Thursday, January 31, 2008

The Walking Climb to Heaven

Artist: Caesar Tin-U
Class: Mrs. Pesin 5th - 6th Period

The majority of the patient cases that I see with Dr. Solomos are that of senior patients whose bodies have started to degenerate; leaving them frail and susceptible to many injuries and diseases. Of my patients, one that has touched me most was a patient that is in the process of fighting breast cancer. At first glance, the last thing you would expect that she had was cancer, since she was a patient that always kept her high hopes up, waiting for that one magical drug that can turn the tide in the battle against cancer. Her heart was strong, her mind was set, and her body fights to the end – living life to its fullest.

This collage was designed to symbolize the gradual steps in the treatment, diagnosis, environment, and life of a patient who has not only breast cancer, but any other type of cancer as well. Living with cancer is a sometimes heart-rattling experience that literally changes how a person views their life from the time before they were diagnosed to have cancer.

Starting from the bottom right, there is a hallway, which simulates the beginning entrance and understanding of the medical field. It also shows the gradual learning process that a patient undergoes, and the slow, steady transition of mind, into one that begins to understand that their days are now numbered.

When one has finally been able to graduate from the hall, they encounter the exit… frequently a sign of delayed hope, such as medical trials, chemotherapy, and experimental medicines. The phrase “Light delivers” symbolizes the frequent turn to religion of many patients who have nothing else to turn to, and a person’s glimmering sign of hope lies at the other end of the road towards a celestial heaven.

The columns that protrude from the “hallway of graduation” that show the strong support that one has when diagnosed with cancer. It shows that you are not alone, and that strong people support your well-being, and will do everything they can in order to make sure that you can be well.

TINY. Oh how TINY hope seems to be when nearing death. Here only one GREAT column supports the fountain of life that sits on top of it. Its GREATness outweighs tiny. A woman is seen to be staring into nothingness, yet another tries to run away from the truth. Rain falls as she runs… rain or tears… nevertheless heaven awaits the fate of all those who were strong enough to last until the very end.

My inspiration to become a doctor came from my grandfather who died of stomach cancer, my father who leads the fight against cancer, and my mother who evermore supports my every decision.

Monday, January 21, 2008

Caesar Tin-U

Mrs. Pesin

Adv. HST Per. 5-6

20 January 2007

Journal Entry for the Week: (1/14/2008) – (1/18/2008)

(References: Courtesy of UpToDate)

Entry 1 | Tuesday, In 8:30 AM – Out 11:14 AM (1/15/2008)

Doctor Shadowed: Dr. Solomos

Pt 1 White-M-79 years (Virtual Colonoscopy Follow up)

Brief: The patient had finished his colonoscopy and was here with Dr. Solomos to follow up on his results. Because the patient had a virtual colonoscopy, Dr. Solomos had to explain that because the “virtual colonoscopy” is not a physical process (it is wholly digital) there can be some errors in the film exposure; and that if necessary, it may be required to go back to the GI lab to get a real colonoscopy. In this case, the film exposure was done correctly and a return trip to the lab was not necessary.

Pt 2 White-F-53 years (Medication Fill Up)

Brief: The patient was in pain. Her blood pressure was lower than normal, and needed a fill up on medication; she was 2 weeks overdue for her last dosage. Part of the patient’s pain is due to the severe obesity Dr. Solomos said later after the examination. The patient complained of both legs cramping severely, plus back pain when she lies down (lumbar portion of the back). A muscle relaxer was also prescribed to relieve back pain.

HOPI: Diabetes, HBP, Asthma

℞: Ketorolac – A pain medication (NSAID) that inhibits prostaglandin synthesis by decreasing the activity of the enzyme, cyclooxygenase, which results in decreased formation of prostaglandin precursors. The reduction of prostaglandin, a chemical that causes muscles to contract (usually causing cramps); will relieve the pains that the patient is feeling.

Pt. 3 AA-M-62 years (Checkup)

Brief: The patient has a family history of dementia, so he came into the office today to check up with Dr. Solomos about preventive medicine. The patient also came in for a yearly physical, he is very healthy (has a very well-developed abdomen, 6-pack) and is in fact the uncle of one of the students that go to Debakey. The patient checked out “smooth” as Dr. Solomos says for the prostate check, and was recommended to take omega 3 fatty acids as a preventive measure against dementia.

