Forced Sterilization in the 21st Century

 

I can’t express how repulsive and disappointing it is to write about current accusations of forced sterilization in the 21st century. Surprisingly, and not at the same time, we are still living in a time where many people believe it is okay to allow forced labor, sex trafficking, forced sterilization, and many more. Historically, it has been recorded that forced sterilization disproportionately impacted people of color. Not too far long ago, in 2013 female inmates in California prisons were sterilized without their approval (Johnson 2013). It was used in order to control the “undesirable” population which in today’s case happens to be those who are in ICE custody (Ko, L, 2016). 

More recently in the Georgia Immigration and Customs Enforcement facility, whistleblower Dawn Wooten who worked at this location as a nurse, detailed a high rate of hysterectomies and medical neglect (Alvarez, 2020). In her complaint to the Government Accountability Project and Project South, Wooten expressed that just about everyone who came to see this particular gynecologist left after getting a hysterectomy (Alvarez, 2020). She even stated that he’s removed the wrong ovary of a patient who went to see him to have the ovary with a cyst removed and now, this young woman can’t have any children. You be the judge of whether this was accidental or purposeful. 

The parallels in the recent accusations and the past are glaring. So, do we turn a blinds eye and act like we never heard about this or, do we find a way to prevent women from being robbed of their unborn children? That is also for you to decide. As an aspiring medical provider, hearing about health professionals abusing their powers is very disheartening and shameful. The LA County has apologized after its numerous forced hysterectomies that happed in the LA county hospital but, what is an apology going to do to a woman who later found out she can’t have any children, to the minority groups who are continually attacked from every angle, and to the little girl who can’t help but wonder if that will happen to her? Nothing. 

Corey G. Johnson / July, et al. “Female Inmates Sterilized in California Prisons without Approval.” Reveal, 7 July 2013, www.revealnews.org/article/female-inmates-sterilized-in-california-prisons-without-approval/. 

Alvarez, Priscilla. “Whistleblower Alleges High Rate of Hysterectomies and Medical Neglect at ICE Facility.” CNN, Cable News Network, 16 Sept. 2020, www.cnn.com/2020/09/15/politics/immigration-customs-enforcement-medical-care-detainees/index.html. 

KO, LISA. “Unwanted Sterilization and Eugenics Programs in the United States.” PBS, Public Broadcasting Service, www.pbs.org/independentlens/blog/unwanted-sterilization-and-eugenics-programs-in-the-united-states/. 

Identifying Bacteria and Pretty Colors

The key to effective treatment for bacterial infection, is identifying the infectious bacteria. Anyone who has ever had a rapid test fail, followed by insufficient antibiotics, can attest to the frustration and confusion prolonged suffering will bring. Furthermore, current methods to accurately identify infectious agents take several days and include expensive processes such as culturing, PCR, and antibody identification. To address this issue, we began using fluorescent molecules with the ability to change their fluorescence depending on their environment. 

The dyes are derivatives of hydroxyflavanoids which are naturally found in plants. Aside from producing the colors we see in leaves in the fall, these molecules have the unique ability to emit three fluorescent signals, as opposed to two, with the third signal being dependent on its interaction with the environment. By modifying different moieties on these dyes, we are able to specify hydrophobic and hydrophilic interactions with the bacteria themselves, as well as within the microenvironment due to chemicals secreted by the bacteria.

Recognizing these unique properties, we developed an array where we plated samples of known bacteria with polymer complexes of four of these dyes. We then measured the fluorescent signals of these dyes at various points of excitation. Using linear dimensional analysis (LDA), we were able to plot the fluorescent signals we had measured. These plots showed not only specificity for singular samples of bacteria, but in mixed samples the plots showed an association between the specific mixtures we had measured. Along with this, the plots between mixtures showed specificity for the ratio of different bacterial samples in a mixture. The goal of this research is to eventually design an inexpensive assay that can be used in most clinics that will allow for specific identification of samples within a couple of hours as opposed to the current model which requires several days.

Oh, and the analysis turned me in to an excel wizard. Thank you for reading!

