Over the weekend, I was invited to speak at the Cardio-Connect Asia Pacific Meeting in Hong Kong on why young people, including athletes, die suddenly, without showing any previous symptom related to a heart problem.

There are several possible causes. One of these is what has been labeled as the Brugada Syndrome, a familial or genetic disease first reported by the Spanish family of cardiologists Pedro, Josep and Ramon Brugada in 1992, as cause of sudden unexplained death syndrome (SUDS) in young males. It is characterized by abnormal electrocardiogram (ECG) findings.

Unfortunately, since afflicted individuals are usually young and without any previous symptom, they are not diagnosed early enough before they suffer sudden cardiac arrest.

There’s good reason to believe that many young Filipino males (although females can also be affected) who have died in their sleep were actually victims of Brugada Syndrome.

Local medical literature calls it bangungot syndrome, because the victims moan and groan in their sleep, and are usually found dead in the morning.

Bangungot preceding death was first reported in the Philippines in 1917, with the “sudden night death” attributed to a nightmarish dream, frequently noted after a heavy meal with alcohol. Bangungot is derived from the Tagalog root words bangon (to rise) and ungol (to moan).

Local myths

Although the syndrome has been embellished with local myths, the association with a heavy carbohydrate and fatty meal, as well as an increased intake of alcohol, has scientific basis.

The identification of young males—aged 25 to 44, presumably healthy, without any known cardiac illness—as at-risk individuals is also consistent with international scientific reports on the Brugada Syndrome.

Southeast Asian males seem to have an increased predisposition to it. Similar cases are also seen in Pacific Rim countries and Polynesian populations where Southeast Asians have migrated.

Foreign epidemiologists RG Munger and EA Booton published a report in an international journal in 1998 titled “Bangungut in Manila: sudden and unexplained death in sleep of adult Filipinos,” based on autopsy records from 1948 to 1982.
They noted that the deaths were seasonal, peaking in December-January. The victims were predominantly males, aged 25-44. The deaths generally occurred past midnight, at around 3-4 a.m. The frequency was 26.3 per 100,000 persons per year in the report.

A report later filed by our colleagues, led by Dr. Giselle Gervacio-Domingo, showed a frequency of 43 per 100,000 per year, still predominantly males. This was based on the National Nutrition Health Survey of 2003, which also looked at the prevalence of other medical problems in the Philippines.

In Thailand, they call it lai tai, and their folklore attributes it to the “widow ghost” who forages the night for healthy young men. The prevalence is 26-40 per 100,000 population.

In Japan, it’s called pokkuri, which describes it as peaceful death in one’s sleep. It has a similar prevalence rate.

Based on available local data, we estimate that there are around 180,000 of our young population in the Philippines who have the Brugada Syndrome, and who are at risk of dying suddenly.

Many of these remain undiagnosed because they usually have no symptoms, and because of their young age, they don’t think it’s necessary to consult physicians and rule out this abnormality.

There lies the dilemma. Do we screen our more than 100 million people to find the 180,000 who might have it? Experts are divided as to the cost-effectivity or advisability of such a strategy.


We agree that it might not be advisable to do an ECG on the entire population. But for those with a history of sudden death in the family, especially deaths occurring during sleep, we recommend that the other family members, especially the males, should be screened.

If one also has a history of fainting (syncope), it’s best to make sure that it’s not related to a heart arrhythmia (irregular heartbeat), which may later lead to sudden cardiac arrest. It’s possible that the life-threatening arrhythmia could only be transient, and terminate spontaneously.

If an individual is diagnosed with Brugada Syndrome, and further tests show increased risk of sudden cardiac arrest, preventive measures may be taken.

Some medicines like good old quinidine have been shown to be effective in preventing life-threatening arrhythmias, but for those who can afford it, an implantable cardiac defibrillator (ICD), similar to an artificial pacemaker battery, is surgically implanted just beneath the skin layer on the chest. It’s hooked to the heart and gives it a mild “shock” (defibrillate) whenever it goes into a life-threatening heartbeat.

One of our young doctors in the hospital has Brugada Syndrome. When he was a surgical resident, he suffered cardiac arrest while doing surgery in the operating room. He was resuscitated and has been on an ICD for more than 10 years now.

He can actually feel the ICD firing from time to time. And every time it does, he pauses and whispers a short prayer, thanking God for saving him from the hundred times he could have died all these years.

Workers exposed to chemicals like deodorizers, sanitizers, disinfectants and sterilizers on the job may be more likely than other people to develop thyroid cancer, a recent study suggests.