History: Elevated PSH

Pt. 4 White-F-69 (“The 10,000 mile check up”)

Brief: The patient came in for a routine checkup of her body, being 69 years old. The patient has osteopenia, post menopausal, and vitamin D3 deficient. She also has had shingles. This patient is also one of the healthiest patients that I have seen while at the clinic. Being 69, she is on no medications at all, besides the daily multivitamin. At the patient’s request Dr. Solomos took her off her estrogen supplements for 3 months now, and is doing pretty well, concerning the transition to a no hormone state.

HOPI: Elevated cholesterol, Shingles

Medication: None

Pt. 5 White-F-36 (Well Woman Exam)

Brief: Patient came in for just a yearly physical. She discussed her day to day activities with Dr. Solomos, concerning mainly on her children’s lives, and asking various questions that pertained to other people besides herself. It was as if she was there for a checkup for not only herself, but also for the other members of her family that were not able to make it. Other than the usual Ear, eye nose, throat exams, the patient requested me not to be present for the rest of her physical, and so I stepped out. Upon stepping out, I met a few of the other interns from Baylor and talked with them about the usual processes of their school year, learning much from them. Mrs. Pesin also showed up at the time when the examination finished.

Tests: Bone Density Test, Mammogram, Blood Work (all done today)

Pt. 6 White-M-50 (Physical)

Brief: The patient has varicose veins in his Left leg, as well as two injured rotator cuffs on both shoulders. The patient complains of pain that wakes him up at night. Dr. Solomos tested the intensity of the patient’s pain by strength testing his joints by making him extend and articulate his shoulder joints. I was not able to stay for the whole duration of the examination, it was time to go.



Entry 2 | Thursday, In 8:31 AM – Out 11:10 AM (1/17/2008)

Doctor Shadowed: Dr. Dyijanto (“Lee”) – Dr. Solomos was busy making a presentation and slideshow for his upcoming lecture.

Pt 1 AA-F-44 years (Med Refill)

Family History: Colon Cancer / Congenital Heart Disease

Brief: The patient came in just for a simple medication refill. Dr. Dyijanto, also known as Dr. Lee is someone that I have known for quite a while before I met him again at Kelsey Seybolds. The patient checked out healthy after Dr. Lee did the usual eye, ear, nose, throat examination and quickly wrote off his prescription refill.

℞: Hydrochlorothiazide - (Apo-Hydro®, Aquazide H®, Dichlotride®, Hydrodiuril®, Microzide®, Oretic®), sometimes abbreviated HCT, HCTZ, or HZT is a popular diuretic drug that acts by inhibiting the kidney's ability to retain water.

Pt 2 White-F-53 years (Pleuric Chest Pain)

Brief: The patient that came in was basic social worker, and was perfectly healthy upon a first glance. The patient described her pains as a pain that comes with sudden onset when she thinks about them. Dr. Lee said that sometimes perfectly healthy patients come in thinking that they are sick and make up their own illnesses, mostly due to their own psyche, stress, or other mental factors.

HOPI: Diabetes, HBP, Asthma

℞: Over-the-counter painkillers

Pt 3 AA-F-45 years (Lightheadedness)

Brief: The patient complained of being light-headed during her long shifts at the place where she works at as a meat cutter. She complains of having blurred vision sometimes, and “blacking out” as a result of her prolonged standing period. Dr. Lee said that it was probably because of the fact that she has blood pooling in her legs and prescribed “Jobe Stockings” also known as compression stockings to help compress the legs and the veins so that blood is encouraged to move up against gravity. Dr. Lee also did a very basic test of blood pressures, from a laying down position, sitting position, and standing position to check to see if she had any problems with her heart pumping equally in these different positions. The test found her pressures to be stable.

The patient was previously on Tylenol 3, a controlled medication for pain that which may cause hepatic cell necrosis, and transferred to Naproxen, another type of pain relief.

