Monthly Archives: July 2014

Recovering From Traumatic Brain Injury

The brain is one of the most important organs in the body—which is why its protected by a dense layer of bone, the skull. The skull is one of the most rigid structures found in nature. The strength of this shield, however, means that any injury to the brain is a serious matter. Indeed, traumatic brain injury is a major cause of death and disability, and one of the most common causes of death in children and young adults. Trauma to the brain can cause physical, cognitive, social, emotional, and behavioral effects, and while full recovery is possible in some cases, it can cause permanent damage or death in others.

A number of things can cause traumatic brain injury, though different causes are common in different environments. For example, one study found that children in urban areas who suffered brain trauma typically had gotten injured playing sports. The Canadian researchers found that 40 percent of these injuries had resulted from hockey. Rural children with head injuries, by contrast, were most often injured as a result of incidents involving motorized vehicles such as dirt bikes.

When a child is brought to the hospital with head trauma, the usual course of action is to give them a CT scan to look for bleeding in the brain that could cause dangerously high intracranial pressure or other life-threatening conditions. However, a study last year found that in many cases of minor head trauma—the lowest of the three levels, with the patient either not losing consciousness or coming to within half an hour and able to hold a normal conversation with no signs of being disoriented—simple vigilance is often sufficient. Children who over a long period show no symptoms of trauma beyond loss of consciousness, the study found, show nearly no risk of what is called a clinically important brain injury.

In the weeks and months a mild traumatic brain injury, even without hemorrhaging, patients often exhibit a constellation of symptoms called post-concussion syndrome. However, more and more doctors are coming to feel that the term is erroneous. Given the circumstances in which concussions occur, and which patients exhibit signs of post-concussion syndrome and which do not, these doctors feel that it is actually a form of post-traumatic stress disorder.

Mold In Buildings

Just as a house is a nice cozy home for a family, the warm, moist interiors of its walls are a nice cozy home for mold. Unfortunately, the mold can be bad for the family’s health. The plants, fungi, and other tiny organisms collectively known as mold include allergens that can be uncomfortable or even harmful in the close quarters of a home or office. Though mold normally live outside on organic matter such as dead trees and fallen leaves, spores can get blown in through open doorways and windows, or brought in by air intakes. Once in the home, they attach themselves to damp surfaces and start to grow, develop, and reproduce.

This isn’t always bad. After all, it was a mold, Aspergillus penicillium, that changed modern medicine, spurring the invention of antibiotics, which made untreatable and often fatal diseases manageable for the first time in history. However, even A. penicillium can cause quite severe allergic reactions in some people. Other types of mold are even less beneficial. One of the most common, Trichoderma longibrachium, is also one of the most potentially dangerous. It produces a toxic substance called trilongins. When absorbed by the body, this prevents cells from getting the potassium and sodium they need. Potassium and sodium are important for circulation and respiration, when they are rendered inert, it can disrupt the heart and the lungs.

There is no real cure for symptoms caused by mold exposure. As long as the person is exposed to mold—such as at home, or at the office—the symptoms will come back even if treatment is provided. The only solution is to remove either the patient or the mold from the environment. Getting fresh air in will help dry out the damp areas molds look for. In humid weather, a air conditioner or a dehumidifier will keep things dry. Anti-mold cleaners will help in places like the bathroom.

However, researchers are looking for a way mold allergy can be treated, for example when removal is not possible or practical. One surprising finding was that vitamin D can actually help prevent mold allergies. Patients in that study with allergies had low vitamin D levels, and when they were administered the vitamin, their allergic reaction lessened and the allergy itself—the tendency to have that reaction—was diminished.

Serotonin And Serotonin Syndrome

A neurotransmitter—a type of chemical used by the nervous system to carry signals from one place to another—called serotonin is synthesized out of a nutrient called tryptophan, which is part of proteins in the brain and in the intestines. Most of it, as much as 90 percent, is in the gut, where it is a part of the digestive process. Serotonin regulates appetite and is responsible for the body's response to poisons and other things that are not fit to eat.

The rest, the serotonin produced and used in the brain, is separate. The blood-brain barrier keeps serotonin in the brain from going to the gut, and vice-versa; the level in one is not effected by the level in the other. Serotonin in the brain is related to mood balance and social behavior. The two functions are not unrelated; among humans, social status is a part of how well one eats. Even in civilization, social occasions often involve food. Culture recognizes the link between interaction and appetite.

