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Health and Disease

Motor Neuron Disease: Symptoms, Causes, and Treatment

Motor neurone disease is the condition where messages from the motor neurones, which help carry electrical impulses from stimuli and sensory neurones, begin to stop reaching the muscles, preventing response. Stimuli include anything from sound, touch, smell, and even taste, which then allow an appropriate response, such as moving your hand away from a boiling object. In motor neurone disease (or MND), muscles, which are effectors in the stimuli-response cycle, meaning they put the response into action, begin to stiffen and waste away. Behavior and mental ability can also be affected. The disease is very uncommon, affecting roughly 5000 in the UK at any time, and can cause different symptoms in each patient.  

Causes

The causes of motor neurone disease are currently unknown. There is no clear hereditary link, although you are more likely to suffer from MND if a close relative has had the disease. MND is much more common in those over 50 and with other conditions, such as specific types of dementia. 

Symptoms

  • Weakness in the legs and ankles as well as trouble climbing stairs and more frequent trips and falls
  • Speech difficulty, including slurring as well as trouble swallowing and inability to express yourself through gestures and body language
  • Difficulty gripping items such as pens, opening jars, and often dropping things
  • Muscle cramps and tingling 
  • Weight loss due to muscle decay, which can cause thinning of arms and legs in particular
  • Inability to control laughter or tears in inappropriate situations
  • Changes to saliva consistency or volume
  • Weakened coughing, causing difficulty as unable to remove saliva
  • Difficulty breathing, leading to fatigue

Types

  1. Amyotrophic lateral sclerosis (ALS)- the most common form of MND that causes muscle wastage 
  2. Bulbar onset MND or Progressive bulbar palsy (PBP)- less common than ALS and affects the muscles in the face, throat, and speech, causing slurring and difficulty swallowing
  3. Progressive muscular atrophy (PMA)- affects a very minute proportion and causes problems with the hands and grip
  4. Primary lateral sclerosis (PLS)- highly uncommon and causes muscle stiffness and selected speech problems and is not usually life-shortening due to very slow progression

What can Motor Neurone Disease be Misdiagnosed as?

Motor Neurone Disease can sometimes present very similarly to Kennedy’s Disease or SBMA. Kennedy’s disease also affects the motor neurones and can cause muscle weakness and wastage, although additional hormonal problems may contribute. These two diseases are often confused at diagnosis, however, those with Kennedy’s disease usually live a normal lifespan. Problems with inflammation of the spinal cord, nerve damage, and muscle damage can also mimic MND, as well as strokes. It is vital to contact a GP as soon as symptoms of MND are observed for diagnostic tests

How is it Diagnosed?

  • Blood and urine tests can show rises in creatinine kinase, which is produced due to muscle wastage 
  • MRIs can prove that symptoms are not caused by another condition such as a stroke
  • Electromyography (EMG) and nerve conduction study (NCS) to show how electrical impulses and nerve function is working
  • Muscle biopsies to disprove other muscular conditions
  • Spinal taps and lumbar punctures can also rule out other conditions

Treatment

Although there is no way to treat the disease itself, there are ways that patients’ quality of life can be improved and day to day actions facilitated. Riluzole is a drug that has been proven to slightly slow down the progression of motor neurone disease, despite it still not being a cure. Specialized clinics with nurses and occupational therapists can help motor neurone disease sufferers. Regular physiotherapy can also help to combat muscle weakness, stiffness, and pain. In a more holistic approach, speech therapists and dieticians can also be involved in patient care to offer advice. 

Emotional support can also be vital for those with motor neurone disease and carers can be one way to allow sufferers to remain living independently. Joining groups and forums, such as the one run by the “Motor Neurone Disease Association”, can help to have advice and support from others who also have the disease. Organizations such as this can also offer financial support for those with motor neurone disease and advise as to where sufferers can seek professional help from hospitals who have expertise in motor neurone disease. 

References

“About MND.” StackPath, http://www.mndassociation.org/about-mnd/.

“Motor Neuron Disease: Types, Symptoms, Causes, and Treatments.” Medical News Today, MediLexicon International, http://www.medicalnewstoday.com/articles/164342#treatment.

“Motor Neurone Disease.” NHS Choices, NHS, http://www.nhs.uk/conditions/motor-neurone-disease/. 

Categories
Health and Disease

A Brief History of Organ Transplantation: The Past, Present, and Future

By Sophie Farr

Published 6:46 PM EST, Thurs June 10, 2021

History

Transplantation began with the basic principle of the Carrel Patch which proved that a vein could be reattached and still support a functioning blood flow. This technique was employed by the Ukranian surgeon Voronoy Kiev and allowed him to accomplish the feat of being the first person to successfully transplant a kidney in a cadaver. 

After this promising start to transplantation, medical advancements were catalysed during the Second World War of 1939-1945 and transplantation especially had major breakthroughs. The war meant that severe injuries were more common and novel treatments could be tested as a last resort. Skin grafts were first used to heal airmen’s burns and this prompted the realisation that the immune system may reject transplants, a problem which has continued throughout the surgery’s development. 

David Hume, an American doctor, was the first to attempt a kidney transplant in a living patient, albeit in the arm instead of in the normal position in the thorax. The implanted kidney was removed After two days and natural function then resumed and the patient miraculously survived. This is still seen in the NHS today with the “Bridge to Transplant System” which uses ventricular assist devices for prospective heart surgery patients that are then removed and if the relief has assisted function, full transplantation may not be necessary. 