Occupational exposure to these chemicals, known as biocides, was associated with a 65 percent higher risk of thyroid cancer, the study found. For people whose jobs might have led to the most cumulative exposure to biocides over time, the odds of thyroid cancer was more than doubled.

The study also looked at pesticides, and didn’t find an increased risk of thyroid cancer linked to these agricultural chemicals.

“Limited studies have investigated occupational exposure to pesticides in relation to thyroid cancer and have reached inconsistent results,” said lead study author Dr. Yawei Zhang, an environmental health researcher at Yale University in New Haven, Connecticut.

“Our study did not support an association between occupational exposure to pesticides and risk of thyroid cancer, but suggested that occupational exposure to other biocides might be associated with an increased risk of thyroid cancer,” Zhang said by email.

Scientists aren’t certain what causes thyroid cancer, though the odds of these malignancies are higher with certain genetic disorders and with exposure to high amounts of radiation, especially during childhood.

Women are much more likely to get thyroid tumors than men, and this type of cancer is more common in white people than in other racial or ethnic groups.

For the current study, researchers compared data on 462 adults with thyroid cancer in 2010 and 2011 to 498 people who didn’t get these tumors but who were otherwise similar and around the same age.

Researchers asked study participants to report all jobs held for at least one year during their lifetimes and to provide detailed information on their job title, duties, company name, type of industry and dates of employment.

Then, researchers calculated potential exposure to biocides and pesticides based on a state database of occupational contact with specific chemicals and pollutants.

Pesticides included primarily agricultural chemicals like insecticides, herbicides and rodenticides. The jobs most often linked to these chemicals were farmer, rancher and other agricultural managers; postal worker; and supervisor of landscaping, lawn services and grounds keeping workers.

Biocides in the study were typically used in medicine or cleaning. Jobs most often tied to these chemicals included healthcare providers involved in diagnosing or treating patients; psychiatric and home health aides; and building cleaning workers.

Women with any occupational exposure to biocides were 48 percent more likely to develop thyroid cancer, while men had more than tripled odds, the study found.

Although the underlying mechanisms linking biocides to thyroid cancer are unclear, it’s possible that these chemicals alter thyroid hormones, researchers note. Triclosan, for example, a chemical widely used in cleaning products, has been shown to decrease levels of two thyroid hormones involved in growth and metabolism.

Another chemical, the wood preservative pentachlorophenol, has been show to lower thyroid hormone levels in rats, the authors also point out.

The study wasn’t a controlled experiment designed to prove biocides or pesticides directly cause thyroid cancer.

Other limitations include the five-year age bands researchers used to compare people with thyroid tumors to similar healthy individuals. It’s also possible the state data on occupational chemical exposure might not always reflect the level of exposure to certain biocides or pesticides by individual people in the study.

But the findings suggest it makes sense for people to be cautious about biocide and pesticide exposure, researchers conclude.

“People should take caution when they apply pesticides or other biocides in work place or at home by wearing protective clothes or mask and washing hands afterwards,” Zhang said.

source: Reuters Health


US researchers on Monday said they have developed a fast blood test for tuberculosis that could speed diagnosis and treatment of the serious and sometimes fatal bacterial infection.

One of the oldest known diseases, tuberculosis, or TB, has killed an estimated billion people over the past two centuries.

A bacterial infection that attacks the lungs and can cause coughing, fever, night sweats and weight loss, TB is one of the top 10 causes of death worldwide today.

Some 10.4 million people were sickened with TB in 2015, and 1.8 million died from the disease, according to the World Health Organization.

However, diagnosing TB remains complicated.

“In the current frontlines of TB testing, coughed-up sputum, blood culture tests, invasive lung and lymph biopsies, or spinal taps are the only way to diagnose TB,” said Tony Hu of Arizona State University’s Biodesign Institute, who led the effort to develop the new test.

“The results can give false negatives, and these tests are further constrained because they can take days to weeks to get the results.”

The new test “outperforms all others currently on the market” and can be completed in hours, researchers said in a statement.

It is also the first to measure the severity of active TB infections by looking at two proteins in the blood — called CFP-10 and ESAT-6 — that TB bacteria release only during active infections.

Its accuracy was about 92 percent, regardless of whether or not patients were also infected with HIV, which can require more complicated testing for TB.

The test is not yet available to the public and its cost has not yet been determined.

