Tag: medicine

Posted in Psychology & Medicine

Berry Aneurysm

Posted on by Jinavie

Stroke is a disease often associated with the elderly, but this is not necessarily true. As much as 5% of the population carry a ticking time bomb in their brain, known as a berry aneurysm. An aneurysm is a weakening of the arterial wall, causing a localised ballooning of the vessel. A berry aneurysm is a common type of aneurysm where the ballooning resembles a berry. What is most troubling is that a large proportion of these aneurysms can present very early (usually congenital, meaning you are born with it), with one research suggesting that 1.3% of the population in the age group of 20 to 39 has a berry aneurysm. If this berry aneurysm was to burst, no matter how young and fit you are, you will bleed into the area around your brain (subarachnoid haemorrhage), suddenly develop a severe, crippling headache (“thunderclap headache”), become confused, show signs of stroke such as speech or movement problems, or simply drop dead.

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Fortunately, only 10% of people carrying a berry aneurysm suffer a ruptured aneurysm and subsequent brain bleed. The other 90% will carry on living their lives, without ever knowing that they had a time bomb in their brain.

Certain factors make the risk of the aneurysm bursting go up, such as high blood pressure, which can be caused by a stressful lifestyle or smoking. But in some cases, as explained above, even a healthy teenager could suddenly drop to the ground with a massive brain haemorrhage.

Berry aneurysms are only one of many ways death could strike unnoticed, no matter how young you may be. You could live a long and healthy life and die peacefully in your sleep when you are 90 years old, or you may have a stroke and drop dead in a few minutes’ time. For all you know, a bus might run you over tomorrow, with no warning whatsoever. Ergo, youth is not an excuse to waste the day you are given. You do not have to achieve something great, or be productive, but at least spend your day knowing that you are doing everything in your power to make yourself happy, without harming your health, your future or other people.

Carpe diem. Seize the day.

Posted in Science & Nature

Dihydrogen Monoxide

Posted on by Jinavie

Many people know about the dangers of chemicals such as lead and dioxin, but there is lack of awareness of an even bigger killed chemical: dihydrogen monoxide. It is a colourless, odourless, tasteless chemical that is responsible for the death of hundreds of thousands of people around the world.

Most deaths caused by dihydrogen monoxide (DHMO) are by accidental inhalation, causing cerebral hypoxia. However, the dangers of DHMO do not end there. Its solid form can cause severe tissue damage after prolonged exposure, and both its gas and liquid forms can cause severe burns. It is possible to overdose on DHMO, with symptoms ranging from excessive diaphoresis and micturition, bloating, nausea, vomiting and body electrolyte imbalance such as hyponatraemia. For those who are dependent on it, withdrawal means certain death. DHMO has also been found in various types of tumours biopsied from terminal cancer patients.

Not only does DHMO have consequences on human health, it is also damaging for the environment. DHMO is the leading cause of the greenhouse effect (surpassing carbon dioxide), a key component of acid rain, accelerated corrosion and rusting of many metals and contributes to the erosion of natural landscapes. DHMO contamination is a real, global issue, with DHMO being detected in lakes, streams and reservoirs across the globe. DHMO has caused trillions of dollars of property damage in almost every country, especially in developing nations.

Despite the danger, DHMO is commonly found in the household, in the form of additives in food and drinks, cleaning products and even styrofoam. There are no regulation laws for DHMO and multi-national companies continue to dump waste DHMO into rivers and the ocean. It is astounding to see such a deadly chemical go unregulated.

If you have not caught on by now, dihydrogen monoxide’s chemical formula is H2O – also known as water. Technically speaking, there are no false statements in the above description. But even children know that water is not only (relatively) safe, but necessary for life. The report on “dihydrogen monoxide” originates from a 1997 science fair project by Nathan Zohner, who was 14 years old at the time. His project was titled “How Gullible Are We?” and involved presenting his report about “the dangers of DHMO” to fifty school students to see what their reaction would be. 43 students favoured banning it, 6 were undecided and only one recognised that DHMO was actually water. Even more surprising is that there are cases (such as in California in 2004), where city officials came close to banning the substance, falling for the hoax. This goes to show how gullible people can be in the face of what they do not know.

