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Eating Disorders

2010-07-30T09:08:00.000-07:00

Your weight
Expert advice to help you maintain a healthy weight

Dissatisfied with your weight?
We're bombarded with scare stories about weight, from size zero to the obesity 'epidemic'. But a healthy weight is determined by different factors for each of us. Our expert advice is designed to help you achieve and maintain a healthy, life-enhancing weight.

Overweight or underweight?
Being the right weight has a positive effect on wellbeing but also on our health, as being the wrong weight can cause a range of medical problems.

Many myths surround eating disorders - that they only affect young women, for example, or they're a modern phenomenon, but what are the realities?

Living with an eating disorder is a miserable, lonely experience. For most people, food is one of life's pleasures and an important social event. So if your feelings about food aren't relaxed, an important part of life becomes extremely stressed. This stress may add to other enormous stresses that may have led to the eating disorder in the first place.

When someone you know and love develops an eating disorder, it's easy to feel confused about what to do, and even threatened or angry.

Unfortunately, many health professionals are just as much at sea. Although eating disorders are increasing, we still know very little about their causes. Worse still, there aren't any quick or easy treatments.

A few things are clear. People with eating disorders aren't:

Bad or being defiant
Going through a 'teenage phase'
The result of poor or inadequate parenting
The product of modern stresses and obsession with weight
Able to snap out of it

What is known about eating disorders?
Many things about eating disorders aren't fully understood, but we do know the following:

Eating disorders have been around for centuries

Diets don't cause eating disorders, but research has shown young women who diet at a severe level are 18 times more likely to develop an eating disorder than those who don't and those who diet at a moderate level are five times more likely

Severe psychological problems, such as obsessive compulsive behaviour and depression, increase the risk of developing eating disorders

How common are they?

The most common form of disordered eating is obesity

Eating disorders include a range of different conditions where people have an abnormal attitude towards food, altered appetite control and unhealthy eating habits that affect their health and ability to function normally. The most common form of disordered eating is obesity, which affects more than one in ten people.

Bulimia nervosa, or binge eating and purging, is twice as common as anorexia.

Men and boys also have eating disorders, but less often than girls or women.

What are the causes?
Families often blame themselves, but they shouldn't. None of the research shows much difference between the ways that families of anorexics work compared with other families.

The causes of eating disorders are complex. They're probably the result of several factors, including:

A genetic tendency
Learned responses and habits, especially to stress
Cultural and social pressures, for example to be slim
Psychological factors, such as perfectionism and lack self-esteem, although it's not known whether this is a cause or effect of disorders

What can families do?

treating eating disorders usually involves years of hard work

The first thing is to accept that there's no quick fix - treating eating disorders usually involves years of hard work. During this time, there can be huge tension and communication can be terrible, but families can play a critical role in helping their relative through the worst.

Families need expert help for this, so talk to your doctor or contact one of the organisations given in our links.

How to help:

1. Help the person affected recognise they have a problem. Try to avoid head-to-head confrontation because it will only end in rebellion, tears and failure.

2. Be prepared to raid all your reserves of optimism and enthusiasm.

3. Try to remain sympathetic, no matter how bad the person's outer expression of their inner turmoil becomes.

4. Don't forget other members of the family and their needs, and don't let your own life, career and enjoyments become swamped or you'll become unable to give support.

5. Keep communication going with the patient and health professionals. What your loved one needs is a cohesive team supporting them.

It's a long road to recovery. After five years, about half of people with eating disorders have recovered, although many remain preoccupied with food, eating and their weight for many more years.

Advice and support
For information about national organisations, visit the Women's Health section on eating disorders.

Children's Weight

2010-07-29T07:03:00.000-07:00

Maintaining a Healthy Weight

2010-07-29T06:57:00.000-07:00

Finding The Time

2010-07-07T09:44:00.000-07:00

Your weight
Expert advice to help you maintain a healthy weight

Dissatisfied with your weight?
We're bombarded with scare stories about weight, from size zero to the obesity 'epidemic'. But a healthy weight is determined by different factors for each of us. Our expert advice is designed to help you achieve and maintain a healthy, life-enhancing weight.

Overweight or underweight?
Being the right weight has a positive effect on wellbeing but also on our health, as being the wrong weight can cause a range of medical problems.

Ever feel there just aren't enough hours in the day to do everything you want, including being more active?

For many people, the same computer-based jobs that have taken the physical element out of work also take up so much time that exercise is the last thing they feel like doing when they get home. The key to finding time to exercise is to realise two things:

It doesnot have to take very long just half an hour a day, in ten-minute bursts if necessary.
It can be built into your day-to-day life - it doesnâ€™t necessarily have to be found as additional time.

If you're in employment
Despite advances in technology, many of us still spend more - rather than less - time at work. However, there are ways in which you can be more active:

Go for a walk in your lunch break.
Try to find at least three different walks and vary them throughout the week. It might even be possible to find an indoor walking route, incorporating stair climbing, for those inevitable bad weather days.
Talk to your employers about promoting health at work. If they don't already, ask if it's possible to provide showers and cycle racks to encourage people to cycle to work. You might even be able to encourage them to provide subsidised membership at a local gym where you could go at lunchtime.
Walk to and from work. If you live too far away, park further from the office or get off the bus or train one stop earlier â€“ even a ten-minute walk will help as long as it is hard enough to get you slightly out of breath.

If you look after children
Having children can change everything about your lifestyle. Some parents find their activity levels drop and their weight increases as going to the gym or playing sport become more difficult. Here are some positive steps you can take:

Exercise with your child.
Take them to the local swimming pool or play in the garden or local park.
Find out which local sports and leisure centres have crÃ¨che facilities, so you can exercise while your child is being looked after.

Walk your child to school.
Not only will this help you to be active, it will also help your child develop an early pattern of physical activity that might stay with them into adulthood.
Find out if there are activities available at your child's school for the local community. Many schools use their facilities for sports and exercise classes in the evenings and at weekends.

If you're based at home
Plan your week so you have to walk to the shops frequently. By going often you'll only have to carry light bags of shopping back.
Look at ways in which you can be more active in and around your home. Use the stairs to exercise, work in the garden or â€“ if you have the space and can afford it - install some gym equipment, such as a mini trampoline or rowing machine, for example. Failing that, invest in a skipping rope.
Look for community-based activity programmes in your local area. These don't have to be fitness classes, just anything that gets you moving. Conservation groups can be a great way to get involved in improving your local environment and being active at the same time.

The early bird
If your normal day really doesn't let you incorporate exercise, one option is to get up earlier. If you normally set the alarm clock for 7.30am, set it for 7am instead and use the extra half-hour to go for a brisk walk or even a swim if you have a pool nearby. We all experience exercise differently at different times of the day because of our individual biological cycle, and you might not be a 'morning person', but it's worth a try as exercise first thing can really wake you up and leave you feeling invigorated for the day ahead.

Night owls
Alternatively, if you're not an early bird, consider looking at how you could use any free time you have in the evening to increase your activity patterns. Most of us spend a lot of time sitting watching TV in the evenings, but you could buy some home exercise equipment and work out while you're doing it.

Experiment to find a time for exercise that suits you best.

Maximise your exercise time
Make an appointment to exercise - and write it in your diary. You could also record what you did in your workout, so you can keep track of your achievements.
You can extend this idea by making a real appointment with a friend, colleague or relative to exercise together. If you've arranged to meet someone, you're a lot less likely to skip it.
Keep some exercise kit handy in the places you spend most of your time. This might mean leaving clothes at college, work, with friends or relatives, or in the boot of your car. By having the right clothes handy you can exercise whenever you get an unexpected free 15 minutes or a sudden burst of enthusiasm.
Consider taking active holidays such as a cycle tour or walking holiday. You still need to get your exercise five days a week, but getting in shape for your holiday might be a good incentive, and if you enjoy it enough it might inspire you to keep it going when you get home.
If you own a car, leave it at home as much as possible and walk or cycle to the shops for those small things such as milk or a newspaper.

Balanced Diet

2010-05-02T07:41:00.000-07:00

Your weight
Balance of good healthExpert advice to help you maintain a healthy weight

Dissatisfied with your weight?

We're bombarded with scare stories about weight, from size zero to the obesity 'epidemic'. But a healthy weight is determined by different factors for each of us. Our expert advice is designed to help you achieve and maintain a healthy, life-enhancing weight.

Overweight or underweight?
Being the right weight has a positive effect on wellbeing but also on our health, as being the wrong weight can cause a range of medical problems.

The Food Standards Agency has designed the 'eatwell plate' to help people get the appropriate balance of foods and nutrients in their daily diet.

Eat a healthy, balanced diet and stay active
The key to a healthy balanced diet is not to ban or omit any foods or food groups but to balance what you eat by consuming a variety of foods from each food group in the right proportions for good health.

The five food groups on the eatwell plate are:

Fruit and vegetables
These should make up about a third of your daily diet and can be eaten as part of every meal, as well as being the first choice for a snack.

You should eat at least five portions of fruit and vegetables each day. Research suggests this can help to protect against cancer, obesity and various chronic diseases such as heart disease. This is because of the unique package of nutrients and plant compounds they contain.

Bread, rice, potatoes and pasta
This food group should also make up about a third of your diet and contains the starchy carbohydrates that are the body's main source of energy.

When selecting products from this food group, choose unrefined carbohydrates over those that have been refined, as they will contain the whole of the grain. Wholegrain foods are rich in fibre and other nutrients that have many health benefits, and people who consume wholegrains seem to have a reduced risk of certain cancers, diabetes and coronary heart disease.

The final third of the eatwell plate is made up of three groups containing foods that need to be consumed in smaller proportions than the other two principal categories. These food groups also contain nutrients essential to our diet, so it's important not to leave them out altogether.

Milk and dairy foods
These should be eaten in moderation because of their high saturated fat content, but they're an important source of calcium, which is essential for healthy bones and teeth. Choose low-fat or reduced-fat versions.

