Leg Operation

I was skiing last week in Italy but sadly a good friend of mine crashed on her skis on day two of the week and broke her fibula and tibia (shinbone); for anatomy of the leg go to http://www.nlm.nih.gov/medlineplus/ency/imagepages/8844.htm. She was taken down the mountain in what I like to call a 'body bag' which is, for those who haven't skied, a one man sledge on skis with someone skiing at the front (check out my facebook photos since I have had the experience of being in one!). She was then admitted to the medical centre in Sauze D'Oulx (the town we were staying at) and then moved to a hospital 40km away at the base of the mountain range in Susa.

In that holiday I learnt so much that I can't actually put it into one post. Firstly it's usually me who is the one breaking bones; having broken both my wrists (one of them twice and having an operation to put pins in), and my right collar bone a couple of times (one of which was whilst on a skiing trip with the same friends)... so usually I am used to being carted into hospital and dealing with the situation in my own way...but this time it was someone else and I had to take up a different position. I felt that I needed to care for them and help them having been in the situation before and did my best by making her comfortable on the slopes for the hour that we waited for medical attention.

Once she was out of sight down the slope (in the blood wagon) it didn't feel like it was over because the rest of us (6 left) had to get down the mountain safely and back to the chalet to get items for her to take to hospital if need be...she did need the things and ended up staying in hospital for a full week, entering on Sunday, operation on Wednesday and leaving the following Sunday.

In her operation she had a rod/nail put in place down the inside of her tibia... "Intramedullary (IM) rods are used to align and stabilize fractures. IM rods are inserted into the bone marrow canal in the centre of the long bones of the extremities (e.g. femur or tibia)" (http://orthopedics.about.com/cs/brokenbones/g/imrod.htm). There is a video that I found of surgery where this happens at (http://tinyurl.com/7p4ajq7), not for the feint hearted!

On the day after the operation I went down to see her for the first time since the accident and it was really nice to see her in a lot less pain than she had been before the operation, because I had been told that she had been uncomfortable due to the lack of movement she had and the caring she had received. In European hospitals there isn't the care that we get in the UK. They don't have nursing staff going around and washing everybody (or even simple things like brushing teeth) and making them comfortable. They come, do what they have too i.e. change a drip, and go away again. What I really noticed was the lack of what's called 'bedside manner' that the staff had, to them it was a job and that's it, there was no attempt at co-operation at all, or even trying to get over the language barrier by using hand signals.

The final point I will make is how I felt in the hospital. When I was there I was so glad to see her and to see that she looked so much more comfortable compared to being on the slopes and being taken down the mountain in a sledge. But something came over me as I stood there looking at her and all the drips and the flasks around her as if I had lots of thoughts and they all came out at once. It was as if I had held something inside me for a whole week...but I still can't explain it! Maybe it was the stress of the week, trying to keep everyone happy and laughing and it all caught up with me?!

But she is home now and in the best of care from her family. For those interested I also found a clip of an amputation (once again, not for the feint hearted) http://www.youtube.com/watch?v=lmlj8OafOwc.

Legionnaires' Disease

Legionnaires' disease is a disease that "causes serious pneumonia (lung infection)" (http://tinyurl.com/83p7449) and is caught by "breathing in droplets of water which contain Legionella bacteria. The illness is fatal in some cases" (http://tinyurl.com/83p7449). However, the Legionella may not always lead to Legionnaires' disease, in some cases it can lead to "Pontiac fever. This is when the bacteria cause a flu-like illness but it is not usually serious" (http://tinyurl.com/83p7449).

The history of where the name for Legionnaires' disease came from is when; "in 1976 an outbreak of pneumonia occurred among American legionnaires (ex-servicemen) who attended a conference. 221 people developed pneumonia and 34 died" (http://tinyurl.com/83p7449).

The Legionella bacterium "thrives in water, and is often spread through water droplets from cooling systems, shower heads and taps, but cannot be spread from person to person" (The WEEK 15th October 2011) with around "35°C being the optimum temperature" (http://tinyurl.com/83p7449). So, "In the UK, and in many other countries, there are regulations on how to maintain water supplies and air conditioning systems used in large buildings" (http://tinyurl.com/83p7449). This therefore limits the risk of Legionnaires' disease in the countries where water system regulations are in place.