Posted in Psychology & Medicine

Stendhal Syndrome

Posted on by Jinavie

There have been recorded cases of people gazing upon a beautiful panorama of Florence or an exquisite painting and suddenly collapsing. The condition is known as Stendhal syndrome, alternatively called Florence syndrome or hyperkulturaemia (excess culture in blood). It has been described as causing tachycardia (rapid heartbeat), dizziness, confusion and fainting after being exposed to a particularly beautiful piece of art or scenery. It is named after French author Stendhal (penname of Henri-Marie Beyle), who upon visiting Florence in 1817 experienced the very condition.

Stendhal syndrome is most likely related to a very common phenomenon known as vasovagal syncope, where extreme emotions overwhelm the brain, induce a massive parasympathetic nervous response, causing the person to faint. There are two major nervous systems: the sympathetic and parasympathetic. The sympathetic nervous system is responsible for the fight-or-flight response and essentially prepares the body for physical activity. The parasympathetic nervous system does the complete opposite and is activated when you are resting or digesting food. Thus, a burst of parasympathetic nervous activity causes a sudden fall in heart rate and blood pressure, causing the brain to lose the oxygen supply needed to maintain consciousness. When the person faints, they collapse and blood flow is restored to the brain. Vasovagal syncope can be caused by anything from standing up very quickly, extreme emotions (e.g. stress, seeing blood or needles) and fatigue. It is the most common cause of collapse and is (usually) completely harmless.

When a person looks at a breathtaking view or a stunning work of art, their brain is overwhelmed by intense emotions of excitement and joy. In the case of Stendhal syndrome, this effect is so great the person is literally blown away by the sight.

The people of Florence have noted that this phenomenon is rather common in tourists visiting the beautiful city.

Posted in Science & Nature

Vision

Posted on by Jinavie

Consider this: if you see something that is not there, or not see something correctly, is that due to a problem in your eyes or your brain? An interesting anatomical fact is that the eyes are part of the brain. They originally evolved from the brain and drifted further and further forwards, connected to the brain by the optic nerves. If you lift a brain out from the skull, the eyes would be pulled backwards too. But technically speaking, eyes are distinct organs by themselves that have merely originated from a portion of the brain. It does not think or make decisions by itself. Just like a camera, an eye records things as it sees it and transmits it to the brain via the optic nerve via electrical signals. The brain then processes the signals in the occipital lobe, located at the back of the head (this is why you “see stars” when you bang the back of your head).

This means that vision can be altered anywhere along the pathway. If you have cataracts, where the lens of the eye becomes clouded, you lose portions of your visual field. If you have a large pituitary gland tumour, it presses on the optic nerve and causes double vision (diplopia) or vision loss. If you have a stroke in the occipital lobe, you can lose your vision. The brain’s role in producing vision can easily be demonstrated in the form of optical illusions. The eye merely records and transmits what it sees, but the brain becomes confused by what information it receives and tries to make sense of it. In the process, we experience bizarre illusions such as static images moving by themselves.

Because of this intricate pathway, some pathologies present with fascinating symptoms. A condition called Anton’s blindness (or Anton-Babinski syndrome) causes a patient to “see” despite being blind. Patients with Anton’s blindness are adamant that they can see perfectly clearly, and will even describe what they are seeing. However, what they “see” is completely different to what the object actually looks like. For example, if the patient looked at a blonde woman wearing a yellow blouse and a red skirt, they may describe her as a brunette woman wearing a blue shirt and black jeans.

The reason for their blindness is that their occipital lobe was damaged (usually by a stroke), leading to an inability to process the information from the eyes. Although the eyes are pristine and record what they see in perfect detail, the brain is incapable of interpreting the signals. The brain then goes on to confabulate, where the brain fills the gap by conjuring up false information. This makes Anton’s blindness quite hard to pick up on as the patient will not complain of it. It is only found when someone pays close attention to the patient and notices subtle cues like the patient bumping into furniture or talking in the direction where they think a person is at (even after they move). Ergo, the patient adamantly believes that they can see as their brain thinks it is seeing things (even though it is not receiving the information from the eyes properly).

