Monthly Archives: September 2016

One sip of a vodka tonic

he woman had a rare condition called “quinine-induced thrombotic microangiopathy,” which caused a body-wide reaction to quinine, a chemical found in tonic water, the doctors who treated her wrote in the case report, published today (Jan. 4) in The New England Journal of Medicine.

The illness “hit like lightning,” said Dr. James George, a hematologist at the University of Oklahoma and the lead author of the report.

At the time of the incident in 2009, the woman told doctors that she had suddenly become ill when driving home from an office party. She developed chills, muscle aches, nausea and abdominal cramps, the doctors wrote.

That night, she ran a fever of 102 degrees Fahrenheit (38.9 degrees Celcius), and her stomach problems persisted. But by the time she went to the emergency room the next morning, her symptoms had improved. At the time, the ER doctors suspected that the woman had viral gastroenteritis — the stomach flu.

But the woman returned to the ER two days later; she still had back pain and had not urinated since she got sick, according to the case report. This time, she was admitted to the hospital, where tests showed that she had experienced kidney damage, according to the report.

The doctors suspected that the woman had thrombotic microangiopathy (TMA), which occurs when blood clots form in the tiny vessels in the body and can be caused by a range of factors, George said.

In her case, however, the cause of TMA wasn’t one that doctors often see, such as problems with blood-clotting mechanisms or a particular type of E. coli infection, George said.

Quinine, the chemical found in tonic water, can also cause TMA, but George said the woman told him that she didn’t take quinine pills or drink gin and tonics. (The Food and Drug Administration banned quinine pills in 2007 because of severe reactions linked to them.)

It was only then that the woman recalled having a sip of a vodka tonic at her office holiday party the night she got sick, George said.

In addition, she also realized that she had a similar reaction 16 months earlier, when she drank a vodka tonic at a wedding and also had to go to the hospital, according to the report. That time, however, her major symptom was a severe headache, the doctors wrote.

 

“Like a tornado”

When a person has quinine-induced TMA, he or she has a particular type of “auto-antibody” in the blood, George told Live Science. Auto-antibodies, which are found in people with autoimmune disease, attack the body as if it were a “foreign” invader.

Normally, these particular auto-antibodies are not very active in the body, George said.

Cencer Treatment Advance

Deaths from cancer in the United States have dropped 25 percent since hitting a peak in 1991, a new report finds.

The drop means that 2.1 million fewer people died from cancer between 1991 and 2014 than would have died if cancer death rates had remained at their 1991 level, the researchers said.

In the report, the researchers attributed the drop in death rates to reductions in smoking and advances in early detection and treatment. The report was published today (Jan. 5) by the American Cancer Society.

“The continuing drops in the cancer death rate are a powerful sign of the potential we have to reduce cancer’s deadly toll,” Dr. Otis Brawley, the chief medical officer of the American Cancer Society, said in a statement. “Continuing that success will require more clinical and basic research to improve early detection and treatment, as well as strategies to increase healthy behaviors nationwide.” [The 10 Deadliest Cancers and Why There’s No Cure]

The decline in cancer death rates was fairly steady for more than two decades, decreasing by about 1.5 percent each year during the study period, according to the report, which was published in the journal CA: A Cancer Journal for Clinicians.

The cancer death rate declined from 215 deaths per 100,000 people in 1991 to 161 deaths per 100,000 people in 2014, according to the report.

A reduction in deaths from four types of cancer — lung, breast, prostate and colorectal — played a key part in the overall decline, the researchers said. For example, lung cancer deaths in men decreased by 43 percent between 1990 and 2014, and in women by 17 percent between 2002 and 2014. The rates of death from colorectal cancer decreased by 51 percent between 1976 and 2014.

Looking ahead to 2017, the researchers estimated that there will be more than 1.6 million new cases of cancer in the U.S., or about 4,600 new diagnoses each day, and more than 600,000 cancer deaths, or about 1,650 deaths each day.

 

Gender and racial differences

In the report, the researchers noted a number of gender and racial differences in both the rates of cancer and the rates of cancer deaths.

Men are 20 percent more likely to get cancer than women, and 40 percent more likely to die from cancer, according to the report. This difference is due in part to the different types of cancer that affect men and women, the researchers said. For example, liver cancer, which is particularly deadly, is three times more common in men than in women, the researchers wrote. And men are four times more likely to get and die of esophageal, laryngeal or bladder cancers compared with women.

Talk About Frequent Headaches

Men who have low levels ofvitamin D may be at increased risk for frequent headaches, a new study from Finland suggests.

The study analyzed information from about 2,600 Finnish men ages 42 to 60 who gave blood samples and answered questions about the frequency of their headaches. The men were originally part of a study on risk factors for heart disease, and were assessed in the years 1984 to 1989.

Nearly 70 percent of the men in the study had blood vitamin D levels below 20 nanograms per milliliter (50 nanomoles per liter), which is generally considered the threshold for vitamin D deficiency. Low vitamin D levels are a particular concern in Finland and other Nordic countries, because these countries are farther north and have less exposure to sunlight, which the body needs to make vitamin D, the researchers said. [9 Good Sources of Disease-Fighter Vitamin D]

On average, men with frequent headaches — occurring at least once a week — had vitamin D levels of 15.3 ng/ml (38.3 nmol/L), compared to 17.6 ng/ml (43.9 nmol/L) among those men without frequent headaches. (In the United States, vitamin D levels are usually reported in ng/ml, while in other parts of the world, they are reported in nmol/L.)

Men with the lowest vitamin D levels (below 11.6 ng/ml or 28.9 nmol/L) were about twice as likely to have frequent headaches, compared to men with the highest vitamin D levels (above 22 ng/ml or 55 nmol/L.)

