Lifelong discrimination linked to high blood pressure in black people

AHA news: lifelong discrimination linked to high blood pressure in black people

Enduring a lifetime of discrimination may increase the risk of high blood pressure in Black people but not in Hispanic, Chinese or white people, a new study suggests.

Previous research has linked lifelong discrimination to the development of high blood pressure, also known as hypertension, in Black people. This new study, however, is among the first to look at multiple types of discrimination in a large multi-ethnic group over a period of time.

The study included 3,297 Black, Hispanic, Chinese and white adults from 45 to 84 years old. They did not have high blood pressure at the start of the study. Participants were asked to report experiences of lifetime and everyday discrimination.

Lifetime discrimination measures included six items, such as being denied a promotion or having life made difficult by neighbors. Everyday discrimination, meanwhile, consisted of nine items, such as being treated with less respect than others or being harassed in day-to-day life.

After nearly two decades, almost half of participants developed high blood pressure. Black participants who reported lifetime discrimination had a 35% increased risk of hypertension, even after accounting for age, income, education, body mass index, physical activity and other factors. Everyday discrimination, however, did not appear to contribute to risk for hypertension.

“Discrimination impacts the health of Black Americans and it should be recognized as a major public health problem,” said Allana T. Forde, lead author of the study published last week in the Journal of the American Heart Association. In November, the American Heart Association issued a “call to action” advisory acknowledging structural racism as “a fundamental cause of poor health and disparities in cardiovascular disease.”

“Health professionals should look beyond traditional risk factors, such as diet and physical activity, and acknowledge discrimination as another risk factor,” said Forde, a researcher at the National Institutes of Health’s National Institute on Minority Health and Health Disparities.

Surprising for researchers, she said, was that lifetime discrimination did not reach the level of statistical significance for contributing to high blood pressure among Chinese and Hispanic participants, even after accounting for being born outside the United States.

Studies in other areas of the U.S. are needed to confirm the findings, researchers said, because the new study was limited to those living in five large cities and one county. In addition, the study only assessed discrimination experiences once at the start of the study, making it unclear what impact changes in discrimination exposure might have had on hypertension development during the follow-up period.

“There is always a concern that not enough subjects were included in the study to show differences in populations or that not all relevant variables were accounted for,” said Dr. Willie Lawrence, chief of cardiology at the Research Medical Center in Kansas City, Missouri. He was not involved in the study.

When measuring decades of discrimination that leads to hypertension, other social determinants of health also must be accounted for. These include health care access, transportation options and a person’s neighborhood.

“Whether communities have sidewalks and green spaces impacts health,” Lawrence said. “If we want to make people healthier, we have to not only eliminate disparities in health care delivery, but we must also seek equity in housing, neighborhoods and education.”

Overall, the study found Black people reported the highest levels of discrimination. About 65% reported lifetime discrimination compared to 42% of Hispanic people, 40% of white people and 23% of Chinese people. Black people most often attributed the unfair treatment to race, whereas white people by far attributed it to non-racial factors such as age, sex or religion. Hispanic and Chinese people were about evenly split between feeling the discrimination was motivated by race versus other factors.

For everyday discrimination, 52% of Black people, 32% of white people, 26% of Hispanic people and 20% of Chinese people reported high levels of exposure.

“Race is complicated in America. It is not genetic,” Lawrence said. “So, I’m not ready to believe that when people of other colors are treated the way Black Americans have been treated for decades that they won’t have higher rates of high blood pressure.”

Even so, he said, “it’s an important study that adds to our belief that social factors impact health.”

Certain, however, is that Black people have higher rates of high blood pressure than other racial and ethnic groups. According to AHA statistics, about 58% of Black adults in the U.S. have the condition, which increases the risk for heart attack and stroke.

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Blood biomarker detects COVID-19 severity and enables early triage


Dr. Kulasinghe, from QUT Centre for Genomics and Personalised Health and School of Biomedical Sciences, delivered the findings to a special virtual meeting of the American Association of Cancer Research (AACR) on “COVID-19 and Cancer” earlier this month.

He said results of the test could inform doctors those patients that were likely to develop a severe infection and require a ventilator when they first present and thus differentiate them from patients likely to experience a milder case and who could go home and self-isolate.

“This is extremely important for the triage of patients when hospitals are running near or beyond capacity,” Dr. Kulasinghe said.

“We used spatial transcriptomic profiling (a technique which enables researchers to map cell-to-cell interactions and genes) to study lung samples from COVID-19 patients who had died.

“These spatial profiling biology approaches to understand complex tissues were voted the method of the year in 2020 Nature Methods.

“We drew upon our previous experience in spatial profiling of lung cancer to study COVID-19 in the lungs.

“Using high-resolution imaging and genomic profiling, we were able to map the presence of the virus in the lungs down to the single cells present in the lung tissue.

“We discovered a handful of pro-inflammatory genes which were upregulated (higher expression) in COVID-19 cases when compared with the closest pandemic virus, swine flu or H1N1, and the lungs of healthy people.

“The pro-inflammatory genes, including one called ifi27, are involved in type 1 interferon response—an inflammatory response to defend the body from viruses and other pathogens.

“The value of measuring this biomarker, ifi27, in a nasal swab or blood sample is in triaging patients because it can tell us how severe the COVID-19 disease is as soon as the patient seeks medical help with COVID symptoms.”

Dr. Kulasinghe said the researchers had measured ifi27 in asymptomatic, mild, moderate and severe COVID-19 cases.

