Importance of Epigenetics

For the longest time, it was thought that the genome was entirely responsible for one’s biological characteristics, such as phenotype or the carrying of an allele for a certain disease. Researchers would often make this assumption when studying the cause of certain diseases. However, after hitting roadblocks under this paradigm, the function of the genome was then reassessed. The reassessment eventually led to the doubtfulness of the assumption that the genome was entirely responsible for all of one’s biological characteristics. Researchers came to this doubtfulness after investigating breast cancer patients without the BRCA gene mutation, after studying non-genotoxic carcinogens, and after considering concepts such as cell differentiation.

If one were to look at the case of breast cancer without considering the epigenetic contributions (meaning contributions that do not cause changes in the gene), they would probably assume that the cancer’s development would be due to the patient’s possession of the BRCA-1 or BRCA-2 genes (mutant strains of the BRCA gene associated with breast and ovarian cancer). However, the statistics show that, in actuality, only 7% of breast cancer cases in the general population are estimated to be of carriers of the BRCA-1 and BRCA-2 genes. So, although the possession of the genes dramatically increase the risk of developing the cancer, it is not an ultimatum.

In the study of carcinogens, it was commonly thought that chemically induced cancer was solely due to genotoxic chemicals, or chemicals that cause damage to the gene. However, this was questioned after observing that the risk of cancer in former smokers was dramatically lower than that of active smokers. This suggests that the carcinogens in cigarette smoke do not mutate our DNA sequence, because if it did then the risk of cancer would stay stagnant in former smokers – not lower. After further investigation, it was found that 64 carcinogens of the list of 162 were not genotoxic. Thus, although a correlation between mutagens and carcinogens exists, they are not synonymous.

Another idea that deprecates the role of the genome is that of cell differentiation. It is known that every single cell in our body possesses the same 2-meter long invariant DNA sequence that stores all of the genetic information of the organism. However the question that used to puzzle scientists was that if all of our cells have the same DNA sequence, how is it that they have different structures and functions? The answer to this, which also explains why patients can develop breast cancer without the BRCA gene mutation and how non-genotoxic chemicals can be carcinogens, is the epigenetic contributions done on the DNA sequence. The epigenetic contributions make it so that each cell only uses and expresses certain genes that pertain to its specific function.

As our DNA that makes up our genome is very long (2 meters), our cells need to package DNA by wrapping it around histone proteins. Forming repeated units of nucleosomes, this DNA-protein complex is known as chromatin, which can be condensed further into chromosomes. The core of one nucleosome is composed of DNA wrapped around a histone octamer. This organized DNA-protein complex allows the cells to regulate what genes are expressed and when. This is done by the use of chemical tags on either DNA sequence or histone tails. These tags, most commonly methyl or acetyl groups, modify gene expression by either closing or opening the chromatin respectively. Silenced genes occur when the chromatin is in a repressed state, and active genes occur when the chromatin is in a more open state.

Because epigenetics is responsible for determining what genes are turned on or off, there are tons of studies that link epigenetics to a large assortment of diseases and conditions. This provides much insight on how to develop different therapies that could treat diseases. The recent progress in epigenetics is reshaping the medical field as scientists are making advancements that were previously thought to be unimaginable.

References:

B. Claus, Elizabeth & M. Schildkraut, Joellen & Douglas Thompson, W & J. Risch, Neil. (1996). The genetic attributable risk of breast and ovarian cancer. Cancer. 77. 2318 - 2324. 10.1002/ (SICI) 1097-0142(19960601)77:11<2318: AID-CNCR21>3.0.CO; 2-Z.

James E. Trosko, Brad L. Upham. 2005. The emperor wears no clothes in the field of carcinogen risk assessment: ignored concepts in cancer risk assessment, Mutagenesis, Volume 20, Issue 2, March 2005, Pages 81–92, https://doi.org/10.1093/mutage/gei017

Moosavi, A., & Motevalizadeh Ardekani, A. (2016). Role of Epigenetics in Biology and Human Diseases. Iranian biomedical journal, 20(5), 246–258. doi:10.22045/ibj.2016.01

Kieran Bissessar
Palliative Medicine

In 1990, palliative care was defined by the World Health Organization as a form of care that targets the chronically ill, those who have progressing diseases that threaten the continuity of life. Such care was recommended for all countries as part of the comprehensive care for human beings. The palliative care specialist treats the patients but not their illness. How? They do so by looking at one’s needs and symptoms not only from the physical, but also from the emotional, social and spiritual point of view. The specialist also looks at the family and the caregiver during treatment and provides care after death in the period of mourning.

Palliative care began in oncology, but today it extends to the carriers of all chronic diseases. Patients with advanced diabetes, heart disease, or chronic lung disease benefit from receiving this type of care. However, even today, those with advanced stages of cancer constitute most patients requiring palliative care. The first step in palliative care treatment is to listen to the patient, to observe him or her as an individual who has a history, a culture, and a level of understanding of his or her own condition. The specialist must be attentive to all the characteristics and conditions of that patient. This was the way that palliative medicine oversaw the patient and his family in order to meet the needs of the family nucleus in a very personalized way - as part of the specific treatment.

From the physical point of view, besides pain, the most common symptoms targeted by palliative care are fatigue and shortness of breath, which are extremely distressing symptoms that can be controlled in a simple way without the need of great technological resources. Other problems that are focused on during treatment include nausea, vomiting, loss of appetite, weight loss, sores, depression, anguish, fear and loneliness. Palliative medicine advocates that one should always seek the cause of the symptom to try to minimize it. Fatigue, for example, can be determined by anemia or a metabolic disorder amenable to treatment. When one cannot fight the cause, there are psychostimulant drugs that can be used since they make people more willing, more cheerful, and more likely to improve their quality of life even if by a little.

It is important to note that most sick people realize when their life is coming to an end. The signs are very clear: one loses mobility in one day; the next day one cannot sit or turn in bed and depends on other’s help to make any movements. The feeling of fatigue becomes very acute, the appetite disappears completely, and it is no use imposing an artificial diet, because the individual no longer responds to any type of treatment. (In fact, to stop feeding at the end of life is providential because it makes the body produce some substances that relieve pain and discomfort.) In palliative medicine, much medication is used subcutaneously. As the picture progresses, some drowsiness and mental confusion may arise. At this stage, it is common for patients to see things and communicate with family members who have sometimes died. Gradually, however, they lose consciousness and sleep most of the time.

In this period, it is important to listen to what they have to say, to listen to their desires and needs, and to reassure their families. There are patients who ask to die at home next to a certain person. The best way to approach them at this stage is to assure them that his or her health specialist will not abandon them, that their family is there and that both the specialists and family want them to end their lives in peace.

References:

https://www.liebertpub.com/loi/jpm

https://www.nia.nih.gov/health/what-are-palliative-care-and-hospice-care

Nathalia Schettino
Collagen Skin Care Credibility

Today, skin care has become increasingly more popular in the beauty market. Places like Sephora and Ulta carry many brands and trends that follow what is popular while also carrying items that have affordable prices, high end prices, and/or attractive packaging. For example, Korean Beauty, better known as K Beauty, has become overwhelmingly popular in the United States. That being said, an ongoing trend of skin care claiming to contain collagen to promote skin quality and “bounce” has been in the market, driving sales for both men and women. Considering that collagen is naturally made in our bodies, how does putting skin care products with collagen on the surface of our skin help (if they even help at all)? Moreover, what is the difference between our own self made collagen compared to the ones in beauty products?

What is collagen exactly? Collagen is one of the most important proteins that our body produces in order to help it stay intact (Cobb, 2017). It is our biological “glue”. This form of collagen is best known as endogenous collagen which is best defined as collagen that is naturally made by one’s body (Cobb, 2017). It can be found in all parts of the body and is most observed in the bones, skin, and muscles (Goddard, 2018). Aside from “gluing” the body together, collagen also promotes new skin formation and recovery when the organism sustains an injury  (Cobb, 2017). There are about sixteen forms of collagen and they all have unique functions that helps the organism function best (Cobb, 2017).

Structures of proteins tend to look messy and this applies to collagen as well. Collagen proteins are typically packed into long fibrils (Cobb, 2017). This means that many little proteins come together and condense to form a long strand. This long strand will then further condense with other collagen strands by wrapping to form a fibril. While to the naked eye this protein fibril is extremely small and is unable to be detected unless with special equipment, it is essentially large to our body in terms of the cellular world.   

Considering that collagen is so important to us, why is collagen in skin care under skepticism? The collagen that is seen in skin care is typically synthetic collagen. This form of collagen is called exogenous collagen (Cobb, 2017). Typically, such skin care products can be purchased in drugstores and beauty stores without any prescription. Because these products are so widely sold, do they really work?

To better understand how they would work, the natural characteristic of skin and cells should be elaborated. Skin is made up of tissue which are made up with very tiny cells. Cells are the base to all living organisms. This includes bacteria, plants, fungi, animals, and humans. Human cells are actually categorized under animal cells. Animal cells do not have a cell wall. A cell wall is usually a steady outer covering that protects the whole cell. Cells with cell walls also have a cell membrane which is a delicate but protective layer found surrounding organelles (mini parts of the cell) and holding the cell together. All cells without a cell wall still have a cell membrane. Bacteria and plant cells have cell walls. Fungi may or may not have cell walls as it depends on the type of fungus. Animal cells however, do not have cell walls and therefore only have cell membranes as their most outer coverings. Cell membranes are semipermeable which means they allow certain molecules into the cell and others are blocked off. Examples of molecules that often enter and leave your cells are water and salt. This acts as protection so that no pathogens or large molecules can randomly enter the cell without proper selection first.

