Archive for the ‘Medical wonders’ Category

Drug resistant bacteria. Image from the Centre for Disease Control, via Wikimedia Commons

Bacteria. They’re tiny. Often useful. And deadly, when our immune systems are unable to keep them in check. In today’s first world we’re so used to taking antibiotics at the first sign of an infection that the idea we could actually die from one seems improbable, almost laughable.

But bacteria are wildly prolific – and so fast in reproducing that new varieties spring up with relative ease. And the latest varieties are nastier than anything we’ve seen in a long, long time. They are resistant to almost every form of antibiotic we’ve created. And all because they carry a gene, which makes them produce an enzyme, which single-handedly puts most antibiotics out of action.

A medical study released last month has tracked the emergence and spread of new drug resistant bacteria carrying this enzyme, called NDM-1 (New Delhi metallo-beta-lactamase). They appear to have sprung up first in India and Pakistan, upon whose populations this new misery can be expected to wreak havoc, while also spreading inexorably worldwide.

Here in the comfort of our first-world cities, it’s easy to think we’ll be safe. After all, our hospitals are good, our sanitation excellent, our vigilance high. And we trust our drug companies to stay ahead of the game, when there’s money to be made from the creation of new drugs.

But drug development is painstakingly slow, and as global travellers return from trips abroad, the newly antibiotic-resistant bacteria are spreading. Already, cases are reported from the USA, Asia, Canada and Europe, with the first mortality recorded in Belgium.

Right now, we don’t know much about the exact origins or spread of the new bacteria. But almost all that stands between us and a return to pre-1930’s mortality rates due to bacterial infection are 2 antibiotics. One is more than 50 years old. The other is new, but not suitable for use in pregnancy or childhood. And this should have us worried.

The stats on what we could expect from a new ‘superbug’ are sobering. Before the discovery of antibiotics, death from bacterial infections was common. They killed people undergoing all kinds of surgery and after giving birth, those with open wounds, severe burns and respiratory illnesses.

This should be a huge concern to all of us. Science is good at finding solutions to problems. But when it comes to the development of new drugs, it’s neither fast nor cheap. Right now, there’s very little in the development pipeline to help us in the short term.

So what will?
Firstly, good sanitation is urgently needed in the developing world, and particularly in India and Pakistan where millions of people are currently exposed to raw sewage. Fix this, and you immediately slow down the rate of exposure.

Secondly, medical tourism must be curtailed, starting immediately. It may be cheaper in the short term to get your dental, cosmetic or surgical work done overseas, but is it worth risking your life, or others to possible infection? Once a superbug arrives, it’s here to stay – just think golden staph, and it’s multiple-drug-resistant cousin, MRSA.

Thirdly, new types of antibiotics are needed, and urgently. Governments need to start throwing money into research which will help us keep ahead of this looming crisis.

Fourthly, all countries need to be highly vigilant about tracking and stopping the spread of these resistant bacteria. Once they get into our hospital systems, they will be extremely difficult to eradicate – increasing misery and mortality within our communities, and putting our lives in jeopardy.

Finally, we need to stop using antibiotics so regularly. This means reducing their use in food production, not demanding a cure every time we have a cold, ensuring doctors prescribe them only where necessary, and preventing their sale over-the-counter, particularly in the developing world. We also need to take them properly – in the right amount, at the right time, and without cutting corners. So that our own bodies don’t become incubators for new types of drug-resistant bacteria.

Basically, it’s the over-use of antibiotics which has landed us in this situation in the first place. As history shows, they are one of our most precious resources – and they’ve just become a whole lot more scarce. Which should give us all the heeby-jeebies.

For more information, check out the ABC’s short history of antibiotics, the original research paper in The Lancet, and this news article from The Globe.

A Mona Lisa smile?

One of these teeth has dental caries. Can you spot which one?

Memo to self: Teeth not as small and insignificant as they look! Last week, after a horrible toothache, I discovered that I have a rotten case of dental caries – aka tooth decay. Although you can’t see much from the outside, apparently one of my teeth has a big cavity and has to be pulled out. While I wait for somebody (anybody?!) to fetch the pliers, the pain is just excruciating. It feels a lot like somebody has driven a knitting needle through my cheek, which is making life utterly miserable. To make things worse, it seems the minute you say ‘teeth’, people start to tell you horror stories. From barbaric dentists to chronic infections, I’ve now heard so many tales of dental suffering and woe that it’s got me thinking. Why isn’t dental health covered by Medicare? And more importantly, how can something SO small in relation to the rest of our bodies cause such big trouble? Well, it turns out that overall well-being can be profoundly affected by dental health. Some types of decay, like the sort I have got, can be very hard to spot and can become quite advanced before anybody realises. Often you need x-rays to reveal what’s going on – and the tell-tale signs are dark patches inside the teeth. Out of interest, I got my dentist to send me the x-ray of my mouth. Can you pick which tooth is giving me all this trouble? First person to email me with the answer wins a prize! I’ve also had a cracking headache for 6 weeks and I wondered if this is connected to the tooth decay. It turns out that it is. As you might expect, the face, mouth and jaws are incredibly rich in nerve endings. There’s a major nerve that serves the mouth and jaw (the Trigeminal nerve) and also the front part of the head. This nerve is also stimulated when you eat really cold things, leading to the phenomenon of ‘Ice Cream Headache’! Not having had a cavity before, I wondered what had caused this one. Was it something I ate, such as the afore-mentioned icecream? Turns out the answer is Yes! It seems that cavities often form in places where food becomes trapped – in between teeth or in the ridges and troughs on top of the tooth. Here acid-producing bacteria can multiply, and these thrive particularly well when we consume a diet rich in sugars. Since prehistoric times, the incidence of tooth decay has increased with the introduction of more sugar into our diets. Interestingly, tooth decay leapt with both the introduction of agrarian (grain-based) diets centuries ago, and also with the invention of fizzy drinks in the 19th century. I don’t really eat or drink a lot of sweet foods but I do eat ‘natural’ sugars found in bread, fruit, wine, dairy products and honey. Over time all of these have probably contributed to my current plight. Which isn’t much of a consolation but at least I haven’t got teeth like some of these people So, little teeth can cause big problems. Like the one in my head right now. The good news is that this small bit of research has happily distracted me from the pain for, oh, at least 30 minutes! If you too need a distraction (or just something to get your teeth stuck into), you can read more here: Medline encyclopedia Dental Dude blog MedicineNet article on toothache And my particular favourite by a very good looking surgeon: Dr Kam’s dental blog In my next blog post, I’ll be watching TV with a small dog called Hamish. Fangs for visiting! Sorry, couldn’t resist…