Food Bolus Impaction: Where Ration is the Right Action

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We have all experienced what an incessantly hectic work-day is like – one in which we don’t even have the time to get a bite to eat; and consequently, when the time finally comes…when we get a hold of that meal, we tend to ingest the food – or rather, inhale it – as quickly as humanly possible in hopes of promptly satiating our stomachs. Yet, when food is devoured quickly and in large quantities it can become obstructed, a condition known as a food bolus impaction. In some cases, the impaction will spontaneously resolve, but when it doesn’t, it becomes a dangerous situation in which patients will require an emergency procedure. Frequently, patients who suffer from a food bolus impaction possess structural abnormalities that predisposes them to an esophageal blockage, and in a preponderance of cases, patients are unaware of these anatomical deformities. Therefore, it is important for the public to learn about all the risk factors associated with a food bolus impaction, as this may someday save them or someone they know from a life-threatening choking episode.

When food is ingested, it has to traverse from the oral cavity into the 10-inch esophageal tube. The esophagus contains three naturally occurring areas of narrowing and, not surprisingly, these are the most common sites of food bolus impactions. In addition to this, patients may also have internal anatomical aberrations which could lead to a blockage, and these include: diverticula (protruding pouches); rings (extraneous tissue that extends from the inner wall); strictures (areas of narrowing due to scar tissue formation); and tumors. Patients with a food bolus impaction will typically present with difficulty swallowing and neck pain. However, in severe cases, they will manifest the following symptoms: choking, drooling, regurgitation of food, wheezing, and respiratory distress. The diagnosis is generally made by direct visualization of the food item via an endoscope, which is a special camera that can be inserted into the esophagus. The treatment involves the use of tools attached to the endoscope which allow the physician to break up the food item, push it forward, or retrieve it. If the gastroenterology specialist detects any of the aforementioned structural abnormalities, they can also treat those via the endoscope.

Food bolus impactions can cause significant complications (e.g. pulmonary aspiration of the food particles), and as a result, these obstructions need to be treated within 12 hours of onset. One may have heard of patients receiving a substance known as a meat tenderizer (a chemical used to degrade meat products) to get rid of an esophageal impaction, but this is no longer recommended as it can cause a perforation of the esophagus. Oftentimes, patients with the aforementioned anatomical abnormalities will have noticed that their food sluggishly treads down the esophagus, a classic warning sign of an inhibiting lesion. Nevertheless, whether you have a predisposing medical condition or not, you can still get a food bolus impaction, so taking proactive measures is an easy alternative. Thus, take your time while eating and make sure that you carefully chew your food, given that this will save you from an untimely Heimlich maneuver and the business end of an operating room endoscope.

Impetigo: The Trials of Job for the Toddler and Child?

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Children have the uncanny ability to transmit infections quickly and easily to those around them – a fact which most of us have witnessed that first hand. Moreover, it seems that whatever disease they get, ends up replicating exponentially. One such example is the disease, impetigo, a superficial bacterial skin infection characterized by its honey-colored crusted lesions around the face. It’s a widespread condition that annually affects around 140 million people worldwide and although it commonly affects children, it is not isolated to this population. Luckily, impetigo is simple to treat, oftentimes only requiring topical antibiotics. Yet, if it is not detected and treated early, impetigo can proceed to cause a deeper infection, one which poses the ability to significantly scar the skin. In addition to this, given its efficient mode of dissemination, the public should take active measures in an effort to prevent the spread of infection.

Impetigo can manifest on normal skin (aka primary impetigo) or it can be the result of a microbial infection on damaged tissue, such as the site of an abrasion or laceration. The most commonly isolated bacteria include staphylococcus aureus (a frequent cause of skin infections) and streptococcus (a microbe that causes strep throat). Impetigo is usually seen in children between the ages of 2-5 and the infection is known to proliferate in warm and humid environments. The clinical manifestation includes an array of small bumps that turn into fluid-filled sacs, all surrounded by a red border, which after about a week, turns into a golden colored crust. Patients can have enlarged lymph nodes around the area of infection but systemic and more common symptoms such as fever are typically absent. Transmission occurs via direct contact of the infected site and the lesions classically appear over the face and extremities. There are other forms of impetigo which are more serious and these usually exhibit deep ulcerated skin lesions. The diagnosis can be made by physical examination alone, but a wound culture could also be obtained if there is a need to determine the specific bacterial source. The treatment for uncomplicated impetigo includes topical antibiotics such as mupirocin; however, if a patient has severe impetigo (e.g. widespread lesions) they will almost certainly require oral antibiotics.

