Female genital mutilation

Female genital mutilation (FGM) refers to the procedures involving removal of parts of female genitalia. The genitals may be cut, injured or deliberately altered for non-medical reasons. FGM usually takes place when girls are infants until the age of puberty. The practice is banned in the UK.  FGM is globally recognised as a human rights violation, but despite being banned, some people choose to carry the procedure out illegally at home or in a private community.

As it has no medical/health benefits FGM is usually carried out for cultural, religious and social reasons. In some communitites it is seen to prepare a woman for marriage or to preserve her virginity. It must be stressed that there is no justification for these kinds of procedures and as a society we must continue to strive to prevent more women from having to suffer throught such a harmful and dangerous procedure.

There are four main types:

  1. Clitoridectomy – this is a removal of the clitoris and can be partial, sometimes only the skin around the clitoris is removed.
  2. Excision – removal of the clitoris as well as of the labia minora, but not the labia majora, which is a larger flap of skin around the vagina.
  3. Infibulation – implanting a seal over the vaginal opening and narrowing it, this is done by removing pieces of skin from elsewhere and placing them over the vaginal opening using stitches in most cases.
  4. Other – harmful procedures include: pricking, cauterizing and scraping the vaginal area.

 

It is clearly evident that undergoing FGM is traumatic for any woman involved and the effects will be with a woman for the rest of her life., but sometimes women and girls can die from the procedure due to unsanitary conditions and lack of medical guidance when carrying out the mutilation. Some of the side effects include:

  • Severe pain
  • Urinary problems
  • Shock
  • Haemorrhage – severe bleeding
  • Swelling of the genital area
  • Scar tissue malformation
  • Childbirth complications risk increasing
  • Infections
  • Sexual problems, during and after intercourse
  • Psychological problems following the emotional trauma

Treatment:

In some cases, treatment will not help, but in others procedures can be undertaken such as deinfibulation to widen the vaginal opening and to recontruct damaged areas of tissue.

If you know someone who is having an FGM procedure, has had one or if you have had one or will have one yourself it is essential to call the police and to obtain aid. You can see your GP or visit a gynaecologist for additional help.

Police: 999

NSPCC: 0800 028 3550

Childline: 0800 1111

References:

http://forwarduk.org.uk/key-issues/fgm/

http://www.nhs.uk/Conditions/female-genital-mutilation/Pages/Introduction.aspx

http://www.who.int/mediacentre/factsheets/fs241/en/

Alzheimer’s Disease and Dementia

Alzheimer’s disease is the most common cause of dementia. It is caused by a build up of protein in the brain to form plaques and tangles. Plaques are clusters of proteins called beta-amyloid that build up between nerve cells. Smaller clumps block signals between nerve cells which leads to damage within the brain. The inflammation caused can trigger the immune system to attack brain cells. Tangles are formed within dying cells and are twists of proteins known as tau. They disintegrate the transport system within cells therefore, depriving cells of their vital nutrients, leading to cell death. The plaques and tangles usually form in the cerebral cortex in areas associated with memory and language.  There is also damage to the hippocampus and it often shrinks with Alzheimer’s disease.

Symptoms include:

  • Memory problems.
  • Personality changes.
  • Disorientation.
  • Problems with speech and language.
  • Hallucination.
  • Depression.
  • Anxiety.

Usually, those over 65 are affected by Alzheimer’s, but early onset alzheimer’s can occur in people who are younger. It is very difficult to diagnose alzheimer’s due to the progressive nature of the disease.

There is no cause for Alzheimer’s disease, but symptoms can be treated with medication. In most cases, treatment is used to slow down progression of the disease. Psychological treatments such as cognitive stimulation therapy may be used. It is a life-limiting condition and can lead to other problems such as difficulty swallowing. In many cases, people survive 8-10 years after diagnoses but this can vary from person to person; most people require palliative care.

 

Dementia is caused by Alzheimer’s disease and is used to describe a wide range of progressive neurological disorders.

Symptoms include:

  • Memory problems.
  • Difficulty with concentrating.
  • Language problems.
  • Spatial Visualisation problems.
  • Difficulty reasoning.

