PULSE VOLUME 7, ISSUE 2. WINTER 2021.. 2021.
MEDICAL ADVANCES TRANSFORMING THE WORLD
from the editor-in-chief Dear Reader,
Entering a new year with the launch of several COVID-19 vaccines but still the continuous presence of the pandemic raging on, we begin to question what lies in the future. Nevertheless, we are optimistic that this year will bring in positive beginnings for many individuals who continue to experience challenges during this time. With the addition of us finishing out our winter quarter, we hope you have a moment during your breaks to give a glance at our newest issue of PULSE that details the medical advances or situations that are currently transforming the world. Turning to our current issue, we present a diverse range of interesting articles from a focus on the ethics of the COVID-19 vaccine to the exploration of the longest frozen embryo. There are also noticeable spotlights on current medical treatments including phlebotomy and botox. Furthermore, our partnered contributors have given us a glimpse into tips for the AMCAS application and MCAT practice tests for those who are readying for medical school. It has been a pleasure working with the current writers, editors, and partnered contributors and I would like to thank them for their ongoing commitment throughout this quarter. With spring nearing closer, please take the time to take care of yourselves before our spring quarter begins. We encourage our readers to stay up to date with current events and support your friends and family as the year 2021 continues onwards. Please enjoy our PULSE winter issue and we wish you luck on your last finals for the winter quarter! With Regards, Sophia Cao
editors EJ Beck Sophia Carino Shayna Cohen Riley Hurr Emory Kim Marissa McCollum Katrina Schmitt
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writers Anna Argulian Ashley Chen Deniz Eracar Areeha Khalid Teresa Nam Chloe Palumbo Sanjana Rao
production Sophia Cao
other contributors MCAT-prep.com Kaplan Test Prep The Princeton Review
CONTENTS EDUCATION 12 SMART TIPS FOR YOUR AMCAS APPLICATION MCAT PRACTICE TESTS: THE BEST PRACTICE YOU CAN GET KAPLAN MCAT PRACTICE PROBLEM
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POLICY DISTRIBUTION DIFFICULTIES: ETHICS OF COVID-19 VACCINE
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RESEARCH PHILOSOPHIES OF MEDICINE THE ALTERNATIVE USES OF BOTOX
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CLINIC THE EVOLUTIONARY BASIS OF DISEASE WORKING MEMORY IMPAIRMENTS IN SCHIZOPHRENIA
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CURRENT EVENTS FROZEN EMBRYOS SHIFT THE FUTURE OF FAMILIES COVID CAUSING SURGE IN TEEN PREGNANCY
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12 SMART TIPS FOR YOUR AMCAS APPLICATION Medical school admission is fierce. We are here to help you get noticed!
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Aim to send out your application in the J's
Plan to submit your AMCAS application as early as possible—ideally in June or July. Applicants are usually processed in the order that their applications are received, so send your application as early as you can.
Have a copy of your offical transcript by your side
Order a personal copy of your transcript so you can refer to it while filling out the Course Work Section of your application. Write down course names exactly as they appear on your tran script, including those you withdrew from, failed, or repeated. AMCAS will check your application against your official transcript, and typos or misremembering on your part can hold things up.
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Know exactly what you'll need. Get familiar with all the pieces of your AMCAS application well in advance so that there are no surprises or races to get transcripts and professor recommendations later on. For example, all official transcripts must be sent to AMCAS directly from the registrar's office, accompanied by the AMCAS Transcript Request Form. AMCAS says, " Problems with transcripts are the number one cause of processing delays and missed application deadlines." To find out how to send transcripts to AMCAS, visit their site. 4. Be honest
In no case should you fabricate, alter, or omit information that is requested on your application. If you are caught lying on any part of your application, even after being accepted or starting at a medical school program, you will be barred from entrance, put on probation, or even expelled.
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EDUCATION
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Prioritize on the Work and Activities section You can list up to 15 extracurricular experiences on your AMCAS application, which may include clinical, research, or volunteer activities as well as honors, awards, and distinguished publications. Don’t waste valuable real estate by listing unrelated, substandard, or short-lived experiences. You'll have the opportunity to designate up to 3 experiences as "most meaningful," which will give you an additional 1,325 characters to explain why. Choose carefully!
Take advantage of The Princeton Review’s Free Medical-School Management Tool where you can manage and organize your pre-med experiences that medical schools prioritize, receive alerts on medical school deadlines, requirements and application updates, and access to The Princeton Review’s expert advice threads on building a strong medical school application.
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Your Personal Statement is a huge opportunity
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Be clear
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Explain inconsistencies
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Be careful with cut and paste
The med school personal statement is a one-page (5,300 characters) essay that gives the admissions committee the opportunity to better understand you as a candidate. It is the best opportunity to give a human face to your medical school application. Don’t underestimate the power of this statement to make a strong, positive impression on an admissions committee. AMCAS says problems with transcripts are the #1 cause of missed deadlines.
Be sure that all your time is clearly accounted for. If there are gaps or ambiguities in the chronology of your education or career, it will send a red flag to the admissions committee. Even if you innocently forget to account for six months during your junior year, admissions committees may suspect that you are trying to hide something.
Don’t let grades and test scores speak for themselves—especially if they are saying bad things about you! Be sure to explain poor or uneven performance on your application in your personal statement and your recommendation letters.
AMCAS warns that if you cut formatted text from a word document and paste it into the online AMCAS application, you might encounter formatting issues that can’t be edited once your application is submitted. Their advice is to draft your essay or significant experiences in plain text first, "preferably in text-only word processing software, such as Microsoft Notepad or Mac TextEdit" and then copy it into your application.
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10. Recruit readers to review your essay
To maximize the chance that your personal statement has broad appeal, you will want to recruit at least three types of readers to look at it in draft form:
2. Someone who knows you very well and who can analyze the content of the essay based on what they know about you and your passions.
3. Someone with a composition or English background who can address whether your statement is appropriately organized, tells a compelling story, and is interesting and grammatically correct.
1. Someone with an admissions background, such as your premed advisor, who can tell you whether the essay is addressed appropriately to your medical school audience
11. Profread (and then proofread again)
There's no spellcheck on the AMCAS application. Make use of the “Print Application” feature, so you can print (and proofread!) a hard copy before you submit. Careless errors and spelling mistakes demon strate inattention and a general lack of regard for the application process.
12. Get advice before you start
Meet with your pre-med advisor or your med school admission counselor to go over your application strategy. Together you can choose which 15 experiences to highlight, who to ask to write your recommendation letters, and the personal statement topic that will make your strengths and back ground shine.
Our Med-School Admissions experts know what it takes it get into medical school. Get the customized strategy and guidance you need to help achieve your goals. Start with a free consultation to see how we can help you!
Learn more – The Princeton Review’s Med School Admissions Counselors.
For more advice on the medical school application process, check out our Medical Admissions Webinar series on Youtube. Listen as The Princeton Review’s Lead Medical School Admissions Counselor, Dr. Anita Paschall, MD, gives various topics ranging from the medical school application timeline, tips for crafting your personal statement, experiences to get you noticed and more!
Ready to prepare for the MCAT®?
Start by taking a free practice test online anytime through PrincetonReview.com/FreePracticeTest. Find out if your starting score could help you get into the university of your choice! A few more points can make a difference. Check out our most popular MCAT courses starting this May to prepare you for the MCAT this summer. Seats are being filled quickly, so don’t miss out! We guarantee an MCAT score of 510+* or your money back! ©2021 TPR Education IP Holdings, LLC. All Rights Reserved. The Princeton Review is not affiliated with Princeton University. MCAT is a registered trademark of the Association of American Medical Colleges (AAMC), which is not affiliated with The Princeton Review. *Restrictions apply. Visit PrincetonReview.com/guarantee for details.
