Podoconiosis: A Possible Cause of Lymphedema in Micronesia.

Podoconiosis is a type of tropical lymphedema sharing some clinical characteristics with lymphatic filariasis. Also referred to as endemic non-filarial elephantiasis, podoconiosis is a non-infectious disease from barefoot exposure to irritant red clay soil of volcanic origins. Podoconiosis is most common in Ethiopia and has also been reported in many other countries, but not in the Pacific Islands. Lymphatic filariasis is endemic in the Pacific Islands and was historically reported as elephantiasis in Micronesia. It was considered to have been eradicated in Guam and the Northern Mariana Islands following World War II. A small number of patients in Saipan exhibited characteristics of lymphatic filariasis but were seronegative for filariasis. Clinical examination of these patients matched podoconiosis much more closely than filariasis. Moreover, these patients reported a history of chronic barefoot exposure to irritant red clay soil and a prodrome characteristic of podoconiosis. While this study is limited to several cases, the results suggest that podoconiosis could be considered a cause of non-filarial lymphedema in Saipan and perhaps other islands in Micronesia. Preventive patient education is focused on discouraging barefoot exposure to red clay soils, particularly in those with a family history of lymphedema. Early recognition of the possibility of podoconiosis would allow appropriate treatment and prevent progression to later debilitating stages of the disease.

Existential pain: impressions from an American Indian reservation.

The existential suffering of members of the Havasupai Indian tribe are described by a physician-anthropologist who spent some time serving as an interim medical provider for the tribe. Pain is often described as having both physical and emotional dimensions. In this paper, the existential dimension is explored through a narrative of the author's experiences.

Club drugs: MDMA, gamma-hydroxybutyrate (GHB), Rohypnol, and ketamine.

Club drugs are substances commonly used at nightclubs, music festivals, raves, and dance parties to enhance social intimacy and sensory stimulation. The most widely used club drugs are 3,4-methylenedioxymethamphetamine (MDMA), also known as ecstasy; gamma-hydroxybutyrate (GHB); flunitrazepam (Rohypnol); and ketamine (Ketalar). These drugs are popular because of their low cost and convenient distribution as small pills, powders, or liquids. Club drugs usually are taken orally and may be taken in combination with each other, with alcohol, or with other drugs. Club drugs often are adulterated or misrepresented. Any club drug overdose should therefore be suspected as polydrug use with the actual substance and dose unknown. Persons who have adverse reactions to these club drugs are likely to consult a family physician. Toxicologic screening generally is not available for club drugs. The primary management is supportive care, with symptomatic control of excess central nervous system stimulation or depression. There are no specific antidotes except for flunitrazepam, a benzodiazepine that responds to flumazenil. Special care must be taken for immediate control of hyperthermia, hypertension, rhabdomyolysis, and serotonin syndrome. Severe drug reactions can occur even with a small dose and may require critical care. Club drug over-dose usually resolves with full recovery within seven hours. Education of the patient and family is essential.