HOPI: Backpain (Tylenol 3)

Tests: CBC – to test for anemia

℞: Naproxen – (Aleve®) Inhibits prostaglandin synthesis by decreasing the activity of the enzyme, cyclooxygenase, which results in decreased formation of prostaglandin precursors, which then reduces pain to the body.

Pt 4 Hispanic-F-52 years (Sick Visit)

HOPI: Asthma (Takes Albuterol for it)

* Albuterol is a corterol-steroid that enlarges the airway. It may cause nervousness, restlessness, and insomnia. Though, if the patient has ever had palpitations, tachycardia, chest pain, muscle tremors, dizziness, headache, flushing, or if breathing difficulty persists, the patient must report this immediately to the doctor, for these are signs that the medication is not working.

Brief: The patient complained of having a congestion, fever, headache, and chest tightness. She also had coughed up mucous, and persisted coughing while in the examination room. After a simple ear eye nose throat exam, Dr. Lee prescribed Flonase for congestion of the nose, and an antibiotic for her cough.

Relating this clinical experience to basic schooling, I can actively see how important it is to have a proper background in communications and socializing abilities. By watching the differences between Dr. Solomos and Dr. Lee, I can see the determining factor that determines who is able to take a higher administrative stance, and one who is still a basic doctor. Dr. Lee’s communication skills is something that must be worked on, since he (still) has trouble finding words to communicate with his patients, sometimes asking me to fill in on the layman’s term of a medical terminology. Though he cannot be blamed for his foreign language barrier, I see exactly how important it is in a patient – doctor relationship to make sure to overcome this barrier by any means possible to ensure the best possible care to the patient.

Sunday, January 13, 2008

Las frutas y las verduras

El aguacate
El ajo
la cebolla
las cerezas
el Durazno
la ensalada
las fresas
los frijoles
los guisantes
Las judías verdes
La lechuga
El maíz
el melón
La papa
La piña
La sandía
La sopa de verduras
El tomate
Las uvas
La zanahoria

Descripciones

Bueno / malo para la salud
caliente
Congelado
Delicioso
Dulce
Enlatado
Fresco
Frito
Grasoso
Horrible
Picante
!qué asco!
Rico
sabroso

Actividades

Añadir
Comer
Cortgar
Probar (ue)
Server (i)


Fruits and vegetables


The avocado
Garlic
Onion
Cherries
The Peach
Salad
Strawberries
Beans
Peas
Snap beans
The lettuce
Maize
Melon
The Pope
The pineapple
The watermelon
The vegetable soup
Tomatoes
Grapes
The carrot

Descriptions


Good / bad for health
Hot
Frozen
Delicious
Sweet
Canning
Fresco
Frito
Grasoso
Horrible
Picante
! What disgust!
Rico
Tasty

Activities


Add
Commercials
Cortgar
Try (ue)
Server (i)



Para el desayuno

El azúcar
El cereal
Desayunar
El huevo
El pan con mantequilla
El pan tostado
Las salchichas
El tocino
El yogur

Para el almuerzo o la cena

Almorzar (ue)
El arroz
El bistec
El camarón
La carne de res
Cenar
La chuleta de cerdo
Los dulces
Los espaguetis
La galleta
El helado
Las mariscos
La paella
El pastel
El pavo
El pescado
El pollo
El postre



















For breakfast


Sugar
Cereal
Desayunar
The egg
The bread and butter
The toast
Sausages
The bacon
Yogurt


For lunch or dinner


Almorzar (EU)
Rice
The steak
Shrimp
The beef
Dine
The chuleta pork
The sweet
The spaghetti
Cracker
The ice cream
The shellfish
Paella
The cake
The turkey
Fish
The chicken
The dessert



Partes del cuerpo

El brazo
La cabeza
El codo
El cuello
El dedo (del pie)
La espalda
El estómago
La garganta
El hueso
La muñeca
El pie
La pierna
La rodilla
El tobillo

Problemas

!Ay!
Doler (ue)
Sentirse mal
Tener…
Calor
Dolor (de)
Frío
hambre
sed

Para mantenerse sano

Caminar
Corer
Descansar
Dormer
Hacer ejercicio
Levanter pesas
Mover (se)
Quedarse en cama

