HDL, LDL and VLDL -The Different Types of Cholesterol
by Gary Stanton

Cholesterol is known to basically occur in every part of our body which is best described as a fat-like and waxy substance. It is something that our body requires in order to function properly although having high levels of cholesterol in the blood increases your risk of heart disease. Now the reason behind this is because too much cholesterol normally ends up sticking to the walls of your arteries which is called plaque. The tendency of plaque is to narrow your arteries and even block them.

To date, there are two main types of cholesterol, and these would be high-density lipoprotein or HDL and low-density lipoprotein or LDL. HDL is identified as the “good” cholesterol while low-density lipoprotein or LDL is identified as the “bad” cholesterol. Now given that cholesterol is a substance that cannot be dissolved in the blood, the role of lipoproteins is to transport it to and from the cells.

Now HDL is deemed to be the “good” cholesterol since the higher your HDL cholesterol level is, your risk of acquiring coronary artery diseases are decreased. On the other hand, LDL is considered to be “bad” cholesterol since the higher your LDL cholesterol is, it then places you at a greater risk for heart disease and other heart related complications.

Now aside from LDL and HDL, cholesterol can still be broken down further into what we call very low-density lipoprotein cholesterol or VLDL. Note that compared to other lipoprotein types, VLDL has the highest amount of triglyceride which is a form of fat that is produced in our body. Given that it has the highest level of triglyceride, having a high VLDL level means that there is a greater risk of acquiring coronary artery disease which causes strokes and heart attacks.

Now apart from these types of lipids and other fats which are collectively called triglycerides; a person’s total cholesterol count also includes Lp(a) cholesterol. Now bear in mind that it is very important for individuals who are over twenty years old to do a blood test in order to know their cholesterol level. In doing so, one may prevent any possible heart related problems and have the option to take immediate action if necessary.

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Spain’s decision to euthanise the dog of a nurse who contracted Ebola has sparked a global outcry and clashes between police and animal rights activists after 390,000 people signed a petition urging to Government to save its life.
Officials from Madrid’s regional government obtained a court order on Tuesday to put down nurse Teresa Romero’s pet Excalibur, despite uncertainty over whether the dog was also infected or risked spreading the disease to humans.

(Ms Romero Ramos ,the nurse who contracted Ebola with her dog Excalibur.)

Ms Romero, 40, contracted the deadly Ebola virus in Spain after treating Spanish missionaries repatriated from West Africa.

Outrage spread rapidly on social media after Ms Romero’s husband, who is being quarantined in a Madrid hospital, reached out to animal rights group via a video appeal.

He told activists: “I’m in the hospital and I’m making a call to all people to help me save my dog Excalibur because they want to kill him just like that, without following any procedure.”

A demonstrator blocking the road to stop the van transporting infected nurse’s dog ‘Excalibur’ A demonstrator blocking the road to stop the van transporting infected nurse’s dog ‘Excalibur’ About 50 furious demonstrators responded to his call by gathering outside the couple’s home in Madrid and shouting “assassins” at those taking Excalibur to be put down. Police were seen pulling away activists blocking the road as firefighters attempted to gain access to the property.

Two protesters were injured as they tried to block the van transporting Excalibur.

Protesters outside the hospital Protesters outside the hospital An online protest via Change.org gathered momentum throughout the afternoon, with over 395,000 people having signed it by the end of the day.

Activists were also camped outside the hospital attempting to pressure local authorities into saving the pet, shouting slogans such as: “Excalibur, you are not alone.”

A riot policeman moves an animal activist A riot policeman moves an animal activist Despite this, Madrid’s regional Government announced on Wednesday evening that it had euthanised the pet, prompting an outpouring of grief on social networks.

Excalibur was “sedated beforehand to avoid suffering,” Madrid’s regional health agency said in a statement.

The corpse was then “put into a sealed biosecurity device and transferred for incineration at an authorised disposal facility”.

Ben Williamson, a spokesperson for PETA, said: “PETA is sad to hear that a dearly loved dog was destroyed because of the Ebola scare, even though no one can point to any evidence that dogs can transmit Ebola and efforts could have been made to quarantine him.

