On Diabetes Worldwide

Diabetes mellitus affects more than 220 million globally, and is among the leading causes of death and disability worldwide. While nearly eight percent of the population of the United States is affected by diabetes - a figure which is expected to rise to 50 percent by 2020 - reports show that almost 80 percent of deaths due to the condition occur in developing nations. Experts indicate that in recent years more people with diabetes, particularly those in the developed world, are aware of their condition, but it is important to ensure that information is made available regarding not only how to manage the condition, but how to prevent it.

A chronic disease stemming from the body’s ineffective production or handling of insulin, diabetes may affect people at different stages of life, particularly childhood, adulthood, or pregnancy. Insulin is a hormone produced by the pancreas and secreted into the bloodstream to lower the amount of sugar in the blood. Excess sugar in the blood can lead to serious health problems, and individuals with diabetes must control their condition, often through monitoring their blood sugar levels and the administration of insulin either through frequent injections or an insulin pump. Type 1 diabetes; also known as insulin-dependent, juvenile, or childhood-onset diabetes; is characterized by deficient production of insulin. Though individuals with Type 2 diabetes, also known as non-insulin-dependent or adult-onset diabetes, often experience the same symptoms as those with Type 1 diabetes including excessive excretion of urine, thirst, vision changes, and fatigue, Type 2 diabetes results from the body’s ineffective use of the insulin it produces. Women may also experience gestational diabetes, which occurs in pregnant women as the placenta produces hormones to sustain the pregnancy which make the body’s cells more resistant to insulin. Reports indicate that in 90 percent of women affected by gestational diabetes, the condition resolves after delivery.

While Gestational diabetes occurs only in pregnant women, and Type 1 diabetes occurs primarily in individuals with a family history of the condition, anyone can develop Type 2 diabetes. Though some factors that contribute to Type 2 diabetes such as age and race cannot be controlled, others, including inactivity, weight, and body-fat distribution can be. According to the World Health Organization (WHO), 90 percent of individuals with diabetes have Type 2 diabetes, and a majority of these cases are the result of excess body weight and a lack of physical activity. Because these factors can also exacerbate the condition of individuals who have diabetes, experts recommend that precautions be taken, including maintaining a healthy diet, exercising, and carefully monitoring blood sugar and insulin levels.

Individuals with diabetes who allow their blood sugar and insulin levels to fluctuate too widely may experience disabling and potentially life-threatening complications. The risk of developing cardiovascular disease, nerve damage, and kidney damage are all greatly increased in individuals with diabetes, as are the potential for damage to the blood vessels of the eyes, nerve damage in the feet, and skin and bone problems. Reports indicate that diabetes increases the chance of foot ulcers and eventual amputation, is among the leading causes of kidney failure, and is responsible for nearly five percent of the 37 million cases of blindness worldwide.

In addition to these potentially disabling complications, if left unchecked, diabetes can lead to death. WHO projections indicate that by 2030, deaths due to diabetes and its complications may reach 2.2 million per year with the most rapid growth occurring in developing nations. Though treatment options are somewhat limited - with frequent blood sugar testing, diet, and an exercise regimen that includes weight training and aerobic activity being most effective - by understanding diabetes it may be possible to better control it and minimize the number of new cases.

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Maternal Mortality Worldwide

Worldwide, a reported 1,500 women die each day as a result of pregnancy-related causes. According to the World Health Organization’s (WHO) “Trends in Maternal Mortality” report, maternal mortality rates (MMR) worldwide have decreased, but remain a persistent public health concern. As noted in previous WHO reports on women’s health, medical staff and services, educational programs, and information pertaining to pregnancy and childbirth may be lacking in some areas. By ensuring that trained medical personnel are available, and that women are able to access pre- and postnatal care, MMR can be further reduced.

The number of women dying due to complications during pregnancy has decreased from 546,000 in 1990 to 358,000 in 2008 with an estimated 99 percent of these deaths occurring in developing nations. Reports indicate that women in developing nations are 36 times more likely to die from a pregnancy-related cause than those in developed countries. Though rates vary within and between countries due to differences in income and between urban and rural populations, the average risk of maternal mortality in developing nations is one in 75, compared with one in 7,300 in developed areas. According to experts, most maternal deaths are avoidable, and are due to four major causes: severe bleeding after childbirth, infections, hypertensive disorders, and unsafe abortions. In addition, approximately 20 percent of maternal deaths are due to indirect causes, including diseases that complicate pregnancy or are aggravated by it such as malaria, anemia, and HIV/AIDS.

