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Sexually transmitted diseases (STDs)

Posted in Uncategorized at 7:00 am by Jenny

Sexually transmitted diseases (STDs) are spread by sexual contact involving the genitals, mouth, or rectum, and can also be spread from a pregnant woman to her fetus before or during delivery. STDs, which affect both men and women, are a worldwide public health concern.

While most STDs can be cured, some cannot, including HIV (which causes AIDS), genital herpes, and human papillomavirus (HPV), which can cause genital warts.

STDs can be spread by people who don't know they are infected. Always use protection every time you have sex, until you are sure you and your partner are not infected with an STD.

If you are in a relationship, delay having sex until you are physically and emotionally prepared, have agreed to only have sex with each other, and have both been tested for STDs.

Abstinence as prevention

Completely avoiding sexual contact (abstinence), including intercourse or oral sex, is the only certain way to prevent an infection.

Discuss safe sex with your partner

Discuss STDs before you have sex with someone. Even though a sexual partner doesn't have symptoms of an STD, he or she may still be infected.

Questions to ask someone before having sex include:

• How many people have you had sex with?
• Have you had sex without a condom?
• Have you ever had anal sex?
• Have you ever had unprotected oral sex?
• Do you have many sex partners?
• Do you inject illegal drugs or have you had sex with someone who injects drugs?
• Have you ever had unprotected sex with a prostitute?
• Have you ever had an STD, including hepatitis B or hepatitis C? Was it treated and cured?
  

Safe sex practices

Some STDs, such as HIV, can take up to 6 months before they can be detected in the blood. Genital herpes and the human papillomavirus (HPV) can be spread when symptoms are not present. Even if you and your partner have been tested, use condoms for all sex until you and your partner haven't had sex with another person for 6 months. Then get tested again.

• Watch for symptoms of STDs, such as unusual discharge, sores, redness, or growths in your and your partner's genital area, or pain while urinating.
• Don't have more than one sex partner at a time. The safest sex is with one partner who has sex only with you. Every time you add a new sex partner, you are being exposed to all of the diseases that all of their partners may have. Your risk for an STD increases if you have several sex partners at the same time.
• Use a condom every time you have sex. Latex and polyurethane condoms do not let STD viruses pass through, so they offer good protection from STDs. Condoms made from sheep intestines do not protect against STDs.
• Use a water-based lubricant such as K-Y Jelly or Astroglide to help prevent tearing of the skin if there is a lack of lubrication during sexual intercourse. Small tears in the vagina during vaginal sex or in the rectum during anal sex allow STDs to get into your blood.
• Avoid douching if you are a woman, because it can change the normal balance of organisms in the vagina and increases the risk of getting an STD.
• Be responsible. Avoid sexual contact if you have symptoms of an infection or if you are being treated for a STD or HIV. If you or your partner has herpes, avoid sexual contact when a blister is present and use condoms at all other times.

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Beware food allergies

Posted in Uncategorized at 7:00 am by Jenny

SIMON’S teacher came over with a tray of prawn rolls. “Here you go, Simon!” she said, offering him one. Much as he loved to eat the roll, Simon declined and explained that he could not eat prawns. That was not the first time he had yearned for forbidden foods at parties or felt alienated from other kids. He often wondered why he could not be like other eight-year olds and eat whatever he fancied without the risk of turning into a red, swollen monster, covered with hives or unsightly rashes and at times, even vomit.

Meanwhile, back at home, Simon’s mother worried that he would defy her instructions on foods to avoid at his class party. In fact, Simon’s food allergy has made his whole family emotionally exhausted with constant fears of life-threatening allergic reactions, guilt, resentment, stress and anxiety.

In trying to keep Simon safe but at the same time give him a sense of normalcy, everyday events that others take for granted including dining out, birthday parties, travelling or just eating at the school canteen is a cause for concern.

Many of us may not even give the Simons amongst us a second thought. After all, isn’t food allergy a growing phase and a small matter of itches and sneezes? This is where we are wrong. The truth is, the symptoms of food allergy can be mildly annoying or seriously life-threatening. They fill up a broad spectrum – from minor itching, sneezing, coughing and hives to vomiting, abdominal cramps, diarrhoea, and of course, the dreaded anaphylaxis or “general shock”, which when left untreated or under-treated may result in death.

And if these symptoms are not good enough reasons for you to respect food allergy, mull over this – food allergy is usually the start of an “allergy march”, that is, if not managed properly, food allergy may lead to other allergic diseases such as eczema and asthma later on.1

In fact, about 50% of infants with food allergy will eventually develop respiratory allergies in later life2. This translates into additional suffering and healthcare costs, not to mention absence from school, social isolation, emotional distress and curtailed participation in sports.

