Category Archives: Diagnosis & Treatment

Diagnostic techniques, and new treatments and medications

Regrowing Spinal Tissue

Proper handling and cleaning of surgical instruments during surgery helps to prevent infections.

Spinal cord injuries are generally regarded as impossible to recover from. The spinal cord is responsible for connecting the brain to most of the body, providing the pathways through which the brain sends signals to the muscles in the arms, legs, and other areas, and receives information from these areas—touch sensations, when a person feels something on the skin. When the spinal cord is injured, these communications are disrupted, and the brain can not communicate as effectively—or at all—with these areas. There are 12,000 new cases of spinal cord injury every year in the United States, generally from automobile accidents, falls, violence, and sports injuries, and most result in permanent paralysis and sensory problems.

Now researchers have found a way to help recovery, and have successfully saved at least one patient’s spine. The researchers used olfactory stem cells to regenerate damaged tissue. The cells were taken from the scent receptors in the nose, an area in which cells are regularly damaged and regularly repaired by the body. Because of this, the tissue could be removed from the olfactory bulb and would be regenerated as part of the ordinary repair process; it also meant that thee cells, which are designed to regenerate and which, being stem cells, are not locked into any specific function, could grow new spinal cord tissue when used there. Though none of the patients in which this was tried made a complete recovery, all three experimental subjects showed a significant degree of recovery and gained back at least some of the lost function.

The most successful procedure was done in a Bulgarian man named Darek Fidyka, who’d had his spinal cord entirely severed in a knife attack, and became completely paralyzed from the chest down. As a result of his injuries, he’d been unable to move or feel anything below his rib cage. Fidyka was the most severely injured of the three patients in the study, and according to doctors, he is believed to be the first person ever to recover from such an injury. From total paralysis, he has recovered to the point that he can walk, with the help of a walker, and drive a car.

Arthritis Relief

SONY DSC

Osteoarthritis is a condition of aging. As a person gets older, the cartilage that protects the joints and helps them move better wears away, leading to pain. Although some wear on the cartilage happens with everybody, arthritis is not simply an inevitable feature of aging. It can be controlled, and even prevented. Repetitive motion without a break wears down the cartilage, and finding a way to avoid that can stave off arthritis. Resting the joints provides some benefit, and lessens wear and tear. On the other hand, exercise can help keep the joints flexible and increase bone strength. Exercise can also help keep weigh under control, which means less strain on the joints, less deterioration of cartilage, and less pain.

One particularly helpful kind of exercise is running. Running wouldn’t seem like an activity that would be beneficial, or even possible, for someone with osteoarthritis, but recent research suggests that going for a run on a regular basis helps prevent damage to the cartilage in the knees. In the past, studies done on professional runners found an increased incidence of arthritis, but people who are involved in less intense forms are less prone to developing the condition. Running helps lower BMI, putting less strain on the knees, as well as building tolerance for movement.

No one has yet found a cure for arthritis, or a way to reverse the damage. A different kind of joint has been suggested as a treatment, but research has found no evidence that medical marijuana is an effective remedy. Medical treatment generally involves drugs to reduce inflammation, along with pain medication. Physical and occupational therapy are used in addition to or instead of medication to manage or relieve pain or to increase range of motion. Braces and orthopedics can help take pressure off affected joints so that the worn-away cartilage isn’t stressed.

Anti-inflammatory drugs called COX-2 inhibitors are commonly prescribed for arthritis, but have been shown to increase the risk of stroke. Another common treatment, acetaminophen, was found in studies to be useless for arthritis pain. However, research has found that high zinc levels contribute to the destruction of cartilage that is behind arthritis, and reducing zinc could help save joints.

Leukemia And Bone Marrow

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Researchers aren’t clear on what causes more than 350,000 people each year to develop caner of the bone marrow, white blood cells, and immune system, known as leukemia. Ionizing radiation is a causative factor in many cases, and certain viruses appear to account for others; there is also evidence of a genetic link, meaning a susceptibility to leukemia runs in families. Some kinds of chemical exposure, such as to benzene, have been found to cause leukemia in combination with other factors.

Leukemia is among the most common cancers among children. Indeed, it is one of the few cancers to affect children in significant number at all. However, the risk of leukemia actually rises with age. Of the 3,500 cases diagnosed in the United States each year, some 90 percent are in adults. In addition to age, risk factors include myelodysplasia and other blood disorders, chemotherapy and radiation therapy for other cancers, some kinds of genetic disorder, and smoking.

