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.
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.
The blog will continue next week.
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.
When the subject of cardiovascular disease comes to mind, most people immediately picture an adult patient with a history of a heart attack; and not surprisingly, the reality is that this is the most commonly witnessed scenario. However, it is essential for people to understand that cardiovascular disease is not isolated to adults, and in the case of Kawasaki syndrome, a condition in which there is diffuse inflammation of the blood vessels, children are the affected population. Although most documented cases in the U.S. have been seen in patients of Asian descent, Kawasaki has been noted across all ethnic groups. Kawasaki is a dangerous disease for two main reasons: first, is that it can mimic a multitude of common childhood syndromes such as mononucleosis and measles, and this similarity oftentimes leads to a delay in diagnosis; the second reason is that this disease is known for its ability to cause fatal cardiovascular complications. Therefore, it is critical for parents to familiarize themselves with the signs of Kawasaki disease, given that brining a child for an early evaluation will be the most significant intervention for a reduced risk of complications.
Kawasaki is an inflammatory systemic disease that has a predilection for the arteries within the heart. The immune system’s abnormal reaction is known to cause destruction and breakdown of the vessel architecture. Kawasaki is typically seen in children under the age of 5 and they classically present with: fever; conjunctivitis in both eyes; mucositis, cracked red lips with a particularly red and bumpy tongue; rash; swelling of the hands and feet; and enlarged lymph nodes on the neck region. The symptoms of disease will usually last about 12 days. Major complications associated with Kawasaki include: coronary artery aneurysm, an abnormal dilation of a heart vessel that could lead to arterial rupture; a decrease in cardiac muscle contractility which may progress to heart failure; and blockage of the peripheral arteries resulting in reduced blood flow and gangrene. The diagnosis is made on the basis of the clinical history and an examination, but it may also include blood tests and special imaging studies. The treatment involves aspirin, a commonly used blood thinner, and an infusion of a drug known as IVIG (Intravenous Immunoglobulin), which decreases the inflammatory response.
Children with Kawasaki have an increased mortality rate within the first two months of disease but this is mostly seen in those who have other cardiovascular conditions. Moreover, scientists have also delineated that children who meet any of the following criteria (male gender, < 1 year of age, or fever >14 days) are at high risk to develop the ominous cardiac complications. In addition to this, it is important to note that Kawasaki is not confined to the cardiovascular system, as it can also involve the gastrointestinal tract and the kidneys. The good news is that Kawasaki is generally considered a self-limited condition and most children do well even in the absence of any treatment. Nevertheless, given that we can’t always accurately predict who will develop serious complications, if a child’s symptoms are suggestive of Kawasaki disease, the best course of action is for parents to immediately contact the pediatrician.
Sometimes, a person will go to bed expecting a full night’s sleep and a refreshing morning start, but they wake up to a surprise: they’re unable to physically walk. An examination of the feet reveals that one of the joints appears to be swollen and painful to the touch, even though the person didn’t experience any recent traumatic injuries. This common scenario, experienced by 8 million Americans, is the classic presentation of a medical condition known as gout: joint inflammation caused by the deposition of uric acid crystals. It can be induced by a series of external factors, such as the intake of certain medications or dietary foods, or it might be affected by an inherent cause such as the excessive production of uric acid. In addition, gout not only can be an extremely painful condition, it can also lead to permanent destruction of the underlying bone and cartilage. Therefore, patients with this condition should focus on seeking prompt treatment, as this will help reduce the risk of complications.
