5 things to take into 2021

 1. Maintain a versatile mindset

    All of us have had to make changes to our lives this year. For those of us fortunate to still have a job, we have had to work in different ways. Some of us have had to develop new skills whilst others will have diversified their portfolio.  For myself as a specialist doctor, maintaining a generalist approach in the field of internal medicine has proved to be invaluable in managing patients with coronavirus 

2. Value your old friends

I have been touched that my old school friends have contacted me this year. Some of them have known me for over 30 years. Old friends provide a window to your past. Keeping in touch with my old friends will be my resolution for the new year.  

3. Be thankful for what you have

Focusing on what we still have will encourage us to be thankful in this unprecedented year. I have kept a thankfulness jar this year and put in a collection of reasons to be thankful this year. I will continue to be thankful in the coming year 

4. Rest often

Rest is often neglected when one has a busy career. However rest is vital to sustain your energy and endurance to prevent burnout. We are all mortal beings with limitations. Thus recognising the need to rest and making time to do so will enhance our well-being 

5. Keep a journal 

I have found writing a journal very helpful to write my thoughts and prayers. Blogging has also become an enjoyable hobby for me. 

World Grand Prix Snooker 2020

 During the Covid pandemic, I have had the chance to watch some world-class snooker on television. I have certainly been treated to some enthralling matches.One player that has impressed me is Jack Lisowski, an Englishman from Gloucestershire. He beat Mark Selby in the World Grand Prix semifinal before losing a thrilling final to Judd Trump, the world number 1. Jack is silky smooth player with a great long potting game. He has yet to win a ranking event but it would not be long before he will win one. He entered the World Grand Prix tournament with a world ranking of 15. This will surely now improve after his runner-up finish at this tournament.      

The Rocket

 I have just seen Ronnie 'The Rocket' O'Sullivan play some incredible snooker in the semifinal of the Northern Ireland Open today. From 3-1 down, he had won 5 games in a row to beat Ali Carter 6-3 to advance to the final of this snooker tournament. It was a pleasure to see him play. He can play either right-handed or left-handed and plays at a fast pace. What an amazing snooker player.       

Malvern Hills

 A view of the Malvern Hills on a bright sunny morning in November. The Malvern Hills continue to inspire me in different ways. I am glad that these hills are right at my doorstep. There are lots to be thankful for during these difficult times.       

An English Autumn part 2

 More lovely autumn scenery. These pictures were taken in a nature reserve in Worcestershire. The name of the reserve is Knapp and Papermill Nature Reserve which is owned by the Worcestershire Wildlife Trust.We only spent 40 minutes in this reserve because it has started to rain. We will come back here someday.    

An English Autumn

 I really love the autumn season in England. It is nice to see the leaves turn yellow and red from the usual green. These pictures were taken in Gheluvelt Park in Worcester on November 8th 2020. It was Remembrance Sunday. We visited the memorial in the park and learnt the significance of the battle of Gheluvelt in Belgium during the First World War. It was a key battle which contributed to the Allies victory. Today is Armistice Day which commemorates the end of fighting in the First World War. The date that World War 1 ended was on 11th November 1918. On this day in 1918 at 11am all fighting ceased. On Armistice Day a two minute silence is observed throughout the country to remember those who have sacrificed their lives for the country during the war.         

Antibody levels in Covid-19

A study from China has shown that antibody levels decrease by approximately 70% by 8 weeks in both symptomatic and symptomatic Covid-19 infections. The study also showed that 40% of asymptomatic infections tested negative for IgG antibodies compared to 12.9% of symptomatic infections. Asymptomatic individuals also had lower pro- and anti-inflammatory cytokines, suggesting a weaker immune response towards Covid-19 compared to symptomatic individuals The steep decline in antibodies is an important finding because this may influence physical distancing measures as these patients could be at risk of re-infection.         

Reference 

Long, Q., Tang, X., Shi, Q. et al. Clinical and immunological assessment of asymptomatic SARS-CoV-2 infections. Nat Med (2020). Published 18th June 2020

Kidney involvement in Covid-19

Proteinuria and haematuria are common in patients presenting with Covid-19. This was observed in a large study from China (1). 43.9% of patients with Covid-19 had proteinuria on admission and 26.7% had haematuria.   This is a fascinating finding. This could point to significant renal pathology in Covid-19. A small renal biopsy case series from North America was published this month (2). This case series showed a variety of glomerular and tubular pathologies in 17 Covid-19 patients presenting with nephrotic range proteinuria and acute kidney injury. None of the cases had evidence of direct viral infection in the kidney.  Knowledge in this area is evolving, and I await further articles with great interest. The articles referenced below will be of relevance to nephrologists worldwide.

References
1. Cheng Y, Luo R, Wang K et al. Kidney disease is associated with in-hospital death of patients with Covid-19  Kidney Int 2020; 97(5): 829-838     
2. Kudose S, Batal I, Santoriello D et al. Kidney biopsy findings in patients with Covid-19.  J Am Soc Nephrol 2020 (published online 17th July 2020)

The crown that lasts

These verses from the Bible encouraged me today

Do you not know that in a race all the runners run, but only one gets the prize?  Run in such a way as to get the prize. Everyone who competes in the games goes into strict training. They do it to get a crown that will not last, but we do it to get a crown that will last forever.

 1 Corinthians 9:24-25

We are truly running an incredible race.

Psalms for the summer series

2020 is a year we will not forget easily. We have halfway through the year and in the UK we are now entering the summer season. This is a good time to reflect on how the year has been.I have found the following psalms from the Bible particularly encouraging during this difficult year. We look to God as our refuge and our source of strength.     

1. Psalm 138 -difficulty

2. Psalm 142 - desperation

3. Psalm 43 - discouragement

4. Psalm 63 - dry seasons

5 Psalm 13 - how long?

6. Psalm 23 - my Shepherd

Good Friday 2020

10th April 2020 (Good Friday) . The world is going through a major crisis. The coronavirus pandemic has not only caused the loss of many lives but has led to job losses and restrictions to normal day- to- day living. This year's Good Friday will be very different. No church services will be available. People have to stay at home.  As we go through this testing period, Christians will remember Jesus's death on the cross today. In the healthcare sector, healthcare workers have to be meticulous in their handwashing and changing their PPE. For those who of us belong to the Christian faith, it is a reminder that whilst we frequently need to clean ourselves whilst we are at work, Jesus came to cleanse us from our sins once and for all through his death on the cross. He only needed to do it once.   

'He gave his life to free us from every kind of sin, to cleanse us, and to make us his very own people, totally committed to doing good deeds.'                                           Titus 2:14