Schistosomiasis: an infectious disease also known as Bilharzia, Katayama Fever, and Snail Fever Infectious Disease Medical InBrief Schistosoma Adult Haematobium or Adult Mansoni by Richard Strongwater, MD and Harish Moorjani, MD Schistosomiasis (bilharzia) is an infection caused by a parasitic flatworm that lives in fresh water of the subtropics and tropics; the worms do not live in salt water or chlorinated swimming pools. It most commonly is seen in Africa, but it also occurs in parts of South America, the Caribbean, the Middle East, and Asia. These tiny worms (cercaria) will penetrate the skin during swimming or bathing in contaminated water or even paddling on a river. Once in the body, the worms grow and can migrate to the liver, bladder, kidneys, and bowel. The worms eventually lay eggs that leave the body via the urine or feces. If the eggs pass out of the body into water, they release larvae that grow inside freshwater snails. After a few weeks, the larvae can infect another human, completing the life cycle. More than 200-million people are infected worldwide. Signs and Symptoms of Schistosomiasis Symptoms of schistosomiasis are related to the immune response to the worms and eggs. Initially, a pruritic papular rash appears that is accompanied by abdominal pain, diarrhea, bloody stool, and gross hematuria. Usually, fever, chills, diaphoresis, cough, headache, and myalgias occur 2-4 days after exposure. In hepatic Schistosoma mansoni infection, lymphadenopathy and eosinophilia may be found. In chronic infection, liver and lung damage, renal failure, infertility, and bladder cancer (squamous cell carcinoma) may occcur. In children, anemia, malnutrition, and learning deficits may be found. Rarely, seizures and paralysis have been reported. Diagnostic Evaluation and Differential Diagnosis In schistosomiasis, eggs may be seen in the stool, especially after the acute infection. S haematobium eggs may be detected in the urine (try multiple samples collected between 12 PM-3 PM). Check treated patients for ova and parasites for up to 1 year to ensure cure. Confirmation may be accomplished with enzyme-linked immunosorbent assay and immunoblot testing. Eosinophilia is found in 20%-60% of persons with acute infections. In cases of S haemotobium, hematuria may be found. Immunoglobulin-E levels may be elevated. Staging and Further Stratifications Intestinal schistosomiasis: Infection with S mansoni tends to be found in southern and sub-Saharan Africa, the Nile River Valley in Egypt and Sudan, South America (Brazil, Suriname, and Venezuela), and the Caribbean (low risk; Antigua, Dominican Republic, Guadeloupe, Martinique, Montserrat, Saint Lucia). Infection with S japonicum is seen in Indonesia, Japan, the Philippines, and parts of China and Southeast Asia. Infection with S mekongi is seen in Cambodia and Laos. More severe symptoms (including lower abdominal pain, diarrhea and constipation) also are associated with hepatocellular and colorectal carcinoma. Urinary schistosomiasis: Infections caused by S haematobium are seen throughoutAfrica and the Middle East. Eggs find their way to the bladder and distal ureters, causing hematuria, obstructive uropathy, renal failure, chronic urinary tract infections, bladder carcinoma, and genital pathology. Treatment Options and Prevention To treat schistosomiaisis, praziquantel may be given to clear the body of worm infestation. Unfortunately, many people become reinfected. Praziquantel paralyzes and kills adult worms most likely by affecting their calcium channels and causing unrestrained calcium ion influx. As of 2019 there were three candidate schistosomiasis vaccines in human clinical trials. According to several vaccine working groups an effective vaccine would need to decrease adult worm burden by 75% in those immunized. According to the World Health Organization January 2022 People are infected during routine agricultural, domestic, occupational, and recreational activities, which expose them to infested water. Lack of hygiene and certain play habits of school-aged children such as swimming or fishing in infested water make them especially vulnerable to infection. Schistosomiasis control focuses on reducing disease through periodic, large-scale population treatment with praziquantel; a more comprehensive approach including potable water, adequate sanitation, and snail control would also reduce transmission. #InBrief #InfectiousDisease Sources: Schistosomiasis (bilharzia). National Health Service website. http://www.nhs.uk/conditions/schistosomiasis/Pages/Introduction.aspx. November 19, 2018. Accessed November 12, 2020. Schistosomiasis. United States Agency for International Development website. https://www.neglecteddiseases.gov/target_diseases/schistosomiasis. Accessed November 12, 2020. Williamson MA, Snyder LM. Wallach's Interpretation of Diagnostic Tests. 9th ed. Philadelphia: Wolters Kluwer/Lippincott Williams; 2011. Traveler's health: Schistosomiasis. US Centers for Disease Control and Prevention Web site. http://wwwnc.cdc.gov/travel/diseases/schistosomiasis. May 4, 2020. Accessed November 12, 2020 Molehin A. Schistosomiasis vaccine development: update on human clinical trials. Journal of Biomedical Science. January 2020; 27(28). https://doi.org/10.1186/s12929-020-0621-y Thomas C, Timson D. The Mechanism of Action of Praziquantel: Can New Drugs Exploit Similar Mechanisms? Curr Med Chem. 2020;27(5):676-696. Doi: 10.2174/0929867325666180926145537 initially published 02/22/2022

Enjoy Pizza Without Guilt: Tips for a Healthier Slice Pizza doesn’t have to be a nutritional no-no! Learn how to make smarter choices—whether ordering takeout, buying frozen, or making it at home—so you can enjoy pizza as part of a balanced diet. Culinary Medicine by Lori A Smolin, PhD and Mary B Grosvenor, MS, RD A warm crust, crispy on the outside, chewy on the inside, covered with sweet tangy tomato sauce, mozzarella cheese, and your favorite topping – who does not love pizza? You can order it takeout, eat it at a pizzeria, buy it frozen, or make it at home. But isn’t it a nutritional no-no? Pizza can be high in calories, refined carbohydrates, saturated fat, and sodium. But pizza ingredients are infinitely diverse and thus so is the nutritional composition of each pie. By choosing wisely you can make this universal favorite part of a healthy diet.  History of Pizza Pizza originated in the city of Naples in southwestern Italy. In the late 18th century Naples was populated with throngs of working poor who needed quick, inexpensive food. Flatbread with toppings such as tomatoes, cheese, oil, anchovies, and garlic met that need. Although this early pizza did not spread to other parts of Italy, immigrants from Naples brought their tasty, crusty pizza with them when they emigrated to New York, New Haven, Trenton, St. Louis, and other American cities.[1] As Italian Americans and their pizza migrated across the country, the popularity of pizza surged, particularly after WWII. This postwar pizza craze eventually reached the rest of the world, including Italy. [1] Today, gourmet and regional variations of pizza are topped with everything from smoked salmon and barbecued chicken to pineapple, beans, kale, and sweet potatoes. Nutritional Contributions of Pizza Pizza is a good source of nutrients that are important for our health.[2] Cheese, for example, is a source of calcium and the enriched flour in the crust contains B vitamins and iron. Tomato sauce and vegetables provide fiber as well as vitamins A and C. But some pizzas are high in saturated fat and sodium, nutrients that we should limit in our diets. For example, cheese and popular high-protein toppings, such as pepperoni and sausage, are sources of sodium and saturated fat. Pizza can also be high in calories depending on the type of crust and which toppings you choose. One slice of a large pan pizza with pepperoni and Italian sausage has 450 Calories, while a slice of thin crust pizza with green peppers and mushrooms has less than half of that amount.  Building a Healthy Pizza: Takeout, Frozen, or Homemade  Whether you are ordering in or taking out, heating a frozen pizza, or making your own, you can make it a healthy or a less healthy meal depending on your choices. When ordering a pizza, start by considering the crust. If you are concerned about calories and carbs, choosing thin crust saves about fifty calories and ten grams of carbohydrate over a large slice of thicker crust pan pizza. You may also have the option for an alternative crust, such as whole wheat or cauliflower, which both add fiber. Be aware however, that cauliflower crusts often contain eggs and cheese so may be higher in saturated fat than a flour-based crust.