Medical Uses of Venom

July 18, 2011

Though the bites and stings of snakes and other creatures can be deadly, researchers have identified compounds and proteins in the venom of some species with potential medical applications. Treatments to slow the growth of some forms of cancer, alleviate chronic pain, and slow the progression of Alzheimer’s disease are in development, and experts are working to identify other possible applications for venoms and animal-derived toxins.

According to John Perez, director of the National Toxins Research Center at Texas A&M University-Kingsville, “Snakes use venom to alter biological functions, and that’s what medicine does too.” The venom of some snakes has been found to have antibacterial applications, as well as slowing cell growth, increasing nerve stimulation, and affecting blood thinning and clotting. Preliminary research has shown that a compound found in the venom of some snakes may be able to inhibit cancer cell migration and slow the growth of tumor cells. Moreover, the anti-clotting proteins that contribute to the lethalness of a snake’s bite have been studied for their possible application as medications for high blood pressure and anti-clotting drugs.

In addition to snake venoms, toxins from a number of other animals have also been found to have medical applications. The saliva of the Gila monster is being studied as a possible drug for the treatment of type 2 diabetes, and proteins which can inhibit or stimulate the growth of blood vessels have been identified within the venom of several amphibians. Naturally occurring and synthesized venom from cone snails are being examined as new treatments for pain, epilepsy, and incontinence. As is the case also in snakes, experts note that there are more than 500 species of cone snail, and that each is able to produce more than 100 unique toxins, all of which could have beneficial medical applications.

Toxins from a number of arachnids and insects have also been examined. Historically bee venom has been used to treat a number of ailments, and in recent years bee venom therapy (BVT) or apitherapy has been touted as a treatment for arthritis, chronic pain, migraines, and multiple sclerosis. Compounds found in scorpion venom which disrupt the growth and spread of invasive tumors have been investigated for possible applications in treating brain cancer. Venoms from spiders have also been studied and research is ongoing to determine if they could be utilized to prevent arterial fibrillation after a heart attack, to regulate and control blood pressure, or to treat erectile dysfunction.

With additional research, it may be possible to identify new treatments for cancer or even HIV/AIDS among the compounds in venoms and toxins. By working to better understand the wealth of resources of the world’s biodiversity, it may be possible to improve global health.

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Mobile Medical Applications

March 14, 2011

The New York Times recently reported that “more human beings today have access to a cell phone than the United Nations says have access to a clean toilet.” Further reports indicate that there are an estimated 5 billion mobile phone users worldwide with three-quarters of these individuals in developing nations. Mobile broadband subscriptions are on track to surpass one billion by 2011, according to Ericsson, a provider of telecommunication and data communication systems worldwide. For healthcare providers in the developed world, smartphones and mobile devices have become increasingly common, and a reported 72 percent of physicians are utilizing smartphones personally and professionally. This global trend underpins the unprecedented potential of mobile applications to help bridge gaps in medical knowledge and address the lack of trained personnel at the point of care in underserved areas.

Illustration by Deborah Ervin

Experts note that the use of mobile applications can simplify the process of sharing clinical images and patient data for physicians consulting on a case and may be particularly helpful in rural and remote regions. To date, two mobile applications have been approved for use by the Food and Drug Administration (FDA) to improve the quality of care provided nationwide. The first, Mobile MIM, allows physicians to examine images of patient scans on iPhones or iPads. According to William Maisel, chief scientist and deputy director for science at the FDA’s Center for Devices and Radiological Health, Mobile MIM “provides physicians with the ability to immediately view images and make diagnoses” without requiring that they be near a workstation. Similarly, MobiUS, a simple medical ultrasound imaging system, which has also recently received FDA approval, can be used to simplify the ultrasound process. Requiring only an ultrasound wand and gel, and a smartphone, MobiUS increases the portability, affordability, and accessibility of this type of non-invasive medical imaging and can help improve the delivery of obstetric and gynecological care.

A number of other medical applications have been developed to aid in diagnosis and provide treatment recommendations. MedRed, an organization whose mission is to make medical knowledge accessible to patients and healthcare providers at the point of care, was recently awarded a contract from the Veterans Affairs Department to pilot a software tool aimed at helping healthcare providers more easily share new and innovative treatment strategies for veterans being treated for traumatic brain injury. The system, called Balto, provides for electronic data capture and exchange, and incorporates clinical decision support technology. Balto’s graphical user interface allows the user to enter patient signs and symptoms in a point-and-click fashion, and receive real-time diagnosis and treatment recommendations based on selected clinical guidelines embedded in the system.

