Friday, July 22, 2016

Disease and the silk road reports that archeologists examining travelers' poop along the route of the Silk Road have found that Chinese parasites were spread by them.

Researchers excavated the 2,000-year-old excrement from a latrine at Xuanquanzhi, a major stopping point along the legendary trading route in northwestern China. The feces were found on “personal hygiene sticks,” rods wrapped with cloth at one end that travelers used to clean themselves after defecating. Microscopic examination revealed the eggs of four parasitic intestinal worms in the feces, including those of Chinese river fluke, which thrives in wet areas and could not have come from the area where the excavation took place—the arid Tamrin Basin. The worm is most common in Guangdong Province, around 1,240 miles from the site, suggesting that the traveler infected with it most likely journeyed a great distance.
and of course it was not just parasites:

Sunday, July 10, 2016

Disease and death: The good news

(cross posted from my main blog)

NYTimes article on killer disease on the decline.

a lot of this is change in diet...

but I wonder if a lot of the decline of heart attack and strokes are due to aggressive treatment of high blood pressure. Here in the Philippines, we frequently see people with a limp walking around. The limp is residual leg weakness after a stroke. Here medicine is too expensive and often blood pressure problems are not detected early.

We used to see a lot of this in the USA, but it became rarer since Aldomet was released in the late 1960s.

Heart disease is less too. Is it the ICU? That people are taking aspirin? Or the decrease in smoking, a major factor in heart attacks.

Colon cancer is the real dilemma. In the 1960's over half the cases were rectal cancer, easily found if you did a rectal exam and/or simple sigmoidoscope. . Now most cases are upstream, requiring a more complicated colonoscopy or barium enema. Why the change? I would say some of it might be from fiber in the diet (colon cancer is rare in parts of East and South Africa where high fiber diets are common). But the change of where the cancer was located started before the American diet started to change in the 1970's. But the graph shows the actual colon cancer rate dropped in the 1990's, which suggests it might indeed be fiber (20 year lag).

Deaths per 100,000 people, age 50 and older 
cancer deaths
If colon cancer
tracked cancer
over all

Screening might also be part of the picture, but I don't have the data on screening. The decrease in death rate might suggest screening and aggressive chemotherapy might be cutting down the death rate.

Another question: It is known NSAIDS, especially Ibuprofen/motrin cut the rate of colon cancer. Is this part of the explantion?

but here is a puzzle: Why is the dementia rate declining?

There are reasons that make sense. Ministrokes result from vascular disease and can cause dementia, and cardiovascular risk factors are also risk factors for Alzheimer’s disease. So the improved control of blood pressure andcholesterol levels should have an effect.
they also cite education, but I suspect this is because if you diagnose dementia with intellectual tests that are passed easier if you are educated....again I wonder if studies (eg MRI) show more alzheimer's dementia in the uneducated? But not all Alzheimer's is dementia.

the deline in stomach cancer is mentioned. This declined long before I went to medical school (I saw two cases only) yet it remained a major cause of death in Japan. I suspect it was because of smoked fish. In recent years, c the preservatives in the food? Again I am lacking the data on Japanese diet. But another question is why is lymphoma of the stomach increasing?

Anyway, some good news

Narcotic abuse: Blame the pushers not the docs

there is a meme in medicine blaming docs for prescribing narcotics to people in pain. So now people will have to suffer because druggies lie, steal, etc narcotics.

LATimes about Oxycontin sales:

Purdue did not shut off the supply of highly addictive OxyContin and did not tell authorities what it knew about Lake Medical until several years later when the clinic was out of business and its leaders indicted. By that time, 1.1 million pills had spilled into the hands of Armenian mobsters, the Crips gang and other criminals. A Los Angeles Times investigation found that, for more than a decade, Purdue collected extensive evidence suggesting illegal trafficking of OxyContin and, in many cases, did not share it with law enforcement or cut off the flow of pills. A former Purdue executive, who monitored pharmacies for criminal activity, acknowledged that even when the company had evidence pharmacies were colluding with drug dealers, it did not stop supplying distributors selling to those stores

When the small family dental supply company my father worked for was taken over by a big conglomerate, he lost his job as an executive, but was given a clerk job instead (they also refused a pension for my mom because he died a few months before his 65th birthday).