Many of these deaths are due, at least in part, to a lack of trained medical personnel available to care for pregnant women and new mothers. WHO data show that less than two-thirds of women in developing countries receive assistance from a healthcare worker during childbirth. In addition to care during delivery, antenatal care is often limited in developing regions. In low- and middle-income countries approximately two-thirds of women have at least one antenatal visit, while in high-income nations nearly all women have at least four antenatal visits, receive postnatal care, and are attended by a midwife or doctor during childbirth. According to the WHO’s Colin Mathers, reducing the MMR worldwide will require countries, international organizations, and charities to collaborate to educate and train additional medical personnel to attend to pregnant women. Dr. Margaret Chan, Director-General of the WHO, has also stated that “No woman should die due to inadequate access to family planning and to pregnancy and delivery care.”

In addition to ensuring that trained personnel are available locally, telemedicine initiatives such as the iConsult program may prove beneficial in lowering the MMR. By combining a software application and website, iConsult may enables healthcare providers in remote and medically underserved areas (Requestors) to receive free advice on difficult cases from medical specialists (Volunteers) including Obstetricians and other maternal and fetal health experts. This type of telemedicine program may be employed to improve health outcomes and lower maternal mortality rates in regions where the necessary personnel are not available.

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On Cholera Worldwide

Though the last major outbreak in the United States occurred in 1911, cholera remains a persistent health concern in many parts of the world, including Asia, the Middle East, Latin America, and sub-Saharan Africa. Recent outbreaks have been seen in Nigeria, where cholera has killed more than 1,500 people this year, and in Haiti, where survivors of the massive January earthquake have been affected by an outbreak that has infected an estimated 2,300 people and killed at least 200. Due to cholera, there are an estimated three to five million new cases reported worldwide and between 100,000 and 120,000 deaths each year. Like other diarrheal illnesses, cholera is easily treatable and can be prevented through the provision of safe water, improved sanitation services, and education about the importance of hygiene.



Cholera is an acute diarrheal infection caused by ingestion of food or water contaminated with the bacterium Vibrio cholerae. Though three-quarters of individuals infected with V. cholerae do not exhibit any symptoms, they may shed the bacteria in their stool for seven to 14 days, potentially infecting others. While V. cholerae is the direct source of cholera infection, the deadly effects of the disease are caused by a toxin called CTX, that the bacteria produce in the small intestine of the host. CTX binds to the intestinal walls and interferes with the normal flow of sodium and chloride, causing the body to secrete large amounts of water and leading to diarrhea accompanied by dehydration. In individuals exhibiting the severe form of the disease, the rapid loss of fluids can lead to dehydration and shock, and without treatment death can occur within hours. Approximately one in 20 individuals infected with the bacteria develops symptoms associated with cholera, which include: severe, watery diarrhea; nausea and vomiting; muscle cramps; dehydration; and shock.

The rapid loss of fluids in a short period of time – often as much as a quart in an hour - associated with diarrhea due to cholera, makes the disease particularly deadly. In order to replenish the fluids and electrolytes that an individual with severe cholera has lost, Oral Rehydration Salts (ORS) must be administered. If a pre-formulated solution is not available, experts suggest combining one-half teaspoon salt, one-half teaspoon baking soda, and three tablespoons sugar in one liter of safe drinking water. With the prompt delivery of ORS, up to 80 percent of people can be treated successfully, with a fatality rate below one percent. Antibiotics may be used in conjunction with ORS to shorten the course and lessen the severity of the illness, however their delivery is less critical to cholera patients than rehydration. To help control the spread of the disease, two types of oral cholera vaccines are also available, but according to experts they provide only a short-term effect and should be administered in areas where ongoing water and sanitation improvement programs are in place.

Despite the simplicity of the cure, thousands of people die each year in regions that lack effective sanitation and water purification systems. Following man-made or natural disasters, the risk of an initial outbreak of cholera growing into an epidemic is greatly increased. As seen recently following floods in Pakistan and Nigeria, the spread of cholera becomes a major public health concern when there is a lack of clean water. By providing treatment as well as information about the importance of boiling water before drinking and maintaining personal hygiene, it may be possible to slow or even stop the spread of cholera and other communicable diseases.

