Popcorn: Delicious or Destructive?

  Popcorn lung (bronchiolitis obliterans), despite having a funny name, is a very serious disease that is becoming increasingly more common. It was first diagnosed in individuals who worked at popcorn factories. These workers were constantly breathing in diacetyl, which was used to create the buttery flavor in microwave popcorn. As a result, workers experienced coughing, wheezing, and shortness of breath (among other symptoms). This was due to the bronchioles of the lung becoming inflamed, resulting in a narrower airway and scarring of the air sacs. Therefore, it became more difficult for these individuals to efficiently breathe (harder to get a sufficient amount of air). Luckily, manufacturers removed diacetyl from their products so we can now enjoy microwave popcorn without potentially damaging our lungs.

Popcorn lung is relatively common in individuals who have recently received a lung transplant since they are more vulnerable to infections. However, it is considered a rare disease in the general population. Although there is a new upcoming population of individuals who are willingly putting themselves at higher risk for Popcorn lung. As the popularity of vapes and e-cigarettes increase, more people are inhaling dangerous chemicals such as diacetyl. Harvard researchers discovered that approximately 76% of e-cigarette brands use diacetyl in their products, despite knowing the dangerous nature of the substance. Even if you are not personally vaping, the second hand exposure can also be detrimental to the health of your lungs.

This issue becomes significantly more alarming as the damage done to the lungs is not always reversible. Physicians often prioritize management, which is more effective if caught early. However, Popcorn lung ranges in its severity and some individuals do not initially experience symptoms. Physicians will often prescribe corticosteroids, inhalers, and oxygen therapy to mediate the symptoms individuals experience. In the case of vaping, the first step would be to quit. Individuals possess autonomy over their bodies and ultimately it is their decision to inhale harmful chemicals. However, this choice should be made after learning more about the potential diseases vaping can cause.

Sources:

https://my.clevelandclinic.org/health/diseases/22590-popcorn-lung-bronchiolitis-obliterans

https://www.lung.org/blog/popcorn-lung-risk-ecigs

https://www.webmd.com/lung/popcorn-lung#1

My Sister Likes the Taste of Soap

  Cilantro is one of the most controversial, heavily debated herbs. To some individuals, it’s a refreshing and bright addition to any meal. For others, cilantro has a pungent soap flavor. This can be attributed to genetic differences between populations. More specifically, variations in taste and sensory receptors that influence overall sensory perception (Knaapila et al., 2012). The genes hypothesized to be involved in cilantro’s perceived taste are TRPA1, GNAT3, and TAS2R50 (Knaapila et al., 2012). This taste study was conducted on twins in order to determine if taste perception is attributed to genetic or environmental factors. I would say it embodies the autonomy biomedical value, as the research took volunteers who willingly consented to be studied. Therefore, autonomy was heavily considered in the experimental process.

My sister and I have opposing views on cilantro. She loves a good cilantro garnish, while I would prefer my food cilantro-less. This doesn’t seem odd, until you consider that we are monozygotic twins. Meaning, we should, for the most part, share fairly similar genomes. In the cilantro debate, this can only mean one thing. We have the soap gene and, therefore, my sister enjoys the taste of soap. Conversely, we don’t have the soap gene and I genuinely don’t like the taste of cilantro. However, it turns out there’s more to the cilantro controversy. Although monozygotic twins share mostly the same genes, there can still be some mutations that result in diversity. Also, it turns out that sensory perception is only partially explained by our genetic foundation. This adds some nuance to the argument. Maybe my sister does have the cilantro soap gene, but there are additional external influences that alter her perception of it. Another possible explanation is that one of us could have acquired a mutation, causing one to have the soap gene and the other one to lack it. Overall, I guess we can’t definitively prove that my sister enjoys the taste of soap, but I would argue that we also can’t prove that she doesn’t.

https://academic.oup.com/chemse/article/37/9/869/327642

https://www.npr.org/sections/thesalt/2012/09/14/161057954/love-to-hate-cilantro-its-in-your-genes-and-maybe-in-your-head

Download your pain away!

