Stroke

The medical term for a stroke is cerebrovascular accident or CVA.

A stroke can occur when blood flow to any area of the brain is cut off. This is dangerous as the blood contains oxygen in the red blood cells which after entering the lungs is transported by oxyhaemoglobin. When a stroke occurs, little to no oxygen reaches areas of the brain which leads to the death of brain cells. Usually, when brain cells die, abilities controlled by that area e.g. speech – cerebral cortex or muscle contraction – cerebellum, can be severely affected.

The main causes of strokes:

  1. Ischemic strokes
  • Blood vessels carrying blood to the brain are blocked by a blood clot or narrowed, resulting in ischemia – severely reduced blood flow.
  • Accounts for 85% of strokes

2. Hemorrhagic strokes

  • A brain aneurysm – bursting of a blood vessel or a brain haemorrhage – blood vessel leak.
  • The leaked blood puts pressure on brain cells causing them to die or be damaged.

3. Transient ischemic attacks (TIA)

  • Blood flow to the brain ceases for a short period of time, often referred to as a mini stroke.
  • Can be caused by blood clots.

 

F.A.S.T is a simple method to remember the signs of a stroke.

F – Face Drooping, A – Arm Weakness, S – Speech Difficulty, T – Time to call the emergency services.

While this is a simple method to learning the signs of a stroke, there are a variety of symptoms associated with having a stroke:

Muscular: difficulty walking, paralysis with weak muscles, problems with coordination, stiff muscles, overactive reflexes, or paralysis of one side of the body
Whole body: balance disorder, fatigue, lightheadedness, or vertigo
Visual: blurred vision, double vision, sudden visual loss, or temporary loss of vision in one eye
Speech: difficulty speaking, slurred speech, or speech loss
Sensory: pins and needles or reduced sensation of touch
Facial: muscle weakness or numbness
Limbs: numbness or weakness
Also common: difficulty swallowing, headache, inability to understand, mental confusion, numbness, or rapid involuntary eye movement
For strokes, time is essential, the faster these symptoms are recognised and the faster a person is taken to a hospital or seen by a doctor, the more brain tissue that can be saved and the less severe and long lasting the effects of the stroke.
As strokes are caused by a lack of blood flow to the brain, aspirin, a blood thinner, is usually given to a patient however if they have a hemorrhagic stroke, this can prove to be fatal, which is why it is important to not self medicate. If it is a hemorrhagic stroke then treatment can begin with drugs being given to reduce the pressure in the brain, overall blood pressure. Surgery can also be undertaken.
Preventing a stroke can be as easy as:
  • Eating a healthy diet
  • Maintaining a healthy weight
  • Exercise regularly
  • Not smoking
  • Avoiding alcohol or moderating consumption

However sometimes, strokes can still occur.

 

References:

http://www.stroke.org/understand-stroke/what-stroke

http://www.medicalnewstoday.com/articles/7624.php?page=3

http://www.strokeassociation.org/STROKEORG/WarningSigns/Stroke-Warning-Signs-and-Symptoms_UCM_308528_SubHomePage.jsp

 

Medical Ethics

“Medical ethics is a system of moral principles that apply values and judgments to the practice of medicine.”

The term medical ethics is incredibly broad. In general, the principles of medical ethics and there actual purpose is to uphold an optimal standard of patient care. However, in practice things are not so black and white.

There are four pillars of medical ethics:

  1. Autonomy – maintaining the patients capacity to think and make their own decisions as to their healthcare, even if it appears medically wrong.
  2. Beneficence – refers to doing what is best for the patient, coinciding with autonomy.
  3. Non-maleficence – not doing harm, however in most procedures there is always a certain amount of risk and almost always side affects.
  4. Justice – giving patients the care they deserve and treating them equally.

 

All doctors take the Hippocratic Oath before practicing medicine and adhere to patient confidentiality throughout treatment.

In an ideal world the four pillars mentioned previously would always be followed strictly. However there are times where doctors are unable to fulfil these standards, resulting in a violation of medical ethics. In most of these cases, the impact may be minor often resulting in a suspension of practice for a brief amount of time however in others the hospital may be sued and/or the doctor may lose his/her medical licence.

One of the biggest ethical issues in healthcare is end of life treatment. A patients family may choose to prematurely terminate aid or may be unwilling to turn off life support. In many cases the patients themselves may request to terminate all treatment in order to die naturally. Despite, the first pillar being autonomy often the medical professionals and family members of patients are forced to decide what is best for the patient if the patient is unable to do so. In some cases, family members do not respect the wishes of loved ones and often blame medical personnel for the decease of a loved one. In other cases, medical personnel make a decision based on their own understanding and knowledge of the patients situation and of treatment. However ultimately, end of life treatment rarely occurs in a manner which ensure everybody’s happiness.

In addition, the allocation of donor organs is another grey area in medical ethics. As you are aware, patients who are in need of a transplant organ are placed on a transplant list. However when an organ becomes available the organ may not go to someone who has been waiting 2 years, but instead to an emergency case. In these cases, the fourth pillar of justice is violated. Is it fair to give the donor organ to a patient who needs it critically when another patient has been waiting for it and has been told that they would be given the organ? Most people would agree that the emergency patient requires the organ as without it they would most likely die. However, denying the patient who has been waiting for the organ is a breach of justice as they have been promised a something that would change there life and standard of living for the better.

