Julian Hopkin CBE FRCP FMedSci FLSW is a physician, researcher and medical teacher. In 2004, he became the founding head of the new Medical School at Swansea University. [1] He is now Professor of Experimental Medicine at Swansea University Medical School [2] and Honorary Physician at the Abertawe-Bro-Morgannwg (ABM) University Hospital. He was appointed a CBE in 2011 for his services to medicine. [3]
Born in Ystradgynlais, Wales, Hopkin attended Maesydderwen School before proceeding to the Welsh National School of Medicine in Cardiff, graduating MB in 1972. [4] He proceeded with his postgraduate clinical training in Cardiff, Oxford and Edinburgh, [4] including a career-influencing period with John Crofton, the initiator of successful combination chemotherapy for tuberculosis. Hopkin undertook scientific training (Master and Doctorate) at the University and Medical Research Council Human Genetics (MRC Human Genetics Unit) in Edinburgh.
In Edinburgh, with John Evans, he described the potent mutagenic actions of cigarette smoke on human cells - going on to quantify the mutagenic and cytotoxic actions of cigarette smoke and their relationship to lung cancer and pulmonary emphysema risks respectively.
Hopkin spent periods in pulmonary medicine practice, in medical student teaching (Fellow and Supervisor of clinical students at Brasenose College, Oxford, [4] 1992–99), and in research at Birmingham and Oxford. In those periods he developed a robust bronchoscopic lavage method to secure precise microbial diagnostics and improved survivals for pneumonia in immuno-suppressed subjects. With Anne Wakefield, he settled the fungal taxonomic status of the important opportunistic pathogen, pneumocystis, and devised a precise mitochondrial rRNA diagnostic for pneumocystis pneumonia, applicable to simple non-invasive simple clinical samples and adopted worldwide.
With the rise in asthma prevalence (1980-2000), Hopkin undertook highly collaborative work addressing the underlying causes. He showed that common up-regulating genetic variants of Th2 immune signalling related to allergic disorder and high IgE levels (sharing, with Dr Taro Shirakawa, the 2001 Daiwa-Adrian Prize in Medicine) but also to low burdens of parasitic work infestation - proposing an evolutionary mechanism in which prevalent parasitic worm infection has provided long term evolutionary selection for up-regulating genetic variants of Th-2 immunity. He contributed epidemiologic data that relate diminished bacterial exposures in early childhood (less tuberculosis; more oral antibiotic receipts) to increased allergic disorder. His current work builds on the latter and focuses on how bacterial exposures shape human immunity relevant to asthma, and how unravelling these microbial mechanisms may provide disease preventing agents.
Pneumonia is an inflammatory condition of the lung primarily affecting the small air sacs known as alveoli. Symptoms typically include some combination of productive or dry cough, chest pain, fever, and difficulty breathing. The severity of the condition is variable.
A cough is a sudden expulsion of air through the large breathing passages which can help clear them of fluids, irritants, foreign particles and microbes. As a protective reflex, coughing can be repetitive with the cough reflex following three phases: an inhalation, a forced exhalation against a closed glottis, and a violent release of air from the lungs following opening of the glottis, usually accompanied by a distinctive sound.
Sputum is mucus that is coughed up from the lower airways. In medicine, sputum samples are usually used for a naked eye examination, microbiological investigation of respiratory infections and cytological investigations of respiratory systems. It is crucial that the specimen does not include any mucoid material from the nose or oral cavity.
In medicine, the hygiene hypothesis states that early childhood exposure to particular microorganisms protects against allergies by properly tuning the immune system. In particular, a lack of such exposure is thought to lead to poor immune tolerance. The time period for exposure begins before birth and ends at school age.
A granuloma is an aggregation of macrophages that forms in response to chronic inflammation. This occurs when the immune system attempts to isolate foreign substances that it is otherwise unable to eliminate. Such substances include infectious organisms including bacteria and fungi, as well as other materials such as foreign objects, keratin, and suture fragments.
Pulmonology, pneumology or pneumonology is a medical specialty that deals with diseases involving the respiratory tract. It is also known as respirology, respiratory medicine, or chest medicine in some countries and areas.
Harrison's Principles of Internal Medicine is an American textbook of internal medicine. First published in 1950, it is in its 21st edition and comes in two volumes. Although it is aimed at all members of the medical profession, it is mainly used by internists and junior doctors in this field, as well as medical students. It is widely regarded as one of the most authoritative books on internal medicine and has been described as the "most recognized book in all of medicine."
Interstitial lung disease (ILD), or diffuse parenchymal lung disease (DPLD), is a group of respiratory diseases affecting the interstitium and space around the alveoli of the lungs. It concerns alveolar epithelium, pulmonary capillary endothelium, basement membrane, and perivascular and perilymphatic tissues. It may occur when an injury to the lungs triggers an abnormal healing response. Ordinarily, the body generates just the right amount of tissue to repair damage, but in interstitial lung disease, the repair process is disrupted, and the tissue around the air sacs (alveoli) becomes scarred and thickened. This makes it more difficult for oxygen to pass into the bloodstream. The disease presents itself with the following symptoms: shortness of breath, nonproductive coughing, fatigue, and weight loss, which tend to develop slowly, over several months. The average rate of survival for someone with this disease is between three and five years. The term ILD is used to distinguish these diseases from obstructive airways diseases.
