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Health and Disease

What is Schizophrenia?

Abstract

Schizophrenia is a chronic mental disorder that affects less than one percent of the U.S. population. When schizophrenia is active, signs and symptoms can consist of delusions, hallucinations, incomprehensible speech, problems with questioning reality and little to no motivation. However, with treatment, maximum signs and symptoms of schizophrenia will significantly enhance the likelihood of being able to diminish its effects and carry out a normal life.

Diagnosis

While there may be no treatment for schizophrenia, many studies are being performed to encounter and more secure treatments. Experts are also unraveling the reasons behind the disorder with the aid devices that read genetics, engaging in behavioral studies, and the use of superior imaging to have a take and observe the mind’s shape and function. These strategies maintain the promise of new and more powerful therapies.

The complexity of schizophrenia can also provide an explanation for why there are misconceptions centered around the sickness. Schizophrenia no longer suggests that the person has inconsistent personas or multiple personalities. Most human beings with schizophrenia aren’t any more risky or violent than human beings within the general population. While restrained, intellectual fitness within the community can also additionally cause homelessness and common hospitalizations, but it’s a false impression that human beings with schizophrenia grow to be homeless or residing in hospitals. Most human beings with schizophrenia stay with their family or in institutions on their own with aids. 

Schizophrenia’s effect on speech, thinking, emotions, and type of lifestyle can affect someone’s social interactions and basic activities. Many human beings with schizophrenia struggle or refuse to recognize that they may be unwell. Hallucinations and delusions can appear very typical to someone who’s experiencing them. This could make it tough to persuade the individual to take medication and cause them to worry about the outcomes or be consumed by the belief that the medicine will damage them.

Symptoms

Symptoms of schizophrenia typically become prevalent whilst someone is a teenager or older, however it is able to have an effect on children. If there’s no records of schizophrenia in a own circle of relatives, the probabilities of developing it are much less than 1%. However, a persons risk increases if either their mother or father has a history of it. It is the notion that an interplay among genes and a number of environmental elements can also additionally cause schizophrenia.

Psychosocial elements might also make contributions to schizophrenia. Studies have observed that dopamine can stimulate the methylation of membrane phospholipids through the activation of the D4 dopamine receptor. Furthermore, it was observed that the D4 receptor is complexed to NMDA receptors, suggesting that the methylation of phospholipids should adjust NMDA receptor activity. This encounter indicates that schizophrenia can also be the end result from an impairment withinside the capacity of D4 dopamine receptors to modulate NMDA receptors at nerve synapses thru phospholipid methylation. This modulation can be crucial for the regular development and cognitive skills of an individual. 

Certainly greater studies are important to follow-up with the findings developed by using those results. There is cause to hope, though, that new findings will now make the cause of schizophrenia clearer. This could also allow for the creation of novel, greater powerful treatments.

Treatment

Ninety percent of human beings with untreated schizophrenia are in low and middle earning countries. Lack of admission to intellectual fitness offerings is a crucial issue. Furthermore, human beings with schizophrenia are much less likely to search for care than the overall population. Schizophrenia is treatable with medicines and psychological support. However, most with chronic schizophrenia lack resources for treatment.

There is obvious proof that old-fashion mental hospitals aren’t great at supplying the remedy for schizophrenia. Human beings with intellectual problems often face issues with primary human rights of folks with intellectual problems. Efforts to develop intellectual establishments for the people must be improved and regulated. People with schizophrenia are prone to human rights violations at each internal intellectual establishment and in communities. Stigma of the disease is high. This contributes to discrimination, which could in cause restriction get admission to intellectual care, education, housing and employment.

 The love and assistance of one’s own circle of relatives and pals performs a critical function in schizophrenia remedy and recuperation. If you have a relative with schizophrenia, you will be suffering with any range of tough emotions, consisting of fear, guilt, anger, and frustration. You might also additionally experience helplessness due the one that you love’s signs and symptoms, involved approximately the stigma of schizophrenia, or embarrassed with their extraordinary behaviors. You could also be tempted to cover the one that you love’s diagnosis from others.

Conclusion

It’s critical to consider that a diagnosis of schizophrenia isn’t a life-sentence. Recovery is possible, especially together with your love and assistance. While managing a cherished one’s schizophrenia may be challenging, the subsequent techniques will let you manual the one that you love on the street to recuperation without dropping sight of your personal hopes and dreams. 

Educate yourself and learn about schizophrenia and its remedy so that you’re knowledgeable to make selections to address signs and symptoms and inspire the one that you love to pursue self-assist techniques, manage setbacks, and paintings toward recuperation. Try to reduce stress and set sensible expectations. Your encouragement and assistance may be critical to the one that you love beginning and persevering with a plan of self-assist.

Mary Sheikh, Youth Medical Journal 2020

References

“Schizophrenia.” Mayo Clinic, Mayo Foundation for Medical Education and Research, 7 Jan. 2020, http://www.mayoclinic.org/diseases-conditions/schizophrenia/symptoms-causes/syc-20354443. 

“Schizophrenia.” Mental Health America, http://www.mhanational.org/conditions/schizophrenia?utm_content=bufferef364. 

“Schizophrenia Images.” Shutterstock, http://www.shutterstock.com/search/schizophrenia. 

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Health and Disease

Review of Hemorrhoids Disease: Causes, Treatments, and Preventions

Warning: Contains sensitive and possibly triggering imagery. 

What are Hemorrhoids?

Hemorrhoids, otherwise known as piles, are a condition where the veins near the opening of the anus swell up. These veins are similar to those of the varicose veins in the legs. Also, there are two types of hemorrhoids: external and internal. Internal hemorrhoid is the swelling of veins around and inside the anus. On the other hand, external hemorrhoids is the swelling of veins under the skin around the anus. External hemorrhoids can be extremely irritating and troublesome, because the skin can become irritated and scrape away. This pain can worsen if a blood clot forms in an external hemorrhoid. Additionally, the pain can come unexpected and can be excruciating. When the blood clot recedes, excess skin remains and causes irritation and itching. Internal hemorrhoids, on the other hand, are less painful, often painless in many cases. However, there is still bleeding. The internal hemorrhoid can develop into a prolapse, which means that part of the anus will protrude outside. When it protrudes, it can collect some particles from stool and irritates. Moreover, wiping will only worsen the itching. According to drugs.com (and medically reviewed by Leigh Ann Anderson, PharmD), the disorder, “Hemorrhoids, also called piles, have been reported to occur in roughly 1 in 20 people in the U.S. Approximately 50% of people over the age of 50 have hemorrhoids.”

Causes and Risk Factors

As one ages, they are more likely to develop hemorrhoids, because the supporting tissues in the anus weakens. Pregnancy is also another risk factor. Here, because the baby’s weight puts pressure on the anal region. Frequent anal intercourse can also contribute to hemorrhoids. 

Nonetheless, the most common cause of hemorrhoids is straining during bowel movements and sitting on the toilet for a long period of time. Other symptoms include:

  •  Chronic constipation or diarrhea
  •  Prolonged daily sitting
  • Low fiber diet
  • Regular heavy lifting
  • Obesity
  • Family history of hemorrhoids
  • Pregnancy
  • The supporting tissues in your anus and rectum are weakening due to aging. 

All of these can cause the veins of the anus to swell and manifest as hemorrhoids. 


Symptoms and Diagnosis

Before reading on, please keep in mind that this article is not meant for medical advice or diagnosis. Please consult your physician if you suspect you have cancer or any other medical issues.

The symptoms of hemorrhoids vary if it is an external hemorrhoid or internal hemorrhoid. Consult your physician if you suspect you have hemorrhoids. 

Common symptoms that shows up in both types of hemorrhoids are:

  • Rectal bleeding
  • Anal itching and iritation around the anal region
  • Leakage of feces and can’t completely clean after bowel movement.
  • Swelling of tissues in the anus region. 

Symptoms that are unique to internal hemorrhoid include:

  • Painless bleeding during bowel movement
  • The swelling tissue pushes pass the anus and can form a prolapse, causing irritation. 