Meat, fish, eggs and beans
This food group includes both animal and plant sources of protein, which is a major functional and structural component of all cells. Protein provides the body with between 10 and 15 per cent of its dietary energy, and is needed for growth and repair.

Foods and drinks high in fat and/or sugar
This group makes up the smallest section on the eatwell plate and includes foods that should only be eaten sparingly because, although they're an important energy source, they contain very few nutrients and are often known as 'empty calories'.

Foods from this group are high in unhealthy components such as saturated fat, trans fatty acids, sugar and salt - all of which are associated with an increased risk of developing certain diseases.

They should only be eaten as occasional treats, or to increase the palatability of other important foods (such as olive oil on salads, a scraping of spread on bread, or a sprinkling of sugar on some tart fruits).

How to eat a balanced diet
Eat a variety of foods to obtain all of the essential nutrients
Too much as well as too little can be bad for you â€“ balance is required
Everyone's plate will look slightly different as we all have different requirements depending on our bodyâ€™s shape and size, and our levels of activity.

Alternative Sources of Protein

2010-05-02T07:33:00.000-07:00

Your weight
Expert advice to help you maintain a healthy weight

Dissatisfied with your weight?
We're bombarded with scare stories about weight, from size zero to the obesity 'epidemic'. But a healthy weight is determined by different factors for each of us. Our expert advice is designed to help you achieve and maintain a healthy, life-enhancing weight.

Overweight or underweight?
Being the right weight has a positive effect on wellbeing but also on our health, as being the wrong weight can cause a range of medical problems.

It's vital our diets contain protein, either from animal or plant sources.

Foods containing protein
Meat, poultry, fish, shellfish and eggs
Pulses, nuts and seeds
Soya products and vegetable protein foods

Why is protein important?
From hair to fingernails, protein is a major functional and structural component of all our cells. Protein provides the body with roughly 10 to 15 per cent of its dietary energy, and is needed for growth and repair.

Proteins are large molecules made up of long chains of amino acid subunits. Some of these amino acids are nutritionally essential as they cannot be made or stored within the body and so must come from foods in our daily diet.

Although all animal and plant cells contain some protein, the amount and quality of this protein can vary widely.

Animal protein
Protein from animal sources contains the full range of essential amino acids needed from an adult's diet. But red meat, in particular, should be eaten in limited amounts due to the high level of saturated fat it contains, which may raise blood levels of 'unhealthy' LDL cholesterol.

A high intake of saturated fat can lead to an increased risk of cardiovascular disease and other related disorders. As an alternative source of animal protein, choose poultry, fish and shellfish.

The 2007 World Cancer Research Fund report recommended meat eaters limit their consumption of red meat to no more than 500g a week, with very little processed meat, as these have both been linked to certain forms of cancer.

Fish is a good source of animal protein. Oil-rich fish such as salmon, mackerel, herring, tuna, trout and sardines are all rich in omega-3 fatty acids, which help to reduce the risk of developing cardiovascular disease.

Shellfish is also a good source of protein and is low in fat.

Aim to eat a couple of portions of fish every week, with at least one portion being an oily fish.

Advice for vegans and vegetarians
Vegetarians rely on plant sources for their daily protein. Plants donâ€™t contain the full range of essential amino acids and so are not as high in nutritional value as animal protein. But by eating a well-balanced diet that contains a variety of different foods, it's possible to consume the required amino acids, regardless of the time of day theyâ€™re eaten or in what combinations within a meal.

Foods such as nuts, seeds, beans, pulses, vegetable protein foods and soya products all contain protein. There are also small amounts in grains and dairy products. Due to this variety of protein-rich foods available in the UK, protein deficiency is rare.

How much is enough?
Health professionals suggest men should eat 55.5g protein a day and women 45g. In practical terms, eating a moderate amount of protein - in one or two meals every day â€“ should give you all the protein you need. Most people in the UK eat far more protein than they actually need.

Serving size
You should eat two to three servings of protein every day from both plant and animal sources. Here are some examples of one serving (about the size of a standard pack of playing cards):

100g boneless meat (eg lean beef, lamb or pork)
100g boneless poultry (eg chicken or turkey breast)
100g fish (eg salmon, sardines or tuna)
2 medium eggs
3 tablespoons of seeds (eg sunflower or pumpkin seeds)
3 tablespoons of nuts (eg almonds or walnuts)

Choosing the right protein
If you can, choose to eat low-fat protein foods as these will help to:

Keep your heart healthy
Keep cholesterol low
Minimise the risk of developing cardiovascular disease and other related disorders

Use this table to choose foods rich in protein but low in saturated fat.

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Protein and weight management
High-protein diets are sometimes popular with people wanting to lose weight, and there have been many studies looking at the effect of such diets on weight loss.

Regardless of the composition of the diet, weight loss will only occur if you expend more energy through activity than your body produces from food.

Protein-rich foods tend to make people feel fuller than foods rich in carbohydrates or fat. This can have a knock-on effect on appetite, minimising feelings of hunger, and helping to reduce overall energy intake.

Diets rich in protein at the expense of carbohydrates, for example, have been associated with slightly greater losses of weight in the short term compared with the recommended high-carbohydrate, low-fat eating plans. But after one year, studies have found there is no difference in weight loss between the two diets.

To control your weight it's important to find an eating pattern that suits your lifestyle and that you can sustain over a long period.

Caffeinated Drinks

2010-03-29T08:44:00.000-07:00

Your Weight
Expert advice to help you maintain a healthy weight

Dissatisfied with your weight?
We're bombarded with scare stories about weight, from size zero to the obesity 'epidemic'. But a healthy weight is determined by different factors for each of us. Our expert advice is designed to help you achieve and maintain a healthy, life-enhancing weight.

Overweight or underweight?
Being the right weight has a positive effect on wellbeing but also on our health, as being the wrong weight can cause a range of medical problems.

Many popular drinks contain the stimulant caffeine. It has a bad reputation, but what effects does it really have and does it bring any health benefits?

Effects of caffeine
Caffeine acts as a stimulant to the heart and central nervous system, and is also known to increase blood pressure in the short term, although there's no conclusive evidence of long-term effects on blood pressure.

The effects on blood pressure are most likely when caffeine is taken in excessive quantities or by people who are highly sensitive to it. People who are hypertensive (have habitual high blood pressure) are advised to avoid caffeinated drinks, and pregnant women should limit their intake of caffeine to less than 300mg a day.

Food Caffeine content
Coffee (mg/cup)
Instant 61 to 70
Percolated ground 97 to 125
Tea (mg/cup) 15 to 75
Cocoa (mg/cup) 10 to 17
Chocolate bar 60 to 70
Cola drinks 43 to 65
(mg/12oz can)

Caffeine and weight loss
Caffeine has been shown to have very modest effects on increasing metabolism, and is sometimes added as an ingredient to weight loss pills. These pills often make claims about speeding metabolism to 'effortlessly melt' excess fat, but in reality the amount of calories that slimming pills containing caffeine would actually burn is very small.

Caffeine may also suppress appetite, but without making other changes to your diet and lifestyle caffeine is unlikely to make a significant difference to your weight.

Coffee
Coffee has been linked with a number of the risk factors for coronary heart disease, including increased blood pressure and raised blood cholesterol levels. But no relationship has been found between drinking coffee and the likelihood of developing coronary heart disease.

Coffee may be beneficial in some areas of health - for example, research has found it may reduce the risk of developing gallstones and kidney stones.

It's difficult to suggest a safe limit for coffee intake because of the huge variation in caffeine content across different brands and an individual's sensitivity to the drug. People with high blood pressure and pregnant women are advised to limit their caffeine consumption.

For the rest of the population, there's no evidence coffee does any long-term harm. Caffeine does have a very mild diuretic effect but, drunk in moderation, you donâ€™t need to increase fluid intake to any significant degree as the loss of fluid is very minimal.

Tea
Tea contains some useful minerals such as zinc, manganese and potassium, and scientists are researching its potential to reduce the risk of coronary heart disease and some cancers.

Tea contains antioxidant substances called flavonoids, which have been shown to help slow or inhibit the chemical reactions thought to take place during the development of coronary heart disease.

Green tea
There's also a lot of interest in the health benefits of green tea, particularly in relation to cardiovascular health. Again, this is due to flavonoids, which are powerful antioxidants found in high concentrations in both green and black teas. The concentration of these compounds depends on how long the tea has been brewed, but can range from 125mg to 140mg.

Some studies have compared the concentration of these antioxidant compounds to that found in fruit and vegetables. Flavonoids bring potential benefits to heart health, as well as possible reductions in the risk of Alzheimerâ€™s disease and other neurodegenerative conditions.

Caffeine and iron absorption
Both tea and coffee contain polyphenols that can bind to iron, making it difficult for our bodies to absorb. Avoiding tea and coffee during and around mealtimes is important for people at risk of iron deficiency.

The Digestive System

2010-03-29T08:36:00.000-07:00

Your weight
Expert advice to help you maintain a healthy weight

Dissatisfied with your weight?
We're bombarded with scare stories about weight, from size zero to the obesity 'epidemic'. But a healthy weight is determined by different factors for each of us. Our expert advice is designed to help you achieve and maintain a healthy, life-enhancing weight.

Overweight or underweight?
Being the right weight has a positive effect on wellbeing but also on our health, as being the wrong weight can cause a range of medical problems.

When you eat, the food's journey through the body is governed by the digestive system.

What is digestion?
Digestion is the process of breaking down food so that it's small enough to be absorbed and used by the body for energy or in other bodily functions.

Digestion involves a number of different stages. The first phase is known as the cephalic (head) phase. It starts before food has even entered your mouth. The sight, smell, taste or even the thought of food will activate saliva in the mouth as well as digestive juices, which contain enzymes to break down food.

In the mouth
Once food is in the mouth, the tastebuds begin determining the chemicals within the food via their nerve endings, in order to give you the taste sensations of salt, sweet, sour or bitter. As your teeth chew and grind the food, breaking it down, it's mixed with saliva. This comprises many enzymes including salivary amylase, which begins to break down the long chains of starch found in foods such as bread, cereals, potatoes and pasta. Saliva also contains mucin, which moistens the food so it can pass easily through the digestive (gastrointestinal) tract.

