Tag: pediatrics

Posted on

Measles is a Highly Contagious Viral Infection of the Respiratory Tract

Cacti on a golf course in Scottsdale, Arizona. (Dr. Noorali Bharwani)
Cacti on a golf course in Scottsdale, Arizona. (Dr. Noorali Bharwani)

Measles is making bad news. It seems to have started in Disneyland. A place where kids go for fun. How ironic and sad. And it has spread to several states in the U.S.

According to Centers for Disease Control and Prevention (CDC) website, 50 people from six states were reported to have had measles in the first two weeks of this month. Most of these cases are part of a large, ongoing outbreak linked to Disneyland in California.

According to CBS news (January 22, 2015), at least 75 people have now been infected with measles virus. The California public health officials are urging those who haven’t been vaccinated against the disease, including children too young to be immunized, to avoid Disney theme parks.

Age of people infected ranges from seven months to 70 years old, including five Disneyland workers.

Measles spreads through the air through coughing and sneezing. It starts with a fever, runny nose, cough, red eyes, and sore throat, and is followed by a rash that spreads all over the body. About three out of 10 people who get measles will develop one or more complications including pneumonia, ear infections, or diarrhea. Complications are more common in adults and young children.

Alberta had a measles outbreak last year. On April 29, 2014, Alberta Health Services declared a measles outbreak in the Calgary, Central and Edmonton Zones of Alberta Health Services (AHS). By July, AHS declared the outbreak to be over.

The best way to prevent measles is to have Measles-Mumps-Rubella (MMR) Vaccine. All health care workers should be vaccinated with two doses of the vaccine. Health care workers are at greater risk of measles infection than the general population because they provide care for ill individuals. A recent review concluded that health care workers were 13 to 19 times more likely to develop measles than other adults.

MMR vaccine is highly effective at preventing measles. One dose is 85-95 per cent effective and the effectiveness of two doses approaches 100 per cent. Two doses provide long-lasting immunity. The vaccines are very safe.

Measles was eradicated by year 2000 because of vaccination. But the virus has made a comeback in recent years, in part because of people obtaining “personal belief exemptions” from rules that say children must get their shots to enroll in school. Others still believe in now-discredited research linking the measles vaccine to autism.

Who started the current outbreak? Should we blame people who refuse to get vaccinated because they believe it is harmful to their children? Apparently, a small number of those stricken had been fully vaccinated. It is also reported the outbreak was triggered by a measles-stricken visitor to one of the Disney parks who brought the virus from abroad last month.

Coughing and sneezing spreads the highly contagious virus. Deaths are caused by complications associated with the disease. Complications are more common in children under the age of five or adults over the age of 20.

There is no specific antiviral treatment. Mostly symptomatic treatment is provided for symptoms and complications. The measles vaccine has been in use for 50 years. It is safe, effective and inexpensive. It costs approximately one U.S. dollar to immunize a child against measles. And it saves lives.

Start reading the preview of my book A Doctor's Journey for free on Amazon. Available on Kindle for $2.99!

Posted on

Six Distinct Types of Inherited Disorders Affect Several Parts of the Body

Rabbit preparing to cross the road. (Dr. Noorali Bharwani)
Rabbit preparing to cross the road. (Dr. Noorali Bharwani)

The title of this column may sound strange and you may not have heard of this condition before. That is because it is not a common problem. It is called Ehlers-Danlos syndrome (EDS). EDS is known to affect men and women of all racial and ethnic backgrounds.

EDS is a group of inherited connective tissue (bones, joints, skin) disorders, caused by various defects in the synthesis of collagen. Collagen is the main structural protein that gives strength to various connective tissues in animals. As the main component of connective tissue, it is the most abundant protein in mammals, making up from 25 to 35 per cent of the whole-body protein content.

Individuals with EDS have disorders marked by extremely loose joints, plastic like loose skin that bruises easily, brittle bones and easily damaged blood vessels. There are six distinct types of EDS currently identified. Each type is thought to involve a unique defect in connective tissue, although not all of the genes responsible for causing EDS have been found.