Symptoms that are unique to external hemorrhoid include:

  • Uncomfortable and pain in the anal region
  • Lumps near or around the anus

When the blood in hemorrhoids pool and forms a clot, it becomes thrombosed hemorrhoids. Symptoms include:

  • Severe pain
  • Swelling
  • Inflammation
  • A hard lump near your anus

When you visit your doctor, they may examine the skin around your anus. They may also do a digital examination. This entails inserting a lubricated, gloved finger into the anus to check the anal canal with a probe called an anoscope. 

Treatment and Prevention

There are lifestyle considerations to prevent them, which includes: 

  • Eating high fiber food
  •  Taking stool softener or fiber pill
  • Drinking more water and nonalcoholic liquids, 
  • Refrain from straining during bowel activity
  • Reduce the time spend sitting on the toilet
  • Taking over-the-counter pain relievers
  • Sitting in a sitz, a tub of warm water, or a bath

     Most hemorrhoids will go away even without at home treatment. However, bleeding internal hemorrhoids and severe cases of prolapse may need professional attention. This is where the doctor operates on the hemorrhoids. There are operations that can be done in the doctor’s office and there are some that require surgeons to operate. 

Operations that can be done in a doctor’s office includes:

  • Rubber band ligation: an operation where the doctor puts a rubber band on the hemorrhoids that cuts its blood supply and will fall out within a week. 
  • Sclerotherapy: The doctor injects a solution into the hemorrhoids which forms a scar tissue that cuts the hemorrhoid’s blood supply off. This is similar to rubber band ligation, but instead of using a rubber band to cut off the blood supply, the physician uses a chemical. 
  • Infrared photocoagulation: This is where the physician directs infrared light towards the hemorrhoid to cut its blood supply so it will fall out.
  • Electrocoagulation: The physician sends an electric current to your hemorrhoids which creates scar tissue and cuts of the hemorrhoid’s blood supply.

Operations that need to be done in a hospital includes:

  • Hemorrhoidectomy: This is when the hemorrhoid doesn’t terminate with the treatment above. The doctor will surgically remove the hemorrhoid with anesthesia.
  • Hemorrhoid stapling: The doctor may use a special stapling tool to remove an internal hemorrhoid and push a prolapse back in the anus. 

Check with your physician for the most fitting treatment for you. 

Ways to prevent hemorrhoids are don’t delay bowel activity, drink plenty of water, eat fibrous food, exercise often, and so on. 

Conclusion

In summary, hemorrhoids are a condition where the veins inside and around the anus swells up. Hemorrhoids can be internal or external, with external being the more painful one. Common causes of hemorrhoids include pregnancy, chronic constipation and diarrhea, spending too long on the toilet, low fiber diet, age, and so on. Symptoms of hemorrhoids include blood in stool, leakage, anal itch, swelling, inflammation, pain and discomfort in the anal region, etc. The physician may observe the outside of the anus or use digital examination. At-home treatment remedies include sitz bath, consuming high fiber food, refrain from straining in bowel activity and minimized time spent on the toilet and so on. Treatment methods that the physician can perform include rubber band ligation, sclerotherapy, infrared photocoagulation, and electrocoagulation. Surgical treatment methods include hemorrhoidectomy and hemorrhoid stapling.

Andrew Pham, Youth Medical Journal 2020

References

Categories
Health and Disease

“Tree Man” Syndrome: The Rare Genetic Disorder

Introduction

 Mahmoud Taluli of Gaza before undergoing surgery to remove the brace like lesions.

“Tree Man” Syndrome, formally known as epidermodysplasia verruciformis (EV), is a rare but physically and mentally taxing condition that causes warts that resemble tree branches to spread all over the body at rapid rates. EV is inherited through a gene  mutation which makes the people affected highly susceptible to human papilloma virus (HPV). HPV is extremely common; in fact over 100 different  strains of this virus exist. However, the Genetic and Rare Diseases Information (GARD) estimates that approximately 200 people worldwide are experiencing EV. Living with EV makes fighting off HPV extremely difficult to combat as the genetic mutation causes a defect in the immune system. Unfortunately, there are no definitive cures; treatments have been met with varying levels of success. 

What is it?

There has been an increasing amount of focus on EV after a Bangaldeshi man made headlines for this condition in 2016, though much remains unknown about this condition due to its rarity. What we do know is that this condition typically manifests itself from childhood with the presentation of small warts; in fact, approximately 7.5% of cases manifest during infancy, 61.5% of cases develop during childhood, and 22% of cases develop during puberty. As the child gets older, their lesions become increasingly larger and appear at a faster rate as EV causes a defect in the immune system that makes the individual more susceptible to HPV, particularly HPV5 and HPV8 are found in 80% of all cases. 

Eventually, some of these lesions can become cancerous. The most common skin cancer that presents itself in EV is squamous cell carcinoma. 30% – 60% of all patients with EV develop squamous cell carcinomas when they are around 40 to 50 years old. Squamous cell carcinoma is often caused by prolonged exposure to ultraviolet light from sources like the sun or artificial light. Thus, it is often recommended for those with EV to avoid staying in areas with high UV radiation exposure for extended periods of time. This recommendation arose from the fact that 30% – 60% of all patients with EV develop squamous cell carcinomas when they are around 40 to 50 years old. 

In terms of genetics, EV has often been associated with an autosomal recessive inheritance pattern (two mutated genes are required to inherit the disease, one from each parent), though other reports that EV is sex linked, sporadoic, or even autsomal dominant inheritance(one mutate gene is required to inherit the disease). Though, there is some agreement over which genes and chromosomes are affected: the EVER1 and EVER2 genes of Chromosome 17. It is here that the proteins that, “form a complex with the zinc transporter protein (ZnT-1) in the endoplasmic reticulum of keratinocytes (aka skin cells)” are created. Zinc is thought to play an important role in wound healing and it may provide an explanation as to why EV occurs. In order to confirm this hypothesis, extensive research must take place.  

Symptoms

The most notable symptom of EV are the growths that resemble branches. This is the most severe symptom of this condition. Other presentations of EV include flat topped papules, a small bump on the skin,  that can vary in color from pink, white, red, brown, or violet, scaly and inflamed patches of skin called plaques, and brown warts. These lesions most commonly develop in areas that are exposed to sunlight: hands, feet, earlobe, face.

In addition to these physical symptoms, EV can be particularly detrimental to one’s self esteem. EV gets in the way of daily tasks and the lack of research surrounding EV often causes those who suffer from the condition to feel stigmatized. Though, to the recent interest in this condition, researchers hope that there may be new opportunities to understand the mechanisms of this troubling disease. 

In July 2019, a 44 year-old man named Mahmoud Taluli underwent four successful surgeries over the span of two years to remove the lesions from his hands. His multiple surgeries included a team of doctors making deep, precise incisions in order to remove thousands of lesions. The doctors performed multiple skin grafts to help the body heal. Despite the fact Tauli underwent extensive treatment, the results of his surgeries are not permanent. His growths continued to develop and he is scheduled to have more surgeries. After receiving the surgeries Taluli was reported saying, “After years of suffering and solitude, I can finally live a normal life. I can play with my children. I can go to family events. I no longer need to cover my hands when I go out in public.” 

Treatment

However, not everyone who experiences this condition experiences the same results. Abul Bajandar, a Bangladeshi man, asked doctors to amputate his hand. He underwent over 20 surgeries to remove the branch-like growths but they have been met with mixed success; his growths continued to form typically larger and faster than before. Recent surgeries, have been tremendously more successful, removing majority of the lesions, but he must go back to return the remaining lesions. Though, some doctors are concerned that he returned too late and the lesions may be incredibly difficult to remove yet again,

Abul Bajandar, before undergoing any surgeries.
Bajandar after undergoing multiple intensive surgeries. He was reported saying “I can finally hold my kid again.