As a refresher, exogenous collagen is synthetic or obtained from other organisms (most popular one  are pigs). Collagen in general are large fibril molecules and therefore cannot enter nor leave the cell due to the cell’s semipermeable membrane. Due to this, applying collagen onto the face does no favor to the individual as the collagen molecules are too large to even be absorbed into the skin. To further look into this, several MDs and PhDs conducted extensive research on collagen used in beauty products where they utilized rats to tests collagen skin care (Aust et al., 2008). After, they observed for changes in the epidermis, melanocytes (proteins that create melanin in skin), and pigmentation markers (Aust et al., 2008). In short, only the pigmentation markers were seen to increase but everything else stayed about the same. The research team concluded, then, that collagen therapy is not very successful (Aust et al., 2008).

References:

Aust, M., Reimers, K., Repenning, C., Stahl, F., Jahn, S., & Guggenheim, M. et al. (2008). Percutaneous Collagen Induction: Minimally Invasive Skin Rejuvenation without Risk of Hyperpigmentation—Fact or Fiction? Plastic And Reconstructive Surgery, 122(5), 1553-1563. doi: 10.1097/prs.0b013e318188245e

Cynthia Cobb, A. (2017). Collagen: What is it and what are its uses?. Retrieved from https://www.medicalnewstoday.com/articles/262881.php

Goddard, S. (2018). Will taking collagen supplements *really* make you look younger?. Retrieved from https://www.netdoctor.co.uk/beauty/skincare/a29497/do-collagen-supplements-work/

Swatschek, D., Schatton, W., Kellermann, J., Müller, W. E., & Kreuter, J. (2002). Marine sponge collagen: isolation, characterization and effects on the skin parameters surface-pH, moisture and sebum. European Journal of Pharmaceutics and Biopharmaceutics, 53(1), 107-113.

Michelle Yip
Can We Slow Down Aging?

Aging is a complex concept that has emotional and physical impacts on a person. It is a futile topic to worry about, yet it looms as a dark cloud, ready to rain on your parade one day. Science fiction movies have innovated ways to slow down and preserve a human for years before and after their death. Scientists have experimented solutions to the ever growing concern of staying young. No one seems to have an actual and feasible solution but there are several ways to slow down one’s aging.

There is no best way to slow down aging but there are simple ways that can alter the way aging can consume us. Medical advances and technology have already helped the world raise the longevity period from 48 years to 71 years, thus improving human life span. But what takes us to a lifespan of 91 years or even 100 years? The answer might be to improve the “health span.” Health care has been stagnant in that respect because not everything is helping to slow the aging process as it is to slowing the dying process.

As we get older, stress becomes a big factor in our life and it is blamed as one of the sole reasons people age faster. Stress releases free radicals that can denature proteins in our body and cause a huge problem in the long run, especially if the stress is chronic, but stress is an essential part of being human. It is actually necessary for the body to train its sympathetic nervous system, our “fight-or-flight” response. So the main focus is how to keep the cells healthy in our body even with factors like stress.

Cells in our body undergo mitosis (division) constantly, and the body has found many solutions on repairing them in case of a mutation. A cell stops dividing after 50 times to protect us from cancer in the body. These “zombie” cells do not stay in the body for a long time but are taken out by the immune system. However, as we age, the number of Zombie cells increases ridiculously. Zombie cells eat up the collagen in our body which causes one to look aged so scientists have found that there are two methods to prevent this: developing “Zombie” agents to kill the cells and to rejuvenate Zombie cells so they act as regular cells once again. Although these solutions are theoretically brilliant, practically they can destroy an entire organ system! It can make the problem worse and can even cause cancer. There have been more studies collected and conducted regarding rejuvenating “Zombie” cells and there has been progress, but not enough to see a difference within the next decade or so.

Another popular topic regarding slowing down aging is cryonics. It is the hypothetical science seen in sci-fi movies that freezes a living person’s body to preserve them when time is right for them to wake up. Cryonics is built on the concept of freezing meat to avoid bacterial damage and to be readily available for use. But the problem with the defrosting of a human body is: how do you find an oven big enough and how will it actually preserve our body? Ice is no friend to our physical composition and can damage the fragility of our bodies. We have fluids everywhere in our system and when water freezes, it expands which can burst our vessels and organs! Scientists’ solution to the problem: turning our fluids to glass. Glass has no crystals that can burst our vessels but it make not be the only solution. Other preservatives like methanol, formamide, and butanediol maybe be toxic but can be used in the way glass can.

We are on the path to a new beginning of slowing down aging. There is a lot of work to be done for the future but all will come to fruition when we are able to say our longevity can extend to 100 years!

References:

https://nypost.com/2019/03/02/science-has-figured-out-how-to-freeze-the-aging-process/

https://www.inverse.com/article/25906-cryogenics-cryonics-vitrification-freezing-preservation-life-extension

Radhika-Alicia Patel
Fixing a Broken Heart

What happens to your body when you fall in love and what happens when you lose that love? Humans are known to be a deeply social species. Our most gratified state arises when we feel belonged in our environment and with those around us. Hence, we tend to form relationships. Our motivation to maintain stable and meaningful social relationships is a common pattern that is rooted in our evolutionary history.

Love in the brain was examined by functional Magnetic Resonance Imaging, or fMRI, in 2003 in order to map the neural activity of the brain when looking at a loved one. The scan showed vibrant fireworks of green, yellow and blue in an image of grey matter, confirming that love is activated by an influx of dopamine. Dopamine is one of the main neurotransmitters that are responsible for the feeling of pleasure and satisfaction, like a reward system. Love isn’t the only thing that wires an increase in dopamine. Nicotine based drugs and cocaine follow the same pattern of increased dopamine activity within the brain to provide a pleasurable feeling. The more dopamine that is released, the better you feel, the more you want it, and the easier it is to become addicted. From parallel conclusions, you can say that love is a drug.

So then what happens when the love is taken away? If you compare it to taking away a drug from a drug addict, it results in withdrawal. The extremity of the withdrawal is then determined by how addicted they were to the drug. Similar to how our body and mind hurts, heartbreak causes our body and mind to hurt. The brain regions involved in anticipating pain and regulating negative emotions are the right anterior insula, which regulates motor control and cognitive function, and the superior frontal gyrus, which links the nervous system to the endocrine system for hormone production. Thus, in response to physical pain, the brain activates the anterior cingulate cortex (ACC) as an alarm for distress.

When in the mire of heartbreak, chances are that you feel pain somewhere in your body. Maybe you feel it in your heart, stomach or maybe even in the palm of your hand. The pain can be temporary, or it can be chronic, depleting you and hanging over a crushing sensation. So if an fMRI of a heartbroken patient were to be taken, if he/she is feeling pain and anger, the fMRI will show color development in the three areas due to increase in the hormone progesterone. Progesterone can be linked to anger and anxiety, which causes an overall depressing effect. In the midst of a heartbreak, the panic and denial of losing a loved one, we tend to show “signs of lack of emotional control” for weeks or months after initial heartbreak. This may result in unsuitable phone calls, writing letters, pleading for reconciliation, crying sessions, uncontrollable drinking, or dramatic encounters in the wake of passion.

If it hurts so much and makes us do crazy things, how can a broken heart be fixed? Unfortunately, there is no yet physical cure for heartbreak. There is no pill to cure it. The closest may be that recent studies have shown that Acetaminophen, the main ingredient in Tylenol, provides a placebo effect on patients resulting in significantly low activity in their brain’s ACC. This means that there is lower sense of distress in the patients.

Although this might not be a solid answer, other studies have shown that sensitive social support is one of the greatest source of relief for emotional distress. Hanging out with your friends or focusing on other things to keep yourself busy are beneficial for a smoother healing process. As much as we’d like to grow a new fresh heart every time we get our hearts broken, that is still not feasible. A heartbreak can distort your sense of self, and although it is a popular feeling that a lot of us can relate on, it is a topic still in research. On the bright side,  just like the neurons in a broken bone grow, change and connect with new neurons over time to heal, your heart also heal.

Work Cited:

Baer, D. (2017, March 03). The science of why heartbreak is so painful. Retrieved from https://theweek.com/articles/683488/science-why-heartbreak-painful

Jaffe, E. (2013, January 30). Why Love Literally Hurts. Retrieved from https://www.psychologicalscience.org/observer/why-love-literally-hurts

Laslocky, M. (2013, February 15). This Is Your Brain on Heartbreak. Retrieved from https://greatergood.berkeley.edu/article/item/this_is_your_brain_on_heartbreak

Walida Ali
Are You Consuming the Right Balance of Fats?

Any of us striving to become healthy are faced with decisions regarding food intake. For some, this may be simply maintaining a balanced diet, while for others, this may be to choose foods for weight loss. Yet, regardless of which group you belong to, we seem to have a subconscious avoidance for fatty foods, and this may be especially true for dieters. However, did you know that there’s a large difference between the effects of different fats? Consuming the right balance of different fats may not only lower our risk of heart disease, but also assist in weight loss.

