Stoptober

Tomorrow is October 1^st, which means the beginning of Stoptober – the 28-day stop smoking challenge. Nearly a quarter of a million people in England and Wales signed up last year and research has shown that stopping smoking for 28 days makes you 5 times more likely to stay smoke-free.

More than 79,000 deaths per year in England are due to smoking-related causes. 90% of lung cancer cases are due to smoking, and it can also cause cancer in other parts of the body. It also damages your heart and circulation, putting you at risk of coronary heart disease, heart attack, stroke and vascular diseases. Additionally, it puts your lungs at risk of chronic bronchitis, emphysema, pneumonia and chronic obstructive pulmonary disease (COPD). So your health is an obvious reason to give up smoking. 

The effect on your body after you stop smoking:

Stopping smoking does not only have a beneficial impact on your health. The average smoker has 13 cigarettes per day - 364 in 4 weeks. Therefore, Stoptober would save you £141 and a whole year without smoking saves you £1,696!

Stopping smoking is not only adding years onto your life, it's saving you money to spend in those years. To sign up, go to https://stoptober.smokefree.nhs.uk. 

The result...

After my last couple of UKCAT practices not going very well, especially in the quantitative section, I had started to panic slightly. But I attempted to remain positive, thinking "it will all come together on the day", and today was it! So here it is...

735 band 1

Verbal - 610

Quantitative - 790

Abstract - 760

Decision - 780

I had been hoping for around the 750 mark, but still very happy with my score. Massive improvement from last year for the verbal and quantitative sections - no idea how quantitative managed to be my highest scoring section! 

For the test statistics to date for this year's test cycle, this puts me in the top 10%! So hopefully there won't be loads of amazing people taking the test between now and the end of the test period!

HPV vaccine for boys?

Since 2008, a vaccine against the human papilloma virus (HPV) has been routinely offered to girls age 12 and 13 as part of the NHS childhood vaccination programme. However, it has been criticised that it is not offered routinely for boys. Currently, if parents want their sons vaccinated, they have to pay £450.

There are more the 100 different types of HPV, and the virus is easily spread by sexual activity. It can cause the common STI genital warts, cervical cancer, as well as cancer of the vagina, anus, penis and mouth. The vaccine Garsidil protects against two types of HPV, which cause more the 70% of cervical cancer cases in the UK.

At the moment, there are regional variations of girls being vaccinated, with 96% in some areas, compared to just 62% in others. Researchers at GSK found that the national uptake of the vaccine is 86%. Experts have said that if 96% of girls across the UK had the vaccine, then 198 cervical cancer cases and 87 deaths could be prevented every year. With 14% of girls not being vaccinated, herd immunity cannot be achieved, which puts many girls and boys at risk.

As boys are not offered the vaccine, this puts them at risk when having sex with the 14% who have not been vaccinated in the UK. Additionally, men are at risk if they are sexually active with men, or with those from countries where the vaccine is not available. More than 2,000 cases of cancer in men are caused by HPV each year. Extending the vaccination programme to boys would outweigh the costs of treating HPV-related diseases.

Scientific experts are meeting to discuss whether boys should also be offered the vaccination against HPV. However, they are investigating whether to extend to it boys, or men who have sex with men, or both. This is absurd as vaccinating only gay men seems extremely unfair to heterosexual men and also women who were over the age to be routinely offered the HPV vaccination. The fairest solution would be to introduce the HPV vaccination to adolescent boys.

First stages

As the medicine UCAS deadline of October 15^th looms closer, the various components of the application are slowly coming together. Yesterday I started my UCAS application, which is a very lengthy process to go through every exam result from GCSE, through A level modules and then my degree! And today, after about 7 drafts and trying to be within the limit, I may have finally finished my personal statement. I now have just 3 days left until I take the UKCAT, so these will be spent doing the last practice tests I have to hopefully prepare me for it! Once I have my UKCAT result, I will then be able to decide which universities are best to apply for – so fingers crossed!

Resisting Alzheimer's

Alzheimer’s disease has a prevalence of 850 per 100,000 people and is the most common form of dementia. Dementia causes deficits in memory, cognitive function and language (for more information on dementia, see my previous post - http://my-medical-musings.blogspot.co.uk/2014/09/dementia-in-news.html).

Image: Upright Health

Alzheimer’s disease is caused by a loss of neurons in the brain, but it is not completely understood why this happens. The dominant theory is the “amyloid hypothesis”, which suggests that proteins misfold, causing fibrous aggregates known as plaques. Pathophysiology may also include oligomers, which are formed in the production of the amyloid plaques. The oligomers are thought to cause toxicity by disrupting cell membranes, causing them to die. Additionally, tau deposits are also thought to contribute. These neurofibrillary tangles interrupt signal transmission between neurons, leading to cell death.

