Blog posts

From bakery to benchside: a medical student’s journey in research

The TB Research Centre’s staff and students

It was extremely challenging for me to stare back at the four rejections that faced me. Four rejections from four separate medical schools. Four independent reviewers telling me I was not to be a doctor. I had to endure seemingly unending encouragements and sympathies from friends and family. Their attempts were well-meaning, but often repetitive. My particular favourite was “I believe Edward Jenner didn’t get into medical school the first time round”. This, of course, was a complete fabrication. I think I always had this naïve cockiness about me, an artless assumption that I had the necessary experiences to stroll into medical school. Perhaps rejection had a subduing effect on my ego, though, I probably would presume most of those who know me would thoroughly disagree.

Nevertheless, it occurred to me that I had a year to convince the doctors of now that I could be a doctor of the future. But then I thought again. I had an entire year to do what I wanted. I found myself avoiding medical work of any sort, and take up a job in a bakery. I normally stop here when I want to impress people, to give the impression that I mastered the art of conjuring delicious, enticing pastries. In fact, it is due to my semi-duplicitous nature that many people still think of me as a great baker. But I’m not. In reality, my primary role was to serve customers, clean and wash up (as well as outline the difference between spelt bread and gluten-free bread: a distinction I still don’t understand to this day). It was an enjoyable job, and it provided me with some money to fuel some travelling later on. Moreover, I had the blessing of taking home two full bags of artisan breads untouched by the day’s customers — a perk which became more and more hedonistic as the year went on. (more…)

World Water Week: Tackling a neglected health crisis

Can you imagine life without access to clean water? Unfortunately for 663 million people this is a reality. That’s nearly one in ten people worldwide living without a safe water supply close to home, spending hours queuing or trekking to distant sources and coping with the health impacts of using contaminated water. SIWI’s (Stockholm International Water Institute) World Water Week, is a pertinent time to reflect on important research carried out by the Schistosomiasis Control Initiative (SCI), a non-profit initiative based at Imperial College London, which highlights why access to clean water is so important to human health.

Schistosomiasis, also known as bilharzia, is a type of parasitic ‘worm’ infection affecting individuals in sub-tropical and tropical regions of the world. It is a major, yet neglected public health problem, where estimates showed that at least 218 million people required preventive treatment in 2015, of which at least 20 million suffer from severe and debilitating forms of the disease (World Health Organisation, 2016). The SCI support treatment programmes against schistosomiasis and soil-transmitted helminth infections in 16 sub-Saharan African countries and Yemen. Since its foundation in 2002, the SCI has supported the delivery of over 140 million treatments for these infections.

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Why study frogs in the School of Public Health?

Rhacophorus moltrechti – a species of frog endemic to Taiwan. Photographed by Lin Chun-Fu.
Rhacophorus moltrechti – a species of frog endemic to Taiwan. Photo by Lin Chun-Fu.

Close your eyes and imagine the high-pitched shrieking of cicadas unified in a crescendo of noise from the treeline. Fireflies blinking their fluorescence through the undergrowth. Bats swooping silently overhead, rustling your hair with their wing beats. Trekking across steep hillsides of wasabi plants during a rainstorm. Not the average working week of a researcher in the School of Public Health, but just some of the sights and sounds I was fortunate to experience when I visited Taiwan in May as a National Geographic Young Explorer.

The aim of my 10-day visit was to collect and swab as many tadpoles, frogs and salamanders as possible. Why, you ask? Tragically, amphibians are being struck down by a fungal plague. In the past 20 years there have been global biodiversity losses, mass mortality events and the extinction of over 200 frog species attributed to chytridiomycosis—a disease caused by the fungal pathogen Batrachochytrium dendrobatidis (Bd). To give you an idea of scale, some researchers are referring to this outbreak as the sixth mass extinction event: something on a par with the dinosaur die-off 66 million years ago in terms of species lost. More recently emerged is its sister pathogen Batrachochytrium salamandrivorans (Bsal), which is causing the deaths of European fire salamanders in the Netherlands. It’s estimated that populations have declined by nearly 20% per year since 2008, leading Bsal to be described by some as the ‘perfect pathogen’. (more…)

