Dr Sanduk Ruit

Dr Sanduk Ruit is a world-renowned eye surgeon from Nepal. After the loss of his sister to Tuberculosis when he was 17, Ruit immediately decided on medicine as his vocation. As he came from a remote Nepalese village he was forced to make long journeys to study, yet he did so to achieve his goal of having a career dedicated to the care of others.

Dr Ruit is known as the ‘God Of Sight’ due to his significant advancements in the field of ophthalmology. Dr Ruit utilises small incision cataract surgeries using intraocular lenses to treat cataracts in some of the most inaccessible and remote places on the planet. Ruit often provides cataract surgeries free of charge as part of his charity ‘ Himalayan Cataract Project’ to treat those who may not have the means or ability to reach medical centres.

In 1986, whilst working in Australia, Ruit and his colleague, Professor Fred Hollows, created the Small Incision Cataract Surgery (SICS) strategy, this procedure used intraocular lenses. After this, Ruit became the first Nepalese doctor to utilise intraocular lenses. Ruit then returned home to Nepal, where he utilised the  procedure to provide good quality eye care for those in remote parts of the country. Dr Ruit often camped and trekked to remote locations with a team to operate suturelessly in order to treat cataracts. However, the procedure was still expensive which made it difficult for use on a wider scale. Therefore, in 1995, Ruit devised an international standard intraocular lens which was just a fraction of the price of the ones produced in the developed world.

The procedure is as follows:

” Dr. Ruit’s innovative small-incision cataract removal technique involves modifying the superior incision to a temporal incision. A sutureless external incision of 6 mm to 7 mm is enlarged to 10 mm internally with a keratome. The nucleus is then removed through the anterior chamber.”

In 1994, Dr Ruit founded the Tilganga Institute Of Ophthalmology, which aims to provide high quality and effective eye care for patients worldwide at an affordable price. The institute is closely linked with the Himalayan Cataract Project and other organisations in order to provide cataract surgeries, often free of charge to people in some of the most dangerous and remote places in the world.

A study published by Dr Ruit and his colleagues in 2007 indicated that his procedure and technique was cheaper, faster, had a smaller recovery time and led to significantly less side effects.

In the past 30 years, Ruit has restored the sight of more than 100,000 people worldwide. In 2006, Ruit treated people in North Korea after gaining special permission from the country to enter. Whilst treating, Ruit was part of a documentary series called ‘Inside – Undercover in North Korea’ alongside Lisa Ling. The documentary was filmed illegally which led to the mission being incredibly dangerous, yet Dr Ruit proceeded with his goal to treat as many people as possible, in total around 1000 North Koreans were aided by Ruit and his team during this period.

References:

http://www.nbcnews.com/id/35935864/ns/health-more_health_news/#.WbwC47KGPIU

https://www.healio.com/ophthalmology/news/print/ocular-surgery-news-asia-pacific-edition/%7B8ec07d3b-a963-4a73-a770-0b06574ff9a0%7D/surgeon-brings-innovative-techniques-to-ophthalmologists-worldwide

http://tilganga.org/

http://vairochana.com/interviews/item/35-an-interview-with-dr-sanduk-ruit-%E2%80%9Cgod-of-sight%E2%80%9D.html

http://www.imdb.com/title/tt0987374/

http://www.cureblindness.org/who-we-are/founders/dr-sanduk-ruit

 

http://edition.cnn.com/2014/12/14/world/asia/nepal-eye-doctor/index.html

 

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Glaucoma

Glaucoma refers to a series of eye conditions that affect vision and can cause blindness if left untreated. It is most common in those who are over 40 and is associated with elevated pressure in the eye (intraocular). It is commonly associated with damage to the optic nerve that is caused by a high pressure in the eye. This is due to a build up of fluid in the eye as fluid takes too long to drain correctly, this is an example of open angle glaucoma. Another risk factor for glaucoma is high blood pressure which can affect and elevate ocular blood pressure as a side effect.

