The Scan by 2 Minute Medicine®: Concussion Protocol, Monstrous Mosquitoes, Eye Transplants and Taking on 23andMe:

The Scan by 2 Minute Medicine® is a pop-culture medical newsletter and exclusive benefit for 2 Minute Medicine Plus subscribers.

We begin with a discussion about concussions in the wake of a severe concussion in the NFL. Then we take a closer look at the increase in mosquito-borne diseases. After that, we examine the recent success of the first eye transplant and other cutting-edge forms of treatment for eye diseases. Finally, we 23andMe, and the benefits of genetic testing amidst a backdrop of corporate turmoil.

Concussion Protocol:

The Story: Miami Dolphins quarterback, Tua Tagovailoa recently suffered a severe concussion after colliding with another player on the football field. This has once again opened the discussion around the dangers and long-term effects of concussions.

What even is a Concussion?

A concussion is technically a form of traumatic brain injury (TBI), albeit a mild form. Given where the brain sits inside the skull, after a hit to the head, the brain may collide with the skull resulting in disturbed function, and what we know as a concussion. Although bumps on the head are common occurrences, concussions can have lasting impacts. Concussions can damage nerves in the brain, and cause metabolic changes in the brain, which is why it is of critical importance to rest and allow healing after sustaining a concussion.

Long-Term Effects of Concussions:

The signs and symptoms of concussions are variable, and they may not show up immediately. Physical symptoms include light sensitivity, headaches, and vision disturbances, while mental symptoms such as problems concentrating or remembering, may also occur. In some cases, post-concussion syndrome may have a lasting effect, whereby symptoms linger for months, and sometimes even years. Another long-term effect, is chronic traumatic encephalopathy, an insidious disorder that causes a buildup of dysfunctional protein in the brain, due to repeated brain injuries. CTE can lead to dementia and can culminate in death.

How does this relate to Tagovailoa:

After colliding with Damar Hamlin, who has suffered severe medical conditions himself, Tagovailoa appeared to convulse on the field, though he eventually walked off the field. This has sparked youth coaches to adopt helmets with more padding, to reduce the risk of head injuries. Although the NFL has modified their concussion protocol, Tagovailoa is well acquantied with it, as this is his 3rd concussion in 5 seasons, which is leading some to suggest that he should not be returning to the game, for his own health.

This is a particularly repetitive story for the NFL, as many former players, including former New England Patriots player Aaron Hernandez, were found to have CTE after their deaths. Many of the players found to have CTE suffered from early deaths, in some cases by suicide. Further studies have indicated that over 90% of former NFL players studied after their death, were found to have CTE. Given that CTE research is reliant on brain donations, the Ontario sports minister, Neil Lumsden, has pledged to donate his brain to brain injury research given his history of Canadian football playing. Despite the continued concussions plaguing the NFL, the awareness of brain injuries provides a glimmer of hope that one day, these mysterious injuries will be understood better.

Monstrous Mosquitoes:

This year, Dr. Anthony Fauci, known for his pivotal role during the COVID-19 pandemic, was hospitalized with West Nile Virus, a virus with no vaccine and no cure in humans. West Nile Virus is a virus spread by mosquitoes and causes West Nile Fever in about 20% of those infected. In severe cases, West Nile Fever can cause confusion, paralysis, and even coma, since the virus can cross the blood-brain barrier and infect the brain tissue.

This is part of an emerging pattern, where mosquitoes and mosquito-borne infections are becoming more common. It is thought that climate change is having a role, as warmer winters, alongside increased precipitation, mean that mosquitoes have more time to breed. In Europe as well, mosquito-borne diseases are surging, as mosquitoes carrying these diseases move north from tropical areas. Although he was hospitalized, Fauci was able to leave and was expected to make a full recovery, nevertheless drawing attention to the severity of this illness and the increase in mosquitoes carrying it.

With nearly 250 million cases in 2022, malaria is another incredibly dangerous mosquito-borne disease. This disease is primarily caused by a parasite that infects red blood cells and can spread to other cells of the body. Famous actress Rebel Wilson has had her fair share of malaria experience, after contracting the disease as a teenager. At age 18, she was hospitalized for 2 weeks after getting severely bitten by mosquitoes but fortunately made a full recovery. Adding to the overall burden of mosquito-borne diseases is eastern equine encephalitis (EEE). This disease was considered extremely rare but is now being declared as an imminent threat to public health in New York State, following the state’s first EEE-related death in nearly a decade. As mosquitoes continue to spread disease globally, extensive research is needed to develop treatments and vaccinations.

Eye Transplants:

After a workplace accident left Aaron James unable to see, smell, or taste, the next steps were not very clear. In May 2023, he was offered an experimental eye transplant. While this was the first instance of a full eye transplant, other parts of the eye have been transplanted before. Corneal transplants, wherein the damaged cornea of an eye is replaced with a clear cornea from a donor, have been performed for decades.

Transplanting a whole eye is extremely difficult, due to the complexity of the organ. One component of the eye, the optic nerve, is comprised of over 1 million nerve fibers, and if damaged, cannot heal itself. Nevertheless, such transplants have been done in animals, but prior to James, never in humans. James’ workplace accident involved exposure to a live wire at over 7,000 volts, requiring many surgeries, and a medical coma. Although his eye transplant did not restore the ability to see, testing shows that nerve cells of the eye are able to sense light, even if that doesn’t translate to a full image.

Other advancements in eye treatment include stem cell therapy. Although this therapy is not currently FDA-approved, clinical trials are underway to examine whether they offer a benefit. In particular, conditions such as retinitis pigmentosa (RP) and age-related macular degeneration (AMD) are diseases where stem cells may be of use, as they involve degeneration of the eye leading to an inability of the body to heal those cells. Stem cells come into play because they can take on many different cell types, including those involved in RP and AMD. As technology continues to evolve, the next frontier of eye technology may not be so far away.

Taking on 23andMe:

As direct-to-consumer (DTC) genetic testing becomes increasingly popular, one of the large players in the field is the company 23andMe. This company rose to fame after allowing consumers to have their genes tested, all by providing a sample of saliva and mailing it out. While this sounds like an interesting idea to many, it also comes with potential drawbacks.

Some studies have suggested that the false positive rate of these DTC tests is high, indicating that even if a result is positive, it may not necessarily be true. With this in mind, a positive result may cause feelings of stress and anxiety, when in reality the result may not be positive at all. As well, this testing does not inform a person about whether they will contract a disease, only whether they have risk factors for it. Given that this is done without proper genetic counseling, it may be difficult for individuals to properly contextualize the results that they receive, leading to panic and anxiety.

There are also benefits to DTC testing, particularly the accessibility. It is not easy for everyone to receive access to screening healthcare, but the fact that DTC testing is available regardless of geographic location means that individuals can learn at least some information about their risk for diseases. This, in turn, increases awareness regarding the role of genes in developing disease, and may even spur some individuals to take further action, such as going for routine screening or engaging in health-promoting behaviors.

23andMe has been plagued with controversies, including a data breach affecting nearly 7 million users. In 2021, the company went public, and since then it has only gone downhill. An extensive debate regarding whether to take the company private has culminated in the resignation of all independent members of the board of directors. Despite this, the company continues to operate and as individuals become more conscious of their health, the role of DTC testing may become more important, if managed correctly.

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