The statistics (all from http://www.primec.co.uk/stats.htm);
-1980-2001 there were 150 to 250 cases reported to the scheme each year.
-From 2002 onwards, that number climbed; with over 550 cases in 2006.
-Hospital Episode Statistics for 2005–2006 showed that over 300,000 cases of community-acquired pneumonia (CAP) were admitted to hospital in England. Over 293,000 were never specified further; studies demonstrate that a significant proportion of these can probably be attributed to Legionnaires’.
-The unusually high case numbers in 2006 occurred predominantly over the summer months.

The idea that cases predominantly happened in the summer months of 2006 follows the evidence that the Legionella bacteria thrive in water with an optimum temperature of 35°C (most likely achieved in the summer months).

The reason why I picked up on this story is because last year (August 2011) "nine people who were diagnosed with Legionnaires' were found to have travelled to Corfu, Greece" (The WEEK 15th October 2011). This shows that there is a risk where you travel; even in the European Union where there are a number of regulatory bodies. But don't be worried because it is a very rare disease and has a very low risk in the United Kingdom.

The story of the nine cases that I mentioned were followed up by the United Kingdom's Health Protection Agency and the story of how they tried to find the source of the illness can be read at this URL; http://news.sky.com/home/uk-news/article/16084823.

The Last Month

In the past month I have reported on a number of issues that have been prevalent in the media. The issues of the "Should Doctors Strike?" and "Assisted Suicide" were both cases which involved ethical issues. The post that I enjoyed writing most was "Cardiothoracic Surgery" mainly because of the videos but also because of the surgery side, which requires huge amounts of skill.

I have learnt so much in the past month about the medical world by doing this blog but have also learnt that I am only scratching at a tiny part of the huge surface that is the medical world. I realise this every time I write a post; when I'm try to back up what I am saying with quotes and ideas from leading doctors and scientists I find myself with a wall of academic papers, newspaper articles, published research and people's opinions but know that I don't have the time to wade through all of it to find out what I need... I resign myself to the fact that I can't wade through and understand everything there is in this world!

As it goes ethics are extremely important in medicine (although the most boring part of Biology AS!) because everything that a doctor does will be scrutinised by the hospital he works in or even by the media if the mistake is bad enough.

For example, even today, a story came out about assisted suicide. The man in question is a severely disabled man who "wants the court to rule that a doctor should be able to help him to die" (http://www.bbc.co.uk/news/uk-16957125). The man suffers from 'locked-in syndrome' where the "patient is mute and totally paralysed, except for eye movements, but remains conscious" (http://www.bbc.co.uk/news/uk-16957125).

So the question is; let him die or not?
From the doctors perspective it's a firm "no" (in all cases of assisted suicide) because of the Hippocratic Oath taken by all doctors to swear that they will practice medicine ethically. The man could be taken to Dignitas to die peacefully, but the doctor will not be allowed to take him, the family would have to take him. Doctors cannot be seen to take someone to die; it would be a media storm. The sad thing is that the doctors personal opinion cannot be known to influence his duty to keep patients alive, even if they believe the patient has the right to die if he wants too.

From the family point of view it would most probably be "yes/no". Yes, because they must be in so much emotional stress and pain and to be put out of their pain might be the best thing for the family as a whole. But on the other hand, this man is someone's son, maybe husband and uncle; he is part of the family, a living human being. It would be devastating for the family to lose him, so they may say no and take side with the doctors.

Whatever decision is made, this is an extremely sad case but is one that has come up before and will come up again in the future, the question is, what is the right thing to do in the circumstances?

Hospital: Weekend Death Rates

I picked up on news today that patients are more likely to die if they are admitted on a weekend compared to a weekday. This has come after a study was carried out in "the Journal of the Royal Society of Medicine" (http://www.bbc.co.uk/news/health-16868428).

Let's look at the stats (all from http://www.bbc.co.uk/news/health-16868428);
1. Research was carried out by UCL (University College London), UEA (University of East Anglia) and Birmingham University.
2. It covered more than 14 million hospital admissions and 187,300 patients who died within 30 days of being admitted (during 2009/2010).
3. For every 100 deaths on a Wednesday there were 116 on a Sunday.
4. The results were consistent with data from 254 not-for-profit hospitals in the United States, which they also analysed.

So the obvious issue here is that more patients are dying on the weekend than in the weekday. This is maybe because of the lack of senior medical staff/consultants working on the weekend; as suggested by Professor Domenico Pagano on the BBC website. The lack of senior staff could have a major impact because of the experience that they offer in emergency situations; experience that can only come with time for junior doctors.