The oesophagus
After the food has been swallowed, it's carried down the oesophagus (a muscular tube) towards the stomach. The oesophagus can contract and relax in order to propel the food onwards, and each mouthful of food takes about six seconds to reach the stomach once swallowed.

The stomach
The stomach is a sack made of muscle and, when it's empty, it has a volume of only 50ml but this can expand to hold up to 1.5 litres or more after a meal. The walls of the stomach are made of three different layers of muscle that allow it to churn food around and make sure it's mixed with the stomach's acidic digestive juices. The presence of hydrochloric acid in the stomach prevents the action of salivary amylase and helps to kill bacteria that might be present. The stomach also produces the enzyme pepsin, which breaks down proteins (mostly found in meat, fish, eggs and dairy products).

The hormone ghrelin is produced by cells lining the stomach. Ghrelin stimulates hunger and tends to increase before a meal and decrease after eating. This hormone forms part of the communication system between the gut and the part of the brain that controls hunger and satiety (how full you feel).

Food can stay in the stomach for a few minutes or several hours in the gastric phase where numerous acids and enzymes are released, including the hormone gastrin. When the food has been churned into a creamy mixture known as chyme, the pyloric sphincter (an opening controlled by muscle) opens and chyme passes gradually into the small intestine.

Prebiotics
These are mainly indigestible carbohydrates called oligosaccharides. On reaching the large intestine, they selectively stimulate the growth and/or activity of beneficial microorganisms already in the colon, such as bifidobacteria and lactobacilli.

The small intestine
About 3ml of chyme is squirted into the small intestine at short intervals as the pyloric sphincter opens. This is known as the intestinal phase and causes the secretion of many hormones, which all aid the digestive process. The sphincter is designed to open partially so that large particles are kept in the stomach for further mixing and breaking down.

Digestion and absorption of fats, protein and carbohydrates occurs in the small intestine. Three important organs are involved:

The gall bladder provides bile salts that help to make fats easier to absorb.
The pancreas provides bicarbonate to neutralise the acidic chyme from the stomach, and also produces further digestive enzymes.

The intestinal wall contains cells that make up the wall of the small intestine. These cells help to neutralise the acid and also produce enzymes to digest food.

The inner surface of the small intestine is folded into finger-like structures called villi, which greatly increase the surface area available for absorption - in fact the surface area of the villi is equivalent to that of a tennis court! Blood vessels receive the digested food from the villi where it's then transported through the blood stream to the liver via the hepatic portal vein.

Fat can take much longer to be broken down, with the process of fat digestion and absorption taking between three and five hours.

The unabsorbed residue of this process finally reaches the end of the small intestine and enters the large intestine.

Probiotics
Probiotics are live bacteria similar to the bacterial micro-organisms that live in the large intestine. They are often referred to as 'friendly bacteria', and come from food sources or dietary supplements. The mix of these 'friendly' bacteria and other gut microorganisms is important for good health, and many factors can alter this delicate balance, such as infection or use of antibiotics. Friendly bacteria are vital for proper development of the immune system, to protect against micro-organisms that could cause disease, and to aid the digestion and absorption of food and nutrients.

The large intestine
This is one of the most metabolically active organs in the body. It measures about 1.5 metres and contains over 400 different species of bacteria that break down and utilise the undigested residues of our food, mostly dietary fibres. As the watery contents move along the large intestine, water is absorbed and the final product - faeces - is formed, which is stored in the rectum before excretion from the body.

Attention Deficit Hyperactivity Disorder

2010-03-26T09:57:00.000-07:00

Definition
ADHD is a problem with inattentiveness, over-activity, impulsivity, or some combination of these. For these problems to be diagnosed as ADHD, they must be out of the normal range for the child's age and development.

Overview, Causes, & Risk Factors

Is ADHD over-diagnosed? Under-diagnosed? Probably both -- and certainly real. ADHD affects children's school performance and their relationships with others. Parents who are wondering if their children have ADHD are often exhausted and frustrated.

Scientific studies, using advanced neuroimaging techniques of brain structure and function, show that the brains of children with ADHD are different from those of other children. These children handle neurotransmitters (including dopamine, serotonin, and adrenalin) differently from their peers.

ADHD is often genetic. Whatever the specific cause may be, it seems to be set in motion very early in life as the brain is developing. Other problems, such as depression, sleep deprivation, specific learning disabilities, tic disorders, and oppositional/aggressive behavior problems, may be confused with or appear along with ADHD. Every child suspected of having ADHD deserves a careful evaluation to sort out exactly what is contributing to his concerning behaviors.

Attention Deficit Disorder (ADD) is the most commonly diagnosed behavioral disorder of childhood, affecting an estimated 3 - 5% of school aged children. It is diagnosed much more often in boys than in girls.

Most children with ADHD also have at least one other developmental or behavioral problem. Every evaluation should include a search for possible additional conditions, including conduct disorder, oppositional defiant disorder, mood disorders, depression, anxiety, and learning disabilities.

Multiple Sclerosis or MS

2010-03-26T09:52:00.000-07:00

Multiple sclerosis (abbreviated MS, also known as disseminated sclerosis or encephalomyelitis disseminata) is an autoimmune condition in which the immune system attacks the central nervous system, leading to demyelination. Disease onset usually occurs in young adults, and it is more common in women. It has a prevalence that ranges between 2 and 150 per 100,000. MS was first described in 1868 by Jean-Martin Charcot.

MS affects the areas of the brain and spinal cord known as the white matter, destroying a fatty layer called the myelin sheath, which wraps around nerve fibers and electrically insulates them. When myelin is lost, the axons of neurons can no longer effectively conduct action potentials. The name multiple sclerosis refers to the scars (scleroses – better known as plaques or lesions) in the white matter. Although much is known about the mechanisms involved in the disease process, the cause remains unknown. Theories include genetics or infections. Different environmental risk factors have also been found.

Almost any neurological symptom can appear with the disease, and often progresses to physical and cognitive disability. MS takes several forms, with new symptoms occurring either in discrete attacks (relapsing forms) or slowly accumulating over time (progressive forms). Between attacks, symptoms may go away completely, but permanent neurological problems often occur, especially as the disease advances.

There is no known cure for MS. Treatments attempt to return function after an attack, prevent new attacks, and prevent disability. MS medications can have adverse effects or be poorly tolerated, and many patients pursue alternative treatments, despite the lack of supporting scientific study. The prognosis is difficult to predict, it depends on the subtype of the disease, the individual patient’s disease characteristics, the initial symptoms and the degree of disability the person experiences as time advances. Life expectancy of patients is nearly the same as that of the unaffected population.

Importance Of Water Fluid

2010-03-24T09:59:00.000-07:00

Bread, Cereals and Other Starchy Foods

2010-03-22T09:24:00.000-07:00

Your weight
Expert advice to help you maintain a healthy weight

Dissatisfied with your weight?
We're bombarded with scare stories about weight, from size zero to the obesity 'epidemic'. But a healthy weight is determined by different factors for each of us. Our expert advice is designed to help you achieve and maintain a healthy, life-enhancing weight.

Overweight or underweight?
Being the right weight has a positive effect on wellbeing but also on our health, as being the wrong weight can cause a range of medical problems.

This food group is your body's main source of energy and contains bread, pasta, rice, potatoes, noodles, chapatti, cereals and other starchy carbohydrates.

Refined and unrefined grains
The foods listed above (apart from potatoes) are all produced from grains, such as wheat, corn or rice. They should be a part of all meals, filling about a third of your plate. They can come in two forms â€“ refined or unrefined (often known as whole grains).

Refined grains have been stripped of their outer bran coating and inner germ during the milling process, leaving only the endosperm. They include white rice, white bread and white pasta.

In a whole grain the bran, germ and endosperm are all still present. The bran is an excellent source of fibre; the germ is a source of protein, vitamins and minerals; and the endosperm supplies most of the carbohydrates, mainly in the form of starch. Unrefined or whole grain forms provide far more nutrients than their unrefined counterparts.

Whole grains are rich in phytochemicals and antioxidants, which help to protect against coronary heart disease, certain cancers, and diabetes. Studies have shown people who eat more whole grains tend to have a healthier heart.

Most people get their whole grain from wholemeal bread or whole grain breakfast cereals such as porridge, muesli or whole wheat cereals. Choose a whole grain variety over processed or refined grains, and look out for added sugar or salt.

Other whole grains include:

Wheat
Oats
Maize
Barley
Rye
Millet
Quinoa
Wild rice

Fibre
Dietary fibre is found in plant foods (fruit, vegetables and whole grains) and is essential for maintaining a healthy digestive system. Fibre cannot be fully digested and is often called bulk or roughage. The two types of fibre found in food are soluble and insoluble.

Soluble fibre, which can dissolve in water, is found in beans, fruit and oat products, and can help to lower blood fats and maintain blood sugar.

Insoluble fibre cannot dissolve in water, so passes directly through the digestive system. Itâ€™s found in whole grain products and vegetables and it increases the rate at which food passes through the gut.

Evidence for health benefits of fibre
High-fibre foods take longer to digest, so keep you feeling fuller for longer. The slow and steady digestion of food through the gut helps control blood sugar and assists with weight maintenance
Fibre helps in the digestive process and can help lower blood cholesterol
Fibre promotes bowel regularity and keeping the gastrointestinal tract clean to help reduce the risk of developing diverticular disease and constipation
A high-fibre diet may reduce the risk of developing diabetes and colorectal cancer

To eat more fibre, try these healthy swaps:

Refined Swap Unrefined
Frosted flakes Bran flakes
White toast Porridge oats
Cereal bar Rice cakes
French bread Wholemeal bread
Normal pasta Wholewheat pasta
Breadstick Dark rye crispbread

How much is enough?
Bread, rice, potatoes, pasta and other starchy foods should make up about one third of your diet. Try these recipes from the BBC Food website:

Banana and Oat Smoothie
Wholemeal pizza baguettes
Ham and watercress sandwich on wholemeal bread
Creamy lentils and brown rice
Using wholemeal flour in baking, as in this Irish Soda Bread or half and half as in these Carrot and Pineapple Muffins

What about GI?
The glycaemic index (GI) is a way of ranking carbohydrate foods based on how quickly they increase blood sugar levels. Low GI foods are especially helpful for people with diabetes, who need to have more control over their blood sugar levels than the general population.