Kigalihe@The Independent

Break in transmission – how Nigeria took control of Ebola

By Edward Wright, University of Westminster

The scale of the ongoing outbreak of Ebola virus in western Africa has taken healthcare workers, scientists, policy makers, in fact everyone, by surprise. Prior to this outbreak the largest number of human cases in a single outbreak was just over 400. In this outbreak it is now more than 7,000.

The identification of Thomas Duncan, the first person diagnosed in the US, who later died, and Teresa Romero Ramos, the Spanish nurse who became the first human-to-human transmission of the virus outside of Africa, has raised questions about whether the virus can be contained in countries outside of Africa.

Ebola virus is a disease of contact, it is transferred from person-to-person by the exchange of bodily fluids (blood, faeces and vomit) from someone who is showing symptoms. And it is likely there will be further cases of Ebola virus imported via infected individuals travelling back from west Africa. A recent study suggested there was a 25-70% chance of the virus reaching France by the end of October and between 15-25% for the UK in the same timeframe. Other research in September said that there was a only 10% chance of a case being identified in the US that month. A day later Duncan presented to his local hospital.

The global network of flights certainly make it more likely that further cases will be imported to countries additional to those already affected. However, given the heightened awareness, and the time these countries have had to prepare for this scenario – and stronger public health infrastructures – they are more likely to be able to limit the transmission of the virus.

Act fast, and act local

There has been lots of discussion about why this outbreak is so much larger than previously. Some of the reasons suggested are: that there has only been one previously documented case of human infection with Ebola virus in West Africa (the virus has primarily caused human infections in central and eastern Africa) so healthcare workers in this region had little previous experience in dealing with Ebola virus outbreaks; there was a delayed response by the local and international public health agencies; and poor existing healthcare infrastructure due to civil war or lack of investment; and the list can go on.

All outbreaks prior to this one in West Africa have been controlled through the implementation and strict maintenance of basic public health strategies – early diagnosis and isolation of infected individuals, provision of appropriate protective equipment for medical staff, contact tracing and education and awareness campaigns targeting the local population. But in the case of the current outbreak, the virus was able to spread in the highly dense and mobile population before these interventions could be put in place.

Breaking transmission

If you can break the transmission you can control the outbreak. These measures have already proved successful. An infected Liberian man who travelled to Nigeria imported the virus, which spread to a further 19 individuals within the country but was quickly contained due to the implementation of the strategies above. In part this was possibly thanks to an existing healthcare surveillance infrastructure in place in Nigeria that is used to monitor for cases of polio. These facilities and personnel were successfully mobilised to limit the spread of Ebola virus. Nigeria has not seen any new cases since August 31 and will be declared “Ebola free” on October 12 if no further cases are detected.

Given the scale of this outbreak, it is likely that further measures will be needed, such as the use of experimental treatments and the fast-tracked development of vaccines and therapeutic drugs, as senior experts concluded at a meeting convened by the World Health Organisation in Geneva at the start of September. It is anticipated there could be a limited roll out of vaccine and drugs to healthcare workers in the region by the start of 2015.

Going airborne?

The other issue that has been at the forefront of peoples’ minds is whether the virus could mutate to become airborne. The honest answer is this is highly unlikely but we can not rule it out.

A recent report in the scientific journal Science identified that there have been changes to the virus’ genetic code during this outbreak but this is only to be expected due to the nature in which the virus replicates. There is no evidence that these mutations have led to the virus becoming airborne. If we look for examples of better studied viruses that mutate, such as influenza and human immunodeficiency virus, we have known about these viruses for a long time and monitored the accumulation of mutations within their genomes.

While the rate of mutations has been prolific these viruses have not changed the mechanism by which they are transmitted. In fact, there is no evidence any virus has changed its mode of transmission due to naturally occurring mutations in their genomes.

Edward Wright does not work for, consult to, own shares in or receive funding from any company or organisation that would benefit from this article, and has no relevant affiliations.

This article was originally published on The Conversation.
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Health Check: does caffeine enhance performance?

By Chris Forbes-Ewan, Defence Science and Technology Organisation

Unlike many drugs, caffeine may be taken legally by people of all ages, which helps make it the world’s most widely used stimulant.