The Coags Uncomplicated mobile application was also developed to assist in medical diagnosis, specifically for bleeding disorders, and allows physicians to input test results and receive a list of possible diagnoses. Mobile applications are in development to help diagnose a number of other potentially fatal conditions as well, including cancer. In addition to applications created for use by physicians, some aim to improve patient awareness and the ability to monitor one’s health. According to Kathleen Sebelius, Secretary of Health and Human Services (HHS), “People in communities can improve their healthcare if they just have the information to do it.” Among application created to allow patients to monitor their condition is Prostate Pal, a free iPhone application developed by urologist Dr. Ronald Yap. Designed to help men keep accurate health records and discuss symptoms with their doctors, Prostate Pal allows patients to track their fluid intake and output, and features a symptoms questionnaire from the American Urological Association. Other iPhone applications intended for consumer use, such as Wheelmap, depend heavily on user feedback and the sharing of information. Wheelmap tags places of interest on a map and shows the user the most wheelchair-accessible route. In addition, users are able to indicate how accessible locations are using a color-coding system, and can also rate the routes the application provides and suggest modifications.

The use of medical applications on cell phones, tablets, and personal computers can help to greatly improve the quality of care delivered worldwide. Clinicians and patients can utilize these innovative new tools to inform diagnosis and treatment decisions, share information about medical conditions, and track symptoms to ensure that medical knowledge is available at the point of care.

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FEMA Online Guide to Disaster Preparedness

Mobile applications that can prepare you for or provide assistance in a disaster situation:

American Red Cross: Shelter View (iPhone – Free)

Disaster Readiness (iPhone – $0.99)

Disaster Readiness (Android – $1.99)

Pocket First Aid & CPR (iPhone – $3.99)

Pocket First Aid & CPR (Android – $2.99)

Emergency Radio (iPhone – $0.99)

Scanner Radio Pro (Android – $2.99)

On the Uses of Stem Cells

October 27, 2009

Though their use remains controversial, new research and innovative procedures indicate that stem cells may be applicable in more situations than previously thought. Stem cells are immature cells with the ability to grow into any type of tissue. Scientists have worked for years to perfect methods of extracting and directing these cells to grow into different tissue types to heal injuries and cure diseases. In addition to human embryonic stem cells (hESCs), methods of using patient specific cells in regenerative medicine are being refined. Like embryonic stem cells, induced pluripotent stem cells (iPS cells) have the potential to become any type of cell in the body. Because iPS cells are made by “rewinding” adult cells to their pluripotent state – a state from which they can grow into other types of tissue – they can be created from a patient’s own tissues, thus lessening or eliminating the risk of rejection. According to the Los Angeles Times, iPS cells could be used to grow insulin-producing beta cells for patients with diabetes or nerve cells for patients with spinal cord injuries.

Amazing Image by Deborah Ervin

Using this type of “adult stem cells,” researchers at the Wayne State University School of Medicine have developed a procedure to increase mobility and quality of life for patients with spinal cord injuries. The process involves the use of progenitor cells from a patient’s own nasal tissue, thus lessening the chances of rejection, tumor formation, and disease transmission sometimes experienced when using donated tissue. Twenty patients with severe chronic spinal cord injuries took part in the Wayne State University study, led by Associate Professor Jean Peduzzi-Nelson. Each received a treatment of partial scar removal in combination with transplantation of nasal tissue and physical rehabilitation. Results from participants, including one paraplegic individual who is now able to ambulate with two crutches and knee braces, indicate that the transplantation of nasal tissue (an “olfactory mucosal autograft”) is an effective and safe treatment for individuals with chronic spinal cord injuries.

Other types of adult cells have also been used for transplantation to damaged tissues. At the Cincinnati Children’s Hospital Medical Center, fat stem cells from a 14-year-old boy were used to form cheekbones that the young patient lacked. This new technique has the potential to benefit approximately seven million people in the United States, including individuals with various forms of cancer, and those injured in conflict situations. A section of bone from a donated cadaver was shaped to resemble zygomatic bones and act as a support structure for the growth of new tissue. Mesenchymal stem cells from the patient’s fat and a growth-encouraging protein were injected into holes in this bone base. Before implantation, the research team wrapped the grafts in periosteum tissue, which helps encourage stem cells to produce bone tissue. Stem cells were harvested from fat tissue as they exist in similar proportions as in bone marrow tissue, but do not require invasive procedures to gather them.

