Avian flu: the wrath of birdzilla or Polly got the sniffles?

The potential damage from an avian flu epidemic is huge, but unlikely. Currently, the virus affects birds and humans who handle dead birds. Only one case of suspected human-to-human transmission exists. If human-to-human transmission can occur with a new strain of the virus, we are susceptible to a pandemic. The many subtypes of influenza act and develop differently. The inflammatory response generated by the virus accounts for the illness. Vaccines are being developed, but the difficulties are real, and the time to success cannot be confidently stated. Lymphopenia, thrombocytopenia, and elevated liver enzymes are common. Treatment has to take into account societal issues as well as the individual health of every patient.

Planning for the HPV vaccine and its impact on cervical cancer prevention.

Genital human papilloma virus (HPV), the most common sexually transmitted disease in the United States, is associated with cervical cancer in women, and penile cancers in men. The infection is asymptomatic until a malignancy develops. Of the more than 90 subtypes, only a small number are associated with malignancies. Vaccines made with recombinant HPV proteins have been shown effective in preventing infection with the more virulent strains of the virus.

Treating the victims after disaster: physical and psychological effects.

Disaster victims present in waves. The initial presenting group is traditionally suffering from mild physical injuries, and the second wave, usually following 6 h later, typically has more serious trauma. Medical problems typically are not adequately treated when a person has psychological reasons to worry about survival. The third wave of victims from untreated medical problems occurs 6 d after the initial disaster. Triage of the initial waves is important to prevent the system from becoming overwhelmed and to begin looking for those who will suffer long-term psychological sequelae. Early intervention in those at greatest risk for long-term issues is important and can be accomplished.

Carbohydrate and calories: it is not what we used to think.

The majority of our diet consists of carbohydrates. Carbohydrates may be glycemic, which can be broken down and turned into simple glucose molecules quickly, or non-glycemic, which are not turned into sugar until they reach the large intestine. The glycemic index tells us how quickly the food we eat is turned into sugar and the glycemic load will give us absolute amounts of sugar introduced into the body by a food. Processing of foods and addition of fructose to the diet are major changes that correlate with weight gain in individuals. Decreasing carbohydrates in the diet goes along with a decrease in total calories in the diet.

Does long-distance running cause osteoarthritis?

There is a dose-response relationship between physical activity and the reduced risk of some diseases (eg, cardiovascular disease, diabetes mellitus). At a certain "dose," however, the reduced risk of some diseases may be offset by an increased risk of injury and osteoarthritis. Osteoarthritis can be caused by trauma to, or overuse of, the joints. Sports injuries often occur as a result of dysfunctions in balance or the musculoskeletal system operating in nonneutral mechanics. It is unclear if long-distance running causes the knee and hip joints to deteriorate. The results of animal studies reveal a pattern of increased incidence of arthritis in these joints when there is a history of injury or use in atypical environments (eg, laboratory settings). Human studies show an increase in radiographic evidence of osteoarthritis in endurance sports athletes, but no related increase in symptoms reported. Although there are not currently enough data to give clear recommendations to long-distance runners, it appears that long-distance running does not increase the risk of osteoarthritis of the knees and hips for healthy people who have no other counterindications for this kind of physical activity. Long-distance running might even have a protective effect against joint degeneration. The authors recommend further study.

Chromosome 21 abnormalities: a review and report of a case of Erondu-Cymet syndrome.

The co-existence of rare clinical findings in a patient with a genetic abnormality has often led to the characterization of new syndromes. Although these genetic syndromes are generally rare, the pathophysiology of these disorders has broadened our understanding of common medical conditions. The variety of disorders that map to chromosome 21 provide insight into the effects of lifelong low pO2 and poor perfusion on various organs. In discovering the different disorders that map specifically to chromosome 21, we can characterized, treat and even prevent some medical conditions. We present the case of a man whose incidental finding of hypoxemia lead to the discovery of many unusual disorders that appear to be related to abnormalities in chromosome 21.

Childhood obesity: normal variant or serious illness?