Finding a treatment is imperative as 50% of patients with EV have lesions that become malignant. However, researchers are met with a unique challenge as so little is known about this condition. Other than surgery, treatment includes topical retinoids (medications that reduce skin inflammation), interferon-alpha (a drug that contains compounds that suppress the cell cycle), and Cryotherapy (freezing off the growths). 

Conclusion

“Tree Man” disease, or epidermodysplasia verruciformis, is an incredibly detrimental disease to an individual. Not only does this disease cause self esteem issues, it can also be the cause of a number of much more serious, non-cosmetic medical issues like HPV and squamous cell carcinoma. Despite its rarity, researchers are optimistic they will be able to find a working cure for EV due to the recent interest in this disease. 

References

  1. Headlines Suggest ‘Tree Man Syndrome’ Curable? (2017, January 28). Retrieved September 30, 2020, from https://www.acsh.org/news/2017/01/11/headlines-suggest-tree-man-syndrome-curable-10711
  2. Rettner, R. (2019, July 10). ‘Tree Man’ Gets Pioneering Surgery for Rare Skin Condition. Retrieved September 30, 2020, from https://www.livescience.com/65907-tree-man-gaza-surgery.html
  3. Epidermodysplasia verruciformis. (n.d.). Retrieved September 30, 2020, from https://rarediseases.info.nih.gov/diseases/6357/epidermodysplasia-verruciformis
  4. Uddin, K., Amin, R., Majumder, S., Aleem, M., Rahaman, A., Dity, N., . . . Uddin, M. (2018, June 5). An ANKRD26nonsense somatic mutation in a female with epidermodysplasia verruciformis (Tree Man Syndrome). Retrieved September 30, 2020, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6099040/
  5. Ngan, V. (n.d.). Epidermodysplasia verruciformis. Retrieved September 30, 2020, from https://www.dermnetnz.org/topics/epidermodysplasia-verruciformis/
  6. Orth G. Genetics of epidermodysplasia verruciformis: Insights into host defense against papillomaviruses. Semin Immunol. 2006 Dec;18(6):362-74. doi: 10.1016/j.smim.2006.07.008. Epub 2006 Oct 2. PMID: 17011789.
  7. Pokharel, S., & Regan, H. (2019, January 21). Bangladesh’s ‘tree man’ is back in hospital and needs more surgery. Retrieved October 13, 2020, from https://www.cnn.com/2019/01/21/health/tree-man-bangladesh-surgery-intl/index.html
  8. Stub, S. T. (2019, July 08). Patient With ‘Tree Man’ Syndrome Says He ‘Can Finally Live A Normal Life’. Retrieved October 13, 2020, from https://www.npr.org/sections/goatsandsoda/2019/07/08/738907620/patient-with-tree-man-syndrome-says-he-can-finally-live-a-normal-life
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Health and Disease

An Overview of Healthcare Systems: United States, Canada, and Australia

Introduction

With the 2020 US presidential election, there has been much discussion over the healthcare system. From Biden to Trump, each side of the political spectrum has different views on American healthcare and different ideas on reform. Namely, the shift from privatized healthcare to public healthcare, otherwise known as healthcare reform. There has been debate over universal healthcare, retaining the current American system, and abolishing the Affordable Healthcare Act. There have also been accusations that a for-profit healthcare system is detrimental to lower class Americans. Countries such as Canada and Australia are often used as examples of ideal public healthcare systems. However, the two are not identical, even if they are both public. Rather, they have marked differences as well which need to be examined as the United States searches for a new model.

United States

Technically, the US has a two-tier healthcare system. A two-tiered system has both a public and a private option. In the United States, this involves Medicare as the public option for those over the age of 65 and Medicaid for low-income citizens. These are funded by federal and state tax revenue. There is also the Veterans Affairs system, which is similar to the UK. The UK has a single-payer system and healthcare facilities are owned by the government. The providers are government employees. Finally, the most common option is private insurance, which covers 56% of the population. After all, the US, unlike other two-tiered systems like Australia or Germany, does not have a well-supported public option. Medicare and Medicaid have restrictions to be eligible, while public options in other countries do not. Consequently, most people carry private insurance.

  Some detractors state that this system is inefficient. Admittedly, the US spends 17.6% of its Gross Domestic Product (GDP) on healthcare in contrast with Australia’s 9.1% and Canada’s 11.4% expenditure. The US also spends approximately $300 more out-of-pocket per capita on medical care. While both Canada and Australia require a specialist referral from a general practitioner or primary care physician, it differs in the United States as some private insurers permit referrals while others will cover not the visit. Others argue that allowing unnecessary specialist visits is expensive and invasive. In general, US healthcare is more expensive. 

Approximately 27% of Americans report that their healthcare system needs to be completely rebuilt [1]. This is also reflected by physician opinion. In a survey of primary care physicians across the world, US doctors were the most likely to report that they spent substantial time struggling with insurance providers and billing, despite new electronic records. Nearly 60% also reported that their patients had difficulty paying for their health services [2]. To corroborate this, American adults are the most likely to have high medical costs, even with insurance. Thus, patients and physicians can confirm that patients have high healthcare costs that are not fully covered by insurance. Consequently, this becomes a burden on patients.

A symptom of this is a phenomenon known as “medical tourism”. On one hand, citizens from developing countries travel  to the US to access better expertise with the latest r technology. Conversely, American citizens also travel to less developed areas where costs may be as low as 10% of prices in the US. Naturally, this occurs with elective procedures, especially cosmetic ones. Elective procedures can still be life-saving. However, they can be scheduled, allowing them to complete these procedures overseas at a lower cost. Emergent procedures must be done immediately and, as a result, cannot be done in a foreign country. So, medical tourism does not ameliorate the costs of emergent procedures [3]. 

Canada

Canada is a single-payer system, where the sole option is the regionally administered public insurance program. Hospitals are often, though not always, public and are considered government property. Their healthcare professionals are considered government employees. There are private practices and hospitals, but they are all compensated by the government. This government compensation is funded by province and federal revenue. There are, however, services that are not covered by the government, such as vision or dental services. Approximately 67% of the population purchases private coverage for these needs. 

An accusation against this single-payer system is that the wait times are substantially longer than private healthcare systems, such as the one in the US. 41% of Canadian adults report that they have waited at least 2 months to see a specialist. In comparison, 9% of American adults report that they have waited at least 2 months to see a specialist. On the other hand, only 15% of Canadians experienced cost as a barrier to access, in comparison to the US’s 33% [1]. Consequently, the Canadian healthcare system is a trade-off between access and wait times. Canadian healthcare is more accessible to lower-income patients due to lower costs, though they must wait longer to receive this treatment than American patients.

The lack of commercialization in Canada also reflects the disposition of patients. In America, there have been assertions that this payment for care has led to patients behaving more like customizers. Patients can demand unnecessary and invasive care. In a study done on cancer patients, Canadian care was less aggressive than in the US. This may be due to the American patients desire for care even when it is futile, because they feel as if they are entitled to this care provided they will pay for it. Other than cancer treatment, some American physicians report that their patients are more demanding of certain services and substances, like opioids. They also report that using patient satisfaction metrics to measure standards of  care pressures them into giving opioids and other unnecessary treatments [4]. Canadians do pursue “medical tourism” for economic reasons, though it is almost solely for cosmetic procedures and other procedures not covered by the government [3]. 

Australia

Australia has a two-tier healthcare system, with both public and private options. Unlike the US however, the public option is universal. There is no income or age requirement and is funded by general tax revenue and earmarked income tax. Like Canada, there are services that are not covered, such as dental or vision services. On top of that, some citizens choose to use the private option. Approximately half the population purchases coverage for uncovered services and private hospitals. Nonetheless, the government negotiates with pharmaceutical companies to lower costs [1]. The Australian government also subsidizes 80% of out-of-pocket costs if it exceeds 1,033 USD. 

