ADHD: Attention deficit or Hyper-attentive?!

Introduction:

ADHD (Attention Deficit Hyperactive Disorder) as the most hereditary disorder of humans, physical or psychological/behavioural has been perhaps the most recognized truly in the field of medicine, even among the experts and researchers. This common disorder starting in childhood, but if untreated endures across the life span, has been known in different terms from the time of antiquity. Hippocrates (460-329 BC) (1), known as the father of medicine, observed patients who demonstrated “quickened responses to sensory experiences” and went on to describe their inability to stay focused “because the soul moves on quickly to the next impression.” Interestingly this ancient Greek physician recognized the condition both as a cognitive and behavioral nature together and not separate. But it took the field about two millennia to bounce back and forth, between recognizing it as predominantly a motoric (hyperactive) condition to a cognitive (inattentive) disorder until the present day. 

George Frederick Still (2), the father of British Pediatrics, in 1902 described and published in the Lancet, the descriptions of 43 children with serious problems of sustained attention and self-regulation, but at the same time paradoxically being “bright and intelligent”. Dr. Still was perhaps the first one to recognize the problem with “self regulation” instead of the label of “Moral Defect” on these children up until 20th century and also appreciating their high intelligence, that has not been widely acknowledged even today! In contrast with the positive and intelligent observation of Still, for the rest of 20th century and even now in 21st century, these children have been mislabeled negatively with having “mild brain damage”, “minimal brain dysfunction”, “mental deficiency”, etc. (e.g. 3-4) 

The pathophysiologic or causative theory of ADHD prompted by Charles Bradley (1902-1979) in 1937, a pediatric neurologist who by accident treated these children Benzedrine sulfate, an amphetamine product with great success, so to born the theory of “dopamine deficiency” prominent to this day. (5-6) In 1952, first edition of DSM (Diagnostics and Statistical Manual) of psychiatric disorders by the APA (American Psychiatric Association) (7) did not include any mention of an ADHD like disorder. Then in 1957, after Laufer and colleagues (8), reporting inattention and hyperactivity, both as two main features of the condition, the second edition of DSM in 1968, included the disorder as a formal diagnostic classification. (9) But before that another bright physician, Keith Conners in 1963 started his first study on the effects of Ritalin (Methylphenidate) in ADHD children and a year later published the first “Conner’s Rating Scale” for the official assessment and rating of the ADHD that is still in common use today. (10) 

In recent years first DSM-IV in 1994 (11) and most recently DSM5 in 2013 (12), have classified the disorder into two subtypes of predominantly inattentive (ADHD-I) and predominantly hyperactive/impulsivity (ADHD-HI), though these they often overlap at least in research samples as “combined”! Impulsivity as a very cardinal feature of ADHD that has been recognized only in recent decades in the disorder, has been poorly defined in DSM-IV & 5 as only “ blurting out” verbally, or “having trouble waiting one’s turn”, and “interrupting or intrudes on others” again more verbally. And the only change from DSM-IV to DSM 5 after a quarter of century has been extending the age of onset from 7 to 12, so prompting some to propose wrongly the new entity of adult onset ADHD. (13) 

 In this article that is a synopsis of my initial work (“ADHD: Revisited” and “ADHD: Hyperattentive, disinhibited, intelligent and evolutionary”) (14-15) I will dissecting into the true nature of ADHD, and reveal its misconceptions, misunderstandings, the shortcomings in its research and its current wrong classification and treatment.

Two young girls having fun painting everything. Childhood, learning, exploration family

 ADHD: One type or subtypes?

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https://medicinerevisited.com/psychiatry/adhd-attention-deficit-hyper-attentive/

PMS & PMDD: The Miserable Period

Introduction:

Premenstrual syndrome (PMS) is a combination of physical and emotional symptoms appearing 7-10 days before some (about 20-30%) women’s menstrual period. Symptoms that could vary in severity and types and among women would usually resolve by the start of the period. Common symptoms include bloating, water retention and swelling, feeling tired, irritability, and mood changes. The pathophysiology or mechanism of the symptoms development is due to the monthly ovulation that starts before menstruation and stops at the start of bleeding. (1)

The process of monthly ovulation for reproduction, consists of three ovarian cycles of follicular phase, ovulation and luteal phase; and three uterine cycles of menstruation, proliferative phase, and secretory phase. In the first ovarian cycle of follicular phase, under FSH (Follicular Stimulating Hormone) there is a gradual increase in the secretion of estrogen that stops the menstrual bleeding, thickening the lining of the uterus in its proliferative phase. Then in the luteal phase of ovarian cycle, Luteal hormone (LH) is released by the follicles or corpus luteum to produce an oocyte that only lives for 24 hours or less to be fertilized by sperm, when there will be secretion of large amounts of Progesterone to prepare the uterus for potential implantation or pregnancy. If implantation does not occur within approximately two weeks, the corpus luteum will involute, causing a sharp drop in levels of both progesterone and estrogen. The hormone drop causes the uterus to shed its lining in a process termed menstruation. (1)

 Real or Fake?!:

PMS in some women, about 3-8% could evolve to Premenstrual Dysphoric Disorder (PMDD) that is a more severe form of PMS with more emotional symptoms, resembling major depression. (1-2) PMS like its subject the female gender has a history of ignorance, degradation and subjugation by the dominant male society, including even the medical discipline. While up to 19th century, it was totally ignored and girls and women alike were accused of faking the symptoms and being all in their heads, later on in the 20th century and still in the 21st century, it has been and it is more a political and social subjects than a medical condition! Women, feminists and even physicians have been blamed for medicalization of PMS, perhaps for some personal gains at the workplace and else or for justification of its treatment. (3-5) Unfortunately and ironically, this medical subject well known to suffering female gender and the primary care physicians, has become a subject of discussion and annihilation even by sociologists and anthropologists that since women are conditioned to expect PMS, therefore they will have it and so it is more hypochondriacal than real! PMS by these groups that some are even women has been misnomered to be a cultural phenomenon that “grows in a positive feedback loop, and thus is a social construction that contributes to learned helplessness or convenient excuse.” and a justification for “rage or sadness”! (5-6)

