Artificial scents and flavors

I just exited from my final lab in Organic Chemistry II (with some elation I must add) in which I was to identify one of four unknown organic compounds using a slew of laboratory procedures. I chose the first compound and proceeded to waft the scent of the compound (this really is a bad idea considering many organic compounds can be highly toxic and/or carcinogenic but it is very quick for identification of a class of compounds). I knew that I had picked a relatively simple compound to identify as it smelled (at least to me) like licorice flavoring in taffy or jelly beans and peppermint (which is a most delicious scent combination by the way).

Whenever we purchase orange soda, perfume or cologne the flavors and scents that we admire are not compounds that are necessarily found in fruits or musk, but rather organic chemicals. Specifically most of these are derived from aptly named aromatic compounds typically derived from benzine, the most studied of aromatics. For instance, my compound was determined to be ethyl benzoate which is a flavoring and scent most often associated with Ylang Ylang and tobacco essences. In wine alone over 200 flavor components are due to organic aromatics, in simple coffee over 800 are present. The interactions of these compounds with taste receptors give rise to the highly complex sensations of taste associated with these beverages.

Perhaps our Organic classes would be more beneficial to the student if they aided theory with practical and intriguing uses and qualities of aromatic compounds. I for one find it more interesting that such simple variations on a simple molecule like benzine can create so many diverse scents and flavors. I most certainly will be able to identify an aromatic ester by its smell.

Drink more milk and enoy the summer

Vitamin D is a group of fat-soluble secosteroids (which is similar in structure to a steroid but involves the breaking of one of a steroids cyclic rings) that are commonly found in fish, eggs and milk. In addition sunlight helps facilitate synthesis in the human body which is thought to be enough to prevent deficiencies. However, fewer individuals are meeting the necessary allotment of time outside to aid vitamin D synthesis and deficiency is becoming a potential problem. According to the National Institutes of Health Dietary Supplement fact sheet the minimum daily requirement for Vitamin D intake is 200 IU (5 mcg), several dietary guidelines recommend 400 IU (10 mcg). For reference, to meet these guidelines 4 glasses of non-fat or low-fat milk would need to be consumed (more of higher fat content milk) or it is suggested by the Mayo clinic that merely 10 minutes in direct sunlight would suffice to prevent deficiency. One would assume that these requirements would be easy to meet (I should mention that one must be careful with vitamin D intake, as I stated earlier it is fat-soluble - it can easily be built up to toxic levels if one is not careful and consumes too many sources of it).

Apparently not. A study described on Eurekalert's online science news website stated that Vitamin D intake levels are so startingly low that "current deficiency levels prompted the American Academy of Pediatrics to double the vitamin D recommendations for children and teens." Half of adolescents, according to the study, are deficient in Vitamin D. It seems to be well-known that Vitamin D and calcium intake will help prevent osteoporosis and other bone problems (primarily in women), but there are other benefits of Vitamin D that are quite beneficial. Studies have correlated adequate Vitamin D intake levels with lower levels of diabetes, hypertension, heart disease and certain cancers. In addition the immune system also benefits from adequate Vitamin D levels (so if you want to prevent catching a bacterial infection, you should perhaps opt for some yogurt over antibacterial soaps).

This being said I think I think it is a pretty simple task to drink another glass of milk per day and spend a few minutes outside. It most certainly will pay off later down the road when we are at risk for all manner of chronic diseases.

Stroke after cardiac bypass

I was perusing Eurkealert.org and came across this interesting study relating cardiac bypass procedures to stroke.

A cardiac bypass involves using existing blood vessels from the patient in order to build an alternate route for blood to flow through around a blockage which are caused primarily by the buildup of fat and cholesterol. In order to prevent organ damage in the patient undergoing a bypass, the body is cooled and subsequently been rewarmed. For years approximately 5% of cardiac bypass patients wake up post surgery with a significant loss of motor activity or speech; to this date few explanations why this correlation of bypass surgery with stroke would occur exist.

Stroke is caused by a disruption to the blood supply of the brain restricting both glucose and oxygen supplies. The brain requires much of the oxygen and glucose in the body in order to function and a disruption of blood flow robs the brain of its nourishment causing cellular death. A recent study from Johns Hopkins may have pinpointed this correlation between stroke and cardiac bypass surgery to the procedure of cooling and rewarming the body in order to prevent organ damage. According to the study blood flow and pressure were recorded for "127 patients undergoing standard, lengthy cardiac bypass surgery during which they spent two hours on a heart-lung machine that circulated their blood for them" and "(e)leven patients undergoing shorter bypass operations were kept at normal body temperature throughout and served as a control group." Of the 127 test subjects 7 suffered from stroke and 1 suffered from a transient ischemic attack which is considered a harbinger for future stroke. None of the control groups suffered an attack of any kind.

