Whoever said laughter is the best medicine didn’t know about a “mother’s kiss.” As it turns out, a recent case review study of nasal foreign bodies found that a mother’s kiss is the best and safest way to remove the object from the nose of a small child or infant.
Using this technique an adult known and trusted by the child blocks the unaffected nostril and blows into the child’s mouth. The blowing should be gentle at first until the adult feels the resistance caused by closure of the glottis (the top of the windpipe at the vocal cords). Then the adult blows with more force which will then usually expel the nasal foreign body. If not expelled, the object often moves to the end of the nostril where it can be more easily reached.
The case review study of 154 patients found this technique very successful and worked on a variety of foreign bodies from a doll’s shoe to beads, beans, sausage and a dead bug. It also avoided trauma caused by instruments in a wiggling child, or the need for general anesthesia.
Get an infected cut or sprain an ankle and you will experience the healing benefit of inflammation. However, with the benefit also come the redness, swelling, heat and pain that are inflammation’s hallmarks. Although unpleasant, these symptoms dissipate rapidly and are reassuring that the immune system is doing its job to clear infection and guide repair of damaged tissue.
The journal Science had a recent review of inflammation as it pertains to chronic diseases. The review looked at new research in three major areas: Type 2 diabetes, cardiovascular disease and neurodegenerative disease. A common factor to all three is the inability of the immune system to clear away the stimulus that triggers the inflammation. Hence, there is a chronic inflammatory state that causes the disease to progress. In the case of Type 2 diabetes, obesity with the resultant saturated fatty acids is the “nonclearable” stimulus to inflammation which leads to insulin resistance, and thereby elevated blood sugars. In the case of cardiovascular disease it is apolipoprotein B, containing lipoproteins which can’t be cleared by the immune system. The resulting chronic inflammation can be measured by a test called C-reactive protein, and it leads to laying down of arteryblocking plaque or atherosclerosis. And in the case of the neurodegenerative disease (Alzheimer’s disease, Parkinson’s, prion disease and traumatic brain injury), it is the formation of protein aggregates that can’t be cleared.
In Alzheimer’s the protein that aggregates is B amyloid, and its presence stimulates immune cells unique to the brain called microglial cells. The chronic inflammation leads to loss of brain cells and thus, dementia. Luckily, understanding these mechanisms is leading to fruitful research. One example is altering JNK molecules. These are the enzymes that cause the diabetes-related inflammation. Drugs to modify these JNK enzymes have proven very successful in curing diabetes in mice models.
Dear Dr.: I heard there might be a new flu vaccine that is egg-free.
You’re right. In fact you’re double right as there are two egg-free flu vaccines soon to be available.
The first one is called Flucelvax, produced by Novartis. Canine kidney cells culture is used to grow the virus instead of chicken eggs. Tested in 11,000 patients, this new vaccine was 84 percent effective in preventing influenza.
The second is Flublok, offered by Protein Sciences. This one is produced by taking the gene that encodes for hemagluttinin antigen and injecting it into baculovirus – a virus found in insects – which then produces large amounts of hemagluttinin antigen. (Remember, flu virus has two main targets for vaccination: hemagluttinin and neuraminidase.)
Tested in 4,600 patients, this vaccine was 75 percent effective. Both vaccines are currently recommended only for persons 18 years old or older.
Dear Doc: ACE inhibitors do their job well, but cause big problems for some patients
Angiotensin-converting enzyme (ACE) inhibitors comprise one of the safest and most effective treatments for hypertension (elevated blood pressure). They work by inhibiting conversion of angiotensin I to its active form, angiotensin II (which leads to hypertension). Unfortunately, they also inhibit the conversion of the peptide bradykinin to its inactive form. Hence, in some people this can lead to a build-up of the peptide which can cause angio edema.
It is unclear why only .1 percent of the people taking ACE are prone to this side effect, but in that .1 percent the symptoms can be dramatic. They include shortness of breath, swelling of the lips, tongue and larynx and in some cases, abdominal swelling.
Another aspect of ACE angio edema that is a bit confusing is that the onset can occur at any time after the person has started the medicine. For many people it occurs after two or three years of use, which leads people to mistakenly think that something else caused their acute symptoms, such as a recent meal.
When ACE-induced angio edema was first understood, it was thought that a safe alternative for the ACE would be an ARB (angiotensin-receptor blocker); unfortunately, these, too, seem to have the same potential for causing mischief.