Using embryonic stem cells from mice, researchers have been able to successfully create a “heart patch” to repair damage caused by heart disease. Bioengineers at Duke University created a 3D mold and used it to grow heart muscle cells or cardiomyocytes. In addition to the mold used to ensure that the cells would not grow as a disorganized mass, cardiac fibroblasts, which comprise up to 60 percent of the heart, were added. These cells helped to guide the growth of the patches and properly align the cells so that they would have properties similar to heart tissue. The heart patches created displayed critical features of heart muscle – the ability to contract and to conduct electrical impulses.

Studies indicate that transplants using pigment-containing visual cells derived from hESCs have also had some success. In individuals who underwent these procedures, structure and function of the light-sensitive lining and the eye (retina) were preserved. For millions who lose their sight or experience low-vision, this type of cell-replacement procedure could prove beneficial. Jennifer Elisseeff, associate professor in biomedical engineering at Johns Hopkins University, and her team have also utilized stem cells to repair damaged and deteriorating knee cartilage. In addition, Elisseeff’s team is working to enable stem cells to reconstruct muscle and fat lost during surgery or trauma and developing an eye patch constructed of special biomaterial derived from collagen to help repair damage to a patient’s cornea.

The use of hESCs remains controversial, though the Obama administration has lifted Bush-era restrictions on federal funding for research based on their use. iPS cells offer an alternative that may prove as beneficial or more so as there is no risk of rejection of the transplanted tissue. For patients with spinal cord injuries, deteriorating vision, compromised heart function, and many other health concerns, treatments using stem cells may offer an opportunity to heal that would otherwise not be available.

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Physicians Using Twitter

September 15, 2009

A recent report from Forrester Research indicates that the use of social networking websites among people aged 35 to 54 increased by 60 percent in the last year. Twitter and Facebook have become popular among federal centers like the Centers for Disease Control and Prevention (@CDCemergency), hospitals like the University of Maryland Medical System (University of Maryland Medical Center – @UMMC), and even individual doctors.

Tweeting Doctors Can Change Healthcare Delivery

Through Twitter, doctors are able to post updates about the events of their day, connect with other healthcare workers, communicate with and inform patients, and even document surgeries and procedures. Results of a recent study by the American Telemedicine Association indicate that doctors and patients have seen beneficial outcomes from using Twitter to connect. Some healthcare providers, like pediatric gastroenterologist Bryan Vartabedian, MD (@Doctor_V), chose to use Twitter as a means to extend their web presence and communicate with existing and potential patients. Clinical nurse Phil Baumann notes additional medical uses for Twitter, including:

  1. Disaster alerting and response,
  2. Diabetes management including blood glucose tracking,
  3. Drug safety alerts from the FDA,
  4. Biomedical device data capture and reporting,
  5. Shift-bidding for healthcare professionals,
  6. Diagnostic brainstorming,
  7. Rare disease tracking and resource connection,
  8. Smoking cessation assistance,
  9. Broadcasting infant care tips for new patients, and
  10. Post-discharge patient follow-up and consultation.

Dr. Joseph Kvedar (@jkvedar), the Director of the Center for Connected Health and iCons in Medicine Member, describes Twitter as “a method of mass communication” that is real-time and “designed for mobility.” The ability to constantly update information also makes Twitter particularly appealing to government health organizations such as the United States Centers for Disease Control and Prevention (@CDCemergency) and the UK’s NHS (@NHSChoices). Using Twitter, these agencies are able to provide up-to-the-minute information regarding disease outbreaks, contact numbers to call for assistance, and other pertinent information. Medical associations such as the Radiological Society of North America (@RSNA), Healthcare Information and Management Systems Society (@HIMSS), and the Biotechnology Industry Organization (@BIOConvention) also use Twitter to keep their members informed about current news, promote events and meetings, and provide a sense of community.

While some providers use Twitter to connect with their patients and peers, others use it to provide information and updates during medical procedures. Recently surgeons in Iowa used Twitter to allow a woman’s family to follow the progress of her surgery in real-time. The Children’s Medical Center in Dallas provided updates when a father’s kidney was transplanted into his son, and the Henry Ford Medical Center (Henry Ford Health System – @henryfordnews) has tweeted during several procedures since January. These updates provide individuals who might not be comfortable watching a surgical procedure to still gain an understanding of the process and a chance to ask questions.