In order to understand how a patient develops gout, we must first review the physiology of the key chemical compound. When the body breaks down substances known as purines (organic compounds found in liver, beans, and beer) it produces uric acid. This chemical dissolves in the bloodstream and is eventually excreted through the urine, but if it does not liquefy appropriately, crystals will be formed and deposited throughout different sites within the body. Gout is a disease that occurs when the uric acid crystals within the joint cause an inflammatory response and, although having an elevated amount of uric acid predisposes a patient to gout, the disease manifestation only occurs if the body’s immune system reacts abnormally. Typical joint gout presents with a tender, swollen, red joint, and this is frequently noted on the big toe. The diagnosis is made by extracting fluid from the joint space and visualizing the uric acid crystals under a microscope. The treatment generally involves anti-inflammatory medications (e.g. ibuprofen), a medication known as colchicine (blocks the inflammatory process caused by uric acid), and either steroid injections into the joint space or oral steroids. Even in the absence of any treatment, most gout attacks will eventually subside.
Gout is customarily encountered on the extremity joints but is not isolated to that region; patients can develop disease in places such as the spine. Due to the fact that gout is an uncomfortable condition which can lead to major disability, patients should focus on the modifiable factors that can aid in the reduction of gout flares. Decreasing the consumption of animal proteins, fat, and alcohol (all known to increase uric acid levels) will help diminish the number of joint gout attacks. Remaining compliant with medications for diseases such as renal failure will also ensure that the uric acid can continue to be adequately excreted through the kidneys. Finally, for those who suffer from frequent recurrent episodes, taking long-term uric acid lowering drugs may provide prolonged protection. For those prone to this disease, whether due to genetics or medical history, remember that adhering to a proper diet and treatment is most critical in the prevention of future gout attacks.
It is estimated that 92% of adults in the U.S. suffer from dental infections, a strikingly high number when one considers that most of these cases are both treatable and preventable. What is even more surprising is that data shows that a significant number of people do not participate in the recommended routine dental care visits and, as a result, they end up having to seek emergency medical treatment for their dental disease. Emergency rooms in the U.S. see approximately one million patients per year for dental conditions, and more than half of these patients are there with dental cavity-related pain, an ailment which can easily be avoided. Untreated dental infections can lead to severe complications such as the spread of bacteria into the deep facial tissues, bone, and blood stream. Fortunately, most people can prevent the acquisition of serious dental disease with proper preventative care; consequently, focusing on obtaining regularly scheduled dental evaluations should be a priority.
In order to understand the physiology of dental disease, we must first review dental anatomy. The tooth forms a peg and socket joint with the bone, and it is held in place by the periodontal membrane tissue. The outside structure of the tooth is covered by a hard material known as the enamel, whereas the inside framework is composed of the pulp, a soft tissue matter composed of nerves and blood vessels. The body is equipped with a series of mechanisms to protect the architecture of the tooth. For example, the tongue helps to cleanse the teeth and the saliva both washes away bacterial acids and acts as a protective barrier. Additionally, the body also produces antimicrobial proteins to aid in this process. Any break in this system, such as a decrease in saliva production or an excessive increase in acid formation, can predispose the tooth to dental decay and bacterial infection. There are a few notable risk factors that may lead to dental disease and they include a genetic predisposition, diabetes, and hormonal changes (which make the gum more sensitive). Patients with an early dental cavity will present with an area of discoloration on their affected tooth, but if the infection makes its way into the pulp, patients will experience severe pain. The diagnosis can be made with a clinical examination and x-rays. The treatment will vary with the degree of infection but it may include a filling, a crown (an artificial tooth cap), root canal (procedure to remove the infected pulp), and tooth extraction.
Routine dental care, both with the dentist and at home, will avert most dental infections. Fluoridation (the addition of fluoride) of the water, currently present in about 2/3 of U.S. states, is a critical factor that aids in the reduction of dental infection. Other key interventions include regularly brushing your teeth with fluoride toothpaste; flossing after every meal; a reduction in sugar rich foods and beverages, which are known to increase acid production; using oral antimicrobial rinses; and cessation of smoking. Adhering to the aforementioned practices will not only guarantee your dental health, but also will result in the likelihood of painless trips to the dentist.