In 1951, a doctor in Paris performed the first ever renal transplant, using the kidney of an executed criminal, into a patient in renal failure. Although the surgery failed, the kidney was transplanted into the groin and bladder which forms the basis of the modern technique. Still in Paris, the first ever successful live kidney donor, Mrs Renard, gave her organ to her son Marius in 1952. Mrs Renard’s kidney functioned in Marius for 21 days but then it ceased but this was most likely due to rejection.

Finally, the first successful transplantation was achieved in Boston in 1954, having been done on a set of identical twins. One twin was experiencing kidney failure and the other donated a kidney which was transplanted without rejection because of their identicalness. After renal transplants had been accomplished, liver transplants followed in the 1960s and the first successful heart transplant happened in 1967. This heart transplant was undertaken by Christian Barnard in Cape Town on a female car crash victim and marked the greatest achievement in transplantation, now allowing full heart and lung transplants. 

Present

Since the amazing triumph of successful transplants, the world has been focused on decreasing the likelihood of complications. Immunosuppressants have been widely used to reduce the chance of rejection and 6MP and azathioprine are the most commonly used after the immunosuppressive effect was demonstrated in a rabbit by Schwarz and Dameshek and on a dog in 1959 by Roy Calne, who later performed the first European liver graft in 1968 in Cambridge. 

Preservation has also been a pressing issue as chance of function is reduced with poor preservation. In the past, kidneys were simply stored in ice, preservation fluid and a plastic ice to remain sterile but this arrangement was less successful with livers so the University of Westconsin Preservation fluid was developed by Jamieson for normal liver function. This fluid, combined with improved anaesthetic and the ability to keep patients warm during surgery to prevent clotting, increased transplantation success rates by the 1980s and further advancements are still improving chances of success today.

The opt-out system of organ donation that the NHS moved to in March of 2020, where all adults are assumed to be donors unless they actively specify against, has mitigated against the issue of how few organ donations the NHS had. This, combined with the risk of reduced function due to storage, means that transplantations have long waiting lists and it is contentious as to who receives them. Currently, storing organs for more than 12 hours in ice means that efficacy decreases by 25% every 6 hours. 

Future

In the future, the main developments are likely to surround storage and preservation. Cold storage can cause tissue injury and immediate graft function is roughly 65% effective, compared to the delayed function that is only 35% effective. In order to combat these worrying statistics, ex vivo normothermic machine perfusion, a new technique that restores kidney function out of the body before it is transplanted to remove the issue of cold storage, is being tested as a way to repair kidneys and allow more organs to be successfully transplanted.

Write up based on “Horrible History of Organ Transplantation and its Future” at the Cambridge Festival 

Sophie Farr, Youth Medical Journal 2021

Categories
Health and Disease

Management for Heart Attacks: Angioplasty and Bypasses

By Sophie Farr

Published 7:21 PM EST, Wed April 21, 2021

What Is A Heart Attack?

Throughout our lives, deposits of saturated fats called plaques can build up in the arteries of our hearts because of high cholesterol levels. Over time, this can lead to the restriction of blood flow due to vessel narrowing. These fatty deposits can lead to a complete blockage of an artery because of formed blood clots. If this occurs in the coronary artery, oxygenated blood may be prevented from reaching the heart muscle tissue. Without this vital oxygen, which is needed for aerobic respiration and normal cell function, the heart muscle can begin to die. The longer the blockage continues, the more damage can be done to the heart;this effect is known as a heart attack. In the worst case scenario, if the clot is dislodged and becomes mobile, it may travel to different areas of the body and, when it reaches the brain, could cause a stroke. 

What Are The Risk Factors For Heart Attacks?

Your risk of having a heart attack is increased by both hereditary and lifestyle factors. Firstly, a diet full of saturated fats, such as butter, cakes and bacon, increases the LDL (low-density lipoprotein) cholesterol in your blood, leading to more fat deposits. Furthermore, a sedentary lifestyle means that deposits build up more readily; smoking can also cause this effect. Another key risk factor is genetics. Men are more likely to suffer from a heart attack than women. Stress hormones, such as cortisol, can increase your heart rate which, in turn, causes more fat deposits in arteries. 

What Are The Symptoms Of A Heart Attack?

The main symptom of a heart attack is severe chest pain which may radiate across the left arm, shoulder or even abdomen. Sufferers describe this pain to be “crushing” and “vice-like”, which can cause patients to collapse and be unable to perform daily activities. Despite some cases having extreme and visible symptoms, women and the elderly are more likely to experience lesser symptoms such as mild discomfort, agitation, lethargy and weakness. 

What Is The Immediate Response In Case Of A Heart Attack?

Treating heart attacks is a key part of most first aid qualifications. If you encounter a suspected heart attack, the crucial thing is to call emergency services as soon as possible to ensure the patient receives required treatment quickly. While you wait for further assistance, the pain of a heart attack can be partially relieved by sitting the patient in the “W” position. This refers to sitting on the floor, against a wall, and bringing your knees upwards to create a “W” shape. If there is access to medication, the patient should chew a 325mg aspirin, which works to thin their blood. This would allow potential blood flow through a blockage. 

Coronary Angioplasty

Coronary angioplasty is a medical technique that attempts to relieve the blockage by expanding the artery. Not all hospitals have access to the resources required to undertake this complicated procedure. Therefore, ambulances always attempt to take patients with suspected heart attacks to advanced cardiology units such as the Royal Papworth. Coronary angioplasties are usually done through a large vessel in the groin (the femoral artery) or the arm. A catheter, with a deflated balloon attached, is threaded through to the potential site of the blockage. Once the afflicted area is reached, the balloon can be inflated which expands the artery and relieves the blockage, allowing oxygenated blood to reach the heart. Commonly, a stent is also placed in the affected artery to hold it open to prevent further damage from deposits. These are typically made of a flexible metal and aid disease management into the future. 

