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 Food Allergies and Intolerances

October 18, 2010

Individuals may experience allergies to any number of substances, but reports indicate that a growing number of Americans suffer from allergies to particular foods. Food allergies affect approximately 12 million Americans, including three million children. ”Food intolerances,” though frequently discussed in conjunction with food allergies, are quite different. Individuals with “intolerance” to certain foods may experience adverse reactions and discomfort if they are consumed. It is important to have an understanding not only of the severity and potential risk of food allergies, but of the difference between true allergies and intolerances.

The majority of adverse reactions linked to particular foods are due food intolerances. Individuals can be intolerant to lactose, gluten, or other foods, and may experience nausea, vomiting, stomach cramping, and diarrhea. While these symptoms are surely unpleasant, they are markedly different from the immune response seen in individuals with food allergies. In addition to bowel discomfort, food allergies can cause an anaphylactic response, leading to tingling and swelling of the mouth and face, hives, trouble breathing, dizziness, or fainting. These symptoms are caused by an response in which the body’s immune system mistakenly identifies a particular food as a harmful substance. An allergic reaction involves two components of the immune system: an antibody called immunoglobulin E (IgE), and a mast cell. When an individual consumes – or in some cases is in close contact with – a food to which they have an allergy, the allergen stimulates specialized white blood cells called lymphocytes which produce the IgE antibody for that specific allergen. This IgE is then released and attaches to the surface of the mast cells in the tissues of the body, prompting the cells to release histamine.

Allergic reactions can range in severity, but reports indicate that they cause 30,000 cases of anaphylaxis, 2,000 hospitalizations, and 150 deaths each year in the United States. According to the U.S. Centers for Disease Control and Prevention (CDC), there are eight foods which account for 90 percent for all food-allergy reactions: cow’s milk, eggs, peanuts, tree nuts (walnuts, pecans, etc.), fish, shellfish, soybeans, and wheat. One of the most common food allergies in the United States is to peanuts, affecting an estimated 3.3 million Americans. The incidence of peanut allergies is increasing, and reports indicate that between 1997 and 2008, the rate of child peanut allergies has tripled. Rates of other food allergies have also increased in recent years, and according to the CDC, the number of children with food allergies increased by 18 percent, between 1997 and 2007. While the cause of the increase is not fully understood, it may be due in part to the risk factors associated with food allergies, which include a family history of asthma and allergies, and elevated IgE levels.

Though there is no proven treatment for food allergies other than the avoidance of the allergen, experts recommend that individuals with food allergies carry injectable epinephrine at all times, as it can help to mitigate severity of the allergic response. In addition to the physical health-related issues resulting from food allergies, reports indicate that more than 30 percent of children with food allergies have experienced teasing or bullying related to their allergy. By gaining an understanding of food allergies and sharing information about them with others, it may be possible ensure that individuals are better informed about how to help prevent allergic reactions, and lessen the stigma faced by children with food allergies.

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On Breast Cancer Worldwide

September 20, 2010

This October marks the 25th annual celebration of Breast Cancer Awareness Month, during which organizations in the U.S. and worldwide will hold events aimed at raising awareness and providing education about breast cancer. In spite of ongoing efforts to inform the public about breast cancer, it continues to be a major health concern worldwide. According to the National Cancer Institute (NCI), in 2010, there will be 209,060 new cases of breast cancer in the United States. Reports from the World Health Organization (WHO) indicate that incidence rates vary worldwide, however as the adoption of “western lifestyles” increase in the developing world, breast cancer has become more common. Due to the lack of adequate diagnosis and treatment facilities in these regions, survival rates are often also significantly lower. In 2004 an estimated 519,000 women died worldwide due to breast cancer, with 69 percent of these deaths occurring in developing nations. By ensuring that information about breast cancer and early detection programs are available, treatment outcomes worldwide can be greatly improved.