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EDUCATION
MCAT PRACTICE TESTS: TESTS THE BEST PRACTICE YOU CAN GET It is quite common for students to stress over their practice test scores for the MCAT-or any life-changing exam for that matter. After all, keeping track of your results from practice tests define the extent and pace of your preparation before the “actual thing.” On the other hand, students tend to overlook one essential and vital element in their test preparation and that is, confidence. Oftentimes, the level of difficulty a particular exam exudes depends on your ability to focus on multiple passages, your familiarity with the flow of the exam, and your knowledge that you are up against random topics. Therefore, taking full-length practice tests that simulate the real MCAT exam should prepare you by exposing you to a broad spectrum of content and effective strategies while granting you a mindset that will keep you from panicking on test day. In other words, the more MCAT practice tests you take, the less surprises you can expect on the real exam. Now, remember that your practice test results should be used primarily to identify your weaknesses and learn from them in the process. MCAT success entails acquiring the right strategies along with addressing your errors. So, here are some important questions to ask yourself during your post-test analysis:
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Did I read the questions thoroughly?
Did I fully understand what the questions were asking?
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Did I read all the answer choices thoroughly?
Did I second-guess my answer?
Unfortunately, performing poorly on the MCAT despite studying prep materials is a common story among students. Time constraints, tough passages, and surprising questions can all get the best of you if you are not prepared for them. For these reasons, you must learn to feel comfortable, confident, and focused with the real exam scenario. And you can best achieve this by taking practice tests. Ideally, you should schedule time to take two to three timed, full-length, practice tests each week for at least two months prior to your test day. And do not forget to try our free MCAT practice test at www.mcat-prep.com.
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EDUCATION
Kaplan MCAT PRACTICE PROBLEM QUESTION Prolonged vitamin B12 deficiency can be associated with subacute combined degeneration of the spinal cord. Patients with this disease have difficulty walking because they lose the ability to feel where their feet are in space. This represents a loss of:
A. vestibular sense B. kinesthetic sense C. parallel processing D. feature detection
THINK YOU’RE READY FOR TEST DAY? Find out with this fun and FREE way to tackle practice MCAT questions from Kaplan Test Prep. Register to receive one sample question a day for the next three months. You’ll get: • A new MCAT-style question each day to test your knowledge and skills • Complete explanations and expert strategies with every question • Compete against your friends to see who’s really ready for test day To get started go to: https://www.kaptest.com/mcat/mcat-practice/free-mcat-practice-question-a-day
B. Kinesthetic sense, or proprioception, refers to the ability to tell where body parts are in three -dimensional space. The sensors for proprioception are found predominantly in the muscles and joints. Loss of vestibular sense, choice (A), would also cause difficulty walking, but this would be due to a sense of dizziness or vertigo, not an inability to feel one's feet. ANSWER winter 2021 || 7
THE DIFFICULTIES OF DISTRIBUTION ETHICS OF THE COVID-19 VACCINE By
Rachel Zhang Sophia Carino
In the past year, the COVID-19 pandemic has brought immeasurable loss, suffering, and isolation to hundreds of millions of people across the globe. As the virus and its new variants exhibit detrimental effects, the world has poured copious funding into the development and research of vaccines. Under normal circumstances, the production and distribution of a vaccine involve extensive funding for research, reviews, and clinical trials in a process which can take several decades. Given the urgency of COVID-19, these results were accelerated to reach approval within just 12 months. As the virus continues its way into 2021, several of these vaccines have been
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approved and are readily available. In the United States, Pfizer-Biotech and Moderna are two mRNA vaccines which were approved in late December 2020. The mRNA injected through the upper arm provides the body’s immune system, particularly the memory T and B cells with key information regarding how to fight the virus given an actual encounter. Pfizer-Biotech administers a two-shot vaccine with a 21-day difference, whereas Moderna has a longer, 28-day difference between the first and second shot. As of February 2021, Johnson & Johnson applied for emergency FDA approval for a different, one-shot vaccination. This
vaccine modifies an adenovirus, which stores instructions to fight COVID-19 in DNA rather than mRNA. Nevertheless, as these vaccines develop and phases of distribution begin, there remain several complex issues regarding which countries and which people should be receiving this finite number of vaccines first.
Distribution In Countries Evidently, the development of a vaccine with sufficient funding has disproportionately occurred in wealthier countries which can afford such urgent acceleration.
POLICY
As these vaccines roll out, many wealthier governments pre-order a large percentage of produced vaccines, to the extent that there are few left for lower-income countries. Due to high global demand, lower-income countries are unable to purchase as many vaccines and must pay a higher price for the same number of vaccines. As of February 4th, 68 countries and territories worldwide have begun vaccine distribution, but only four of these countries are from Africa. South Africa, a region hit hard by the virus and the new variant, paid $5.25 per dose when compared to the $3.00 per dose deal secured by the African Union just two weeks before. With 1.5 million cases and 45,000 deaths, South Africa requires these vaccines just as much, if not more than other lower-paying countries do. And yet, while wealthy countries increase their vaccine distributions and buy up the finite supplies which exist, there also comes the realization that an improved economy and safe world
can only be achieved through equal distribution to lower-income countries as well. In the US, the Pfizer and Moderna vaccines require refrigeration at colder temperatures, and these conditions cannot be maintained in many parts of the world. To deliver two separate shots in a given timeframe, there must be modes of transportation and tracking, which is also not globally plausible. More vaccines and more distributable vaccines must be extended to lower-income countries or the world is incapable of returning to any former sense of normalcy.
Distribution In Populations Within each country, there are additional issues in deciding which people within the population receive the vaccine first. Should it be healthcare workers? Elderly? Teachers? Politicians? What about prisoners? The general public? Should the vaccine be distributed at random?
There are many conflicting views about the prioritized demographics in vaccine distribution, and there are many conflicting reasons in favor of different people. While primary distribution to healthcare workers is a given, the situation gets more complicated immediately afterwards. When it comes to the elderly versus younger generations, vaccinating older adults averts less deaths, whereas vaccinating younger adults averts more infections. Prisons have become COVID-19 breeding grounds, as communal living in confined spaces facilitates spread. When it comes to in-person educational instruction, teachers also need the vaccine for this to be a safe experience. Different countries and groups of people have considered these prioritizations in different ways, as there is no concrete answer for the distribution of finite vaccines amongst a sea of people who wish to receive it. In the US, the Centers for Disease Control and Prevention
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has announced their distribution phases (left image). The City of Chicago follows a similar order of distribution phases (right image).
Taking the Vaccine While the development of COVID-19 vaccines decreases the risk and severity of COVID19, there are several reasons why a person may avoid taking the vaccine. The CDC recommends against taking the mRNA vaccine for anyone who has had either anaphylaxis (severe allergic reaction) or an immediate allergic reaction to polyethylene glycol (PEG), polysorbate, or any other potential allergen in an mRNA COVID-19 vaccine. Many people express concern about safety due to the speed at which the vaccine was produced, and many believe the misconception that the vaccine could alter one’s DNA. Many are also concerned regarding the longterm effects of the vaccine. Despite these concerns, a majority of the population must take the vaccine in order to return to some resemblance of normal life. Roughly 70-90% of the population must either be vaccinated or have antibodies against the virus
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to achieve herd immunity, assuming that COVID-19 variants do not make this entirely impossible. Lingering concerns and refusing people will make this process rather difficult.
