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The Black Death and Other Pandemics
Published in Scott M. Jackson, Skin Disease and the History of Dermatology, 2023
A few thousand cases of bubonic plague occur each year in the world today; these cases provide us with a modern look at the medieval disease. A comparison of the medieval accounts to a summary of modern accounts of bubonic plague in Arizona and Madagascar supports the diagnosis of plague as the cause of the Black Death.43 Modern plague starts with fever, chills, weakness, and headache a few days after a flea bite. Then, the patient develops a bubo, which is a markedly enlarged, exquisitely tender infected lymph node in the region of the flea bite. Flea bites, which occur most commonly on the lower extremities, are most likely to cause buboes in the groin region. Children, who typically play low to the ground, are susceptible to flea bites on the upper extremities. In these cases, and in cases associated with a cat bite or scratch, the buboes are more common in the underarm or neck. Untreated bubonic plague can lead to sepsis with DIC, pneumonia, or meningitis. Septicemic and pneumonic forms of plague can both occur with or without a preceding bubo; pneumonic plague can result from inhalation of infected aerosolized respiratory secretions. Plague patients can uncommonly experience severe tonsillitis (pharyngeal plague) or prominent gastrointestinal symptoms, confusing the picture. The most atypical reported route of acquiring plague was a case of pharyngeal plague after the ingestion of camel meat from camels infected with plague by flea bites.44 Indeed, in modern plague, the flea appears to play a crucial role in the transmission of the infection.
A brief history of pandemics
Published in Edward M. Rafalski, Ross M. Mullner, Healthcare Analytics, 2022
Prior to our understanding of the germ theory of disease, diseases such as the plague were thought to be caused by “miasmas” or pockets of unclean air, and the role of insect and rodent vectors was unappreciated. The Justinian Plague, named after the Byzantine Emperor Justinian I, began in Southeast Asia, spread to Constantinople, capital of the Byzantine Empire and the major trading port linking Asia and Europe, and spread in waves throughout Europe, North Africa, and the Middle East in 8–12 year intervals from 541 to 750 CE [5]. The plague is caused by a bacterium, Yersinia pestis, which is carried by fleas and lice. These vectors live on rodents including black rats but can pass the disease on to humans when the rats are in close proximity. The grain ships traveling to Constantinople were a rich environment for these rats and brought the plague with them.
“Turkey is Almost a Perpetual Seminary of the Plague”
Published in Lori Jones, Disease and the Environment in the Medieval and Early Modern Worlds, 2022
As a result, even though Europeans often viewed foreign spaces and foreign bodies as sites of disease, it made sense to locate the origins of plague in a place that would remain foreign, not in one that they inhabited. If their colonial and imperialist projects required the English and the French to find a place outside of their control in which to situate plague, the economic and political decline of the Ottoman Empire over the seventeenth century provided them with a suitable location. By turns Western Europe’s most visible competitor, military threat, and cultural and religious Other, the empire was, until about the mid-seventeenth century, also an important economic and diplomatic partner, a paradox that initially generated a complex image of the Turks among Europeans. But relocating plague among them helped bolster suggestions that outbreaks in Europe were imported from or carried by peoples who were themselves diseased or, otherwise, undesirable (Jones 2022a; Varlık 2017).
Expert opinion paper on the treatment of hemophilia A with emicizumab
Published in Hematology, 2023
Francisco-José López-Jaime, Olga Benítez, Bolívar Luis Díaz Jordán, Adrián Montaño, Julia Coll, Laura Quintana París, María Del Carmen Gómez-del Castillo Solano
Although experience is limited, especially in neonates, PUPs and patients undergoing major surgery, emicizumab has been shown to be a promising therapeutic option for HA. Clinical trial and real-life studies have shown that emicizumab is successful in reducing ABR, suggests improved joint health with resolution of target joints and thus an improvement in patients’ quality of life. Clinical trial results have also revealed a safe drug profile, with no serious adverse events or development of FVIII inhibitors in most patients. In addition, emicizumab-treated patients were able to undergo minor and major surgeries safely, without the need for prior prophylaxis in the case of minor interventions. The stability of emicizumab’s pharmacokinetics also generates confidence among clinicians, as there is no need for laboratory monitoring of drug levels. Still, more studies are needed to help confirm these findings and address some of the concerns that continue to plague clinicians and are outlined in this article.
War on Rats: the architecture of the bubonic plague in Galveston
Published in Baylor University Medical Center Proceedings, 2023
The first case arrived in the summer of 1920. On June 8, a 17-year-old boy began experiencing plague symptoms: he was cold, dizzy, and his right femoral gland had a swelling, or “bubo.”1 Investigators found rats near the grain store where he worked as a collector as well as a dead rat and fleas at his home. Eight days later, the young man was unconscious. Four hours after he was admitted to John Sealy Hospital’s isolation ward, Emil Horridge became the first victim of Galveston’s bubonic plague. Figure 1 shows documentation of the first human case of bubonic plague in Galveston in a laboratory notebook.5 Two hours after Horridge died, Dr. Henry C. Hartman (1881–1963), chairman of the Department of Pathology at the University of Texas Medical Branch, began the autopsy.6 As reported by Hartman and his colleague, Dr. Anna M. Bowie (1890–1980), in the Journal of the American Medical Association, Horridge’s autopsy included pathologic findings of hemorrhagic necrosis of the right femoral gland, cloudy swelling and edema in the heart, marked hyperemia of the lungs, an enlarged spleen with hemorrhages, acute nephritis, fatty degeneration of the liver, and erosions in the gastric mucosa.7
Research progress on antiviral constituents in traditional Chinese medicines and their mechanisms of action
Published in Pharmaceutical Biology, 2022
In TCM, infectious diseases caused by viruses are referred to as ‘plagues’. The pathogenic mechanisms of viruses mainly include the direct damage or apoptosis of host cells, the alteration of normal cellular functions, the induction of excessive inflammation or pathological injury, the immunosuppression, etc. Adhering to the syndrome differentiation-based treatment in TCM, these viral infectious diseases are often treated with heat-clearing, fire-purging, and heat-clearing, damp-drying principles, which are supplemented by drugs that benefit Qi and blood, nourish yin and engender fluids. To date, there have been extensive studies on the antiviral effects of TCM in vitro, which focus on single herbs such as Lonicera japonica Thunb. (Caprifoliaceae) flower (Jinyinhua), Forsythia suspensa Thunb. Vahl. (Oleaceae) fruit (Lianqiao), Angelica dahurica (Fisch. ex Hoffm.) Benth. et Hook. f. ex Franch. et Sav. (Umbelliferae) root (Baizhi), and Curcuma zedoaria (Christm.) Rosc. (Zingiberaceae) rhizome (Ezhu), as well as some of their active constituents (Law et al. 2017; Lee et al. 2020; Li, Xie, et al. 2020; Wan et al. 2020). Although their definite antiviral effects have been verified by in vivo or in vitro experiments, the specific mechanisms of their antiviral actions have scarcely been explored, where the emphasis is on the extraction of single herbal medicines. Flavonoids, polysaccharides, triterpenoids, alkaloids, etc. are mostly common constituents in the existing reports of antiviral TCM.