Ideally foods with a low GI, such as those rich in soluble fibre like oats and legumes, should be eaten more frequently than those with a high GI. But the texture, type of cooking or processing used, and the amount and type of sugars present can all affect the GI. Since foods are often consumed as part of a meal or snack, it can be difficult to calculate the GI. Focusing on unrefined, high-fibre, whole grain cereals and minimising rapidly absorbed, refined cereals and sugary foods will all help to lower the GI of your diet.

Importance Of Salt

2010-03-22T09:16:00.000-07:00

Choosing Healthier Options

2010-03-22T09:08:00.000-07:00

Fats and Sugar

2010-03-22T09:02:00.000-07:00

These foods, although an important energy source, often contain few other nutrients, so it's healthier to limit their consumption.

What are they?
This group, which includes foods such as cakes, biscuits, sweets, sugar-sweetened drinks and crisps, makes up the smallest section of the Food Standards Agency's 'eatwell plate'.

Fat facts
Fat transports the fat-soluble vitamins A, D, E and K around the body
It can often improve the flavour and perception of foods, increasing their palatability
It supplies essential nutrients such as fat-soluble vitamins and essential fatty acids (EFAs)
EFAs must be supplied from the diet, and are thought to have a positive effect on heart health and the immune system
It has a key role in membrane structure
It cushions, and so protects, the internal organs
It's stored in adipose tissue (a thick layer of tissue under the skin) as a long-term fuel reserve. Excess fat may also accumulate around your organs, especially in the abdominal cavity

Fat is a concentrated source of energy. Just 1g provides nine calories - more than double the calories in 1g of protein or carbohydrate.

This means it's much easier to consume too many calories when eating high-fat foods. People trying to manage their weight should reduce fatty foods to help cut calories. We all need some fat in our diets, but small quantities of EFAs are the key to good health.

The two types of fat
Fat can be divided into two main groups - saturated and unsaturated.

Saturated fat is generally solid at room temperature and is usually from animal sources. It's found in lard, butter, hard margarine, cheese, whole milk and anything that contains these ingredients, such as cakes, chocolate, biscuits, pies and pastries. It's also the white fat you can see on red meat and underneath poultry skin.

How much saturated fat you eat is associated with increased blood cholesterol concentrations and an increased risk of heart disease. Eating less helps to minimise the risks it poses to heart health.

Unsaturated fat is usually liquid at room temperature and generally comes from vegetable sources. Monounsaturated and polyunsaturated fats are both included in this group.

Unsaturated vegetable oils are a healthier alternative to saturated fat and can be found in sesame, sunflower, soya and olive oil, soft margarine and in foods such as oily fish, including mackerel, sardines, pilchards and salmon. Where possible, you should ensure the fat you eat is unsaturated.

Did you know...?

A jam doughnut contains 10.9g fat
A slice of malt loaf contains 0.7g fat
A teaspoon of peanut butter contains 5.4g fat
A pint of whole milk contains 22.8 g fat
A handful of mixed nuts contains 21.6g fat

How much is enough?
Government guidelines recommend fats make up no more than 35 per cent of the energy in your diet, and that saturated fats should provide less than 11 per cent of total energy intake.

For the average woman, this means about 70g of total fat a day; for men, roughly 95g.

The latest National Diet and Nutrition Survey showed that, on average, UK adults consume about the right amount of fat, but that the intake of saturated fats is currently too high for good health (at present they provide about 13 per cent of total energy).

To reduce the amount of fat in your diet, try the following:

Look for alternatives to cakes, biscuits and savoury snacks, which are often high in fat - try fresh fruit, dried fruit and cereal-based products
Trim any visible fat off meat and poultry
Buy lean cuts of meat and reduced-fat minces
Poach, steam, grill or bake food rather than fry it
Swap whole milk for semi-skimmed or skimmed
Opt for low-fat dairy products
If you use lard, butter or hard margarine, switch to vegetable oil and low-fat spreads

Sugary foods
There are two types of sugar - those found naturally in fruit and milk (which are fine and don't need to be cut down) and those that are added to the diet.

These added sugars can be found in a variety of foods including confectionery, soft drinks, desserts and breakfast cereals. Added sugars are a great source of energy, but provide no other nutrients.

Sugary foods and drinks pose a threat to dental health, especially if consumed between meals.

Even the sugars in honey and fruit juices can cause tooth decay if good oral hygiene isn't followed and you consume a lot of these foods.

Only have sugary foods at mealtimes, when other dietary and oral factors can help to minimise the risk they pose to your teeth.

Sugary drinks have been identified as a possible cause of obesity. These drinks do not trigger the same sense of fullness as food with similar calories, increasing the risk of overeating.

How to reduce consumption of sugary foods
Swap sugary drinks for water, low-fat milk or artificially sweetened drinks to reduce your calorie intake
Try swapping sugary snacks for fruit or bread-based options such as fresh whole fruit or teacakes/malt loaf
Try to halve the amount of sugar you put in hot drinks, or cut it out completely
Buy reduced-sugar varieties of jam and marmalade
Choose tinned fruit in natural juice rather than syrup

Packing A Lunchbox

2010-02-25T10:46:00.000-08:00

Fruit and vegetables

2010-02-23T10:33:00.000-08:00

Preconception and pregnancy

2010-02-21T08:12:00.000-08:00

Your weight
Expert advice to help you maintain a healthy weight

Dissatisfied with your weight?
We're bombarded with scare stories about weight, from size zero to the obesity 'epidemic'. But a healthy weight is determined by different factors for each of us. Our expert advice is designed to help you achieve and maintain a healthy, life-enhancing weight.

Overweight or underweight?
Being the right weight has a positive effect on wellbeing but also on our health, as being the wrong weight can cause a range of medical problems.

When planning for a baby, a healthy diet will provide you and your partner with the nutrients needed to prepare your body for conception. When you become pregnant, what you eat is also vital for the development and well-being of your unborn baby and may affect its future health.

Body weight and fertility
Being a healthy body weight is important before pregnancy. If you're very underweight, it can be more difficult to conceive. Being obese may also cause problems with conceiving especially if you suffer from polycystic ovary syndrome. Women who are obese while pregnant also increase the risk of complications during pregnancy, delivery and in the few days after birth.

The ideal weight range is usually calculated using the body mass index (BMI). A BMI between 18.5 to 25 is a healthy weight for most people and associated with relatively low risks. For people with a BMI over 30, even a small weight loss can greatly increase your ability to conceive and have a healthy pregnancy. Take steps either to lose or gain weight in a sensible way before you become pregnant. Crash dieting is not good for your health, and limiting your range of foods may deplete your nutrient stores. If you're concerned about your weight, you may find it useful to speak to your doctor or practice nurse for further advice.

and your partner¦
Eating a healthy diet and being the right body weight is important for men who are hoping to become dads, too. There have been many studies looking at specific nutrients such as zinc and selenium and male sperm quality. However, the key messages for men are:

Aim to be the right weight for your height by eating sensibly and exercising on a regular basis
Follow the principles of healthy eating. Eating a variety of foods will help ensure you have all the nutrients you need such as zinc and selenium
Stick firmly within the alcohol limits. Do not exceed three to four units per day on a regular basis, preferably with some alcohol-free days each week

A balanced diet
With a few exceptions, you can continue to eat a normal, healthy diet before and during pregnancy. This includes regular meals and snacks, and a sensible healthy eating regime containing:

plenty of starchy carbohydrates - bread, rice, pasta, breakfast cereals, chapattis, couscous and potatoes
plenty of fruit and vegetables - at least five portions a day
low or reduced fat dairy products such as milk, yoghurt, fromage frais and pasteurised cheeses
lean sources of protein, such as meat, poultry, fish, eggs (well-cooked), beans and pulses
not too many fat-rich and sugary foods
at least eight medium glasses of fluid each day
very little or no alcohol

Generally, pregnancy can progress well with the need for only very small increases in protein, carbohydrate, fat, vitamins and minerals. The digestive system in pregnant women changes and becomes more efficient at absorbing certain nutrients. In fact, with only a few exceptions, most of the additional nutrient needs of pregnancy can be met by eating a well-balanced and varied diet. So the old adage 'eating for two' doesn't mean you should eat twice as much food.

Weight gain
Optimum weight gain in pregnancy depends on your pre-pregnant weight. The baby and amniotic fluid are only a small part of the weight gain, the rest is an increase in the mother's fat stores to provide an energy reserve for later breastfeeding. There are no specific recommendations for pregnancy weight gain in the UK. However in the USA, thinner women are encouraged to gain a little more weight, anywhere between 12.8kg and 18kg (28lb to 40lb), while women of an average weight should aim for between 11.5kg and 16kg (25lb to 35lb). Overweight and obese women should aim to gain less weight and this should be discussed with your midwife or health care provider.

Pre-school children

2010-02-16T10:30:00.000-08:00

Adult's Diet

2010-02-14T09:52:00.000-08:00

Infants Birth to Six Months

2010-02-04T10:36:00.000-08:00

Childrens Health

2010-01-30T11:44:00.000-08:00

Older adults - staying fit and healthy

2010-01-27T11:10:00.000-08:00

Your weight
Expert advice to help you maintain a healthy weight

Dissatisfied with your weight?
We're bombarded with scare stories about weight, from size zero to the obesity 'epidemic'. But a healthy weight is determined by different factors for each of us. Our expert advice is designed to help you achieve and maintain a healthy, life-enhancing weight.

Overweight or underweight?
Being the right weight has a positive effect on wellbeing but also on our health, as being the wrong weight can cause a range of medical problems.

