Can Stress Cause Autoimmunity?

Autoimmune diseases are usually multifactorial that include things like genetics, environmental factors, diet, hormones, and stress. We know that genetics can be a huge factor, but not the deciding factor that causes someone to develop an autoimmune disease. For example, Crohns disease is multifactorial and someone who has a parent that has Crohn's disease is 20-30% more likely to develop it (Feuerstein, 2017). Many of these diseases are out of our control, but these multifactorial ones can be managed with good diet, behaviors, and treatment. In the main research article I was looking at, it emphasized that both physiological and physical stress have been implicated in the development of autoimmune diseases. They saw this effect in animal and human studies. They also found that up to 80% of patients reported emotional stress before disease onset (Stojanovich, 2008). The stress before and the onset of the diseases then increases the stress of the person which creates this vicious cycle where the person is in a prolonged period of stress that disrupts the immune system. This is also due to stress triggered hormones being released that leads to immune dysregulation and increasing cytokine production. The specific cytokine talked about was IL-6 which is a proinflammatory cytokine. Anytime we have chronic inflammation, it's typically a bad thing that leads to something like arthritis depending on the area being affected. 

To sum it up, stress is a factor to autoimmune disease and is one of the factors that we can limit. Habits and lifestyle choice are some of the best ways to have a better life despite having an autoimmune disease.

Feuerstein, J. D., & Cheifetz, A. S. (2017). Crohn Disease: Epidemiology, Diagnosis, and Management. Mayo Clinic proceedings, 92(7), 1088–1103. https://doi.org/10.1016/j.mayocp.2017.04.010

Stojanovich, L., & Marisavljevich, D. (2008). Stress as a trigger of autoimmune disease. Autoimmunity reviews, 7(3), 209–213. https://doi.org/10.1016/j.autrev.2007.11.007

Ehlers Danlos Qualities & Tragedies of Life

Working in healthcare, even emergency care, providers are accustomed to their department "frequent fliers" - those individuals frequently presenting to seek medical care. One subset of these repeat clientile rest in those diagnosed with Ehlers Danlos Syndrome (EDS), a connective tissue (bone, tendon, ligament, and blood vessel) disorder that causes joint hypermobility, skin hyperextensibility, and tissue fragility (The Ehlers Danlos Society, 2023) to varying degrees. Research suggests a strong genetic component to the disease, meaning there are no current cures but rather a focus on alleviating symptoms as they arise. 

These patients do not have a choice but to seek care within the very system that oppresses and diminishes their experiences. The first EDS patient I encountered was seeking treatment for their sixth (6th) hip replacement within a 12-month period. As a 41-year-old... Increased joint mobility contributes to abnormal ranges of motion that cause pain and dislocations, attributing to a decreased quality of life and unbelievably limiting expectations of living; Ehlers Danlos patients can experience a dislocating joint up to once per day (Parry, 2017). Although there are varying degrees of symptomatic expression, early recognition and treatment can present novel treatment options for those affected. 

For the diseases that we are able to recognize and treat early, physical therapy becomes the primary focus, but research progresses as time continues. Joint disability and dislocation lead to an inhibition in activities of daily life, generally curating a protective and preemtpive course of treatment. Families can initiate anticonvulsive, symptom-alleviating, or best-attempt premature treatment to combat EDS. With knowledge of potential future EDS struggles, a family is able to prepare for their independent course of treatment to grant a sense of autonomy to the patient. 

The Ehlers Danlos Society. (2023, July 24). What is EDS?. The Ehlers Danlos Society. https://www.ehlers-danlos.com/what-is-eds/

Parry, J. (2017, January 11). Managing dislocations and subluxations in hypermobile Ehlers-Danlos syndrome and hypermobility spectrum disorders. Managing dislocations and subluxations in hypermobile Ehlers-Danlos syndrome and hypermobility spectrum disorders – The Ehlers-Danlos Support UK. https://www.ehlers-danlos.org/information/managing-dislocations-and-subluxations-in-hypermobile-ehlers-danlos-syndrome-and-hypermobility-spectrum-disorders/

EDS and Autonomy of Choice

Working in healthcare, even emergency care, providers are accustomed to their department "frequent fliers" - those individuals frequently presenting to seek medical care. One subset of these repeat clientile rest in those diagnosed with Ehlers Danlos Syndrome (EDS), a connective tissue (bone, tendon, ligament, and blood vessel) disorder that causes joint hypermobility, skin hyperextensibility, and tissue fragility (The Ehlers Danlos Society, 2023) to varying degrees. Research suggests a strong genetic component to the disease, meaning there are no current cures but rather a focus on alleviating symptoms as they arise. 

These patients do not have a choice but to seek care within the very system that oppresses and diminishes their experiences. The first EDS patient I encountered was seeking treatment for their sixth (6th) hip replacement within a 12-month period. As a 41-year-old... Increased joint mobility contributes to abnormal ranges of motion that cause pain and dislocations, attributing to a decreased quality of life and unbelievably limiting expectations of living; Ehlers Danlos patients can experience a dislocating joint up to once per day (Parry, 2017). Although there are varying degrees of symptomatic expression, early recognition and treatment can present novel treatment options for those affected. 