“We saw that ifi27 is elevated in a step-wise manner with severe cases having high ifi27 levels.”

Dr. Kulasinghe said researchers knew that ifi27 was elevated in the blood of COVID-19 patients.

“But there had not been any evidence of where the signal for the high ifi27 levels was coming from.

“By spatial profiling lung tissue of COVID-19 patients who had died we got a much deeper picture of the cellular changes driven by viral infection and that the lungs were a source of the raised ifi27.

“This technique also allowed us to identify which cells in the lungs the virus was binding to.”

This collaborative research project with University of Queensland Diamantina Institute and the Walter and Eliza Hall Institute of Medical Research was awarded the Ausbiotech Johnson & Johnson Industry Excellence Collaboration Award and Industry Choice Award in 2020.

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What is Angiography?

Angiography involves the use of x-ray imaging to examine blood vessels. The images generated during an angiography procedure are known as angiograms.

Coronary angiography – Image Copyright: kalewa / Shutterstock

First, a needle is placed into the femoral artery. All areas of the body can be addressed from this one site. After needle access is established, catheters and wires are threaded through the arterial system to the target area of interest.

When the imaging is performed, an iodine-based contrast medium is usually injected into the system. The medium highlights the blood moving through the vessels.

Angiograms are performed in hospitals with patients usually under local anesthesia. The procedure may take from 20 minutes to several hours, depending on the difficulty of the test and how much contrast is required.

The Need for Angiography

If a patient has problems with their circulation, a physician may suggest that the patient undergoes an angiography to determine what is causing the problems. The results of the test may also help the physician develop treatment options.

Angiography can be used to detect significant arterial disease, which can lead to such conditions as stroke, heart attack, gangrene, and organ failure. The imagery from coronary angiography can help physicians plan a patient’s treatment for angina and heart attacks.

Types of Angiography

A variety of angiography procedures are available that can be harnessed to diagnose different medical conditions.

  • Computed tomography angiography (CTA) utilizes x-rays, software, and hardware to produce horizontal, or axial, images, or slices, of blood vessels for diagnosis.
  • Coronary angiography visualizes the inside of the coronary arteries. These images can locate stenoses in the arteries that may be responsible for chest pain, and which could cause a heart attack.
  • Digital subtraction angiography (DSA) images blood vessels in the brain to check blood flow.
  • Radionuclide angiography is a nuclear medicine procedure. A small amount of radionuclide (radiopharmaceutical or radioactive tracer), aids the examination of the target tissue. Resting radionuclide angiography assesses the heart's chambers in motion.
  • Pulmonary angiography images the blood vessels to evaluate various conditions, such as aneurysm, stenosis, or blockages.
  • Magnetic resonance angiography (MRA) uses magnetic resonance imaging (MRI) and contrast dye to visualize blood vessels. Physicians often use MRA to examine the heart and other soft tissues, and to assess blood flow.
  • Renal angiography, also called arteriography, images the renal blood vessels to detect any signs of blockage or abnormalities affecting the blood supply to the kidneys.

Angiography Therapies

During an angiography, certain therapies can be performed, such as angioplasty or stent placement. Percutaneous coronary intervention (PCI), known as coronary angioplasty, is a non-surgical procedure that opens narrow or blocked coronary arteries.

The procedure restores blood flow to the heart muscle, which may have been blocked by plaque buildup. If the plaque ruptures, a blood clot can form on its surface.

A large clot has the potential to block the flow of blood through a coronary artery, a common cause of a heart attack. Over time, ruptured plaque also hardens and narrows the coronary arteries.

PCI can restore blood flow to the heart. During the procedure, a thin, flexible catheter with a balloon at its tip is threaded through a blood vessel to the affected artery, guided by x-ray imaging.

Once in place, the balloon is inflated to compress the plaque against the artery wall. This restores blood flow through the artery.

The procedure can optimize symptoms of coronary heart disease, including angina. The procedure also can lessen heart muscle damage caused by a heart attack.

Stents can be placed in arteries during PCI. Before the balloon is inflated, a stent is placed around it. When the tip of the catheter moves to the desired site, the balloon is inflated, pushing plaque against the artery wall. This widens the artery and helps restore blood flow. The fully extended balloon also expands the stent, pushing it into place in the artery.

The balloon is deflated and pulled out along with the catheter. The stent remains in the artery. Over time, cells grow to cover the mesh of the stent.

Potential Complications

With angiography, patients may experience bleeding or bruising where the artery was entered. They may have an allergic reaction to the contrast. Not often, the access artery may be blocked. Very rarely during angioplasty or stent placement, part of the arterial blockage can break off and travel to other arteries.



Further Reading

  • All Angiography Content

Last Updated: Feb 20, 2019

Written by

Joseph Constance

Joseph Constance has written about research, development, and markets in the health care and related fields. He has authored a number of articles, and business analysis/market research reports in the medical device, clinical diagnostics, and pharmaceutical areas. Joseph holds an MA from New York University in Communications. He enjoys spending time with his wife, biking, traveling, and learning about different cultures.

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Types of Lung Cancer Surgery

Lung cancer is a common and serious type of cancer that is diagnosed in around 44,500 people in the UK every year. People affected by lung cancer do not usually develop symptoms in the early stages of the condition, but eventually they may develop a persistent cough, start coughing up blood, feel breathless, experience unexplained fatigue and weight loss and find breathing or coughing painful.