Since impetigo is mostly a disease common among children, it is important for parents to teach their kids proper hygiene and disease prevention. Adhering to the following practices will help avert an infection: frequent hand washing with soap and water; not sharing towels, clothes, or other personal items where bacteria can be present; covering sections of the skin with active infections so that it doesn’t spread to other segments of the body or to other people; and using disposable tissues given that impetigo is frequently found on the face. If your child develops the classic crusted lesions, a topical antibiotic treatment for five days should suffice. Furthermore, it should be emphasized that prompt treatment for impetigo is critical, as it will not only reduce the risk of the infection spreading but will also avoid a potentially embarrassing or even unsightly appearance.

Listeria – Consider the Conspicuous Cautions

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It may come as a surprise that a current outbreak of Listeria monocytogenes has reached 11 states and confirmed to have caused 3 deaths. Consequently, the CDC (Centers for Disease Control and Prevention) has put out a general announcement advising the public to avoid the consumption of prepackaged caramel apples, given that 88% of those currently infected with Listeria reported eating this specific item right before they became ill. Listeria is a well-known bacteria which humans generally acquire through the consumption of contaminated food and, although it can affect anyone, it can be particularly dangerous in pregnant females and those with a weak immune system. Infections with Listeria largely occur as sporadic events but occasional outbreaks, such as with the caramel apples, still occur. It is important to note that among food-borne infections, Listeria has been rated as the third most deadly. Therefore, when the CDC issues an advisory, it’s important that the public pay attention. Additionally, people should familiarize themselves with the general risk factors associated with Listeria in the interest of avoidance.

Listeria’s primary habitat is soil and decaying vegetable matter, with healthy appearing animals often acting as carriers. One of its most interesting properties is that it has the ability to survive and multiply in refrigerated temperatures; so even if a product is initially minimally contaminated, when exposed to this environment it can quickly get saturated with Listeria. The typical clinical manifestation involves a gastroenteritis-type condition in that patients present with fever, vomiting, diarrhea, and joint pain. This occurs within 24 hours of the bacterial ingestion, making it easy for people to decipher the root cause of the infection. On the other hand, if Listeria becomes invasive and spreads throughout the body, patients can develop sepsis (critical illness as a result of bacteria in the bloodstream), brain abscesses, or meningitis. Scientists have delineated a set of risk factors which predispose patients to developing the severe form of illness, which include: pregnancy, steroid treatment, having diseases such as cancer or diabetes, and being at the extremes of age (i.e. an infant or an elderly individual). As opposed to the gastroenteritis manifestation, the bloodstream materialization has an incubation period (time between disease acquisition and manifestation of illness) of approximately 35 days. The diagnosis is made with a combination of the clinical presentation, stool tests, blood culture samples, and spinal fluid analysis. The treatment consists of antibiotic medications.

The public can play an active role in minimizing the chances of infection by adhering to the following measures: washing raw vegetables before consumption, keeping refrigerator temperatures below 40F, cleaning knives and cutting boards after handling uncooked food, eating precooked meals as soon as possible, thoroughly cooking raw food that comes from animals, and drinking pasteurized milk. Moreover, for individuals in the aforementioned high-risk categories, additional practices should include avoiding soft cheeses, refrigerated smoked seafood, and prepackaged salads containing chicken and eggs. For the most part, patients with a normal immune system will fully recover from a Listeria infection. However, for patients at high risk for critical illness, extra precautions need to be taken, as a severe Listeria infection can result in death.