Soluciones y medicinas

El enfermero, la enfermera
Examiner
El medico, la médica
Poner…
la inyección
La radiografía
La receta
Recetar…
la medicina
la pastille
Recomendar (ie)

Body parts


The arm
The head
The elbow
The neck
The finger (foot)
The back
Stomach
The throat
The bone
The wrist
The foot
The leg
The knee
The ankle

Problems


! Oh!
Doler (EU)
Feeling bad
Have…
Heat
Pain ()
Cold
Hunger
Thirst
To stay healthy
Walk
Corer
Relaxing
Dormer
Exercise
Levanter weights
Move

Staying in bed


Solutions and medicine


The nurse, the nurse
Examiner
The doctor, the doctor
Putting…
Injection
The radiograph
The recipe
Recetar…
Medicine
The pastille
Recommend (ie)



Friday, January 04, 2008

Summer Research 2007:
Caesar Tin-U, & An Vo

Abstract:

We propose a new, electroless, facile and controllable preparation of the transitional metal hydroxide mixture and its thin film. The film, Co/Ni blended hydroxide, is prepared by dipping coating techniques. The resultant, Co/Ni hydroxide film, is very stable in alkaline solution as evidenced by its well-defined, repeated redox (reduction/oxidation) peaks that may associate with their II/III surface transition. This newly formed thin film demonstrated electrocatalysis towards various analytes. Most noteworthy, the film can sense monosaccharides in the presence of disaccharides or multi-saccharides. Our results show that the oxidation of glucose, fructose, ribose, sorbose, galactose, and xylose (all monosaccharides) can be facilitated or catalyzed by the thin film, while the catalytic current relies on the respective concentration to certain extent.

Equal concentration of disaccharides, including lactose, sucrose, and maltose, and polysaccharides, such as starch, have revealed insignificant oxidation responses on the prepared thin film. Electrocatalysis occurs at the site where the surface is reaching its fastest electrochemical redox transition (II/III). To expand our method into a broad application, we found a conventional pencil can serve as an electrode to bear all sensing features as above, which provides a more cost-effective and public-accessible sugar sensor. Consequently, our newly fabricated mixture film has the potential to be developed into a simple, non-enzymatic alternative for the current sugar assay.

Introduction:

Monosaccharides are an important carbohydrate in metabolism. The living cell uses it as a source of energy and metabolic immediately. The basic carbohydrate units are glucose, galactose, and fructose which are found in blood. In addition, glucose is more important because there is only glucose levels are regulated via insulin and glucagon. The detection of sugar, either total determination or selective determination, are an active subject in life science and fermentation industry. Furthermore, the hydroxides and oxyhydroxides of transition metals have been focused not only on health care but also on coating, corrosion, and battery industry. There are considerable interests of these compounds in sensor technology recently. Traditionally, the bulky and thin film material of these hydroxides can be prepared by diverse techniques including physical vapor deposition (i.e. sputtering), pyrolysis of chemical sprays, immersion processes, casting, and electrochemical deposition. Depending the preparation conditions, the morphology and microstructure of the thin film can be manipulated resulting in different properties achieved. In this experiment, dipping (or immersing) coating technique has been used.

Cobalt/nickel hydroxides are highly insoluble material in water. In this presentation, we developed a new, facile fabrication of thin Co/Ni hydroxide films that can be deposited onto all conventional substrates. Our approach is electroless, fast in making stable thin films that is easily manipulated for its attachment and thickness. In this work, we found our newly made cobalt hydroxide thin films show electrocatalytic capacity towards monosacccharides while other carbohydrates are present. Our approach therefore constitutes a new, selective, and non-enzymatic protocol for monosaccharides. In addition, the effects of different experimental parameter, such as enrichment time, enrichment potetial and different concentration ions of Co/Ni were controled and investigated.

Materials:

Pencils were obtained from Michael’s Store. Polishing power (alpha alumina 1 Micron), 1.0M CoCl2, 1.0M NiCl2, 1.0M NaOH, 50% (wt%) NaOH, glucose, fructose, ribose, sorbose, xylose, galactose, sucrose, lactose, maltose, refined can sugar, starch, and conventional chemicals were used.

