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Welcome to the October MedSceNe! This is our second issue this year! Inside you’ll find an example of what you can do during your elective, another book review and the first of a new and exciting Medical School Newsletter. We are still looking for a new committee and article ideas so check us out at our temporary website or drop us an email at medscenencl@gmail.com How did you like our last issue? Find something interesting that you weren’t expecting? Or maybe you didn’t? Tell us why and we’ll sort it out for you. Done something exciting with your society recently, we’d love to hear about it and spread the good news. A word from the Editor: Hey guys, once again I‟m afraid to say another newspaper has been written by yours truly, so lets get a new committee in here & get it sorted. This issue is very exciting for me as your very own Medical School has developed an exciting an interesting Newsletter so you can know more about those talented people working behind the scenes. It also features a complete account of my elective; you can use it as an example of what you will see and be able to do while you are away, or alternatively what you can do if you choose to stay in the UK! I hope you enjoy this issue and I look forward to hearing your thoughts, Regards, Christopher Taylor 5th Year Intercalating Student


Yes ladies and gentlemen, this is all about my elective and is more or less unabridged. I hope to use it to show you some of the things you are able to achieve while away. I am aware this may not all be your cup of tea but it allowed me to do a lot while I was away and get an interesting project under my belt when I was back. This is also a perfect example of two very different individual electives you could arrange. As you may have gathered from the first two pages I did a lot of sightseeing over the course of my 4weeks away in Auckland, New Zealand, but I must stress that I did all of this in my own time at weekends at my own expense. During the week from Monday to Friday 8am to 5pm, I was on placement in the Intensive Care Department. I arranged the placement through Auckland University which shares links with Hospital. This unfortunately was not free to organise as there were some administration costs, as well as arranging for a Student Work Placement Visa and accommodation. My experience with the department was brilliant in the end. My supervisor had split my placement into two halves; the first two weeks in the Cardiovascular Intensive Care Unit and the last two weeks were spent in the Critical Care Unit. This allowed me to see very different sides to Intensive Care Medicine and the patients on the wards. I spent my time in CV ICU shadowing the Doctors, attending teaching sessions, monitoring patient care post-surgery and examining CXRs and ECGs. There were also opportunities to observe valve replacement surgery bypass operations and spend time with the anaesthetists. I definitely refreshed my knowledge of CV Medicine and increased my understanding of the patient care pathway immediately post surgery, the common CV pathologies and complications seen in NZ and the similarities of the care provided with that of the UK.


My time spent in the CCU was remarkably different to that of CV ICU. While in CCU I saw many patients with Guillain-Barré Syndrome (GBS) - a motor neuron disease, commonly precipitated by a viral infection that leads to a systemic inflammatory response where the patient experiences symmetrical ascending weakness in a glove and stocking distribution that progresses slowly. If weakness develops in the respiratory muscles patients commonly require respiratory support until they recover sufficiently. The ward was generally filled with chronic neurological patients and I was able to take away two very interesting and quite different case histories. I‟ll only tell you about one though so as not to take up too much of your time. A 21yr old male with Cytomegalovirus associated Acute Haemorrhagic Leukoencephalopathy. As you may have guessed this is a „Zebra‟ and you DO NOT have to learn this for any exam; however, it is fascinating, at least if you enjoy Neurology like I do… After 5days of generally non-specific signs his level of consciousness declined and an initial CT showed cerebral oedema and meningeal enhancement. A Lumbar Puncture was performed which showed a raised White Cell Count, raised proteins and low glucose, as well as a raised intracranial pressure. I have attached an edited photo of an MRI scan to demonstrate the patient‟s condition after the LP. In general LPs are very dangerous in patient‟s with raised ICP and should not be performed, however, this case is unusual because of the underlying pathology in thatAHL is a hyperacute autoimmune demyelination of white matter and accounts for about 5% of known cases of encephalitis. The pathology is similar to that of Multiple Sclerosis but involves a necrotizing encephalitis, haemorrhage and oedema. There is a 70% mortality and 70% of those that survive are left with severe neurological deficits. Thus, the Doctors involved in this patient‟s care theorised that the LP may have reduced the pressure on the brain & allowed him to survive. Unfortunately, the result of the pathology / LP left the patient with the equivalent of a Locked-In Syndrome as he was paralysed from the head down and unable to communicate. The Doctors were amazingly supportive of the family and spent the 2weeks while I was there working tirelessly to manage the patient care and organise a long-term care plan… It was a great example of teamwork and Doctors caring for their patient‟s and their families.