Q Fever – Avoid a Quizzical Quandary

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The mad cow disease epidemic reached its peak in 1993, when authorities reported that they were witnessing an all-time high of 1,000 new cases per week; and consequently, mad cow disease quickly became the subject of headlines throughout the world. Since then, strict regulations have been developed for the cattle industry in an effort to protect the public from developing a critical illness. However, serious disorders brought about by cattle still occur, with some now being far more prevalent than mad cow disease. One such example is that of Q fever, a disease caused by the bacteria coxiella burnetii, distributed worldwide and mostly acquired via farm animals. Its clinical manifestation resembles a variety of other syndromes, making it difficult for physicians to accurately diagnose their patients. Moreover, it also has a long incubation period (time from disease acquisition to presentation), adding another element of complexity given that patients don’t necessarily make an association between the animal exposure and the disease itself. Naturally, being acquainted with the typical symptoms of Q fever is recommended but more importantly, is that people learn to recognize who is at risk for the development of this infection.

The bacteria that causes Q fever is known for its ability to withstand heat and other harsh environments, and as a result of this, they can survive for prolonged periods of time. As mentioned, coxiella burnetii is commonly found in cattle, but can also be seen in sheep and goats. The infected animals shed the bacteria in their urine, feces, milk, and placenta; and because the animals only act as carriers, they don’t portray symptoms of illness. A human acquires the bacteria when they inhale dust that has been contaminated with any of the aforementioned products. Once this occurs, it may take up to 20 days for the patient to develop any physical symptoms. Patients with an acute infection will typically develop fever, cough, malaise, and can proceed to develop pneumonia and hepatitis (liver inflammation). On rare occasion, patients may also develop meningitis and myocarditis (inflammation of the heart muscle). The diagnosis is made with a combination of the physical exam and pertinent historical data (e.g. exposure to farm animals), as well as with a specialized blood test. The treatment includes antibiotic medications, although in some cases patients will have spontaneous resolution of disease.

The bulk of cases witnessed in the U.S. have been verified in the following groups: veterinarians, meat processing plant workers, sheep and dairy employees, livestock farmers, and those working in research facilities. If involved with farm animals, one should make sure there is adequate disposal of high risk tissue (e.g. placenta). Employees of designated research facilities should have an appropriate method to bag and wash laboratory clothing. Lastly, even for those who are not directly involved with farm activity, it’s recommend that they strictly adhere to pasteurized milk products. Although vaccines have been developed for Q fever, the only available type in the U.S. is reserved for those doing specified research with at-risk animals. As with any other disease, the main focus should be on prevention; but if Q fever is acquired, there is no need for panic – the overwhelming majority of patients with this illness enjoy a full recovery.

Yeast Infections: Easily Gotten; Easily Dismissed

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Constant vaginal burning and discomfort are certainly considered disconcerting symptoms for most women, not to mention the fact that they also bestow a token of embarrassment. Unfortunately, these signs are all too familiar to most females and are typically encountered when a woman acquires a vaginal yeast infection. Data shows that 75% of females have had at least one formal diagnosis of a yeast infection during their lifetime, with half of these women stating that they have had more than one episode. Oftentimes, the clinical symptoms of this condition might be confused with those associated with sexually transmitted diseases, but yeast infections are not considered as such. Most yeast infections are caused by candida albicans, a fungus which actually forms part of the normal microbes found in the vaginal canal. It only causes disease when it enters the local cells and propagates within the region. The good news is that even though yeast infections bring about some uncomfortable symptoms, they are generally not considered dangerous conditions; and the treatment for this disease is both simple and highly effective.

Scientists have proposed that the candida fungus migrates from the rectal area into the vaginal canal, where the infection can either be a sporadic event or it provoked by a series of medical circumstances. The most commonly noted risk factors include: A) poorly controlled diabetes, given that the excess glucose acts as a prodigious agent for the growth of the fungus; B) antibiotic use, since taking the antimicrobial drug suppresses all other normal organisms, eventually allowing the fungus to dominate the region; C)an increase in estrogen (e.g. pregnancy or birth control pills), which has the ability to stimulate candida growth; and D) immunosuppression, as the cells that normally protect you from an infection are not properly functioning. Symptomatic yeast infections present with a burning sensation in the vaginal region as well as burning with urination, localized soreness, irritation, and pain with sexual activity. The diagnosis is made with a combination of the clinical examination and a vaginal sample laboratory test. The treatment includes antifungal medications, which can be taken as an oral drug or a topical formulation, which studies have shown work with equal efficacy.