Similar to Canada, 60% of primary care physicians report that their patients face longer wait times to see specialists [2]. In a study conducted at the Townsville Hospital in Australia, the original health system sent  referrals, then triaged them. However, this ended in long waitlists unless the condition was critical. A solution devised by Townsville Hospital was then to reduce and update referrals. A follow-up letter was sent to patients who had waited longer than 2 years, requesting that they either: 1) take no action if they felt their referral was no longer necessary or 1) visit their general practitioner (a primary care physician in the United States) to update the referral [5]. 

In other cases, patients were willing to pay the premium of private care in exchange for faster treatment.With the presence of a private option, once again, care is more “customer service”-focused. Approximately 60% of US and Australian physicians use patient satisfaction metrics. In Canada, this figure is only 15% [2]. 

Conclusion

Each healthcare system is different, with varying strengths and weaknesses. With the impending US election, it is vital that the American voters understand the nuances of each and how it affects Americans, specifically in the COVID-19 pandemic. A contraindication is that this article does not cover every healthcare system available. While healthcare is variable and every country differs in its  policies these nuances are opaque to many healthcare professionals, let alone the general public. Nonetheless, people must be educated before they vote. A democracy cannot function without an educated public that knows what is best for themselves and society as a whole. These decisions affect millions of citizens and must not be taken lightly.

Aleicia Zhu, Youth Medical Journal 2020

References

[1] The Commonwealth Fund. (2012). International Profiles of Health Care Systems. The Commonwealth Fund. www.commonwealthfund.org/sites/default/files/documents/___media_files_publications_fund_report_2012_nov_1645_squires_intl_profiles_hlt_care_systems_2012.pdf

[2] Schoen, Cathy, et al. (2012). A Survey of Primary Care Doctors in Ten COuntries Shows Progress in Use of Health Information Technology, Less in Other Areas. Health Affairs, 13(12). www.healthaffairs.org/doi/full/10.1377/hlthaff.2012.0884.

[3] Horowitz, M.D., et al. (2007). Medical Tourism: Globalization of the Healthcare Marketplace. MedGenMed, 9(4), 33.

[4] Ho, T.H., et al. (2011). Trends in the Aggressiveness of End-of-Life Cancer Care in the Universal Health Care System of Ontario, Canada. Journal of Clinical Oncology, 29(12). dx.doi.org/10.1200%2FJCO.2010.31.9897

[5] Stainkey, L.A., Seidl, I.A., Johnson, A.J. et al. (2010). The challenge of long waiting lists: how we implemented a GP referral system for non-urgent specialist’ appointments at an Australian public hospital. BMC Health Serv Res, 10, 303. doi.org/10.1186/1472-6963-10-303

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Health and Disease

Defeating Breast Cancer While Leaving Healthy Cells Unaffected

Introduction

Cancer treatment today often includes a painful experience for the patient.  Chemotherapy is known to contain powerful substances that kill rapidly dividing cells, even healthy ones.  Scientists at Johns Hopkins Medicine and the University of Oxford recently published their results with a new technique they’ve been working on that is capable of killing breast cancer cells while keeping healthy cells safe.  One common cause of cancer is a mutation within the genetic coding of a cell that causes it to multiply without anything to suppress it.  This unrestricted division of the cell can lead to them becoming cancerous. 

How does cancer start? Damaged cells multiply.

Methods

While studying lab-grown breast cancer cells, one of the lead researchers, Dr. Holland, noticed a trend amongst them.  The cancer cells were dependent on centrioles, which played a crucial role in their survival and multiplication.  Centrioles are cylindrical organelles that form necessary spindles in mitosis, a process in which cells divide.  They are the core of centrosomes that provide structure for cells and assist in separating DNA during cell division.  Although other cells were able to divide without centrioles, these breast cancer cells were not able to.  With deeper research, they found that there was a section of the cancer cells that had multiplied a strange amount of times.  One specific protein, TRIM37, was being produced excessively by genes in that area.  This protein controls centrosomes and when there are high levels of the protein, it results in defective centrosomes instead.  These flaws lead to consequences later during cell division and this instability in cell division typically contributes to the development of cancer.

In order to impede the division of cells with an excessive amount of TRIM37, researchers utilized a drug that targeted PLK4 genes.  The PLK4 inhibitor specifically hinders the proteins that form centrioles.  Unfortunately, they found that adding this drug to their lab-grown breast cancer cells with normal levels of TRIM37 does not impact their cell division even without centrioles.  However, for the cells with overexpressed TRIM37, they were unable to divide and died or did not grow anymore.  Holland devised a plan to identify cells that contained high levels of TRIM37 and allow the PLK4 inhibitor to kill the breast cancer cells without harming the healthy cells.

They came across precisely why the cancer cells with regular levels of TRIM37 were unaffected by the PLK4 drug.  Diagram D shows the effects of the PLK4 inhibitor on a cancer cell with regular levels of TRIM37 compared to a cancer cell with an excessive amount of it.  There is a substance called the pericentriolar material (PCM) around the centrioles that performs the same function as centrosomes.  In the first path, it states that the “PCM foci promote MT nucleation” which means that the pericentriolar material substitutes for the depleted centrosomes in order for cell division.  On the other hand, the cells overexpressing TRIM37 eventually died.  The high levels of TRIM37 deteriorates the pericentriolar material and the PLK4 drug stops the production of centrosomes.  Without these two, there is no way for the cell division to occur.  

Conclusion

 This research from Johns Hopkins Medicine and the University of Oxford is a breakthrough in the world of cancer.  9% of breast cancers are caused by the over-expression of TRIM37 and being able to kill these cancer cells while leaving the healthy ones unaffected is a huge step towards finding the best way to treat cancer.  Holland and the team are now working on using similar drugs to the PLK4 inhibitor because it is not stable and safe enough to use for patients.  In addition, they are testing this inhibitor on other cancer cells to see if they are sensitive as well.  Dr. Chapman, another researcher on the team, stated, “We’ve found a previously unknown genetic vulnerability in breast cancer, and discovered a means to exploit this vulnerability and selectively kill cancer cells.  We hope that in the future, other researchers and pharmaceutical companies can generate new drugs that can target this process, to produce more effective and safer cancer treatments.”

References

Nature, “Targeting TRIM37-driven centrosome dysfunction in 17q23-amplified breast cancer”, 9 September 2020, https://www.nature.com/articles/s41586-020-2690-1

Johns Hopkins Medicine. “New way to target some rapidly dividing cancer cells, leaving healthy cells unharmed.” ScienceDaily. ScienceDaily, 9 September 2020. www.sciencedaily.com/releases/2020/09/200909114901.htm

University of Oxford, “Previously unknown ‘genetic vulnerability’ in breast cancer cells target of research.” 10 September 2020 https://www.ox.ac.uk/news/2020-09-10-previously-unknown-genetic-vulnerability-breast-cancer-cells-target-research#

Johns Hopkins Medicine, “Scientists Identify New Way to Target Some Rapidly Dividing Cancer Cells, Leaving Healthy Cells Unharmed”, 9 September 2020 https://www.hopkinsmedicine.org/news/newsroom/news-releases/scientists-identify-new-way-to-target-some-rapidly-dividing-cancer-cells-leaving-healthy-cells-unharmed

Fierce Biotech, “Blocking tumor cell division to stop breast cancer.” 9 September 2020, https://www.fiercebiotech.com/research/blocking-tumor-cell-division-to-stop-breast-cancer

National Human Genome Research Institute, “Centriole”, https://www.genome.gov/genetics-glossary/Centriole

Sciencing, “What Would Happen If a Cell Didn’t Have Ribosomes?”, 16 April 2018, https://sciencing.com/would-happen-cell-didnt-ribosomes-19003.html

Patient Navigator Training Collaborative, https://www.patientnavigatortraining.org/chronic_disease/module3/1_index.htm

Categories
Health and Disease

Obsessive-Compulsive Disorder (OCD): More Than Being Obsessively Neat and Tidy

Abstract

Obsessive-Compulsive Disorder (OCD) is the fourth most common psychiatric illness (Fitzgerald). According to the Anxiety and Depression Association of America, 1 in 40 adults and 1 in 100 children in the U.S. are affected by OCD. OCD is a two-part mental disorder beginning with an obsession over certain thoughts and leading to the repetition of certain actions in a continuous cycle that impairs daily life. The process begins with obsessive thoughts (obsessions) that cause anxiety and lead to the individual repeating a behavior (compulsions). This could look like visualizing the spread of germs contaminating one’s hands, leading to excessive hand washing. Following through with compulsions only grants temporary relief from anxiety before the individual encounters another OCD trigger. However, if the individual does not follow through with the compulsion, it could result in anxiety and panic attacks. Both the obsessions and compulsions are involuntary. 