Studies have shown that leukemia patients have an abnormally high number of neutrophils, which are a type of white blood cell that plays a role in the immune system. This can result from infections or burns among other causes, but it appears to be a sauce rather than an effect of leukemia—a high neutrophil count leads to chronic myeloid leukemia, the cancer doesn’t raise the neutrophil count. That means lowering the count, such as, research suggests, by reducing the intake of fatty acids called ether lipids that sustain them, can help prevent cancer.

Although leukemia is responsive to chemotherapy, a common form of treatment in severe cases involves bone marrow transplants, which replaces the diseased tissue with healthy tissue grown from donor stem cells. This procedure, however, carries with it a high risk of what is called "graft-versus-host disease," in which the transplanted cells reject the new host body, treating its cells as an infection, and cause the equivalent of an autoimmune reaction in multiple organs. This is one of the primary marrow transplants fail. A new test, that can better assess risk for graft-versus-host disease and guide doctors in preventing or treating it, may help make transplants safer, so thy can help more patients.

Swine Flu Deadlier Than Thought

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A swine flu pandemic in 2009 cost the lives of, according to contemporary World Health Organization figures, some 18,500 people. That was the number of laboratory-confirmed cases, but more recent research, taking into account victims who may not have had access to proper medical care, has led the international organization to revise that figure upwards. In fact, the new statistic cited puts the death toll at more than 15 times the original count, attributing some 284,500 deaths to the disease. The number swells to over half a million when people with pre-existing health problems that were exacerbated by the infection are included.

That pandemic occurred around nine decades after the previous major outbreak of swine flue, in 1918, which struck 500 million people and killed as many as 20 percent of them, more than one in every 30 people on Earth at the time. Another outbreak happened in 1976, confined to Fort Dix in New Jersey, and another one the next year in what was the the Soviet Union. The culprits in these outbreaks were strains of the H1N1 virus, which is common in pigs and an occupational hazard of hog farmers and livestock veterinarians. However, only around 50 pig-to-human transmissions have been identified since in the half-century or so it became possible to detect.

In the aftermath of the 2009 pandemic, vaccine serum for H1N1 has been added to the annual seasonal flu shot given to patients in the United States. Many people, however, do not get vaccinated, either due to misplaced skepticism leading to doubts about the safety of efficacy of the vaccine or due to a perceived lack of resources. Increasingly, subsidized vaccination is available at low or no cost for those who might not otherwise be able to get it, but education is still necessary to answer the doubts and ensure people are informed about the need to be vaccinated.

Other preventative measures can help supplement vaccination, even when too few people are vaccinated for herd immunity to necessarily take effect. People who might have been infected or exposed should wash their hands after coming in from outdoors. Surfaces in the home and car should also be cleaned regularly.

Medical Cannabis

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As an increasing number of people have legal access to marijuana—rather, to cannabis, as it is generally referred to in medical contexts—for medical purposes, debate over these changes in the law continues. Medical experts and ethicists continue to discuss what good it might do, what harm it might do, and whether the good outweighs the harm. Some of this debate is misinformed, on both sides, but it is necessary, as with any treatment, to balance the potential benefits with an awareness of the possible downside.

Though the long-term effects of cannabis are not well studied, some fears about cannabis are misplaced. Though there are people who make a habit of using marijuana, cannabis is not habit-forming on a chemical level the way some painkillers are. In fact, a recent study found that in states that have legalized cannabis for medical purposes, deaths from opioid painkillers, which can be addictive, are 25 percent lower than in states that have not. Although only 60 percent of deaths from these medications are in people with prescriptions, prescribing cannabis instead can lead to an overall reduction in the amount of these drugs in circulation.

Cannabis has a long history as a medical treatment. More than 3,000 years ago, cannabis was used to alleviate headaches, prevent nausea, treat gastrointestinal disorders, relieve constipation, ease labor pains, and stop nosebleeds. The substances tetrahydrocannabinol and cannabidol have properties that are medically useful in certain situations. and in 1990 researchers found sites in the body that specifically respond to these substances. Now it is used to treat stomach cramps, to help chemotherapy patients deal with nausea, to help people who have conditions or are undergoing treatments that affect the appetite avoid malnourishment, and to treat muscle spasticity, and research is ongoing into other possible benefits.

For example, recent studies suggest marijuana may have some use in treating epilepsy. Patients with severe forms of the seizure disorder have shown significant reductions in symptoms—in particular, a greatly reduced frequency of seizures—from using cannabis. The reduction seems to be primarily due to cannabidiol rather than the psychoactive component, THC, though both substances have anti-convulsant effects.

