August 1st, 2009 by Paul Auerbach, M.D. in News
Tags: Dengue Fever, Infectious Disease, Mosquito, Mosquitoe, West Nile, Zika Virus
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In the June 11, 2009 issue of the New England Journal of Medicine appears an article by Mark Duffy and colleagues entitled “Zika Virus Outbreak on Yap Island, Federated States of Micronesia.” This outbreak occurred in 2007, and was described as a cluster of 108 persons with confirmed or suspected infection, characterized with main symptoms of skin rash, fever, conjunctivitis, and painful joints. Other less common symptoms were muscle aches, pain behind the eyes, tissue swelling and vomiting.
As reported by the authors, there were no hospitalizations, bleeding problems in victims, or deaths. The predominant mosquito culprit was Aedes hensilli. The disease was determined to be mild in this outbreak. Zika virus is in the family of flaviviruses, which include West Nile, dengue, and yellow fever viruses. It has been diagnosed in Asia and Africa, and is transmitted by infected mosquitoes. Before this particular outbreak, there had only been 14 cases of human Zika virus disease previously documented.
The diagnosis was made in this outbreak by sending serum samples from patients to the Centers for Disease Control and Prevention (CDC) Arbovirus Diagnostic and Reference Laboratory in Fort Collins, Colorado.
How did this virus turn up in Yap? The most likely introducer was an infected mosquito or human. So, given the abundance of mosquitoes and propensity of people to travel, we may soon see this disease in other regions around the globe.
image courtesy of www.cdc.gov
This post, New Mosquito-Born Virus Could Come To US, was originally published on
Healthine.com by Paul Auerbach, M.D..
July 31st, 2009 by RamonaBatesMD in Better Health Network, News
Tags: Achilles Tendon, bioactive sutures, bone marrow, Johns Hopkins, Orthopedic Surgery, stem cells
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H/T to MedGadget who’s post introduced me to “bioactive sutures.” What a great idea by the Johns Hopkins biomedical engineering students!
……have demonstrated a practical way to embed a patient’s own adult stem cells in the surgical thread that doctors use to repair serious orthopedic injuries such as ruptured tendons. The goal, the students said, is to enhance healing and reduce the likelihood of re-injury without changing the surgical procedure itself.
The project team of 10 undergraduates focused on Achilles tendon injuries which require repair in approximately 46,000 people in the United States every year. The surgery may fail in as many as 20%. Recovery can take up to a year even with successful surgery. If this new suture speeds healing and lowers failure rates – what potential!
At the site of the injury, the stem cells are expected to reduce inflammation and release growth factor proteins that speed up the healing, enhancing the prospects for a full recovery and reducing the likelihood of re-injury. The team’s preliminary experiments in an animal model have yielded promising results, indicating that the stem cells attached to the sutures can survive the surgical process and retain the ability to turn into replacement tissue, such as tendon or cartilage……………
As envisioned by the company and the students, a doctor would withdraw bone marrow containing stem cells from a patient’s hip while the patient was under anesthesia. The stem cells would then be embedded in the novel suture through a quick and easily performed proprietary process. The surgeon would then stitch together the ruptured Achilles tendon or other injury in the conventional manner but using the sutures embedded with stem cells.
*This blog post was originally published at Suture for a Living*
July 30th, 2009 by Medgadget in Better Health Network, News
Tags: Child, fMRI, Half A Brain, MRI, Neurology, Pediatrics, Radiology, Seizures
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The scans presented here are of a ten year-old German girl who was discovered to be missing the right hemisphere of her brain. Incredibly, she is perfectly normal, except for a history of seizures and a slight weakness on her left side. Attending school with others of her age, it is reported that she is able to study and play sports, just like other kids around her. Of course, the mystery is how is this all possible? To answer the question, University of Glasgow scientists used an fMRI to see where the left eye’s vision is processed. Turns out that the brain’s visual area responsible for the right eye offered up some space for the left.
Normally, the left and right fields of vision are processed and mapped by opposite sides of the brain, but scans on the German girl showed that retinal nerve fibres that should go to the right hemisphere of the brain diverted to the left.
Further, the researchers found that within the visual cortex of the left hemisphere, which creates an internal map of the right field of vision, ‘islands’ had been formed within it to specifically deal with, and map out, the left visual field in the absence of the right hemisphere.
Dr Lars Muckli of the Centre for Cognitive Neuroimaging in the Department of Psychology, who led the study, said: “This study has revealed the surprising flexibility of the brain when it comes to self-organising mechanisms for forming visual maps.
“The brain has amazing plasticity but we were quite astonished to see just how well the single hemisphere of the brain in this girl has adapted to compensate for the missing half.
“Despite lacking one hemisphere, the girl has normal psychological function and is perfectly capable of living a normal and fulfilling life. She is witty, charming and intelligent.”
The girl’s underdeveloped brain was discovered when, aged three, she underwent an MRI scan after suffering seizures of brief involuntary twitching on her left side.