The two main types of lung cancer are non-small cell lung cancer and small cell lung cancer. Surgery is generally used to treat non-small cell lung cancer. Small cell lung cancer is not usually treated with surgery, unless it is in the very early stages, because this form of lung cancer has usually spread beyond the lung by time it has been diagnosed meaning it is not possible to remove it all using surgery. Generally, chemotherapy and radiotherapy are used to treat small cell lung cancer.

Surgery for lung cancer may involve removing a portion of the lung or the whole of the lung. A procedure where the lung cancer and a small portion of healthy tissue is removed is called a wedge resection; removal of a larger portion of the lung is referred to as a segmental resection and surgery to remove one of the lobes of the lung is called a lobectomy. When the entire lung is removed, the procedure is called a pneumonectomy.

Wedge resection

A wedge resection involves removing a small, wedge-shaped area of the lung that contains the cancer, along with some of the surrounding healthy tissue. This operation is only performed when the physician thinks the cancer has been diagnosed while it is in the early stages and is only present in one very small area of the lung.

It may also be performed to diagnose lung cancer. If a specialist believes the cancer has spread to another area of the lung, they will not recommend that this procedure is performed.

Segmental resection

Segmental resection or segmentectomy involves removal of a larger portion of the lung than a wedge resection, although the whole lobe is still not removed.


A pulmonary lobectomy is a common procedure where a lobe of the lung that contains cancerous cells is removed. There are three lobes to the right lung and two lobes to the left and the lungs can still function with the lobes that remain. When two lobes are removed, the procedure is referred to as bilobectomy. A specialist will recommend this procedure if they think the cancer is presenting in just one area of the lung. This is the most commonly used operation for treating lung cancer.

Sleeve resection

A small proportion of people with lung cancer undergo an operation called a sleeve resection. This may be performed in order to avoid removing the entire lung if the cancer is located within a central area of the lung and is growing into one of the bronchi. The affected bronchial tissue is removed along with any surrounding cancer in the lobe.


Removal of the entire lung is recommended if the tumor is in the central area of the lung and involves either the two left lobes or the three right lobes. People can still breathe normally with only one lung, but a doctor will organize a breathing test before surgery to diagnose any existing breathing problems and help a patient decide whether this type of surgery is suitable for them.

Keyhole surgery for lung cancer

Sometimes, surgeons can use keyhole surgery to remove non-small cell lung cancers that are in the very early stages. A flexible tube with a camera attached to it is passed through a small cut in the chest, allowing the surgeon to examine the lungs with the assistance of video guidance. A small number of cuts are then made in the side of the chest, through which surgical instruments can be inserted to perform the surgery.



Further Reading

  • All Lung Cancer Content
  • Lung Cancer
  • Lung Cancer Causes
  • Lung Cancer Symptoms
  • Lung Cancer Diagnosis

Last Updated: Aug 23, 2018

Written by

Sally Robertson

Sally has a Bachelor's Degree in Biomedical Sciences (B.Sc.). She is a specialist in reviewing and summarising the latest findings across all areas of medicine covered in major, high-impact, world-leading international medical journals, international press conferences and bulletins from governmental agencies and regulatory bodies. At News-Medical, Sally generates daily news features, life science articles and interview coverage.

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What is a Vitrectomy?

A vitrectomy is a surgical procedure that may be carried out for a number of reasons:

  • improving vision in patients experiencing complications from diabetes
  • removing foreign bodies from the eye in cases of trauma
  • taking a biopsy to diagnose infections or diseases
  • as part of other operative procedures on the retina

The aim of the procedure in most cases is to remove the vitreous humour to allow access to other parts of the eye.

The vitreous humour is usually a transparent, gelatinous substance inside the eye, found behind the iris and the lens, and in front of the retina. Its only purpose is to give volume to the eye.

There are two different types of vitrectomies, posterior pars plana vitrectomy and anterior vitrectomy.

Posterior pars plana vitrectomy

This type of vitrectomy is carried out by a retina specialist. This procedure involves removing the vitreous gel from the eye through the pars plana, the region of the eye that is thought to have no function in the post-fetal period and as such is thought to be the safest point of entry into the eye. Surgical instruments are also introduced into the eye through the pars plana.

The vitreous jelly is dissected and then peeled or sucked out through small 1mm cuts made into the white of the eye. Any necessary repairs to the retina are carried out, as well as removing any foreign bodies, or, in the case of surgery to treat complications of diabetes, leaking blood vessels are sealed.

Image Credit: Saginbay / Shutterstock

Anterior vitrectomy

Anterior vitrectomies are carried out when vitreous gel leaks through the pupil and into the anterior (front) chamber of the eye. Eye trauma, cataracts of the lens, and corneal or glaucoma surgery, can cause this to occur. Anterior vitrectomies aim to minimize the risk of developing future problems due to leaking vitreous fluid, and to improve visual recovery.

Vitrectomy procedure: steps

Before the vitrectomy is done, pre-operative assessments are carried out. A full history is taken, covering both general and eye health, and details of medications prescribed for other conditions are discussed. Checks to ensure that anesthesia may be safely used on the individual patient will also be carried out. General anesthesia is usually used for vitrectomy procedures, but local anaesthetic can also be used if precisely placed.

Once a patient is underneath anesthesia, the eye is kept open with forceps. The doctor will make a small (1mm) incision, and cut through the pars plana, also known as the sclera or the white of the eye. A surgical microscope that allows a wide view of the inside of the eye, along with a magnified view, is inserted. Fiberoptic cables are also used to illuminate the inside of the eye. These instruments are inserted via separate openings. The vitreous fluid is then extracted using a vitrectomy probe and any retinal problems are treated at the same time. In diabetics, leaking blood vessels are laser-coagulated at this time.