Another issue is what action to take now that this study has been carried out. What really needs to happen is that there needs to be more experienced doctors in the hospitals or close enough to the hospitals to be there in an emergency rather than on call (not very practical though). If there are more consultants consistently in the hospitals over the whole week, then the death rate should theoretically be lowered, based on the idea that experienced staff around means less deaths (but not no deaths).

It would be interesting to get some statistics on the mortality rates against the number of consultants and junior doctors working on the wards to see if there is a correlation between mortality rate and the experience of the staff on duty.

Should Doctors Strike?

Although it’s a dull story, it is an important ethical issue in the medical world on the basis of whether doctors should ever strike or withdraw their services.

Both Unite, “which represents 100,000 NHS members” (http://www.bbc.co.uk/news/business-16790168) and The British Medical Association (BMA), “the professional medical association and trade
union for doctors and medical students” (www.bma.org.uk) have rejected the new pension reform set out by the government. “Unions point out that, overall, public workers must pay more and work longer” (http://www.bbc.co.uk/news/business-16790168) but the government have said that it is the “final deal on the table, and that it is fair” (http://www.bbc.co.uk/news/business-16790168).

So, what actually is the bare outline of the new pension scheme?
The people in the health service who will be spared from the pension reform are, the "530,000 NHS staff earning between £15,000 and £26,557" and "those less than 10 years away from retirement" (http://www.bbc.co.uk/news/business-16259238).

But those who earn more than £26,557 will be expected to pay more towards their pension; as reported on the BMA website, "currently doctors pay 6.5%, 7.5% or 8.5% depending on what they earn" but "by April 2014 individuals who are currently paying 8.5% will have to pay 14.5%" (http://tinyurl.com/6umt56a). On top of the increase in rates that doctors will have to pay towards their pension, they will also have to "work to the age of 68 to be able to draw a full pension" (http://tinyurl.com/6umt56a), up from 60 on the 'old' pension scheme.

Some surveys were carried out by the BMA which showed that "8 out of 10 association members thought the NHS pension scheme proposals were unacceptable" (http://tinyurl.com/78rsmqm). The new scheme has lead to doctors "saying for the first time in a generation, they would be prepared to take industrial action" (http://tinyurl.com/78rsmqm).

In this story there are a number of talking points;
Firstly, the fact that the amount that a doctor will have to pay towards his pension will rise, as illustrated in the statistics above, which means that they are therefore not getting paid as much from the government at the end of their careers by the government, but are funding a lot more of their pensions themselves.

Secondly, raising the age of retirement means that the average doctor will spend around 44 years in the medical service (assuming they graduated at 24 years of age and then started their foundation years immediately after graduation). That is a staggering length of time to sustain the high demands of time, learning and commitment that is necessary for a doctor.

Thirdly, the ethical issues of strike action by doctors. This is surely the most important talking point that has resulted from the governments new plans on pension reform. Doctors have said that they would be willing to take industrial action against the new reforms. But what could that mean for the patients, and is a dispute over pensions a justifiable reason to withdraw their services from the public domain. This argument was summed upon the BMA website; "the BMA will now draw up detailed plans on taking industrial action, with all attempts being made to minimise any risk of harm to patients" (http://tinyurl.com/78rsmqm). So it shows that they are being cautious in the matter...

It would be great to hear your points of view on this matter by posting a comment underneath or even sparking a good discussion based on what you think should happen or what is best for the community.

James Maskalyk

So there is this guy James Maskalyk. Doctor, writer, humanitarian worker.

Short overview.
"Practices emergency medicine in Toronto, founding editor of the open access journal Open Medicine (http://www.openmedicine.ca/). He has worked for Medecins Sans Frontieres (MSF) (http://www.msf.org.uk/) since 2005 as a writer and doctor. Wrote a memoir, Six Months in Sudan. Also written a blog about his experiences" (http://www.sixmonthsinsudan.com/page/blog/). (Student BMJ 2011;19:d6429). All of those links are worth checking out if you have a few minutes.

I read an interview on him in the BMJ and he seems like such an inspiration to young doctors after his travels to South America and I loved this comment, "I saw how sick people seemed compared with patients in Calgary, Canada where I was training. I knew that medicine could be a tool to working towards understanding and embracing an unfamiliar world." (Student BMJ 2011;19:d6429).

'PathFinder' Brain Surgeon Robot

In reference to last weeks post, Worldwide Flu Pandemic?, the story has developed, with the BBC posting an article on the 20th of January saying "scientists who created a potentially more deadly bird flu strain have temporarily stopped their research amid fears it could be used by terrorists" (http://www.bbc.co.uk/news/world-us-canada-16662346), full story on that URL.

