Single Ventricle Anatomy: the heart surgeries that redirect blood flow to maximize the single ventricle

Background on single ventricle anatomy:
About 5 in 100,000 newborns are born with a single ventricle defect, meaning they are born with only one functional ventricle (2). There are a variety of types of single ventricle defects, such as hypoplastic left heart syndrome (HLHS), tricuspid atresia, and heterotaxy with common AV valve, just to name a few (1). Having only one ventricle is damaging to the heart and oxygen delivery in the body, causing cyanosis, volume overload on the single ventricle, decreased ventricular function, and congestive heart failure (1). Therefore, it is important to diagnose and treat infants with single ventricle anatomy as soon as possible, often performing the first surgery within days after birth (1, 2, 3). For now, the only available treatments for these infants include a heart transplant or the series of the Fontan procedures (1, 3). The Fontan procedures are a creative and impressively successful treatment for single ventricle defect, having a 75% 25-year post surgery survival rate in Australia and New Zealand (3). The Fontan procedures are fairly new in medical practice, thus some of the first patients to receive the Fontan procedures are about 30 years of age today (3).

The fun stuff about surgery and redirecting blood flow (1):
The Fontan procedures are broken into 3 main surgeries, with the first surgery performed only days after birth, and the last surgery performed around 2-4 years of age. The purpose of the Fontan procedures is to redirect blood flow in order to maximize the one ventricle without overloading it. I will walk through the redirecting of blood flow specifically for HLHS, where the left ventricle is underdeveloped, although for many types of single ventricle defects, the operations have very little variations.

An underdeveloped left ventricle seriously decreases systemic flow, along with backing up pulmonary flow. The first surgery, called the Norwood operation, is aimed at establishing sufficient systemic circulation and pulmonary flow. The surgeons do this by widening the atrial septum (the hole between the left and right atria). This allows for mixing of oxygenated and de-oxygenated blood in both atria. They also connect the pulmonary artery to the ascending aorta, along with a shunt between the two. So, the blood (ox and de-ox) in the right ventricle now pumps to the aorta, instead of the pulmonary artery. This is what allows for systemic flow! But, what about pulmonary flow? The ascending aorta is also connected to the pulmonary artery through a shunt. This means that some blood flowing through the aorta is diverted to the pulmonary artery, allowing for blood flow into the lungs. Everything is all great now, right?

Well, the right ventricle is still working extremely hard to pump this blood to the body and the lungs, which is okay for a little while, but long-term, the heart will fail doing this. So, onto step 2! The second surgery, called the bi-directional Glenn shunt procedure, is performed somewhere between 4-9 months of age. The main aim of this procedure is to redirect blood flow to the right pulmonary artery, thus less work for the right ventricle. They do this by connecting the superior vena cava to the right pulmonary artery. So, now the blood returning to the heart from the upper body is now flowing directly and passively to the lungs, instead of to the right atrium. This improves pulmonary flow, without taking away from the redirected systemic flow.

To complete these procedures, the third surgery, called the Fontan procedure, connects the inferior vena cava to the pulmonary artery. Thus, now our blood flow goes from the body to the superior and inferior vena cava to the pulmonary arteries. From here, the blood flows passively to the lungs and the oxygenated blood flows back to the heart to the left atrium, which flows to the right atrium through the hole between them. This blood then goes to the right ventricle and is pumped to the aorta to the body! Thus, blood flow is completely redirected successfully in a way that ensures both pulmonary and systemic flow, while also not overloading the single ventricle.

Sources:
1. O'Brien, P., J. Boisvert. (2001). Current Management of Infants and Children with Single Ventricle
Anatomy. Journal of Pediatric Nursing 16(5): 338-350.

2. "Single Ventricle Defects." Boston Children's Hospital. Retrieved from: http://www.childrenshospital.org/conditions-and-treatments/conditions/s/single-ventricle-defects

3. d'Udekem, Y., et al. (2014). Redefining expectations of long-term survival after the Fontan procedure. Circulation 130(11): 32-38.

