Wednesday, July 25, 2012

Antioxidants


I've wanted to write a brief piece on the use of antioxidants for a while now, and it seems like with the articles I've been stumbling on, I should have written one a while ago.

The problem with many medical discoveries is that they are never cut-and-paste solutions to our problems. Researchers with a whole alphabet behind their name (triple-PhD type folks) look at a culture of cells on a tea-plate-sized dish and find that with the addition of drug X there is an increase in function Y. Whoa-my-god. Those cells are found in the pancreas; ergo-facto ingesting drug X will increase Y in the body and make you a half-droid disease fighting machine. ALERT THE MEDIA! QUICKLY! (it's usually the media behind this fabrication, but some of the researchers are to blame as well)

Not so fast. Pretty much anything can be taken out of context by the media and expanded into a new pseudomedical revolution. And when the facts come in that there were actually some holes in the findings, the media and it's half brother, pharma, are not as likely to respond. After all, everyone's making money; why ruin the fun?


This is the craze with antioxidants. Unfortunately more recent findings are having trouble reaching the general public, and thus we have more advertisements about, more products with and more spotlight on the 'benefit' of antioxidants. However, I can see why it's hard to break the myth - the theory behind it is very logical and can easily be swallowed (badoom-tschhh) by the consumer, no matter the educational background.

Brief Mechanism

Before I get into this, Dr. Steven Novella wrote a great piece on this that you might find interesting (apologies if the following information is a bit repetitive)

In the process of metabolism, reactive oxygen species (or ROS) can be produced. These are highly reactive compounds that rip apart compounds (react in a random manner) and leave them to do the same thing. What you get is a chain of unfortunate dismemberments. Think of it this way. A bully charges the first kid he sees and takes his ice cream. Now the kid is mad, so he bullies the next kid he sees. What you get is a chain reaction and a neighbourhood of disgruntled, damaged, oxidant kids. The rest of this article doesn't really work for this example since it turns out we want to keep some of those bullies around in the body (but not on the playgrounds).

Antioxidants provide a band aid to this problem by scavenging the premises for the 'bullies', if you will, and reacting with them. So theoretically, the antioxidants stop the harmful effects of ROS by neutralizing them. And there you have the punch line of the whole antioxidant movement.

Cancer is caused by a DNA mutation which results in the wrong instructions being sent to the cells. What you get is a resource hogging, proliferating machine that ultimately leads to the death of its provider. But what causes the mutation? The finger has been pointed at ROS since they can attack protein links and DNA (it's not the only cause, but an easy target).

What's the deal?

As Dr. Novella put it, it makes no sense to tip the scale in one direction. The human body has evolved over such a long period of time to have a sustainable balance in its system through complex cascades and competing environments. The body requires the use of its oxidants (even at a potential risk) to exchange information between cells and kill of potentially dangerous cells. The body uses nitric oxide (an oxidant) as a retrograde neurotransmitter and hormone to play important roles such as vasodilating vessels, promoting second messenger systems in cells, immunity and erection (yea, I was just as surprised). The body also uses various other chemicals that would be considered oxidative to protect itself from harm. It is theorized that just as the oxidants can cause damage to cells to cause cancer, they can damage cancerous cells to stop the spread or its development. And antioxidants can disrupt that delicate use of oxidants. In fact, fat-soluble antioxidant vitamins A and E have actually been shown to increase mortality in those that take them. Vitamin E is very controversial as it has been shown to decrease the risk of colorectal and pancreatic cancer, but increase prostate cancer risk. Dr. Novella has some great examples in his article.

Should I?

The takeaway from any of my posts is always DO YOUR RESEARCH. I may ultimately be wrong, but as long as the truth is found by those that are looking for it, I'm happy. 
  • If you hear something about a supplement, look up information about it online form a credible source. A doctor wrote the testimonial? Look him/her up and see their credentials. 
  • Scientists did the research? There's no such thing. Research can be done by pathologists, immunologists, microbiologists (you know, the ones with the letters behind their name). 
  • Most marketing ploys use 'scientist' to try to prove that their product works. Look up both sides of the argument - which has more support?
  • Tired of reading opinion-based forums for information? Check with a research database.


Saturday, July 21, 2012

Medical Tattoos


As opposed to wearing Medical ID Alert Jewellery, some choose to turn to more permanent options. And why not? If you have a serious condition, such as diabetes or epilepsy, this allows for an identification tool, when unconscious, so that appropriate treatment and diagnosis can be made on the spot. Check out some of the tattoos that people came up with.