Obesity is a serious medical issue. Problems that develop in children with a high body mass index include high blood pressure, asthma, and cardiovascular disease at a young age. Obese children also have less upper body strength and decreased endurance. Early weight gain in the first week of life predicts later obesity. More televisions in the house and greater television watching also correlate with more obesity. Although male and female children rarely meet the minimum suggested amounts of nutrients, they exceed the suggested number of calories. Managing obesity should start before the teenage years. Food education has been shown to be an effective method of weight control.

As if the cancer wasn't enough! Understanding and treating the pain that comes with cancer.

In people with cancer, pain often occurs from the malignancy, from procedures done to diagnose, stage, and treat the malignancy, and from the toxicities of therapy used in treating the cancer. Of people with cancer, 75% complain of some sort of pain. Determining whether the pain is from tissue damage or nerve structures will guide therapy. Assessment of the severity of the pain by location, oncological type, as well as psychosocial and environmental factors are necessary to understand and treat the pain that accompanies cancer. Medical interventions include non-opioid analgesics, opioids, and multiple different combinations of medications. Adjuvant medication like anticonvulsants and steroids are being used frequently to help people feel more comfortable.

Shin splints: painful to have and to treat.

When people overuse their legs they develop an uncomfortable awareness of these limbs manifested as a dull burning or aching. The cause is often clear to the person with the problem as a result of the often obvious relationship to overdoing an exercise or activity and the pain. "Shin splints" is the lay term; physicians use the term medial tibial stress syndrome. The pathophysiology that leads to this pain is unclear, although there are a number of competing theories. Differential diagnosis includes stress fractures and compartment syndromes. Bone tumors or lipomas can also cause similar pain to shin splints. Diagnosis can be made by history alone in a majority of cases, but if the diagnosis is unclear, an X-ray and magnetic resonance imaging should be considered. Treatment is still mostly supportive and symptom related. Rest is the most important aspect of treatment. Locally applied cold and anti-inflammatory medication have also been felt to be beneficial.

Probiotics: the benefits of bacterial cultures.

Probiotics are bacterial cultures widely used in the treatment of disease. They are available without a prescription. Bacterial interference between types of bacteria and immunomodulation are the most common explanations as to why people may benefit from these treatments. The data on the use of probiotics in pediatric and adult diarrhea, inflammatory bowel disease, ileal pouchitis, urogenital infections, allergy, skin infections, and cancers are reviewed. Although generally safe, cases of complications from probiotic therapy are discussed, as well as potential problems that may develop.

A practical approach to fibromyalgia.

Fibromyalgia is the name given to a collection of symptoms with no clear physiologic cause, The constellation of symptoms are clearly recognizable as a distinct pathologic entity. The diagnosis is made through clinical observations made by the examiner. Differential diagnosis must include other somatic syndromes as well as disease entities like hepatitis, hypothyroidism, diabetes mellitus, electrolyte imbalance, multiple sclerosis, and cancer. Diagnostic criteria are given as guidelines for the diagnosis, not as absolute requirements. Treatment of this condition remains individualized and relies heavily on having a therapeutic relationship with a provider. Treatment of this syndrome needs to be looked at as an ongoing process. Goal oriented treatment aimed at maintaining specific functions can be directed at helping a patient get restorative sleep, alleviating the somatic pains that ail the patient, keeping a person productive, regulating schedules or through goal oriented agreements made with the patient. Since this syndrome is chronic and may effect all areas of a persons functioning the family and social support system of the person being treated need to be evaluated. Patients often seek alternative medical treatments for this problem including diet therapy, acupuncture, and herbal therapy. Treatment must involve more than just the symptoms presented and the patient can only be treated successfully if they are willing to work at changing their own perceptions, and ways of relating to stressors in their world.

Retrospective analysis of hiccups in patients at a community hospital from 1995-2000.

Hiccups are a physiologic phenomenon noted in animals and humans. There is little understanding of what makes hiccups occur and whether or not they have any productive purpose. A retrospective analysis of all patients seen in a community hospital over a 5 year period was conducted to see who is affected by hiccups, evaluate laboratory findings in people with hiccups, and to see what the currently accepted treatment is for hiccups. The vast majority of patients were male, older than 50 years of age, and with co-morbid conditions. Laboratory values appeared to be of little value in determining whether treatment interventions would be effective. Gastroenterology was the service most consulted and EGD the most common procedural intervention conducted, but with little success. No treatments showed a statistically significant effect.