Serotonin is also associated with clinical depression. Depression often includes poor motivation and low libido and sexual response, and depressed people have low levels of serotonin in the brain, where it regulates those things. It is not clear whether low serotonin causes depression or depression reduces serotonin levels, but it seems that the low serotonin in turn affects libido and motivation.

That's why depressive patients are advised to eat healthy and get exercise and sunlight, all of which boost serotonin production. It's also why treatment for depression includes a class of medications called selective serotonin reuptake inhibitors. These SSRIs prevent serotonin produced in the brain from being reabsorbed after it is used. With more serotonin around, these symptoms often diminish.

However, an excess of serotonin can also cause problems, specifically, a condition called serotonin syndrome. This condition, which is almost always a result of SSRIs or other medications that cause serotonin to accumulate, can result in nausea or diarrhea as well as restlessness, confusion, twitching, perspiration, shivering, and goose bumps. In severe cases it can cause fever, irregular heartbeat, and seizures. The symptoms usually go away when the medication is stopped or adjusted, but can be fatal if ignored.

The End Of The Guinea Worm

According to an announcement last month, an old foe may be on the way to total defeat. Public-health specialists say that the parasite Dracunculus medinensis, or Guinea worm, has very nearly been eliminated, and is on the road to complete eradication. The parasite is transmitted in drinking water, and causes pain, fever, and nausea, and in the long term, sores on the skin—in which it is often visible—and arthritis and paralysis if treatment is not administered. The only treatment for guinea worm disease is drawing the three-foot-long worms to the surface of the skin and then pulling them out of the body.

In 1986, when the current eradication push began, there were 3.48 million cases primarily in 20 African countries. In 2013, there were just 148 cases in only four countries, a tremendous advance in less than 30 years. Three-quarters of those cases were in newly independent South Sudan, where the Carter Center, a non-governmental organization founded by former United States president Jimmy Carter to improve health in the Third World, has been focusing its efforts to defeat D. medinensis once and for all. In 2008, the Carter Center announced the forthcoming end of Guinea worm; that year, there were 4,647 cases, more than 30 times as many as currently.

Guinea worm eradication presents unique challenges. There is no vaccine, and no treatment other than complete removal. On the other hand, the parasite almost never returns to an area in which there are no infected humans. That means that while the painful removal process must be done for each infected person, one this is accomplished, the worm is definitively gone. The most recent national success story is Ghana, which has not had a reported case since 2010 and is in line to be certified by international agencies as Guinea worm-free.

In 2014, thus far, only two countries—South Sudan and Chad—have reported any cases at all of Guinea worm infestation. Most of the effort now is political. South Sudan has had internal conflicts since before independence, and Chad has be in the midst of civil war for over a decade. These conditions make it difficult for people to carry out humanitarian work, or to develop the infrastructure necessary to sustain that work.

Detecting Sepsis

Infections, indirectly if not directly, cause a substantial amount of strife. The pathogen can get into the bloodstream and cause high fever, flushed skin, fast heart rate, low blood pressure, delirium, and swelling of the whole body that can continue even once the infectious agent itself is entirely gone. This condition is known as sepsis, and if not properly treated, it can be fatal. In all, more people die each year from sepsis than from prostate cancer, breast cancer, and AIDS put together; according to a study released earlier this year, only one in ten hospital patients have sepsis, but it is responsible for half of all hospital deaths.

Sepsis is not always apparent until it is already occurring; there are few warning signs, though patients with certain conditions are more prone to developing it. That means it is especially important for doctors and other health care personnel to be alert, looking out for signs. One factor that makes a tremendous difference in survival rates, researchers have found, is how often the staff at a particular hospital is called on to treat patients with sepsis. Hospitals with high volume of sepsis patients treated it more effectively, overall, than hospitals in which it was a rarer occurrence, and at approximately the same cost per patient. The mortality rate for sepsis at busier hospitals was nearly 25 percent lower.

Testing for sepsis is an important part of providing treatment. Unfortunately, testing can take a long time, time health care professionals don't always have. Researchers have recently found a biomarker—a protein or other chemical characteristic of a condition, found in the blood of people who have it—that may make it possible to find sepsis with a simple blood test. That means more cases caught in the early, more tractable stages, and it means getting patients the treatment they need in hours, rather than days. The blood test, if it proves effective, would also be more precise, reducing guesswork and curtailing the role of intuition and fallible judgment.

In addition to better testing, more effective treatment may be available in the near future. A protein found in cells has properties that scientists believe could make it possible for the protein to fight sepsis. The treatment is still being investigated but laboratory tests have found it effective.