[3,4]  Now select a sauce. We usually think of pizza with red sauce, which is made from tomatoes and is loaded with vitamin A, vitamin C, and the antioxidant lycopene. This is usually the lowest calorie option. In contrast, white sauce or Alfredo is typically made with butter, heavy cream, and cheese making it higher in calories and saturated fat than red sauce. Pesto is a healthier alternative to white sauce because, although it is high in calories, it is made with olive oil and nuts, which add healthy fats. Some specialty pizzas even use unique sauces like barbeque, buffalo, or ranch; these may add more sugar, sodium, or fat than red sauce.  Next think cheese. Most pizzas are topped with a high-fat mozzarella. It melts and stretches well but is high in calories, sodium, and saturated fat. You can reduce the amounts of these by substituting part-skim mozzarella or just asking that less cheese be put on your pie.  Pizza toppings range widely in the nutrients they contribute. Traditional pizzas are topped with processed meats like sausage and pepperoni that are high in calories, saturated fat, and sodium. If you want to add a healthier protein source, choose a lean option like chicken or shrimp. Vegetable toppings add fiber and vitamins without much saturated fat or sodium so pile them on – mushrooms, onions, garlic, peppers, extra tomatoes, spinach, artichokes.  Vegetables are also low in calories and fiber so they help fill you up with fewer slices.  While all these suggestions apply to a pizza shop pie, they can also help guide your frozen pizza choices. Frozen pizzas offer a quick, inexpensive meal that can be kept in your freezer for several months yet be ready to eat in under 30 minutes. You can choose a frozen pizza with the typical high-fat pepperoni and sausage toppings or one with plenty of vegetables on a whole-wheat, cauliflower, or chickpea crust. Because frozen pizzas come with a Nutrition Facts label, you can compare the nutritional pros and cons of the various choices. Also, once you get it home you can personalize it by adding extra vegetables or other healthy toppings.  Making your own pizza can be fun and allow you to control what goes on and what stays off your pizza. You can go all out and make a homemade crust or buy the variety of your choice. If you love the flavor of pepperoni or sausage, add some to your pizza, but balance it with lots of veggies. If you are concerned about calories, top your pie with a healthy sauce and reduce the cheese calories by using low-fat cheese, limiting the amount of cheese you add, or not using cheese at all. Making pizza at home also allows each family member to personalize their pie. Bottom Line There are no rules about what can be on your pizza or even what is in the crust or sauce. If there is a food you love, chances are you will love it on a slice of pizza. Also remember that the pizza need not be the entire meal. Having a slice of pizza along with a green salad easily fits into a healthy diet. Try our BBQ Black Bean and Corn Pizza recipe ! References [1] Turim G. A Slice of History: Pizza Through the Ages. HISTORY. Published July 27, 2012. https://www.history.com/news/a-slice-of-history-pizza-through-the-ages ‌ [2] Manaker, L. Is Pizza Healthy? Here’s What a Dietitian Wants You to Know. EatingWell. Published July 4, 2023. https://www.eatingwell.com/article/8055628/is-pizza-healthy/1 . https://www.facebook.com/EatingWell .  [3] Ehsani, R. Eight Tips for a Healthier Pizza, According to Registered Dietitians | Everyday Health. EverydayHealth.com . https://www.everydayhealth.com/diet-nutrition/easy-ways-to-make-pizza-night-healthier/ [4] US Department of Agriculture. FoodData Central. Usda.gov . Published 2019. https://fdc.nal.usda.gov

How Smart Devices and Wearables Are Shaping Weight Management Can the Internet of Things (IoT) help with weight management, or is it just another tech trend? From fitness trackers to AI-powered food logging, digital tools are making it easier to monitor diet and exercise. But are they truly effective in achieving long-term health goals? by  Lori A Smolin, PhD and Mary B Grosvenor, MS, RD The internet of things  – what? The internet of things is the network of internet-connected devices, such as tablets, cell phones, and fitness trackers, that can exchange information.[1] These devices have become tools for managing health  and body weight.[2] Over 40% of Americans adults use health-related cell phone apps and 35% use wearable trackers to monitor the key components of weight management – how much we eat and how much we move .[3] Does using this internet of things help people to manage their weight or is it just another gimmick? Managing Body Weight Managing body weight requires balancing the calories we eat with the calories we expend in physical activity in order to bring our weight into the healthy range and keep it there. Currently, Americans are not doing a very good job of this; forty percent of U.S. adults are obese. [4] Th e typical American diet contains too many high-calorie, highly processed foods and  sugar-sweetened beverages, and not enough fruits and vegetables; less then 25% of adults meet physical activity recommendations.[5,6] Managing weight requires choosing a healthier diet and getting more exercise. However, these lifestyle changes are difficult to make and even more challenging to maintain. An important component of successful behavior change is monitoring intake and/or activity.[ 1 ]   The internet of things offers a variety of tools that assist in self-monitoring. Digital Tracking of Activity and Intake We typically track activity using “wearables,” which are electronic devices worn on the body to capture and relay medical, biological, and exercise data.[7]  While early wearable trackers counted steps to monitor activity, newer devices actually estimate how many calories we expend. Calorie expenditure is measured using a combination of sensors. Some  measure movement and acceleration  to track the amount of activity, while sensors that monitor heart rate  assess  the intensity of activity. This data is interpreted using complex algorithms that estimate the number of calories burned. Devices such as Apple watches, Fitbits, Samsung rings, and Garmin fitness trackers can now tell you how many calories you have burned in a specific workout such as an outdoor run, a bicycle ride, or a pool swim, as well as for the entire day. The ability to track calorie intake currently requires more effort than merely strapping on a wearable. The old school way to monitor intake is to record everything you eat and drink and then calculate your calorie intake from this log, but this can be tedious and time consuming. The process has been made easier by nutrition and fitness apps that instantly calculate the calories in each food you record and keep a tally of calories for the day .[8]   But to use these, you still need to log the food on your device and  measure or estimate the portions you consume. To make this easier, there are apps that upload nutrition data for packaged foods when you scan the barcode on the label; a downside is that this information is only reliable if you consume the portion size listed on the label. Other  apps use AI to estimate portions and calculate calories from a photo of your plate of food; this can also simplify tracking, but these apps only have data for a limited number of foods.[9] The latest technology for tracking intake, much of which is still under development, assesses consumption by monitoring eating behaviors and physiological changes. Some use sensors and cameras to measure how many times you chew or move your hand to your mouth.[10]  Another wearable estimates calorie consumption using a sensor that measures the movement of nutrients and fluids in and out of cells .[11] While this technology reduces the burden of   recording intake, it can’t  estimate calorie intake until nutrients are absorbed, which can take up to 8 hours after eating. This limits the usefulness of tracking for  people who rely on real-time calorie data to modify their intake throughout the day. A drawback of trackers is that the data these devices generate are not necessarily accurate. For example, the number of steps your tracker records may vary depending on the type of activity you are engaged in and whether you wear the tracker on your wrist, ankle, or hip.[12] Tracking calories expended in activity is even less accurate than step counting. A review of the literature found that none of the devices evaluated were within 30% of actual energy expenditure.[12] Accurately tracking food intake is also fraught with problems; consumers may forget to log all of their intake or misjudge their portions sizes. [1,13] These inaccuracies can reduce the effectiveness of tracking for weight loss, particularly if you follow the numbers precisely. For example, if your tracker overestimates the calories you burn or you underestimate your portions, you may allow yourself to consume more, eventually stalling your weight loss. Can the Internet of Things Help You Lose Weight? The internet of things facilitates self-monitoring, which can help improve exercise and dietary patterns.