Severe yeast infections (generally seen in those who present with more than 4 episodes per year or in patients who a deficient immune system) will require a prolonged treatment course. Moreover, for those interested in preventative methods, taking long term suppressive therapy (e.g. taking antifungal medication for 6 months) helps to prevent disease recurrence, with the caveat that this is only effective while the patient is actively taking the medication. Other measures, such as taking probiotics, garlic, or douching, are not considered effective. In addition to this, studies have demonstrated that there is no true relationship between wearing tight clothing and the development of an infection. Most women have infrequent and mild infections, and in this category, taking the topical antifungal will suffice. Yet, more importantly, all women should be aware of the fact that they can immediately start the antifungal topical medication on their own, given that this is conveniently found over-the-counter and is considered a benign drug.

Zinc – The Silver Bullet for the Common Cold?

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We all look forward to enjoying the festive holiday season – a special time filled with family gatherings and snow-covered scenery; however, what we don’t anticipate with as much excitement is the possibility of acquiring the ever-present common cold. Most adults are familiar with the classic symptoms of this malady: days of incessant coughing, a mucus flow that never ends, uncontrollable sneezing, and a generalized feeling of malaise. In approaching the “cough and cold” pharmacy aisle, some quickly realize that there are numerous treatment options, but they key in on the fact that the ingredient of zinc is repeatedly used in a variety of formulations. The reason for this is that in 1970, scientists reported that zinc had the ability to inhibit the replication of the rhinovirus (one of the causative agents of the common cold), and since then zinc has been included in a number of medicines. Some studies have declared that zinc has favorable results while others have stated that the data is inconclusive. Despite these conflicting efficacy results, the fact remains that zinc is included in a multitude of products designed to target the common cold; consequently, consumers should become familiar with what zinc is and how it works.

Zinc is an essential trace element which is usually obtained through protein-laden foods. It is absorbed in the small bowel and stored in the kidney and liver. Zinc plays an important role in numerous biological reactions, and one of its most critical tasks involves helping the immune system adequately respond to infections. Reports have even stated that zinc might be able to block the effects of certain microbes. Through the examination of patients who are zinc deficient, we have been able to better clarify what zinc does in the human body. For example, patients who lack a substantial amount of zinc are found to have a depressed immune system, an impaired sense of taste and smell, decreased vision, and a reduction in sperm production. Recent studies focused on zinc treatment as a remedy for the common cold have found that zinc is able to reduce the duration and severity of illness, and this response is enhanced when patients take zinc within 24 hours of the onset of symptoms. The most commonly reported side effects of zinc treatment include bad taste, nausea, and anosmia or the inability to perceive odor (especially notable with the intranasal formulations).

Many scientists note that the significant heterogeneity among the published clinical trials (e.g. individual studies use different dosages and constituents of zinc) makes it difficult to arrive at a solid conclusion. Nonetheless, if someone decides to take zinc as a medical therapy for the common cold, it is best to go with the syrup or lozenges than with the intranasal form (due to risk of anosmia). Zinc supplementation is relatively safe, but the bottom line is that whether you bulk up on zinc or not, the cold will eventually resolve on its own. Therefore, focusing your efforts on adequate hydration and a proper diet will probably help you get rid of the cold faster than any other medical supplementation.

Waterborne Giardia Parasite – Spend Time Outdoors? Keep Your Guard Up.

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Camping and hiking are recreational outdoor activities that we all enjoy, and even though these leisure-time endeavors may be thought of as lax and unregimented, they still encompass a set of essential standard guidelines that we should all follow. One of the most critical rules for those who engage in outdoor and wilderness activities is to make sure that the drinking water is adequately filtered; because if not, you might come face to face with the notorious waterborne parasite known as Giardia Lamblia. This parasite is abundant in mountainous streams and has a reputation for causing a severe diarrheal illness. Moreover, the signs and symptoms of this illness can mimic many other gastrointestinal disorders, oftentimes leading to a delay in proper diagnosis. Therefore, everyone should familiarize themselves with the classic clinical symptoms of Giardia, but most importantly, the focus should be on learning the parasite’s mode of transmission in order to prevent the acquisition of the disease.