For the diseases that we are able to recognize and treat early, physical therapy becomes the primary focus, but research progresses as time continues. Joint disability and dislocation lead to an inhibition in activities of daily life, generally curating a protective and preemtpive course of treatment. With knowledge of potential future EDS struggles, a family is able to prepare for their independent course of treatment to grant a sense of autonomy to the patient. 

The Ehlers Danlos Society. (2023, July 24). What is EDS?. The Ehlers Danlos Society. https://www.ehlers-danlos.com/what-is-eds/

Parry, J. (2017, January 11). Managing dislocations and subluxations in hypermobile Ehlers-Danlos syndrome and hypermobility spectrum disorders. Managing dislocations and subluxations in hypermobile Ehlers-Danlos syndrome and hypermobility spectrum disorders – The Ehlers-Danlos Support UK. https://www.ehlers-danlos.org/information/managing-dislocations-and-subluxations-in-hypermobile-ehlers-danlos-syndrome-and-hypermobility-spectrum-disorders/

How Does Caffeine Affect Us Physiologically?

 Considering a large population around the world drinks coffee or some kind of caffeinated drink, I decided to do some research looking into the effects and what's going on physiologically when we consume these products. 

What I found was that caffeine generally has three effects on the central nervous system. One of them is its ability to stimulate antagonism at the adenosine receptor level. Methylxanthine, a naturally occurring molecule in coffee, teas, and energy drinks triggers a stimulatory effect on these receptors which are important releasing neurotransmitters for sleep regulation, arousal, cognition, memory, and learning (Fiani, 2021).  The second mechanism affects how methylxanthine promotes the movement of calcium through the sarcoplasmic reticulum and plasma membrane. Then, the calcium is released by the synaptic into the peripheral and central nervous systems. It once again affects the neurotransmitters that are dependent on the calcium entering the nerve endings. Research said that with a low concentration/ low dosage of caffeine, the calcium uptake is greater than normal. It also said that a large dosage inhibits this calcium uptake which is probably due to too much calcium flooding the system. The final mechanism mention was methylxanthines ability to inhibit phosphodiesterases which prevents cAMP from being broken down. cAMPs function is to release hormones like dopamine, epinephrine, and norepinephrine when there is an accumulation of it. This affects your mood, memory, alertness, and cognitive function. It's some really interesting stuff and the conclusion that this study came to was that caffeine had the biggest effects on mood, specifically anxiety, enhancing processing speed, short term and long term memory in adults (Lieberman, 2002). Children were not well research in this study and called for more attention and research to be done in the pediatric population. 

Fiani, B., Zhu, L., Musch, B. L., Briceno, S., Andel, R., Sadeq, N., & Ansari, A. Z. (2021). The Neurophysiology of Caffeine as a Central Nervous System Stimulant and the Resultant Effects on Cognitive Function. Cureus, 13(5), e15032. https://doi.org/10.7759/cureus.15032

Lieberman, H. R., Tharion, W. J., Shukitt-Hale, B., Speckman, K. L., & Tulley, R. (2002). Effects of caffeine, sleep loss, and stress on cognitive performance and mood during U.S. Navy SEAL training. Sea-Air-Land. Psychopharmacology, 164(3), 250–261. https://doi.org/10.1007/s00213-002-1217-9

Surrogacy Dilemma

    Pregnancy is, in my opinion, one of the greatest biological capabilities that we are capable of. Developing a human being within your own body and then going on to be its parent and raise the child into a fully grown capable human being is something many people in our world dream of. However, for some this is not a possibility due to infertility issues that may arise under a wide array of circumstance. A rise in infertility has lead to an increase in assisted reproductive techniques, or surrogacy, as a common practice. Surrogacy is when a surrogate mother bears a child for a couple or individual who are may be infertile. There are two types of surrogacy that can be implemented, the first being gestational fertility, which as become more common, which uses in vitro fertilization and then places the embryo within the surrogate mother (Saxon et al. 2012). The other type is traditional surrogacy, where the surrogate mother is impregnated with the fathers sperm artificially, this means that the surrogate mother is genetically and gestational the mother of the child (Saxon et al. 2012). Typically, when surrogacy is performed, there is a contract signed between the mother and the couple or individual who will be the child's parents.

