Tuesday, 17 January 2017

Let's cut the chord then, or shall we not?

Very recently I was asked by a relative for my opinion on how valuable and realistic it is the collecting of chord blood and placenta stem cells for therapeutic purposes. I've done it twice with a company named Future Health Biobank, with headquarters set in Nottingham (UK), if I'm not wrong. I did it for my first child and now again a few weeks back for my daughter. Now the person asking my opinion is going to have a child soon and after my advice started looking for information on what realistically is offered by the advances made in stem cell-based therapies.

There is plenty of information on the web, made available with minimum complication and with a straight forward verbatim. However, after visiting several web pages designed for the purpose, I realised that not many, if any at all, wastes any time providing specific, accurate, up-to-date research references on the specific medical utilisation of stem cell therapies for fixing health issues.

When I decided for the stem cell collection, I myself was vaguely instructed on how effective these therapies present themselves to patients, numbers and science involved in it. Because it is one thing to mention that "Stem cells found in the chord blood have been used for blood related illnesses since 1988 and are now commonly used to treat over 85 diseases, including leukaemia, anaemia and thalassemia". This is too generalist, this is almost common knowledge these days. Another thing is to read the chapter entitled "Advances in Stem Cell therapy" that is part of the series "Stem Cell Biology and Regenerative Medicine". This chapter provides an article that I wasn't able to read entirely but if you'd like to, the chapter is priced at £19.95 and the whole ebook at £112. The abstract gives evidence that there is very saucy information for those who want more than just a mere "this can be useful", and are actually looking for a "how is that useful?". If you'd like to purchase the book, access here for more information.

Now, my relatives were given a few articles a nurse passed them, and these contain information that was expected to clarify many of the aspects that were still a gray area. In the nurse's opinion "stem cell therapy wasn't that good because it could only fix blood-related problems", "and the collection has got to be immediate otherwise there is no point". Well, who am I to judge information coming from a nurse who's dealing with births on a daily basis. But as a science writer, former researcher, current medical information officer, educated person, scientifically prepared individual, I can provide my perspective on how people mess up when they say stuff so blunt and vague as that. Sure, she knows she's talking to parents who probably know little about such a specific research realm, but the simple fact that you reduce, say, a possible treatment for leukaemia, to something like "could only fix blood-related problems" reveals a bit of a boisterous simplification of what could mean the possibility of saving your children from a horrific death. For me personally, and trying not to point my fingers so coldly, I don't cherish such approach. In my humble opinion if she wanted to say something like that she could go with "it might fix blood-related problems". See the difference in providing a positive perspective from reducing it to a prior judgmental reduction of its inherent potential capacity to fix a serious health issue?

The articles provided by the nurse (pretty much everything was from web pages) were about delayed chord clamping improving the child's future mental abilities. And also criticising early chord clamping, having it as a possible cause of infant brain damage.

Well, you know me, I don't like to talk about stuff I don't know, but I was asked for an opinion. And I had to read these articles to actually base my opinion on the literature they were given. So what did I find in these pieces of text my relatives were offered?

"Early chord clamping (within the first three minutes of birth) -> reduces the risk of excess bleeding for mums but increases the risk of hypoxia and incidence of autism in children.

If the chord is not clamped -> Children will eventually start breathing on their own gaining an adequate homeostasis by themselves -> The chord vessels clamp themselves and the oxygen flow is not interrupted until the child got stable.

Chord clamping in premature babies can be devastating".

Chord clamping is responsible for:


And might also be related to:


OK, so all this came from a commercial page. Biased? Very Possibly! There is no known link, to the best of my knowledge, between early chord clamping and increase in autism as it is reported by Russel et al in their article "A qualitative analysis of lay beliefs about the aetiology and prevelance of  autistic spectrum disorders (2010)". But when one takes a look at the remaining articles one is confronted with some scientific evidence that is not offered in the shape of a direct scientific reference... however, for a trained mind, it is easy to find these in proper databases. Here is what I could compile for you that is mainly based on research by Ola Andersson et al:

- Delayed chord clamping did not affect iron levels or neuronal development at age 1 year old in a sample of 347 babies assessed [2] but showed improvements in reducing prevalence of neonatal anaemia [4], therefore naturally associated to future impaired development; 

- Delayed chord clamping for a period of 180 seconds after delivery resulted in similar overall neuronal development among 4-year old children when compared to clamped ones, but the first showed better pro-social indicators [3];

- Delaying chord blood clamping for over 1 minute after the actual exit of the baby's shoulders is likely to increase the risk of phototherapy for jaundice and increase the levels of haemoglobin in the first 2 days of life, but no difference is observed at 3 to 6 months of age [5].