 

A medical condition:

Read the full text here:

https://medicinerevisited.com/general-medicine/genitourinary-disorders/pms-pmdd-miserable-period/

Probing into the Brain development to redefine the different stages of Life

Introduction:

Human’s life as we know, goes through quite distinct stages. But these stages are not as simple as infancy, childhood, adolescence, adulthood and old age as most of us even medical fields recognize. That is why many medical studies including those in neuropsychiatry or neuropsychology plan their studies based on the above commonly known life stages. Even in many instances children including infants are mixed up with adolescents in studies or adults with elderly. As we know for example pediatrics cover the medical care of infancy, childhood and adolescents, while as we will read here with clear evidence by probing into the brain development that any of these stages are quite distinct. Here by probing into the brain development, a new classification and definition of different stages of life is presented that is vital to understand for medical, psychological and behavioural, even medical intervention of diseases and in a near future their preventions.

 Psychological, behavioural and cognitive classification of life stages:

Long time ego, Freud (1) the father of psychology and psychoanalysis divided early stages of life into: 1) Oral stage in the first year of life or infancy; 2) Anal stage in the second year of life; 3) Phallic stage in the 3-5 years of life; 4) Latency stage of 6-11, and 5) sexual stage from 12 to 18 years of age. Due to the sexual nature of his psychology, Freud’s classification of life stages was based on sexual development and the pressure on ego by id and superego and all speculative and not experimental and scientific.

 After Freud, Erik Erickson (2) tried to classify all stages of life from infancy up to old age as: 1) Birth-2 years (Infancy), that he believed the stage of learning Trust; 2) 2-4 years (Toddlers), when the child moves toward Autonomy; 3) 3-5 years (Preschoolers), when the child becomes Initiative; 4) 6-12 years (school age), when the child starts to become Industrious, more aware of themselves as individuals and responsible; 5) 13-19 years (Adolescents), when the teenager starts the process of Identity and role identification and self-confidence; 6) 20-40 (young adulthood), when the young adult enters Intimacy and serious and life long relationships; 7) 40-65 (middle adulthood) when the middle aged adults are at the stage of generativity vs. stagnation; 8) Late adulthood (65-death) when the individual facing integrity or despair. 

 

Later on Jean Piaget (3) classified the stages of life from a cognitive developmental perspective into: 1) Sensorimotor Stage: Birth-2 years, when the infant perceives the world around only through his senses and discovers the surroundings by his motor movements; 2) Preoperational stage: 2-7 years, when the child masters the language, expressing himself and controls surrounding somewhat by speech without yet having any sense of abstracts, logic and no mental power to operate well enough in the environment; 3) Concrete operational stage: 7-11 years, when the child is more logical, though still in a concrete manner without understating the abstracts; 4) Formal operational stage: 11-18 years, when the teen masters the abstract logic, hypothetical and deductive reasoning. Like Freud, Piaget did not go beyond adolescence and did not cover the cognitive development beyond age 18, even into adulthood.

 

None of the above classifications of the stages of life that were proposed in the first half of 20th century, based on the different stages of brain development and were strictly observational, though from quite distinct perspectives. The second half of the past century and the advent of neuroimaging and neurochemical studies brought to medical specially the filed of neuroscience, that the brain goes through different stages of development and that would not stop after the stall of the growth of the brain in size by age five. The neuroscientists cruising in the field of the brain development soon discovered not increasing in the number and sizes of neurons, but increasing in the surface of the brain by folding and making the convolutions and gyries, and specification in the development of the brain for different purposes throughout the different stages of life. Here I will present some of these discoveries as we walk through different years of life in an attempt to re-define the stages of life based on the development of the brain.    

The brain development during the fetal stage of life:

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https://medicinerevisited.com/neurology/probing-brain-development-redefine-different-stages-life/

Alopecia: The secret behind the patchy and total hair loss

Introduction:

Alopecia or pathological hair loss is different than the normal hair loss or hair fall that everybody has to a certain degree, specially as aging. The illness Alopecia if it is limited to a small patch or patches, mostly on scalp that can happen in other areas of the body as well, is called “Alopecia areata”. Alopecia that often is areata or localized as a small patch or patches and most often self-limited and improves, could also rarely lead to the total hair loss of the scalp that is called “Alopecia totalis”, or the total hair loss of the body, called “Alopecia universalis. (1)

Alopecia in its three types is an autoimmune disease, where the body immune system by mistake attacks its own hair follicles for wrongly being recognized as foreign. If there is no inflammation, scars or fibrosis at the site of alopecia areata, the condition is mostly reversible and self-limited, specially in children and adolescents. Alopecia like any other autoimmune diseases could be partly hereditary and runs more in the families with such history or other immune disorders. But like any other immune disorders or any so called “genetic disorders”, Alopecia can occur in anyone for the first time with no hereditary background history of any autoimmune disorders. So what would be the primary cause or trigger of “T cell lymphocytes” as the defenders of the body or our immune system to attack its own?! (2)

 

The secret behind Alopecia:

As it has been discussed in detail in other articles on autoimmune disorders such as MS (Multiple Sclerosis) and Diabetes Melitus Type 1 on this site, the trigger to the autoimmune disorders are external and caused by microbial invasions. Metabolic defects in the endogenous retinoids, a chemical compound that are vitamers of vitamin A and important in immune function and activation of tumor suppressor genes have been shown to play a key part in the pathogenesis of the alopecia areata. This defect is not only seen in alopecia but also in skin cancers as well. (3) Moreover other than the T lymphocytes, specially the interferon gamma (IFNG) and other T helper cells, cytokines and substance p, all important members of our immune system are involved in alopecia. (4-5)

While there is a well consensus among the experts in the autoimmune pathogenesis of Alopecia, the research has rarely gone behind the scene to identify the primary cause or enemy of our immune system that defects it so it attacks itself! This is despite many evidential reports since late 1940’s and 1950’s, confirming the link between different focal infections from parasitic Tineas to syphilis and fungal infections. (6-9) There have also been surprisingly early reports in 1950’s and 70’s of the reversal of alopecia areata with antibiotics. (10-11) 

 

Read the full text here:

https://medicinerevisited.com/dermatology/alopecia-secret-behind-patchy-total-hair-loss/

Why antipsychotics for depression?: When the experts miss the concept!

