New Device Detects Brain Bleeds without CT scan

This week, I’ll be discussing a new medical device on the market called the AHEAD 300, developed by BrainScope Inc.  Using an algorithm paired with EEG (electroencephalogram data), this device is able to detect whether or not patients have a brain bleed (McMains and Nelson, 2017).  An EEG is used to measure the electrical activity of the brain. 

Despite being 97% accurate, this device still raises a major concern.  Of the 2.5 million people who show up to the ER with head injuries each year, 75,000 will have a false negative on the test—meaning that the device says they don’t have a brain bleed when, in fact, they do (McMain and Nelson, 2017).  The current standard for detecting a brain bleed is CT scan which can be expensive for patients.  However, The AHEAD 300 should not be seen as a replacement for a CT scan. 

The best use I see for this type of device is as a first line of defense.  Perhaps in small, rural hospitals without a CT machine or during times when a CT scanner is in high demand the AHEAD 300 would be used to quickly screen patients who are suspected of having a head injury.  Then when the CT scanner opens up, or they are transferred to a different hospital, a CT scan would confirm the diagnosis.  A possible use this article recommends is on the sports or battlefield.  Patients could be evaluated quickly and then if they have a brain bleed they could be transported to the hospital rapidly (McMains and Nelson 2017).

McMains, V. and Nelson, L. (April 5^th, 2017). Quickly assessing brain bleeding in head injuries using new device. Retrieved from: http://www.hopkinsmedicine.org/news/media/releases/quickly_assessing_brain_bleeding_in_head_injuries_using_new_device

EM fields--another risk factor for ALS?

Electromagnetic fields are something that all of us are exposed to every day.  Our cell phones, household appliances, and radio waves—even visible light—all give off forms of electromagnetic radiation.  Prolonged exposure to certain types of radiation are associated with a greater risk of cancer, but a new study suggests that electromagnetic fields may play a part in developing amyotrophic lateral sclerosis (ALS) (New Scientist, 2017).

ALS is a neurodegenerative disorder that affects the patient’s ability to control voluntary muscle movements.  Eventually, this condition may lead to the loss of the ability to speak, eat, and breathe (ALS Association, 2017).  ALS can lead to death in less than two years from the onset of symptoms (New Scientist, 2017).  Examples of celebrities who suffer(ed) from ALS include renowned physicist Stephen Hawking, NFL player Steve Gleason, and Yankee’s first baseman Lou Gehrig.  In fact, ALS is sometimes referred to as Lou Gehrig’s disease.  Below is a video of Lou Gehrig's farewell address at Yankee Stadium after being diagnosed.

Anyway, this study suggests that occupational exposure to extremely low frequency magnetic fields might be to blame for the development of ALS.  Some of the jobs that the article cites as high risk are electric line installers, welders, sewing machine operators, and aircraft pilots.  In this analysis, the listed groups were twice as likely to develop ALS as the general population.  Although there appears to be a link between electromagnetic fields and ALS, researchers still do not understand the mechanism behind it.  The study does note that out of the 64,500 subjects involved, only 82 actually developed the disease.  This means the study barely passed the test for statistical significance (New Scientist, 2017). 

Going forward, it is important for more studies in this area to be done in order to confirm or refute the findings of this one.  This is one good thing the ALS ice bucket challenge did.  In addition to raising awareness about ALS, it also helped fund studies such as this one, that may help find a cure.

This week, I would also like to encourage my readers to check out my friend Joe’s blog.  Each week he writes about a different topic regarding the engineering that goes into creating music.  For example, last week Joe wrote about a mechanism for automatically tuning a piano.  A process that once took about an hour, can now be done in less than a minute.  This system works by sending an electrical current through the strings of the piano, which causes them to change their pitch.  If you are a musician, or are interested in music in general, I would definitely recommend you check out Joe’s blog, Manufacturing the Music.

