This post is the first in a new series highlighting the successes of alumni of Emory's Center for the Study of Human Health. Our graduates go on to work in a variety of fields and partake in a variety of further training. This semi-regular series will demonstrate these outstanding alumni outcomes.
By: Salima S. Makhani
This fall, I was the first in my family to start my journey as a medical student. I have recently begun Mercer University School of Medicine’s Problem-Based Curriculum (PBL), which has exposed me to a different style of learning, such as stimulating intimate discussions among classmates, encouraging interactions in small groups, and sharing our thoughts on each patient’s case. Cases we review range from discussing nutritional and lifestyle aspects of a diabetic patient to analyzing lab findings consistent with a myocardial infarction. This case-based approach reminds me of my undergraduate years at Emory University in the Center for the Study of Human Health.
I initially started college focusing my studies on Biology, similar to many of my pre-med peers. Although I was following the path I carved out for myself, I was still searching for a more holistic understanding of medicine and health. After my first class with Dr. Lampl in Predictive Health and Societies, I knew that The Center for the Study of Human Health would prepare me best in my aspiration of being a physician.
As a rising Junior at Emory in 2013, I was determined to be a part of the first cohort of students to graduate with the Human Health major. I took part in all the Center had to offer including, for example, going to the study abroad program with Human Health professors in Paris, France in the summer of 2014. The combination of my foundational science and preventative medicine courses served an integral role in applying my knowledge from the classroom to volunteer services with Emory Emergency Medical Service (EMS).
Equipped with this unique perspective on health and medicine, I pursued a Masters of Science in Preclinical Sciences at Mercer University School of Medicine in 2015. I then trained as a medical scribe at various Emergency departments in Georgia and Illinois. In addition to scribing, I decided to revisit Emory, coordinating clinical research with Emory’s Department of Urology. Emory surgeons served as my mentors, training me to not only learn the foundations of clinical research, but also to analyze data, draft a manuscript and become published as a first author of a major study in the Journal of American College of Surgeons.
I am so grateful for the undergraduate and post-graduate experiences that have prepared me for where I am today. The Center for the Study of Human Health lies at the roots of my journey. I will continue to integrate this knowledge into my education as I aspire to be a physician serving one of the many under-served communities in Georgia.
By: Taylor Eisenstein
Upon visiting a hospital—a word derived from the term ‘hospitality’—patients are greeted by physicians and hospital staff. Hospital lobbies are often large, open, and welcoming; certain hospitals, like Grady Memorial Hospital in Atlanta, embellish their lobbies with ornate decorations or historical remnants. Behind the scenes, medical students undergo rigorous training so that they can learn to treat and address patients in a proper manner. Individuals today, however, often neglect to consider the origins of hospitals and medicine.
This past summer, I had the opportunity explore medicine, hospitality, and compassion as I traveled to over 50 sites and more than 47 towns and cities in Italy with the Italian Studies Summer Program, an interdisciplinary venture that focused on bioethics, humanities, medicine, and compassion. This study abroad experience involved faculty from the Emory Center for Ethics and School of Medicine in collaboration with the Italian Studies program. Different hospitals and universities observed on this study abroad provided insight into the history of health and medicine and illuminated the integration of medicine with art. Snapshots of just a few of the places that I visited in Italy are described below.
Ospedale degli Innocenti
Located in Florence, Italy, the ‘Hospital of the Innocents’ initially served as an orphanage for young children. Parents unable to care for their babies could anonymously leave them in a rotating wheel that would then carry them into building. Sometimes parents would leave half a locket or trinket with the child and keep the other half, as a way to maintain a connection with their loved ones. The image of a baby comfortably swaddled in fabric became a prominent sign for the Innocenti, which inspired the symbol of the American Academy of Pediatrics today. Filippo Brunelleschi designed this building in the 1400s; by constructing certain open spaces that actively filtered in light, he helped facilitate an environment conducive to healing for orphaned children.
Ospedale Santa Maria Nuova
Founded in 1288, the ‘Hospital of Santa Maria Nuova’ is the oldest hospital currently operating in Florence and offers services such as dermatology, radiology, neurology, psychiatry, and more. This hospital also hosts an elaborate piece of architecture called The Cloister of Bones, a temple built in the nineteenth century that acted as a burial site.
Santa Maria della Scala
Located in Siena, this hospital—now a museum—once cared for children and the sick. Abandoned babies were provided with wet nurses, and girls were even given dowries. Because it was positioned among common traveling routes, this hospital also provided welcome lodgings for pilgrims, as indicated by the presence of a Pilgrim’s Hall. Frescoes in the hospital provide insight into early medical treatment and the fusion of care and compassion. For instance, Caring for the Sick by Domenico di Bartolo seemingly depicts an extremely ill man being comforted and supported through his illness; it also portrays another man whose injuries are being examined.