In 2001, news arrived that the "first medical robot designed to operate on the brain has begun clinical trials at Queen's Medical Centre in Nottingham, UK" (http://tinyurl.com/6vcogut). This sounds quite astounding if you think about the level of accuracy and precision that surgeons need to have and; in terms of ethics, surely we couldn't give over the job of neurosurgery to a robot? This video shows neurosurgery that was carried out with an awake patient and underlines the accuracy that a neurosurgeon needs (http://www.youtube.com/watch?v=FD8ckoy9NVU). They are able to do it while the patient is awake because there are no pain receptors in the brain and there can be "anaesthetic administered locally, to the scalp" (http://tinyurl.com/7dbrwec).

The robot that began its trials in 2001, called the "PathFinder, will not be able to do operations that are not already possible, but it could do them much faster and more accurately" (http://tinyurl.com/6vcogut). PathFinder can "align the surgical tools to within 1mm" (http://tinyurl.com/6wrqgnz) which is incredible and is certainly more accurate than conventional surgery, because of the movement of the surgeons hand with the instruments.

The PathFinder is also very safe, otherwise it would not pass the trials or even be used; as this New Scientist article illustrates, "despite the name, surgical robots are not automatic and do not operate in any way like factory assembly-line robots. Rather, they are precision machines controlled remotely by a surgeon" (http://tinyurl.com/6nfeb4b). Another article, http://www.imperial.ac.uk/college.asp?P=7449, shows an experiment that was carried out based on the precision of knee surgery by a robot called 'Acrobot' and also illustrates the precision of these robots.

Another example of a robot used for neurosurgery is the 'NeuroArm'. The team on the NeuroArm Project had to overcome a number of challenges, including "how could a machine be created to be as precise and dexterous as the human hand, without compromising surgical technique?" (http://www.neuroarm.org/project/). This is one of the questions that all of the companies who make robots for surgery must ask themselves. Another video (http://tinyurl.com/7383jft) shows the NeuroArm in action.

Ten years on from when PathFinder was first unveiled I have been unable to find any statistics on the performance of the robot at all or in fact many other articles on the robot. But there are other surgical robots that have been developed (worth looking at) since 2001, such as the NeuroArm (http://www.neuroarm.org/project/) and also the ROBOCAST (http://tinyurl.com/7pk33h9).

Worldwide Flu Pandemic?

Another article from the New Scientist website that I found was looking into this question; "Two labs have made lethal, highly transmissible versions of bird flu virus – do the risks of it escaping outweigh the benefits of the research?" (http://tinyurl.com/7q74mgz). The labs have "brewed up variants of H5N1 that can spread between ferrets merely breathing the same air" (http://tinyurl.com/7q74mgz) which shows that this is an extremely contagious virus that could most certainly cause a pandemic in human beings.

I found out about the H5N1 virus, Avian Influenza, on PubMed Health (The World's Largest Medical Library). Avian Influenza is a "flu infection in birds; the virus that causes the infection in birds can mutate to infect humans, such mutation could start a deadly worldwide epidemic" (http://tinyurl.com/3hcyygv). People have been infected with the virus all across the world and "slightly more than 60% of those who became ill have died" (http://tinyurl.com/3hcyygv). This is a staggering statistic, which was also hinted by D. A. Henderson of the University of Pittsburgh, Pennsylvania who said that the "1918 flu would look like nothing if this really got loose." To give a scale to his words, he is referring to the epidemic "known as 'Spanish Flu' or 'La Grippe' between 1918-1919 which killed between 20 and 40 million people" (http://virus.stanford.edu/uda/).

In 2004 the H5N1 virus "caused poultry disease in eight Asian countries and infected at least 44 people, killing 32, most of these people had close contact with poultry" (http://tinyurl.com/7maqhxz). This shows that there are recent examples of the severity of this flu. New Scientist say that they "don't know for sure that the viruses would behave the same way in people as in ferrets [indicated in the aforementioned experiment], but the assumption has to be that they do" (http://tinyurl.com/7q74mgz). However on another website, http://tinyurl.com/7maqhxz, it is suggested that "the virus does not easily transmit from human to human" due to the binding properties of the H5N1 virus.