Glassy carbon (GC) electrodes, Ag/AgCl reference electrode, platinum wire electrode, the electrochemical analyzer (model CHI 400A), the stirring rode, the stirring plate, the picoamp booster, the Faraday cage was from CH Instruments (Austin, TX).

Procedures:

Preparation of the thin Co/Ni hydroxide films by using dipping coating technique

To prepare the Co/Ni hydroxide film coated electrode, a glassy carbon (GC) electrode was firstly put into 1.0 mL 1:1 mixed 1M Co/Ni chloride solution for 30 seconds, then was taken off and dipped into 1.0 mL 50% (wt%) NaOH for another 30 seconds. The GC was subsequently withdrew from its solutions and rinsed gently with slow distilled water (or deionized water). Finally, the film coated GC electrode was placed into 1M NaOH for characterization and electrocatalysis.

Voltammetry and electrocatalysis

In an electrochemical cell containing 10.0 mL of 1.0 M NaOH, aliquot of sugar stock solution or other analytes were added and mixed by using magnetic stirring. A three-electrode setup (including a bare or modified GC working electrode, a platinum counter electrode, and a Ag/AgCl reference electrode) was introduced into the cell for electrochemical study. The main techniques used in this study were cyclic voltammetry (CV) and chronoamperometry (CA). For the control purpose, a blank electrolyte that only contained plain 1.0 M NaOH was used for comparison. When using CA for hydrodynamic voltammetric experiment, a Faraday cage with magnetic stirring was utilized to promote mass transfer and to minimize the environmental noise. The CV was done from -1.0 ~ +0.6 V (vs. Ag/AgCl) range and the CA was carried out at fixed potential (+0.35 ~ + 0.6 V).

Results and Discussion:

Cobalt and nickel are transitional metals with variety of applications. Cobalt hydroxide and nickel hydroxide are well-known insoluble compounds with Ks.p. ~ 10-15. In this work we explore this insolubility for surface attachment and modification. Our new approach involves the in situ precipitation of Co/Ni hydroxide by a simple “dipping” protocol (see scheme 1). Fig.1 illustrates the resultant Co/Ni(OH)2 film (the red line) and the glassy carbon (GC) electrode (the blue line) in 1.0 M NaOH solution. As can be seen, the film modified electrode exhibits a well-defined, reversible redox peaks at ~ +0.3 V. Since the bare GC does not generate appreciable voltammetric signal in the NaOH media (the blue line), this pair of reversible peaks correspond to the reduction/oxidation of the deposited Co/Ni(OH)2, etc. The Co (II/III) and Ni (II/III) moieties within the insoluble hydroxide film network (see scheme 2). The Co/Ni(OH)2 film appears grey, and is very stable in alkaline media (500 voltammetric cycles result in only 5% activity loss). The voltammetry of the film under different voltammetric scan rates were investigated and its results were listed in Fig. 2. The voltammetric currents of both anodic peak and cathodic peak were found directly proportional to the scan rate (ip= kυ, plot not show) in the 0.05 – 0.30 V/s range while the peak potentials (Ep.a and Ep.a) have negligible shift, which are the typical features of a surface-confined process. Fig. 2 therefore further proves the strong adsorption of cobalt hydroxide and nickel hydroxide, probably due to their very low K s.p. values, or even through some synergic/co-crystalline precipitation.

The Co/Ni(OH)2 film has shown electrocatalysis towards sugar molecules, especially to monosaccharides, as evidenced in Fig. 3. As an example, 5 mM fructose does not show any response on the bare GC electrode (the black line) in the potential range examined. When using the film modified electrode, the anodic current is significantly enhanced at potentials ranging +0.3 ~ +0.6 V. Other carbohydrates of low molecular masses, such as glucose, xylose, and ribose, all exhibit similar behavior as fructose, that is, their enhanced oxidation current superimpose the anodic peak of the film itself. Considering the Co (II/III)/Ni (II/III) redox active center and this superimposition of the anodic current, we can conclude that these sugar molecules are electrocatalytically oxidized at the thin film modified electrode. Further, these electrocatalysis show features of the fast surface kinetics, leaving the bulky concentration gradient as the limiting step for the solution mass transport. Accordingly, the oxidation current of sugar molecules displays a concentration dependence, as witnessed by the linear increase of anodic current at +0.4 V upon successive addition of sugars, Fig. 3.