Introduction:

The idea of recommendation and prescription of second generation of antipsychotics in the treatment of depression (major unipolar depression, bipolar depression, depression in schizophrenia and even a milder depressive condition such as dysthymia) started in early 2000’s. First the experts recommended these agents that are originally synthesized to treat psychotic disorders such as schizophrenia, as augmentation to anti-depressants in the treatment of refractory depressions. (1-3) Soon such studies that are mostly sponsored by pharmaceutical corporations, suggested the use of antipsychotics not as an adjunct, or for the treatment of depression in psychotic disorders, or even bipolar disorder that could be accompanied by psychotic features, but for the treatment of pure unipolar major depression and as the first line treatment. (4) Nowadays it is not uncommon that even primary care physicians, psychiatrists and family physicians prescribe antipsychotics in the treatment of a patient who suffers from a simple depression. The pharmaceutical companies synthesize and market such antipsychotics (e.g. Quetiapine, Aripiprazole, Lorasidone, etc.) (these are these generic names that in different markets are sold under different brand names) have also been able to acquire indication for the treatment of depression for their products. The market sales continue to rise and the treatment indications of these antipsychotics are expanding beyond depression to other psychiatric disorders such as anxiety disorders, PTSD (Post-Traumatic Stress Disorder) and beyond. (5-6)

 A curious and cautious consumer may wonder why he or she should be prescribed an antipsychotic while having no psychotic disorder (delusions, hallucinations, etc.) but a simple depression! This article attempts to explore this wonder and show throughout the history of psychiatry, that the use of antipsychotics have not been limited to the recent time and the second-generation antipsychotics, but such attempt in the past failed over time. The experts might respond to this critic that the new antipsychotics possess such chemical structure that work on the neurotransmitters involved in depression (mainly serotonin and norepinephrine). But our lay patient could respond back that what about the impact of the antipsychotic component of these medications?! If the depressed patient is not psychotic and does not have any imbalance or over-sensitively in his or her dopamine neurotransmission (involved in psychosis) what would be the consequences of taking an antipsychotic that affect this neurotransmission. For example would he or she develop side-effects such as EPS (Extra-pyramidal symptoms) or simply abnormal movement disorders such as tremors and akathisia (restlessness and feet fidgeting, etc?! What about dampening the lay patient’s dopamine system in the brain that he or she needs it for all his or her cognitive faculties, etc.?! Since the poor lay patient could not keep this dialogue long enough against the experts who are masters of twisting the facts around to prove their points of intentions per pharmaceutical giants’ order, this article will strive to do so on the behalf such lay depressed patient and million others across the globe.

Digging the grave of antipsychotics:

Read The full text here:

https://medicinerevisited.com/psychiatry/why-antipsychotics-for-depression-when-the-experts-miss-the-concept/

 

Pathologic fracture: When the bone breaks without trauma!

pathologic-fracture-4

Bone fractures are most commonly occur after a trauma. But one wonders how bone can break or fracture without or with trivial trauma. Common sense may suggest that a fragile or weak bone can break easily, and that is true and the underlying reason or pathophysiology of pathologic fracture. Pathologic fracture, or the bone fractures without or with minimal traumas, has been known since 19th century.(1) It is caused by weakness in the bone structure, commonly occur due to osteoporosis. (2-3) But it also could be due to other pathologies such as cancers, infections such as osteomyelitis or bone infection, bone cysts, osteomalacia (soft bone) or paget’s disease, or even osteopetrosis (hard bone). (4-11) These fractures could be cause of a wide arrays of infections from venereal diseases, to tuberculosis, and even salmonella, (5-8) or cancers such as leukemia of childhood (9), or a cause of cancer treatment such as radiation. (10) It could also occur in a wide age range from infants and children to adults, and not only in elderly who are more common to have osteoporosis. (11-12) Pathologic fracture could also occur in many bones of the body from long bones of upper and lower extremities, to the hip and vertebrae and a small bone such as lower jaw or mandible. (13)  

 Osteoporosis, known commonly appearing in old age, specially in women has also been known for long that can occur at an earlier due to treatment with corticosteroids, used often for arthritic conditions. (14-15) This is while corticosteroids are paradoxically used also in the treatment and prevention of osteoporotic fractures. (16-17) Although pathologic fractures, specially occur in long bones and in elderly with osteoporosis in the hips, it can also occurs elsewhere including vertebral bones that is again paradoxically corticosteroids are reported to be used for its treatment and prevention. (18-19) Unrecognized such pathologic fractures of the vertebra have also been reported by radiologists without any such reports by the treating physicians in cancer patients, that partly could be due to the cancers and partly due to non-corticosteroid treatments of cancers. (20)

 pathologic-fracture-7

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https://medicinerevisited.com/pathologic-fracture-when-the-bone-breaks-without-trauma/

Suicide species: Why some people kill themselves?

