THROAT DISEASES Comments turned off

FEVER CONUNDRUM

By admin on August 26th, 2010

PFAPA syndrome, which was first described by Marshal and friends at 1987, is a syndrome mostly seen under the age of 5, including relapsing fever, oral aphtous lesions (mouth sores), pharyngitis and lumps on the neck. The fever is episodic, meaning in every 21-28 days (every month, often families know the exact day when an attack will start!), a 39oC fever occurs and lasts for 3-6 days. It can be accompanied by a sore throat, mouth ulcers, or enlarged cervical lymph nodes. During episodes, the child looks very ill and complains about at least one of the three symptoms mentioned above. On the day the fever starts, the child will feel a little bit ill before the attack and the family knows an attack is about to start. Not all children have all symptoms, especially mouth sores. Some children have other symptoms like joint pain, abdominal pain, headache, vomiting or diarrhea.

The answer to what causes this syndrome is not yet known. No gene defect has yet to be found in PFAPA, although in some cases more than one family member has the disease. No infectious cause has been found in PFAPA, thus it is not a contagious disease. It is clear that the inflammatory process is activated during episodes, but it is not clear why it is triggered.

There are no laboratory tests, or imaging procedures, specific for diagnosing PFAPA. The disease is diagnosed based on the results of a physical examination and other symptoms. Inflammatory blood tests like the white blood cell count, erythrocyte sedimentation rate and the C-reactive protein are increased during attacks. Before the diagnosis is confirmed, it is important to exclude all other diseases that may present with similar symptoms (especially a streptococcal throat). The dramatic response to treatment (see below) also helps diagnose PFAPA.

Beacuse the cause is unknown, there is no specific treatment to cure PFAPA. The aim of treatment is to control symptoms during the episodes of fever. In most children, the disease will resolve by itself without treatment, usually after the age of 10 years. A single dose of steroid (usually prednisone), given when symptoms first appear, has been shown to shorten an episode and sometimes even end the episode. However, the interval between episodes may also be shortened with this treatment, and the next episode may occur earlier than expected. In patients with very frequent attacks, a tonsillectomy (removing the tonsils by surgery) may be considered.

Over time, the intervals between the episodes will increase and usually after the age of 10 years resolve by itself. Children with PFAPA continue to grow and develop normally.

REFERENCES:

1. PFAPA Sendromu: Bir Periyodik Ateş Tablosu, Fırat Tıp Dergisi 2006;11(1): 75-77,

Metehan ÖZEN, Gül YÜCEL, İnönü Üniversitesi Tıp Fakültesi, Malatya

2.http://my.clevelandclinic.org/disorders/periodic_fever_syndrome/rheumatology_overview.aspx

EAR DISEASES Comments turned off

EFFECTS OF MOBILE PHONE USAGE ON EAR AND BRAIN

By admin on August 19th, 2010

Mobile phones, are now an integral part of modern telecommunications because they allow people to maintain continuous communication without hampering freedom of movement.

The widespread use of mobile telephones has given rise to concern about the potential influences of electromagnetic fields (EMFs) on human health. Mobile phones emit a pulsed high-frequency electromagnetic (EM) field that may have adverse effects. They transmit and receive microwave radiation at frequencies mainly ranged between 800 and 2000 MHz, which excites rotation of water molecules and some organic molecules, but is non-ionising and so would not be expected to damage DNA. This microwave radiation has been reported to have thermal and non-thermal effects in humans.

Hertz is a unit of frequency (of change in state or cycle in a sound wave, alternating current, or other cyclical waveform) of one cycle per second. For example, in the United States, common house electrical supply is at 60 hertz (meaning the current changes direction 60 cycles per second). Kilohertz (kHz) is 1000 times, Mega Hz (MHz) is 1 milion times, Giga Hz (GHz) is 1 billion times of hertz.

Mobile phone networks operate in one of three bands; 900 MHz, 1800 MHz and 2.2 GHz, using two different technologies, Global System for Mobile Communications (GSM) and Universal Mobile Telecommunication System (UMTS). GSM is the commonest international operating standard for the second generation of digital cellular mobile communications. It enables mobile phones to be used across national boundaries. In the UK this technology operates in the 900 MHz and 1800 MHz frequency bands. UMTS is the next generation (third generation ‘3G’) of mobile phone technology, which is every other day having a widespread usage of video phones and access to multimedia information.

