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| Sunday, 5 December 2004 |
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Some childhood ills refuse to go away by Holly VanScoy, Like the sequel to a bad movie, some medical conditions can show up years after an initial infection or injury. Many of them are every bit as bad - or worse - the second time around.
Once a common childhood illness that's now preventable by vaccination, chickenpox is characterised by an itchy, red rash that lasts 10 to 12 days, sometimes with a low-grade fever. But even when the itch passes and the rash fades, the chickenpox virus - known as varicella-zoster - has merely gone underground. According to Dr. Bob Sears, a paediatrician in San Clemente, Calif., and co-author of 'The Baby Book', the chickenpox virus is very persistent. "It never completely leaves the body," he explained. "Varicella-zoster remains dormant in the nerves, and for most people, it is dormant forever." "Forever dormant in most people" doesn't mean all people, however. The varicella-zoster virus can come roaring back to life as shingles, also known as herpes zoster. According to the U.S. Centers for Disease Control and Prevention, approximately 300,000 cases of shingles occur in the United States each year. And this is not a pleasant condition. Shingles is more common after age 50, and the risk increases with advancing years. The condition causes numbness, itching or severe pain followed by clusters of blister-like lesions in a strip-like pattern on one side of the body. The pain of shingles that can persist for weeks, months or years after the rash heals is known as post-herpetic neuralgia. Shingles in and of itself isn't contagious, but you can get chickenpox if you've never had it. According to the U.S. Centers for Disease Control and Prevention: "People who have not had chickenpox can catch chickenpox if they have close contact with a person who has shingles. So, you get shingles from your own chickenpox virus, not from someone else." Theoretically, it's possible that you then could get shingles after you've had chickenpox. Chickenpox isn't the only disease that has a nasty habit of coming back to haunt you. Mononucleosis - or 'mono' - is another. Mono is a fairly common acute illness in children and young adults caused by the Epstein-Barr virus (EBV), said Sears. EBV infection initially causes fever, a rash and sore throat, accompanied by fatigue that can last several months. "Most people get over this illness," the paediatrician explained, "but some will go on to suffer from chronic fatigue syndrome, where the mononucleosis virus reactivates and causes fatigue, headaches and other general symptoms." Then there's Bell's palsy, usually a temporary condition characterised by inflammation of one of the facial nerves resulting in weakened or paralysed facial muscles on one side of the face, which can also result from EBV infection. Other rare EBV-delayed effects include rupture of the spleen, inflammation of the heart muscle (myocarditis), involvement of the central nervous system (aseptic meningitis and encephalitis), and a nervous system disorder known as Guillain-Barr syndrome that can paralyse muscles. And don't think viruses are the only culprits responsible for adult medical complications. Even relatively unspectacular childhood injuries can have significant health consequences later. Dr. Andrew Iwach, an ophthalmologist on the clinical faculty at the University of California, San Francisco, said eye injuries that occurred decades earlier can manifest themselves in adulthood as serious visual disturbances. "Blunt trauma injuries are the worst culprits," Iwach said. "Everyone expects there to be damage when a sharp object pokes a child in the eye. But what isn't so widely recognised is the longer term consequence of being whacked in the eye by something as relatively innocuous as a tennis ball." Such an impact can set off a shock wave in the eye which results in a hyphema - or bleeding in the anterior chamber, an area between the cornea and the iris. Hyphemas are bad enough the first time around but, according to Iwach, they are particularly vexing when the damage done in childhood re-emerges later in life and affects visual acuity. "Whenever I see a patient who has one eye with an elevated level of intraocular pressure, I'm alert to the possibility that there was a history of blunt trauma to that eye," he said. "Sometimes that injury was many, many years in the past. And, often, the individual did not recognise the severity of the original blunt force trauma to the interior of the eye because the injury appeared to heal. But in actuality, these conditions can merely lie silent for a period, then re-emerge." Iwach said the key to preventing permanent damage is to secure immediate diagnosis and treatment. "These injuries can't be ignored," he said. "If they are, they have a way of popping up in the future and affecting a person's ability to see." Courtesy ScoutNews Chest pain not from heart? Check again, docs urged People who go to the emergency room with chest pain and are told that it is not caused by a heart attack or angina might want to get a second opinion. Findings from a new study indicate that on rare occasions heart-related chest pain is incorrectly chalked up to something else. In the study, nearly 3 per cent of patients who were sent home with a diagnosis of non-heart chest pain went on to have a heart attack or related problem in the next 30 days, Dr. Chadwick Miller of Wake Forest University, Winston-Salem, North Carolina, and colleagues report. Patients with heart disease risk factors, such as diabetes or high cholesterol, were at greatest risk, according to the report in the Annals of Emergency Medicine. "I would suggest patients with high-risk features should not be considered (non-heart) unless the treating physician is absolutely confident," Miller told Reuters Health. "Essentially, I would lower my threshold for doing a (heart) evaluation in these patients." While ER doctors tend to err on the side of caution when treating patients with chest pain, often admitting them for observation, physicians are under pressure to cut costs, the authors note. The researchers set out to determine whether some patients with apparent non-heart chest pain might need additional evaluation. The findings are based on a study of 2,992 patients who were diagnosed with non-heart chest pain. Despite their diagnosis, 2.8 per cent of patients experienced a heart attack or related event in the next 30 days. associated with such an event included male sex, older age, and traditional heart disease risk factors. The average age for patients who experienced such events was 61.2, compared to 47.9 for those who did not. Patients who complained of weakness, as well as those whose main complaint was not chest pain, were more likely to have a heart-related problem. Miller said that people diagnosed with non-heart chest pain may "deserve closer scrutiny" in order to identify cases that are really caused by the heart. However, even with closer scrutiny, he says it is likely that a small percentage of heart attacks will always be missed. SOURCE: Annals of Emergency Medicine, December 2004. Award for Indian Surgeon The 6th Asian Congress on Oral and Maxillofacial Surgery was held in Tokyo from November 20 to 23. Presided by Prof. Hiroyasu Noma and organised by the Asian Association of Oral and Maxillofacial Surgery, the congress attracted attendance of 1150 surgeons from all over the world, among which eleven were Indians. Four hundred research papers were presented and evaluated by a panel of expert judges. Among these Dr. S. M. Balaji's paper on the 'Correction of Traumatic Telecanthus' bagged the first prize. Prof. Kenichi Kurita, the General Secretary of the Asian Association of Oral and Maxillofacial Surgery presented a certificate of merit and a cash award of fifty thousand yen to Prof. Dr. S. M. Balaji, in appreciation for his innovative surgical technique. |
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Take chickenpox, for example.