I think, based on the theories of the biologists and the conflicting views on how effectively the virus will take hold in humans, that we need to be aware that there is a serious risk associated with laboratories manufacturing and testing this virus and that maybe there should be limited access for those those who are working on the virus, so as to reduce the chances of passing it on. Maybe the scientists should live on a campus where they are isolated from others while they are experimenting on the virus. So in answer to New Scientist's question; "do the risks of it escaping outweigh the benefits of the research?" I would say that yes, it is worth the research so we can learn more about mutations and viruses but there needs to be strict regulations and monitoring in place to deal with the risk of a pandemic.

Indian drug-resistant TB

I picked this story up from the New Scientist website (http://tinyurl.com/6oqv3rf) which was about a "strain of tuberculosis that is resistant to all existing TB drugs" which has been "emerged" in Mumbai, India.
Tuberculosis is an infection caused by bacteria that infects the lungs but can also "spread to other parts of the body". Either, the "immune system deals with it, or it fails to kill or contain it. If it is not treated, an active TB infection can be fatal. It can damage the lungs to such an extent that a person cannot breathe properly" (http://tinyurl.com/78j3mds). There have been "12 confirmed cases of which three are dead" said Zarir Udwadia of the Hinduja National Hospital and Medical Research Centre in Mumbai "(head of the team whose diagnoses of four cases has just been published)", (http://tinyurl.com/78j3mds).

"Several medicines are used to treat TB and the treatment usually lasts six months" (http://tinyurl.com/789jpvy). The issue with the strain of TB that has been uncovered is that it is drug-resistant (as indicated in the title...) and this has caused a big worry to Mumbai as it is such a densley populated city and TB is passed on "through inhaling tiny droplets of saliva from the coughs or sneezes of an infected person" (http://tinyurl.com/78j3mds) which is incredibly easy when there are so many people, ("30,000 per square km", http://tinyurl.com/6lpbyco). The worry is that this will result in an epidemic in Mumbai with an incurable disease affecting the majority of the population of the city. "It's estimated that on average, a tuberculosis patient infects 10 to 20 contacts in a year" (http://tinyurl.com/6oqv3rf).

The only way to prevent this strain from continuing to be spread is by "quarantining them in hospitals with isolation facilities till they become non-infectious – which is not practical or possible" (http://tinyurl.com/6oqv3rf) and will become even harder to enforce as there becomes more people affected.

The World Health Organisation (WHO) will be organising a meeting to "decide what steps to take next" (http://tinyurl.com/6oqv3rf). New Scientist also mentions two other cases, one in Italy (2007) and another in Iran (2009) where there were cases of people with "totally drug-resistant (TDR) tuberculosis" and say that the "Indian report is the first since then" (http://tinyurl.com/6oqv3rf).

PIP Breast Implants

I didn't really know a lot about the recent breast implant story but I decided to find out about it...this is what I came up with.

Recently there has been a lot of coverage in the news about PIP (Poly Implant Prothese) breast implants due to "a health scare, after French authorities found a rupture rate of 5% and recommended implants were removed" (http://www.bbc.co.uk/news/health-16395244). Poly Implant Prothese was a French firm that "were banned in 2010, after their implants were found to contain industrial grade silicone gel, rather than medical grade" (http://www.bbc.co.uk/news/health-16395244). This supposedly led to a higher risk of the implants rupturing.

Andrew Lansley, the Health Secretary for England, launched a review, at the beginning of the week, due to the conflicting evidence for the rupture rates of the PIP implants. Some sources claimed that there was only a "1% (rupture rate) - in line with other implants" (statistics from the Medicines and Healthcare products Regulatory Agency (MHRA) (http://www.bbc.co.uk/news/health-16395244). Fergus Walsh, the medical correspondent for the BBC, has written an article at http://www.bbc.co.uk/news/health-16401016 about warnings of the statistics that have been produced and how some of it can be misleading due to the way that the data has been set out and collected.

In essence, this story is about the peoples reaction to the story. "40,000 British women have been fitted with the implants" (http://www.bbc.co.uk/news/health-16395244). Essentially, the data that Andrew Lansley is trying to get is the data that these women want to know; how many British women have had ruptured implants?

The options aren't very good at the moment for the women who have had the PIP implants. "Private clinics are refusing to replace the implants free of charge" (http://tinyurl.com/7w9o556). Looking at Attwood Solicitors website I found that those with the PIP implants can put a claim in for compensation but it's  not guaranteed. They also directed me to other websites for 'patient advice'.