Coronary Bypass

A coronary bypass involves taking a blood vessel from either the arms (radial arteries), chest (internal mammary arteries), or legs (greater saphenous veins) and reattaching it to the heart. This redirects blood flow to ensure oxygenated blood reaches the heart. The blood vessel created is referred to as a graft, and the whole procedure is done in 3-6 hours under general anesthetic. If there is a risk of a patient experiencing further damage to the heart in the same area, or another heart attack, this graft can help to lower the risk.

Sophie Farr, Youth Medical Journal 2021

References

NHS England, “Treatments for Heart Attacks”, Accessed March 2021 from: https://www.nhs.uk/conditions/heart-attack/treatment/#:~:text=Primary%20percutaneous%20coronary%20intervention%20(PCI),-Primary%20percutaneous%20coronary&text=It’s%20a%20procedure%20to%20widen,such%20as%20low%2Ddose%20aspirin.

NHS England, “Coronary Artery Bypass”, Accessed March 2021 from:

https://www.nhs.uk/conditions/coronary-artery-bypass-graft-cabg/

Mayo Clinic, “Cardiac Catheterization” Accessed March 2021 from: 

https://www.mayoclinic.org/tests-procedures/cardiac-catheterization/about/pac-20384695

Categories
Biomedical Research

Asphyxiation and Westaby Tubing

By Sophie Farr

Published 5:49 PM EST, Sun March 7, 2021

Introduction

The world renowned cardiothoracic surgeon, Professor Stephen Westaby, details tragic cases of asphyxiation during his career in his memoir, “Fragile Lives,” and his innovation, which revolutionised treatment. Asphyxia is a broad term which refers to when the body does not have sufficient oxygen, resulting in unconsciousness and  suffocation. Although they may all result in asphyxia, there are a plethora of different causes of the critical state which include choking, severe burns, seizures, carbon monoxide poisoning and contact with other harmful chemicals. This allows the condition to be separated into two causes: physical or chemical asphyxia. This article will focus on physical asphyxia but also touch on carbon monoxide poisoning as the most common cause of chemical asphyxia. 

Physical Asphyxiation

Physical asphyxia is typically due to obstruction or mechanical force which prevents your cells from receiving sufficient oxygen through breathing. For example, choking is an obstruction which results in asphyxiation due to it preventing you from taking deep enough breaths to supply the body with adequate oxygen levels. In cases such as these, as well as similar causes such as aspiration which is where food or water travels down an incorrect pipe, treatment is urgently required to remove the blockage. Many people will be familiar with the Heimlich maneuver and abdominal thrusts to resolve choking and CPR. Furthermore, mouth to mouth resuscitation is also commonly used to save the victims of drowning (a type of aspiration). But what happens when parts of your own body are causing this fatal obstruction?

Seizures are another more common cause of physical asphyxiation due to epileptic seizures sometimes causing apnea or a sudden break from breathing. If this occurs, oxygen saturation can plummet to fatal levels and require immediate treatment. Epileptic seizures can also cause asphyxia through force as the airway can occasionally become obstructed by objects such as pillows when convulsing. 

As Professor Stephen Westaby narrates in his book, many cases of asphyxia are the result of trauma such as severe burns. He tells the harrowing story of a young boy Cape Town, Olim, who had been the victim of an explosion in his house, inhaling toxic gases,  likely due to a stove or gas cooker. In cases such as this, the body’s own process of recovery, through inflammation of the affected tissue and scabbing to allow healing, can cause asphyxiation. These patients are likely to already be in critical conditions, unable to breath unsupported by a tracheostomy: a surgery where incisions are made in the trachea to allow air to be ventilated through tubing through the neck. However, treatment such as this can be dangerous due to the risk of infection around the exposed tubing and not always accessible, especially in crisis hospitals where this young boy was treated. 

Westaby Tubing

Professor Westaby was personally affected by the traumatic complications as his own grandmother had experienced asphyxiation in the final weeks of her struggle against thyroid cancer. This connection to the horror patients’ experience inspired him to not only become a doctor due to wanting to prevent other people suffering through that level of pain and fear, but also made him determined to treat the young boy. Having previously treated a construction worker, Mario, who had suffered extensive burns in an accident, Westaby had made great scientific progress by pioneering a new technique for asphyxiation. He employed the help of a company which produced medical tubing and requested them to produce a Y-shaped piece which could be fed down the bronchi, through the damaged tissue, until it reaches a healthy lung to aid breathing and relieve asphyxiation. This procedure, although novel and potentially risky, alleviated the patient’s suffering and allowed for easier management of an otherwise horrifically painful illness. Westaby received the honor of having the new medical tubing named after him and it is now branded as “Westaby Y-Tubing”.

Despite being presented with an even more complex case, due to it being on a child who was malnourished and had a significantly smaller respiratory system, Westaby adapted his treatment to a child’s body. His adaptability and confidence are key skills any doctor requires; although there were risks to the surgery, Olim’s injuries were likely to be fatal therefore it was worth attempting treatment to improve his quality of life. The operation was successful but, tragically, Olim passed away a year and a half later with no obvious cause. 

Chemical Asphyxiation

The most common cause of chemical asphyxiation is carbon monoxide poisoning. The colourless, odourless, toxic gas binds with haemoglobin in red blood cells to form carboxyhemoglobin. This results in a reduced capacity for the red blood cells to carry oxygen and, in turn, the effects of asphyxia due to insufficient oxygen levels. Therefore, the symptoms of carbon monoxide poisoning, such as fainting, are the same as the broader disease. In order to prevent poisoning, house owners should purchase a CO monitor to detect the gas in case of emergency.

