Author: noorali

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Paternity Test: Is it reliable?

Justin Bieber took a DNA test last week in New Jersey. He wants to refute the claims of a San Diego woman who filed a paternity suit against Bieber. The suit has since been withdrawn, but Bieber’s legal team intends to sue the accuser, Mariah Yeater, in order to discourage future baseless claims.

Yeater is 20. She had claimed that she had sex backstage with the 17-year-old last year and that he was the father of her baby, born in July. She was demanding child support. Bieber has denied the allegation.

Yeater may face charge of statutory rape since the singer was only 16 years old at the time of the alleged sexual encounter.

What is paternity test?

I went to Wikipedia to look for an answer. A paternity test establishes genetic proof as to whether a man is the biological father of an individual. A maternity test establishes whether a woman is the biological mother of an individual. Currently, genetic testing is the most reliable standard. It is the most advanced and accurate technology to determine parentage.

In a DNA parentage test, the result (called the probability of parentage) is zero per cent if the alleged parent is not biologically related to the child. The probability of parentage is typically greater than 99.9 per cent when the alleged parent is biologically related to the child, says the Wiki article.

Almost all individuals have a single and distinct set of genes. Rarely, individuals, known as “chimeras”, have at least two different sets of genes. There have been several cases of DNA profiling that falsely “proved” that a mother was unrelated to her children.

A person’s DNA is created from DNA (genetic material) of both parents in roughly equal numbers. A person’s DNA is a unique combination of genetic material in a new cell. This genetic material is known as the nuclear genome of the individual, because it is found in the nucleus.

Comparing the DNA sequence of an individual to that of another individual can show whether one of them was derived from the other. The mitochondria in the cells also have their own genetic material termed the mitochondrial genome. Mitochondrial DNA comes only from the mother.

Proving a relationship based on comparison of the mitochondrial genome is much easier than that based on the nuclear genome. However, testing the mitochondrial genome can prove only if two individuals are related through maternal descent. This is of limited value. It could not be used to test for paternity.

Nuclear DNA can accurately identify the father and the mother, and is the most common material used in parentage testing.

Several laboratories across Canada provide paternity testing. There are many ways to collect specimens for the test. For the test to be legally binding, one has to follow strict guidelines to prevent fraud. The sample is sealed in tamper-evident packaging. The least invasive and most common form of paternity testing uses the buccal (lining of the mouth) swab. This consists of a special swab, similar to a cotton-tipped swab. The swab is rubbed against the inside of the cheek to collect loose cells to be used for testing. One can also use a blood sample.

To ensure the identities of the parties involved, participants must produce a government issued ID. They will also be photographed. DNA can also be collected from the baby before birth. Amniocentesis can be performed between the 14th and 20th weeks of pregnancy.
A chorionic villus sample is obtained by inserting a thin needle into the vagina to collect tissue.

The cost for paternity testing varies widely, depending on which type of test is chosen. The cost of a buccal swab test collected at a facility is around $500, plus the charge for collection. For pre-natal testing, there may be an additional fee.

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Mindfulness Meditation: A Journey to Personal Discovery

There are many ways to meditate. Mindful meditation is one way to achieve peace. It can recalibrate family dynamics and help adults and children relax and focus their thoughts. And it can take only three minutes to do, anywhere you can find a spot to sit or stand.

Mindful meditation has been used to help adults for 30 years. Now it is being used to help students function better, clear their mind of cluttered thoughts and some experts think it may help students achieve better exam results.

“Research already shows that mindfulness therapy has huge potential for kids with attention deficit hyperactivity disorder (ADHD) and anxiety,” says an article in the Globe and Mail. It is one of the cornerstones of the increasingly popular practice of mindfulness, a blend of Buddhism-inspired calm and cognitive-behavioural therapy.

Experts say the key to this rests in the idea that thoughts and feelings – especially negative, anxious ones – aren’t necessarily reality and don’t have to be permanent, says the article. It quotes a Toronto child psychiatrist and mindfulness expert M. Lee Freedman who puts it simply to her patients: “You don’t actually have to believe everything you think.”