And among all the numerous articles one can find in this topic, I guess the ultimate summary line is that for a technique that has no additional costs and no associated side-effects or reported adverse events, if there is a minimal advantage in reducing the risks of anaemia for these children, then why not doing it and applying it as a common practice? However, there are some recent indications that delayed chord clamping might be associated to increased bilirubin levels in neonatals, but I'd rather prefer jaundice than a short supply of antibodies, white and red blood cells for adequate iron levels and immune responses. On the other hand, collecting those necessary 150-ish milliliters of blood soup where stem cells 'proliferate' might represent risks some will be willing to take if it is for tackling tougher problems in the future. Whatever anyone might say, the choice is not only yours but also of scientists in looking into this matter further, urgently.

[1] Are doctors causing infant brain damage by clamping  the umbilical chord prematurely?, Kencap Medical solutions, [http://m.kenyon.webnode.com/umbilical-cord-articles/], last visited on the 17th of January 2017, last update unknown.

[2] Andersson, O., Domellof, M., Andersson, D., Hellstrom-Westas, L. (2014). "Effect of delayed vs early umbilical cord clamping on iron status and neurodevelopment at age 12 months - A randomized clinical trial". JAMA Pediatrics, 168(6), pp. 547-554.

[3] Andersson, O., Lindquist, B., Lindgren, M., Domellof, M., Hellstrom-Westas, L. (2015). "Effect of delayed on neurodevelopment at 4 years of age". JAMA Pediatrics, 169(7), pp. 631-638.

[4] Andersson, O., Hellstrom-Westas, L., Andersson, D., Domellof, M. (2011). "Effect of delayed vs early umbilical cord clamping on iron status and neurodevelopment at age 12 months - A randomized clinical trial". BMJ, 343, pp. 1-12.

[5] Boehmer, S. and Armando, Q. (2016). "Among healthy term infants , is delayed cord clamping superior to usual practice for preventing clinically significant anemia at 6 months of age?". Helpdesk Answers, Evidence-Based Practice, 19(1), pp. 10-11.

Thursday, 5 January 2017

Did you know that...

... the mesentery, formerly considered to be just a fragmented structure, has now been promoted to organ, according to the famous medical textbook "Gray's Anatomy", read about it here.

... the corticoids mimic corticosteroids (hormones produced by the adrenal gland, like for example cortisone). They influence many systems, especially the so-called stress-hormone, cortisol! And have implications on inflammatory processes, weight, homeostasis, circadian rhythm, etc. More info here.

... if you want to check drug interaction potential for two or more drugs, before you even think of taking them, you can access the drugs.com website and use their app. But please do not discard professional advise as your personal records and medical history are crucial for your treatment. Use this tool merely as an informative/educational weapon. You can also access it form the thetoxicologisttoday website, down there on the Toxic Databases at the bottom left.

Monday, 2 January 2017

The role of a Medical Information Officer

After finishing my PhD in Molecular Microbiology in the University of Nottingham (UK) I confirmed my change of career path whilst joining ProPharma Group, a company that "provides validation, compliance and technical services to pharmaceutical, biotechnology, medical device and related industries". My role? Multilingual Medical Information Officer. And why? Because I am fortunate enough to speak 3 languages, almost 4 if I was that confident to get my rusty French out there as I do it when I'm on my own singing the tunes of Tom Sawyer's cartoon intro.

My closest friends weren't a bit surprised about my career change as I had been 'threatening' to actually try a leap of faith after my last years in research. The reasons were so vastly explored in this blog that it would be tough to name the most crystal clear posts on the matter. But if you are indeed curious about it, try hit the tag 'Careers' or even the tag 'Detoxifying Notes' and you'll be able to find my spiritual purge. If you want the main reason in the shape of a twit, let me say that as it is built today, research does not offer ANY stability to ANY researcher wanting to have a FAMILY. But this is like the tip of the iceberg; there are a million of other valid reasons to despair whilst being a researcher these days.