B12 In The Body

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Vitamin B12, or cobalamin, is an important nutrient. It is an essential nutrient, meaning in this case not that it is necessary for good health—though it is—but it is not produced in the body, and must be consumed in food or supplements. Vitamin B12 is needed to produce red blood cells and effects the functioning of the brain and nervous system. It is also used to treat cyanide poisoning, to essentially suck the cyanide out of the bloodstream so it can be passed harmlessly.

It is also, unsurprisingly, used to treat B12 deficiency. B12 deficiency is rare, because most people consume more than they need and the body stores the excess—as much as five years’ worth—primarily in the liver. Certain medical conditions or treatments can diminish the body’s ability to absorb or use B12, however, and this can lead to symptoms such as fatigue, depression, and impaired memory. More severe deficiency can result in irreversible damage to the brain and nervous system, leading to dementia.

Dietary sources of vitamin B12 include in fish and shellfish, meat, eggs, and dairy products. Vitamin B12 is often added to livestock feed in the United States, so farmed meat generally has particularly high levels. Vegans, who don’t eat eggs or dairy, often need to take supplements, which are typically made from a synthetic form called cyanocobalamin. This molecule does not occur in natural sources but is easily converted by the body into the natural forms of the vitamin. Vegetarians who do eat eggs and dairy products may still need supplements, because vegetarian diets often feature a lot of soy, which can impair B12 absorption.

Scientists have recently found signs of a previously unknown role for vitamin B12. In conjunction with the compound taurine—known from energy drinks, but actually an important nutrient in its own right, with important roles in the functioning of the cardiovascular and central nervous systems—B12 helps regulate the creation of new bone tissue.

This means doctors may be able to add osteoporosis to cyanide poisoning and vitamin B12 deficiency on the list of conditions treated with B12. While it can stop or even reverse cognitive decline resulting from B12 deficiency, there is no indication B12 can improve cognitive function in healthy people.

Sleepless Nights

There are a number of things that can keep a person up at night. Some of these things are thankfully rare, such as fatal familial insomnia, a genetic brain disease in which sufferers—about 100 in the two and a half centuries since it was discovered, from 40 families around the world—sleep progressively less over the course of 18 months, ending in delirium and death.

Most insomnia, however, comes from more prosaic causes. It might be neurological problems, such as traumatic brain injury, or mental illnesses, such as depression, anxiety, schizophrenia, bipolar disorder, or others. It might be a physical illness, such as rheumatoid arthritis, or a side effect of medications such as corticosteroids. Excessive caffeine intake, or consumption late in the day, might be the culprit. It might be simple stress.

Unfortunately, insomnia can also cause stress. The vicious cycles are one of the most frustrating aspects of insomnia. Another example: insomnia can exacerbate depression or anxiety disorders. Moreover sleeplessness has a number of undesirable effects on a person’s daytime life. Being tired after being up all night means poor decision making aptitude, lack of concentration, and unhealthy eating habits. If one person in a couple is sleeping badly, and especially if both are, they will be worse at managing conflict within the relationship and will snap at each other more often and more viciously.

Treating insomnia generally focuses on environmental factors. Avoiding light, noise, and excitement late at night. Restricting caffeine and alcohol—which can interfere with sleep cycles—late in the day. Avoiding the bedroom except for sleeping, to strengthen the mental association. Maintaining a regular sleep schedule without naps. Using light to keep the brain’s circadian rhythm on track. Medications can be prescribed, but they can be habit-forming and can cause the patient to become accustomed to using drugs in order to sleep. Additionally, some of these drugs have worrying side effects.

Recently, a Harvard University neurologist proposed another potential solution to the problem, involving an area of the brain stem called the "parafacial zone." This is one of the structures responsible for automatic bodily functions such as breathing. The scientist says it is also responsible for sleep, and suggests targeted insomnia treatments that operate on the region directly may in the future treat insomnia without side effects or addition.

Who Is At Risk For Renal Disease

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Chronic kidney disease often is not felt or recognized until kidney function is almost completely gone. Although it gets progressively worse over a period of months, symptoms don’t generally appear until around three-fourths of the function has already been lost. However, even though there are no noticeable symptoms of renal disease in the early stages, there is still damage occurring. While generally the value of screening is negligible in people who don’t already show signs of kidney trouble, regular screening is recommended for people who are at risk. That means obese people, smokers, people with high blood pressure or heart problems, people with a family history of kidney failure, people over 60, diabetics, and black, Asian, and Native American people.