    There, of course, are a handful of ethical issues that arise when discussing the idea of surrogacy. The first being the idea that when a surrogacy is performed, it creates a divided between genetic, gestational, and social parenthood, as the surrogate mother will be the gestational (and potentially genetic) mother of the child, while the parents will take over for the social aspect of parenthood (Meinke, 1988). Another issue that comes up is the detrimental effects that surrogacy can have on the surrogate mother. There is an extreme amount of stress that comes with being a mother and going through pregnancy under normal circumstance, but in surrogacy there is added stress due to the emotional and psychological effects that can arise from giving up the baby (Meinke, 1988). In fact, there have been cases where the surrogate mother refused to give up the child and had to go to court to sort out the custody of the child.The final ethical issue that I will talk about is perhaps the most concerning to me, the idea of commercial vs. altruistic surrogacy. This is an area where things get very complicated, as both sides of the argument have significant ethical issues. With commercialized surrogacy, the mother is financially rewarded, which can lead to the the development of a market for this type of exchange. This can lead to exploitation by coercion and potential reproductive labor being forced on individuals, especially in lower income areas (Blazier and Janssens, 2020). On the other side, altruistic surrogacy also has ethical issues. This is when there is no financial reward to the surrogate mother, with can lead to exploitation in other ways (Blazier and Janssens, 2020). There have been countries that have taken up each approach, with the Netherlands taking a altruistic approach and India taking a commercial approach to surrogacy, but, overall it is clear that both sides have their issues, and there is regulations that need to be put in place to keep the best interest of the mothers and the couples in mind.

Blazier, J., & Janssens, R. (2020). Regulating the international surrogacy market:the ethics of commercial surrogacy in the Netherlands and India. Medicine, Health Care and Philosophy, 23(4), 621–630. https://doi.org/10.1007/s11019-020-09976-x 

Saxena, P., Mishra, A., & Malik, S. (2012). Surrogacy: Ethical and legal issues. Indian Journal of Community Medicine, 37(4), 211. https://doi.org/10.4103/0970-0218.103466 

Surrogate motherhood: Ethical and legal issues ... - georgetown university. (n.d.). https://repository.library.georgetown.edu/bitstream/handle/10822/556906/sn6.pdf?sequence=1 

Physiology of Peripheral Nerve Injuries

     When one thinks of nerve damage in the body, our minds may first go to internal causes such as diabetes or autoimmune diseases such as rheumatoid arthritis. In fact, I would probably agree with this train of thought, especially as someone who is more aware of the internal processes of the body than the common person. That is until I was called to the hospital one day last summer to pick up my sister who had cut her finger while opening a package. Initially the doctors did not think that there was any serious damage in the finger, and sent her on her way with a bit of surgical glue to close the wound. A few days later, however, she began to loose feeling in her finger, which of course began to raise some flags. She finally went to see an orthopedic surgeon, who identified that she had in fact completely severed the nerve in her hand and would need to go into surgery as soon as possible to attempt to repair the nerve.

     This type of peripheral nerve injury (PNI) by laceration makes up about 30% of all PNIs (Burnett and Zager, 2004). When an injury to the nerve takes place, there is a degenerative process that takes place, and the damaged nerve endings will retract due to the elastic endoneurium (Burnett and Zager, 2004). Inflammation then occurs, leading to swelling and the formation of scar tissue(Burnett and Zager, 2004). If this is not treated shortly after the injury, there can be detrimental affects to the nerve, including nerve death, this is what happened in the case of my sister. Due to the fact that the ER doctors did not initially detect any issue with the nerve and she was sent home, this allowed for the degradation to occur to the nerve causing it to die. As I mentioned, she was able to get a surgery performed to try and resolve the issue, but they had to use a cadaver nerve to replace the damaged nerve in her finger. There were a few months of treatment and occupational therapy required, but now she is able to fully use her finger again with fully neurological function.

Burnett, M. G., & Zager, E. L. (2004). Pathophysiology of peripheral nerve injury: A brief review. Neurosurgical Focus, 16(5), 1–7. https://doi.org/10.3171/foc.2004.16.5.2 

The Costly Consequences of Vaccine Misinformation

Misinformation-fueled hysteria has produced conspiracies surrounding vaccinations for years, tragically and predominantly arising from a scientist frustrated with his data yielding undesired results. Andrew Wakefield believed a positive correlation existed between the Measles, Mumps, & Rubella (MMR) Vaccine and autism diagnoses in children - setting out on a mission to prove it. The eventually-published studies vastly skewed any data collected, while demonstrating poor experimental etiquette - ranging from extremely small sample size (12 subjects) to declining recognition of other contributions and correlations in his discussions (Children's Hospital of Philadelphia, 2013). 

Autism did not receive an official, distinguishable definition until the mid-2000s, preceded by ideals of Asperberger Syndrome (National Autistic Society). With the combination MMR vaccine becoming available in 1971, closely followed by the main Wakefield paper being published in 1998, a monumentally drastic reduction of parent's opting to vaccinate their children resulted. Initial approval of the MMR vaccine gave way to vaccination requirements, educational propagation, and eager compliance that was undone by Wakefield and his supporters. 