Diabetics









Adrenal Insufficiency

 Haemophiliac

Epilepsy

Do Not Resuscitate (DNR Request)


 No CPR

Allergies

 Implanted Defibrillator



 Also there are some cool nanotechnology that's making its way into health monitoring and identifying systems. The new idea is that nano-equipped tattoos would be able to provide needed 'injections', such as insulin or antibiotics, when a need for them is detected by the clever sensors.

Saturday, July 14, 2012

Reading the Minds of 'Unconscious', Vegetative Patients


A not-so-new development is finally getting some spotlight in a June article, Neuroscience: The mind reader, in the scientific journal, Nature. Using conventional brain scanners, but with new implications, researchers are finding ways to recognize whether a comatose patient or a patient in a vegetative state has the ability to form thought to answer questions, without moving a muscle. Under the assumption that the patient can hear, researchers can instruct the patients to think of specific activities or objects to answer basic questions while getting an fMRI scan. Although the main experiment described in the article showed only one of the patients fully responding, the main researcher, Owen, remains positive that this technique will liberate closed off patients and prove their consciousness.

Mechanism

The idea behind this method is actually quite simple (and that's what makes it brilliant). The method makes itself viable based on the fact that thinking about activities activates regions implicated in actually doing those activities.
When healthy, conscious adults imagine playing tennis, they consistently show activation in a region of the motor cortex called the supplementary motor area, and when they think about navigating through a house, they generate activity in the parahippocampal gyrus, right in the centre of the brain.
Knowing this, Owen and colleagues asked patients in a vegetative state to think of playing tennis (motor activation) to answer yes, and to think of the spatial arrangement of their house (parahippocampal activation) to answer no. To see the activation, they used an fMRI scanner which responds to changes in blood flow. Activated regions require resources and therefore have an increased flow to them, picked up by the scanner. 

Implication

Having the patients answer factual questions, such as "What is your dad's name?", shows that a fraction of patients in a vegetative state are responsive and have a state of 'consciousness'. Out of the 54 patients enrolled in the study, 5 could wilfully modulate their brain activity. Of those 5 however, 3 showed signs of awareness and only 1 could reliably answer yes or no questions. This shows that some sort of communication could be established between vegetative patients and their loved ones. Although the technique is fairly primitive and doesn't establish a way to understand the patient's ideas (since you can only ask them yes or no), it does pave the way for new technologies and sets new ethical boundaries for comatose and vegetative patients.

Other Methods

There are other methods that use the same approach that could make brain scanning a lot more telling and informative of the patients consciousness. 

Shinkareva Method

This technique identifies cognitive states, much like Owen's, however it focuses on objects of higher specificity. Subjects are asked to think of either a kind of tool (hammer, pliers) or a dwelling (house, castle) while in a fMRI scanner that picks up the brain regions being activated. The researchers in this study were able to identify which one the subject was thinking about with about 80% accuracy. As interesting as this approach is, the researchers are hitting only 30% above the 1/2 chance they would have without the scan. However it is possible that this will lead to a more precise technique that asks for more than a hammer.

Haynes Method

This is a method that really makes you think "Hmmm... What else can we do with that?". Subjects freely decided if they wanted to subtract two numbers that were given to them or add them. Assessing the prefrontal cortex, implicated in executive functions such as reasoning, planning and (here) assessing one's own state, the researchers were able to decode which function the person was doing using a clever software. Although this technique resulted in 71% accuracy, it really proved how much can be learned by assessing the activation of a brain region.

Final Thoughts

Using fMRI to assess brain states, as done by Owen, can be instrumental in determining the consciousness of a patient in a vegetative state. It really shows how little we know about the brain and how much there is still to find out. With new techniques, methods, and scanners, it will be possible to communicate with loved ones disconnected from the world. As well, as you can guess, this also means a lot for medical ethics that struggles to define 'consciousness'.

Nature - Neuroscience: The mind reader

Check out these videos on the topic.

Ramachandran on Consciousness



Mind Reading in an MRI scanner




Tuesday, July 10, 2012

Geo-Medicine New Frontier In Medical Informatics







Geo-medicine. There's a term I haven't heard being thrown around very much. At all actually. This epidemiological approach to collecting patient data can show new trends in disease and symptom records.
According to Esri, a Redlands, Calif.-based GIS vendor, "A geographic information system (GIS) integrates hardware, software, and data for capturing, managing, analyzing, and displaying all forms of geographically referenced information." A GIS application allows users to plug data into electronic maps to find out where particular things are, measure the quantity or density of those things in certain geographical areas, or find out what's inside a particular area or what's nearby.
Healthcare professionals and researchers can use data plugged in by users of this system to find correlations between diseases and geographical areas, socioeconomic status, age, and diet, to name a few. A 2010 study published in the Journal of American Board of Family Medicine, used the GIS system to find correlations between socioeconomic status and blood sugar markers. Further assessments of data can give new insight into the causative factors behind other common symptoms in society such as depression and stress.