Svechkarev, D., Sadykov, M. R., Houser, L. J., Bayles, K. W., & Mohs, A. M. (2020). Fluorescent Sensor Arrays Can Predict and Quantify the Composition of Multicomponent Bacterial Samples. Frontiers in chemistry, 7, 916. https://doi.org/10.3389/fchem.2019.00916

The Idiocy of Idiopathic Diseases

 

            While I do not mean for you all to take the title of my article literally, I do believe there is some sort of ineptitude when it comes to these diseases, as you would think with all the knowledge we hold and scientific understandings of diseases we have, we would be able to discover a cure or insight into these incurable illnesses. As described by MedicineNet, an idiopathic disease is described as any disease that is of uncertain or unknown origin may be termed idiopathic. While this does not affect me personally, my mother was diagnosed with Subglottic Stenosis around five years ago, a fairly rare idiopathic disease effecting around 1 in every 400,000 people. This condition is characterized by the narrowing of the upper trachea, more specifically the cricoid cartilage, with the most prominent symptoms being stridor and dyspnea, with minor symptoms being increased mucous production, voice changes, and persistent cough (National Organization for Rare Diseases). Nearly ever individual diagnosed with this disease is female and premenopausal, and usually falls within the age range of 30-50 (Mayo Clinic).

            With the descriptives out of the way, we can now focus on my mothers story of how her diagnosis came about. Having struggled with severe asthma most of her life, it was not until her mid-40’s that she decided to visit a family friend who is an ENT Doctor at Mayo Clinic, to see if maybe her asthma was more than she had thought. As she would come to discover, her airway was about 60% closed, and the culprit was ISS (Idiopathic Subglottic Stenosis). While there is not a direct cause as to why ISS affects people the way it does, it is often thought to originate from a trauma accident involving the trachea or improper intubation due to surgery or emergency medical intervention. Although neither of those have been proved to exactly cause ISS, my mother had not experienced either of those events and was back to square one when it came to thinking, “how in the world did I get this condition.”

In terms of surgical intervention and standard therapies related to this disease, endotracheal scopes are often performed every three to six months depending on severity of the disease and balloon dilations are performed to increase the diameter and circumference of the airway (Mayo Clinic). Personally, my mother has an endotracheal scope performed around every six months or as needed, and a balloon dilation every year to year and a half. In a study recently performed by the North American Airway Collaborative, over one thousand patients who have ISS were examined, of which 98% of them were Caucasian women, and a new hypothesis was formed that this may be a hormonally driven disease, while some argue that its genetic, a specific answer has not yet been derived (Gelbard et al., 2016). As someone who has a family member that is directly affected by this condition, it is infuriating to have to know that there really is no proven treatment for this illness, and makes me think why do we not have the answers when there is so much knowledge out there on other diseases, but why not this one.

 Works Cited

Gelbard A. et al. Disease homogeneity and treatment heterogeneity in idiopathic subglottic stenosis. Laryngoscope. 2016 Jun;126(6):1390-6. doi: 10.1002/lary.25708. Epub 2015 Nov 4. PMID: 26536285; PMCID: PMC6198250.

N., & Gelbard, A., MD. (2018, July 19). Idiopathic Subglottic Stenosis. Retrieved October 04, 2020, from https://rarediseases.org/rare-diseases/idiopathic-subglottic-stenosis/

Schiavo, D. M., M.D. (n.d.). Pulmonary, Critical Care, and Sleep Medicine. Retrieved October 04, 2020, from https://www.mayoclinic.org/medical-professionals/pulmonary-medicine/news/multidisciplinary-care-of-idiopathic-subglottic-stenosis/mac-20451594

 

Up in Smoke

    Since the 1960s, smoking has become something of a trend. It has built up a reputation of being “cool” back then, and even now. Besides being considered a popular act, people began to use it more as a way of coping, relaxing, and winding down. However, this method of relaxation contains addictive and hazardous chemicals. Over the years, as our population has become more and more health conscious and more aware of what they are putting into their bodies, cigarette companies began to create e-cigarettes, vapes, JUULs, etc. in order to market their products as a "safer alternative". 

