On Arthritis Worldwide

October 24, 2011

Causing swelling and pain in the joints, arthritis leads to substantial activity limitation, work disability, reduced quality of life, and increased healthcare costs, arthritis is the most common cause of disability in the United States with nearly 19 million Americans reporting activity limitations. Experts indicate this figure will balloon to 67 million by 2030. An estimated half a billion people – 10 percent of the world population – experiences some form of impairment or disability, and as the population of the U.S. and other nations increases, it is expected that the incidence of age-related disabilities including arthritis will also increase. Careful monitoring of the condition can help to improve treatment outcomes, and gaining an understanding of the condition and taking precautions to care for one’s joints before arthritis develops may make it possible to mitigate its effects or delay its onset.

Image by Deborah Ervin

Arthritis is caused by the breakdown of the cartilage that normally protects the joints of the body, and is typically seen in individuals 65 and older. The inflammation of one or more joints most commonly associated with arthritis frequently worsens with age. There are over 100 types of arthritis, but osteoarthritis and rheumatoid arthritis are among the most common. Osteoarthritis is caused by wear and tear on the joints and is seen almost exclusively in older individuals, while rheumatoid arthritis is an autoimmune disorder and may be seen in younger individuals as well. Regardless of type, arthritis causes pain, inflammation, and swelling, and restricts movement. Standard treatments focus on relieving symptoms and improving joint function, and may include medications, physical therapy and exercise regimes, lifestyle changes, and surgery if the condition does not improve through the use of more conservative measures.

Steroidal and non-steroidal anti-inflammatory drugs (NSAIDs) can be used to relieve some of the pain and irritation associated with arthritis, and experts are working to identify new medications that may prove beneficial. While medications do provide relief for some individuals, moderate exercise has been found to be highly beneficial to individuals with arthritis. Certain exercises and stretching techniques have been observed to markedly improve the range of motion and strength of muscles surrounding joints in individuals with arthritis. Despite the benefits of moderate exercise to reduce pain and ease stiff joints, a recent study  found that many individuals with arthritis do not get the recommended 2.5 hours of moderate-intensity, low-impact activity per week which could improve their condition.

By ensuring that individuals with arthritis and pre-arthritic individuals understand the importance of stretching and exercise, it may be possible to lessen the severity of the condition. In addition to strengthening the joints, these activities can lead to weight loss and improve overall health.

 

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On MRSA Infections Worldwide

June 20, 2011

Methicillin-resistant Staphylococcus aureus (MRSA) infection has become increasingly common in recent years, due in large part to overuse of antibiotics. According to a 2007 report in Emerging Infectious Diseases, a publication of the Centers for Disease Control and Prevention (CDC), the average number of MRSA infections doubled nationwide between 1999 and 2005 – from 127,000 to 278,000. During the same period, the number of annual deaths from MRSA infection increased from 11,000 to more than 17,000. By increasing awareness about the risk factors associated with and steps that can be taken to avoid MRSA infection, it may be possible to reduce or eliminate its spread.

MRSA infection is caused by a strain of Staphylococcus (staph) bacteria that has become resistant to the antibiotics commonly used to treat staph infections, which include methicillin and penicillin. Generally, MRSA is spread through skin-to-skin contact, openings in the skin (cuts or abrasions), contact with contaminated surfaces, crowded living conditions, or poor hygiene. MRSA frequently manifests first on the skin as a reddish rash with lesions resembling pimples which may begin to drain pus, or lead to cellulitis, abscesses, and impetigo. In addition, the initial skin infection can spread to almost any other organ in the body, resulting in more serious symptoms and potential complications.

Designations are made between types of MRSA infection based on the location where the infection took place. Hospital-acquired MRSA (also called health-care-acquired, HA-MRSA, or HMRSA) remains one of the most common types of infection. Individuals who are hospitalized, those with invasive medical devices such as catheters, and those residing in nursing homes are at an increased risk of acquiring HA-MRSA. Community-acquired MRSA (CA-MRSA or CMRSA) is another common type of infection, and is seen most frequently in individuals participating in contact sports or those living in crowded or unsanitary conditions. While the average adult death rate among individuals with MRSA is estimated at five percent of infected patients, individuals with HA-MRSA are at an increased risk of experiencing complications including organ damage.

Dr. Marc Siegel, an associated professor of medicine at New York University, and others recommend an evaluation of the overuse of antibiotics by humans as well as in livestock as a means of eradicating MRSA and reducing drug resistance in other strains of bacteria. In addition, experts note the importance of good hygiene practices  including washing hands frequently, keeping wounds covered with bandages until they have healed, and washing soiled clothes and sheets in hot water can help to prevent the spread of MRSA. The timely diagnosis of individuals infected with MRSA achieved through an analysis of a skin sample helps to better ensure not only treatment for the individual, but also a decreased risk of infecting others.

