Saturday, March 21, 2015

TB report

CDC report says immigrants from Asia have the most tuberculosis.

lots of data in the article, but it is all mixed up so hard to comprehend.

and then they mix homelessness and TB into the mix. Uh, are Asian immigrants homeless, or is it the homeless who are injecting drugs, getting TB and spreading it through homeless shelters.

As I said, lots of data, but not organized or connecting the dots.

another article is about IV drug use and HIV. lots of IV drug abusers are MSM too.

Sorry but I'm too sleepy to get this data organized either.

Wednesday, March 18, 2015

well, duh

NYTimes quotes NEJM article that notes most kids who die of malaria die from cerebral malaria.

guess what? when they get cerebral malaria, their brain swells.

well, duh.

Their answer? Put the kids on ventillators.

“What’s killing these kids is that they stop breathing, because the respiratory center in the brain stem is compressed by the swelling,” said Dr. Terrie E. Taylor, the senior author of the study and a professor at the Michigan State College of Osteopathic Medicine. She spends about half the year working in Malawi. Ventilators might save some children, Dr. Taylor said, by maintaining their breathing through the worst of the brain swelling, which usually lasts for only a few days. Ventilators are not widely available in Africa, but providing them “is not beyond the pale,”

of course, ignore the real problem:

Get rid of stale water where the mosquitos breed.

Use DDT.



give prophylactic anti malarials to stop the kids from being infected.

Stop counterfeit/substandard anti malarials from being sold (i.e. get rid of activists who decry drug companies that make money from selling drugs and say that "generics" work, when the dirty little secret is that a lot of the "Generics" are substandard...and get officials to stop counterfeits that look like the brand names from being imported)

True, having clinics treat by adding prednisone/steroids may help, but that wasn't what was investigated.

Remember: Kids have fevers all the time, and they don't always get taken immediately to the clinic. And cerebral malaria can have a very fast onset.

Sunday, March 8, 2015

Near death experiences: You don't always see the light.

BBC article.

Doctors mostly dismissed such anecdotal evidence as hallucinations, and researchers have been reluctant to delve into the study of near-death experiences, predominantly because it was viewed as something outside of the reach of scientific exploration. But Sam Parnia, a critical care physician and director of resuscitation research at Stony Brook University School of Medicine in New York, along with colleagues from 17 institutions in the US and UK, wanted to do away with assumptions about what people did or did not experience on their deathbeds. It is possible, they believe, to collect scientific data about those would-be final moments. So for four years, they analysed more than 2,000 cardiac arrest events – moments when a patient’s heart stops and they are officially dead.
 Of those patients, doctors were able to bring 16% back from the dead, and Parnia and his colleagues were able to interview 101 of them, or about a third. “The goal was to try to understand, first of all, what is the mental and cognitive experience of death?” Parnia says. “And then, if we got people who claimed auditory and visual awareness at the time of death, to see if we are able to determine if they really were aware.”
 Seven flavours of death Mr A, it turned out, was not the only patient who had some memory of his death. Nearly 50% of the study participants could recall something, but unlike Mr A and just one other woman whose out-of-body account could not be verified externally, the other patients’ experiences did not seem to be tied to actual events that took place during their death.
Instead, they reported dream-like or hallucinatory scenarios that Parnia and his co-authors categorised into seven major themes.
“Most of these were not consistent to what’s called ‘near-death’ experiences,” Parnia says. “It seems like the mental experience of death is much broader than what’s been assumed in the past.”
 Those seven themes were:
 Seeing animals or plants
 Bright light
Violence and persecution
 Seeing family
Recalling events post-cardiac arrest

I have one problem with this: You see, people who do not "die" can also go through similar experiences. For example, several people on the "miracle of the Hudson" airplane state they had these types of experiences, although none were sick or dying, just in peril...and presumably their "soul" did not leave the body (which is one explanation of the phenomenum).

And yes, I believe in heaven...and our Native American patients who were dying often saw relatives (they called it seeing the other side). And numerous stories relate how a dying person sees a relative who is there to welcome them home...sometimes a relative they didn't know had died.

Patients who are dying often "say goodbye" before they die.
Similarly, the senile/comatose etc. often "come to" and say goodbye before they die.

And in medical school, we were warned that if a patient didn't want surgery because they were convinced they would die, then don't do the surgery because they actually would die.

Could the fever from Dengue fever cure some cancers?

A long article on the BBC about "spontaneous" remission of various cancer tumors.

The technique, developed by American start-up PrimeVax, involves a two-pronged approach. It would begin by taking a sample of the tumour, and collecting dendritic cells from the patient’s blood. These cells help coordinate the immune system’s response to a threat, and by exposing them to the tumour in the lab, it is possible to programme them to recognise the cancerous cells. Meanwhile, the patient is given a dose of dengue fever, a disease normally carried by mosquitoes, before they are injected with the newly trained dendritic cells.
Under the supervision of doctors in a hospital, the patient would begin to develop a 40.5C fever, combined with the widespread release of inflammatory molecules – putting the rest of the immune system on red alert. Where the tumour was once able to lurk under the radar, it should now become a prime target for an intense attack from the immune cells, led by the programmed dendritic cells. “Dengue fever crashes and regroups the immune system, so that it is reset to kill tumour cells,” says Bruce Lyday at PrimeVax.
this double approach (but not with dengue) was used against Joy's sister's cancer, and no it did not work.

so don't get your hopes up...