Not only are people from racial minority backgrounds more prone to kidney disease due to genetics, studies now suggest that socioeconomically disadvantaged people—poor people and members of racial minorities—are more prone to kidney disease and tend to have worse outcomes when they do have kidney disease, with it being far more likely to lead to complete kidney failure than for the population overall. The researchers say this study is a first step towards shrinking this gap by improving outcomes for these population.

Treating renal disease is next to impossible, especially in the later stages. Most patients who progress all the way to kidney failure are forced to manage the disease by periodically using a dialysis machine, essentially a mechanical kidney. Instead of treatment, the primary focus is on prevention. Quitting smoking lowers risk of kidney disease, as does moderation in alcohol and over-the-counter pain medications—these can affect the digestive system, kidneys included, if taken too much. Maintaining a healthy weight can help, with one study suggesting the "Mediterranean diet," high in plant foods and low in red meat, lowers kidney disease risk.

However, possible treatments are being investigated, particularly to arrest the progress of the disease before the kidneys shut down entirely. Statins, used to lower cholesterol, are now being recommended to kidney patients as well. A separate research team found tat kidney disease is associated with poor metabolism, and fixing the metabolism might stop the disease from worsening.

Tuberculosis And The Heart

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In 2012, more than one and a quarter million people died from a condition often considered a relic of the past: tuberculosis. Tuberculosis infections reached a low at the later part of the last century, but rose again with the spread of AIDS—it is one of the most common opportunistic infections—and the development of drug resistant strains of the bacterium.

Researchers estimate that one in three people in the world has the TB bacterium but does not have the disease; these people have what is known as latent TB, which is not contagious. Even when it is contagious, catching it, especially from brief contact with a stranger, is difficult. long term close contact is needed for it to spread. HIV is the biggest risk factor, with one in eight TB sufferers being HIV-positive. Smokers, malnourished people, and alcoholics are also at risk. TB susceptibility is also a side effect of certain medications.

People with tuberculosis cough up mucus or blood, get chills and fever, poor appetite and weight loss, fatigue, and night sweats Left untreated, tuberculosis can cause major complications, whether or not it ends up being fatal itself. The disease can get into the brain, resulting in meningitis, or it can spread to other organs ans disrupt their functioning. Tuberculosis that spreads from the lungs to the heart can result in a fatal condition known as cardiac tamponade, in which fluid accumulates in the area around the heart, compressing it.

Recent research has found that tuberculosis survives and spreads by taking advantage of the very mechanisms intended to shut it down and destroy it. The initial immune response to a tuberculosis infection is to isolate the bacteria in what are called granulomas. The body then extends blood vessels into these granulomas. The bacteria use these blood vessels, first, to get enough oxygen to survive, and then to escape the granulomas holding them and spread within the body. This may be what causes TB to go from latent to active. A medical approach based on preventing this blood vessel growth is being explored as a potential treatment for tuberculosis.

Treatments For Lupus

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The 1.5 to 2 million people—primarily some combination of black, female, and under 40—who have been diagnosed with the autoimmune disease lupus have such a wide range of symptoms that it can sometimes be difficult to pin down what is and isn’t lupus. Unlike most autoimmune diseases, which have a specific target such as the thyroid or skin, lupus can affect almost any part of the body. In particular, it causes problems with connective tissue within the organs. The most common symptoms are rash and sensitivity to light, though almost any symptom someone experiences could be lupus, particularly if there seems to be no other explanation.

In particular, experts note that the initial symptoms of lupus, such as headaches and seizures, are difficult to distinguish from symptoms of neurological problems, despite lupus not being a disease of the nervous system directly. People who have lupus are at an elevated risk for stroke, because it affects the heart, and about one n three lupus sufferers has migraines as a result. In some patients, lupus can even cause them to hear voices or experience mood swings. These factors can cause doctors to erroneously treat patients for neurological conditions they don’t actually have. Unfortunately, once lupus is correctly diagnosed, the treatments themselves may have adverse neurological effects.

Now a new treatment technique is being investigated that involves taking a personal approach to treating patients with lupus. Each individual case of lupus is different, and using DNA sequencing, doctors hope to discover what specifically is behind the disease in each patient and address the specific manifestation of the disease that patient has. This targeted treatment, if feasible, would reach the particular genetic irregularities in an individual patient and treat the patient’s disease directly.

Until then there are other experimental treatments being developed for lupus. One is actually derived from parasitic worms. Researchers hope that the same molecule that the parasites use to hide from the immune system could do the same for the organs that set it off in autoimmune diseases such as lupus. This would shield the organs from the immune system, without turning it down to the point that the patient is vulnerable to actual infections.