Seeing is not believing. You see what you believe.

Posted in Science & Nature

Virgin Birth

Posted on by Jinavie

Although the concept of virgin birth (i.e. conception without intercourse) is common in many religions, there is no conclusive evidence of actual human virgin birth in recorded history. Except in one medical article written in 1874 by a Dr Capers.

In this article, Dr Capers describes a case study of a miraculous conception during the Battle of Raymond during the US Civil War. A soldier was shot in the testicles and the musket ball carried the non-musket ball (read: testicle) into the uterus of a girl working in a nearby field. The doctor attended to the girl who was shot and treated the wound in her abdomen. The bullet was not found.

Over the following nine months, the doctor realised the girl was pregnant, although she claimed to be a virgin. After nine months, a healthy boy was born. Stranger yet, the doctor realised the boy’s scrotum was unusually swollen and upon examination, found that he was carrying the musket ball that impregnated the girl in the first place. He thus concluded that the testicle that was carried by the musket ball was lodged inside her uterus and sperm leaked out. The soldier was eventually found and was told about this bizarre story and the two were married.

This case study has become a famous story told by doctors around the world. Unfortunately, it is completely false and the doctor who wrote the article admitted to faking it to amuse himself. Ergo, there are still no recorded cases of a virgin birth in humans.

The closest to a virgin birth that was recorded is a case study of a young woman who was performing oral sex on a man. She was found by her boyfriend during the act and the boyfriend stabbed her and her lover with a knife. The knife injured her oesophagus, causing the sperm in it to track down the abdomen and down to her reproductive organs. By a stroke of luck, an egg was misplaced during ovulation, causing it to drift into the abdomen instead of the fallopian tube (ectopic pregnancy), and met with the sperm. The egg was then fertilised and the girl presented to the hospital three months later with excruciating abdominal pain. The ectopic fetus was removed.

Posted in History & Literature

Surgeon

Posted on by Jinavie

In many cultures (especially in Asian countries), the public conception of doctors has changed where surgeons are considered the “real doctors”. This is particularly evident in Asian dramas where main characters tend to be surgeons, saving the patient’s life with dramatic operations and charisma. The idea that surgeons are superior to physicians may go as far as some adults advising medical students to become surgeons for a higher status (again, more evident in Asia). However, as the root of surgery is completely different from that of medicine, technically it is a misnomer to call a surgeon a “doctor”.

This is reflected in the relatively unknown fact that a fully-trained surgeon is referred to as “mister”, not “doctor”. To understand why surgeons call themselves Mr., we must look into the origin of the surgical discipline.

In ancient times, surgery was limited to treating flesh wounds and setting bones (with some exceptions such as trepanation), such as those sustained during battles. Other than the odd few cases of specialised surgeons such as Galen of ancient Greece and Hua Tuo of ancient China, it is hard to find records of doctors employing surgery as a form of treatment. This was mainly due to two reasons: that surgery was considered a “dirty, unrefined” form of treatment, and that surgery was too risky.

For a long time, especially in the Western world, surgery was considered to be of a lower status compared to medicine. It was considered more of a craft tradition – something which physicians believed was beneath them. Because of this, surgeries were mainly performed by barbers in medieval Europe. One can still find evidence of a barber’s alternative historical role on the barber’s pole, which has white, red and blue stripes. The white stripe symbolises bandages, the red symbolises arterial blood and the blue symbolises venous blood. This originates from the practice of bloodletting, where white bandages wrapped around a pole would get dyed red from the blood, giving the appearance of the barber’s pole. The profession of “surgeon” did not formally appear until around the 18th century when a Guild of Surgeons was formed in England. However, physicians refused to accept surgeons as equals for a further century. When they did come to accept that surgery was a legitimate form of medical treatment, the surgeons decided that they did not want to be assimilated as doctors, so they chose to keep their title of “mister” to distinguish themselves from physicians.

