Monthly Archives: January 2013

Ectopic Pregnancy

About one in one hundred pregnancies, mostly in older women, is ectopic, meaning the fertilized egg does not correctly implant in the uterine lining. Generally, it instead rests in the fallopian tubes, which lead from the ovaries to the uterus. This may be a result of damage or inflammation in the reproductive organs, but sometimes the cause is simply unknown.

When this happens, the fetus is unable to properly develop and is not viable. However, left alone, the fetal tissue will develop for a certain amount of time before dying, possibly damaging the mother’s internal organs. This is why ectopic pregnancies often require medical or surgical intervention.

Ectopic pregnancies feel like normal ones at first. The initial indicators of pregnancy—such as missed periods and nausea—are the same whether the embryo implanted normally or not. However, ectopic pregnancy is soon after indicated, often, by unusual pelvic or abdominal pain, and doctors can usually diagnose it at around eight weeks. There may also be some vaginal bleeding, which resembles period bleeding despite a positive pregnancy test. The fallopian tube may leak blood, which can cause the feeling of needing to go to the bathroom, or even shoulder pain.

Sometimes the fallopian tube ruptures, causing lightheadedness and shock; this is actually a medical emergency and you should call 911. By contrast, sometimes there are no symptoms at all, and the problem is not found until a prenatal doctor visit.

While it is possible to have a normal pregnancy after an ectopic pregnancy, each one does make subsequent ones more likely. This risk can be reduced by having the non-viable embryo removed sooner rather than later. Women over 35 are at high risk regardless of previous pregnancy history. Some fertility drugs can also raise the likelihood. On the other hand, while fertilization after surgical sterilization or while using an IUD is vanishingly rare, when it does happen there is a strong probability of ending up outside the uterus.

Smokers have a high risk of experiencing ectopic pregnancy, because cigarette smoke causes changes that make the fallopian tube environment resemble that of the uterus just enough to encourage implantation. Some medical conditions can increase the risk of ectopic pregnancy, such as endometriosis, pelvic inflammatory disease, or chlamydia.

Morquio Disease

Morquio syndrome is an extremely rare genetic condition. It is only found when both parents are carriers when the child gets two copies of the gene that causes it, and fewer than one in every 200,000 children is born with the disease. It is a disorder of the processing of mucopolysaccharides, a type of carbohydrate used in the development of body tissue. In the two types of Morquio syndrome, the body doesn’t have enough of one of two enzymes that break down a particular type of mucopolysaccharide called keratan sulfate, the functions of which include cushioning the joints from shock. When it’s not properly broken down, however, the excess can cause significant damage to organs and tissues.

This damage takes a variety of forms. Initial signs typically appear between the ages of 12 months and three years, though prenatal testing can determine if a child will be born with the condition. The condition results in several obvious musculoskeletal indicators, such as a curvature of the spine called kyphoscoliosis, knock-knees, an abnormally large head, coarse facial features with wide gaps in the teeth, a large head, a short trunk, and ribs that flare out at the bottom of the rib cage like a bell. A typical Morquio patient, particularly in cases of type A, will generally be found to have some other, less obvious symptoms, including a heart murmur, an enlarged liver, poor nerve function, or clouding on the corneas of the eyes. If a child shows these symptoms and has not been tested prenatally, the most common test is examining the urine for mucopolysaccharides that were not broken down.

Though cognitive function is not impaired by Morquio, heart failure is a risk, and patients often have respiratory problems as they get older. In addition, underdeveloped and damaged bone structure could cause serious complications, including paralysis. The paralysis risk and related issues can be dealt with surgically. People with Morquio syndrome need to be particularly careful about diet and lifestyle factors associated with heart disease. There is no cure for the condition, though enzyme replacement therapy is being investigated. Symptoms such as respiratory issues and vision problems generally respond to specific treatments.

How Flu Helps Infections Prosper

Over 6,000 Americans have been hospitalized for flu so far this season. In fact, according to the Centers for Disease Control and Prevention, this season’s flu is officially classified as an epidemic. This isn’t rare—it often reaches epidemic levels, and nearly every year there are one or two fatalities. It’s not just the flu itself, however, that’s responsible. Flu opens up the body to opportunistic infections, lowering resistance and making patients more vulnerable to invading bacteria. Most of the people who died in the Spanish flu epidemic in 1918 to 1920, in fact, were victims of these infections, including pneumonia.

Scientists now think they have an idea of the mechanism behind this enhanced vulnerability to infection. What they found is that the flu virus itself alters the way the immune system works—with a little help from a molecule on the inside—and inhibits it in doing its job of protecting the body. The virus doesn’t merely protect itself, it protects attacking bacteria that are present at the same time.

