High fat diets, Breast milk, and the affects on babies

            Recent studies are showing that breast-feeding infants instead of formula feeding is the best option for the health of the baby because breast milk can help prevent infections, allergies, and protect against many chronic conditions. That being said, a new study done by Chen et al. found that having a diet of high fats, especially during lactation, can change the activity of messenger RNAs (mRNA) and micro RNAs (miRNA) in the breast milk. Altered RNAs can lead to heath conditions such as cancer heart disease and stroke.

           

            An experiment was done using two groups of pregnant mice, one group had a high-fat diet during gestation, while the other group had a normal diet. New born mice were divided into 4 groups:

            Born to and fed by mothers that had a high-fat diet

            Born to and fed by mothers that had a normal diet

            Born to mothers with a high-fat diet but fed by mothers that had a normal diet

            Born to mothers with a normal diet but fed by mothers that had a high-fat diet

            The results showed that the milk from mothers that had a high fat diet also contained high fat content and also had 1500 mRNA genes and 25 miRNA genes expressed differently than the mother’s milk on a normal diet. This research can potentially show that babies breast fed from mother’s eating a high-fat diet could be at a higher risk for chronic diseases as adults, such as diabetes, high blood pressure, and heart disease.

            Therefore, is it ethical to say that breastfeeding is the best choice to feed babies if we are not giving mother’s all the information, especially about their diet? Mother’s would/should follow a diet that is low fat especially during lactation. Is it ethical for doctors to force breastfeeding on some mother’s when their lifestyle isn’t able to support the low-fat diet, and knowing that there could be harmful health affects down the road for the baby? I believe that women should be able to have all the facts, pros and cons, of breast-feeding and formula feeding from their doctor and then be able to make that choice specific to what is best for them and their babies.

“High-Fat Diet May Change Breast Milk Makeup, Affect Baby.” American Physiological Society > High-Fat Diet May Change Breast Milk Makeup, Affect Baby's Health, 21 Nov. 2017, www.the-aps.org/mm/hp/Audiences/Public-Press/2017/76.html.

Spinal Cord Injuries- Can Stem Cells Possible Help?

 As a volunteer at Craig Hospital in the rehabilitation center, I have met a number of paraplegics who work hard to stay mobile and are striving to maintain mobility in their lower extremities. Only about 0.4% of the 17,000 new cases of a spinal cord injury each year are able to fully recovery (Shende & Subedi, 2017). It would be amazing to see new treatments develop that might help some of these patients possible regain voluntary movement and there have been a number of research done with stem cells that might be a viable treatment.  

Spinal cord injuries (SCI) are some of the most life-changing injuries. An SCI can come from a number of accidents that will cause a lesion in the spine and lead to loss of sensory and motor neurons (Libro, Bramanti, & Mazzon, 2017). For most SCI, there is a traumatic event, a genetic disease, or a degeneration of the nerve cells, that causes the dysfunction of the spinal cord. The spinal cord is then unable to send nerve signals from the brain to the body and it can result in paralysis.

In one experiment, Dr. Levenberg, engineered human stem cells that allowed paraplegic rats to walk. To begin, they harvested stem cells from the membrane lining in the mouth. To do this, the research team built a scaffold that allowed the stem cells to attach and differentiate into supportive cells that can serve to stabilize and neurons in the rat’s spinal cord. By the end of the differentiation the stem cells formed a complete spinal cord transection, which they inserted into the rats. After the implantation, 42% of the rats showed the ability to support their weight and walk, then 75% of the rats showed sensory improvement (Levenberg et al, 2006). This study is a far way from helping humans, but help can give hope to future potential treatments for SCIs.

Reference:

Levenberg, S., Finegold, B., & Stix, G. (2006). Growing Replacement Parts. Scientific American, 295(6), 56.

