Barts MedSoc end of year reflections

Last week saw the end of my first experience as a GP tutor to Barts Malta first year medical students. The MedSoc programme, as it is called, is a series of twelve themed days from October till May dealing with a range of topics from the GP perspective. Topics dealt with included chronic pain, diabetes and pregnancy amongst others.

I was on a learning curve. Organising visits to associations, agencies, old people's homes and patients' residences as well as preparing tutorials and practical sessions....the work was intensive. Seeing my students motivated and eager to learn made it all worthwhile.

So this week it was with a bit of a heavy heart that I met Upe, Hish, Lexie and Casey for the last time. Knowing however that the experiences shared will stay with us for a long time...

Hair Apposition Technique for scalp lacerations

In urgent care we often come across injuries to the head which result in lacerations to the scalp.  Often dramatic due to the profuse blood supply of this region causing copious bleeding, they however rarely require more than simple suturing. An exception is small children, who we know are often accident prone and tend to get agitated very easily when at the doctor. An agitated child makes the procedure of suturing immensely more complicated, increasing the risk of failure of the procedure and injury to the operator. For this reason a technique for treating scalp lacerations known as hair apposition technique  (HAT) is a very valid alternative. Made public in 2002 this method involves using the patient’s own hair as the suture material and obviates the need for anaesthetic infiltration and use of needles. Furthermore the patient is spared having to return to the clinic for removal of sutures. As always patient selection is important, thus HAT is not advised for patients with  persistent profusely bleeding wounds and those with extensive contamination. For obvious reasons HAT is not suitable for bald patients or those with sparse or short hair. More information can be obtained in the video below. 

Overeating

What makes us overeat? What drives us to take in all those extra calories? Former Food and Drug Administration Commissioner Dr David Kessler explores these issues in this interesting interview.

When to give the meningitis B vaccine

Meningitis is a term used to refer to inflammation of the meninges, the tissue covering the brain. This is often caused by infection. One type of microbe that causes meningitis is Neisseria meningitidis and this leads to a disease called Invasive Meningeal Disease (IMD). IMD is an aggressive form of infection that quickly spreads to the blood and nervous system causing high fever, severe headache, a rash and can deteriorate to loss of arms or legs, coma and death.

Neisseria meningitidis is a very common microbe, mostly residing in the throat of carriers without causing any harm. It is estimated that around 10% of people have it. Transmission is by droplets of saliva as when breathing into another person's face, sharing of eating utensils, sneezing without covering the face and poor hand hygiene.

Problems arise when Neisseria starts to multiply uncontrollably such as in people with weakened immune systems. There are 5 subtypes of this meningitis microbe, namely ABCWY. Up till recently there was a vaccine available for subtypes ACW and Y. Subtype B was not covered. This situation changed when a shot targeted at the B subtype became commercially available and the demand for it was (and still is) huge. This in part was aided by news stories of deaths in children having been stricken by meningitis B and the consequent emotional outpour duly amplified on social media platforms such as Facebook and Twitter. In Malta you had people going over to Sicily with cooler bags to buy the vaccine and bring it over.

A close look at the facts reveals that IMD is a rare disease with two major peaks of incidence. The first occurs in the first year of life and the second peak towards teenage. The first peak is much more significant than the second. Furthermore the currently available vaccine covers against around 80% of type B Neisseria meningitidis and the duration of immunity beyond 48 months is unknown. This means that widespread use of this vaccine will presumably cause natural selection for the uncovered 20% of strains, thus rendering the vaccine useless in the long term.

Two respected internationally recognised organisations have issued different recommendations with regards immunisation with meningitis B vaccine in healthy individuals. These are the British NHS and the Center for Disease Control (CDC) of the United States. The NHS recommends that the meningitis B vaccine is given to all children in the first year of life together with the other routine vaccines. This approach assures protection during the age wheninfection with the meningitis B bacterium is most likely. However there is no assurance that the child will remain covered through life. CDC on the other hand recommends giving the vaccine to children as they reach teenage.

One should note that the vaccine is considered safe to all effects but it does carry the risk of side effects such as pain at injection site, fever, loss of appetite and nausea.

So in conclusion I have to say that the development of this vaccine has been a welcome development, but more research is needed to increase the range of protective cover it provides and to elucidate the length of immunity it affords.