Suicide and suicidal behaviors are very rare in animals and seem to be more of defensive nature unlike in humans that is not so, but intentional and against life. (1-2) Suicide in humans is a global issue that has resulted in 842,000 deaths globally in 2013, up from 712,000 deaths in 1990. (3) This makes it the 10th leading cause of death worldwide. (4) 75% of suicides globally occur in the developing world. Rates of completed suicides are generally higher in men than in women, ranging from 1.5 times as much in the developing world to 3.5 times in the developed world. (5) There are an estimated 10 to 20 million non-fatal attempted suicides every year. (6) Non-fatal suicide attempts may lead to injury and long-term disabilities. In the Western world, attempts are more common in young people and females, and suicide is the second cause of death among adolescents after accidents. (7-8)

suicide-3 

Factors that affect the risk of suicide include mental disorders, drug misuse, psychological states, cultural, family and social situations, and genetics. (8) Mental disorders and substance misuse frequently co-exist. (9) Other risk factors include having previously attempted suicide, the ready availability of a means to take one’s life, a family history of suicide. (7) For example, suicide rates have been found to be greater in households with firearms than those without them. (10) Socio-economic problems such as unemployment, poverty, Homelessness, and discrimination may trigger suicidal thoughts. (11) About 15–40% of people leave a suicide note. (12) Genetics appears to account for between 38% and 55% of suicidal behaviors. (13) War veterans have a higher risk of suicide due in part to higher rates of mental illness such as post traumatic stress disorder (PTSD) and physical health problems related to war. (14)

 suicide-2

Half of all people who die by suicide may have major depressive disorder; and having a mood disorder such as depression or bipolar disorder increases the risk of suicide 20-fold. (6) Other mental disorders’ risk of suicide are Schizophrenia (14%) that leads about 5% of such patients die from suicide, borderline personality disorder, PTSD, eating disorder, and substance use disorders. (6-7, 15) Approximately 20% of suicides have had a previous attempt, and of those who have attempted suicide, 1% complete suicide within a year, and more than 5% die by suicide within 10 years. (7) Acts of self-harm are not usually suicide attempts and most who self-harm are not at high risk of suicide. Some who self-harm, however, do still end their life by suicide, and risk for self-harm and suicide may overlap. (16)

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https://medicinerevisited.com/psychiatry/suicide-species-why-some-people-kill-themselves/

 

Digital Addiction: The end of free thought and will

Introduction:

Since the industrial revolution of 17 to 18th century in Europe, humans who freed themselves from slavery, feudalism, monarchy and alike, were worried about their dependence and overcoming by their own scientific creations.(1) Perhaps the first of these fears is demonstrated in the popular story of Dr. Frankenstein in 1818, who became a victim of the torment of his own creation.(2) Later on in many stories and films such as Space odyssey 2001, this fear warned us all! Although none of the fears of human clone, machines or robots did not materialize, humans became addicted first to televisions, then video games and most recently to computers, internet, social media, cell phones and alike. This dependency and addiction has not been limited to only a small group of scientists and creators, but has become an epidemic world wide, affecting ordinary people of all ages and totally out of control and a real concern in all lands.

digital-addiction 

The free thought as expressed in philosophy for example by the popular phrase of Rene Descartes’ “I think therefore I am”, that was the foundation of humans’ modern achievements, has faded away.(3) Similarly the free will that was well expressed through existentialism, and well expressed for example by the popular phrase of Arthur Schopenhauer’s “The world is my representation.” has been totally lost. (4-5) Humans rapidly became slaves once again as in the remote past before the industrial revolution, but this time not to religion, or monarchies, landlords, or another human, but to their own byproducts. The computer that was initially created for fast computing, then as an information technology, soon was transformed to a social media and communication, brain idling and washing device. The invention of mobile devices has facilitated this addiction, dependency, obsession and loss of free thought and will globally and across the life span. In the following we will see how digital addiction has become the most common and worrisome addiction of all types, worse than addiction to gambling, and illicit drugs.

 digital-addiction-5

From TV to the Internet and beyond:

After the world war II, when TV invented and became a public entertainment device at home, addiction to it also started with its medical and psychiatric consequences such as reactive apathy and obesity. (6-7) Then soon came the video games such as Nintendo, and by the 80’s personal computers and by the 90’s internet. The medical concern grew so much that medical and psychological journals such as “Cyberpsychology Behaviour” for studying the medical and psychological complications of cyber-addictions were founded. (8) The obsessive and compulsive use of digital technology brought behavioural problems and symptoms similar to any addictive disorder, so the term “digital addict” and “digital addiction” were coined. (9)

Read the full text here:

Digital Addiction: The end of free thought and will

Respiratory failure: In memory of the late Cesaria Evora, the Barefoot Diva

Introduction:

Cesária Évora with the nickname of the “Barefoot Diva”, for always going on the stage barefoot, to me like many other listeners who do not even understand the lyrics of her song, was a very special singer with an incomparable heavenly voice. She is dearly missed for more than 4 years, dying from respiratory failure on December 17, 2011. Cesaria or the “Queen of Morna” or to me “Miss Perfumado”, for her popular album, was born on 27 August 1941 in Mindelo, Sao Vicente, Cape Verde and died in the same place at home surrounded by family and friends. She was popular not for a heavenly voice, or being barefoot on the stage, but smoking on the stage during the intermissions, despite the rules of the concert halls and an ambassador of Cape Verde, the rest of Africa and UN World Food Programme. She was smoking to the last moment of her life, surrounded by family and friends at her home in Cape Verde, with always open doors. 

It was June 2002, when in Montreal Jazz festival, while in the morning after the first day of arrival, in a coffee shop, I heard her voice and music. I learnt her name for the first time that morning and saw her for the first time in the festival as she happened to be there. One more time, I was privileged to see her performance in Toronto, where she appeared as usual barefoot and smoked during the intermission, applauded by the audience who mostly like me, perhaps did not understand the lyrics of her songs. That , I guess did not matter as we do not understand the song of a canary or cardinal, or an angel if sings for us! Later on, I learnt her songs were about her love for her little country and Africa, that she would be homesick when she was away for short performances. Also  wishing rain that was rare for her dry homeland that in a few days will change it to a large beautiful garden. Singing for her mama to hear her, and for Africa, the cradle of the world and the fertile continent, to unite and live in peace not wars, and becoming the “United States of Africa” and realizing their capabilities,… 

Cesaria’s father, a part-time musician died, when she was 7 years old,   and at the age of 10 she was placed in an orphanage, as her mother could not raise all her six children. At the age of 16, she was persuaded by a friend to sing in a sailors’ tavern. In the 1960s, she started singing on Portuguese cruise ships stopping at Mindelo as well as on the local radio. It was only in 1985 when at the invitation of Cape Verdean singer Bana, she went to perform in Portugal. In Lisbon she was discovered by the producer José da Silva and invited to record in Paris. Évora’s international success came only in 1988 with the release of her first commercial album “La Diva Aux Pieds Nus” (The barefoot diva), recorded in France. Prior to the release of this album, Cesaria recorded her first LP titled “Cesaria” in 1987, that was later released in 1995.