I looked at three of the five websites that they advised the patients to look at;
- Harley Medical Group quoted The Chief Medical Officer (Dame Sally Davies), she said, "there is not enough evidence to recommend routine explantation (removal) of these breast implants". HMG have decided to find out which of their patients were given PIP implants and deal with those people, but have decided not to give free removals. (http://tinyurl.com/6prsrpq).
-Surgicare Medical Group have said that they have not been recommended to remove these implants and say they have been monitoring their rupture rates over several years and have not found any data that is a cause for concern. (http://tinyurl.com/6p7c9x9).
-Transform Cosmetic Surgery Group commented saying that they do not have sufficient data of ruptures in the PIP implants to remove them free of charge for their patients. (http://www.transforminglives.co.uk/latest-news.html).

Andrew Lansley said today that "private clinics that fitted implants have a "moral duty" to remove them" and that "the NHS would pay to remove, but not replace, implants if a private clinic refused" the issue with this is for the taxpayer who will then have to foot the bill; but he then said that "if the NHS was forced to remove an implant "the government would pursue private clinics to seek recovery of our costs" (http://www.bbc.co.uk/news/uk-16523464).

Assisted Suicide

As most people know Dignitas is the Swiss suicide clinic founded in 1998. I decided to go on the internet and find out some news stories about it after the news that "there is a strong case for allowing assisted suicide for people who are terminally ill in England and Wales" (http://www.bbc.co.uk/news/health-16410118). The case, made by The Commission on Assisted Dying, was that "it was possible to allow assisted dying within a strict set of rules to ensure it was not abused" (http://www.bbc.co.uk/news/health-16410118), the whole story is on the BBC News link.
Digging around on the internet I found an article on MailOnline on the 20th October 2011 about nurses not being able to tell patients about Dignitas or even offer it up as a suggestion even if asked about it by patients. They were even told they could go to prison for talking to patients about assisted dying, (whole story at http://tinyurl.com/7z6op7d).

Another story, run by The Telegraph on the 8th January 2012, gives information about a "clampdown" on the clinic because of the increasing number of British people who are travelling to Switzerland to die. Legalisation that could be put in place aims to make the patients have a longer counselling service to make sure that they want to die, (whole story at http://tinyurl.com/ldqh75).

The final story, a famous one, about a 23 year old rugby player who took his life at Dignitas. He was one of the youngest British man to take his life at Dignitas and was the first time it was really noticed by the British public, (whole story http://www.guardian.co.uk/uk/2008/oct/18/11).

These stories really bring the ethical issues to light, that people do really want to end their lives for one reason or another, as they don't see that it's worth living for anymore. The issue for doctors is that it is their duty to keep these patients alive, and giving them an option of suicide doesn't follow with their duty.

Disaccharides and Monosaccharides

Another one for AS Biology, by request...

A monosaccharide is a single sugar molecule such as Glucose, Fructose and Galactose. These bind together via glycosidic bonds to form disaccharides and water in a condensation reaction. To separate them again water needs to be added and a hydrolysis reaction takes place.

Glucose and Glucose create Maltose.
Glucose and Galactose create Lactose.
Glucose and Fructose create Sucrose.

The two Glucose molecules in Maltose are joined by a 1-4 glycosidic bond. This is because the Carbon's that form the bond bind to the Oxygen on Carbon 1 and Carbon 4. When there are branches in the structure they are linked by a 1-6 glycosidic bond as well as 1-4 glycosidic bonds, illustrated in this image (http://tinyurl.com/7qfy8zd).

The main structures (tested at AS level) are Amylose, Amylopectin and Glycogen. Amylose and Amylopectin are used to store energy in plants and Glycogen is an energy store in humans (broken down in respiration for ATP).

-Amylose (starch store) is a spiral structure with 1-4 bonds only and is not branched.
-Amylopectin (starch store) has more branches than Amylose as it has 1-4 and 1-6 glycosidic bonds.
-Glycogen has a lot more branches than Amylopectin and is used in humans due to the number of branches speed at which it can be hydrolysed, as humans need a higher energy rate than plants.

All three molecules are insoluble so have no osmotic effect on the cells, and are polysaccarides (many saccharides).

Transcription and Translation

This is one for those doing AS Biology this week...

The difference between RNA and DNA is that RNA is a single strand, has a ribose sugar opposed to a deoxyribose sugar, and uses the base Uracil as a replacement to Thymine.

