Secondhand ICDs to be Legalised?

Over the years, the development of biology and medicine has often been hindered by the towering obstacle that is "ethics". The latest debate surrounding this topic has been over the use of second hand implantable cardioverter defibrillators (ICDs), which is a small battery-powered electrical impulse generator that is implanted in patients who are at risk of sudden cardiac arrest due to ventricular fibrillation. The device is designed to pick up any signs of cardiac arrhythmia and correct it by initiating a jolt of electricity. It has been reported in Mumbai, India that 81 adults have been given second hand ICDs, removed from adults in the United States. Collaborating doctors arranged their own transport for the devices, which were taken from the US to the Holy Family Hospital in Mumbai, where they were cleaned, sterilised and given to informed patients who were not in a position where they could afford a new one.

Implantable Cardioverter Defibrillators can cost up to $87,000

Behzad Pavri, from the Thomas Jefferson University Hospital in Philadelphia, and his colleagues reported few complications (only one fractured lead, and one dislodged lead) and no infections, in a case series in Annals of Internal Medicine. The report tracked 75 of the 81 patients for more than two years. Devices were deployed appropriately in half of the patients, giving shocks or antitachycardia pacing when required. Nine patients died during the follow-up, an average of 771 days after receiving the second hand device. The American team procured many cardioverter defibrillators from funeral directors. Other devices were donated by patients having a replacement.

In actual fact, the reuse of ICDs in America has been prohibited by the US Food and Drug Administration and federal laws prohibit funeral directors from collecting up. Therefore, the doctors taking part in this exercise are on uncertain ground legally but are calling for changes to liberalise the "charitable use" of second hand ICDs. However, two experts in global health warn that that might be premature. Giving potentially substandard drugs or devices to the world's poor is highly controversial and has rightly been discredited in the past. Clear ethical guidance is urgently needed to shape well-intentioned efforts to reduce health inequalities and get life-saving treatments to those who need them most. It is paramount that in the first instance they ensure their efforts are completely and utterly 100% safe.

Pavri is confident that donating used ICDs to patients in India is ethical. "The most unethical stance would be to withhold appropriate therapy in a patient who would benefit from therapy simply because of financial considerations. A reused device is better than no device, given the risk of sudden death." I, for one, completely agree with him.

Treating Healthy Cells to Prevent Cancer

On 4-7 November, at the 8th annual National Cancer Research Institute conference in Liverpool, two new strategies were put forward to prevent cancer cells from recruiting healthy cells to help them both grow and spread. The first would prevent the proliferation of surviving tumour cells through the dampening of the immune system post-cancer treatment. The other would stop breast cancer from reaching organs such as the lungs blocking an "accomplice" vital to any such spread.

The former strategy would essentially be implemented on women who have undergone breast cancer treatment previously in order to prevent cancer relapses by reducing the levels of regulatory T-cells (lymphocytes) which suppress the immune system. These cells are known to be more common in women with particularly large and aggressive breast cancers. This additional course would take place after the original treatment and would ideally be fairly cheap, using the relatively non-toxic anti-cancer drug: cyclophosphamide. A study of 35 women indicated that the drug may potentially be effective in preventing the spread of such harmful cells.

Regulatory T-cells (1)

"If you use cyclophosphamide at low doses, you can reduce [numbers of these cells] substantially without affecting other cancer defences,"claims Oleg Eremin of the Queen's Medical Centre at the University of Nottingham. He originally got the idea to use cyclophosphamide by monitoring the levels of regulatory T-cells in women with breast cancer before, during and after treatment. Each of the women had large breast tumours and some had six times the normal level of T-cells. This suggested that the cancer cells somehow ramp up the number of their "accomplices".