For the 61 percent of Americans who search online for medical advice, Twitter may not provide enough information. The social networking website Facebook allows healthcare workers or medical associations to connect with colleagues and patients. For the reported 55 percent of patients who want to be able to communicate with their doctors via email (according to a Manhattan Research study) it can offer another means of communication. Dr. William Cooper, a cardiothoracic surgeon, says that Facebook presents a way to always be available to his patients. According to Pauline Chen, MD (@paulinechen), it is unclear if engagement via Facebook and Twitter helps or hinders a patient-doctor relationship.

This concern is echoed by other physicians, including Dr. Sachin Jain, a resident physician at Bringham and Woman’s Hospital, who has accepted Facebook friend requests from patients, but “wondered about the appropriateness of the interaction.” In addition to the expectation that a physician would be “instantly available 24/7,” some doctors worry about the security of Facebook and other social networking websites, as well as potential HIPAA violations and litigation concerns. For many physicians, Facebook, Twitter, and other forms of social media are seen as “blurring the line between work and private life” – something that may cause some hesitation and discomfort.

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The New York Times on Twitter UsersUSA Today/Science Fair on the Medical Uses of TwitterAssociated Press on Tweeting During OperationsOn Medical Associations Using TwitterDr. Pauline Chen on TwitterCNN on Physicians on Facebook – More on Physicians and Medical Professionals Using Twitter

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A Killer in the Developing World

August 17, 2009

HIV/AIDS and malaria are major health concerns worldwide, however the World Health Organization (WHO) reports across much of Asia and Africa secretory diarrhea – which accounts for 1.6 million deaths annually – is an even greater threat. Each day in India, diarrhea-related diseases kill 1,250 people, only slightly fewer than the H1N1 virus has killed globally to date (1,500), according to the WHO. Caused by E.coli, cholera, and other bacteria, viruses, or parasites, diarrhea affects individuals more often in areas that lack safe water and appropriate sanitation. In individuals with secretory diarrhea, infectious agents cause too much water to enter the bowel and be evacuated from the body, leading to excessive dehydration and eventually death if appropriate treatment is not received.

Diarrhea in the Developing World
In nations of the developing world, including Bangladesh, India, Mali, and Pakistan, aid organizations and government agencies have begun distributing zinc supplements to villagers as a treatment for diarrhea. Data from recent studies documented in the August 2009 issue of the Journal of Leukocyte Biology suggest that zinc may help to activate the T-cells needed to destroy viruses and bacteria, including those that cause diarrhea. Time Magazine reports that in tablet or liquid form, zinc can be used in combination with oral-rehydration therapy (ORT). While it is not entirely clear how zinc helps halt diarrhea, Oliver Fontaine, a diarrhea specialist for the WHO, explains that a single course of zinc treatment can stave off diarrhea for three months.

Unlike zinc, which often produces an immediate improvement in an individual’s health, the glucose present in ORT (a solution of sugars and salts) slows the evacuation of fluids allowing for the absorption of electrolytes in the intestines, and halting the progression of dehydration to a chronic state. Because of the delay in the improvement of symptoms with ORT, “Mothers don’t see ORT as real treatment,” according to Eric Swedberg, senior director of health and nutrition at Save the Children U.S. Though ORT is an effective treatment for diarrhea, only about 35 percent of families in diarrhea-stricken countries utilize the method.

By offering zinc in combination with ORT, government-run programs in Ethiopia and Tanzania hope to increase the number of people surviving diarrheal outbreaks. Additionally, efforts are being made in Mali to add zinc to the country’s list of essential drugs, a step towards improving the distribution of the tablets. To halt the recent outbreaks of diarrhea in Nepal that have led to 235 deaths to date, the Office of the Prime Minister has begun coordinating efforts to construct a toilet in each household, provide sources of potable water, and improve waste disposal systems. In addition, the Nepali government has mobilized 298 personnel to aid in providing treatment in the area through 89 health camps.

