Aaron Liebskind

11/24/19
Ir1
English 10 GT

Interview with Doctor Sudhir Kathuria

​
Interviewee: Dr. Sudhir Kathuria
Location: Johns Hopkins Bayview Medical Center
Title: Diagnostic Radiologist
Date: November, 24th, 2019

O​n Sunday, November, 24th, 2019 at 7pm, I met with Doctor Kathuria, who is a Diagnostic
Radiology specialist in Baltimore, Maryland. He graduated from medical school in 1996 and has
over 23 years of diverse experience in Diagnostic Radiology. He is affiliated with many other
hospitals including Johns Hopkins and Johns Hopkins Bayview Medical Center. Dr. Kathuria
cooperates with other physicians in medical groups such as Johns Hopkins University.

Questions and Answers:

1. What causes the damage of Myelin Sheaths resulting in multiple sclerosis?

A. This is predominantly immunologic mediated. T cells of the patient's own immune system
attack the protective Myelin sheaths of the nerve fibers resulting in communication problems
between brain and rest of the body.

2. What are some current forms of treatments for multiple sclerosis?

A. There are several important components of treatment:

a) Symptomatic management:
There are specific drugs used based upon the type of symptoms a particular patient has. e.g. Pain
medications (Cymbalta, lyrica, neurontic, tegetrol, effexor etc), Bladder dysfunction (Botox,
DDAVP nasal spray, Prazosin, oxytrol etc), Infection (Bactrim, Cipro, Levaquin, and other
antibiotics), Bowel dysfunction (Colace, Metamucil, Dulcolax etc), Muscular spasticity (Valium,
baclofen, botox), Tremors (Klonopin, Laniazid), Dizziness/Vertigo (meclizine)
b) Management of Relapses:
High dose oral or i.v. corticosteroids (Solu-medrol, prednisone); Plasma exchange therapy
(Plasmapheresis)

c) Drugs for modifying the course of disease:

There are several FDA approved medications that can delay the progression of disability. Some
of these are oral medications (teriflunomide, siponimod); some injectable (interferon beta -
1a/1b); and some are infused (alemtuzumab, mitoxantrone etc)

d) Physical therapy: ​Stretching and strengthening exercises

e) Emotional support

3. When were stem cells first used in a clinical setting for MS?

A. I believe one of the early clinical pilot study results was published in 1997.

Fassas A, Anagnostopoulos A, Kazis A, Kapinas K, Sakellari I, Kimiskidis V, Tsompanakou A.

Peripheral blood stem cell transplantation in the treatment of progressive multiple sclerosis: first
results of a pilot study. Bone Marrow Transplant. 1997;20:631–638

4. Has stem cells been an effective use of treatment for MS?

A. Study results are encouraging and have potential to develop into effective management.

5. And what are the newest discoveries in treatment for MS?

A. There are always new drugs coming for better symptomatic management and modifying the
course of the disease. However, stem cell transplantation and genetic modifications have the
potential of significantly improving our ability to control and potentially cure the disease.

6. Is stem cells an affordable treatment for the general public?

Developing new treatments is generally expensive in the beginning as there are significant
amount of time and money is spent. Stem cell treatment is currently very expensive.

7. Does the risk of MS increase with age?

A. MS can be seen at any age but most commonly diagnosed between 20 to 40 years of age.
8. Is there any correlation or causation of cell deviation to MS?

A. I am not sure if you are asking the cause of the disease? MS is T cell mediated autoimmune
disease. Before these abnormal T cells auto react autoimmune response against the self-antigens
in the Central nervous system, these cells undergo several migration steps that are controlled by
receptors, adhesion molecules, and chemokine. There are chromosomal regions such as 6q23
found to be associated with MS. There can be multiple points of causation in this complex
disease.

9. What are the risks involved in the harvesting of stem cells?

A. These are generally well tolerated. However, depending upon the source (Peripheral blood,
mesenchymal, or bone marrow) there are some risks such as infection, seizure, vasculitis, and
suboptimal stem cell collection.

10. What causes MS to relapse in the body?

A. MS Relapses are caused by active inflammation in the central nervous system that is immune
mediated and leads to new areas of myelin damage around the nerve fibers. These new events
can be triggered by environmental factors such as infection and stress. Some patients are more
prone to progressive or relapsing MS likely secondary to their genetic predisposition.

Reflection:
I felt that Dr. Kathuria was very responsive and courteous about my research project request. He
asked me to come to his home office to do the interview. So my dad drove me to his house. He
was welcoming and asked me to sit in his office. He then asked what questions I have for him. I
had prepared a document with my questions and went over each one while he listened. Then he
recommended that I leave the questions with him and also send him an email with a copy. He
asked that I give him a few hours to respond with the correct information. I gave him a copy of
the questionnaire and thanked him for his help and time. He later sent the document back to me
with his answers bolded for each question. I thought the interview was a bit strange as he asked
for me to email it as opposed to sitting down and filtering through each. I feel that although the
answers and information Dr. Kathuria provided were very detailed, I did not learn as much
because he was not there with me to explain the answers. I would definitely like to be present
with the interviewee to learn as they explain their answers as I feel it is important to ask any
follow up questions immediately. I feel that this interview was very straightforward as Dr.
Kathuria handled the answers directly then sent them to me. The process on the whole was short
but I still learned from the material.
Aaron Liebskind
12/14/19
Ir1
English 10 GT

Interview with Doctor Tsion Abdi - GI

​
O​n Sunday, December, 14th, 2019 at 7pm, I met with Doctor Tsion Abdi, who is a
Gastroenterologist in Columbia, Maryland. She is affiliated with multiple hospitals in the area,
such as Johns Hopkins Bayview Medical Center and Johns Hopkins Hospital in Baltimore
Maryland. Dr. Abdi received her medical degree from Georgetown University School of
Medicine and has been practicing for the last ten years. I outlined my questions as the following
and doctor Abdi answered as clearly and diligently, elaborating on as many details as possible.