At first, glaucoma presents with no symptoms and vision appears to be normal. However, if left untreated it can lead to loss of peripheral vision (vision to the side), over time central vision can also decline leading to very limited vision and blindness.

There are two types of glaucoma:

  • Open angle glaucoma – The eye drainage system begins to falter and results in a build up of fluid and pressure in the eye.
  • Closed angle glaucoma – When the iris in the eye is close to the drainage area and blocks the draining angle. When the drain becomes completely blocked eye pressure rises rapidly and it is classified an emergency.

Vision loss cannot be recovered with glaucoma, so it is vital that it is caught early. Due to the lack of symptoms in the early stages, it is incredibly difficult to detect and necessitates regular visits to an ophthalmologist or optician.

Symptoms:

  • Open angle – Loss of peripheral vision, tunnel vision and patchy spots.
  • Close angle – Eye pain, nausea, vomiting, headaches, severe eye pain, blurry vision, rainbow coloured rings or halos around lights.

The cause of primary glaucoma is unknown. However, secondary glaucoma may be due to pre-existing conditions such as diabetes, cancerous tumors, advanced cataract or inflammation.

There are a number of risk factors associated with glaucoma, which include:

  • Old Age
  • Cataracts
  • Diabetes
  • Ethnic Background – East Asians/African Americans/those of Hispanic descent are more likely to develop glaucoma.
  • Myopia (short-sightedness)
  • Eye surgeries and other eye conditions.

 

References:

http://www.glaucoma.org/glaucoma/glaucoma-awareness-video-with-robert-fechtner-md.php

https://www.glaucomafoundation.org/about_glaucoma.htm

http://www.medicalnewstoday.com/articles/9710.php

https://nei.nih.gov/health/glaucoma/glaucoma_facts

https://www.aao.org/eye-health/diseases/what-is-glaucoma

http://www.mayoclinic.org/diseases-conditions/glaucoma/basics/symptoms/con-20024042

http://www.medicinenet.com/glaucoma/article.htm

 

The Ethics Surrounding The Use of Animals In Clinical Trials

The use of animals in the trials of medicines, cosmetics and other equipment for use by humans has always been a controversial topic. In recent years, activism from groups such as PETA has brought this problem to the forefront of the public eye.

The main arguments against the use of trials on animals stem from the idea that if we are testing goods for use on humans we should subject the trials to humans rather than animals. Many also disapprove of the conditions animals are kept in, which include small boxes. A variety of trials also involves inducing animals with a particular disease and/or inhibiting their food and water intake to observe a response to additional stimuli. After successful campaigning, there are now stricter regulations on the environment an animal is kept in, which animals can be used. Many companies have to get clearance from the home office to trial on animals and as part of this clearance have to disclose the nature of their trial, how many animals they will use and the basic procedure which is then reviewed by a panel. These laws and regulations have proven to be successful in a number of first world countries, however, they are difficult to enforce in third world countries

Those who are pro the use of animal testing often speak of the supplementary benefits of trials on animals before trials on humans. One argument is a reduction in human casualties. If we test on animals before going to human trials any adverse reactions to the medication/trial conditions can be noted and it can be modified for human use. This is another area of controversy and many argue that animals have equal rights to humans and as they are unable to choose to take part in these trials, they should not be subjected to them. At present, a large percentage of trials are first trialed on animals before moving to the next phase. Many people believe that trialing is a necessary evil and is needed for the greater good of humanity. Some pro trial advocates are against trials for cosmetics as they are not a necessity but are pro using trials to test medications.

References:

http://animal-testing.procon.org/

https://www.peta.org/issues/animals-used-for-experimentation/animal-testing-101/

https://www.crueltyfreeinternational.org/why-we-do-it/what-animal-testing

 

Brain Imaging Breakthrough

In recent news, researchers at the Cardiff University Brain Imaging Centre have produced new scanning equipment to show the workings of the brain. One user has stated that the research was akin to using the Hubble telescope after years of using binoculars.