Although asphyxia has a multitude of different causes, professionals such as Professor Stephen Westaby offer us hope that medical advancements are offering innovative advancements as time progresses. His career acts as an example for aspiring doctors who can learn from these transferable skills of problem solving, pragmatic thinking, and creativity.

Sophie Farr, Youth Medical Journal 2021

References

“What is Asphyxia?” Web MD, Accessed February 2021 from: https://www.webmd.com/first-aid/asphyxia-overview#1 

“Fragile Lives” Professor Stephen Westaby

“Asphyxiation” Medical News Today, Louise Morales-Brown, September 2020; Accessed February 2021 from: https://www.medicalnewstoday.com/articles/asphyxiation 

Geevasinga, Nimeshan et al. “Choking, asphyxiation and the insular seizure.” Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia vol. 21,4 (2014): 688-9. doi:10.1016/j.jocn.2013.05.012 

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Health and Disease

Hypothyroidism: Possible Cause of Fatigue, Weight Gain, and Constant Coldness?

Introduction

Approximately 5 in 100 people in the US, over the age of 12, suffer from hypothyroidism. This condition, more commonly known as an under-active thyroid, can cause unpleasant symptoms such as chronic fatigue which can make the daily lives of those affected significantly harder. Luckily, the disease can be easily treated but needs constant monitoring throughout one’s life to ensure that they have the correct dosage of medication

Symptoms

  • Excessive tiredness
  • Weight gain
  • Low mood
  • Constipation
  • Sensitivity to cold
  • Dry and scaly scalp
  • Brittle hair and nails
  • Slow movements and thoughts
  • Muscle aches and weaknesses

What is Hypothyroidism?

The thyroid gland is a butterfly-shaped organ in front of the trachea which controls the release of vital hormones. Your metabolism is controlled by this small organ and the hormones it releases allow the regulation of energy gained from food. The main hormones the thyroid is responsible for are triiodothyronine (T3) and thyroxine (T4) and fluctuations in these levels can cause symptoms of either hypothyroidism or hyperthyroidism (known as an overactive thyroid). If the thyroid gland doesn’t produce enough T3 or T4, you begin to experience the symptoms of an underactive thyroid which can result in constant tiredness, gain in weight, and a lower mood if not treated properly. 

Causes

An underactive thyroid can be present from birth, this is called congenital hypothyroidism, and all newborns in hospitals will be tested through the blood spot test at roughly 5 days old. Sometimes the immune system randomly attacks the thyroid gland, causing you to develop an underactive thyroid, and this common cause is known as Hashimoto’s disease. This disease causes hypothyroidism as a result of an autoimmune disorder, rather than direct damage to the gland, as it causes inflammation which prevents normal hormone function. 

Other causes of hypothyroidism can include damage to the thyroid during radiation treatment or surgery for a severely overactive thyroid, goiter, or thyroid cancer. During these procedures, excessive damage may be caused due to radiation attacking healthy cells as well as cancerous ones or a surgeon having to remove the whole organ as a result of other conditions. The treatment for hypothyroidism due to these causes is the same as that of Hashimoto’s and the symptoms can usually be easily treated using the right dose of hormone replacement. 

Finally, one other cause of hypothyroidism, albeit less common, is thyroiditis. Thyroiditis is a broad term that encapsulates any inflammation of the thyroid. Initially, thyroiditis can cause secretion of increased T3 and T4, leading to symptoms of overactive thyroid, which can last for the first 3 months after developing the condition. After this period, the thyroid may become underactive, which is usually temporary and only lasts a year- a year and a half, but occasionally is permanent. Thyroiditis can come on after childbirth (postpartum thyroiditis), due to a bacterial or viral infection (subacute thyroiditis), or painless, asymptomatic thyroiditis (“silent” thyroiditis). 

Diagnosis

If you suspect you may be suffering from an underactive thyroid, it is important to speak to a family doctor so they can either perform diagnostic tests or refer you to a hospital’s endocrinology department if your case appears to be severe. Typically, the initial diagnosis of hypothyroidism can be made through a thyroid function test which is performed similarly to a classic blood test. This can show your medical team whether you have high levels of TSH (thyroid secreting hormone) and your T4 function. Once this test is performed, you can usually be treated by your local family doctor or GP but you may be referred to a specialist hormonal department (endocrinology) at a hospital if you are under 16, pregnant, or have underlying health issues that may affect treatment. 

Treatment

Usually, an underactive thyroid is treated using oral hormone replacement tablets of levothyroxine. Most patients will have their TSH and T4 levels monitored at regular 3-month intervals to ensure you have the right dosage to effectively replace the lacking T3 and T4 hormones. Initially, you may be started on a low dosage (for example 25 micrograms) but if symptoms do not improve this can be adjusted, usually by going up by 25 micrograms or potentially 12.5 micrograms in children for a less dramatic increase. Once the correct dose is found, patients usually report an improvement in symptoms and only require monitoring on a yearly basis. However, it is important that if, after a while, your symptoms worsen to contact your doctor as this may indicate that your dosage is incorrect. 

Complications

Rarely, hypothyroidism can cause complications such as heart disease, goiter, pregnancy complications, and in extremely severe cases myxoedema coma. These complications typically only occur if a patient has suffered from a severely under-active thyroid, without treatment, over a long period of time. It is vital to contact a medical professional if you appear to be suffering from any of these complications and are experiencing classic symptoms of an under-active thyroid. 