While this study does suffer from a minuscule control group, it does help point that the rewarming technique may somehow interfere with the autoregulation mechanism that helps to prevent damage to the brain from blood pressure fluctuation. Currently the research team for the study is developing a near-infrared monitoring device for cardiac bypass surgeries to display blood flow in real-time allowing surgeons to alter blood pressure in order to protect the brain from risk of stroke.

Chloride channels and epilepsy

According to the Mayo Clinic, epilepsy is "a disorder that results from the generation of electrical signals inside the brain, causing recurring seizures." The symptoms of seizures vary drastically, some patients may simply blankly stare for a few moments while others may convulse. In order for a diagnosis of epilepsy, one lone seizure is not sufficient. Statistically speaking, approximately 1 person out of 100 will experience at least one seizure in their lifetime and for 7 out of 10 persons experiencing multiple seizures (epilepsy), no cause may be found. It is clear that due to the risk of death and injury from seizures due to drowning, falling, burning, car accidents and complications in pregnancy, much work must be done to determine specific causes of epilepsy (it is currently believed that oxygen starvation during the natal and prenatal periods may contribute as well as simple differences in brain structure).

A new study by the Max Planck Institute of Neurobiology (I find it interesting that many biomedical facilities were named after physicists, not that this is incorrect as all biological processes seem to arise from conglomerations of quantum physical interactions; still it seems more appropriate for an institute of neurobiology to be named in honor of a neurologist, neuroscientist, psychiatrist or psychologist) has studied the physiology of the chloride channel ClC-2 which has been implicated in a relation to epilepsy and seizures. A prevailing theory of the function of the Clc-2 channel is that as the amount of functioning ClC-2 channels decrease, the more likely the neuron will be activated (its excitability increases due to the greater intracellular concentration of negatively charged chloride ions. However in mice with genetically malformed ClC-2 channels were no more susceptible to seizures than the healthy controls. More confusing is that despite this lack of susceptibility of mice with dysfunctional ClC-2 channels, the neurons lacking the channels were still more excitable than the normal neurons. The answer to this conundrum is actually quite elegant; as the neurons lack ClC-2 on excitatory neurons (which can signal other neurons and lead to actions, or seizures), so do inhibitory neurons (which will lead to nonaction, or help prevent seizures).

It is proposed in this study that while ClC-2 channel presence is implicated in excitability, it may still be implicated in epilepsy. Protein channels may be opened or closed due to presence of chemicals that both naturally (neurotransmitters, hormones , etc.) and unnaturally (medications, drugs, etc.) occur in the brain. It is proposed that the neurons can alter the structure of the ClC-2 neuron in order to alter its excitability (essentially a normal neuron with mitigating factors can act as though it was a dysfunctional neuron as compared to the study described above).

Clearly, we know little about the neurobiological basis of epilepsy and some of what we have discovered is complex and confusing. We need to carry out more research both on the cellular, molecular and clinical scales in order to determine the pathophysiology of these neurological diseases. Neuroscience is a young field, and as V. S. Ramachandran describes, every science must enter into an experimental phase before it can answer its primary question. Neuroscience, it appears is still in it's experimental stage.

Anti-oxidants and cirrhosis

I have always been particularly fond of dark chocolate. My brother is in the habit of purchasing extremely high cacao level chocolates for my tasting (my last was a 95% cacao chocolate bar which is nearly solid cacao, it was quite delicious). Much recent work in nutritional health centers on the effect of anti-oxidants and their benefits to the body. This is unsurprising since oxidizing agents have severe effects on the human body including the breaking of the DNA backbone rendering cellular processes non-functional.

A recent presentation at the International Liver Congress 2010 (sounds like a riveting engagement) enumerated the effects of dark chocolate which like blueberries, red wine and acai berries are high in anti-oxidants. According to the clinical study, dark chocolate liquid meals which contained 85% cacao (a very good percentage as far as taste is concerned I must add) at 0.55 grams/kilogram of the patients body weight were administered to patients suffering from end stage liver disease. The patients receiving the treatment showed improvement in post-prandial (after eating) hepatic blood pressure. High liver blood pressure is associated with blood vessel rupture in cirrhotic patients and by administering a source of anti-oxidants as a nutritional supplement, such as dark chocolate, these problems may be avoided.

I believe that we should be more aware of the benefits of anti-oxidant rich foods, and perhaps it is prudent for American physicians to begin considering recommendations for patients at risk for cirrhosis (alcoholics, college students, etc.) to increase their intake of anti-oxidant rich foods. I certainly would not complain about being told to eat some dark chocolate after meals to help prevent cirrhosis.

Nicotine and intensive care

As of 2007, 19.8% of Americans smoked (a decrease from 20.8% in 2006) according to the CDC's Morbidity and Mortality Report. Withdrawal from nicotine due to cessation of smoking can have several complications that provide difficulty for cessation of use including irritability, concentration difficulties, fatigue, insomnia and gastrointestinal problems among other complaints.