[ 1]  A review of the effectiveness of activity trackers found that users increased their physical activity and overall fitness.[14]  Likewise, people who track their food intake are more likely to succeed at losing weight. [15] Logging what you eat can make you more aware of what and how much you eat; this increased awareness makes you more accountable for your choices and help you to monitor your progress. Currently, millions of Americans are using fitness trackers to promote physical activity and weight loss, but long-term success is dependent on continuing to track and about a third of users stop tracking within a few months. [16,17 Some tracker attrition is related to ease of use; less tech-savvy users may quickly give up their devices if they can’t comfortably interact with them.[18] Some users have specific tracking objectives, so  they are more likely to continue to track if they can set these as goals in their trackers .[19] Others rely on the goals and motivators programmed into trackers. Reminders telling users to “stand up” or that they have exceeded calorie limits can be encouraging to some but annoying to others. Some tracking apps try to increase motivation and continued use by offering virtual rewards for achieving specific milestones and incorporating the ability to compete with others and participate in online communities. For continued success, the tracking technology needs to match the needs of the user. When users are engaged and motivated either on their own or through their devices, they are more likely to continue tracker use and when they continue to track, they are more likely to succeed. [ 1,19] Bottom Line Monitoring  what you eat and how active you are is  important for successful weight management. When individuals are aware of what and how much they eat, they are more likely to make healthy choices and when they track their exercise, they are more likely to challenge themselves to do more.[20] Although not the solution for everyone, tracking, through the internet of things, allows users to conveniently monitor activity and intake . For those who continue to use it in the long term, it is more than just a gimmick, it is a valuable tool for managing body weight. References [1] Del-Valle-Soto C, López-Pimentel JC, Vázquez-Castillo J, et al. A Comprehensive Review of Behavior Change Techniques in Wearables and IoT: Implications for Health and Well-Being.  Sensors . 2024;24(8):2429. doi: https://doi.org/10.3390/s24082429  [2] Tricás-Vidal HJ, Lucha-López MO, Hidalgo-García C, Vidal-Peracho MC, Monti-Ballano S, Tricás-Moreno JM. Health Habits and Wearable Activity Tracker Devices: Analytical Cross-Sectional Study.  Sensors . 2022;22(8):2960. doi: https://doi.org/10.3390/s22082960 ‌  [3] Vaidya A. Over a Third of Adults Use Health Apps, Wearables in 2023, Up From 2018. Virtual Healthcare. Published 2023. https://www.techtarget.com/virtualhealthcare/news/366597158/Over-a-Third-of-Adults-Use-Health-Apps-Wearables-in-2023-Up-From-2018  [4] CDC. FastStats - Overweight Prevalence. Centers for Disease Control and Prevention. Published January 5, 2023. https://www.cdc.gov/nchs/fastats/obesity-overweight.htm ‌  [5] CDC. Healthy Habits: Fruits and Vegetables to Manage Weight. Healthy Weight and Growth. Published May 8, 2024. https://www.cdc.gov/healthy-weight-growth/healthy-eating/fruits-vegetables.html ‌  [6] CDC. FastStats - exercise or physical activity. CDC. Published December 15, 2022. https://www.cdc.gov/nchs/fastats/exercise.htm ‌  [7] Yasar K. What is wearable technology? - Definition from WhatIs.com . SearchMobileComputing. Published May 2022. https://www.techtarget.com/searchmobilecomputing/definition/wearable-technology ‌  [8] Van Pelt J., Performance Nutrition and Wearable Trackers - Today’s Dietitian Magazine. www.todaysdietitian.com . https://www.todaysdietitian.com/enewsletter/enews_0421_01.shtml  [9] Hill S. Photograph your meal with the Foodvisor app for caloric, nutritional estimates. Digital Trends. Published January 22, 2019. https://www.digitaltrends.com/mobile/foodvisor-calorie-counting-app/#dt-heading-just-snap-a-pic ‌  [10] Alshurafa N, Lin AW, Zhu F, et al. Counting Bites With Bits: Expert Workshop Addressing Calorie and Macronutrient Intake Monitoring.  Journal of Medical Internet Research . 2019;21(12):e14904. doi: https://doi.org/10.2196/14904  [11] HealBe. GoBe Features. How Does GoBe Measure Calorie Intake? Healbe.com . Published 2023. Accessed February 19, 2025. https://healbe.com/info_intake_gobe3  [12] Germini F, Noronha N, Borg Debono V, et al. Accuracy and Acceptability of Wrist-Wearable Activity-Tracking Devices: Systematic Review of the Literature.  Journal of Medical Internet Research . 2022;24(1):e30791. doi: https://doi.org/10.2196/30791  [13] Bailey RL. Overview of Dietary Assessment Methods for Measuring Intakes of foods, beverages, and Dietary Supplements in Research Studies. Current Opinion in Biotechnology. 2021;70(PMC8338737):91-96. doi: https://doi.org/10.1016/j.copbio.2021.02.007 ‌  [14] Patel MS, Asch DA, Volpp KG. Wearable Devices as Facilitators, Not Drivers, of Health Behavior Change. JAMA. 2015;313(5):459. doi: https://doi.org/10.1001/jama.2014.14781 [15] Ferguson T, Olds T, Curtis R, et al. Effectiveness of wearable activity trackers to increase physical activity and improve health: a systematic review of systematic reviews and meta-analyses. The Lancet Digital Health. 2022;4(8):e615-e626. doi: https://doi.org/10.1016/s2589-7500(22)00111-x ‌  [16] USDA NUTRITION EVIDENCE LIBRARY Diet Self-Monitoring and Body Weight: A Review of the Evidence Nutrition Insight 48 BACKGROUND.; 2012. https://nesr.usda.gov/sites/default/files/2019-05/Diet%20Self-Monitoring%20and%20Body%20Weight.pdf ‌  [17] Fawcett E, Van Velthoven MH, Meinert E. Long-term weight management using wearable technology in overweight and obese adults: A systematic review (Preprint). JMIR mHealth and uHealth. 2020;8(3). doi: https://doi.org/10.2196/13461 ‌  [18] Attig C, Franke T. Abandonment of personal quantification: A review and empirical study investigating reasons for wearable activity tracking attrition. Computers in Human Behavior. 2020;102:223-237. doi: https://doi.org/10.1016/j.chb.2019.08.025 ‌  [19] Jin D, Halvari H, Maehle N, Olafsen AH. Self-tracking behaviour in physical activity: a systematic review of drivers and outcomes of fitness tracking. Behaviour & Information Technology. 2020;41(2):1-20. doi: https://doi.org/10.1080/0144929x.2020.1801840 ‌  [20] Georgia State University. Are Fitness Watches Motivating Users to Stick to Fitness Goals? Here’s What the Research Says. Georgia State News Hub. Published January 23, 2024. Accessed February 19, 2025. https://news.gsu.edu/2024/01/22/fitness-watches

New research brings hope for healthcare clinicians facing post-pandemic mental health. In an article published in December 2024, researchers treated thirty healthcare clinicians with a history of post-COVID pandemic depression, burnout, or post-traumatic stress disorder (PTSD), either with oral psilocybin or niacin used as a placebo. Psilocybin is a compound that comes from fungi like mushrooms and is converted in the body to psilocyn which is a hallucinogen similar to LSD. Psilocybin is a partial agonist of the 5-HT2A receptor, with the ability to induce neuroplasticity (the brain's ability to reorganize and rewire neural connections), which may be beneficial for depression.  Inclusion criteria included no previous mental health disorder prior to the pandemic,  symptoms lasting at least six months, willingness to taper any antidepressant use if on one, and avoidance of pregnancy.  Exclusion criteria included substance use disorder, use of psychedelics within the previous 12 months, unstable medical conditions or having a first-degree relative with a history of  schizophrenia, bipolar disorder, or paranoid disorder.  The medications were given in a seven-hour session after preparatory sessions and there were three follow-up sessions with experienced clinicians. A clinician-administered Montgomery-Asberg Depression Rating Scale (MADRS) was used by blinded raters both before and at 28 days after the treatment, as well as tests for PTSD and burnout.  At day 28 participants were told which drug they had received and the niacin group was given the chance to take the psilocybin, which 12 participants did.  