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Respiratory failure: In memory of the late Cesaria Evora, the Barefoot Diva

 

Intelligence: What is it and are the IQ tests correct?!

Introduction:

According to Oxford dictionary, “intelligence” means “The ability to acquire and apply knowledge and skills.” Webster dictionary defines “intelligence” as “the ability to learn or understand things or to deal with new or difficult situations.” Webster has another definition for “intelligence” that is related to CIA and other governmental spy agencies as “Secret information that a government collects about an enemy or possible enemy; also : a government organization that collects such information.” The medical dictionary online has this definition for intelligence: “The ability to learn and to deal with new situations and to deal effectively with tasks involving abstractions.” Wikipedia has a broader definition: “Intelligence has been defined in many different ways including one’s capacity for logic, understanding, self-awareness, learning, emotional knowledge, memory, planning, creativity, adaptive behavior, problem solving and self-control. It can be more generally described as the ability to perceive information, and retain it as knowledge to be applied towards adaptive behaviors within an environment or context.”

 Intelligence has been defined in many forms, e.g., logic, abstract thought, comprehension, self-awareness, learning, emotional, retaining, planning, invention, creation, problem solving, etc. An editorial statement by fifty-two researchers defines the intelligence as “A very general mental capability that, among other things, involves the ability to reason, plan, solve problems, think abstractly, comprehend complex ideas, learn quickly and learn from experience. It is not merely book learning, a narrow academic skill, or test-taking smarts. Rather, it reflects a broader and deeper capability for comprehending our surroundings—”catching on,” “making sense” of things, or “figuring out” what to do.” (1)

 Generally speaking of intelligence, comes of mind IQ or Intelligence Quotient that is measured by different tests including Stanford-Binet, Raven’s progressive matrices, the most currently used Wechsler intelligence scales for children and adults, the Kaufman assessment battery for children, etc. Some tests consist of a single type of task; others rely on a broad collection of tasks with different contents (visual-spatial, verbal, numerical) and asking for different cognitive processes (e.g., reasoning, memory, rapid decisions, visual comparisons, spatial imagery, reading, and retrieval of general knowledge). The psychologist Charles Spearman early in the 20th century carried out the first formal factor analysis of correlations between various test tasks. He found a trend for all such tests to correlate positively with each other, and named it g for “general intelligence factor”. He interpreted it as the core of human intelligence that, to a larger or smaller degree, influences success in all cognitive tasks and thereby creates the positive manifold. This interpretation of g as a common cause of test performance is still dominant in psychometrics. (2)

 Read the full text here:

https://medicinerevisited.com/psychiatry/intelligence-what-is-it-and-are-the-iq-tests-correct/

Medical News: Revisited

In this post and page, the medical news are critically revisited, so the readers know the truth from false, specially in this era of confusion and terror!

Cinnamon: Is it good for better learning?

Is Obesity linked to higher risk of death?

Is Gluten-free diet really good?

Fruits & vegetables could help treat obesity, type 2 diabetes, cardiovscualr diseases and cancers!

Skin bacteria do not change much, despite regular washing!

Antibiotic use and its consequences for the normal microbiome

Does Neurofeedback work for ADHD?

Read all the medical news here:

Medical News: Revisited

Much ado about nothing: Too many research, not many results!

Introduction:

That is sad to learn that the world, specially the strongest economies and the most powerful countries on the face of earth, care and spend more on killing their own kinds and each others than caring and spending on their well-being! The U.S. outpaces all other nations in military expenditures. The world military spending totaled more than $1.6 trillion in 2015. The U.S. as we see in the diagram below, accounted for 37% of the total. U.S. military expenditures are roughly the size of the next seven largest military budgets around the world, combined. Interestingly, a third world country, Saudi Arabia, that basically survives on oil resources, and now seems not to have an immediate enemy, such as Iraq in the past, is the third leading country in the world on military spending, even more than England, France, Japan and many other countries! (1)

 wolrd_military_spending_barchart_large
The military spending of the united states swallows more than half (54%) of this country’s total budget, as we see in the diagram below, while science takes only 3%, education and health only 6% each! (2)

discretionary_spending_pie,_2015_enacted_large-2

 

While, the health and science portions of the US budget are trivial, the medical research in discovery of new treatments and the well-being of people comprises only a small portion of this skim budget. The NIH (National Institute of Health) of US invests nearly $32.3 billion annually in medical research, more than 80% of this funding goes to the universities and medical schools than the community health centers, the first gates of entry of people into medical arena, seeking help and treatment. As we see in the graph below, more than three times of NIH budget, i.e. $98.3 billions are only spent by the top 10 pharmaceutical companies in US, not on improvement of the people’s health or even drugs research, but on marketing. The amounts spent on sales and marketing are shown in orange, while the amounts spent on research and development are in blue. (3)

Pharmaceutical spendings

Now lets see, how this meager amount of money spent on the health research that is the main focus of this article. Spending less money and efforts by the governments on the health research could be at the first glance, the reason of humans’ failure to overcome common and simple disabling and killing diseases. But probing deeper into the issue, reveals that even the meager health research budget are not spent wisely, and while there are many researches, there are very few discoveries and solutions.

Read the full text here:

https://medicinerevisited.com/general-medicine/much-ado-about-nothing-too-many-research-not-many-results/

 

Epilepsy: The delayed sequelae to early head traumas!

