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The Mystery Behind a Kazakh Town’s Sleeping Sickness

In 2013, the residents of Kalachi, a small village in Kazakhstan, began to take to their beds with a mysterious illness. They couldn’t stop falling asleep. When they woke up, often days later, they remembered nothing. Newspapers (and mental_floss) called it a “sleeping sickness” (unrelated to the African sleeping sickness transmitted by flies) and multiple investigations into the causes—patients’ ages and schedules, the town’s air quality, the food and water people were consuming—turned up nothing. But after years of study, the Kazakh government thinks it has figured out the underlying cause of the outbreak. Maybe. 

The first reported case of the sleeping sickness came in 2010, in a neighboring village. In 2013, the mystery took on new urgency as eight different people from Kalachi (a town of just 640) fell asleep over one weekend, unable to stay awake for any longer than it took to go to the bathroom or eat a little food.

When these otherwise healthy adults finally awoke from their trances, they didn’t remember anything that had happened, even the times when they had seemed awake enough to eat or talk or have a cigarette, as BuzzFeed reported during a week-long investigative trip to the region. One man even woke up in the Kazakh capital of Astana, unable to remember being on the plane that brought him there. People felt nauseous and dizzy; they hallucinated, ranting about images only they could see and at times becoming borderline violent. More than 100 people fell ill at some point. Even a cat was affected. 

This happened again and again over the course of several months, with waves of residents falling prey to the sickness in the beginning of 2014, then later that spring, then again that summer. The nearby uranium mines were a likely culprit, and scientists tested the earth, water, and local food for radon, a gas known to cause cancer. The air was tested for carbon monoxide. People’s hair and fingernails were tested for radiation. Doctors could find nothing wrong with the patients, and no factors to tie them all together. 

Were people being poisoned? Or was it just a case of mass psychogenic illness (essentially mass hysteria), like the “dancing plague” or the numerous population-wide panics throughout history over shrinking penises?

Finally, in the summer of 2015, authorities announced that they had discovered the culprit: high concentrations of carbon monoxide and hydrocarbons coming from the mines caused a lack of oxygen in the air in the area. By the time the announcement came in the summer of 2015, 150 people had already moved away, while another 240 were on a list of people seeking resettlement. Still, a radiologist who had been studying the outbreak told BuzzFeed that the verdict was “only the working theory,” and that researchers were still studying the medical anomaly. In late December of that year, scientists from the National Nuclear Center of Kazakhstan confirmed this explanation.

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Medicine
New Technique Can Spot a Heart Attack in the Making Long Before It Happens
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Cardiology experts have developed a noninvasive way of measuring the fat around a person's blood vessels, which could help determine their risk for dangerous cardiac events. The researchers described their technique today in the journal Science Translational Medicine.

Heart attacks are incredibly common, affecting around 750,000 Americans every year. Heart disease is the number one cause of mortality in the U.S., responsible for one out of every four deaths. There are many reasons for this. Among them is the difficulty of identifying at-risk patients before it's too late.

Cardiologists' current method of choice uses a metric called coronary calcification score (CCS) to measure the hardening of a patient's arteries. CCS is a reliable way to predict future heart problems, paper co-author Charalambos Antoniades said in a statement, but it has its limitations.

"When coronary calcification is detected," he said, "it is already too late, as the calcification is not reversible."

And so, rather than measuring calcification, many researchers have begun looking for a way to measure blood vessel inflammation, which is usually a pretty good—and early—predictor of heart disease.

The inflammation itself can be hard to see without entering a patient's body. But recent studies have shown that it rarely travels alone: Blood vessels that are inflamed are also often wrapped in larger fat cells than healthy vessels. 

With this link in mind, Antoniades and his colleagues decided to try measuring the fat cells instead. They reviewed computed tomography scans from 453 patients about to undergo heart surgery, and used these data to create what they call the fat attenuation index (FAI). The higher a patient's FAI, the more inflammation they had, and the more advanced or severe their heart disease. 

