CONTENT: Part One

From the Editor

2

FALL / WINTER 2006-2007

A PUBLICATION OF THE MEDICAL DIVISON OF THE AMERICAN TRANSLATORS ASSOCIATION

The Irritable Gut3

Clinical Rounds

7

Bits - Pieces-Facts -Fig-

12

Pitfalls andCaveats9

Mid -Year

Conference

Caduceus

Website - Blog

Listserv

San Francisco

Best wishes for 2007

Fall / Winter 2006/07

Caduceus is a quarterly publicationof the Medical Division of the

American Translators Association, anon-profit organization dedicated to

promoting the recognition oftranslating and interpreting as

professions.

EditorRafael A. Rivera, M.D., FACP

bukrak@bellsouth.net

Assistant EditorElena Sgarbossa, M.D.

Editorial StaffGilberto Lacchia, M.D.

ProofreadersDiane Howard

Ester DiazMaria Rosdolsky

Graphic DesignDeborah Sales

Please mail all correspondence andcontributions to:

bukrak@bellsouth.net

It is with the typical combination of sadness and joy - a lotof the first and some of the second - that we say goodbye toone of our solid contributors to Caduceus, Leon McMorrow.Leon has been a steady contributor and can take credit formuch of the growth and acceptance of our newsletter. Sinceour beginning he has shared his creative knowledge andlooked for ways to increase readers’ participation in ourproduct, not an easy undertaking. Leon is not going far, hejust needs to cast his net of interests in a different direction.You will see his fingerprints scattered throughout this issue.

The lead article deals with the vexing problems of anunfriendly gastrointestinal system. The brain-gut connectionremains an axis of evil in the lives of many.

Maria Rosdolsky has put together for this issue a German toEnglish physical examination glossary. She plans to followwith other future German to English renditions in futureissues. Members interested in submitting glossaries, wordlists and similar formats in English paired to other languagesare welcome to submit their work.

Assistant editor, Elena Sgarbossa tells us about the“translation” of medical discoveries into the realm of patientcare, the pathway from bench to bedside.

Michael McMann completes his rendition of Ethics andProfessionalism in Internet Actions, a wide rangecommentary on the ethics governing a translator’s work ashe or she relates to the Internet world.

Zarita Araujo-Lane and Vonessa Williams bring a verypersonal medical interpretation experience to our attentionalong with some derivative advice.

Completing the issue are the usual columns and sources thatwe hope you enjoy. Your comments are always welcome.

Instructions to Authors

Submissions for publications must be sent electronically in Word format. Thedeadline for submissions for the Fall issue of Caduceus is 31 March, 2007.

Caduceus carefully reviews its content in order to eliminate any textual errors.Nevertheless, we apologize for any errors in grammar, punctuation, typographyand the like which may inadvertently appear on our pages.

Contents of this newsletter are the property of the Medical Division of ATA.Permission to use, or republish or reproduce information contained herein canbe obtained from the editor.

A PUBLICATION OF THE MEDICAL DIVISION OF ATA From the Editor | 2

A PUBLICATION OF THE MEDICAL DIVISION OF ATA THE IRRITABLE GUT | 3

Introduction

The word “gut” is almost a term of endearment forgastroenterologists and abdominal surgeons. Theancient Anglo-Saxon word refers to the humandigestive system - all of it - nearly 30 feet long ifstretched out straight. The string of organs that weknow as the alimentary canal or digestive tractcomprises the esophagus, the stomach, the smallintestine and the large intestine or colon (whichincludes the rectum) in that order.

All these organs of the gut are always in motion,driven by the muscular layers within the wall of thegut. Coordinated contractions move foods and fluidsand secretions - produced by the gut or entering thegut from adjoining organs - in a propulsive, dynamicmotion called peristalsis. The primary purpose of allthis activity is called digestion - the breakdown andconversion of foods into nutrients that are absorbableinto the circulatory system while leaving the non-absorbable portion to be expelled by a highly efficientdisposal system.

The Basics of GI Function

No sooner a lick of ice cream or a morsel of bread or apiece of fruit enters the mouth digestion begins.Besides the physical activity of chewing and movingaround the mouth, saliva is secreted to soften the itemsand convert complex starches into simple sugars,Saliva also allows taste buds to sense flavors.

by Rafael A. Rivera, M.D., FACP

Man should strive to have his intestinesrelaxed all the days of his life.