The scientists believe the right hemisphere of the girl’s brain stopped developing early in the womb and that when the developing optic nerves reached the optic chiasma, the chemical cues that would normally guide the left eye nasal retinal nerve to the right hemisphere were no longer present and so the nerve was drawn to the left.
This implies that there are no molecular repressors to prevent nasal retinal nerve fibres from entering the same hemisphere.
Dr Muckli added: “If we could understand the powerful algorithms the brain uses to rewire itself and extract those algorithms together with the general algorithms that the brain uses to process information, they could be applied to computers and could result in a huge advance in artificial intelligence.”
Press release: Scientists reveal secret of girl with ‘all seeing eye’…
*This blog post was originally published at Medgadget*
July 27th, 2009 by Nicholas Genes, M.D., Ph.D. in Better Health Network, News, Opinion
Tags: CDC, Emergency Medicine, Flu, H1N1, Infectious Disease, media, New York City, Pulmonology, Social Media, Twitter
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Friends visiting New York City this summer keep asking if it’s safe. As in, will they be catching and suffering from novel H1N1 (swine) flu.
I like to think my friends are pretty sharp, discerning folks (after all, they’re choosing my company) so I have to attribute these inappropriate questions to a wider problem.
For reference, here’s the latest and thought probably not last NYC DOH guideline on H1N1, which notes about 900 hospitalization and 45 deaths in H1N1+ patients over three months. About three quarters of these patients had at least one risk factor such as existing lung disease.
This deaths and hospitalizations are concerning, naturally, but some perspective is in order: as many as half a million New Yorkers have been infected with H1N1, and this spring in US cities, we actually saw a smaller fraction of deaths due to infectious respiratory illness, compared with 2008. Also, for reference, based on data from a few years ago, I’m guessing that any given three month period, there are between 10,000 to 15,000 deaths in New York City.
So why were ED’s swamped in May? Why are my friends still afraid to come to NYC? Dr. David Newman has some thoughts in EPMonthly:
…with constant messages of swine flu lethality on the nightly news, it is little surprise that ED’s in New York City, departments in a chronic state of over-crowding and crisis, were soon bursting at the seams with record volumes. In some institutions daily ED volumes doubled, as EP’s worked through third-world conditions of extreme crowding, questionable hygiene, extended wait times, and swarms of infectious, coughing congregates all within arm’s reach of each other.
The impact is clear: lives were lost. High quality studies have shown repeatedly that when ED’s experience crowding patients in need of rapid, high intensity care are identified later, treated more slowly, and devoted fewer resources. Mortality goes up during crowding in virtually every condition that has been studied, including MI, sepsis, and others. The irony is stark: Once a critical mass is reached, the more that come to be saved, the fewer we can save.
…The overall management of information during the swine flu of 2009, despite some progress in our access to information, was misguided and dangerous. Frantic media outlets drove a nation to fabricated fears, while state-level institutions not only failed to contain or counteract these messages, but also used expensive, fruitless, prescription-only pills, available to most only in their local ED’s, as a means of false comfort. Instead of using honest information to provide safety, comfort and education, the approach created panic, cost money and resources, and took lives.
All of this was preventable and is reversible for the future. There is no reason why the media cannot be recruited into the information dissemination process…
Unfortunately, there is a good reason why: Responsibly framing public health risks is no longer a role that suits traditional media. They’ve decided it’s just not in their interest.
I remarked on this years ago with West Nile virus, which never will never kill as many as, say, food poisoning or swimming pool accidents.
There are many factors driving the public appetite for health risk information — and that’s understandable. I think it’s even ok for news organizations to shuffle around reporting to some extent, to satiate those desires.
But what happened in NYC this spring was media malpractice — night after night, opportunities to put the risks of swine flu in perspective were passed up for breathless reporting. I recall one occasion in which a phalanx of reporters were camped outside a hospital I worked at, providing next to no detail about an infant who died it respiratory distress. It turns out this child did not have H1N1, but communicating that was not a priority — by the next day the lead story was ED’s are overcrowded and schools are closing.
EPMonthly ran a nice sidebar from Dr. Jim Augustine, enumerating the ways in which ED docs can engage the media to get the right message out.
But I’m more encouraged by approaches to bypass traditional media and reach patients directly. Yesterday I heard some encouraging news from the CDC: their emergency twitter feed has over 500,000 followers. Millions saw their videos. This is amazing reach, for public health communication.
It wasn’t enough to help ED’s this spring. But individual hospitals and the CDC is ramping up their use of social media, even as traditional news sources decline in influence. It’s really the first good viral news I’ve heard in a while.
*This blog post was originally published at Blogborygmi*
In the June 11, 2009 issue of the New England Journal of Medicine appears an article by Mark Duffy and colleagues entitled “Zika Virus Outbreak on Yap Island, Federated States of Micronesia.” This outbreak occurred in 2007, and was described as a cluster of 108 persons with confirmed or suspected infection, characterized with main symptoms of skin rash, fever, conjunctivitis, and painful joints. Other less common symptoms were muscle aches, pain behind the eyes, tissue swelling and vomiting.