However, malaria was once used to destroy syphillis of the brain which was fatal in the bad old days before Salvarsan and Penicillin.

Tuesday, March 3, 2015

GIGO Studies

GIGO: Garbage in, garbage out.

So moms who took antibiotics during pregnancy have kids with a higher rate of "asthma" and allergies?

uh, maybe it was because mom had low grade "asthma" and usually needs or wants antibiotics when she got bronchitis?

Or did they include the moms who took antibiotics for UTIs?

without reading the study, who knows.

And the side bar contains similar GIGO articles.

Related Stories

In "asthma", there are two reasons it is more commonly diagnosed: one, the threshhold is lower (in the past, unless one wheezed all the time you didn't get diagnosed with "asthma". Now if you get a little bronchospams when running etc. you are diagnosed as such), two, air pollution.

David Warren writes a scathing essay on these studies, that justify the nanny state, and of course, more funding for more "research"...

According to the latest research, he writes facetiously, coffee may be good for your heart. It just might prevent cholesterol build-up in the arteries and … blah blah blah. I refer to some Korean study in the news this morning, but the findings (not of causation but of statistical correlation) are hardly new. There was for instance a big Dutch study five years ago, which redeemed tea as well as coffee, and I vaguely remember others. “More research is needed,” say all the people who make money from such pointless research. We are trained to nod sleepily in agreement. These hugely expensive, perpetually inconclusive, and very soft epidemiological studies are what most people have in mind when the magic word, “science,” is invoked: for we are living in an age of magic.Actual science would show the mechanism by which a specific constituent in coffee, such as caffeine, operates within the human metabolism to produce specific reactions in a long, very specific chain, leading to a specific result. 
and he notes that they are aiming at other people's sins, the innocent pleasures of ordinary people, not the traditional sins of promiscuity, seducing children, aborting offspring etc. But I'll probably quote that part on my boinkieblog.


related item: divorce fuels kid's sugary intake.

"When families separate, one of the things that is most impacted for kids is their day-to-day routines," said Jeff Cookston, professor and chair of psychology at SF State and lead researcher on the study. "Children are looking for consistency in their family environment, and family routines provide that security and continuity."
The study is the first to examine the real-time eating habits of divorced and married families, rather than rely on family members' recollections of past meals or behavior. Cookston and his colleagues interviewed the participants -- parents and children in both married and divorced families -- and asked them to keep five-day diaries of their eating habits. When they looked at the data, they found that children whose parents were separated or recently divorced were much more likely to drink sugar-sweetened beverages than children whose parents are married. Divorce did not appear to have a major impact on other unhealthful behaviors such as skipping breakfast or eating dinner outside the home.
The reason, Cookston says, is likely ease and access. Divorce can put a great deal of stress on families, including children, and drinking sugary beverages can be a "quick fix" for dealing with that stress.
why, yes.

And as StrategyPage notes: Ways that soldiers cope with stress are sugary drinks and junk food, cigarette smoking, and video games...

The troops know that the drugs they take have bad side effects, but combat is inherently dangerous, and staying awake and stress free is the easiest way to avoid all the other dangers. In addition to these immediate problems there is the longer term impact of stress and tobacco has always been good at that. So when pilots land they go looking for a drink and a cigarette. Same with sailors, who are still allowed to smoke in specified areas and these smoking stations are always busy when the crew is under a lot of stress. Thus for all its long term problems, tobacco is still one of the best short term anti-stress solution. The other one is candy, but that has more immediate shortcomings as well as long-term dangers that explains all the efforts to cure bad eating habits. Then there are violent video games, which unexpectedly turned out to be an excellent combat stress reliever as well as useful in dealing with long-term (PTSD) combat stress problems. It’s still unclear what the long-term downside is for these games. The problem with video games is that they are not as convenient as tobacco. In any event the search continues for more effective combat stress relievers.

and I would add: Alcohol and sex.

this last part is a problem in Muslim lands, since honor killing might be the fate of the friendly girls. But there are some lovely ladies among the military who help...alas, some men mistake the lovely and willing with the non willing, so rape is a major but little talked about problem...and now, with Obama pushing gay/transvestites in the military, expect more unreported problems.

Am I being cynical? Well, we can't keep young male employees here since they get sexually harassed by a family member who will remain nameless. Half just quit, and the other half go along for the money until the wifey finds out and fires them...and this doesn't include the guy at the farm party who passed out and ended up raped. Luckily he was greedy, but our cook got upset because she was no longer getting any love from her boy toy.

Ah life in the Philippines....

related item: How beer made civilization.

Monday, March 2, 2015

will ultrasound treatment help heel pain?

one common problem is pain on the heel, aka plantar fasciitis, where the plantar fascia (that's the broadcloth like support that holds up your arch and tendons) inserts to the heel bone.

photo source

Usually you treat it with NSAIDS (eg advil/alleve/aspirin) and stretching, also shoe inserts to keep the arch from falling. Some people say to use splints, but I could never get people to actually keep using them.

photolink here.

Now they suggest ultrasound might help those with this nasty painful but not serious cause of heel pain.

I used to give a lot of cortisone shots for this (on "the res" where I worked, to get ultrasound treatment took making a request via the tribal health board, since we didn't have the machine...and since this treatment was not urgent, often it didn't get funded).

usually I warned the patient that the shot was very painful: enough to make strong men cry.

And they agreed with me.

But usually it did help the pain