Like other types of cancer, breast cancer develops when abnormal cells divide in an uncontrolled fashion and spread to surrounding tissue (metastasize). Breast cancer is a malignant form of tumor growth which can develop in both men and women, but is approximately 100 times less common in men. An estimated one in every eight women will be diagnosed with breast cancer during their lifetime, making it the second most commonly diagnosed cancer after skin cancer in women in the United States. There are many types of breast cancer, but two of the most common are ductal carcinoma, which begins in the cells that line the milk ducts of the breast; and lobular carcinoma, which begins in the lobes or lobules of the breast. Unlike less common forms of breast cancer, including inflammatory breast cancer which is marked by heat, redness, and swelling of the breast, these common types of breast cancer tend to manifest similarly.

The first signs of breast cancer may include a lump in the breast or thickening of breast tissue, change in shape of the breast, changes in the breast or nipple skin, or bloody discharge from the nipple. Tumors in the breasts may be detected during clinical breast exams, mammograms and other imaging tests, or self breast exams. A mammogram is a black-and-white image of the breast similar to an X-ray. Though some recommendations differ, the American Cancer Society suggests that women undergo yearly mammograms beginning at age 40. Though mammography has proven to be an effective screening method and can help ensure early diagnosis of breast cancer, the Centers for Disease Control and Prevention (CDC) indicates that more than 7 million women in the United States have not had a recent mammogram.

Following the identification of a tumor within the breast, a determination must be made regarding how advanced the spread of the cancer is so that it can be effectively treated. The “Stages” into which breast cancer are categorized – from Stage 0, defined by abnormal cells that are not invasive cancer, to Stage IV, defined by cancer which has spread throughout the tissues of the body. The Stages indicate how aggressively the cancer is spreading within the breast, to the surrounding tissue and lymph nodes, and throughout the rest of the body. Depending on the progression of the cancer, treatment options may include chemotherapy and surgery. Chemotherapy is a drug treatment that uses powerful chemicals to slow the growth of cancer in the body or kill off the cancer cells. Though it is effective, chemotherapy, which can produce a number of side effects, including nausea, vomiting, hair loss, and fatigue, is often used in combination with surgical interventions. Breast-sparing surgeries, which aim to remove cancer from the breast while preserving the surrounding tissue; and mastectomies, in which the entire breast is removed, are often employed.

Though breast cancer treatment can be physically and emotionally painful, there are currently over 2.5 million breast cancer survivors in the U.S. and many more around the world. Breast cancer can occur at any age, but the risk of its development increases as an individual gets older. While the cause is still unknown, there are a number of factors linked to an increased risk of developing breast cancer including the presence of certain “breast cancer genes,” a woman’s age, family history, and age at the onset of menstruation and menopause can increase their risk of developing breast cancer. While little can be done about some of these factors, some women with a genetic predisposition to developing cancer have opted to undergo preventative mastectomies to reduce their risk. Individuals can also help to reduce their risk by maintaining a healthy lifestyle.

By ensuring that individuals are made aware of the importance of regular clinical and self breast evaluations and that early detection and diagnosis programs are made available, treatment outcomes can be greatly improved.

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West Nile Virus

August 23, 2010

West Nile virus (WNV) is an infection transmitted to humans and animals by mosquitoes which have fed on infected birds. According to the Centers for Disease Control and Prevention (CDC), between 1999 and 2008, 28,961 confirmed and probable cases of WNV were reported. Though 80 percent of individuals infected with WNV show no symptoms, approximately one in 150 develop severe illness with symptoms including high fever, vision loss, and paralysis. Though there is no vaccine or cure for WNV, it is important for individuals to have an understanding of how best to protect themselves from infection.