Nowadays it’s common for people use words like LDL and HDL, but many have little understanding behind what they mean. LDL and HDL both refer to lipoproteins, which are protein and lipid assemblies that function to move fats through our body. LDLs are what people commonly refer to as “unhealthy” fats and stands for low-density lipoprotein. These fats carry higher levels of cholesterol compared to other lipoproteins and deliver cholesterol throughout the body; it’s for this reason that they’ve become known as “bad.” Too many LDLs in our body leads to excess cholesterol, which can accumulate and clog arteries. However, it’s a misconception to believe that LDLs are “harmful,” as the function of LDLs are meant to help our body tissues acquire the cholesterol needed to synthesize vitamin D and various steroid hormones.

HDLs are what people refer to as “healthy” fats and stands for high-density lipoprotein. These fats contain a higher composition of proteins than fats and collect cholesterol throughout the body to either recycle in the liver, break down other fats, or excrete from the body. By collecting cholesterol throughout the body, HDLs are believed to be good because they lower the risk of cardiovascular diseases.

In reality, we can’t simply consume HDLs and avoid LDLs because our bodies require cholesterol as building blocks for important compounds used in our body. As such, what really matters is maintaining a balanced ratio of the two fats. The ideal ratio of HDL to LDL varies between individuals, but a general recommendation is to maintain a 0.4 to 1 ratio. For details regarding your specific case, consult a physician.

Managing this balance between HDLs and LDLs depends on one’s intake of the various kinds of fats. Some of these large categories include saturated, unsaturated and trans fats, but there are differences even amongst these groups. In the past, it was believed that saturated fats are best avoided because they promote higher levels of LDL and clog arteries more easily. Trans fats were believed to not only increase LDLs but also lower HDL levels. Unsaturated fats on the other hand were said to increase HDLs and considered beneficial, but recent research studies have shown that many of these beliefs are overgeneralizations. Not all saturated fats are the same. For instance, research conducted by Dr Nita G Forouhi found that consuming very long chain fatty acids – with 22 carbons or more – was associated with decreased type 2 diabetes risk and the same was true for saturated fats with an odd number of carbons. Even the source of fat makes a difference, as people eat foods that come with a multitude of nutrients. The interaction between these nutrients also has different effects on the body. Avocado contains the same amount of saturated fat as three slices of bacon, but consuming avocados reduces LDL levels while bacon increases them. Likewise, eating a serving of fatty nuts everyday could reduce weight loss rather than eating a chocolate chip cookie because not all the fats in nuts are digested, rather they get excreted without being absorbed.

Perhaps next time when you go shopping for groceries, you could do some more research beforehand on what “fatty” foods would be more beneficial than harmful for you. Remember that many fats are good for us and play important roles in managing our everyday health. When consumed in proper amounts and balanced with the rest of our diet, fats can not only reduce our risk for disease, but also help assist in weight loss.

References:

https://healthyeating.sfgate.com/connection-between-hdl-ldl-fats-9580.html

http://www.industrialsectors.com/the-perfect-cholesterol-ratio-for-an-individual

https://www.healthline.com/nutrition/healthy-vs-unhealthy-fats#saturated-fats

https://www.weightwatchers.com/us/article/unhealthy-vs-healthy-fats

https://www.healthline.com/nutrition/nuts-and-weight-loss#section1

Sherry Chow
Swyer Syndrome: A Look into Women with a Y-Chromosome

When we refer to our sex, what do we really mean? While it is easy to say that sex merely refers to what type of genitals we have, in reality, it is a little more complicated than that.

All humans have a pair of chromosomes. Females contain two X-chromosomes, while males have one X-chromosome and one Y-chromosome. This means that all humans have at least one X-chromosome. This chromosome is vital to the proper formation of our body. The X chromosomes also contains information relating to the formation of female-specific sex characteristics, such as the formation of a uterus, vagina, and ovaries. The Y-chromosome, on the other hand, is much smaller, and mostly contains information related to the formation of male-specific characteristics, such as the formation of male genitals. A fetus will, by default, be a female (as, barring any severe genetic disorders, it will always have at least one X-chromosome), and will only become a male if they also have a Y-chromosome. Otherwise, females will simply have an extra X-chromosome in place of a Y-chromosome. Thus, the chromosomal makeup for females will typically be XX, while the chromosomal makeup for males will be XY. Note, however, the use of the word “typically.” While genetic sex (an individual’s sex chromosomes) will typically match with their phenotypic sex (an individual’s genitalia), certain chromosomal disorders can trigger a discrepancy between the two. One such disorder is called Swyer Syndrome.

Swyer Syndrome refers to a chromosomal disorder in which a genetic male has a dysfunctional Y-chromosome. Specifically, the parts of the Y-chromosome which control the development of male genitalia are unable to function. As explained before, all fetuses will be female by default, unless a Y-chromosome is present. If the Y-chromosome is unable to actually alter the development of the fetus, however, the fetus will remain a female despite having a Y-chromosome. This fetus will thus be phenotypically female despite being genetically male, meaning that the fetus will develop female external genitalia, despite being genetically male. This alteration is not without consequence though. For one, the female will be unable to develop functioning ovaries due to only having one X-chromosome. Instead, benign tumors called gonadoblastoma will develop in place of the ovaries, rendering the female genetically sterile, and thus unable to achieve menstruation.

Another consequence is that the female will begin to experience hormonal imbalances starting at puberty, due to the presence of the Y-chromosome. While the Y-chromosome is unable to allow the formation of male genitalia, its partial functionality still reduces the overall estrogen levels of the female as she reaches puberty. If left untreated, these lower estrogen levels can prevent the female from developing certain secondary sexual characteristics. This means that females with untreated Swyer Syndrome will typically be taller than the average woman,  with smaller breasts, and an overall body type closer to that of a eunuch (a male castrated before puberty) than a of mature woman. Other negative health side effects include reduced bone mineral density, and higher risk of developing cancer due to the presence of gonadoblastoma in the body.

Swyer Syndrome can be difficult to treat, as it is symptoms don’t typically manifest until puberty, and it can only be properly diagnosed with an MRI scan. Upon identification, Swyer Syndrome is typically treated with hormone therapy throughout puberty, where additional estrogen is supplied to the patient to compensate for their own body’s lack of it. The gonadoblastoma are also typically surgically removed, so as to eliminate the cancer risk they present. With these treatments, a woman with Swyer Syndrome can avoid some of the more severe medical disorders caused by Swyer Syndrome. Furthermore, while women with Swyer Syndrome don’t have functioning ovaries, the rest of their genitalia should function normally. In fact, a woman with Swyer Syndrome can even successfully carry a fetus to term, should they opt to receive a donated ovum (though their uterus is usually smaller than those of genetic females, often necessitating a C-section). Overall, with the correct treatments, a woman with Swyer Syndrome can live a fairly normal and healthy life.

References:

“Swyer Syndrome : Current Opinion in Endocrinology, Diabetes and Obesity.” LWW, journals.lww.com/co-endocrinology/Fulltext/2014/12000/Swyer_syndrome.13.aspx.

George Galanis
Is Someone I Know a Psychopath?

Psychopaths are popular in the realm of American films like American Psycho, No Country for Old Men, and The Silence of the Lambs, to name just a few. According to a paper published in the Journal of Forensic Sciences, researchers analyzed 400 of the most iconic psychopathic characters in film, judging how realistic or incredible each portrayal is. One thing can be said for certain: taking a look into the entertainment industry, many people have an interest in the topic of psychopaths. Then comes the question: is there anyone around me who is a psychopath?

It is estimated that 1% of the population is a psychopath. This may mean there is a fair chance that you walked past a psychopath today as you were going about your day. It may also mean that someone close to you can potentially be a one. Unlike in movies, many of which portray psychopaths as cool, intelligent killers, psychopaths within our society are difficult to spot. Psychopathy is a real mental disorder associated with lack of conscience and empathy. People with psychopathy may have amoral and antisocial disorders and may lack the ability to form meaningful relationships. The condition involves a lessened degree of physiological response, like sweat, when exposed to an emotional stimulus. This may contribute to their apparent lack of affect. Psychopathy is a spectrum disorder, which means it’s not an all or nothing condition -- we can all have a little psychopath in us. It is diagnosed with the Hare Psychopathy Checklist, which looks for traits such as sexual promiscuity and impulsivity.

The treatment of psychopathy has not been explored extensively. This may be due partly to inaccurate representation in media on the reality of psychopaths. There has been little clinical research of funding that go into psychopathy research, compared to other psychiatric disorders. Although psychopaths may be a small percentage of our community, they may have considerable impact within society, especially if they are in positions of political power or if they happen to be close loved ones. So far, treatment for psychopathy remain unfruitful, and conventional psychotherapy also seems ineffective. Although the neurobiological condition may not be treated, behaviors can be changed, so long as the individual with psychopathic symptoms is willing to do so. No drug so far can induce empathy in a person who does not have the capacity to care. We must understand that the brain of a psychopath is unlike that of our own, possibly linked to a stunted paralimbic system at birth.

At this point, it is near impossible to help an adult who is psychopathic. However, the field of child psychopathy seems to provide hope for young individuals with psychopathic symptoms, granted they receive early diagnosis and proper treatment. Researchers created a checklist with which to rate toddlers on behavioral traits that may indicate future psychopathy. These include lack of guilt after misbehaving, ineffectiveness of scolding, deceit, and lies. Studies show that children who score high on this scale tend to have greater behavioral problems as an older child. Currently, there is a treatment called “decompression treatment” that has been used on juveniles who had gotten in trouble with the law and had psychopathic symptoms. Only 10% of those who received this treatment were rearrested, compared to 70% in the no treatment group.