Libro, R., Bramanti, P., & Mazzon, E. (2017). The combined strategy of mesenchymal stem cells and tissue-engineered scaffolds for spinal cord injury regeneration (Review). Experimental & Therapeutic Medicine, 14(4), 3355-3368. doi:10.3892/etm.2017.4939

Shende, P., & Subedi, M. (2017). Pathophysiology, mechanisms and applications of mesenchymal stem cells for the treatment of spinal cord injury. Biomedicine & Pharmacotherapy, 91693-706. doi:10.1016/j.biopha.2017.04.126

Organ Donations-Should the Opt-in Policy be changed?

Organ Donations-Should the Opt-In Policy be changed?

There are 122,625 people on the waiting list for an organ donation and each day die 22 people die from lack of available transplants, (Volk). The supply of donors isn’t meeting the demand, and millions are suffering. Is there a way to possibly increase the number of donors?

One major example of this is the Opt-In policy that the US has. Currently, the Opt-In policy is that a donor has to state that he or she would like to be a donor, rather having an Opt-Out policy where the donor has to say he or she doesn’t want to be a donor.

One study done found that switching to an Opt-Out policy might increase the number of deceased donors, but may decrease the number of live donors, such as those found in kidney donations. Yet this study also concluded that switching to an Opt-out policy would still lead to overall increased donations from the deceased (Shepherd et al).  

When compared to nations with an opt-out system the U.S. has very low numbers of donors. A study in Austria was done, and it showed that “Austria, with an Opt-Out system, has 99.98% of the population consenting while the U.S. on an Opt-In system has 28% of the population consenting to donate, while when surveyed it appears about 85% of the U.S. population would want to be organ donors,” (Ahmad).  The study also found that there is a direct correlation between consent rates and effective donations. In a number of nations with Opt-Out policies, there is shorter waiting list for organs, (Ahmad). Though, some that do not want to donate might be marked as donors, due to the default effect, in which most will not put in the effort to change the default. For the most part, this policy would increase the number of donors and help to increase the number of transplants.

Is it ethically to do this though? Overall switching to this policy, still always someone the right to chose not to donate an organ. It shows that most likely the number of deceased organ donors would increase. I think this might be ethically solution that might be able to help save a number of lives.

References:

Ahmad, G., & Iftikhar, S. (2016). An Analysis of Organ Donation Policy in the United States. Rhode Island Medical Journal (2013), 99(5), 25-27.

Shepherd, Lee, et al. “An international comparison of deceased and living organ donation/Transplant rates in opt-in and opt-out systems: a panel study.” BMC Medicine, BioMed Central, 24 Sept. 2014, bmcmedicine.biomedcentral.com/articles/10.1186/s12916-014-0131-4.

Volk, Michael L. "Organ Quality as a Complicating Factor in Proposed Systems of Inducements for Organ Donation." Law and Contemporary Problems, vol. 77, no. 3, 2014, pp. 337-345. EBSCOhost, doi:scholarship.law.duke.edu/lcp/all_issues.html.

Physician fatigue. Is it dangerous?

Surgery is typically a delicate procedure that requires care and a sharp eye to perform. Surgeons work long hours, and individual surgeries can last for several hours. After the second or third surgery of the day, it is not at all surprising that surgeons might feel extremely fatigued. Is this a problem? Fatigue can have the same effect on mental capacity as impairment from alcohol, and this could compromise a surgeon's ability to perform effectively.

In a study that I found, it was shown that the level of fatigue in surgeons is directly correlated to decreased ability in surgery. Physicians and medical staff were shown to be fatigued for 50% of the day, and could be extremely fatigued for as much as 25% of the day. Surgeons that showed extreme fatigue were as much as 22% more prone to error during surgery than one who is fresh (McCormick et al. 2012).

It could prove to be a responsible move to allow for surgeons and surgical staff to have rest time after a long surgery in order to become more focused for the next surgery. I had the opportunity to watch a neurosurgeon in the summer of 2015 perform two surgeries. Each one was over four hours long, and there was only about an hour of downtime between them, then there was a 5 hour surgery after that. During this downtime, the surgeon, P.A.'s, and the nurses were busy completing paperwork and preparing for the next surgery. There was barely any time for them to eat or physically prepare. It might not be possible to provide dedicated rest time due to the high demand of surgery, but it could prove useful by allowing surgical teams to recuperate and provide better service to patients.