Circadian Clock Dictates Metabolic Functionality

          Our circadian clock dictates our daily functions, when we eat, when we sleep, and our activities in between are all influenced by our circadian clock. It ensures that our physiological processes are operating correctly and at the appropriate times, but since we’re all human and our circadian clocks get thrown into the ringer numerous times, our bodily functions may not be working in the optimal conditions as we want them to. The substances that we ingest and put into our bodies have a great effect on the functions of our circadian clock, which can make us either more tired or more energized depending on what we eat. According to the journal article, “Physiological responses to food intake throughout the day” the researchers talk about how a change within our circadian clocks shifts our metabolic rhythms, which help maintain glucose homeostasis, and insulin response, the article also takes about how eating at a certain time of day will influence fat and sugar profiles and eating at different times every day will influence adiposity and body weight; these changes may occur due to the timed feeding cycle that is not in sync with our circadian clocks.

           This article talked about a study done in mice and how housing them in a light and dark cycle and fed them with a high fat diet would gain more weight when food is available only in the light phases of the cycle, the part of the cycle where they should be resting. This study was interesting because they compared the mice meal timing to humans and how we have an increased interest on the effects of meal timing on metabolism and body weight. They found correlations between people who eat at night with obesity and that night eating syndrome is most prevalent in the obese and overweight people. Weight loss studies, stated in the article, also points out the correlation between food timing and body weight; in one of the experiments they had women who were obese/overweight to consume an energy restricted diet with different portions of energy dispersed throughout breakfast and dinner. Those who consumed more energy at breakfast lost more weight but also improved their metabolic functionality in insulin sensitivity and triglyceride concentrations. This study supports the hypothesis that the timing at which we eat our food is an important factor in maintaining a regular body weight.

Article Source:  
Johnston, J. D. (2014). Physiological responses to food intake throughout the day. Nutrition Research Reviews, 27(1), 107–118. http://doi.org/10.1017/S0954422414000055.

The stuff in poop that kills: Vibrio cholerae

Within the first hour of arriving in Dhaka, Bangladesh, I passed a man with his pants down urinating into the flooded waters that pooled around us. Mistaking a floating bag for a rock, I stepped and sank deep into the plastic bag. The field researchers whipped around with horror and amusement on their faces. I stared down at my legs submerged in the brown water and watched a piece of feces bubble and bump against my calf.  I couldn't have asked for a warmer welcome into the discipline of cholera and diarrheal diseases.  

Vibrio cholerae, a gram-negative bacterium, affects over 1.4 billion people globally and kills hundreds of thousands of people each year. For several years I worked as a research coordinator for a NIH funded study on cholera prevention. My team set out to produce a sustainable behavior-based program called CHoBI-7, to prevent the spread of cholera among household contacts.

Simple interventions like a providing a hand washing station, teaching when there are hand washing opportunities with pictures, and teaching when and why to boil water, were among some of the tools we provided. Our dream was to save lives, millions at a time.

Our findings demonstrated that our Cholera Hospital Based Intervention for 7 Days (CHoBI7) was effective in significantly reducing symptomatic cholera infections 6 months post-intervention. The next step is to scale-up the program so a greater proportion of the country as well as other countries can benefit from CHoBI7.

In the United States, we take our water quality, sanitation, and hygiene for granted. I challenge you to think on when you first learned about hand washing or when you first trusted that your drinking water isn’t contaminated with your neighbor’s urine and feces. Will you get rice-water diarrhea today? Maybe not, but someone across the globe will. Next time you do the dishes, think about all the clean water you let rush down the drain, think about your drain and how it's connected to a pipe that goes somewhere. And as you stare at that clean water you're wasting, know that you've done this ... just because you can.

George, C. M., Jung, D. S., Saif-Ur-Rahman, K. M., Monira, S., Sack, D. A., Rashid, M. U., ... & Winch, P. J. (2016). Sustained uptake of a hospital-based handwashing with soap and water treatment intervention (cholera-hospital-based intervention for 7 Days [CHoBI7]): a randomized controlled trial. The American journal of tropical medicine and hygiene, 94(2), 428-436.

Eating Disorders and College Students

There are many students in colleges around the country that struggle with eating disorders.  A study showed that about 11 million Americans continuously struggle with eating disorders (1).  The study also shows that about 32% of females and 25% of males in college struggle with eating disorders (1).  With this being said, I feel like it is important to provide information regarding eating disorders and the physiological impact that eating disorders have on the body.  It is also important to provide support for people who struggle with these eating disorders.