Actress Goldie Hawn is author of a new book on mindfulness called 10 Mindful Minutes. Her foundation funded research found mindfulness helped students achieve better reading scores, less absenteeism and a 63 per cent rise in optimism. Now she is working to bring this message to parents to reduce stress in their lives and be more in control of their emotions and reactions. She hopes that this would make us better parents.

Mindful meditation is also effective in some clinical settings, reducing chronic pain and preventing depression relapses. Newer studies on group therapies adapted for children with ADHD and anxiety show that mindfulness is a serious alternative or supplement to medication, says the article.

Mindful meditation is a journey to personal discovery. The idea is, not to rush and not to react or over-react when you feel stressed.

The goal is to increase awareness. Through this increased awareness, the meditator is gradually transformed. The ultimate goal is to be aware or mindful at all times. It is this non-stop awareness that leads to self-transformation.

Your mind will be more focused on whatever task you are doing. You will have more compassion and gradually suffer less and less from negative emotional states which cause unnecessary sufferings. You will learn to live in the present moment rather than being lost in thoughts about the past and worry about the future.

The usual instruction for mindfulness meditation is to observe the breath. There are many variations to this. The one I found on the Internet is summarized here.

You can watch your breath in any way you like. You can feel your belly rise and fall. You may feel the air flow through your throat. You may feel the air in your nostrils. When you find you are no longer mindful of your breath, gently come back to the breath again. It is important not to get frustrated. This may happen often but stay focused or mindful on your breathing. This will help stabilize your mind. And learn to stay focused.

Start with three minutes. Every time you take a break, stop for three minutes and do your breathing exercise. Use the stopwatch and timer on your cell phone. You can increase this gradually to several minutes, depending on how much time you have. Make sure your breathing is always slow and relaxed, with a slightly longer exhale than inhale.

Slow breathing calms the nervous system, lowers blood pressure and reduces pulse rate.

Hate and anger hurts us all eventually. May be mindful meditation will make us more aware of our emotions and actions and help us live a tranquil and healthy life. Live in the present and plan for the future.

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San Francisco – A Place for Good Health and Continuing Medical Education

Click on photo for full size.

Ferry Building
Ferry Building

Fisherman's Wharf
Fisherman’s Wharf

San Francisco as seen from Twin Peaks
San Francisco as seen from Twin Peaks

Sabiya and Noorali at the Golden Gate Bridge.
Sabiya and Noorali at the Golden Gate Bridge.

San Francisco, California, is one of my favourite cities. I was there with my wife at the end of October for the largest surgical conference in the world – the American College of Surgeons’ Annual Congress. It is attended by about 12,000 surgeons and about 5,000 other individuals.

Besides attending the conference, we did some sightseeing. This was my fourth visit to San Francisco and third for my wife. So we had seen most of the places before. But we did the rounds again to see if anything had changed and recall some old memories.

San Francisco is the financial, cultural, and transportation center of the San Francisco Bay Area with a population of 805,235. It is a peninsula and the second-most densely populated large city in the United States after New York City. I will briefly mention three important dates in the history of San Francisco which every tour guide will mention.

First, in 1776, colonists from Spain established a fort at the Golden Gate and a mission was named after Saint Francis. Second, the California Gold Rush of 1849 propelled the city into a period of rapid growth, increasing the population in one year from 1,000 to 25,000. Third, 75 per cent of the city was destroyed by the 1906 earthquake and fire.

Today, San Francisco is one of the top tourist destinations in the world, ranking 33rd out of the 100 most visited cities worldwide, and is renowned for its chilly summer fog, steep rolling hills (more than 50 hills within city limits), mix of architecture, and its famous landmarks, including the Golden Gate Bridge (you can walk the bridge), cable cars, and Chinatown. Lombard Street is best known for the one-way section in which the roadway has eight sharp turns that have earned the street the distinction of being the crookedest street in the world.

You can shop, eat and relax at the Ferry Building and Fisherman’s Wharf. You can go there every day and you won’t be bored. This area is a must for anybody who loves food and wine and the beautiful view of the waterfront, Alcatraz (a visit there is a must) and the Golden Gate Bridge.