Though there is no 100% cure for psychopathy; however, if detected at birth, an individual’s psychopathic behavior, at the very least, may be reduced. This provides some hope for future treatment in this neurological and psychological disorder. Unlike how the media treats psychopaths, we must understand that they are humans, just like us, though their brains may be wired differently. Of course, society cannot excuse psychopathic behavior, particularly in the context of harming others. This is why it is important for not just advancements in the treatments of psychopathy, but in better public understanding of the condition.

References:

https://www.psychologytoday.com/us/blog/fulfillment-any-age/201611/can-we-identify-psychopathy-in-young-child

https://modlab.yale.edu/news/can-psychopaths-be-cured

https://neuroinstincts.com/treatment-psychopathy/

https://www.psychologytoday.com/us/basics/psychopathy

https://www.maxim.com/entertainment/least-most-realistic-psychopaths-movies-2018-01

Mary Yoshikawa
Work Hard, Play Hard, Sleep Hard

We’ve all heard the typical sayings used to motivate and comfort an athlete: “You can do it if you put your mind to it!”, “Eyes on the prize!”, and “Hard work beats talent if talent doesn’t work hard!” However, a crucial piece of advice that athletes should be reminded of more often and not take lightly is to get a good night’s rest.  It’s funny to think that how well you perform can depend partly on how well you sleep and for how long. Whether it is observing changes in activity from sleep deprivation or sleep extension, multiple studies strongly suggest good sleep for improved athletic performance.

A study at Stanford University was done on the men’s varsity basketball team during the National Collegiate Athletic Association seasons from 2005 to 2008. Data was recorded during the basketball player’s normal sleeping hours and was used as a baseline to establish a sense of normal physical performance. The baseline was approximately 6.8 hours and was maintained for 2-4 weeks.  A period of extended sleep was then initiated and lasted for 5-7 weeks. Researchers compared free throw shots and field goal shots made by each participant after a specific number of attempts during baseline sleeping hours and during extended sleeping hours and found an increase in mean shooting percentage for the latter. Extended sleeping hours were also associated with decreased sprint times, faster reaction times, and lower self ratings of fatigue.

Another study focuses on both the effects of lack of sleep. A meta-analysis study described in the article “Sleep, circadian rhythms, and athletic performance” analyzed up to 113 already published articles related to sleep and exercise. Several articles indicated that sleep deprivation ranging from 30 to 60 hours did not affect certain muscle strengths and movements such as knee flexion torque, elbow flexion or extension strength. Endurance of the knee flexors and extensors was also not affected in 40 meter dashes. Although there were exceptions to some muscle movements, the data overall supported that activities of high power output for a short period of time are not affected by sleep deprivation of a couple nights or less. A possible explanation for these outcomes across different research studies is that sleep decreases motivation. Although the tasks mentioned require motivation, they do not require a high level of it. Therefore, sleep deprivation does not come in effect in short but high power activities.

The effect of sleep deprivation on activities of longer duration is another story however. One study from the meta-analysis reported that activities such as sprinting and 50 minute exercises of repeated deep squats were negatively affected by 30 hours of sleep deprivation. Additional studies showed that two to three nights of sleep deprivation decreased treadmill walking distances as well ergometer cycling distances. The decrease in distance coverage proposes that sleep deprivation leads to accelerated exhaustion and thus, has a significant effect on long duration physical performance.

All of the studies mentioned do not come without their flaws and limitations. There are other factors to consider such as the athletes’ training regimen, diet, and age as well as the sleep debt of the participants and time of day the activity is performed. What can be confirmed is that optimal sleep can help obtain optimal athletic performance. Who knew sleep could have so much power?


References:

Mah, Cheri D., et al. “The Effects of Sleep Extension on the Athletic Performance of Collegiate Basketball Players.” Sleep, vol. 34, no. 7, 2011, pp. 943–950., doi:10.5665/sleep.1132.

Thun, Eirunn, et al. “Sleep, Circadian Rhythms, and Athletic Performance.” Sleep Medicine Reviews, vol. 23, 2015, pp. 1–9., doi:10.1016/j.smrv.2014.11.003.

Rachanne Nabong
Stem Cell Transplant for Hair Restoration

Androgenic alopecia, commonly referred to as pattern baldness, is the most common form of permanent hair loss in men and women. According to the American Hair Loss Association, roughly 60% of men notice some degree of thinning before the age of 35, and 85% of men have a significant level of hair loss by the time they are at the age of 50. Of those affected by androgenic alopecia, 40% are women – most of whom have already experienced menopause. Despite being concomitant to the aging process, androgenic alopecia often has a negative impact on one's self-esteem. Because we usually associate voluminous hair with youth, attractiveness, and healthiness, it’s unsurprising to notice depression and anxiety in balding individuals.

The ubiquitous nature and the emotional effects of androgenic alopecia demonstrates the exigency for hair loss treatments. In 2018, the Hair Loss Treatment Manufacturing Industry made 4 billion dollars in revenue and grew by 4.3%. Currently, the most common treatments for androgenic alopecia are minoxidil, finasteride, and hair transplants. Minoxidil and finasteride are both FDA-approved drugs that minimize the levels of Dihydrotestosterone (DHT) produced in the scalp. DHT is a chemical derivative of testosterone produced during androgen metabolism that is heavily linked to hair loss in men and women. Although helpful in slowing down hair loss, the results diminish once one stops taking the drugs. Therefore, minoxidil and finasteride are not long-term solutions in treating androgenic alopecia.

Hair transplantation is a surgical technique that involves removing hair follicles from a region of the scalp and transplanting them to the balding areas of the scalp. After many months, the transplanted hair would eventually grow back. Although this solution is a long-term solution to treating androgenic alopecia, an individual is limited by the amount of hair they have left. Also, depending on the surgeon and the quality of the procedure, the results can sometimes look unnatural.

However, using regenerative medicine as an approach seems to provide an answer to the drawbacks that arose using the previous methods. The idea behind stem cell therapy involves renewing ones dead hair follicles and adding growth factors to promote hair regrowth. Stem cells possess the potential to develop into many types of cells in the body. Such cells are responsible for creating new cells such as erythrocytes, cardiomyocytes, and neurons. However, in cases such as hair follicles, our body may not always replace them. Certain stem cells have the unique ability to revive old/damaged cells in the body. Exploiting this feature, scientists were able to develop a procedure similar to a regular hair transplant, but instead of transplanting individual follicles, stem cells are transplanted. It begins by taking a donor region with the hair follicles, reproducing them, and then implanting them back in the balding regions.

Researchers have been experimenting with methods to culture hair follicles for many years. Hair follicles are developed from unipotent epithelial stem cells and multipotent mesenchymal stem cells. By replicating this process in-vitro, these researchers were able to grow new hair follicles. However the yield wasn’t high enough to be able to restore a patient's full head of hair. Japanese researchers were able to improve upon this method by introducing an oxygen-permeable-mini-chip to dramatically increase the yield in harvesting follicles. This chip is a small polymer than has wells in it. The follicles in these wells are covered with a collagen mesh layer and then transplanted into the balding regions of the scalp. When transplanted into the skin of immunodeficient mice, regrowth was observed in only 18 days. An obstacle was that the mice had to be immunodeficient in order for this to work because their bodies would otherwise recognize the stem cells as foreign invaders and attack them. Doing this to a human would have been unwise because it would increase the likelihood of developing an infection. However, by harvesting stem cells from the patient themselves, this would no longer be an issue.

The results seem promising and we already possess the technology necessary to carry out this procedure. Scientists are still working out the smaller details but say that treatments should be ready by 2020. Estimates for this procedure range from 3,000 to 10,000 dollars depending on the patients level of hair loss. If successful, this can change the current state of the hair restoration market and the way people view modern medicinal techniques.

References:

https://www.chicagohairinstitute.com/blog/2018/06/29/hair-loss-statistics-191787

https://www.everydayhealth.com/skin-and-beauty/psychological-effects-of-hair-loss.aspx

https://www.gminsights.com/industry-analysis/hair-transplant-market

https://www.ibisworld.com/industry-trends/specialized-market-research-reports/life-sciences/otc-medicines/hair-loss-treatment-manufacturing.html

https://ghr.nlm.nih.gov/condition/androgenetic-alopecia#statistics

https://bioinformant.com/stem-cell-treatment-for-hair-loss/#grow

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3496047/

https://medicalxpress.com/news/2018-02-baldly-japan-scientists-regrow-hair.html

https://www.healthline.com/health/stem-cell-hair-transplant

Kieran Bissessar
Overcoming Motion Sickness

The idea of traveling can be a negative one if you are someone who is affected by motion sickness, even if the effects are not extremely severe. Whether it is traveling by car, train, airplane, or boat, for some people, motion sickness can suddenly and easily kick in. Fortunately, however, there are many tips that one can implement to overcome motion sickness, both medically and non-medically.

It is suggested that one tries out the non-medical remedies before taking medication, which should be done only for severe motion sickness. A common tip is to be careful of what one consumes before a trip-- foods that are heavy, spicy, rich in fats, or have strong odors are generally suggested as foods to avoid. In addition, excessive alcohol and smoking are also not recommended for traveling. On the other hand, consuming ginger, water and clear beverages, crackers, toast, bananas, and applesauce are recommended for combating nausea. Waiting to eat something delicious after traveling instead of before may be a better decision to make! However, one should not travel on a completely empty stomach either. A 2004 study from Alimentary Pharmacology & Therapeutics showed that a light meal with protein reduces the effects of motion sickness.