Eating well and being active will help you stay fit and healthy so you can live life to the full and reduce the risks of ill health.

Older adults in the UK
The number of older adults in the world is growing both in absolute and relative terms. In 1994, 16 per cent of the UK population was aged over 65. By 2031, this will increase to 23 per cent, and 10 per cent of this figure will be made up of people over 75 years old. The greatest challenge over the coming years will be maintaining the health of this increasing number of older adults.

Deciding what we mean by 'older people' is a little arbitrary. The World Health Organization classifies people aged between 45 and 59 as 'middle age', 60 to 74 as 'elderly' and over 75 as 'old'.

But the nutritional needs of older adults are difficult to neatly categorise into absolute age groups. Dietary needs depend on current health, and while many older people are fit and active, some others who are younger may be frail and require additional care.

Nutrition for generally fit and healthy older adults
Activity
Research shows that remaining active can help to maintain both mental and physical health. Keeping up the activities you enjoy doing will help to maintain physical fitness and preserve muscle tissue. Preserving your strength will help to maintain your independence. Remember, activity doesn't necessarily mean joining an exercise class. Gardening, walking to the shops and housework can all count as types of activity too.

Energy
Energy requirements can decline with age, particularly if physical activity is limited, but the need for protein, vitamins and minerals remains the same. It's vital that food choices are nutritionally dense, which means you still need to eat a variety of foods to get all the vitamins and minerals you need, but with fewer calories. If you're overweight or obese, it's even more important to be calorie conscious.

Fat
Advice to restrict fat intake, particularly cutting saturated fat to improve heart health, remains true for older people who are fit and well. A dietary survey of older people showed most eat too much saturated fat. Above the age of 75, fat restriction is less likely to be beneficial, and isn't appropriate if the person is frail, has suffered weight loss or has a very small appetite. In fact, in these situations additional fat may be used to increase the calories in meals and snacks to aid weight gain. Read our tips for tackling nutritional problems for older people.

Fibre
Older people can suffer from constipation and bowel problems mainly due to a reduced gut motility and inactivity. To relieve this, try eating high-fibre cereal foods, fruit and vegetables. Raw bran and excessive amounts of very high-fibre foods are not the answer, though; they're too bulky and may interfere with the absorption of certain nutrients. To help the gut work properly, it's also important to drink plenty of fluid, approximately eight medium glasses a day.

Fluid
Dehydration can make people feel drowsy or confused, it's important to drink, even if this means extra trips to the toilet. The risk of dehydration can be higher in older people because their kidneys don't function as efficiently as those of younger people. Older people are also not as sensitive to the feeling of thirst. Fluid intake doesn't just mean water - it can also include such drinks as tea, coffee, fruit juice and squash.

Sugar
Generally fit and healthy older people should limit foods and drinks that are rich in sugar, as it can impair dental health and contribute to weight gain when energy intake is too high. But for people who have a poor appetite, or who have lost weight, sugar-rich foods can be a useful source of calories.

Iron
Anaemia is common in older adults. Poor absorption of iron, due to changes in the gastrointestinal tract, blood loss and the use of certain drugs - together with a poor dietary intake - may be causal factors. Make sure your iron intake is sufficient by eating red meat and foods from non-meat sources (such as fortified cereals, dried fruit, pulses and green leafy vegetables) every day. Absorption of iron from a meal containing non-meat sources is maximised by consuming foods rich in vitamin C at the same time (such as a glass of fruit juice, fresh fruit or vegetables).

Weaning

2010-01-26T11:22:00.000-08:00

Your weight
Expert advice to help you maintain a healthy weight

Dissatisfied with your weight?
We're bombarded with scare stories about weight, from size zero to the obesity 'epidemic'. But a healthy weight is determined by different factors for each of us. Our expert advice is designed to help you achieve and maintain a healthy, life-enhancing weight.

Overweight or underweight?
Being the right weight has a positive effect on wellbeing but also on our health, as being the wrong weight can cause a range of medical problems.

By around six months of age, your baby's energy and nutrient requirements become difficult to meet with breastmilk or formula alone, so it's time to start weaning them on to food.

When to start weaning
At six months, a baby's digestive system has matured enough to cope with solid food, and other developmental changes (such as the ability to bite and chew) mean your baby is ready to experience new tastes and textures.

The Department of Health recommends that weaning shouldn't be introduced until the age of six months, but your baby may show signs of wanting to try solids earlier than this. If this is the case, discuss your baby's readiness to try weaning foods with your health visitor.

The aim of weaning is gradually to introduce a variety of tastes and textures so that, by the age of one, your baby's enjoying a varied and healthy diet.

Every baby's different. Some enjoy trying new tastes and textures, moving through weaning quickly and easily, while others need a little more time to get used to new foods. Proceed at your baby's pace, moving on to each new food and weaning stage when it's right for them.

How to start

Before you begin, here are some general tips for successful weaning:

Choose a good time of day for your baby to start on solids. This should be when they're not too tired or hungry (in the early stages, offering a breastfeed or a little formula beforehand will mean your baby is not too hungry and so is less frustrated with learning to take solids from a spoon).

Allow plenty of time.

Don't force food on your baby. If they don't want to try a food, stay calm, take the food away and offer it again later or in a few days' time.

Prepare for some inevitable mess by keeping plenty of bibs and cloths to hand.

Only heat up a small amount of food each time so you don't waste food your baby doesn't eat. You can always heat up more if your baby is keen.

Don't reheat previously uneaten food.

Always stay with your baby when they're eating.
Always test the temperature of food before you give it to your baby - it shouldn't be too hot.
Encourage self feeding. As your baby develops and shows signs of wanting to feed independently, give them a spoon or finger foods to try.

Stages of weaning

There are three main stages:

1. In the first stage, you start to introduce the feeling of a spoon in your baby's mouth, along with first tastes and textures.

Mix some of the following foods with a teaspoon of either breastmilk or formula (whatever your baby's usual milk is):

Pureed vegetables such as carrot, swede or potato
Pureed fruit such as banana, or cooked pear or apple
A non-wheat-based cereal such as baby rice, sago or cornmeal

Don't force food on your baby, especially at this stage. Remember they're getting most of their nutrients and energy from breast or formula milk. If your baby refuses to eat, it might be too early for them, so try offering the food again in a few days.

2. Once your baby's used to taking food from a spoon, start to slowly increase the amount and number of times a day you offer it. Initially, you'll probably just offer food once a day, but you can now start to introduce it twice and then three times. Remember to go at your babyâ€™s pace.

At this stage, start to introduce the following:

Full-fat cow's milk products such as full-fat yoghurt or a cheese sauce (you can use full-fat milk in cooking, but avoid giving it as a drink until your baby is over a year old)
Purees of meat, or pulses

Gradually cut down the amount of cereals you offer, but continue introducing new fruit and vegetables

You can also now begin to use some of the foods you cook for yourself. Homemade pureed foods are cheaper than shop-bought products, and have the added benefit of introducing your baby to the kinds of foods your family eats. Freeze small amounts of home-made food (try using ice cube trays for handy portion sizes). Remember you don't need to add salt, honey or sugar to your babyâ€™s food.

3. Start to offer thicker purees and then introduce soft lumps. By the end of this stage, your baby will also be moving on to mashed and chopped foods. Remember to offer a variety of foods to ensure your baby receives all the necessary vitamins and minerals.

Things to remember at this stage are:

Your baby should still be having 500ml to 600ml of breastmilk or formula every day.
Aim for a starchy food, a fruit and a vegetable at each meal.
Every day your baby should have one serving of protein-rich food such as soft cooked meat, fish, tofu or pulses such as lentils. Eggs should be thoroughly cooked so the yolk is hard.

Around this stage, your baby might start to enjoy finger foods, such as chopped fruit and vegetables (initially vegetable sticks should be lightly steamed to make them a little easier to chew), bread sticks or toast.

Chewing helps with oral muscle development, which is important for speech development. Try to avoid biscuits and snacks that are high in sugar.

Always stay with your baby to make sure they don't choke on any finger foods.

You're now moving towards including all the foods your family usually eats in your baby's diet. You'll probably still need to modify the texture by mashing or chopping as appropriate for your baby.

Adolescence

2010-01-23T11:38:00.000-08:00

Your weight
Expert advice to help you maintain a healthy weight

Dissatisfied with your weight?
We're bombarded with scare stories about weight, from size zero to the obesity 'epidemic'. But a healthy weight is determined by different factors for each of us. Our expert advice is designed to help you achieve and maintain a healthy, life-enhancing weight.

Overweight or underweight?
Being the right weight has a positive effect on wellbeing but also on our health, as being the wrong weight can cause a range of medical problems.

Teenagers go through many changes, and it's vital their diets keep pace with this development.

Teenagers and diet
Teenagers' diets should sustain growth and promote good health. During this time, a number of physiological changes occur that affect nutritional needs, including rapid growth and considerable gains in bone and muscle (especially in boys). This is also a time when teenagers begin to develop real independence from their parents, including making decisions about the food they eat. Teenagers often choose food in response to peer pressure or as an act of defiance against parents. It's not all bad news, as there are many opportunities to encourage healthy dietary habits in teenagers, particularly when relating good food choices to sporting or physical prowess. Ensure there are plenty of healthy options available at home for healthy meals and snacks.

Nutrition
The National Diet and Nutrition Survey of Young People Aged 4-18 Years provides detailed information on the nutritional intake and physical activity levels of young people in the UK. .

The findings reveal average consumption of saturated fat, sugar and salt is too high, while that of starchy carbohydrates and fibre is low. During the seven-day recording period, more than half the young people surveyed hadn't eaten any citrus fruits, green leafy vegetables (such as cabbage or broccoli), eggs or raw tomatoes. The survey also showed that one in ten teenagers have very low intakes of vitamin A, magnesium, zinc and potassium. Intake of iron and calcium was also below ideal levels among many of the teenagers. Meanwhile the rising levels of obesity suggest many young people are eating too many calories.