To Conclude The COVID-19 pandemic presents itself to the world as a difficult, unfamiliar situation through which inequities and dysfunctional systems are brought to light. The distribution of COVID-19 poses several ethical and reasonable questions regarding how the United States, and also the entire world, should respond to the difficulties provided by a global health crisis. As the virus spreads further and new variants arise, only time will tell the extent to which our vaccines are effective and if the world is able to combat the COVID-19 pandemic on a united front in favor of a return to normalcy. “Different COVID-19 Vaccines.” Centers for Disease Control and Prevention. Centers for Disease Control and Prevention, Jan 25, 2021. https://www.cdc.gov/coronavirus/2019-ncov/ vaccines/different-vaccines.html. Dooling, Kathleen. “Phased Allocation of COVID19 Vaccines.” Centers for Disease Control and Prevention. Centers for Disease Control and Prevention, Dec 20, 2020. https://www.cdc. gov/vaccines/acip/meetings/downloads/slides2020-12/slides-12-20/02-COVID-Dooling.pdf.
Fring, Gustavo. “Medical vaccine in shoulder stock photo.” Pexels. Pexels, Jul 22, 2014. https:// www.istockphoto.com/photo/medical-vaccinein-shoulder-gm502686281-43845142?utm_ campaign=srp_photos_noresults&utm_ content=https%3A%2F%2Fwww.pexels. com%2Fsearch%2Fvacccine%2F&utm_ medium=affiliate&utm_source=pexels&utm_ term=vaccine. “How the Johnson & Johnson Vaccine Works.” The New York Times. The New York Times, 2020. https://www.nytimes.com/interactive/2020/ health/johnson-johnson-covid-19-vaccine. html. “Information about the Moderna COVID-19 Vaccine.” Centers for Disease Control and Prevention. Centers for Disease Control and Prevention, Jan 25, 2021. https://www.cdc.gov/ coronavirus/2019-ncov/vaccines/differentvaccines/Moderna.html. “Information about the Pfizer-BioNTech COVID19 Vaccine.” Centers for Disease Control and Prevention. Centers for Disease Control and Prevention, Jan 25, 2021. https://www.cdc.gov/ coronavirus/2019-ncov/vaccines/differentvaccines/Pfizer-BioNTech.html. McSweeney, Eoin & Chingon, Nyasha. “Western countries have ‘hoarded’ Covid vaccines. Africa is being left behind as cases surge.” CNN. CNN, Feb 5, 2021. https://www.cnn.com/2021/02/05/ africa/vaccine-race-africa-intl/index.html. Moscato, Lindsay. “Why more countries need covid vaccines, not just the richest ones.” MIT Technology Review. MIT, Jan 26, 2021. https://www.technologyreview. com/2021/01/26/1016733/covid-vaccineglobal-inequality-covax. “More than 209 Million Shots Given: Covid-19 Tracker.” Bloomberg. Bloomberg, Feb 22, 2021. https://www.bloomberg.com/graphics/covidvaccine-tracker-global-distribution/. Thompson, Stuart. “How Long Will a Vaccine Really Take?” The New York Times. The New York Times, Apr 30, 2020. https://www. nytimes.com/interactive/2020/04/30/opinion/ coronavirus-covid-vaccine.html. “Vaccine Distribution Phases.” Chicago.gov. City of Chicago, Feb 10, 2021. https://www.chicago. gov/city/en/sites/covid19-vaccine/home/ vaccine-distribution-phases.html.
RESEARCH
PHILOSOPHIES OF MEDICINE By
Areeha Khalid Katrina Schmitt
Many people think “medicine” is one big field with a series of subspecialties. In fact, there are many different philosophies on how one should approach healing! From traditional alternative medicine techniques, like acupuncture, to interventions based on the mind, like meditation, practitioners all over the world treat physical and mental illnesses very differently. In this piece, we’re going to focus on allopathy, osteopathy, and homeopathy specifically.
Allopathy Although humans have practiced forms of rudimentary healing since the beginning of time, the first known records of medical treatments for diseases were kept by an Egyptian physician named Imhotep and date back to 2600 BC. Over two thousand years later, Hippocrates, widely credited as the father of modern medicine, began
the scientific study of medicine in Greece. Early practices of medicine used treatments that were not very effective, or even downright harmful. However, as science and human knowledge developed, medicine, too, evolved into the research-based field we see today. Allopathy (or the “M.D.”) is typically what people imagine when they think of a “doctor” or “going to medical school,” and the standardized form of medicine used in the U.S. and many countries around the world. Interestingly, the term allopath, which originates from Greek (where allos means “against'' and pathos means “suffering”), was first used as a critique by homeopaths in the early nineteenth century towards allopathic medicine for their approach of treating the symptoms of a disease, as opposed to the root cause or disease prevention. However, over time allopathic medicine has become the conventional form of medicine,
using scientific discoveries (such as vaccines, administration of exogenous, and new medications and surgeries) to not only treat the symptoms of diseases but eliminate or prevent many illnesses altogether. Allopathic doctors attend medical school for four years, followed by a three- to seven-year period of residencies or fellowships that allow them to specialize in a subfield of their choice, from dermatology to neurology. In the U.S., there are over one hundred and fifty medical schools that offer M.D. programs for students to pursue allopathic medicine.
Osteopathy Osteopathy (or the “D.O.”) is an offshoot of allopathic medicine based on the philosophy that all body systems are interrelated, and thus illnesses should be treated in the context of the whole body. Osteopathy began in 1874 by Dr.
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Andrew T. Still, a Union Army surgeon during the American Civil War. Dr. Still’s experiences during the war, coupled with the death of three of his children from spinal meningitis, led him to conclude orthodox medicine was frequently ineffective or dangerous. Osteopathic medicine approaches the treatment of illnesses by trying to correct the body structure itself, thus prompting the body to function more effectively and heal itself. This is done through manual techniques, or osteopathic manual medicine (OMM). Brian F. Degenhardt, D.O., gives an example of this approach through a patient he treated who had suffered severe stomach pains for several months and had been prescribed medication for irritable bowel syndrome by an M.D. but wasn’t experiencing any symptom relief. Dr. Degenhardt began his examination by asking about the patient’s history and helping her examine her lifestyle and routine critically. This was followed by a structural examination using
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palpation, a method in which the doctor feels areas of the patient’s body in order to determine what isn’t functioning properly. Using these methods, Dr. Degenhardt identified muscles and joints that were too tight in the patient’s body that were ultimately affecting her digestion, and also concluded this tightness was being further aggravated by several stressful situations in her life. He then used manipulation to relieve the muscle tightness and joint restriction over the course of a couple weeks, helping to resolve the symptoms without need for further medication. Thus, osteopathy is built on the foundation of disease prevention, with a desire to treat the whole patient, not just the symptoms of an illness, in a way that is specific to each patient. Today, there are just under fifty schools of osteopathic medicine in the U.S., and the D.O. degree is recognized in over sixty-five countries. Osteopathic medical students do the same amount of schooling as allopathic medical students
but take additional classes on the musculoskeletal system and other areas relevant to their approach. Similar to allopathic doctors, after completing their education osteopathic doctors can begin working in a wide range of specialties. Due to their philosophy, many osteopathic doctors choose to pursue careers in family medicine, internal medicine, and pediatrics. Many osteopathic doctors also choose to begin practices in rural and underserved areas.
Homeopathy Homeopathy is just one example of unorthodox medicine that has existed for centuries. Despite their continued popularity around the world, these unorthodox approaches to healing have been labeled with a variety of derogatory terms, from “quackery” to “contemporary and alternative medicine,” as modern medicine becomes increasingly standardized and research-driven. Homeopathy began in Europe by Samuel Hahnemann in the
RESEARCH nineteenth century. Hahnemann believed that in order to cure a patient’s illness, he needed to administer a medication that would produce the patient’s symptoms to a lesser degree if given to a healthy person. For example, if Hahnemann were to encounter a patient with severe nausea, he would want to give them a medication that provoked mild nausea in a healthy person. This principle, known widely as “like cures like,” is based on the foundation that giving the patient such a medication in very small doses would trigger the body’s natural defenses, and promote the body to resolve the symptom on its own. Clearly, this approach was extremely different from that of the orthodox medicine of the time. Indeed, allopaths and homeopaths have a long-standing animosity. Homeopaths were prevented from joining the American Medical Association until 1903, and homeopathic medications were only allowed to be sold openly in American markets after 1939. Despite these controversies, homeopathic medicine has risen in
popularity in the past decade, especially in the U.S., where patients consist of largely white, affluent people younger than the patients generally seen by conventional physicians. The sheer amount of people drawn to homeopathy may be because of its straightforward approach, consisting of long consultations therapeutic in nature. Patients of homeopathic practitioners tend to swear by the effectiveness of their treatments, although the limited research that has been done on homeopathy has found that it has limited or no effects on illness.