Other suggestions are based on the specific situation one is in. For example, some find that they do not suffer from motion sickness if they are driving the car. Rather, they experience it when they are in the passenger seat. If one is sitting in a train, it may help to pick a seat that faces the forward direction instead of one that faces the back of the train, or a seat that is closer to the front than the rear, which tends to be bumpier. If one is on a ship, it may also help to move closer to the front. A change in position, if possible, may be helpful-- some find lying down to be better, while others find standing up to be better. If possible, fresh air may help with the motion sickness, but if not, fans and air vents may provide the same assistance. Other sources of motion sickness symptoms include reading, watching movies, or playing games on a smartphone. This is due to the sensory disconnection that forms between the eyes and the inner ear, as our eyes do not perceive movement but the inner ear does. An alternative option would be to listen to an audiobook or to music.

A remedy that may help makes use of the acupuncture pressure P6 (nei guan), which is located three fingers below the wrist of the inner forearm. It should be found in the depression between the two wrist tendons, and by applying firm pressure for four to five seconds, it may help alleviate nausea and dizziness. There are wrist bands that one can wear, which has the same purpose of applying pressure on this pressure point. There have been studies performed to study the role of P6 in alleviating nausea and dizziness for both pregnant women and post-operative patients (Werntoft, E. et al. Werntoft E, Dykes AK. Effect of acupressure on nausea and vomiting during pregnancy. A randomized, placebo-controlled, pilot study. J Reprod Med. 2001;  Nunley, C. et al. The effects of stimulation of acupressure point p6 on postoperative nausea and vomiting: a review of literature. Perianesth Nurs. 2008.)

If natural and non-medical remedies fail, one may turn to medicine for motion sickness. Common brands include Bonine, Antivert, Meni-D, and Antrizine. Depending on the medication, it can be taken before traveling to prevent motion sickness. However, like many other types of medicines, it does not come without side effects and so it should be taken with caution. Side effects such as drowsiness and tiredness are extremely common for these anti-motion sickness medications.

There are many options that one can take to overcome motion sickness, and if it is not completely overcome, it can at least be alleviated. Motion sickness should not be a reason to dread traveling or to not travel long distances, especially when there are many available remedies. It comes down to finding the most effective method, which is on an individual level. Hopefully, traveling can become enjoyable again!

References:

https://www.onemedical.com/blog/live-well/motion-sickness-cures/

https://www.healthline.com/nutrition/foods-to-eat-when-nauseous#section8

https://www.healthline.com/health/motion-sickness-remedies#quick-tips

https://vestibular.org/news/06-18-2013/new-views-motion-sickness

https://exploreim.ucla.edu/self-care/acupressure-point-p6/

Stephanie Chan
Is White Noise Good for You?

Have you ever heard of white noise? You might have heard of it when someone was describing their learning environment, what they used for sleeping, or what they used for relaxing. Newborn parents claim that it is a lifesaver for putting their baby to sleep. Students claim that it is the reason they can concentrate for hours at a time.  White noise is a random broadband noise that makes a continuous sound at all frequencies. It’s basically a constant “sh” noise that is proven to provide a quiet environment. It can also be described as an anti-noise.

White noise can be found everywhere! It can be the buzzing of people in a coffee shop, it can be the noise of rain drops on your window sill, it can be the breathing of someone sleeping next to you, or it can be the whirring of a fan. White noise is such a prevalent feature of modern society that there are machines that can be purchased for the sole purpose of emitting different frequencies and levels of sound. There are even apps dedicated to different types of white noises.

Personality of the listener is a factor in whether white noise may work for you. If you like loud music in the background, studies show that it is because you crave a distraction from boring work. If you need pin drop silence, studies also show that it is because a distraction takes your mind off a task. White noise can help both types of situations. It provides a signal that masks a novel signal that might arise around you. It is sort of like a shield that takes you into a focused state of mind. However, some people can thrive or be negatively affected by white noise.

You might claim that noise or silence helps you with learning. White noise can actually help you more because it can change the activity of your midbrain. The midbrain is important for motor movement, eye movement, and auditory and visual processing. It can help you improve your memory and is linked to reward pathways. White noise triggers dopamine, a neurotransmitter linked to rewards, and enhances the network between brain regions to improve memory. White noise can be especially beneficial to those with attention deficits. This exposure to a consistent background noise can improve cognitive abilities. White noise can even help with sleep! It creates a routine and blank cover that blocks you from startling noises.

There are many reasons to want to use white noise in your daily routine now but there are also reasons on why not to use it. According to past studies, white noise can even affect brain cells over a long period of time. This is why white noise can cause tinnitus, which is a constant ringing in your ears. This can be prevented by turning down the volume of which you are playing white noise. Anything under 120 decibels should be your go to! Over 120 decibels can damage hair cells inside your ear and in the long term, cause permanent loss of hearing. So remember to be aware of what white noise you are using and how loud you may have the white noise playing.

If you think that white noise is too much of a risk for you, try pink noise or brown noise or blue noise. There are no definitive studies that compare these different noises and it all comes down to personality or preference. White noise encompasses all sound frequencies just as white light encompasses all colors of the rainbow. In particular, pink noise is the alternative that most people use instead of white noise because it is louder and powerful at lower frequencies. Pink noise is often used to help put someone in a deeper and longer sleep state.

So, is white noise actually good for you? There are beneficial reasons to start experimenting with white noise and you should try it! It could be what takes your learning, focus and memory to another level. It can be the added factor for a good night's rest. However, you must also be aware of the possible detriments to your ears.

References:

https://remembereverything.org/white-noise-good-for-studying-work/

https://www.psychologytoday.com/us/blog/memory-medic/201706/does-white-noise-help-you-learn-0

https://www.cogneurosociety.org/whitenoise_bunzeck/

https://greatist.com/live/sleep-white-noise

https://www.elitedaily.com/p/is-white-noise-bad-for-you-experts-say-it-all-depends-on-how-you-use-it-11776251

http://www.berkeleywellness.com/healthy-mind/sleep/article/pink-noise-sleep

Radhika-Alicia Patel
Are You Feeling S.A.D. ?

Winter rolls around and it seems like your day to day life has taken a turn for the bleak. You feel sluggish, you're sleeping too much or too little, it’s becoming difficult to do the activities that once gave you enjoyment, and the world looks and feels bleak. But why do you feel like this? You may have S.A.D. Although somewhat unfortunately named, S.A.D. is a real mental disorder that impacts around 5% of the U.S. population in a give year. Commonly passed off as the“winter blue”, S.A.D. can be very dangerous and detrimental to a population and a person. There can be very serious symptoms and issues that come with these “winter blues” indicators.

Seasonal Affective Disorder is a type of depression that is related to the change of seasons. Those impacted tend to feel hopeless, fatigued, unenergized, and most notably- feeling depressed. This disorder is mostly prevalent in women, so much so that 4 in 5 cases of S.A.D. are of  women. Although the disorder is mostly associated with the dreary winter season, people may also experience S.A.D. during the summer - although this account is less documented.

Even though the symptoms can be easy to tell, the causes of S.A.D. are still unknown. There seems to be a correlation between lower levels of sunlight and the amount of serotonin that a person’s neurotransmitters makes. Lower levels of serotonin have been found in people who were diagnosed with depression and related illnesses. It could also be that the Sun’s rising and setting disturbs a person's circadian rhythm which has been linked to depressive thoughts. Along the same train of thought, when the Sun is out for fewer hours in the day, more melatonin can be produced. Melatonin is the hormone responsible for sleeping, with fewer hours of sunlight, more melatonin is produced which may unsync a person's biological clock. The correlation between the amount of hours the Sun is out is also directly related to one's geographic location, meaning that those who live farther away from the equator are at a higher risk of developing S.A.D.

Scientists may not know the exact cause behind S.A.D. but there are treatments that have been found to help those with the ailment. The most common treatment is Phototherapy- in other terms, it means that one uses special lights or lamps to decrease the amount of melatonin that the body produces. This has been found to work for many people who are impacted by the disease and the method  has been used since the 1980s. Similarly, medication that blocks the production of serotonin has been found to have positive impacts as well. However, this can come with side effects.

Seasonal Affective Disorder can be incredibly dangerous and it can have serious implications on one's  day-to-day life. Although it isn’t as widely known as other mental illnesses, it is still very serious and it is important to reach out to medical professionals if you believe you suffer from S.A.D. It is also important to try and get as much sunlight as possible especially in the winter months when the Sun is out for fewer hours and other illnesses may be causing trouble. Simply spending more time outside, exercising, taking supplemental vitamins, and even increasing the amount of lights you have in your home can help reduce your risk of S.A.D.

References:

https://www.nimh.nih.gov/health/topics/seasonal-affective-disorder/index.shtml

https://www.mayoclinic.org/diseases-conditions/seasonal-affective-disorder/symptoms-causes/syc-20364651

http://www.mentalhealthamerica.net/conditions/sad

Carlos Martinez-Mejia
How Does Prolonged Screen Time Affect Your Vision?

Growing up, we’ve heard our parents tell us not to watch TV for too long because it’s “bad” for our eyes. But what does that mean? Does prolonged screen viewing cause damage to our eyes? Or is there no effect at all? In this generation, technology has increasingly become a part of our everyday lives, making us more reliant on it. In fact, 97% of classrooms in the United States have at least one computer for children to use, and smart devices are becoming readily available and given to kids less than five years old. As screen time rises, parents worry about the harmful effects of increased screen exposure and indeed, extensive electronic use can cause eye strain when looking at the screen for too long.

