Marasmus

by Marcus Cimino

I bet you guys were “starving” for another post, huh? Well today, we’ll talk about a condition that affects people who are actually starving: marasmus.

So what is it? In a nutshell, it is a type of undernourishment where a person is not getting enough calories in general. This is not to be confused by kwashiorkor which is mainly a lack of protein.

How do you tell those two apart? Well you should focus on the stomach as a child with kwashiorkor has a distended stomach.

Another big difference is that marasmus starts before 1 year of age while kwashiorkor starts after 18 months.

In addition to the physical characteristics above, the person will be fretful, irritable and extremely hungry. The mortality rate in these patients is higher when experiencing an illness or injury. Yet, compared to kwashiorkor, the survival rate is higher.

So what does this have to do with south park? Well in season 1, the boys of south park encounter Marvin, an Ethiopian. They get to know Marvin and a very little about Ethiopia. See the link below for the happy ending!

http://southpark.cc.com/clips/150038/back-home

 

So in short: Marvin is starvin’ because he has marasmus. He appeared in Southpark before season 1 was complete and marasmus occurs most often before a person is 1 year old. He is extremely hungry and fretful. It’s probably best if he doesn’t get sick or injured.

Interesting note: The rate of marasmus is not that high in Ethiopia. It is actually highest in Mali and Angola.

Advertisements

Appendix Cancer

Both cooler than the other side of the pillow

by Marcus Cimino

Due to the recent passing of Stuart Scott I thought I would use Janurary 4th to show how medicine really does permeate through life. Even when watching Sportscenter, medicine is there in the background, behind the scenes. Behind the “Booyahs” and suits and ties, behind the Iconic quotes and little black dresses.

Sometimes human biology is so covert, you don’t know it’s happening until it’s too late. Such is the case with appendix cancer.

appendix cancer picture

An accessory organ that has not had a known use for a really, really, long time (Source: http://www.shootoutcancer.org/ originally from WebMD)

 

To start, appendix (or appendiceal) cancer is an extremely rare form of cancer. How rare? Of just intestinal tumors, it only makes up 0.5%. Additionally, it is often asymptomatic. As its name implies, it grows inside the appendix, and only when it is large enough to block the opening of the appendix(or it has already metastasized) does it cause symptoms. The majority of these start in the distal portion, far away from the opening, so you can imagine that it could grow for a while before being a problem.

These most common type of (these extremely rare) tumors are classified as carcinoid, which means they grow somewhere in the intestines. You can test a patient’s 5-HIAA level in their urine(higher specificity) and CGA level in their blood(higher sensitivity). However other things like appendicitis must be rule out first.

Accuracy of “non-essential” can be debated (Source: Pinterest.com)

 

So how is it treated? Well it depends on its size and whether or not it has metastasized. Most tumors less than 2-3 cm* without metastasis can be removed by performing an appendectomy and that’s it. Others will need some combination of chemotherapy and surgery(e.g. right colectomy if the tumor has spread through multiple layers of the appendix).

Not proper sterile technique, patient still clothed. (Source: original work from The Simpons, image found on imgur.com)

 

 

As you can imagine, prognosis also depends on this. Simple and small tumor – 100% survival. Larger with some local metastasis – 78%  and larger with distant metastasis and lymph node involvement – 32%**

So as you can see, if not caught early, it can spread and become a very serious illness. Unfortunately, we have recently lost Stuart Scott, a prominent and influential sportscaster on Sportscenter. What may be less known is that Audrey Hepburn, famously known for her role in Breakfast at Tiffany’s, also suffered from and succumbed to appeniceal cancer. It is unfortunate two people who were so commonly known had such a rare disease.

So with that said, here is Stuart Scott’s speech from the 2014 ESPY’s for those who have yet to see it. Powerful Stuff.

*Th actual size of the tumor for staging and risk profile depend on who you ask/what research you read

**These numbers are from this paper.

*** While writing this I found a charity dedicated to appendix cancer, check it out for more information. I Also found this charity started in Audrey Hepburn’s name that tackles several causes. I don’t know much about them so any comments on them are appreciated!

Mercury Poisoning

by Marcus Cimino

Wow, well the “daily” part of daily dose post is difficult to satisfy. Now I know why Jon Stewart’s hair is so grey.

intro photo

Now he needs the flag to stay warm. (Sources: Left – vh1.com, Right – wikimedia.org)

I also heard from some friends that my last post needed less technical terms and more pictures. I agree. Additionally that’s a hard way to get readers when one starts out with that topic(like a bat out of hell).

