran like this:

"The sports drink market is worth £1bn a year in Britain. But according to an article in the British Medical Journal, in most cases, people would do just as well, if not better, to drink water. The review of 104 popular brands found that although manufacturers make many grand claims for the effectiveness of their often calorie-laden drinks - whether in boosting performance or aiding recovery - there is a "striking lack of evidence" to back up most of them.

For instance, Lucozade Sport, the UK's bestselling sports drink, is said to have "an isotonic performance fuel to make you faster, stronger, for longer". But when Dr Carl Heneghan, director of the University of Oxford's Centre for Evidence-Based Medicine asked manufacturer GlaxoSmithKlise (GSK) if they could assess the research on which these claims rest, he was given what scientists call a "data dump" - 40 years' worth of research which included 176 studies. His team managed to examine 101, before concluding that "the quality of the evidence is poor, the size of the effect is often minuscule and it certainly doesn't apply to the population at large who are buying these products". They were similarly sceptical about claims that branched-chain amino acids - found in some of GSK's protein drinks - can enhance performance and recovery. One nutrition expert, Professor Mike Lean of the University of Glasgow, described the evidence for amino acids improving muscle strength as "absolute fringe", and in any case "totally irrelevant" in the context.However, GSK stands by it's claims, which it insists are backed up by science."

This article seems to play down the use of sports drinks branding them as a waste of money because there is no proof of their ability to increase performance or aid recovery. I then dug around in PubMed and on the BMJ to try to find some of the research papers where the data had come from and found this: http://tinyurl.com/cyzt7lp, a paper talking about the birth of sports drinks their use because of dehydration rather than thirst.

"The researchers also contend that much of the science behind sports drinks is biased or inconclusive and that empty calories from sports drinks are major contributors to childhood obesity and tooth decay" (http://tinyurl.com/coye356). So here we can see that there societal issues to do with the consumption of these drinks, although how many would one have to drink to lead to childhood obesity?

A BMJ article states that "Healthcare professionals should be encouraged to talk with patients about the calorific content of SSBs [sugar sweetened beverages] when discussing lifestyle modification to manage overweight and/or obesity . . . Consumption of water in preference to other beverages should be highlighted as a simple step towards healthier hydration: recommending 1.5 to 2 litres of water daily is the simplest and healthiest hydration advice you can give.” (http://www.bmj.com/content/343/bmj.d4280) So this article also agrees with the obesity issue arising from the consumption of sports drinks.

However I think that the killer argument came from the BMJ when Powerade were quoted on their website saying “water doesn’t have the performance benefits of a sports drink,”—but it does not go on to quantify what those benefits are" (http://tinyurl.com/cyzt7lp).

If you read the BMJ article (http://tinyurl.com/cyzt7lp then you can make up your own mind based on the evidence/lack of evidence of whether they actually are beneficial..?!
 

Seymour Medical Practice W/E

I had another two days of work experience last week at another General Practice in Bristol but this time in Easton rather than Hartcliffe.

It was very ineteresting to see the difference between the two Practices in terms of the way that they were run but also the cohort of patients that they had on their books. In Easton the patients were mainly of Caribbean, Central African or Indian origin opposed to the white cohort in Harcliffe. The issues that arose from the patients were also very different in Easton with less depression and long term illness but more cancers and varied illnesses. Due to there being a large number of African and Caribbean patients there was a lot of Prostate Cancer in the male patients, as the incidence of prostate cance is higher in black men than those of other ethnicities (http://seer.cancer.gov/statfacts/html/prost.html) with a lot of men coming in for the latter end of their courses of injections to control the cancer. 

There were a number of ethical situations raised in my time there. For example there were issues to do with the taking of medication and one man had not been taking it for some weeks, ignoring the doctors advice that it would be beneficial to his health. As it is not possible to force someone to take their tablets the doctor therefore gave a balanced argument for and against why he should take his pills and gave him the choice based on the data from drug trials and the discussion that they had had as to whether he should now continue with the drugs.

Another example was where someone was suspected of having lung cancer having spread from another part of his body, which he had already had operations for. It was then discussed whether he would like to attempt another operation to remove this next tumor which could soon be fatal. But he wished not to have any more surgery for the time being and wanted to try alternative herbal medicines. He thought that maybe this would be better than conventional medicine, as he had once seen someone get better on them and also believed in miracles. The doctor once again gave a balanced argument as to the benefits and risks of these medicines and gave the facts of the lack of data to suggest that they work efficiently and effectively in all patients.

I also spent time with one of the practice nurses who was in charge of the 'Stop Smoking' programme at the practice and consultations to do with malaria tablets and the options available and also asthma check ups.