The study adds to a growing body of evidence linking low vitamin D levelsto an increased risk of certain diseases and conditions, including headaches. The new study is one of the largest to look at the link between vitamin D and headaches, the researchers said.

However, the study was conducted at a single point in time, so the researchers cannot tell which came first, the low vitamin D levels or headaches, the scientists said. It’s possible that people with frequent headaches may be less likely to spend time outside, and so they have less exposure to sunlight, the researchers said. However, this explanation may be less likely in Finland, where people overall have less exposure to sunlight, the researchers said.

In addition, because the study involved only men, it’s not clear if the findings also apply to women, the scientists said.

The Liquid After Medication

A 6-year-old girl in Oregon experienced severe nicotine poisoning after her parents accidentally gave her liquid nicotine meant for electronic cigarettes instead of a children’s liquid pain reliever, according to a new report of the girl’s case.

The child survived, but nicotine poisoning can be fatal, and the researchers warned that such cases could become more common as e-cigarettes rise in popularity.

“As electronic cigarette use proliferates, children are now increasingly at risk of toxicity from ingestions of much larger quantities of nicotine from highly concentrated refill liquid, as in our case study,” Dr. Matthew Noble, an emergency medicine physician at Oregon Health and Science University, and a co-author of the report, said in a statement.

The girl had previously sprained her ankle, and was taking children’s Motrin (which contains ibuprofen) for pain relief. But when the bottle was finished, the girl’s mother used it to store some liquid nicotine that she had bought online to use in an e-cigarette.

The child’s father didn’t know the Motrin bottle contained nicotine, and he gave the child a 10-milliliter dose of the liquid for her pain, according to the report. The girl immediately felt a burning sensation in her mouth and throat, which led the father to take a small sip of the liquid. He realized it was liquid nicotine and immediately called poison control and an ambulance, the report said. [27 Oddest Medical Cases]

Before the paramedics arrived, the girl lost consciousness and began involuntarily jerking her limbs. She later regained consciousness, but did not respond to questions or commands, the report said.

The girl was taken to the emergency room, where she began vomiting and sweating, and her pulse dropped from 150 beats per minute to 60 beats per minute, the report said.

Doctors gave her an anti-nausea medication and a sedative, and placed a tube in her throat to keep her airway open. They also gave her a medical form of charcoal used to help treat drug overdoses, because it absorbs nicotine and other drugs.

About an hour after she arrived at the ER, the girl was admitted to the intensive care unit and placed on a ventilator overnight. The next day, she was taken off the breathing support and was able to respond to commands. Doctors gave her a physical exam, which showed normal results, and she was released from the hospital.

The researchers estimated that the child consumed about 700 milligrams of liquid nicotine. Some studies have estimated that ingesting as little as 500 mg of nicotine can kill an adult. An average regular cigarette delivers about 0.2 to 2.4 mg of nicotine. [10 Scientific Quit-Smoking Tips]

In addition, a blood test done about an hour after the girl arrived at the hospital showed she had a blood level of nicotine of 348 nanograms per milliliter. The level of nicotine in the blood after an adult smokes a regular cigarette is about 12 to 54 ng/ml, the report said.

The researchers also tested the liquid nicotine that the child ingested, and they estimated that the concentration of nicotine in the original product was more than double the concentration that was listed on the product label.

“This finding supports previous work demonstrating that electronic cigarette refill containers may have unreliable commercial labeling and widely variable actual nicotine concentration compared with that advertised,” the researchers wrote in their report.

Growing in Adulthood

The part of the brain that specializes in recognizing faces becomes denser with tissue over time, new research finds.

The discovery is surprising to researchers, because brain development from childhood into adulthood was long thought to happen mostly through the pruning of synapses, the connections between neurons. In other words, the brain was thought to develop by becoming more streamlined, not by growing new tissue.

The study also showed that these changes in brain structure correlated with the ability to recognize faces. In general, adults are better at recognizing faces than children are, said study leader Jesse Gomez, a doctoral candidate in neuroscience at Stanford University.

But development is personalized. “There are some kids that have adult-like tissue values, but those kids also have adult-like brain function,” Gomez told Live Science. Likewise, some adults who were bad at recognizing faces showed child-like density in their face-recognition region, he said. [Inside the Brain: A Photo Journey Through Time]

 

The changing brain

The textbook explanation of brain development is that infants are born with a riot of neurons and connections that get snipped away over time, Gomez said. Useful connections strengthen, while those that are underutilized get pruned. As a result, the brain becomes more efficient.

This process certainly takes place over the first three years of life, Gomez said, but little is known about development after age 3. He and his colleagues are tackling the question by scanning the brains of elementary-school children again and again over time, and comparing those children’s brains to the brains of young adults.

While comparing the child brains with the adult brains, the researchers found increasing density with age in the posterior part of a brain region called the fusiform face area, located in the visual cortex, near the back of the brain. This brain region specializes in differentiating human faces.

 

Excitable brains

To detect these changes in density, researchers used a method called qualitative magnetic resonance imaging (qMRI). Standard MRI can differentiate between different brain tissues, like white matter and gray matter, Gomez said, but it can’t give any sort of absolute values of brain-cell density that can be compared between people. The new method, qMRI, can. It works by exciting protons in the water in brain tissue. The time it takes for those protons to calm back down to their resting state provides some information about brain density, Gomez explained.

He compared the excited protons to spinning tops.

“You can think, if a top is on a cluttered table, it’s going to slow down more quickly and bump into things and fall down more quickly,” Gomez said. In the same way, if a proton is in an area dense with tissue, it will settle down more quickly. Thus, a quicker time to relaxation means a denser brain region.