Inside: Targeted treatment for Crohn’s disease Volume 11: Number 1. 2018 ISSN 2009-0838 smj Royal College of Surgeons in Ireland RCSI Student Medical Journal Big budget brain projects RCSI DEVELOPING HEALTHCARE LEADERS WHO MAKE A DIFFERENCE WORLDWIDE Acknowledgements Thank you to RCSI Alumni for their continued support to us as students – providing career advice, acting as mentors, enabling electives and research, and supporting the publication of the RCSIsmj since its inception in 2008. We, as today’s generation of students and tomorrow’s generation of alumni, are very grateful for this ongoing support. A special thanks to Prof. David Smith for the time and encouragement he has given to the RCSIsmj Ethics Challenge and for his support of the annual debate. We would also like to thank the Dean, Prof. Hannah McGee, for her sponsorship, and Margaret McCarthy in the Dean’s Office for her constant endorsement and assistance. The RCSIsmj was extremely privileged to have a number of professors and clinicians involved in this year’s journal club. We would like to thank the following for their support of, and participation in, the journal club, and to express our appreciation of the time, knowledge and expertise they shared with us: Dr Nurul Aminudin Prof. Fionnuala Breathnach Dr Frank Doyle Dr Joseph Galvin Prof. Arnold Hill Prof. Samuel McConkey Dr Mark Murphy Mr David O'Brien RCSIsmjcontents 4 Editorial Royal College of Surgeons in Ireland Student Medical Journal 4 Director’s welcome Executive Committee RCSI Ethics Challenge Director Jenna Geers 5 RCSIsmj Ethics Challenge 2018/2019 Editor-in-Chief Suzanne Murphy Peer Review Director David Maj 6 RCSIsmj Ethics Challenge winner 2017/2018 Senior Editor Rachel Adilman Assistant Peer Review Cameron Chalker Senior Staff Writer Alexandra Mitcham Research spotlight Executive Secretary Oludare Alabi 10 Spotlight on research at RCSI – Prof. Peter Conlon Webmaster Gemma Wright Ballester Interview Peer Reviewers 11 The generalists Andrew Mikhail Matthew McMurray Alison Hunt Case report Jodie Odame Shaghayegh Esfandnia 14 Diagnostic dilemma: a rare cause of lower back pain Elise Halpern Rachel Dharamshi Original articles Tessa Weinberg Monika Cieslak 19 When the brain goes quiet: cortical silence inhibition in schizophrenia Bunmi Adesanya Magar Ghazarian Review articles Moyowa Boyo David Seligman 24 Plastic surgery’s role in aneuploidy Deena Shah 29 The misnomer of the ‘oral contraceptive pill’ Melvin Hoo Chuin Shen Savannah Norman Nadine Copty Staff reviews Sakshi Kirpalaney 35 Doctors and doping in sport Staff Writers 41 Faking it: disease-fighting bacteria and the future of synthetic biology Katie Nolan 46 From womb to withdrawal: born addicted Julia Hunter Jessica Millar 52 Treatment is on target in Crohn’s disease with biologic agents Sumara Jaimungal 59 Out of Africa into a genetic bottleneck: how evolution has shaped modern disease Maria Mikail 67 Are emerging treatments in Parkinson’s disease curative or just buying time? Education Director Claire Gallibois Education Officers Perspectives Catherine Uhomoibhi 73 HPV vaccination: facts versus fears Farah Adamali 77 Making the match Sannihita Vatturi 82 Is a robot reading my x-rays? Public Relations Director Matthew Patel 86 Big budget brain projects Public Relations Officer Melissa Mae Gabriel 91 ‘What’s in a name?’ Book review 95 Fitting in JOURNALISM CONTENT DESIGN The Malthouse, 537 NCR, Dublin 1. Abstracts T: 01-856 1166 F: 01-856 1169 www.thinkmedia.ie 96 Investigating the impact of enhancer methylation on gene expression in metastatic Design: Tony Byrne, Tom Cullen and Niamh Short colorectal cancer Editorial: Ann-Marie Hardiman, Paul O’Grady and Colm Quinn 98 Implications of stroke for informal caregivers: a five-year follow-up Please email comments to [email protected], join our Facebook page, or follow us on Twitter @RCSIsmj to discuss journal articles. Submissions to [email protected]. See www.rcsismj.com to find out more, see past editions, and follow our blog. Volume 11: Number 1. 2018 | Page 3 RCSIsmjeditorial and director’s welcome Rising to the challenges of research James Bryce once said: “Medicine [is] the only profession that labors campaign can have on a vaccination programme. Senior staff writer incessantly to destroy the reason for its existence”. Alexandra Mitcham examines the role of doctors in doping in sports, and considers our ethical obligations as healthcare professionals. Medicine is a constantly evolving field, striving to move forward even Finally, Carol Rizkalla looks at how we define illness. Through simple when it can seem impossible. As healthcare professionals we attempt to semantics we could be allowing the development of eugenics as halt the disease process and give our patients an