Now I know your only interested in all the fun things I got up to so here‟s a breakdown of what I got up to over my weekends. I guarantee this was all weekends apart from one Wednesday which I was given off but I crammed a lot in! 

Auckland Domain and Botanical Gardens followed by Auckland Museum with Maori Cultural Performance

Ferry to Rangitoto Island where I walked to the summit (298m) twice, saw some breathtaking shipwrecks and explored some volcanic caves 

Wai-O-Tapu Thermal Wonderland with the famous Lady Gnox Geyser, followed by Waimangu Thermal Walks, Te Puia Thermal Park with their own world famous Geyser and I finished the day with the Tamaki Maori Village Experience with my 3rd Cultural performance and traditional Maori Hangi Meal - all breathtaking experiences

I

needed to relax the next day so spent the day in the Polynesian Spa with 42oC baths looking over Lake Rotorua watching the Sun rise before travelling to Hobbiton, the official Lord Of The Rings film set - I am unfortunately bound to secrecy to not share any photos after signing the Secrets Act for the new film and fear of losing a lot of money and pictures from Hollywood!


My Wednesday off involved cycling 40miles around the most mountainous / hilly island that is more famous for its wine than its destructive bike ride

I also spent a weekend away exploring the Bay of Islands enjoying a lovely leisurely drive followed by the spectacular Waitomo GlowWorm Cave tour and a 7hr Epic Lost World Waitomo adventure. This involved a 100m abseil into a sinkhole followed by a struggle through waterfalls, trek through shoulder deep water upstream after a heavy rain and against gripping currents and jumping through the pitch black into the icy water below.

I spent my final weekend actually exploring Auckland‟s Districts; Parnell, Ponsonby, K‟road and the Central Business District followed by a trip around the Art Gallery and a casual 40m Bungy Jump off Auckland Bridge. I also squeezed in a cheeky day trip to explore Sydney with a trip around the Opera House, Domain and Botanical Gardens with a quick stop for pictures by the Harbour Bridge.


Instead of conforming to normal elective protocol I organised a research project at the Institute of Neuroscience for 8weeks to allow me to gain sufficient experience in in vitro brain slice recordings and human electroencephalogram recordings. This all fits under the umbrella of my project title: “Unravelling the commonalities in the

distribution of gamma oscillations in the rat and human auditory cortex”

Basically, what this means in a nutshell was that by extending my elective slightly I was able to gain new skills and learnt a lot about basic research methods and critical appraisal. I have really valued my time in the department, met some really interesting people and learnt a lot about research which I had little to no experience of beforehand. If any of you are lost by this title Gamma oscillations are the result of high frequency firing of groups of neurons in response to key stimuli; namely attention, consciousness and potentially in the formation of memories a.k.a. „the binding problem‟. There is of course a whole set of very complex research journals dedicated to these which, as I am sure you are grateful for, I am not prepared to go into further detail about. I unfortunately did not manage to gather any EEG recordings because another researcher was using the EEG lab, but I did learn to use the equipment and helped them set up all 64-electrodes in the cap and run the majority of their experiment with them. After reading through countless journals I decided to put together a review article of my findings which, as you can imagine, were not as straight forward as I had hoped but learnt many a thing or two along the way. I would encourage more students to explore research as this need not be as laboratory based as mine was but instead students may wish to make theirs more clinically orientated… If anyone would like further information regarding my activities over my elective or tips on how I arranged any particular aspect of it please email me at: christopher.taylor2@ncl.ac.uk


Wilderness Medicine Society aims to help people learn about and experience how to give medical treatment in remote and challenging environments as well as having exciting outdoor adventures! We provide excellent pre-hospital and acute care teaching in fantastic remote locations both locally and further afield with weekends away to Glencoe, the Cairngorms, Lake District, North York Moors and Northumberland.

