RaMedz

Volume 6, Issue 3

May 2015

The Medical Journal of the Ramaz Upper School

Using the Medicine of the Past to Find the Treatments of the Future By: Mathew Hirschfeld ‘17 In the beginning of April, an eminent source for health-related news reported on a study, in which researchers from the University of Nottingham in the United Kingdom might have discovered a potential new treatment for methicillinresistant Staphylococcus aureus (MRSA) in an unlikely source: a 1,000-year-old medieval manuscript. The eye infection remedy, which researchers found in Bald’s Leechbook, a book containing an assortment of Anglo-Saxon treatments for a multifarious array of ailments, was as effective, if not better, at killing MRSA than conventional antibiotics. This atypical kind of breakthrough is not an isolated incident. Over the past year, the same health-related news source has reported on several similar studies, during which researchers found inspiration for future treatments and approaches in the medicine of the past.

The question no longer seems too unreasonable: Why is it that history consistently offers the present and the future new ideas for avenues of research, especially when our collective understanding of the human body and health has progressed so far over the past 1,000 years?

The Ebola crisis that dominated world news last year produced two papers that looked to the past as a mode to remedy the present. When two American missionaries contracted the Ebola virus, an experimental drug untested on humans, known as ZMapp, was administered. Following this treatment, the missionaries underwent what was referred to as a miraculous recovery from the disease that has a case fatality rate of around 90%. In the Annals of Internal Medicine, Dr. Scott Podolsky stated that the development of the ZMapp treatment had much in common with methods of treating illness, which were developed toward the end of the 19th century, inspired by the work of luminary microbiologists such as Louis Pasteur and Robert Koch.

ZMapp was created by collecting antibodies formed in the blood of mice after exposing them to fragments of the Ebola virus, which mirrors the technique of passive serotherapy, originally used to treat diseases such as pneumonia and meningitis.

Staff Editors-in-Chief Arianne Rothschild Yakira Markovich

Faculty Advisor Ms. Lenore Brachot

Using the Medicine of the Past to Find the Treatments of the Future (continued) By: Mathew Hirschfeld ‘17 A particular team of researchers decided to peer even further back into history to find ways of dealing with the Ebola virus. Dr. Igor Linkov, a visiting professor of the Ca Foscari University, Italy, and colleagues believe that 14th century Venice contains various lessons regarding how to alleviate such a crisis. In 1347, Venice became the epicenter of a plague epidemic. Following the initial attempts to fight the disease with prayer and ritual, the Venetians eventually responded by instigating what experts have dubbed “resilience management.” Although they did not comprehend the disease itself, the authorities introduced a system of inspection, the quarantining of stations on nearby islands and the wearing of protective clothing. These measures helped Venice to remain prosperous even after the early devastation wrought by the plague.

According to Dr. Linkov, “Resilience management can be a guide to dealing with the current Ebola outbreak in Africa, and others like it, as well as other issues like population growth and the impacts of global climate change. Similar to what the officials of Venice did centuries ago, approaching resilience at the system level provides a way to deal with the unknown and unquantifiable threats we are facing at an increasing frequency.”

This example illustrates one fundamental motive behind why researchers may be inclined to examine the past to treat diseases of the future, and that reason is historical precedence. The parallels between the epidemics faced by 14th century Venice and present day West Africa are numerous enough to suggest that one or two lessons learned may still be applicable. Here, history is repeating itself.

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New Study shows to be more effective in detecting Down Syndrome By: Oriya Romano ‘17 A new study conducted by Dr. Mary Norton, professor of clinical obstetrics and gynecology at the University of California-San Francisco revealed that a blood test was more effective in diagnosing a chromosome abnormality than standard screening test. The main study was to see if this blood test could detect an abnormality on the 21st chromosome-Down Syndrome.

This is a common genetic condition that affects 1 in every 700 babies born in the US. It occurs when an extra copy of the 21st chromosome is produced. This cell with the extra chromosome is replicated throughout the body. This causes developmental abnormalities such as flattened features, reduced muscle tone, and small hands and feet. All pregnant women are offered a screening test during the first trimester giving them an idea of how likely their child is to be diagnosed with Down Syndrome.