Moses Maimonides. 1135-1204 A.D.

A good set of bowels is worth more to a manthan any quantity of brains.

– Josh Billings (Henry Wheeler Shaw), 1818-1885,

Swallowing is an enormously complicatedneuromuscular activity which we do consciously andunconsciously all day long. Once the bolus of foodenters the esophagus it doesn’t just fall by gravity, itis taken down by a stripping peristaltic motion at apredetermined speed of 3 cm per second. At eitherend of the esophageal tube there are sphincters –upper and lower esophageal sphincter - which, undernormal circumstances, open to allow unidirectionalforward passage of food and close promptly toprevent reflux or retrograde flow of contents.

The stomach is an extraordinary mixing vat thatprocesses whatever reaches it. The combination ofswallowed saliva plus hydrochloric acid and theenzyme pepsin, both produced by the glands thatpopulate the stomach, grind and churn and mashuntil everything is reduced to a thick liquid calledchyme. Once ready the stomach delivers this mix bymeans of its own peristaltic activity through thepyloric sphincter into the duodenum, the very first

portion of the smallintestine. The delivery ofstomach contents to theduodenum is under theinfluence of many factorsincluding hormones aswell as emotional factorsand physical activity, all ofwhich can either delay orhasten gastric emptying.On the average it takesapproximately 2 hours forthe stomach to convert the

composition of food into the typical liquid staterequired to move ahead. The composition of ameal itself influences the processing timewithin the stomach. Higher protein takes longer andhigher fat content the longest.

A PUBLICATION OF THE MEDICAL DIVISION OF ATA THE IRRITABLE GUT | 4

In the small intestine - all 21 feet of it - is wheremost of the digestive processes take place. Food intransit is literally bathed in digestive enzymes.proteins and carbohydrates are broken down intofatty acids, simple sugars and amino acidsrespectively, all of which can then be absorbed. Thefirst portion of the small gut, as mentioned, is theduodenum where bile from the liver and trypsin,amylase and lipase from the pancreas find their way

into it via respective ducts to promote digestion. Bileemulsifies fat enabling its absorption. Pancreaticenzymes help digest proteins, carbohydrates andfats. Once reduced to absorbable products thesenutrients are absorbed through the wall of the boweland sent to cells throughout the body by way of thebloodstream and the lymphatic system. In addition,minerals such as iron and calcium are also absorbedin the duodenum. After the duodenum lies the

WHAT IS A FUNCTIONAL DISORDER?Whenever a medical problem is common yet difficult to get a diagnostic handle on it because it is a very personal experienceand there are no observable or measurable defects detectable by physical examination or available diagnostic testing, it iscustomary to call it a ‘functional’ problem. It is a genuine compromise between what is an undeniable personal experiencecoupled to the frustrating absence of clues as to possible causation that could lead to appropriate treatment.

Abdominal pain in various locations, abdominal distension, which may or may not be relieved by bowel evacuations,abnormal stool frequency or form of stools, tendency to constipation or diarrhea, flatulence, need to evacuate urgently aftermeals and presence of mucus in stools are frequent in the life of IBS patients. Physical examination and currently availablediagnostic testing modalities are usually normal. Irritability, anxiety or depressive symptoms are fairly common and, as isusual with functional problems, it is difficult to tell whether these are cause or effect of living with an unsolvable medicalproblem. Treatment is directed at the relief of symptoms.

jejunum, eight feet long where fats and starches arefurther broken down, digested and absorbed. Nextis the ileum, twelve feet long, where water, vitaminB12 and bile salts are absorbed.

Finally, the leftover material arrives at the colon orlarge intestine, a four foot long muscular tube aboutthe size of your fist. Approximately a quart ofliquid arrives from the ileum each day, 80-90percent of which will be removed by the colon.Bacteria normally residing in the colon feed ofwhatever remains of ingested food. Colonicbacteria also produce fatty acids as well ashydrogen and, in some people methane gas. Someof these gases are retained as nutrients while othersare expelled as gas. Undigested matter travels to therectum where a sensitive mechanism of sphincters,internal and external, will trigger the need to have abowel movement. The external rectal sphincter isunder voluntary control allowing release at aconvenient time.

