‘I Am Breathing’ Film Screening in Berlin

Last week I organized a screening of the motor neuron disease documentary ‘I am breathing’ in Berlin. Produced by a team from Edinburgh, the film screening took place at the Charité and was attended by about thirty people from various walks of life. About half those in attendance were young neuroscientists like myself, and we had an interesting discussion of the movie and the disease behind its production at the end.
Motor neuron disease is not a common neurodegenerative disorder. Despite being rare, the disease (which is actually a combination of several distinct conditions characterized by a specific loss of the nerves that control movement) possesses many unique features that highlight the need to understand it better. First of all, the disease affects those in the prime of their lives so to speak – unlike Parkinson’s or Alzheimer’s disease. It is relentlessly progressive and fatal typically within a few years. Cognition is left completely intact (as is sensation), and thus patients afflicted with MND are usually lucid and aware of the devastating deterioration occurring in their bodies throughout the course of the illness.
On the other hand, the disease also appeals to scientists – it is in fact a very curious malady. It affects motor nerves in the central and peripheral nervous systems indiscriminately, yet spares all other nerve types. It does not improve with currently available treatment strategies which other similar neurological illnesses respond to such as immunosuppressants and immune modulating drugs. This is likely because there is very little inflammation in MND – the nerves simply degenerate and die, with little reaction from the body.
The film itself was very touching. It follows Neil – a man with MND’s final message to his infant son. His sense of humour was remarkably intact throughout his battle with MND, and he consistently made the audience laugh. Although I have a feeling much of the audience might have had some trouble understanding the thick Scottish accents (there were German subtitles also), I think everyone took something from the screening event.

More to come about the film, as well as the screening event soon. I’ve had quite a crazy month with my studies both in Berlin and Edinburgh, and now I’m writing this post while headed to Portugal for a weeklong workshop (which I also hope to find the time to post about soon). Until then, enjoy these photos of the ‘I am breathing’ screening at the Charité in Berlin.

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Neuroscience in Krakow

I returned on Sunday from the wonderful city of Krakow which hosted the IBRO/IRUN NEURONUS 2013 forum. The city is spectacular, with some magnificent architecture and a rich albeit tumultuous history. I travelled with a group of friends from Berlin, and we managed quite a bit of sightseeing in the scarce free time we had. We toured the historic landmarks of the old city and visited Schindler’s factory (now a museum exhibiting the history of Krakow during World War Two).
The forum itself was very interesting, with speakers from around the world including Poland, the United Kingdom, Germany, the Netherlands and Canada. Aimed at students, the forum covered a wide range of topics from cellular and molecular aspects to clinical and affective neuroscience. There was truly something for everyone during the four action-packed days of intensive lectures, interactive sessions and poster presentations. I had some lively discussions with some of my colleagues from Poland about Alzheimer’s disease and stroke during the poster sessions, and learned a great deal about the cutting-edge research on disorders of consciousness from a world-renowned expert.
Although there were (unfortunately) no speakers from Edinburgh, I learned about some fascinating research being done in Cambridge in collaboration with a group at the University of Edinburgh and the Medical Research Council on multiple sclerosis. I also attended an interactive medical case report session of rare and interesting neurological illnesses presented by local medical students.
Now I’m back in Berlin, for another three weeks of lectures followed by my final exam in early June, and I’m also continuing my Laboratory Medicine module for the MSc Internal Medicine at the University of Edinburgh.
I’ll be posting more about the forum soon! 🙂

Some photos from Poland:

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NEURONUS 2013

Greetings from Krakow! The 2013 NEURONUS neuroscience forum is in its third and final day. I’ve had a really busy schedule the past few days, with lectures and teaching sessions all day mixed in with sightseeing and tourist events. Thus, I haven’t had much time to post about the conference but I will be doing so soon (there are so many interesting things going on here!). For now, I leave you with some photographs of Krakow and the forum.