An ultrasound is used to measure the amount of fluid that is accumulating around the baby’s neck tissue, because an increased buildup may indicate abnormalities. But the new study suggests that using a regular blood test that is usually recommended for high risk pregnant women should just be used as a first step due to it being more accurate than the ultrasound. The way it works is by detecting the cell-free fetal DNA circulating in the pregnant women’s blood and seeing if there are extra copies of the 21st chromosome. (cfDNA test)

The study to prove this started with 18,955 pregnant women between 10 and 14 weeks of gestation. 76% of these women were between the ages of 30-35 but 24% were over the age 35. This is important because the 24% of the women who are over 35 are at higher risk of having a child with chromosomal abnormalities.

Every woman was given both the screening and cfDNA test. Among all these women 38 cases of Down syndrome were identified. The cfDNA test correctly identified all 38 of the cases while the screening test only identified 30 cases.

There are cons to this test. First is that the test costs more than the common tests and will take longer to identify the abnormality, so for low risk women this might not be worth the money and time. The cfDNA test also doesn’t give the same broad range of abnormalities that regular methods offer. Other abnormalities such as Patau syndrome and Edwards syndrome are detected more frequently on the screening test as opposed to the cfDNA test. However the test has a positive side as well. This test offers a less invasive and more accurate identification of the chromosomal abnormality than traditional methods. By being less invasive the rate of related miscarriages may also decrease.

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It Could Be Old Age, or It Could Be Low B12 By: Sarah Araten ‘16 At the age of 85 Ilsa Katz was having memory problems, with symptoms similar to those of Alzheimers, and when tested, it became clear that she was Vitamin B12 deficient. Her daughter, Vivian Atkins, wondered why people are not regularly tested to see if they have enough Vitamin B12. There are many different types of ways get a sufficient amount of Vitamin B12. Foods high in Vitamin B12 include meats as well as fish, though chicken does not have as much. Other foods produced by animals, such as eggs and milk, also contain B12, but not as much. Vitamin B12 is vital in our body system, because it helps in the creation of healthy red blood cells, facilitates in DNA creation, as well as keeps a person's overall nervous system in good shape. One of the problems with Vitamin B12 is that there are many people who do not get enough, for various reasons.

People who drink too much or people who have had previous stomach surgery are just some of the types of people who have a greater chance of not getting enough Vitamin B12. Vegetarians and vegans have an especially high risk of becoming deficient in the vitamin, as they are not eating animal products. Luckily vitamin supplements, injections, and B12 fortified lollipops are just some of the many ways for people to increase the amount of Vitamin B12 they have in their bodies.

Knowing that many people do not get enough Vitamin B12 will encourage people to try and get their Vitamin B12 tested, and try to eat foods rich in Vitamin B12. Since Vitamin B12 helps our memory, our mood, and many other aspects of our life, it is essential that we make it part of our everyday meal. Who knew that Vitamin B12 could make such a big impact in our lives?

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Dr. Klapholz Speaks at the Pre-Med Club By: Gabriel Klapholz ’17 My father, Dr. Ari Klapholz, a pulmonologist and sleep specialist, recently spoke at the Pre-Med Club in March. Dr. Klapholz grew up in a house where doctors were exalted. A part of his upbringing, medicine played an important role in how he decided his career. Dr. Klapholz received medical certification in internal medicine, critical care medicine, pulmonary medicine and sleep medicine.

As the Director of Pulmonary Critical Care at Cabrini Medical Center, a Catholic hospital, Klapholz worked in the intensive care unit (ICU), which, in my father’s words, is “not a very restful place.” The ICU is a common setting for a pulmonologist, or lung doctor, where a specially trained staff cares for high-maintenance patients.

Dr. Klapholz called his work in the ICU “an eye-opening experience,” where he needed great communication skills. Doctors in the ICU need to be able to give the truth easily to a concerned family. Despite being a Catholic institution, the hospital was willing to take patients off ventilators with consent from the family. Interestingly, Dr. Klapholz informed us that the last six months of one’s life is when the most healthcare money is consumed.