Eating disorders can be serious illnesses.  Eating disorders are usually associated with obsession with body weight, food, and body shape.  The most commonly known eating disorders include bulimia nervosa, anorexia nervosa, and binge-eating disorder.  Anorexia Nervosa is when the patient sees themselves as overweight; however, most of the time the person is severely underweight (2). The most common characteristic of Anorexia is the people continuously weight themselves, eat very small portions of food, and typically severely restrict their diet (3).  Bulimia occurs when people have frequent episodes of eating substantial amounts of food, but after the binge-eating episodes, the person compensates for the overeating by vomiting, fasting, using excessive amounts of diuretics and/or laxatives, and/or exercising excessively (3).  There are many physiological complications that arise from having eating disorders. 

Melatonin is a hormone that is released at night, which helps a person fall asleep.  The hormone is usually released around 9pm. However, many patients with eating disorders have lower levels of melatonin in their body (4).  This causes symptoms such as having a hard time falling asleep and staying asleep (4).  Also, when the body experiences prolonged periods of decreased nutrient intake, then the activity of opioids in a patient’s brain begins to increase (5). This causes the person to have positive feelings, which enables the person to continue adhering to the strict dieting regimen (5).  During times of starvation, many patients become anemic and become deficient in calcium (6).  Calcium is very important to help proteins fold, which facilitates normal enzymatic activity (6).  Iron is also important to chelate to hemoglobin.  The iron allows an individual to transport oxygen to their tissues in their body (6). This is important to ensure oxygen delivery is efficient.  These are just a few examples of how eating disorders affect the body.  

           

References:

1.      Schubert, A. (2016). Students push body positivity for National Eating Disorders Awareness week. Retrieved, April 03, 2018 from http://college.usatoday.com/2016/02/25/eating-disorders-awareness-week/

2.      Anorexia: Signs, Symptoms, Causes and Articles for Treatment. (n.d.). Retrieved April 03, 2018, from https://www.eatingdisorderhope.com/information/anorexia

3.      Eating Disorders. (n.d.). Retrieved April 03, 2018, from https://www.nimh.nih.gov/health/topics/eating-disorders/index.shtml

4.      Kennedy, S. H. (1994). Melatonin disturbances in Anorexia Nervosa and Bulimia Nervosa. International Journal of Eating Disorders, 16(3), 257-265.

5.      Grzelak, T., Dutkiewicz, A., Paszynska, E., Dmitrzak-Weglarz, M., Slopien, A., & Tyszkiewica-Nwafor, M. (2017). Neurobiochemical and psychological factors influencing the eating behavior and attitudes in anorexia nervosa. Journal of Physiology and Biochemistry, 73(2), 297-305. doi:10.1007/s13105-016-0540-2

6.      Costa, N. D., Schtscherbyna, A., Soares, E. A., & Ribeiro, B. G. (2013). Disordered eating among adolescent female swimmers: Dietary, biochemical, and body composition factors. Nutrition, 29(1), 172-177. doi:10.1016/j.nut.2012.06.007

Can you train a brain to be less Autistic?

Throwback to 12 years ago when my younger brother was diagnosed with Aspergers and my family was frantically trying to figure out how we would best support him. We decided on "Brain Training," or in fancier terms-- Neurofeedback for Autism Spectrum Disorders.
Basically, my brother's brain was mapped which revealed that he had hyperactive delta waves and hypoactive alpha waves. This means that his everyday consciousness resembled a typical person's dream-state. The brain training itself was a game on a screen that he controlled by activating his alpha waves more and decreasing the activity of the delta waves. By doing this, he was learning to connect brain activity with functional connections, in turn, improving his sociocommunicative abilities.
The idea is that his brain would eventually just learn to do this on a regular basis (LTP??) because of the brain's experience-based plasticity---AKA operant conditioning (Datko, et al. 2017).

The question is, can we use this type of conditioning for other behavioral disorders, such as ADHD, OCD, anxiety, etc.?

Why You Should Practice Slow Deep Breathing Daily.