One Field, Many Philosophies Just as with any field, there are many theories as to what medicine is and how it should be approached. Allopathy, osteopathy, and homeopathy consist of just three schools of thought to modern medicine in the West, although there are countless other philosophies from the East that have been in practice for thousands of years. Becoming aware of these differences is helpful for a patient to find
an expert best-suited to their own ideals and needs, as well as for a pre-medical student looking to see what career path they’re interested in pursuing! “A Brief History of Osteopathic Medicine .” History of Osteopathic Medicine - Its Origins & Approach to Healthcare. American Association of Colleges of Osteopathic Medicine. Accessed February 14, 2021. https://www.aacom.org/ become-a-doctor/about-osteopathic-medicine/ history-of-osteopathic-medicine. Degenhardt, Brian F. “Osteopathic Manipulative Medicine: Optimizing Patient-Focused Health Care.” American Association of Colleges of Osteopathic Medicine. Accessed February 26, 2021. https://www.aacom.org/becomea-doctor/about-osteopathic-medicine/ omm-optimizing-patient-focused-health-care-. Hajar, Rachel. “History of Medicine Timeline.” Heart Views 16, no. 1 (2015): 43–45. https:// doi.org/10.4103/1995-705x.153008. “Homeopathic Remedies for ADHD: Research and Reviews of Natural Treatments.” ADDitude, February 5, 2021. https://www.additudemag. com/homeopathy-for-adhd-popular-remediesscientific-evidence/. Loudon, Irvine. “A Brief History of Homeopathy.” Journey of the Royal Society of Medicine 99, no. 12 (December 2006): 607–10. https://doi. org/10.1258/jrsm.99.12.607. Oppel, Lloyd. “Allopathy--A Term That Diminishes the Profession.” British Colombia Medical Journal 52 (2010). “Osteopathic Medicine (OMM).” Nashville Osteopathic and Integrative Medicine, November 21, 2020. https:// nashvilleosteopathicmed.com/osteopathicmedicine. “Types of Complementary and Alternative Medicine.” Accessed February 14, 2021. https://www.hopkinsmedicine.org/ health/wellness-and-prevention/types-ofcomplementary-and-alternative-medicine.
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THE ALTERNATIVE USES OF BOTOX By
Chloe Palumbo Riley Hurr
Often accompanied by the glitz and glam of the red carpet, Botox has emerged as a staple of the cosmetic world with its powerful skin wrinkling reduction formula. Produced from a protein generated by Botulinum toxin which is generated from the bacterium Clostridium botulinum, Botox is a type of injectable neurotoxin that weakens muscles by inhibiting nerve signals responsible for muscle contraction. While small doses of Botox are most commonly reserved for cosmetic purposes, in the past decade Botox has recently made a breakthrough in its wide array of medicinal applications. One of the most groundbreaking medicinal applications of Botox is treating chronic migraines. This breakthrough was first discovered when Dr. William Binder noticed that his patients reported fewer migraines after receiving Botox injections.
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Following this observation, the pharmaceutical company Allergan explored these findings by conducting further studies which yielded promising empirical results, eventually leading to FDA approval of Botox in treating chronic migraines in 2010. While the mechanism through which Botox reduces chronic migraines is still unknown, it has been speculated that the injection of Botulinum neurotoxin inhibits the release of neurotransmitters, specifically those involved in pain production, including substance P and calcitonin gene-related peptides (CGRP). By inhibiting neurotransmitter release, neurotransmitters involved in pain production are prevented from traveling to the nerve endings to generate a pain response. Specific Botulinum toxin treatment consists of several injections once every three months in the head
and neck area where pain fibers responsible for headache production are located. While serious side effects outside of mild neck pain and headaches are rare, standard treatments are typically considered before Botox injections due to the high frequency of Botox injections required. Nevertheless, Botox has proven to be a beneficial, safe, and effective treatment for chronic migraines and is being administered across a plethora of headache centers across the United States. In addition to treating chronic migraines, Botox has been proven to be effective in combating excessive sweating, a condition known as hyperhidrosis. Once Allergan observed that patients who received Botox injections for facial spasms were sweating less, scientists began to study whether patients with severe primary axillary hyperhidrosis–a rare disorder characterized by
RESEARCH excessive sweating of the hands, feet, armpits, palms, and other areas–exhibited decreased sweat activity after Botox injections. The promising findings of the study led to FDA approval of Botox in treating underarm sweating in 2004. Such treatment typically consists of injections at the specific site of excessive sweating, where the overactive nerves responsible for sweat gland activation are paralyzed, leading to an overall decrease in sweating at the injection site. In fact, the International Hyperhidrosis Society, reports that underarm sweating was reduced by 82-87%, lasting anywhere up to a year. Although Botox has only been approved to treat underarm sweating, it is often administered by doctors as an off-label treatment for other areas of the body such as the forehead and palms. In fact, studies have found that Botox injections were successful in reducing palm sweating in as much as 80-90% of cases and forehead sweating by 75% for up to five months. Additionally, Botox has been administered to treat forms of overactive bladder activity from urinary incontinence (the involuntary leakage of urine) to urinary urgency (the sudden urge to urinate). Botox bladder injections can help alleviate and even eliminate urinary incontinence and urinary urgency by preventing muscular contractions through the relaxation of the thick muscle bands of the bladder. In fact, as much as 70- 75% of patients reported a decrease in urinary incontinence after Botox injections. Injections typically last up to six months and possible side effects of Botox bladder injections include bleeding in urine, increased urine retention, and
urinary tract infections. The applications of Botox even extend into the realm of mental health, with numerous studies backing the efficacy of Botox as an antidepressant. In fact, one study conducted by the FDA found that those who received Botox injections to treat excessive sweating, spasms, migraines, and wrinkles reported up to 40-88% less depression than those who received alternative treatments for the same conditions–results independent from the medical condition and site of Botox injection. While precise mechanisms underlying how Botox works to combat depression are still largely ambiguous, scientists have speculated that Botox can travel to and impact parts of the central nervous system that are largely responsible for the regulation of moods and emotions. Such speculation is corroborated by the observation that depression is often associated with increased muscle tone–a phenomenon that Botox can help to target by weakening the muscles. While there is still much more testing to be done, the empirical data offers promising potential for Botox as an antidepressant, especially in cases where patients suffer from both depression and chronic conditions. From treating depression to overactive bladder activity, Botox has emerged as more than a mere anti-wrinkle cosmetic injection, proving itself to be an incredibly versatile toxin with seemingly limitless potential. That being said, such a toxin is not to be administered without caution. In fact, in 2009 the FDA required that Botox carry the black box warning label due to its serious long-term potential effects. Although rare, Botox has the potential to spread beyond the injection site, causing muscle
weakness, paralysis, difficulty breathing and swallowing, and even vision problems. The off-label administration of Botox to treat a wide array of medical conditions has even given rise to a number of high-profile lawsuits concerning the off-label uses of Botox in causing detrimental long-term effects. While the alternative applications of Botox come with some risk, loads of empirical data on the alternative applications of Botox back its efficacy and safety as a treatment for a widespread range of medical conditions. "Botox for Overactive Bladder.” Botox for Overactive Bladder - Center for Womens Pelvic Health at UCLA - Los Angeles, CA. Accessed February 27, 2021. https://www. uclahealth.org/womens-pelvic-health/botox. "Botox for Sweating: How It Works, Target Areas, and Effectiveness.” Medical News Today. MediLexicon International. Accessed February 27, 2021. https://www.medicalnewstoday. com/articles/botox-for-sweating#finding-a specialist. "Botox: Cosmetic and Medical Uses, Procedures, and Side Effects.” Medical News Today. MediLexicon International. Accessed February 27, 2021. https://www.medicalnewstoday.com/ articles/158647. DVU_admin. “What to Expect: Botox Injection for Overactive Bladder (OAB).” New Jersey Urology, January 13, 2020. https://njurology. com/what-to-expect Botox-injection-foroveractive-bladder-oab/. “Everything You Need to Know About Botox for Sweating.” Healthline. Healthline Media. Accessed February 6, 2021. https://www. healthline.com/health/beauty skin-care/botoxaftercare. “How Do Bladder Botox Injections Work?” Mayo Clinic Health System. Accessed February 27, 2021. https://www.mayoclinichealthsystem.org/ hometown health/speaking-of-health/how-dobladder-Botox-injections-work. Paul Rizzoli, MD. “Does Botox Reduce the Frequency of Chronic Migraine?” Harvard Health Blog, September 9, 2019. https://www.health.harvard.edu/blog/ does-Botox-reduce-the-frequency-of chronicmigraine-2019091817772. Rogers, Kristen. “Botox Could Ease Depression in Addition to Wrinkles, Study Finds.” CNN. Cable News Network, July 30, 2020. https:// www.cnn.com/2020/07/30/health/Botox-fordepression-treatment wellness/index.html. Sifferlin, Alexandra. “11 Surprising Uses For Botox.” Time. Time, January 5, 2017. https:// time.com/4501839/Botox-inection-wrinklesmigraine-depression/. Botox Injection Sites for Chronic Migraine Treatment. Migraine Pal. Accessed February 26, 2021. https://migrainepal.com/botox-formigraine/.