Cabrini Medical Center closed in 2008, at which point my father went into private practice with New York Cardiovascular Associates (NYCVA). While the practice mainly consists of cardiologists, pulmonologists are also necessary as the heart and lungs are both medically and biologically intertwined – problems in one lead to problems in

the other.

Dr. Klapholz spoke about how pulmonologists primarily take care of chronic obstructive pulmonary disease (COPD) and other lung diseases.

Emphysema, a subcategory of COPD, is particularly common and can even be caused by genetic susceptibility. Lung cancer is another major issue that Dr. Klapholz deals with on a daily basis.

After all, lung cancer is more prevalent nowadays than breast cancer. Only 10% of lung cancer patients don’t smoke.

The cancer’s prevalence can be attributed to the fact that 18-20% of the US population still smokes.

Nowadays, according to my father, pulmonologists are very interested in sleep. Sleep apnea—shallow or obstructed breathing during sleep—is the most common sleep disorder treated in Dr. Klapholz’s office. Signs of sleep apnea begin with nothing more than snoring, but the condition is very dangerous. Sleep apnea often causes “microsleeps,” short stints of sleep set off by sleep deprivation. Often, these microsleeps lead to car accidents.

Klapholz told the room of students that, most likely, we are all chronically sleep-deprived, as adolescents should be getting nine hours of sleep every night. In terms of solutions to sleep apnea, the CPAP machine “revolutionized the field.” According to Klapholz, it is a humane way of using a ventilator. In addition to the CPAP machine, oral appliances, which move the jaw forward to allow in air, are also used to prevent sleep apnea. In more severe cases, however, the problem can be solved surgically. For example, a potential cure is removal of the tonsils 5

in children. One can develop sleep apnea at any age. In general, the condition is associated with weight gain and obesity, but 50% of patients are genetically predisposed.

Another condition that Dr. Klapholz deals with is insomnia. Insomnia is often caused by stress and anxiety. If the insomnia lasts for longer than three months, then it is considered chronic. Chronic insomnia is often an elderly issue, due to depression, death fears or aches and pains. It causes a disruption of the circadian rhythm, making it harder to treat than sleep apnea.

Klapholz said that the best way to treat it is through cognitive behavioral therapy (CBT) and not through drugs. The goal of this is to “divorce their day from their night.” The aforementioned sleep aids can cause addiction and injury.

Dr. Klapholz, with the help of another sleep specialist, currently works in a sleep lab of eight beds, where people sleep for the night to be monitored and diagnosed.

New Methods to Test for Breast Cancer By: Jessica Fuzailof ‘17 Breast cancer, the leading type of cancer for women worldwide, has a very high survival rate in western countries, but remains a very serious issue for millions of women around the world. A large variety of factors are said to increase the risk of developing breast cancer. Among those factors are certain cancer-risk genes, the most common being BRCA1 and BRCA2. Today, a saliva-sample based test has been created to test for ovarian and breast cancer for one tenth the normal price. Previously, testing of BRCA genes has typically been limited to women with history of cancer in their families, and insurance companies only cover testing in those cases. The argument here is that testing should be offered—and carried out—for all women thirty years old and above. Simply relying on family history is not enough, considering that the mutation can be inherited from the paternal side and that sometimes a family history of ovarian or breast cancer may exist, but not be evident.

The opposition to simple, online, easily accessible testing comes from experts citing sources from Myriad, a company that had a monopoly on BRCA testing for a long time and therefore has the most data. Myriad stated that two

percent of the detected mutations could not be determined as either dangerous or benign. Other companies reported numbers that go higher than two percent.

Researchers and companies are working together to try and lower those statistics so that the salivasample testing will be as beneficial as it can.

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Yoga Helps Older Adults Battle Depression and Anxiety By: Arianne Rothschild ‘16 Yoga is known to reduce stress and provide health benefits such as weight management, increased flexibility, improved respiration and improved muscle strength. Yoga is generally a younger adult form of exercise due to the stretching and positioning. Older adults typically do not give yoga a try, but a recent study reviews effects of yoga and similar exercises in adults ages 60 and over. Of the adults participating in the study, up to 40% experienced stress. Another 15-20% of adults were depressed. The journal Aging & Mental Health examined the results of 15 studies done over the past 20 years that test methods of relaxation. The different relaxation methods tested were yoga, listening to music, tensing and relaxing different groups of muscles, massage therapy and stress management training.

