Anxiety or Depression: Chicken or Egg?!

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Introduction:

In Medicine, the existing of more than one condition or disease is common and it is so called “Comorbidity”. This term by definition refers to the co-existence of two conditions without any relationship such as causal. In other word, comorbidity is the co-existing of two conditions in parallel with no relationship, or different pathophysiology and treatment paths. But in fact that is not the case in many situations, as one condition may give rise to another, or in a better sense, one is primary and the other is secondary. For example hypertension or high blood pressure can lead to stroke and its consequences such as hemiplegia, or diabetes as a primary condition could cause many complications as secondary conditions such as diabetic foot and poor vision, etc. The treatment of the primary condition such as diabetes or osteoporosis could prevent the secondary condition such as diabetic wounds and bone fractures.

 Although some of these co-conditions that are still commonly labeled as “comorbidity” are very obviously primary and secondary to each other with a causal or consequential relationship, some conditions specially in Psychiatry may not look that much related to each other. For example in ADHD, secondary conditions or complications such as depression, oppositional defiant and anti-social behaviours or disorders, substance use disorders, etc. while not much superficially related, they are in fact so, and treatment of ADHD would prevent majority of the others. For the first time, I coined the term “post-morbidity” in ADHD for these secondary conditions or complications that are still in the literature considered loosely “comorbidity” with no apparent causal relationships. (1-2)

 

A similar relationship exists between depression and anxiety that are commonly comorbid in psychiatry and it is still considered with no causal or temporal relationship as simply “comorbid” in the literature and among experts. If two conditions are causally related and not appreciated as such, it will affect their treatments and both conditions could be treated with two treatments, e.g. two or more medications. But if there is a causal relationship, the treatment of the primary condition would prevent and treat the secondary or “post-morbid” condition, while their pathophysiologic relationship is more appreciated and understood. In this paper, I will show for the first time that such a primary and secondary or “post-morbidity” relationship exists between depression and anxiety that has never to this date been recognized.

 

Depression and Anxiety: Are they related?

Read the full text here:

https://medicinerevisited.com/psychiatry/anxiety-depression-chicken-egg/

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Polypharmacy: When too much good is no good!

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Introduction:

While medications from the time of antiquity have saved lives and do so more and more over time, have fostered health and increased longevity, too many medications or polypharmacy, particularly if it is not necessary, could cause more harms than benefits. Polypharmacy is seen in all age ranges and in all countries, but more in patients with comorbidities or more than one medical conditions, specially in the older population that is more risky and cause more harms and is more common in developing countries. Although it is assumed commonly that polypharmacy is used in comorbidity conditions, one would be surprised that it is common as well in single medical conditions, when physicians helplessly add to the number of medications to bring under control a non-responsive medial condition. (1-3)

 

The common and known unfavorable effects or harms of polypharmacy are adverse drug reactions, drug-drug interactions, low adherence to drug therapy and stopping all the medications by the patient, psychological dependency of the patient that only medications could help so not to resort to non-pharmacotherapy modalities if available, also physical dependency if the medication (s) are addictive, and finally the burden of the body tissues and organs by too many medications as foreign objects, specially on liver and kidneys that mostly metabolize the medications. In addition, it is also assumed that polypharmacy causes unnecessary health expenditure, directly due to redundant drug sales and indirectly due to the increased level of hospitalization caused by drug-related problems. Drug-related problems are reported to cause a substantial proportion of all emergency treatment and admissions to hospitals such as in elderly population. (4-7)

 Unfortunately many studies of polypharmacy have primarily been conducted on samples of elderly individuals admitted to hospitals or nursing homes, and only a few have been population-based studies, though some of these again have also been limited to elderly individuals. A recent register study showed that 2/3 of all individuals in a national population who were being prescribed with 5 or more drugs were < 70 years of age, indicating that multiple medication use is not only common in elderly population. A recent Swedish Prescribed Drug Registery in the period of 2005-2008 has shown an 8.2% increase in polypharmacy (>5 medications). (8-9)

In this article, we discuss first polypharmacy in different age groups, elderly, adults, children and adolescents, then across a few common medical disciplines, among comorbidities and single medical conditions.