These are all brilliant trips giving people a chance to learn new skills and make great new friends!


In the past we have joined mountain rescue teams for practical teaching on how to deal with the challenge of casualties in remote locations, had evening talks from inspiring doctors working in developing countries and extreme environments, small group ABC/BLS teaching sessions and outdoor activities such as caving, climbing, orienteering, walking and going for a dip in the North Sea! One of the highlights of last year was the survival weekend with the Royal Marines, sleeping out and eating strange food, a true learning experience! We are an enthusiastic, fun and a very friendly group of people who enjoy the outdoors and medicine so why not become involved today? We guarantee you will be cold, wet and happy. Check out our website at:

nclwilderness.co.uk


Daniyal Daud, President, 2011-12 A warm welcome to the new academic year! Have you thought about a career in research? The Academic Medicine Society (AMS) at Newcastle is a society for medical students who want to learn more about and participate in research. Newcastle is a world-renowned centre for research in a number of biomedical areas including ageing, neuroscience, cancer and genetics among others. Therefore, this places the medical students at Newcastle in a prime position to get a flavour for conducting research and to incorporate research placements in their curriculum.

Founding The need for clear and ready guidance regarding research and academia to be available to medical students in all stages provided a strong impetus for the founding of the society. The society was officially founded in 2010 by two fourth-year medical students, Jen Jardine and Matt Sayer who had both had experience of research as part of the course and were keen to share what they had learnt from their placements. In the new academic year of 2010-11, Jen and Matt expanded the AMS committee to five other members: Emily Shrimpton, Andrew Harper, Alison Pitts, Al Hafidz and Daniyal Daud. Together, the new team set about publicising the extent of research going on in Newcastle through speaker evenings, and opportunities to participate in research such as summer projects and academic electives.

Speaker evenings Through 2010-11, the AMS hosted a number of speaker evenings with speakers from a range of specialties such as hepatic medicine, neurology and cardiothoracic surgery. The speakers were academic clinicians; they talked about their area of research and how research was important throughout their training and career. They encouraged the audience of medical students to get involved in research early if they were interested in an academic career.


Summer projects Box 1: The research institutes of Newcastle University

Paid and unpaid summer research placements at one of the eight research institutes at Newcastle University (Box 1) were advertised especially to students in Stages 1 and 2, but also those in Stages 3 and 4. The AMS encouraged students to contact academics in their areas of interest (there was quite an array to choose from!), with the assistance of the society if they needed it. Due to the endeavours of the AMS, a record number of medical students sought research placements in a wide range of areas. The placements of 2011 have generally been enjoyable for the students – earning while they were learning research methods and techniques. In addition, the students have made contacts in the academic arena and they may also get a poster or publication out of their work!

Research Course This was a day-long course run by medical students and academic doctors was held especially for students hoping to do research in the summer, but was open to all. It included an introduction to topics which students may have been unfamiliar with: study design, critical appraisal and basic statistics.

Academic Foundation Programme The AMS held information sessions about the academic foundation programme, both in the Northern Deanery and elsewhere in the country. Speakers included the director of the AFP in the Northern Deanery, Professor Andrew Gennery, as well as current trainees in the AFP; they talked about the structure of the AFP and tips on applying for an AFP post.

Conference The grandest and most exciting event of the academic year was the National Academic Medicine Student Conference 2011, held in our very own medical school on Saturday 7th May, 2011. Abstracts were submitted from medical students across the country, and the list of delegates included students from Southampton to Manchester to Dundee. The day-long conference consisted of plenary lectures by influential academics from Newcastle and other universities, oral presentations of a selection of research projects, and popular workshops on topics ranging from presenting research to applying to the Academic Foundation Programme. A proportion of delegates also had the chance to present posters of their research. Prizes were awarded to the best posters and oral presentations.


