Sponsored by the FHHS Cardiology Club

December 18, 2015, Volume 1, Issue 1

Leukocytes and Kidneys and Brains, oh my!

Did you know?

The surface area of a

human lung is equal
to a full size tennis
court.
Your left lung is
smaller than your right
lung to make room for
your heart.
During your lifetime,
you will produce
enough saliva to fill
two swimming pools
A fetus acquires
fingerprints at the age
of three months.
Your body gives off
enough heat in 30
minutes to bring half a
gallon of water to a
boil.
All facts were obtained from
http://icantseeyou.typepad.com

Cardiology ClubWednesdays, Period 10 &

After Period 11
The Cardiology Club of
Awesomeness
by Alexandra Kaziyeva
The Cardiology Club is designed for
students who are interested in careers
in the health sciences, relating to
cardiac and vascular medicine. The
Cardiology Club's purpose is to
inform students about the different
diseases that are prevalent in the field
of cardiovascular medicine.
In addition, the Cardiology Club focuses on providing guidance for students
who are interested in pursuing a career in medicine. During weekly club meetings,
discussions arise about various health professions, current medical issues, surgeries;
the faculty of the cardiology club also aims to invite various guest speakers to talk
about the medical field. In sum, the goal of the Cardiology Club is to allow FHHS
students to gain complete understanding of the facets of cardiovascular medicine.
Students will be able to bond with others who share their dreams and determination for
an extraordinary time of discovery, as they are welcomed to lead future careers in
cardiovascular medicine.

Medical-Biology Club Fridays, Period 8

The Med-Bio club discussions are based on various health issues and diseases. In
addition, the club will have physicians and other medical personnel come and
communicate with its members about their experiences, struggles, and successes that
they faced, pursuing their line of work. In sum, the med-bio club invites everyone who
is passionate about medicine to participate in the various discussions throughout this
school year.

You
Interested? Join!
Supervisor(s): Daniel Yakubov,Are
Mira
Fattahova,
& Nancy Yousry
Advisor: Ms. Stone

FHHS Journal of Medicine

December 18, 2015, Volume 1, Issue 1

Nephrology
What is Kidney Dialysis?
By Leanna Zaurov

Kidney dialysis is a life changing treatment for many

patients who have experienced end stage (stage 5)
kidney failure. Kidney dialysis is the artificial
process of the removal or filtration of harmful
wastes, such as salts from blood. The filtration of
wastes from blood is a procedure done innately by
the kidneys, however, when the kidneys are at the
end stage of failure, the process of dialysis takes over
the natural function of the kidneys. The kidneys play
a crucial role in the human body; approximately
1500 liters of blood is filtered by our kidneys. A
human would not be able to survive without the
kidneys, because the collection of waste products in
the blood would eventually lead to the poisoning of
the blood, resulting in either a coma and/or death.
There are a number of ways that kidneys can achieve
kidney failure; the lack of blood flow to the kidneys,
direct damage to the kidneys, the blockage of urine
form the kidneys, as well as other various diseases.
There are two main types of dialysis treatments,
peritoneal dialysis and hemodialysis. During
hemodialysis, the patient is connected to a filter
called a dialyzer by tubes cannulated to either the
created fistula (connection of two blood vessels) or
the inserted graft (artificial connection between two
blood vessels). The blood is slowly pumped from the
body into the dialyzer, where waste products and
extra fluid are removed. The filtered blood is then
pumped back into the body.

Process of Hemodialysis; Google Images

Process of Peritoneal
Dialysis; Google Images

When a patient receives

peritoneal dialysis treatments,
the blood does not leave the
body; instead a hollow tube
called a Peritoneal Dialysis
(PD) catheter is placed into the
peritoneal cavity, the
abdominal cavity where the
intestines are located. The
peritoneal dialysis process
occurs when sterile fluid
containing glucose, called
dialysate, flows through the
lining of the belly, called the
peritoneum. Through osmosis
(diffusion of water), waste
products are diffused in the
dialysate. The dialysate pouch
is drained and replaced with
new and clean dialysate; the
changing of the dialysate
pouch occurs 4-5 times per
day.

