day 1 of the project

Question 1

What is social accountability

Answer 1

as an obligation for medical schools to re-orientate their teaching and the research towards addressing the needs of the community that they’re based in.

Question 2

What are the 4 key principles of social accountability

Answer 2

1. involve patients, community members and stakeholders
2. think about who is truly benefiting from your research
3. think about whether your project is addressing the health needs of all sections of the community.
4. to make the best use of the resources available to you and for your project to be sustainable.

Question 3

What did Charles Huggins discover in the 1940s ?

Answer 3

1. prostate cancer was dependent on androgen presence to progress.
2. gave his patients oestrogen and the tumour stopped growing and when he re added testosterone it grew again.

Question 4

what did the first clinical trial i the 1970s discover?

Answer 4

that oestrogen was effective at reducing tumour size in comparisson to placebo

HOWEVER
the side effects included a massiveincrease in thromboembolitic caridovascular toxicity and there was also and increase in direct cardiac effects

Question 5

what did andrew shally discover?

Answer 5

He discovered that LHRH agonists also suppressed the hypogonadal axis and therefore suppress androgen production

Question 6

What were the side effects discovered for LHRH agonists?

Answer 6

cardiovascular disease,
osteoporosis -> leads to fracture which lead 40% into care homes and another 40% perish
sexual dysfunction-> affects couples
erectile dysfunction and gynaecomastia

Question 7

How where they thinking of reintroducing the oestrogen therapy to reduce androgen production

Answer 7

1. given orally it undergoes first pass through the liver to which it is absorbed and regulates the production of pro-coagulant proteins ->cardiovascular toxicity
2. but if given by a parenteral method, in other words sublingual, i.e. under the tongue, intramuscular, intradermal, subcutaneously, transdermally, or transcutaneously, by the method which does not involve them going through the intrahepatic circulation, and can be delivered in such high concentrations. These cardiovascular toxicities may be avoided.

Question 8

Why do LHRH agonsitshave such string side effects?

Answer 8

1. they suppress 90% of testosterone and since testorone is aromatised to oestrogen there is a also an 80% reduction in oestrogen
2. with oestrogen therapy there is only a loss of testorone and oestrogen remains leading to reduced side effect