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On Herbal Dietary Supplements

December 13, 2010

Herbal dietary supplements are traditionally used to alleviate or prevent certain medical conditions, including digestive problems and depression, or to improve an individual’s quality of life. While these supplements and other medicinal herbs fall under the jurisdiction of the Federal Drug Administration (FDA), the Dietary Supplement Health and Education Act of 1994 gives responsibility for testing and ensuring safety of products to the manufacturer. Recent reports indicate that some supplements may contain potentially harmful substances in addition to their active ingredients, but consumers are often not aware of these ingredients or of the way that supplements or vitamins may interact with other medications.

The FDA defines “dietary supplements” as products taken by mouth which contain vitamins, minerals, herbs or other botanicals, amino acids, and/or other substances such as enzymes or metabolites. A national survey found that 52 percent of American adults had used supplements within the last 30 days, and the popularity of supplements in the United States continues to increase. Among the most commonly reported products were multivitamins (35 percent), vitamins E and C (12-13 percent), calcium (10 percent), and B-complex vitamins (5 percent). Though research has shown that some dietary supplements, including folic acid and calcium, are effective in preventing or treating diseases, in the case of other supplements, additional research is needed to prove the efficacy of their use.

While some supplements have not yet been proven safe and effective, others have been linked to serious adverse events by clinical research or case reports. Consumer Reports has documented twelve supplements including colloidal silver, comfrey, and kava, which have been linked to serious health problems such as permanently turning the skin a bluish color and damage to the liver and other organs. A recent study of 40 herbal dietary supplements by the U.S. Government Accountability Office (GAO) found trace amounts of at least one potentially hazardous contaminant in 37 of the products tested. Wide variation has also been seen in the amount of active compounds in supplements, and some, including St. John’s wort, have been found to negatively affect the efficacy of prescription medications.

Because of the potential for interactions with prescription medications, it is important that consumers consult their physician before taking any supplements. Consumers should also be aware that some claims made by manufacturers about the benefits of particular supplements may not have been verified. Though FDA regulations do not permit manufacturers or retailers to make claims that their products can treat, prevent, or cure specific conditions, these regulations are not always adhered to. Some individuals’ health may benefit from the use of certain supplements, but experts advise consumers to be aware of the potential risks of taking supplements and ask their doctor if there is the potential for any type of drug interaction.

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On Cholera Worldwide

November 1, 2010

Though the last major outbreak in the United States occurred in 1911, cholera remains a persistent health concern in many parts of the world, including Asia, the Middle East, Latin America, and sub-Saharan Africa. Recent outbreaks have been seen in Nigeria,  where cholera has killed more than 1,500 people this year, and in Haiti, where survivors of the massive January earthquake have been affected by an outbreak that has infected an estimated 2,300 people and killed at least 200. Due to cholera, there are an estimated three to five million new cases reported worldwide and between 100,000 and 120,000 deaths each year. Like other diarrheal illnesses, cholera is easily treatable and can be prevented through the provision of safe water, improved sanitation services, and education about the importance of hygiene.

Cholera

Cholera is an acute diarrheal infection caused by ingestion of food or water contaminated with the bacterium Vibrio cholerae. Though three-quarters of individuals infected with V. cholerae do not exhibit any symptoms, they may shed the bacteria in their stool for seven to 14 days, potentially infecting others. While V. cholerae is the direct source of cholera infection, the deadly effects of the disease are caused by a toxin called CTX, that the bacteria produce in the small intestine of the host. CTX binds to the intestinal walls and interferes with the normal flow of sodium and chloride, causing the body to secrete large amounts of water and leading to diarrhea accompanied by dehydration. In individuals exhibiting the severe form of the disease, the rapid loss of fluids can lead to dehydration and shock, and without treatment death can occur within hours. Approximately one in 20 individuals infected with the bacteria develops symptoms associated with cholera, which include: severe, watery diarrhea; nausea and vomiting; muscle cramps; dehydration; and shock.

The rapid loss of fluids in a short period of time – often as much as a quart in an hour – associated with diarrhea due to cholera, makes the disease particularly deadly. In order to replenish the fluids and electrolytes that an individual with severe cholera has lost, Oral Rehydration Salts (ORS) must be administered. If a pre-formulated solution is not available, experts suggest combining one-half teaspoon salt, one-half teaspoon baking soda, and three tablespoons sugar in one liter of safe drinking water. With the prompt delivery of ORS, up to 80 percent of people can be treated successfully, with a fatality rate below one percent. Antibiotics may be used in conjunction with ORS to shorten the course and lessen the severity of the illness, however their delivery is less critical to cholera patients than rehydration. To help control the spread of the disease, two types of oral cholera vaccines are also available, but according to experts they provide only a short-term effect and should be administered in areas where ongoing water and sanitation improvement programs are in place.

Despite the simplicity of the cure, thousands of people die each year in regions that lack effective sanitation and water purification systems. Following man-made or natural disasters, the risk of an initial outbreak of cholera growing into an epidemic is greatly increased. As seen recently following floods in Pakistan and Nigeria, the spread of cholera becomes a major public health concern when there is a lack of clean water. By providing treatment as well as information about the importance of boiling water before drinking and maintaining personal hygiene, it may be possible to slow or even stop the spread of cholera and other communicable diseases.