Iron deficiency
Iron deficiency is one of the most common nutritional deficiencies in the UK. In the National Diet and Nutrition Survey, up to 13 per cent of teenage boys and 27 per cent of girls were found to have low iron stores. Rapid growth, coupled with a fast lifestyle and poor dietary choices, can result in iron-deficiency anaemia. Teenage girls need to take particular care because their iron stores are depleted each month following menstruation.

The main dietary source of iron is red meat, but there are lots of non-meat sources, too, including fortified breakfast cereals, dried fruit, bread and green leafy vegetables. The body doesn't absorb iron quite as easily from non-meat sources, but you can enhance absorption by combining them with a food rich in vitamin C (found in citrus fruits, blackcurrants and green leafy vegetables). In contrast, tannins found in tea reduce the absorption of iron, so it's better to have a glass of orange juice with your breakfast cereal than a cup of tea.

Calcium deficiency
The survey also highlighted that 25 per cent of teens had a calcium intake below the recommended level, which has serious implications for their future bone health.

Osteoporosis is a disease that causes bones to become brittle and break very easily. Bones continue to grow and strengthen until the age of 30, and the teenage years are very important to this development. Vitamin D, calcium and phosphorous are vital for this process, with calcium requirements for the teenage years ranging from 800mg to 1,000mg per day.

Calcium-rich foods should be consumed every day. The richest source of calcium in most people's diet is milk and dairy products. Encourage your teenager to eat two to three portions of dairy food each day â€“ for example, a glass of milk, a 150g pot of yoghurt and a small matchbox-sized piece of cheese. If your teenager doesnâ€™t eat dairy products, try fortified soya milk. Dairy foods are often avoided by teenage girls because of concerns about fat content. Low-fat dairy foods are equally rich in calcium, so providing these versions to aid consumption can be helpful.

Foods to choose
Adolescence is a time of rapid growth, and the primary dietary need is for energy - often reflected in a voracious appetite. Ideally, foods in the diet should be rich in energy and nutrients. Providing calories in the form of sugary or fatty snacks can mean nutrient intake is compromised, so teenagers should be encouraged to choose a variety of foods from the other basic food groups:

Plenty of starchy carbohydrates - bread, rice, pasta, breakfast cereals, chapattis, couscous and potatoes
Plenty of fruit and vegetables - at least five portions every day
Two to three portions of dairy products, such as milk, yoghurt, fromage frais and pasteurised cheeses
Two servings of protein, such as meat, fish, eggs, beans and pulses
Not too many fatty foods
Limit sugar-rich food and drinks

Other important dietary habits to follow during adolescence include:

Drink at least eight glasses of fluid a day.
Eat regular meals, including breakfast, as it can provide essential nutrients and improve concentration in the mornings. Choose a fortified breakfast cereal with semi-skimmed milk and a glass of fruit juice.
Take regular exercise, which is important for overall fitness and cardiovascular health, as well as bone development.

Tackling Tips Nutritional Problems for Older People

2010-01-22T11:08:00.000-08:00

Every Day Practice

2010-01-17T11:13:00.000-08:00

"He who has health has hope, and he who has hope has everything." (-Arabian Proverb)

1. Move More
Make it a daily challenge to find ways to move your body. Climb stairs if given a choice between that and escalators or elevators. Walk your dog; chase your kids; toss balls with friends, mow the lawn. Anything that moves your limbs is not only a fitness tool, it's a stress buster. Think 'move' in small increments of time. It doesn't have to be an hour in the gym or a 45-minute aerobic dance class or tai chi or kickboxing. But that's great when you're up to it. Meanwhile, move more. Thought for the day: Cha, Cha, Cha…. Then do it!

2. Cut Fat
Avoid the obvious such as fried foods, burgers and other fatty meats (i.e. pork, bacon, ham, salami, ribs and sausage). Dairy products such as cheese, cottage cheese, milk and cream should be eaten in low fat versions. Nuts and sandwich meats, mayonnaise, margarine, butter and sauces should be eaten in limited amounts. Most are available in lower fat versions such as substitute butter, fat free cheeses and mayonnaise. Thought for the day: Lean, mean, fat-burning machine…. Then be one!

3. Quit Smoking
The jury is definitely in on this verdict. Ever since 1960 when the Surgeon General announced that smoking was harmful to your health, Americans have been reducing their use of tobacco products that kill. Just recently, we've seen a surge in smoking in adolescents and teens. Could it be the Hollywood influence? It seems the stars in every movie of late smoke cigarettes. Beware. Warn your children of the false romance or 'tough guy' stance of Hollywood smokers. Thought for the day: Give up just one cigarette…. the next one.

4. Reduce Stress
Easier said than done, stress busters come in many forms. Some techniques recommended by experts are to think positive thoughts. Spend 30 minutes a day doing something you like. (i.e.,Soak in a hot tub; walk on the beach or in a park; read a good book; visit a friend; play with your dog; listen to soothing music; watch a funny movie. Get a massage, a facial or a haircut. Meditate. Count to ten before losing your temper or getting aggravated. Avoid difficult people when possible. Thought for the day: When seeing red, think pink clouds….then float on them.

5. Protect Yourself from Pollution
If you can't live in a smog-free environment, at least avoid smoke-filled rooms, high traffic areas, breathing in highway fumes and exercising near busy thoroughfares. Exercise outside when the smog rating is low. Exercise indoors in air conditioning when air quality is good. Plant lots of shrubbery in your yard. It's a good pollution and dirt from the street deterrent. Thought for the day: 'Smoke gets in your eyes'…and your mouth, and your nose and your lungs as do pollutants….hum the tune daily.

6. Wear Your Seat Belt
Statistics show that seat belts add to longevity and help alleviate potential injuries in car crashes. Thought for the day: Buckle down and buckle up.

7. Floss Your Teeth
Recent studies make a direct connection between longevity and teeth flossing. Nobody knows exactly why. Perhaps it's because people who floss tend to be more health conscious than people who don't? Thought for the day: Floss and be your body's boss.

8. Avoid Excessive Drinking
While recent studies show a glass of wine or one drink a day (two for men) can help protect against heart disease, more than that can cause other health problems such as liver and kidney disease and cancer. Thought for the day: A jug of wine should last a long time.

9. Keep a Positive Mental Outlook
There's a definitive connection between living well and healthfully and having a cheerful outlook on life. Thought for the day: You can't be unhappy when you're smiling or singing.

10. Choose Your Parents Well
The link between genetics and health is a powerful one. But just because one or both of your parents died young in ill health doesn't mean you cannot counteract the genetic pool handed you. Thought for the day: Follow these basic tips for healthy living and you can better control your own destiny.

The Role Of Protein As A Fat Burner

2010-01-16T11:44:00.000-08:00

Scientific studies have recently been conducted to verify the fact that if you eat more protein, especially during a lowered calorie diet, you will wind up losing less muscle tissue than those who don't. It should be pointed out here that the number one thing to remember when losing weight with any method, is to make sure you don't lose too much muscle mass. Muscles increase the metabolism greatly which means if we lose enough of it, our metabolism can drop sharply.

Muscles burn fat because they need calories for maintenance. So the more muscle you have, the more calories you will burn daily. People who go on starvation diets lose large amounts of muscle tissue. When these people return to normal eating habits, their metabolism will actually work slower from the lost muscle mass. They will tend to put on even more weight than they initially lost from dieting and losing weight becomes even harder and frustrating.

Protein is a word that literally means "of prime importance". It is an essential nutrient that is used to build the body, especially the muscles. It's also used to build organs, hair, hormones, nails and many more body parts. The human body cannot operate or survive without adequate protein. People who tend to have issues with their weight were found to eat much less protein than needed. Your protein needs will be much higher if you regularly engange in exercise or are very mentally active.

Protein is such a useful tool for weight loss in many ways, one of them being for it's thermic value. Of all the food types, protein has the highest thermic value which means that it is the hardest to digest and uses up more calories in the process. Taking longer to digest, it will leave you feeling satisfied for a longer period of time. It also doesn't cause your blood sugar level to spike too quickly.

An important aspect of protein is that it's made up of what's called amino acids. There are actually 12 essential amino acids that the body is unable to produce by itself and has to acquire them from external food sources. The majority of people are deficient in certain amino acids. This is either because they simply don't consume enough, or that they don't eat foods that have high quality protein within them that the body can easily assimilate. Eggs and yogurt contain protein of high biological value. What this means is that we can use this type of protein much easier than other types. Another good source is whey protein powder.

If the foods that you eat regularly are low in nutrients and amino acids, your body will be hungry more often. This is because it needs to eat a lot to get those nutrients that it needs. If on the other hand, you started to eat nutrient-dense foods, the body will need less food and only need food when it needs calories for energy. This is actually one of the biggest reasons why people fail on crash or fad types of diets. They feel intense hunger when depriving their body from what it really needs.

It needs to be mentioned here that when cook protein, parts of it actually get transformed and destroys certain key amino acids. Protein is sensitive to heat, so it is a good idea to add a few raw protein sources to your current diet. These could include seeds, yogurt, nuts, fruit, some vegetables, whey and cheese that have not been cooked. This will provide you with all 12 of those essential amino acids that the body craves. It can then produce the other acids from the initial 12.

To also help preserve the muscle tissue in the body, you can do more exercise or weight training. If your body needs it's muscle for frequent motion, it will tend not to use them as fuel. It will begin using stores of fat to feed the muscles and cells in the body.

Potassium - Importance

2010-01-14T06:55:00.000-08:00

A serving of banana a day, keeps you from a doctor away. Ever wondered why it earns this recognition. Banana is considered as one of the richest source of Potassium.

What Is Potassium?

Potassium is one of the essential minerals. The greater portions are found in our bones, while the smaller quantity of it, can be found inside our body cells. It serves as a sentinel of the body water inside the cells.

However, a smaller quantity of Potassium can also be found outside the cells, which is crucial on the activity of the muscles specifically the heart muscles. Small variations of Potassium levels in the body can signals change in the Electrocardiogram (ECG). ECG is a test that records the electrical activity of the heart.