To support these and other similar efforts, funding for the provision of the potentially life-saving drugs, and awareness of their effectiveness must be increased. In 2007, only four percent of all U.S. funding for research of epidemics in the developing world was devoted to finding solutions to decreasing the number of diarrhea-related deaths. Support from organizations like the Bill and Melinda Gates Foundation have provided some support, but additional funding is still needed not only to ensure that zinc tablets are more widely distributed, but also to assist in efforts to improve the quality of available water and waste treatment measures.

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WHO on Water Treatment and Safe StorageOn Diarrhea and Tuberculosis in IndiaTime Magazine on Zinc to Treat DiarrheaDiarrheal Deaths in NepalOn Zinc Fighting Infection

Air Travel and Disease

July 7, 2009

As the number of cases of influenza A(H1N1) (“swine flu”) continue to rise, researchers are seeking solutions to slow the spread of the virus. A recent report from CNN indicated that the World Health Organization (WHO) has recorded 29,669 cases and 145 deaths in 74 countries. The virus has been categorized as a phase 6 “moderate pandemic” by the WHO, meaning that most individuals who are infected will recover. However, amidst recent reports of mothers bringing their children to “swine flu parties” to expose them to the virus (a practice that the British Medical Association has spoken out against), an individual has presented with drug-resistant swine flu. Efforts to create effective vaccines are ongoing, as are alternative means of tracking and slowing the spread of the virus.

Air Travel and Disease

A group of Canadian researchers have analyzed the correlation of the spread of the disease (specifically focusing on influenza virus A (H1N1)) and air travel patterns. The project, known as BioDiaspora, tracks the movements of 2.2 billion airline passengers annually which can then be used to map the possible and probable spread of disease. As reported in the New England Journal of Medicine, the researchers gathered data from the International Air Transport Association (IATA) from the period between March and April 2008. Information about a total of 2.35 million passengers who flew from Mexico to 1,018 cities in 164 countries was mapped and compared to the spread of A(H1N1) to date. According to Dr. Kamran Khan, preliminary data indicated “If you had fewer than 1,400 arrivals from Mexico, you had only a 7 percent chance of getting an imported case.” In countries with more than 1,400 arrivals, the chance of infection in the area increased to 92 percent.

By tracking the spread of outbreaks of disease and comparing them with air travel patterns, researchers can predict which regions are at the highest risk of early infection. According to Dr. Michael Gardam, director of infectious disease prevention and control for the Ontario Agency for Health Protection and Promotion, disease-tracking tools may prove invaluable when dealing with outbreaks of infectious diseases, particularly those with short incubation periods. With this information, it will be possible to inform physicians in potential hotbeds of infection about how to identify a given disease, and ensure that vaccines are prepared and available in order to help stop the spread.

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WHO Information on PandemicsCNN Report on A(H1N1)New England Journal of Medicine on BioDiaspora

Health Among Aboriginal Populations

May 27, 2009

Rural areas often do not have the same quality of resources – especially health resources – available to urban areas. Among indigenous groups such as the Aboriginal and Torres Strait Islander populations of Australia, this is a particularly pressing problem. According to the Australian Government’s Australian Institute of Health and Welfare, as of 2001 an estimated 2.4 percent of Australia’s population identified as being of “Aboriginal origin,” “Torres Strait Islander origin,” or both.  Around 25 percent of the indigenous Australian population – compared to two percent of the non-indigenous population – lived in areas classified as “remote” or “very remote.” As in other nations, non-urban areas often are not surveyed regularly, so gaps in health and welfare information are not sufficiently monitored or addressed.
Aboriginal Woman with Child
The Australian Medical Association reports that representatives from the Indigenous Dentists’ Association have called for measures to improve oral health among indigenous groups such as the fluoridation of community water supplies. Per Medical News Today, the Dietitians Association of Australia indicates that due to the lower economic means of many people living in remote areas, high-quality nutritious food is not always available. Further, items such as sodas, sweets, and fried food are more available in rural areas and are lower-cost. Since one in every three Aboriginal people over the age of 15 worries about going without food, making healthy food options more available and affordable is a major concern to improving the overall health of the population.

Areas like the Northern Territory, where around 29 percent of the population are indigenous, also face a shortage of medical professionals to treat the conditions exacerbated by poor-quality food and lack of appropriate medical and dental care. Telemedicine programs such as iConsult provide opportunities to improve medical care in these areas and treat or lessen the severity of many conditions.

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CIA World Factbook – AustraliaAustralian Medical Association (Healthcare Providers)Medical News Today (Food and Nutrition)