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.

Neuron length

Neurons are fully differentiated cells arising from the ectoderm which also gives rise to epithelial cells. Functionally neurons are highly specialized to deliver cellular messages from receptor cells to each other or to effector cells. While most neurons are small enough that several thousand could rest on the tip of a dull pencil, some have quite long extensions, or neurites, which may stretch up to a meter in an adult human. However, until recently it was not known what process allowed these neurites (which are primarily located in the spinal regions and are often associated with reflex action and motor activity) to become morphologically different.

A research team from Gumma University led by Assistant Professor Koji Shibasaki and Professor Makoto Tominaga from the National Institute for Physiological Sciences (NIPS) in Japan have identified the TRPV2 receptor on neurons as a mechanical stretch-sensor for helping neurons to develop longer processes. Previously this receptor had been identified as a heat receptor activated in temperatures in excess of 52 degrees Celsius. The research group, however, found activation of this receptor in embryos unexposed to high temperatures, the research group then found that activation of this receptor in developing neurons caused increased growth in axon length (a neurite typically associated with sending signals, dendrites are typically associated with receiving signals and are much shorter and typically more branched). According to Dr. Shibasaki,

We revealed the molecular mechanism why spinal motor and DRG sensory axons can extend such long neurites [sic] toward peripheral tissues. It is really important finding that extending axon can convert mechanical power to electrical energy. I hypothesized that axon outgrowth is regulated by the positive feedback mechanisms through membrane stretch. Now, we can explain why rehabilitation is necessary to improve severe neuronal damage (ex. after traffic accident). The answer could be the activation of TRPV2 by movement of damaged tissue. This molecular mechanism can be applied to neuronal repair, if we can synthesize TRPV2 targeted medication.

This study may provide an answer for how in the future we may be able to foster growth of undamaged neuron processes to replace damaged axons. It is also interesting that when considering neuroscience even the basics of cellular biology such as how neurons begin to differ morphologically are unknown due to the relative youth of this field. There is clearly much more experimental research left to be done before neuroscience may answer some of its larger questions.

Ritalin and neuroplasticity

Nootropics are medications used to increase such diverse mental faculties as cognition, memory, motivation and attention. Perhaps some of the most widely used nootropics by college students are Ritalin, Adderol and the new smart drug of choice, Modafinil. The use and sale of these drugs for non-medicinal purposes is a felony and a further downside of these medications is that both Adderol and Ritalin can be habit forming as found by Martha J. Farah, director at the Center for Cognitive Neuroscience at the University of Pennsylvania as published in the journal Nature. They essentially trigger the brain's reward system (which is the boost in motivation felt by an individual taking either of the two drugs).

According to Eurekalert.org, an online science news abstract service, physicians treat millions of children per year to improve the children's ability to focus. But in addition to aiding in concentration Ritalin accelerates learning. A recent study by Antonello Bonci of the Ernest Gallo Clinic and Research Center and professor of neurology University of California - San Francisco has shown that the mechanism for learning new material that Ritalin fosters involves neuroplasticity. Essentially the drug strengthens connections at the synaptic level and fosters the creation of new synaptic connections, specifically those that involve dopamine pathways.

More research on drugs affecting learning should be performed as it is possible that drugs such as Ritalin may become used for rehabilitation of stroke survivors to facilitate the forming and strengthening of connections. Perhaps when the habit forming nature of these drugs are better understood we may see similar nootropics appearing legally that are as effective as Adderol, Ritalin and Modafinil.