Bioengineering

1
Bioengineering World Health

• Lecture Four

2
Bioengineering in the News

• Ethics Lancet Study Faked!
• http//www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd
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  t
• http//www.npr.org/templates/story/story.php?story
  Id5165566
• Single pill for HIV
• http//www.npr.org/templates/story/story.php?story
  Id5163844
• Packaging Malaria Drugs
• http//www.npr.org/templates/story/story.php?story
  Id5164602

3
Summary of Lecture 3

• Developing World
• HIV/AIDS
• Unintentional injuries
• Cardiovascular diseases
• Tuberculosis
• Developed World
• Unintentional injuries
• Cardiovascular diseases
• Cancer
• Self-inflicted injuries

4
Overview of Lecture 4

• What are the major health problems worldwide?
• Leading causes of mortality for ages 45-59
• Developed world
• Developing world
• Global health challenges

5
Leading Causes of Mortality Ages 45-60

• Developing World
• Cardiovascular diseases,
• Cancer (malignant neoplasms),
• Unintentional injuries, and
• HIV/AIDS
• Developed World
• Cardiovascular diseases,
• Cancer (malignant neoplasms),
• Unintentional injuries, and
• Digestive Diseases

6
Review Ischemic Heart Disease

• Atherosclerosis
• Hardening and narrowing of the arteries due to
  build up of plaque.
• When the coronary arteries become narrowed, the
  supply of oxygen and nutrients to the heart is
  restricted. This damages the heart tissue.

7
Review Treatment Options
Coronary Artery Bypass Graft
Angioplasty
8
ReviewCerebrovascular Disease and Stroke

• Third leading cause of death in the US
• Causes of stroke
• Blood vessel supplying the brain is blocked
• Thrombosis (clot in vessel)
• Embolism (clot breaks off and lodges in blood
  vessel in brain)
• Vasoconstriction or spasm
• Venous collapse

9
ReviewCerebrovascular Disease Treatment

• Thrombolysis
• Break up blood clot
• Rehabilitation
• Experimental Treatments
• Angioplasty
• Heparin and Coumadin
• Blood Thinners
• Aspirin

At right X-ray image showing before and after
treatment
10
Cancer, Ages 45-59

• Cancer kills 1.5 million people aged 45-59 each
  year throughout the world each year
• Lung cancer
• 263,000/year deaths in this age group
• Stomach cancer
• 185,000 deaths/year
• Liver cancer
• 179,000 deaths/year
• Breast cancer
• 148,000 deaths/year

11
Review Cancer

• Tumor
• Abnormal mass of tissue
• Growth exceeds that of normal tissue
• Purposeless and preys on host
• Result of genetic damage to a cell
• Types of Tumors
• Benign (not harmful)
• Malignant (harmful)
• Only malignant tumors can spread (Metastasize)

12
Microscopic Appearance
13
2004 Estimated US Cancer Deaths
Men290,890
Women272,810
25 Lung bronchus 15 Breast 10 Colon
rectum 6 Ovary 6 Pancreas 4 Leukemia
3 Non-Hodgkin lymphoma 3 Uterine
corpus 2 Multiple myeloma 2 Brain/ONS 24
All other sites
Lung bronchus 32 Prostate 10 Colon
rectum 10 Pancreas 5 Leukemia 5 Non-Hodgkin 4
lymphoma Esophagus 4 Liver intrahepatic 3bil
e duct Urinary bladder 3 Kidney 3 All other
sites 21
ONSOther nervous system. Source American Cancer
Society, 2004.
14
Biology of Tumor Growth

• Natural history of most cancers has 4 phases
• Malignant transformation in target cell
• Growth of transformed cells
• Local invasion
• Distant metastases

15
Importance of Cancer Screening

• 90 of cancer deaths are due to metastasis.

16
Lung Cancer Epidemiology

• United States
• 99,000 males die per year
• 78,000 females die per year
• Five year survival 14
• Only 15 of patients are diagnosed with localized
  disease (most have metastasized by the time it is
  detected)
• Risk factors
• Smoking
• Actively increases relative risk 13X
• Passively increases relative risk 1.5X

17
Lung Cancer Clinical Manifestations

• Signs and symptoms
• Coughing, wheezing, difficulty breathing,
  recurrent pneumonia
• Diagnosis
• Screening (Looking for disease in people without
  symptoms)
• Trials of chest x-ray, sputum cytology, NOT
  SUCCESSFUL
• Diagnosis (person has symptoms, looking for a
  cause)
• CT directed biopsy
• Uses X-ray imaging to guide a surgical procedure
  where tissue is removed
• Bronchoscopically directed biopsy
• Uses a camera to guide a surgical procedure where
  tissue is removed

18
Lung Cancer Treatment

• Localized
• Small Tumor Possibly surgery (remove tumor)
• Large Tumor Surgery and Chemotherapy or
  Radiation Therapy
• Metastatic
• Chemotherapy and Radiation Therapy

At Right Chemotherapy is an anti-cancer drug
given intravenously.
At right Radiation therapy uses x-rays to kill
cancer cells.
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32ps307cat_id20077article_set31544
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19
Digestive Diseases

• Worldwide, 456,000 people aged 45-59 die each
  year from digestive diseases
• Cirrhosis (scarring) of the liver
• Kills 250,000 people each year between the ages
  of 45 and 59

http//www.georgetownuniversityhospital.org/body.c
fm?id555563actionarticleDetailAEProductIDAdam
2004_10AEArticleID000421
20
Liver

• Largest organ in the body
• Metabolizes fat and glucose (sugar)
• Helps remove toxic substances from blood
  Produces
• Bile to help absorb fats
• Proteins that regulate blood clotting
• Immune agents
• Loss of liver function can produce severe disease
  and death

21
Liver Microscopic Organization
22
Cirrhosis

• Normal liver is replaced with scar tissue as a
  result of chronic injury, interfering with liver
  function
• Causes of cirrhosis
• Chronic alcoholism
• Viral hepatitis infection
• Symptoms of cirrhosis
• Exhaustion, loss of appetite, nausea, vomiting
  blood, weakness, weight loss, and abdominal pain.
  