While food allergy can occur at any age, it is most prevalent in infancy because infants’ digestive tracts and immune systems are still immature3. Most food allergies occur during the first three to four years of life4, and are now estimated to affect 5-20% of all children worldwide5.

Yes, we can! As the adage goes, “Prevention is better than cure”, only in the case of food allergy there is no cure for now. Therefore, we have to work on the prevention part. As parents, you have the power to avert or at least minimise the risk of allergy in your children and lead them towards a healthier and happier life. The secret lies in making the right decisions about food and feeding, right from day one,

Breastfeeding

In terms of allergy prevention, breast milk is undoubtedly the best for infants. Mothers are encouraged to exclusively breastfeed their infants for at least the first six months of life. Let’s see why:

• Breast milk is hypoallergenic, that is, it does not trigger allergic reactions in the baby. However, nursing mothers need to watch their diet and exclude highly allergenic foods because some babies may develop allergic reactions towards certain proteins in these foods that are transmitted through the milk.
• Breast milk enhances immune functions.
• Breastfeeding has a long-term preventive effect against non-food allergies2.
  If you are not able to breastfeed due to medical reasons, please seek your doctor’s advice for alternatives.
  

Weaning

Weaning or the introduction of solid foods to babies is a high-risk period. We mentioned that babies have immature digestive and immune systems, which make them vulnerable to allergies. As such, weaning should be delayed until the baby is at least six months old (as recommended by WHO) and even then, highly allergenic foods such as shellfish and peanuts must be avoided during the entire first year.

Introduce only one new food a week to your baby. This will help you detect any adverse food reactions easily. For a start, you may want to give your baby rice cereals as it rarely causes allergic reactions and then gradually add other foods like fruits, vegetables, chicken and fish to his diet. Knowing that food allergy can rob us of a free and healthy life, it is time we take action. Start with your own kids. Give them a chance for an allergy-free life.

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Eczema treatment: what’s the story?

Posted in Uncategorized at 7:00 am by Jenny

Two new types of non-steroidal medication for atopic eczema were supposed to bring relief from the long-term side effects of corticosteroid creams. But now questions about the risk of cancer have arisen.

A two-year-old girl with atopic eczema on her face, before treatment (left) and 4 weeks after treatment (right) with tacrolimus, a non-steroidal ointment.

THE dry, prickly itch of atopic eczema is a terrible thing. It is maddeningly incessant and makes it near impossible to do anything but scratch.

For many years, the treatment of this hereditary skin allergy has revolved around good skincare and corticosteroid creams.

While the skincare aspect, including use of moisturisers and avoidance of irritants, remains a steadfast recommendation, we can now herald new types of topical medications besides corticosteroids.

A two-year-old girl with atopic eczema on her face, before treatment (left) and 4 weeks after treatment (right) with tacrolimus, a non-steroidal ointment.“Corticosteroids are very effective drugs in the treatment of eczema. But when used for the long term – month after month, year after year – they cause a thinning of the skin, which is potentially permanent,” says Prof Alan Fleischer, professor and chair of the Department of Dermatology in Wake Forest University School of Medicine, North Carolina, United States.

With this unpleasant side effect marring the use of corticosteroids, the introduction of a new class of medications, called calcineurin inhibitors, seemed like a welcome relief.

But uncertainty continues to cloud the issue, especially after the US Food and Drug Administration (FDA) slapped a black box warning (the highest level of caution) on these drugs, cautioning of cancer risk.

How these drugs came about

In the past decade, two types of calcineurin inhibitors, tacrolimus and pimecrolimus, have been discovered to be effective in treating atopic eczema.

Calcineurin inhibitors are immune-suppressant drugs. They act by blocking the activity of an enzyme called calcineurin. This then interferes with the cell signalling process and stops the subsequent immune response.

These drugs have their roots in organ transplantation, as they were originally used systemically to prevent rejection in organ transplants.

When used in eczema, Prof Fleischer notes, “they are not more effective than corticosteroids, but at least they do not cause skin thinning, and are therefore safer.”

He even goes so far to say that calcineurin inhibitors are the best-studied drugs that have ever been introduced in atopic eczema.

So how did scientists miss the link between these drugs and cancer?

Actually, says Prof Fleischer, they didn’t.