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THE EVOLUTIONARY BASIS OF DISEASE By
Sanjana Rao Esther J Beck
A phlebotomy, or the act of ‘blood letting’, was a common treatment for most illnesses in medieval times, as it was believed that the withdrawal of blood from the patient would help balance their humors and cure them. This practice, said to be the most common treatment used in Europe, was relatively commonly used until the beginning of the 19th century. Modern medicine has since dismissed the practice as pseudoscience, however, there is at least one disease that it does effectively treat: Haemochromatosis. Haemochromatosis is an inherited condition where your body absorbs too much iron, leading to excess iron buildup in your organs. This can have
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potentially fatal effects, leading to liver disease, heart problems, and diabetes, and patients often suffer from joint pain and fatigue. Those afflicted with this condition often unknowingly treat their disease by becoming blood donors, using phlebotomies to get rid of the excess iron in their body and alleviate their symptoms. Nearly 6% of individuals of Caucasian descent carry or are afflicted with the inheritable form of haemochromatosis. But how did it arise and become so prevalent? Natural selection, or the survival of the fittest, is the idea that traits that make an organism better adapted to their environment are more likely to be passed on and therefore increase in prevalence
in a population. Individuals with traits that increase their ‘fitness’ survive longer or have a reproductive advantage, leading to more individuals with that trait. These traits arise via mutations, which lead to altered phenotypes. The mutation that leads to hereditary haemochromatosis is found in the HFE gene, and is called C282Y. So what evolutionary benefit could a mutation that results in excess iron uptake give us? There are at least two possible explanations. The first is that it is a ‘thrifty’ mutation, allowing our ancestors to make the most of the resources available to them. During the time this mutation that leads to hemochromatosis is hypothesized to have arisen, the northern Euro-
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pean population’s diet changed. With the advent of the agricultural revolution, they shifted from a meat-rich paleo diet to a more iron deficient cereal based diet. This mutation may have helped them adapt to this change and prevent anemia, especially menstruating women. The other explanation surrounds the immune system of afflicted individuals. Micro-organisms such as bacteria depend heavily on iron for their growth and proliferation, suggesting that individuals with hemochromatosis would be especially susceptible to infection. However, that does not appear to be the case. Instead, macrophages in affected patients have a lower iron content than those of healthy patients, protecting them from bacteria that rely on macrophage iron. One such bacterium has been responsible for billions of deaths worldwide, Myobacterium tubercolosis, the cause of tubercolosis.
Haemochromatosis isn’t the only genetic disease that provides resistance to disease. Cystic fibrosis is another genetic disorder that causes buildup of mucus in the airways and lungs. It too is caused by a recessive mutation, requiring affected individuals to inherit both copies of the mutated gene (CTFR). Carriers, or heterozygotes, lack one functioning copy, and thus do not have many functioning CTFR proteins. As these are required for the entry of S. typhi (the cause of typhus) into the cell, it is hypothesized that heterozygotes may have a resistance to typhus. In addition, heterozygotes have been shown to have some level of tuberculosis resistance, as carriers lack sufficient activity in arylsulphatase, an enzyme essential to the virulence of M. tuberculosis. Heterozygote advantage is a common phenomenon, where individuals who have only one mutated copy of the gene reap the
benefits (such as disease resistance) without the often fatal downsides that affect those with both mutated copies (homozygotes). Another example of this is sickle cell anemia, where a point mutation in the 12th amino acid of the hemoglobin gene leads to brittle, warped red blood cells that resemble sickles. In the homozygous form, patients have a low life expectancy as these cells can get stuck in arteries and cause vaso-occlusive crises, and have lowered oxygen carrying capacity. In heterozygotes, however, there is enough normal hemoglobin present such that red blood cells are not overly warped. However, there is enough defective haemoglobin to give carriers resistance to malaria. The protozoan that causes malaria, Plasmodium, spends part of its life cycle in red blood cells. In carriers, the defective hemoglobin causes the cells to rupture prematurely, preventing the proliferation of Plasmodium.
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This resistance to malaria explains the pattern of sickle cell trait prevalence in the population, as it is most common in regions where malaria is endemic as it is selected for in these regions. In regions where malaria is uncommon, the trait is purely disadvantageous, and is thus less prevalent. How can we use what we’ve learnt from evolutionary medicine to our advantage? Asian glow, or alcohol flush syndrome is a condition that mostly affects approximately 30 to 50% of Chinese, Japanese, and Koreans. It results from a deficiency in an enzyme that is integral to the metabolism of alcohol, acetaldehyde dehydrogenase 2, resulting in a buildup of (toxic) acetaldehyde in one’s system. There are multiple possible theories as to how this arose, including the methods of purification of water in Asia versus Europe. In Europe, fermentation and the production of alcohol was a common method to purify and store beverages. In Asia, tea was more common, and water was purified by boiling. In addition, it has been hypothesized that the elevated levels of acetaldehyde seen in individuals with alcohol flush syndrome may protect against some types of parasitic infections, such as Entamoeba histolytica.
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The mechanism of action behind alcohol flush syndrome has been used by industry in the form of disulfiram. Disulfiram, brand name Antabuse, inhibits acetaldehyde dehydrogenase 2, leading to the buildup of acetaldehyde and the adverse symptoms seen in individuals with alcohol flush syndrome. This drug is used to treat alcoholism by inducing the effects of a hangover immediately upon consumption of alcohol, negatively conditioning the individual. By studying the evolutionary basis of disease, we can better understand the pathophysiology of the condition and find potential avenues of treatment for other diseases. In addition, with the advent of gene therapy, it may be possible to alleviate the burden of many genetic diseases on homozygotes while still preserving their evolutionary advantage. By understanding historical problems and the traits that arose to solve them, we can find out of the box solutions to epidemics that still plague us today — from tuberculosis to addiction. Neil D. Theise .Liver and Gallbladder. In:Robbins and Cotrans Pathologic Basis of Disease. 9th edition. "Sickle Cell Disease Overview". 2021. Practical Pain Management. https://www. practicalpainmanagement.com/patient/ conditions/sickle-cell-disease/sickle-celldisease-overview.