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On Food Allergies and Intolerances

Individuals may experience allergies to any number of substances, but reports indicate that a growing number of Americans suffer from allergies to particular foods. Food allergies affect approximately 12 million Americans, including three million children. ”Food intolerances,” though frequently discussed in conjunction with food allergies, are quite different. Individuals with “intolerance” to certain foods may experience adverse reactions and discomfort if they are consumed. It is important to have an understanding not only of the severity and potential risk of food allergies, but of the difference between true allergies and intolerances.

The majority of adverse reactions linked to particular foods are due food intolerances. Individuals can be intolerant to lactose, gluten, or other foods, and may experience nausea, vomiting, stomach cramping, and diarrhea. While these symptoms are surely unpleasant, they are markedly different from the immune response seen in individuals with food allergies. In addition to bowel discomfort, food allergies can cause an anaphylactic response, leading to tingling and swelling of the mouth and face, hives, trouble breathing, dizziness, or fainting. These symptoms are caused by an response in which the body’s immune system mistakenly identifies a particular food as a harmful substance. An allergic reaction involves two components of the immune system: an antibody called immunoglobulin E (IgE), and a mast cell. When an individual consumes - or in some cases is in close contact with - a food to which they have an allergy, the allergen stimulates specialized white blood cells called lymphocytes which produce the IgE antibody for that specific allergen. This IgE is then released and attaches to the surface of the mast cells in the tissues of the body, prompting the cells to release histamine.

Allergic reactions can range in severity, but reports indicate that they cause 30,000 cases of anaphylaxis, 2,000 hospitalizations, and 150 deaths each year in the United States. According to the U.S. Centers for Disease Control and Prevention (CDC), there are eight foods which account for 90 percent for all food-allergy reactions: cow’s milk, eggs, peanuts, tree nuts (walnuts, pecans, etc.), fish, shellfish, soybeans, and wheat. One of the most common food allergies in the United States is to peanuts, affecting an estimated 3.3 million Americans. The incidence of peanut allergies is increasing, and reports indicate that between 1997 and 2008, the rate of child peanut allergies has tripled. Rates of other food allergies have also increased in recent years, and according to the CDC, the number of children with food allergies increased by 18 percent, between 1997 and 2007. While the cause of the increase is not fully understood, it may be due in part to the risk factors associated with food allergies, which include a family history of asthma and allergies, and elevated IgE levels.

Though there is no proven treatment for food allergies other than the avoidance of the allergen, experts recommend that individuals with food allergies carry injectable epinephrine at all times, as it can help to mitigate severity of the allergic response. In addition to the physical health-related issues resulting from food allergies, reports indicate that more than 30 percent of children with food allergies have experienced teasing or bullying related to their allergy. By gaining an understanding of food allergies and sharing information about them with others, it may be possible ensure that individuals are better informed about how to help prevent allergic reactions, and lessen the stigma faced by children with food allergies.

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On Alzheimer's Disease

Dementia is not a specific disease, but rather a group of symptoms affecting intellectual and social functioning. The most common form is a progressive form of presenile dementia first identified in 1906 by Dr. Alois Alzheimer, known as Alzheimer’s disease. Experts indicate that the number of individuals with Alzheimer’s worldwide could increase from 35.6 million to 65.7 million by 2030, due in part to the growth in aging populations. Additional reports indicate that in the U.S. alone there are currently 5.3 million people living with the disease, and this figure is projected to increase to 16 million by 2050. While there is no cure for Alzheimer’s disease, through treatment and education, it may be possible to improve outcomes for those with the condition.

Accounting for 50 to 80 percent of dementia cases, Alzheimer’s disease is marked by the loss of intellectual and social abilities severe enough to interfere with an individual’s daily functioning. As it progresses, Alzheimer’s disease may lead to mood swings, distrust of others, social withdrawal, and depression. Though it is not a “normal” part of the aging process, the risk of developing Alzheimer’s disease increases with age. Approximately five percent of people between the ages of 65 and 74, and nearly half of those over the age of 85 have Alzheimer’s disease. Although there is no known direct cause for the disease or means to ensure its prevention, research suggests that there may be a genetic link to the development of Alzheimer’s, and that lifestyle choices like maintaining a healthy weight and exercising one’s body and mind can at least delay the onset of the condition.