Regulatory T-cells (2)

Having shrunk the tumours through chemotherapy, which consisted the implementation of cyclophosphamide and two other drugs, then surgically removing any remaining tumours, Eremin and his team discovered that although the level of regulatory T-cells fell significantly, it was still above normal. Furthermore, they observed that once the chemotherapy had finished, these figures began to creep up again. His hypothesis is that it is the more resistant cancer cells that linger in the body and stimulate the production of the T-cells. Over the next six months or so, it is Eremin's wish to monitor the progress of these same women to see if their regulatory T-cell counts continue to rise. If this proves to be true, it is probably then worth attempting to keep these cells in check and prevent relapses with a second course of cyclophosphamide.

Meanwhile, a team at the Institute of Cancer Research in London, led by Clare Isacke, have made headway in the battle to prevent breast cancer cells from spreading into the lungs, liver and other tissues. The process begins with these cells binding into the surface of blood vessels in the lungs. Isacke has discovered that they can only do this if they are attached to a protein "accomplice" in the blood. It is this binding that can potentially be blocked by drugs.

Isacke also discovered that cancer cells were least invasive if they lacked the surface sugars required for grasping the protein. Blocking the protein, which she will name when she publishes her results in full, might be enough to reduce cancer's spread, and Isacke is confident that drugs can be found that are able to do this. "We'd like to find ways to disrupt this collusion without harming normal interactions between healthy cells," she says.

Ballon d'Or 2012 Shortlist (ENG/ES)

The following 23 players have been shortlisted for the FIFA Ballon d'Or 2012 (in alphabetical order): 

Sergio Agüero (Argentina), Xabi Alonso (Spain), Mario Balotelli (Italy), Karim Benzema (France), Gianluigi Buffon (Italy), Sergio Busquets (Spain), Iker Casillas (Spain), Cristiano Ronaldo (Portugal), Didier Drogba (Côte d’Ivoire), Radamel Falcao (Colombia), Zlatan Ibrahimović (Sweden), Andrés Iniesta (Spain), Lionel Messi (Argentina), Manuel Neuer (Germany), Neymar (Brazil), Mesut Özil (Germany), Gerard Piqué (Spain), Andrea Pirlo (Italy), Sergio Ramos (Spain), Wayne Rooney (England), Yaya Touré (Côte d’Ivoire), Robin van Persie (Netherlands) and Xavi (Spain)

Radamel Falcao: Best striker in the world?

It's difficult to have too many objections with the shortlist published by FIFA for the Ballon d'Or this year. Once again, the football fan is left in no doubt that the two Spanish giants Barça and Real are lightyears ahead of any other club team in Europe, their strength displayed through their eleven (out of the twenty-three allocated places) nominations. That said, this doesn't necessarily say all that much about the quality/strength-in-depth of La Liga itself as only one player (Radamel Falcao) was selected from the other eighteen teams in the Spanish top division. Six players were nominated from the Barclays Premier League, representing the "newly-established" top four of Manchester United, City, Chelsea and Arsenal. Despite their fairly sub-standard UEFA Champions League debut appearance, Manchester City's impressive league campaign was enough to get three players (Agüero, Balotelli and Yaya Touré) onto the 2012 shortlist. Something makes me think that the unresolved debate of "La Liga or Premier League?" will remain unanswerable for at least another year. One query I'd have with the names put forward this year would be the lack of German-based players. Although both the Bundesliga and Italian Serie A have taken serious hits in recent times as they've leaned in the direction of becoming intermediate leagues for young, developing players, it was surprising not to see names such as Götze or Lewandowski make the cut, especially taking into account the latter's thirty-odd goal tally last term. One would be entitled to question the exclusion of such players when a player as mercurial as Mario Balotelli has been included. There is no doubt in anyone's mind that he is an unbelievably talented individual, with potential on and off the ball. The performances he put in for Italy at Euro 2012 (most notably against Germany in the semi-finals) were nothing short of brilliant. However, a mixture of temperamental issues, inconsistency and mishaps off the field would lead one to question his nomination.