It was reported that in the psilocybin group, participants had statistically significant and probably clinically significant larger decreases in depressive symptoms than the niacin group. The mean change in MADRS score (representing change in depressive symptoms) comparing the first preparation session to 28 days after therapy  was −21.33 in the psilocybin group compared with −9.33 in the niacin group. The authors state that it is thought that a 6-to-9-point difference in MADRS scores are considered clinically significant. No significant change was found in burnout or PTSD symptoms between the groups.  There were a few minor side effects such as nausea or headache but no acute psychotic episodes.  Weaknesses of the trial include the small number of participants and the fact that by the end of the seven-hour treatment session all the participants correctly identified whether they had gotten psilocybin or niacin which could affect the blinding of the study. Also, while compared against a niacin placebo, this study did not compare psilocybin against standard therapy. Comments:     This is one of a number of studies that have looked at the use of psychedelic drugs in the treatment of treatment resistant depressions and PTSD. Some of these studies have shown potentially positive effects, but patient selection and the presence and availability of therapists are felt to be important to prevent precipitation of a psychotic episode, and the therapy is still considered experimental.  Click here if you wish to read more about newer psychiatric treatments for depression that are being investigated.   References Back AL, Freeman-Young TK, Morgan L, et al. Psilocybin Therapy for Clinicians With Symptoms of Depression From Frontline Care During the COVID-19 Pandemic: A Randomized Clinical Trial. JAMA Netw Open. 2024;7(12):e2449026. Retrieved from: https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2827553

New research indicates influenza may cause more long-term neurological problems than COVID-19 in hospitalized patients. In a study published in April 2024, researchers compared patients who had been hospitalized for COVID-19 versus patients who had been hospitalized for influenza, for post-infection long-term neurological sequalae.  They compared the incidence of migraine headaches, epilepsy, neuropathy, movement disorders, stroke and dementia. It was reported that during a year of follow-up, post-infection neurologic diagnoses were observed in 2.79% of the COVID-19 group versus 4.91% of the influenza group.  They looked at 438,581 individuals, half in each cohort.  The influenza group contracted all six disorders in higher numbers than the COVID-19 group.  All six differences in incidence rates were statistically significant.  For example, neuropathy occurred in 1.89% of COVID-19 survivors and 3.61% of influenza survivors.  Stroke occurred in 1.97% of COVID-19 patients and 2.4% of influenza patients.   The authors were surprised by the results as their hypothesis was that COVID-19 would cause higher levels of disease than influenza.  These results differ from other studies that have reported higher rates of post-infectious sequalae in COVID patients.  The researchers suggested that other studies looked at shorter lengths of time and in reviewing the data for this study found that early after a hospitalization, COVID risk might be higher than influenza, but not at one year. One weakness of the study is the use of ICD codes to identify subjects and diagnoses, which might misclassify patients.  Another is that, especially at the beginning of the COVID-19 pandemic, previously healthy patients might have been more likely to need hospitalization and less likely to suffer neurological sequalae than chronically debilitated influenza patients needing hospitalization. Comments:   Although these results were the reverse of some other studies, in this study of hospitalized patients, post-infectious neurological sequalae at one year were higher with influenza infection than COVID-19.  This study serves as a reminder that both influenza and COVID-19 can have serious long-term negative health effects for some of the patients who contract those diseases.             References de HavenonA et al. Burden of Neurologic Health Care and Incident Neurologic Diagnoses in the Year After COVID-19 or Influenza Hospitalization. Neurology. April 23, 2024 102 (8). First published on line March 20.2024. Retrieved from: https://www.neurology.org/doi/10.1212/WNL.0000000000209248

Explore the health benefits of garlic, from its ancient medicinal uses to modern research. Learn how this versatile ingredient can enhance flavor and promote well-being. Culinary Medicine by Mary B Grosvenor, MS, RD and Lori A Smolin, PhD Garlic, one of the first plants cultivated by humans, has been used to flavor food around the world for over 4,000 years.[1,2]  For much of that time, it has also been used for its curative properties. [1] Today, we continue to use garlic for both its culinary and medicinal benefits.  The Stinking Rose Garlic is often referred to as “the stinking rose,”;  a name linked to French writer and physician, Henri Leclerc in the early 1900’s. He translated this from garlic’s ancient Greek name.[3] Despite this nickname, the garlic plant is not a rose; it is a member of the lily family, a group which also includes onions, chives, and leeks.  Most of the fresh garlic we use comes from the  bulb or head of the plant. This underground structure is an expanded part of the stem, from which the roots grow. Each bulb is composed of 10 to 20 cloves enclosed in a papery cover. Garlic bulbs are harvested in late summer when the foliage starts to turn yellow.[4] There are two main types of garlic, softneck and hardneck. Softneck garlic bulbs are what is typically sold in the grocery store because they have a longer shelf life. Hardneck garlic has a milder flavor, and is often grown in home gardens. Hardneck garlic plants also produce green stalks, called scapes, which are developing flower buds that resemble large chives or scallions. The scapes are harvested in the early summer and can be used in cooking the same as the cloves.   How We Consume It Garlic is used in cuisines around the world from Asia, to Africa, the Middle East, Europe, and the Americas.  Koreans eat a whopping 22 pounds of garlic per person per year while Americans consume about 2.5 pounds per person annually.[5] We use garlic to spice up our food; the distinctive flavor and odor of garlic are released when the garlic cloves are damaged by cutting, chopping, mincing, crushing, pressing or puréeing.[6] Garlic provides a pungent flavor to sauces, soups, stir-fries, and marinades; it can also be roasted whole and smeared on bread.  Garlic is even added to sweets like ice cream and chocolate chip cookies. Many people also consume garlic as a supplement; the potential health benefits of garlic have created a $3.31 billion market for garlic supplements.[7] Health Benefits of Garlic Garlic has been said to ward off sickness, plague, and even vampires.[8]  While there is no evidence for the vampire claim, garlic has been used for centuries in traditional medicine to treat a variety of ailments. Garlic was administered as a remedy for depression in China and for weakness, cough, and rheumatism in India. Ancient Egyptians and Greeks consumed garlic to increase strength and Romans used it to cleanse the arteries and maintain the fluidity of blood. [9] In early Britain, garlic in teas and tinctures was used to treat colds, fever, and diarrhea. In the 1700s, garlic was attributed to saving hundreds from a plague outbreak in southern France. During WWI it was used to prevent infections and during WWII, despite the availability of penicillin, the Russian army continued to use garlic, earning it the name Russian penicillin.[1] Today we know that garlic supplies vitamin A and vitamin B6 as well as the minerals calcium, selenium, and phosphorus, but because we only use it in small amounts, it does not add significant nutrients to the American diet. Garlic does, however, provide a wealth of phytochemicals, notably sulfur-containing compounds that have antimicrobial, antifungal, anti-inflammatory, antioxidant, anti-aging, and anti-cancer properties.[10]  Allicin, the  phytochemical that gives garlic its sharp flavor and pungent odor, is thought to provide much of its antimicrobial activity.[10] The phytochemicals in garlic may help reduce the risk of cardiovascular disease; there is evidence that garlic, primarily as supplements, can lower blood pressure as well as total and LDL cholesterol. [9,11,12] While the amounts of garlic we consume in food are safe, some people may experience heartburn and stomach upset, particularly from consuming raw garlic.[12] Allergic reactions are also possible. Garlic, when taken as a supplement, may increase the risk of bleeding so should be avoided by those taking blood thinners or planning for surgery.