 

Polypharmacy across life span:

In the above mentioned Swedish study of polypharmacy between 2005-2008, the prevalence of more than one medication in elderly (>70) was 80% on average, with more than 5 drugs averaged 45%, and more than 10 medications was about 13% on average. In adult age group, the prevalence of more than one medication was 30-40% in the age range of 20-49, but that jumped to > 50% in 50’s and to about 65% in 60’s. The use of more than 5 and 10 medications were rare until the 5th and 6th decades of life that was about 10% and 20%, but the use of more than 10 medications was still rare. In children and adolescence surprisingly the use of more than one medication was quite high about 18% in the first decade and 22% in the second decade of life. The number of individuals on polypharmacy and excessive polypharmacy over 5 medications were quite high, >4,500 in the first decade of life, >9,000 in the second, about 18,000 in the third, >35,000 in the fourth, close to 70,000 in the fifth, >138,000 in the sixth, >220,000 in the seventh decade of life, and in the elderly, 70-79 years old it was close to 250,000 and in the 80-89 years age group, it was >210,000. Surprisinlgy in all age groups the prevalance of polypharmacy has been increasing over years from 2005-2008. (9)

 Read the full text here:

https://medicinerevisited.com/general-medicine/polypharmacy-much-good-not-good/

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Legalization and Medicalization of Marijuana: When Ignorance Harms!

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Introduction:

Marijuana or cannabis extracted from cannabis plant possesses about 483 known compounds including at least 65 cannabinoids, most active THC (Tetrahydrocannabinol). The drug causes “high” or “stoned” feeling, euphoria and change in perception, that are used, mostly smoked for. But the drug has many other effects, or side-effects such as an increase in appetite, impairing cognition (attention, concentration, memory, thinking, learning, planning, etc.), dry mouth, impaired motor skills, red eyes, anxiety or its exacerbation and even paranoia and psychosis in susceptible individuals. Globally an average of 4% of the world population between the ages of 15 and 65 use marijuana. In 2015, 43% of Americans had used cannabis, which increased to 51% in 2016. All these data makes Marijuana, the most commonly used illegal drug both in the world and the United States. (1-2)  

 

Marijuana or Cannabis: Benefits Vs. Harms

Marijuana or Cannabis that is considered by lay people and lawmakers and some physicians to have potential medical benefits, and medical marijuana has been legislated in many parts of the world, is not as beneficial that is harmful. A recent meta-analysis found that cannabinoids that were originally justified in medical use for treatment of cancer chemotherapy-related nausea and vomiting, or in the treatment of pains and spasticity, showed inconclusive benefits for many of these indications such as improvement of appetite and weight, reduction in tic severity, and improvement of mood or sleep in such patients. On the flip side, cannabinoids and cannabis have acute and long-term adverse effects. In randomized controlled trials, cannabinoids increase the risk of total adverse events, serious adverse events, and dropout due to adverse events. Cannabis impairs cognition, and driving after cannabis use is associated with an increased risk of traffic accidents, including fatal accidents. Long-term cannabis use may lead to dependence, respiratory conditions, psychosis. Cannabis use during pregnancy may compromise certain pregnancy outcomes such as fetal growth, and use during adolescence may compromise neurodevelopment, social adjustment, and vocational success. (3-17)

 

Data from the Global Burden of Disease Study 2010 suggested that, during 2010, an estimated 13.1 million persons were dependent on cannabis; peaked in the 20- to 24-year age group, and was nearly twice as high in males as in females. Cannabis dependence was associated with 2,057,000 years of life lived with disability and the same number of disability-adjusted life-years. In Canada, these statistics were estimated to be 10,533 years of life lost due to premature mortality, 55,813 years of life lost due to disability, 66,346 disability-adjusted life-years, and 287 deaths in 2012. (3-6) Cannabis use has long been suggested to adversely affect cognition, and a recent systematic review concluded that verbal learning and memory and attention are functions that are most consistently impaired by acute and chronic cannabis use. (7) Psychomotor impairment occurs most obviously during acute intoxication but may be detected in chronic users, as well. The neuropsychological deficits probably arise from impairments that have been identified in hippocampal, prefrontal, subcortical, and other brain networks that subserve cognition. (8)

 

Read the full text here:

https://medicinerevisited.com/general-medicine/1679-2/

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Self-abuse: Why some people abuse their bodies and minds?!

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Introduction:

The term self-abuse first may bring to the mind self-harm, self-medicating, drugs abuse, masochism and so on. While these behaviours are common and life wasting, threatening, at times lethal, and important to be reviewed and discussed on its own, this article is not on this subject. This paper will review and discuss more masked and perhaps unrecognized types of human behaviours that are self-abusive, deteriorating and the causes of morbidities and in long-run even life shortening. These behaviours will be classified into sacrificing sleep; restricting or indulging eating behaviours; lack or extreme of physical activities; and unhealthy social activities through social media and virtual life.