Types of dementia:

  1. Alzheimer’s disease (see above)
  2. Vascular dementia – Due to a series of small strokes which cause pockets of cell damage in the brain. Memory is less affected, but instead language and speech problems ensue. It is possible to have Alzheimer’s as well as vascular dementia at the same time, this is mixed dementia.
  3. Frontotemporal dementia – Affects personality and behaviour more than memory. It is known as frontal lobe or Pick’s disease. It can be confused with depression and psychosis.
  4. Dementia with Lewy Bodies – Movement is affected including motor skills. Tremors are common, similar to those of Parkinson’s disease, in addition, tremors can also occur.
  5. Early Onset Dementia – Occurs in those below 65 and can be accompanied by depression and anxiety in younger people as well as familial stress.

Dementia can be treated via drug use and the most common form of treatment for Alzheimer’s are three drugs known as donepezil, rivastigmine or galantamine. Memantine can be used to treat a more progressive form of Parkinson’s disease.  Those with vascular dementia are treated in order to alleviate symptoms such as high blood pressure and cholesterol. Those with dementia with Lewy bodies are treated with the same drugs as alzheimer’s in order to treat hallucinations.

 

References:

https://www.dementiauk.org/understanding-dementia/about-dementia/

https://www.alzheimers.org.uk/info/20007/types_of_dementia/1/what_is_dementia

http://www.alz.org/what-is-dementia.asp

http://www.nhs.uk/Conditions/dementia-guide/Pages/about-dementia.aspx

https://www.alzheimers.org.uk/info/20007/types_of_dementia/2/alzheimers_disease

http://www.nhs.uk/Conditions/Alzheimers-disease/Pages/Introduction.aspx

 

Breast Cancer

Cancer is caused by the uncontrollable division of cells and can come in two forms: benign and malignant. Malignant tumors invade surrounding body tissue and are able to metastasize and spread to other parts of the body, whereas benign tumors are relatively harmless.

Symptoms of breast cancer include:

  • Breast Lumps (90% are not cancerous)
  • Change in size/shape/feel of breast
  • Breast pain
  • Skin Changes
  • Changes in nipple position
  • Fluid from nipples

Risks include:

  • Age
  • Ethnicity
  • Substance Abuse
  • Diet/Exercise
  • Overweight/Obese Patients
  • Genetics – family with cancer
  • Cancer genes
  • Many more

The TNM staging system stands for Tumour, Node, Metastasis.

  • T describes the size of the tumour
  • N describes whether there are any cancer cells in the lymph nodes
  • M describes whether the cancer has spread to a different part of the body

Number staging ranges from 1-4 and relate to size of tumor and its spread.

Early, locally advanced and secondary breast cancer.

Early: The cancer has not spread to areas outside the breast.

Locally Advanced: Cancer has not spread but the tumor is 5cm or larger, growing in chest skin/muscle or present in the lymph nodes in the armpits.

Secondary: Also known as stage 4 is when the cancer has spread to other parts of the body.

Grading is also used:

  • low grade – grade 1 (slow growing)
  • intermediate grade – grade 2
  • high grade – grade 3 (faster growing)

 

Diagnosis involves attending screenings, visiting a GP and then undertaking MRI and possibly CT scans to show the size and position of the tumor.

Treatment varies depending on the grading systems mentioned previously. Surgery, chemotherapy, radiotherapy, hormone therapy, biological therapy and clinical trials. Surgery is usually used for the lower grade cancers that are positioned in such a way that they can be easily removed. Types include:

  • Lumpectomy – removal of the cancerous tumor
  • Mastectomy – removal of the breast
  • Breast Reconstruction
  • Lymph Node Removal

 

For many patients and their families, breast cancer can be incredibly scary and difficult to deal with. It is important to learn as much as you can about breast cancer and to make an informed position. Breast cancer is not only hard on the person who has it, but also their friends and family. It can be difficult to adjust but it is vital to support one another and to ensure mental health does not deteriorate rapidly.

References:

http://www.cancerresearchuk.org/about-cancer/breast-cancer

http://www.nhs.uk/conditions/Cancer-of-the-breast-female/pages/symptoms.aspx

https://www.breastcancercare.org.uk/

Parkinson’s Explored

Parkinson’s disease is a neurological condition that affects one in 500 people. Parkinson’s disease is caused by a loss of nerve cells in a part of the brain known as the substantia nigra. These nerve cells are responsible for the production of dopamine. Dopamine acts as a messenger between the parts of the brain and nervous system that help control and coordinate body movements.