Types of OCD

OCD has many faces, and while every case is different, a person’s OCD commonly falls into one of these five categories.

  1. Checking

Checking is when someone with OCD “makes sure” of something, whether that’s if they left the stove on, if they turned off the bathroom lights, if they locked the front door, etc. It’s accompanied by fears of a dreadful event, such as the person’s home burning down or the death of someone close to them or even themselves (“Types of OCD”). The anxiety disorder side of OCD is what fuels this fear. The individual must check if they forgot their wallet; otherwise, their two-year old niece will be diagnosed with an incurable disease. These thought processes and the resulting compulsions—in this case, checking for a wallet—commonly impede the person’s daily life. It can result in someone being unable to leave their house until they check (and then check again), causing delays in a person’s day that they cannot do anything about.

  1. Contamination / Mental Contamination

The obsessions of someone with contamination related OCD is tied to a fear of harm to themselves or a loved one. It is also associated with a fear of germs and dirt. People with contamination OCD often avoid objects, places, or other people in fear of contamination through germs, dirt, etc. They may avoid public spaces, door knobs, shaking hands, among other things. Compulsions may be repeatedly washing hands until they’re raw, brushing teeth, showering, or laundering clothes immediately after returning home. They follow through with these compulsions to ensure that they don’t become ill or cause others to become ill (“Types of OCD”).

In addition, there is also a mental side to contamination related OCD. It is similar to physical contamination with the exception that people with this subtype of OCD perceive the contamination as happening internally, inside their body. They also feel the urge to clean out the contaminants, which in this case are negative thoughts or things they’ve heard, instead of the usual germs or debris. Similar to contamination OCD, they do this by showering and washing (“Types of OCD”). The key difference between contamination and mental contamination OCD is the presence of a physical object versus a human. The source of germs and dirt in contamination OCD is a physical object. However, the “germs and dirt” of mental contamination OCD—aka the negative things they’ve heard—originates from another human.

  1. Hoarding

Hoarding is not unique to OCD; it can be a mental disorder on its own or a symptom of another mental illness such as OCD or OCPD (“Hoarding: The Basics”). Hoarding is when someone is unwilling to discard certain possessions and, instead, feels the need to save them, resulting in an excessive accumulation of clutter that impairs their daily life. That need to save possessions can be for a number of reasons, and, in some cases, is linked to OCD and anxiety. For instance, some people with hoarding OCD believe that items that touch the floor are contaminated; therefore, no one should touch these items else they also become contaminated (“OCD Symptoms: OCD-Related Hoarding”). These obsessive thoughts are similar to those of someone with contamination related OCD. This thought process renders the person physically and mentally unable to dispose of the item, leading to excessive accumulation as the cycle continues.

  1. Rumination and Intrusive Thoughts

Both rumination and intrusive thoughts in OCD revolve around certain thoughts in an individual’s head. In the context of OCD, rumination is when an individual spends an excessive amount of time focusing on a question or thought. They can be focusing on a religious or philosophical topic such as life and death. However, they don’t arrive at a conclusion that satisfies them, leaving them to ponder for excessive amounts of time (“Types of OCD”).

For someone with OCD, intrusive thoughts are when disturbing thoughts reappear over and over in an individual’s mind. These thoughts are involuntary, and someone with OCD may begin believing these thoughts. Anxiety stems from the fear that they may act on the repugnant thoughts or impulses. These thoughts may be related to violence, sexual harm, relationships, etc. An example of an intrusive thought would be obsessing over the thought of harming other people with kitchen knives or other sharp objects, and the compulsion would be locking away those objects so as not to harm anyone (“Types of OCD”). The individual may question why they are having these thoughts or be consumed by the thought that they have already performed the violent action (even though they haven’t).

  1. Symmetry

People with symmetry-related OCD feel uncomfortable when objects are not aligned symmetrically or if an action isn’t done symmetrically. They become fixated on the positions of objects—such as books or clothes—and cannot move on until those objects are arranged in the “right” way (“Types of OCD”). People with OCD can also feel this way about certain actions; they have to perform an action on both sides or any number of sides to maintain balance and symmetry. For example, if someone with symmetry-related OCD scratches the left side of their face, they must scratch the right side to avoid a feeling of discomfort (Fitzgerald). This can be tied to a fear of harm to the person themself or someone close to them, but it can also just be to avoid the unease that they experience before satisfying a compulsion.

Causes

Symptoms of OCD commonly begin to appear in the pre-adolescent and early adulthood stages of life. The most common age range in which people start to experience the symptoms of OCD is between the ages of 10 and 24, but OCD can start at any age (Fitzgerald). The causes behind OCD are not crystal clear, but they may be linked to biological, genetic, and environmental factors. 

Cases of OCD have been linked to family in many ways. For instance, immediate family members of a person with OCD have a 25% chance of also developing the disorder (Ford-Martin). This means that the parents, siblings, and children of someone with OCD have increased chances of also having OCD, hinting that the disorder is somehow connected to family lines. This pattern may be a result of learning from and watching the behaviors of a family member with OCD (“Obsessive-compulsive disorder (OCD)” [NCH Healthcare System]). Part of the answer may also lie in genetics. Some twin studies have revealed that identical twins—twins that come from the same egg and therefore share all of their genes—are more likely to both develop OCD than fraternal twins. Genetics is not the only determiner though, as the rate for both identical twins exhibiting OCD is not 100% (Fitzgerald)

Some suggest that abnormal brain activity that differs from those without a mental illness or disorder may also be responsible for the obsessions and compulsions of OCD. Researchers have found that the orbital cortex of the brain is hyperactive in people with OCD, which may be responsible for the feelings of “alarm” that push people toward fulfilling compulsions (Ford-Martin). Abnormally low levels of serotonin in the brain may also play a role in OCD, as serotonin aids in communication between the frontal lobe and other parts of the brain that are connected to OCD compulsions (Ford-Martin).

Diagnosis

OCD can only be diagnosed by a mental health professional such as a psychiatrist or psychologist. It is usually done through an interview-like process in which a series of questions are asked to identify if the core aspects of OCD are present and therefore warrants a diagnosis. Examples of questions that a professional may ask are if the patient frequently cleans, if the patient checks things a lot, if the patient is bothered by thoughts they can’t rid themselves of, etc. Professionals take into account the effect of the symptoms on the patient’s life, whether the symptoms are time-consuming (taking up more than an hour each day), cause distress, impede function in daily life, etc. (“Diagnosing OCD”). One commonly used assessment is the Yale-Brown Obsessive Compulsive Scale (Y-BOCS), which has five questions each for obsessions and compulsions; the Y-BOCS assesses the factors mentioned above (Fitzgerald).

Treatment

OCD is usually treated with cognitive-behavioral therapy (CBT) and medications.

Cognitive-behavioral therapy is a type of psychotherapy that has proven to be effective in treating certain mental illnesses. More specifically, the technique of exposure and response prevention (ERP) is the most effective in treating OCD; it helps reduce symptoms in 75%-80% of OCD patients (Fitzgerald). In ERP, the patient and therapist create a list of the patient’s obsessions and compulsions, starting with something mild and getting more extreme—these tasks look different for every patient based on their OCD. The idea is to expose the patient to OCD-triggers without having them give into compulsions. Patients start at a mild level where they will be able to tolerate not giving in to a compulsion. With each CBT session, the patient moves up the list with more difficult, OCD-inducing tasks. The tasks are repeated, and with each exposure, the anxiety associated with an obsession is reduced until the patient finds it manageable. One example of ERP is if a patient with contamination OCD is tasked with touching contaminated objects with increasing time between when they make contact and when they’re allowed to wash their hands (or give in to their compulsion).