Every year, 300,000 patients head to the operating room for the repair of an acute intestinal obstruction, a potentially life- threatening condition in which the products of digestion are trapped in the bowel. This can occur as a result of a physical blockage (e.g. presence of a mass) or because there is aberrancy in the normal bowel physiology. Although there are numerous causes for this condition, the most commonly recognized one is the presence of adhesions, which are scar tissue formations that occur after any surgical intervention. Unfortunately, an intestinal obstruction may cause a number of non-specific symptoms that can mimic a great variety of bowel disorders, leading some patients to stay at home as they incorrectly attribute their symptoms to a benign illness rather than a bowel obstruction. Because the mortality risk of this disorder is directly proportional to the duration of illness, it is critical that patients undergo a prompt evaluation and diagnosis. If recognized early, conservative treatment might suffice, but if the intestinal obstruction has been present for a prolonged period of time, emergency surgery will surely be warranted.
In order to understand why an obstruction occurs, one must first review the normal intestinal physiology. When food enters the small intestine, the nervous system signals the initiation of a process known as peristalsis, a muscular contraction that pushes the food through the rest of the bowel. Any anomaly within this operation will impede the flow of intestinal contents. During an obstruction, the bowel wall above the blocked site stretches and this thinning leads to a decrease in blood flow resulting in death of the intestinal tissue. Other common causes of a passageway obstruction include hernias, tumors, volvulus (twisting of bowel), and foreign bodies. Yet, when it comes to the functional causes of an obstruction (a.k.a. pseudo-obstruction), diseases affecting the intestinal musculature or the nervous system are the typical culprits (e.g. diabetes, Parkinson’s). The typical symptoms of an intestinal obstruction include abdominal pain and distension, nausea, vomiting, and the inability to pass stool. The diagnosis can be made with a combination of the patient’s physical examination and a radiographic study such as a CT scan. The initial treatment involves the insertion of a nasogastric tube, which is used to disrupt the blockage, but if this therapy fails, the patient will have to undergo surgery.
The rate of complication with an intestinal obstruction is 42%; those who have a hernia as the primary cause are at the highest risk for this. As stated above, patients who undergo abdominal surgery [irrespective of the type of surgery or the time of onset of the procedure] are likely to develop adhesions and this can put them at risk for a bowel obstruction. Given that this is not a preventable disease, the most critical step is for people to be aware of how it presents itself, especially if they have any of the aforementioned risks. There is a phrase frequently cited by surgeons which states, “the sun should never rise or set on a small bowel obstruction,” which means that urgent medical attention should be given to all patients with an intestinal obstruction, as any delay in treatment may result in an internal infection or even death.
Painful abdominal cramping in association with a change in bowel movements might represent a non-specific gastrointestinal virus; or it could be the manifestation of a potentially serious disorder known as diverticulitis. More commonly found in patients over the age of 60, diverticulitis is a disease that involves an inflammation of the colonic wall and has the ability to cause severe complications. The underlying disorder (i.e. diverticulosis) that predisposes patients to diverticulitis is unquestionably widespread, with some sources reporting that more than 1 in 10 Americans have the disease. Of those, 25% will go on to manifest diverticulitis. What’s more, this statistic is not isolated to the aforementioned age category and also occurs in young adults. Additionally, scientists have stated that the prevalence of diverticulitis has been steadily increasing, a trend that has been witnessed in several countries. It’s important, therefore, for people to learn about the typical symptoms of this disorder and understand that receiving prompt and simple treatment is usually all that’s necessary to eradicate the infection.