You can catch the cable car from the waterfront and visit the downtown area for some exotic shopping. It is here that the Financial District is centered, with Union Square, the principal shopping and hotel district nearby.

There are more than 3,500 restaurants in San Francisco catering food to suit any taste or ethnic background. San Francisco has more restaurants per capita than any other city in the United States. It is considered the top city for dining out.

If you love biking or walking then San Francisco is your kind of city. Cycling is a popular mode of transportation with about 40,000 residents commuting to work regularly by bicycle. Pedestrian traffic is a major mode of transport as well.

In 2011, Walk Score ranked San Francisco the second most walkable city in the United States. After a good meal (fish with plenty of omega-3), a glass of red wine, you can walk up a hill and get your cardio work-out for the day before retiring for the night.

The conference was intellectually stimulating, the food was gasrtonomically satisfying, the red wine was relaxing and walking kept my conscious clear. I came home feeling smart and healthy. Remember, all work and no play is not good for your health.

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More About Steve Jobs and Pancreatic Cancer

Dear Dr. B: I read your column on Steve Jobs and pancreatic cancer. I am puzzled. You say that most people with pancreatic cancer survive only few months after the diagnosis. So how did Jobs, who was diagnosed in the fall of 2003 – and who revealed it publicly in 2004 – manage to survive for eight years? Is it because he could afford to buy good health care?

Answer: That is what it looks like. But the real story is different. Jobs had a rare form of pancreatic cancer, known as neuroendocrine cancer, which grows more slowly and is easier to treat. It is not unusual for patients to survive several years with this type of cancer.

Most common cancer of the pancreas is adenocarcinoma.. My sister had adenocarcinoma. So did Nobel Prize winner immunologist Ralph Steinman, actor Patrick Swayze and football great Gene Upshaw. They all died within a few months of diagnosis. Jobs, with his vast fortune, and Steinman, with his use of experimental immunological treatments, could not forestall indefinitely the dismal outcome of the disease. In the end, both kinds of pancreatic cancers are incurable.

What is the difference between adenocarcinomas and neuroendocrine (NE) tumours?

The pancreas has two distinct kinds of tissue, hence two very different types of cancer. About 95 per cent of pancreatic cancers are adenocarcinomas arising from exocrine glands of the pancreas. These glands produce enzymes to digest fat in our diet.

Scattered in that larger organ are thousands of tiny islands. These are islands of endocrine tissue which makes hormones like insulin that are secreted into the blood. Tumours in these cells are known as islet cells tumours or NE tumours. Jobs had NE cancer.

Approximately half of NE tumours are functioning and half are nonfunctioning. That means patients who have functioning tumours exhibit characteristic syndromes caused by the uncontrolled secretion of insulin, gastrin and other hormones. Consequently, functioning tumours are typically diagnosed when they are smaller than nonfunctioning tumours.

Unfortunately, most patients who have NE carcinomas have locally advanced or metastatic disease. Treatment is directed towards the metastatic disease of the liver. Surgery, chemotherapy, radiotherapy and immunotherapy have been tried. None of them are curative. But palliation and prolongation of life can be gained by few years.

Patients who have locally advanced disease have a median survival of about five years. One form of treatment that is not recommended for most pancreatic cancer is a liver transplant. There is speculation that the liver transplant Jobs received in 2009 had been necessary because the cancer had spread to his liver. In Jobs’ case, did liver transplant prolong his life?

Medical research suggests that patients should be considered for liver transplant if all or most (more than 90 per cent) of NE liver metastases can be resected. Liver resection is safe (operative mortality less than six per cent) and effectively palliates pain and hormonal symptoms in most patients.

Liver transplant may prolong survival but it is not curative because the disease recurs in most patients despite apparent complete resection. Patients who receive liver transplants must take immunosuppressant drugs for the rest of their lives to limit their risk for rejection. But while these drugs serve their purpose, a compromised immune system can leave patients vulnerable to other diseases. Liver transplantation must therefore be considered with great caution.

Steve Jobs was a controversial and complex man when he was alive. After his death, he continues to create speculation and controversy. May his soul rest in peace!

Start reading the preview of my book A Doctor's Journey for free on Amazon. Available on Kindle for $2.99!