 

As new medical technologies further develop every day this new pain management treatment is straight out of a science fiction story. For those suffering from chronic pain, the idea of simply opening an app and changing a setting to relieve their pain sounds too good to be true. But with a spinal cord stimulator, this is totally possible. Sensory neurons wrap around to the dorsal side of the spinal cord and continue this way up the spinal cord to the brain. Placing a spinal cord stimulator which sends a low electrical signal that disrupts these sensory pain signals from reaching the brain and replacing them with a different one. This new signal is typically described as tingling rather than a painful feeling. The issue with using a spinal cord stimulator Is you are not treating the underlying causes of the pain. For example, if the pain is due to a mechanical issue this will not be changed and could cause more physical damage to tissues or joints that would not otherwise occur if you could feel pain. Therefore, it is often used as a last resort treatment.

The surgery is fairly simple, to begin the patient is mildly sedated and two leads are placed in the epidural space typically in the lower thoracic region. They are run along the entire length of the epidural space with guidance from x-rays until they find their new home typically in the thoracic region. The leads are maneuvered to locations associated with the patient’s worst described pain. The sedation is lifted and the leads are activated. After some calibrating to ensure all the right areas are “turned off” the patient is hooked up to an external portable battery. After the trial, if it was a success, they will leave the leads in and simply unhook the portable battery and insert a little permanent battery much like a pacemaker into the back under the skin. This battery is charged much like modern phones with wireless charging capabilities. Once inserted under the skin, the patients have full control over the device through the use of their phones. They can change the intensities for different activities to block out or allow a certain amount of signal. If for whatever reason the patient is not totally satisfied worth the spinal cord stimulator there is the option to simply pull the leads and the patient is left with nothing but a tiny incision scar. They could then continue to pursue other options of treatment. This treatment bypasses the need for steroids, opioids, and injections and helps proved patients' autonomy with chronic pain treatment.

 

Nichols, T., Mandybur, G., & Orlando, M. (2021). Spinal Cord Stimulation, SCS. Spinal Cord Stimulation | Cincinnati, OH Mayfield Brain & Spine. Retrieved September 29, 2022, from https://mayfieldclinic.com/pe-stim.htm

Sivanesan, E. (2021, August 8). Spinal cord stimulator. Johns Hopkins Medicine. Retrieved September 29, 2022, from https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/treating-pain-with-spinal-cord-stimulators

Make sure you R.I.C.E !!

Fernando Carrillo

9/30/2022

Many athletes will most likely be familiar with the R.I.C.E treatment. It stands for Rest, Ice, Compress, and Elevate. It is a really useful technique to use whenever one experiences an injury. R.I.C.E can help with soft tissue injuries like sprains, twisted ankles, pulled muscles, bruises, etc. It is best when one follows R.I.C.E immediately after sustaining an injury for best results. Now lets break it down! Rest is needed so that the injured tissues can begin to relax and become less tense. Resting also helps with reducing the disruption of 'fragile fibrin bond' which is one of the first processes of healing. Ice has several benefits, it is a type of general cryotherapy, it reduces any bleeding within the tissues and induces vasoconstriction. The cooler temperature also helps with feeling less pain in the general area. The goal of compression is to reduce any swelling and stop hemorrhage. Edema is caused by the exudation of fluid from the damaged capillaries into the tissues and compression helps with reducing this process. Finally, elevation lowers the pressure of the injured area and prevents/reduces bleeding tissues in the injured area. Elevation also encourages the drainage of the exudate through the lymph vessels and limits edema (swelling caused by trapped fluids in the tissues/body). The idea of R.I.C.E relates to our lectures with the idea of pressures, tissues, and blood flow through the body. By using gravity, compression, cryotherapy, and rest, we can allow our bodies to heal to the best of their ability by providing the best environment. 

Source:

Michel P.J. van den Bekerom, Peter A.A. Struijs, Leendert Blankevoort, Lieke Welling, C. Niek van Dijk, Gino M.M.J. Kerkhoffs; What Is the Evidence for Rest, Ice, Compression, and Elevation Therapy in the Treatment of Ankle Sprains in Adults?. J Athl Train 1 July 2012; 47 (4): 435–443. doi: https://doi.org/10.4085/1062-6050-47.4.14 

About Last Night: “Fencing Reflex”

 

Stress Hurts My Stomach

Everything we have been learning in this class so far has been about stress and how it affects the body. College students know more than most that stress can have some major effects on one's mental, physical, and emotional well-being. In this case, there seems to be a strong correlation between college students perceived stress levels and their gastrointestinal habits. 