West Nile Virus

West Nile virus is making its return in the warm weather. Rockland County in New York is one of a number of areas over 35 states in which there have been reports of infection or signs that mosquitoes are carrying the disease. As of this week, New York has joined Arizona, California, Colorado, Georgia, Iowa, Louisiana, Mississippi, Missouri, Nebraska, New Mexico, Oklahoma, South Dakota, Tennessee, Texas, and Wisconsin in having reported West Nile virus infections in human beings to the Centers for Disease Control. In 2012, there were 107 cases of West Nile in New York State, and nine resultant deaths. Health officials say the appearance of the virus in Rockland was the first in the state this year.

West Nile virus doesn’t usually affect human beings; other than the mosquitoes that are carriers, birds are the most commonly infected animals. Infection with the virus may not have any symptoms. Only about one in every 150 people to become infected with the virus actually gets sick from it, mostly children and the elderly. When symptoms do appear, they are often mild—headache and skin rash, most commonly. It was strictly a tropical disease until the very end of the 20th century, only coming northward in the 1990s. There were more than 25 times as many cases in the United States in 2002 as in the three previous years combined, and nearly 16 times as many deaths. The good news is that the mortality rate is dropping; only four percent of people who got sick in 2012 died, compared to 15 percent in 2001.

There is no cure for West Nile disease. Preventing it means eliminating the mosquitoes responsible for spreading the disease. On an individual level, window screens and insect repellant are the tools people use, protecting themselves from the insects. Elimination of standing water—birdbaths, tire swings, persistent puddles—denies them a place to gather. In addition, health officials in many places conduct eradication campaigns, eliminating the mosquitoes for good.

Interestingly, while West Nile virus is related to the pathogen responsible for Dengue fever, the same prevention methods don't necessarily work on both. In fact, a mosquito bacteria that blocks transmission of Dengue fever to humans has the exact opposite effect on West Nile virus. In a study, mosquitoes protected against Dengue virus had higher than normal West Nile infection rates, the opposite of what the researchers had expected.

Arthritis In Children

Juvenile arthritis is one of the most common childhood diseases in the United States, responsible for an average of 827,000 hospital visits to treat children and adolescents with these conditions each year. In all, around 294,000 children under the age of 18 are affected by pediatric arthritis and rheumatologic conditions. An autoimmune condition, juvenile rheumatoid arthritis is characterized by experience joint pain and stiffness, especially when getting up in the morning or after a nap, and swelling of the knees and other joints.

If the condition is not properly and promptly treated, children who have it could have poor bone development, and might not grow normally. Another condition common with juvenile arthritis is an eye inflammation called uveitis. Although uveitis is asymptomatic itself, it affects the eye's shape and can result in various vision problems later in life, including cataracts and glaucoma, and in some cases can cause total blindness. Children are more at risk for permanent damage from rheumatoid arthritis than adults are because their immune systems are still developing.

Juvenile rheumatoid arthritis is an inherited genetic disease; so far, scientists have linked variants of around 20 genes to the various forms of the condition. However, not everyone with arthritis-causing variants of those genes will develop rheumatoid arthritis. The genetics simply lead to vulnerability—someone born with the rheumatoid arthritis genetic trait will develop the disease in response to certain environmental factors that don't have that effect on most people. The leading hypothesis is that children raised in scrupulously clean environments develop autoimmune diseases such as arthritis because the immune system needs something to latch on to.

It is particularly important to treat arthritis in children because it could isolate them, leading to poor socialization during childhood. The focus of treatment is to enable kids to be physically active and socially involved with their peers. Painkillers and anti-inflammatory drugs are prescribed for the symptoms, with care taken not to interfere with the child's development. Physical therapy helps the child avoid flare-ups, and participate fully in childhood.


Hypertension, or high blood pressure, often occurs with no symptoms. Even when blood pressure is extremely elevated, the first indicator is often a high reading on a blood pressure test at a medical checkup—or worse. Sometimes, patients who have had hypertension for a long time will experience headaches, nosebleeds, and dizzy spells, but in many cases high blood pressure only makes itself known through heart attack, stroke, or kidney failure, or diabetes and prediabetes, coronary and other health problems caused by chronically high blood pressure.

In fact, chronic primary hypertension—not caused by an underlying condition such as kidney disease, thyroid disease, or diabetes—can be fatal if ignored. According to the Centers for Disease Control and Prevention, high blood pressure deaths have noticeably risen over the past ten years, and 60 percent of those deaths happen to people younger than 75.