GIVE A SPIT – SAVE A LIFE What is Marrow? Marrow is the student branch of Anthony Nolan. We people onto the bone marrow register who, might save the life of someone with Leukaemia or other blood borne diseases. Bone marrow donation is, now, often much like giving blood. We want students to know the facts and give them the opportunity to save a life. We also have a lot of fun raising money for Anthony Nolan including pyjama days, the infamous Marrow strip, bag packs, cake sales and new to 2011 a naked calendar...

Why do people need bone marrow transplants? Bone marrow is crucial for producing white blood cells needed for a normal immune system. Blood cancers such as leukaemia damages bone marrow directly, and to be treated requires chemotherapy that completely destroys the remaining marrow stem cells. At this point the patient must receive a stem cell transplant in order to survive.

Why should I join the register? Often, a transplant is the last hope for a person suffering from leukaemia or other serious blood disorders. For a successful bone marrow transplant, a very close “tissue type” match is needed. We therefore need as many people on the register as possible to increase the likelihood that everyone who needs a transplant can get one.


How can I join the register? Come to one of the Newcastle Marrow Clinics. All you need to do is fill out a form and spit in a tube – easy! Your tissue type is identified from your spit and put onto the Anthony Nolan database, and will stay until you are sixty. The main criteria for joining the register are: • 18-40 years old • weigh more than 8 stone (50kg) and be within our BMI limits • be in general good health • be planning to live in the UK for at least the next three years

What happens if I’m a match? You will be contacted by the Anthony Nolan team who will take a blood sample and give you a medical examination to ensure you‟re healthy enough to proceed. There are two types of bone marrow donation – you should be prepared to donate using either: 

Peripheral blood stem cell donation – 3 injections over 3 days stimulate your stem cell production. These cells overflow into the bloodstream and are removed from a vein in your arm in a similar way to giving blood. A machine filters off the stem cells and the blood is returned to you. Some donors have flu-like symptoms for a day or two during the injections. Currently, 80% of people donate this way.

Stem cells from the pelvis You‟ll be given a general anaesthetic and doctors will take some of your stem cells from your pelvis using a needle and syringe. Our donors often tell us that the side effects after the procedure are tiredness (due to the anaesthetic) and a little bruising around the hip that lasts a few days - the pride at having helped save a life, however, stays with them forever.

If you want more information on the next clinic or willing to get more involved with the fantastic charity that is Newcastle Marrow drop us a line at info@newcastlemarrow.co.uk The Anthony Nolan Trust is a Registered Charity, No. 803716 / SCO38827


Season 1: Pilot episode Itâ€&#x;s a normal morning for House, attempting to avoid Dr Cuddy and the inevitable Clinic Duty, that is until the case of a young kindergarten teacher is thrown at him and his team of experts in diagnostic medicine. The patient presents with dysphasia, a collapse and witnessed shaking. The team feel the best course of action is to perform an MRI to rule out a brain tumour as the cause, however, the patientâ€&#x;s airway becomes constricted and he team have to perform a hasty tracheostomy and cancel the MRI. Meanwhile, during Clinic Duty House is struck with a new diagnosis of cerebral vasculitis. After a short course of steroids the patient improves and all is apparently well. After this short calm the patientâ€&#x;s condition markedly declines and House forces the team to break in to her house in an attempt to find another piece to the puzzle. It is only after an enlightening conversation that House discovers that she had ham in her fridge and thus throws out the differential of Cysticercosis. This is not as easy as it seems as the patient refuses any further treatment and House must use all of his communication skills to persuade her, and despite not quite managing to do so with all the elegance we would like in our own doctor, he convinces her to allow them to perform an X-ray. This highlights the tapeworm like a bullet in her leg, she accepts the treatment and another impossible case is solved!