Many fitness watches on the market today come with deep breathing features that prompt you to take a moment to focus on your breath and practice mindfulness. Controlled breathing began in eastern cultures as pranayama or yogic breathing. Although, this practice has recently gained much popularity in our western world. However, physiological effects have hardly been examined in our medical community. Less than a year ago, a research investigation discovered a variety of benefits deep breathing has on the body, positively affecting your respiratory, cardiovascular, cardiorespiratory, and autonomic nervous system. Controlled deep breathing was found to increase ventilation efficiency and pulmonary gas exchange in the respiratory system. Moreover, deep breathing increased venous return, which increased cardiac output, which helped synchronize pulse fluctuations with the heartbeat. Last, focusing on your breath increased vagal activity, causing parasympathetic dominance in your peripheral nervous system. Enhancing vagal activity from the study was shown to improve the autonomic nervous system’s ability to react to physical and mental stress. Overall, the study found these physiological systems improved heart rate variability (HRV), which is controlled mostly by the autonomic nervous system. Therefore, improved heart rate variability preserved autonomic function, which has been shown to decrease mortality and thus increase longevity among the general population. HRV reached its optimal level at a respiratory rate of six breaths per minute. In other words, the best effects of deep breathing on your body result from focusing your breath to a rate of six breaths per minute. Being a month into fall semester, I imagine many of us might be looking for ways to reducing or controlling our stress. Deep breathing could be your answer for reducing your stress in the short term and increasing longevity in the long term. Russo, M. A., Santarelli, D. M., & O’Rourke, D. (2017). The physiological effects of slow breathing in the healthy human. Breathe, 13(4), 298–309. http://doi.org/10.1183/20734735.009817

The Untold Story of Atomic Veterans

If you ask almost anyone about nuclear bombs they most likely think of the bombs dropped on Hiroshima and Nagasaki during World War II. These heinous acts destroyed the two cities, killed over 100,000 people, and have caused severe defects on the survivors due to being exposed to the massive amounts of radiation (1). During the Cold War, more research was conducted to understand the effects of being exposed to a nuclear blast and the subsequent radiation. In the 1950s, members of the Royal Air Force were essentially tricked into being exposed to nuclear blasts. Over 22,000 atomic veterans were exposed to numerous nuclear tests, and a majority of these men eventually died from various cancers. Less than 3,000 of these atomic veterans are alive today, and themselves and their families are experiencing the backlash of nuclear radiation exposure. The living atomic veterans have developed skin cancer, issues with their skeletal system, such as bone spurs, and a few men believe exposure to the radiation has made them infertile. Decreased sperm counts, and possible infertility, has also been observed in Hiroshima and Nagasaki survivors (1). The survivor’s families, for those men who could have children, are also being affected. One man claims 16 out of his 21 descendants, children and grandchildren, have birth defects and other health problems associated with his exposure to nuclear radiation. Another man claims his daughter died at the age of 13 of a cancer so rare that it has no name. He claims she developed a hump on her back and that she started growing hair all over her body that required her to be shaved twice a day. He also claims that today, at age 81, he feels as if the skeleton is “crumbling” within him (2). The UK Ministry of Defence has claimed that there is “no evidence to link these tests to ill heath” (3). Some veterans have recently received compensation, however, a majority of the men have not. For some, there is no amount of money that can compensate for what they have gone through, and have to live with, as a consequence of these tests.

Video on Atomic Veterans: https://www.youtube.com/watch?v=Y__dxTaGEp0&t=0s&index=2&list=LLNg7GRiZR30rEVieRuFW85A

Other References:
1. Ohkita, T. (1975). Review of Thirty Years Study of Hiroshima and Nagasaki Atomic Bomb Survivors. Journal of Radiation Research. 16, 49-66.
2. https://www.bbc.com/news/health-43075718
3. https://www.forces.net/news/veteran-who-saw-atomic-bomb-tests-finally-receives-mod-compensation

CHRISTMAS?!?! An all year time for healthcare providers?

What is better than free stuff? Nothing, right? Well on my daily Instagram scroll through, I noticed that one person posted about a verifying healthcare movement, in particular, the medical industry’s practice of giving gifts to doctors. George Kanabe, a second- year student at Fordham Law School wrote an article about how many medical industry companies give gifts to doctors and the implications it has on the care that the doctor will provide to the patient. I thought it was interesting how gift- giving influences the doctor to choose the promoted products even when those products held no demonstrated advantage over existing ones. It’s important to consider the real purpose of a company to provide such gifts and the values that the doctor themselves hold to accept or deny. I think many would say that they wouldn’t accept gifts. It was interesting to see that in one of the studies in the article they found that while 85% of medical students believe it is improper for politicians to accept gifts, only about 46% feel that it is improper for doctors to accept gifts of similar value from industry. Why do you think that medical students have such a different opinion when a politician accepts gifts as opposed to when a healthcare person does?