Future-istic

With all the technology that we have today, I can't help but think 'It's about time'. But another part of me always fights back with 'What if it didn't'. What if this technique didn't make it's way into medicine at all and epidemiologists would stick to the current expensive, time-consuming methods of data collection for disease control? I think it's important to give new technology a chance to prove its effectiveness by sponsoring it for health professionals around the world who are curious to use it. After all, what is there to lose? 

Working Together

And while we're on the topic of collection of information, why not mention the snail paced advancement of EMR, electronic medical records, in Canada. This should be one of the fastest changes in medicine! How is it that in a world where the average Canadian/American interacts with an iPad/smartphone/laptop 20 times a day and can get everything from Cloud storage to augmented reality, but has to call their old family physician to try to get them to hand over their medical records? Technology deserves a fair chance. With app developers for Android and Apple, there is a huge workforce that is ready to develop anything that medicine requires. Why not use it? The combination of geo-medicine, electronic medical records, and third party medical apps, we can have a medical system that is less expensive and more efficient. The only thing getting faster is the time of your medical appointment.

Don't Lose Track

Leave it to the professionals. Proper data analysis is key to making sure that information provided by the GIS is accurate and realistic. A widespread use of this method of data collection will provide answers, it's a matter of interpreting them correctly. Is playing computer games a causative factor for depression or is it that gamers tend to be dehydrated and lack sunlight (not necessarily true, just for the sake of argument)? What will information tell us about disease? I think it's important that information provided by this new system is interpreted carefully as it might point to a z-factor that in reality is more of an incidental confounding factor rather than a causative one. 

Geo-Medicine New Frontier In Medical Informatics

Tuesday, June 12, 2012

MIT Develops a Method to Stop Bleeding in Seconds

Researchers from Hong Kong University and MIT have come up with a new way to stop bleeding in a matter of seconds using a peptide liquid. This nanobiological advance makes a significant contribution to future emergency medicine and surgery, potentially reducing blood loss and cutting surgery time in half.

Normal Healing

Normal wound repair is an extremely complex process consisting of multiple mechanisms and systems working together to establish homeostasis, produce inflammation and remodel the affected area. After the insult, bleeding usually occurs, putting a body in an unbalanced state as its losing blood and nutrients. Through vasoconstriction and coagulation (blood clotting), the body is able to seal off the wound from the rest of the world and establish a stable environment, in homeostasis.

Function of the Peptide Liquid

The peptide liquid assists the body at the first stage, without affecting the other states, as far is we know. While the body is trying to reduce the blood flow to the area by constricting the vessels, the liquid gel forms a thin barrier that provides a physical restriction on where the blood can flow. What's great about this peptide liquid is that it doesn't increase the clotting rate of the blood, as it might be suspected at first. The researchers' argument for this is that normal blood clotting factors start working about 90 seconds into the insult, a time frame much later than the effect of the liquid, and platelet aggregation, a tell-tale sign of blood clotting, is not found with the application of the liquid. Induction of clotting would otherwise create potential problems such as thrombosis, a huge blood clot obstructing the blood vessels, and/or embolism, the dislodgement of the clot into the bloodstream, which has fatal effects if it ends up in the lungs or brain.

The liquid also does not induce an immune response, a major problem in developing new drugs and techniques. 


The peptides in the solution further provide building blocks for the remodeling phase of wound repair to assist in required nutrient supply. 

Uses

The authors bring forward some very important uses for the liquid, first being its application in the OR. They state that:
"more than 57 million Americans undergo nonelective surgery each year, and as much as 50 percent of surgical time is spent working to control bleeding"
Current, and comparatively primitive, techniques, such as clamping, applying pressure and cauterizing, do not offer efficient enough blood cessation or require signification effort and stamina to perform throughout the whole operation. Reducing the energy expenditure to just keep the patient stable, which would include reducing blood loss, is a major asset that would speed up operations and reduce complications.

Another use proposed by the authors is the use of the liquid on battlefields (why not ER?). The liquid can be used in liquid environments and is easy to apply in a non-specific manner during emergencies.

Practicality

The development shows promise for future medicine if further tests support the results. The peptide solution is easy to apply and works through a mechanism that doesn't disturb the body's homeostasis or immune systems, and provides the body with nutrients and building blocks for repair. I would love to see this nanomedical liquid make its way into standard medical procedures (considering the results are replication and are deemed safe, of course)

TECHTALK - New Material Halts Bleeding

 

Comments? What do you think of this development?