Yoga and music were the most effective in reducing stress as well as depression. Yoga had the best long term benefits – for up to 6 months after the study, positive results stayed.“It could help counterbalance the negative effects of aging, improve physical functioning, postpone disability, decrease morbidity and mortality, stimulate the mind, and increase hope, reducing the risk of anxiety and depression,” the study authors

claim. In second place for long term effects is the progressive muscle resistance testing (PMRT). PMRT left positive results which lasted 14 weeks after the conclusion of the study. “It is believed that the PMRT has a tranquilizing effect, triggers a sense of peacefulness, helps participants retreat mentally from their problems and curtails negative thoughts, reducing depressive symptoms,” the authors write.

Though it may be difficult to maneuver one’s body at an older age, the results should be a worthwhile counter balance. One is never too old to exercise or relieve stress.

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Celiac and Gluten Sensitivities By: Julia Lipman ‘16 Celiac disease is estimated to affect about three million Americans, a number that is increasing each year.

Researchers are working on possible medications for this condition. A person with Celiac disease cannot ingest gluten and if so, it may cause damage to one’s intestines. Kristen Sweet, a woman who has Celiac disease, speaks out about her condition and how it affects her life. She explains that it is not safe for people suffering with the disease to go out and eat beyond the boundaries of their homes where they would trust others to make sure their food contains no gluten. This risk is often a major problem because if even a little bit of gluten is contained within the food, it can cause major stomach issues, often for several days.

As the disease has become more common, pharmaceutical companies are rushing to discover possible drugs for patients suffering from the disease. Drugs are not expected to make their debut until 2018 but there are reports that the tested drugs appear to be somewhat successful. Celiac is now known to be an autoimmune disease where the body’s immune system is attacking itself. As of now, the only suggested “cure” for people suffering from Celiac disease is to go on a gluten-free diet. Although this gluten-free diet is helpful and will often help a person’s Celiac

disease lesson in seriousness, it is not considered a true cure. After studying many adults’ intestines after years of going on a gluten-free diet, they still found damaged intestines. Companies and researchers are working very hard on discovering further details regarding the disease and hopefully will find a cure in the near future.

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NFL Players to Receive Compensation for Head Injuries By: Gabriel Klapholz ’17 Chronic traumatic encephalopathy (CTE) is a brain disease that is common among NFL athletes. It is a degenerative disease resulting from frequent damage to the head.

Recently, a study was conducted at the University of California, Los Angeles (UCLA), which comprised of 14 retired NFL players who suffer from CTE. These former athletes, as a result of the disease, have come victim to mood swings, depression and other neurological issues.

The study sought to find a method for researchers to study CTE in live tissue, rather than in tissue acquired following death. Up until now, researchers have had great difficulty in using living patients to study the brain disease. The study, which was published by Proceedings of the National Academy of Sciences, highlights growing, yet gradual, progress for the researchers.

During the study, the former NFL players showed large amounts of tau protein in their brains, which is a sign of CTE. Researchers gave the players PET scans, or positron emission tomography scans. The protein was also found postmortem in the autopsies of other players that suffered from the disease. 24 patients with Alzheimer’s disease and 28 participants with no known neurological issues were evaluated alongside the 14 retired athletes to provide for more conclusive results.

The group of 28 subjects served as a control, yet the group of 24 patients showed different concentrations of tau

protein than those of the NFL players, raising questions about the true nature of the disease. Two years ago, similar research was initiated and the current discoveries come to build on past results.

Some of the study’s findings, however, have come under question. The PET scan was developed at UCLA, but many claim it to be inaccurate.

Researchers’ discoveries also fall short on the topic of predisposition to the disease, an issue that remains in question as to why some people naturally develop CTE. In total, fully testing an individual costs approximately $10,000. The number includes the money required for the PET scan. Despite the great cost, some claim that more testing is needed at other medical centers to affirm the accuracy and usefulness of the PET scans.