A reduction in dopamine levels is responsible for many of the symptoms of Parkinson’s disease. However, the majority of symptoms occur after around 80% of nerve cells have been lost. The exact cause of the loss of nerve cells is unknown but lead researcher’s believe that it is caused by a combination of genetic and environmental factors.

 

Parkinson’s disease accompanies a wide variety of symptoms including loss of movement, rigidity, tremors, insomnia and depression. Everyone who has Parkinson’s experiences these symptoms in a different way and to different degrees.

Parkinsonism is the umbrella term which describes conditions that share the same symptoms as Parkinson’s disease. Idiopathic parkinson’s, or Parkinson’s Disease, is the most common type of parkinson’s. There is no known cause for this type of parkinson’s. It is usually diagnosed by measuring response to medication, if symptoms alleviate and decrease in severity, then it can be said that the patient does suffer from idiopathic parkinson’s disease.

Vascular Parkinsonism occurs when blood supply to the brain is restricted. This atypical form of Parkinson’s usually affects older people with diabetes and those who have suffered from a stroke. Symptoms include a difficulty speaking and swallowing and in making facial expressions. Cognitive problems and memory loss also accompany this form of Parkinson’s disease.

Drug induced Parkinsonism occurs through use of neuroleptic drugs that are used to treat schizophrenia and other psychotic disorders. These drugs block dopamine and are thought to be the biggest cause of drug-induced parkinsonism. In this type of Parkinson’s recovery can occur at a much faster rate than that of others.

Dementia with Lewy Bodies is similar to Parkinson’s and Alzheimer’s. Symptoms include problems with memory and concentration, attention, language and the ability to carry out simple actions. Yet again, dementia with lewy bodies is a progressive condition which worsens with time.

People who have genes that are prone to Parkinson’s may be more likely to develop the condition when combined with other factors, such as environmental toxins or viruses.

Treatment of Parkinson’s disease varies, however drug treatment is the main form of treatment used. Drug treatments aim to increase the level of dopamine that reaches the brain and stimulate the parts of the brain where dopamine works. Examples of drugs used in treatment include:

Levodopa which is a chemical building-block that your body converts into dopamine. It replaces the dopamine that is lost in

Dopamine agonists which act like dopamine to stimulate your nerve cells.

 

However, these drugs can have side effects, one example is dyskinesia which is where those who have Parkinson’s suffer from involuntary movements that are uncontrollable. Another side effect is impulsive and compulsive behaviour. This affects people who are taking dopamine agonists, which act in a similar manner to dopamine within the body.

Therapies that are used in treatment include physiotherapy, occupational therapy, speech and language therapy, seeing a dietician and complementary therapies.

Surgery is also used in treatment despite medication being the main sort of treatment. The main procedure carried out is:

Deep Brain Stimulation, which is used to minimise symptoms. Deep brain stimulation involves implanting very fine wires with electrodes at their tips into the brain.These are connected to extensions that are placed under the skin behind the ear and down the neck. They are connected to a pulse generator (a device like a pacemaker), which is placed under the skin around the chest or stomach area. High frequency stimulation is targeted onto a small area, this changes some of the electrical signals responsible for the symptoms of Parkinson’s.

Lesioning: can also be used which involves making selective damage (a lesion) to cells in a target area of the brain. The target site is found using a brain scan. An electrode is then inserted into the site and an electric current is passed through the tip. The current is used to target some of the cells that control movement.

In our day and age, Parkinson’s disease and its symptoms are both manageable and treatable and with advances in modern medicine, the process is becoming increasingly streamlined, improving the quality of life for those with Parkinson’s worldwide.

Emphysema

Emphysema is a type of COPD, and leads to a shortness of breath. Emphysema affects lung tissue and lung elasticity in a number of ways, but mainly by damaging the alveoli and bronchioles. When the alveoli are damaged they can no longer support the bronchioles, so they collapse. Due to there being less alveoli, less oxygen will enter the bloodstream.

Cigarette smoking is one of the largest causes of emphysema, and also adds to damage as it leads to inflammation as well as alveolar damage, and increased mucus production. Symptoms include:

  • Shortness of breath.
  • Wheezing
  • Fatigue
  • Mucus production

A preliminary test for emphysema is using a stethoscope to listen for a hollow sound in the chest. Other tests include: Spirometer tests, X-rays, Electrocardiogram, Pulse Oximetry.