Teatro Anatomico: The Anatomical Theatre
Universities once employed the use of anatomical theatres in order to perform dissections and teach anatomy to curious observers, including medical students and physicians. The first anatomical theatre was built at the University of Padua—the fifth-oldest currently operating university in the world—in the late 1500s. A small operating table is positioned in the middle of the theatre, on a bottom level; seating capable of serving more than one hundred individuals is elevated and looks down on the table. Demonstrations would sometimes be accompanied by live music. Additionally, the University of Bologna, the world’s oldest surviving university, holds a smaller anatomical theatre that depicts images of prominent historical figures, such as Hippocrates and Galen.
“It is time to sound the alarm. During the past 3 years, the wily gonococcus has become less susceptible to our last line of antimicrobial defense, threatening our ability to cure gonorrhea and prevent severe sequelae.” The patient that triggered this warning was infected with a strain of Neisseria gonorrhoeae (Gc) that was resistant to all approved antibiotics except for one drug, a problem not previously encountered. This recent sobering message from Bolan et al (1) succinctly warned of the impending public health crisis due to the emergence of strains of Gc with decreased susceptibility to the most frequently used antibiotics approved for therapy. In 2007 the Centers for Disease Control and Prevention (CDC) placed Gc on the dubious “Super Bug” list due to high prevalence (> 5%) of strains in the USA that were resistant to penicillin, tetracycline or fluoroquinolones. In many underdeveloped countries, particularly in Southeast Asia, the problem of antibiotic resistant Gc is more acute with strains resistant to these relatively cheap antibiotics predominating.
The emergence of drug resistant (Gc) has its origins in the late 1930s with the use of sulfonamides to treat gonorrhea, which due to resistance was only briefly (5 years) effective. This was a predictor of the future of gonorrhea treatments because resistance to newly introduced antibiotics continued, albeit less rapidly, over the next seventy years. While initially sensitive to new antibiotics, some Gc strains develop single - or multi-step mechanisms of resistance and then spread the determinants to other Gc. These resistant Gc often have their origin in Asia and first appear in in the USA in Hawaii and western states and then spread quickly across the country. In the absence of a vaccine and the likelihood that one will not exist in the foreseeable future, antibiotic usage is the most effective way for both curing the afflicted and halting further spread of Gc in the community. Failure to do either can cause severe complications in the reproductive tract (especially for women) and other organs. Importantly, Gc infections increase HIV acquisition and transmission. Hence, antibiotic resistance may hinder efforts to combat the HIV/AIDS epidemic. With over 700,000 cases of gonorrhea in United States and over 100 million cases worldwide each year, the public health crisis that would be encountered by untreatable infections is worrisome indeed.
The problem of antibiotic resistant Gc is not unique in infectious diseases. Many bacterial infections are becoming refractory to antibiotics due to resistance. It is estimated that over 25,000 of US citizens die annually due to infections caused by antibiotic bacteria; the problem is more acute in under-resourced countries. Moreover, infections caused by antibiotic resistant bacteria have considerable costs for healthcare systems often requiring prolonged hospitalization of the afflicted individual and more expensive treatments. As an example of the severity of the problem of antibiotic resistance and human health, more people now die annually in the United States due to infection caused by antibiotic resistant strains of Staphylococcus aureus. Clearly, we need new antibiotics, but this will take time for their development, clinical trials and implementation; at best, we can hope for a new antibiotic in 5 years. In the meantime, better detection methods for identifying resistant strains are needed to guide physicians to use alternative treatment regimens. These detection methods are best done during an office visit (so-called “point- of- care” diagnostics). In the absence of new antibiotics, it is prudent to invest in vaccine development to prevent infections.
“No action today, no cures tomorrow” was the warning voiced by the World Health Organization in April, 2011 as they brought forth the crisis of treating bacterial infections with antibiotics in an era of antibiotic resistance. Fortunately, there is now considerable recognition that the overall problem of antibiotic resistance is a major global public problem. In September of this year the White House announced the government response to resistance and similar efforts are underway in Europe. Gonorrhea is just an example of the possibility that humankind may be exiting a “Golden Age”. Many bacterial infections acquired in the community or in the hospital are often difficult (if not impossible) to treat. From a medical perspective, the introduction of rational chemotherapy for treating bacterial infections, was perhaps the greatest medical achievement of the 20th century. On a personal note, I remember telling medical students in the early 1990s that they should have frank discussions (and listen attentively!) with older physicians who began their practice prior to the 1940s (when penicillin was first introduced) to learn what it was like to treat patients in the pre-antibiotic era since they would be the first generation of doctors in the post-antibiotic era. I fear that for some bacterial infections, this warning will become a reality if we do not act now.