How common is Ehlers-Danlos syndrome? According to some literature, the exact numbers are difficult to estimate. It is believed the combined prevalence of all types of this condition may be about one in 5,000 to 40,000 individuals worldwide. There are many sub-groups of the condition that are hard to estimate.

First description of EDS was by Hippocrates in 400 B.C. In 1657 a Dutch surgeon noted a case history of a boy with very lax skin. The first association of very mobile joints to skin was published in 1892 in Moscow by A.N. Chernogubov. In 1901, Edvard Ehlers and in 1908 Henri-Alexandre Danlos described different disorders involving joints and skin with bruises. In 1936, the disorder was named Ehlers-Danlos syndrome.

Treatment is based on the symptoms. Unfortunately, there is no specific cure. Individuals with EDS generally have a normal life span. Their intelligence level is normal. Those with the rare vascular type of EDS are at greater risk of rupture of a major organ or blood vessel. These individuals have a high risk of sudden death.

What do we know about genes and mutation?

A gene is a unit of heredity that is transferred from a parent to offspring and is held to determine some characteristic of the offspring. Mutation is a natural process that changes a DNA sequence. And it is more common than you may think.

As you know genetic disease is caused by an abnormality in an individual’s genetic material. The abnormality can range from minuscule to major. It occurs from a discrete mutation in a single base in the DNA of a single gene to a gross chromosome abnormality involving the addition or subtraction of an entire chromosome or set of chromosomes. Sounds complicated?

Some genetic disorders are inherited from the parents, while other genetic diseases are caused by acquired changes or mutations in a preexisting gene or group of genes. Mutations occur either randomly or due to some environmental exposure. A gene mutation is a permanent change in the DNA sequence that makes up a gene. Well, this is a short introduction to genetics.

If you have a family history of EDS and are planning to have children then you should seek genetic counseling. You can learn more about EDS from the Ehlers-Danlos National Foundation website.

Start reading the preview of my book A Doctor's Journey for free on Amazon. Available on Kindle for $2.99!

Posted on

It Takes Three Minutes to Understand Tourette Syndrome

Skaters practicing at University of Calgary. (Dr. Noorali Bharwani)
Skaters practicing at University of Calgary. (Dr. Noorali Bharwani)

My niece’s grandson has Tourette syndrome. How much do we know about this condition?

Youtube has a three-minute video that is quite touching, simple and educational. The disorder was named after a French neuropsychiatrist, Gilles de la Tourette, who successfully assessed the disorder in the late 1800s. Males are affected about four times more often than females. There is usually a family history of tics.

The syndrome becomes evident in early childhood or adolescence between the ages of two and 15. It is manifested by multiple muscle and/or vocal tics lasting for more than one year. The presentation is usually involuntary (outside one’s control). It involves movements (tics) of the face, arms, limbs or trunk. The symptoms may be complicated, involving the entire body, such as kicking and stamping.

Verbal tics (vocalizations) are manifested by grunting, throat clearing, shouting and barking. The individual may suffer from coprolalia (the involuntary use of obscene words or socially inappropriate words and phrases) or copropraxia (obscene gestures). Others may repeat word of others (echolalia), repeating ones own words (palilalia), and repeating movements of others.

Fortunately most individuals with Tourette’s syndrome have mild symptoms. Some may have associated conditions like attention problems, obsessional compulsive behavior, and learning disabilities. For most, there are no barriers to achievement in their personal and professional lives. Persons with Tourette syndrome can be found in all professions.

There is no specific treatment or preventative measure. Tourette Syndrome Foundation of Canada (TSFC) has an educational website worth visiting. The goal is to educate both patients and the public of the many facets of tic disorders. Increased public understanding and tolerance is important to people with Tourette syndrome and their families.

This reminds me of a story I read somewhere.