Messi won the Ballon d'Or in 2009, 2010 & 2011

In terms of the actual winner, I honestly cannot see anyone whose name is not Lionel Messi getting their hands on the Ballon d'Or this year, or any time soon for that matter. In 2011, he established himself as the best player of his generation. In 2012, in my eyes, he surpassed his national hero, Diego Maradona, and successfully engraved his name into footballing stardom. All that's stopping him from becoming the best of all time is that one elusive outstanding international performance at a major competition (namely the World Cup). To achieve this, both he and his compatriots will have to be on song at Brazil 2014. I strongly believe that this will be the case and that they'll go far, using the proximity of the competition to their advantage. Even if FIFA tried to spin it round on him, claiming that a player who competed at this summer's Euro 2012 has achieved more over the course of this year, one can not forget that as we were watching some fairly drab, non-eventful group stage matches, Messi was out scoring a more than memorable hat-trick to down Brazil 4-3 in the States. So the excitement this year really surrounds the second and third places. Looking down the list of twenty-three, it's very difficult to pick names and put some higher than others because each and every one has excelled for both club and country this calendar year. That said, after some thought and consideration, this is what I've decided my top three would be:

1) Lionel Messi (FC Barcelona and Argentina)

As mentioned above, there is no doubt in my mind that Lionel Messi was the best footballer on the planet in 2012, and probably has been for the past five or so years. Despite playing in a trequartista role at the Camp Nou just behind either David Villa or Alexis Sánchez, over the course of the 2011/12 campaign he managed to break Pelé's record of 77 goals in a season by netting 82 in 69 appearances. In Liga BBVA he also ended up with the second most assists (16), only one behind Real Madrid's Mesut Özil. Although the 2012 calendar year proved fruitless in terms of silverware for Messi and Barcelona, his contributions were invaluable for both club and country; so much so that he was awarded the Argentina national team captaincy by head coach Alejandro Sabella, who went on to claim that Messi had even improved since then. As long as everything goes to plan, I think it's safe to assume that Leo will be receiving his fourth Ballon d'Or on 7th January.
Como mencionado antes, no hay duda que Lionel Messi era el mejor futbolista en el mundo durante 2012, y probablemente de 2007. A pesar de que jugando como "trequartista" al Camp Nou un poco detrás de David Villa o Alexis Sánchez, a través de la 2011/12 temporada podía batir el récord de Pelé de 77 goles en una temporada al marcar 82 goles en 69 partidos. En Liga BBVA, solamente Mesut Özil de Real Madrid hizo más asistencias de Messi. Aunque el año calendario de 2012 era en cierto modo infructífero desde el punto de vista títulos para Messi y Barcelona, sus contribuciones en la selección argentina y Barça también eran inestimables; hasta tal punto que era designado capitán de Argentina del entrenador Alejandro Sabella. Sin lugar a dudas, creo que Leo recibirá su cuarto Balón de Oro el siete de enero.

