From the category archives:

Global health

ROP screening in the NICU

Gretchen Hamn (L) and Margie Young screen a premature infant for retinopathy of prematurity. (Photos: Katherine C. Cohen)

We’re in the Neonatal Intensive Care Unit at South Shore Hospital. Six tiny, swaddled preemies are ready to be examined, their eyes numbed and their pupils dilated with special drops.

Gretchen Hamn, NNP, and medical assistant Margie Young go from isolette to isolette. Young tends to the first baby and gently positions him for his exam. Hamn pulls over a cart and extends a kind of hose with a camera at the tip. This she places directly on each of the baby’s eyes, taking a digital video of his retinas. Full story »

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The exceedingly complex life cycle of malaria. Within it lies the key to developing a vaccine against the parasite. (CDC)

The malaria parasite (or parasites: four species of Plasmodium can cause malaria in people) has a really complex life cycle.  That complexity has allowed this mosquito-borne parasite from bringing untold misery to the human race for millennia. The World Health Organization thinks it causes 216 million cases of disease every year, while the U.S. Centers for Disease Control and Prevention estimates that some 3.3 billion people live at risk of malaria infection around the globe. Even in the United States, where malaria was officially eradicated 60 years ago, there are still about 1,500 cases every year.

All these numbers add up to one fact: we need a vaccine, badly. This is where malaria’s complexity becomes a problem. Full story »

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Ed. note: Ben Warf, MD, was just named a 2012 MacArthur fellow, receiving a five-year, $500,000, “genius” award from the John D. and Catherine T. MacArthur Foundation.

We know climate patterns can affect crop yields, fish populations in rivers, people’s allergies and more. Now, for the first time, research has linked weather patterns with a brain disorder in babies typically treated by neurosurgeons—one that causes cognitive impairment, spasticity and blindness.

In East Africa, twice a year, at the midpoint between the rainy and dry seasons, rates of hydrocephalus surge among newborn babies. It starts with a fever and sometimes convulsions; if they survive, the babies develop “water on the brain” and their heads enlarge dramatically.

Ben Warf, MD, a neurosurgeon at Boston Children’s Hospital, discovered this during his years as a medical missionary in Uganda. Working with a non-governmental organization called CURE International, he founded a pediatric neurosurgical hospital, doing about 1,000 operations a year—more than half of them for hydrocephalus—on children from Uganda and surrounding countries.

In the United States, hydrocephalus is typically part of a congenital disorder like spina bifida. But Warf found that 60 percent of the cases he and his Ugandan team were seeing arose from infections in newborns.

Working with mathematicians, Warf and colleagues crunched data from nearly 700 such cases against rainfall data for the children’s home villages, generated by the National Oceanic and Atmospheric Administration, Full story »

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Diseases like malaria strike children harder than adults, but clinical trials for these diseases rarely include or focus on children. Why? (WHO/P. Virot)

We’re pretty focused on the safety of the things around us. Our drinking water gets checked for chemicals, bacteria and other things that could make us sick. Kids’ car seats are tested to make sure they’ll keep children safe in an accident.

But there’s one surprising arena where this focus on safety and testing often falls short: the medications we give our children. Not just in the United States, but globally.

There are lots of reasons why fewer drugs get tested for safety and efficacy in children than in adults. It’s time-consuming, expensive and, frankly, risky. The ethics of testing new medications in children are pretty thorny.

And, overall, the market for pediatric drugs is much, much smaller than that for drugs for adults, since children fortunately don’t get sick as often as us grown-ups.

But for some diseases like asthma and diarrheal diseases, children bear a greater burden than adults—one that’s not matched by the amount of research done on drugs for kids. Full story »

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Maryam Idan (center), a young Iraqi girl with sickle cell disease, was lucky: she could be cured with a stem cell transplant. Leslie Lehmann, MD, wants to make such transplants an option for more sickle cell patients.

I was surprised when chatting recently with Leslie Lehmann, MD, clinical director of the Stem Cell Transplantation Program at Dana-Farber/Children’s Hospital Cancer Center (DF/CHCC). She turned to me and asked, “Did you know there’s been a cure for sickle cell disease for nearly 40 years?”

I had to admit that I didn’t. I’ve always thought of sickle cell—a painful and debilitating disease caused by an inherited mutation that makes red blood cells stiffen into a characteristic sickled shape—as a chronic disease to be managed, not one that could be cured.

I’m not alone in that belief. Lehmann often asks this question when she give talks for medical students, residents and other physicians. Their reaction is puzzlement, then a shaking of heads.