It was just like Hillview Medical Practice in terms of the volume of patients through the doors every day and the number of patients on the books, but it was very evident as to the differences between the two practices in terms of the people that attended and the different sort of issues that they brought with them.

Vietnam and Laos

Recalling the 'Legionnaires' Disease' post back in February, it was reported that "the total number of confirmed cases is 52, while the number of suspected cases is at 48" (http://tinyurl.com/7tebrer) in Edinburgh.

I am travelling to Vietnam and Laos for a month with my school and thought I would look into two of the illnesses that can be caught from spending time in these countries (Japanese Encephalitis and Rabies).

Japanese Encephalitis. This "can be a serious illness causing inflammation of the brain, caused by a virus" (http://tinyurl.com/dys8sc7) and is transmitted by "the bite of infected mosquitoes, not transmitted between humans" (http://tinyurl.com/dys8sc7). The vaccine is recommended for travelling to East Asia as can be seen on this map http://emedicine.medscape.com/article/233802-overview which shows the predominant area where it occurs (there is also more information about the virrus itself on this website.

I mentioned that it 'can be serious' and this is because it is "usually a mild illness with no symptoms, only around 1 in 200 having the serious illness" (http://tinyurl.com/dys8sc7) where  "encephalitis (inflammation of the brain) occurs. This can cause permanent brain damage and is fatal in some cases" (http://tinyurl.com/dys8sc7).

Rabies. As most of you know it is passed on from the bite or scratch of an animal infected with the rabies virus. "The virus passes through the cut skin and travels (gradually) into the nervous system. It causes spasms, fear of water, madness, paralysis and usually death" (http://tinyurl.com/d6bw8n4). It is therefore a very serious illness, just like Japanese Encephalitis in the cases where it does cause encephalitis. To immunise yourself from rabies there is a series of injections which "stimulate your body to make antibodies against the rabies virus" (http://tinyurl.com/d6bw8n4). If you are bitten then it is recommended that you "clean the wound thoroughly and seek medical help" with "symptoms usually starting 2-8 weeks after however, symptoms may occur months or even years after" (http://tinyurl.com/d6bw8n4).

Both of these illnesses are serious and are worth considering for immunisation before travelling, especially if travelling to the areas where they occur, such as South East Asia. Whatever the illness or wherever you are travelling you should always research the diseases/illnesses from that country so that you can go to your doctor with an idea of the immunisations you will need to have/discuss having. A very good website for finding out about illnesses is http://www.patient.co.uk/.

As I am away for a month this will be the last before I get back but I have work experience on the two days after I get back so will update you then.

EuroSCORE

EuroSCORE stands for "European System for Cardiac Operative Risk Evaluation" (http://www.euroscore.org/what_is_euroscore.htm) and it is used in cardiac surgical theatres for "calculating predicted operative mortality for patients undergoing cardiac surgery" thus "a good measure of quality of cardiac surgical care" (http://www.euroscore.org/what_is_euroscore.htm). Effectively it calculates the risk of survival/death of the patient undertaking a cardiac operation based on 17 items of information in three categories "patient-related, cardiac-related and operation-related factors" (http://www.euroscore.org/euroscore_scoring.htm). These are then all taken into account and a formula is used (http://www.euroscore.org/logisticEuroSCORE.htm) to calculate the EuroSCORE for the patient.

All of the factors contribute to a final score/percentage chance of death and is used in a huge number of hospitals across the UK and Europe.

The data used to calculate the score was developed from studying "nearly 20 thousand consecutive patients from 128 hospitals in eight European countries. Information was collected on 97 risk factors in all the patients. The outcome (survival or death) was related to the preoperative risk factors. The most important, reliable and objective risk factors were then used to prepare a scoring system" (http://www.euroscore.org/what_is_euroscore.htm); which is a huge number of people and body of risk factors to develop a scoring system based on a patients risk relative to what has happened in the past.

News Bias

"Can spending less time sitting down add years to your life?"

The first paragraph of this BBC report (http://www.bbc.co.uk/news/health-18767278) on whether spending time sitting down actually increases your risk of death or not appears misleading to the research that has actually been produced. They say "limiting the time we spend sitting to just three hours a day could add an extra two years to our life expectancy." The key word in this sentence is the word 'could'. Later in the report it is reported that "experts say the US estimates are too unreliable to predict personal risk" and even that "the researchers themselves acknowledge there are flaws that make its findings less than reliable." So why have the BBC published this report and why do other news corporations publish research in their papers/websites that doesn't appear to give a conclusion? For example, I found another website that published this story but had a completely different angle that seemed to suggest it was firm. The website (http://tinyurl.com/bmbwxot) did not publish anything about the fact that the research may have had flaws and only suggested that it was unreliable was when they stated "they used the data to extrapolate the effects of sitting down on the health of an entire population" but to the eye of someone who doesn't understand the term extrapolation in terms of data this would mean nothing and would presume that the data was in fact reliable.