After a press release on 9/12/2007, all of people’s minds were confused about the safety of these devices. According to research presented at the American Academy of Otolaryngology-Head and Neck Surgery Foundation’s Annual Meeting & OTO EXPO in Washington, DC, 100 people who had used mobile phones for over a year suffered increases in the degree of hearing loss over the span of 12 months. Furthermore, the study also discovered that people who used their phones for more than 60 minutes a day had a worse hearing threshold than those with less use. The authors warn users of cell phones to look out for ear symptoms such as ear warmth, ear fullness, and ringing in the ears (tinnitus) as early warning signs that you may have an auditory abnormality. They also suggest the use of earphones, which they found to be safer than holding a mobile phone up to the ears.

 So, this article would be about a review of recent researches about the effect of cell phone on the ear and brain.

WHAT IS RADIOFREQUENCY?

Telecom systems – radio, television, wireless telephones, mobile phones, pagers, radars and satellites – emit invisible electromagnetic radiation or radiofrequency (RF). The radiation spectrum includes microwaves (frequencies between 300 MHz and 300 GHZ) and reaches close to infrared radiation. RF is also used daily in microwave ovens and diathermy medical devices (thermoablation); the latter are used in treating cardiac arrhythmias, snoring and sleep apnea, tumors and other conditions.

Biological effects of radiofrequency/microwaves:

RF is a non-ionizing radiation, as opposed to X-rays and gama radiation; it does not, therefore, have enough energy to destabilize electrons or break chemical bonds in DNA.

The effect of RF on living organisms may be didactically divided into the following: 

1) Thermal effects: These are the best known effects. They result from water molecule polarization as electromagnetic waves course through tissues and produce heat (temperature variation over 1oC). This is the principle behind microwave ovens and medical diathermy devices.Devices that generate RF between 350 and 500 kHz or microwaves over 2 GHz are used for thermoablation surgery. Tissue temperatures reach 50-100oC, resulting in local necrosis and coagulation. Temperatures over 100oC vaporize and carbonize tissues. 

The power of radio and television transmitters may reach many kilowatts; mobile phone base stations may reach over 100 W. On the other hand, the power of mobile phone handsets and cordless phone base units is very low, respectively around 0.01-2 W and 0.09W. For this reason mobile phones do not cause thermal effects on a user’s organisms. It has been calculated that the temperature in the head increases by not more than 0.11oC while using a mobile phone, although a feeling of warmth may be felt in the ear during a telephone call.

 2) Non-thermal effects: These take place with no temperature change in biological tissues. These effects have not yet been fully clarified, and are the reason for many debates among scientists.

These effects include electrical force induction and possibly an increase in heat shock protein synthesis in cells. Continuous heat shock protein synthesis, however, may be involved in oncogenesis (cancer formation. No study thus far has demonstrated that exposure to RF without thermal effects produces genetic mutations or chromosomal aberrations in mammal cells, which suggests that RF can not initiate tumors. 

The International Commission on Non-Ionizing Radiation Protection (ICNIRP) formulates and publishes exposure limit guidelines for EMF radiation, based on critical review of the published biological effects and health risks. In the frequency range 10 MHz to 10 GHz, which encompasses mobile phone related EM radiation, near-field models of energy absorption become important. Local (that is anatomical regional) energy absorption can be high and energy density reported as specific absorption rate in units of watts/kilograms (SAR) is the recommended dosiometric measure. Radiowaves transmitted by the most commonly used mobile cellular phones in the UK are within SAR limits set by the ICNIRP, because all makes of modern GSM (Global System for Mobile Communications) mobile phones, emit EMF radiation that results in less than 1 W/kg radiation in the head. Individual national governmental agencies set SAR guidelines, which indicate to the public safe levels of electromagnetic exposure related to electrical appliances.

The National Radiological Protection Board in the United Kingdom guideline recommends a limit of 10 W/kg in the head which is five times the ICNIRP limit. To learn about any cell phone SAR limit you can visit the web site of The Federal Communications Commission (FCC) of USA (http://www.fcc.gov/cgb/sar/). For example, did you ever read the safety information in the manual given with your cell phone? “The …………. device might not come with a holster (body-worn accessory). If you wear the ………….. device on your body, always put the ……………. device in a ……………….device holster equipped with an integrated belt clip supplied or approved by Research In Motion. If you do not use a holster equipped with an integrated belt clip supplied or approved by RIM when you carry the …………….. device, keep the…………………device at least 0.98 in. (25 mm) from your body when the ………………….device is transmitting.” Will you still carry it in your pocket over your heart?

WHAT IS THE EFFECT OF CELL PHONE ON HUMAN BODY?