Approximately 80% of the world’s caffeine is consumed in the form of coffee; it’s been estimated that 500 billion cups of coffee are consumed throughout the world every year.

Tea, chocolate, cola drinks, and energy drinks and shots are the other main sources of caffeine.

Impact on physical performance

Caffeine has been used to good effect by athletes as an aid to physical performance for many years. Initially, it was believed to be of greatest benefit in endurance events (marathon running, for instance, or long-distance swimming).

More recently, we’ve realised that caffeine also boosts performance for short-term, high-intensity activities, such as middle-distance running, and stop-start sports, such as tennis.

Until a decade or so ago, it was thought that very high doses of caffeine (higher than could be obtained by simply drinking coffee, for example) were needed to enhance athletic performance.

Such high doses could usually only be obtained from caffeine-containing capsules, and often led to adverse side effects.

Consequently, the International Olympic Committee (IOC) banned caffeine use by athletes above a certain level of intake.

But by early this century, it became clear that moderate doses of caffeine — achievable by drinking coffee, tea or energy drinks — were just as effective as very high doses for enhancing physical performance. And they had minimal risk of side effects.

It was also discovered that caffeine intake is “self-limiting” to some extent, that is, extremely high doses are likely to have a detrimental effect on athletic performance.

So, in 2004, the IOC ban on caffeine was completely lifted; Olympic athletes may now take as much caffeine as they like.

How much is enough?

What, then, is the most appropriate source of caffeine if you’re an athlete who wants to safely obtain a performance benefit?

Well, you could try coffee or tea, but the amount of caffeine in these beverages varies greatly. Energy drinks, on the other hand, are formulated to contain a known quantity of caffeine, so they allow for a more controlled intake.

A dose of about three milligrams of caffeine per kilogram of body weight will give you the desired boost to performance, with little likelihood of inducing the “caffeine shakes” that can result from overdosing.

So, for example, if an energy drink contains 80 milligrams of caffeine, and you weigh 55 kilograms, a couple of cans of energy drink will provide the recommended dose.

Some people believe that caffeine is a diuretic, that it promotes excessive urine production and therefore leads to dehydration. This is not correct, at least when caffeine is consumed in moderate amounts by habitual users.

People who regularly drink tea, coffee, cola drinks, energy drinks or energy shots can expect to receive the desired performance enhancement from caffeine without experiencing greater dehydration.

Making you sharper

There’s also evidence that caffeine improves some aspects of mental performance. Doses up to about 200 milligrams (similar to the dose that enhances physical performance) lead to increasingly quicker reactions, increased alertness, elevated mood and improvements in activities such as typing (greater typing speed with fewer mistakes).

The quantity of caffeine needed to enhance mental performance can be obtained by drinking one or two cups of coffee, one or two cans of energy drink, or several cups of tea. (But note the earlier advice that caffeine concentration is very variable in coffee and tea.)

People who need to maintain vigilance during a period when they would normally be asleep, such as long-distance truck drivers, nightwatchmen, shift workers, students “cramming” for exams and soldiers on sentry duty, often use caffeine from coffee, tea, energy drinks and shots or capsules to keep them awake and alert.

The US Army now uses a commercially available caffeinated chewing gum called “Stay Alert” in one of its combat rations (the First Strike Ration). This ration is issued to soldiers who are expected to take part in operations of up to 72 hours with minimal sleep. Stay Alert gum contains 100 milligrams of caffeine per stick and there are five sticks in the First Strike Ration.

A little doubt

In the interests of objectivity, I should point out that a small minority of researchers believe that caffeine does not truly enhance mental performance. Rather, they claim that taking caffeine will simply overcome the drop in performance that results from caffeine withdrawal in people who are used to having caffeine in their body.

But looking at data from military studies I’m familiar with, I believe there’s little room for doubt that caffeine can greatly enhance at least some aspects of cognitive performance, particularly when people are sleep-deprived.

It’s important to keep in mind though that overdosing on caffeine is potentially dangerous, particularly for those (mostly young) people who consume too many energy drinks or shots – especially if they combine these with alcohol.