[12] Supplements may also interfere with the effectiveness of some drugs, including those used to treat HIV infection. The most common side effect of garlic consumption, from both food and supplements, is a garlicky body and breath odor; the sulfur compounds in garlic are absorbed into the bloodstream and released in sweat and exhaled through the lungs. [12] Bottom Line When garlic became known as the stinking rose, the name was not meant to be a term of endearment, but it is used as one today.  So, don’t shy away from garlic. Enjoy it in your spaghetti sauce, stir-fry, or kim chi; it will make your food tastier and provide health-promoting phytochemicals.  References [1] Petrovska BB, Cekovska S. Extracts from the history and medical properties of garlic. Pharmacognosy Reviews. 2010;4(7):106. doi: https://doi.org/10.4103/0973-7847.65321 ‌ [2] Simon P. Simon: Garlic Origins : USDA ARS. Usda.gov . Published 2016. https://www.ars.usda.gov/midwest-area/madison-wi/vegetable-crops-research/docs/simon-garlic-origins/ ‌ [3] Garlic: The Stinking Rose. In the Garden. Published October 11, 2011. https://joansbolton.wordpress.com/2011/10/11/garlic-the-stinking-rose/ [4] From Garden to Table: Garlic! NDSU Agriculture and Extension. Published January 31, 2022. https://www.ndsu.edu/agriculture/extension/publications/garden-table-garlic [5] All About Garlic! Pocket Guide. NDSU Agriculture. Published July 17, 2024. https://www.ndsu.edu/agriculture/extension/publications/all-about-garlic-pocket-guide ‌ [6] Lornec, C. Stinking facts about garlic. MSU Extension. https://www.canr.msu.edu/news/stinking_facts_about_garlic [7] Market. Garlic Supplement Market Size, Share, Growth | Report 2034. Marketresearchfuture.com . Published 2025. https://www.marketresearchfuture.com/reports/garlic-supplement-market-26929 [8] Tauber J. Booseum: Vampires! Carnegiemnh.org . Published 2020. Accessed February 15, 2025. https://carnegiemnh.org/booseum-vampires ‌ [9] Sleiman C, Daou RM, Antonio Al Hazzouri, et al. Garlic and Hypertension: Efficacy, Mechanism of Action, and Clinical Implications. Nutrients. 2024;16(17):2895-2895. doi: https://doi.org/10.3390/nu16172895 ‌ [10] El-Saber Batiha G, Magdy Beshbishy A, G. Wasef L, et al. Chemical Constituents and Pharmacological Activities of Garlic (Allium sativum L.): A Review.  Nutrients . 2020;12(3):872. doi: https://doi.org/10.3390/nu12030872 ‌ [11] Sun YE, Wang W, Qin J. Anti-hyperlipidemia of garlic by reducing the level of total cholesterol and low-density lipoprotein. Medicine. 2018;97(18):e0255. doi: https://doi.org/10.1097/md.0000000000010255 [12] National Center for Complementary and Integrative Health. Garlic. NCCIH. Published December 2020. https://www.nccih.nih.gov/health/garlic ‌

Recent Study Shows Walking Can Add Years to Your Life In a study published November 2024, the authors cross referenced 2017 U.S. mortality data with physical activity estimates from the 2003–2006 National Health and Nutritional Examination Survey.  The subjects wore accelerometers which measured physical activity and then the authors converted that data into walking-equivalents (based on number of calories burned) to measure levels of activity.  They reported that adults over the age of 40, who were in the top 25% of physical activity, had an average of 5.3 increased years of life expectancy compared to those in the lowest 25% of physical activity.  Those in the second and third quartiles of physical activity from the top had an increase of 3.5 years and 0.6 years of life expectancy respectively compared to the lowest 25%. It was also reported that if those in the lowest 25% of physical activity walked (or increased walking-equivalents) for an extra hour a day, the predicated life expectancy starting from age 40, would increase by 6.3 years.  If those in the lowest 25% of physical activity group increased walking-equivalents to the same level as those in the highest 25% of physical activity, life expectancy from age 40, was calculated to increase by 10.9 years.  For those in the second highest quartile of physical activity, an extra hour of walking was predicted to increase life expectancy by 2.8 years and for those in the third quartile of physical activity an extra hour of daily walking was calculated to increase life expectancy by 1.9 years.   Comments This study reported the positive effects of exercise, in this case daily walking or walking-equivalents, on life expectancy.  The predicted greatest gains for increased exercise were for those in the lowest 25% of physical activity, although all groups below the top 25% were found to benefit from more exercise.  This data is similar to other studies that have demonstrated that daily exercise can increase life span.   There are many possible reasons for the beneficial effect of exercise including reducing all of the following: inflammation in the body, cancer risk, diabetes risk, arteriosclerotic heart disease and stroke risk, the risk of hip fractures, and the risk of contracting dementia and Alzheimer’s disease.  Exercise also may improve bone health and depressive symptoms.   If you are interested in learning more about this topic, click here to read the article The Proven Benefits of Exercise .   References Veerman L, Tarp J, Wijaya R. Physical activity and life expectancy: a life-table analysis. British Journal of Sports Medicine Published Online First: 14 November 2024. Retrieved from: https://bjsm.bmj.com/content/early/2024/10/07/bjsports-2024-108125   Lee DH et al. Long-Term Leisure-Time Physical Activity Intensity and All-Cause and Cause-Specific Mortality: A Prospective Cohort of US Adults. Circulation. August 16, 2022, Vol 146, Issue 7. Retrieved from: https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.121.058162?cookieSet=1 Garcia L et al. Non-occupational physical activity and risk of cardiovascular disease, cancer and mortality outcomes: a dose–response meta-analysis of large prospective studies. British Journal of Sports Medicine 2023;57:979-989. Retrieved from: https://bjsm.bmj.com/content/bjsports/57/15/979.full.pdf Caplen, S. The Proven Benefits of Exercise. FibonacciMedicine. March 6,2024. Retrieved from: https://www.fibonaccimd.com/post/the-proven-benefits-of-exercise-cme

New Study on Links to Pesticide Use and Increased Prostate Cancer Risk A November 2024 article, an environment‐wide association study, looked at 295 pesticides that were used in 3,107 U.S. counties and compared that to the prostate cancer incidence and deaths in those counties. They knew approximately how much pesticide was used due to agricultural reporting requirements in the National Water‐Quality Assessment Project. The years 1997–2001 and 2002–2006 were used in the study and the prostate cancer incidence and mortality rates were followed in the individual counties for 10-18 years.  The authors reported that twenty-two of the pesticides were positively correlated with prostate cancer. The term pesticide includes herbicides, fungicides, and insecticides. Four pesticides were positively associated with the incidence of prostate cancer mortality.  They used a complicated measurement of a 1‐standard‐deviation increase in log‐transformed pesticide use (kilograms of pesticide used per county) correlated to prostate cancer and mortality incidence increases per 100,000 people. The highest rate of prostate cancer increase found was 7.11 cases per 100,000 people for every standard deviation increase in the use of the fungicide propiconazole.  Limitations of the study include that data from people captured in one county’s geographic area may have moved there from another location during the time frame used in the study.  There may also be other variables not accounted for that potentially could affect the results. As with any correlation/association study, correlation of two variables does not necessarily indicate causation of one by the other.  Comments:  This study documents the potentially negative effects of pesticides used in agriculture, in this case an increase in prostate cancer and mortality. Herbicides constituted about 50% of the twenty-two substances found to have a correlation to prostate cancer. Four of the pesticides were found to have a correlation to prostate cancer deaths.  In this study glyphosate (GLY) was found to potentially increase the incidence of  prostate cancer by 3.67 cases per 100,000 people for every standard deviation increase in its use. In another study from 2024, glyphosate, the active component of glyphosate-based herbicides which are some of the most commonly used herbicides in the world, was tested for in men being treated in a French infertility clinic. It was reported that 56% of the subjects tested positive for glyphosate and the levels in semen were four times that found in blood. Finding glyphosate in semen suggests it may also be deposited in the prostate gland. The researchers found markers of increased oxidative stress in both blood and semen in subjects who had elevated GLY levels compared to controls. Oxidative stress results from the accumulation of reactive oxygen species, such as oxygen free radicals, which can cause cellular damage to tissues. Oxidative stress, in other research, has been implicated in the development of some cancers.  