Sophie Farr, Youth Medical Journal 2021

References

NHS England, “Underactive thyroid”, Accessed January 2021 from: https://www.nhs.uk/conditions/underactive-thyroid-hypothyroidism/ 

US Department of Health and Human Science, “Hypothyroidism”, Accessed January 2021 from: https://www.niddk.nih.gov/health-information/endocrine-diseases/hypothyroidism#causes

Endocrine Web, “Thyroid gland overview”, Accessed January 2021 from: https://www.endocrineweb.com/conditions/thyroid-nodules/thyroid-gland-controls-bodys-metabolism-how-it-works-symptoms-hyperthyroi#:~:text=The%20thyroid%20gland%20is%20a,way%20your%20body%20uses%20energy.

Categories
Health and Disease

Retinal Detachment: About the Disease, Symptoms and Treatment

Introduction

Retinal detachment is the term that means the retina (the thin coating at the back of your eye) becomes loose. This disease must be treated urgently to preserve sight, typically through surgery.

Causes

The most common cause of retinal detachment is PVD or posterior vitreous detachment. Posterior vitreous detachment is a condition increasingly likely with age and is caused by variations in the vitreous gel which is a clear gel-like substance that fills the space between the lens and retina in the eyeball. This cause of retinal detachment does not present with pain and rarely causes sight loss; PVD commonly causes symptoms of black “floaters” obstructing vision and what patients have described as flashing lights. Over time, the brain adapts to the symptoms caused by PVD, learning to ignore them, and sight returns to the same condition as before the disease manifested. It is paramount that anyone who experiences symptoms of PVD consults an ophthalmologist or optometrist as 1 in 10 cases of the disease will result in a retinal tear and could trigger retinal detachment which requires emergency surgery.

Although most cases of PVD can be left to resolve themselves, and most do not result in retinal detachment, you are more likely to experience complications if:

  • You are short-sighted
  • Have had eye surgery before
  • Have experienced eye trauma
  • Have a family history of detachment

Tests

  • Retinal Examination: An optometrist or ophthalmologist can inspect the back of the eyeball, including the retina, by using a bright light and a variety of special lenses which allows for a detailed view of the whole eye, showing any tears of the detachment of the retina
  • Ultrasound: medics can also perform an ultrasound test on the eye to check for tears or possible detachment if the vision of the retina is otherwise blocked by bleeding.

If no tear or detachment is diagnosed on the first examinations, the doctor may ask for you to return a short time later to check for delayed tears due to the vitreous separation. It is common for both eyes to be examined even if the patient is only symptomatic in one.

Treatments for Retinal Tears

As retinal tears are usually a precursor for complete detachment, doctors may try to treat the occurring tear to prevent it from progressing and preserve sight. There are two mains ways this can be done:

  • Laser Surgery (Photocoagulation): A laser beam is concentrated at a point in the eye through the pupil. The surgeon can burn around the tear using the laser, prompting the retina to rejoin or “weld” to the scarred tissue.
  • Freezing (Cryopexy): Surgeons can use a freezing probe on the outer surface of the eye, under local anesthetic, and directly over any tears. Similar to laser surgery, this causes scarring which allows the retina to be reattached to the eye’s wall.

Both treatments for retinal tears can be done within one day at an outpatient clinic with minimal recovery time. The surgeon would likely advise you to avoid anything which could jar the retina (such as jumping, sudden movements, or sports) for a few weeks to allow the tear to weld.

Treatments for Retinal Detachment

Retinal detachment must be treated in only days after diagnosis to allow for eyesight to be preserved. The type of treatment depends on the severity of the detachment and 3 main surgeries can be performed:

  • Pneumatic Retinopexy: an air bubble or bubble of gas is inserted into the vitreous cavity and, if it is in the correct positioning, it can push the area containing holes against the wall of the eye, preventing the flow of liquids behind the retina. Any fluid collected under the retina is absorbed by itself, allowing the retina to attach to the wall. You will be required to keep your head in the same position for a couple of days after surgery to allow the bubble to stay in the right position.
  • Scleral Buckling: silicone material can be sutured to the sclera surrounding the area containing the holes. This causes an indent in the eye’s wall, relieving the effects of the force provoked by the vitreous pulling on the retina. If the detachment is severe, or many tears and holes have occurred, a scleral belt can be placed around your eye which will remain in position permanently but not obstruct vision.
  • Vitrectomy: The vitreous and any tissue pulling on the retina can be removed by a surgeon and then air, gas, or silicone-based oil can be injected to flatten the surface of the retina. Eventually, the substance injected is absorbed and the vitreous space can be filled again with body fluid. This procedure is often paired with scleral buckling in severe cases of detachment.

Although surgery can be successful, some people will require multiple procedures before their detachment has been fully repaired. Detachment can be a recurring problem so it is vital that, if you redevelop symptoms, you consult an ophthalmologist or optometrist. In some cases, vision cannot be fully restored but most treatment plans and combinations can help preserve a large proportion of vision.

Sophie Farr, Youth Medical Journal 2021

References

NHS England, Retrieved 16/12/20 “Detached Retina” https://www.nhs.uk/conditions/detached-retina-retinal-detachment/

Mayo Clinic, Retrieved 16/12/20 “Retinal Detachment”
https://www.mayoclinic.org/diseases-conditions/retinal-detachment/diagnosis-treatment/drc-20351348





Categories
Health and Disease

Glaucoma: Causes, Treatment, and Diagnosis

What is Glaucoma?

Glaucoma is an eye condition categorized by damage to the optic nerve. The optic nerve transmits light detected by the eye as electrical signals to the brain so it can decipher an image. When the optic nerve suffers damage, such as in glaucoma cases, it can lead to sight loss if not treated promptly. Typically, glaucoma is genetic, and the common disease affects 1 in 50 Europeans over 40. 