The reason why surgery was considered an unrefined art in the past mainly focuses on three issues: bleeding, pain and infections. Before modern surgical developments, uncontrolled bleeding was a real issue in surgery. This not only made surgeries extremely messy, but it was also dangerous for the patient as patients would often die from shock (dangerously low blood pressure). On top of this, anaesthetics was only introduced in the late 19th century, meaning before that, patients had to suffer the pain of their flesh being cut and stitched with no relief. Of course, this meant that surgeries were almost always a brutal scene, with the agonising screams of the patients filling the room, while they sprayed blood everywhere. Lastly, even if the patient somehow survived the surgery without bleeding out or dying from the stress and pain, there still remained a high risk of post-operative infection. Thus, surgeries were most often unsuccessful and were considered a barbaric form of treatment with no promise.

Thanks to medical advancements, surgery has become an important aspect of medicine, where one cannot live without the other. However, the tension still remains between physicians and surgeons, with each profession jokingly mocking the other whenever a chance arises.

Posted in Science & Nature

Caesarean Section

Posted on by Jinavie

(To read about how babies are made and born, read the From Cell to Birth miniseries! https://jineralknowledge.com/tag/arkrepro/?order=asc)

Most animals give birth through a female’s vagina. Of course humans are the same when it comes to natural birth, but nowadays, it is not uncommon to find women wanting a caesarean instead of the traditional method. A caesarean (also called C-section) is a surgical procedure where the fetus is taken out by cutting through the lower abdomen into the uterus. The history of caesareans is quite dark. Back in the old days when medicine was not advanced, caesareans were mostly used to rescue fetuses from mothers who had died during childbirth. The first record of a successful caesarean where the mother survived dates back to the 1500s. Many people believe the word “caesarean” came from the Roman emperor Julius Caesar, who was allegedly born via a caesarean. However, it was rare for caesareans to be performed in Roman times and even if they were, the mothers almost certainly died in the process. Given that his mother was alive and healthy well into his adulthood, it is highly unlikely that Caesar was born by caesarean (there are no concrete records of it either).

There is much debate to whether a caesarean is better or worse than natural birth (except in emergency situations where a caesarean is required). According to research (in cases without known risks to the fetus), the mortality rate is definitely higher in babies born by caesarean compared to those born naturally. This is most likely due to a caesarean bypassing some of the physiological changes that occur during vaginal birth.

Another debate is about the use of general versus regional anaesthesia (spinal block) when doing a caesarean. A fascinating fact about childbirth is that when a baby is born, it cries to expand its lungs but then quietens down for about an hour (unless it is in pain or there is some stimuli). This is possibly a mechanism to allow bonding between the mother and baby. New mothers often remember the moments following the birth of the child as extremely emotional and blissful. Contrastingly, mothers who are under general anaesthesia and not awake when their child is born bond less with the baby initially (some mothers do not even recognise the baby as their own). Thus, unless it is an emergency caesarean, a spinal block (which allows the mother to be awake and painless) is preferable over general anaesthesia.

Lastly, it is common tradition to cut the umbilical cord straight after the child is born. But is this okay? When the fetus is in the uterus, it shares its cardiovascular system with the placenta. The umbilical cord connects the two and carries blood to and fro. At any given point, the placenta contains 30~50% of the fetal blood. If the umbilical cord is suddenly cut, the fetus essentially loses this blood, being born in a state of low blood volume. If you look at the umbilical cord, you can see that it is about 1m in length, which is enough for the baby to be put next to the mother’s breasts for breastfeeding and bonding. Perhaps we are cutting the cord too soon, not letting the blood flow back from the placenta to the fetus.

If you think about it, humanity has been giving birth without too many problems to survive generation after generation for 200,000 years (otherwise we would not exist). Although the mortality rate was high, Mother Nature has optimised childbirth over time through evolution. Ergo, it is possible that modern medicine is intervening too much in a natural process. We must always consider whether medical advances are helpful or harmful to us.