Finally, one ethical issue which is not always addressed is access to care. In many cases, millions of people living in third world country simply do not have access to the healthcare that we have in England or other first world countries. In England the healthcare system is free, provided you pay tax. A patient could have treatment worth £3000 without actually spending that much. However in a variety of countries people do not have access to basic healthcare such as the vaccinations given at birth in western countries, and regular health checks. In reality, despite being unable to control the flow of money, we are basing the right to live based on where a person lives and their assets. This is essentially a breach of human rights and injustice. However, in the real world a doctor working in England for example is unable to control the financial status of a country in Africa, and in extension whether there is adequate healthcare. This inability to change this violation of ethics has led to a variety of non-profit organisations such as the MSF, providing free healthcare to those who can not afford it in other countries.

To conclude, knowledge of medical ethics is a vital part of becoming a healthcare professional and without a code of conduct modern medicine would be vastly different from the high standard of patient care we receive today.

 

Through this post we have briefly discussed a range of ethical issues in medicine. For further information, please refer to:

 

Down Syndrome

Down Syndrome is a chromosomal disorder, that forms due to the inheritance of an extra chromosome 21.

Some of the most common symptoms of Down Syndrome are low muscle tone, small stature, an upward slant to the eyes, and a single deep crease across the centre of the palm. However, not every person who has Down Syndrome will experience the same level of these physical traits. Furthermore, Down Syndrome also impairs cognitive disability.

Individuals with Down syndrome have a higher risk of some diseases including Alzheimer’s and epilepsy.However, people with Down syndrome also have a lower risk of hardening of the arteries, diabetic retinopathy, and most kinds of cancer.

In fact, older women, usually over 40 are more likely to develop Down Syndrome. We are now able to detect whether a foetus has Down Syndrome by gene probing and genetic screening.

There are three types of Down Syndrome:  trisomy 21, translocation and mosaicism.

Trisomy 21 is usually caused by nondisjunction which is an error in cell division. This is 95% of Down Syndrome cases, the inheritance of an extra chromosome 21.

Translocation occurs in around 4% of cases. In these cases there are still 46 chromosomes, but an additional full or partial copy of chromosome 21 attaches to another chromosome, usually chromosome 14. Resulting in the symptoms that accompany Down Syndrome.

Finally, mosaicism is the least common case of Down Syndrome and occurs in around 1% of cases. A mixture of two types of cells, some containing the usual 46 chromosomes and some containing 47 results in Down Syndrome in these individuals.

The causes of Down Syndrome are unknown however maternal age is a significant factor. But as younger women usually have more children, 80% of Down Syndrome children are born to children with mothers younger than 35. Around 5% of cases are traced back to the father and 14% of Down Syndrome cases are hereditary

References:

http://www.medicalnewstoday.com/articles/145554.php

http://www.ndss.org/Down-Syndrome/What-Is-Down-Syndrome/

 

 

 

 

Autism and Vaccination

For decades the risk surrounding vaccinations has been in the public news spotlight. However how accurate are the risks that we are so readily warned about?

One of the most heavily reported on vaccinations is the MMR vaccination, Measles Mumps and Rubella, which supposedly has close links with autism. In 1998 the famous Wakefield Paper was released researching this phenomenon. The results showed suggested that the MMR vaccine may “predispose to behavioural regression and pervasive developmental disorder in children.”

However despite the small sample size of 12 children and relatively uncontrolled nature of the study its publication led to a rapid decline in MMR vaccination rates as many parents began to fear the development of autism in their children.

Many wholeheartedly believed the study but others noted that the availability of better health care services and the fact that autism in children is usually identifiable at the same age that the vaccination is given, In fact, now we know that it is in fact the closeness of the age which autism is identified by specialists and the age that the MMR vaccination is given that may have caused the widespread belief of a link between the two.

Furthermore, the study, held under scrutiny was found to have concealed the financial interests of Wakefield himself in what is now seen to be one of the largest ethical violations of our time. This is due to the fact that ‘Wakefield had been funded by lawyers who had been engaged by parents in lawsuits against vaccine-producing companies’. This despite the obvious notion that the findings had been inconclusive given the insufficiency of data to actually prove the link between the vaccination and autism, many parents continued to opt out of the vaccination.

In fact in February 2010, after admitting that several elements in the paper were incorrect, Wakefield and others who had contributed to the publication of the study were held guilty of ethical violations and scientific misinterpretation.

“The British Medical Journal has published a series of articles on the exposure of the fraud, which appears to have taken place for financial gain.”

Unfortunately, the Wakefield fraud led to millions of children developing Measles, Mumps and Rubella throughout the world due to not being vaccinated at a younger age. In 2008-2009 there were dozens of measles outbreaks across the globe notably in England, America and parts of Canada. The Wakefield fraud whilst being one of the biggest cases of fraud in medical history led to the deaths and illnesses of thousands of children worldwide.

References:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3136032/

http://www.voicesforvaccines.org/mmr-and-autism-our-story/

http://briandeer.com/mmr/lancet-paper.htm