Symptoms

Glaucoma is usually slow progressing and in most cases, the patient will have been suffering from the disease, asymptomatic, before they first seek advice from an ophthalmologist. Initial warning signs of glaucoma are changes to your peripheral (outer edge) vision, blurred vision, or seeing rainbow circles. Glaucoma is often discovered during a routine eye health check-up and treatment can progress from there. Occasionally, acute cases of glaucoma can come on rapidly, causing intense eye pain, nausea, red eyes, tenderness, seeing rings around lights, and blurred vision. It is imperative to seek medical attention, such as an emergency eye clinic or A&E care if you think you may be suffering from glaucoma; the sooner a glaucoma patient can be diagnosed, the sooner they can get treatment, potentially saving their sight. 

Types

Most glaucoma cases are primary open-angle glaucoma. This type of disease usually progresses slowly over years and is typically caused by drainage channels in the eye becoming clogged over time. There is also acute open-angle glaucoma: where the drainage channels suddenly become clogged, causing sudden and immense pressure build-up. Acute glaucoma is uncommon, but it is vital that you know where your nearest A&E or emergency eye clinic is in case you ever suffer from the disease. Secondary glaucoma is a different variation of the disease caused by a separate, underlying, eye condition. For example, inflammation of the eye (uveitis) can lead to secondary glaucoma. Congenital glaucoma is an extremely uncommon type of glaucoma, occurring in young children, which is caused by an abnormality of the eye. 

Causes

Currently, opticians are unsure of anything you can do to reduce your risk of glaucoma. However, your chances of developing the condition are increased for these reasons: you have a family member with glaucoma; you are of African, Caribbean, or Asian descent; you suffer from long-sightedness, short-sightedness, or diabetes; you are of an older age. It is crucial to let your optician know if you have symptoms of glaucoma, especially acute glaucoma if you fall into any of these categories. It is also important to follow your optician’s advice and to regularly go to eye appointments to test for glaucoma and a multitude of other diseases. 

Tests

The most common test for glaucoma is the non-contact tonometry test or the NCT. This involves an optician releasing a puff of air into your eye. A machine can then measure your eye’s resistance to the air, without needing any contact. This procedure is painless and non-invasive and can be performed in a regular opticians appointment. Opticians also have machines that can measure the pressure in your eye, another investigative method for diagnosing glaucoma. 

Treatments

Unfortunately, opticians are unable to solve vision loss which happened before a glaucoma diagnosis; their main aims will be to alleviate symptoms and to prevent further damage to the optic nerve. Treatment options for glaucoma depend on the severity, and type, of the case. Most patients suffering from primary open angle glaucoma will be prescribed eye drops-reducing pressure. Other treatment plans, typically for more severe cases, include laser eye treatment to release blocked drains and to reduce how much fluid your eyes produce; surgery to improve the drainage channels, allowing more fluid to be released, reducing pressure; more regular appointments with an optician or ophthalmologist to assess your glaucoma. 

Link between Diabetes and Glaucoma

Those who suffer from diabetic retinopathy are more likely to develop glaucoma. Retinopathy can lead to abnormal blood vessel growth which can cause the natural drainage of the eye to become blocked. Because of this link between certain types of diabetes and glaucoma, it is important that you communicate with your endocrinologist (specialist hormone doctor) and ophthalmologist to ask whether regular screening needs to happen. 

Sophie Farr, Youth Medical Journal 2020

References

Diabetes.co.uk, 15th Jan 2019; https://www.diabetes.co.uk/diabetes-complications/glaucoma.html

NHS UK, 15th Feb 2018; https://www.nhs.uk/conditions/glaucoma/#:~:text=Glaucoma%20is%20a%20common%20eye,not%20diagnosed%20and%20treated%20early.

Glaucoma UK; https://glaucoma.uk/

Specsavers UK; https://www.specsavers.co.uk/eye-health/glaucoma 

Categories
Health and Disease

Thyroid Eye Disease: Symptoms, Diagnosis, and Treatment

Introduction

Thyroid eye disease, also known as Graves’ eye disease, is an autoimmune condition in which the eye muscles and fatty tissue behind the eye become inflamed. The main symptoms of thyroid eye are red, uncomfortable, and “bulging eyes.” These are caused by inflammation of the eyelid, tear glands, muscles, and fatty tissue behind the eye. Occasionally, this inflammation can lead to stiffness in the muscles, which can cause double, or blurred vision, as eyesight is not aligned between both eyes due to not being able to move parts of the muscle. Thyroid eye is an autoimmune disease caused by an immune attack on the tissue around the eye, irritating it and causing inflammation. 

Most people suffering from thyroid eye disorder (or TED) have Graves’ disease, which can detrimentally affect the thyroid gland, usually causing hyperthyroidism (overactive thyroid). 25% of those with Graves’ disease will also develop TED sometime before or during treatment.  Those suffering from Graves’ disease will double their chances of developing TED by smoking. A person diagnosed with thyroid eye will likely be placed under the care of an endocrinologist (a doctor specializing in hormonal diseases) as well as an ophthalmologist (an eye doctor). These departments will be the first port of call during treatment and should be informed if symptoms worsen.

Symptoms and Diagnosis

One major issue associated with TED is how difficult it is to diagnose. Thyroid eye is usually mistaken for symptoms associated with hayfever, conjunctivitis, or allergies. There are signs that directly point to TED and not the aforementioned conditions: continuing symptoms all year around with no improvement in winter months, no stickiness around the eye, and no improvement of symptoms after trialling different allergy solutions. 