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Posted in Psychology & Medicine

Sleeping Sickness

Posted on by Jinavie

A woman travelling in Africa is bitten by what appears to be a mosquito. She swats the insect and keeps on going about her journey. The next week, she finds that she has a small nodule where she was bit. She is also feeling slightly unwell, with fever and fatigue. Over the following two weeks, her fever worsens (coming and going intermittently) and she notices large lumps along the back of her neck. By this stage, she is experiencing muscle and joint pain as well. After returning home from her trip, she finds that her symptoms have not resolved. On top of her fever and pains, she begins experiencing headaches, mood swings, lethargy, confusion, clumsiness, delayed response to pain, sleepiness during the day and insomnia at night. She begins to worry that something is wrong, but she believes that it is a bad flu and does not see a doctor. Her symptoms worsen with time (sleeping up to 15 hours a day), until one day, she falls asleep and does not wake up. She is taken to a hospital, where it is discovered she is in a coma. She dies within a week.

This is the typical presentation of sleeping sickness, also known as human African trypanosomiasis. It is an infectious disease caused by a protozoan parasite called Trypanosoma brucei (comes in two types: T. brucei rhodesiense (East African type) and T. brucei gambiense (West African type)), which is transmitted by tsetse flies – a bloodsucking fly endemic to sub-Saharan Africa (there are also case reports of sexual transmission between people). When infected, the parasite rapidly proliferates in the patient’s bloodstream. It is not detected by the host immune system, thanks to a surface protein called VSG. This allows it to spread through the patient swiftly and silently via the circulatory and lymphatic systems. The early symptoms (intermittent fever, rash, lymph node enlargement), typically presenting about a week or two after infection, are due to the parasite spreading through the blood and lymph. As the infection spreads, the parasites begin to invade the central nervous system (although in the West African type of the disease, patients often die from the toxic effects of the parasite replicating in the blood before they reach this stage).

As the infection spreads through the CNS, it causes the neurological symptoms described in the case. The sleepiness (from where the disease gets its name from) worsens as the disease progresses, with patients finding it difficult to wake up in the morning, even sleeping for over 20 hours. The sleepiness is caused by a chemical called tryptophol, which is produced by the parasite. Essentially, the neurological symptoms appear as if the person’s brain is slowing down, until they fall into a coma, resulting in death without treatment (usually within 2~3 years since the infection).

Sleeping sickness is invariably fatal unless treated early. Once the patient reaches the second stage (neurological phase), treatment becomes very difficult. The current first line treatment is a drug called melarsoprol, which is a form of arsenic. Because of its toxic nature, it is extremely dangerous and there is around an 8% chance of the patient dying from side effects. Fortunately, there are less dangerous and more effective treatments such as eflornithine (which only works for the West African type) being developed.

Posted in Psychology & Medicine

Hanging

Posted on by Jinavie

Hanging is one of the most popular methods of execution and suicide throughout the ages. It is typically performed by fashioning a noose (most commonly with the eponymous hangman’s knot), placing it around the victim’s (or own) neck. The person then falls from a short height (e.g. dropped from a stand or stepping off a stool), upon which the force of the body pulling down causes the noose to tighten. This can kill a person via two ways. Firstly, if the force of the drop and the knot is strong enough, the sheer force of the noose tightening and the person being suspended by their neck will cause their neck to break. This causes spinal cord injury at the cervical level, where the brainstem lies. When the brainstem is damaged, the person loses control of autonomic processes such as breathing, causing instant death. Secondly, if the neck does not break, the person will be strangulated by the noose. This will kill the person through either choking (from airway obstruction) or brain ischaemia (as the carotid arteries are cut off). Pressure on the carotid artery may also cause something called a carotid reflex, where powerful nervous signals cause the heart to beat so slowly that it stops.