Caffeine undoubtedly enhances many aspects of physical performance, and very likely several aspects of mental performance too. And unlike most performance-enhancing drugs, it’s legal, readily available, and comes in forms that are highly acceptable to most people.

Chris Forbes-Ewan received funding from the National Health and Medical Research Council in 2006 for his contribution to the development of Nutrient Reference Values for Australia and New Zealand. His contribution was in the area of estimated energy requirements.

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MADRID—A Spanish medical worker tested positive for Ebola after treating an Africa-based missionary who had been infected with the virus and flown to Madrid, officials said Monday, reporting the first suspected transmission outside West Africa.
Spanish medical-worker representatives expressed alarm over the case, saying it raised questions over the adequacy of the country’s medical procedures for treating Ebola patients and preventing the spread of the disease in the country and beyond. The female medical worker was infected while working at Madrid’s Carlos III hospital, which had been specially prepared to treat the disease.
Spanish officials sought to play down any sense of crisis but said they were unable to explain what went wrong.
“We’re investigating what was the source of the contact, verifying if all the established protocols were followed to the letter,” Ana Mato, Spain’s health minister, told a televised news conference. “Rest assured that we are taking all measures to guarantee the best medical care for the patient and the safety of the medical staff and the wider population,” she added.
The infected medical worker, whose name wasn’t disclosed, was part of a team that treated Brother Manuel García Viejo, a 69-year-old Spanish missionary, before he died of Ebola on Sept. 25. He had been flown to Madrid three days earlier from Sierra Leone, where he served as medical director of a hospital.

Health officials said the infected medical worker had been in contact once with Brother García Viejo while he was alive and with his clothes after he died.

She registered a slight fever on Sept. 30, health officials said, and was admitted to a suburban Madrid hospital on Sunday. The infection was confirmed by two tests, the second one on Monday, they said.

Antonio Alemany, director of primary health care in the Madrid region, said the medical worker was in a stable condition and running a fever that hasn’t surpassed 101.48 degrees Fahrenheit.

She was kept in isolation at the suburban facility, Mr. Alemany said at the news conference, brushing aside criticism by some medical workers that the patient wasn’t being held in a special quarantine room.

“Isolation is the only requirement,” he said, urging calm and repeating several times that Ebola is transmitted only via direct contact with the bodily fluids of an infected person.

Mr. Alemany said officials were trying to determine the number of people with which the medical worker, a married woman with no children, had been in touch recently and were taking the temperature of those they had tracked down twice a day.

The infected medical worker was one of 30 at Carlos III hospital who had treated Brother García Viejo and a Spanish priest, the Rev. Miguel Pajares, who died of Ebola there in August, five days after being flown to Madrid from Liberia.

All of those medical workers are undergoing medical tests, officials said.

The Carlos III hospital had been selected and prepared to treat the Rev. Pajares, the first European to be repatriated after being infected during the latest Ebola outbreak. At the time, the Spanish government distributed protocols to all other hospitals and primary health-care centers in Madrid on how to treat the disease.

“We don’t know whether any errors were made,” Mr. Alemany said. “We’re investigating what the mechanism of transmission could have been.”

Some Spanish medical-worker representatives said the case should spark a re-evaluation of the procedures and facilities used to treat Ebola patients.

“Something went wrong,” Máximo González Jurado, head of Spain’s General Nursing Council, told Spanish news agency EFE. “They need to establish if the protocol is correct or not correct so that a case like this, that never should have happened, doesn’t happen again.”

Daniel Bernabeu, a radiologist who is president of the Amyts doctors association, said on Monday that he felt “a mix of consternation and indignation” over news of the case.

“Work has been carried out according to the established protocols, and it will be necessary to analyze exactly in what circumstances the contagion occurred,” Dr. Bernabeu told EFE. “Any contact [with an infected patient] carried with it a risk the government had to assume.”

In August, Dr. Bernabeu raised questions about the decision to bring the Rev. Pajares to Spain rather than treat him in Liberia, saying Spanish medical facilities may not have been prepared to handle the disease.

The World Health Organization estimates that the latest Ebola outbreak has killed more than 3,400 people.