What comes out as feces is primarily water, bile,mucus and cells shed from intestinal lining.Undigested food usually makes up very little of theresidue. The exception is fiber, the more you takein, the more you will have in the stool.

If all goes according to plan one is hardly aware ofthis long and complicated process. But for manypeople the gut is an unfriendly part of the body, thecause of many miseries.

A PUBLICATION OF THE MEDICAL DIVISION OF ATA THE IRRITABLE GUT | 5

The Irritable Gut

A malfunctioning gut is a problem that afflicts some20% of the world’s population and goes by anincreasing number of names, among them:

spastic colon irritable bowel syndrome functional bowel syndrome functional colitis idiopathic constipation nervous diarrhea nervous indigestion intestinal neurosis mucous colitis.

Irritable bowel syndrome (IBS) is probably the mostcommonly used appellative in North America.

Whenever a medical problem goes by many names itusually indicates that there is little if anyunderstanding of the nature of the symptoms. So, thediagnostic effort is directed at excluding the diseaseswe do understand. It has been said that only 10% ofmedical illnesses canbe attributed tospecific mechanismso f d i s e a s e s .According to thetraditional biomedicalconcept of disease,t h e f u n c t i o n a lg a s t r o i n t e s t i n a ldisorders – IBS andmany others are reallymedical “non entities”because of the absence of detectable structural,biochemical, or physiological abnormalities. Yet, asmentioned, functional gut problems are very real tovery many people. It is a very common, if not themost common, set of symptoms in the practice ofany gastroenterologist. What it should NOT beconfused with is inflammatory bowel disease (IBD)which includes two well known serious diagnosableentities - Crohn’s disease (also known as regionalileitis or regional enteritis) and ulcerative colitis.

The Brain-Gut Connection

The brain and the gastrointestinal system areintimately connected. Have you ever had a “gut-wrenching experience”? Do certain situations makeyou nauseous? Isn’t it true that your “gut reaction” isoften contrary to what you hear from the salesman orthe newscaster, or even your best friend? Indeed, thebrain and the gut are intimately connected. Anintricate communication network present within thewalls of the GI tract - known as the enteric nervoussystem (ENS) (enteron refers to the digestive tract) -communicates with the brain via the spinal cord withthe help of hormones, neurotransmitters andconnections to the central nervous system; thesevarious connections affect muscles, mucosa andblood vessels in the digestive tract. This complex“gut-brain system” is nearly equal in size andcomplexity to the body’s central nervous system.

Studies have shown that functional GI symptoms arenot necessarily the result of dysfunction in the bowelproper but maybe due to disturbances in the brain-gut nerve pathways that may lower pain thresholdsor affect movements and contractions in the GI tract.It is a universal experience that the brain has a directconnection to the stomach if only because thethought of eating something we like very much canset off stomach secretions and contractions evenbefore the food gets there. “Just the thought of it…”

Intolerance, allergy, sensitivity or “maybe I atesomething gone bad? ”

Any of the above can give rise to very similarsymptoms but they are not really the same. Anallergy is an abnormal response mediated by ourimmune system, whereas a food intolerance remainsa mystery until, through trial and error, we hit thejackpot and learn to avoid the food item that bringson the symptoms. The most typical case of foodintolerance is that of lactose (milk sugar) which inthe intolerant person - one lacking the enzymelactase which breaks down lactose - causes

A PUBLICATION OF THE MEDICAL DIVISION OF ATA THE IRRITABLE GUT | 6

heartburn, gas, nausea, upper abdominal pain,stomach upset, cramps, diarrhea and flatulence, allthe common symptoms of a functional disorder.Lactase deficiency is common in certain ethnicgroups including Jews, African Americans, NativeAmericans and Asians. Lactose intolerant personsavoid symptoms by avoiding dairy products oradding a special enzyme preparation called Lactaid.

Another food intolerance centers on difficulties indigesting wheat or substances that contain the wheatprotein gluten, found in products containing wheat,rye and barley. Gluten intolerance is different fromgluten sensitivity which is an immunologicalreaction to gluten which causes celiac disease orgluten-sensitive enteropathy - an autoimmuneinflammatory disease of the small intestine.Exclusion of dietary gluten results in healing of theintestinal mucosa and resolution of the associatedmalabsorption syndrome.