The researchers then compared the FAI of 40 additional patients with the results of invasive scans of the inflammation in their hearts. Sure enough, each patient's FAI matched the swelling onscreen.

There are many benefits to using FAI, the authors say. Not only is it noninvasive and accurate, but it can be used in tandem with CCS and other methods for an even more complete picture. The next step will be validating the test's safety and accuracy in clinical trials.

FAI scans "could help direct these new types of treatments to the appropriate subgroups of patients at greatest risk," Antoniades says, "reducing costs and targeting more powerful drugs to the patients who will benefit most."

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Health
Don't Panic About the Plague
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If reports of measles and whooping cough making a reappearance aren't alarming enough, the news that three people in New Mexico have contracted plague this year might have you on edge. But these aren't the only recent cases of plague in the state—the disease appeared in both 2016 and 2015, causing one death—or even in the U.S.

In 2015, a child contracted the plague in Yosemite National Park, and so did a tourist from Georgia; park officials closed a campground where they discovered two dead squirrels infected with the disease. That same year in Colorado, a pitbull infected four humans with pneumonic plague before being put down, and two other Colorado residents died from plague, including a 16-year-old boy.

It all seems very scary, but don't go sealing yourself in protective gear yet. There's less to fear about plague than you may think. While the public is prone to panic that a medieval illness, which wiped out a quarter of Europe in the Middle Ages during the Black Death, has suddenly arisen from obscurity, the truth is: Plague never left.

Though we haven't seen a widespread epidemic of plague since the early 20th century, thanks to advances in sanitation and medicine, and there hasn't been a human-to-human case of transmission in America since 1924, an average of seven new cases are reported every year in the U.S. From 2010 to 2015, there were 3248 cases, including 584 deaths, reported worldwide, according to the World Health Organization.

Yersinia pestis, the flea-borne bacteria that's most often responsible for plague, infects rodents; humans are “incidental hosts,” who can acquire the infection if bitten by an infected flea or rodent. Compared to the 14th century, when the Black Death spread wildly, or the late 19th century, when 10 million people died of the disease after it traveled from Hong Kong to port cities worldwide, most people today live in more sanitary conditions and have less frequent contact with the rodents most likely to carry the infected fleas. Today, 95 percent of plague cases originate in parts of sub-Saharan Africa and Madagascar.

The most common of the three strains of plague is the notorious bubonic plague, which causes painful swollen lymph nodes (also called buboes) and was responsible for Europe's Black Death—so named because internal hemorrhages caused by the infection make the skin appear black. But the pitbull that infected four Colorado residents carried the rarer respiratory strain of pneumonic plague, which is contagious when the infected person coughs up infected particulates. There is also septicemic plague, the most lethal form, which infects the blood, and most often occurs when plague virus has gone undetected and is allowed to spread.

In the U.S., you're generally only at risk of contracting plague in late spring to early fall if you've been in a rural or semi-rural area of the West, especially New Mexico, Arizona, or Colorado, and have had contact with fleas or rodents including ground squirrels, chipmunks, prairie dogs, or rats. And even then, the risk is low.

Only the pneumatic version of plague is contagious from human to human (though untreated bubonic plague can become pneumonic), but you have to be coughed upon, or receive fluid from an infected person upon an open wound or directly into your mouth or nose.

Plague symptoms mimic any flu—fever, chills, headache, difficulty breathing or coughing—but people have been known to cough up blood with the pneumonic variety. If you've been in a rural area, or camping, and come down with these symptoms two to three days later, it's best to go to a hospital.

Now for some good news: While untreated plague is quite deadly, people with plague who are treated with antibiotics within 24 hours of infection have strong recovery rates.

So while it's good to be aware and take precautions, the chances of another plague pandemic remain slim.

This story was originally published in 2015 and has been updated. 

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