MLB. (1 July 2014). Gehrig delivers his famous speech at Yankee Stadium.  Retrieved from: https://www.youtube.com/watch?v=nNLKPaThYkE

New Scientist staff and Press Association.  (29 March 2017).  ALS linked to occupational exposure to electromagnetic fields.  Retrieved from: https://www.newscientist.com/article/2126263-als-linked-to-occupational-exposure-to-electromagnetic-fields/

The ALS Association.  (2017). What is ALS? Retrieved from: http://www.alsa.org/about-als/what-is-als.html??referrer=https://www.google.com/

Laughter as a sign for gelastic seizures

Ahhh, the sound of waves hitting the beach, birds chirping, the laughter of a child—these are things people might cite as the most pleasant sounds we hear.  However, one of the examples above might be a sign of something more severe.  One sign of a gelastic seizure is short bursts of unexplained giggling or laughing (Kerrigan and Iyengar, 2017).  What parent would think to bring their child to the doctor because of laughter?  Many times, parents do not seek medical attention until another type of seizure begins to develop. 

In the case of Justin Cho, his parents thought he was just a happy child, but after he suffered a more severe epileptic seizure, they realized his laughter was a symptom all along.  Justin had a lesion in his brain called a hypothalamic haratoma that was caught during an MRI after his seizure.  Left untreated, a lesion of this type could cause problems with cognitive development (Kerrigan and Iyengar, 2017).  Using state-of-the-art technology, doctors were able to destroy the lesion using a laser during a minimally invasive procedure (Mohney, 2017).  Minimally invasive procedures of this type seem to be on the rise today throughout the medical community, given the lower risk for infection and shorter recovery times.  

MRI of a hypothalamic haratoma

https://images.radiopaedia.org/images/1989176/c256908147f43b8f42fb938b4d0740_big_gallery.jpeg

This case is just one more example of how something seemingly benign can actually be something much more serious.  Thankfully, Justin made a full recovery and is back to his normal self.

Works Cited:

Kerrigan J.F. and Iyengar, S. (2017). Gelastic and Dacrystic Seizures.  Retrieved from: http://www.epilepsy.com/learn/types-seizures/gelastic-and-dacrystic-seizures

Mohney, G. (March 24, 2017).  Boy's giggle fits turned out to be rare form of epileptic seizures. Retrieved from: http://abcnews.go.com/Health/boys-giggle-fits-turned-rare-form-epileptic-seizures/story?id=46349008

Electric shock--to relieve pain?

At one time or another, we have all be victims of static shock.  Whether by accident or a mischievous sibling or friend, it is not a pleasant experience.  But there is some evidence that mild electric shock could be beneficial in treating migraine headaches. 

A recent study published in Neurology shows that electrical stimulation to the skin can help reduce migraine pain by 50% (Yarnitsky et al, 2017).  64% of patients reported that their pain was reduced by at least half—a result similar to current migraine medications on the market.  This treatment may be beneficial to patients who are unable to derive relief from traditional methods. 

The use of electrical shock to treat pain is not new, however.  Neuropathic pain can be treated using transcutaneous electrical nerve stimulation (TENS).  Neuropathic pain is pain that originates from the nerves.  Sometimes, nerves may be damaged following injury and can cause neuropathic pain as a result.  This type of pain can often be debilitating and is traditionally treated with painkillers such as aspirin or morphine.  Some patients may turn to TENS in order to get pain relief (DeSantana et al, 2008).

TENS works by stimulating nerves and interfering with the pain signals reaching the brain.  This relies on the gate control theory of pain—basically, the stimulation from the TENS device “closes the gate” and inhibits the nerve carrying neuropathic pain signals (Mayedi and Davis, 2012). 

There is still much research to be done in this area, but for the moment, it appears that electrical stimulation may be a suitable solution for patients who wish to avoid painkillers.