The Rome Criteria

In order to elucidate functional situations where anexisting medical problem definitely affects normalfunctioning yet there is no detectable abnormalitiesthat could possibly explain the symptoms, clinical

research needs to be based on strictly defined criteriathat includes specifically worded symptoms andduration periods. This creates a standard approachthat permits data collection and eliminates ambiguityas much as possible. This was the case with the nowwell established DSM (Diagnostic and StatisticalManual) set of diagnostic criteria for PsychiatricDisorders, currently in its 4th edition enjoyingworldwide use. It is also the current approach for allknown functional gastrointestinal disorders which isknown as the Rome criteria.

The Rome criteria is the product of almost 20 yearsof diligent work by a number of clinicians and

scientists who first met in Rome,Italy in 1988 and have over theyears delineated a set of symptom-based diagnostic criteria forfunc t iona l gas t ro in t es t ina ldisorders. The first book, titledRome I, was published in 1994later revised as Rome II in 1998,with the hope that it could helpclinicians make “posit ive”

diagnoses of functional bowel disorders - rather thanmere diagnoses of exclusion. The latest updatereleased in September 2006 is the Rome III edition.

REFERENCEShttp://www.romecriteria.org/reviews.htmlhttp://www.aafp.org/afp/20021215/2259.htmlhttp://www.james.com/beaumont/dr_life.htm

http://ajpgi.physiology.org/cgi/content/full/289/4/G722#ABShttp://www.gutwisdom.com/

A REMARKABLE EXPERIENCE

Early researchers relied on basic, yet remarkable observations to learn how the digestive tractresponds to emotions. In 1833, Dr. William Beaumont, a US Army surgeon was given an inside view, soto speak, when Alexis St. Martin, a French-Canadian traveler, was accidentally shot in the stomach.He developed a gastric fistula, or opening of the stomach to the skin, that allowed Beaumont notonly to observe the pumping to-and-fro motion of the stomach, but also to see what happened whenhis patient expressed different emotions. In his journals, Beaumont wrote that when St. Martinshowed fear, anger or impatience, his stomach mucosa (lining) turned pale and produced less gastricjuice. Studies have since shown that powerful emotions evoke both increased and decreased stomachsecretions.

In another experiment, a student agreed to allow a view of his sigmoid colon through a sigmoidoscope. During the exam someonepresent mentioned cancer of the colon and the startled student leapt to the conclusion that this was his diagnosis, the lining ofhis colon blushed and contracted rapidly, only to relax and regain its normal color when that student was reassured that he didnot have cancer.

As manyof youm a ya l r e a d yknow, 3m a j o rt o o t hnumberings y s t e m sare in useacross theglobe, and

there are many other little-used methods. Awarenessof this fact seems to be more common outside theU.S. Here, the American Dental Association adoptedone method for its own purposes (ADA resolution,1968), and therefore knowledge of other systems isnow weak in the U.S. But what is the translator ofdental records to do? Serve his reader and supply thelocal version through conversion? Serve theinternational community by using the source-

language system (perhaps indicating this in afootnote) and thereby ensuring elimination of errorfrom conversion? Sometimes your client will giveyou specific instructions; I am asked by a journaleditor I work with always to do a conversion to theU.S. system. Here is the story.

A PUBLICATION OF THE MEDICAL DIVISION OF ATA Clinical Rounds | 7

by Leon McMorrow

1. Palmer Notation MethodOriginally developed by an Austrian dentist(Zsigmondy) in 1861, the method looks at thedentition (the two dental arches) as a scientist orgeographer would, in terms of quadrants or 4sections on 2 planes (upper/lower and left/right). The upper left arch (left maxilla) isnamed the upper left quadrant (ULQ) and giventhe symbol of a capital L (└). The individualteeth are numbered 1–8, starting from the leftfront tooth (1) and moving backward to the leftupper wisdom tooth (8), whether this is presentor not.The upper right arch (right maxilla) is namedthe upper right quadrant (URQ) and given thesymbol of a backwards L (┘).

The same approach is adopted to the lower arch(mandible), except that the L and backward Lare upside down (┌ and ┐ respectively). Theindividual tooth number is placed inside thequadrant symbol, which is quite easy to do inwriting, but a nuisance with a typewriter orprinter. Hence it has fallen out of favor with theintroduction of the FDI system.