For smokers, the first treatment is to cease smoking. Medication is also used to relax muscles around the airways and anti inflammatory medication, to increase airway diameter. Oxygen therapy is also used to provide a more rapid recovery, however this is not to be used in the long-term.

References:

https://medlineplus.gov/emphysema.html

http://www.webmd.boots.com/smoking-cessation/emphysema

http://my.clevelandclinic.org/health/articles/emphysema

 

Regeneration of the Pancreas

US researchers have discovered that the pancreas can be stimulated to regenerate if a fasting diet is taken up. The diet mimics periods of feast and famine. It was tested on mice and highlighted that beta cells were regenerated through the fasting. The beta cells detect the blood glucose level and stimulate the release of insulin which is used to control blood sugar along with glycogen and glucagon.

However this diet did lead to low blood sugar and a decrease in a hormone called IGF-1. Doctors have discouraged people from attempting to start a crash diet as it is important to see a physician first to ensure that the body is able to cope with such a varied diet.

Those who took part lost up to 4kg but put this back on in the feasting period of the diet.

This type of treatment reduces the need for drugs and can be seen to have fewer side effects than the traditional medication used in both type 1 and type 2 diabetes.

References:

http://www.bbc.co.uk/news/health-39070183

http://www.cell.com/cell/fulltext/S0092-8674(17)30130-7

The Development of Three Person Babies

In recent news, the UK Government just approved the making of babies from 3 people rather than the conventional and biological 2. The move has been met with an abundance of controversy and debate. The production is an advanced form of IVF and was developed by medics from Nottingham.

Research suggests that the first of these babies may be born as early as late 2017. The technique was initially developed in the 1990s in order to combat infant mortality as a result of mitochondrial defects inherited from the mother. Leigh Syndrome was rife amongst women who were predisposed to the genes’ children. Symptoms began to appear in the first year of life and many families suffered through the heart ache of multiple infant deaths, some whilst still in the womb. Leigh Syndrome affects the mitochondria as a result of a genetic mutation in the DNA of the fetus, which eventually leads to a loss of mobility and death within three years of life. 1/5 of the mutations is as a result of a mitochondrial defect whereas the others as a result of DNA mutation.

The method involves the extraction of all viable and useful DNA from the mother’s egg and the healthy mitocondria from the donor egg to produce a new egg. The new egg contains around 0.1% donor DNA. The process is called pronuclear transfer and was first tested using mice in 1983, since then the process has een refined and redevelopped for safe use in humans.

In January 2017 a baby girl was born in Ukraine using pronuclear transfer and another couple is expecting a male child in the following months.

Last year, a baby boy was born using a process known as spindle transfer. Spindle fibres and chromosomes are removed from a donor egg and replaced by those of the mother. The egg is then fertilsied by the fathers’ sperm. This method posseses a higher risk as chromosomes are suceptible to falling off the spindles when they are implanted so this can lead to a child being born, lacking vital chromosomes or too many. The boy who was born last April appeared to be in perfect health, however in many diseases, symptoms become visible in their first few years of life, so he is being monitored carefully.

Despite the UK passing laws condoning the use of this method in cases where the mother is affected by the mitochondrial disease, the doctors involved and parents have received a large backlash of criticism, regarding the ethics of the process. Proffessor Murdoch from the Newcastle team stated that: “The translation of mitochondrial donation to a clinical procedure is not a race but a goal to be achieved with caution to ensure both safety and reproducibility.” At the moment the method is almost exclusively used for parents where the mother has a mitochondrial defect so many argue that is not a violation of ethics but rather a preventitive measure against the mitochondrial disease, whereas others argue that it is simply fertility treatment. In many cases, arguments suggest that whilst these procedures increase life expectancy to over 3 years of age, they may lead to more problems as the child ages and can lead to a very poor quality of life.

In these cases, it is important to understand that there is a very fine line within medical ethics and what can be seen as a preventitive measure can cause more harm in the future. Despite this it is important to acknowledge that 3 healthy infants have been born and only time will tell how these procedures will affect this children and others like them, in the future.

 

References:

https://www.sciencenewsforstudents.org/article/how-make-three-parent-baby

http://www.bbc.co.uk/news/health-37485263

http://www.bbc.co.uk/news/health-38648981

http://www.bbc.com/news/health-38328097