The culprit, according to a German study, is a molecule called TLR7. A receptor protein, its ordinary function in healthy people is to detect and identify pathogens, microorganisms that cause disease. However, when flu strikes, TLR7 makes it harder for bacteria to be caught, and the immune foot-soldiers tasked with destroying bacteria are restrained.

Our results confirm that in the long run the flu virus suppresses the body’s ability to defend itself against bacteria. Presumably, this is an unwanted side effect of the viral infection, said Dr. Sabine Stegemann-Koniszewski, the primary author of the study, in a statement.

TLR7 can itself be suppressed. In some conditions, a drug called imiquimod is used to do just that. However, this may not work for flu because the molecule is an inherent part of the immune response to that illness. TLR7 is in fact activated by flu, and is necessary to fight that off. However, further research may find a way to make it possible to mitigate this effect while still leaving it useful against flu itself, slowing bacterial infections and making them more treatable and less common.

Possible Cause of CFS

Chronic fatigue syndrome is more than just being tired all the time. It’s a pervasive tiredness, one that merely resting does nothing to alleviate. In particular, CFS has nine characteristics. Symptoms are loss of concentration, a sore throat, unexplained muscle pain, fatigue, sleep that isn’t restorative, exhaustion that lasts more than 24 hours, joint pain without swelling that moves around, swollen lymph nodes, and new and unfamiliar headaches. Tiredness and at least four other symptoms need to be present for a diagnosis of CFS to be made.

Although CFS is a recognized medical condition, it is difficult to diagnose. Even if all the symptoms are present, a diagnosis generally isn’t made unless other possible causes are ruled out. Ordinary sleep disorders, for example, often cause fatigue, as do many medical conditions. Muscle ache is also a symptom of a number of medical conditions, and that possibility is typically explored. However, a new study suggests that some cases of CFS can be recognized by looking for certain viral infections that are otherwise dormant.

The study suggested that in these cases, CFS is the result of an excessive immune response to Epstein-Barr virus, which is ordinarily associated with mononucleosis and some other illnesses. The virus doesn’t always go away; instead, it merely becomes inactive. When it reawakens in the blood, this can lead to CFS. However, there appear to be a number of other causes as well, not all of them known. Immune impairment of some kind appears to be linked with CFS, but what causes this impairment cannot always be found. However, a controversial hypothesis that a virus called XMRV was a cause of the condition has proven unfounded.

There are no medical treatments that offer complete relief, but antidepressants and sleep aids can make the condition more bearable. Psychological counseling can help patients negotiate the limitations the condition places on them. Destressing one’s life is a useful coping mechanism, and stretching exercises can help with the aches and pains; yoga includes elements of both and is recommended for chronic fatigue patients.

Ribosome Robots

What can machines tell us about the human body? Scientists are working on creating machines that can simulate the body’s functions down to the cellular level and smaller, making it possible to test medications, procedures, and theories about how diseases such as cancer work without putting people at risk. For example, scientists in Manchester, in England, recently created a robot ribosome that mimics the part of the cell that builds proteins out of DNA.

This can help researchers in figuring out exactly how real ribosomes do what they do, how the process sometimes goes awry, and how it can be harnessed in the service of health. The robot itself can also be used to manufacture organic compounds out of molecules that are difficult to produce in the lab by standard techniques.

“Just as robots are used to assemble cars in factories in the big world, one day we hope we will be able to use artificial machines like these in molecular factories to construct new things with great efficiency,” David Leigh told the BBC. Leigh and his team were the researchers behind the robotic ribosome. He went on to suggest that his machine could someday go beyond the ribosome and use molecules biological mechanisms can’t act on.

Cellular ribosomes read the instructions encoded in DNA to assemble chemicals called amino acids into protein chains called polypeptides. These proteins are then used in the construction of organs and other tissue.

“[W]ith our artificial machines, we’re not limited by the same building blocks of nature. So, we should be able to make new materials with other types of building blocks—new types of plastics, new types of catalysts, pharmaceuticals and so on,” Leigh said.

In the future, the process may be used to synthesize medications for specific conditions. The technique might even be able to make medications to order, fist figuring out what the illness might respond to and then building a medication to fit. The artificial ribosome, and the lab-created code it reads, wouldn’t be restricted to organic substances found in nature.