While vaccines possess risks (as is applicable to any medication), their dangers are extensively and carefully examined before being accepted and promoted for human use. Vaccines were generally accepted as the future of eradicating contagious diseases until skepticism degraded this hope, festering fear instead. This fear has not only affected the MMR subset of vaccines, but grown to encompass the concept of vaccines in general; as conspiracy continues to be fed, declining vaccination rates lead to decreased immunity and a higher susceptibility of becoming infected - regardless of immunization status (Conis, 2019). This inaccurate vaccine trepidation must be resolved for the future of treatable diseases within humanity. 

The Children’s Hospital of Philadelphia. (2014, November 5). Vaccines and Autism. Children’s Hospital of     Philadelphia. https://www.chop.edu/centers-programs/vaccine-education-center/vaccines-and-other-            conditions/vaccines-autism

Conis, E. (2019). Measles and the Modern History of Vaccination. Public Health Reports, 134(2), 118–125. https://doi.org/10.1177/0033354919826558

National Autistic Society. (n.d.-b). The history of autism. National Autistic Society. https://www.autism.org.uk/advice-and-guidance/what-is-autism/the-history-of-autism 

Questionable Ethics of Hospital Birth Practices

For all of history, until relatively recently, women have traditionally given birth using positions that are instinctively beneficial and allow for gravity to aide in the birthing process. Currently, however, a more technological approach is widely accepted in hospitals and by most care providers. Women give birth lying on their backs, and in many cases push when their doctors or nurses tell them to, rather than when they feel a natural urge to. 

An article I found about healthy birth practices explores where current research stands on birth positioning and directed pushing and emphasizes the gaps in the research and what is currently practiced in the majority of hospitals. The authors first focus on birth positioning. There have been over 30 years of research which confirms that giving birth in a supine position has no advantages for mothers or infants, and in fact is clearly inferior to traditional positions of standing, sitting, or squatting. Despite this knowledge and no research that refutes it, the number of women who give birth in a supine position has continued to increase. The article then discusses directed pushing. For about as long as people have been questioning the supine position, there has been research into the practice of directing women to push as soon as the cervix reaches full dilation. Patient-directed pushing has been shown by multiple studies to be a superior practice, which promotes the health of mothers and infants, and is more in line with the body’s natural physiological processes, ensuring a smoother birth. 

I find it a little bit unbelievable how this research has been consistently refuting accepted practices for three decades, and still almost nothing has changed. When medical practices that are widely accepted conflict with the natural physiological processes of the human body, there is something obviously wrong. Is it ethical to continue to promote practices that are continually proven to be less effective and even harmful? I would say that it is most certainly not. This is an excellent example of the way in which health care systems often exhibit bias against female patients. It is a discrepancy we do not talk about enough, so I think it is important to teach ourselves about examples such as this one. 

Source: 

DiFranco JT, Curl M. Healthy Birth Practice #5: Avoid Giving Birth on Your Back and Follow Your Body's Urge to Push. J Perinat Educ. 2014 Fall;23(4):207-10. doi: 10.1891/1058-1243.23.4.207. PMID: 25411541; PMCID: PMC4235063.

When Should Animals Be Used in Research?

 In my time at Regis, I have had several classes that have discussed the ethics of the medical field because many people might be going into that field. Some people might even be moving on to becoming researchers and it's important to understand what we can and cannot do. Most if not all doctors will take a hypocratic-like oath to do no harm to other unless it's necessary, and to do good onto others. The medical field can be a dangerous place for those who are not careful and don't understand the rules ethics boards have made. For this post, I wanted to talk more about the use of animals in research as this is also one of the topics that we cover in any ethics class. What makes an animal deserving of beneficence? Does having a vertebra make certain animals more deserving of ethical consideration? 

One interesting paper I found was looking at the idea and seeing whether or not if animals are as good as we think they are. The paper goes on to say that animals have been used as a tool of science since the 18th century and has served as a way for us humans to conduct experiments and understand our own anatomy. It highlights that animal studies have been "invaluable for elucidating general functional similarities, pathways, processes, and guiding the development of hypotheses to test in target animals" (Wall, 2008). Don't get me wrong, animals are important when we can't experiment on what we want to. However, efficacy of the animal model needs to be taken into consideration when doing these studies. If not, it becomes a waste of time, energy, money, and can lead to stress on the animals. Researchers have developed ways to look at what makes a good animal model by using genome sequencing and comparing the knowledge being found with the animal study and applying that to the target animal. I'm not sure how much this has been discussed in other people classes, but this is a new topic for me. How closely do these animals resemble the target animal we want to test treatments on? I guess a lot of this is factored into choosing which animal they will test, but it always raises the question: how many animals models are being wasted through testing? 

