Macular Hemorrhage from Bungee Jumping

A 25-year-old woman with no clinically significant medical history and with normal coagulation and hematologic studies went bungee jumping from a vertical height of 150 ft (45.7 m). Immediately afterward, she noticed a substantial decrease in vision in her left eye, with a large central scotoma; no other symptoms were noted and there was no pain. On examination, the patient's right eye was found to have a normal disc and vessels (Panel A, arrowhead) and normal fovea and macula (Panel A, arrow). Examination of the left eye showed a normal disc and vessels (Panel B, arrowhead), but the foveal and macular architecture was obscured by a large macular hemorrhage just below the level of the internal limiting membrane (Panel B, arrow). Vision was 20/400 in the left eye when the patient used peripheral scanning and 20/20 in the right eye. The patient had a form of Valsalva retinopathy due to increased venous pressure in the upper body, brought about by sudden deceleration in the head-down position (such as occurs during bungee jumping). She underwent surgery with evacuation of the blood in the left eye. Visual acuity in the left eye 1 week later was 20/25 and has remained stable.


The New England Journal of Medicine

6 Serious Medical Symptoms

1. Paralysis of the arms or legs, tingling, numbness, confusion, dizziness, double vision, slurred speech, trouble finding words, or weakness, especially on one side of the face or body.

These are signs of stroke -- or a "brain attack" -- in which arteries that supply oxygen to the brain become blocked or rupture, causing brain tissue to die.

Symptoms depend on which area of the brain is involved. If a large blood vessel is blocked, a wide area may be affected, so a person may have paralysis on one side of the body and lose other functions, such as speech and understanding. If a smaller vessel is blocked, paralysis may remain limited to an arm or leg.

2. Chest pain or discomfort; pain in the arm, jaw, or neck; breaking out in a cold sweat; extreme weakness; nausea; vomiting; feeling faint; or being short of breath.

3. Tenderness and pain in the back of your lower leg, chest pain, shortness of breath, or coughing up blood.

These are symptoms of a potentially dangerous blood clot in your leg, especially if they come after you've been sitting for a long time, such as on an airplane or during a long car trip. These signs can also surface if you've been bedridden after surgery.

4. Blood in the urine without accompanying pain.

Kidney Stones or a bladder or prostate infection are common causes of blood in the urine.

5. Asthma Symptoms that don't improve or get worse.

Asthma attacks are marked by wheezing or difficulty breathing. When an attack doesn't improve or worsens, a patient should get emergency care.

If an asthma attack is left untreated, it can lead to severe chest muscle fatigue and death, say Shulman and Birge. Some people with persistent asthma hesitate to go to the emergency room because they've gone so many times before, or they need someone to drive them because they're too short of breath. So instead of seeking care, "They try to hang in there," Birge says, even if they need higher doses of inhalants or have decreasing lung function measurements when using a device to measure how well they move air out of their lungs.

6. Depression and suicidal thoughts.

"Depression can be a very, very serious problem because people can commit suicide," Shulman says. "Some people will not seek care when they are depressed because they think that they'll be perceived as being crazy or not strong or not manly, and they have to understand that there is a chemical imbalance going on in their brain. It is a disease just like any other disease."

Symptoms of depression include sadness, fatigue, apathy, anxiety, changes in sleep habits, and loss of appetite. Depression can be treated with medications and psychotherapy.

Health Issues

Health Challenges

Despite incredible improvements in health since 1950, there are still a number of challenges, which should have been easy to solve. Consider the following:

• One billion people lack access to health care systems.
• Around 11 million children under the age of 5 die from malnutrition and mostly preventable diseases, each year.
• In 2002, almost 11 million people died of infectious diseases alone, far more than the number killed in the natural or man-made catastrophes that make headlines. (These are the latest figures presented by the World Health Organization.)
• AIDS/HIV has spread rapidly. UNAIDS estimates for 2007 that there are roughly:
  • 32.8 million living with HIV
  • 2.5 million new infections of HIV
  • 2 million deaths from AIDS
• There are 8.8 million new cases of Tuberculosis (TB) and 1.75 million deaths from TB, each year.
• 1.6 million people still die from pneumococcal diseases every year, making it the number one vaccine-preventable cause of death worldwide. More than half of the victims are children. (The pneumococcus is a bacterium that causes serious infections like meningitis, pneumonia and sepsis. In developing countries, even half of those children who receive medical treatment will die. Every second surviving child will have some kind of disability.)
• Malaria causes more than 300 million acute illnesses and at least 1 million deaths, annually.
• More than half a million people, mostly children, died from measles in 2003 even though effective immunization costs just 0.30 US dollars per person, and has been available for over 40 years.

These and other diseases kill more people each year than conflict alone.

AIDS

People living with HIV:

• 33 million people living with HIV worldwide
• 30.8 million adults
• 15.5 million women
• 2.0 million children under 15

New HIV cases in 2007:

• 2.7 million total new cases
• 2.3 million adults
• 370,000 children under 15

HIV-related deaths in 2007:

• 2.0 million total deaths

Tobacco

Tobacco and smoking have a number of negative effects:

• Tobacco smoking kills
• Tobacco exacerbates poverty
• Tobacco contributes to world hunger by diverting prime land away from food production
• Tobacco production damages the environment
• Tobacco reduces economic productivity
• While the Tobacco industry may employ people, this can be considered an example of “wasted labor”, capital and resources.

Obesity

Food systems causes of obesity:

The main problem has been the increased availability of high energy food, because of:

• Liberalized international food markets
• Food subsidies that “have arguably distorted the food supply in favour of less healthy foodstuffs”
• “Transnational food companies [that] have flooded the global market with cheap to produce, energy dense, nutrient empty foods”
• “Supermarkets and food service chains [that are] encouraging bulk purchases, convenience foods, and supersized portions”
• Healthy eating often being more expensive than less healthy options, (despite global food prices having dropped on average).
• Marketing, especially “food advertising through television [which] aims to persuade individuals—particularly children—that they desire foods high in saturated fats, sugars, and salt.”

Water and Sanitation

Much of the world lives without access to clean water. Privatization of water resources, promoted as a means to bring business efficiency into water service management, has instead led to reduced access for the poor around the world as prices for these essential services have risen.

It takes a great deal of water to manufacture our goods:

• 1 newspaper takes 150 gallons
• 1 liter of orange juice takes 1000 gallons
• 1 pound of beef takes 2500 gallons
• 1 new car takes 40,000 gallons

Almost fifty per cent of the developing world’s population – 2.5 billion people – lack improved sanitation facilities, and over 884 million people still use unsafe drinking water sources. Inadequate access to safe water and sanitation services, coupled with poor hygiene practices, kills and sickens thousands of children every day, and leads to impoverishment and diminished opportunities for thousands more.

Poor sanitation, water and hygiene have many other serious repercussions. Children – and particularly girls – are denied their right to education because their schools lack private and decent sanitation facilities. Women are forced to spend large parts of their day fetching water. Poor farmers and wage earners are less productive due to illness, health systems are overwhelmed and national economies suffer. Without WASH (water, sanitation and hygiene), sustainable development is impossible....