Patients on dialysis treatments, either peritoneal

dialysis or hemodialysis, can live normal lives,
however the patients need to be careful with their
diet. Even though dialysis may aid patients suffering
from kidney failure, it is not as efficient as the
kidneys themselves; therefore, some patents opt to
receive a kidney transplant.

Process of Hemodialysis; Google Images

References provided upon request

FHHS Journal of Medicine

December 18, 2015, Volume 1, Issue 1

Neurology
Autism Spectrum Disorder
By Amela Redzepagic

Autism Spectrum Disorder, commonly known

as, autism, is a serious development disorder that
impairs ones ability to communicate and interact with
people. More than 200,000 people in the United States
are affected by this disorder every year. People are
diagnosed with autism, usually at a young age, through
continuous observation. Doctors observe one with
autism by watching the persons communicational and
social interactions with others.
Symptoms an autistic
person may exhibit are
aggression, crying,
screaming, inappropriate
social interactions, poor
eye contact, self-harming,
etc. Autistic people may
also have learning
disabilities and could
suffer from depression.
Other common symptoms
may include anxiety,
sensitivity to sound,
walking on tip toes, and
Autism Awareness Banner;
lacking empathy.

At a young age, my first cousin was

diagnosed with autism. I am seven years older than
him, so I have seen him struggle with autism. Many
of the symptoms, which include worsening social
and communicational skills, are candid. My cousin
harms himself by scratching and picking his skin
until he bleeds. Also, he is sensitive to noise that
causes him discomfort. For example, he hates when
people sniffle; when he hears someone sniffle, he
will get mad about it. My cousin has been taking
prescription medication since he was a little boy.
He is used to them, so if he misses his daily pill by
more than a half hour, he will not feel so good for
the rest of the day. Autism is a very serious
disorder, and is not only difficult on the autistic
person, but also is difficult for their families.

Google Images

There are prescriptions that many autistic people

use daily to treat the onset symptoms; two
medications that treat the autism symptoms are
Risperidone and Quetiapine (Seroquel). However,
since people can choose not to use these drugs,
many use different alternatives to help treat autism
symptoms with natural remedies. Three most
effective natural treatment options are fish oil
supplements, magnesium supplements, and
melatonin supplements. Fish oil contains omega-3
fatty acids that can help reduce behavior and
improve the autistic patients social and
communicational skills. Autistic people have low
magnesium levels, which can cause sporadic and
unusual behavior like body rocking, teeth
grinding, and noise sensitivity; magnesium
supplements can reduce the erratic body behavior.
Melatonin in humans helps regulate the normal
sleep cycle; melatonin supplements help with
sleep disorders that majority of those affected by
autism may have.

Autism Speaks Logo; Autismspeaks.org

3
References provided upon request

FHHS Journal of Medicine

December 18, 2015, Volume 1, Issue 1

Forgetting How to Live!

By Luiza Tadchiev

At the age of seventy-nine, my

grandfather and I were playing
badminton. He was better than anyone I
had ever played. He would recall stories
from his youth, even memories that he
had from over 70 years ago. My
grandfather never knew a dull moment.
Hes a walking joke book, with a joke on
every imaginable topic. Couple of years
later, I noticed that he had started to
repeat comments over and over again. At
first, my family thought nothing of the
situation; we thought my grandfather was
just getting old and it was common for
people his age. But as time progressed, he
didnt know where he was. At my
cousins wedding, he was completely lost
and disoriented. At a distant family
members funeral, he didnt understand
what was going on. My grandfather
having Alzheimers shocked my whole
family. On some days, he will remember
everything very well, on other days; he
will stay silent and not talk unless its
absolutely necessary. The saddest
realization is that there is no cure and he
will only get worse with time.