By Jeannette Neumann at jeannette.neumann@wsj.com and Ilan Brat atilan.brat@wsj.com

Kigalihe@WST

Nobel Prize in medicine: decades of work on ‘the brain’s GPS’ recognised

By Luc Henry, Swiss Federal Institute of Technology in Lausanne

The 2014 Nobel Prize in Physiology or Medicine was awarded with one half to John O’Keefe and the other half jointly to May-Britt Moser and Edvard Moser “for their discoveries of cells that constitute a positioning system in the brain”.

The maps humans created, first on paper and then digitally, have had a dramatic impact on the organisation of society and its relationship to the world we live in. But to a large extent, we can still walk around and not get lost, even if we do not carry a map. Building mental maps of our environment is crucial to navigate spaces that we visit again.

Have you ever wondered how you manage to go from your bed to the bathroom in the dark and not hit the dinner table? Or how you know that you need to take a right when leaving the cinema in order to find the shortest way to the bus that will bring you home?

Three decades apart, two seminal contributions to our understanding of how the brain deals with spatial information and memory were made by the recipients of the 2014 Nobel Prize. Using sensitive electrodes to observe and record the activity of single brain cells, they identified specialised neurons that work together to create and memorise mental maps.

In the early 1970s, John O’Keefe, now director of the Sainsbury Wellcome Centre in Neural Circuits and Behaviour at University College London, described a peculiar observation: when a rat is walking around the room, the very same cell would get activated in any given place: neuron A would always fire when the rat is in the top left corner while walking in the middle of the room would trigger neuron B. O’Keefe identified these neurons in a brain region called the hippocampus – named after its resemblance to the seahorse – and called them “place cells” because of their activity associated with specific locations.

Although it was known that the hippocampus has association with memory and learning, this was the first experimental evidence for a functional role in building spatial maps. After exploring a new environment, a collection of place cells could store a cognitive map, or neural representation of the visited layout.

Thirty years later, a system complementary to place cells was discovered in a region of the brain adjacent to the rat hippocampus. It is in the entorhinal cortex that another kind of neurons was found by May-Britt and Edvard Moser, a married Norwegian couple who spent a short time at University College London working with O’Keefe before being offered a position at the Norwegian University of Science and Technology (NTNU) in Trondheim in the 1990s.

They showed that, contrary to place cells, a specific neuron of the entorhinal cortex would be activated not in one given corner of the room, but at regular intervals during the exploration of the the surrounding space. The importance of these cells emerged when the researchers mapped the activity pattern for single neurons on the top of a representation of the environment over a long exploration time. They observed a clear hexagonal pattern of activity. These “grid cells”, as they were named, were covering the entire environment and would combine with place cells in a circuit that together built a perfect co-ordinate system and hence a navigable mental map.

While our knowledge about the function of place cells and grid cells in primates, including humans, is limited due to the difficulty in conducting similar experiments in large animals, studies of rodents and some other small mammals, such as bats, have shown this system is conserved and works in a similar fashion. Together, these cells process the combination of many sensory inputs and compute a positioning system that probably tells us how far we are from our starting point or when we reach a turning point, building a mental representation of a relative co-ordinate system that can be used to navigate the world.

By giving the prize to three neuroscientists, the Nobel committee has recognised scientific achievements which helped us understand a very important subject that has intrigued philosophers for centuries – how we understand and memorise our position in time and space. These observations also explain why brain injury and conditions – such as Alzheimer’s disease – have an impact on memory and orientation. In an age when mapping the human brain has become a goal for society, a deep understanding of the mechanisms that determine cognition and behaviour had to be recognised as one of the foundations of future success.

Luc Henry does not work for, consult to, own shares in or receive funding from any company or organisation that would benefit from this article, and has no relevant affiliations.

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Without better public health systems, Ebola will be difficult to contain

By Isoken Tito Aighewi, Benedict College

With a high fatality rate and a terminal phase that causes bleeding and haemorrhagic fever, the Ebola virus has always attracted grisly fascination, yet funding and action against it have never been particularly high. The current outbreak in West Africa is unprecedented – it has now killed more than 1,500 people – and it appears to have stimulated a chain reaction, from treatment using experimental drugs and fast-tracking human trials, to mapping the genomes of the virus in order to gain better understanding of the species involved.

