Public Health

August 31, 2007 on 12:44 pm | In Uncategorized | Comments Off Pulled from the Brink: Remember the girl who survived rabies? How's she doing? Very well:

Twenty-seven months after exposure, the patient continued to have fluctuating dysarthria and gait difficulties, plus an intermittent sensation of cold in the feet. She had no difficulties with her instrumental activities of daily living, including driving. In high school, she took college-level courses in English, physics, and calculus. She scored above average on a national college achievement test, graduated from high school in 2007, and planned to attend a local college in the fall. She had no problems with peer relations or mood disorders.

Alas, others have been unable to duplicate the success of her treatment, so if you are bitten by a bat be sure to get your rabies shots.

August 31, 2007 on 12:27 pm | In Uncategorized | Comments Off Remembering Katrina: The medical feats we didn't hear about:

Besides rescuers and local first responders, another big story at the Dome was the medical center. Like a Chinook helicopter landing on your roof, that sure was hard to miss. Fifteen doctors and a total of 65 medical personnel set up at the New Orleans Arena, within spitting distance of the Dome. It was primarily for survivors brought in by air and boat, but also for people in the Superdome with medical problems. There was never any shortage of medical care, Dressler and Bush both said.

The Arena medical center cycled through triage and treatment of up to 5,000 injured or sick victims, Dressler said. Those in the worst shape were evacuated to the New Orleans airport and out of the region, those in good shape hydrated and sent to the Superdome. The success of the makeshift medical center was such that there were just six deaths at the entire Superdome complex: four of natural causes, one drug overdose, and one suicide during the week of supposedly rampant anarchy and death.

Triage (there was another medical facility at the airport) may have been the most critical element in limiting deaths once the levees broke and the city flooded. Rescue operations were brisk, but survivors of that kind of trauma aren't always coherent or aware of their own life-threatening injuries, particularly dehydration. Absent care, hundreds if not thousands could have died even after they were rescued and brought to the Dome.

Most of the national media also neglected to mention the seven babies that National Guard physicians delivered, something Maj. Ed Bush said he pointed out repeatedly. Overall, the false claims of up to 200 dead at the Dome, including murder victims, had clueless FEMA officials showing up at the end of the week with a refrigerated 18-wheeler to claim the stacks of bodies.

And questions unanswered.

Competitive swimming linked to lower back injury

August 11, 2007 on 11:41 am | In Uncategorized | Comments Off NEW YORK (Reuters Health) - Elite swimmers appear to experience higher rates of lower back disk degeneration than recreational swimmers, study findings suggest.

A screening study of 56 male and female competitive swimmers identified lower back disk degeneration in 68 percent, report Dr. Koji Kaneoka, University of Tsukuba, and colleagues at the Japan Institute of Sports Sciences.

By comparison, among 38 male and female recreational swim club members, lower back disk degeneration was evident in 29 percent -- a rate similar to that of the general population, the researchers note in the American Journal of Sports Medicine.

Kaneoka and colleagues suggest that "excessive competitive swimming activities" may account for higher rates of disk degeneration among the elite swimmers, who had been swimming, on average, more than 49,000 meters weekly for over 9 years. The recreational swimmers, on the other hand, reported swimming about 8,400 meters weekly for 5.4 years, on average.

Using magnetic resonance imaging, the investigators spotted disk degeneration in the lumbar spine in the both groups of swimmers, particularly between the fourth lumbar (L4) and the first sacral (S1) vertebrae - the area where the lower back joins the pelvis.

The competitive swimmers had significantly higher rates of degeneration, 27 and 43 percent in the L4-L5 and L5-S1 disks, respectively, compared with rates of 13 and 21 percent in the recreational swimmers.

There was no relationship between disk degeneration and the swimmers' most frequently used strokes.

Kaneoka's team undertook the study after three of 39 members of the Japanese national swim team were impeded by lumbar disk herniation in an international competition. Despite the findings from the current study, however, the researchers say further investigation is needed to confirm any association between swimming frequency and duration and disk degeneration in the lower back.

SOURCE: American Journal of Sports Medicine, August 2007

Copyright © 2007 Reuters Limited.

Hearing test may spot babies at risk for SIDS

August 11, 2007 on 11:41 am | In Uncategorized | Comments Off NEW YORK (Reuters Health) - A subtle difference in responses on a newborn hearing screening test may identify babies who are at risk for sudden infant death syndrome (SIDS), according to a new study.

A disruption of the function of the inner ear may interfere with not only hearing but also with a baby's control of breathing during sleep, the researchers explain in the medical journal Early Human Development. This defect in the inner ear of newborns can be detected with a particular hearing test, called "transient evoked otoacoustic emission" or TEOAE.

Dr. Daniel D. Rubens from Children's Hospital & Regional Medical Center, Seattle, and associates compared the TEOAE screening results of 31 infants who subsequently died of SIDS with those of 31 matched healthy babies.

The hearing responses tended to be higher on the right side than on the left among the normal babies, but tended to be higher on the left side in the infants who succumbed to SIDS.

"The direction of the asymmetry among the SIDS infants was reversed and it further supports the potential application of newborn hearing tests for identifying at-risk infants," the investigators write.

They have planned several animal studies to investigate the possible association between inner ear damage and breathing control, and to shed light on the mystery of sudden infant death syndrome.

"The animal study findings will hopefully turn things around to substantiate the understanding of the mechanism of death," Rubens said. "I expect results from the animal study within 3 to 6 months."

SOURCE: Early Human Development, online July 3, 2007.

Copyright © 2007 Reuters Limited.

Magnetic stimulation may ease ringing-in-the-ears

August 11, 2007 on 11:41 am | In Uncategorized | Comments Off NEW YORK (Reuters Health) - For some people with chronic tinnitus -- a persistent, inescapable sensation of ringing in the ears -- repeated magnetic stimulation through the cranium appears to provide temporary relief, Italian researchers report.

However, enthusiasm for repetitive transcranial magnetic stimulation, or rTMS, for tinnitus "should be tempered," Dr. Simone Rossi told Reuters Health. "The beneficial effects of rTMS are short-lived, and only about a half of tinnitus sufferers may benefit from it."

Tinnitus affects millions of people, and in some it can lead to psychiatric distress, sleep disturbances, and work impairment, Dr. Rossi of the University of Sienna and colleagues point out in the Journal of Neurology, Neurosurgery, and Psychiatry.

The team tested the effects of rTMS in 16 patients with tinnitus. They underwent active treatment and sham treatment in random order, without knowing which was which.

During sessions on 5 days, the coil generating the magnetic field was positioned close to the skull over the left temporal region for active treatment; in the sham set up, the coil was positioned at 90 degrees to the head so that the magnetic field pointed away from the brain.

Two patients actually dropped out because of worsening symptoms, the researchers report, but eight patients responded.

Among the responders, subjective tinnitus scores improved by an average of 35 percent, but the condition returned to original levels after 2 weeks.

This good, albeit transient, response, said Rossi "might indicate that the brain reacts somewhat positively to stimulation."

These data "could help in the selection of tinnitus patient candidates for more invasive, chronic, neuromodulatory strategies such as epidural implants on the auditory cortex," Rossi added.

He was referring to what he described as a "sort of pacemaker for brain stimulation." Work on such a device "is in progress in this sense in many labs."

SOURCE: Journal of Neurology, Neurosurgery, and Psychiatry, August 2007.

Copyright © 2007 Reuters Limited.