A number of case-control studies have investigated the relation between mobile phone use and CNS tumors. They are as follows:

Muscat et al. (2000) 17469 cases, 422 controls, Result: No increased risk

Inskip et al. (2001) 18782 cases: 96 acoustic neuromas, 799 controls, Result: No increased risk

Muscat et al. (2002) 1990 acoustic neuromas, 86 controls, Result: No increased risk

Hardell et al. (2003) 201429 cases,1470 controls, use>5 years, Result: Increased risk when using analog handsets, and when using digital handsets for over 5 years

Christensen et al. (2004) 21106 acoustic neuromas, 212 controls, Result: No increased risk

Lönn et al. (2004) 7148 acoustic neuromas, 604 controls, Result: Increased risk when using analog

handsets for 10 years or more.

Hardell et al. (2005) 23413 cases: 84 acoustic neuromas, 692 controls, Result: Increased risk when using analog.

The International Agency for Research on Cancer (IARC) coordinated a feasibility study in 1998 and 1999, which concluded that an international study of the relationship between mobile phone use and brain tumour risk would be feasible and informative. Interphone was therefore initiated in 2000 as an international set of case-control studies in 13 countries around the world focusing on four types of tumours in tissues that most absorb RF energy emitted by mobile phones: tumours of

the brain (glioma and meningioma), of the acoustic nerve (schwannoma), and of the parotid gland. The objective was to determine whether mobile phone use increases the risk of these tumours. Interphone is the largest case control study of mobile phone use and brain tumours yet and includes the largest numbers of users with at least 10 years of exposure.

The Interphone Study Group concluded with the following key message:

A reduced odds ratio (OR) for glioma and meningioma related to ever having been a regular mobile phone user possibly reflects participation bias or other methodological limitations. No elevated OR for glioma or meningioma was observed ≥10 years after first phone use. There were suggestions of an increased risk of glioma, and much less so meningioma, in the highest decile of cumulative call time, in subjects who reported usual phone use on the same side of the head as their tumour and, for glioma, for tumours in the temporal lobe.

But, the majority of subjects in the Interphone Study Group were not heavy mobile phone users by today’s standards. The median lifetime cumulative call time was around 100 hours, with a median of 2 to 2½ hours of reported use per month. The cut-point for the heaviest 10% of users (1640 hours lifetime), spread out over 10 years, corresponds to about a half-hour per day. Today, mobile phone use has become much more prevalent and it is not unusual for young people to use mobile phones for an hour or more a day. This increasing use is tempered, however, by the lower emissions, on average, from newer technology phones, and the increasing use of texting and hands-free operations that keep the phone away from the head.

Professor Elisabeth Cardis (Interphone Principal Investigator) said that “the Interphone study will continue with additional analyses of mobile phone use and tumours of the acoustic nerve and parotid gland.” She added:,”Because of concerns about the rapid increase in mobile phone use in young people − who were not covered by Interphone −, CREAL is co-ordinating a new project,

MobiKids, funded by the European Union, to investigate the risk of brain tumours from mobile phone use in childhood and adolescence.”

IARC has scheduled a comprehensive review of the carcinogenic potential of mobile phone use under the auspices of its Monographs Programme. The review, scheduled for 24-31 May 2011, will consider all published epidemiological and experimental evidence, including the new data from the Interphone study.

RESULT

  1. Read the safety information on the instructions manual very carefully and search for the SAR limit of your cell phone.
  2. Never carry your cell phone over your body without a holister and don’t use it for chat. Use it if there’s any emergency and the speech should not last long.
  3. Don’t let your kids use the cell phone right to their ears or with a bluetooth. They should use it with a handsfree headset if needed. It has been suggested that, using a cell phone with a headset decreases the RF exposure 90% .
  4. Don’t use your cell phone while it’s plugged, because there are some cases that the cell phone exploded while the person was speaking.

 

REFERENCES:

  1. http://www.newswise.com/articles/view/533259/
  2. http://www.icnirp.de
  3. Aracy Pereira Silveira Balbani, Jair Cortez Montovani. Mobile phones: influence on auditory and vestibular systems. Rev Bras Otorrinolaringol 2008;74(1):125-31;
  4. Khalil S, Nunez DA. Do mobile ‘phones have a detrimental impact on auditory function? Laryngol Otol. 2006 Oct;120(10):822-6. Epub 2006 May 15.
  5. Interphone study reports on mobile phone use and brain cancer risk- IARC press release, 17 May 2010
  6. Lönn S, Ahlbom A, Hall P, Feychting M. Mobile phone use and the risk of acoustic neuroma. Epidemiology 2004; 15: 653-9.