Check us out on:

and tell us what

you TH_NK!

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 fol-

lowed by Auckland Museum with Maori Cul-

tural Performance

Ferry to Rangitoto Island where I walked to

the summit (298m) twice, saw some breath-

taking shipwrecks and explored some vol-

canic 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

P o l y n e s i an

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 se-

crecy to not share any photos after sign-

ing 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 fan-

tastic remote locations both locally and further afield with week-

ends 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

It‟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

patient‟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 patient‟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.’

Oliver 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 - £6.99

Amazon: Used - from £0.99 New - from £1.35

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 5: Figure 3:

Figure 1: Figure 2:

Figure 4:

Figure 1: A Direct Hernia Figure 2: An Indirect Hernia Figure 3: Important vessels in Hesselbach‟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]