The procedure usually takes several hours.

As vitreous jelly does not reform by itself, it is necessary to replace it with one of the substances below:

  • A gas bubble that is absorbed naturally over 2-3 weeks
  • Air that is absorbed within 24-36 hours
  • A blend of gas and air
  • An oil or heavy liquid that is surgically removed later

The chamber that was once filled with vitreous jelly will be filled naturally with aqueous humour after the gas and air have been absorbed.

Recovery from vitrectomy surgery

After vitrectomy surgery, vision will be blurred for several weeks. The eye will be sensitive and swollen, and improvement may not be seen until two weeks after the surgery.

If gas or oil has been used to replace the vitreous jelly, some patients are told to position their head in a downward tilt to ensure that the gas or oil is against the treated area of the retina, as gas will float to the top of the eye. Patients are asked to do this for around 4 to 14 days, for 50 minutes per hour, although this can change depending on the reason for the surgery. To make this more comfortable, neck pillows can be used. It is also advised that patients lie on their front when sleeping. All of these measures help the retina to heal in the right place.

Complications from vitrectomy procedures

Cataracts are known to occur after vitrectomies. The formation of cataracts has been linked to high oxygen levels in the proximity of the lens, which isn’t usually exposed to a lot of oxygen. It is hypothesized that the substances used to replace vitreous fluid do not keep oxygen away from the lens as efficiently as the natural vitreous fluid does. Retinal damage can also occur when air is inserted into the eye to replace the vitreous fluid.

If patients experience a significant decrease in vision quality, or increase in colored discharge, pain, swelling, light sensitivity or redness, emergency medical attention from an eye hospital should be sought.

Some patients may experience high pressure in the eye, which is treated with eye drops. Increased pressure in the eye can cause double vision and pain.

There is also a risk of infection, as with any surgical procedure. Infections will usually be treated with antibiotics.

Other complications include:

  • Bleeding in the eye
  • Damage to the lens
  • Problems with eye movement
  • Inflammation
  • Retinal re-detachment
  • Drooping eyelid
  • Distorted or blurred vision



Further Reading

  • All Vitrectomy Content

Last Updated: Feb 26, 2019

Written by

Lois Zoppi

Lois is a freelance copywriter based in the UK. She graduated from the University of Sussex with a BA in Media Practice, having specialized in screenwriting. She maintains a focus on anxiety disorders and depression and aims to explore other areas of mental health including dissociative disorders such as maladaptive daydreaming.

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Dangers of Vitamin Deficiency During Pregnancy

Skip to:

  • What vitamins and nutrients are essential during pregnancy?
  • Vitamin B12
  • Vitamin C
  • Vitamin D
  • Folate
  • Iron
  • Calcium
  • What are the dangers of vitamin deficiency during pregnancy?
  • Vitamin B12 deficiency
  • Vitamin D deficiency
  • Vitamin C deficiency

During pregnancy, the body prepares for the fetus’ development and the breastfeeding process.  The body goes through many physical and hormonal changes. The mother needs to consume more foods rich in vitamins and nutrients to support the baby.

Proper weight gain and eating healthily reduces the risk of complications. Subsequently, the woman’s nutritional condition affects the infant later in life, particularly in his cognitive development, heart health, and the tendency to become overweight or obese.

The food pregnant mothers eat is the major source of nourishment of the body, so it’s vital to consume foods that are rich in vitamins and nutrients.

What vitamins and nutrients are essential during pregnancy?

Vitamin B12

Vitamin B12 or Cobalamin is an essential vitamin that plays a pivotal role in the production of red blood cells. It’s also important for neurological function and DNA synthesis. Vitamin B12, which is bound to protein in food, is released by the activity of gastric protease and hydrochloric acid in the stomach.

When combined with folic acid during pregnancy, vitamin B12 can help prevent spina bifida and other spinal or central nervous system birth defects. Mothers deficient in B12 are more likely to give birth to infants affected by spina bifida.

The major sources of vitamin B12 are beef, ham, pork, fish, dairy products, eggs, chicken, nutritional yeast products, and lamb.

Sources of Vitamin B12 (Cobalamin). Image Credit: Bitt24 / Shutterstock

Vitamin C

Vitamin C, also known as ascorbic acid, is a vitamin that occurs naturally in some foods. It can also be available as a dietary supplement. Vitamin C is an antioxidant that’s important for the skin, bones, and connective tissues. Aside from this, it helps the body absorb iron and boost the immune system.

Vitamin C during pregnancy may help reduce complications such as maternal anemia, intrauterine growth restriction, and pre-eclampsia. The most common sources of vitamin C include broccoli, greens, tomatoes, citrus fruits, and red or green peppers.

Foods High in vitamin C. Image Credit: bitt24 / Shutterstock

Vitamin D

Vitamin D helps the body absorb calcium, which is needed for strong bones. People can get vitamin D by exposing bare skin to sunlight. You can also get vitamin D through supplements and diet.

Vitamin D is very important for mothers and their developing babies. It plays an important role in bone metabolism by regulating the calcium and phosphate balance. It also helps reduce the risk of low birth weight, pre-eclampsia, and preterm birth.

Foods rich in vitamin D include fatty fish such as salmon, mackerel, and tuna, beef liver, egg yolks, and cheese.