It is said that whether a person dies a quick, clean death via neck fracture or a slow, painful death via strangulation depends on how good the knot is. A hangman’s knot is made up of a loop with a series of coils above it. The more coils there are, the more friction it adds to the knot, making the noose harder to pull closed. A true hangman’s knot is defined as thirteen coils, which provides enough resistance to cause a neck fracture when a person falls. If there are fewer knots than that, the knot will tighten too quickly around the neck and not provide enough resistance to cause a neck fracture. This leads to strangulation, which is far more excruciating and a very inhumane way to die. If there are too many knots, there will be too much resistance and there is a risk of decapitation, leading to a very messy situation.

In forensic medicine, there are certain signs that reveal a victim was hung. For example, the C2 spine (second vertebrae in the neck) will exhibit a hangman’s fracture, where there is fractures on both sides. Fracture of the hyoid bone (a small bone below the chin) is also a classic sign of hanging. There will also be bruises along where the noose was and every sphincter would be open (which leads to immediate voiding of the bowels and bladder at the time of death). If the person died of strangulation rather than neck fracture, they will show signs of asphyxiation, such as blue lips (cyanosis). Another interesting result of hanging is something called a death erection. As the name suggests, it is when a corpse is found with an erection, most likely due to hanging. This is probably caused by the noose crushing the cerebellum, causing a reflex erection. The same phenomenon has been observed in women as well.

Posted in Psychology & Medicine

Five Stages Of Grief

Posted on by Jinavie

Dr. Elisabeth Kübler-Ross was a psychiatrist who was greatly interested in the field of death and dying. She believed that medical students and doctors should be aware of how important the topic was. One of her major contributions to the field of medicine was a theory inspired by her work with terminally ill patients. Dr. Kübler-Ross discovered that patients who were given bad news often reacted in a rather predictable pattern of five “stages”. She also found that these theoretical stages of coping with dying also applied to other grieving processes, such as a child going through a divorce or grieving a break-up. It is important to note that these stages are not absolutely complete or chronological, but only a general theory of how people react to grief.

  1. Denial: A person’s initial response to any bad news or trauma is usually denial. Denial is a hardwired defence mechanism of the brain to protect the mind from trauma. However, it may hinder the process of coping, with some people being perpetually stuck in this stage while never fully coping with their grief. An example thought during this stage is “This can’t be happening to me”.
  2. Anger: Once the person overcomes their denial and recognises reality, they respond with anger. This is an externalisation response where the mind tries to deal with the bad news by lashing out. It can be seen as the mind’s response to the confusion that arises from receiving the bad news, which may be caused by cognitive dissonance arising from the conflict between denial and reality. Because people at this stage often lash out with rage and verbal abuse (sometimes even physical), they may be difficult to deal with. Thus, it is important to recognise that this is a natural response to grief and try to support them even though they are acting abusive. An example thought during this stage is “It’s unfair that this is happening to me”.
  3. Bargaining: When the anger settles down, a person attempts to deal with the grief with logic instead of emotions. They will try to negotiate with a higher power to delay their death, such as through praying. This stage shows how desperate and vulnerable the person is while trying to deal with the bad news. They will try to do anything to make the grief go away, or at least reduce it. However, this stage rarely produces any viable solutions. An example thought during this stage is “If I can have a few more years, I will do anything”.
  4. Depression: With both emotions and logic failing to protect them from the grief, the person will fall into a state of depression. Hope is lost and the person understands that resistance is futile (an example of learned helplessness). By this stage, the person has become quiet and withdrawn, often detaching themselves from family and friends. Ironically, trying to cheer a person up during this stage is ill-advised. It is more beneficial if the person can pull through the depression and process it to make it to the last stage of grief. An example thought during this stage is “Why bother, I’m going to die anyway”.
  5. Acceptance: The last stage of grief is not only accepting that death is unavoidable, but also recognising that there is still time before that. The person reaches a state of clarity and comes to term with the grief, achieving some inner peace. The time taken to reach this state varies and some people may never reach it at all. It is also important to note that just because the person receiving the bad news has accepted it, others around them may not have processed the grief. An example thought during this stage is “Everything is going to be okay”.