The causes of high blood pressure are varied, and it’s not clear exactly how it happens. Risk factors include being middle-aged or older, being African-American, smoking, stress, not getting enough potassium or other essential nutrients, and a sedentary lifestyle. People with a family history of hypertension are especially at risk. That suggests that susceptibility to high blood pressure is at least partly hereditary.

One cause researchers say contributes to high blood pressure is lack of vitamin D. This vitamin is interesting because, while it can be gotten from food, is also found in sunlight. A study last month found evidence that vitamin D deficiency can cause high blood pressure in people. The patient’s personality is also a factor. Happy thoughts can actually lower the risk of a heart attack and other heart-related complications. Indeed, administering supplemental vitamin D actually helps lower blood pressure. Other ways to get blood pressure down include maintaining a healthy body weight, getting plenty of exercise through such activities as brisk walking, drinking in moderation if at all, and eating a diet low in salt but with plenty of fruits and vegetables.

Childhood Obesity

According to the Centers for Disease Control and Prevention, childhood obesity has doubled over the past 30 years—and obesity in adolescents has quadrupled. In 1980, five percent of teenagers were obese; in 2012, it was close to 21 percent. All in all, more than one in three children under 19 were overweight or obese in 2012. The World Health Organization call this explosion of childhood overweight and obesity one of the most serious public health challenges of this century.

This is why illnesses and conditions once thought to be exclusively the province of adults have started to be seen more and more in children and teenagers. Obese children are vulnerable to serious health problems, such as prediabetic conditions and type 2 diabetes, heat disease, high blood pressure, and stroke. Like their adult counterparts, obese children are prone to sleep apnea and bone and joint problems. Moreover, as these children become adults, they tend to remain obese, and are more likely to suffer health problems than people who became obese as adults.

Studies have found that children who spend time in front of screens, such as watching TV, are more likely to be obese than children who engage in other activities, even if they get the same amount of exercise However, one significant difference between obesity in children as opposed to in adults is that children are not in charge of their environment—how much free time they have, and when, what food is in the house, what sort of exercise they are able to get, leisure-time activities, and other aspects of daily life are in the hands of their parents and guardians. So it is the parents and guardians, understanding long-term consequences, who have to take the lead.

That means making healthy food available to kids, and giving them plenty of opportunities for exercise. For a child to successfully adopt healthy eating habits, it is necessary for the whole family to do so—children pick up what they see. This means preventing a child from being overweight is an excellent opportunity for everyone in the house to eat healthy and get in shape. Talking to kids about the truth behind snack and fast-food commercials—without being scary or unduly condemning—can help moderate the temptations.

Infected Wounds

Most people are surrounded by germs most of the time. But this isn’t cause for concern—the body is very good at warding off illness. Most of the time, people don’t even notice. However, the first line of defense against infection is the skin, and when that is breached—when a wound or injury happens—the danger increases. When bacteria enters a wound, the immune system normally springs into action. When the immune system is compromised, or even just overwhelmed, however, the result is an infection that can, depending on what and where the infection is, can be anywhere from unpleasant to deadly.

That’s because wound infection can cause sepsis, inflammation over the entire body that results from the immune system kicking into high gear to fight a particularly strong bacterial barrage. However, the inflammation itself can cause organ and tissue damage throughout the body. That is why it is important to take steps to avoid infection. In hospitals—where a "e;wound,"e; often deliberately inflicted in the form of surgery, may be sizable, and the patient’s immune system is likely to be compromised due to illness or aspects of the surgery, steps are taken to avoid sepsis. Wounds in other settings are likely smaller, but in the absence of such precautions as incisions made with careful attention, and in clean rooms, more effort may be needed after the fact.

Cuts and scrapes are common types of injuries—in fact, someone who has a scrape or even a cut may not even notice until it scabs over. Puncture wounds are less common, but not unknown. In either case, it is necessary for the bleeding to be stopped before the wound is cleaned. Bleeding itself is a part of the defense against infection, washing out the initial wave of bacteria. After cleaning the wound, antibiotic cream is applied to get rid of bacteria, and a dressing or bandage provides protection.

Even with precautions such as these taken, infection is still possible. Most infection is minor and passes within a few days, but in some cases people with infected wounds require medical attention. Infection can be spotted under the dressing. Infection is likely present when the wound is red, painful, or swollen, or smells foul. Bleeding after the wound should have scabbed, or pus coming out, may also be an indicator of infection. In addition, a person with an infected would may complain of dizziness, or have a fast heartbeat.