In addition to these effects of nicotine withdrawal, a recent study published in Critical Care, a BioMed Central open access journal, has shown that nicotine withdrawals can cause "serious agitation in intensive care patients." This study found that patients suffering from nicotine withdrawal were more likely to remove their catheters and tube, require anti-psychotic medication, physical restraints or sedatives. In fact the patients suffering from nicotine withdrawal were twice as likely to become agitated as non-nicotine patients.

The purpose of this test was more to provide grounding for later testing of nicotine replacement therapy (NRT) in the case of intensive care patients. This is a particularly sensitive area within the emergency community as NRT has been associated with higher mortality rates. However, due to the harm caused by patients suffering from nicotine withdrawal, it seems prudent to see whether NRT actually does affect mortality rates (this has not been scientifically proven). If NRT is viable for treatment of patients then hospitals can address the difficulties associated with nicotine withdrawal in a critical care setting.

For watchers of medical television hows...

There was a dearth of interesting new studies on Eurekalert.org for the past few days so I have decided to do something different and write about a (semi) rare neurovisceral genetic disorder. Acute intermittent porphyria (AIP) is a disease caused by buildup of heme precursors (the oxygen carrying component of hemoglobin in red blood cells among other things) in the liver. These two compounds, delta-aminolevulinic acid (ALA) and porphobilinogen (PBG) can cause nonspecific symptoms including severe abdominal pain, paraesthesia (tingling in the arms and legs), paralysis and psychosis. These attacks may be infrequent and between attacks the patient may feel very healthy.

This laundry list of symptoms makes AIP particularly difficult to diagnose. However, there is a tell-tale sign that can lead to quicker diagnosis. ALA and PBG are excreted in urine and during an acute attack urine may be red or purple in color (this is not in itself definitive enough for a diagnosis of AIP and urine tests for the levels of PBG and ALA must be performed).

It is estimated the 1 in 20,000 people carry the defective gene for AIP, however, due to some unknown reason only 10% of those with the defective gene express it. For those 1 in 200,000 AIP can be a serious risk as infections, medications, smoking, alcohol and other drugs can all trigger an acute attack.

As of now there isn't an approved cure or treatment for AIP (liver transplants have been done and show promising signs of curing the disease, but are highly unfeasible in most cases). However, just as in the case of phenylketonurics, simple lifestyle compensations such as limiting alcohol and smoking, treating infections rapidly, and watching food intake can allow patients with AIP to have a normal life.

New method of treatment for migraine

Chances are you have probably had to use a nasal medication or saline solution sprays for alleviation of allergy symptoms or coughing. Generally these sprays have tow problems: drip-out (yes, this is actually a scientific term) and an unpleasant taste. A recent development in order to combat these problems has been worked upon by OptiNose. This innovative nasal drug administration system can deliver a dry powder form of the medication.

However, it was not this particular innovation that I found interesting (I don't have a problem with normal nasal sprays). Typically, medication dosed intranasally treats cough and allergy problems, however, a recent study published in Cephalgia has shown that a dry nasal treatment for migraines reduces migraine pain after two hours in 57% patients (20 mg dose) and 54% (10 mg dose). 25% of those given placebo treatments also had alleviated pain in 2 hours making the finding statistically significant.

As migraines affect more than 28 million Americans a year (mostly women) I think it is very important that more research be done into the pathophysiology of migraines. In addition new medications such as intranasal treatment in addition to knowledge of risk factors for migraines will greatly reduce the effect of this problem.

Diagnostic Imaging and shorter stays

Computed tomography (CT) and magnetic resonance imaging (MRI) are diagnostic imaging studies that have been used for screening purposes in preventative medicine and to supplement previous imaging techniques such as x-rays (CT actually is a high level of x-ray radiation that is simply shot from different angles with the resulting images superimposed to form a three dimensional structure) and ultrasonography.

The Journal of the American College of Radiology has recently published a study that links these diagnostic tests with shorter hospital stays (this, I thought was rather common sense - the more tests that are performed, the quicker the diagnosis can be found and treatment performed). The catcher to this study, however, is that on average healthcare costs have been found to be reduced as the costs of CT and MRI are lower than that of inhospital stays (the decrease in costs will only be possible if testing is performed early before hospitalization can occur). These inpatient costs account for roughly 18% of total healthcare insurance premiums paid and have been increasing by 8% annually. It seems prudent to test earlier rather than later when such diagnostic imaging as abdominal CTs and neurological MRIs are necessitated.

It is important for diagnosis to be rapid and efficient in the field of medicine for the patient and as CT and MRI scans reduce both the time of stay in the hospital and thus the cost of inpatient care, it is essential to perform diagnostic imaging studies as quickly as possible when they are thought necessary (this is not to say that they should be administered more frequently, this will increase the cost of care and of cancer for the patient). Hopefully, this practice will become more prevalent.