The cure is there, though. It’s a stem cell (aka bone marrow) transplant. The catch is that it’s not available to everyone—but for reasons that Lehmann thinks can be overcome. Full story »

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This pig helped launch a drug shortage that is getting progressively worse. (Dingar/Wikimedia Commons)

Al Patterson, PharmD, is director of Pharmacy at Boston Children’s Hospital. Read his February 13, 2012 testimony before the Massachusetts Legislature’s Joint Committee on Public Health. 

More than 80 percent of the United States supply of heparin, a commonly used blood thinner, originates from pigs reared in farm co-ops in China. Farmers scrape mucus from the intestines and send it to central processing facilities, where heparin is extracted and purified before being sold to U.S. pharmaceutical companies.

But in 2007, blue-ear pig disease, causing a respiratory syndrome, became endemic in Asia—leading to a shortage of pigs and a shortage of heparin. In order to preserve their market share, producers began creating fraudulent substitutes, including one that behaved chemically like heparin, but was actually a manmade compound known as oversulfated chondroitin sulfate (OSCS) derived from pig, sheep or cow cartilage. Full story »


In just a few short days, London will play host to more than 10 million sports fans from around the world. Is the city ready to keep them all healthy? (Ben Sutehrland/Flickr)

In the blockbuster Contagion, Gwyneth Paltrow travels to Hong Kong on business and returns to suburban Minneapolis with flu-like symptoms. Within days she is dead. Paltrow is the index case in a pandemic that sweeps across the world. Contagion is a dramatic example of how a series of mundane, every day activities—such as shaking hands, drinking from a glass and blowing on dice for good luck—can rapidly and effectively spread disease.

Starting Friday, this year’s summer Olympics will kick off in London, the international hub of Europe. Can you imagine the potential for disease spread in a city that will host ten million athletes and tourists from all over the world? Full story »

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(Pierre Guinoiseau/Flickr)

People sometimes say that children with autism “march to a different drummer” or “vibrate at a different frequency.” New research analyzing electrical activity in the brain—via electroencephalography, or EEGs—makes it tempting to speculate that these clichés have some truth to them.

EEGs have been around for close to 100 years, and are relatively cheap. But interpretation of these squiggly lines has barely scratched the surface of what they can tell us.

Recent research suggests that EEGs might have a lot to say about how the brain is connected up, and how it processes and integrates information. These messages—if we could properly hear them—might someday help clinicians diagnose autism much earlier than they can now.

The EEG tracks different kinds of rhythms, which show up as waves that oscillate at varying frequencies. Full story »

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Efforts to create a malaria vaccine have had limited success. Springer and colleagues solved the 3D structure of a key protein on the parasite -- and found a fragment which they'll soon test as a vaccine. (Photos_by_Angela/Flickr)

From the perspective of a wealthy country, malaria is a problem that is solved. It’s like smallpox. We ask, Who gets it?  Who cares? Isn’t it better to invest in diabetes?

In truth, malaria is more infectious than ever, endemic to 106 nations, threatening half the world’s population and stalling economic development and prosperity.

That’s part of the reason why Timothy A. Springer, PhD, an investigator in the Program in Cellular and Molecular (PCMM) Medicine at Boston Children’s Hospital and the Immune Disease Institute (IDI), took on Plasmodium falciparum, the parasite that causes malaria. Another is that he likes solving problems in immunology – and has made his name discovering molecules that both promote and fight infections, in part by understanding their structures. Full story »

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The Gutenberg press disseminated ideas to a wider society. But in the clinical world, much information is still on "lockdown." (Wikimedia Commons)

The best things in life are free: friends, sunny days, beautiful vistas. Wouldn’t it be nice if knowledge were also free? Historically, libraries promulgated knowledge sharing because it was for the public good. We see this spirit increasingly embraced on the Internet – take the recent announcement of a collaboration between Harvard and MIT to make their courses freely available to users around the world via the edX platform.

But have we made all useful knowledge available in a way that allows for the greatest societal advancement? Not really. According to Ken Mandl, MD, MPH, director of the Intelligent Health Laboratory at the Children’s Hospital Informatics Program (CHIP), one important source of information still on lockdown is clinical trial data. In an article called, “Learning from Hackers: Open-Source Clinical Trials” published this month in Science Translational Medicine (not currently available in full text), Mandl and his coauthors call for making raw, de-identified clinical trial data free to the public. Full story »

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