Do you know your teeth by number?– an international dilemma

A PUBLICATION OF THE MEDICAL DIVISION OF ATA Clinical Rounds | 8

2. FDI (World Dental Federation) system.The Palmer approach is basically replicated,using the quadrant method, but instead of beinggiven awkward symbols, the quadrants are giventhe numbers 1 to 4. Quadrant numbers are: 1 =right upper quadrant; 2 = left upper quadrant; 3 =right lower quadrant; and 4 = left lowerquadrant. The individual tooth numbers aresimilar to the Palmer method. Therefore themaxillary (upper) and mandibular (lower) centraland lateral incisors are called the “ones” and“twos” respectively (in German die Einer/Zweier). The other individual teeth are numberedas follows: canines = “threes” (Dreier inGerman); premolars = “fours” and “fives”; andthe molars = “sixes" / “sevens” /“eights” (similarly in German). A nice chart isprovided in Wikipedia at http://en.wikipedia.org/wiki/FDI_World_Dental_Federation_notation

When the teethare coded, theyappear forexample as 11 /21 / 31 / 41,meaning thecentral incisor ineach of the fourquadrants. Thewisdom tooth(third molar) ineach of the fourquadrants iscoded as 18, 28,38, and 48. Caution: 11, 18, 21, 28, 31, 38, 41and 48 are not sequential numbers, but codes fora quadrant + tooth. This is a major problem forthe unpracticed translator, when comparing teethhere with those in the next system.

3. Universal Numbering System.This system is a straight 1–32 number sequence,beginning at the right upper wisdom tooth (third

molar), whether or not this is present. The numbersc o n t i n u earound tothe otherend of them a x i l l a r yarch at theleft upperw i s d o mtooth (= 16)and thendrop to thew i s d o mtooth belowit (= 17) and continue back around the mandibulararch to the lower right wisdom tooth (= 32). Tooth32 is directly under 1, while 17 is under 16.

These charts show how human teeth are numbered inthe United States by general dentists.

Please note that countries outside of the US as well asorthodontists may use different systems in which theydivide the teeth into four quadrants and start at thefront and number 1– 8 to represent the 8 teeth in eacharch. Each quadrant should have a number and thenthe tooth number after it. In addition orthodontists willdraw an “L” shaped angle around the number andpoint “arms” of the “L” in the direction of thequadrant. For example an “L” with number 3 writtenin it would be the upper left canine - also known asnumber “11” using the more commonly used systembelow.

A PUBLICATION OF THE MEDICAL DIVISION OF ATA PITFALLS AND CAVEATS | 9

by Elena Sgarbossa, M.D.

What is “Clinical Translation?”

At first glance clinical translation suggests medicaltranslation - yet it is not. Clinical translation is arecently coined term that refers to an integrativeconcept in medicine. The concept alludes to theefficient transfer of recent scientific discoveries intonew medical treatments; the transit “from bench tobedside” is strongly encouraged. In addition, this“bench to bedside” path is expanded, so that benchincludes not only experimental science but also newdiagnostic tools and therapeutic strategies. Clinicaltranslation is also called knowledge translation.More common names for this discipline aretranslational medicine and translational research.

Translational medicine emerged from a need. Fordecades it had been obvious that clinicians oftenlacked understanding of scientific aspects of disease,while basic scientists lacked appreciation of thedifficulties inherent in dealing with humans. Thusbasic scientists and clinicians typically engaged in“parallel talking.” Transforming this sterile pattern ofcommunication into an ongoing conversation is thecore of translational medicine.

Ultimately, translational medicine strives to close thegap between what is known and what is offered topatients. This can be achieved by accelerating thetransfer to clinical practice of diagnostic andtherapeutic advances that were proven effective inwell-conducted trials (i.e., evidence-based).Translational research also recognizes that whilediscoveries travel from the laboratory to the clinic,the opposite is also true. Clinical observations,human tissues and samples, and diagnostic imagesare the substratum upon which new understanding ofdiseases is built. Thus, a two-way street develops:bench to bedside and bedside to bench.

This comprehensive approach encompasses severalareas including the scientific, regulatory, andclinical arenas. It requires interaction andcooperation between basic researchers, clinicians,laboratory professionals and manufacturers. This ishow translational medicine will ultimately impacthealth policy.