The use of pesticides has allowed increased agricultural production to help feed an ever-increasing world population. However, their use does appear to potentially have some negative health consequences, especially for agricultural workers.  If you wish to read more about the herbicide glyphosate and its potential effect on fertility, click here.   References Soerensen SJC et al. Pesticides and prostate cancer incidence and mortality: an environment-wide association study. Cancer. 2024; 1-9. Retrieved from: https://acsjournals.onlinelibrary.wiley.com/doi/epdf/10.1002/cncr.35572 Vasseur C, Serra L, El Balkhi S, et al. Glyphosate presence in human sperm: First report and positive correlation with oxidative stress in an infertile French population. Ecotoxicol Environ Saf. Published online May 1, 2024. Retrieved from: https://www.sciencedirect.com/science/article/pii/S014765132400486X?via%3Dihub Chang VC, Andreotti G, Ospina M, et al. Glyphosate exposure and urinary oxidative stress biomarkers in the Agricultural Health Study. J Natl Cancer Inst. 2023;115(4):394-404. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10086635/ Kubsad, D., Nilsson, E.E., King, S.E. et al. Assessment of Glyphosate Induced Epigenetic Transgenerational Inheritance of Pathologies and Sperm Epimutations: Generational Toxicology. Sci Rep 9, 6372 (2019). Retrieved from: https://www.nature.com/articles/s41598-019-42860-0#citeas

Explore the world of zucchini! Delve into its history, nutritional benefits, and culinary versatility. Discover how zucchnini can enhance your diet and inspire delicious dishes. Culinary Medicine by Mary B Grosvenor, MS, RD and Lori A Smolin, PhD Zucchini has been called a humble vegetable. But it is commonly consumed in 57 different countries around the world.[1] It is used in side dishes, added to salads, made into pickles, tossed atop pizzas, baked it into cakes and breads, and even julienned into noodles. Why is this unpretentious summer squash so popular? History and Botany of Zucchini Zucchini is well travelled. Its ancestors were cultivated in what is now Mexico and the northern regions of South America. It was brought to Europe after the European colonization of the Americas began. Cultivation flourished in Italy and what we know as zucchini today was carried back to the Americas by Italians who immigrated to the US in the 1920s.  Today it is grown in most of North America and Europe, as well as in parts of South America and Asia.[2] Botanically zucchinis are categorized as a summer squash, which are the fruit of bushy plants that are harvested in mid to late summer when they are immature and the skin is still soft.[2] Summer squash include pattypan and yellow squash, as well as zucchini.[3]  They grow best a warm climate (70-95°F) and cannot tolerate frost. Zucchini is typically harvested when 6-10 inches long and loses taste if left to grow larger.[2]  It has a reputation for overwhelming home gardens in both yield and size. If you are negligent in your zucchini harvesting you may find fruits of 2 feet in length or more; the world record is over 8 feet! [4]  Though we typically eat the fruit along with its small soft seeds, the flowers are also edible and are considered a culinary delicacy.[2] Nutritional and Health Benefits Zucchini is a low-calorie vegetable: A half cup of cooked zucchini has only about 10 calories. One reason for the low-calorie count is that it is 95% water.  Despite this high water content, it does contain a variety of nutrients. It is a good source of fiber and  vitamin C and provides smaller amounts of B vitamins, vitamin A, and vitamin K as well as minerals such as magnesium, copper, and potassium.  Zucchini is also a good source of carotenoids such as lutein, zeaxanthin, and beta-carotene. [5]  The nutritional makeup and phytochemical content of zucchini results in a number of health benefits. Because of its high fiber and water content, zucchini can make you feel full after consuming fewer calories, helping to attain and maintain a healthy body weight.[6] The fiber content of zucchini may also help reduce the risk of heart disease and  type 2 diabetes. [6]  In addition, the fiber in zucchini reduces the risk of constipation and promotes a healthy microbiome, which in turn reduces the risk of inflammatory diseases. The antioxidants in zucchini - particularly carotenoids - promote eye health and may contribute to a reduced risk of heart disease and cancer.[6] Zucchini also contains compounds called cucurbitacins, which possess pharmacological potential for reducing inflammation and the risk of cancer, atherosclerosis, and diabetes. [7] Unfortunately, when consumed in large amounts, cucurbitacins can cause toxicity symptoms ranging from abdominal pain, vomiting, and diarrhea to low blood pressure and gastrointestinal bleeding. However, the risk of toxicity from commercially available zucchini is low. Cucurbitacins are very bitter so you can avoid problems by discarding zucchini that have an extremely bitter taste [8].  Zucchini: A Versatile Vegetable Zucchini has many names - baby marrows in South Africa, courgettes in France and the United Kingdom, and zapallito in Latin America and Spain.[1] It also has may uses. Zucchini can be prepared simply by cutting it raw into a salad or roasting, grilling, steaming, sautéing, boiling, broiling, microwaving or air-frying it with herbs.[9] French cuisine prepares courgettes in the side dish ratatouille.[2] Japanese cuisine uses zucchini flowers in tempura; Italian food has a version of this zucchini flower dish called “fiori di zucca.” Egyptians make zucchini with tomatoes, garlic, and onions. In Mexican cuisine zucchini (calabacitas) is used in soups and quesadillas. In the popular Turkish dish “mücver, ”zucchini is shredded, combined with flour and eggs, and fried. It can be sliced and then baked or fried to make Zucchi chips. In addition to its role as a vegetable, shredded zucchini can be added to breads, muffins, cookies, and brownies. It can be blenderized into smoothies and spiralized to make zoodles, a low-carb substitute for pasta noodles. Bottom Line Zucchini is affordable and in the summer months may be overly abundant, especially for home gardeners. It is also abundant in terms of nutrition, health benefits, and culinary versatility.  Try this healthy Recipe with Zucchini: Zesty Zucchini with Pesto, Pasta, & Sun Dried Tomatoes Chicken Noodle Soup with Zoodles References [1] Zucchini - World Food Map. Worldfoodmap.org . Published 2024. Accessed January 7, 2025. https://www.worldfoodmap.org/food-groups/other-vegetables/food/zucchini [2] Zucchini History - Where Did Zucchini Come From? Vegetablefacts.net . Published 2024. https://www.vegetablefacts.net/vegetable-history/zucchini-history/ [3] Moulton M. Zucchini vs. Summer Squash: Are They The Same? What’s The Difference? Epic Gardening. Published January 15, 2022. Accessed January 7, 2025. https://www.epicgardening.com/zucchini-vs-summer-squash/ [4] Records GW. Longest zucchini/courgette. Guinness World Records. Published May 9, 2018. Accessed January 7, 2025. https://www.guinnessworldrecords.com/world-records/longest-zucchini-courgette [5] Martínez-Valdivieso D, Font R, Fernández-Bedmar Z, et al. Role of Zucchini and Its Distinctive Components in the Modulation of Degenerative Processes: Genotoxicity, Anti-Genotoxicity, Cytotoxicity and Apoptotic Effects.  Nutrients . 2017;9(7). doi: https://doi.org/10.3390/nu9070755 [6] Petre A. 12 Health and Nutrition Benefits of Zucchini. Healthline. Published February 19, 2019. https://www.healthline.com/nutrition/zucchini-benefits [7] Kaushik U, Aeri V, Mir SR. Cucurbitacins - An insight into medicinal leads from nature. Pharmacogn Rev. 2015 Jan-Jun;9(17):12-8. doi: 10.4103/0973-7847.156314. PMID: 26009687; PMCID: PMC4441156. [8] Raman R. Can You Eat Raw Zucchini? Healthline. Published April 15, 2019. Accessed January 7, 2025. https://www.healthline.com/nutrition/can-you-eat-zucchini-raw#safety [9] The 9 Best Ways to Cook Summer Squash. Better Homes & Gardens. https://www.bhg.com/recipes/how-to/cook-with-fruits-and-vegetables/summer-squash/