In order to reduce symptoms of thyroid eye, it is imperative the sufferer attempts to quit smoking, if they are in the habit. Furthermore, it is important that they listen to their doctor’s advice and are aware of their changing thyroid levels, as well as monitoring them and following medical advice (e.g. attending blood tests every six months). This can sometimes help to alleviate symptoms and reduce the chance of TED becoming more severe.

It is vital to recognize that TED massively impacts individuals’ lives. From self confidence, to eyesight, thyroid eye can affect your daily life. Many sufferers struggle with low self esteem and self consciousness due to their eyes having a “bulging” appearance. Double vision can also be frustrating, meaning those with thyroid eye can experience confusion, especially when reading or trying to understand someone’s facial expression. This can be taxing on the patient, as well as family and friends, so it is crucial that everyone researches how they can support their loved one. Charities such as the “Thyroid Eye Disease Charitable Trust” and the “British Thyroid Foundation” can offer support and advice to help patients come to terms with the condition and adapt their daily life for ease. 

Treatment

There are a range of different treatments to help with some painful symptoms of TED. Artificial tears can be used to reduce the feeling of “grit in the eye” that can be associated with thyroid eye disease. If inflammation is severe, a doctor may prescribe an oral steroid to reduce it, or administer steroids intravenously. Some patients also find that having prisms attached to glasses can reduce their double vision. There are also surgical options to fix double vision, protect the eyelids, create space in order to allow the eye to close better, and protect the eyeball. 

The best thing a family member can do for a loved one suffering from TED is support and listen to them. Any disease affecting eyesight can be extremely unnerving for the sufferer, as their independence decreases, they may have to become more reliant on those around them. Especially for adults, double vision can be frustrating as it makes day to day activities harder. Teenagers and young people may feel self-conscious about their appearances and the possibility of having to wear an eye patch to alleviate vision problems. A caretaker, friend, or relative, should offer help, but make sure to give them space and allow their loved one to attempt things independently. They should be careful not to sound condescending, be supportive, and if they are comfortable discussing it, talk to them about the condition and their emotions surrounding it. Before forcing their help upon someone, those close to a person with thyroid eye should communicate with them and ask what they would like you to do.

References

Douglas, Raymond S. “Thyroid Eye Disease (TED or Graves Eye Disease).” Thyroid Eye Disease (TED or Graves Eye Disease) | Kellogg Eye Center | Michigan Medicine, http://www.umkelloggeye.org/conditions-treatments/thyroid-eye-disease.

“Graves’ Eye Disease.” American Thyroid Association, http://www.thyroid.org/graves-eye-disease/.

MacEwen, Caroline. “Expert Opinion – Diagnosing Thyroid Eye Disease.” GP, GP, 14 Mar. 2012, http://www.gponline.com/expert-opinion-diagnosing-thyroid-eye-disease/ophthalmology/article/1120742.

“Thyroid Eye Disease.” British Thyroid Foundation, 2019, http://www.btf-thyroid.org/thyroid-eye-disease-leaflet.

“Thyroid Eye Disease.” Cleveland Clinic, my.clevelandclinic.org/health/diseases/17558-thyroid-eye-disease. 

Sophie Farr, Youth Medical Journal 2020

Categories
Health and Disease

Nystagmus: Types, Causes, and Treatments

Nystagmus is an involuntary shaking of the eye, or both eyes, similar to a twitch. They can move in different directions: vertical, horizontal, and in circular motions. Typically, nystagmus is a sign of another underlying eye or neurological condition. If someone has nystagmus, it can be picked up using special equipment and tests, one being the caloric reflex. The caloric reflex test is when a doctor, or nurse, gently runs either hot or cold water, or air, down one ear canal. If the patient has nystagmus, this test will stimulate it because of the temperature gradient.

One cause of nystagmus is an inner ear infection. Infections, such as labyrinthitis and vestibular neuritis, are known to cause nystagmus due to the eye attempting to compensate for the lack of balance. This is a similar effect as travel sickness; if the fluid in the ear is unstable due to an infection, you will feel as if you are constantly in motion, and the eyes and ears will be receiving different sensory messages. The eyes then overwork to attempt to regain equilibrium and balance, causing nystagmus. This particular type of nystagmus should resolve itself once the inner ear infection has been fought off. To diagnose this nystagmus, an ophthalmologist may get you to follow their finger up and down and side to side to check which direction triggers the shuddering of the eye.

Another type of nystagmus can be brought on by conditions such as albinism and develop in infants aged 2-3 months. This nystagmus, due to ocular albinism, is more common in male babies and early signs of it may include them tilting or “bobbing” their head to get a clearer vision. Other symptoms of albinism, which are likely to coincide with the nystagmus, are a lack of pigmentation in the iris and abnormal connection between the nerves on the retina and the brain. Treatment for ocular albinism includes glasses, which can improve vision greatly, as well as sun shields and rimmed headgear to reduce the effects of light sensitivity related to albinism.

One of the most common causes of nystagmus is a neurological condition, usually present since birth. Some conditions which can cause nystagmus include multiple sclerosis, Meniere’s disease, and strokes. Nystagmus due to multiple sclerosis is most often a result of the disease-causing damage to the cerebellum and affecting muscles, vision, and balance. In addition, certain medications for epilepsy can cause nystagmus due to how they interact with the brain. To diagnose what the root cause of the nystagmus is, a neurologist or ophthalmologist may suggest for you to get a CT scan or MRI of the brain to rule out any more sinister causes.