Prof Alan Fleischer... 'Corticosteroids are very effective drugs in the treatment of eczema. But when used for the long term - month after month, year after year - they cause a thinning of the skin, which is potentially permanent.'Cancer risk: the evidence

As a result of the backlash from the recent controversy surrounding Vioxx (a painkiller linked to heart disease) and anti-depressants (linked to suicidal behaviour in adolescents) in the United States, the FDA became a great deal more cautious in regulating drugs.

“In February 2005, the FDA convened a panel to look into topical immuno-suppressants, mainly the two calcineurin inhibitors. Interestingly, the panel did not look at corticosteroids, even though those are immuno-suppressants as well,” relates Prof Fleischer.

He says that there were two major randomised, controlled human trials that showed the risk of cancer actually decreasing when patients used either type of calcineurin inhibitor, compared to corticosteroids or an emollient.

In the trial looking at tacrolimus, none of the 4,200 patients treated with tacrolimus developed cancer. However, out of the 900 in the vehicle (a cream or ointment that does not contain the medication) group, one developed skin cancer, while out of the 1,400 given corticosteroids, two developed cancer.

In the pimecrolimus trial, only two out of the 19,000 pimecrolimus-treated patients developed cancer. By contrast, five out of 4,000 patients treated with either topical corticosteroids or vehicle developed cancer; four in corticosteroid-treated patients and one in a vehicle-treated patient.

However, the FDA also looked at animal studies, where lab rats and monkeys were given huge systemic doses of tacrolimus and pimecrolimus.
For instance, says Prof Fleischer, when monkeys were given oral doses of pimecrolimus that were 20 times higher than the highest oral dose that’s ever been given to humans, they began to develop cancer.

“Based on these animal data, not on the human data, the FDA gave a black box warning to pimecrolimus and tacrolimus. But these were based on theoretical evidence from animal studies.

We’re talking about massive systemic doses of these agents in animals,” he points out.
A non-issue or a real issue

The cancer risk of calcineurin inhibitors is nothing new. Like all immune-suppressant drugs, tacrolimus does cause cancer.

“About 4% of (transplant) patients who are treated long-term with these drugs will develop lymphoma,” explains Prof Fleischer.

However, in transplant patients, tacrolimus is delivered directly into the system. By contrast, the drug is only applied to the skin for eczema treatment.

“You get vanishingly tiny blood levels that disappear two weeks after they are administered,” he assures.

Furthermore, he points out that there are big differences between people and the laboratory mice used in animal studies.

“We don’t apply the drug to our whole body surface. Our skin is also much thicker and can resist penetration much better than their skin.

Long-term use of corticosteroids in the treatment of eczema can cause side effects like thinning of the skin, red blotches and stretch marks.

Long-term use of corticosteroids in the treatment of eczema can cause side effects like thinning of the skin, red blotches and stretch marks. “Mice groom themselves; we humans spend relatively little time licking ourselves. And lastly, mice have much larger surface-to-volume ratio compared to humans, which means that they’re being administered absolutely massive systemic doses of the drug through the skin,” he elaborates.

“So it’s interesting,” he says, shrugging eloquently. “There is animal data suggesting that massive systemic doses can cause problems. And human data show just the opposite.”

Because of the black box warning, the debatable cancer risk has become “a major issue that’s actually a non-issue, and yet it’s a real issue”, in Prof Fleischer’s opinion.

Now, he still prescribes calcineurin inhibitors, but he takes some extra time to counsel his patients.

“Many of my patients are Internet-savvy and they read things. If I prescribe a drug that has a black box warning, and don’t discuss this with them ahead of time, they will think the worst. I think that taking 30 seconds to discuss this with patients is worthwhile.”

Other side effects

Calcineurin inhibitors are not without their side effects, however. “The biggest side effect of calcineurin inhibitors is a stinging, burning and itching sensation when applied on very inflamed skin,” says Prof Fleischer. “This is probably a very direct drug effect on the skin’s nerves.”

The burning is “tremendous”, but transient, lasting a few minutes to an hour. Patients can circumvent it by using corticosteroids first for a few days, if they have very inflamed skin. A calcineurin inhibitor can be introduced when the skin is “calmer”.

“Beyond that, these drugs are extraordinarily safe. They do not increase the risk of skin infection, and can normalise the skin thickness (in skin that has been thinned by corticosteroids),” Prof Fleischer remarks.

“They have even been shown to normalise the growth of children,” he adds. This is of great concern to parents, as a child with serious eczema is not likely to grow normally.

Nevertheless, Prof Fleischer is not recommending that calcineurin inhibitors replace corticosteroids completely in the treatment of eczema.

“Corticosteroids are very useful and inexpensive drugs, and we must mind the finances of our patients and of the government,” he says reasonably.