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On Drug Resistance

June 28, 2010

As the distribution of medications worldwide advances, individuals gain access to improved treatment options. Among the medications most frequently distributed are antibiotics. Though expanded access to medicines is “clearly desirable,” it can also create “challenges in preserving the efficacy of these drugs.” A recent report from the Center for Global Development (CGD) indicates that antibiotic distribution programs put in place by the World Health Organization, government agencies, and other groups may be contributing to the increased incidence of drug-resistant bacteria. According to Nancy Birdsall, the president of the CGD, “Drug resistance is a serious problem that doesn’t get serious attention.”

Antibiotics and antimicrobial agents are the most effective means of combating infectious disease. However, as a class of drugs, antibiotics are unique in that once an antibiotic is utilized, the bacteria it is intended to fight begin to develop a resistance and the effectiveness of the medication is diminished. According to British researchers who analyzed 24 previous studies, the excessive prescription and use of antibiotics for coughs and flu-like illnesses leads to antibiotic resistance. Studies indicate that the overuse of medications, inconsistent drug quality, and other factors hasten the adaptation of resistance to given antibiotic and antimicrobial agents.

This increased resistance to commonly used antibiotics can result in “superbugs,” such as methicillin-resistant Staphylococcus aureas (MRSA), which is the cause of more than 50 percent of staph infections in US hospitals. Additionally, in the developing world, drug-resistant strains of malaria, tuberculosis, HIV/AIDS, and other diseases are the cause of death for millions of children each year. According to Céire Costello Research Associate at the University of Bristol, “there are some concerns that some common infections are becoming increasingly difficult to treat.” This is seen with increasing frequency in many remote and medically underserved areas of the world where medication dispersal programs are especially  prevalent. Reports indicate that 60 to 80 percent of dysentery cases among children in Latin America are “resistant to the drugs recommended to treat it.”

By retaining the medications available now and developing new drugs, experts hope to be able to continue combat bacterial infections effectively. Because of the lengthy development and testing process associated with creating new medications for mass consumption, it is critical to ensure that drug resistance is minimized as much as possible. By urging providers to keep track of which antibiotics they prescribe and how frequently, it may by possible to help slow the rate of drug resistance. It is also essential for clinicians and individuals worldwide, particularly in the developing world, to be aware of the importance of not over prescribing or over using antibiotics.

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Tuberculosis Worldwide

April 5, 2010

Tuberculosis kills more than 1.7 million people around the world each year, and this figure is growing as over-crowded conditions in poverty stricken areas can elevate transmission rates. The World Health Organization’s (WHO) recently published report, entitled “Multidrug and extensively drug-resistant TB (M/XDR-TB): 2010 Global Report on Surveillance and Response” outlines the prevalence of the disease and its potential global impact. In it, data from 114 countries around the world are examined to determine the extent of this “serious threat to global health.”

Mycobacterium tuberculosis, the organism that causes tuberculosis (TB), is an airborne bacteria exclusive to humans and can be transmitted through close personal contact, particularly coughing. According to the United States Centers for Disease Control and Prevention (CDC), the bacteria usually affect the lungs of an individual, but can also impact the kidneys, spine and brain. Nikoloz Sadradze, International Committee of the Red Cross (ICRC) medical delegate, explains that more than two billion people – approximately one in three – carry the microbes that cause TB, but only one in ten will actually experience symptoms. Effective treatment of TB depends on daily doses of courses of medication lasting six to eight months. Tuberculosis infection is defined as multidrug-resistant (MDR-TB) if it cannot be eradicated by the antibiotics commonly used to treat tuberculosis: isoniazid and rifampicin. It is classed as extensively drug-resistant (XDR-TB) if it is also resistant to fluoroquinolone antibiotics and the injectable drugs amikacin, kanamycin, and capreomycin. If an individual contracts a MDR-TB or XDR-TB strain, a combination of oral medications, injections, and other treatment may be required for 24 to 36 months or longer. Costs associated with treating MDR-TB are, on average, 10 times more than “standard” TB. The WHO reports that 60 percent of individuals who contract of TB have been cured.

The WHO also reports that drug-resistant forms of TB killed approximately 150,000 people in 2008, and that 50 percent of all cases of MDR and XDR-TB occurred in India and China. Further, 57 countries have had at least one case of XDR-TB since September 2009, according the WHO report. Programs to combat the spread of tuberculosis have been established by the WHO in 30 countries around the world, primarily those that are impacted most by the disease. Reports from the CDC indicate that reported TB cases in the United States are at an all time low, but that there were a total of 108 reported cases of MDR-TB in the U.S. in 2008. According to the WHO there were approximately 440,000 reported cases of MDR-TB worldwide in 2008. Many cases of MDR and XDR-TB are due to individuals lacking access to necessary medical attention and drug treatments. In addition to a lack of available treatment, reports indicate that only an estimated seven percent of patients with MDR-TB are diagnosed.

In regions where access to medical care and treatment may be limited, telemedicine can be used to improve the rate of diagnosis and treatment outcomes. Programs like iCons in Medicine allow healthcare providers in remote and medically underserved areas to connect with physicians who can provide knowledge and guidance for recognizing and treating tuberculosis.