Wall, R. J., & Shani, M. (2008). Are animal models as good as we think?. Theriogenology, 69(1), 2–9. https://doi.org/10.1016/j.theriogenology.2007.09.030

Advancing our Understanding of Treatments for Spina Bifida Patients

Spina Bifida is a neurological disorder in which the spinal column of a developing fetus does not close correctly. This neural tube defect occurs within the first month of pregnancy and can cause damage to the nerves and spinal cord. The effects of Spina Bifida range in severity, with the most severe cases having a myelomeningocele (MMC), which is an incomplete spinal canal. Hydrocephalus (excess cerebrospinal fluid in the brain) is, according to this review, the most important comorbidity of MMC, because a buildup of fluid in the ventricles of the brain causes pressure to be put on brain tissue which can lead to a variety of negative effects. Treatment for hydrocephalus is usually the placement of a shunt to drain excess CSF down the spinal column. 

In this review, researchers discuss key aspects of hydrocephalus, assessing where current research stands. One thing they discussed was intrauterine closure of myelomeningocele (IUMC), which has been proven to reduce cases of hydrocephalus in Spina Bifida patients. In cases where IUMC is not an option, patients must undergo surgery to close the MMC and to place a shunt for hydrocephalus. Doing both in one surgery can reduce the strain on the child. In less severe cases, there has been a recent trend towards treatments that care for infants with MMC while delaying the placement of a shunt, and this has led to a reduction in the number of cases which need a shunt to combat hydrocephalus. Throughout infancy, childhood, adolescence, and adulthood, shunt failure is relatively common. Recent research has increased understanding of the signs of shunt failure, and more must be done to minimize its frequency in the future. 

Spina Bifida is very interesting to me, because it is a disease which affects the nervous system, and therefore has impacts on multiple bodily processes. I think it is amazing and a testament to the complexity of the human body that people with Spina Bifida can live with damage to a structure as vital as the spinal cord. Continued research has led to amazing advancements and expansion of our knowledge on Spina Bifida and hydrocephalus. The researchers in the review mentioned that more research needs to be done on adults with this disorder because people are living longer with the condition, and I think that is an incredible reminder of how far we have come, and how far there still is to go. 

Source: 

Blount, J. P., Maleknia, P., Hopson, B. D., Rocque, B. G., & Oakes, W. J. (2021). Hydrocephalus in Spina Bifida. Neurology India, 69 (Supplement), S367–S371. https://doi.org/10.4103/0028-3886.332247 

Ethical Issue: Assisted Dying

 

There are four principles in biomedical ethics: autonomy, beneficence, nonmaleficence, and justice (Akdeniz et al., 2021). Autonomy is defined as the right of the patient to decide the care that they should receive (Akdeniz, 2021). Beneficence is defined as the responsibility of the physician to provide the best care they can for the patient (Akdeniz, 2021). Nonmaleficence is a principle in which the physician should not give harm to patients (Akdeniz, 2021), a vow called the Hippocratic Oath that is derived from Latin called “Prinum non nocere”, or “first, do no harm” (Shmerling, 2015). Due to the first three principles, Assisted Dying or Assisted Suicide has been a controversial ethical problem facing the medical field (Dugdale et al., 2019).

Assisted Dying (AD) is a term that includes both physician-assisted dying and voluntary active euthanasia (Fontalis et al., 2018). Physician-assistant dying is when a physician aids in the process of dying of the patient upon the patient’s wish by providing lethal drugs for the patient to self-administer (Fontalis, 2018). The same happens in voluntary active euthanasia, except in this case, the physician performs the administration of the lethal drugs (Pereira, 2011). In both cases, the patient will die an unnatural death through the administration of lethal drugs. Currently, AD is legal in four European countries (Netherlands, Belgium, Switzerland, and Luxemburg), Canada, Colombia, and the United States (Fontalis, 2018).

Pro arguments for AD include the right for patient autonomy and the relief of suffering (Dugdale, 2019). Another pro argument is that AD is safe medically and provides an option for people to choose to die safely instead of committing suicide and die other ways (Dugdale, 2019). Cons argument include the slippery nature of the determination of what is considered an “incurable and irreversible” terminal illness (Doerflinger, 2018); (Dugdale, 2019). An investigation on Oregon’s law on Assisted Dying shows that the eligibility of patients for AD is based on “two doctors think they are likely to die in six months without treatment – even if they could have been cured by treatment or could live for years or decades if treated” (Doerflinger, 2018). Another con argument is that seriously ill patients are usually influenced by depression and suicidal thoughts (Doerflinger, 2018); (Dugdale, 2019), which can influence their decision for AD, but they are often not referred to for psychological evaluation for clinical depression (Dugdale, 2019). In addition, the financial stress of an expensive healthcare system could definitely be a contributing factor to end-of-care decisions, and 55% of patients who agree to assisted dying because they don’t want to become a “burden on family, friends, or caregivers” (Doerflinger, 2018).

Citations:

Akdeniz, M., Yardımcı, B., & Kavukcu, E. (2021). Ethical considerations at the end-of-life care. SAGE Open Medicine, 9, 20503121211000918. https://doi.org/10.1177/20503121211000918

Doerflinger, R. M. (2018). Oregon’s Assisted Suicides: On Point.

Dugdale, L. S., Lerner, B. H., & Callahan, D. (2019). Pros and Cons of Physician Aid in Dying. The Yale Journal of Biology and Medicine, 92(4), 747–750.