 

Sacrificing Sleep:

More and more people in this era of rat race, profit hunger for a few and financial struggle for the rest, and also dependency on digitalism, social media and alike, cannot get enough of sleep or enough of a good and restful one. Therefore deliberately sacrificing one’s sleep to stay up on their gadgets, social media and else, or having sleep deprivation due to work and else has become an epidemic world wide. Therefore it is not uncommon to see many with sunken eye, fatigue, daytime sleepiness on the wheel, at work and school, or looking clumsy and even with weight gain as a result. (1)

 It is not just the amount and the hours of sleep that people do not get enough, but the quality of sleep! The sleep is comprised of different stages: Stage 1 (when feeling drowsy and sleepy); Stage 2 (or light sleep); Stage 3 & 4 (deep sleep); and REM (Rapid Eye Movement) sleep when one dreams. Every night our sleep goes through 4 to 5 of such a cycle, the first starting from 1-4 then REM, and so on. People who do not wake up in the middle of the night and have a sound sleep, they do not go back to stage 1 after the first cycle. Stage 2 of sleep is the prominent part of the sleep in normal adults, about 45-50% and deep or stages 3 & 4 comprises about 15% and REM about 25%. But most adults with sleep deprivation, insomnia, any other sleep disturbances and disorders, people with anxiety, depression, stress, worries, etc. do not get much of deep sleep or none. While REM sleep is for the restoration of mental fatigue, so anxious and worried people have more of it, stage 3 &4 that is deep or slow wave sleep is for the restoration of physical fatigue, so children get more of it due to their higher physical activities. (2)

 

Unfortunately even children and teens nowadays due to addiction to their gadgets and games, staying up till late at night, first of all do not get enough hours of sleep, and since they are not physically active, not much of deep or restful sleep. The case for children could be worse and life determining as the growth hormone and many others alike do secrete during stages 3, 4 and REM. The low secretion of growth hormone not only causes slow and poor physical growth, also the growth and development of the rest of the body organs, specially the brain. (3)

 Moreover sleep disturbances such as nightmares, sleep talking, sleep walking, night-terrors, sleep apnea, restless leg syndrome in sleep are becoming more and more common. Although many children, teens and even youngsters whose population of unemployment and dropping schools is on the rise, may sleep in the day and try to compensate their lack of night sleep, their sleep-wake cycle is deranged. The sleep-wake cycle or circadian rhythm, one of the important and vital cycles of life and nature, works on the rise and set of sun, so that is why melatonin a hormone that with addition of sunlight, gives us skin and hair color, and Vitamin D that gets activated by sun to deliver calcium to our bones are all dependent on a normal and healthy sleep-wake cycle. As a result as they say “Nothing is like a good night sleep”! (4-8)

 Read the full text here:

https://medicinerevisited.com/general-medicine/self-abuse-people-abuse-bodies-minds/

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Biosensors and the personalized medicine: Towards the future

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Introduction:

Humans have always watched and used animals and plants to detect danger and warning signs for climate changes and natural disasters. One of typical and popular of these had been the use of Canaries in coal mining even up until 1980’s as an early warning system of toxic gases such carbon monoxide, as the gas would kill the bird before affecting the miners. (1) This is the basis of “biosensors” that uses a biological element in an organism such as humans to detect and sense abnormality and diseases, or measuring certain functions. A common old such example is the “artificial cardiac pacemaker” that is implanted in the individual when the natural heart pacemaker for control of the heart beat is not working properly. Cardiac defibrillator also separately or at the same time could be implanted for the individuals with arrhythmia and at risk of cardiac failure. In the case of the pacemaker, when it does not detect normal heartbeat through its sensor, it will stimulate the ventricle of the heart with a short low voltage pulse that will normalize the heart beat. (2-3) Another popular type of biosensor in common use is the blood glucometer in diabetes. This biosensor uses the enzyme glucose oxidase that breaks down the glucose as a measure of blood glucose level. In brief, the biosensors through their transducer or detecting element, detects a measurable change in chemical, physiological or electrical system of the organism such as humans. (4) The blood glucose biosensor monitors blood sugar chemically, and the pacemaker detect abnormal heart beats physiologically and electrically.  

 The application of biosensors since the early use of cardiac pacemaker has evolved over the past half a century, and with more advancement in digitalism, the idea and research is extending to make the biosensors personalized and available to everyone into their digital gadgets such as their cell phones. While the personal gadgets such as cell phones already carry health monitor applications, including vital signs monitoring, the biosensors research’s goal is to bring to the hands of the individuals diagnostic and treatment tools. In this article, I will explore this area of research and advancement in medicine and will show the path towards the future of medicine that will be personalized. Since this area of medicine research is aggressively progressing and a detailed review of the subject is beyond the scope and space of this site, a concise review of a few areas of the biosensor development in a few fields of medicine will be conducted and presented.(5)

 Beyond pacemaker for our Hearts:

Since the heart is one of the most vital organs of the body and mortality due to the cardiac diseases such as heart attacks are still the leading cause, and since the invention of pacemaker saved so many lives in the past, the area of biosensors in cardiology is worth of advancement and consideration. Heart other than being the most vital organ of the body, is also the most active, working 24/7 even in sleep, so is a unique organ functioning physiologically, dynamically, electrically and magnetically. The artificial pacemaker that was adapted in invention from the natural heart pacemaker itself, was based on the electrical currency within the heart. To go beyond and use the biosensors for further diagnostic and treatment tools of the heart diseases, the research needed to invent more sophisticated devices to detect and control other functional parameters of the heart, e.g. physiological, dynamic and magnetics field of the heart beyond electrical conduction. Therefore these parameters such as oxygen saturation, blood flow pressure, its pH, cardiac output, temperature, and the sound of the heart beat all needed to be counted and put into the invention of these devices. (5)

 

Read the Full text here:

https://medicinerevisited.com/general-medicine/biosensors-personalized-medicine-towards-future/

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Leukemia: In the memory of Sohrab Sepehri and for the little Shauna

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Introduction:

Leukemia or the white blood cells cancer are either acute or chronic. Either of these types are divided to lymphocytic or lymphoblastic, myeloid or myeloblastic, hence ALL (Acute Lymphoblastic Leukemia), CLL (Chronic Lymphoblastic Leukemia), AML (Acute Myeloblastic Leukemia), or CML (Chronic Myeloblastic Leukemia). In leukemias the white blood cells that are in charge of the body immunity and produced in the bone marrow, are not fully developed, abnormal and in produced in great numbers. Therefore the immunity of the inflicted individuals are seriously affected and present with a variety of infections, bleeding, bruises, fever, etc. ALL is most commonly occur in children and is the most common blood cancer in this age group, but the other types of leukemias, AML, CLL and CML are more common in adults. While ALL is the best prognostic of these leukemias, the rest of the three have poorer prognosis, specially AML. The cause of these common blood cancers are not fully known, but inheritance and environmental factors such as radiation in its etiology have been proposed. This is while more than 2 million people worldwide are affected with leukemias with a mortality of more than 350,000 per year.

 

Sohrab Sepehri, a Persian poet and painter whose a few of his verses and paintings are posted here in between the texts, died at age of 51 from this killing cancer. He was born in a desert town of Iran, Kashan, but loved life and nature like no one else. He excelled more in poetry than painting that was his original art career, though his real life job was a teacher as none of his art work could provide for him and he did not write or paint for living. As you read a few of his poems here, he offered the poetry an imagery quality as if painting the words while versing. His poetry has been translated into many languages including English, French, Spanish, German, Italian, Swedish, Arabic, Turkish and Russian among others. He is more closer to Rumi, the ancient Persian poet, and his thoughts were more like sophism and Buddhism.

 

Shorab Sepehri

And Shauna is a little girl only 7 years old who at this very moment struggles with leukemia, and under chemotherapy has lost all her hair, wearing wig, her kidneys have been damaged and had to go under dialysis, her liver and nerves have been affected with treatment, and after all she has not cured yet. But she is positive, loves life and animals, specially dogs, cats and the fish in my office aquarium, when she comes in with her mom who is under my care for the treatment of the burden of care of her and her older brother who suffers from autism. Shauna also loves the nature as Sohrab did, and if she survives her killing cancer, perhaps one day she will be a poet, painter or both!

Another Victim of Mutation:

Leukemia like other cancers is another victim of gene mutations. As the nature takes care of itself, there is a “tumor suppressor gene” that over time has evolved in our system like other immune factors such as white blood cells themselves that defend our body against foreign invasions mostly by different microbes. But like in autoimmune disorders that the T-cells and other immune factors attack its own system, specific mutations in the cell divisionary process of white blood cell precursors, i.e. the stem cells, by microbial invasions or radiations is the pathophysiologic process of leukemia development.

 

Read the full text here:

https://medicinerevisited.com/general-medicine/oncology-cancers/leukemia-memory-sohrab-sepehri-little-shauna/

 

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ADHD: Attention deficit or Hyper-attentive?!

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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?

Read the full text here:

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

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PMS & PMDD: The Miserable Period

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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/

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

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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:

Read the full text here:

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

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Alopecia: The secret behind the patchy and total hair loss

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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/

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

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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/

 

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Pathologic fracture: When the bone breaks without trauma!

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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

Read The full text here:

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

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Suicide species: Why some people kill themselves?

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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)

Read The full text here:

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

 

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Digital Addiction: The end of free thought and will

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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

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

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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.

Read the full text here:

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

 

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

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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/

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Medical News: Revisited

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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

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

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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/

 

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Epilepsy: The delayed sequelae to early head traumas!

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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)

Read the full text here:

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

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