“If patients are using corticosteroids responsibly, which is for very short periods of time”, this is acceptable and safe, he notes.

Calcineurin inhibitors are a more rational alternative for those who need treatment over and over for the long term, such as months or years.

Even Prof Fleischer, who is convinced of the safety of these drugs, believes that patients should not get carried away with its use.

“Some patients use tacrolimus to prevent the disease from coming back, but I think that’s a mistake. I think that patients, whenever possible, should be off-drug,” he says.

Good bathing behaviour, avoidance of allergens, and dutiful use of moisturisers are far better ways of controlling eczema, in the long run.

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Molluscum contagiosum

Posted in Uncategorized at 7:00 am by Jenny

Overview

Molluscum contagiosum is a relatively common viral infection of the skin that most often affects children. The firm bumps (papules) are painless and disappear within a year without treatment. If the papules are scratched or injured, the infection can spread to surrounding skin.

Though common in children, it affects adults as well. In adults, molluscum contagiosum may appear on the genitals and is considered a sexually transmitted disease (STD) in this area. The disorder may be seen in adults with an altered immune system.

Molluscum contagiosum spreads through direct person-to-person contact and through contact with contaminated objects. Because it spreads easily, doctors often recommend medical treatment, especially for adults.


Signs and symptoms

Molluscum contagiosum results in raised, round, flesh-colored bumps (papules) on the skin. The papules are small — typically 2 to 5 millimeters in diameter — and characteristically have a small indentation or dot at their top. The bumps can become red and inflamed. You can easily remove the bumps by scratching or rubbing them, but this spreads the virus to adjacent skin.

In children, the papules typically appear on the face, neck, armpits, hands and arms. In adults, molluscum contagiosum may be a sexually transmitted disease (STD) and is usually seen on the genitals, lower abdomen, inner upper thighs and buttocks. The disorder doesn't lead to serious illness and isn't related to genital warts, which are caused by the human papilloma virus (HPV). However, adults with genital molluscum should be screened for other STDs.

Molluscum contagiosum is a common skin infection that results in raised, round, flesh-colored bumps (papules) on the skin. The papules can become red and inflamed.



Causes

Molluscum contagiosum results from an infection by the molluscum contagiosum virus — a member of the poxvirus family. This virus spreads easily through direct skin-to-skin contact and through contact with contaminated objects, such as toys, doorknobs or faucet handles. The virus also spreads through sexual contact with an affected partner. Scratching or rubbing the papules spreads the virus to nearby skin. Heat and moisture in the fold areas of skin, such as the armpits, may hasten the spread of the virus.


When to seek medical advice

If you suspect you or your child has molluscum contagiosum, consult your family doctor or a dermatologist. He or she can diagnose the infection by examining the characteristic papules. If there's any doubt, he or she may take skin scrapings from the infected area and view them under a microscope.


Treatment

For people with a normal immune system, molluscum contagiosum resolves without treatment within six to 18 months. It may take longer for children whose immune systems aren't fully developed.

Because molluscum spreads easily, doctors often recommend medical treatment, especially for adults. Treatment may include removal of the papules by:

• Scraping or curettage
• Surgical removal
• Freezing (cryotherapy)
• Laser therapy
• Medications used to remove warts also may be helpful in removing the papules.
  

Although molluscum contagiosum typically doesn't cause itching, some people develop dermatitis or eczema around the papules. Treatment for itching caused by dermatitis may include over-the-counter 1 percent hydrocortisone creams or ointments, or prescription topical steroids. However, these medications should be applied only to the areas of dermatitis and not the molluscum papules.

The disorder may be progressive and more extensive for people with certain skin disorders such as atopic eczema or for those with weakened immune systems, such as those with AIDS. People with weakened immune systems should seek professional treatment for molluscum contagiosum.


Prevention

To help prevent the spread of the virus:

• Avoid touching, rubbing or scratching the papules. Shaving over the infected areas also can spread the virus.
• Don't let others use your clothing, towels, hairbrushes or other personal items. Refrain from borrowing these items from others as well.
• Avoid sexual contact until the papules are treated and have completely resolved.

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Thalassemia

Posted in Uncategorized at 7:00 am by Jenny

What is thalassemia?





Thalassemia is an inherited blood disorder that causes the body to produce less hemoglobin. Hemoglobin helps red blood cells spread oxygen all through your body. Low levels of hemoglobin may cause anemia, an illness that makes you feel weak and tired. Severe cases of anemia may damage organs and result in death.

What causes thalassemia?