But why would 'Healthcare Today' take to the side of the argument that the data is reliable? What is their motive for giving a bias to the data? Going to the root of the data, the actual paper itself from BMJOpen, I found that Dr Peter Katzmarzyk, the man who conducted the research, came to the conclusion that "reducing sedentary behaviours such as sitting and television viewing may have the potential to increase life expectancy in the USA" (http://tinyurl.com/d4jlx8w) and that the rise in life expectancy is in the bounds of "1.39 and 2.69 years for sitting and 0.48 and 2.51 years for television viewing" (as above). This is a published piece of research and it is now the job of other scientists to research this further and test the conclusions of Dr Katzmarzyk, so in the future we will see the validity of the data.

But the point I was trying to illustrate was that you should never take the first news story you see as truth, always try to get opinion from lots of news corporations to account for all of the sides of the story that they are trying to portray. This means that you can build a picture of the story and the different angles to it. The best items to read would be the paper itself so that you get the pure data and can draw your own opinion. I learnt this by reading a book called 'Bad Science' by Ben Goldacre who shows how to get past the media angle and at the data and opinions that are valued in the science community i.e. leading researchers/scientists.

Chest Drain

I saw quite a few chest drains on the respiratory ward and also in ITU (intensive care unit) whilst in the hospital so thought I would find out what they do. A chest drain is "a hollow, flexible tube in the chest, acting like a drain" (http://www.nlm.nih.gov/medlineplus/ency/article/002947.htm). They are used to drain fluids from the body such as  "blood, fluid or air from around your lungs, allowing the lungs to fully expand" (http://tinyurl.com/d37r3ur), so it is mainly used when the lungs have been compressed, thus decreasing the size of the lungs and causing reduced efficiency. The chest x-ray below (http://tinyurl.com/cw6cy96) shows a 'pleural effusion' (shadow on the right side of the picture (left lung))-the "buildup of fluid between the layers of tissue that line the lungs and chest cavity" (http://tinyurl.com/3e5hnul) which is the area where the chest drain takes fluid from, in "the space between the inner lining and the outer lining of your lung" (http://tinyurl.com/d37r3ur).

The "body produces pleural fluid in small amounts to lubricate the surfaces of the pleura, the thin tissue that lines the chest cavity,surrounds the lungs. A pleural effusion is an abnormal, excessive collection of this fluid" (http://tinyurl.com/3e5hnul).

It is inserted and guided to the right area by 'numbing the area where the drain will be inserted, it is then inserted through a cut in your skin between your ribs' (http://tinyurl.com/d37r3ur) as can be seen below (http://www.umm.edu/patiented/articles/000618_2.htm).

The tube, once in the right position (as above), then removes the fluid from the lining of the lung using suction. It is then removed once no more fluid comes out of the drain as there is no need for the drain anymore. An x-ray is then carried out again to see the improvement and the lung should look almost normal, with almost all of the fluid removed.

Video of the procedure: http://www.youtube.com/watch?v=fp1uBR8Lvn4.

BRI Work Experience

Haven't posted for a while...sorry about that! So i'm going to make it up to you all and do a few posts in the next few weeks..

A short one for now. Just finished three days of work experience at the BRI (Bristol Royal Infirmary). I had a day on a cardiac ward which dealt with some pre-op patients and other patients with severe heart issues leading to other issues in the body and I witnessed a number of extremely ill patients. I also spent a day in cardiac theatre, observing two open heart operations as in the 'Cardiothoracic Surgery' post, one of which was to replace the mitral valve (left atroventricular valve) of the heart and the other was to remove and replace a section of the Aorta. Both of these were extremely tricky operations but carried out with great skill by the surgeons.

In theatre there is a huge amount of teamwork required for a successful operation. The two surgeons require a surgeons assistant to pre-empt what the surgeon will need in terms of tools, and will then ask for the tools off the nurses who are in the non-sterilised zone. Then there is the anaesthetist and his/her assistant and also someone who is in charge of the cardiopulmonary bypass machine, which takes over heart and lung function in the operation whilst the heart is stopped.

On the third day I spent time on a different ward mainly involved in respiratory illness where I met some fantastic foundation doctors, training doctors and consultants. Talking with them and just observing them was so interesting and gave me such an insight into what to expect in the first few years of being a qualified doctor and beyond that and have acted as role models for me to aspire too in the future.

One news story, found it in The WEEK (9th June 2012 issue 872 page 16), bit of a funny one!
"Doctors in India have operated to remove a live fish from the lung of a 12-year-old boy. Anil Barela accidentally inhaled the 9cm specimen while playing a fish-swallowing game with fiends on the banks of a river!!"