Article about this:

https://supreme.findlaw.com/legal-commentary/the-medical-industrys-practice-of-giving-gifts-to-doctors.html

Link to the study statistic: 

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4101871/

Diagnose Me Dr. Buzzfeed, DDS

New trends are coming in all the time, especially with social media, it can be the easiest way to promote products to the masses. Companies have promoted things like fat loss teas or using professional healthcare students promoting scrubs which of course would gather interest and hopefully, in the end, the desire to buy that product. One thing in this phenomenon that I have noticed is the use of charcoal toothpaste as a natural alternative to whiten teeth as opposed to spending enormous amounts of money by going to the dental office to do treatments like Zoom Whitening. The question then arises, does it really work? Typical toothpaste contains abrasives that help remove stains like coffee or red wine, taking a look into the ingredients of charcoal toothpaste its evident that it has harsher abrasives. If people were to really research charcoal toothpaste products, they would find out that it isn’t even FDA approved and no scientific evidence showing the effectiveness of charcoal toothpaste. I think people just look for short term solutions and disregard the long-term negative effects of a product. In a product that has harsher abrasives, going back and forth on your teeth causes the wearing down of the enamel and roughening the surface, opening the tooth surface to an easier adhesion of those substances that stain teeth.

Whitening teeth can be done at home, but now products like do it at home retainer teeth straightening kits are attracting the masses. As a pre-dental student and dentists opinions toward these treatments, its our duty to advocate and educate patients the absurdity of this as we are trying to look in the beneficence of the patient. I want them to have cheap treatment, but also quality care. I think it is important for the patients to know that these at home procedures are on a case by case depending on the severity of their condition. Although dentists are the professionals and go to school for a large amount of time, it is ultimately the autonomy of the patient to decide what they want. This brings in the question, are these products bringing in a new age of people feeling comfortable doing procedures that should be done by professionals?

Magnesium Deficiency and HPA Axis Disruption

Over this last year, I've found that Magnesium (Mg2+) is essential to good health, especially my mental health. Among various other roles, magnesium plays an important physiologic role in HPA axis balance, and ultimately in the stress and anxiety-related behaviors of animals. The HPA axis, or the hypothalmic-pituitary-adrenal axis, is one of our central stress response systems. The HPA axis begins at the hypothalamus, which releases corticotropin releasing hormone, or CRH, to bind to the anterior pituitary. The anterior pituitary in turn releases  adrenocorticotropic hormone (ACTH) into the bloodstream, making its way to the adrenal cortex, where it stimulates the release of cortisol into the blood.

Although the mechanisms of magnesium's HPA axis modulation are unknown, a few studies note that a deficiency can lead to altered HPA axis function. More specifically, researchers found that magnesium deficient mice (given only 10% of daily Mg2+ requirement) showed higher levels of anxiety-related behaviors, increased body weight, increased transcription of CRH, and elevated ACTH plasma levels compared to control mice. The research also showed that the magnesium deficient mice responded well to anti-depressant (chronic despiramine treatment reversed axis abnormalities) and anxiolytic (diazepam reduced PVN hyper-excitability) medication treatments. The researchers hypothesize that magnesium may be an essential ion in intracellular and interneuronal processes when considering abnormal anxiety on a neurolobiological basis.

I first discovered the relationship between magnesium deficiency and anxiety about a year and a half ago, much before I read any papers on it. At that time, I had been living in chronic, HIGH stress lifestyle for months and months, and I practically added onto it daily. One day, after a rather strenuous session of moving a slate pool table from the 6th floor of an apartment building to my car in the midsummer heat, the accumulated stress pushed me to my limit and I just broke. I developed a severe form of anxiety called depersonalization and derealization (or DPDR, look up descriptions of it on reddit and you might catch a glimpse of the agony that DPDR is). I thought I had died and gone to Hell. No other way to describe it. This lasted for about 8 grueling months, all the while appearing to be treatment resistant. Over that time, I repeatedly read that DPDR was simply the body's normal response to extremely stressful situations and often occurs during traumatic situations. I also learned it can be caused by magnesium deficiency. I decided to give magnesium glycinate supplements a try, and day by day of taking the recommended dose along with a normal diet (and months of counseling), my symptoms improved significantly. I believe that both the stressful lifestyle and a diet lacking in sufficient magnesium lead my body to be overly stressed, resulting in the DPDR symptoms.

