AMIRALI BANANI
EXPERIENCES
Internship at Centre for Cardiovascular Innovation — Centre d’Innovation Cardiovasculaire (CCI-CIC)
VANCOUVER GENERAL HOSPITAL , VANCOUVER, BC, CANADA | MARCH 21-24, 2023
During spring break in 2023, I had the splendid opportunity to intern for a short period at the Centre for Cardiovascular Innovation, a clinical research centre operated by the University of British Columbia (UBC) Faculty of Medicine that facilitates regional and international clinical trials for cardiovascular researchers in BC investigating novel therapies for the treatment of certain cardiac conditions. This internship took place at Diamond Health Care Centre and Jim Pattison Pavilion at Vancouver General Hospital in Vancouver, Canada under the guidance of Dr. Brady Robinson. Below are some of the incredible activities that I did at CCI-CIC as well as my reflections on the experience.
ACTIVITIES
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Overview of CCI and the innovative projects that CCI researchers are working on to revolutionize cardiac procedures. This was led by Dr. Brady Robinson, Clinical Research Project Manager at CCI-CIC, whose current research project — called COMPLETE TAVR (CTAVR) — focuses on essentially combining Transcatheter Aortic Valve Replacement (TAVR) and Percutaneous Coronary Intervention (PCI) into a single procedure that can help patients with symptomatic aortic stenosis (AS) get treated while managing their concomitant coronary artery disease (CAD). Currently, patients who have CAD and have had PCI done in the past can not receive a TAVR to treat their AS, but CTAVR is set to make it possible to do so. The study is a stratified randomized trial led by the UBC Faculty of Medicine / Vancouver General Hospital with participating medical research institutions across Canada and the United States. 4,000 patients and 100 participating institutions are required for the study (∼200 patients and 60 institutions have been incorporated as of March 2023), and once complete, CTAVR would be the largest study of its kind in the world. Its results will be published in the prestigious New England Journal of Medicine and could have tremendous implications if successful.
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Observing cardiac catheterization procedures in the Cardiac Catheterization Laboratory (Cath Lab) at Vancouver General Hospital. In these procedures, catheters were inserted through the patients’ common femoral artery and pushed up to the heart to assess blood flow in the coronary arteries with angiography (using X-Rays and contrast dye injected by the catheter). The catheters were also used for PCI: a coronary revascularization procedure performed by the insertion of stents that open up blocked coronary arteries in patients with CAD.
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Assessing the suitability of several patients to participate in the CTAVR research study using inclusion and exclusion criteria assessing the patients’ current cardiac health (based on measures such as heart rhythm, blood pressure, jet velocity, LVEF, AVA area and index, lesions in coronary arteries, and NYHA Functional Classification during physical activity) and medical history (which entails past cardiac or other related medical conditions and operations).
REFLECTIONS
For me, the most influential part of my work experience at the UBC Centre for Cardiovascular Innovation was acquiring first-hand insight into COMPLETE TAVR, the flagship research project that the team of CCI researchers is working on. Once again, this developing research study is aiming to develop a method to treat a condition known as aortic stenosis in patients with coronary artery disease using cardiac catheterization, which dismisses the need for surgical procedures. As part of this experience, I got to observe the day-to-day tasks of Dr. Brady Robinson (as a reminder, the Clinical Research Project Manager of CTAVR), who regularly hosted meetings with scientists from different health institutions across Canada and the United States who are participating in the study and sought to recruit new patients for the study based on a set of inclusion/exclusion criteria to determine whether they are suitable to participate in CTAVR. As previously explained, as part of one of my favourite activities, I played the role of a research coordinator as I got to review these criteria and decide whether a set of four patients with different cardiac conditions and medical histories were eligible for the study. And of course, I had the opportunity to observe live cardiac catheterization procedures in the Cath Lab at Vancouver General Hospital, which was a tremendous experience!