The scan shows the wiring of the human brain. White areas/matter make up the inner part of the brain and are made of dense fibres packed in a tight arrangement. Siemens engineers used the latest computer tools to create 3D images mapping the brain and the nerve impulses and signals of a patient. The scanner uses colour coding to highlight the direction of travel of the impulses and density of fibres to produce a more refined image and a new way of viewing brain mappings. This technology can be used to learn more about and possibly aid the treatment of dementia, MS and epilepsy along with numerous other neurological conditions.

References:

http://www.bbc.com/news/av/health-40487049/the-most-detailed-scan-of-the-wiring-of-the-human-brain

http://www.9news.com.au/world/2017/07/05/15/17/worlds-most-detailed-scan-of-the-human-brain-shows-how-information-travels

http://businessnewswales.com/cardiff-university-brain-research-imaging-centre-cubric-wins-major-science-buildings-award/

The Ethics of Abortion

In recent news, women of Northern Ireland are now able to get free abortions on the NHS in Britain. At present, in Northern Ireland, abortions are only allowed if the mother’s life is in danger or if there is a serious risk to her mental or physical health. Hundreds of women are forced to travel from Northern Ireland to England in order to get an abortion, this is costly and can be incredibly difficult for women.

In many religions and cultures, people believe that abortions should not be allowed unless there are extreme circumstances, for example, if a woman has been raped. Many believe that abortions result in an unlawful killing of a person and can be compared to murder. However, with current laws, in the UK abortions can be carried out until 24 weeks, but in some circumstances, it can be carried out later.

In the UK we are incredibly fortunate to have abortions available on the NHS, in countries like America many women are forced to carry out abortions by themselves at home or at a reduced price locally, but this is very dangerous.

At present, there is no scientific consensus as to when life begins so one can not truly say that women who want an abortion are killing or endangering a child as there is still a debate as to when life begins. Many pro-life advocates believe that life starts at fertilization, others believe it starts when limbs appear or when a major organ system assimilates.

However, the rights of the mother should not be put under the rights of an unborn fetus, The woman is alive and well and we should not undermine her rights and ability to make decisions by putting a zygote in front of her life and decisions. In addition, should we really bring a child into an overpopulated world and one in which its mother was forced to conceive it? Human rights violations in terms of the fetus are dependent on the age of the fetus, below 24 weeks the rights of the mother should be prioritized. However as the mother comes closer to full term, we must consider the human rights violations brought about by the death of a fetus.

Many pro-life supporters believe that abortion is a form of infanticide, which is the unlawful killing of children. Many countries are rife with female infanticide which is gender-based killing, People often kill female babies as traditionally, women were forced to live with their husband’s parents leaving their own parents without someone to care for them. This problem is especially prevalent in China after the one-child policy, which prompted many to kill and abandon female babies in order to try to conceive a male. In some countries, males are also more desired in rural areas as they are seen to be better workers. Abortions on the basis of sex are not lawful and in most cases, the sex of the child cannot be found before 24 weeks.

References:

http://www.bbc.co.uk/ethics/abortion

http://ethics.sandiego.edu/presentations/AppliedEthics/Abortion/abortion.pdf

http://www.bbc.co.uk/news/uk-politics-40438390

http://www.prochoiceactionnetwork-canada.org/abortioninfo/misconce.shtml

http://www.csus.edu/indiv/g/gaskilld/ethics/abortion.htm

 

Invasive Lobular Carcinoma

Invasive Lobular Carcinoma is the second most common type of breast cancer and accounts for 8% to 14% of breast cancers, after Invasive Ductal Carcinoma. Carcinoma describes cancer occuring in the epithelial or lining layer of cells, almost all cases of breast cancer are carcinomas. The carcinoma can either be in the milk ducts or in the lobules and in some cases can be in both areas. ILC is characterised by small rounded cells that be difficult to find on mammograms as they do not readily form masses.