How to PREPARE for surgery and speed your recovery

PREPARE for surgery

All types of surgery require preparation and, afterwards, recovery time. But according to the oesophago-gastric cancer team at Imperial College Healthcare NHS Trust, undergoing major surgery is like running a marathon. The PREPARE for Surgery programme, designed by the team, ‘trains’ patients for surgery based on their individual needs. It looks at different factors important to focus on before and after a procedure, including physical activity, diet, psychological wellbeing and medication management. Here clinical nurse specialist Venetia Wynter-Blyth explains how the programme helps patients adopt the good habits needed to aid their recovery.

The PREPARE for Surgery programme is all about treating a patient holistically and looking at the whole picture. We know when someone is due to have surgery, the psychological side of preparation is just as important as the physical side; so we work hard as a team to strike the right balance and have a positive impact on our patients’ post-operative outcome.

Once we know someone is going to have surgery for oesophago-gastric cancer, we invite them to our PREPARE clinic. We assess every patient in clinic and establish their ‘baseline’ measurements. This gives us a benchmark to improve on over the four to six weeks it takes to complete the programme, and prior to the patient’s surgery. Our surgical team makes sure they schedule procedures with enough time for patients to benefit fully from PREPARE. (more…)

How teaching life skills can help children with ADHD

I started working with young people with attention deficit hyperactivity disorder 25 years ago. Over the years, our knowledge and understanding of ADHD has come a long way – mostly down to scientific research – taking the condition from a relatively unheard one to a household one. Too often, we associate ADHD with children, however it’s now recognised to be a lifetime condition with many undiagnosed adults continuing to experience symptoms throughout their lives, despite the abundance of international guidelines on the assessment, treatment and management of ADHD. With many young people reaching adulthood with undiagnosed ADHD, or even misdiagnosed, they will not receive the optimal treatment for their symptoms and associated problems. Unfortunately, many will not reach their potential, and for some, they feel their future is bleak.

It doesn’t have to be this way. The good news is that there are large treatment effects for ADHD interventions and one can intervene at any age. However, early intervention is key if children with ADHD are to mature into confident young adults who experience good mental wellbeing and can effectively plan and organise their lives. I’ve always believed that we should be providing early intervention programmes that work directly with the child as well as those involved in their care and education. Hence, drawing on cognitive behavioural therapy (CBT) – a technique commonly used for phobias, depression and bipolar – I developed the ‘Helping Children with ADHD’ individual treatment and ‘The STAR Detective’ group intervention to provide life skills to children, their parents/carers and others involved in their care. (more…)

TB or not TB? Why tuberculosis remains one of the top 10 causes of death today

Tuberculosis

I was always a sickly child – when I was eleven years old, doctors injected my forearm with tuberculin in order to check whether my immune system raised a response to the bits and bobs of dead tuberculosis (TB) bacteria in it. If it did, it meant my immune system had already been prodded into battling TB, that is, it had previously encountered or was currently encountering an infection with TB bacteria. The injection site swelled like a furious bee sting, the doctors decided TB was the root cause of all my troubles, and I was intensely medicated for the next six months. My symptoms improved, and I have since evolved (visibly even!) towards the hale and hearty end of the healthiness spectrum.

In retrospect, now that I am medically trained and pursuing a PhD in TB immunology, I can appreciate all that my care team must have had to consider before starting an eleven-year-old child on a rigorous anti-TB treatment based on an educated guess. My symptoms were not typical of classical lung TB, the most common and infectious form of TB, they were mostly gastrointestinal, but then TB has also been known to stitch the gut into uncomfortable knots. My mother had recently been diagnosed with a cold abscess, due to TB of the bone, and though this could not possibly be infectious (based on centuries of observation) it still raised flags as it meant I had a history of contact with a TB patient. I showed an immune response to the tuberculin skin test (TST), but then I had received the BCG vaccine, which is a close relative of TB bacteria. This meant I could elicit a cross-reactive immune response and result in a positive TST even in the absence of TB infection due to the similarity of the two bacteria. (more…)