The study split a cohort of college students into a control group and an experimental stressed group. The two groups were given two surveys. One was a common stress questionnaire and the other was a gastrointestinal habits survey. The control group was evaluated during the regular academic period and the experimental group was evaluated during the examination period. 

Researchers found that students in these examination periods reported increased perceived levels of stress, which is not surprising to anyone who has experienced these trying times. However, the study also showed that more than 40% of these stressed college students declared a change in their gastrointestinal habits during these times. These changes included abdominal pain, abdominal discomfort, and changes in stool consistency. 

The overall conclusion of the article is that functional gastrointestinal symptoms are commonly associated with high levels of stress and could be considered to be a negative response to stress. These levels of perceived stress only increase with age, which means it's all downhill from here. 

If further research is to be done on this topic, there should be more research into the long-lasting impacts of these stressful events on one's gastrointestinal health. I also think that it would be interesting to research if these functional gastrointestinal symptoms have any impact on cognitive abilities during these stressful times. 

As midterms and final exams roll around, we can now all understand why our stomachs hurt while trying to ace those exams. 

Balmus IM, Robea M, Ciobica A, Timofte D. PERCEIVED STRESS AND GASTROINTESTINAL HABITS IN COLLEGE STUDENTS. Acta Endocrinol (Buchar). 2019 Apr-Jun;15(2):274-275. doi: 10.4183/aeb.2019.274. PMID: 31508190; PMCID: PMC6711640.

Should You Be Scared of a Sinus Arrhythmia?

In the world of cardiology, many different types of arrhythmias exist. However, sinus arrhythmia is often overlooked. In many patients, this is a marker of good cardiovascular health and is asymptomatic, only found on routine EKG (Soos and McComb, 2021). Other arrhythmias, such as supraventricular tachycardia, atrial fibrillation, ventricular tachycardia, and more, can be serious and life-threatening. Sinus arrhythmias rarely present with symptoms, but if shortness of breath, edema, or chest pain are present, they can be an indicator of underlying disease such as congestive heart failure (Soos and McComb, 2021). Overall, sinus arrhythmias sound like something to be scared of, but much of the time, they are harmless!

A person’s heart rate is determined by the sinoatrial node, or the pacemaker, of the heart, which controls the rate of contraction. The SA node is under control of the SNS as well as the vagal nerve, the main nerve of the PNS (Berntson, Cacioppo, and Quigley, 1993). The main type of sinus arrhythmia is called respiratory sinus arrhythmia. Simply, in RSA, heartbeat increases with inspiration and decreases with expiration. The R-R interval (time between two R-waves) on an EKG varies with respiration in RSA (Yasuma & Hayano, 2004). Mechanisms of RSA are unclear, but it is assumed there are multiple components in both central and peripheral systems that contribute (Berntson, Cacioppo, and Quigley, 1993). We know, however, that RSA results from cardiac and pulmonary system interactions, and having RSA may even increase efficiency of gas exchange in the lungs (Yasuma & Hayano, 2004)!

I have personal experience with RSA. I didn't know I had it until wearing a cardiac event monitor after being misdiagnosed with SVT. Below is an instance of sinus arrhythmia. I also had episodes of PVCs, bradyarrhythmia, tachycardia, and a three-second pause (that I didn’t notice!) In my opinion, there are many ethical issues surrounding cardiology. Many patients tell stories of healthcare providers dismissing cardiac conditions as anxiety. Luckily, I have providers who believe what I feel. Ethically, I think it is best in healthcare that all cardiac symptoms are treated as such until proven otherwise. The criminal justice system plays by “innocent until proven guilty”, so I think cardiac conditions should be cardiac until proven that they aren’t. If a patient with SVT is shrugged off, they could have permanent damage done to their heart – and that damage and time will never be replaced.