In addition, Potassium is necessary in water and acid base balance of the body, aids in the conversion of glucose to glycogen (the storage form of glucose that will be used up if the body needs it such as in fasting), serves as a catalyst to many enzymes that is needed for body processes. In other words, Potassium is vital to many important chemical processes that the lack or excess of it creates disturbance in our system.

Potassium Requirement

Based on our recommended energy and nutrient intake, an adult needs about 1600mg to 2000mg of Potassium. This is the safe level of our body to maintain homeostasis or balance.

Food Sources of Potassium
Potassium is widely distributed in natural foods. A serving of a medium size of banana contains about 490mg of Potassium. Among the many rich sources of Potassium are legumes, whole grains, oranges, avocado, broccoli and green leafy vegetables.

Potassium Alert
Though Potassium is necessary, precautions must be taken care of, especially for those who are taking medications which leads to excretion of Potassium such as diuretics. This can lead to a condition called hypokalemia, (Low levels of Potassium in the blood).

It is imperative to consult the doctor if you are taking medications for the heart and kidney problems.

The Lack and Excess of Potassium

Hypokalemia is a condition with low levels of Potassium in the blood. The normal level of Potassium in the body is 3.5-5.5 mEq/L; this condition needs immediate medical intervention. Any condition that leads to lowering of Potassium levels in the body should be closely watched such as diabetic ketoacidosis, renal problems, and Cushings Syndrome (hormonal problems). Among the earliest signs of Potassium deficiency are muscle weakness, fatigue, confusion, hypertension and depression.

Hyperkalemia is a disorder with a Potassium level greater than 5.5 mEq/L has been linked to kidney problems. Symptoms of hyperkalemia include malaise (body weakness), palpitations and mild hyperventilation.

These are the basic facts that everyone needs to know. Potassium is essential for our bodily processes, but careful monitoring of Potassium rich foods must also be observed to prevent disturbance that can lead to abnormal rhythm of the heart which would eventually cause cardiac arrest and death.

Thus, the adage of a banana a day, will keep us healthier each day is true.

Scalp Acne Treatment

2010-01-06T11:42:00.000-08:00

Scalp acne treatment is very difficult, specially if there are other existing scalp problems such as dandruff and a very oily scalp.Acne is a skin problem that affects almost all individuals in their puberty stages. Some people even experience acne outbreaks later in their 40s and 50s. Nearly all of us have a fair idea regarding the different types of acne and their causes. And the main reason for developing acne is blockage of the sebaceous gland, which over a period of time gets accumulated with oils and skin debris. Eventually, the acne affected areas become inflamed and infected, resulting in various displeasing symptoms.

The worrying fact is that acne can erupt in any part of the body, including the face, neck, chest, back and scalp. Even though outbreak of this skin problem on the face or any other location is unsightly and difficult to treat, scalp acne is one of the least curable skin conditions. In short, scalp acne treatment differs from the therapeutic approaches for other types of acne. Based on whether acne on the scalp is mild (scalp folliculitis) or severe (necrotica miliaris), you can practice certain methods for scalp acne cure.

Treatment for Scalp Acne

Acne on scalp and hairline are triggered by factors like oily skin, irregular shampooing, poor scalp hygiene and prolonged stress. If scalp acne is left untreated, there is a high risk that the area gets infected with bacteria and yeast. The condition is even more worse in people who have dandruff and a naturally dry or oily scalp. For treating scalp acne, home remedy should be tried first. Some of the natural methods for treating acne on the hairline and scalp are discussed below:

Cleaning Scalp: Keeping the itchy scalp clean, aids in fast healing of the acne condition. You can make use of a formulation that contains salicylic acid as one of its ingredients. Do not irritate the scalp while cleaning, as it can worsen the acne problem. Rather, you can use a cotton ball for gentle application of the scalp cleaning product.

Using Correct Shampoo: As per hair experts, irregular shampooing and using a poor quality shampoo is the leading cause for pimples on scalp. Taking a note of this point, scalp acne treatment includes a regular head bath with a mild and healing shampoo. You can always consult a hair expert for tips on reliable shampoo brands for scalp acne treatment.

Avoid Conditioners: Maximum brands of hair conditioners are formulated with humectants that aid in keeping the hair moist and soft. Hence, an individual with acne on scalp should refrain from using conditioners until the acne disappears completely. But, for people with dandruff and scalp acne problems, an anti-dandruff shampoo with conditioner can be used on a regular basis to avoid excess drying of the scalp.

Prescription Medicine: In case of serious scalp acne that has a high risk of infection, prescription antibiotics and steroids are used for acne treatment. Depending upon the severity and patient's health; topical ointments, oral tablets or both may be recommended for fast and effective acne scalp treatment. Make sure that you avoid products with benzoyl peroxide, as it can alter the original hair shade.

This was a brief overview on how to get rid of scalp acne. As we have seen, scalp acne treatment is primarily focused on keeping the scalp clean and free of debris, which are triggering factors for acne development. Using soda water and white vinegar to rinse hair also helps in getting rid of acne on the scalp. Coming to the prevention measures of scalp acne, you can do so by minimizing the use of oily hair styling and hair care products. Instead rely on natural hair products to avoid the onset of scalp acne.

Scalp acne is one of the many places that area wreaks havocs on people all over the world. This article will discuss the most common scalp acne causes and treatment options available.

Scalp acne is a relatively new form of acne condition that just appears on the scalp. Interestingly enough, scalp acne is caused as a result of the same factors and triggers as acne that occurs on other parts of the body.

Generally speaking, scalp acne's dermatological term is scalp folliculitis. Scalp folliculitis is inflammation of the scalp's hair follicles. Another common term for scalp acne is acne necrotica miliaris and proprionibacterium acne folliculitis.

Scalp acne looks similar to other forms of acne with small pustules occurring throughout the individual's scalp. Unfortunately scalp acne is incredibly itchy and is particularly prevalent in the front of the hairline where it is also most noticeable.

Scalp acne also varies in severity from just a few scalp acne lesions to more severe acne. As a result of its placement on the scalp it is also very hard to not scratch at the pustules. As a result scalp acne can become extremely painful and take on a crusty, unattractive appearance.

Scalp acne does not clear up quickly. It can take around four weeks for it to clear up sufficiently. Scalp acne is known to develop when an individual is stressed and when the scalp is very oily. Perhaps not surprisingly, research has also confirmed that scalp acne can appear if a person doesn't wash their hair often enough or when using too oily hair products.

How To Treat Scalp Acne

One of the best ways to treat scalp acne is to use a mild normal shampoo to wash the scalp. An anti-dandruff shampoo should be avoided as it is too harsh. However, there is no problem in using a conditioner after washing your hair.

As well as using gentle hair products there are also a number of scalp acne products available for this sole purpose. These scalp acne products include clindamycin solution, erythromycin solution and other antibiotics applied directly to the scalp.

The most severe form of scalp acne is acne necrotica and is characterized by very large and unfortunately noticeable follicular spots or papules that have been inflamed. Scalp acne, if left untreated, can form a black crust and leave permanent and very unattractive scars. This severe scalp acne is not limited to the scalp and can pass to other parts of the face also.

Dandruff Treatment for Guys

2009-12-31T10:19:00.000-08:00

Dandruff is the most common problem like acne is. It is more prone to victimize men though because they have relatively dry skin tone and they are more likely to get affected by the environmental conditions than women do. Dandruff is caused by the problem of self-flake shedding of the skin. Generally, it is believed that people who have rough and dry scalp get this sort of condition but this can also be a consequence of excess oily and wet skin. When we talk about getting rid of dandruff, we are not only dealing with the range of shampoos and conditioners here, there can be a lot of things that can be done for the solution. You can get the same respective results from cheap methods rather than going for expensive cosmetic procedures and methods.

Home remedies for dandruff are plenty and there is a long list of things you can apply to get rid of the itchy flakes.

You can consider using tea tree oil as a remedy or as a suitable dandruff treatment for men. Although the product is taken to be really ordinary but it can do wonders for you; there is no confliction about this statement at all. You would find the most positive outcomes and notice that your hair fall and dandruff both would be reduced with the passage of time. Tea tree oil has a property, which is anti-fungus. It is perfect for the dandruff treatment because it can be mixed with a variety of different lotions creams and formulas to get the results. You can apply it with the shampoo that you are using or 15 to 20 minutes before taking a shower.

You might have also heard about the coneflower oil for the removal of dandruff because it is relatively popular among numerous ingredients of the dandruff free shampoos and conditioners. Similarly, you can use red clover extracts over your head scalp that is usually known as "scalp remedy" in the market. The product is effective and perfect in terms of quality and comprehension.

People also consider vinegar for the reduction of dandruff problem because of its acidic nature. Grape vine is ought to work on the extreme conditions and it is also supposed to act smoothly over the scalp. You can simply rinse your scalp with it before you take a shower.

I have discussed several dandruff treatments for men, now its up to you to decide which is the most appropriate and the suitable one.

A Practical and Comprehensive Guide for Parents

2009-12-27T14:28:00.000-08:00

Skin

Babies' skin just isn't as smooth and clear as the advertisements say it is. Almost every baby develops a fine pink or red rash whenever the skin is irritated by rubbing on bedclothes, by spitting up, or by very hot weather. Almost all of these fine pink rashes will go away promptly if the skin is bathed with clean water whenever it is dirty, and washed with mild soap once a day.

Many babies develop waxy scabs on the scalp and forehead, called "cradle cap" or "seborrhea." Daily scrubbing with mild soap and a wash cloth will usually keep this under control.

Small, red, blotchy "birthmarks" on the eyelids and back of the neck are so common that they are called "stork bites." They usually show up when the baby is between 1 and 4 weeks old. They go away by themselves after a year or so, and cause no trouble of any kind. There is nothing to do but wait.

Bright red raised "strawberry marks" are also quite common. They appear after one or two months, grow rapidly for a few months, stop growing and gradually disappear. Unless your baby has one that is particularly large or in a spot where it is constantly being irritated, it is best to let it go away by itself.