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A prelude to Poland

In anticipation of my upcoming trip to Krakow, where I will be attending a neuroscience forum (NEURONUS 2013), I thought I would post about the rich history of medicine in Poland.
While I am tempted to begin with Copernicus (1473-1573), perhaps a slightly more recent review of Polish achievements in medicine is more relevant. In my field of neurology, two names immediately come to mind when Poland is mentioned – the German psychiatrist Alois Alzheimer who spent the later stages of his career at the University of Breslau (now Wroclaw) and French neurologist of Polish descent Joseph Babinski who described the abnormal plantar reflex occurring after damage to the pyramidal tract. Others who are more intimately linked to Poland are neurophysiologist Napoleon Cybulski, who discovered adrenaline and Samuel Goldflam who helped describe the autoimmune neuromuscular disorder myasthenia gravis in the late nineteenth century. Goldflam studied under neurology legends Karl Friedrich Otto Westphal (German) and Jean-Martin Charcot (French) but spent most of his life in Warsaw. Edward Flatau is another name worth mentioning, he studied in Moscow under such great names as Sergei Korsakoff and worked with famed anatomist Heinrich Von Waldeyer-Hartz. Flatau made major contributions to our knowledge of migraines, the spinal cord and pediatric neurology.
Although I always unconsciously tend to make things all about neurology, Poland’s contribution to medicine extends far and wide across all disciplines. A few of the most noteworthy pioneers include Albert Sabin (Polish-born American) who developed the now widely used oral polio vaccine, Andrew Schally (Polish-born American) who received the Nobel Prize in Medicine for his work on peptide hormones in the brain (he received an honorary doctorate from the Jagiellonian University which is hosting the NEURONUS forum) and Tadeusz Krwawicz, an ophthalmologist who pioneered the field of cataract surgery.
So, my next post will (hopefully) be from the exciting city of Krakow! 🙂

”So you’re an MD?”

That’s a question I tend to get a lot. People always like to know if I have an MD whenever I mention that I went to medical school or that I’m a ‘doctor’. I used to reply, ”Not exactly, I’m an MBBS.” and then proceed to explain what that means (Bachelor of Medicine and Surgery). Recently, however I’ve given up and answered with a plain and simple ”Yep.”

So I decided to delve a bit deeper into why differences exist between the nomenclature of primary medical degrees. Worldwide, I was surprised to find out that most countries in fact use MBBS or a similar post-nominal letters such as MBBCh.It’s mainly just the US and Canada that use MD to refer to the primary medical degree. And yet, even here in Europe, I get a confused response when I try to explain the difference (thanks to the likes of ER, Grey’s Anatomy, House, I suppose). What was even more surprising, however, was that the US actually took the idea of the letters MD from the UK, Scotland to be specific. Until the 19th century, Scotland actually awarded medical graduates with MDs while the rest of the UK awarded MBBS, MB BCh, etc. Medical schools in Scotland, including the University of Edinburgh, award MBChB.

In the UK, Commonwealth nations, as well as in Sudan (where I earned my primary medical degree), MD is a postgraduate qualification usually awarded after a doctor is specialized and after he/she has done significant research – so it’s almost like a PhD in a sense.

In Germany, medical graduates don’t receive a post-nominal title. Instead, they are awarded the pre-nominal ‘Dr.med’.

Who needs an MRI? Welcome to the Third World

This post was inspired by a comment made by one of my professors during a lecture last week. She was explaining to the class how older, experienced physicians (from ‘way back when’) can pinpoint lesions with great accuracy based on symptoms and signs alone, without the need for fancy modern equipment such as MRI scanners. This is of course true, but it got me thinking of my own medical education.

One of the advantages of having studied medicine in a Third World country is that I was taught from early on to rely on clinical features to come up with accurate and precise diagnoses. While I am certainly no expert in doing so, I think people who practice in underdeveloped countries have a distinct advantage over their more technologically-oriented counterparts in developed countries. This is particularly true for emergency situations – MRI machines (and even CT scanners) are few in poor countries – laboratory tests are often outdated and transiently available and immunologic or genetic testing are especially cumbersome to locate. Thus, a junior doctor quickly develops the prowess of analyzing a patient’s presentation to come up with a single faulty aspect to be blamed.

In no other discipline is pinpointing precise lesion locations more important than in neurology. In fact, that is what neurology is all about. If we were to remove this aspect of the discipline then the specialty as we know it would cease to exist. In the preface to the first edition of one of my favorite books: ‘Introduction to Clinical Neurology’, neurologist Dr. Douglas J Gelb asks that very question – Is neurology obsolete? At least it lives on in developing countries, for now.

Exam time

So I realize it’s been a while since my last post (over two months, besides the last two which I actually started weeks ago but only just posted). The reason for this is, I’ve been swamped with lab work since mid-January, and I just handed in my final lab report and started a ten-day break from studying!