• Patients bruise and bleed easily and become
  highly sensitive to medicines with increasing
  loss of liver functions.

23
Summary Leading Causes of Death
Ages 15-44 HIV/AIDS Unintentional injuries
Cardiovascular diseases Tuberculosis Unintention
al injuries Cardiovascular disease
Cancer Self-Inflicted Injuries  
Ages 0-4 Perinatal conditions Lower respiratory
infections Diarrheal diseases Malaria Perinatal
conditions Congenital anomalies Lower respiratory
infections Unintentional injuries  
Ages 45-59 Cardiovascular diseases Cancers
Unintentional injuries HIV/AIDS Cardiovascular
diseases Cancer Unintentional injuries
Digestive Diseases  
24
Review the DALY

• DALY
• Disability adjusted life year
• Measures years of disability free life lost when
  a person contracts a disease. Combines mortality
  and morbidity.
• Examples
• Stroke 6 DALYs
• Car accidents 9 DALYs
• Self inflicted injuries 17 DALYs
• Violence 9 DALYs
• Lower respiratory infections 1 DALY
• HIV 28 DALYs

25
0-4 Years Old Developing World
26
0-4 Years Old Developed World
27
15-44 Years Old Developing World
28
15-44 Developed World
29
45-59 Years Old Developing World
30
45-59 Years Old Developed World
31
(No Transcript)
32
New World of Global Health

• Bill and Melinda Gates Foundation
• Pledged 6 billion since 1999 to global health
  issues
• Roughly the same as the WHO budget during the
  same time
• Global Fund to Fight AIDS, TB and Malaria
• 8.6 billion to 128 countries launched in 2002
• Presidents Emergency Plan for HIV/AIDS Relief,
  2004
• 15 billion

33
Challenges Faced

• Countries struggle with procurement policies
  (hard to convert to drugs)
• Shortages of trained health care workers
• http//www.npr.org/templates/story/story.php?story
  Id4987628
• Corruption
• Lack of coherent approach

34
What is a grand challenge?

• Scientific or technical innovation that
• Removes a critical barrier to solving an
  important health problem in developing world
• High likelihood of global impact and feasibility
• Different than
• Simple statement of a big problem in global
  health
• HIV/AIDS, malnutrition, lack of access to medical
  care, lack of resources
• Meant to
• Direct investigators to specific breakthrough
  that provides solution to a significant health
  problem(s)

35
Global Health Challenges

• 200 million medical research initiative
• Grand challenges in global health
• Bill and Melinda Gates Foundation
• Encourage scientific and technological solutions
  to diseases that disproportionately affect the
  developing world
• Announced in January 2003
• http//www.npr.org/templates/story/story.php?story
  Id939533

36
Call for Grand Challenges

• Call For Ideas I (May 2003)
• 1048 submissions from scientists and institutions
  in 75 countries
• Scientific Board heard proposals (August 2003)
• Problem
• Roadblock (obstacle to progress)
• Challenge
• List of potential benefits

37
Goals and Grand Challenges

• Seven Long Range Goals
• 14 Grand Challenges
• Heavily oriented toward infectious disease
• Infectious diseases account for the most profound
  discrepancies between advanced and developing
  economies
• Causes of infectious diseases are well-known
• Can more easily formulate technical and
  scientific obstacles to progress
• Results reported in Science (Oct 17, 2003)

38
Goals and Grand Challenges

• Improve childhood vaccines
• GC1-Create effective, single dose vaccines that
  can be used soon after birth
• GC2-Prepare vaccines that do not require
  refrigeration
• GC3-Develop needle-free delivery systems for
  vaccines
• Create new vaccines
• GC4-Devise reliable tests in model systems to
  evaluate live attenuated vaccines
• GC5-Solve how to design antigens for effective
  protective immunity
• GC6-Learn which immunological responses provide
  protective immunity

39
Goals and Grand Challenges

• Control insects that transmit infectious disease
• GC7-Develop a genetic strategy to deplete or
  incapacitate a disease-transmitting insect
  population
• GC8-Develop a chemical strategy to deplete or
  incapacitate a disease-transmitting insect
  population
• Improve nutrition to promote health
• GC9-Create a full range of optimal bioavailable
  nutrients in a single staple plant species
• Improve drug treatment of infectious disease
• GC10-Discover drugs and delivery systems that
  minimize the likelihood of drug-resistant
  organisms

40
Goals and Grand Challenges

• Cure latent and chronic infections
• GC11-Create therapies that can cure latent
  infections
• GC12-Create immunologic methods that can cure
  chronic infections
• Measure disease and health status accurately in
  economically in poor countries
• GC13-Develop technologies that permit
  quantitative assessment of population health
  status
• GC14-Develop technologies that allow assessment
  of individuals for multiple conditions or
  pathogens at point-of-care

41
Grand Challenge Proposals

• NIH issued request for proposals to address
  challenges
• Grants of up to 20M over five years or less
• http//www.grandchallengesgh.org/

42
Summary of Lecture Four

• Developing World
• Cardiovascular diseases,
• Cancer (malignant neoplasms),
• Unintentional injuries, and
• HIV/AIDS
• Developed World
• Cardiovascular diseases,
• Cancer (malignant neoplasms),
• Unintentional injuries, and
• Digestive Diseases