PET Scan of Normal & Alzheimers Disease; Google Images

Alzheimers is a disease that people get

from the age of 65; with early on-set
Alzheimers people experience symptoms
between the ages of forty and fifty. This
disease is a form of dementia and causes
memory loss which can seriously hinder a
persons daily life routine. The death of the
nerve cells is due to plaques, which are
deposits of beta-amyloid that build up in
between nerve cells and tangles. Plaques and
tangles develop faster in those who have
Alzheimers. The warning signs of
Alzheimers are memory loss, challenges in
solving problems, difficulty completing tasks,
confusion, vision issues, issues with speaking
or writing, misplacement of things, poor
judgment, disinterest in activities, and mood
changes. A lot of progress has been made in
the last 15 years regarding research for this
disease.

Progression of Alzheimers Disease; Google Images

4
References provided upon request

FHHS Journal of Medicine

December 18, 2015, Volume 1, Issue 1

Surgery
Dialysis Access
An Overview
By Daniel Yakubov

Brachiocephalic Fistula Creation; google images

Abstract

Renal disease is the 9th leading cause of death in the

United States. Currently over 26 million American Adults
have renal disease and currently 33% of Americans are
at risk of needing dialysis. In 2014, 470,000 Americans
died from renal failure. From those 470,000 patients,
over 50,000 died waiting for dialysis treatments. As of
June 2014, approximately 450,000 Americans are on
dialysis and over 150,000 Americans are waiting for
Dialysis. Every year as the staggering numbers increase
for patients that need dialysis, the use of AVF and AVG is
being more prevalent among patients. Even though
dialysis access procedures can offered readily, many
Americans belonging to minority groups are excluded.
Every day, 12 people situated within minority
populations, die waiting for a kidney. The paper written
encompasses all attributes of renal disease and dialysis,
including the issues associated with social disparities and
financial status.

Permanent Dialysis Options

The Arteriovenous Fistula or AV Fistula is type of vascular access that involves the
direct abnormal connection of an artery and vein through the process of
anastomosis. The connection of the blood vessels is done usually underneath the
skin by a vascular surgeon. The connection of an artery and vein cause the vein to
become deeper and bigger in size, resulting in adequate blood flow needed for
dialysis. The increase in pressure in the vein causes an increase in strength of the
vein, which makes repeated needle cannulations easier. Fistulas are particularly
favorable for long term dialysis patients, because fistulas are less prone to infection
and blood clotting. The fistula is usually placed in the forearm, but at times the
Fistula must be placed in the upper arm if the forearm contains unsuitable veins and
arteries for the creation of a fistula. It is also preferred that the fistula be placed in
non-dominant arm to provide comfortability for the patient. To ensure the Fistula is
ready for use, the fistula will need a 6 week maturation period. When the patient
goes for dialysis treatment, a healthcare worker will place two needles into the
fistula, one drawing blood from the patient and one returning the filtered blood to
the patient.
Arteriovenous Grafts are similar to AV Fistulas. Instead of connecting an artery
directly to a vein, the graft is an indirect connection of the artery and vein by a
synthetic sterile tube. AV Fistulas are used for patients that have strong arteries
and veins, but when a patient, usually an elderly patient, has small or weak arteries
and veins an AV Graft is used. Just like the Fistula the Surgeon places the graft
under the skin in the patients arm. The grafting tube acts as a natural vein, allowing
blood to flow through it. In the operating room the surgical team will first clean the
surgical site with betadine. The Vascular Surgeon will then make an incision and
connect one side of the synthetic graft to an artery, and the other side of the graft
to the vein. The graft will then restore blood flow in the particular region allowing
for adequate dialysis access. The incision site will be closed with stiches. The graft
requires a 2 week maturation period.