-Transcription
This is the process where mRNA (messengerRNA) is formed when the DNA unwinds in a certain section. The strand of DNA is copied via free nucleotides coming together opposite their complementary bases and being stuck together into the mRNA by RNA polymerase. The mRNA then leaves the cell through the nuclear pores and attaches itself to a ribosome. Once it has left the DNA, it winds itself back up into its double helix structure.

-Translation
This process involves tRNA (transferRNA) and ribosome's. The ribosome acts as a holding site for the tRNA and mRNA to come together and for the mRNA to be translated. On the tRNA there is an anticodon. This anticodon is complementary to a codon (triplet base sequence) on the mRNA and the i.e. if the mRNA had a triplet code of UGC the anticodon would be ACG. The tRNA therefore has complementary bases to the mRNA and this is the start of the formation of the amino acid chains.

Attached to the top of the tRNA is a certain amino acid and this amino acid forms a peptide bond with the amino acid on the next tRNA, which has an anticodon that is complementary to the next triplet code. This is how the proteins are formed, where they then form a tertiary (3D) structure to create the final product.

I found a video on YouTube (http://www.youtube.com/watch?v=TfYf_rPWUdY&feature=related that sums it up quite well.

Platelet Donation

Carrying on from the topic of blood donation I will move onto platelet donation. The method used of taking the platelets out of the blood is called plateletpheresis. This term derives from apheresis which "involves removing whole blood from the donor and separating the blood into individual components" (http://www.medicinenet.com/hemapheresis/article.htm), in plateletpheresis it is the removal of platelets from the blood and then pumping the blood back into the body.

All types of apheresis involve "connecting the blood in the patient/donor's veins through tubing to a machine that separates the blood components, separation is done by either a centrifuge process or a filtration process" (http://www.medicinenet.com/hemapheresis/page2.htm). Once the components have been removed the blood is directed back into the body via another blood vessel.

But although it sounds all well and good to donate platelets, what are they needed for? Platelets are a part of the blood that assist in blood clotting by coming together and forming a platelet plug. The platelets that are taken from the donors are given to those who are "unable to make enough platelets in their bone marrow" (http://www.blood.co.uk/platelets/). This could be because of a "disease such as leukaemia or other cancers or the treatments they have had" (http://www.blood.co.uk/platelets/). However, the donors are able to make enough platelets to replenish the ones that have been taken "(only 20% taken) very quickly" (http://www.westred.org/BldAphr.htm).

The issue with platelet donation is that unlike blood, "they can be stored for only a few days" (http://www.blood.co.uk/platelets/about/). This means that there need to be frequent platelet donations to keep stocks up.

This clip on YouTube shows the process of donating plasma, which as I said earlier is the same as donating platelets but extracting a different component of the blood, (http://www.youtube.com/watch?v=hDsdY8-_lCo).

Blood Donation

There are fears that in the year of 2012 the United Kingdom will have a blood shortage, which may cause issues at the Olympic Games and other events, with "extra bank holidays leading to a drop in donations as most people give blood during the working week" (http://www.bbc.co.uk/news/health-16338795).

Blood, after being taken from donors, is collected in plastic bags which "contain anticoagulents and other preservatives" (http://tinyurl.com/d7zfw2h). Anticoagulents are drugs used to thin out blood and stop it clotting (coagulating), therefore making it useable for transfusions. The bags that the blood is stored in have a "material that allows for diffusion of gasses permitting optimum cell preservation" (http://tinyurl.com/d7zfw2h).

Once it has been bagged and taken to where it is to be stored, it is then "tested for Hepatitis B and C, HIV as well as other infectious diseases" (http://tinyurl.com/d7zfw2h) to make sure it is fit for use. It is then "stored in a fridge for up to 42 days, or frozen for up to 10 years" (http://tinyurl.com/d7zfw2h).

This means that a huge volume of blood can be stocked. On the National Blood Service website (http://www.blood.co.uk/StockGraph/stocklevelstandard.aspx) there are a number of graphs to show the stocks that are donated daily and also the stocks in the whole country (except for blood held in hospitals).

So on the BBC News website there is a quote from NHS Blood and Transplant that we will need "2 million pints (1.1 million litres) of blood plus an extra supply for Olympic visitors" (http://www.bbc.co.uk/news/health-16338795).

HRH Prince Phillip left Papworth Hospital yesterday morning and is home with his family.

Cardiothoracic Surgery

With news yesterday that an 18 year old was stabbed in the heart yesterday on Oxford Street, I thought it would be a good time to talk about surgery that can be carried out to save someone who has been stabbed in the heart.

