Max and Keira’s law: an overview on the advantages, disadvantages and alternatives to an opt-out organ donation system in the UK

Summary: Despite definite implementation of the law, there have been concerns over the presumed consent given for retrieving organs from the deceased; ignorance and lethargy from certain members of the public may mean that true informed consent can never be obtained when collecting organs. To combat this, expensive national campaigns would need to be launched to make the public aware of the new process, as well as educating them on how to opt out of the process if necessary. Regardless of these challenges, there are many advantages to the new law. Advantages include an increase in successful organ donations and transplant, as well as potentially an increased availability of organs for use in medical research, drug development and university teaching. Relevance: To increase the number of organ donors in England, the government will implement Max and Keira’s Law: all adults over the age of 18 living in the United Kingdom become potential organ donors after their death, unless they choose to opt out. The law will be employed by spring 2020. Despite there being presumed consent for the retrieval of organs, families of the deceased will still be contacted to recheck consent, and ensure that family wishes are upheld. Take Home Messages: Based on the advantages, the move to the opt-out system appears to be a sensible method to increase the number of organs available for use in medicine. Proposed alternatives such as xenotransplantation and 3D bioprinting have the obvious benefit of providing an almost infinite supply of organs. However, these alternatives remain in the preclinical stages, with ethical challenges and infection risks that need to be overcome before they can be used in hospitals

Flour fortification with folate to reduce risk of Spina Bifida

Summary: Spina bifida is the most common neural tube defect (NTD) and is caused by an interaction of genetic and environmental factors. The congenital condition results from the failure of closure of the caudal neural tube and can led to a variety of complications. Current prevention and management interventions include taking folic acid supplements and undergoing operation before or after birth. The compulsory fortification of flour with folic acid has been successful in countries such as the USA, where studies have found that the prevalence of spina bifida declined by 31% since fortification was introduced. Despite the evidence to support the legislation, there are many concerns regarding folic acid fortification. These include certain ethical considerations regarding the feelings of those already living with NTDs as well as a potentially increased risk of cancer due to excess folic acid in the diet. Relevance: The British Government has recently announced plans to discuss the mandatory fortification of flour with folic acid. This is in response to the establishment of a causal link between NTDs such as spina bifida and low folic acid levels in mothers during the embryonic stage of pregnancy. Evidence suggests that a diet containing folic acid reduces the risk of spina bifida in offspring by up to 70%. Take Home Messages: Further research is needed to explore the long-term effects of increased folic acid in the diet; however, it appears as though the evidence for the mandatory fortification of flour with regards to a significant reduction in the risk of developing NTDs such as spina bifida outweigh potential risks

Novichok: an overview of the world’s deadliest nerve agent

Relevance: The Novichok class of nerve agents are noxious chemical-weaponized organophosphates. Though its use is prohibited under the 1997 Chemical Weapons Convention, the attempted murder of an ex-Russian spy and his daughter has turned a spotlight on one of the world’s deadliest poisons. Summary: Novichok was developed by the Soviet Union in the 1970s and is reportedly ten times more lethal than VX, the nerve agent used to assassinate the half-brother of North Korean leader Kim Jong-un. Novichok produces its toxic effect by irreversibly inhibiting acetylcholinesterase. Unlike other nerve agents, it is thought to target both the central and peripheral nervous systems. Exposure to Novichok invariably leads to death. Take Home Messages: With an increase in worldwide chemical weapons usage, including recent use in the United Kingdom, clinicians should know how to rapidly recognize symptoms of nerve agent poisoning, lend their expertise in the education and treatment of such attacks and administer life-saving antidotes

An overview of the epidemiology, transmission, pathogenesis and treatment of scabies

Summary: Scabies is a well-known, yet a poorly understood neglected tropical disease (NTD). Although less common in the UK, scabies epidemics regularly occur abroad, in tropical, less developed communities (LDCs). Cases are prevalent in communities which tend to live with overcrowding, poor sanitation and limited access to healthcare facilities and medication; this environment provides the perfect breeding ground for the growth and the transmission of scabies. The body has a delayed response to infestation, this is due to the scabies mite’s ability to disrupt the complement cascade and delay the onset of the adaptive arm of the immune response Relevance: Contrary to popular belief, anyone can become infested with scabies. Although not usually life-threatening, scabies can cause unpleasant symptoms, as well as worsen existing skin conditions, which can reduce a person’s quality of life. Prompt diagnosis is challenging in LDCs. When failed to be diagnosed, scabies may lead to serious complications such as secondary skin sepsis, as well as allowing further transmission. Scabies is highly contagious; clinicians should be aware how to spot and treat scabies early on, and additionally know to offer treatment to other members that the patient has been in close contact with. Take Home Messages: Management for scabies is relatively simple and involves the application of topical medication, such as Permethrin. Despite this, there are still many barriers to treating epidemics in LDCs, such as a lack of access to treatment and healthcare professionals, a lack of awareness from clinicians about the condition’s clinical manifestations, as well as lack of infrastructure to definitively diagnose the condition. Despite progress in management of the condition, the pathophysiology and transmission of the condition are only partly understood, and the rise of resistance to current scabicides is indicative of the need for newer treatments, especially within resource poor communities