Image: Brain Athlete

There are few drug current treatments for Alzheimer’s that target neurotransmitters, but their efficacy is not great. Therefore, researchers are looking at targeting processes that cause pathophysiology. A recent article in Nature Neuroscience reveals how researchers at the University of California may be in the early stages of understanding how the brain may be able to fight early damage.

The study involved 71 adults with no signs of mental decline memorising a series of pictures in detail and later recalling them whilst their brain activity was recorded. Results found that of those with amyloid deposits, better recall correlated with increased brain activity. The researchers suggested that their brains were able to adapt to compensate for early damage caused by the protein. Whilst this is a significant finding, more research is needed for further understanding of how people react to amyloid differently and the next stage will be to test those with Alzheimer’s disease.  

One researcher suggested “people who spend a lifetime involved in cognitively stimulating activity have brains that are better able to adapt to potential damage”. So keep doing that sudoku, no matter how long it takes you – just keep the brain active!

MISSING: Cerebellum!

A woman, age 24, was admitted to hospital in China after complaining of dizziness and nausea, only to find she had part of her brain missing. Her mother reported she had not walked until age 7 and she had not been able to walk steadily her whole life. A CAT scan revealed that she had no cerebellum and that the space was instead filled with cerebrospinal fluid.

Top image: Normal brain showing cerebellum (http://myweb.tiscali.co.uk/ataxia.pages/)

Bottom image: Brain missing cerebellum (Feng Yu et al.)

The cerebellum modifies motor commands in order to maintain balance and posture, coordinate voluntary movements, and it plays a part in motor learning and cognitive functions. Although it represents 10% of the brain’s total volume, it contains 50% of its neurons.

Only a few are known to have lived without the entire cerebellum, but it usually causes severe mental impairment, motor disorders or epilepsy. However, this woman only had a moderate motor deficiency, and despite her speech only becoming understandable at age 7, she only had mild speech problems.

The doctors suggest that normal cerebellar function may have been taken over by the cortex, showing how plastic the brain is, being able to compensate for such an important part.

Dementia in the news

Dementia is becoming an increasingly common topic amongst news stories on health and a poll has revealed that nearly 60% of over 50s in the UK are more scared of developing dementia than cancer. The ageing population means more people are being diagnosed as they are living longer. However, a health study reported this week that twice as many people in the UK are developing dementia before the age of 65. The research showed that there are thousands of early-onset dementia sufferers in their 40s, as well as more than 700 in their 30s!

Dementia is a term used to describe a set of symptoms that are caused by brain conditions, the most common form being Alzheimer’s disease. Such diseases do not only affect the elderly, and therefore, need to be recognised in younger generations. Early symptoms of dementia include: lack of initiative/interest, changes in personality/mood, misplacing things, problems with keeping track of things, poor judgement, distortion of time or place, language problems, difficulty performing familiar tasks (e.g. dressing), and the most obvious symptom – memory loss. However, younger people with these symptoms may be reluctant to report such symptoms to the doctor, as they may be afraid of the stigma surrounding dementia. Therefore, they may fear that they will be discriminated against, especially in the workplace.

It was also reported this week by researchers from the Alzheimer’s Society that patients with dementia are effectively paying a “dementia tax”. They found that on average £32,242 was spent a year on care for a patient with dementia, but only around one third came from the NHS or council funds. The other two-thirds came from private care services or in the form of unpaid care. Those with cancer or heart problems get all their care for paid by the NHS, which seems unfair. However, the cost of caring for those with dementia is increasing due to the ageing population, so it would be extremely costly to the NHS to pay the full cost of care.

Dementia has also been in the news this week for being linked to use of anxiety and sleeping pills. This was found in a study of 2,000 people aged over 66 with Alzheimer’s disease in Quebec, Canada, compared with 7,000 healthy individuals of the same age. They found that the use of benzodiazepines for longer than the recommended 12 weeks was linked to a 51% increased risk of dementia. However, they did not find an underlying reason behind the link and suggested a limitation of the study was that anxiety and sleep disturbance are early symptoms of Alzheimer’s disease.

New rules on the pitch

The lack of immediate medical treatment for players who suffered head clashes at this year’s FIFA World Cup has sparked a lawsuit, brought about by a group of players and parents in the US. The group are asking for the rules of football to be changed to allow better prevention and management of head injuries and concussion. It is thought that three bouts of concussion could cause permanent brain damage and heading the ball repeatedly may reduce cognitive function.

The Premier League has introduced new rules on how to deal with head injuries, starting in the 2014-15 season. The policy states that a player suffering a head injury must now leave the pitch and the club doctor must decide whether the player is able to continue, not the team management. If there is a confirmed or a suspected loss of consciousness, the player will not be allowed to return to play. Home teams must also have a third “tunnel” doctor to support the doctor of each side. Furthermore, a campaign is to be launched to make players and managers aware of the dangers of head injuries and players must undergo baseline neurological assessments as part of their annual medical check-up.