What is the role of normal kidney functions and

what is dialysis?
Our kidneys are two bean shaped organs, about the size of our fist
that help in filtering the unwanted materials our bodies want to
excrete. Located below our ribcage and behind our spine, the
kidneys process approximately 180 200 Liters of blood each day
to produce 1 2 liters of urine. Each Kidney is made up of millions
of filtering units called nephrons. Each nephron includes a filter,
called a glomerulus, and a tubule. The Glomerulus lets fluid and
waste pass through it; however prevents large molecules like
proteins from passing. The filtered fluid then passes through the
tubule, which sends minerals back into the blood stream, and
removes wastes. The final outcome of this process is the production
of urine. One ureter, connected to each kidney, pushes the made
urine into the bladder. From that point on, the urine is excreted
through the urethra located in the penis and above the vagina. In
addition to filtering out wastes, our kidneys keep levels of
electrolytes stable, such as sodium, potassium, and phosphate. Our
kidneys also make hormones that help regulate blood pressure.
When kidneys fail, dialysis is required to uphold the process of
filtering blood. Dialysis is the artificial process of diffusion and
ultrafiltration. Dialysis is used for patients who have acute kidney
failure (temporary loss of kidney functions) and for patients who
have permanent loss of kidney function (Stage 5 chronic kidney
disease).

Arteriovenous Fistulae
Pros
Tends to last
many years
Less risk of
infection
Less risk of
clotting

Cons
Bleeding after
needles are
removed
Visible in
forearm/upper
arm
Fistulas may fail to
mature

Arteriovenous Grafts
Pros
Shorter
maturation
period
Can be implanted
readily

Cons
Higher risk ok
infection
Higher risk of
clotting
Grafts dont
usually last as
long as fistulas;
Last only for
about 3 years

Arteriovenous Graft;
google images

FHHS Journal of Medicine

Temporary Dialysis Options

Catheters are hollow tubes which allow
blood to flow in and out of the patients
body. The Shiley Catheter is an example
of an access catheter that is usually
placed for temporary dialysis access for
up 3 weeks. A catheter is placed usually
when a patient desperately needs dialysis
and/or is waiting for either the fistula or
graft to mature.

December 18, 2015, Volume 1, Issue 1

Prevalence of different types of Dialysis Access

AV Fistulae: AV Fistula use increased from 28% to 55% percent within a 9 year period
from 2005 to 2014. Overall use of AV Fistulas has increased for both men and women.
AV Graft: Over the past 9 years, AV Graft use has declined from 48% to19% within a 9
year period from 2005 to 2014. The decline in AV Graft use explains the rise of AV
Fistula use.
Catheter Placements: Only about 18% of all dialysis patients use catheters.

Catheter Placements
Pros
Can be used for dialysis
immediately
Easy removal and
placement

Cons
May cause narrowing
of veins
Higher risk of
infection

Post-Operative Complications
Along with any type of surgery, complications may arise. With either
an AV Graft or AV Fistula a patient may exhibit certain complications
such as:
An Infection may become present after surgery. Symptoms of local
swelling, pain, redness, and puss drainage may arise. Just remember
to never insert a needle into an infected area, because the bacteria
that caused the initial infection may then spread to the blood
stream causing more negative consequences to arise.
Brachiocephalic Fistula Creation; google images

A Pseudoaneurysm may also become present after surgery. A

pseudoaneurysm is a collection of blood contained by surrounding
tissue, also commonly referred to as a false aneurysm. Repeated
needle cannulation within the same area of the prosthetic graft or
fistula and the presence of venous anastomotic stenosis are the
main factors that contribute to the formation of a pseudoaneurysm.

Thrombosis is the local coagulation of blood (blood clotting) in a

blood vessel. Thrombosis can also be a post-operative complication
and may cause severe pain at the site of thrombosis, tremors, and
absence of feeling at the AVF site.
*Other complications may exist*

Complications & Incidence

Complication
Thrombosis
Stenosis
Congestive Heart Failure
Ischemic Neuropathy
Aneurysm
Infection

Incidence (%)
17-25%
14-42%
12-17%
1-10%
5-6%
2-3%

100

90
80
70

Patency (%)

A Hematoma can form when a puncture site is present in either the

graft or fistula. The blood spreads between the tissue and either the
graft or fistula wall, which will result in swelling and discoloration. If
a needle is inserted into the hematoma, the blood around the
puncture site will often clot, making it necessary to create another
puncture site for cannulation.