OCD can also be treated by medication that increases levels of serotonin (selective serotonin reuptake inhibitors or SSRIs). These are fluoxetine, fluvoxamine, paroxetine, sertraline, citalopram, and escitalopram. Clomipramine and venlafaxine are antidepressants that may also be prescribed for OCD patients; risperidone and haloperidol are antipsychotics that are an option for severe cases of OCD (Ford-Martin).

The last resort for OCD patients that don’t respond to CBT or medication is brain surgery. The operation removes a part of the brain called the “cingulate cortex” (Ford-Martin). The surgery is beneficial to 30% of OCD patients who receive it, resulting in lessened symptoms (Fitzgerald).

Conclusion

Obsessive-Compulsive Disorder is a mental disorder that significantly interferes with the daily lives of sufferers through a series of obsessions and compulsions; it is much more than the media’s portrayal of OCD being obsessively neat or tidy. OCD can look different for every patient, and the exact cause of the disorder hasn’t been determined. However, treatment through CBT and medication can help lessen symptoms, and it is important that people with OCD are not misunderstood and seek the professional help they need.

Michelle Li, Youth Medical Journal 2020

References

“Diagnosing OCD.” OCD-UK, http://www.ocduk.org/ocd/diagnosing-ocd/. Accessed 28 Sept. 2020.

Fitzgerald, Jane A., et al. “Obsessive-compulsive and Related Disorders.” The Gale Encyclopedia of Mental Health, edited by Brigham Narins, 4th ed., vol. 3, Gale, 2019, pp. 1149-56. Gale Health and Wellness, link.gale.com/apps/doc/CX2491200351/HWRC?u=mlin_m_newtnsh&sid=HWRC&xid=5cfaa5d0. Accessed 28 Sept. 2020.

Ford-Martin, Paula, and Lisa C. DeShantz-Cook. “Obsessive–Compulsive Disorder.” The Gale Encyclopedia of Alternative Medicine, edited by Deirdre S. Hiam, 5th ed., vol. 4, Gale, 2020, pp. 1942-45. Gale Health and Wellness, link.gale.com/apps/doc/CX7947800639/HWRC?u=mlin_m_newtnsh&sid=HWRC&xid=492d0698. Accessed 28 Sept. 2020.

“Hoarding: The Basics.” Anxiety and Depression Association of America, ADAA, adaa.org/understanding-anxiety/obsessive-compulsive-disorder-ocd/hoarding-basics. Accessed 23 Sept. 2020.

“Obsessive Compulsive Disorder.” Georgia Behavioral Health Professionals, http://www.mygbhp.com/condition/obsessive-compulsive-disorder/. Accessed 28 Sept. 2020.

“Obsessive-compulsive Disorder.” National Alliance on Mental Illness, http://www.nami.org/About-Mental-Illness/Mental-Health-Conditions/Obsessive-compulsive-Disorder. Accessed 28 Sept. 2020.

“Obsessive-Compulsive Disorder.” National Institute of Mental Health, http://www.nimh.nih.gov/health/topics/obsessive-compulsive-disorder-ocd/index.shtml. Accessed 28 Sept. 2020.

“Obsessive-Compulsive Disorder (OCD).” Anxiety and Depression Association of America, ADAA, adaa.org/understanding-anxiety/obsessive-compulsive-disorder-ocd. Accessed 24 Sept. 2020.

“Obsessive-compulsive disorder (OCD).” NCH Healthcare System, http://www.nchmd.org/education/mayo-health-library/details/CON-20199571. Accessed 23 Sept. 2020.

“OCD Symptoms: OCD-Related Hoarding.” BeyondOCD.org, beyondocd.org/information-for-individuals/symptoms/ocd-related-hoarding. Accessed 28 Sept. 2020.

“Types of OCD.” OCD-UK, http://www.ocduk.org/ocd/types/. Accessed 27 Sept. 2020.

“What Is Obsessive-Compulsive Disorder?” American Psychiatric Association, http://www.psychiatry.org/patients-families/ocd/what-is-obsessive-compulsive-disorder. Accessed 28 Sept. 2020.

Categories
Health and Disease

The War of Genes vs Disease

Throughout the past several years, you have definitely heard speculations, observations, and many theories regarding the dramatic increase in obesity rates of individuals in the United  States. For over a decade, scientists have been experimenting and attempting to discover genes, alleles, and other genetic material that may contribute to obesity. However, scientists did discover that clusters of cells were found to play a pivotal role in the development of obesity. Although it had taken time for scientists to further study this phenomenon in-depth, they established that there is a myriad of genetic variants present that contribute towards the rate.

This idea was determined by the combination of two sets of data that involved an analysis of a person’s health, their specific attributes, and a separate set of single-cell RNA sequencing data. The first set of data, associated with humans, involved finding information about one’s genome and their body weight. For the second set of data, information was found about unique genetic codes and different portions of the genomes of the mouse populations. When both sets of data were combined to be accurate, scientists concluded that the genetic variants that contributed towards obesity were present in 26 disparate cell populations. This indicated that individuals with obesity had a higher chance of having identical genetic variants with one another.

Given from prior research, scientists know that the brain is the foundation for diseases and it is a region that controls the body’s needs for food and energy. Obesity is an intricate disease that involves more than just excessive body fat; It involves unhealthy habits, risks of other illnesses, and other detrimental effects. It is suggested that clusters of cells that process actions related to habits and eating contribute towards an individual’s rate of obesity. Recent findings also revealed that specific forms of brain cells determine the response and vulnerability to obesity. These are enthralling ideas that have been analyzed more deeply and are still being further looked at before coming to a final conclusion.

In late August, there were reports regarding how transplanted brown-fat-like cells were linked to reducing risks of obesity and diabetes, compared to human white fat cells that are existing in the body. This discovery shows the complex relationship between the body cells and the diseases in the human body. The way that cells interact and generally respond to sensory behaviors determines a lot of attributes of our health. Although there isn’t sufficient data to terminate all chances of acquiring obesity, scientists are getting much closer to putting together the pieces to prevent obesity at a higher rate and dissect the genetic traits behind this disease.

References

  • Pascal N Timshel, Jonatan J Thompson, Tune H Pers. Genetic mapping of etiologic brain cell types for obesity. eLife, 2020

Sajia Athai, Youth Medical Journal 2020

Categories
Health and Disease

Congenital Analgesia: The Condition Where You Cannot Feel Pain

While you may feel the rush of pain through your body when you stub your toe, the feeling is not felt at all to those with congenital insensitivity to pain. Congenital insensitivity to pain or congenital analgesia is an extremely rare condition when one is unable to experience physical pain. While this may seem beneficial to some, it is in reality quite detrimental, as those with CIP are unaware of any injuries that potentially could have occurred to them. This can potentially affect the life expectancy to those affected, as many health related issues and injuries can go undetected.

Congenital insensitivity to pain is caused by a mutation on the SCN9A gene, and is inherited as an autosomal recessive trait. SCN9A codes for the production of voltage gated sodium channels called Nav1.7s and when there is a mutation present, these channels are as a result affected.  Nav1.7 channels are on nerve cells, specifically on the ends of nociceptors or nerves that sense pain. When the mutation on the SCN9A gene occurs, these channels are affected, therefore affecting the individual’s ability to sense pain. 

People with congenital insensitivity to pain are able to distinguish whether something is sharp, or hot, however, they are unaware of any pain that is resulting due that specific stimulus. Due to this, people with CIP may experience bone fractures, burns, and underlying health issues. 

While there is no treatment for CIP, those affected are recommended to take annual X-rays and MRI’s, due to any possible injuries that could have occurred, as well as avoiding circumstances of self-injury. 

Congenital insensitivity to pain or congenital analgesia is a fascinating condition that affects very few individuals. Even though no treatment is available yet, many professionals in health care continue to research and bring more insight and understanding to this condition today. 