During my time at CCI, I learned a lot about how new research studies are formulated and developed through an extensive process of research design development, patient and researcher recruitment, and innovation — one that may take several years to prepare and perform. I also learned how and for what purposes cardiac catheterizations are performed to diagnose and treat cardiovascular conditions like coronary artery disease, as well as how modifications to this cardiac procedure can open up a whole new scope of opportunities to treat cardiovascular diseases without the need for risky surgical operations. After completing this work experience, I have developed an even greater understanding and passion for medical research.
The biggest challenge I had during my placement was probably in the Cath Lab at VGH as I tried to understand step by step what was going on during the cardiac catheterization procedures through the monitors in the control room that displayed the angiographic images and ECG recordings. The angiographic images were black and white and — before the dye was injected by the catheter to highlight the coronary arteries — showed the heart, its arteries and the surrounding parts as faded objects, which sometimes made it difficult to identify where the catheter was during the process and thus what exactly was happening at each stage of the catheterization. The way I overcame this challenge was by simply asking the specialists in the control room to explain to me exactly what I was looking at on the angiogram as well as what was going on at each step, whether it was the insertion of the catheter through the aortic arch and into the heart or the injection of iodine dye into the coronary arteries (a more visually prominent step). Always satisfy your curiosity by asking questions, which in turn will satisfy your thirst for knowledge!
CONCLUSION & APPRECIATION
My goals for this placement were to deeply explore some of the innovative research taking place at CCI and acquire experiential exposure to the process of research in medicine, which I would love to pursue in the future. I have certainly achieved these goals as I am now much more aware of the large-scale preparation that goes into making studies like COMPLETE TAVR possible.
I sincerely thank Dr. Brady Robinson for spending time off his busy schedule to show me around and teach me about CCI as well as the COMPLETE TAVR project and Dr. Jacqueline Saw for demonstrating first-hand how cardiac catheterizations work in the Cath Lab at VGH. This work experience certainly wouldn’t be so rewarding without them.
I laud the efforts being made by researchers at CCI-CIC to innovate in the field of Clinical Cardiology and wish them the greatest success in the future.
CCI-CIC website: https://cci-cic.org
TEDxYouth@SunsetBeach
VANCITY THEATRE, VANCOUVER, BC, CANADA | SEPTEMBER 9, 2022
In January 2022, I became the Director of Communications for a TED event organized independently by youth in Vancouver, Canada known as TEDxYouth@SunsetBeach. The event, set to take place in September of the same year was intended to provide students and educators from Vancouver and beyond with an opportunity to showcase some of their incredible work and experiences, express opinions on how to solve pressing issues, and share inspiring personal stories. From increasing access to technology in Malawi by shipping portable classrooms equipped with computers, to an influential speech on how to solve Canada's opioid crisis using lessons from Portugal, speakers at the event frankly impressed us all.
Being part of the team that organized this amazing TEDx event was truly special. There was quite a lot that had to be done in order to prepare and stage the event, from seeking for sponsors and increasing publicity through social media to acquiring a venue and a crew of staging engineers. All the hard work was worth it in the end, however, as we staged our first successful TED event at Vancity Theatre on September 9, welcoming a carefully selected array of speakers from Vancouver and other cities such as Montreal and Chicago. The theme for this year's event was "The Changing World" — a theme that complements the true state that our dynamic world is in right now as a result of unprecedented global events from the COVID-19 Pandemic to Russia's invasion of Ukraine.
We will be back again next year for our next event. For more information about TEDxYouth@SunsetBeach, please visit our website through the following link: TEDxYouth@SunsetBeach (tedxyouthsunsetbeach.com)
HARVARD SUMMER SCHOOL 2022 @ HARVARD UNIVERSITY
CAMBRIDGE, MASSACHUSETTS, UNITED STATES | JULY 25 - AUGUST 5, 2022
On July 23, the day after Summer at Hopkins ended, we drove almost 900km from Baltimore to Boston, visiting Albany on the way. After leaving Baltimore at around noon, we arrived at our hotel in Boston at almost 10 PM. I spent the night packing and preparing for the next day, in which I would move in for my next big experience: Harvard Summer School.