Works Cited:

Desantana, JM, Walsh, DM, Vance, C, Rakel, BA, Sluka, KA.  (2008).  Effectiveness of Transcutaneous Electrical Nerve Stimulation for Treatment of Hyperalgesia and Pain.  Curr Rheumatol Rep, 10:6, 492-499.  Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2746624/

Moayedi, M and Davis, KD.  (2013).  Theories of pain: from specificity to gate control. Journal of Neurophysiology.  109(1), 5-12.  Retrieved from: http://jn.physiology.org/content/109/1/5

Yarnitsky, D, Volokh, L, Ironi, A, Weller, B, Shor, M, Shifrin, A, Granovsky, Y. (2017). Nonpainful remote electrical stimulation alleviates episodic migraine pain. Neurology.  Retrieved from: http://www.neurology.org/content/early/2017/03/01/WNL.0000000000003760

Obesity and Arthroplasty

This week I will be taking a break from my normal blogging material to talk about my literature review topic.  The topic I chose was arthroplasty in obese patients.  Arthroplasty is the replacement of a joint, usually due to osteoarthritis.  As a prospective medical student, I wanted to write about something that would be relevant to the field I want to go into.  With the obese population rising and the number of hip replacement surgeries expected to reach 500,000 per year 2030, this seemed like a good area to look into.

                What I found while doing this review is that high BMI (body mass index) patients, specifically the morbidly obese (BMI >40), have a greater risk of developing complications after surgery and having poorer outcomes than non-obese and even obese patients (Deakin et al, 2016).  Two other studies also found that the super-obese (BMI >50) were at even greater risk to develop complications (Arsoy et al, 2014) (Werner et al, 2017).  Despite these documented higher risks for complications and poor outcomes, surgeons continue to give morbidly obese patients arthroplasty procedures.

                This also goes back to my profile a professional essay.  When I asked an ER physician what advice he would give to prospective doctors he said, “always do what’s right for the patient.”  In many cases, arthroplasty is the only way that patients are able to get relief from the pain caused by osteoarthritis.  So, surgeons do what they can to relieve the pain by performing the procedure.  This view is supported by Krushell and Fingeroth’s 2007 study. 

                Patients need to be made aware of any risks they may incur as a result of the surgery, but they should continue to be able to choose a procedure that vastly improves their quality of life.

References:

Arsoy, D, Woodcock, JA, Lewallen, DG, Trousdale, RT.  (2014).  Outcomes and Complications Following Total Hip Arthroplasty in the Super-Obese Patient, BMI >50.  The Journal of Arthroplasty, 41, 1899-1905. http://dx.doi.org/10.1016/j.arth.2014.06.022

 Deakin, AH, Iyayi-Igbinovia, A, Love, GJ.  (2016).  A comparison of outcomes in morbidly obese, obese and non-obese patients undergoing primary total knee and total hip arthroplasty.  The Surgeon.  http://dx.doi.org/10.1016/j.surge.2016.10.005

Krushell, RJ and Fingeroth, RJ.  (2007).  Primary Total Knee Arthroplasty in Morbidly Obese Patients: A 5- to 14- Year Follow-up Study.  The Journal of Arthroplasty.  22(6), 77-80. doi:10.1016/j.arth.2007.03.024

Sechrest, RC. (10 November 2013). Artificial Knee Replacement. Retrieved from:  https://www.youtube.com/watch?v=m8LDBlZN-XM

Werner, BC, Higgins, MD, Pehlivan, HC, Carothers, JT, Browne, JA. (2017).  Super Obesity Is an Independent Risk Factor for Complications After Primary Total Hip Arthroplasty.  The Journal of Arthroplasty, 32, 402-406. http://dx.doi.org/10.1016/j.arth.2016.08.001

Botched surgeries lead to paralysis, death

This week’s installment of “Strange Medicine” might better be described as disturbing.  This story comes out of Dallas, TX and involves Christopher Duntsch, a neurosurgeon who was convicted of intentionally maiming a seventy-four-year old woman during surgery, leaving her paralyzed.  While his trial focused on this case, several others have been injured or killed after going under the knife in the hands of Duntsch (Ballor, 2017).  His defense attorneys claim his surgical mistakes are the result of him having the skill of a first-year resident—essentially a rookie doctor.  Prosecutors argue, however, that he had years of training and knew what he was doing.  Perhaps the most alarming piece of evidence is a 2011 email from Duntsch that says he is ready to become a “cold blooded killer” (Ballor, 2017).    