At least that’s what I thought, this week is my assessment week at the University of Edinburgh’s online distance learning MSc in Internal Medicine. This is the third such assessment week since I started last September, but it’s definitely the most challenging. Ten weeks of study culminating in one exam that includes all aspects of internal medicine bundled into 100 questions. From the kidneys to the brain, the skin to the liver – nothing is off-limits! I’ve been handling my lectures and tutorials well thus far, but I still feel like I should be studying more! The exam is in the style of the Membership of the Royal College of Physicians (MRCP) exams, which I hope to take sometime next year. I’m looking forward to the challenge of the exam, and I believe that the excellent preparation I received from the teaching staff at Edinburgh will serve me well. The program is brilliantly designed to guide it’s students through a wide range of topics, focusing on common illnesses, which is what the MRCP exam aims to test.

That being said, I may not have so much time to post anything this week, but I plan to come back next week with more exciting stories to tell! (And hopefully a victorious conquest of the exam)

Till then 🙂 !

What’s in a name? II. Giving credit where credit is due.

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Following up on my last article about eponyms, this time I move to the naming of organisms after their discoverers. For a long time, and to this day, the pathogen Pneumocystis jirovicii, which is a fungus that causes a specific type on pneumonia in immunocompromised people (such as those with HIV), is commonly referred to in the literature and among medical professionals as Pneumocystis carinii. The reason for this is that when it was first discovered, it was found in rats and named after the man who first described it – the Italian bacteriologist Antonio Carini. Later on, it turned out that the organism which causes human infection is different from the one initially described in rats. Not only that, but Carini mistook the parasite for a different form of another parasite, Trypanasoma cruzi (which causes Chagas disease). It was through the efforts of two French researchers that it was recognized as a distinct organism. To make matters even more complicated, P. jirovicii’s namesake, the Czech parasitologist Otto Jírovic, published his findings on the parasite ten years after two Dutch researchers had discovered that same organism! Anyway, the name was officially changed from P. carinii to P. jirovicii over fifteen years ago, yet the former still remains in common usage. There has been some debate regarding this change, with some people arguing that changing the name after such a long time is futile – that people will still use the old – and causes unnecessary confusion. I guess it just goes to show, you can’t teach an old dog new tricks. However, that doesn’t explain why I often use the old nomenclature too. At least I think it doesn’t.

What’s in a name? I. Eponyms and a dark history

Ask people what they think of the use of eponyms in science and you will get a mixed response. In medicine, eponymously named syndromes, structures, processes and laws are everywhere, though there is much debate about whether they should be in routine use. Personally, I’m a big fan of eponyms – they may not be descriptive or informative as the proper terms they signify, but I think they have a certain appeal. There’s a lot of history to be unearthed when encountering an eponym for the first time, and it’s status as a tribute to the discoverer/inventor is so … wonderful!

That being said, there’s a dark side to eponyms as well, one that I recently encountered after attending a tutorial (part of the MSc Internal Medicine program) at the University of Edinburgh. The topic was sexually transmitted disease, and a syndrome known as reactive arthritis came up. This disease, which describes urethritis, conjunctivitis and arthrits, is eponymously named ‘Reiter’s syndrome’ (the eponym was not used during the tutorial, and I had wondered why not). Now, I had heard this eponym being used very often during medical school, more often in fact than the proper term for the condition, but I had never known who Reiter was. So, after the end of the tutorial I did some digging and found out that the disease was named after Hans Reiter, a German doctor who was a member of the Nazi party and was convicted of war crimes for experimenting on people in concentration camps. Apparently, over the past decade the term Reiter syndrome has fallen out of favor within the medical community, and many people who generally oppose the use of eponyms are using it as an example of why they should be abandoned. Moreover, there are several other medical eponyms with similar Nazi histories, including the Clara cell and Wegener’s granulomatosis. There has been considerable effort so far to replace the use of these terms with other, more informative titles. What this means for the future of eponyms in medicine is not yet known.

On a side note: Living in Germany, it’s interesting to observe how people react to the country’s complex and distressing past. The Charité, the main university hospital and medical school in Berlin, was once home to many convicted Nazi physicians. I’m not sure whether similar eponyms are used here for the mentioned structures and diseases, but it would be interesting to find out.