David, a second-grader, was bumped while getting on the school bus and suffered a two-inch cut on his cheek. At recess, he collided with another boy and two of his teethe were knocked loose. At noon, while sliding on ice, he fell and broke his wrist. Later at the hospital, his father noticed David clutching a quarter in his good hand. “I found it on the ground when I fell,” David said. “This is the first quarter I ever found. This sure is my lucky day.”

In a small or big way, we are all blessed with something good. So keep smiling.

Start reading the preview of my book A Doctor's Journey for free on Amazon. Available on Kindle for $2.99!

Posted on

Circumcision: The Controversy Continues

Mother and son. (iStockphoto)
Mother and son. (iStockphoto)

“What advice should a physician give to parents considering whether or not to have their baby circumcised?” asks Dr. Jeff Blackmer. Dr. Blackmer is a Director of Ethics at the Canadian Medical Association (CMA). His column appears in the Bulletin of the CMA which is part of the Canadian Medical Association Journal (CMAJ February 5, 2013).

The Canadian Paediatric Society (CPS) evaluates scientific evidence and sets guidelines in matters affecting children’s health. Since 1996, CPS has advised physicians that circumcision of newborn should not be routinely performed as there was no medical benefit. This, of course, has not changed the practice. Some parents request circumcision for their sons for religious reasons or family tradition.

In August, 2012 the American Academy of Pediatrics (AAP) updated its 1999 policy on circumcision to say that there are some medical benefits to having the procedure. Circumcision lowers risk of urinary tract infection, cancer of the penis, and sexually transmitted infection. Blackmer says that CPS is reviewing the evidence and may release an updated statement.

In 2011, Dr. Noni MacDonald, Section Editor of CMAJ wrote an article in the CMAJ under the title, “Male circumcision: get the timing right.” (CMAJ April 19, 2011). Dr. Noni MacDonald is a Professor of Paediatrics and of Computer Science at Dalhousie University with a clinical appointment in Paediatric Infectious Diseases at the IWK Health Centre in Halifax Canada. She is the former Dean of Medicine at Dalhousie University.

“The most commonly performed surgical procedure in the world – male circumcision – is done for therapeutic, prophylactic, religious, cultural and social reasons. Discussions of male infant circumcision for health reasons are always split,” says MacDonald in her article.

Those who support circumcision say that there are significant potential health benefits including a decreased risk for some sexually transmitted infections, a decrease in HPV-related penile cancer and reduced phimosis and paraphimosis (tightness of the foreskin).

Those who oppose circumcision say that the procedure is not without likely complications – about 1.5 per cent – and it is a painful procedure for the newborn.
Medical organizations in western countries have discouraged infant circumcision for many years. MacDonald asks, “The question now is whether the findings from the randomized trials of adult male circumcision in sub-Saharan Africa that show circumcision halves the risk of acquiring HIV and decreases risk for HSV-2 (a herpes simplex virus that can cause genital herpes) and high-risk HPV in heterosexual African adult men push these organizations to change their positions on routine infant circumcision.”

MacDonald adds, “… none of the sub-Saharan African studies examined infant circumcision; all involved adult male circumcision. There is no new evidence that infant circumcision provides any added benefit to the neonate, infant or young child with respect to HIV and HPV protection. The potential benefit from circumcision only begins to accrue when the male becomes sexually active.”

The dilemma is: if the infant is not going to benefit from circumcision until he is sexually active then should we offer circumcision during peripubertal time? Would the male adolescent be willing to go through the procedure? Currently, infants have no choice. The choice for them is made by their parents.

The World Health Organization agrees there is evidence that male circumcision significantly reduces the risk of HIV acquisition by men during penile-vaginal sex, but also state that circumcision only provides partial protection and should not replace other interventions to prevent transmission of HIV.

Well, what is the conclusion? I will quote Dr. Blackmer from his ethics corner column mentioned earlier. It says, “Some parents will always choose circumcision, some will always reject it, and some will decide based solely on the evidence.” The only thing a physician can do is present the evidence and let the parents make the decision.

Start reading the preview of my book A Doctor's Journey for free on Amazon. Available on Kindle for $2.99!