But my friends were also quite surprised at the nature of my new role as a medical information officer. Surprised and also ignorant, I may say. Thus, I decided to explain just a little better what I do, with the help of two websites: 1) The PIPA one - Pharmaceutical Information and Pharmacovigilance Association that provides a great summary definition of the actual MI role, and the 2) ABPI  one - Association of British Pharmaceutical Industry that provides a really well-structured insight to what tasks are lined up for a medical information officer. 

These are the straight answers to those questions my friends bombarded me with.

What do you do?

"Medical Information Professionals usually work within the commercial divisions of Pharmaceutical companies. They provide evaluated, balanced information and advice on clinical aspects of medicines to healthcare professionals (e.g., physicians, pharmacists, nurses, and NHS managers) and to patients. Information and advice are based upon published literature, confidential company data and experience.

Medical information professionals also provide proactive information services to company personnel, typically providing expert support to medical, marketing, sales, or NHS liaison staff. They are often responsible for checking advertising and promotional material against the ABPI code of Practice for the Pharmaceutical Industry. They may also be involved in monitoring drug safety and reporting suspected adverse reactions to company products to the regulatory authorities". [1]

How do you do it?

"To do this [medical information professionals] use:

- reference text books,
- medical and pharmaceutical journals,
- research papers (including clinical trials, systematic reviews),
- guidelines produced by expert bodies.

Some people working in the medical information provide information in response to a specific question asked by a healthcare professional. The question is researched and the relevant sources collated to answer the enquiry in a fair and balanced way. The findings are summarised and relevant highlights are presented to the healthcare professional." [2]

What about your career prospects?

"A role in medical information within the pharmaceutical industry will provide you with a range of training and development opportunities during your career. This will lead to natural career progression within your company, or provide you with the relevant experience to work in a range of related jobs within the industry.

You may move from the position of an information officer to an information manager, moving upwards into other managerial areas. You may be able to specialise in a particular area, and this may help with promotion, but is likely that you'll need to move between jobs for this." [1]

[1] Medical Information (MI), Pharmaceutical Information & Pharmacovigilance Association, [http://www.pipaonline.org/Medical-Information-MI-], last visited on the 2nd of January 2017, last update unknown. 

[2] Medical information, ABPI - Careers, [http://careers.abpi.org.uk/working-in-the-industry/commercial/Pages/medical-information.aspx], last visited on the 2nd of January 2017, last update unknown. 

Friday, 30 December 2016

Bay leaf and type II diabetes

What up me ducks? I did not abandon this article as I received this question long time back from an anonymous enquirer. But I just don't want to make of The Toxicologist Today a monoculture where only bay leaf articles flourish, like Cuba and sugar cane in the beginning of the 20th century. So I try and space the topics a bit more to get different people involved and also learn from other aspects of science. But I also try and answer all my readers, and on the 4th of November this year, someone asked me the following:

"I'm interested in the bay leaf for type 2 diabetes. What is the best way to consume it for maximum benefits?"

Well, I'm no professional cook (even though I create some kick-ass food at home) so I won't be focusing too much on recipes, but I will look into literature available on bay leaf benefiting diabetes type II.

Most people are aware of diabetes and all it encompasses, but I'll offer a very quick review for the sake of those who have been oblivious to it 'til today:

There are two main types of diabetes, mellitus (where glucose is not processed adequately and efficiently and excess glucose ends up 'unfiltered' in the urine) and insipidus (where the kidney does not reabsorb enough water reducing its capacity to concentrate urine).

And there are two main types of diabetes mellitus: type I (formerly known an insulin-dependent) and type II (formerly known as non-insulin dependent).

Diabetes insipidus can result in two very typical problems, i.e., polyuridia (production of large volumes of dilute urine) and polydipsia (tremendous thirst!). In any case the diagram up there can aid further understanding. 

Now, how can bay leaf help with diabetes type II, if it can indeed help with diabetes at all?!

Matter of fact it does help according to Khan et al (2009) [1] that conducted a study where groups of people were given capsules containing different amounts of ground bay leaves (ranging from 1 to 3 g) for a month, and a number of physiological indicators were measured for improvement, resulting in:

- 8% decrease in the so called 'bad cholesterol' levels, the low density lipoprotein cholesterol (LDLC);
- An increased average of 24% in the so called 'good cholesterol' levels, the high density lipoprotein cholesterol (HDLC);
- A decreased average of around 30% in the levels of triglycerides (stored lipids in the blood, let's say) that can cause atherosclerosis (thickening of the artery walls due to the invasion of white blood cells);
- The placebo group showed no shift whatsoever - that's good news!