The process needs to be carried out extremely quickly due to the loss of blood from the heart whilst it continues to contract, which means that the victim needs to be transported to the nearest cardiothoracic theatre as soon as possible for a good chance of survival. The problem is that not all hospitals do cardiothoracic sugery (surgery on the heart), there are a number in London, as well as private hospitals all over the United Kingdom but not all cities have specialist cardiothoracic surgeons at their local hospitals.

To start the heart surgery the surgeon will open the chest cavity "through the patients breastbone" (http://tinyurl.com/czudd7b) with an incision and then pull the rib cage open using a surgical tool called a 'haight-finochietto rib retractor', which then opens up the area of the chest that the heart sits in. It should take the surgeon one minute from making the incision in the breastbone, to having has his hands on the heart.

At this point the surgeon can make a decision whether to use a "heart-lung bypass machine, which takes over the hearts pumping action and moves blood away from the heart and allows the surgeon to operate on a heart that isn't beating and has no blood in it." (http://tinyurl.com/czudd7b). Or he can do surgery on the heart while it is beating, where they will use a clamp to steady one section of the heart that needs surgery, whilst the rest of the heart beats regularly. This second process takes a lot of skill and a very steady hand.

In the case of a stabbing there will be a hole in the heart which needs to be stitched up to stop the bleeding. To get to the heart the 'pericardium' needs to be penetrated. This is a "fluid filled sack that surrounds the heart; and works to keep the heart contained in the chest cavity, limit heart motion and prevent the overexpansion of the heart" (http://tinyurl.com/dxe7deb). Once the pericardium is penetrated, the surgeon is free to stitch up the stab wound and stop the bleeding.

After the surgeon has stitched up the wound and taken off the clamp/released the heart-lung bypass machine, he can either stitch up the pericardium or leave it unstitched. If he were to stitch it up this could "increase the risk of a cardiac tamponade, a compression of the heart that can occur when blood/fluid builds up between the myocardium (heart muscle) and the pericardium" (http://tinyurl.com/crysoby).

This shows that not only does a surgeon have to be very quick in his decision making, he also has to be very calm, as he only has one chance to get it right. To see this process in action click on the link (http://www.youtube.com/watch?v=hM4u2PXyBpg), but please note that it contains images of open chest cavities and live surgery.

Unfortunatly the 18 year old who was stabbed died on scene with a single stab wound and was unable to receive any medical attention.

HRH Prince Phillip

The news came out today that HRH Prince Phillip, The Duke of Edinburgh, has had a stent put into his coronary artery (the artery that takes blood to the heart muscle) due to a blockage and had caused him chest pains, known as angina.

He was flown to Papworth Hospital which is a specialist cardiothoracic hospital. This means that it deals with "diagnosis and management of surgery in conditions of the heart, lungs and oesophagus" (http://www.nhscareers.nhs.uk).

Now, a stent is a "small mesh tube used to treat narrow or weak arteries" (http://tinyurl.com/c26r4wl).

So what this stent effectively does is keeps the arteries open so that blood flow to the heart is restored, this is known as “angioplasty" (http://tinyurl.com/c26r4wl).

The way that this stent is inserted is by making a small opening in a blood vessel “in the upper thigh, arm or neck and then feeding a tube, with the stent lying on a deflated balloon, into the opening in the blood vessel. The doctor will then observe his movements of the stent by X-ray " (http://tinyurl.com/c26r4wl) so that he can position the stent in the right place of the coronary artery. He will then inflate the balloon in the right area, where the blockage is and the stent will be in place to keep the artery open. "Over time the cells in the artery wall will grow over the stent and it will be permanently fixed in the artery" (http://tinyurl.com/c26r4wl).

The Royal biographer; Penny Junor said, "He is an extraordinarily fit man. He takes a lot of exercise and he does an awful lot of work." (http://www.bbc.co.uk/news/uk-16325517). It is rather unusual for this to happen to someone who is so active, but it could be the result of a blood clot or a plaque that has formed, which is to do with the high blood pressure in the arteries. Because of the fact he is 90 could owe to the fact that his arteries are weaker, as the muscle and elasticity has become harder and not so strong.

Getting Started

So starting out in the blogging world... I've set this up to not only introduce medical knowledge and science in news to you, but also to try and find out about it myself. I am looking to do medicine at University and there is no better way to prepare for it than to start writing and really having a passion for it.

I hope you enjoy this blog and will join me on the journey. I only have One Life, and therefore One Chance at making a difference to peoples lives through medicine.

Benjamin