Innholdsfortegnelse for Volume 1 Issue 1 i Aster Medical Journal (AMJ)

Correspondence: S Heller Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK s.heller@sheffield.ac.uk Abstract Objective To compare the effectiveness of insulin pumps with multiple daily injections for adults with type 1 diabetes, with both groups receiving equivalent training in flexible insulin treatment. Design Pragmatic, multicentre, open label, parallel group, cluster randomised controlled trial (Relative Effectiveness of Pumps Over MDI and Structured Education (REPOSE) trial). Setting Eight secondary care centres in England and Scotland. Participants Adults with type 1 diabetes who were willing to undertake intensive insulin treatment, with no preference for pumps or multiple daily injections. Participants were allocated a place on established group training courses that taught flexible intensive insulin treatment (“dose adjustment for normal eating,” DAFNE). The course groups (the clusters) were then randomly allocated in pairs to either pump or…

There was a certain kind of quiet hopefulness when, in late April this year, the last Ebola patient of the West African epidemic – a two-year-old boy – walked out of a treatment facility in Monrovia, Liberia. With the smouldering embers of the outbreak fading, there was cause for celebration. But there remains the impotent fear of the unseen: Ebola is still out there, lurking. We just don’t know where it’s hiding or when it will be back. And if we’re going to stop Ebola in the future, we have to find its hiding places. Ebola is a zoonotic disease, meaning that it can spread between animals and humans. It burns hot and fast through people. Its ruthless nature means that we are often the end of the line for…

Jennifer Adair carried out her first gene therapy experiment several years ago. A cancer treatment, it involved collecting blood from a patient, and then adding to these cells a new strand of DNA—a gene—that would protect them from a powerful chemotherapy. The altered cells were then reinfused into their veins. The study, involving 11 patients, proved fairly successful. But Adair, who runs a gene-therapy lab at the Fred Hutchinson Cancer Research Center in Seattle, says it took three sleepless scientists around 96 hours just to process a single person’s cells in a multimillion-dollar clean room. “I said, ‘Wow, we really need to simplify this,’” Adair recalls. Gene therapy is moving quickly from experiment to medical reality. But with potential treatments for cancer and rare diseases now showing promise, scientists are…

Thirty years ago a young anaesthetist, newly appointed as head of department at Calicut Medical College Hospital in the Indian state of Kerala, encountered a case that would change his life. A college professor aged 42 with cancer of the tongue had been referred to him by an oncologist. The man was in severe pain and the anaesthetist, Dr M R Rajagopal, was asked if he could help. He injected the mandibular nerve in the jaw in a procedure known as a nerve block, and told the patient to return in 24 hours. Next day, the pain had almost completely gone and Dr Raj, as he is known, was pleased with his work. “He asked me when he should come back. I told him there was no need to come…

Director, WHO Collaborating Centre for Policy And Training on Access to Pain Relief and Founder-Chairman, Pallium The efforts by pioneers over the last quarter of a century have resulted in progress, some of which may hold lessons for the rest of the developing world. In recent years, a few of the major barriers have begun to be overcome. The South Indian state of Kerala, which has 3% of India’s population, stands out in terms of achieving coverage of palliative care. This has been achieved initially by non-government charitable activity, which catalysed the creation of a government palliative care policy. The nongovernment action, by involving the community, serves to strive for quality of care as the government system improves coverage. On the national level, recent years saw several improvements, including the…

In a dream Brian Hanley told me about, he’s riding a bus when he meets a man in dark leather clothing. Next thing he knows, he is splayed across a tilted metal bed, being electrocuted. The dream was no doubt connected to events that took place last June at a plastic surgeon’s office in Davis, California. At Hanley’s request, a doctor had injected into his thighs copies of a gene that Hanley, a PhD microbiologist, had designed and ordered from a research supply company. Then, plunging two pointed electrodes into his leg, the doctor had passed a strong current into his body, causing his muscle cells to open and absorb the new DNA. The effort is the second case MIT Technology Review has documented of unregulated gene therapy, a risky…