A general surgeon witnessed one of Duntsch’s butchered surgeries.  After seeing the patient’s abdominal cavity filling with blood, he confronted Duntsch about the bleeding.  The general surgeon stopped the bleeding and the surgery continued, however the general surgeon cancelled his remaining cases with Duntsch and vowed not to work with him again (Goodman, 2016). 

The biggest question surrounding this case is why Duntsch was allowed to continue practicing medicine after so many failures.  From an outsider’s perspective, it seems that there needs to be continuous checks on a physician’s competence to ensure he is treating patients effectively.  I think of all the other personnel in the operating room, including the general surgeon mentioned above—why wasn’t he reported sooner?  Certainly, surgeons make occasional mistakes—nobody is perfect.  However, the frequency and seriousness of the mistakes Duntsch was making should have raised some red flags.  Perhaps if he had been reported to the medical board sooner, more patients would have received care from a competent physician. 

Sources:

Ballor, Claire.  (2017, February 21^st).  Dallas doctor who performed questionable surgeries gets life in prison.  The Dallas morning news.  Retrieved from http://www.dallasnews.com/news/courts/2017/02/20/doctor-sentenced-life-prisonfor-botched-spine-surgery-dallas-county

Goodman, Matt.  (November, 2016).  Dr. Death.  D Magazine.  Retrieved from http://www.dmagazine.com/publications/d-magazine/2016/november/christopher-duntsch-dr-death/

Meat allergy...from a tick bite?

Imagine you are at a nice restaurant celebrating your birthday.  It’s a special occasion so you decide to order a steak, one of your favorite foods.  Soon after enjoying your meal, you start to feel funny—you start to get an itchy rash, your tongue and throat begin to swell.  You are in anaphylactic shock—caused by an allergic reaction. (Other signs and symptoms of anaphylaxis can be found here).  ‘’But I’m not allergic to anything,” you might say.  You’ve eaten steak many times and never had this kind of reaction.  At the hospital, your doctor may ask, “Were you bitten by a tick recently?”  Confused, you answer “Yes, but I don’t see what that has to do with my allergy.”  Strangely enough, some tick bites may be the cause for a late-onset allergy to red meat (Commings et al, 2011).

We tend to think that allergies are something we are born with, maybe to peanuts or an insect sting or bite.  But it is possible to develop an allergy later in life.  In this case, a tick bite from the lone star tick (pictured below) causes an allergy to the molecule galactose-alpha-1,3-galactose (alpha-gal), an oligosaccharide that is also found in red meat.  Patients who are bitten by this tick see serum levels of the IgE antibody for alpha-gal increase by twenty times, or more (Commings et al, 2011).  The antibodies are proteins in the blood that bind to antigens such as alpha-gal.   This kicks off the body’s immune response that leads to anaphylaxis.  It may take up to eight hours for a reaction to occur after eating the meat (Encyclopedia of Life).

Amblyomma americanum (Lone Star Tick)

The lone star’s tick territory ranges from Texas to as far north as Maine, but is mainly found in the southeastern United States.  Areas of the Midwest, including the St. Louis area are also home to these ticks.  Their habitat consists of meadows and wooded areas (Encyclopedia of Life).  I personally know two people who have been bitten by the lone star tick and subsequently developed an allergy.  As someone who enjoys steaks and hamburgers (maybe a little too much), I will certainly be careful to avoid situations where I can be bitten.

Territory of the Lone Star Tick

Sources:

Amblyomma americanum: Lone Star Tick. (n.d.) In Encyclopedia of Life. Retrieved from         http://www.eol.org/pages/514547/overview

American Academy of Allergy Asthma & Immunology. (n.d.). Anaphylaxis. Retrieved from: http://www.aaaai.org/conditions-and-treatments/allergies/anaphylaxis#Tab2

Commings, SP, James, HR, Kelly, LA, Pochan, SL, Workman, LJ, Perzanowski, MS, . . ., Platts-Mills, TAE. (May 2011). The relevance of tick bites to the production of IgE antibodies to the mammalian oligosaccharide galactose-α-1,3-galactose. The Journal of Allergy and Clinical Immunology, 127(5), 1286-1293. http://dx.doi.org/10.1016/j.jaci.2011.02.019