Foods rich in vitamin D. Image Credit: bitt24 / Shutterstock


Folate is a B-vitamin that helps produce DNA and other genetic materials. Folate is important in red blood cell production and to reduce the risk of neural tube defects, such as spina bifida.

Foods rich in folate include legumes, asparagus, leafy green vegetables, beets, eggs, citrus fruits, broccoli, and brussels sprouts. Both dietary consumption and supplementation are recommended. To be effective in preventing neural tube defects during development, women wishing to become pregnant should initiate folate supplementation prior to conception.


Iron is an important mineral needed by the body for various functions. For instance, iron is a part of hemoglobin, a protein that carries oxygen from the lungs to the different cells of the body. Plus, it aids in the storage and use of oxygen in the muscles.

During pregnancy, the body’s blood volume rises to compensate for the increased demand for nutrients and oxygen. The demand for iron goes up to cope with the increased blood supply. The needed amount of iron should be doubled to about 27 mg per day. The most common sources of iron include green leafy vegetables, beans and lentils, tofu, cashews, fortified breakfast cereals, baked potatoes, and whole grains, to name a few.


Calcium, a mineral important for life, helps build bones. It also enables the blood to clot, aids in muscle contraction, and helps the heart to beat. But, about 99 percent of all calcium stores in the body is in the bones and teeth.

During pregnancy, the body needs calcium from food or supplements. The recommended dosage is about 1,000 mg of calcium each day. Foods rich in calcium include cheese, milk, and yogurt.

What are the dangers of vitamin deficiency during pregnancy?

Vitamin deficiency during pregnancy may cause a wide array of maternal and fetal complications.

Vitamin B12 deficiency

Low levels of vitamin B12 during pregnancy may increase the likelihood of neural tube defects. In a study, the researchers found that mothers of children affected by neural tube defects had significantly lower vitamin B12 status.

Vitamin D deficiency

Vitamin D deficiency has been associated with an increased prevalence of pre-eclampsia, which is a common cause of mortality among pregnant women and their infants. According to a study, adverse health outcomes such as low birth weight, pre-eclampsia, neonatal hypocalcemia, bone fragility, heightened risk of developing of autoimmune diseases, and poor postnatal growth have been linked to low vitamin D levels during pregnancy.

Vitamin C deficiency

Vitamin C deficiency among pregnant women may lead to serious health effects on the fetus’ brain. In a study, the researchers said that even marginal vitamin C deficiency in the mother prevents the baby’s hippocampus, an important part of the brain responsible for memory, from developing by about 10 to 15 percent.

The best way to ensure that a woman’s body has appropriate vitamin levels to support a healthy pregnancy is to establish healthful eating habits prior to becoming pregnant. A prenatal care visit is highly recommended to address any potential nutritional deficits that should be addressed prior to trying to conceive. Folate supplementation is also recommended pre-conception and during pregnancy to prevent neural tube defects. The usefulness of vitamin supplements during pregnancy for vitamin B12 and vitamin C is less clear and is currently under study. Healthcare providers may recommend that pregnant women take calcium and iron supplements during pregnancy to ensure that the mother has appropriate levels to maintain her own bone and blood health.


  • American Pregnancy Association. (2019).
  • National Institute of Child Health and Human Development. (2017).
  • Pannia, E., Cho, C.E., Kubant, R., Sanchez-Hernandez, D., Huot, P.S.,  Anderson, H. (2016). Role of maternal vitamins in programming health and chronic disease. Nutrition Reviews.
  • Rumbold, A, Nagata, O., Shahrook, S., and Crowther, C.A. (2015). Vitamin C supplementation in pregnancy. Cochrane Database of Systematic Reviews.
  • Chidambaram, Balasubramaniam. (2012). Folate in pregnancy. Journal of Pediatric Neurosciences.
  • Molloy, A., Kirke, P.,Troendle, J., Burke, H., Sutton, M., Brody, L., Scott, J., and Mills, J. (2009). Maternal Vitamin B12 Status and Risk of Neural Tube Defects in a Population With High Neural Tube Defect Prevalence and No Folic Acid Fortification. Pediatrics.
  • Finkelstein, J., Layden, A., Stover, P. (2015). Vitamin B-12 and Perinatal Health. Advances in Nutrition.
  • McCullough, M. (2007). Vitamin D Deficiency in Pregnancy: Bringing the Issues to Light. The Journal of Nutrition.
  • Mulligan, M., Felton, S., Riek, A., and Bernal-Mizrachi, C. (2009). Implications of vitamin D deficiency in pregnancy and lactation. American Journal of Obstetrics and Gynecology.
  • Nyborg, P., Vogt, L., Schjoldager, J., Jeannet, N., Hasselholt, S., Paidi, M., Christen, S., and Lykkesfeldt, J. (2012). Maternal Vitamin C Deficiency during Pregnancy Persistently Impairs Hippocampal Neurogenesis in Offspring of Guinea Pigs. Plos One.

Further Reading

  • All Pregnancy Content
  • Early Signs of Pregnancy
  • Is it Safe to Exercise During Pregnancy?
  • Pregnancy: 0-8 weeks
  • Pregnancy: 9 – 12 weeks

Last Updated: Aug 13, 2019

Written by

Angela Betsaida B. Laguipo

Angela is a nurse by profession and a writer by heart. She graduated with honors (Cum Laude) for her Bachelor of Nursing degree at the University of Baguio, Philippines. She is currently completing her Master's Degree where she specialized in Maternal and Child Nursing and worked as a clinical instructor and educator in the School of Nursing at the University of Baguio.