Eye strain is a repetitive strain injury caused by insufficient rest to the muscles. Glare from the amount of light that shines into your eyes and the position of the computer can also lead to muscle fatigue. Dry Eye syndrome, a condition where a person’s eye doesn’t produce enough tears to keep the eye lubricated, is often mistaken as an effect to screen exposure. Tears are necessary for the eye to maintain a healthy front surface to provide clear vision. Those with Dry Eye Syndrome tend to experience a burning sensation of the eye, irritation, sensitivity to light, redness, watery eyes, and blurry vision. Common causes of this syndrome are aging, medical problems like diabetes, rheumatoid arthritis, thyroid disorder, Vitamin A deficiency and more. Studies have shown that our eyes blink on average 12 times per minute. So the dry eyes, irritation, tears, and all symptoms similar to Dry Eye Syndrome, do not equate to the syndrome itself, but rather, it is us as humans forgetting to blink a sufficient amount when looking at a screen. Similar effects can also develop when straining your eyes to read a book.

In today’s generation, studies have shown that increased screen exposure to children at young ages result in higher frequency of myopia, or nearsightedness, due to a child’s habit of holding electronics very close to his or her face and the lack of outdoor activities to allow the eyes to exercise short and long distance vision.

The most important thing in alleviating eye strain is to rest your eyes. It is crucial to deliberately blink frequently if you are at your computer for extended periods of time so that the tears used to lubricate your eyes do not evaporate. Positioning your computer correctly, about 18-30 inches away from your face in a 10 to 15 degree slant can aide with minimizing eye strain. Lowering the glare will help with excessive use of your eye muscles as well. You can also use the “20-20-20 rule” to rest your muscles. Stop looking at your screen every 20 minutes and focus on something 20 feet away for 20 seconds. Closing your eyes for a few minutes every 30 minutes also provides the same effects.

For adolescents, the American Academy of Pediatrics (AAP) has revised their recommendation for childhood screen time. They recommend little to no screen exposure to kids 18 months or younger. For children between 18 months to 2 years old, screen time should be limited and supervised, and topics of screen time should be educational since children learn at an accelerated rate in the first few years. For children between the ages of 2 to 5 years old, screen time should be limited to one hour a day, and the same limits should still be in place for children 6 years and older. It is crucial to make sure that electronics do not inhibit a child’s every day activity.

References:

Bhola, R., Dr. (2017, August 23). The Effects of Too Much Screen Time on Children's Vision. Retrieved from https://blog.chocchildrens.org/effects-of-screen-time-on-childrens-vision/

Cashin-Garbutt, A. (2018, August 23). Does looking at a computer damage your eyes? Retrieved from https://www.news-medical.net/health/Does-looking-at-a-computer-damage-your-eyes.aspx

Computer vision syndrome: Is your computer affecting your vision? (2018, Sep 17). Hamilton News, Mountain Edition Retrieved from http://proxy.library.nyu.edu/login?url=https://search-proquest-com.proxy.library.nyu.edu/docview/2108572536?accountid=12768

Walida Ali
Overdose: Inside Your Body

In recent years, many cities around the country have come to realize a certain commonality in deaths in their communities: those caused by overdoses. States like Pennsylvania, Ohio, Delaware, and Rhode Island have a drastic number of overdose mortality rates, and even within New York City, we can see that the number has steadily increased since 2014. What was once an estimation of 200 deaths per quarter in the year 2014 has risen to over 350 per quarter by 2017. Opioids are largely the cause, with Fentanyl currently being part of over half of the overdose deaths.

But what exactly is an overdose? An overdose occurs when the body has taken too many drugs or other substances to handle. The body itself has a limit and an overdose is reached once this limit is trespassed. Symptoms of an overdose depend on the type of drug(s) taken.

Depressants include everything from opioids, medical depressants, and alcohol. As their name suggest, these drugs work to depress the body’s system, slowing down the nervous system, heart rate, breathing, but can also work to relieve pain. Opioid death is really common not only because they are highly addicting, but also because they slow down one's heart rate and breathing until they both stop and the person dies. Loss of consciousness is one of the most common signs of opioid overdose.

The human body naturally contains what are called endogenous opiates that are in charge of controlling regular body functions. These endogenous opiates bind to opiate receptors in the body that are able to inform the body to calm down. Opioids have the same shape as endogenous opiates but typically produce stronger reactions. They are able to turn off the same neurons that are sending pain signals from the place of harm to the brain, relieving one's pain, and increasing dopamine production which rewards the brain and makes one happier, with this result being an increase to one's desire to take even more opioids. Antagonist drugs such as naloxone, often used by paramedics and other medical staff, help by blocking off the receptors so that the opioid isn’t able to bind to them and produce extreme reactions. This is a crucial drug for patients experiencing an overdose.

Alcohol poisoning can occur when one is  drunk in too high a concentration in too short of a time. This combination prevents the body from functioning normally by leading to  loss of coordination, low body temperature, disorientation, irregular and slow breathing, and seizures. Opioids include drugs such as fentanyl, morphine, and heroin. They have a similar chemical structure to opium, from which the name is derived. Benzodiazepines, or medical suppressants, include Valium, Xanax, and Serepax (all market names), and are used to treat anxiety and insomnia. Although overdoses from these alone are uncommon, they should not be mixed with any other drugs or alcohol.

Stimulants, on the other hand, include amphetamines, cocaine and methamphetamine and they affect particularly the brain and the heart, increasing dopamine production. Overdoses can lead to heart attacks, strokes, and seizures. Signs of overdose also include hallucinations, headaches, chest pains, and very high body temperatures.

When determining the chances of an overdose, it is important to keep in mind the body’s ability to tolerate the specific drug as well as the drug’s half-life. If a person takes a particular drug constantly, their tolerance to it will build up and they’ll find that they need more of that drug to give the same effect they once had. Overdoses are common when people stop using a drug for a period of time, decreasing their tolerance, and then they go back and take the same amount they used to take originally. They think their body can handle this sudden high intake, but it cannot and so they soon experience an overdose. The half-life of a drug refers to the length of time it takes for the drug to lose its potency and decompose. Certain drugs have a longer half-life, like benzodiazepines, and a person taking the same amount for multiple days will find that a large part of the drug taken a day before is still in their system. This can increase chances of overdose because people aren’t aware of how much they should be taking and overdo it.

Overdose is not something to be taken lightly, and if you or someone you know is having trouble controlling their drug intake or is in danger of an overdose, contact a health provider or emergency services. Their life may be at risk.

References:

“Unintentional Drug Poisoning (Overdose) Deaths Quarters 1 ...” 1.Nyc.gov, New York City Health , Oct. 2017, www1.nyc.gov/assets/doh/downloads/pdf/basas/provisional-overdose-report-second-quarter.pdf.

“National Center for Health Statistics.” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, 10 Jan. 2018, www.cdc.gov/nchs/pressroom/sosmap/drug_poisoning_mortality/drug_poisoning.html.

“Overdose Basics.” International Overdose Awareness Day, www.overdoseday.com/resources/overdose-basics/ .

“A Look at the Physical Anatomy of an Overdose.” DrugAbuse.com, 27 July 2016, www.drugabuse.com/what-happens-to-your-body-during-an-overdose/

“Opioids and the Body: The Science of an Overdose.” Opioids and the Body: The Science of an Overdose | UA College of Medicine MD/PhD Program, 5 Jan. 2017, www.mdphd.medicine.arizona.edu/news/2017/opioids-and-body-science-overdose.

Naile Ruiz
Chronic Pain and Physical Therapy

We often hear of physical therapy being used to help patients with rehabilitation, many times after a surgery or any traumatic experience. However, it’s hard for many people to think that physical therapy can actually be used to treat chronic pain as well. In fact, did you know that the Centers for Disease Control and Prevention (CDC) actually recommends physical therapy and other non-drug options for chronic pain? For those of us that aren’t fully aware, chronic pain is defined as pain lasting more than 12 weeks and affects over 116 million Americans yearly. Even though the condition is often lumped into one category, it is important to keep in mind that chronic pain often varies greatly and can be treated in many different ways. As such, it’s common for patients to be put in multidisciplinary treatment programs. While seeking for medical advice on treatment is important, there are also some key things to keep in mind.

Recently, there’s been a growing national issue with the use of opioids that has subsequently carried over into their use in the treatment of chronic pain. There are many risks to opioid use and the rise in overdose deaths has become a national concern. In many cases, doctors have been seen to use opioids as a go-to treatment that may result in drug abuse or reliance in the medicine, not focusing on treating it long-term at all. In reality, opioids should be used only in the case of a strong need to function, such as cancer treatment or palliative care. Because of this, the CDC recommends non-drug options for treatment of chronic pain as they are believed to be cases where the benefits don’t outweigh the risks. According to the CDC Guideline for Prescribing Opioids for Chronic Pain - United States, 2016, there is a large amount of evidence that points towards physical therapy being an effective treatment for chronic pain in both pain and function management.

In using physical therapy to treat chronic pain, you should expect multiple sessions and possibly practicing exercises at home for maximum effect. The sessions might include a mixture of low-impact aerobic training exercises that increase heart rate but go easy on the joints, strengthening exercises that might focus on core muscles or other parts of the body, pain-relief exercises that target pain areas, or stretching. These exercises are targeted to relieve pain and manage body function, but rarely hurt the patient. Physical therapy treatment of chronic pain is believed to be more thorough because not only can therapists treat patients with flexibility exercises, posture awareness, and body mechanic instructions, but they can also help them understand the primary cause of their pain. Additionally, having someone to instruct them on what helps their pain and what doesn’t, how to work with their pain, and repeating words of encouragement throughout is a understandably longer-lasting treatment than opioids.