(Side note: if anyone wants to feel a sinus arrhythmia, let me know and you can feel my pulse)

Soos MP, McComb D. Sinus Arrhythmia. [Updated 2021 Sep 24]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK537011/

Berntson, G.G., Cacioppo, J.T., & Quigley, K.S. (1993). Respiratory sinus arrhythmia: Autonomic origins, physiological mechanisms, and psychophysiological implications. Psychophysiology, 30, 183-196. DOI: 10.1111/j.1469-8986.1993.tb01731.x.

Yasuma, F. & Hayano, J. (2004). Respiratory sinus arrhythmia: Why does the heartbeat synchronize with respiratory rhythm? Chest, 125(2), 683-690. https://doi.org/10.1378/chest.125.2.683

Copeptin and kidney oxygenation in adolescents with or without obesity

Patients with diabetes mellitus, are prone to develop diabetic kidney disease. A condition that if it is not treated properly, it can evolve to chronic kidney disease. This reduces their life span, since kidney malfunction is harder to treat than the common symptoms or effects of diabetes.

Endocrine hormones that are highly involve in the endocrine reaction in the human body, have been the most common biomarkers to identify kidney disease. Arginine vasopressin (AVP) and its surrogate, copeptin, have been implicated in diabetic kidney disease (DKD) pathogenesis, which develops in a subset of people with longstanding type 1 diabetes (Refardt et. al. 2019). Vasopressin is elevated in obesity & metabolic syndrome as well as cardiovascular and kidney disease (Jalleh 2021). However, the exact mechanism is unknown, but may relate to neurohormonal activation in obesity and insulin resistance. Measuring vasopressin is associated with technical difficulties, due to its relatively small size and short half-life (Asfar 2017). Therefore, Copeptin is a more stable peptide derived from the same precursor molecule as vasopressin and is recognized as a surrogate marker for vasopressin useful in the assessment of fluid and osmosis status in various diseases (Asfar 2017). Vasopressin has been implicated in regulating kidney oxygenation in animal models through its action on sodium transporters in the kidney as well as activating the renin-angiotensin-aldosterone system (as shown in the figure to the right). There are no data on the effects of vasopressin on kidney oxygen availability in adolescents with and without obesity.

Therefore, more studies should be performed by measuring copeptin, which can lead or diagnose early DKD and/or CKD (Chronic kidney disease). This would allow doctors, researchers, and even the patients to have a better understanding of kidney diseases and how to prevent them. Allowing, a lower rate of kidney failure during the early adult stages. Unfortunately, the scientist's community is still working on ensuring a safe and harmless way to perform these studies in patients. This ensures the safety of patients, and allows for better results due to an increase in people willing to participate in such studies.

References:

Afsar B. (2017). Pathophysiology of copeptin in kidney disease and hypertension. Clinical hypertension, 23, 13. https://doi-org.dml.regis.edu/10.1186/s40885-017-0068-y 

Jalleh, R., & Torpy, D. J. (2021). The Emerging Role of Copeptin. The Clinical biochemist. Reviews, 42(1), 17–25. https://doi-org.dml.regis.edu/10.33176/AACB-20-00001

Refardt, J., Winzeler, B., & Christ-Crain, M. (2019). Copeptin and its role in the diagnosis of diabetes insipidus and the syndrome of inappropriate antidiuresis. Clinical endocrinology, 91(1), 22–32. https://doi-org.dml.regis.edu/10.1111/cen.13991 

CARPEDIEM for the Most Fragile Patients

    This isn't your typical “seize the day.” The cardio-renal pediatric dialysis emergency machine is a fairly new development for pediatric patients. 

Acute kidney injury is the sudden reduction in blood and/or oxygen flow to the kidneys, resulting in a decreased glomerular filtration rate and urine output. Blood filtration is crucial for organ function and with kidney failure, organ decline can be rapid. Before the Carpediem system, mortality rate for severe pediatric AKI was at least 50% (Ronco et al., 2012). Renal replacement therapy (RRT) is indicated to prevent fluid build up, but we adapted adult dialysis machines to much smaller and fragile patients. Up until 2014, there was no true pediatric RRT system. The FDA authorized the Carpediem system in 2020 (Cincinnati Children’s, 2021). Using traditional machines for pediatric patients presents several challenges. There was difficulty with trying to get the accurate blood flow and oftentimes machines have varied “reaction times” before fluid balance error occurs (Ronco et al., 2012). 