A diverticulum is a sac-like protrusion at a weak point within the colonic wall. The presence of a diverticulum fundamentally means that a person has diverticulosis. If the diverticulum undergoes microscopic perforation, a bacterial inflammatory process ensues which is known as diverticulitis. The majority of patients with diverticulitis experience left-sided lower abdominal pain, low grade fevers, and either diarrhea or constipation. Of note, the reason why patients develop abdominal pain on the left lower side is due to the fact that the narrowest and most susceptible part of the colon, the sigmoid, is located there. Serious complications such as bowel obstruction, abscess (collection of pus) formation, or a major perforation of the bowel are rarely encountered. The diagnosis is generally made with a combination of the patient’s clinical presentation and radiographic imaging studies such as a CT scan. Most patients can be successfully treated with an outpatient antibiotic regimen, but if the patient is elderly, immunocompromised, or has a high fever, they will likely warrant admission to the hospital. Of all the patients with diverticulitis, 20-40% will have a recurrent episode, and elective surgery may be considered in those with four or more presentations of diverticulitis.
Many researchers believe that our dietary habits account for the rise in diverticulosis and diverticulitis seen worldwide. Previously, scientists thought that hard small food particles such as popcorn and nuts were responsible for the development of the diverticulum but data has shown that these foods are not associated with this process. On the other hand, what has been demonstrated is that patients who consume a higher amount of fatty foods and red meat have an increased risk of developing diverticular disease. More anecdotally, many people believe that processed foods are a contributing factor to a variety of disease processes, which has created a movement back to organically produced food items. In addition to this, data has also shown that consuming a high fiber diet and being involved in vigorous exercise activity reduces the risk of symptomatic disease. In fact these are beneficial practices that everyone should partake in irrespective of this disease entity. In any respect, paying attention to both potential symptoms and best practices is a sensible way to reduce the risk of diverticular disease.
Enterovirus D68 has become a major antagonist in recent news headlines, as it has been noted to be the culprit of a severe illness that has resulted in the hospitalization of multiple children. Unfortunately, its notorious reputation is not unfounded, given that several children have lost their lives as a result of this particularly aggressive infection. EnterovirusD68 causes a severe respiratory illness which has been responsible for various disease outbreaks in the past. Interestingly, although scientists have known about this virus and its biological activities since 1962, they had never seen as many cases as they have witnessed throughout this year. Researchers are still trying to decipher why the virus has precipitated a nationwide outbreak. To date, the CDC (Centers for Disease Control and Prevention) has confirmed a total of 664 cases, a number expected to increase since the virus is still within its peak season. Despite the fact that we are unable to eliminate the virus from the environment, we can focus on proactive and critical measures, such as preventing the acquisition and spread of disease.
The enteroviruses are ubiquitous in our environment and the EnterovirusD68 is only one of 100 scientifically classified strains. High rates of infection predominantly occur during the summer and fall but the virus is present throughout the year. Enterovirus D68 can be found in respiratory secretions and it is generally transmitted when someone infected coughs or sneezes around another individual. The incubation period (time from acquisition of disease to manifestation of symptoms) is variable but it ranges from 3-5 days, whereas the infectivity period (length of time that patients can transmit disease) can easily last several weeks. Patients with this type of enterovirus classically experience fever, runny nose, sneezing, cough, wheezing, shortness of breath, and body aches. The diagnosis is made by a specialized laboratory cell culture test and the treatment is generally supportive because there is no preventative vaccine or cure. It is important to note that despite the fact that this virus can affect anyone, it has been reported to be more aggressive in children, particularly in those with a history of asthma or any other chronic lung disease.
The public, especially parents, might be concerned about Enterovirus D68 but the fact of the matter is that the majority of patients with this virus are substantially more likely to manifest a mild non-threatening illness than a severe disease. Nevertheless, if your child is displaying symptoms of a respiratory illness [which could be due to this or any other type of virus in the community] it is reasonable to request a prompt evaluation by a physician. More importantly, even if your family is not displaying signs of illness, it is best to prevent the disease altogether. Therefore, everyone should partake in the following routine practices: wash your hands often with soap and water; do not touch your eyes, nose, or mouth with dirty hands; avoid close contact with people who are sick; cover your mouth and nose when coughing and sneezing; and disinfect your surrounding work and home surfaces frequently. These simple activities, when regularly executed, might make the ultimate difference between who gets ill and who stays healthy.