    Multiple cases, however, have come to light where  adolescents have been hospitalized with lungs similar to that of an 80 year old, likely due to the vapor. Though JUULs, e-cigarettes, and vape pens may not contain all of the same harsh chemicals of cigarettes themselves, they can still induce oxidative stress, inflammation, damage in lung cells (Muthumalage et al., 2019). In December 2019, Muthumalage et al. conducted a study looking at the induced effects of e-cigarettes, specifically different JUUL pod flavors and their effects. Researchers compared the amount of superoxide production in bronchial epithelial cells, epithelial barrier dysfunction, and DNA damage upon exposure of vapor in lung cells in different JUUL pod flavors such as fruit medley, cool mint, crème brulee, cool cucumber, mango, classic menthol, etc. (Muthumalage et al., 2019). The flavoring chemicals in the pods contain alcohols and aldehydes which form byproducts such as acetals, induce irritation through mitochondrial oxidation of the lung and inflammatory responses and can induce barrier dysfunction (Crème Brulee and Cool Cucumber) and lead to cell death (Muthamalage et al., 2019). Inhaling vapor with these chemicals and varying percentages of nicotine not only pose issues for lung cells, but they can also negatively effect the cardiovascular system including the possibility of atherosclerosis, hypertension, thrombogenesis and MI (Muhumalage et al., 2019). Though smoking has been somewhat of a trend over the years and may seem to be a way of relaxation that is safer than cigarettes, the "safer alternative" e-cigarettes and vape pens pose just as many problems to our health. 

source: 

Muthumalage, T., Lamb, T., Friedman, M. R., & Rahman, I. (2019). E-cigarette flavored pods induce inflammation, epithelial barrier dysfunction, and DNA damage in lung epithelial cells and monocytes. Scientific reports, 9(1), 19035. https://doi.org/10.1038/s41598-019-51643-6

The American dream and Alzheimer's

 If you have experienced American society in any way, especially American english class society, you have probably heard the aspirational narrative of the American Dream. That fantastical idea that anybody, no matter where you come from and who you are, anything is possible if you just work hard enough to get there. This can be a very motivational thought, however it has also led to the toxic work obsessed and sleep deprived culture that we have developed in the United States today. The 40 hour work week minimum that constitute our full time career jobs, the 8am school starts that begin as young as 6 years old, in combination with the constant overstimulation from technology that keeps us up later at night than our normal circadian rhythm would allow, all of these practices are leading to a massive accumulation of sleep debt starting at a very young age. 

Alzheimer’s disease has been linked to increased amounts of the beta-amyloid peptides as well as accumulations and aggregations of the tau protein in the brain (Lucey et al., 2019). In a normal day, tau proteins aggregate in healthy human brains and are then cleared away while sleeping so that day to day aggregations are not adding up (Collins, 2019). Studies have shown that decreased amounts of non rapid eye movement sleep (NREM) lead to increases in beta-amyloid depositions (Lucey et al., 2019) which is an early signal of Alzheimer’s and chronic lack of sleep correlates to increased tau protein tangles which indicates disease progression and decline in cognition (Collins, 2019). Generally, tau protein levels increase during waking hours and decline when humans are sleeping. A study performed by Holtzman concluded that when adult humans did not sleep for an entire night, there was a 30% increase in beta-amyloid in the individuals CSF along with tau protein levels increasing by about 50% (Collins, 2019). In studies of chronic sleep deprivation done on mice it was shown that less sleep increased the amount of tau protein found in the animals brains and that the tangles that appeared over time were in the same locations as those found in people with Alzheimer’s disease (Collins, 2019). 

It may not be possible to get enough sleep every single night but it is worth consciously making a decision to try to do so as often as possible. The studies linking Alzheimer’s to sleep deprivation are very new and more research is being conducted but in the meantime, getting more sleep certainly isn’t going to hurt. 

Collins, F. (2019). Sleep loss encourages spread of toxic Alzheimer’s protein. NIH Director’s Blog. Available from: https://directorsblog.nih.gov/2019/02/05/sleep-loss-encourages-spread-of-toxic-alzheimers-protein/ 

Lucey, B. P., McCullough, A., Landsness, E. C., et al. (2019). Reduced non-rapid eye movement sleep is associated with tau pathology in early Alzheimer’s disease. Science Translational Medicine, 11(474). doi: 10.1126/scitranslmed.aau6550

What is that flesh eating bateria?

I am sure everyone has heard about a crazy case of a person losing a limb to "flesh eating bacteria". When I first heard about it, I thought that someone would have to be swimming in infected water or be in some exotic location to be susceptible to this issue. It was not until I started working in the ER that I discovered that this flesh eating bacteria was really necrotizing fasciitis, and anyone who simply gets a paper cut could die from it. 