How can these ambitious goals be realized? Acrucial step is that of procuring public funds. Forthis purpose the National Institutes of Health (NIH)has established an Office of Translational Research,at both the national and local levels. To obtaingrants, researchers must define project milestonesand specify timelines. The early stages of a projectserve to identify candidate therapeutics; in latestages, researches may submit to the FDA anInvestigational New Drug (IND) or InvestigationalDevice Exemptions (IDE). Obtaining NIH fundinghas never been a facile or expeditious process forany discipline, however -and translational medicineis no exception.

The editors of the Journal of TranslationalMedicine have posed, not long ago, thattranslational medicine may still be "lost intranslation." Basic research and computer modelsproduce results that are indeed difficult toextrapolate (or translate) into clinical medicine. Onereason is the disparate nature of biological research- which leads to sound hypothesis building - and theclinical realm - which does not yield directly to thedevelopment of useful treatment strategies dictatedfrom "clean" basic science. The translationparadigm also raises new ethical questions. Whatcould be, for example, the implications ofprioritizing research goals according to theirpotential for translation?

A PUBLICATION OF THE MEDICAL DIVISION OF ATA

. Translational medicine, thus, has arisen to fill aneed. Yet the implementation of translationalmedicine in the “real world” is undoubtedlycomplex. Several challenges remain unresolved.

Some of its goals, however, have been alreadyincluded in several programs in medical centers andscientific societies countrywide. Hence, in our dailywork we may be reading and hearing more aboutclinical translation –which will not mislead us intothinking “medical translation”.

PITFALLS AND CAVEATS | 10

REFERENCES:

Sugarman J, McKenna WG. Ethical hurdles for translational research. Radiat Res 2003;160:1-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=12816517&query_hl=1&itool=pubmed_docsum

Mankoff SP, Brander C, Ferrone S, Marincola FM. Lost in Translation:Obstacles to Translational Medicine.Journal of Translational Medicine 2004;2:14. http://www.translational-medicine.com/content/2/1/14/abstract/#B1

Lang ES, Wyer PC, Haynes RB. Knowledge Translation: Closing the Evidence-to-Practice Gap. Ann Emerg Med2006; [Epub ahead of print]. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=17084943&query_hl=3&itool=pubmed_docsum

A PUBLICATION OF THE MEDICAL DIVISION OF ATA MID-YEAR CONFERENCE | 11

Medical Division Mid Year ConferenceCleveland, Ohio

The program for our first mid-year conference is still in progress ....

What’s it like to manage the delivery of health care to patients coming from all over the world. The ExecutiveDirector of Global Patient Services at the Cleveland Clinic Foundation will give us an overview of life in the world oftertiary medicine. What’s it like to be a medical interpreter in this environment?

View live cardiac surgery performed at the Cleveland Clinic via direct satellite feed with explanation of what’shappening by a physician from the Cleveland Clinic.

All about becoming a medical interpreter.

Legal - ethical issues in medical interpretation - a panel.

Understanding congenital heart defects.

Anatomy and physiology of the Central Nervous System presentation followed by complementary breakoutsessions in German, French and Spanish.

Advances in thoracic and cardiovascular surgery.

Clinical Trials - an overview of terminology.

End of Life - overview, terminology, approach to adults and children.

Understanding the unspeakable - psychoanalysis and psychotherapy research.

Translational research on disease prevention - from terminology to practicalrecommendation.

Holly Mikkelson will be with us.

And much more…….

MAY

31

A PUBLICATION OF THE MEDICAL DIVISION OF ATA BITS — PIECES — FACTS — FIGURES | 12

A little bit of everything

evidence based medicine - A common phrasethese days, is the application of the best availablemedical evidence in making decisions about the careof individual patients. Normally, practicingphysicians integrate new medical evidence derivedfrom controlled studies into their clinical expertisei.e., their accumulated knowledge derived fromactual experience in the treatment of patients. Thedifficulty for clinicians is keeping up with theoverwhelming number of reports that appear in themedical literature. Also the conversion of evidencereports into practice strategies is not that simple.(See Pitfalls and Caveats in this issue)

cervical cancer vaccine for boys - The FDAhas already approved a 3 shot series of the HPV(human papilloma virus) vaccine for women ages 9to 26 , hopefully to be given before girls becomesexually active, since it does not protect thosealready infected with the virus. The FDA is nowconsidering approval for use in boys. (source: H. LeeMoffitt Cancer Center, Tampa, FL)