But what has prevented this outbreak from being easily contained is the lack of public health infrastructure in the region.

Preparedness

The current outbreak in West Africa should stimulate a complete shift in public health policy. If future occurrences of this and other emerging diseases are to be prevented or their impact minimised, we need to learn a great lesson now. An effective treatment for Ebola would be good, a vaccine to prevent the disease even better, but the best thing that could come out of this is a more organised and trusted public health system.

First and foremost, none of the developing countries that have been hit, including Liberia, and Sierra Leone, were prepared nor had the capacity to manage the outbreak. For this you need trained personnel and a good public health infrastructure. For example, it was only after the outbreak that many hospitals saw the need to create quarantine units or holding centres, despite Ebola being a real health risk. Getting people to come forward to be immediately isolated has been a problem.

Communication

The publicity given to the outbreak has also been unprecedented – thanks to the 24/7 news cycle, the internet and affordable mobile phones. Good communication is crucial, but it’s clear that media can be used to spread bad as well as good messages.

In Nigeria, which thankfully has not seen a full-blown outbreak, panic as well as the rumour that drinking or bathing in salt water can prevent Ebola infection has led to at least two deaths. In Liberia, where a national curfew was set up, violent clashes took place in the West Point slum area of Monrovia after a quarantine was ordered. While tension is perhaps inevitable, the situation could have been managed better.

Without being able to drive home alternative messages to build trust, counter the stigma of the disease and tell people what symptoms to look out for and what to do, then there will be a problem.

Mobile phones are now affordable for many in African countries and are an asset for disseminating useful health education, particularly during emergencies. However, the information must come from trained public health officials with an appropriate background in risk communication – rather than those only interested in sensational news broadcast. These skills could better assist politicians, the press and government officials in communicating appropriately.

There are also cultural issues around the eating of game meat (bush meat), a delicacy in most West African cultures and the likely origin of the Ebola virus. Ebola virus, like plague, rabies, psittacosis, Lyme disease and others, are zoonotic diseases or infections transmitted between vertebrate animals and humans.

It should follow, then, that avoiding or protecting the species that harbour them would be one plausible approach for preventing future outbreak. This would mean beginning a process of reconciling the protection of the species for biodiversity with that of zoonotic disease prevention. In other words, some wildlife species known to harbour pathogens that are transmitted to humans such as monkeys, bats, chimpanzees, should be regulated.

Firmer commitments

There is the need for national governments in Africa to start or improve their public health infrastructure and health staffing to address future outbreaks of infectious diseases which are inevitable – particularly in view of climate change effects and the resulting shift in disease spread.

Despite a commitment in the Abuja Declaration to allocate at least 15% annual budgets to health care by 2015, only six countries in Africa – including Liberia – have met this goal. According to World Health Organisation figures about a quarter of African Union member states were spending less on health now that they were in 2001. Now is the perfect time to push for countries to make good on their promises. And it will also impact other big problems such as HIV/AIDS, tuberculosis and malaria.

Public health is all about preventing diseases before they happen and in poorer countries, the need is even greater. Moving forward, individual African nations and in collaboration with the African Union, should formulate public health policies and statutes for training, research and developing infrastructure in line with what obtains in more technologically advanced nations.

This must come in addition to the clinical research around the Ebola virus itself. By so doing, the WHO and Centers of Disease Control in the US and the respective ministries or departments of health in West Africa can share data and best management practices for addressing these emergencies in the future.

There are other issues such as the enormous economic losses and ratings agency Moody’s has already warned of the potential impact of the virus on the region. So when it comes to costs, it is better for African counties to avoid being penny wise and pound foolish by investing more in preventive rather curative measures that may or may not exist in the future.

Isoken Tito Aighewi does not work for, consult to, own shares in or receive funding from any company or organisation that would benefit from this article, and has no relevant affiliations.