Well, anyway, he came home one day and said he saw an oder for thousands of amphetamine pills being sent to "clinics" in Tiajuana. Obviously these were being diverted to sell in the US. But since there was not yet a war on drugs, and since this was before Methamphetamine was made into a Class II prescription, he didn't report it. If he had, he would have lost his job, and he was too old for anyone else to hire.

Saturday, July 9, 2016

The Zika puzzle: Why are there so few cases of microcephaly in Colombia?

The meme goes on about Zika and birth defects.

Did you know Zika has affected tens of thousands outside of Brazil?

there is a similar outbreak in Colombia. According to the CDC, the highlands where my son lives is less likely to be affected.

But that outbreak has caused some to question the link between Zika and microcephaly.

and now some are wondering if the insecticide might be behind the huge number of cases in Brazil:

Recently, the New England Journal of Medicine published the preliminary results of a large study of pregnant Colombian women infected with Zika. Of the nearly 12,000 pregnant women with clinical symptoms of Zika infections until March 28, no cases of microcephaly were reported as of May 2. At the same time, four cases of Zika and microcepy symptomless for Zika infections and therefore not included in the study itself....

The NECSI report analyzes the data and shows that the four cases of Zika and microcephaly that have been observed till April 28 are just what would be expected due to the background rate -- of the 60,000 pregnancies about 20,000 births would already be expected. The expected microcephaly rate for countries with no reported infections of 2-in-10,000 births gives exactly four cases. The study also notes that until April 28 there has been a total of about 50 microcephaly cases in Colombia, of which only four have been connected with Zika.

 The four cases are expected for the coincidence of Zika and microcephaly in the same pregnancies even if Zika is not the cause.

In light of this evidence, NECSI says the cause of microcephaly in Brazil should be reconsidered. One possibility that has been raised is the pesticide pyriproxyfen, which is applied to drinking water in some parts of Brazil to kill the larvae of the mosquitos that transmit Zika. 

Pyriproxyfen is an analogue for insect juvenile hormone which is cross reactive with retinoic acid, which is known to cause microcephaly. A physicians group in Brazil and Argentina, the Swedish Toxicology Sciences Research Center, and NECSI have called for further studies of the potential link between pyriproxyfen and microcephaly. 

Has this been noted elsewhere?

Time reports 12000 cases in Colombia, but laments at the end of their article:

The study authors note that in 2010, over half of all pregnancies in Colombia were unintended and less than half of sexually active women reported using a condom the last time they had sex, though 61% said they used contraception in general.
This shows the meme being pushed: the idea that sex without babies is the goal, and that if you don't delberately plan a kid, it's "unintended"

Ah, but for many people (including most people in the USA before the pill and the sexual revolution), babies just happened. You accepted the kid as part of life, and often behind this was the idea that there was a plan behind things, a karma, the will of God behind all things good and bad.

Yes,  Zika is a major public health worry, (albeit not as serious as Dengue, which is not being pushed with the hysteria of the Zika outbreak) but why does my paranoid mind think it's more about contraception than babies?

this is especially true if earlier outbreaks suggested only one percent of pregnant women who got the virus had a microcephalic baby.

update: more links to the original articles.

NEJM has several articles on it but the review article is HERE discussing the epidemiological studies that made them suspect the Zika virus, but notes why doctors were not as quick to blame the virus as the MSM:

This cautious approach toward ascribing Zika virus as a cause of birth defects is not surprising, given that the last time an infectious pathogen (rubella virus) caused an epidemic of congenital defects was more than 50 years ago, no flavivirus has ever been shown definitively to cause birth defects in humans,4 and no reports of adverse pregnancy or birth outcomes were noted during previous outbreaks of Zika virus disease in the Pacific Islands.
a;ctually, the outbreak in the Pacific Islands was too small to be significant, but in that epidemic the rate of microcephaly in infected women was one percent, which is small but higher than baseline.

Link for the NEJM preliminary report from doctors in Colombia.

Preliminary surveillance data in Colombia suggest that maternal infection with the Zika virus during the third trimester of pregnancy is not linked to structural abnormalities in the fetus. However, the monitoring of the effect of ZVD on pregnant women in Colombia is ongoing.
Translation: A lot of the moms who got Zika in early pregnancy haven't delivered yet, so data is lacking, but if you got Zika later in pregnancy you and your baby probably will do okay.