2) Cristiano Ronaldo (Real Madrid C.F. and Portugal)
For the past five years, Ronaldo has lived in Lionel Messi's shadow. However, 2012 was the year when CR7 managed to claw his way back into contention. Like Messi, despite not playing up front, Ronaldo managed to net the most goals out of any of his teammates, netting 60 times in 55 appearances for Real Madrid in all competitions. To put this statistic into perspective, the next top scorer for Real Madrid was the highly-impressive Frenchman Karim Benzema with 32 goals. The 2011/12 season proved to be an eventful one for the Portuguese winger, from his preseason hat-trick against Guadalajara to receiving the "Trofeo Alfredo Di Stefano" for the best La Liga player at the end of the season, helping Real Madrid to their first league title in four years. On the international scene, Ronaldo was formidable for Portugal at Euro 2012, finishing as joint top goalscorer with three goals and helping them reach the semi-finals only to get beaten by Spain on penalties. To top off a great year, Ronaldo received his 100th cap on 16th October 2012 against Northern Ireland at the age of 27. His progress over the course of 2012 was ironically highlighted at the Camp Nou in early October when he matched Lionel Messi blow-for-blow during the third El Clásico of the season, netting two goals in answer to his counterpart's two to make the full-time score 2-2. No wonder he's recently stated that he'd vote for himself if he could this year!
En los últimos cinco años, Ronaldo ha sido segundo a Lionel Messi. Sin embargo, 2012 era el año cuando "CR7" podía volver a contención. Como Messi, a pesar de no jugar como delantero, Ronaldo podía marcar 60 veces en 55 partidos en representación de Real Madrid en todas competiciones. Poner esta estadística en perspectiva, el próximo goleador superior era el delantero francés muy valorado Karim Benzema. La 2011/12 temporada resultó ser una temporada muy ajetreada por el ala portugués, empezando con un hat trick contra Guadalajara y terminando con su aceptación del "Trofeo Alfredo Di Stefano" por el mejor jugador en La Liga a la conclusión de la temporada, ayudando Real Madrid a ganar el título desde de cuarto años. Además, Ronaldo era formidable a la Eurocopa 2012, marcando tres goles, y ayudando Portugal a llegar a la semifinal cuando perdió a España en penaltis. El dieciséis de octubre 2012, Ronaldo recibió su corona centésima en un partido contra Irlanda del Norte a la edad de veintisiete. Destacó su progreso al Camp Nou, irónicamente, en lo mismo mes concordando Lionel Messi con todos movimientos, marcando dos goles contra los dos de Messi. El partido terminó 2-2. Messi había encontrado la horma de su zapato.

3) Radamel Falcao (Atlético Madrid and Colombia)
This guy is the best centre forward in the world at the moment. End of. Having scored 36 goals in his debut season at Atlético Madrid in all competitions, he has even been recognised by some as the best signing in 21st Century Spanish football. His prolific goalscoring record has also been acknowledged by many managers, with the likes of Pep Guardiola and Fabio Capello singing his praises. It's fair to say that after the Brazilian Ronaldo surpassed his peak, the footballing world has perhaps not been gifted with a natural goalscorer of his quality. That said, Falcao seems to be edging closer and closer to becoming his successor. His ability to put the ball the in the back of the net from any position, under any circumstances has only been matched at times by Robin van Persie during the course of 2012. However, although there is no doubt the latter has improved his right foot shooting in recent times, Falcao's finishing with both feet has indeed been unparalleled. This, simply put, is the reason why he would fit into any team on the planet regardless of their style of play. I'd be surprised if he wasn't on the move in January.
Este tío es el mejor delantero en el mundo en este momento. Sin argumento. Al marcar 36 goles durante su primera temporada a Atlético, algunas personas también dijeron que él es el mejor fichaje del fútbol español durante el siglo veintiuno. Algunos entrenadores, como Pep Guardiola y Fabio Capello han reconocido su forma prolífica. Es justo para decir que antes de la época del Ronaldo brasileño, el mundo de fútbol ha faltado un delantero de su cualidad. Sin embargo parece que Falcao pueda ser su sucesor. Su capacidad para marcar goles bajo alguna circunstancia se enfrentará solamente con Robin van Persie a veces durante 2012, pero sus tiros con los dos pies son sin rival. Por esta razón, se integraría muy bien en todos los equipos del mundo. Sería muy sorprendido si Falcao no viajaba en enero.

  

Ankle Injuries

To be completely honest with you, recently, it feels like I've been living at the physio's. Therefore, it seemed appropriate to take a further look into ankle injuries. Ideally, I intended on doing a bit of research into my own "disability" but it turns out that my specific case is fairly uncommon due to the fact that I went over on the inside of my ankle rather than the outside (which is a lot more common). The ligaments on the inside are a great deal stronger than on the outside, meaning that although it'll heal more effectively and return back to its original condition, the recovery time could be up to three times as long. Unsurprisingly, there wasn't much on the worldwide web in relation to my injury so I thought I'd look into ankle injuries in general.