First identified in Uganda in 1937, WNV occurs when Culex pipiens mosquitoes feed on infected birds, which serve as vectors for the virus, and then pass the virus on to humans. WNV cannot be passed from one individual to another through close personal contact, and the primary method of transmission is through the bite of an infected mosquito. Mild infections (West Nile fever) are seen in approximately 20 percent of individuals, and are marked by symptoms including fever, headache, and body aches. Individuals with severe infections (severe West Nile disease) may experience inflammation of the brain (encephalitis) or of the brain and surrounding membranes (meningoencephalitis), and three to 15 percent of WNV infections result in death. According to CDC statistics, in 2009 there were a total of 663 cases of WNV in the United States, and 30 of these resulted in death.

The CDC indicates that WNV is an established seasonal epidemic in North America, beginning in the summer and continuing into the fall. In addition to documented cases in the United States, both sporadic cases and major outbreaks of encephalitis related to WNV have been reported in Africa, West Asia, Australia, Europe, and the Middle East. Recent reports have documented outbreaks in Greece and British Columbia, Canada; as well as in New York, Pennsylvania, and northwestern Indiana.

Like malaria, dengue, and other mosquito-borne illness, rates of WNV infection increase during periods of warm weather when mosquito populations are most active. Torrential rains in early summer and persistent high humidity in many regions of the United States have created the ideal breeding climate for mosquitoes. Experts recommend taking preventative measures to avoid infection including the “5 D’s”:

  • Dusk and Dawn – avoid being outdoors during these periods which are when mosquitoes are most active
  • Dress – wear clothing that limits exposed skin
  • DEET – use repellents containing DEET (picaridin and oil of lemon eucalyptus are other repellant options)
  • Drainage – eliminate areas of standing water in which mosquitoes lay eggs.

In addition, dead birds, particularly crows, which display signs of illness should be reported to authorities for proper disposal. As health officials continue to track outbreaks of WNV, individuals can take appropriate measures to limit their risk of infection and keep their community healthy.

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Using Social Media for Organ Transplantation

July 26, 2010

Reports indicate that the number of organ donors in the U.S. has decreased in recent years, while the number of patients in need of an organ transplant continues to grow. In 2006, there were 8,019 cadaveric organ donors and 6,732 living donors. Both figures have since decreased, and in 2008 there were only 7,990 cadaveric donors and 6,218 living donors. According to the National Kidney Foundation, 104,748 individuals in the United States are currently awaiting an organ transplant of some type, and more than 4,000 new patients are added to this figure each month. Organs from donors are matched to waiting recipients by a national computer registry called the National Organ Procurement and Transplantation Network (OPTN). In addition, close relatives and family members often undergo testing including tissue matching and blood typing to determine if they are a viable candidate for donation. Many organs, including kidneys, can be transplanted from either living or recently deceased donors, provided they have good kidney function, and low risk for certain disorders including high blood pressure and diabetes.

Transplants using kidneys from both living and cadaver donors are frequently successful, with about 94.9 percent and 97.96 percent of cadaver and living (respectively) donor kidneys still functioning after one year. In spite of the success rate, the wait to receive a transplant, which can often be several years and often requires dialysis and other physically taxing treatments, is too long for some individuals, and a number have chosen to utilize online social media to seek out possible donors. The Baltimore Sun reports that 80,000 people in the United States are currently awaiting kidney transplants, but just over 16,000 were completed last year. For individuals seeking to increase their chances of finding a donor, Annette Whinery, the coordinator of University Medical Center’s living donor program, says that it is becoming common for patients to seek out living donors on their own, often through church, work, family, and friends. Dr. Ngoc L. Thai, director of Allegheny General Hospital’s Center for Abdominal Transplantation, recently completed a transplant surgery in which the donor and recipient connected via Facebook. “It’s the way of the future,” according to Dr. Thai, who says that he expects more patients to turn to social networking websites for help finding donor matches. In addition to Facebook, some patients and their family members have turned to Craigslist and other websites to find possible donors.