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African Sleeping Sickness Symptoms

African sleeping sickness (Human African Trypanosomiasis) is a tropical disease that is endemic in many areas of Sub-Saharan Africa, with a prevalence of around ~60 million people worldwide. In the acute phase, patients typically present with fever, headache, and joint pain. In the chronic disease, the infection manifests in other body areas, including the CNS, and affects the sleep cycle, hence the name.

pixelheadphoto digitalskillet | Shutterstock

African sleeping sickness is a serious disease that can cause meningoencephalitis, coma, or death. The condition is caused by two species of Trypanosoma brucei; Trypanosoma brucei rhodesiense (East African Sleeping Sickness) which causes a more acute illness (~2% cases), and Trypanosoma brucei gambiense (West and Central African sleeping sickness) which presents initially as intermittent fever or headache and slowly becomes a chronic disease (~98% cases).

The disease is mainly transmitted by tsetse flies that feed on human blood, but can also be acquired through mother-to-child (vertical) infection, mechanical transmission, accidental infections, and sexual transmission.

Symptoms of African Sleeping Sickness

Human African trypanosomiasis is a condition that, when left untreated, causes high morbidity. The earliest symptom of East African sleeping sickness is a local skin reaction called Trypanosomal chancre that appears about five days after being bitten by a tsetse fly. Regional lymphadenopathy may also be present.

First stage

The initial and most common manifestation of a generalized infection with Trypanosoma brucei is the occurrence of fever which comes and goes in a periodic cycle that is aligned with parasitic multiplication in the body. Other symptoms include headaches, muscle pain and joint ache.

In East African sleeping sickness, these clinical features appear within a few weeks of infection, and can also include lymphadenopathy. This type of sleeping sickness is more severe, and can result in myocardial dysfunction and death within a few weeks.

West African trypanosomiasis presents with less significant symptoms, including hepatosplenomegaly and rash, making early diagnosis more difficult.

Second stage

A few months after a person has been infected by West African Sleeping Sickness, the parasite begins to cross the blood-brain-barrier (BBB), and enter the central nervous system (CNS). At this stage, patients begin to experience mental and cognitive changes, caused by chronic encephalopathy. This typically manifests as the patient being unable to concentrate for long periods of time, along with a disrupted sleeping pattern.

Prognosis for patients with African Sleeping Sickness

In it's early stages, the symptoms of African Sleeping Sickness are no different from many other conditions, meaning some patients will go undiagnosed until they enter the chronic stage. As such, there are an estimated 50,000-500,000 deaths each year from this condition. As the acute phase occurs so rapidly, early detection is essential.

This disease is treatable if diagnosed within about two to three weeks after infection, before the parasite has reached the CNS. Almost all patients who get appropriate treatment within this period recover fully, except for an estimated 2.5% who will develop encephalopathy as a side effect of Stage 1 treatment.

Current studies into the prognosis of African sleeping sickness show that while treatment is still possible in the second stage, the survival rate is low. Mortality is also high in patients who remain untreated during the six months after infection, due to the crossing of the BBB by the parasite.

Records of patient mortality show that more than 80% of African sleeping sickness deaths occur because of minimal to no intervention for the condition.


Patients with African sleeping sickness may fully recover from the condition as long as appropriate treatment is provided early in the course of the illness. The lack of treatment opportunities for many patients suffering from the disease is the primary cause of continued high mortality and fatality rates.


  • Trypanosomiasis, human African (sleeping sickness). World Health Organization.
  • African Trypanosomiasis. Centers for Disease Control and Prevention.
  • Human African trypanosomiasis. The BMJ.
  • Human African trypanosomiasis. ESAI Access to Medicines.
  • African Sleeping Sickness. University of Rochester Medical Center.
  • African Sleeping Sickness and its Mark on the Human Genome: An Evolutionary Tale. Harvard University Graduate School of Arts and Sciences.
  • Duration of symptoms and case fatality of sleeping sickness caused by Trypanosoma brucei rhodesiense in Tororo, Uganda. East African Medical Journal.

Further Reading

  • All African Sleeping Sickness Content
  • What is African Sleeping Sickness?
  • African Sleeping Sickness Causes
  • African Sleeping Sickness Treatments

Last Updated: Dec 21, 2018

Written by

Gaea Marelle Miranda

Gaea graduated from the University of the Philippines, Manila, with a degree in Behavioral Sciences,cum laude . Majoring in psychology, sociology, and anthropology, she approaches writing with a multidisciplinary perspective.

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Do Migraines Increase Risk of Stroke?

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  • What is a stroke?
  • Migraines: causes and treatments
  • Migraines and strokes
  • Can migraines contribute to strokes?

Migraines and strokes are neurological disorders, and those affected by migraines are known to be at increased risk of stroke. However, an explanation for this association remains elusive. It is not yet known whether migraine itself predisposes to stroke, or whether persons affected by migraines have another, unknown risk factor that increases their risk of stroke.

What is a stroke?

A stroke occurs when the blood supply to the brain is interrupted. This causes affected neurons and other brain cells to be starved of oxygen, killing them.

There are three main types of strokes; Ischemic stroke, hemorrhagic stroke and transient ischemic attack (a warning or “mini-stroke”). A hemorrhagic stroke results from a burst blood vessel in the brain that causes a bleed around the local area.