References

“Congenital Insensitivity to Pain.” Genetic and Rare Diseases Information Center, U.S. Department of Health and Human Services, rarediseases.info.nih.gov/diseases/12267/congenital-insensitivity-to-pain.

“Congenital Insensitivity to Pain.” Wikipedia, Wikimedia Foundation, 20 June 2020, en.wikipedia.org/wiki/Congenital_insensitivity_to_pain.

“Life Without Pain .” :: Medical Discovery News :: http://www.medicaldiscoverynews.com/shows/260-pain.html.

“Nav1.7.” Wikipedia, Wikimedia Foundation, 16 Apr. 2020, en.wikipedia.org/wiki/Nav1.7.

“Treatment: Is There a Treatment(s) for Congenital Insensitivity to Pain?” ThinkGenetic, http://www.thinkgenetic.com/diseases/indifference-to-pain-congenital-autosomal-recessive/treatment/4530.

Bharathi Arivazhagan, Youth Medical Journal 2020

Categories
Health and Disease

Thyroid Eye Disease: Symptoms, Diagnosis, and Treatment

Introduction

Thyroid eye disease, also known as Graves’ eye disease, is an autoimmune condition in which the eye muscles and fatty tissue behind the eye become inflamed. The main symptoms of thyroid eye are red, uncomfortable, and “bulging eyes.” These are caused by inflammation of the eyelid, tear glands, muscles, and fatty tissue behind the eye. Occasionally, this inflammation can lead to stiffness in the muscles, which can cause double, or blurred vision, as eyesight is not aligned between both eyes due to not being able to move parts of the muscle. Thyroid eye is an autoimmune disease caused by an immune attack on the tissue around the eye, irritating it and causing inflammation. 

Most people suffering from thyroid eye disorder (or TED) have Graves’ disease, which can detrimentally affect the thyroid gland, usually causing hyperthyroidism (overactive thyroid). 25% of those with Graves’ disease will also develop TED sometime before or during treatment.  Those suffering from Graves’ disease will double their chances of developing TED by smoking. A person diagnosed with thyroid eye will likely be placed under the care of an endocrinologist (a doctor specializing in hormonal diseases) as well as an ophthalmologist (an eye doctor). These departments will be the first port of call during treatment and should be informed if symptoms worsen.

Symptoms and Diagnosis

One major issue associated with TED is how difficult it is to diagnose. Thyroid eye is usually mistaken for symptoms associated with hayfever, conjunctivitis, or allergies. There are signs that directly point to TED and not the aforementioned conditions: continuing symptoms all year around with no improvement in winter months, no stickiness around the eye, and no improvement of symptoms after trialling different allergy solutions. 

In order to reduce symptoms of thyroid eye, it is imperative the sufferer attempts to quit smoking, if they are in the habit. Furthermore, it is important that they listen to their doctor’s advice and are aware of their changing thyroid levels, as well as monitoring them and following medical advice (e.g. attending blood tests every six months). This can sometimes help to alleviate symptoms and reduce the chance of TED becoming more severe.

It is vital to recognize that TED massively impacts individuals’ lives. From self confidence, to eyesight, thyroid eye can affect your daily life. Many sufferers struggle with low self esteem and self consciousness due to their eyes having a “bulging” appearance. Double vision can also be frustrating, meaning those with thyroid eye can experience confusion, especially when reading or trying to understand someone’s facial expression. This can be taxing on the patient, as well as family and friends, so it is crucial that everyone researches how they can support their loved one. Charities such as the “Thyroid Eye Disease Charitable Trust” and the “British Thyroid Foundation” can offer support and advice to help patients come to terms with the condition and adapt their daily life for ease. 

Treatment

There are a range of different treatments to help with some painful symptoms of TED. Artificial tears can be used to reduce the feeling of “grit in the eye” that can be associated with thyroid eye disease. If inflammation is severe, a doctor may prescribe an oral steroid to reduce it, or administer steroids intravenously. Some patients also find that having prisms attached to glasses can reduce their double vision. There are also surgical options to fix double vision, protect the eyelids, create space in order to allow the eye to close better, and protect the eyeball. 

The best thing a family member can do for a loved one suffering from TED is support and listen to them. Any disease affecting eyesight can be extremely unnerving for the sufferer, as their independence decreases, they may have to become more reliant on those around them. Especially for adults, double vision can be frustrating as it makes day to day activities harder. Teenagers and young people may feel self-conscious about their appearances and the possibility of having to wear an eye patch to alleviate vision problems. A caretaker, friend, or relative, should offer help, but make sure to give them space and allow their loved one to attempt things independently. They should be careful not to sound condescending, be supportive, and if they are comfortable discussing it, talk to them about the condition and their emotions surrounding it. Before forcing their help upon someone, those close to a person with thyroid eye should communicate with them and ask what they would like you to do.

References

Douglas, Raymond S. “Thyroid Eye Disease (TED or Graves Eye Disease).” Thyroid Eye Disease (TED or Graves Eye Disease) | Kellogg Eye Center | Michigan Medicine, http://www.umkelloggeye.org/conditions-treatments/thyroid-eye-disease.

“Graves’ Eye Disease.” American Thyroid Association, http://www.thyroid.org/graves-eye-disease/.

MacEwen, Caroline. “Expert Opinion – Diagnosing Thyroid Eye Disease.” GP, GP, 14 Mar. 2012, http://www.gponline.com/expert-opinion-diagnosing-thyroid-eye-disease/ophthalmology/article/1120742.

“Thyroid Eye Disease.” British Thyroid Foundation, 2019, http://www.btf-thyroid.org/thyroid-eye-disease-leaflet.

“Thyroid Eye Disease.” Cleveland Clinic, my.clevelandclinic.org/health/diseases/17558-thyroid-eye-disease. 

Sophie Farr, Youth Medical Journal 2020

Categories
Health and Disease

Lung Cancer: When Your Own Lungs Betray You

Your lungs are really amazing. An anatomy professor explains why

Introduction

When lung cells are frequently exposed to a carcinogen (cancer-causing factor), the cells’ DNA and metabolic processes may be damaged; as a result, creating abnormal cells within the organs. These cells do not function properly like normal cells. They also multiply at a faster rate than normal cells and form tumors, or clumps of cancerous cells, inside the lungs. Cancerous tumor cells will start demolishing healthy cells near it. Ultimately, it will start metastasizing or spreading to organs near the lungs, like the bones, adrenal glands, liver, kidneys, and even the brain. This will be adverse to the body’s metabolism since these cancer cells do not aid the lungs like normal, healthy cells and can cause death. There are two types of lung cancer, small cells (the more aggressive type) and non-small cells. The majority of lung cancer cases are non-small cell lung cancer (84%). As for 2020, the American Cancer Society estimated that there are approximately 228,820 new cases of lung cancer and 135,720 deaths from lung cancer. About 1 in 17 women and 1 in 15 men will get lung cancer in their life, both smokers and non-smokers, although smokers will have a higher chance of having lung cancer. Its survival rate is measured in a relative survival rate method: 5-year relative rate by the American Cancer Society. It compares patients with identical stages and types of cancer to the rest of the population. For instance, people with localized lung cancer have a 5-year relative survival rate of 61%. This means that the people who have this type of cancer usually are about 61% more likely to live 5 years longer than those who don’t have this type of lung cancer. ACS also uses the SEER (Surveillance, Epidemiology, and End Result) database, which divides lung cancer into three stages: localize (the cancerous cells still resides within the lungs), regional (cancer had spread to neighboring structures from the lung), and distant (cancer metastasized to other organs). This chart is from the American Cancer Society that shows 5-year relative survival rate for non-small cell lung cancer from 2009 to 2015:

SEER stage5-year relative survival rate
Localized61%
Regional35%
Distant6%
All stages combined24%

This chart from American Cancer Society shows the 5-year relative survival rate for small-cell lung cancer between 2009-2015:

SEER stage5-year relative survival rate
Localized27%
Regional16%
Distant3%
All stages combined6%

Keep in mind that these numbers show an overall statistic; patients may have a better or worse chance of survival, for there are other personal factors that contribute. These numbers also only apply to the first time a patient is diagnosed.