So here’s something a little more simple(I think):

Mercury poisoning!

I really like tuna, alright? Do you have a problem with that? (Sources: http://img2.wikia.nocookie.net/ for the hat and http://i.ytimg.com/ for Ari Gold)

I really like tuna, alright? Do you have a problem with that? (Sources: http://img2.wikia.nocookie.net/ for the hat and http://i.ytimg.com/ for Ari Gold)

So What is it? When one consumes or is exposed to too much mercury.

What are the symptoms? It varies case by case as the mode of exposure(inhalation, skin contact consumption etc.) can determine which symptoms are more prominent. They are dysthesias(abnormal senses), headaches, emotional changes, insomnia, muscle atrophy/fasciculations(twitching), and tremors.

In fact, the Mad Hatter from Lewis Caroll’s Alice in Wonderland is a reference to the high prevalence of mercury poisoning as it was used to make hats during the 1800’s and hat makers would be afflicted (maybe you have heard the term “mad as a hatter”?)

Yet despite all of the advances we have made in hat making technology, it can still occur. in December 2008, Jeremy Piven was hospitalized for mercury poisoning which was attributed to his consumption of sushi twice a day. It could explain why Ari Gold, the character Jeremy Piven plays on the sow “Entourage”,  had so many emotional outbursts and headaches.

 photo hqxMiFn_zpsa201a164.gif

Ok so how is it treated? Well besides cutting back on the sushi (tuna, swordfish, shark and mackerel), patients can also go under “chelation therapy”, which basically means the drug takes up the mercury and the new molecule formed as a result can be excreted from the body safely.

For more detailed info, I recommend checking out this.

Wolf-Parkinson-White Syndrome

Well I figured I would start the new year with my first official post…. but I don’t think this will be posted until Janurary 2nd(oops). Part of it was due to I was out late for NYE. Maybe some of you the other night had a special some-one as the ball dropped on Dec. 31st. They took the words right out of your mouth. Your heart was palpitating, the champagne made you feel dizzy and you couldn’t catch your breath to speak. Maybe he/she took the words out of your mouth while kissing you, or maybe those symptoms were something more serious. Maybe it was Wolf-Parkinson-White Syndrome!

(Yes this is Meatloaf. Source: Guardian.co.uk)

(Yes this is Meatloaf. Source: Guardian.co.uk)

(Source: Wikipedia.com)

So what is it in a nutshell? An abnormal pathway in the heart between the ventricles and the atria.

What are the symptoms? Dizziness, shortness of breath, palpitations and syncope(fainting). The severity of the syndrome can vary depending on which version you have but can lead to sudden cardiac death.  You don’t have to worry too much as it is only present in 0.1-0.3% of the general population and only 0.6% of cases result in sudden cardiac death. But important to consider if undergoing surgery or taking medication.

How do you diagnose it? Well if you are good at picking up context clues you could probably guess that and ECG is involved by shifting your gaze to the right. That arrow is pointing to what is called a delta wave. It comes after the p wave and before the QRS complex(often described a slurred QRS) during the person’s resting heart rate. When they have symptoms they will likely have atrial fibrillation or atrial flutter on an ECG

(Source: Eli.com)

What gene is it? Well there are likely several, but the most common gene found is the PRKAG2 gene which encodes for a kinase protein the behaves differently. As a result there are 2 main types of WPW Type A and Type B(which have different findings on ECG), but check out the further reading below for that.

So how do you treat it? Well for meds, there is amiodarone(class III anti-arrhythmic) and procainamide(class Ia) which will extinguish the atrial arrhythmia occuring. What’s important is to avoid adenosine(class V), diltiazem(class IV), and verapamil(classIV) when treating a patient who WPW who has atrial fibrillation or atrial flutter. This is because it may lead to uncontrollable ventricular arrhythmias.  Cardioversion is also acceptable but the definitive treatment is cardiac ablation; meaning, going into the heart and and burning this accessory pathway.

So what’s the deal with Meatloaf? Well he was actually diagnosed with WPW. So if you give your heart to the Wolf(-Parkinson-White) with the delta wave, make sure to take the amiodarone, procainamide or ablate it first.

If you want a more comprehensive understanding, read this. For an actual journal publication, read this.