Cysticercosis Cysticercosis is caused by ingesting food contaminated with the eggs of Taenia solium a form of tapeworm. It can also be caused by poor hygiene via the faeco-oral route. Food products commonly infected include: Pork, Fruits and Vegetables that have generally been prepared poorly / undercooked The earliest reference to tapeworms were found in the works of ancient Egyptians that date back to almost 2000 BC. Recent examination of evolutionary histories and DNA evidence show that over 10,000 years ago, ancestors of modern humans in Africa became exposed to tapeworm when they scavenged for food or preyed on antelopes, and later passed the infection on to domestic animals . The tapeworm that causes cysticercosis is endemic to many parts of the world including China, Southeast Asia, India, sub-Saharan Africa, and Latin America. It is also the most common cause of symptomatic epilepsy worldwide. As shown in the diagram to the right; after ingesting the eggs these migrate to muscles or the brain, forming cysts that may persist for years. Symptoms depend on the location of the infection:  Brain lesions may cause seizures and/or neurological deficits = neurocysticercosis  Eye lesions can cause blindness or changes in their vision  Heart lesions may cause abnormal rhythms or failure Non-specific symptoms of cysticercosis may include: Myositis, Fever, Eosinophilia and muscular pseudohypertrophy that may progress to atrophy and fibrosis. Typical tests for the parasite include antibody blood tests, stool samples, biopsy of potentially affected areas, imaging tests and if necessary a Lumbar Puncture. The outlook is generally good as antiparasitics can remove the parasite and steroids can help reduce inflammation. Anticonvulsants may be used to prevent seizures and surgical intervention may be necessary for more intraventricular or spinal pathologies.


„The Man Who Mistook His Wife for a Hat is populated by a cast as strange as that of most fantastic fiction. The subject of this strange and wonderful book is what happens when things go wrong with parts of the brain most of us don‟t know exist… Dr Sacks shows the awesome powers of our mind and just how delicately balanced they have to be‟ Sunday Times „Who is this book for? Who is it not for? It is for everybody who has felt from time to time that certain twinge of self-identity and sensed how easily, at any moment, one might lose it‟ The Times In this great book we discover the wonders of the brain and the diverse and spectacular ways in which it can go wrong. Through the use of particular cases Dr Sacks has seen throughout his career we discover what it means to be human, through Loss, Excess, Transportation and the Simple. My favourite cases include:  The Man Who Mistook His Wife for a Hat  The Man who Fell out of Bed  Phantoms  Eyes Right! and  A Matter of Identity As Oliver Sacks states in his Preface: „Hippocrates introduced the historical concept of disease, the idea that diseases have a course, from their first intimations to their climax or crisis, and thence to their happy or fatal resolution. Hippocrates thus introduced the case history, a description, or depiction, of the natural history of disease - precisely expressed by the old word ‘pathography’. Such histories are a form of natural history - but they tell us nothing about the individual and ‘his’ history; to restore the human subject at the centre we must deepen a case history to a narrative or tale: only then do we have a ‘who’ as well as a ‘what’, a real person, a patient, in relation to disease. Thus the case histories in this book hark back to the ancient tradition by which patients have always told their stories to doctors.’


O

liver Sacks is a physician, best-selling author, and professor of neurology and

psychiatry at Columbia University Medical Center. Born in 1933 in London he earned his medical degree at Oxford University and from 1965 has lived in New York. He is by far one of my favourite authors and one of the many neurologists that I look up to and drive my interest in neurology. This is a must read for any student, particularly those that would dismiss neurology as a career; fascinating and thought provoking. Recommended Retail Price - ÂŁ6.99 Amazon:

