Vaginal Mesh Implants

At present, the vaginal mesh implant scandal has been compared to the thalidomide scandal which plagued women of the 1960s and their infants.

The synthetic polypropylene implants were used as an alternative to more invasive procedures for the treatment of urinary incontinence and prolapse that occurs after childbirth. Many patients began to complain about chronic pain, bladder spasms and continual pelvic pain due to the mesh cutting through vaginal tissue as well as an inability to walk after sex.

The mesh implant launched by Johnson & Johnson without a clinical trial has led to law suits on all fronts and an estimated $57 million dollars was given to one woman alone as compensation.

It was revealed earlier this year that over 800 women will be taking legal action against the NHS for its part in the scandal. Thousands of woman had been advised to have tension-free vaginal tape surgery across the United Kingdom. Over 92,000 women have had these implants from 2007-2015. Despite having the implants being removed, many women will have to deal with permanent side effects both psychological and physical. A campaign known as Sling the Mesh has been launched.

Professor Carl Heneghan from the University of Oxford compared the scandal to the thalidomide scandal as the thalidomide scandal resulted in an immediate change in drug regulation and this scandal will do the same with the regulation of devices and implants.

Many have criticised the medical proffession and doctors of all ranking after the scandal. There was a desperate need to have stricter regulations and a better approach to the complaints made by women post-operatively as this could have resulted in many of them not having to deal with permanant side effects. This scandal has been incredibly eye opening and will hopefully result in stricter regulations worldwide when dealing with implantation of devices.

References:

http://www.bbc.com/news/uk-scotland-27887766

https://www.theguardian.com/society/2017/sep/29/revealed-johnson-johnsons-irresponsible-actions-over-vaginal-mesh-implant

https://www.theguardian.com/society/2017/aug/31/vaginal-pelvic-mesh-explainer

http://www.bbc.com/news/uk-41671020

http://www.bbc.com/news/health-39567240

http://www.independent.co.uk/news/long_reads/transvaginal-mesh-vaginal-procedure-surgery-tvt-gynaecology-thalidomide-womens-health-psychology-a7862126.html

http://www.telegraph.co.uk/health-fitness/body/vaginal-mesh-scandal-could-bigger-thalidomide/

https://www.theguardian.com/society/2017/oct/19/vaginal-mesh-implants-if-i-lift-my-leg-my-whole-body-shakes

https://slingthemesh.wordpress.com/

 

Advertisements

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

 

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

 

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

Trigeminal Neuralgia

The trigeminal nerve or fifth cranial nerve is the nerve that sends pain impulses to the brain. When the nerve malfunctions, impulses can be sent at the wrong time, when there is no real pain. However, the sufferer will still feel sharp pain of great intensity. It usually occurs when the protective coating around the trigeminal nerve, the myelin sheath is damaged. High blood pressure, tumours and multiple sclerosis can cause this damage. Rarely, a tangle of arteries and veins called an arteriovenous malformation can also lead to the attack. The attacks can span from a few seconds or to a few minutes, the pain is often unbearable It often only affects one side of the face, usually the right hand side.

The attacks are often brought about by light touching of the face, this can be due to light intensity, wind, air conditioning, eating, washing and even breathing. This means that it is incredibly difficult to control. It usually occurs in those who are over 40 and is more frequent in women than in men.

Treatment can vary but usually:

  1. Anticonvulsant Drugs

Carbamazepine is often used in treatment in order to prevent nerve firing. It slows down nerve impulses, reducing the ability to transmit pain messages. It has to be taken in large doses in order to be effective.

2.  Surgery

Surgery such as nerve replacement therapy can be used in treatment. Through cutting part of the nerve, numbness occurs and the pain is dulled or ceases. However, the nerve may regrow which results in further pain and the need for more surgery and medications.

The National Institute of Neurological Disorders and Stroke (NINDS) is researching the disease. Mice can be used to understand the relationship between the nervous system and the vascular system. Researchers are looking at the role estrogens may play in affecting nerve pain activity, due to the disease being more prevalent in women compared to men.

 

References:

https://www.tna.org.uk/pages/condition.html

https://www.tna.org.uk/pages/condition.html

https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Fact-Sheets/Trigeminal-Neuralgia-Fact-Sheet#3236_1

The Liver

The liver is the second largest organ in the body and is responsible for:

  • Detoxification of poisonous substances like alcohol.
  • Producing bile that is used in lipid digestion.
  • Controlling cholesterol levels by breaking down cholesterol through use of HDL’s.
  • Aiding blood clotting.
  • Fighting infections.

Types of liver diseases:

  1. Alcohol-related

Alcohol consumption can lead to a build up of fats within the liver. Fatty liver disease is reversible, if alcohol consumption is reduced drastically for around a month. Alcoholic hepatitis can occur after substance abuse with alcohol and binge drinking. Cirrhosis can also occur when the liver has been scarred. A liver transplant is only required, usually, in the late stages of cirrhosis. However usual treatment is to reduce alcohol consumption drastically after diagnosis and maintaining a balanced life style.

2. Non-alcoholic fatty liver disease.

This usually occurs in people who are overweight or obese and leads to a build up of fat within the liver. This can lead to fibrosis which causes persistent inflammation that leads to  scar tissue around the liver and nearby blood vessels. This can then later turn into cirrhosis.

3. Hepatitis

This is inflammation of the liver due to a viral infection or damage caused by alcohol. Symptoms include joint pain, high temperature, feeling sick, jaundice and itchy skin to name a few. Types of hepatitis:

  • Hepatitis A
  • Hepatitis B
  • Hepatitis C
  • Hepatitis D
  • Hepatitis E
  • Alcoholic hepatitis
  • Autoimmune hepatitis

4. Haemochromatosis

This is an inherited condition that is due to a slow build up of iron in the body. Symptoms include: weight loss, joint pain, fatigue, weakness etc. Treatments include: phlebotomy: removal of blood to stabilise iron levels and chelation therapy: medication to reduce iron levels. Haemochromatosis is caused by a faulty gene that affects how the body absorbs iron from food.

5. Primary biliary cirrhosis

This occurs when the bile ducts in the liver become damaged. This leads to a build up of bile in the liver that leads to cirrhosis, scarring. The immune system attacks bile ducts, this scars bile ducts making it difficult for bile to move out of the liver. It is a progressive condition that worsens over time.

Liver disease can usually be treated in a variety if ways, but in the worst cases a transplant may be required.

References:

http://www.nhs.uk/conditions/liver-disease/Pages/Introduction.aspx

http://www.medicinenet.com/liver_disease/page3.htm

http://www.nhs.uk/conditions/Liver_disease_(alcoholic)/Pages/Introduction.aspx

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

http://www.nhs.uk/conditions/Hepatitis/Pages/Introduction.aspx

http://www.webmd.boots.com/a-to-z-guides/digestive-diseases-hepatitis

https://www.britishlivertrust.org.uk/liver-information/liver-conditions/hepatitis-c/

http://www.nhs.uk/conditions/Haemochromatosis/Pages/Introduction.aspx

https://www.britishlivertrust.org.uk/liver-information/liver-conditions/haemochromatosis/

http://haemochromatosis.org.uk/

http://www.nhs.uk/conditions/Primary-biliary-cirrhosis/Pages/Introduction.aspx

http://www.mayoclinic.org/diseases-conditions/primary-biliary-cirrhosis/basics/definition/con-20029377

https://www.britishlivertrust.org.uk/liver-information/liver-conditions/primary-biliary-cirrhosis/

 

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/