Our mechanistic study showed both cobalt and nickel metal wires are electroactive in alkaline media (data not shown). However these metal electrodes are not stable and are subjected to corrosion in alkaline media. Our results further revealed both cobalt hydroxide and nickel hydroxide exhibit redox (reduction/oxidation) activity when deposited onto the GC electrode separately (data not shown). Nevertheless, their individual sensing towards sugars is unstable and is more subjected to electrode fouling by the oxidized product. As a comparison, our current mixed Co/Ni(OH)2 film demonstrates a much more reversible, stable, and significant enhancement in the sugar electrocatalytic oxidation. This may be due to the formation of more surface-attachable film from a co-deposited Co/Ni hydroxide with lower K s.p than individual components. The mixed, defective Co (II/III)/Ni (II/III) network may have accounted for the much enhanced electrocatalysis through a synergic promotion within their co-crystalline structure. A possible mechanism for this electrocatalysis is proposed in Scheme 3.

The electrocatalysis of sugars on the mixed Co/Ni hydroxide film modified electrode has potential for the sensor application. Fig. 4 substantiates this sensing prospect by showing a near-linear responding pattern when using chronoamperometry. By using this method, the linear dynamic range for a prospective sugar sensor based on the Co/Ni hydroxide film is 0.0 – 10.0 mM in alkaline media. The film also demonstrates selectivity toward monosaccharides against other carbohydrate compounds with higher molecular masses. For this monosaccharide preference, Fig. 5 displays the response toward fructose (a monosaccharide), fructose mixed with maltose (a disaccharide), and fructose mixed with starch (a polysaccharide), respectively. As can be seen from Fig. 5, incorporation of disaccharide or polysaccharide do not interfere with the fructose sensing. To expand our sensing study into a broader application basis, we found conventional pencils also exhibit all of the preparation and electrocatalysis as above. As can be seen from Fig. 6, the film attached pencil gives response to ribose. Therefore, the monosaccharide sensing by the Co/Ni hydroxide film sheds a new, selective, direct, and non-enzymatic approach for the sugar assay. This new assay will be more cost-effective and public-accessible when combining with conventional material such as pencil.

Conclusion:

A new, facile preparation of thin cobalt/ nickel hydroxide films was introduced. The resultant film is stable and electroactive in alkaline solution. The film exhibits electrocatalytic capacities towards sugars, specifically, towards monosaccharide carbohydrates. The electrocatalysis originates from the fast surface Co (II/III)/Ni (II/III) process and its catalysis in the sugar oxidation. Pencils can be used in these study and application. Practically, these responses constitute a new base for the selective, direct, and non-enzymatic sensing protocol for monosaccharide sugars.

References:

[1] M. Pontinha, S. Faty, M.G. Walls, M.G. S. Ferreira, M. D. C. Belo, Corrosion Science. 2006, 10, 2901.

[2] I. G. Casella, MGatta, T. R. I. Cataldi, J. Chromatogr. A 2000, 878, 57.

[3] I.G. Casella, J. Electroanal.Chem. 2002, 520, 119.

[4] P. Benson, G.W.D. Briggs, W.F.K. Wynne-jones, Electrochim. Acta 1964, 9, 281.

[5] N. Ozer, D-G. Chen, T. Büyüklimanli, Solar Energy Materials and Solar Cell.1998, 52, 223.

Acknowledgments:

The authors are grateful to Department of Natural Sciences and Scholars Academy at UHD through the scholarship (A.V.) sponsored by U.S. Army Research Office (Award No. W911NF-04-1-0024). This research was also supported by the UHD ORC grant, the Welch Foundation (No. BJ-0027), and the Undergraduate Analytical Research Program from SACP ( Pittsburgh, PA ). The assistance by SACNAS to present this work is greatly appreciated.