McCormick, F., Kadzielski, J., Landrigan, C. P., Evans, B., Herndon, J. H., & Rubash, H. E. (2012). Surgeon fatigue: a prospective analysis of the incidence, risk, and intervals of predicted fatigue-related impairment in residents. Archives of Surgery, 147(5), 430-435.

I Heart You: Pulmonary Valve Replacement and Ethics

In some congenital cases, there are severe heart defects that need to be addressed surgically and immediately.  One of these issues is known as Tetralogy of Fallot, which is a devastating combination of four heart defects.  The symptoms range from cyanosis, shortness of breath, fainting spells, and heart murmurs, to lethargy, finger and toe clubbing, and inefficient weight gain (Mayo Clinic, 2017).

Another main concern for patients with Tetralogy of Fallot is right heart failure.  Physiologically, we should understand that the right side of the heart pumps deoxygenated blood into pulmonary circulation through the pulmonary artery.  Whether the issue is a malformation of the heart or some severe form of occlusion, and with proper candidacy, the patient may opt to surgically replace the pulmonary artery with pulmonary valve replacement surgery (Mitropoulos et al., 2017). 

On the other hand, based on a case-by-case standpoint, the patient may opt to wait to do neonatal surgery, as a little more time outside of the uterus may allow the newborn to withstand stresses of a very invasive surgery. 

The ethical issue considers non-maleficence.  Mitropoulos et al. (2017) concludes that the longer one waits to do the pulmonary valve replacement, in instances of Tetralogy of Fallot, increases the likelihood of reoperation.  Treatment with bioprosthetic valve replacement lies at the intersection of immediate and long-term care.  Unfortunately, with Tetralogy of Fallot, pulmonary valve replacement is just one of the many congenital cardiac issues that will need to be dealt with.  Nevertheless, considering what ought to be done, physicians should consider minimizing surgical treatments on newborn with Tetralogy of Fallot by moving to do the pulmonary valve replacement as soon as possible.


References
Mayo Clinic. Tetralogy of Fallot. (2017). Mayo Clinic Foundation for Medical Education and Research.

Mitropoulos, F. A., Kanakis, M. A., Ntellos, C., Loukas, C., Davlouros, P., Kousi, T., & Chatzis, A. C. (2017). Pulmonary valve replacement in patients with corrected tetralogy of Fallot. Journal Of Cardiovascular & Thoracic Research, 9(2), 71-77. doi:10.15171/jcvtr.2017.12

3D Printing of Live Bacteria

A team of biologist from Delft University of Technology in the Netherlands have been studying the making of live bacteria with a 3D printer. The bacteria created from 3D printers could be the next big idea in cleaning up toxic chemical spills, consuming biodegradable plastics, and creating new biomedical applications. Bacterial composition and metabolism were thoroughly investigated to ensure that all the appropriate components were provided to ensure the bacterial cells would live and be functional (Schaffner, et al, 2017). Having the capability to create any type of bacteria that was in demand could potentially be a game changer in cleaning up pollution on and in the ground and ocean. This new technique allows scientists to manipulate the DNA, composition, shape, size, and metabolism of the bacteria they create. This freedom allows scientists to develop exactly what type of bacteria is wanted or needed.

However, there is one draw back that could come of this groundbreaking discovery, biological warfare agents. The most commonly known form of biological warfare is the bioterrorist attack using anthrax spores (Thayselvam and Vijavaraghavan, 2010). This new technology allows the creator to manipulate the bacteria being developed in any way they choose. With this new technology, scientists can manipulate the DNA, composition, shape, size, and metabolism of the bacteria they create. Antibiotic resistant bacteria are the result of genetic mutations which are not susceptible to the antibiotics. MRSA, for example, is one of the best known antibiotic resistant bacteria. It is resistant to all but a few antibiotic cocktails. Developing and printing any composition of bacteria imaginable could lead to the creation of a superbug resistant to all antibiotics and antibiotic cocktails which could be used as a biological warfare agent.

