The Impact of Pulmonary Tuberculosis on Muscle and Fat Wasting
Tuberculosis (TB) remains a global epidemic that is associated with considerable morbidity attributable to the systemic effects of infection. The classical symptoms of weight loss, fatigue and muscle wasting are clinically well recognised and the long term burden of systemic inflammation is thought to contribute to declining lung function. However, there is little published work profiling these clinical observations and the effects this may have on the host immune response to TB infection.
This project is a prospective clinical cohort study investigating whole body composition (using DEXA scans and multi-frequency bioelectrical impedence), lung function decline (corrected for cigarette and cannabis smoking), lung damage (quantified by cross-sectional analysis of radiological (CT) imaging) and the host immune response (T-cell function and genome (transcriptomic) analysis) in patients with active Pulmonary TB. Additionally, the longitudinal changes that occur during TB treatment and recovery will be examined.
The main objective of this project is to identify systemic biomarkers that link the inflammatory response and the muscle wasting seen in active TB and compare these with established and novel biomarkers in a cohort of COPD patients. A secondary aim is to describe the effects of cannabis smoking on the immune response, muscle wasting and lung function decline.
The ACF will be involved in the collection of whole body mass and appendicular measures of muscle and fat using techniques such as DEXA and bioelectrical impedance.
Determining the clinically relevant anatomy to teach UG medical students
Human anatomy has been a core component of undergraduate medical education for many years, and while it continues to be a key theme, the depth of anatomy taught has seen a steady decline. The need for a solid foundation of anatomical knowledge, while more readily appreciated as essential for those pursuing surgical careers, is important for any practicing clinician. Clearly, which areas of anatomy are most relevant will vary depending on the postgraduate speciality. With ever increasing pressures on space within the UG curriculum, there is obvious priority to ensuring what is taught best enables students to meet the demands of the breadth of future clinical practice.
While the GMC do not currently stipulate specific outcomes for the level of anatomy within the UG medical curriculum, the future introduction of the UK Medical Licensing Assessment will likely lead to efforts to better establish ILOs for the basic sciences, as a whole. In 2016, in response to the lack of consensus and guidance on the appropriate level of anatomy, the Anatomical Society defined a core regional anatomy syllabus of 156 ILOs, which were to help curriculum planners determine the clinically relevant anatomy to teach UG medical students. The proposed ILOs were determined by a Delphi panel of experts, which included surgeons, radiologists and anatomists.
The first step of the project will involve a series of focus groups and surveys with a variety of early clinical trainees from medicine, surgery and primary care. The purpose of this will be to identify whether there are elements of the 156 identified ILOs that represent a base of anatomical knowledge common across a breadth of specialities (surgical and non-surgical). The second step will be to explore how well they perceive (by self-report) to have retained knowledge of those areas of anatomy (identified in the first step of the project).
The findings from this project will help to better define areas of anatomy that are seen as most important, relevant and common to a breadth of clinical specialities. Further work/projects could explore how this anatomy could be prioritised or given greater attention within the UG medical curriculum, or early postgraduate period and whether there are any interventions that can be applied to improve retention of knowledge in those areas.