The Carpediem system is a technological advancement that has improved the conditions of pediatric patients in critical care. According to studies in the EU, there is a 97% survival rate at the end of treatment (Medtronic, n.d.). With a machine that connects to smaller catheters, closely monitors fluid balance for patients under 10kgs, there is reduced blood vessel damage and infection. 

Pediatric AKI is considered an orphan disease because it affects fewer than 200,000. This presents some ethical issues for this condition and other rare diseases because research funding and therapy development is much lower. This affects not only treatment but preventative measures as well. Because symptoms of pediatric AKI can appear in the least a course of hours, treatment must be swift. Now pediatric AKI mortality is much lower, but there are still hurdles to overcome with its prevention.

Dijken, C., Fjellman-Wiklund, A., & Hildingsson, C. (2008). Low back pain, lifestyle factors and physical         activity: A population based-study. Journal of Rehabilitation Medicine, 40(10), 864–869. https://doi.org/10.2340/16501977-0273 

Home. Cincinnati Childrens. (n.d.). Retrieved September 29, 2022, from https://www.cincinnatichildrens.org/news/release/2021/carpediem 

Ronco, C., Garzotto, F., & Ricci, Z. (2012). CA.R.PE.DI.E.M. (cardio–renal pediatric dialysis emergency machine): Evolution of continuous renal replacement therapies in infants. A personal journey. Pediatric Nephrology, 27(8), 1203–1211. https://doi.org/10.1007/s00467-012-2179-8 

Pre-term birth and the altered HPA axis

 It is known that stress leads to an increase in cortisol levels, and this can have different outcomes depending on short term vs. long term stress. As we know cortisol is released, by the adrenal cortex, in response to stress turning the sympathetic nervous system on. This results in an increase in blood glucose for brain and muscle use, decrease in digestion, reproduction, and growth, and an increased heart rate, respiratory rate and blood pressure. However, while in the short-term this is a beneficial response, in the long term this disrupts the body’s normal need to rest and repair.

Currently there is a lot of research that has found a correlation between preterm birth and a decreased functioning of the hypothalamic-pituitary axis. One such study found that the young adults between the ages of 19-27 born preterm have lower cortisol and insulin levels in response to psychosocial stress than do young adults of the same age group born at term (Kaseva 2014). Reduced cortisol levels tell us that the preterm young adults have a reduced stress responses than young adults born at term. Babies born preterm are at risk for being born with underdeveloped organs and vital physiological functions. A peptide, adrenomedullin, highly concentrated in preterm babies has an inhibitory effect on the production of cortisol which may be influencing the low cortisol levels of preterm babies (Travers 2021). Therefore, preterm babies have a reduced HPA axis to begin with, which carries on to their reduced hormone production later in life.

This is a relatively new area of study because new medical knowledge and equipment has increased the survival rate of babies born preterm. Children born preterm would have not survived 50 or more years ago, but with modern technology these children are able to live long and full lives. Thus, the long-term effect of preterm birth is only now coming to light. Some effects may include cardiovascular issues, high blood glucose, high blood pressure, and neurodevelopmental disorders (Luu, Rehman, Nuyt 2017). As stated above, insulin levels in preterm babies reduces that amount of glucose taken up by tissue cells, leaving high amounts of glucose in the blood. The increased blood glucose alters the osmotic balance increasing blood pressure. Blood pressure among other preterm underdevelopments affect the cardiovascular circulation, thus altering the structure of the heart. Overall, the reduced functioning of the HPA axis found in individuals born preterm alters the steroid production and normal responses to environmental stimuli.