Patency of AVF & AVG

60
50

AVF

40

AVG

30

20
10
0
0

Years

Conclusions
As a patient, one should always research best possible solutions and outcomes for oneself. If a patient is admitted into the hospital with stage 5
CKD and the Glomerular Filtration Rate is <15 mL/min, then dialysis is the best option. Everyone is technically entitled to dialysis treatment, but
certain disparities may impede a patients ability to obtain dialysis treatment. Arteriovenous Graft and Fistula Access provides the most
positive outcomes in retrospect to temporary access options such as, a Catheter. Either choosing the AVF or AVG, may cause the patient to be
susceptible to complications, but can be managed under supervision by6medical personal at a medical establishment. The overall goal of
dialysis access is to prolong the life of the patient with end stage renal disease.
References provided upon request

FHHS Journal of Medicine

December 18, 2015, Volume 1, Issue 1

Oncology
The White Lies of
Leukemia!

Signs and Symptoms of Leukemia

Each type of Leukemia has different signs and
symptoms. Usually slow-growing or chronic
Leukemia doesnt cause any immediate symptoms,
but that is not the case for aggressive or rapidly
growing acute Leukemia.

By Polina Musheyeva and Daniella Jauregui

What is Leukemia?
Leukemia is the cancer of White Blood Cells
(WBCs). This cancer occurs when irregular
leukocytes are formed in the blood marrow.
Leukocytes fight infection, but at times, they are
abnormally produced. An abundance of these
abnormal leukocytes, cause the body to be
susceptible to many infections. There are over
50,000 cases of Leukemia and over 24,000 deaths
reported yearly in the United States. The four
common types of Leukemia are Acute Lymphocytic
Leukemia, Chronic Lymphocytic Leukemia, Acute
Myeloid Leukemia, and Chronic Myeloid Leukemia.
Acute Lymphocytic Leukemia is commonly
prevalent in children, but can also affect adults.
Acute Lymphocytic Leukemia consists of immature
lymphoid cells that grow rapidly in the blood. Over
6,000 people are affected by Acute Lymphocytic
Leukemia in the United States, yearly. Chronic
Lymphocytic Leukemia is a slow-growing cancer,
which usually affects people over the age of fiftyfive; Chronic Lymphocytic Leukemia is rare in
children or adolescents. Acute Myeloid Leukemia
involves the rapid growth of myeloid cells. Acute
Myeloid Leukemia occurs in both children and
adults, and affects about 18,000 people in the United
States, yearly. Chronic Myeloid Leukemia only
affects adults; about 6,000 people in the United
States are affected by Chronic Myeloid Leukemia
yearly.

Signs and symptoms of Leukemia include:

Fevers
Night Sweats
Swollen Lymph Nodes (usually painless)
Feeling of fatigue or tiredness
Easy bleeding or bruising
Frequent infection
Bone or joint pain
Weight loss

Diagnosing Leukemia?
Upon viewing the patients medical records
or symptoms, physicians are likely to diagnose
patients based on their blood samples. Blood
samples are put under microscopes and are
searched for abnormal leukemic cells. Another
form of diagnosis may include bone marrow
sampling.

Treatment
Depending on the type of leukemia, the treatment
varies. The following are 6 types of treatment for
overcoming leukemia.
Treatment includes:

Comparison between normal blood smear

and Leukemic Blood Smear; Google Images

Targeted therapy

Chemotherapy

Biologic therapy

High-dose chemotherapy with stem cell

transplant

Donor lymphocyte infusion (DLI)

Surgery
References provided upon request

FHHS Journal of Medicine

December 18, 2015, Volume 1, Issue 1

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