Sources

Schaffner, M., Ruhs, P. A., Coulter, F., Kilcher, S., & Studart, A. R. (2017). 3D printing of

bacteria into functional complex materials. Science Advances, 3(12).

doi:10.1126/sciadv.aao6804

Temming, M. (2017, December 01). New 3-D printed materials harness the power of bacteria.

Retrieved December 04, 2017, from https://www.sciencenews.org/article/new-3-d-

printed-materials-harness-power-bacteria

Thavaselvam, D., & Vijayaraghavan, R. (2010). Biological warfare agents. Journal of Pharmacy

and Bioallied Sciences, 2(3), 179-188. doi:10.4103/0975-7406.68499

The fever phobia

According to Elkon-Tamir et al., fever is the chief complaint in up to one third of pediatric office visits.  Elkon-Tamir et al., further explain that many parents and caregivers have fever phobia.  This fever phobia is a result of general caregiver misunderstanding such that fevers themselves can cause central nervous system damage, seizures, and death, without fully understanding the physiology behind fevers and the greater concern of associated symptoms and underlying causes. 

In the article, “Fever and Antipyretic Use in Children”, authors Dr. Sullivan, Dr. Farrar and their team of researchers, address the use of antipyretics in the pediatric population in cases of fever.  They address this because despite in depth knowledge of the physiology of fever, the use of antipyretics are frequently given “even though there is either minimal or no fever.”(Bilenko, 2006)

According to the article, antipyretic use may relieve discomfort in patients with fevers and reduce water loss, however, associated risk with antipyretic use is that lowering the fever may delay diagnosis of underlying condition and may lead to drug toxicity.  Furthermore, the researchers point out that much of the phobia surrounding fevers comes from the undistinguished difference between fever and hyperthermia.  Fever is described as a physiological action from the hypothalamus versus a hyperthermia which “is a rare and pathophysiologic response with failure of normal homeostasis” (Sullivan, 2011) that may increase risk of brain damage, delirium, convulsions.

The authors emphasize that physicians monitor for antipyretic effect to improve activity and feeding.   They also focused on the use of acetaminophen, ibuprofen, and a combination of both and explained how these drugs are commonly alternated in children with fever.  They further expressed that proper dosing for each medication in accordance to guidelines and medical direction are crucial in order to reduce toxic effects. (Sullivan, 2011)

Because of this fever phobia noted in parents and caregiver, healthcare professionals should do their best to improve communication and education.  There are many ethnic, cultural, and language barriers that can disrupt the effective medical direction and advise.  These barriers should be over come in order to apply the principle of beneficence for the pediatric patient and in order to apply the principle of autonomy to the parents who are usually the ultimate medical decision makers.  I believe that many resources exist within our hospitals and clinics that aim to improve medical knowledge of those receiving the services and therefore should be used appropriately.

References

Bilenko, N., Tessler, H., Okbe, R., Press, J., & Gorodischer, R. (2006). Determinants of antipyretic misuse in children up to 5 years of age: A cross-sectional study. Clinical Therapeutics, 28(5), 783-793. doi:10.1016/j.clinthera.2006.05.010

Elkon-Tamir, E., Rimon, A., Scolnik, D., & Glatstein, M. (2017). Fever Phobia as a Reason for Pediatric Emergency Department Visits: Does the Primary Care Physician Make a Difference? Rambam Maimonides Medical Journal, 8(1), e0007. http://doi.org/10.5041/RMMJ.10282

Sullivan, J. E., & Farrar, H. C. (2011). Fever and Antipyretic Use in Children. PEDIATRICS, 127(3), 580-587. doi:10.1542/peds.2010-3852