England players help to promote the FA head injury campaign

However, this does not fully the tackle the risks associated with head-to-ball contact. In 2002, Jeff Astle, the former West Bromwich Albion player and England striker, died at age 59 due to chronic traumatic encephalopathy. This degenerative brain condition is usually associated with boxers, but in this case, it is thought that it was caused by heading footballs. After a long-running campaign, Astle’s family met with FA chairman Greg Dyke in August and the Football Association has agreed to research into head injuries in the sport. Although footballs are much lighter than those used in the 1960s when Astle was playing, footballs can travel up to around 60mph in a professional match. Therefore, these blows to the head can still have a serious impact on the brain, even though they are not severe enough to cause concussion. Not only is it thought to cause cognitive impairment; it is also likely to have an effect on memory. Studies have shown that those heading the ball more often performed worse on memory tasks and tests of their attention span. Furthermore, those who were frequent “headers” showed obvious signs of mild traumatic brain injury on scans.

Some researchers argue that head trauma is usually due to the head clashes when players are going to head to ball, rather than the contact with the ball. Nevertheless, these studies show that head injuries in football can have very serious consequences. The research the FA has agreed to is likely to reveal more information into the dangers of heading the ball. However, long-term studies are needed to assess the lasting effects. It has been suggested that young footballers should be limited on how often they can head the ball. Will there be a time in the future where there are restrictions on the number of times professional players are allowed to head the ball?

Ashya King - neglect?

On Saturday it was reported that parents took their 5-year-old son suffering from a brain tumour from hospital, against medical advice. After medical staff from Southampton General Hospital informed the police that Ashya King was in “grave danger”, an international search was launched and Hampshire Constabulary obtained a European arrest warrant. Additionally, Ashya was made ward of court, which means he is appointed a guardian by the court.

The family were found in the city of Malaga in Spain on Saturday evening, where they have an apartment. The parents were arrested the same day and taken to a prison just outside Madrid, whilst 5-year-old Ashya was taken to a hospital in Malaga.

The European arrest warrant was granted on the grounds of neglect as the parents had been advised that Ashya’s condition would become critical if he was removed from hospital. One major concern was that the battery in his feeding device would run out. However, Ashya’s older brother posted a video on YouTube explaining that they were charging the device in the car on the journey to Spain and they had the same resources available as in the hospital, as they were able to order them online. He also explained that they had travelled to Spain to sell their property in order to fund a treatment provided in the Czech Republic, called Proton Beam Therapy. This is a form of radiation therapy that uses beams of protons directed more precisely at the tumour than other conventional treatments. The beams stop once they hit the target, which supposedly causes less damage to the surrounding tissue.

Ashya’s parents refused consent to their extradition to the UK, and are remaining in custody for 72 hours while the High Court Judge considers granting bail. Ashya’s six siblings were unable to visit their brother as he was under police guard. This meant the 5-year-old was alone, and unable to speak or understand any Spanish. However, yesterday afternoon Ashya’s eldest brother was allowed to visit him.

The family and the public have criticised the police’s approach to finding Ashya and his parents, saying it was a “ridiculous chase” and “cruel” that the parents are being “treated like fugitives”. However, the intention of seeking alternative treatment was not known during the search for the family on Saturday, and the police were just going by what they were told by Southampton General Hospital.

It is understandable that it was instinct for the parents to try and do what is best for their child. Ashya’s parents made it clear they are willing to do whatever is necessary for their son’s health, as they consented to blood transfusions during an operation two months ago, which in the end was not needed. However, removing Ashya from hospital against medical advice was irresponsible. Not only would travelling by car from the UK to Spain be tiring and stressful for Ashya, but also his family were unable to properly monitor his condition, which could have put him at great risk. Ashya’s parents attempted to discuss the use to proton beam therapy with the doctors at Southampton General Hospital, but ignored their judgement that the treatment was unsuitable for their son. Nevertheless, they could have informed the hospital that the clinic in the Czech Repeublic had agreed to assess whether Ashya was eligible so that arrangements could have been made for Ashya to be safely transported from the UK.

Despite what may be interpreted as neglect, it is critical that the situation resolves. Ashya will be scared, confused and missing his parents. The family needs to be reunited and it is vital that communication is made between the family, Southampton General Hospital and the proton beam therapy centre in the Czech Republic in order to agree on the best course of treatment for Ashya.

UPDATE (03/09/2014)
After publishing this post on Tuesday, the same day the Crown Prosecution Service withdrew the European arrest warrant, saying "there is insufficient evidence for a realistic prospect of conviction for any criminal offence". Since being released on Tuesday, the parents were reunited with Ashya at the hospital in Malaga today.

My ALS ice bucket challenge!

I wrote about the benefits of the ALS ice bucket challenge over a week and have been waiting to be nominated. Yesterday, I was finally nominated by my sister, Izzie.

So here it is!