acceptable quality of genome editing fails to clarify certain key research terms. In a world that life. In the 11 years since the RCSIsmj was founded, healthcare has seen is constantly moving, we need to stop and consider if we are all on the changes that seemed unimaginable in 2007. In this issue we consider same page when it comes to the everyday terminology we use. how, despite such major advances, a significant number of conditions Despite the problems and challenges, the failures and the still require greater research in terms of both understanding the disappointments, research will always continue to push forward, trying condition, and the development of safe and effective treatments. passionately to eradicate disease from this world. This RCSIsmj is, for Furthermore, we look at how the amazing advances of science have also most students, their first experience of taking their initial tentative steps led to problems and ethical questions. Staff writer Jessica Millar looks at on the road towards life-changing research. the evolving therapies for Parkinson’s disease, and asks if they truly have a role in the treatment process. Maria Mikail considers the impact of cortical inhibition on patients with schizophrenia. Katie Nolan examines the recent increase in synthetic biologic agents and questions their future role in treating conditions from E. coli infection to HIV. Constantly striving for advancement creates a double-edged sword and there is potential for new treatments to be misunderstood, misused, or even exploited. Social media, something that would never have previously impacted on healthcare, now has the power to ‘make or break’ a health campaign. Laura Staunton looks at the impact of the HPV Suzanne Murphy vaccine on the wider public and reflects on the effect a negative media Editor-in-Chief, RCSIsmj 2017-2018 Director’s welcome I am delighted and honoured to welcome you to this year’s RCSIsmj. interests in a long view of his research career, and invites students to Over the last 11 years it has been the purpose and pleasure of the boldly move forward according to their own curiosity and drive. RCSIsmj to publish students’ research and original academic writing. Each As the time of my involvement with the RCSIsmj comes to a close, I have edition is part of an entirely student-run process and involves an the privilege of handing over the reins to a truly passionate, intelligent, impressive network of collaboration: students submit their own original and creative staff. As always, we are overwhelmingly grateful to the work, and our peer review team scrutinise submissions after Dean’s office and faculty of RCSI, without whose support this publication anonymisation; based on these recommendations, editorial staff select would not be possible and with whose encouragement the RCSIsmj articles for publication, guide alterations and make suggestions, ensuring continues to go from strength to strength. Finally, I hope that you, like that everything that glitters truly is gold. This year we revamped and me, are awed by the success and innovation of those who have fine-tuned our internal processes so as to best showcase the incredible contributed already and find that this edition spurs you on to greater talent and intelligence of our contributors. engagement with medical research in future! Inspiring students to conduct and engage with research is central to our passion and purpose. Our educational staff help provide students with the tools to scrutinise academic publications, continue to run our popular journal clubs, and host passionate faculty to speak about their own publications and work. Our blog, which this year opened to submissions from any RCSIsmj staff member, will open to submissions from all RCSI students next year as a more informal entry to academic writing. As students at the dawn of our careers, we look to those already in the field for wisdom and inspiration; thus, this year we continue the section spotlighting the research of RCSI faculty. Prof. Peter Conlon, Jenna Geers Associate Professor of Medicine at RCSI, speaks about his enthusiasm and Director, RCSIsmj 2017-2018 Page 4 | Volume 11: Number 1. 2018 RCSIsmjprize Ethics challenge 2018/2019 CONSCIENTIOUS OBJECTION IN MEDICINE In January 2018 the Conscientious Objection (Medical Activities) Bill place on a doctor’s freedom as it protected vulnerable patients from received a second reading in the United Kingdom’s House of Lords. harm.4 In the United Kingdom2 and Australia5 doctors are permitted This Bill seeks to clarify the extent to which a medical practitioner to refuse women a termination of pregnancy if they object on with a conscientious objection may refrain from participating in religious or moral grounds; however, they are expected