In a more recent study by Aljamal (2011) [2] where the author attempted to determine if bay leaves could prevent or even alleviate type II diabetes, again, capsules containing 2 g of ground bay leaves were administered to two groups of people for a month. The treated group and the placebo group. The results for the treated group revealed:

- A 30% decrease in plasma glucose levels (in raw terms the sugar in their blood);
- A 24% decrease in the LDL cholesterol (remember the bad one);
- An 18% increase in the HDL cholesterol (remember the good one);
- A 25% decrease in triglycerides and no significant changes in the placebo group (again, great news!).

The obtained values in both studies are very close generating yet more robustness to the assays. So we can assume, base on both articles, that:

2 g of ground bay leaf daily for a period of 30 days may indeed benefit the health of people with type 2 diabetes, due to the improvement of the specifically measured cardiovascular indicators.

See you soon guys, and have a very healthy 2017. Let's try and make people live up to the age of 125 for the rest of the century!

Post image kindly taken from a website that generates so many pop-ups I won't leave you the link here, for the sake of your sanity!

2nd image kindly taken from 'Ask the food lab: What's the point of bay leaves?', Serious Eats, [http://www.seriouseats.com/2014/03/ask-the-food-lab-whats-the-point-of-bay-leaves.html], last visited on the 30th of December 2016, last update unknown. 

[1] Khan, A., Zaman, G., Anderson, R. A. 92009). "Bay leaves improve glucose and lipid profile of people with type 2 diabetes". Journal of Clinical Biochemistry Nutrition, 44(1), pp. 52-56.

[2] Aljamal, A. (2011). "Effects of bay leaveson the patients with diabetes mellitus".

Wednesday, 21 December 2016

A brief history of time by Stephen Hawking

OK, I assume it. I became so intrigued with the character that Stephen Hawking is, that far before the hype of his image 'exploitation' in the American TV hit 'The Big Bang Theory' (that I just loooooove), I had to know more about his work. Immediately comes to one's mind, almost naturally, his book 'A Brief History of Time'. I visited Waterstones online and purchased it alongside yet another book on a not so unrelated topic (near death experiences) that I will analyse in depth when the right time comes. But let me share with you my brief opinion on the book? 
I have only read half of it and I always read the full book regardless of liking it or not. I always give the writer a chance and I make the commitment of reading the efforts of a person who sat at a computer table and wrote through his ideas, opinions, imaginations for weeks or months. But this book let me down! I'm sorry to all those in the Stephen Hawking blind support crew who just appreciate everything he does without questioning the inherent quality. The person is unquestionably wise, genius and ingenious, incredibly clever like I don't even think I will be in my future 1000 lives. He lived through a horrific disability with an impressive capacity and example of stern ambition. But his book is in my opinion a poor amalgam of subjects intended for the general public, but quite often loses track on the needed simplicity that should be applied to its writing. The examples are poor, the images that intend to give physical body and facilitate interpretation of the examples are even poorer. The most impressive factor is that the book is capable of explaining the hard topics extremely well, for then making a mess of the simplest topics by using confusing explanations, paradigms, examples. 

Anyway I'm only half-way through, but so far I understand that if you don't have a basic knowledge of Physics you won't get most of it. I'm sorry, but that is an undeniable truth! If you deal with Physics on a daily basis you might find it simplistic, but honestly still a bit of a Picasso frame, as there are bits and bobs that could be better lined up. Some parts are like back and forth leaps that simply maze the reader a little too much. I'll keep reading it, though, but so far it's a 2.5 out of 5. 

But let me offer you two antagonistic perspectives from other readers that might help you decide whether to buy it or not.

Readers opinions kindly obtained from [http://www.goodreads.com/book/show/3869.A_Brief_History_of_Time#other_reviews]

The toxicity of microwaved plastic

Throughout our lives we resort to microwaving food basically everyday without fully paying attention to the dangers associated to the likelihood of their leaking toxicants (due to container degradation). Such degradation stems from, for example, overheating material that does not stand such high temperatures and releases their degraded products onto/into the food within their volume.

One of these products is the famous bisphenol A, very recently involved in a reported scandal of potential harm for babies due to their presence in plastic feeding bottles. And that prompted many scientific studies on the toxicity of such materials to babies when plastics are used (not obligatory heated) in feeding young age children. But the danger potentials are a widespread exposure of all of us to these toxicants. But let's try and understand a bit better what is under the spotlight in this scenario.