Thyroid Disease

Fifteen million Americans have been diagnosed with thyroid disease, and it’s estimated an equal number are undiagnosed. Thyroid diseases, in which the thyroid gland produces either too little or too much of its hormone, are more common than diabetes or heart disease, and occur more frequently in women than in men. These conditions generally run in families.

The thyroid produces a hormone—simply called thyroid hormone—which is used in almost every cell to run the metabolic process and help generate energy. The hormone comes in two varieties, thyroxine and triiodothyronine. Both types direct and regulate metabolism.

When the wrong amount of thyroid hormone is produced, it leads to problems. Too much causes an enlargement called a goiter, and can lead to hair loss, muscle weakness, diarrhea, irritability, weight loss and other symptoms. The symptoms of producing too little thyroid hormone include unexplained weight gain, constipation, sore muscles, forgetfulness, and signs of clinical depression. The wrong amount in either direction causes fatigue, and can increase the risk of miscarriage.

Here are some other things to look for that may indicate thyroid trouble:

  • Changes in hair, skin, and nails. Your fingernails may separate from the nail-bed, hair might change texture or fall out, your skin may become thick and scaly or, depending on what the problem is, fragile or thin.
  • Carpel tunnel or tendonitis. Thyroid problems can cause aching or weakness in the arms, legs, and feet.
  • Menstrual irregularities. Too little or too much hormone can both throw off your cycle, making periods less frequent and lighter or more frequent and heavier, respectively. In either case, it could affect your fertility.
  • Chronic high cholesterol. Because of thyroid hormone’s role in metabolism, too little could lead to a seemingly intractable cholesterol problem.
  • Anxiety. Thyroid hormone also regulates mood and emotional responses, meaning irregularities with the thyroid gland can cause mood disorders such as depression, anxiety, or panic disorders.

If you have any of these signs, see your doctor right away. They can perform blood tests to measure the amount of both types of thyroid hormones your body is producing and using, as well as the hormone produced in the pituitary gland that activates the thyroid.

Leukemia Treatment Varies with Age

New strides are being made in treating certain common types of cancer. It’s not simply a matter of new drugs. Researchers are coming up with more and better ways to target treatments, to determine which patients are likely to receive the most benefit from what approach, and to tailor the treatment program accordingly. That means as soon as the disease—in particular, chronic lymphocytic leukemia, the most common type of leukemia, which can by controlled but not eliminated by chemotherapy—is discovered in a patient, doctors can figure out the treatment most likely to work for that patient, rather than running through the available ones arbitrarily until finding something that works.

In particular, different treatments work differently in patients of different ages. Normally, the patient’s age is given very little weight when it comes to determining a treatment protocol for CLL. However, a recent study at The Ohio State University found that patients over 70 and under 70 had different treatment outcomes for some regimens. In particular, a drug called chlorambucil, sold as Leukeran, helped the older patients live longest, even though it is less effective in younger patients.

By contrast, in patients under 70, a drug called fludarabine, sold as Fludara, was found to lead to longer lifespans after diagnosis and longer periods of dormancy, during which the disease did not progress. This may have lead to misleading results in clinical trials. Most participants in those trials have been in their early 60s and responded to Fludara. Meanwhile, most CLL patients are over 65, and many over 70, and that drug is less effective for them.

However, there is a suggestion that all patients, regardless of age, can benefit from fludarabine used in combination with another drug called rituximab. That’s why the researchers suggest that future drug trials with older adults ought to start with rituximab and similar drugs, rather than fludarabine. The study also showed that another drug, alemtuzumab, administered after chemotherapy to perform a sort of “sweeping-up” function and get rid of remaining cancer cells, is largely ineffective in this type of leukemia, and confers no significant benefit on patients of any age.

Glaucoma

More and more Americans are being affected by the eye disease glaucoma. Over 2.2 million people in the United States are estimated to have the disease, though only about half have been diagnosed. As much as 12 percent of blindness is believed to result from glaucoma, making it one of the leading causes of blindness, particularly in people over 60. Ten percent of people being treated for glaucoma lose their vision, and this is almost inevitable if it’s untreated; there is no cure, though surgery can stop it from getting worse in some cases.

Glaucoma is actually a group of diseases involving excessive fluid in the eye. In the most common type, primary open-angle glaucoma, happens when the channels that drain the fluid become obstructed. This causes pressure to build up inside the eyeball. This type of glaucoma is actually very responsible to treatment if caught early, but it progresses so slowly that vision may be significantly—though gradually—diminished before it is discovered. Regular eye examinations are the only way to detect the condition while it is still easily treatable and before too much vision is lost.