The Anatomy of the Ankle:

Tibia, Fibula, Talus, Ankle Joint

The Ankle Joint is surrounded by two ligaments:

1) Syndesmotic ligaments - (high ankle sprain)

2) Anterior talofibular ligament - (collateral ligament injury - ankle sprain) 

Anterolateral Ankle Pain:

High Ankle Sprain:

This consists of the sprain or tear of the syndesmotic ligaments that connect the tibia and the fibula at the ankle. It can be diagnosed through rotational stress with visual examinations or through a CT (computed tomography) scan and may require surgery.

Anterolateral Impingement:

Anterolateral Impingement is essentially the restriction of the ankle's full range of motion due to soft tissue or osseous (bone) pathology. This often occurs when the soft tissue thickens or undergoes fibrosis, causing adhesions that extend into the ankle joint. On the other hand, however, a spur in the tibial bone can impinge the talus is also a major cause of the aforementioned limitation in the ankle's motion as the spur's anterior lip gets in the way of the talus during dorsiflexion, which can also lead to chronic ankle pain. In this case, the patient may require debridement of the spur. This type of impingement has been found to be common in athletes who have had previous recurring ankle injuries of a similar nature.

Ankle Sprains:
In the case of ankle sprains, pain is normally anterior and localised in the fibula and can normally be attributed to a ligament sprain. They are more often than not the result of when the ankle is forced into an unusual/unnatural position, the ligaments will either get partially or completely torn. An ankle sprain is usually treated with: immobilisation, ice therapy, physical therapy and, in some extreme cases, surgery. It is normally fairly easy to distinguish the difference between a sprain and a fracture by assessing the patient's ability to walk. Although a certain amount of pain will have to be endured, someone with a sprained ankle should be able to walk. Conversely, if the patient is not able to walk, he/she has more likely than not suffered a fracture. Pain that is localised posterior to the fibula can usually be attributed to an injury of the peroneal tendons, which line the back of the fibula and lateral malleolus.

AT = Achilles Tendon

PL = Peroneus Longus

SPR = Superior Peroneal Retinaculum

IPR = Inferior Peroneal Retinaculum

PB = Peroneus Brevis

Lateral Ankle Pain:

Patients with this problem usually describe the pain as coming from the outer part of the ankle or just behind the lateral malleolus, more specifically, occurring in the area where the tendons in the two muscles (superior and inferior fibular retinacula) glide within a fibrous tunnel.

Peroneal Inflammation/Tendonitis:

Occurs when the tendons are subject to excessive and repetitive forces which lead to pain and swelling.

Peroneal Tendon Subluxation:

Is similar to an ankle sprain, occurring after a retinaculum injury, especially in dorsiflexion or eversion (turning outward) of the foot.

Posterior Ankle Pain:

Achilles Tendonitis:

When the achilles tendon is overused, it can cause irritation and inflammation. More often than not, this will result in pain, swelling and tears within the tendon. With age, lack of use or overexercising, it can become prone to injury/rupture. To check for the existence of an achilles tendon rupture, it is necessary to perform the Thompson Test (essentially the squeezing of the calf muscles). A positive result (i.e. showing that there is a rupture) would be demonstrated by the fact that the ankle would not move.

Posterior Ankle Impingement:

This can occur due to the os trigonum or large posterior process of talus (stieda syndrome) and is common among athletes such as ballet dancers.

Medial Ankle Pain:

Tarsal Tunnel Syndrome:

This refers to the compression/squeezing on the posterior tibial nerve that produces symptoms of pain and numbness, localised on the medial (inside) area of the ankle. If conservative treatment methods were to fail, surgical treatment, more specifically, tarsal tunnel release surgery may be required. A similar syndrome is the posterior tibial tendon tear, which is one of the leading causes of failing arches in adults.