A report describing the test was published in the Proceedings of the National Academy of Sciences, a peer-reviewed US journal.

source: Manila Bulletin

After menopause, women who take estrogen therapy may be less likely to develop severe oral health problems than peers who don’t take hormones or other treatments for age-related bone damage, a recent study suggests.
During menopause and afterward, the body slows production of new bone tissue and women face an increased risk of osteoporosis. Falling levels of the hormone estrogen around menopause can contribute to fragile, brittle bones associated with both osteoporosis and periodontal disease, or infections around the teeth and gums.
For the current study, researchers examined data on 492 women in Bahia, Brazil, who had gone through menopause and had bone density scans between 2009 and 2011. The group included 113 women treating osteoporosis with calcium and vitamin D supplements, or with estrogen alone or in combination with the hormone progestin.
Overall, the rate of severe periodontitis - when the inner layer of gums pull away from the teeth - was 44 percent lower among the women taking estrogen for osteoporosis, the study found.
“I imagine that a patient who forgoes osteoporosis treatment with estrogen because of its risks is unlikely to change her mind after learning there is a potential connection to periodontal disease,” said Natalia Chalmers, director of analytics at the DentaQuest Institute in Westborough, Massachusetts.
“But if she is already predisposed to severe periodontitis, it is important for her to know how osteoporosis may make her condition worse,” Chalmers, who wasn’t involved in the study, said by email.
Risks of estrogen therapy can include increased odds of heart disease and breast cancer, Johelle de S. Passos-Soares of the Federal University of Bahia in Brazil and colleagues note in the Journal Menopause. Passos-Soares didn’t respond to requests for comment on the study.
Periodontitis is a leading cause of tooth loss in older adults. As gums pull away from the teeth, debris collects in the mouth that can become infected and plaque can spread below the gum line. In severe cases so much gum tissue and bone are destroyed that teeth become loose and fall out.
Women in the study were 61 years old on average, and ranged in age from 50 to 87. They typically when through menopause when they were around 47 years old.
Women treating osteoporosis averaged about 9 missing teeth, 8 decayed teeth and 2 teeth with fillings or restorations. They were also more likely than women not treating osteoporosis to have visited a dentist within the past two years.
With estrogen treatments, fewer women had periodontal disease, which researchers defined as gaps at least 5 millimeters deep between the gums and the jaw around at least 30 percent of teeth. But the difference from women not using estrogen was too small to rule out the possibility that it was due to chance.
However, osteoporosis treatment was associated with fewer cases of severe periodontitis and significantly fewer teeth that had gaps at least 4 millimeters deep between the gums and the teeth.
The study isn’t a controlled experiment designed to show whether estrogen treatment after menopause directly prevents gum disease or severe periodontitis.
Limitations of the study include the fact that researchers looked at women at a single point in time, so they couldn’t determine when the women developed oral health problems relative to when they went through menopause or started estrogen treatments. Women in the study were also recruited from a health center, making it possible the findings might be different in a broader population of patients, researchers note.
It’s also possible that women who seek routine care for one aspect of their health may be more likely to get treatment for other health issues, Chalmers said. That means the connection between osteoporosis treatment and women seeking more preventive care in general might explain a lower risk of periodontal disease.
“The link between osteoporosis and periodontal disease is not clear, and more studies are needed to fully assess this connection,” Chalmers said. “However, we can say that patients affected by each condition share risk factors such as age, smoking, hormonal change and genetics, as well as calcium and vitamin D deficiency.”


Humans likely developed large and powerful brains, researchers said Monday, with the help of what is today the simplest of snacks: fruit.

Eating fruit was a key step up from the most basic of foodstuffs, such as leaves, and provided the energy needed to grow bulkier brains, the scientists argued.

”That’s how we got these crazy huge brains,” said the study’s corresponding author Alex Decasien, a researcher at New York University. ”We have blown up the quality of our food that we are eating.”

The study published in Nature Ecology & Evolution looked at the staple foods of over 140 species of primates, and assumed their diets haven’t changed much over the course of recent evolution.

According to the research, the animals which feast on fruit have brains that are about 25 percent bigger than those filling their bellies primarily with leaves.

The results call into question the theory that has prevailed since the mid-1990s, which says bigger brains developed out of the need to survive and reproduce in complex social groups.

Decasien said the challenges of living in a group could be part of getting smarter, but found no link between the complexity of primates’ social lives and the size of their grey matter.

What did correlate strongly with brain size was eating fruit.

Foods such as fruit contain more energy than basic sources like leaves, thus creating the additional fuel needed to evolve a bigger brain.

At the same time, remembering which plants produce fruit, where they are, and how to break them open could also help a primate grow a bigger brain.

A larger brain also needs more fuel to keep it running.

source: Manila Bulletin