Cited Study: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3198864/

*IUDs are AWESOME* (as stated by me and the American College of Obstetricians and Gynecologists)

Regardless of what kind of health provider we become, we will interact with women and patients affected by and/or connected to women every day. An important health topic is that of sexual and reproductive health and its implications on the patient and those around her. Knowing the range in different types of contraception from fertility awareness strategies to long-lasting reversible contraception (LARC) such as the IUD (intrauterine devices) are imperative.

The American College of Obstetricians and Gynecologists recommends LARCs as the first-line contraception method to be encouraged for most women. LARCs have been reported to be the most effective form of reversible pregnancy prevention methods. However, each woman’s circumstance is unique and it is our responsibility as educated, informed, and ethical providers to provide options that work optimally for each patient and their intended outcomes.

In March 2018, a study published by the Journal of Obstetrics & Gynecology, found that female physicians who worked as women’s health specialists had a substantially higher use of LARC than the general population. From the total population of women who use birth contraception in the United States, 12% elect to use a form of LARC. In the study’s population of Ob/Gyn residents, 49% of women were using LARC as their contraception method, with 91% of them using the levonorgestrel IUD (also marketed as Mirena). Ob/Gyn residents are arguably among the most educated and trained providers on evidence-based family planning (Ziger et al., 2017). This study analyzed surveys from participants in the Ryan Residency Training Program. Currently, 40% of US Ob/Gyn residencies have incorporated the Ryan program in the United States and Canada.

Although there are some studies and political commentaries about perceived “scary” implications of IUDs – we should take time to explore the numerous benefits and “amazing” aspects of IUDs. There are non-hormone IUD options, multiple other tested and supported LARC methods, as well as oral, injectable, surgical, insertable, and attachable methods. There are also options that involve no devices at all such as fertility awareness methods and abstinence. The important thing is to realize there are MANY options with some being more beneficial for others.  The following website outlines EIGHTEEN different birth control methods: CLICK HERE TO LEARN MORE!

Zigler, R. E., Peipert, J. F., Zhao, Q., Maddipati, R., & McNicholas, C. (2017). Long-acting reversible contraception use among residents in obstetrics/gynecology training programs. Open access journal of contraception, 8, 1.

Promising Oncolytic Virotherapy Agents

Recurrent breast cancer patients urgently need new therapies to improve their quality of life. Existing therapies often cause debilitating side effects that severely degrade their quality of life. Oncolytic viruses develop a therapeutic modality that allows it to selectively destroy tumor cells. Oncolytic agents such as herpes simplex virus, vaccinia virus, measles virus, and many others are in general clinical trials for several cancers to demonstrate safety and efficacy. For oncolytic virothearpy to be adopted, it must first show it can eliminate metastatic diseases. Scientists have begun “arming” oncolytic viruses by giving the virus anticancer transgenes (genetic material that has been transferred naturally). By doing so, the virus is able to target tumor environments and inhibit angiogenesis in those areas. In addition, to further enhance viral efficacy the oncolytic agent is given immune-stimulating factors. When the oncolytic agent is given an anticancer transgene and immune-stimulating factor, the virus effectively inhibits growth and metastases of breast cancer. Other studies show if oncolytic viruses are used with other therapeutic strategies, tumor cell apoptosis increases. In addition, combination therapy is shown to inhibit breast cancer cell growth. The way in which the oncolytic agents are delivered is also very important to understand. When administering oncolytic virotherapy intravenously it was noted that the virus mediated tumor growth suppression quicker and within that specific area. In addition, it was seen that primary tumors were completely eliminated when oncolytic viruses were administered. Even though many clinical trials are in progress to further support oncolytic viral therapy, caution must be taken to not interpret these findings incorrectly. Oncolytic therapy must be tested on a case-to-case basis with consideration of the the cell line, the virus, timing, and mechanism. However, their is hope that oncolytic therapy will work for individuals with recurrent cancer.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4918380/