In a study published in December 2024, researchers correlated almost 9 million U.S. death certificates with occupational data for the presence of Alzheimer’s disease listed as a cause of death. They used data from a national data registry of U.S. deaths.  They reported that taxi cab drivers and ambulance drivers have statistically lower risks of developing Alzheimer’s disease than all the other 441 occupations they compared them to.  Airline pilots, sea captains and bus drivers all had higher Alzheimer’s disease risk than taxi and ambulance drivers. This is in contrast to the finding that vascular and unspecified dementias were not found to be less prevalent in taxi and ambulance drivers than in other professions.  A previous study had looked at MRI scans of London taxi cab drivers and reported that taxicab drivers had, on average, larger hippocampus volumes than control subjects. They also found that hippocampal volume correlated to the number of years worked as a taxi driver. The authors of that study suggested that the constant use of navigational skills possibly increased the size of the hippocampus. The authors of the current Alzheimer’s study postulated that similar changes in the brain’s hippocampus might be protective for Alzheimer’s disease. They also stated that the reason bus drivers did not have the same benefit might be due to fixed routes that did not require active navigation.  Weaknesses of this study include the fact that the mean age of death was lower in taxi and ambulance drivers than other occupations, being 64.2 to 68.7 years compared to a mean of age of death of 74.3 for the other professions. Thus, taxi and ambulance drivers tended to die younger which could have affected the results, even though the authors state they adjusted the statistics for age. The cause of death on the death certificate is determined by health care provider and documentation may be incomplete leading to incomplete data. A person may have held multiple jobs in their life as opposed to one which could lead to inaccurate profession assignment.  Finally, there may be unknown confounding variables not taken into account which might lead to inaccurate results. One thought is that perhaps certain ethnic groups, who may have either increased or decreased risk of Alzheimer’s disease, might tend to cluster in certain occupations.   Comments:  In this interesting study, taxicab and ambulance drivers were found to have lower rates of dying from Alzheimer’s disease than other professions, although there was no protection against vascular and undefined dementias. The authors postulated that the active navigational process involved in these professions increased hippocampal size and might be protective. There were a number of weaknesses in the study design that might have affected the results, including the younger age of death of taxi and ambulance drivers than those in other professions.  However, the issue of brain plasticity (the brain's ability to reorganize and rewire neural connections) by environmental stimuli is an intriguing one. In other studies , it had been suggested that individuals with conservative political views have larger brain amygdalae than those with more liberal views.  The question being, does a genetic predisposition to having certain areas of the brain being larger lead to a certain way of thinking and viewing the world, or does one’s approach to life lead to hypertrophy of some areas of the brain.  Click here if you are interested in reading more about Does Brain Anatomy Affect Political Ideology? References R Patel V, Liu M, Worsham C M, Jena A B. Alzheimer’s disease mortality among taxi and ambulance drivers: population based cross sectional study BMJ 2024; 387 :e082194. Retrieved from: https://www.bmj.com/content/387/bmj-2024-082194 E.A. Maguire et al. Navigation-related structural change in the hippocampi of taxi drivers, Proc. Natl. Acad. Sci. U.S.A. 97 (8) 4398-4403. Retrieved from: https://www.pnas.org/doi/full/10.1073/pnas.070039597 Petalas DP et al. Is political ideology correlated with brain structure? A preregistered replication IScience. September 19, 2024. Retrieved from: https://www.cell.com/action/showPdf?pii=S2589-0042%2824%2901757-7 Kanai R et al. Current Biology. 21 677-680, April 26, 2011. Political Orientations Are Correlated with Brain Structure in Young Adults. Retrieved from: https://www.cell.com/current-biology/pdf/S0960-9822(11)00289-2.pdf Nam NH et al. Amygdala structure and the tendency to regard the social system as legitimate and desirable. Nature Human Behaviour. December 2017. Retrieved from: https://vanbavellab.hosting.nyu.edu/documents/Nam.etal.2018.NHB.pdf

BRIEF: Explore the history of syphilis, from its mysterious origins to modern treatments. Learn about its impact on history and the ongoing struggle to eradicate this ancient disease. One Night with Venus, and a Lifetime with Mercury Causative organism – Treponema pallidum (pale twisted thread) Two Treponema pallidum spirochetal bacteria magnified 950 times under darkfield illumination microscopy Syphilus Past Syphilis first struck in Europe in the late 15th century after Naples (under Spanish rule) fell to the French in 1495. This followed with an onslaught of names for the new disease [9]: AKA The French Disease by the English, Germans, and Italians AKA The Disease of Naples by the French AKA The Spanish Pox by the French AKA The Russian Disease by the Polish AKA The Christian Disease by the Turks AKA The Chinese Pox by the Japanese Is it possible that Syphilis might have been one of the few diseases that the indigenous natives in the New World gave to the Europeans, unlike smallpox and a host of others that the Europeans brandished on the Aboriginals? In 1530 the Italian physician, Girolamo Fracastoro, published a poem entitled Syphilis sive morbus Gallicus (“ Syphilis, or the French Disease ”). The poem  tells the story of a shepherd named Syphilis who for insulting the sun god Apollo, is punished with a horrible pestilence that brings out “foul sores” on his body. General Paralysis of the Insane and Malariatherapy In 1927 Dr. Julius von Wagner-Jauregg, an Austrian neurologist, was awarded the Nobel Prize for his novel discovery of using one disease to fight another. “Malaria therapy” was given to thousands of GPI (late stage “general paralysis of the insane”) patients all over the world. Malarial disease seemed to slow the progression of dementia and other late-stage symptoms. [9]  Patients subjected to malaria were then treated with quinine “after treatment was completed”. Luckily, penicillin came soon thereafter. Historic Treatments for Syphilis Mercury Malaria Arsenical compound salvarsan Penicillin Famous Victims Henri de Toulouse-Lautrec, Paul Gaugin, and Edouard Manet are known to have died from syphilis as well as classic author Oscar Wilde and mobster Al Capone. Syphilis Present Syphilis is a systemic bacterial infection caused by the spirochete Treponema pallidum . In 2023, the CDC reported there were 209,253 cases of syphilis in the U.S., an increase of 84% from 2018, and the highest number of cases reported since 1950.[1,2]  The WHO estimated that in 2022 there were eight million infections world-wide.[3] Primary syphilis - indurated chancre on the lip A syphilis vaccine has so far eluded scientists.[4] The treatment for uncomplicated primary and secondary syphilis in non-pregnant adults remains a single dose of benzathine penicillin G. For penicillin-allergic non-pregnant patients, doxycycline is recommended. Although azithromycin has in the past been effective in treating syphilis, due to increasing resistance, it is no longer recommended.[5] Close up of Secondary stage syphilis sores (lesions) on the palms of the hand. Referred to as "palmar lesions" Pregnant women who are allergic to penicillin should undergo desensitization for penicillin G prior to treatment.[5,6,7]  The treatment of pregnant women with syphilis differs from non-pregnant women and clinicians are advised to use the link below to get more information. There was a benzathine penicillin G shortage in early 2024 at which time the CDC recommended treating only pregnant women and neonates with congenital syphilis with benzathine penicillin. The recommendation was to treat everyone else with doxycycline, but as of September 2024 the shortage had ended and benzathine penicillin G is again the recommended antibiotic for all.[5,8]     Click here for further information on syphilis, syphilis and pregnancy, tertiary and neurosyphilis and HIV patients with syphilis. Syphilis is also mentioned in the free CME on this website in the article " What’s New in Adult Sexually Transmitted Infections Management and Prevention for 2024 " References [1] Sexually Transmitted Infections (STIs). CDC. Last Reviewed: January 30, 2024 Retrieved from: https://www.cdc.gov/std/statistics/2022/default.htm [2] National Overview of STIs in 2023. CDC. November 12, 2024. Retrieved from: https://www.cdc.gov/sti-statistics/annual/summary.html [3] Syphilis. WHO. 21 May 2024. Retrieved from: https://www.who.int/news-room/fact-sheets/detail/syphilis [4] Kojima N, Konda KA, Klausner JD. Notes on syphilis vaccine development. Front Immunol. 2022;13:952284. Published 2022 Jul 28. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9365935/ [5] Primary and Secondary Syphilis. CDC Sexually Transmitted Infections Treatment Guidelines, 2021. Last Reviewed: July 22, 2021. Retrieved from: https://www.cdc.gov/std/treatment-guidelines/p-and-s-syphilis.htm [6] Syphilis During Pregnancy. CDC Sexually Transmitted Infections Treatment Guidelines, 2021. Last Reviewed: July 22, 2021. Retrieved from: https://www.cdc.gov/std/treatment-guidelines/syphilis-pregnancy.htm [7] Syphilis. CDC. Last Reviewed: October 3, 2024. Retrieved from: https://www.cdc.gov/std/treatment-guidelines/syphilis.htm [8] Bachmann LH, Mena L. Clinical Reminders during Bicillin L-A® Shortage. CDC. February 26, 2024, updated  September 9, 2024‎. Retrieved from: https://www.cdc.gov/sti/php/from-the-director/2023-07-20-mena-bicillin.html [9] Dobson, M. Disease. The Extraordinary Stories Behind History’s Deadliest Killers. Published by Quercus. 2007. www.quercusbooks.co.uk