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Health Check: what you need to know about ear wax

By Chris Brennan-Jones, University of Western Australia

Ear wax, or cerumen, is a naturally occurring substance produced in the ears of many mammals, including humans. Despite popular beliefs about its uncleanliness, it helps keep our ears clean by filtering dust, debris, and other substances, such as shampoo and crayons, and protects the ear canal from infection.

The ear canal is essentially a cul de sac of skin that, unlike skin everywhere else, doesn’t get to remove dead cells through physical erosion. Ear wax is the creative solution to this problem.

Produced by the sebaceous and cerumenous glands in the ear canal, ear wax contains a range of organic compounds, including saturated and unsaturated long-chain fatty acids, alcohols, squalene, and cholesterol. Its precise composition varies between people and will depend on diet, ethnicity, their age, and the environment.

Ear wax has an important role in the ear’s function and, in most cases, doesn’t need to be got rid of. Our ears are self-cleaning, and if functioning as they should, require no input from us to keep them clean.

In some people, this self-cleaning mechanism gets disrupted, and ear wax gets trapped at some point along its path out of the ear canal. This can happen for a number of reasons including the anatomy of your ear (some people have a rather sharp bend in their ear canal).

Or, it can be due to the introduction of foreign bodies such as cotton buds, which actually cause the ear wax to become impacted deep in the ear canal. Because the ear keeps producing wax, the blockage slowing gets bigger, staying in the ear for years or decades.

Impacted wax can have a number of side effects including pain, general irritation, and sometimes infection. In some cases, it has been associated with tinnitus, which is a buzzing or ringing sound in the ears without an apparent direct cause.

Impacted ear wax can affect the movement of the ear drum or occlude the ear canal, making it difficult for sound to pass through. This occurs in up to 35% of people over the age of 65 and can cause a mild hearing loss, which is typically alleviated once the wax is removed.

Many efforts to clean ears actually disrupt its self-cleaning cycle. But with over 1,000 patents for ear wax removers, there’s clearly a strong desire – and market – out there to get rid of the stuff.

Still, you only need to have your ears examined if you’re experiencing the kind of symptoms of impacted ear wax mentioned above. In the first instance, a few drops of water or natural oil (olive, for instance or almond oil) can be effective for softening the wax and promoting its natural migration out of the ear.

If there’s no improvement, then you should consult a doctor, who may arrange for your ear to be syringed with water or refer you to an ear specialist to have the wax suctioned out under a microscope.

What you should never do is stick anything in your ear to clean it. At best, you will push part of the wax deeper into the ear, making it more difficult to remove. At worst, you will puncture your ear drum, resulting in a significant amount of pain, hearing loss, and a swathe of specialist appointments.

Sadly, most people neither believe nor heed warnings from health professionals regarding the use of cotton buds. And most hospitals will see approximately 150 cases of eardrum perforations every year because of this. These perforations sometimes heal themselves, but often become permanent, causing pain, hearing loss and requiring surgery to repair.

Clearly, the adage that you shouldn’t put anything in your ear that’s smaller than your elbow is still true today.

There’s no evidence that ear candling is effective at removing or softening ear wax. In fact, it’s more likely to block your ear with candle wax, cause burns, or puncture your eardrum instead. Indeed, a number of national public health bodies have warned about the ineffectiveness of ear candling and its potentially harmful effects.

Ear wax may be a little gross, but it’s a normal and rather useful part of the body. Together with snot, tears and sweat, ear wax is one of the non-specific barriers that help keep our body functioning at optimum levels and preventing infection. You don’t have to love any of these but hopefully understanding why they exist will help people control their distaste for them.

Chris Brennan-Jones receives funding from the Cochlear Foundation, the Lions Hearing Foundation (WA) and has previously received funding from the Medical Research Council (UK) and Action on Hearing Loss.

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Explainer: how does the immune system work?

By Steven Maltby, University of Newcastle and Vicki Maltby, University of Newcastle

The immune system is critical for protecting against illness-causing organisms, such as viruses, bacteria and fungi, which are collectively known as pathogens. Without it, we would quickly become infected, sicken, and die.

Immune cells are constantly on the lookout for pathogens, patrolling the blood by moving around in the blood. Around half your blood volume is fluid known as plasma; the remainder is made up of millions of different types of cells.