Acting now comes with considerable costs and dedicated efforts by academia, government agencies and industry will be required and coordinated. As an academic, I can best relate to what academic centers like Emory University can contribute. We have a track-record in drug discovery for treating infectious diseases. Locally, Emory scientists (notably Professors Liotta and Schinazi) have contributed significantly to bettering human health through developing effective drugs to treat HIV/AIDS patients. Their efforts can serve as an example as to how to marshal local scientists and clinicians to maximize efforts in drug discovery, understanding mechanisms of resistance, using best practices for antibiotic use (stewardship) and surveillance of resistance trends and detection of such strains in the community. Emory is fortunate to have a large cohort of faculty involved in infectious diseases research and clinical practice. Importantly, our academic leaders (notably President Wagner) have demonstrated a commitment to furthering work in drug discovery. Thus, I am optimistic that we can make significant contributions in the global effort to fight back against antibiotic resistant bacteria.
Emory University School of Medicine is one of twenty research centers in the United States and Canada taking part in a trial assessing RNA gene expression to predict a child's risk of a autism spectrum disorders (ASDs) at a very early age. Diagnosis currently occurs between the ages of 4 and 5 years, and earlier identification of an ASD can enable earlier therapies that may lead to better long term outcomes. The trial is not looking at one specific genetic marker, but rather at a host of RNA expression levels from multiple genes that are associated with speech and social behaviors.
To learn more, read the full Emory News Center report.
Researchers across Emory are participating in numerous projects that examine the different relationships between “sugars” and cancer.
First, Emory was recently awarded two grants totaling $2.5 million dollars over five years from the National Cancer Institute to study the sugary coatings of cancer cells. Novel diagnostic methods and anticancer treatments are expected to come from this research. Read more at: http://news.emory.edu/stories/2012/08/cancer_glycomics_grants/index.html.
Second, Emory researchers continue to investigate cancer cell’s “sugar cravings”. Cancerous cells use up more glucose than healthy cells, as they turn off the mitochondria which are typically responsible for producing energy and instead rely on glucose. In the video below, Jing Chen, PhD, associate professor of hematology and medical oncology at Emory University School of Medicine and Winship Cancer Institute, explains how his team is examining whether anticancer therapies can target this mis-appropriation of glucose. To read more about the research, please visit: http://shared.web.emory.edu/whsc/news/releases/2011/12/enzyme-that-flips-switch-on-cells-sugar-cravings-could-be-anti-cancer-target.html.
Researchers from the Department of Neurology, Program in Sleep Medicine at the Emory University School of Medicine investigated the role of sleep in improving the working memory of patients with Parkinson’s disease (PD). Reduced memory capacity is a lesser known symptom associated with PD, which is more commonly associated with visibly slow movements and tremors.
The research team examined how PD patients with and without sleep apnea, a condition where the airway is obstructed and blood oxygen levels decline during sleep, performed on working memory tests after a nights’ rest. The patients without sleep apnea performed better on the tests, and PD patients also taking dopamine-enhancing medications had improved outcomes over those not taking the medications. For more information about the study, including comments form the first author, postdoctoral fellow Michael Scullin, please visit: http://news.emory.edu/stories/2012/08/sleep_improves_working_memory_in_PD/campus.html.
The findings underline the importance of addressing sleep disorders in the care of patients with Parkinson’s, and indicate that working memory capacity in patients with Parkinson’s potentially can be improved with training. The results also have implications for the biology of sleep and memory. The results were published this week in the journal Brain.
Dr. William Hu, assistant professor of neurology at Emory University School of Medicine, in collaboration with researchers from Washington University at St. Louis, the University of Pennsylvania, and Bristol Myers Squibb have released the results of preliminary study aimed at developing a blood test for Alzheimer’s disease. The disease is currently diagnosed through techniques like spinal taps or PET imaging, which can be uncomfortable and expensive for patients. A blood test could not only reduce costs associated with diagnosis, but potentially offer earlier detection.
These results, based on a cohort of 600 individuals both with and without an Alzheimer’s disease diagnosis or mild cognitive impairment, revealed four potential biomarkers of the disease that could be identified in blood samples: apolipoprotein E, C-reactive protein, B-type natriuretic peptide, and pancreatic polypeptide. For more information on the study results, please visit: http://news.emory.edu/stories/2012/08/alzheimers_blood_test/campus.html.
Emory University School of Medicine has joined Michelle Obama’s Joining Forces Initiative, serving with other member organizations such as the Association of American Medical Colleges (AAMC) and the American Association of Colleges of Osteopathic Medicine (AACOM), to serve the health care needs of veterans through research, education, and patient care. Veterans have unique health needs, including traumatic brain injury (TBI) and post-traumatic stress disorder (PTSD).
Just a few of the ways Emory University provides unique care to veterans includes:
More information about Emory University’s involvement in the Joining Forces Initiative is available in this press release. Full details are available on the Initiative’s website.