The causes of hemorrhagic strokes include high blood pressure, and to a lesser extent and brain aneurysms (rupturing of balloon-like expanses of blood vessels). Ischaemic strokes are more common and are characterized by the blockage of blood flow to regions of the brain due to a blood clot.

Blood clot in the human brain. Ischemic stroke in the cerebral artery and thrombus Image Credit: Designua / Shutterstock

These blood clots can be formed due to atherosclerosis deposits in the blood vessel of the brain or due to the lodging of a blood clot that has travelled from another area of the body.

Risk factors for ischaemic strokes include smoking, high blood pressure, obesity, high blood cholesterol, and diabetes mellitus.

Migraines: causes and treatments

Migraines are a form of moderate/severe headache that affects approximately 20% of women and 6.67% of men. There are several types of migraine which vary based on the expression.

Image Credit: Mykola Samoilenko / Shutterstock

Migraines that have warning signs before the migraine attack begins are called migraine with aura. Migraines without prior warning signs are called migraine without aura.

Silent migraines are migraines without headaches but with other migraine symptoms. Some of the other symptoms of migraines are feeling/being sick, increased photosensitivity, increased noise sensitivity (hyperacusis), poor concentration, and abdominal pain.

Additionally, the warning signs before an aura/silent migraine range from vision problems, to dizziness, and even difficulty speaking and loss of consciousness.  Some of these symptoms resemble stroke symptoms.

Migraines usually progress in stages, although not all stages are met or expressed in order for every migraine, even in the same patient. These stages are;

  1. Prodrome – changes in mood, energy levels, or behavior before a migraine attack.
  2. Aura – the warning signs that occur before a migraine attack occurs (such as visual changes). Migraine without aura attacks does not express this stage.
  3. Headache – Pulsating/throbbing pain originating in the head, which can also be accompanied by additional symptoms, as previously discussed. These are often one-sided but can be bilateral.
  4. Resolution – when the symptoms begin to fade and the migraine attack ends.  

Migraines and strokes

Migraines and strokes are heavily linked as they are both neurovascular disorders with similar physiological properties.

Migrainous infarction is the occurrence of a stroke during a migraine attack, with symptoms that persist for longer than 60 minutes. The incidence of this disorder is exceptionally low, with only 0.2-0.5% of all ischaemic stroked being migrainous infarction.

The posterior blood circulation of the brain is more affected than the anterior circulation during a migrainous infarction. This results in visual deficits, sensory deficits, inability to form/comprehend language (aphasia), weakness of one side of the body (hemiparesis), and weakness of all four limbs (tetraparesis).

The prognosis for migrainous infarctions is favourable, with most cases showing a complete recovery.

One theory for the relationship between  migraine and stroke is the cortical spreading depression (CSD) hypothesis. This theory suggests that a decrease in cerebral blood volume starts during the aura phase of a migraine and spreads anteriorly through the brain; this stage is followed by an increase in blood flow to different tissues. Ultimately, this results in the migraine aura attack. Patients with migraine without aura show posterior hypoperfusion.

A potential response to CSD is severe vasoconstriction instead of vasodilation, which is detrimental to the health of the brain. Due to the low incidence of migrainous infarctions and the high incidence of migraines, is it clear that the cerebral blood flow during a CSD does not cause ischaemic stroke in the vast majority of cases. This suggests that CSD may only be a factor of migrainous infarctions instead of a direct cause.

Can migraines contribute to strokes?

Population studies have shown that patients with migraines are twice as likely to suffer from an ischaemic stroke compared to individuals that do not suffer from migraines.

Risk factors for migrainous infarction include young age (under 45 years of age), being female, smoking, and use of oral contraceptives.

An important distinction is that increase risk of strokes due to migraines has only been observed with migraine aura, with migraine without aura showing no increased risk. Theories discussing the increased risk of ischaemic stroke and migraines include:

  • The migraine predisposing an individual to ischemic strokes
  • Common comorbidities between migraine and stokes
  • Certain genetic disorders associated with migraines and strokes
  • Migraine-specific medication – I.e. vasoconstrictors – that increase the risk of a stroke

As of 2015, 38 different gene loci have been linked to migrainous infarctions. One of those is a polymorphism in the methylenetetrahydrofolate reductase gene. This gene is responsible for the metabolism of folate and homocysteine and is associated with increased susceptibility to migraine auras.

Cerebral Autosomal Dominant Arteriopathy with subcortical infracts and leukoencephalopathy (CADASIL) is a disorder of small cerebral arteries that is associated with migraines and ischaemic strokes. Ischaemic strokes occur in approximately 60%-85% of patients with CADASIL.

Mitochondrial encephalopathy lactic acidosis and stroke-like episodes are a genetic heterogeneous mitochondrial disorder which results in many neurological symptoms mainly affecting the central nervous system. This includes seizures, cortical blindness, episodic vomiting, migraines, and stroke-like episodes.


  • (2019). Stroke.
  • Lee, M., et al. (2016). The Migraine–Stroke Connection. Journal of Stroke.
  • Migraine and Stroke: What’s the Link? What to Do?
  • Stroke and migraine is there a possible comorbidity?

Further Reading

  • All Migraine Content
  • What are Migraines?
  • Migraine Diagnosis
  • Migraine Pathophysiology
  • Migraine History

Last Updated: Oct 20, 2019

Written by

Samuel Mckenzie

Sam graduated from the University of Manchester with a B.Sc. (Hons) in Biomedical Sciences. He has experience in a wide range of life science topics, including; Biochemistry, Molecular Biology, Anatomy and Physiology, Developmental Biology, Cell Biology, Immunology, Neurology  and  Genetics.