The NFL now seeks settlement with the retired athletes who claim that they were not properly warned of the realistic threat of head injury and concussion. A player discovered with the disease since 2006 is qualified to receive up to $4 million. However, if CTE is found in a player after the official date of the settlement, which is up to the pending decision of a federal judge, that player will not receive monetary compensation. Many believe that this is simply an attempt by the NFL to protect future conflicts, as the league is certain that other NFL players will later succumb to the disease.

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Can Blindness be Cured?

By: Oriya Romano '17 The long term effects of this injection are still unknown but new gene therapy cures can potentially be derived from this trial.

Researchers say that this can lead to cures for more common degenerative eye diseases.

Scientists at the University of Oxford in the UK conducted an experimental test to try to restore some sight to people with choroideremia. This disease is caused by a mutation in the CHM gene. As the photoreceptors in the retina degenerate, the person's eye sight worsens. This affects about 1 in 50,000 people and eventually makes the person completely blind about the time they are middle age.

There is no treatment for this disease but recent attempts proved to be successful. The clinical trial started with six male patients between the ages of 35-63 who have choroideremia. They were all injected a single time with a harmless virus containing a healthy copy of the CHM gene. By doing this the researchers hoped that the healthy gene would stop the photoreceptors from dying. The patients in this trial were not completely blind but their ability to see varied. Six months after the injection, the patients came in to be examined for any changes. Four of the patients found that their sensitivity to light improved and the other two men that previously had more advanced choroideremia showed the most substantial results.

Their whole sight improved and they were able to read 2-4 more lines on the eye chart than they were previously able to.

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Aspartame and Pepsi By: Avi Neiditch ‘16 Pepsi Co. has decided to stop putting Aspartame in its diet drinks in response to the recent decline in sales.

Seth Kaufman, the CEO of pepsi, said that “Aspartame is the number one reason consumers are dropping diet soda.”

The change will only affect varieties of Diet Pepsi in the U.S. market.

Aspartame has sparked controversy where studies have claimed that the same dosage of aspartame given to humans was given to mice, the mice received tumors. However, European regulators and US Food and Drug Administration have not been convinced that aspartame is at all harmful. The only group of people who cannot consume Aspartame is people with the inherited disease of phenylketonuria because they are unable to metabolize a component of aspartame.

Other companies have also decided to ditch the Aspartame, such as General Mill’s, the maker of Yoplait Light. As consumers move toward a more natural diet, Yoplait Light’s sales have dropped. In contrast, the full calorie Yoplait, has seen an increase in sales. The cause being more and more people wanting to avoid Aspartame.

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Works Cited Using the Medicine of the Past to Find the Treatments of the Future http://www.medicalnewstoday.com/articles/292266.php

By: Mathew Hirschfeld

New Study shows to be more effective in detecting Down Syndrome http://www.medicalnewstoday.com/articles/291895.php

By: Oriya Ramano

It Could Be Old Age, or It Could Be Low B12 By: Sarah Araten http://www.nytimes.com/2011/11/29/health/vitamin-b12-deficiency-can-cause-symptoms-thatmimic-aging.html?_r=0 New Methods to Test for Breast Cancer By: Jessica Fuzailof http://www.nytimes.com/2015/04/21/business/more-accurate-affordable-tests-for-detectingbreast-cancer-genes.html?ref=health&_r=0 Yoga Helps Older Adults Battle Depression and Anxiety http://time.com/3834499/yoga-elderly-depression/

By: Arianne Rothschild

Celiac and Gluten Sensitivities By: Julia Lipman http://www.nytimes.com/2015/04/29/business/celiac-diseases-prominence-has-drugcompanies-racing-to-find-treatments.html?ref=health&_r=0 NFL Players to Receive Compensation for Head Injuries By: Gabriel Klapholz Belson, Ken. "Progress Is Seen in Detecting C.T.E. in Living Patients." New York Times. N.p., 6 Apr. 2015. Web. 8 Apr. 2015.

Can Blindness be Cured?

By: Oriya Ramano http://www.medicalnewstoday.com/article/271257.php Aspartame and Pepsi By: Avi Neiditch http://www.bbc.com/news/health-32478203 http://www.foxnews.com/leisure/2014/06/25/yoplait-light-changing-artificial-sweeteners/

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