Physical therapy has been found effective in reducing pain and improving function for at least 2-6 months. According to the CDC Guidelines, physical therapy should be chosen for pain management over a variety of situations. This includes, but isn’t limited to cases such as when the risk of opioid use outweighs the rewards, when patients want to do more than simply reduce pain, when the pain or function problems are related to areas such as the lower back, hip, knee, or fibromyalgia, and when pain lasts 90 days. If you’re struggling with chronic pain, any of these situations could be you, so next time you’re talking to your doctor about treatment for your chronic pain, remember that physical therapy may be a better and safer option than opioids.

References:

.https://www.moveforwardpt.com/DidYouKnow/Detail.aspx?cid=cd52bad5-f4a3-4f1f-a387-9cd4a3bc1842

https://medlineplus.gov/magazine/issues/spring11/articles/spring11pg5-6.html

http://www.apta.org/PTinMotion/News/2015/1/14/ChronicPainNIH/

http://www.apta.org/Media/Releases/Consumer/2013/12/5/

https://www.webmd.com/a-to-z-guides/condition-15/pain/physical-therapy

Naile Ruiz
How Having Pets can Potentially Better your Quality of Life

Many people who own pets can generally agree that they enjoy their pet’s company. According to the 2017-2018 APPA National Pet Owners Survey, it is found that around sixty eight percent of American homes have a pet of some sort, with the most prominent being dogs. An interesting survey conducted by Houzz, which surveyed 10,000 pet owners in eleven different countries, found that seventy one percent of the people surveyed from France and ninety percent of those from the United States said that one of the best aspects of owning a pet is how happy they made their owners. While we pet owners may sacrifice an arm and a leg to pay their veterinary fees, our pets may actually be helping us reduce our medical bills, even if by a little. Before I begin, I want to address that this article is not referring to service animals, who have specific duties related to their owners.

Referring back to the Houzz survey, people surveyed also said that the second top benefit of owning a pet is that they help their owners to deal with stress. Another potential correlation with the reduction in stress is the fact that pets also help improving their owners' cardiovascular health. One study that was endorsed by organizations such as the American Association of Cardiovascular and Pulmonary Rehabilitation found that people who own dogs have a lower risk of heart disease as well as lower blood pressure and cholesterol. For individuals who had already been diagnosed with some sort of cardiovascular illness, canines still had health benefits, helping owners to be four times more likely to be alive after a year in direct contact with a pet and to have a higher likelihood of surviving a heart attack. It has also been discovered that cats do have a similar impact to that of dogs. A separate ten year study found out that those who owned cats, either currently or beforehand, were forty percent less likely to have a heart attack and thirty percent less likely to die from other cardiovascular diseases.

To millions of people, having a pet means having a friend. Roughly nine out of ten people say that their pet is part of the family, as shown by The Harris Poll, which surveyed 2,194 adults in May 2011. This is evident through many things we let our pets do, including sleeping on the bed with us. There are many stories in which a pet, whether it be bird or a dog, has helped people mentally, often when they are going through a rough patch in life. A survey conducted by the Mental Health Foundation in partnership with Cats Protection in 2011 uncovered that of the six hundred participants, some who had cats and others who did not, eighty seven percent of the individuals believed that owning a cat had a positive impact on their well-being, while another seventy six percent said that having a cat allowed them to deal with life easier. Clearly, there are both physical and mental benefits a pet can potentially provide. While I previously addressed that this article does not include service animals, many people may regularly purchase or adopt  animals with the intention of benefiting either their physical or mental health.

In addition, there are many pet specific benefits. For example, owning a dog helps certain people keep track of their physical life, but that is not to say that owning a cat cannot help its owner exercise more. There are so many more benefits that can be discovered through online searching. However, just like most things, owning a pet may not be for everyone. You know yourself best and if you already had bad experiences with pets, maybe owning one is not for you. For some people, being near animals may actually worsen their quality of life. If you are unsure, depending on your previous experiences with animals, you may potentially want to foster a pet and try out the new experience.


References:

http://www.americanpetproducts.org/press_industrytrends.asp

https://www.petsbest.com/blog/how-we-share-homes-with-pets-varies-worldwide/

https://www.mnn.com/family/pets/stories/11-studies-that-prove-pets-are-good-your-health

https://theharrispoll.com/americans-have-always-had-interesting-relationships-with-their-pets-whether-that-pet-is-a-cat-dog-parakeet-or-something-else-the-pet-industry-is-thriving-and-for-good-reason-more-than-three-in-f/

https://www.mentalhealth.org.uk/a-to-z/p/pets-and-mental-health

Cherry Lam
Headaches: Various Types and How to Manage Them

Approximately one in seven Americans report recently experiencing severe headaches. In fact, in hospital settings, headaches and head pains together are the fourth most common reason for visits to the emergency department. Even if you have never had a headache severe enough to warrant a trip to the doctor’s office or receive a formal diagnosis, it is likely that you have experienced a lesser headache at least once in your life. What is the difference? How can we best manage the ensuing pain? In this article, we will take a brief look at the different kinds of headache and proven strategies for dealing with them.

The first way headaches are classified is by whether they are “primary” or “secondary.” A primary headache is a medical condition in its own right, rather than a symptom of something else. If another condition or situation is causing the pain, it is a secondary headache. Migraines and cluster headaches belong to the primary category. The secondary classification covers many potential causes: dehydration, allergies, high blood pressure, even caffeine withdrawal. Note that a headache of either classification can be either episodic (i.e. short in duration and infrequent) or chronic in nature. In the case of a chronic primary headache, it may be necessary to start a pain management plan with your physician. With chronic secondary headaches, however, it is usually sufficient to identify and treat the underlying problem.

As the underlying causes of primary headaches are not yet fully understood, treating them requires work with a physician. Those who suffer from migraines may find that there are certain foods, stress levels, or other triggers that make it more likely they will experience an attack. Identifying these triggers and avoiding or reducing exposure to them over time is one way to make living with the condition easier, but there are also medications made specifically for treating migraines. If over-the-counter pain medications are insufficient, a physician may prescribe you a triptan to take during attacks. Triptans (e.g. sumatriptan/Imitrex, rizatriptan/Maxalt) are anti-inflammatory drugs that can provide relief whereas over-the-counter drugs may not.

Secondary headaches, on the other hand, are fairly well characterized and can often be remedied at home or with basic over-the-counter medications. Staying well-hydrated will naturally reduce the occurrence of dehydration headaches – and if you are ever unsure of the cause of a headache, drinking some water is always a good first step. In addition, because caffeine affects the circulation of blood in your brain, routine users may experience headaches if they do not get their regular “fix” when their brain expects it. Just as too much caffeine can be a bad thing, too little can also be bad if one’s brain has adjusted to a regular dosage! It is for this reason that many over-the-counter headache treatments include a small amount of caffeine.

Severe allergies can cause headaches centered around the sinuses, which can be cleared out by taking decongestants. However, a persistent sinus headache that resists such treatment could indicate a sinus infection, which may require antibiotics in addition to decongestants. Regardless of the mode of action, clearing the sinuses should provide relief from the headache.

References:

https://www.ncbi.nlm.nih.gov/pubmed/25600719 - Burch, R.C. et al., 2015. The prevalence and burden of migraine and severe headache in the United States: updated statistics from government health surveillance studies.

https://www.healthline.com/health/headache/types-of-headaches
https://headaches.org/about/frequently-asked-questions/

Jonathan Arthur
Zocdoc and Anti-Kick Back Laws

With the increasing number of people seeking doctors each year, the process of finding a suitable physician and scheduling an appointment has become more and more difficult. We not only have to check for the doctor’s availability, but also whether he or she is covered by our insurance plan. On numerous occasions, we have been asked to wait over a countless number of phone calls as the individuals on the other side confirm whether or not they can accept our medical insurance. There are also numerous forms we have to fill out before finally walking in and having the doctor examine us. It was tiring procedures like this that spurred the appearance of services like Zocdoc, an online medical appointment booking service.

Zocdoc enables patients to search for doctors based on their location and insurance plan. The service displays each doctor’s availability, user ratings, and allows users to fill out any waiting forms online beforehand. These services enabled both the patient and doctor to work through the appointment process more smoothly. For the healthcare providers using the service, Zocdoc charged them an annual subscription fee, regardless of the number of patient referrals the doctor received through Zocdoc. However, as it was recently announced, this pricing model is about to change. Rather than charging doctors a flat rate fee, doctors would now be charged based on a per patient referral basis – meaning that doctors would be charged for each booking they receive through the service. For users registered with the service, ZocDoc has stated on its website that the new pricing model is intended to “fairly reflect the number of bookings each practice receives from Zocdoc,” but this has not sat well with all doctors. When Zocdoc was reached out for a comment on the situation, they replied with, “We take compliance with federal and state laws, including New York’s, seriously. For more details on our new pricing model’s compliance, please read our FAQ: https://www.zocdoc.com/about/pricingupdate/ny/.” On their website, the company writes, “... we worked closely with the governor’s office and regulators at the New York State Department of Health (DOH), as its Office of Professional Misconduct (OPMC) is responsible for enforcing the laws and regulations that govern the practice of medicine by physicians and most other similarly licensed professionals… After careful review, DOH agreed that our new pricing complies with the relevant state laws and regulations governing the practice of medicine and professional licensure, including the State Education and Public Health Laws, as Zocdoc's Marketplace does not make ‘referrals’ and our new pricing model does not constitute a ‘fee-splitting’ arrangement with licensed providers, as these terms are understood under these laws.”