About 5 months prior to this, I applied for Harvard Summer School at around the same time as I did for Summer at Hopkins. The application required me to have my school send each of my transcripts from grades 8-10 as well as a letter of recommendation from one of my counsellors or teachers. Additionally, I had to respond to four different academic prompts by writing a paragraph for each to express my thoughts on them. Altogether, the application process for Harvard Summer School was more tedious than that of Summer at Hopkins, and the acceptance rate into the program was rather low. Taking into consideration the competitive nature of the application, I thoughtfully looked over and recited every paragraph that I wrote to ensure that my responses were coherent. Finally, when it was all polished, I submitted my application at the end of February. After about four weeks, on March 29, the decision for my application came out, and I was informed that I had been accepted into Harvard Summer School. Coincidentally, I was notified that I had gotten into Summer at Hopkins on the same day. I immediately accepted their offers of admission and applied to both programs later that day. I never foresaw that I would be spending my summer at Johns Hopkins and Harvard University. It was at that moment that I knew I would have the summer of my life.
For Harvard Summer School, I applied for a course known as Epigenetics & Gene Regulation. The course was no cakewalk. It expanded on the principles of AP Biology to teach us about how environmental factors meticulously affect the molecular mechanisms by which our genes are expressed and encoded into protein using complex terminology and explanations. Most biology courses in high school and even in university focus purely on genetics and inheritance. However, this course was unique in that it used the concepts of gene expression and combined it with new emerging concepts that are still being researched and debated. This speaks to the fact that Epigenetics is a novel field that still requires a lot of investigation to fully understand. Much of the research that we reviewed in the course was very recent and provided us with valuable insights into potential studies that we could investigate in the future to further the research.
Despite the difficulty of the course, the constant encouragement and excellent teaching of our teacher, Dr. Amy Tsurumi, an Associate Professor of Surgery at Harvard Medical School, made it much easier for us to understand all the challenging material. In the first week, we learned through day to day lectures all the theory about Epigenetics and how the expression of genes are regulated by certain biomolecules in response to environmental stimuli. Then, using our knowledge, we spent the second week of the course writing a mock grant proposal for the National Institutes of Health (NIH) on a topic of choice that involves a particular epigenetic mechanism. After compiling our research, we organized and structured it in a document following the NIH's guidelines for writing a grant proposal. Finally, after finalizing our proposals, we each created a short 5-minute presentation summarizing our research and presented our work on the final day of the course.
My grant proposal was titled "The Use of Hypomethylating Agents Against DNA Hypermethylation in clear cell renal cell carcinoma (ccRCC)". Methylation is the process of adding methyl groups to a particular molecule. In DNA, methylation is a crucial process that helps regulate the expression of certain genes. However, if too many methyl groups are added, termed "hypermethylation", certain conditions such as ccRCC can arise. This is because the excess methyl groups prevent tumour suppressor genes from being transcribed by transcription factors. When these tumour suppressor genes can not be transcribed, tumour suppressor proteins can not be synthesized, meaning that the formation of a potential tumour can not be inhibited. My research essentially focused on molecular players known as hypomethylating agents that enter the nucleus of renal cells and demethylate VHL (von Hippel-Lindau) tumour suppressor genes so that they can be transcribed. In my grant proposal, I proposed to use advanced testing methods such as RT-qPCR (reverse transcription-quantitative polymerase chain reaction), MeDIP-Seq (methylated DNA immunoprecipitation sequencing), and Western Blotting to evaluate the efficacy of the hypomethylating agents in demethylating VHL genes as well as how much of them will be required to ensure a satisfactory outcome. With these hypomethylating agents, it is possible to prevent or potentially even cure ccRCC.