Necrotizing fasciitis is a soft tissue infection that primary affects the superficial fascia and surrounding tissues, resulting in the subsequent death of those tissues (Bellapianta 2009). As we learned in anatomy, some of the functions of fascia are to compartmentalize and prevent the spread of infection, so you can imagine that if this area itself became infected, there would be extreme consequences. There are three main characteristics for clinical diagnosis which are often known as the triad: erythema, swelling, and pain out of proportion (Bellapianta, 2009). The first patient I saw that had this issue presented as a typical case as they had a very small area of erythema to the L flank with some swelling, but they were so uncomfortable which made the clinical suspicion much higher for necrotizing fasciitis when bringing together the patient's tachycardia, hypotension and extremely elevated lactic acid levels. 

There is currently a clinical scoring system used for cases where there is suspicion for necrotizing fasciitis known as the Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC). This score includes labs values, see Figure 1,  that have been found to be sensitive for infections that are caused by bacteria that commonly cause necrotizing fasciitis, such as group A Streptococcus (Bellapianta 2009). If an individual has a high score with LRINEC, further studies can be performed such as CT imaging which has been found to be sensitive for detecting necrotizing fasciitis, although an MRI would be more depictive (Bellapianta 2009). 

It turns out that even though anyone can come down with this pesky infection, but it turns out that individuals that are immunocompromised, such as diabetics, chronic corticosteroid users, and IV drug users, are more susceptible than others (Bellapianta 2009). 

So how is this condition treated? First off, the patient will receive antibiotics to cover for possible bacterial culprits, then the patient will head off to the OR for surgical debridement of the area and biopsy (Bellapianta 2009). Continued observation of these patients is critical as this infection can spread quickly and the patient can also decompensate rapidly, resulting in limb loss, septic shock, renal failure or multisystem organ failure (Bellapianta 2009). Mortality of this condition widely varies but has been seen to be dependent on a few major things: time of onset to surgical debridement, immunocomprimised state, and age (Bellapianta 2009). 

So what this all means is do not cut yourself, stay healthy, and if you think something is wrong, get it checked out! If you are interested, you can of course see it in Grey's Anatomy Season 2 Episode 15 where it is so "accurately" depicted. This may be one of the episodes where surgical residents might actually be in the ER in reality. 

Figure 1: LRINEC scoring system. 

Sources:

Bellapianta JM, Ljungquist K, Tobin E, Uhl R. Necrotizing fasciitis. J Am Acad Orthop Surg. 2009 Mar;17(3):174-82. doi: 10.5435/00124635-200903000-00006. PMID: 19264710.

Do you have a Low or High Pain Threshold?

Neanderthals are an extinct species that lived about 40,000 years ago in which some modern humans mated with. From the mating, gene transfer occurred where future descendants picked up some of the Neanderthal genes. The difference between Neanderthals and modern-day humans is that Neanderthals were known to be hunter-gathers while modern-day humans produced and maintained a living through agriculture and domestication of animals. An interesting gene that a group of humans currently obtain is a variant of a gene that encodes an ion channel that initiates the sensation of pain. A group of researchers in the UK studied the ion channel and found insightful information that peoples with this variant of a gene experiences more pain than usual. The ion channel of interest is the sodium channel called NAV1.7. This sodium channel is important for impulse generation and peripheral pain pathways. This variant gene is found in people from central and southern America as well as in Europe. In the cell, an individual with Neanderthal variant genes that goes through an action potential, which occurs in the ion channel, has two important factors that occur during this process. One factor that occurs is that there is an increase in the availability of sodium channels for activation. From this, it results in an increase of sodium channels to remain open for a longer period. This leads to a lower threshold of receiving pain.  An interesting discovery was that individuals that contained the ion channel, experienced pain as if they were eight years older where pain sensitivity generally increases. When going into the genetics of this variant gene, they figured out that there was a three amino acid difference between the Neanderthals and modern-day humans. Due to these three amino acid substitutions, individuals in present-day time have a higher pain sensitivity. Now the true question is, do you think that your pain threshold is low? 

Zeberg, H., Dannemann, M., Sahlholm, K., Tsuo, K., Maricic, T., Wiebe, V., . . . Pääbo, S. (2020). A Neanderthal Sodium Channel Increases Pain Sensitivity in Present-Day Humans. Current Biology, 30(17). doi:10.1016/j.cub.2020.06.045

Neanderthals may have had a lower threshold for pain. (2020, July 23). Retrieved October 05, 2020, from https://www.sciencedaily.com/releases/2020/07/200723115900.htm?fbclid=IwAR1Q_bk0x6uTEsd9u-xKPzykQT_bZnm86MwInWp8pCTi_ZAZoLqd9FOx6SI