"How Does Disulfiram (Antabuse) Interact With Alcohol (Ethanol) To Cause Patients To Get So Sick?". 2021. Ebmconsult.Com. https://www. ebmconsult.com/articles/disulfiram-antabusealcohol-ethanol-mechanism-interaction. Wertheim, Bradley. 2021. "The Iron In Our Blood That Keeps And Kills Us". The Atlantic. https:// www.theatlantic.com/health/archive/2013/01/ the-iron-in-our-blood-that-keeps-andkills-us/266936/. Hollerer, Ina, and Andre Bachmann. 2017. "Pathophysiological Consequences And Benefits Of HFE Mutations: 20 Years Of Research". Haematologica. https://www. haematologica.org/article/view/8060. Rühli, F.J., Henneberg, M. New perspectives on evolutionary medicine: the relevance of microevolution for human health and disease. BMC Med 11, 115 (2013). https://doi. org/10.1186/1741-7015-11-115 "Haemochromatosis". 2021. Nhs.Uk. https://www. nhs.uk/conditions/haemochromatosis/. Stephen C. Stearns, Randolph M. Nesse, Diddahally R. Govindaraju, Peter T. Ellison. “Evolutionary perspectives on health and medicine”. Proceedings of the National Academy of Sciences Jan 2010, 107 (suppl1) 1691-1695; DOI: 10.1073/pnas.0914475107 "Hemochromatosis - Symptoms And Causes". 2021. Mayo Clinic. https://www.mayoclinic. org/diseases-conditions/hemochromatosis/ symptoms-causes/syc-20351443. Bosch, Lander et al. “Cystic fibrosis carriership and tuberculosis: hints toward an evolutionary selective advantage based on data from the Brazilian territory.” BMC infectious diseases vol. 17,1 340. 12 May. 2017, doi:10.1186/s12879017-2448-z
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SOURCES OF WORKING MEMORY IMPAIRMENTS IN SCHIZOPHRENIA AN OVERVIEW FOCUSING ON THE IDENTIFICATION OF WORKING MEMORY IMPAIREMENTS AND THEIR CELLULAR BASIS By
Deniz Eracar Shayna Cohen
History of Schizophrenia
Working Memory Processes
Schizophrenia is a neuropsychological disorder which is associated with dramatic impairments in neurocognitive functions such as selective attention and memory. The first accounts that indicate an association between schizophrenia and memory dysfunction date back to Kraepelin’s clinical observations in 1919, which state that patients with schizophrenia “[..](could) not keep a thought in mind” (Kraeoplin, 1919). This observation has paved the way for publications of numerous research studies involving schizophrenic patients and memory tasks. Over time, multiple research groups have realized that the cognitive symptoms, or their lack thereof, of schizophrenic patients were compatible with the presence of an underlying deficit in working memory processes.
By Baddeley and Hitch’s definition (1974), working memory processes describe a limited-capacity “working space” for information processing. The cognitive deficits in working memory in schizophrenia patients appear to reflect a disturbance in executive control and the processes that facilitate complex information processing and behavior, which are, as the research of numerous research groups have indicated, functions that the dorsolateral prefrontal cortex (DLPFC) is responsible for (Carter et al.,1999). Comparably, similarities between schizophrenic symptoms and the symptoms observed in patients with frontal lobe dysfunctions were pointed out almost two decades ago (Park et al., 1992) and made evident through the usage of electrophysiology and
delayed response tasks. In these tasks, non primate subjects were momentarily shown the location of a food item that was then quickly placed behind an opaque screen and tested to see whether they remember the correct location of the food item after a delay period of a few seconds. The studies with delayed-response tasks lead to two significant conclusions: Firstly, It was observed that primates with dorsolateral prefrontal cortex, just like schizophrenics, performed poorly on these tasks (Kojima et al., 1982) and secondly, the tasks demonstrated that the neurons in and around the principal sulcus of the prefrontal cortex became activated during the delay period, hypothetically to keep the presented information in the mind when the visual stimuli leading to that information was kept out of view.
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Working Memory Tasks and Paradigms However, the idea that neuronal activity during the delayed periods was reflective of a working memory process was resisted until Goldman-Rakic (1994) used a oculomotor-response paradigm to study delayed-response performance, which showed that the prefrontal neuronal activity sharply increased at the end of the presentation of a visual stimulus, remained active during the delay period in the absence of the stimulus but prior to a response, and then decreased abruptly at the end of the delay. All of these observations pointed towards a working memory process. By combining this observation with anatomical studies, GoldmanRakic was able to conclude, without pinpointing the location of the lesion, that the deficits seen in working memory in schizophrenic patients were either directly or indirectly caused by injury to the cortico cortical and cortico subcortical pathways that establish inner models of reality and adjust them to contemporary demands. This preliminary statement relating working
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memory deficits to prefrontal dysfunction was followed by later studies that utilized brain scanning techniques, which provided direct evidence that the working memory impairments were caused by DLPFC impairments. When schizophrenic patients and control groups were engaged in the Wisconsin Card Sort Task, it was observed that the regional cerebral blood flow in the DLPFC of the control group participants was increased whereas the blood flow to the same region in schizophrenics was not (Weinberger et al., 1986), once again highlighting the role for the DLPFC in the psychopathologic character of schizophrenia. To specify further the dorsolateral prefrontal contribution to schizophrenia symptoms, Park and Holzman (1992) devised a research study that not only tested schizophrenic patients on the oculomotor delayed-response (ODR) task, but also included a haptic version of the same task and two additional control tasks of which one did not require working memory and the other was a digit-span task. The performance of schizophrenic patients was compared to the performance of normal controls and bipolar
patients, and it was concluded that the schizophrenics performed poorer than the two other groups being tested in memory-guided delayed responses, regardless of the modality of the task.
Cellular Basis of Working Memory Impairments Park et al.’s findings were in accordance with the previous findings that local blockage of dopamine D1 receptors in the DLPFC impaired performance on ODR tasks (Kojima et al., 1990), which definitively identified DLPFC as the cardinal source of working memory deficits in patients with schizophrenia. Rao et al., by utilizing the past observation that schizophrenic patients showed alterations in the markers of GABA neurotransmission, were able to observe that injecting GABA antagonists to primate research subjects disrupted their working memory performance. Additionally, it was shown that when bicuculline methiodide (BMI), a GABAA receptor antagonist, was delivered to rhesus monkey subjects performing spatial ODR tasks, an increase in the overall activities of both
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interneurons (FS) and putative pyramidal cells (RS) was observed. The major implication of this increased activity was decreases in both the iso-directional and the cross-directional inhibition of both cell types, which further caused both RS and FS neurons to lose their spatial tuning, consequently resulting in GABAA mediated inhibition in the spatial working memory process (Rao et al., 2000; Arnsten et al., 2012). The scientific community’s current understanding of the neurophysiological mechanisms underlying working memory deficits in schizophrenia is built on the recent research observations that nearby neurons with spatial tuning rely on connections on spines to maintain firing without the need for bottom-up sensory stimulation (Goldman-Rakic, 1995; Gonzalez-Burgos et al., 2000; Arnsten et al., 2012) . Wang et al.’s recent iontophoretic studies as well as their predictive computational models have suggested the dependence of the persistent firing of nearby neurons on NMDA receptors (Wang et al., 2011) , and specifically the NR2B subunits found in the synapse, as persistent neuronal firing is only made possible with the slower kinetics of the NR2B receptor (Wang,
1999). As working memory arises from excitation within layer III prefrontal cortex pyramidal cell NMDA circuits, the deep layer III microcircuits are thought to be afflicted in schizophrenia, which is a significant contributing factor to DLPFC dysfunction (Glantz and Lewis, 2000).