Fontalis, A., Prousali, E., & Kulkarni, K. (2018). Euthanasia and assisted dying: What is the current position and what are the key arguments informing the debate? Journal of the Royal Society of Medicine, 111(11), 407–413. https://doi.org/10.1177/0141076818803452

Pereira, J. (2011). Legalizing euthanasia or assisted suicide: The illusion of safeguards and controls. Current Oncology (Toronto, Ont.), 18(2), e38-45. https://doi.org/10.3747/co.v18i2.883

Shmerling, S. R. H. (2015, October 13). First, do no harm. Harvard Health. https://www.health.harvard.edu/blog/first-do-no-harm-201510138421

Mental Health and Lupus

Systemic lupus erythematosus (lupus) is a chronic, inflammatory,  autoimmune disease affecting organs such as connective tissues, skin, joints, and kidneys. Lupus is most commonly diagnosed in younger age groups. It could lead to fatal complications and organ damage. Lupus is currently classified as a rare disease with no cure. Lupus patients experience physical symptoms that depend on the organ that is affected, but they also experience negative emotional symptoms and experiences. Their quality of life is negatively impacted by physical dysfunction and psychosocial factors such as anxiety, depression, and poor self-esteem. Anxiety and depression have a biological connection with lupus, and about 40% of patients with lupus also have anxiety and depression. Lupus patients feel the most anxious when they are unable to control their physical functions and become worried about the progression of their disease. Quality of life in patients with lupus has been worse than in patients who have hypertension, diabetes mellitus, or myocardial infarction.  

A previous study in Korea assessed patients with lupus' quality of life. They found a mean quality of life score of 63 out of 100, which shows an average quality of life. This mean quality of life score is around the same range in patients with lupus in Britain, Turkey, and Mexico. However, patients with lupus reported a poorer quality of life when they had trouble walking and engaging in self-care. They reported a higher quality of life when they could participate in social activities. Anxiety, disease activity, depression, and duration since diagnosis were the most significant contributing factors towards a patient's quality of life. There have been other studies that support depression as the most decisive factor towards lower quality of life instead of anxiety. 

Mental health should be made a high priority for patients with lupus. There should be more resources and supportive care given to patients with lupus and any chronic disease to improve their quality of life. Quality of care is also dependent on healthcare interactions, and a higher quality of care could improve quality of life due to numerous hospital and doctor's visits. Other factors contribute to quality of life, such as disease onset, severity of symptoms, complications, and medications, but improving mental health could help raise quality of life. Care teams can provide helpful resources to patients by enabling those unable to engage in self-care, providing more social activities, and motivating patients to pursue their careers are some ways the quality of life can be improved. Lupus is a rare chronic disease but has brutal and devastating symptoms at times. More research should be done to enhance the quality of life for patients with lupus and any chronic illness. 

Arora, S., Katz, P., Nika, A., Sequeira, W., Block, J. A., Yazdany, J., Yelin, E., & Jolly, M. (2023). Does higher quality of care in systemic lupus erythematosus improve quality of life? Arthritis Care & Research, 75(6), 1198–1205. https://doi.org/10.1002/acr.24979 

Cho, O.-H., Hwang, K.-H., & Lim, J. (2021). The influence of anxiety and depression on Korean Lupus Patients’ quality of life. Nursing Practice Today. https://doi.org/10.18502/npt.v8i3.5936 

The Ethical Decision to Add Zombie Cells to Improve Old Age

 Over these past few months, there has been a topic in the scientist field, known as zombie cells. However, what exactly are those zombie cells? Zombie cells are cells that are damaged and refuse to die, therefore as we age the damaged cells start to accumulate them that can cause aging and conditions like Alzheimer’s disease (Barbour 2023). The correct term of the zombie cells are senescent cells, that have been the talk of improving health in old age. The meaning behind the name “zombie” cells is due  to the chemicals that spit out and cause damage to nearby cells, this turns them into zombie cells. Zombie cells affect the function of some organs and tissues in the body. 

    This organ damage is more susceptible in older aged individuals, since the damaged cells accumulate, and go through a irreversible removal in the cell cycle called apoptosis or lose the ability to grow that stimulate the immune system to clear those cells, and so the older you get the harder it gets for the those damage cells to get cleared more effectively.Therefore, because of those zombies cells researchers have been able to come up with how to clear these cells, as they are creating drugs to remove the senescent cells, so that humans can inject these drugs to live a longer healthier life (Shubin, 2017). It questions whether this ethical to the idea of naturalization of life and what effect does it have on the economy? How ethical is it to have this drug? 