Glaucoma is particularly a risk for people over 60. In fact, some ethnic or racial groups, such as African-Americans, start to develop a significant risk at age 40. African-Americans are also more likely to develop blindness as a result of glaucoma. People of Asian descent are also more prone to certain types of glaucoma. Another risk factor is having a medical condition such as heart disease or type two diabetes, or a history of corticosteroid use. There is some evidence that glaucoma runs in families.

There is no cure for glaucoma and no way to reverse the damage. Eyedrops and oral medications can help alleviate the pressure by improving drainage or reducing the production of fluid in the eye. In extreme cases, surgery may be needed to open the drainage channels or implant a tube through which the fluid can drain. Relaxation techniques can help alleviate the pressure without or as a supplement to medication. Cannabis is often touted as a way to reduce the pressure, but it only works for a few hours. Lots of exercise and a healthy diet with minimal caffeine can help prevent or slow the damage from glaucoma.

Not Too Late for a Flu Shot

Influenza evolves. Every year, every season, the flu is different. That’s why the flu vaccine has to change every season, and why a vaccine only lasts a year and needs to be readministered annually. Anyone can get the flu, but vaccination is particularly important for children between six months and two years old, adults over 65, and people with chronic illnesses. Pregnant women should also be sure to get vaccinated; not only is there no evidence that the flu vaccine will harm the baby, there is a strong association between the flu itself and fetal death. Only 47 percent of pregnant women get vaccinated, even though it’s much safer for the baby for them to do so than not. Flu season is peaking now, but it’s not to late to get protected.

Often, people don’t get vaccinated out of fear. Often, these fears are unfounded. For example, people are often afraid that if they get vaccinated too early, its effectiveness will wear off. In fact, it never wears off. The only reason you need to reup every year is to get protected against new strains; each season’s shot protects you against that season’s variety of flu for years to come. Indeed, the protection lasts longer than the strain does even if you get vaccinated early.

Another fear is that the vaccine will itself make you sick. While there are side effects in a small number of people, and there’s a two-week window after vaccination during which you are not yet fully protected, the vaccine itself does not cause flu. What does sometimes happen is the immune response to the viruses in the vaccine causes symptoms that appear similar to those of flu—but much weaker. However, this isn’t a sign of illness, and it doesn’t have the other health effects of flu, such as opportunistic bacterial infections and other potential damage.

People who have had a severe reaction to the vaccine in the past should talk to a doctor before getting vaccinated again. Similarly, most vaccines use ingredients derived from chicken eggs, and so people with egg allergies should likewise talk to a doctor. If you’ve had Guillain-Barré syndrome and you’re not in a high-risk group, let your doctor know before getting vaccinated. If you’re immunocompromised, that’s something else you should discuss. If you have an illness with fever, wait until you recover before getting the vaccine.

Blood Donation

American hospitals are chronically short of an important supply: transfusable blood. In fact, hospitals in some cities have been so short that elective surgical procedures have had to be canceled. In 2012, the American healthcare system experienced one of the worst shortages on record, with almost 90 percent of the country having less than a day’s supply available. The problem was particularly bad in the Northeast.

The shortages weren’t due to vampires. The American Red Cross, one of the largest organizations collecting and processing blood donations, said there simply weren’t enough donors to meet demand. Currently, only about five percent of eligible donors give blood. That’s why January is National Blood Donor Month. Federal law prohibits paying people for blood—studies show that the practice compromises the safety of the blood supply—but by taking an hour every three months, you can save lives.

Eligibility requirements to donate blood include:

  • Being at least 17; some states allow 16-year-olds to donate blood with parental permission.
  • Not having acute infections.
  • Not using blood thinners such as coumadin.
  • Blood pressure between 80/50 and 180/100 (normal blood pressure is 120 systolic/80 diastolic).
  • Not having a blood transfusion in the U.S. in the preceding 12 months, or in the United Kingdom since 1980.
  • Not having sickle-cell disease, though the sickle-cell trait without the disease is acceptable.
  • A male prospective donor cannot have had sexual relations with a man since 1977, per Federal law.
  • Weighing at least 110 pounds.

Your local blood center can determine, confidentially, whether you’re eligible to donate, based on your lifestyle and medical history.

When you come to donate, you will need to show some ID, generally two forms or a Donor Identification Card. There is a private interview to determine whether you have any conditions that might keep you from donating, and then a simple examination to check your temperature, blood pressure, and pulse. The blood draw itself uses a new sterile needle, and it takes about ten minutes to collect a pint of blood. After you’ve had about 15 minutes to recover and restore fluids or electrolytes, you are done. You can return eight weeks later to help more people live out their lives.