I should note that I've read anecdotal cases of Zika encephalitis in newborns causing the brain to shrink.

the NECSI report is here.

The strongest evidence is in favor of Zika, through the observation of Zika virus in neural tissue, though a key piece of evidence is missing in the expected rise of cases in other locations, specifically Colombia. Evaluation of the potential role of pyriproxifen is difficult due to the limited number and nature of available studies, which should be revisited as they include some evidence for neurodevelopmental toxicity. The possibility of DPT immunizations of pregnant women as a factor is largely ruled out by an increase in immunization in countries in which microcephaly cases are not being reported. There is no direct evidence for GM mosquitoes as a cause. If there is a dramatic increase in cases of microcephaly in Columbia in the next three months, the case for Zika will be dramatically strengthened, and the case for pyriproxyfen and GM mosquitoes will be essentially ruled out. On the other hand if the cases do not materialize, Zika will essentially be ruled out and pyriproxyfen would become the strongest case with GM mosquitoes a speculative alternative along with other environmental toxins.

their report on pyriproxyfen toxicity is here. 

summary: It's action and metabolite is similar to another chemical that can cause microcephaly, the toxicity studies claimed it was safe but did show problems, and the chemical was overused in Brazil, i.e. giving moms a higher dosage than elsewhere:

Finally, the pyriproxyfen use in Brazil is unprecedented—it has never before been applied to a water supply on such a scale. Claims that it is not being used in Recife, the epicenter of microcephaly cases, do not distinguish the metropolitan area of Recife, where it is widely used, and the municipality, where it is not. Given this combination of information we strongly recommend that the use of pyriproxyfen in Brazil be suspended pending further investigation.

Dengue? we have an app for that

IEEESpectrum reports that India has an app for Dengue fever outbreaks.

Researchers have developed a reliable early warning system for dengue fever outbreaks in Lahore, the capital city of the province of Punjab in Pakistan. Based on statistical analysis of dengue-related phone calls to a public health hotline, the system can track the incidence of symptoms down to the neighborhood and give local government officials a three-week heads up on potential outbreaks.

the article explains that many third world countries don't have the resources to spray/clean up everywhere, but if they get a headsup that there are dengue cases in the area, they can prioritize cleanup/ spraying in these areas.

Dengue spread via mosquitoes, and only can spread the disease if a person with dengue is in the area.... by noticing new areas with dengue cases, they can kill/stop mosquito breeding before the bugs spread the disease to more folks.

Friday, July 8, 2016

High cholesterol leads to less cancer? Or is it the statins?


If you have high cholesterol, you have less cancer.

If you are fat you have more cancer.

So is it because folks with high cholesterol take statins?

When statins first came out, the joke was that they lowered your death rate from heart disease, but the death rate stayed the same: one study showed an increase in bowel cancer in that group, another showed an increase in homicide/suicide.

later studies showed it was a coincidence.
So this is just an early question that needs investigation

Bipolar Mary Lincoln

I am always bemused when someone gets their two minute fame by deciding a famous person or epidemic is something different.

The latest: Mary Todd Lincoln, whose bouts of mania (hyperspending) and depression suggest a classic case of bipolar illness, instead is supposed to have suffered from B12 deficiency.

Uh no. B12 deficiency causes dementia, not mania.. and it was fatal back then, which is why they called it "pernicious anemia".

The article also says she had syphilis, a more common diagnosis that can cause mania, and would explain her walking difficulties at the end of her life.

However, her mood swings predated her marriage to Lincoln, which is more consistent with bipolar disease... or maybe a hysterical narcissitic personality. Maybe both: Her bouts of severe depression are well documented, but her buying sprees were what led to her son putting her in an asylum. She was released after a year, and lived several more years.

this would not happen with B12 deficiency

As for syphilis: It was a common diagnosis in those days since young men frequented the friendly ladies of the evening before marriage.

And Mary Lincoln might indeed have had tabes dorsalis.

more HERE.


Friday, July 1, 2016

Hanta virus is back

Nothing to worry about unless you live in the SW USA.

But New Mexico has reported a 4th case of Hanta virus.

Hantavirus infection is transmitted by infected rodents through urine, droppings or saliva. People can contract the disease when they breathe in aerosolized virus.

I was working in NM in 1999 after the bad outbreak... only one case in our area and none in our IHS hospital. But we had to screen for it...