Cannabis use for the treatment of Epilepsy

There has always been an interest in the use of cannabis to treat epilepsy, but it was not until recent that appropriately controlled studies have been completed. In this paper Gaston and Szaflarski address the updated research around cannabidiol (CBD), a non-pshychoactive component of cannabis to treat epilepsy. Data from both open-label expanded access programs (EAPs) and randomized placebo-controlled trials (RCTs) of highly purified oral preparation of CBD, which was recently approved by the FDA, is discussed. In EAPs significant improvement in seizure frequency was seen among the  treatment-refractory epilepsy (difficult to treat seizures) population. In addition, RCTs have demonstrated significant seizure reduction in patients with different syndromes. The most common side effects with the administration of highly purified CBD is diarrhea and sedation, with sedation being more common with patients taking concomitant clobazam (drug associated with seizures). There was also an increase of enzymes associated with the liver and heart that were being secreted when administering CBD.  When administering CBD, it is reported that there is a clear interaction with clobazam, by significantly increasing the levels of the active metabolite N-desmethyclobazam, and this is measured by the CBD’s inhibition of the liver enzyme CYP2C19 (the long term effect is still unknown). EAPs also demonstrate POSSIBLE interactions with other drugs that are administered to treat seizures. In some cases it was reported that drug adjustments (related to epilepsy) had to be made after the administration of CBD. Even though, the research being done looks to be promising, the future effects are still unknown. CBDs safety and efficacy to treat epilepsy must be further researched. Future controlled studies encompassing various ratios of CBD and THC need to be done to further demonstrate the potential benefits for epilepsy patients. As of now the data looks to be promising and as a society we are making progress. As we make progress it brings to attention many of the bioethical values we have discussed. In particular non-malefesance and beneficence are called into question for the patients. Scientists want to do no harm while conducting clinical trials for the overall benefit of others (beneficience), but with the unknown long term effects, should we delve further into studies to find out? CBD may have the potential to treat difficult cases of epilepsy, but is that enough reason to venture into the unknown?

  https://www.ncbi.nlm.nih.gov/pubmed/30194563

Can a cup of coffee prevent type 2 diabetes?

I stumbled across an article that talks about type 2 diabetes prevention with a drink that many individuals in the US consume, coffee. Marilyn Cornelis, a nutritionist at Northwestern University Feinberg School of Medicine, is exploring the idea that black coffee has the most potential to prevent type two diabetes. Coffee drinkers have had a slightly reduced risk of cardiovascular disease, cancer, and Parkinson’s disease in addition to the decreased risk of type 2 diabetes. Epidemiological studies have begun supporting this statement and it is inferred that the chemical compounds released in the roasting process and high levels of antioxidants have a huge influence of how the body is interacting with them. However, at the end of the day Dr. Cornelis states that it is the metabolites, small building blocks, that are directly helping prevent type two diabetes. Dr. Cornelis is in the process of completing a study that takes into consideration 46 individuals that go from a four week coffee-free diet to a whopping eight cup coffee diet for a month. The FDA has acknowledged the coffee benefits and has suggested five cups as a healthy upper limit. However, with data supporting the prevention of type two diabetes we have to take into consideration individual’s tolerance to coffee. Some individuals genes influence the ability to metabolize caffeine and make it more efficient without feeling the immediate jitters or jolt of energy (ultimately allowing them to drink more coffee and having a greater prevention for type 2 diabetes). These are hopeful findings for the US population, since as a nation we struggle with diabetes and cardiovascular disease. Knowing that a simple adjustment to our everyday lifestyle can be beneficial to our health should be an easy transition.

http://www.diabetesforecast.org/2016/jul-aug/can-a-cup-of-coffee-prevent.html?loc=dorg_recentadv

Do opioids really help?

I just read a study published in March of this year comparing the effect of opioid and non-opioid treatments for patients with chronic back pain and hip/knee osteoarthritis pain. In the group treated with opioids, included treatments were immediate-release morphine, oxycodone, or hydrocodone/acetaminophen. In the non-opioid group, treatments involved acetaminophen or NSAIDs. The study found that over a period of 12 months opioid therapy was no better than non-opioid therapy in improving pain-related function, but did lead to an increase in adverse side effects. Pain intensity was slightly lower in non opioid-treated patients.

            This article caught my interest because a lot of states have tightened their opioid laws recently in an attempt to combat the widespread opioid abuse the United States is currently in the midst of, which is responsible for thousands of deaths a year among other issues. As anyone who has worked in a clinical setting no doubt knows, the use of opioids in the treatment of chronic musculoskeletal pain is a relatively standard approach. Many of the doctors I’ve worked with through the changeover have struggled with how to continue treating patients with chronic pain. Many are poorly equipped to handle treating addiction and do not have much in the way of alternative options, at least in family practice settings. At some point there is uncertainty about how much of a patient’s pain is chronic and how much is coming from the opioid use itself. The most recent guidelines now discourage use of opioids for chronic pain because there is not sufficient evidence for benefits that outweigh the potential serious harm they can cause.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5885909/