Physicians at Highline Orthopaedics have expressed that the new pricing model is against the the Anti-Kickback State law and that it is unethical to charge on a per appointment basis. Below is a written statement from the physicians at Highline Orthopaedics expressing why the new pricing model will not work:

To most laymen, tech developers and their platforms are mystifying. The value of technology platforms, is determined by the users that populate it (the exposure or reach they have). The greater number of users, the more valuable. One group of developers, set up in New York’s trendy SoHo neighborhood, has decided they are above Federal Law, and can swindle unknowing doctors, taking advantage of the disorganization in the healthcare industry, by charging doctors a commission for each patient they bring in. Like club promoters counting heads.

In July of 2007, the medical appointment-scheduling platform ZocDoc was a gift to both physicians and patients. As a patient, I didn’t want to log onto my insurance website (or worse, call), enter the password I definitely forgot, find my plan, scroll through a list of doctors who seem to be in no particular order, find a phone number, call it, wait on hold, maybe get an appointment, maybe not, they have an opening for two (2) weeks from today. I’ll see if other doctors are available sooner, I’ll call back, then call around, no one is. Call back the first office only to be told that that appointment was taken. Make one for a later date. Show up and find that they don’t take my insurance plan. No. With ZocDoc, you saw the physicians credentialed through your insurance plan, their specialties, schedule and availability, and reviews, all in one place, and could easily schedule and get seen right away.

Somehow, instead of advancing and expanding this platform, ZocDoc decided it was switching gears and began implementing a commission-based business model. What does that mean? Instead of charging physicians an annual fee as they were--in their so-far-successful 11 years--they will be charging PER APPOINTMENT. In the middle of last year, but confirmed last week, providers were sent an email saying ZocDoc would be changing their business model. ZocDoc would begin taking a piece of every single appointment. OpenTable has a similar policy, they charge one ($1) dollar per diner. What does ZocDoc feel is fair? $80. EIGHTY, yes.

The 1988 Ethics in Patient Referrals Act: The Stark Law and the Practice of Medicine, based entirely on the American Medical Association’s Code of Ethics, describes a violation as: “a medical referral of a patient between physician and at least one other ‘outside’ entity; such as a physician and a hospital, or two physicians not in the same group practice, where a prohibited financial, or compensation arrangement exists between them.

A commission-based business model does not work for healthcare. Would it be wrong to refer a patient to a doctor I knew was bad, simply because he paid me to refer patients to him? It is also illegal. Recently, the Seventh District Court of Appeals ruled on a case involving a physician who was referring his patients who required homecare to a specific homecare company that was paying him for the referrals. When a physician or entity is a “gatekeeper” to care and payment. Even with no formal record or contract (all payments were made in cash), Dr. Patel was fined over $30,000, 200 hours of community service, and faces eight (8) months in prison. Let’s hope ZocDoc’s executives are ready.

Originally, ZocDoc’s emphasis was on Value-based-Care (vs. Fee-for-Service model), which encouraged professionals to engage with patients, offer care that’s apposite for the individual, invest in technology, and incentivize providers for coordinated and effective care services.  It also presented a centralized way of pairing physicians with patients who needed care. They charged physicians a yearly fee of several thousands of dollars and that was that. They seemed to be expanding nicely; slow and steady wins the race. Apparently, too slow, and too steady.

After 11 years, far from their first $3 million Series A in 2008, the founders are likely tired and want to sell. Traditionally, we operate under the assumption that the more products you sell, the more money you make. And while this is technically true, more product output doesn’t always equal better long-term profitability. This is especially true for tech startups. Most (not ZocDoc) have a culture that prioritizes platform development over product innovation. Think UBER. An product is very limited in what it can do, a platform’s value is determined by the users that populate it and can easily be morphed into something else down the road. Its value is how many users it has. Every physician they alienate devalues the company more and more until you have few patients and even fewer physicians and become irrelevant.

References:

https://www.zocdoc.com/about/newpricing/

https://www.oig.hhs.gov/compliance/physician-education/01laws.asp

Sherry Chow
Blood Pressure Basics

Blood pressure is one of the most crucial aspects of a clinical checkup. And rightly so– an abnormality in regular blood pressure may be indicative of larger, more serious conditions. You may recall having a black cuff wrapped around your arm during your visits to the clinic and feeling it tighten as the doctor or nurse inflated it with air. While the process may seem simple, measuring blood pressure enables doctors to screen for hypertension, assess whether an individual is suitable for a certain sport or occupation, determine whether a medical procedure should be performed on a patient, and much much more.

Most people know that blood pressure should be maintained at certain levels, but what exactly? To understand more about blood pressure, first it is essential to know what the normal range is. Normal blood pressure is generally described to be 120/80 mm Hg. In this format, 120 is the systolic pressure and 80 is the diastolic pressure. Systolic pressure refers to the pressure that the blood exerts on the walls of arteries as the heart beats, and diastolic blood pressure refers to the pressure that blood exerts against the walls of the artery between beats.

Generally, most people are concerned when blood pressure levels go beyond the normal range. According to the American Heart Association, elevated blood pressure is when systolic blood pressure is 120-129 mm and diastolic blood pressure is less than 80. However, this condition is likely to develop into high blood pressure if necessary precautions are not taken. Anything beyond the scope of high blood pressure is then known as Hypertension, which comes in two stages. Hypertension Stage 1 is systolic blood pressure of 130-139 or diastolic pressure of 80-89. At this stage, doctors often inform patients about necessary changes to their lifestyle and may consider medication. Hypertension Stage 2 is then systolic pressure of 140 or higher or diastolic pressure of 90 or higher. At this stage, doctors are likely to prescribe both blood pressure medication and lifestyle changes. In even more severe conditions, an individual enters hypertensive crisis, where systolic blood pressure is greater than 180 and diastolic pressure is greater than 90. Individuals at this stage must seek immediate medical attention. If you diagnose yourself with 180/120 blood pressure, it is recommended to wait 5 minutes then test again to see if blood pressure readings are consistently high. If so, you should contact your doctor immediately. Individuals with hypertensive crisis may be experiencing organ damage. Symptoms of this include nosebleed, headache, shortness of breath, back or chest pain, weakness, changes in vision, and difficulty speaking.

Oftentimes, high blood pressure comes with no noticeable symptoms, which is why it is often regarded as a silent killer. The damage may slowly progress in the body years before symptoms come to awareness. High blood pressure causes damage to arteries and to the heart, as excessive blood flow puts stress on these structures. Perhaps less known is that high blood pressure can cause damage to the brain, including mild cognitive impairment and dementia as a result of deprivation of blood within the brain. Furthermore, high blood pressure affects the kidneys, which are the organs necessary in excretion of fluid and waste from the body. However, these functions are dependent on functional blood vessels. As such, high blood pressure could lead to kidney failure, kidney scarring, or kidney artery aneurysm. Even the eyes are susceptible to damage, as high blood pressure may damage the small, fragile blood vessels that deliver blood to the eyes. This could cause retinopathy, choroidopathy, or optic neuropathy – more simply known as eye blood vessel damage, fluid buildup under the retina, and nerve damage. Other less known possible dangers include bone loss, sleep apnea, and sexual dysfunction. Although there may be no direct causal relationship, there are also a variety of symptoms that may be indirectly associated with high blood pressure. These include blood spots in the eyes, facial flushing, and dizziness.  

A less well known condition is hypotension, or low blood pressure. A blood pressure reading of less than 90/60 is defined to be low blood pressure. For many people, low blood pressure does not have any negative symptoms. However, individuals with abnormally low blood pressure may suffer from dizziness and fainting, and for some, it can be fatal. Major symptoms also include nausea, blurred vision, fatigue, and lack of concentration. Extreme hypotension can result in cold and clammy skin, shallow breathing, a weak and rapid pulse, and confusion. Low blood pressure can happen to anyone. However, people who take certain medications, such as alpha blockers, have a higher risk. People who also suffer from other diseases, such as Parkinson’s, diabetes, and some heart conditions may have a higher risk of low blood pressure.

However, it is important to know that there is a large deal of individual variation in blood pressure. What may be considered low blood pressure to you may be normal for another person. As a note, sudden changes in blood pressure are almost always dangerous, as it abruptly changes the amount of blood supplied to various regions of the body. As with all medical conditions, it is important to consult a medical professional and not rely on self-diagnosis. This is especially true with blood pressure complications because blood pressure has a great deal of individual variation, making it difficult to analyze one’s own blood pressure. It is important to know the warning signs so you can promptly receive necessary medical attention and be on your way to a potentially swift recovery.

References:

https://emedicine.medscape.com/article/1948157-overview?pa=HVpiJEn3NCvf%2BYiYReO7E6UNPsj6znqZWxI3OI0wXg9Z2h44gOLa%2Fl%2FuNT5vtxU9CvdbUrKQdOHpnXMMKxsAgysFovC7sre62KO%2Fim3hebs%3D

http://www.heart.org/HEARTORG/Conditions/HighBloodPressure/KnowYourNumbers/Understanding-Blood-Pressure-Readings_UCM_301764_Article.jsp#.WyyDC9MvxE4

https://www.mayoclinic.org/diseases-conditions/high-blood-pressure/in-depth/high-blood-pressure/art-20045868

Mary Yoshikawa