Alzheimer’s disease is most often diagnosed using a combination of blood or spinal fluid tests to rule out other possible causes of dementia, and brain scans to locate any visible abnormalities. Though doctors can accurately diagnose 90 percent of Alzheimer’s patients, the condition can only be diagnosed with complete accuracy during an autopsy. A post-mortem microscopic examination of the tissues of the brain of individuals with Alzheimer’s, reveals two abnormal structures called “Plaques” and “Tangles,” which are damaging to nerve cells. Plaques contain deposits of a protein fragment called beta-amyloid and build up between nerve cells, while twisted fibers of tau protein known as Tangles form inside dying cells. Though researchers do not yet have a full understanding of the role that Plaques and Tangles play in the progression of Alzheimer’s disease, experts believe that they block the communication among nerve cells and disrupt cell activities. Recent research has shown that Tangles may offer some insight into how quickly Alzheimer’s disease will progress in an individual, leading to the development of potentially tau-lowering drug treatments.

New research suggests that large doses of vitamin B may halve the rate of brain shrinkage in individuals with mild cognitive impairment. Though the mechanism by which B vitamins slow the progression of Alzheimer’s has not been identified, some B vitamins have been shown to control levels of homocystieine, an amino acid associated with an increased risk of Alzheimer’s. These new treatments, as well as the medications commonly used to help improve some of the symptoms of Alzheimer’s, which include cholinesterase inhibitors and memantine can help to improve the lives of individuals with Alzheimer’s. On average, these live half as long as a peer who does not have the disease – meaning that a 75-year-old diagnosed with Alzheimer’s can expect to live another six years, while a 75-year-old without the condition may live 12 years. However, because of the variance in the severity of cases and the speed with which symptoms progress, the life-expectancy of individuals with Alzheimer’s varies greatly.

Further research related to testing, diagnostic, and treatment procedures may lead to improved outcomes for individuals with Alzheimer’s. By gaining a better understanding of this condition and its causes, it may be possible to slow or halt its progression and improve the lives of millions of elderly individuals worldwide.

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On Breast Cancer Worldwide

This October marks the 25^th annual celebration of Breast Cancer Awareness Month, during which organizations in the U.S. and worldwide will hold events aimed at raising awareness and providing education about breast cancer. In spite of ongoing efforts to inform the public about breast cancer, it continues to be a major health concern worldwide. According to the National Cancer Institute (NCI), in 2010, there will be 209,060 new cases of breast cancer in the United States. Reports from the World Health Organization (WHO) indicate that incidence rates vary worldwide, however as the adoption of “western lifestyles” increase in the developing world, breast cancer has become more common. Due to the lack of adequate diagnosis and treatment facilities in these regions, survival rates are often also significantly lower. In 2004 an estimated 519,000 women died worldwide due to breast cancer, with 69 percent of these deaths occurring in developing nations. By ensuring that information about breast cancer and early detection programs are available, treatment outcomes worldwide can be greatly improved.

Like other types of cancer, breast cancer develops when abnormal cells divide in an uncontrolled fashion and spread to surrounding tissue (metastasize). Breast cancer is a malignant form of tumor growth which can develop in both men and women, but is approximately 100 times less common in men. An estimated one in every eight women will be diagnosed with breast cancer during their lifetime, making it the second most commonly diagnosed cancer after skin cancer in women in the United States. There are many types of breast cancer, but two of the most common are ductal carcinoma, which begins in the cells that line the milk ducts of the breast; and lobular carcinoma, which begins in the lobes or lobules of the breast. Unlike less common forms of breast cancer, including inflammatory breast cancer which is marked by heat, redness, and swelling of the breast, these common types of breast cancer tend to manifest similarly.

The first signs of breast cancer may include a lump in the breast or thickening of breast tissue, change in shape of the breast, changes in the breast or nipple skin, or bloody discharge from the nipple. Tumors in the breasts may be detected during clinical breast exams, mammograms and other imaging tests, or self breast exams. A mammogram is a black-and-white image of the breast similar to an X-ray. Though some recommendations differ, the American Cancer Society suggests that women undergo yearly mammograms beginning at age 40. Though mammography has proven to be an effective screening method and can help ensure early diagnosis of breast cancer, the Centers for Disease Control and Prevention (CDC) indicates that more than 7 million women in the United States have not had a recent mammogram.