    In late 2016, there has been research done on mice and rats, and it has been seen that the drugs that have been created kill the senescent cell, so they have started up companies to develop this drug for humans (Shubin, 2017). As they been put to work and  the need to stop old age, there is a controversy in this drug that is coming out as the removal of the senescent cells help get rid of all the cardiovascular disease that comes with aging. As this drug has been a help to improve conditions such as cataracts, diabetes, heart failure, and kidney problems (London, 2023). The removal of these zombie cells can lead to improved cardiomyocyte survival and cell cycle activity, and the ability to form new blood vessels. However, there is controversy as it can trigger DNA damage and shorten our telomeres, and having a drug that does this present a huge economy standpoint on older people taking this drug to have a longer life will double the population and amount of carbon footprint that will be created if people who are 65 years old can live up longer than what they are suppose to because of this drug. There's a lot of controversy on DNA damage of the zombie cells because of the unpredictable effects on the future genome (Ungar 2022). 

    Even though there's a lot more information on the ethics of how well this drug will work, it leads to disagreement within the society of whether it is ethically correct to do that, and what are the cons and pros that come with doing such thing, especially in the human body that can bring further advancements on research.

Work Cited:

Dominick Burton,Research Fellow. (2023, June 8). Killing “zombie” cells to improve health in old age. The Conversation. https://theconversation.com/killing-zombie-cells-to-improve-health-in-old-age-74557 hubba177. (2019, November 1). Defining “zombie cells.” Medical School. https://med.umn.edu/news/defining-zombie-cells

King’s College London. (2023, April 25). New Group of drugs found to eliminate “zombie” cells associated with cardiovascular disease. https://www.kcl.ac.uk/news/new-group-of-drugs-found-to-eliminate-zombie-cells-causing-cardiovascular-disease#:~:text=’Senescence’%20is%20the%20term%20given,cell%20survival%20and%20reparative%20potential.

Ungar, L. (2022, September 1). Zombie cells central to the quest for active, vital old age. AP News. https://apnews.com/article/zombie-cells-central-quest-active-vital-old-age-e52713983444185dcd6ed116305d0764

X, S. (2023, April 20). New Group of drugs found to eliminate “zombie” cells associated with cardiovascular disease. Medical Xpress - medical research advances and health news. https://medicalxpress.com/news/2023-04-group-drugs-zombie-cells-cardiovascular.html

The Complications of Emphysematous Cystitis

     Emphysematous cystitis is a rare infection of the urinary system that produces gas production in the bladder, and can be considered a complicated urinary tract infection. This is because there is a production of yeast and bacteria that develops in the urinary tract that causes this urinary infection, and it is mostly diagnosed in diabetic middle aged women than in men (Eken, 2013). The disease has no diagnostic clues, and can be noticed by the presence of air in imaging studies. This disease can be potentially fatal if it is not taken care of, and there are many factors that can derive this disease, however, with proper care it can be taken care of on time before it is too late.

    About two thirds of this disease is caused by E.coli, and the other third is caused by Enterbacter, Clostridium, Staphylococcus aureus species (Eken, 2013). E. coli usually lives in the gut, however, when feces shed it causes the bacteria to spread to an opening of the urinary tract and the bladder causing problems (Bhandari, 2017). A patient with this usually has dysuria, hematuria, abdominal pain, urinary urgency, and small presence of air bubbles called pneumaturia (Alma, 2013). 

    There was a rare case, in which, they could not find out what the 49 year old female, had type two diabetes and was in the emergency room for urinary frequency and pneumaturia for several weeks. They had to take laboratory tests because it was unknown of what it was that she had, and the tests did reveal abnormal results as there was a lot of bacteria in urine; however it was found that she had hyperglycemia, and she was not diagnosed with this disease until she did computed tomography to find the gas in the bladder wall (Nelson, 2021). 

    This can be diagnosed, by looking at through radiography, and it can be difficult to look at pneumaturia, especially in diabetic patients. This is because "carbon is produced through fermentation due to the glucose concentrations being high, however in non-diabetics it is seen that the tissue proteins and urinary lactulose that serve as substrates increase the pressure of the pneumaturia" (Alma, 2013). This rare urinary disease can lead to other problems like Crohn's disease or carcinoma of the colon or bladder, and if not treated with antibiotics can lead to death. As the overall death rate of people with this disease is 22.9% (Chen, etc, 2023). Even though this disease is rare in the urinary system, it allows us to be better informed about diseases that have death rates, as it serves as a learning experience to learn about diseases that are very rare in the healthcare field.

Work Cited 

Bhandari, T. (2018, December 27). UTI treatment reduces E. coli, and may offer alternatives to antibiotics. Washington University School of Medicine in St. Louis. https://medicine.wustl.edu/news/uti-treatment-lowers-numbers-gut-e-coli-may-offer-alternative-antibiotics/#:~:text=become%20life%2d Threatening.-,Most%20UTIs%20are%20 used%20by%20E.,where%20they%20can%20cause%20problems.