Weighing up dodgy diets

Weighing up dodgy dietsMagazines and newspapers are full of so-called ‘tips’ or ‘advice’ for the image conscious, detailing extreme diets followed by the rich and famous to achieve dramatic weight loss, or new diets apparently supported by the latest scientific research. One example is the gluten-free diet, made fashionable particularly in the sporting world by former world number one tennis player Novak Djokovic (1). Having had a reputation for being physically weaker than his rivals, Djokovic was eventually diagnosed with coeliac disease and the resulting gluten intolerance. Eliminating gluten from his diet transformed his career.

Many have since adopted the gluten-free diet with the hope of boosting their own energy levels, but have had mixed results. Recent studies show that being ‘gluten-intolerant’ is hardly a medical condition that can be diagnosed and scientists have struggled to establish a mechanism for supposed gluten intolerance. So unless you suffer from coeliac disease triggered by gluten, following a gluten-free diet could do more harm than good, as gluten-free foods are often low in fibre and key nutrients, and high in sugar. (more…)

The magic of crystallography

Light micrograph (LM) of Insulin crystals
Light micrograph of insulin crystals.

Originally published in the Imperial Magazine in June 2017, Professor Naomi Chayen explains why, when it comes to medicine, crystals may indeed have magical properties.

To grow a crystal used to be considered a kind of magic. Perhaps that’s because crystals are so beautiful: it is easy to understand why so many people are fascinated by them and believe that they bring good fortune, or have healing powers. And yes, they do have powers. Crystallise a substance – a protein, for example – and you can understand its structure. We prize diamonds for their beauty: I prize protein crystals for their potential power to unlock new treatments, in everything from cancer to diabetes. They are my diamonds.

My own involvement with crystallography was a happy accident. I was encouraged into the field by one of its great pioneers, Professor David Blow. At that time, growing a crystal was regarded as more of an art than a science. There was a sense that one had to have ‘green fingers’, like a gardener: knowing the basic components of success but also using some kind of indefinable sixth sense.

I became fascinated with them. I wanted to bring scientific fundamentals to the process and create crystallisation methods that would work all over the world, from Kathmandu to Tokyo. Of course, crystallisation is not new. In 1914, Max von Laue won a Nobel Prize for his discovery that X-rays could be diffracted by crystals, making it possible to work out their structure. In those early days, there was a great rush to crystallise as many things as possible. Any substances that were simple to crystallise, were crystallised. (more…)

Ten minutes in Beirut: the harsh struggle for health and life facing Middle-Eastern refugees

Beirut, Lebanon
Beirut, Lebanon

20 June is World Refugee Day, and my short morning walk to the American University of Beirut (AUB) provides a daily and grim taste of the global refugee crisis. At 8:50am I take a right out of my Beirut flat onto a bustling and polluted Lebanese street. I live opposite a cheap hotel that hosts medical tourists – Iraqis, mainly – due to crippling of health systems in the region. A quick glance to my left and I’ll see two women outside a supermarket holding babies and pleading with ingoing shoppers for a small bottle of milk. To my right I see a large but flattened cardboard box, knowing this will soon become the cushion for a young mother and her two children. I’ll see them on my way home and I’ll worry about the toddler, who looks thin and tends to wander into the road.

By 8:55am I’m on a steep descend towards the main entrance of AUB. As I pass by a beautifully colourful series of flower shops on my left, I see an elderly man in plain clothes sitting on a white, plastic chair and holding a cup of tea. He has an expressionless face, he has damaged red skin around his ankles, he is obese, and he is silent. We exchange a look and I feel despair; not just for him, but for the nine year old girl who used to be in his place up until April this year. Also silent, she would sit and curiously watch passers go by. She was from Aleppo, a city brought down to its knees in recent years, and she told me her mum wouldn’t let her go to school in Lebanon. I dare not ask the elderly man what happened to her, but let’s not be under illusions – gender-based violence and early marriage are a feature of armed conflicts. (more…)