A copy of the original article can be viewed by clicking on the document shown.
Here are some of the places that I would visit on a typical day at Harvard Summer School:
For the duration of the program, I stayed at Lowell House, one of Harvard University's 12 undergraduate residences or "houses". The building boasts a neo-Georgian design, and consists of two courtyards. Lowell House is located between Harvard Yard and Charles River, and its unique blue-capped bell tower is a landmark of the Harvard skyline.
At Lowell House, I was housed in a single-bedroom dorm on the 2nd floor. I would wake up at 7 am each day for breakfast in Lowell's own dining hall (pictured below) before heading to class which began at 8:30 am. On the first day of the program, we were given our own personalized Harvard ID cards which we used as a fob to enter buildings across the Harvard campus and a key for unlocking the door to our dorm. These were each attached to a lanyard which we had conveniently placed around our neck at all times.
Lowell House on a summer day
SUMMER AT HOPKINS 2022 @ JOHNS HOPKINS UNIVERSITY
BALTIMORE, MARYLAND, UNITED STATES | JULY 11 - 22, 2022
My time at Johns Hopkins University for the Summer at Hopkins pre-college program was, all things considered, a life changing experience. Not only did I learn valuable knowledge and clinical skills that I would apply in the future in medical school and beyond, but I also made lifelong friends from all around the world. In addition, I acquired tremendous insight into what university life is like in my two weeks living and studying at Johns Hopkins -- and all I can say is that it is EXCITING!
Back in February 2022, I discovered the Summer at Hopkins program through individual research and was immediately fascinated by the catalog of courses that were offered at the program. Johns Hopkins University has always been one of my dream schools, so I saw this as a tremendous opportunity to experience what it's like being a student at the university while benefiting from an enriching educational experience. I applied for a course known as Medical School Intensive, which was essentially a mini simulation of medical school, and I couldn't be more satisfied with my selection.
From the Medical School Intensive course, I learned valuable medical techniques such as blood typing, how to take an IV, and basic surgical procedures such as suturing. In addition, what made the course truly unique was our daily excursions to Johns Hopkins Hospital, where we had the privilege of doing simulated medical operations at their Medicine Simulation Center. For example, we were able to use a mannequin with a simulated heartbeat to learn how to diagnose heart diseases by listening to its different heart rhythms with a stethoscope. On another day at the simulation center, we learned how to perform intubations on both child and adult mannequins using real-life medical devices. On a few other occasions, we had the privilege of doing lab work at Johns Hopkins’ state-of-the-art Undergraduate Teaching Laboratories using lab equipment that we typically would not have access to in high school.
Along with these practical activities in the Medical School Intensive course we also had intriguing lectures covering a wide variety of topics in medicine, resulting in a perfect balance of theory and practice. The new concepts and techniques I learned in my 2 weeks at Johns Hopkins profoundly broadened my perspective of the medical field and what it’s like to live and study at one of the world’s most prestigious universities. I would recommend Summer at Hopkins to students who are keen on being part of an enriching educational experience over the summer — especially if they are interested in medicine.
Personal Reflections
“Johns Hopkins University has always been one of my dream schools, so I saw this as a tremendous opportunity to experience what it’s like being a student at the university while benefiting from an enriching educational experience.
In the Medical School Intensive course I learned valuable medical techniques such as blood typing, how to take an IV, and basic surgical procedures such as suturing. In addition, what made the course truly unique was our daily excursions to Johns Hopkins Hospital, where we had the privilege of doing simulated medical operations at the Medicine Simulation Center.
The new concepts and techniques I learned in my 2 weeks at Johns Hopkins profoundly broadened my perspective of the medical field and what it’s like to live and study at one of the world’s most prestigious universities.” -Amirali on his experience with the 2022 Pre-College Course Medical School Intensive
Credit: JHU Summer at Hopkins via Instagram (@jhusummer)