The majority of cells are red blood cells that transport oxygen around. A minority are white blood cells, or immune cells that act as the body’s army. The immune system produces many different types of these white blood cells, each with a specific role.

The factory

All blood cells start their life in the bone marrow, which is the hollow part of the bones; every cell type originally comes from blood stem cells. While blood stem cells produce all of our blood cells, other types of stem cells in the bone marrow produce organs, the bone itself and so on.

Stem cells are able to replace themselves, but must also constantly produce new cells to replace old ones. Red blood cells are replaced after several months, while different immune cell lifespans range from days to years.

When the bone marrow doesn’t produce enough blood cells, it can result in anemia (reduced red blood cells) or cytopenia (low cell numbers). These conditions cause low energy or “immuno-deficiency”, which means the body fails to produce a strong immune response, leaving the person more susceptible to infection and illness.

Producing too many blood cells, on the other hand, can result in blood proliferative disorders or blood cancers. People with myeloproliferative disorders, for instance, start with minor symptoms but can end up having difficulty breathing, high blood pressure and heart attack or stroke. And constant high levels of blood cells can lead to a diagnosis of leukemia (white blood cell cancer).

The army

After immune cells are produced in the bone marrow, they quickly enter the blood stream. Many then enter tissues, especially those lining our skin, lungs, and gut, where they wait for pathogens or invaders. Others patrol the body until they encounter invaders.

These cells serve as the first line of defence against invaders that would make us sick; they’re called the “innate” immune response.

Innate immune response deals with the majority of invaders that enter our body. The cells involved respond to very broad signals that are shared by many types of invaders. The signals they look out for include essential components of bacterial cell walls or molecules present on the surface of viruses.

When they detect an invader, immune cells sound an alarm, calling more immune cells to the area from the blood. The innate immune response causes the common signs of inflammation including swelling, pain, heat, redness and loss of function.

When the cells respond to harmless signals, they can cause conditions including allergic rhinitis (hayfever), asthma and food allergies.

Getting educated

If the innate response fails to control an infection, the body will have to activate the “adaptive” immune response. Adaptive immunity develops a specific response for each invader.

Adaptive immune cells go through an extensive education before they can fight invaders. One type of cells (T cells), move to a specialised organ near the heart, called the thymus, for their education. Another type (B cells), remain in the bone marrow.

During their education, these cell types must pass two quality-control steps. The first step ensures that each cell is capable of making a response if they encounter their particular invader. This makes sure no further energy is wasted on keeping non-responsive cells alive, or expanding these cell populations.

The second step ensures the cells won’t respond against the body. Any such cell must be removed so it doesn’t cause damage. Failure to remove these “self-reactive” cells can result in autoimmune diseases, such as diabetes, multiple sclerosis and autoimmune arthritis.

Once educated, the cells move through the body, visiting lymph nodes to monitor for invaders. Lymph nodes, which are located throughout the body, are the swollen areas we can feel in our armpits or throat when we’re getting sick.

Each adaptive immune cell can only respond to one type of invader, so the body must generate a huge number of these cells to respond to the numerous invaders it may encounter.

When they encounter an invader they recognise, adaptive immune cells replicate and attack it. This requires time and is the reason why it can take a week of illness before an infection is cleared.

Once an infection is cleared, the immune cells that fought it stay alive so they can rapidly respond if they ever encounter the same invader again. This is called a memory response and it’s the reason vaccination works.

Vaccines activate our adaptive immune response, without the risk of making us sick because they only expose us to a portion of the invader or an inactive part of it. The immune cells become educated to recognise this part of the invader and this creates a strong memory response if that invader is ever encountered again.

The immune system produces millions of specialised cells everyday to keep bodies healthy. What’s really amazing about the complex process behind it is that when it’s working properly, we don’t even notice it’s there at all.

Steven Maltby receives funding from The University of Newcastle and the Canadian Institutes of Health Research (CIHR). He is affiliated with The University of Newcastle.

Vicki Maltby receives funding from The Multiple Sclerosis Society of Australia (MSRA) and the Canadian Institutes of Health Research (CIHR). She is affiliated with The University of Newcastle.

This article was originally published on The Conversation.
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