Introduction:

Since age 14, when my younger brother in the early morning hours had his first fit of seizure, that shook us by surprise and terror, our family life changed for ever! Every day and every minute we were in anticipation of him having a fit, at the breakfast table in the morning, that happened the most, or during the day in school while we were not present to protect and taking him to medical attention. It took years until the seizure slowed down and came under control after many trials of anti-epileptics. At the time, nobody, even the medical experts knew the cause of a very common and ancient malady of humans. But while I was not yet even in medical school, I knew that during his childhood, he had several falls with head traumas, though I could not put things together and make a sense of the trauma as a common cause of epilepsy, that then was called “idiopathic”, meaning unknown cause!

Epilepsy or seizure that has been recorded as one of the oldest disease of the humans, as far back as 2000 BC in Akkadian records in Mesopotamia, has been affected commons and greats such as Julius Caesar and Alexander the Great. The disease for centuries had been known through ignorance as caused by “possession by evil spirits”, or named the “sacred disease”. First it was Hippocrates, the father of medicine who in the fifth century BC, rejected the idea that the disease was caused by spirits, and proposed that epilepsy was not divine or satanic in origin, but a medically treatable disease of the brain. He also proposed, heredity an important cause, and described worse outcomes if the disease presents at an early age, and instead of referring to it as the sacred disease, he called it the “great disease” giving rise to the modern term “grand mal” used for tonic–clonic seizures. Despite this landmark ancient work of the father of medicine, evil spirits continued to be blamed until at least the 17th century, and inflicted people with epilepsy were stigmatized, shunned, or even imprisoned, or put in asylums side by side with the mentally ills, or the criminally insanes. This was resolved and epilepsy was accepted as a disease of the brain only when in the mid-1800s, the first effective anti-epileptic medication, “bromide” relatively treated some cases. (1)

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https://medicinerevisited.com/neurology/epilepsy-the-delayed-sequelae-to-early-head-traumas/

Children of a lesser God: When guardians shatter the Futures!

“I loved music, until my music teacher got upset at one of my classmates, aggressively grabbed him by the neck, kicked him out of the class and swore at him” Sebastian in grade 5.

 Still I cannot believe what Sebastian told me and happened in his school, in “Beverly Acres Public School” in Richmond Hill, Ontario, Canada, about a maltreatment, physical and verbal abuse of a 10 years old child in front of the whole class! When I told Sebastian that I am going to write up the incident in my website and the world will know about it, he was excited to hear what others might think of the situation and condemn the abuse by their teacher!

 “Children of a lesser God” is originally a play by Medoff that in 1986 was adapted to a feature film, about a school for the deafs, their sufferings and struggles to learn. While any physical defect of a child could be considered by some or the child himself or herself as being of a lesser attention by the God to him or her, the mental defects of a child and more importantly so, the trauma, maltreatment and abuse that befall on a normal and healthy child could be taken as such.

A search in “pubmed” of the NIH (National Institute of Health) of the United States, reveals the following number of research papers: on child abuse in total:40331; child abuse by teachers:412; by clergy:115; by preiests:123! The child welfare of the US government reports that relatives, babysitters, and foster parents are the common perpetrators. The American humane association reports the following rate of common child abuse and maltreatments: neglect 62.8% as the highest type of abuse; physical abuse 16.6%; sexual abuse 7.1%; emotional and psychological abuse 7.1%; medical neglect 2% and “others” at 14.3%. Canadian child welfare agency, reports that in 2007, there were an estimated 67,000 children in out-of-home care across Canada. The Canadian Incidence Study of Reported Child Abuse and Neglect reports an increase of abuse reports from 135,261 in 1998 to 235,315 in 2003 and 235,842 in 2008. Neglect and exposure to intimate partner abuse and violence has been reported at 34% to be the highest, followed by physical abuse at 20%, emotional maltreatment at 9% and sexual abuse at 3%, different than the statistics in US, though both are similar in being western, mainly English speaking societies with multi-cultural striatum. Child issues that perhaps triggered more abuse by the perpetrators have been reported to be Academic difficulties: 23%; depression, anxiety, withdrawal: 19%; Aggression: 15%; Attachment issues: 14%;Intellectual & developmental disabilities: 11%; and ADD/ADHD: 11%. Care-givers risk factors have been reported to be the highest among the victims of domestic violence and abuse at 46%. Schools have been the most common source of abuse reports at 24%.

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Children of a lesser God: When guardians shatter the Futures

A Tribute to the Mastermind, Stephen Hawking: Neuromuscular Disorders

Introduction:

One wonders how many people know “Stephen Hawking”! Is he well known as “Oprah Winfrey”, the late “Prince”, or “Michael Jordan. The last year movie of “The theory of everything” casted by the brilliant actor, Eddie Redmayne and earned him an Oscar, has perhaps introduced more people to the mastermind “Stephen Hawking” whom this article is dedicated.      

 Stephen Hawking, one of a few living genius of our time, is an English theoretical physicist and cosmologist, and the director of Research at the Centre for Theoretical Cosmology at the University of Cambridge. His scientific works include collaboration with Roger Penrose on gravitational singularity theorems in the framework of general relativity, and the theoretical prediction that black holes emit radiation, often called Hawking radiation. Hawking was the first to set forth a theory of cosmology explained by a union of the general theory of relativity and quantum mechanics, so called “The theory of everything”. Hawking has a rare early-onset, slow-progressing form of Amyotrophic Lateral Sclerosis (ALS), commonly known as motor neurone disease, that has gradually paralysed him over the decades. He now communicates using a single cheek muscle attached to a speech-generating device. Hawking has not limited his knowledge to the scientific arena for the experts, but has popularized it by writing easy read books such as “The brief history of time” for the public. (1-8)

 Neuromuscular Disorders:

Neuromuscular disorders encompass a large group of disorders, including ALS, that befell on Stephen Hawking slowly from his final year at Oxford until his formal diagnosis at age 21. These disorders that lead one way or another, to the impairment of the function of different muscles of the body, are caused by either the pathology in the neurons controlling such muscles, or the pathology at the junction of the neurons to the muscles. If just the neurons in the central nervous system are involved, such as in stroke or CVA (cerebrovascular accident), or Parkinson’s disease, they are classified as “upper motor neuron” disorders. If only the neuromuscular junctions are involved, such as spinal muscular atrophies, they are classified as “lower motor neuron” disorders. Some of these disorders such as ALS (Amyotrophic Lateral Sclerosis) are mixed of upper and lower motor neuron disorders. (9-10)

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A Tribute to the Mastermind, Stephen Hawking: Neuromuscular Disorders

The Killer Cancer of the West: The Colorectal

Introduction:

Colorectal cancer, also known as colon cancer, is a cancer that starts in the colon or large bowel and could extend to the rectum, the end of the large intestine. Blood in stool, change in the bowel movements, weight loss, feeling weak and tired are the common signs and symptoms. Although genetic or family history of colon cancer and colon polyps, is currently considered the principal risk factor, only a small fraction of the population, 5-25% only have such a history. But constipation specially in old ages when the large bowel like many other parts of the body is more vulnerable and weak, and mostly occurs as a result of diet high in meat and low in fiber increases the risk of colorectal cancer. Other diseases of the small and large bowels such as inflammatory bowel diseases, including Crohn’s disease and Ulcerative colitis, and also polyps of the large bowel could increase the risk of colorectal cancer. In fact the cancer often typically starts as a polyp and a benign tumor that over time grows and spreads and becomes a killer cancer. Globally, colorectal cancer is the third most common type of cancer making up about 10% of all cases, with about 1.5 million new cases and 700,000 deaths per year, and the second leading cause of death from cancer in the the developed or Western societies. Colorectal cancer is one of the few diseases that is more common in developed countries than the developing or under-developed lands that carry most of the human’s diseases due to infections, poor hygiene, poverty and insufficient medical care. (1-3)

 The Normal & healthy Colon:

The normal function of the colon is fermentation of undigested food remnants such as starch and protein in order to extract energy from otherwise indigestible carbohydrates, production of vitamins, to absorb water and electrolytes and to transport waste products (feces) to the rectum for excretion/defecation. Food remnants, intestinal secretions, digestive juices and exfolated intestinal cells are metabolised by the bacteria (microbiome) in the colon. (4) In the bottom of each colonic crypt, 4-6 stem cells give rise to the enormous amount of colonocytes and host the potential of accumulating genetic and epigenetic changes. (5) As a result of the ongoing and rapid proliferation, the colonocytes move from the lower parts of the crypts up towards the colonic lumen at a speed of approximately 1 cell position per hour. When colonocytes reach the luminal surface they are exfoliated. Thus, a crypt is fully renewed in 2-8 d. The total proliferation rate is 3-10 billion colonocytes per day. This makes the colonic mucosa the organ with the highest proliferation rate of all organs in mammals. The rapid replication of cells require a readily available supply of nutrients for tissue synthesis and the process is very responsive to dietary changes. (6)

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The Killer Cancer of the West: The Colorectal

H1N1,HIV, SARS, MERS, Ebola, Zika, Noroviruses: What is next?!

Warning: Do not read, if you are very sensitive or a worrier.

Introduction:

Microbial world have dominated the earth for billions of years and gradually evolved to all forms of life as we know it, including plants, animals and us, humans. If the microbial longevity on earth is a book of 1000 pages, the human’s life history on earth is less than a line of it! Microbes of all types, from bacteria, to fungus, to parasites and viruses have survived through infestation of their hosts, including humans for billions of years, and we just came to know them not long ago, less than a couple of hundreds years ago. By learning about the hygiene, use of detergents, alcohol, other disinfectants, then anti-microbial agents such as antibiotics, and vaccines, we were able to fight some of these infections befalling on us. So until a little while ago, we thought that infections and infestations have faded out, at least from the developed lands and only remains to be a struggle in the developing nations due to poor hygiene and poverty. But the last few decades have opened our eyes very well that the “survival of the fittest” is still the rule and we are all at the mercy of the rulers of the earth, the microbes and we might be at the verge of extinction soon. Unfortunately our life history on earth could be a lot shorter than what we thought, not because of the greed of our war machines, or the anger of the sun or another extraterrestrial attack on our being, but by microbial invasions! While we thought of “evolution” as an upward phenomenon to create us, humans so to rule the world and destroy it, we well observed and understood that “evolution” is in every direction, and the “wisest” is not the “winner”, but the “strongest”.

Epidemics that have been a relatively rare incidents and exceptions in the past, have become the rule over the past couple of decades and have evolved to “Pandemics”! by our globalization, in fact we have helped the microbial world to get closer to all of us and we are not just sharing our gossips, greed, and ideas, but our germs. Through our infiltration to the nature and the wild, urbanization and destroying the environment, we have delineated the boundary between the civil and the wild life. As we will read in more detail in the following, more than %65 of our humans’ infections and the recent epidemics and pandemics are “Zoonotic” or originating from other animals, specially the wild life, into our very beings. It seems that the microbial invasions are all in full force and we are in full surrender, and we will fade out by acute attacks of epidemics and pandemics from outside, and at the same time, like Trojans invaded from within by the autoimmune disorders, cancers, degenerative, physical and mental disorders all caused by microbial invasions. If at the end anyone survives on earth, their genes have been mutated by the microbial attacks and we may not be humans after all as we know it today! Although these lines could be quite frightening and nightmarish, it is truly scientific and is known to microbiologists for a while. We may not have the solution to the survival yet, as the attacks are very serious and much sophisticated. But the first step is the knowledge of what is happening so to search for a collective solution and resistance altogether across the globe, that could never happen! In the following, after a brief review of the microbial invasions on humans throughout our short history, I will summarize an example of a few recent microbial invasions in the forms of epidemics and pandemics across the globe, while the list and detail of all could not be recorded here or perhaps anywhere else.