Some individuals awaiting transplant and those who have recently received a transplant choose to use social networking websites to tell their story, rather than to ask others to consider donating an organ. Through blogs, Facebook, and Twitter, individuals in need of kidneys and other organs are able to keep others informed. Recent research has shown that people fighting chronic illnesses and those with serious health problems, such as those that might require an organ transplant, are using social media to find information and connect with others with similar ailments. Social networks like the Transplant Trust and Patients Like Me allow patients awaiting transplants, their families, physicians, donors, and others to connect with one another. In a recent study by Teri Browne, PhD, from the University of South Carolina in Columbia, this type of connection was shown to help patients navigate and understand the process of getting a transplant more easily.

According to Dave Bosch, spokesman for the Gift of Hope, an organ and tissue donor network, “Social media has become the way people communicate, very personally, about what’s going on in their life.” Dr. Kenneth Prager, director of clinical ethics and chairman of the Medical Ethics Committee at New York Presbyterian Hospital, notes that Internet appeals for organ donations raise a number of questions of fairness. While Dr. Prager states that “Solicitations undermine the concept of a level playing field,” which is the primary objective of the OPTN, “there is nothing illegal in advertising or using the Web for personal or health reasons. Altruistic organ donors have the legal right to designate recipients.” It is important to note, however, that the sale of kidneys and other organs is illegal, and all donations must be made without compensation.

Though the use social media to address matters related to an individual’s health may seem somewhat unusual, it is a trend that seems to be gaining in popularity. Some experts even argue that the solicitation for kidney and other organ donation on websites like matchingdonors.com, Craigslist, and Facebook may help to encourage individuals to consider donation and benefit the population of individuals in need of organs as a whole.

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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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Using SMS for Healthcare

June 14, 2010

Over 4.1 billion cell phones are in use globally, and they are quickly becoming a part of the “digital life” for many.Reports indicate that individuals worldwide now use Internet-based and mobile technologies to find health-related information more frequently than ever before. Although cell phones are more common than computers in some areas of sub-Saharan Africa, it is important to note that they are frequently low-cost models with less features as opposed to high-tech smartphones, so mobile web-based information and applications may not be available.

As a means of delivering health-related information in remote areas, many clinics and organizations have begun to utilize short message service (SMS) technology. SMS or “texting” is a mature technology that is supported worldwide on all cellular network operators, through which messages of up to 160 characters can be delivered to a user’s cell phone. In regions where “personal computer technology” may not be available, it is possible to better ensure the delivery of health-related information through the use of basic cell phones and SMS technology. Over the past few years, SMS-based systems have been put in place throughout the developing world to combat diseases like malaria, provide medical and health information, and support rescue and relief efforts following natural disasters.

In regions where malaria is prevalent, SMS systems, such as the “SMS for Life” program currently in use in Africa, have been implemented to deliver information about the availability of treatment and medications. This program allows the inventory of anti-malarial medications at healthcare facilities throughout Africa, particularly in remote areas, to be tracked by clinics and aid organizations to improve distribution rates. Similar programs which allow physicians to monitor their patients at a distance have been put into practice for other diseases, including a program to ensure the provision of quality care to patients with HIV/AIDS in Kenya. This type of patient-monitoring SMS program has also been instituted to allow healthcare workers in Rwanda to monitor pregnant patients remotely, provide basic health and well-being information to patients throughout Africa, and provide clinic location information to patients in India.

SMS systems have also been established following natural disasters, such as the earthquake that struck Haiti on January 12, 2010. A number of relief organizations set up SMS shortcodes, which assisted individuals searching for friends and family members. Shortcodes are set numbers – usually only five digits long – used to quickly and easily gather messages for delivery. Additionally, SMS messaging and shortcodes allowed for a simplified donation process to a number of aid organizations providing assistance in Haiti.

Although mobile applications, smartphones, and other cutting edge technologies have provided enormous advancements in healthcare, high-tech solutions are not always appropriate for worldwide use. In settings where reliable Internet connectivity may not be available and where basic cell phones are the norm, SMS-based systems allow for the distribution of health-related information to a wider audience.

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