What is the problem?

The problem is that a big percentage of the plastics we use as containers or vehicles in our food chain use bisphenol A (BPA) and poliethilenes in their making process. BPA is a material used in the making of polycarbonate and epoxy resin liners and alongside poliethilenes behaves as an endocrine disruptor with health impacts on growth, sexual maturation and even neuronal development [1]. If I am not wrong I wrote about it here, here and also here (visit for some extra goodies).

Are there studies about it?

Numerous to be fair! But for the sake of the example let me just 'cherry pick' one conducted at a Granada University Hospital (Southern Spain) with a cohort of mother-son pairs as a population. This population was presented to an estimated intake of BPA of around 1.1 μg per day, and no relationship was found between BPA exposure and maternal socio-demographic variables studies, as well as newborn characteristics [2]. And you know why? Because these mothers were fed mostly fish and juice cans. However, pregnancy exposure to low levels of BPA is still a concern.

What products should we be worried about?

In addition to BPA anything from plastic components like:

- phtalates (used to increase flexibility of plastics) [3];

- polybrominated diphenyl ethers (PBDE) (used as flame retardants in products that are in contact with plastics; PBDE shows anti-androgen activity and disrupts thyroid hormone homeostasis) [4] [5];

- tetrabromobisphenol A (TBBPA) that is almost like a super-fusion of the shared properties of BPA and the brominated flame retardants (PBDE) - this is a carcinogenic substance with a keen eye for attacking the thyroid [5].

- alkylphenols (used as antioxidants in products made from plastics and rubber) - studies focusing on these found them to alter the mammary gland in rats [6].

Big names confuse me, any simpler way to recognise them?

Well, actually there is! Look for the image up there and read it through carefully. In addition, you can also use this image here as aid for a quick idea of what you are about to lick!

Any Alternatives?
Yes, resort to the good 'old' clear glass and white ceramic when you can't find the dangerous triangle numbers mentioned above. Resort to conserving food in glass and ceramic containers rather than the plastic ones as the issue is not solely related to heated plastic, but dangerous substances leaking from plastic that has been in contact with your food. Scratched plastic containers are also of concern.

Don't know if I believe that? Used plastic all my life and still have my balls!

Hard to believe? No problem, trust Harvard then. Harvard Medical School produced a fantastic article that works as a family health guide softly covering all that has been discussed herein and some extra tips for the family. Just access it here.

Before I go just wanted to say that this article was recommended by my mum. I wrote it after she asked me to stop using plastic like a thousand times. I am on the way to do it, mum, now you can stop sending me those scary emails. Cheers all.

[1] Erler, C. and Novak, J. (2010). "Bisphenol A exposure: Human risk and health policy". Journal of paediatric nursing, 25(5), pp. 400-407.

[2] Mariscal-Arcas, M., Rivas, A., Granada, A., Monteagudo, C., Murcia, M. A. and Olea-serrano, F. (2009). "Dietary exposure assessment of pregnant women to bisphenol-A and microwave containers in Southern Spain".Food and chemical toxicology, 47(2), pp. 506-510.

[3] US Department of Health and Human Services, 14th Report on Carcinogens (RoC) (2016), CAS NO. 117-81-7, Di(2-ethylhexyl) Phtalate.

[4] Polybrominated diphenyl ethers , United States Environmental Protection Agency, [https://www.epa.gov/assessing-and-managing-chemicals-under-tsca/polybrominated-diphenyl-ethers-pbdes], last visited on the 21st of December 2016, last update unknown.

[5] Talsness, C. E., Andrade, A. J. M., Kuriyama, S. N., Taylor, J. A., Saal, S. F. (2009). "Components of plastic: experimental studies in animals and relevance for human health". Phylosophical transaction of the Royal Society of Biology, 364(1526), pp. 2079-2096.

[6] Alkylphenols, Breast Cancer Fund, [http://www.breastcancerfund.org/clear-science/radiation-chemicals-and-breast-cancer/alkylphenols.html?referrer=https://www.google.co.uk/], last visited on the 21st of December 2016, last update unknown.

Bottom image kindly taken from Safe Plastic Nubers (Guide), Baby Green Thumb, [http://www.babygreenthumb.com/p-122-safe-plastic-numbers-guide.aspx], last visited on the 21st of December 2016, last update on the 6th of June, 2011.