Read the full text here:

https://medicinerevisited.com/infections-2/h1n1hiv-sars-mers-ebola-zika-noroviruses-what-is-next/

The Vomit Bug: Invading Cruise Ships and St.Maarten (A very up-close and personal experience with the microbial invasion)

For the March break and Easter, we went back to the beautiful island of St.Maarten, where we purchased a condo in the Sonesta Great Bay several years ago. Since the resort decided suddenly and unilaterally a couple of years ago changing to an “adults only” hotel, the condo and time share owners with young children like us have to either not to go there and forget about their initial purpose and investment, or to stay in the condo and not use the hotel facilities as it is prohibited with family with children. But we kept going as we love the island and since we could go to the sister resort of Sonesta Maho daily and still enjoy our vacation somehow.

 This time when we arrived on March 15 for a 2 weeks stay, we were warned about a “stomach bug” on the island, mostly in the Maho resort. So we refrained to go to Maho and locked ourselves in our condo and satisfied ourselves with only the visual pleasure of the beautiful scenery and the ocean. After about a week, and reassurance from the hotel managements that there have not been any new cases for a few days, we decided to take our three young kids out of the condo to the Sonesta Maho, where kids and family are welcome. We could not believe how quiet was the resort that usually specially during the March breaks are stormed with families and young children! We stepped in the restaurant after sanitizing our hands several times, per recommendation of the hotel management. The restaurant that was always very busy, looked like a ghost restaurant and obsolete like after an extra-terrestrial attack on earth, very quiet with only us and a few others. We decided to sit outside in the open area by the ocean to be safer from the bug if still around. Inside the buffet restaurant, the foods were served to us by the staff wearing gloves and not letting us touch the food or the cutleries. All this seemed very suspicious and smelled the danger, but we relied on the reassurance of the hotel managements that there have been no new cases and the resort is safe as long as we sanitize our hands that we did several times. Long story short, we went on the next day, March 22 as well and enjoyed the resort and the beach, and watching the landing and takeoffs of the planes in the Maho short runway by the ocean.

 The night of March 22, was nightmarish, as first our daughter started with projectile vomiting repeatedly all night long, shivering and fevering, sobbing in fear of doom and dying. Then our youngest son, became sick the same, vomited everywhere, scared to die, then my wife who was courageously cleaning after them, started to throw up violently that frightened all of us, including me and my middle son, barricading ourselves in another room to be at least the two safe, but oblivious of the fact that the bug has already been in all our bodies and it was just a matter of time to show its symptoms! I could not sleep all night long, worried of what is going to happen to us in our vacation that supposed to be all in peace and fun. I had already read about the bug, a virus called “norovirus” or “vomit bug” that you will read in detail soon after the conclusion of my personal encounter. The night passed relatively uneventful other than my worries for the two of us in the barricade, but all of a sudden in early morning, my boy jumped off the bed in nausea, ran to the washroom and locked himself in, kept vomiting in the toilet for at least half an hour, not letting me who was scared, in as he is a big boy with pride. This scenario happened again three or four times until the vomits stopped around noon. After that he had diarrhea all day long, spending all of the Wednesday, March 23rd between the washroom and the bed. Shortly after him, in the morning, while I was thinking how I have been exempted by the mercy of the virus, that an instantaneous nausea overcame me so ran to the washroom and had a projectile bloody looking vomit.  We all did not recover until the third day and fortunately survived this microbial invasion as there are cases of death as you will read in the following.

The vomit bug or Norovirus is a genus of Norwalk virus, named after Norwalk, Ohio in US, where an acute outbreak of gateroenteritis occurred among children in 1968. This virus is the most common cause of viral gastero-enteritis in humans, transmitted by fecally contaminated food or water, by person-to-person contact and via aerosolization of vomited virus and subsequent contamination of surfaces. Norovirus is a very tiny, un-enveloped RNA virus possessing the highest mutation rate even among other RNA viruses.

Read the full text here:

https://medicinerevisited.com/infections/the-vomit-bug-invading-cruise-ships-and-st-maarten-a-very-up-close-and-personal-experience-with-the-microbial-invasion/

Obsessions, Compulsions, Undo harm, Rituals, Superstitions: OCD

https://youtu.be/x2J5RWf_LJk

Introduction:

“The boy who could not stop washing” or “When once is not enough”, two book titles on Obsessive Compulsive Disorder (OCD) that tell a lot about this devastating behavioural and mental condition. This illness that can start as early as early teens, is not limited to washing and cleaning, but obsessions about tidiness, orderliness, checking, rechecking and more. Obsession is a repetitive anxiety provoking thought that something is not clean, tidy, organized, in order, not right, etc. that will not leave the inflicted individual alone. Then the person feels obliged to do something to stop the burdening thought (compulsion) that leads to “compulsive act” that is washing, cleaning, ordering, tidying, checking and rechecking until feels satisfied that is hard to reach. Associated or underlying this chain of thought (obsession), urge to act (compulsion) and the act (compulsive act) are, “doubt” and “superstition” that things are not clean or right the way should be, and if not act upon, some harms will befall on the individuals or beloved ones. Then rituals will come to play, and the person in the eyes of others could appear not anymore as a clean, tidy, or a “perfectionist”, but as totally insane who has lost his touch with reality and cannot be convinced by others. The cases that come to medical attention, are usually more than a mere perfectionism and consists of all the above, that makes it very hard to treat.

The big question is that what causes OCD, specially from an early age. Is it a personality that is labeled “obsessive compulsive personality”, or is it rooted in “perfectionism”, or in anxiety-ridden subjects, or is it genetic and familial? The fact is that many of OCD patients, have had no obsessive compulsive personality, or perfectionism, no history of previous anxiety and none of their other family members suffer the same. The etiology is still unknown, hence the treatment is incomplete and failure in many instances and prevention is not in agenda as nobody knows how! In this article, I will attempt by search in the available literature to answer some of these dilemmas and somewhat clear the path to the treatment and hopefully the prevention.

 Did it all start from a “sore throat”?

Read the full text here:

https://medicinerevisited.com/psychiatry/obsessions-compulsions-undo-harm-rituals-superstitions-ocd/

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