2022 Mid Wales Diary

Mid Wales Diary

David Holland

BSc(Hons) Pod-Med, CBiol, CSci, FFPM-RCPS(Glasg).

2021 was a busy year for me. Work carried on at a slightly slower pace than in 2020 - good thing too! I finally submitted a paper to The Foot - a peer-reviewed journal which enjoys a multi-profession international readership, and we should be in print this year - open-access too. My co-author is a widely-published PhD, and Honorary Research Associate at the Institute for Human Evolution at the prestigious University of Witwatersrand of South Africa.

Things have been moving apace at Wyvern. As I write this, on December 18th, the river has already been into the garden. This is normally a January incursion. Sign of things to come for 2022 perhaps? Otherwise the upstairs interior at Wyvern is almost complete, and Alison has designed and prepared, with some professional help, a new bed in the back garden for fruit trees and shrubs.

As you read this, it’s well worth remembering that Spring is just around the corner!

I came across two topics in late 2021 which may be of professional interest to the readership: The first concerns cocaine - the street drug. There is little doubt that vast quantities of this drug are being used throughout the UK. I’m not about to moralise on this. I’ve never taken it myself, and I regard the taking of street drugs a matter of choice. I assume the consumer has weighed up all the pros and cons. After that, well, it’s up to them.

You may already be aware, whether Podiatrist or FHP, that cocaine can initiate vascular disease. This includes accelerated atherosclerosis (1) which I didn’t previously realise. It can affect seemingly healthy young people I’ve just given a medicolegal opinion on such a case. The Podiatrist in question made an assumption about health and circulatory status based on the patient’s age and lifestyle. The patent (now minus one of his legs from the knee down) neglected to mention a habitual cocaine use.

The second topic of interest - equally important and much more uplifting - is a possible answer to growing antibiotic resistance. We all know that antibiotics are necessary, but there is an acknowledged problem - growing bacterial resistance. In 2018 it was estimated that approximately 28% of bacterial infections were resistant to antibiotics. By 2050 it is estimated this will rise to 40%, leading to an additional 10 million deaths a year world-wide. One answer to antibiotic-resistant bacteria is naturallyoccurring nanoscopic viruses called phages which can infect and kill bacteria. Phages have been used clinically since the early 1920’s. However their use nearly died out with the advent of antibiotics (2) . With phage therapy there is a need to isolate the infecting organism, then choose the phage which is specific in its action against that organism. Antibiotics can be applied fairly indiscriminately - broad-spectrum antibiotics work against a host of bacteria, not just one type. There is also a commercial advantage to antibiotics - after the very considerable cost of development they are easy to produce and market.

Exeter University is building up a library - a phage biobank - which, it is hoped, will eventually take the place of much antibiotic prescribing. The advantages of modern phage therapy over antibiotic therapy are clear:

Much lower development costs (hopefully under a commons licence, meaning the development cannot be patented for profit), much faster development, increased clinical safety (less side-effects than antibiotics), and most importantly an ability to mutate, as all viruses do, to overcome bacterial resistance. In addition, because phages target specific bacteria, the good bacteria - those in the gut for example - are unaffected. In some cases phage therapy can also be used in conjunction with antibiotic therapy.

However we do need the right phage for each infecting organism - hence the need for a phage biobank.

Some newly-identified phages have weird and wonderful names (the phage discoverer can name their own phage) - LemonAid - discovered in the River Lemon in Devon - specific against Acinetobacter baumannii, KylieMinegg - discovered in a chicken coop, and specific against Psudomonas aeruginosa a bug associated with Cystic Fibrosis.

Phages are natural - and everywhere. If you would like to learn more about the Exeter University phage project, or become a phage-hunter yourself (Exeter Uni will provide the kit) visit www.citizenphage.com.

REFERENCES

1. Keren Bachi et al. Vascular disease in cocaine addiction (2017) (open-access). 2. Ben Templeton. The hunt for ‘holes of hope’ in The Biologist, Vol 68 No 4. Winter 2021.