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India experts find traces of lead, nickel in patients’ blood

Indian health officials have found traces of nickel and lead in a few blood samples taken from hundreds of patients who have been hospitalized by a mysterious illness in a southern state, officials said.

The Andhra Pradesh state government said in a statement Tuesday night that investigations by experts from the All India Institute of Medical Sciences have not been able to ascertain the source of excessive nickel and lead particulate matter in the patients’ blood.

Reports from other tests by experts at the Indian Institute of Chemical Technology, including toxicology reports and blood cultures, are being awaited, the statement said.

Health officials and experts are still baffled by how the heavy metals got into the patients’ blood, and whether they are the cause of the mysterious illness that has left over 585 people hospitalized and one person dead in Andhra Pradesh. The illness was first detected Saturday evening in Eluru, an ancient city famous for its handwoven products.

People with the illness started convulsing without any warning, said Geeta Prasadini, a state health official.

Andhra Pradesh Chief Minister Y.S. Jaganmohan Reddy held a virtual meeting Wednesday with officials who included experts from India’s top scientific institutes. Reddy said 502 of the people with the illness have been discharged after showing improvement.

The patients showed symptoms ranging from nausea and anxiety to loss of consciousness.

What is confounding experts is that there doesn’t seem to be any common link among the hundreds of people who have fallen sick. All of the patients have tested negative for the coronavirus and other viral diseases such as dengue, chikungunya and herpes. The patients aren’t related to each other and don’t all live in the same area. They’re from different age groups, including about 70 children, but very few are elderly.

Initially, contaminated water was suspected. But the chief minister’s office confirmed that people who don’t use the municipal water supply have also fallen ill, and that initial tests of water samples didn’t reveal any harmful chemicals.

A 45-year-old man who goes by the single name Sridhar was hospitalized with symptoms resembling epilepsy and died Sunday evening, doctors said. Prasadini said his autopsy didn’t shed any light on the cause of death.

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‘Repliclones’ fuel perplexing persistence of HIV in the blood of some patients on therapy

Increasingly, UPMC’s chief of infectious diseases—a well-regarded expert in HIV/AIDS—is contacted by a perplexed physician describing a patient with HIV who insists they are adhering to the daily medication regimen meant to keep the virus in check, but testing says otherwise.

Virus is still showing up in the patient’s blood, something clinicians believe can’t happen when the infection is controlled with medication. University of Pittsburgh School of Medicine scientists report today that they’ve solved the mystery—and the answer has clinical implications.

In a study published in the Journal of Clinical Investigation, Pitt infectious disease researchers show that the issue isn’t nonadherence to medication or resistance to the drugs. Instead, the patients are victims of what the scientists have dubbed “repliclones”—large clones of HIV-infected cells that produce infectious virus particles.

“We found that repliclones can grow large enough and produce enough virus to make it appear that antiretroviral therapy isn’t working completely even when it is,” said senior author John Mellors, M.D., who holds the Endowed Chair for Global Elimination of HIV and AIDS, and is chief of the Division of Infectious Diseases at Pitt and UPMC.

HIV replicates by taking over a cell’s machinery and using it to produce more virus, which can then go on to infect other cells. Antiretroviral therapy, which is taken daily, prevents the virus from infecting new cells so that even though HIV can’t yet be cured, it can be controlled to the point that it isn’t detectable in blood tests.

Elias Halvas, Ph.D., research assistant professor in Pitt’s Division of Infectious Diseases, and Mellors led a multidisciplinary team of U.S.-based HIV scientists in investigating the medical records and blood from eight patients with non-suppressible HIV viremia—detectable virus in the blood—despite adherence to antiretroviral medications. Repeated samples of each patient’s blood revealed identical viral genetic sequences that did not change over time.

“This indicates that, in the individual patients, the virus in their blood was coming from identical cellular factories,” said Halvas.

In short, rather than the virus going out and infecting new cells, already infected HIV-producing cells are growing into large clones that make and release virus. Current medications for HIV infection block the virus from infecting new cells but don’t affect virus production from cells or clones of cells that are already infected.

“Even though we don’t have evidence that the virus produced by these repliclones is then infecting new cells—which would be detrimental to the patient’s immune system—they could cause other problems, such as chronic inflammation,” said Mellors, who also is Distinguished Professor of Medicine at Pitt. “If the patient were to stop drug therapy, the virus could have a head-start on rebounding. And repliclones are a key barrier to developing a true cure for HIV.”

The immediate implication of their discovery, Mellors said, involves informing clinicians and patients that HIV viremia can be caused by repliclones. This can help clinicians in developing disease management plans that may allow continuation of current antiretroviral regimen, knowing that switching the treatment may not suppress the viremia. Instead, the patient can be monitored over time for changes in the level of viremia, which can decline as the repliclone shrinks or sometimes can stay the same or increase slowly. Large increases in viremia should prompt the review of medication adherence again and exclusion of new drug resistance, Mellors added.

For the long-term, scientists must figure out how repliclones escape the immune systems and how they can be efficiently killed to cure the infection. While more research is needed, Mellors and his team speculate that smaller, less easily detected repliclones may be present throughout the body and be responsible for the rapid rebound of HIV in patients who stop their therapy. An added complexity is that all the cells of a repliclone may not all be making virus at the same time and thus remain hidden from the immune system as a latent or invisible reservoir of HIV.

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