Being diagnosed with nystagmus can impact individuals’ lives. Not only could nystagmus be the first indicator of a more invasive disease, but it can also cause a decline in eyesight and make it uncomfortable to do normal things. Many people that suffer from nystagmus say that it is an unpleasant feeling and twitching can strain the muscles in the eye. Getting a thorough consultation with an ophthalmologist is the first step in improving your nystagmus related symptoms; they can consider whether you need glasses or other methods to control the symptoms.

A lot of sufferers, especially teenagers, may feel quite self-conscious about their nystagmus due to it being visible to other people. Stress and fatigue can also exacerbate nystagmus so sufferers must try to stay away from tense environments and keep good sleep hygiene. Anyone with nystagmus must remember that it is not anything to be embarrassed about or hide, it is involuntary and nothing to be ashamed of. Sufferers need to speak to their medical team to get more support with their condition and to ensure it is monitored for any signs of regression or progress.

References

“Labyrinthitis and Vestibular Neuritis.” NHS , NHS, 11 Feb. 2020, http://www.nhs.uk/conditions/labyrinthitis/.

“Nystagmus.” American Optometric Association, American Optometric Association, http://www.aoa.org/patients-and-public/eye-and-vision-problems/glossary-of-eye-and-vision-conditions/nystagmus#:~:text=and%20drug%20toxicity.-,What%20causes%20nystagmus%3F,stroke%2C%20multiple%20sclerosis%20or%20trauma.

“Nystagmus.” American Optometric Association, http://www.aoa.org/patients-and-public/eye-and-vision-problems/glossary-of-eye-and-vision-conditions/nystagmus#:~:text=Nystagmus%20is%20a%20vision%20condition,or%20in%20a%20circular%20pattern.

Wachler, Brian S. Boxer. “Nystagmus: Symptoms, Causes, Diagnosis, Treatment.” WebMD, WebMD, 7 Nov. 2019, http://www.webmd.com/eye-health/nystagmus.

Categories
Biomedical Research

Antimicrobial Resistance- What it is and Why it’s a Problem

During the lockdown, many museums and festivals have chosen to continue their yearly programs in a digital format. Some of the most famous events in the world of academia, such as the Hay Festival, have become free and available online, creating countless opportunities for individuals from all over the world to come together and learn. When I heard about the Hay Festival digital program, I was extremely excited and delved in and booked dozens of lectures with famous names such as Laura Bates, Gloria Steinam, and Stephen Fry. Although all of them were incredible, the one that stood out to me was “The Drugs that Don’t Work” with Dame Sally Davies. 

Sally Davies was the Chief Medical Officer for England as well as the Chief Scientific Adviser at the Department of Health. She started her career as a clinical practitioner and has pioneered research and advancements in many medical fields. The particular lecture I watched was based on her book of the same title, “The Drugs that Don’t Work”. The book is based on antimicrobial resistance, a deadly phenomenon afflicting the world. Antimicrobial resistance, or AMR, is when microorganisms change or mutate (change in the base sequence of the DNA)  after being exposed to an antimicrobial drug, such as an antibiotic or anti-malaria. This allows the microorganisms to become immune to the effects of the drugs and “superbugs”, such as MRSA, can develop.

MRSA, or Methicillin Staphylococcus Aureus, is a “superbug” which can cause infections in various areas of the body. And the main issue faced with MRSA is that it is resistant to most common antibiotics which allows it to spread rapidly in hospitals through contact, causing infections ranging from mild skin ones to life-threatening ones such as lung, blood, and surgical wound infections. For a while, it was a major problem in British hospitals, and many surgical patients were advised to bring their own hand towels to use for washing to ensure the towel wouldn’t drape along the floor and potentially have contact with the bacteria. It is estimated that 2% of the population will carry MRSA and it can be transmitted through touching someone with it or an object that a carrier has held. In hospitals now they still test you for MRSA before any operation and you will likely have a swab taken from the skin in your armpit, groin or nose to test for it. 

One of the things that were most poignant to me about her lecture was just how often antimicrobials are used in the farming and aquaculture industries. Many farmers use antibiotics to promote growth in plants and reduce the risk of infections. The antibiotics are a cheaper alternative to implementing infection control and hygiene measures so have been used excessively and unnecessarily. Not only this, but they are also used in aquaculture, the breeding, and farming of fish, to prevent and treat bacterial disease. These same antibiotics are used to treat human pathogens as well, so as they are used so frequently in farming industries, it allows them to adapt their DNA coding and become resistant to treatment. This is detrimental to human health and Sally Davies said that every year, more people are now dying of the effects of AMR than cancer. 

Are you shocked that you do not have much knowledge on an issue that could prove so deadly to the human race? Dame Sally Davies said that one of the greatest downfalls is the lack of education for the public on AMR. Although some people in the UK may be accustomed to the little “AMR song” they play in general practitioner surgeries, we have nowhere near enough exposure to the true risks of antimicrobial resistance. Sally Davies even went as far as to state that the effects of AMR could reduce the global GDP, gross domestic product, by 3.5% which is a significant loss.

In order to reduce the increase of antimicrobial resistance, there are a few measures that everyone can take. For example, it is imperative that you do not share prescriptions with others as If that person has a viral infection, and you are giving them antibiotics, the medication will not work and will increase the AMR in the microbiome in their gut. Misusing medication is one of the most dangerous things you can do, even if you are not talking about antimicrobial resistance. Furthermore, do not use any leftover prescriptions or self prescribe if you have not sought the advice of a registered doctor. Although you might think that there is no harm in trialing a medication, especially if you are experiencing similar symptoms as before, it is incredibly unwise to do this without going to your doctor first. 

This lecture was informative and shed light on a complex issue that may prove very dangerous in our future. Antimicrobial resistance needs to be addressed and it is important that the public is educated on it and how they can reduce their risk.