Another study that introduces the social factor of race into the correlation between cortisol levels and preterm birth found that black adolescents had the same cortisol levels as term adolescents, and preterm non-black adolescents had the expected reduced cortisol levels. Further studies of these results should look into the social factors that disproportionately affect these groups. Preterm black individuals may be experiencing higher levels of stress due to social factors that appears as a normal cortisol level for a term adolescent. The preterm black adolescents may still have a blunted HPA axis, but the response is higher because of an increased stimulus. Many environmental factors influence the daily lives of humans which may not have detrimental effects in the short term, but in the long term can alter an individual’s normal physiology. Overall social issues must also be viewed with a scientific lens and vice versa.

Brown, C. L., Myers, K., South, A. M., Shaltout, H. A., Jensen, E. T., Nixon, P. A., & Washburn, L. K. (2020). Influence of race on the effect of premature birth on salivary cortisol response to stress in adolescents. Pediatric research, 87(6), 1100–1105. https://doi.org/10.1038/s41390-019-0682-3

Kaseva, N., Wehkalampi, K., Pyhälä, R., Moltchanova, E., Feldt, K., Pesonen, A. K., Heinonen, K., Hovi, P., Järvenpää, A. L., Andersson, S., Eriksson, J. G., Räikkönen, K., & Kajantie, E. (2014). Blunted hypothalamic-pituitary-adrenal axis and insulin response to psychosocial stress in young adults born preterm at very low birth weight. Clinical endocrinology, 80(1), 101–106. https://doi.org/10.1111/cen.12251

Luu, T. M., Rehman Mian, M. O., & Nuyt, A. M. (2017). Long-Term Impact of Preterm Birth: Neurodevelopmental and Physical Health Outcomes. Clinics in perinatology, 44(2), 305–314. https://doi.org/10.1016/j.clp.2017.01.003

Travers, S., Martinerie, L., Xue, Q. Y., Perrot, J., Viengchareun, S., Caron, K. M., Blakeney, E. S., Boileau, P., Lombès, M., & Pussard, E. (2021). Adrenomedullin: new inhibitory regulator for cortisol synthesis and secretion. The Journal of endocrinology, 251(1), 97–109. https://doi.org/10.1530/JOE-20-0564

Why We Should Weep More :)

There are many ways that humans express how they are feeling. Smiles, laughter, anger, sadness, and many more. But the one that seems the most intriguing is crying/weeping. Crying occurs when the muscles around the eyes contract which stimulates the lacrimal gland to produce tears. However, there is a distinct difference between crying and weeping. Whereas crying is most often expressed through facial expressions and shaking as a response to anger or pain, weeping is often associated with the shedding of tears. A recent article published in the New Ideas in Psychology journal analyzed the meaning and importance of weeping. Unlike crying, weeping is a mechanism that is limited to humans due to our ability to comprehend various emotional states, which has made it an interesting topic for researchers to study. When humans weep, it results in homeostatic regulation due to increased endorphin production when tears run down the sides of our faces. Because of these endorphins, a soothing feeling is sent to the central nervous system and pituitary gland, leading us to feel better immediately after crying. Thus, crying stabilizes your mood, which “is a vital part of a healing or growing process that should not be hindered”. Therefore, the next time you think that you should hide your emotions or choke down your tears, think again! Weeping and the shedding of tears is an important human behavior that should be talked about more!

Bellieni, C. V. (2017). Meaning and importance of weeping. New Ideas in Psychology, 47, 72–76. https://doi-org.dml.regis.edu/10.1016/j.newideapsych.2017.06.003

Diabetes and the Eyes

    It is well known that hyperglycemia associated with diabetes is dangerous to many cells throughout the whole body. One such area of the body effected by diabetes is the eye. In fact, diabetic retinopathy (DR), or disease of the retina, is the leading cause of blindness in people over the age of 50 (Lutty, 2013).  

    The development of DR starts in response to hyperglycemia. Autoregulated responses of retinal blood vessels to increased blood sugar first lead to microaneurysms and pericyte loss (Wang & Lo, 2018). Pericytes are cells that provide support for retinal capillaries, so you can see how losing them would have negative consequences for the eye. Next, a pathway of inflammation is activated by leukostasis, in which white blood cells stick and accumulate, forming plugs in retinal blood vessels (Wang & Lo, 2018). In diabetic patients, leukostasis is driven by the upregulation of chemokines (which attract and activate leukocytes) and leukocyte adhesion molecules (Lutty, 2013). All these effects on retinal vasculature further damage the endothelial cells of the retina, leading vascular leakage. A “leaky” vasculature greatly increases the chance of diabetic macular edema, which ultimately causes visual function loss in diabetic patients (Lutty, 2013). 