Causes 

Tobacco is the most common cause of lung cancer. It is also a highly significant risk factor for lung cancer. As many as 80-90% of patients diagnosed are smokers or former smokers. The carcinogens in tobacco products can cause and hasten the process of lung cancer. It can further make your lungs more affected by hazardous chemicals such as radon and asbestos. Those who are exposed to smokes from these tobacco products (secondhand smoking) can be at risk of lung cancer. Adding on, if a smoker can quit smoking, the chances of getting lung cancer significantly reduces, although never diminishes. Therefore, it is always optimal to quit smoking. 

Another risk factor of lung cancer is carcinogens. These are chemicals that, when consumed, can have the ability to cause cancer. Radon, asbestos, tar, arsenic, thorium, chromium, nickel, soot, are all carcinogens, just to name a few. The longer a person is exposed to these carcinogens, the higher the risk for lung cancer. These carcinogens can also be carried in the air (if polluted). Cooking with kerosene fuels, biomass, etc. can also contribute to lung cancer. 

People of 65 and older are also at higher risk for lung cancer. Also, people with a history of lung diseases (like COPD and pulmonary fibrosis) may also be at a higher risk of getting this kind of cancer. Adding on to the last point, the people with a family history (immediate members) suffering from lung cancer are also at higher risk of getting the disease. This can be passed down through genetic mutation (extremely rare) or by being exposed to the same environmental risk factors (such as smoke from tobacco products and carcinogens). 

Radiation therapy can contribute to the chances of getting lung cancer. People being treated for breast cancer and Hodgkin lymphoma. Although the current medical advances that can minimize this risk factor, it is still a concerning aspect not to be overlooked. 

Diet can also affect the likelihood of getting lung cancer. Unsafe water sources that contain arsenic can cause damage to the lungs and potentially cause lung cancer. People who take many beta-carotene pills over the year can increase their likelihood of getting lung cancer. However, foods that contain beta-carotene are considered safe.

Please keep in mind that all these factors have the CHANCE of causing cancer. Other factors such as the amount of time a person is exposed to these risk factors may determine if they will get cancer or not. Getting exposed to charcoal’s smoke will not give you cancer immediately. The dose is the poison. 

Lung Cancer Risk Factors Infographic

Symptoms and Diagnosis

Before reading on, please keep in mind that this article is not meant for medical advice or diagnosis. Please consult your physician if you suspect you have cancer or any other medical issues.

Symptoms of lung cancer don’t usually manifest until the later stages of this disease. However, in many cases, these symptoms do manifest early on; as a result, the patient will have a higher chance of survival. Symptoms of lung cancer can be confused with other lung diseases and disorders. Therefore, it is important to consult your physician if you are concerned that the symptoms listed below may signal lung cancer. Several symptoms of lung cancer includes:

  • Constant and worsening coughs
  • Blood or sputum-coughing
  • Hoarseness
  • Constant chest pain that gets more painful when performing activities that involves the lung (laughing, coughing, deep breathing, etc.)
  • Shortness of breath
  • Lung infections such as bronchitis and pneumonia occur oftenly
  • Wheezing 

Some symptoms that manifest when the cancer spreads to other organs:

  • Bone pain
  • Swelling of the lymph nodes
  • Seizures, headaches, dizziness, and other nervous system-related symptoms
  • Jaundice (when the skin and eyes turn yellow)
  • Blood clots

Doctors choses diagnosis based on factors like a patient’s medical history, symptoms, and physical exam results. As for the USC lung cancer screening program, patients must meet these criteria, as quoted from their website linked below:

  • “You must be at least 55 years old; have smoked the equivalent of one pack of cigarettes a day for 30 years; and be either a current smoker or have quit within the past 15 years
  • You must be older than 50; have smoked the equivalent of one pack of cigarettes a day for 20 years; and have at least one of the following risk factors:
    • Significant chronic lung disease (chronic obstructive pulmonary disease [COPD], pulmonary fibrosis)
    • Exposure to toxins such as radon, asbestos, coal and diesel fumes
    • A first-degree relative with lung cancer
    • A personal history of lung cancer, lymphoma or head and neck cancer”

Doctors may perform an imaging test on you for cancer signs. This means taking pictures of parts that are inside your body. One method that your doctor may use is CT scanning. CT scanning uses the typical donut-like machine with a table that pierces through the hole that you see in medical movies. It is an X-ray machine that takes several pictures of different parts of your body as you slide through the machine. Another method is PET scanning. This method is where the patient ingest a radioactive sugar that when a special camera takes pictures, the pictures show whether the cancer has metastasized to other organs or lymph nodes or not. Furthermore, bone scanning is where your doctor injects a safe amount of radioactive material in your veins. This substance would then gather up in the abnormal region of your bone and express themselves as a dense, gray to black shade, which can be cancerous. There are many other kinds of imaging methods out there. 

Procedures that your doctor may perform includes but not limited to:

  • Sputum cytology (where your doctor takes the phlegm, sputum or mucus from the lung to inspect them for cancer cells.)
  • Bronchoscopy biopsy (your doctor inserts a long and flexible tube down to your airways in order to remove a sample from the region for inspection.)
  • Endobronchial ultrasound (your doctor inserts a tube down your airways with ultrasound attached to it in order to look at nearby tissues, organs, and lymph nodes. Needles will pass through the bronchoscopy to get the biopsy sample. The patient will be numbed and will be under light sedation.)
  • Thoracentesis (due to cancer, or some other medical conditions, your back may be filled with liquid. Your doctor will use a needle and inject it in the between your ribs to drain the fluids. The fluid then will be inspected for cancer cells.)
  • And so on…

If you suspect that you have cancer, please consult your doctor and discuss your concern.

Surprising Lung Cancer Symptoms

Treatment

When doctors have enough evidence to diagnose you with cancer, you will begin treatment. The most common three methods are surgery, chemotherapy, and radiation therapy. For small cell lung cancer, chemotherapy and radiation is more common. Another treatment method is targeted therapy. It is a subcategory of chemotherapy. However, unlike general chemotherapy, where the drug will eliminate all kinds of cells, healthy or cancerous, targeted therapy only attacks cancer cells. A new and emerging cancer treatment is immunotherapy. This means that doctors train your immune system to fight against cancer. Three types of immunotherapy includes: CAR T Cells (Chimeric Antigen Receptor T cells), where scientists generate a special kind of antigen receptors on the patient’s T-cells so they can easily bind to the cancer cell’s antigens and eliminate them. Another immunotherapy treatment is cancer vaccination. This is quite self-explanatory. The doctor injects harmless cancer cells into your body to prepare your body for defense when the real cancer hits. Thirdly, checkpoint inhibitors are basically drugs that disable the proteins that prevent your body from fighting cancer. Complementary and Alternative Medicine can go along with standard treatment. These include acupuncture, meditation, magnet therapy, herbal teas, and so on. These are only several treatment methods. Check with your physician for the most fitting treatment for you. 

Lung Cancer Symptoms, Causes, Treatments, Surgeries, and more

Conclusion

Overall, lung cancer is when your lung cells mutate and don’t function properly; it gets in the way of your normal organ functions. It can be divided into non-small cell lung cancer and small cell lung cancer. The three stages of cancer are localized, regional, and distant. Some causes of cancer include tobacco, exposition to carcinogens, family history of lung cancer, old age, etc. When lung cancer manifests in symptoms, these symptoms include constant and worsening cough, blood-coughing, wheezing, jaundice, bone pain, swelling of lymph nodes, etc. Your doctor can diagnose you through CT scans, PET scans, bronchoscopy biopsy, thoracentesis, and so on. When you are diagnosed with lung cancer, a team of doctors may treat you with surgery, chemotherapy, immunotherapy, radiation, and so on.

References

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Andrew Pham, Youth Medical Journal 2020