Used - from ÂŁ0.99

New - from ÂŁ1.35


Your Guide to Abdominal Wall Hernias A Hernia is defined as: “part of an organ that protrudes through the wall of the cavity containing it” They are a common presentation accounting for approximately 10% of the workload on surgical wards, 75% of which will be for inguinal hernias. There are 80-100,000 operations per year in the UK alone and the lifetime risk of developing a hernia is 27% in men, while only 3% in women. They are an important learning outcome as they can easily develop complications and emergency surgery is associated with a higher mortality rate than that of elective surgery. There is a form of classification for hernias; (Nyhus Classification) and although it is not commonly used it can be a useful aid when describing them. Types of hernia include: Indirect & Direct Inguinal, Femoral, Umbilical, Paraumbilical, Epigastric, Incisional, Spigelian & Richter‟s hernias. Common complications include: Pain, Constipation, Perforation, Peritonitis, Obstruction, Strangulation, Irreducible / Incarceration & Gangrene The main differentials are: Sebaceous Cyst / Lipoma, Haematoma / Arterial Aneurysm, Lymphadenopathy, Appendicular Mass / Abscess, Carcinoma Transplanted Kidney, Ectopic Testical, Hydrocoele or Saphena varix Some key complications of repair include: Visceral damage, Vascular damage, Damage to the Vas, Spermatic vessels or Urinary tract, Adhesions, Nerve Injury, Obstruction and/or Fistulisation

How to examine Hernias: 

Introduce self and wash hands, position patient standing and undressed from the waist down (unless the hernia is clearly visible of course!)

Define the characteristics of the hernia

With 2 fingers feel for a cough impulse

Attempt to reduce the hernia (be very careful you do not want to strangulate it - in normal circumstances do not attempt this phase, ask the patient if it can be reduced)

Examine the same site contralaterally (30% of hernias progress bilaterally)

Perform a full systems exam to assess the patient‟s fitness for surgery

It is possible to use USS/CT if diagnosis unclear


Figure 1:

Figure 3:

Figure 2:

Figure 5:

Figure 4:

Figure 1: A Direct Hernia Figure 2: An Indirect Hernia Figure 3: Important vessels in Hesselbachâ€&#x;s Triangle Figure 4: Laproscopic view of a Hernia Figure 5: Historical treatment for Hernias (A Truss - a technique still used today)


The Science Gingers tend to have more “light melanin” than dark, so creates a ginger spectrum, as seen above really! Most gingers tend to have few hairs on their head! 90,000 for gingers / 110,000 for brunettes / 140,000 for blondes (so they are thicker!) The recessive ginger (Melanocortin-1 receptor) gene was only discovered in 1997! Yes, the spork and nose hair trimmers were invented before gingerness was explained! So beware, you may be carrying the gene yourself, carrying on the ginger generation into your children! Now isn‟t that a scary thought! However, it could die out within 100 years, unless that is, people have as much sex with gingers as possible to save the gene! You all have my number, yeah? No, oh well, was worth a try! Darwin‟s theory of Natural Selection states organisms should evolve to gain advantages to suit their environment to give them the best chance for survival. Be it avoiding predators… So how does bright ginger hair turn up? No idea, the greatest scientist are still unsure, maybe everyone knows how hard we are! Or even better, the „sex selection theory‟, basically, gingers have survived cause everyone wants to shag them… well duh, everyone knows that… don‟t they? Can you really turn ginger from eating too many wotsits – no, but if you do obtain a rare condition called kwashiorkor it does tend to turn dark hair ginger, due to extreme malnutrition, but not from having too many carrots, wotsits or Irn Bru I‟m afraid! Are Gingers harder than other people? The evidence is pretty mixed on this, in 2005 a study by the Medical Research Council‟s Human Genetic Unit say that the reds are less likely to fell pain, but another study claims the opposite! But who needs such evidence when we have people like Chuck Norris fighting Communists, Boudicca battering Romans and Anne Robinson find the weakest links on TV? Of course Gingers are harder! Are Gingers Genetically Superior? Red heads have an enormous contribution to the world despite being relatively few in numbers, but should we conclude to them as superior beings? Could it be that as gingers are unable to stay out in the sun as long as others that their attentions are diverted to more worthwhile events than sunbathing? It would make sense… Well, that pretty much summarises it! I hope that from this brief little guide that you have learnt all that you need to survive in the cruel gingerist world we live in! [Adapted from the book by Tim Collins]


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