Relevance To Our Society Although the specifics of the neurophysiological mechanism underlying the working memory deficits observed in schizophrenia patients require further investigation, dorsolateral prefrontal cortex dysfunction has been repeatedly identified as the main source of the working memory impairments observed in schizophrenics. As schizophrenia is one of the prominent diseases whose treatment with neuroleptic drugs is still the focus of the neuropharmacology sector, an overview of the neurocognitive processes that it is known to affect along with the neurophysiological processes that result in these impairments is necessary for an understanding of the efficiency of these drugs.
Kraepelin, E., Robertson, G. M., & Barclay, R. M. (1919). Dementia praecox and paraphrenia. Chicago: Chicago Medical Book Co. Baddeley, A. D., & Hitch, G. (1974). Working memory. In Psychology of learning and motivation (Vol. 8, pp. 47-89). Academic press. Carter, C. S., Botvinick, M. M., & Cohen, J. D. (1999). The contribution of the anterior cingulate cortex to executive processes in cognition. Reviews in the Neurosciences, 10(1), 49-58. Kojima, S., Kojima, M., & Goldman-Rakic, P. S. (1982). Operant behavioral analysis of memory loss in monkeys with prefrontal lesions. Brain research, 248(1), 51-59. Goldman-Rakic, P. S. (1994). Working memory dysfunction in schizophrenia. The Frontal Lobes and Neuropsychiatric Illness. Washington, DC, 71-82. Rao, S. G., Williams, G. V., & Goldman-Rakic, P. S. (2000). Destruction and creation of spatial tuning by disinhibition: GABAA blockade of prefrontal cortical neurons engaged by working memory. Journal of Neuroscience, 20(1), 485-494. Arnsten, A. F., Wang, M. J., & Paspalas, C. D. (2012). Neuromodulation of thought: flexibilities and vulnerabilities in prefrontal cortical network synapses. Neuron, 76(1), 223-239. Goldman-Rakic, P. S. (1995). Cellular basis of working memory. Neuron, 14(3), 477-485. González-Burgos, G., Barrionuevo, G., & Lewis, D. A. (2000). Horizontal synaptic connections in monkey prefrontal cortex: an in vitro electrophysiological study. Cerebral Cortex, 10(1), 82-92. Wang, M., Gamo, N. J., Yang, Y., Jin, L. E., Wang, X. J., Laubach, M., ... & Arnsten, A. F. (2011). Neuronal basis of age-related working memory decline. nature, 476(7359), 210-213. Wang, X. J. (1999). Synaptic basis of cortical persistent activity: the importance of NMDA receptors to working memory. Journal of Neuroscience, 19(21), 9587-9603. Glantz, L. A., & Lewis, D. A. (2000). Decreased dendritic spine density on prefrontal cortical pyramidal neurons in schizophrenia. Archives of general psychiatry, 57(1), 65-73.
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FROZEN EMBRYOS SHIFT THE FUTURE OF FAMILIES By
Ashley Chen Emory Kim
Born from a 27-year-old embryo, Molly Gibson breaks her sister’s record for the longest-frozen embryo to result in a live birth. Her unique story brings a new meaning to the term “old soul.” On October 14, 1992, weeks before Bill Clinton was elected for president, an embryo was frozen. In February 2020, as the COVID-19 pandemic had begun to take hold, that embryo was thawed and transferred to the uterus of 28-year-old Tina Gibson, a Tennessee woman who had struggled to start a family with her husband, Ben. On October 26, 2020, along came Molly—a 6-pound, 13-ounce baby girl—breaking the record for the longest frozen embryo to have resulted in the birth of a child. The previous record-holder, the embryo that created her sister, Emma, had been frozen for more than 24 years. Both baby girls were frozen together as embryos that were donated by the same couple, making the girls full genetic siblings. Like many other families who turn toward donor embryos, the Gibsons did so due to their fear of passing a genetic disorder onto
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their offspring. Ben has cystic fibrosis and Tina is a carrier. Cystic fibrosis (CF) is a genetic disorder that alters the way the body produces mucus; mucus aids in the function of organs and systems and should be thin and slippery. However, in the case of CF, mucus becomes thick and sticky, blocking tubes and ducts throughout the body. Their unique story opens the door for a better understanding of assisted reproductive technology (ART) as well as challenges conventions for future generations of children, families, and embryos. Embryo donation stems from the process of in vitro fertilization (IVF), a type of assisted reproductive technology. IVF helps people with infertility who want to have a baby as well as parents who run the risk of passing a genetic disorder onto their offspring. Infertility encompasses women who are unable to conceive after one year of trying. Often brushed under the rug, infertility is a serious issue that affects about 6% of married women aged 15 to 44 years in the U.S. In fact, 2% of all births in the U.S. now result from ART—indicating that births via ART have skyrocketed more than
threefold since 1996. In vitro fertilization involves retrieving eggs from a woman’s ovaries and fertilizing them with sperm. The fertilized egg, or embryo, can then be frozen for storage or transferred to a woman’s uterus. According to Dr. Sigal Klipstein, “once an embryo is frozen, it stays at the same level of development forever.” There are two different ways in which embryos can be frozen: slow freeze and vitrification. Slow freezing involves cooling the cell very slowly—at a decrease of roughly 1 Celsius per minute—until the final storing temperature of -196 ℃ is reached. The entire process spans over a couple of hours. Over time, slow freezing has become less prevalent, as embryos undergoing the slow freeze technique are less likely to survive the thaw, giving rise to the popularity of vitrification. Indeed, according to Valojerdi and his coworkers (2009), vitrification provides “a higher survival rate of human embryos and minimal deleterious effects on post-warming embryo morphology.” As it turns out, speed plays a crucial role in the success of egg freezing. The longer
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the freezing process takes, the more likely it is that ice crystals will form in the cell, increasing the risk of cell structure damage and reduction in cell functionality. Luckily, biologist Dr. Masashige Kuwayama and others developed breakthrough vitrification protocols in the early 2000s. While the slow freezing technique takes hours, vitrification is completed in minutes. Vitrification, or flash freezing, is a method that cools cells so quickly to -196 ℃ that they become vitrified—glass-like. To paint a more concrete picture of the process, the Gibson embryo was frozen and left in a deep freeze in liquid nitrogen for many years. Similarly, frozen embryos can be transferred back to the person who produced the egg or to another person. Regardless of how long an embryo has been frozen, it can be thawed and transferred, as the potential to become a pregnancy does not decline as a result of being frozen. With the currently available and highly developed assisted reproductive technology, the future of frozen embryos shines bright. The Gibsons challenge the boundaries of donor embryos, prompting
scientists to engage in a broader discussion about the protection of embryos frozen in storage. In fact, a large number of embryos in frozen storage present a practical issue for private clinics in addition to medical centers as keeping track of embryos harbors difficulties. However, while Gibsons’ story provides unprecedented exposure to in vitro fertilization and frozen embryos, their story may eventually become the convention. According to Omurtag, “as more and more embryos are frozen, it will not be unusual for couples seeking embryo donation to use embryos that were stored in 2010 and to use them in 2040.” Indeed, the Gibsons give hope to others who undergo IVF as well as those who are considering using frozen embryos—combating the issue of infertility and lowering the risk of the inheritance of genetic disorders. “Baby Girl Born From Embryo Frozen for 27 Years.” WebMD. WebMD, December 4, 2020. https://www.webmd.com/baby/ news/20201204/baby-girl-born-from-embryofrozen-for-27-years. “Cystic Fibrosis (CF): Symptoms, Causes, Diagnosis, Treatment.” WebMD. WebMD, December 12, 2019. https://www.webmd.com/ children/what-is-cystic-fibrosis#1.