In this case, cancer has spread to surrounding tissues after being generated in the milk-producing lobules of the breast. It is invasive as it invades other parts of the breast. Over time, ILC can spread to the axillary lymph nodes, most commonly those situated under the armpits.

It is most common in women between the ages of 45 to 55, however, women outside of this range can develop ILC in some cases.

Symptoms include:

  • an area of thickening or swelling
  • a change in the nipple, for example if it turns inwards (inverted)
  • a change in the skin, such as dimpling or thickening

 

IF YOU EXPERIENCE ANY OF THESE SYMPTOMS OR OTHERS ASSOCIATED WITH BREAST CANCER, SEE YOUR DOCTOR IMMEDIATELY.

Mammograms, which are x-rays of the breasts, are usually used to diagnose breast cancer. Additionally, you could have a biopsy or an MRI scan, this is dependent on your physician.

In some cases a lumpectomy may be carried out, which is where the tumour/mass is removed without deconstruction of the breast. In some cases, a mastectomy is advised, especially if the tumours are relatively large. Many women also have their lymph nodes removed as a precaution or if the cancer has spread.

After surgery, radiotherapy, chemotherapy, biological therapy and hormone therapy may be used to treat cancer and can be a preventative measure. For some women, a hormone imbalance can cause uncontrolled growth of cancer cells so hormone therapy using oestrogen is used to reduce risk of recurrence.

Some breast cancers contain HER2/neu which is a growth-promoting protein that can cause the cancer to spread more quickly. Drugs that target the HER2 protein include Herceptin, a type of monoclonal antibody (antibody produced from a single clone of B cells), Tykerb, Perjeta and Kadcyla.

Testing of the sample can be done using immunohistochemistry (using antibodies that stick to the HER2 protein causing cells affected to change colour) and fluorescent in situ hybridisation (fluorescent DNA pieces stick to the HER2 gene, cells affected can be counted under a microscope).

References and Additional Information:

http://www.breastcancer.org/symptoms/types/ilc/subtypes

http://www.hopkinsmedicine.org/breast_center/breast_cancers_other_conditions/invasive_lobular_carcinoma.html

https://breast-cancer-research.biomedcentral.com/articles/10.1186/bcr767

https://www.cancer.org/treatment/understanding-your-diagnosis/tests/understanding-your-pathology-report/breast-pathology/breast-cancer-pathology.html

http://www.cancerresearchuk.org/about-cancer/breast-cancer/stages-types-grades/types/invasive-lobular-breast-cancer

Multiple Sclerosis

Multiple Sclerosis is a life long condition that affects the brain and spinal cord. It usually diagnosed in people who are in their 20s and 30s.

It is an autoimmune condition, the immune system attacks the brain or spinal cord. In MS the immune system attacks the myelin sheath, a protective coating, around nerve cells. This results in messages transmitted along these nerves being disrupted, slowed and weakened.

Symptoms include:

  • Fatigue
  • Numbness
  • Balance and co-ordination problems
  • Muscle stiffness and spasms
  • Cognitive difficulties
  • Difficulty walking
  • Problems with vision

MS can occur in two ways:

  1. Relapsing-remitting MS

This occurs when symptoms progressively worsen in the span of a few days. The attacks may occur every few years. Although around half of the people with MS of this sort do go on to develop the second type within the next 15-20 years.

2. Primary progressive MS

In this type of MS there are no periods of remission, but instead symptoms progressively worsen.

Treatments include using steroids to treat relapses. Disease-modifying therapies can be used to reduce the frequency of relapses as well as specific treatments focused on alleviating symptoms.  At present, there is no cure for either type of MS and it will progressively get worse. However research is leading to strides in the development of new medication.

 

References:

https://www.nice.org.uk/guidance/cg186

http://www.nhs.uk/conditions/Multiple-sclerosis/Pages/Introduction.aspx

https://www.mssociety.org.uk/what-is-ms

http://www.ms-uk.org/whatisms