    While DR is mostly considered a microvascular disease, there is also evidence that diabetes influences retinal neurons, also leading to diabetic retinopathy. High glucose levels have been shown to induce mitochondrial dysfunction and apoptosis in retinal neurons (Tien et al., 2017). Damaging retinal neurons, and thus damaging the eye’s ability to transmit signals to the brain will no doubt influence one’s ability to see/process images. 

Early detection of symptoms of diabetic retinopathy is crucial for further treatment and prevention of blindness in diabetic patients. Annual eye exams are important for everyone, but they are of utmost importance for patients with diabetes (which is why your optometrist may recommend an exam every 6 or 3 months)!  

 

References 

Lutty, G. A. (2013). Effects of diabetes on the eye. Investigative ophthalmology & visual science, 54(14), ORSF81-ORSF87. 

Tien, T., Zhang, J., Muto, T., Kim, D., Sarthy, V. P., & Roy, S. (2017). High Glucose Induces Mitochondrial Dysfunction in Retinal Müller Cells: Implications for Diabetic Retinopathy. Investigative ophthalmology & visual science, 58(7), 2915–2921. 

Wang, W., & Lo, A. C. (2018). Diabetic retinopathy: pathophysiology and treatments. International journal of molecular sciences, 19(6), 1816. 

Once a Treatment not Always a Treatment

Kawasaki disease (KD) is an acute febrile systemic vasculitis that predominantly occurs in children below five years old (Agarwal, 2017). This means the walls of their blood vessels begin to inflame and swell. This disease is commonly diagnosed by a group of signs and symptoms which can be confirmed by laboratory tests (Agarwal, 2017).  

KD begins in an infected site of small-sized arteries, typically coronary arteries (Agarwal 2017). If this disease is left untreated, it can lead to further complications related to heart diseases; complications as coronary artery aneurysm, thrombosis, stenosis, and death (Agarwal 2017).

The most common treatment for KD in the acute phase is using Intravenous immunoglobin (IVIG) and aspirin which reduces the incidence of coronary abnormalities to less than 5% (De Rosa 2007). As for aspirin, it is used in a higher dosage than a normal user, it is used primarily for its anti-inflammatory properties, and then lower dosage for anti-thrombotic effects (De Rosa 2007). Specifically, IVIG has been proven to be highly effective in reducing disease symptoms or at least the severity of coronary artery aneurysms (De Rosa 2007). These coronary artery aneurysms develop in 15-25% of untreated children, however, 10-15% of cases develop resistance to this treatment (Rigante 2010). Intravenous Immunoglobin (IVIG) treatment since is the most common and successful way to be treated. Slowly more and more cases are becoming resistant, forcing researchers to find other drugs and treatment techniques that help children at a young age.

Agarwal S, Agrawal DK. Kawasaki disease: etiopathogenesis and novel treatment strategies. Expert Rev Clin Immunol. 2017 Mar;13(3):247-258. doi: 10.1080/1744666X.2017.1232165. Epub 2016 Sep 13. PMID: 27590181; PMCID: PMC5542821.

De Rosa G, Pardeo M, Rigante D. Current recommendations for the pharmacologic therapy in Kawasaki syndrome and management of its cardiovascular complications. Eur Rev Med Pharmacol Sci. 2007 Sep-Oct;11(5):301-8. PMID: 18074939.

Rigante D, Valentini P, Rizzo D, Leo A, De Rosa G, Onesimo R, De Nisco A, Angelone DF, Compagnone A, Delogu AB. Responsiveness to intravenous immunoglobulins and occurrence of coronary artery abnormalities in a single-center cohort of Italian patients with Kawasaki syndrome. Rheumatol Int. 2010 Apr;30(6):841-6. doi: 10.1007/s00296-009-1337-1. Epub 2010 Jan 5. PMID: 20049445.