A defect in one or more genes causes thalassemia. It is an inherited blood disorder, passed from parent to child. Both parents must carry a gene for the disease in order to pass it to their child.

What are the types of thalassemia?

Alpha thalassemia and beta thalassemia are the two main types of the disease. Beta is the most common form. A "carrier" has one normal gene and one thalassemia gene in all body cells, a state sometimes called "thalassemia trait." Most carriers lead completely normal, healthy lives.

Beta thalassemia

Beta thalassemia occurs when one or both of the genes that produce beta-globin don't work or only partly work the way they should. People need both alpha- and beta-globin to make hemoglobin. Beta thalassemia mainly affects people from the region around the Mediterranean Sea (such as Greeks and Italians) and, less often, people of African or Asian descent.

There are several subtypes of beta thalassemia. Which type you have depends upon whether one or both genes are affected and whether those genes still produce some working beta-globin.

• If you carry the genetic trait for thalassemia or have one damaged beta-globin gene, you may have mild anemia and probably will not need treatment. This condition is called beta thalassemia minor or beta thalassemia trait. You have thalassemia trait when you inherit a normal gene from one parent and a thalassemia gene from the other.
• When both beta-globin genes are damaged, moderate or severe anemia may develop. In this situation, you have inherited a thalassemia gene from each parent.
• If you have moderate anemia (beta thalassemia intermedia), you may need blood transfusions. People who have beta thalassemia intermedia usually live into adulthood.
• People with severe anemia (called beta thalassemia major or Cooley's anemia) usually will not live into adulthood without treatment. Symptoms of anemia usually develop within 6 months of birth. 1 If the child starts receiving blood transfusions early and continues to receive them throughout life, he or she is likely to live longer. Death is usually a result of damage to organs, such as the heart or liver. Lack of oxygen or iron overload from blood transfusions causes the organ damage.

Alpha thalassemia

Alpha thalassemia occurs when one or more of the four genes that are vital to making hemoglobin are missing or damaged. Alpha thalassemia mainly affects people from southeast Asia, China, and the Philippines, although it occurs in many populations throughout the world. It is sometimes seen in people of African descent.

There are four subtypes of alpha thalassemia. Each type represents the loss of or damage to one, two, three, or four genes.

• One gene: If one alpha-globin gene is missing or damaged, you will have no symptoms and will not need treatment. However, you are a silent carrier. This means you don't have the disease but you can pass the defective gene onto your child. Smaller-than-normal blood cells may be the only sign of the condition.
• Two genes: If two alpha-globin genes are missing or damaged, you will have very mild anemia that will not need treatment. This is known as alpha thalassemia minor or alpha thalassemia trait.
• Three genes: If three alpha-globin genes are missing, you will have mild to moderately severe anemia. This is sometimes called hemoglobin H disease, because it produces a heavy hemoglobin. The body removes this heavy hemoglobin faster than it does normal hemoglobin. The more severe forms may need treatment with blood transfusions.
• Four genes: If all four alpha-globin genes are missing (alpha thalassemia major), the fetus will be stillborn or the child will die shortly after birth. 1 The hemoglobin produced by this condition is sometimes called hemoglobin Barts.

What are the symptoms of thalassemia?

Mild thalassemia usually does not cause any symptoms. However, symptoms of anemia may develop in more severe forms of the condition and may include:

• Weakness.
• Fatigue.
• Lightheadedness.
• Skin that looks paler than normal.
• Jaundice (skin and whites of eyes appear yellow).
• Dark urine.
• Decreased appetite and weight loss (poor growth in a child).
• Rapid heartbeat.
• Shortness of breath during exercise.

How is thalassemia diagnosed?

A physical exam and complete medical history are usually the first steps in diagnosing thalassemia. Tests that help confirm a diagnosis of thalassemia include:

• Complete blood count (CBC) and blood smear.
• Gene test.
• Iron level test, to determine whether iron deficiency anemia is present.
• Blood test that measures the amounts of different types of hemoglobin (hemoglobin electrophoresis), to help find out which type of thalassemia you have.
• A complete blood count (CBC) test on other members of your family (parents and siblings), to discover whether they may also have thalassemia.

How is thalassemia treated?

Treatment for thalassemia depends on your symptoms.

• Mild thalassemia, the most common form, does not need treatment.
• Moderate thalassemia may be treated with folic acid supplements and blood transfusions.

Severe thalassemia may be treated with:

• Blood transfusions.
• Folic acid.
• Splenectomy, which is surgical removal of the spleen.
• Bone marrow transplant, in some severe cases.

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