Giardia is frequently found in bodies of water worldwide and exists in two forms. When the parasite is in the water it is contained within a protective capsule known as a cyst – a structure in which the parasite can survive for a prolonged period of time. When a human ingests cysts from an infected source, such as stream water, the parasite breaks the capsule and attaches itself to the intestinal tract, resulting in the clinical manifestation of disease. As the parasite exists the colon it reverts to cyst form and is passed back into the environment through the excretion of feces. Most patients with symptomatic Giardia present with fever, diarrhea, nausea, vomiting, weight loss, and abdominal cramping. The diagnosis is made through an analysis of a stool sample. The treatment generally involves hydration, replacement of electrolytes, and antibiotic treatment. Of note, the Giardia cysts can also be transmitted from person to person as well as through contaminated food. Interestingly, a person with Giardia may remain asymptomatic for several weeks, which poses a problem as they continue to disseminate disease without ever realizing that they were infected to begin with.

Young children less than 5 years of age are reported to have the highest rates of infection and special attention should be given to this population. Daycare outbreaks are not uncommon and, in this setting, caretakers should make sure that they frequently wash their hands and take extra caution with diaper disposal (these can contain the infectious cysts). For those who are in the outdoors, being diligent about water filtration will be the key to preventing disease. Campers have the option of either boiling the water to 70 degrees Celsius for 10 minutes or they can use an iodine based water filtration system. These are the two preferred methods because Giardia cysts are known to be resistant to chlorination. Whether you are inside the home with your children or enjoying the bounties of nature, remember that practicing proper hand hygiene and drinking sterilized water when outdoors will be the principal interventions that will keep you and others from getting seriously ill.

Xenical – X-Out the Fat!

ALLI ET XENICAL, LA MOLECULE ORSILAT

The unrelenting obesity crisis continues to plague American life, with recent statistics stating that it is affecting 78.6 million adults. Consequently, many health and wellness companies are focusing on developing a product that can help constrain these numbers. Among the many marketed items focused on obesity is a drug named Xenical, approved as a prescription drug in 1999 and subsequently made available over-the-counter in 2007 (with the retail name Alli). Moreover, as opposed to some of the other over-the-counter medications, Xenical comes with a significant amount of background research and data, given that the drug has been extensively tested since its first introduction into the market. After careful analysis of the vast research, scientists have confirmed that Xenical is a safe drug, a conclusion that the FDA (Food and Drug Administration) agreed with, as demonstrated by the fact that the drug is currently sold without a prescription. Yet, notwithstanding its safety profile, it is still important to understand the drug’s mechanism of action and its potential deleterious side effects.

When a human consumes fat, an enzyme (a protein involved in a biological reaction) found in the pancreas is released. Its function is to break down the fat into smaller elements that can later be absorbed by the intestines. Xenical works by blocking this pancreatic enzyme, leaving the large fat compound intact and unable to be absorbed. The fat compound washes away in the gastrointestinal system and is eventually excreted with the stool. Studies have shown that Xenical is a very effective weight loss drug and it is also safe for the cardiovascular system. [This is in contrast to drugs that contain ephedrine, which can increase the blood pressure and heart rate.] In addition to this, Xenical has also been found to have other beneficial reactions, such as lowering blood pressure and cholesterol levels. Xenical’s predominant side effects include an increase in abdominal cramps, gas, and the development of oily stools. It can also reduce the absorption of the fat-soluble vitamins (A, D, E, and K) and patients taking Xenical are advised to purchase multivitamin supplementation. Lastly, Xenical could increase a patient’s risk for the development of kidney stones, so patients with a history of this should consider alternative treatment. Of note, some reports in the literature state that Xenical can induce liver injury but scientists have determined that Xenical is not the specific causative agent.

The most commonly cited side effect, that of oily stool, can be reduced if patients lower their fat intake to less than 30% of fat per day. If patients adhere to this, not only will they experience a reduced instance of side effects, but also the beneficial results of the drug will be enhanced. When deciding whether or not to purchase this drug for use, the buyer must consider that, like many other drugs or forms of treatment, the effects are increased when also engaging in additional healthy habits, such as routine exercise. Furthermore, as with any other medication or supplement, it is wise to consult your physician before engaging in this drug therapy; this will result in a well-informed decision that will allow people confidence that they are embracing weight loss in a safe manner.