An opportunistic infection is an infection caused by pathogens that take advantage of an opportunity not normally available. These opportunities can stem from a variety of sources, such as a weakened immune system, an altered microbiome, or breached integumentary barriers. Many of these pathogens do not necessarily cause disease in a healthy host that has a non-compromised immune system, and can, in some cases, act as commensals until the balance of the immune system is disrupted. Opportunistic infections can also be attributed to pathogens which cause mild illness in healthy individuals but lead to more serious illness when given the opportunity to take advantage of an immunocompromised host.
AIDS-defining clinical conditions is the list of diseases published by the Centers for Disease Control and Prevention (CDC) that are associated with AIDS and used worldwide as a guideline for AIDS diagnosis. CDC exclusively uses the term AIDS-defining clinical conditions, but the other terms remain in common use.
Hypersensitivity pneumonitis (HP) or extrinsic allergic alveolitis (EAA) is a syndrome caused by the repetitive inhalation of antigens from the environment in susceptible or sensitized people. Common antigens include molds, bacteria, bird droppings, bird feathers, agricultural dusts, bioaerosols and chemicals from paints or plastics. People affected by this type of lung inflammation (pneumonitis) are commonly exposed to the antigens by their occupations, hobbies, the environment and animals. The inhaled antigens produce a hypersensitivity immune reaction causing inflammation of the airspaces (alveoli) and small airways (bronchioles) within the lung. Hypersensitivity pneumonitis may eventually lead to interstitial lung disease.
WHO Disease Staging System for HIV Infection and Disease in Adults and Adolescents was first produced in 1990 by the World Health Organization and updated in September 2005. It is an approach for use in resource limited settings and is widely used in Africa and Asia and has been a useful research tool in studies of progression to symptomatic HIV disease.
The current staging system for HIV infection in children was developed in 2005 and builds upon the staging system in place since 1987. A child is defined as someone under the age of 15. This staging system also requires the presence of HIV infection: HIV antibody for children aged 18 months or more; virological or p24 antigen positive test if aged under 18 months.
Eosinophilic pneumonia is a disease in which an eosinophil, a type of white blood cell, accumulates in the lungs. These cells cause disruption of the normal air spaces (alveoli) where oxygen is extracted from the atmosphere. Several different kinds of eosinophilic pneumonia exist and can occur in any age group. The most common symptoms include cough, fever, difficulty breathing, and sweating at night. Eosinophilic pneumonia is diagnosed by a combination of characteristic symptoms, findings on a physical examination by a health provider, and the results of blood tests and X-rays. Prognosis is excellent once most eosinophilic pneumonia is recognized and treatment with corticosteroids is begun.
Allergic bronchopulmonary aspergillosis (ABPA) is a condition characterised by an exaggerated response of the immune system to the fungus Aspergillus. It occurs most often in people with asthma or cystic fibrosis. Aspergillus spores are ubiquitous in soil and are commonly found in the sputum of healthy individuals. A. fumigatus is responsible for a spectrum of lung diseases known as aspergilloses.
Aspergillosis is a fungal infection of usually the lungs, caused by the genus Aspergillus, a common mould that is breathed in frequently from the air, but does not usually affect most people. It generally occurs in people with lung diseases such as asthma, cystic fibrosis or tuberculosis, or those who are immunocompromised such as those who have had a stem cell or organ transplant or those who take medications such as steroids and some cancer treatments which suppress the immune system. Rarely, it can affect skin.
Pneumocystis pneumonia (PCP), also known as Pneumocystis jirovecii pneumonia (PJP), is a form of pneumonia that is caused by the yeast-like fungus Pneumocystis jirovecii.
Swansea University Medical School is a medical school on Swansea University's Singleton campus. It is linked to additional teaching centres located throughout South and West Wales, including Cefn Coed Hospital, Singleton Hospital and Morriston Hospital in Swansea, Prince Philip Hospital in Llanelli, Withybush General Hospital in Haverfordwest and Bronglais Hospital in Aberystwyth. The Medical School also has a network of primary care teaching centers.
Lycoperdonosis is a respiratory disease caused by the inhalation of large amounts of spores from mature puffballs. It is classified as a hypersensitivity pneumonitis —an inflammation of the alveoli within the lung caused by hypersensitivity to inhaled natural dusts. It is one of several types of hypersensitivity pneumonitis caused by different agents that have similar clinical features. Typical progression of the disease includes symptoms of a cold hours after spore inhalation, followed by nausea, rapid pulse, crepitant rales, and dyspnea. Chest radiographs reveal the presence of lung nodules. The early symptoms presented in combination with pulmonary abnormalities apparent on chest radiographs may lead to misdiagnosis of the disease as tuberculosis, histiocytosis, or pneumonia caused by Pneumocystis carinii. Lycoperdonosis is generally treated with corticosteroids, which decrease the inflammatory response; these are sometimes given in conjunction with antimicrobials.
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