Why chili is the ultimate cold-weather comfort food? Explore its health benefits, and uncover the nutritional value not only of a bowl of chili but also of its star ingredient—the mighty chili pepper.  Culinary Medicine by Lori A Smolin, PhD  and Mary B Grosvenor, MS, RD On a cold wintry day nothing takes the chill off like a steaming bowl of chili. This thick spicy soup or stew warms you up not only because it is a hot meal but also because the phytochemicals in the chili peppers can actually raise your body temperature. [1] This filling, comforting dish is also a nutritional powerhouse that can boost your intake of protein, vitamins, minerals, and phytochemicals.* There is no actual consensus on the origins of chili, but one legend contends that a chili recipe was brought to San Antonio, Texas by immigrants from the Canary Islands in the 1700s. By the 1800’s San Antonio’s Military Square was alive with chili stands, where brightly dressed women called chili queens  cooked and served chili, known as bowls o’red . At the 1893 Chicago World’s Fair it was served up at the San Antonio Chili Stand, introducing people from all over the country to what is now the official state dish of Texas.[2]   Original chili recipes consisted of chili peppers, meat (usually beef and pork), fat, onions, garlic, salt, and other spices. Chili became an early trail food with the invention of chili bricks, a dried mixture of dehydrated beef, suet, salt, and chili peppers that with a pot of boiling water made a quick campfire meal. As people and chili moved around the country many regional variations evolved. By the 1920s some chili recipes included beans, although there is still great debate as to whether “real chili” can include beans, and by the 1940s tomatoes became a mainstay of most chili recipes. Chili recipes come and go, but the chili peppers, from which chili gets its name, are always present. Botanically, chili peppers are considered berries, and categorized as fruits, but we eat them like a vegetable and use them like a spice. Nutritionally, they are an excellent source of beta-carotene (a precursor of vitamin A, which gives them their red color) and vitamin C (a  hot green chili has more vitamin C than an orange) , both of which are antioxidants. There are thousands of different varieties: Ancho, Habanero, Pasilla, Mulato, Serrano, and Jalapeno to name a few. Each has a different shape, size, color, and degree of hotness. The hot, burning feeling you get when eating chili peppers is from the phytochemical capsaicin. The level of capsaicin determines how hot the pepper tastes and is measured in Scoville Heat Units (SHU), a hotness scale invented in 1912 by a pharmacologist named Wilbur Scoville.[3] At one end of the scale is the bell pepper, which has no capsaicin so has a 0 SHUs. In the middle is cayenne pepper with 3000 to 5000 SHUs and the world’s hottest pepper is Pepper X with 3.2 million SHUs. Chilis add flavor to our food and also have a rich history in traditional medicine; the Mayans used them to treat stomach aches, skin rashes, and arthritis.[4]  Today we know that the capsaicin in chili peppers has anti-inflammatory and antioxidant properties. Capsaicin is sold in lotions and patches to treat muscle and joint pain as well as pain caused by migraines and peripheral neuropathy.[5,6] Chili peppers and capsaicin supplements are suggested to promote weight loss by increasing energy expenditure and reducing appetite. [7]  These have also been studied in the prevention and treatment of heart disease and cancer without conclusive results.[8,9] Only minor side effects such as stomach pain, burning sensations, nausea, and bloating  have been reported with daily intakes up to the amount of capsaicin in 2 jalapeno peppers (4mg). [10] So, rustle up a bowl of chili. It’s warm and comforting, takes only a little bit of effort to make, and fills you up fast. The peppers in chili are not the only health promoting ingredient. Beans such as kidney beans or black beans add protein and fiber. The original chili recipes were probably higher in saturated fat from the beef, pork, and suet than would be recommended today, so to limit the saturated fat choose a leaner meat such as extra lean ground beef or ground turkey breast or experiment with a plant-based meat substitute. Most recipes include tomatoes, which provide phytochemicals such as lycopene, an antioxidant that gives them their red color, and lutein, an antioxidant that is good for eye health. [11]  There’s no right or wrong way to make chili, so get creative. Add other vegetables such as onions, garlic, carrots, celery, sweet potatoes, corn, cauliflower, and zucchini; this reduces caloric density and adds flavor and texture as well as vitamins, minerals, fiber, and phytochemicals. You can prepare it in a pot on the stove or allow it to simmer all day in a slow cooker, so it is waiting for you when you get home. And left-over chili often tastes better than it does the day it is made. Eat it straight out of a bowl or use it to top pasta or a baked potato.  * Phytochemicals are  compounds found in plants .  They give plants their color, taste and aroma. Editor’s comment- if you suffer from chronic acid reflux, esophagitis or chronic gastritis you may want to avoid spicey chili. #CulinaryMedicine Try our meatless chili recipe - Chili non Carne References [1] Ludy MJ ., Moore GE, Mattes RD. The Effects of Capsaicin and Capsiate on Energy Balance: Critical Review and Meta-analyses of Studies in Humans.  Chemical Senses . 2011;37(2):103-121. doi: https://doi.org/10.1093/chemse/bjr100 [2] To Bean or Not To Bean: Jumping Into the Chili Debate. Culture. Published February 5, 2015. https://www.nationalgeographic.com/culture/article/the-great-chili-debate#:~:text=Everette%20Lee%20DeGolyer%2C%20oil%20millionaire [3] How Do You Measure the “Heat” of a Pepper?.  NIST . Published online June 23, 2022. https://www.nist.gov/how-do-you-measure-it/how-do-you-measure-heat-pepper#:~:text=A%20tool%2C%20called%20the%20Scoville  [4] Salehi B, Hernández-Álvarez AJ, del Mar Contreras M, et al. Potential Phytopharmacy and Food Applications of Capsaicin.: A Comprehensive Review.  Natural Product Communications . 2018;13(11):1934578X1801301. doi: https://doi.org/10.1177/1934578x1801301133 [5] These Are the Best Capsaicin Products for Arthritis Pain. Healthline. Published August 22, 2022. https://www.healthline.com/health/capsaicin [6] Maihöfner CG, Heskamp M ‐L.S. Treatment of peripheral neuropathic pain by topical capsaicin: Impact of pre‐existing pain in the QUEPP‐study.  European Journal of Pain . 2013;18(5):671-679. doi: https://doi.org/10.1002/j.1532-2149.2013.00415.x [7] Zheng J, Zheng S, Feng Q, Zhang Q, Xiao X. Dietary capsaicin and its anti-obesity potency: from mechanism to clinical implications.  Bioscience Reports . 2017;37(3):BSR20170286. doi: https://doi.org/10.1042/bsr20170286 ‌ [8] Szallasi A. Dietary Capsaicin: A Spicy Way to Improve Cardio-Metabolic Health?  Biomolecules . 2022;12(12):1783. Published 2022 Nov 29. doi:10.3390/biom12121783 [9] Szallasi A. Capsaicin and cancer: Guilty as charged or innocent until proven guilty?  Temperature . Published online January 11, 2022:1-15. doi: https://doi.org/10.1080/23328940.2021.2017735 ‌ [10] NIH. Office of Dietary Supplements - Dietary Supplements for Weight Loss. Nih.gov . Published 2017. https://ods.od.nih.gov/factsheets/WeightLoss-HealthProfessional/ [11] Ali MY, Sina AAI, Khandker SS, et al. Nutritional Composition and Bioactive Compounds in Tomatoes and Their Impact on Human Health and Disease: A Review.  Foods (Basel, Switzerland) . 2020;10(1). doi: https://doi.org/10.3390/foods10010045 initially posted 2/2024