“superbug” - The rising incidence of hospitalacquired infections is of great concern in Americanhospitals. Of yet greater concern is the risingresistance to antibiotics. At the top of the list is awell known organism called Staphyloccus aureus, S.aureus, or just staph for short (remember strep, shortfor Streptococcus, as in strep throat). The name“superbug” has been given by the press to amethicillin-resistant Staph aureus - MRSA, which isincreasingly common in both hospitals andcommunities. MRSA is resistant to all kinds ofpenicillins, including amoxicillin, dicloxacillin,methicillin, as well as penicillin-like drugs calledcephalosporins, for example cephalexin. MRSA is aglobal problem. For further information go toCenters for Disease Control, cdc.gov and WorldHealth Organization, who.int.

Drug Reactions - Speaking about drugs, as manyas 700,000 Americans end up in hospital emergencyrooms every year because ofadverse reactions toprescription medications,often mixed with over thecounter drugs and herbalsupplements. People over 65were twice as likely asyounger ones to be seen inER departments and several times as likely torequire admission to the hospital in 2004 and 2005.High on the list of drugs involved were insulins fordiabetes, opiate-containing pain killers such asOxyContin and blood thinners such as Coumadin.Also common were reactions to antibiotics and overthe counter cold remedies.

SEXUALLY TRANSMITTED DISEASESIn Descending Order of Frequency

Sexualtransmission

includes genital,anal, oral and skin

contacts

Human Papilloma Virus(HPV)

Trichomoniasis

Chlamydia

Genital Herpes

Gonorrhea

Hepatitis B

Hepatitis C

HIV / AIDS

Syphilis

HOW DOES ANTIBIOTIC RESISTANCEDEVELOPS?

Antibiotic resistance develops when changes(mutations) that occur in bacteria cause each new

generation of the organism to be less susceptible oreven fully resistant to the effect of an antibiotic.

antidepressants and suicide - An unlikelycouple? Not so. Antidepressants are effectivemedications proven to reduce the overall suicide rate

in depressed patients.However, recent datahas shown thatantidepressants canincrease the risk ofsuicidal behavior inyounger adults ages18 – 24. Anadditional 2004 FDAwarning for use inchildren led to af a l l o f f i na n t i d e p r e s s a n tprescription forchildren – and aconcomitant increase

in suicides in that age group. What a conundrum.Experts worry that additional warnings would curtailthe use and ultimately do more harm than good. Ageneral consensus is simply to monitor allpatients antidepressants more closely.

ablation - Tricky medical word. From the Latinablatio, ablatus, meaning “.. to carry away”Historically used as a synonym of excision, removal,extirpation or amputation of a diseased body part ortissue by surgical means. Currently, with advancingtechnology, the use has narrowed to the virtualdestruction or elimination of diseased or abnormaltissue via the delivery of some form of energy -electrical, chemical, thermal, radiofrequency, others.A good example is a procedure called pulmonaryvein ablation (PVI) in which an interventionalcardiologist can deliver bursts of radiofrequencyenergy into the left atrium at the base of the fourpulmonary veins [see figure below] to eliminate thesource of abnormal electrical impulses that causeatrial fibrillation, the most common cardiacarrhythmia in advancing age. Also the lining of theuterus can be entirely ablated while leaving the restof the uterus in place in pre-menopausal women withheavy menstrual bleeding who do not contemplateany further childbearing.

A PUBLICATION OF THE MEDICAL DIVISION OF ATA BITS — PIECES — FACTS — FIGURES | 13

Electrical Conduction System

SAD DUE TO SAD?

SAD stands for Seasonal AffectiveDisorder, a seasonal depression thatoccurs and recurs in the Winter.

Sadness, loss of energy, increase ordecrease in appetite, excessive sleeping, irritability oranxiety, loss of interest in social activities - just like inany other case of depression - are all typical clinicalsymptoms of SAD. The observation that the changefrom Fall to Winter is associated with a diminution ofsunlight which in susceptible persons leads to adepressive syndrome has been confirmed as result ofthe interesting discovery that exposure toartificial sunlight can afford relief toSAD patients. This is called lighttherapy and can be used alone or incombination with standardantidepressants.