Chen, Y.-H., Hsieh, M.-S., Hu, S.-Y., Huang, S.-C., Tsai, C.-A., & Tsai, Y.-C. (2023, February 13). Scoring systems to evaluate the mortality risk of patients with emphysematous cystitis: A retrospective observational study. MDPI. https://www.mdpi.com/2075-4426/13/2/318#:~:text=Several%20studies%20had%20 reported%20the,%25%20%5B2%2C3%5D.

Eken, A., & Alma, E. (2013). Emphysematous cystitis: The role of CT imaging and appropriate treatment. Canadian Urological Association journal = Journal de l’Association des urologues du Canada. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3840514/#:~:text=Emphysematous%20cystitis%20is%20a%20relatively,diabetic%20patients%20with%20unusual%20presentations.

Emphysematous cystitis - mayo clinic proceedings. (n.d.). https://www.mayoclinicproceedings.org/article/S0025-6196(21)00186-5/fulltext

Intrauterine Growth Restriction (IUGR) and Complications on Future Developments

 

Intrauterine Growth Restriction (IUGR) is a condition when the fetus is growing at a slower rate than normal (Sharma et al., 2016), and it is often associated with low birth weight or small for gestational age (SGA). However, IUGR is not the same as SGA, even though the two terms are often used interchangeably (Sharma, 2016). SGA means the baby weight less than 10^th percentile, whereas IUGR means the baby shows features of malnutrition and in-utero growth retardation (Sharma, 2016). IUGR affects about 10% of pregnancies and can be caused by a variety of factors such as maternal factors (ex: maternal age, socioeconomic status, etc.,), fetal factors (ex: pregnant with twins or triplets, genetic syndromes, etc.,), placental factors (ex: infections, placental weight, etc.,), and genetics (Sharma, 2016). Diagnosis of IUGR can be more accurately determined if the provider knows the first day of the last menstrual period and by 3^rd-trimester ultrasounds (Intrauterine Growth Restriction, n.d.). Once diagnosed, IUGR pregnancies could be managed antenatally and monitor and during delivery (Sharma, 2016; Peleg et al., 1998).

Babies born with an IUGR or SGA or both are often at a higher risk for health problems that can carry later into adulthood (Sharma, 2016). Some short-term complications of IUGR include conditions related to the lungs (such as pulmonary hemorrhage and persistent pulmonary hypertension), the heart and the kidneys (Sharma, 2016). This is due to a redistribution of blood flow from other parts of the body to provide nutrients and oxygen for the brain (Tchirikov et al., 1998) (Yajnik, 2004). Due to this, IUGR babies also have lower muscle mass compared to babies who are appropriate for gestational age (AGA), and this reduction in muscle mass and strength carries into adulthood (Brown & Hay, 2016). Other long-term consequences of IUGR that carry into adulthood include hypertension, immune dysfunction, lung abnormalities, ischemic heart disease, etc., in addition to an increased risk for neurodevelopmental problems (Wang et al., 2016) (Sharma, 2016) such as poor reading and mathematics learning (Sharma, 2016).

Even though there are a lot of complications regarding IUGR, according to Cleveland Clinic, most fetuses diagnosed with IUGR are healthy and just need more monitoring during pregnancy. In addition, environmental factors can play important roles in the development of a child that carry consequences into adulthood. By providing your child with a healthy and safe environment to live and learn in, a child with IUGR can thrive and live happy like any other children.

Citations:

Brown, L. D., & Hay, W. W. (2016). Impact of placental insufficiency on fetal skeletal muscle growth. Molecular and Cellular Endocrinology, 435, 69–77. https://doi.org/10.1016/j.mce.2016.03.017

Intrauterine Growth Restriction: Causes, Symptoms & Treatment. (n.d.). Cleveland Clinic. Retrieved November 28, 2023, from https://my.clevelandclinic.org/health/diseases/24017-intrauterine-growth-restriction

Peleg, D., Kennedy, C. M., & Hunter, S. K. (1998). Intrauterine Growth Restriction: Identification and Management. American Family Physician, 58(2), 453–460.

Sharma, D., Shastri, S., & Sharma, P. (2016). Intrauterine Growth Restriction: Antenatal and Postnatal Aspects. Clinical Medicine Insights. Pediatrics, 10, 67–83. https://doi.org/10.4137/CMPed.S40070

Tchirikov, M., Rybakowski, C., Hüneke, B., & Schröder, H. J. (1998). Blood flow through the ductus venosus in singleton and multifetal pregnancies and in fetuses with intrauterine growth retardation. American Journal of Obstetrics and Gynecology, 178(5), 943–949. https://doi.org/10.1016/s0002-9378(98)70528-9

Wang, Y., Fu, W., & Liu, J. (2016). Neurodevelopment in children with intrauterine growth restriction: Adverse effects and interventions. The Journal of Maternal-Fetal & Neonatal Medicine, 29(4), 660–668. https://doi.org/10.3109/14767058.2015.1015417

Yajnik, C. S. (2004). Obesity epidemic in India: Intrauterine origins? The Proceedings of the Nutrition Society, 63(3), 387–396. https://doi.org/10.1079/pns2004365