Questions and Answers:

1.​ ​ ​What causes women to be more prone to Multiple Sclerosis vs. men?

A. It is speculated that environmental factors in rural to urban areas accompanying

urbanization may trigger the developmental of more causes in women over men. The estimated
female to male ratio is 1.4:1. This increased in 2012 to 2.3:1. The reason is unknown, however
a recent case control study from, 2012 noticed the increase in incidences of MS in women from
the period since 1980’s. This was also concurrent with the population shift.

2.​ ​ ​Are there any recent clinical research studies for Multiple Sclerosis?

A. There is a current research study that is looking at the use of Simvastatin which is a
reduction in the annual rate of whole brain atrophy. This is the loss of neurons and a marker for
MS progression.

3.​ ​ ​What are the risks for Stem Cell treatments?

A. There are many risks but it out weights the progression of MS. One can develop severe
fever as well as transient neurologic deterioration and engraftment syndrome.

4.​ ​ ​Is MS and autoimmune disease?

A. It is Heterogeneous disorder or one predisposition gene at chromosome 12p13 with varying
clinical and pathologic features. The true cause of MS remains unknown. The most widely
accepted theory is that MS begins as an inflammatory, immune, mediated disorder.

5.​ ​ ​Is MS linked to genetics?

A.​ Yes. Over 100 Polymorphisms are associated with MS. The strongest association is
HLA-DRB1. This gene provides the instructions to make protein which helps to play a crucial
role in the immune system. ​The HLA-DRB1 gene is part of a family of genes called the human
leukocyte antigen (HLA) complex. The HLA complex helps the immune system distinguish the
body's own proteins from proteins made by foreign invaders such as viruses and bacteria.

6.​ ​What are the Symptoms of MS?

A. MS is typically present in young adults with distinct episodes of Central Nervous System
(CNS) dysfunction that relapse and remit such as:
· Unilateral Optic Neuritis – (​this is inflammation of the Optic nerve causing vision loss)
· Painless Binocular Diplopia – (​this is occurring double vision in both eyes)
· Transverse Myelitis – (​inflammation of the gray and white matter of the spinal column)​
· Motor Symptoms – (​movements)
· Focal Brainstem or Cerebellar Symptoms – (​mummers arising in the midbrain or medulla)​
· Vision Loss

7.​ ​How is MS diagnosed?

A.​ MS is typically diagnosed with imaging specifically via the McDonald Criteria MRI. This
will show any discrete lesions or plagues.
Dr. Tsion Abdi Site Visit - Reflection
I reached out earlier in the week, by telephone to Dr. Abdi and left a message for her. She called
me back right away and I explained that I’m working on an Independent Research project and
was hoping that she could be available for a few questions surrounding the Multiple Sclerosis
disease. She said she would be more than happy to learn what I was researching and how she
can help. She took my address and said she would come for a bit on Friday. On Friday,
December, 14th, 2019 at 7pm, Dr. Abdi rang my doorbell. I greeted her and was very excited
and happy that she actually showed up. I invited her in and led her to a table. My parents
introduced themselves and offered her something to drink but she declined.
Who:
I met with Dr. Tsion Abdi, who is a Gastroenterologist in Columbia, Maryland. She is affiliated
with multiple hospitals in the area, such as Johns Hopkins Bayview Medical Center and Johns
Hopkins Hospital in Baltimore Maryland. Dr. Abdi received her medical degree from
Georgetown University School of Medicine and has been practicing for the last ten years. I
outlined my questions as the following and doctor Abdi answered as clearly and diligently,
elaborating on as many details as possible.

Where: My Residence:
​5039 Gaithers Chance Drive
Clarksville, MD 21029

What:
As a course requirement I am interested in interviewing another doctor for my Independent
Research project to get a different perspective and further my knowledge with interviewing
techniques and Question and Answer Strategies.

Why:
I was expecting to learn and understand more about the symptoms of Multiple Sclerosis and the
effects of Stem Cells and the impact they can provide on mitigating the disease. As well as the
reasons why it is prone to women versus men in certain parts of the world. In addition, I wanted
to also understand more about the genetic behaviors and whether there are any newer research
studies being conduction today. I believe that interviewing multiple doctors and gaining other
insightful information is allowing me expand my knowledge in the area of Multiple Sclerosis and
to learn more about interviewing.

When: ​Friday, December, 14th, 2019 at 7pm.

My first impression over the phone was that Dr. Abdi was very kind and wanted to help in any
way that she can. Upon arrival at my house she was just as calm and reassuring that we will
together make this a productive visit. I thank her for taking the time to come to my home but I
believe that since she suggested coming to my residence that she preferred to have my parents
present during the meeting. We sat down at the table and I gave her a copy of the question that I
prepared. She reviewed them quickly and then began answering them. I took notes as quickly as
she was speaking and she also was very nice to jot down some bullet points on her copy as well.
Although she is a Gastroenterologist she was very knowledgeable on some of the questions while
on others she did on site research on her computer to give me the answers.

I believe my interview with Dr. Abdi was very successful and insightful. I have learned about
the many symptoms of the Multiple Sclerosis disease. That MS is typically present in young
adults with distinct episodes of the Central Nervous System (CNS). I have learned about the
links to genetics and that over 100 Polymorphisms are associated with MS and the strongest
association is HLA-DRB1. This is a gene that provides the instructions to make protein which
helps to play a crucial role in the immune system. Most importantly, I have learned that there is
a current research study that is looking at the use of simvastatin which is a reduction in the
annual rate of whole brain atrophy. This is the loss of neurons and a marker for MS progression.