Following the identification of a tumor within the breast, a determination must be made regarding how advanced the spread of the cancer is so that it can be effectively treated. The “Stages” into which breast cancer are categorized – from Stage 0, defined by abnormal cells that are not invasive cancer, to Stage IV, defined by cancer which has spread throughout the tissues of the body. The Stages indicate how aggressively the cancer is spreading within the breast, to the surrounding tissue and lymph nodes, and throughout the rest of the body. Depending on the progression of the cancer, treatment options may include chemotherapy and surgery. Chemotherapy is a drug treatment that uses powerful chemicals to slow the growth of cancer in the body or kill off the cancer cells. Though it is effective, chemotherapy, which can produce a number of side effects, including nausea, vomiting, hair loss, and fatigue, is often used in combination with surgical interventions. Breast-sparing surgeries, which aim to remove cancer from the breast while preserving the surrounding tissue; and mastectomies, in which the entire breast is removed, are often employed.

Though breast cancer treatment can be physically and emotionally painful, there are currently over 2.5 million breast cancer survivors in the U.S. and many more around the world. Breast cancer can occur at any age, but the risk of its development increases as an individual gets older. While the cause is still unknown, there are a number of factors linked to an increased risk of developing breast cancer including the presence of certain “breast cancer genes,” a woman’s age, family history, and age at the onset of menstruation and menopause can increase their risk of developing breast cancer. While little can be done about some of these factors, some women with a genetic predisposition to developing cancer have opted to undergo preventative mastectomies to reduce their risk. Individuals can also help to reduce their risk by maintaining a healthy lifestyle.

By ensuring that individuals are made aware of the importance of regular clinical and self breast evaluations and that early detection and diagnosis programs are made available, treatment outcomes can be greatly improved.

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Flooding in Pakistan

Reports indicate that recent flooding in Pakistan has affected the lives of at least 15.4 million people and left a third of the nation – including approximately 7.9 million acres of cultivated land900,000 homes have been destroyed by surges of water, and a reported six million people do not have access to food, shelter, and potable water. In addition, the United Nations indicates that 1,600 have died and more lives are at risk as the threat of water-borne illness continues to rise.

Floods began in late July following a period of particularly heavy monsoon rains and have continued through August. Many have sought shelter in camps established by aid organizations, but public health experts warn that the crowding associated with displaced persons camps could exacerbate the spread of disease. Scabies, a skin infection caused by mites that burrow and cause pimple-like irritation, is becoming increasingly common in the camps. According to some reports, tens of thousands of infected individuals are among the 600,000 people in relief camps set up in Sindh province. In these tented camps which have been established in army compounds, schools, and public buildings, healthcare providers are struggling to contain outbreaks of acute diarrhea, the precursor to fatal cholera.

According to Mark Ward, acting director of the U.S. Agency for International Development’s office for foreign disaster assistance, “When you are dealing with this much water and that many people it [cholera] is almost unavoidable.” In addition, the World Health Organization (WHO) has reported 204,000 cases of acute diarrhea, 263,300 cases of skin diseases, and 204,600 cases of acute respiratory diseases in flood-affected regions. Thousands of cases of suspected malaria have also been documented and the conditions for mosquito-borne as well as water-borne illness are present.

The delivery of treatment for these fast-spreading communicable diseases has been compounded by the lack of adequate clinical facilities. Reports indicate that 200 health facilities were damaged or destroyed. Vaccination programs have been established in Charsadda and Peshawar regions and more than 100,000 children have received polio shots. Despite these efforts, millions, including 3.5 million children are at risk of contracting disease, and require water, shelter, or emergency care. Radio and text messaging campaigns have also been put in place to distribute information about the importance of hand washing and good hygiene.

While funding for humanitarian aid has been limited to date, the UN and other international organizations continue their efforts to garner support. Assuring that food, water, shelter, and medical treatment are available for those who need them is the primary concern of aid organizations currently working in Pakistan. By delivering effective medical treatment in a timely fashion while also working to prevent the spread of diseases, outbreaks can be contained.

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Learn more about how you can participate in iCons in Medicine’s ongoing efforts to support rehabilitation relief in Haiti - under water. At least