Shortly after Cameron Harding’s one-month check-up, his mother, Alison, saw that her newborn seemed to stop moving. She’d unwrap him from a swaddle and his arms would flop to one side. He wouldn’t kick his legs or turn his head. The diagnosis: spinal muscular atrophy. The inherited illness, which destroys the motor neurons that control movement, often kills children before they turn two. Cameron’s case was severe enough he’d probably never even have a birthday. But when he was seven weeks old, Cameron’s parents enrolled him in a clinical trial for an experimental drug. In videos shot two months later, he could move his head and reach for a toy. No child with his condition had ever made such a recovery before. The drug Cameron received, Spinraza, was approved in…

Young women who have survived cancer have an increased risk of having a preterm birth and a low birthweight baby, a large case control study of cancer survivors has found. Five year survival rates are now over 80% in patients who have had adolescent and young adult cancers. Studies show that around two thirds of young women who survive cancer want the possibility of having children, but information on their potential risk of adverse birth outcomes is limited. Researchers used the North Carolina Central Cancer Registry to identify 2598 women who survived adolescent and young adult cancers diagnosed in 2000-13, linking their records to state birth certificate files to investigate birth outcomes in their offspring. They compared these with a control group of 12 990 women with no history of…

Sitting in a bare room on the first floor, Dr. K. Suresh Kumar, director of the institute, recounts an experiment that has translated into a movement, bursting out of hospital walls and seeping into the soul of the community. He is wary of individual attention and gently says he is merely part of the core team that began the Pain and Palliative Care Society at Calicut Medical College in 1993. “It is about community ownership,” he says. But as the director of the first World Health Organisation Collaborating Centre for Palliative Care in the developing world, and a pioneer in the field who watched over the unprecedented growth of palliative care, he has become the face of the initiative in the Malabar - an area of southern India lying between…

DOCTORS WERE ONCE VIEWED AS ILL-PREPARED FOR LEADERSHIP ROLES BECAUSE THEIR SELECTION AND TRAINING LED THEM TO BECOME “HEROIC LONE HEALERS.” BUT THIS IS CHANGING. The emphasis on patient-centered care and efficiency in the delivery of clinical outcomes means that physicians are now being prepared for leadership. The Best Hospitals. The Mayo Clinic is America’s best hospital, according to the 2016 US News and World Report (USNWR) ranking. Cleveland Clinic comes in second. The CEOs of both — John Noseworthy and Delos “Toby” Cosgrove — are highly skilled physicians. In fact, both institutions have been physician-led since their inception around a century ago. Might there be a general message here? A study published in 2011 examined CEOs in the top-100 best hospitals in USNWR in three key medical specialties: cancer, digestive…

Alison Frase remembers the first moment when she thought gene therapy had a chance of curing patients like her son Joshua of a rare genetic muscle disease called X-linked myotubular myopathy. It was 2007, and she was viewing a video of a crippled mouse on her home computer. Four weeks earlier, the mouse had been injected with an engineered virus carrying a new strand of DNA intended to correct a genetic mutation that made its muscles limp and weak. Frase watched in awe and began to cry as the mouse’s limbs started to twitch. Eventually, it picked itself up and walked for the first time. “I thought, who cries watching a video of a mouse?” she recalls. Frase is very likely the reason why the same treatment is now about…

As an expedition doctor with the California Academy of Sciences, he’s handled dehydration in the Gobi Desert, poisonous spider bites in Papua, New Guinea, and altitude sickness in Argentina. But one of the biggest challenges, Lewin says, is saving victims of venomous snakebites, which he deems the world’s most neglected tropical disease. Neglected, he says, because 75% of snakebite victims who die never make it to a hospital. When you’re deep in a rainforest or high atop a mountain on a scientific expedition, medical treatment can be hours or even days away, Lewin explains. When a venomous snake bites, it can send paralyzing neurotoxins coursing through the victim’s veins. The nervous system becomes progressively disabled, and death comes when neurotransmission ceases. With no instructions to breathe, the muscles of the…