“Infertility FAQs.” Centers for Disease Control and Prevention. Centers for Disease Control and Prevention, January 16, 2019. https:// www.cdc.gov/reproductivehealth/infertility/ index.htm#:~:text=About%206%25%20of%20 married%20women,marital%20status%20 (impaired%20fecundity). Jamieson, Amy. “Baby Born from 27-Year-Old Embryo: What This Means for the Future.” Healthline. Healthline Media, December 19, 2020. https://www.healthline.com/health-news/ baby-born-from-27-year-old-embryo-whatthis-means-for-the-future. Johnson, Jon. “Embryo Freezing: What Is the Process and Who Benefits?” Medical News Today. MediLexicon International, March 13, 2019. https://www.medicalnewstoday.com/ articles/314662#what-is-an-embryo-and-howdo-people-create-one. Livingston, Gretchen. “A Third of U.S. Adults Say They Have Used Fertility Treatments or Know Someone Who Has.” Pew Research Center. Pew Research Center, July 17, 2018. https://www. pewresearch.org/fact-tank/2018/07/17/a-thirdof-u-s-adults-say-they-have-used-fertilitytreatments-or-know-someone-who-has/. Pavone, Mary Ellen, Joy Innes, Jennifer HirshfeldCytron, Ralph Kazer, and John Zhang. “Comparing Thaw Survival, Implantation and Live Birth Rates from Cryopreserved Zygotes, Embryos and Blastocysts.” PubMed Central. Medknow Publications Pvt Ltd, January 2011. https://www.ncbi.nlm.nih.gov/pmc/articles/ PMC3136065/. Salumets, Andres, Anne-Maria Suikkari, Sirpa Mäkinen, Helle Karro, Anu Roos, and Timo Tuuri. “Frozen Embryo Transfers: Implications of Clinical and Embryological Factors on the Pregnancy Outcome.” National Institutes of Health. U.S. National Library of Medicine, May 9, 2006. https://pubmed.ncbi.nlm.nih. gov/16684837/. “What's the Difference between Slow Freezing and Vitrification?” Extend Fertility. Extend Fertility LLC., November 21, 2016. https:// extendfertility.com/slow-freezing-vsvitrification/.
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COVID CAUSING SURGE IN TEEN PREGNANCY AROUND THE WORLD By
Teresa Nam Marissa McCollum
The ongoing COVID-19 outbreak across the world has called into action numerous measures to mitigate the extremity of its exposure. National lockdowns, quarantining, and social isolation have been at the heart of the potential cure to this wildfire-like outbreak. To help the containment effort, schools all across the globe have shut down, resulting in “nationwide school closures in 194 countries, affecting nearly 1.6 billion learners—over 90 percent of the world's school-going population,” forcing students to stay at home with a newly-improvised remote education system. With students forced to stay home,
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there is now a new societal issue at hand: teen pregnancy. School shutdowns proved to be a complication for many low-income students that depended on the education system for food and resources. Many of these students are now lacking a safe haven, no longer able to run away from existing problems in their home lives. This proved to be especially true for girls, who are more at risk of spending time with adult male figures and engaging in risky sexual behavior without the protection of school. Those with ongoing sexual abuse and exploitation at home are now even more vulnerable to this atrocity.
With COVID-19, homes have now become the most dangerous place to be for many of these girls. Developing countries such as Kenya and Africa have been especially seeing this increasing trend in teen pregnancies, with girls at risk of never returning to school again. In a town of Lodwar in Kenya, the reported number of teen pregnancies seen at the International Rescue Committee aid was seen to nearly triple to a staggering 625 pregnancies from June to August, compared to 226 in the same length of time the previous year. This jump in teen pregnancies was seen in neighboring refugee camps as well, caused
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by girls being out of school due to the outbreak. Child marriages, which many girls below the age of 18 fall victim to, are expected to increase as well, with the numbers expected to reach an extra 13 million marriages in the next ten years according to the UN. Child marriages directly connect to adolescent pregnancies and a full dependence of these young girls on their husbands, taking them out of the education system for good. With education for girls in developing countries known to provide a plethora of benefits including better employment, later marriage, healthier lifestyle and children, and less exposure to sexual violence, this issue proves to be largely harmful to their futures. With teen pregnancies now increasing more than ever, more attention than ever is needed to meet the growing demands for care. Yet these needs are not being met, with valuable resources taken up by the pandemic. The health system has been fully devoted to treating COVID-19, and has slowed down care regarding reproductive health, with many such centers even closing down. As pregnancy is the leading cause of death among girls aged 15-19, such a lack of atten-
tion during these unprecedented times has been more detrimental than ever. Young girls are already at a disadvantage with the societal stigma surrounding teen pregnancies. However, with COVID-19 entering the scene, it makes them ever more susceptible to pregnancy complications and dangerous abortions. A healthcare system that is both more welcoming and more protective warming of pregnant teens is fundamental in handling this growing societal issue. However, during these times a solid development and full implementation of a system that allows for female students outside of the education system during this outbreak to safely return to their studies should be implemented. Nevertheless, it is clear that the ongoing pandemic has been causing much social distress with its far-reaching effects, impairing vital areas of the healthcare system. the importance of education in developing countries. Accessed February 26, 2021. https:// www.kudroli.org/blogs/the-importance-ofeducation-in-developing-countries. Canada, Global Affairs. “Education in Developing Countries.” GAC, June 8, 2017. https:// www.international.gc.ca/world-monde/ issues_development-enjeux_developpement/ human_rights-droits_homme/education. aspx?lang=eng.
“COVID-19 Aftershocks: Access Denied: Teenage Pregnancy Threatens to Block a Million Girls across Sub-Saharan Africa from Returning to School - World.” ReliefWeb. Accessed February 26, 2021. https://reliefweb.int/report/world/ covid-19-aftershocks-access-denied-teenagepregnancy-threatens-block-million-girls. Franjić, Siniša. “Adolescent Pregnancy Is a Serious Social Problem.” Journal of Gynecological Research and Obstetrics, April 30, 2018. https:// www.peertechz.com/articles/JGRO-4-149.php. Woolston, Chris. “Teen Pregnancy.” HealthDay. Consumer Health News | HealthDay, October 26, 2020. https://consumer.healthday.com/ encyclopedia/men-s-health-28/men-s-problemshealth-news-469/teen-pregnancy-643940.html. Livingston, Gretchen, and Deja Thomas. “Why Is the U.S. Teen Birth Rate Falling?” Pew Research Center. Pew Research Center, May 30, 2020. https://www.pewresearch.org/ fact-tank/2019/08/02/why-is-the-teen-birthrate-falling/. Mersie, Ayenat. “Teenage Pregnancies Rise in Parts of Kenya as Lockdown Shuts Schools.” Reuters. Thomson Reuters, November 16, 2020. https://www.reuters.com/article/ us-health-coronavirus-teenage-pregnancie/ teenage-pregnancies-rise-in-parts-of-kenya-aslockdown-shuts-schools-idUSKBN27W11H. “EDUCO Warns: The Risk of Child Marriage and Teenage Pregnancy Has Increased as a Result of COVID-19 - World.” ReliefWeb. Accessed February 26, 2021. https://reliefweb.int/report/world/ educo-warns-risk-child-marriage-and-teenagepregnancy-has-increased-result-covid-19. “Colorado Teens Pregnant during Coronavirus Face Increased Isolation and Difficult Decisions.” The Colorado Sun, October 16, 2020. https:// coloradosun.com/2020/10/16/teen-pregnancycolorado-coronavirus/. NBC4 Washington. “Quaran-Teens? Pregnancies Spike During COVID Lockdown.” NBC4 Washington. NBC4 Washington, July 7, 2020. https://www.nbcwashington. com/news/national-international/ quaran-teens-pregnancies-spike-during-covidlockdown/2354360/.
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