Large areas of pale blue discoloration, called "mongolianspots" are common, especially on the trunk of dark skinned infants. They become less obvious as the child grows older and have no importance.

Diaper Rash—Urine and bowel movements are irritating to the skin, especially when they stay in contact with the skin for a long time.

Prevent diaper rash by changing diapers frequently, by rinsing the diaper area with clean water at each diaper change, by rinsing diapers thoroughly after washing, and by applying a layer of zinc oxide paste (you can buy it at any drug store) to any irritated area.

If your baby gets a diaper rash in spite of this, you should:

* Leave off the plastic pants (or plastic covered disposable diapers) except when absolutely necessary. Using 2 or more cloth diapers at nap time and at night will make this less messy.
* Leave the diaper area completely uncovered for a few hours each day (nap time or early evening is most convenient); put a couple of diapers under the baby to prevent soiling.
* Apply a thin layer of zinc oxide paste to any irritated area after cleansing at each diaper change.

When to Worry—Any pimple or rash that gets bright red and enlarges, or that develops blisters or pus, may be the beginning of an infection that will need medical care. You can soak such a rash with a washcloth or towel wrung out in warm water, and keep it clean by washing with mild soap and water twice a day. If it gets worse, or if it doesn't get better in 24 to 48 hours, you should get medical advice.

Any rash that looks like bleeding or bruising in the skin should be seen by a doctor promptly (unless you know it really is a group of bruises).

Legs and Feet

Most babies' legs and feet don't look "normal" until the child has been walking for several years! The feet seem to turn in or out in the first year of life. By age 12 to 18 months the legs look bowed.

Almost all of these funny-looking feet and legs are perfectly normal and will gradually straighten out as babies run, play and climb. If you can move the foot easily into a "normal" looking position, and if the foot moves freely when the baby kicks and struggles, it is almost certainly a normal foot that developed a bend or twist while the baby was sitting on it during your pregnancy.

You won't cause bowed legs by pulling your baby into a standing position or letting your baby walk or stand "too early." Also, babies won't walk any sooner by being placed in a walker—which usually isn't much fun for babies anyway.

Umbilical Hernia—Swollen Navel

About one-fourth of all babies develop a swelling at the navel. This usually grows rapidly for several months, then grows with the baby for several months, then gets smaller and disappears. Large hernias may not go away until the child is 4 to 6 years old. The bulge often gets tight or tense when the baby cries or coughs.

Since these hernias almost always go away if they are left alone for long enough, there is no reason to have them repaired by surgery. They almost never cause any kind of trouble or pain. Occasionally a 4- to 6-year-old child may be embarrassed by a particularly large hernia, and it can be repaired at that time. By waiting, you will almost certainly save your baby an unpleasant and unnecessary operation.

Genitals

The boy's penis and scrotum and the girl's clitoris and labia are usually rather large at birth. They get slightly smaller over the next few weeks.

A girl may have a slight white creamy discharge from her vagina in the first few weeks, which is normal. It should become less and less and should not irritate the skin. Get medical advice if it becomes worse or if she develops a discharge after the first week or two. Any bulge or lump in a girl's genitals should be checked by a doctor.

One or both of a boy's testicles may seem particularly large, and be surrounded by a water sac or "hydrocele." Hydroceles are painless, cause no harm and go away without treatment, usually within a few months. Seek medical care for any swelling in the groin, and seek medical care immediately for any painful swelling in the groin or testicles.

If you want your boy circumcised, have it done while you are still in the hospital. It is not necessary, and it should almost never be done as a special operation once you and he have left the hospital (except for religious circumcisions).

A circumcision should heal completely within a week to 10 days. The tip of a circumcised boy's penis may become irritated by the diaper. Put a little vaseline or zinc oxide paste on the irritated area each time you change the diaper.

If your boy is not circumcised, don't try to pull the skin back over the tip of the penis. It will hurt and irritate. As he grows the skin will gradually loosen until it will pull back with ease (it sometimes takes as long as 3 or 4 years).

Sucking

Most babies get their thumbs and fingers in their mouths and suck on them. Many seem to find it especially enjoyable and do it often. It causes no harm and can be ignored.

Some parents don't like the looks of thumb and finger sucking and substitute a pacifier for the thumb. This also is fine and the pacifier can be thrown away toward the end of the first year. But don't substitute the pacifier for the attention, food or diaper changes that your baby wants and needs when he or she is crying! And don't use a bottle of formula or juice as a pacifier!

Crossed Eyes

When awake and alert, your baby's eyes should look straight at you. One may turn in or out slightly when your baby is particularly tired, but both eyes should work together almost all of the time. If not, seek medical advice at your baby's next checkup. Don't be fooled by a wide nose which may make the eyes look as if they are turning in.

Very Frequent Urination

Most babies urinate nearly every hour until they are 2 or 3 months old, every 2 or 3 hours for the rest of the first year, and will sometimes urinate 2 or 3 times in a very short period. However, you should tell the doctor at the next checkup:

* If your young baby never seems to go more than one-half hour without urinating;
* If your older baby seldom goes more than an hour without urinating;
* If your baby strains hard to urinate; or
* If urine always comes out in a weak trickle or very fine tight stream.

Colds

Many babies have a slightly stuffy, rattly noise in their noses nearly all the time. This is not a cold; it just seems to be the way they are made. It will become less and less noisy and noticeable as your baby gets older and the air passages of the nose get larger. Your baby will also learn to clear the nose by sniffling. Don't use cold remedies for such a baby. You may be able to reduce the noise by sucking out the nose several times a day with a small rubber bulb called a nasal syringe.

Most babies will have 2 or 3 real colds in the first year and a perfectly normal baby may have 8 or 9. During colds, most babies become a little fussy and lose part of their normal appetite. Their noses run with clear watery material, which becomes thick and sticky in a few days. Their eyes may get red; they may cough and make a lot of noise when they breathe. They may have fever. The whole thing may last only 4 or 5 days or as long as 2 or 3 weeks, and a cough may take 4 or 5 weeks to disappear completely.

Neither you nor your doctor can do much about it except keep your baby as comfortable as possible. If your baby seems uncomfortable with aches and pains, give half a baby aspirin 3 or 4 times a day. Use the nasal syringe to clear the nose when stuffiness causes discomfort.

When You Should Worry—If your baby seems very weak and sick, has no energy to even cry loudly, nurses poorly, doesn't want over half of the usual bottle, doesn't wake up to be playful for even a short time—then you should seek medical care quickly.

How sick your baby acts tells much more about how serious the illness might be than anything else. If your baby has a high fever and a cough, but takes some of the bottle eagerly and wants to play, you don't have to worry. But if your baby is listless; weak; uninterested in attention, play or the bottle; you should get medical advice.

If your baby has labored breathing, you should get medical care promptly—day or night. Labored breathing means working so hard at breathing—getting the air in and out—that there is no energy left for anything else, even for nursing or for playing. Making a lot of noise breathing is not important, but having to work very hard to breathe is!

If your infant cries or moans as if in pain for several hours during a cold, you should get this checked by a doctor. If he or she is just fussy and goes to sleep after you give comfort and/or half a baby aspirin, you need not worry. But painful cries should not be ignored.

You will probably want to check with a doctor the first few times your baby has a bad cold, but you will soon learn what to expect with colds and how to treat them.

You really can't do much to prevent colds. Colds are most contagious—most easily passed from one person to another—during the few days before the signs of a cold appear. Once you have had a cold for a day or two, you are unlikely to give it to someone else. So keeping your baby away from people with signs of a cold will not help much.

Fever

Fever is the body's natural response to many infections. If your baby has a fever, there is something wrong. But how high the fever is doesn't tell you anything about how serious the sickness is. If an infant with a high fever is playful and cheerful, the sickness is not likely to be serious and you need not worry. A child with only a slight fever or no fever who appears to be sick and weak needs medical attention. Fever should warn you to watch carefully, but it doesn't tell you how sick your child may be.

Many babies will have a fever with every cold. Many have a fever for a day or two with no other signs of illness except tiredness and fussiness.

Most of the time an infant with a fever needs no special treatment. Give plenty to drink and take off any extra sweaters or blankets. If your baby seems uncomfortable or particularly jittery, give one-half a baby aspirin every 6 hours if your child is 3 to 8 months old. Give one-half a baby aspirin every 4 hours if your baby is 9 to 18 months old. Aspirin will reduce the fever, but fever itself does no harm. Use aspirin for pain and discomfort. Leave the fever untreated unless the baby seems uncomfortable.

If your child has a fever you can't explain for 4 or 5 days in a row, you should seek medical advice even if he or she doesn't seem very sick.

Vomiting

Your baby may vomit during a cold or fever—or have an illness which may have vomiting, or vomiting and diarrhea, as its only signs.

When your baby vomits, don't give anything to eat or drink for one hour. Then give one-half ounce of cold sweet juice, tea with sugar or soft drink. Repeat this half-ounce feeding every 10 or 15 minutes for an hour. Give 1-ounce feedings every 10 or 15 minutes for the next hour, and 2-ounce feedings as often as your baby wants them for the following hour. If there is no more vomiting, it is now safe to give small amounts of cereal, formula, crackers or toast. But don't give more than 2 ounces to drink at one time until there has been no vomiting for 6 hours.

If vomiting occurs after you start this routine, wait one hour and start again at the beginning with half-ounce feedings.

If your infant continues to vomit for more than one day or seems very sick and weak, you should get medical advice.

Care of a Sick Child

Don't worry if a sick child doesn't want to eat, but be sure to give plenty to drink. If there is a fever or diarrhea, your baby may be particularly thirsty. Give only the usual amount of milk and offer water, juice or soft drinks in between.

Let your baby decide how much exercise and sleep are needed. Babies who want to be up and playing can be allowed to do so. Babies who are sick enough to need extra rest will soon lie down and fall asleep by themselves. Better a happy child playing quietly than a child screaming in the crib because someone said, "Your baby's sick and should be kept in bed."

Try to keep your baby comfortable. This often means fewer blankets and clothes rather than more, especially for a child with a fever. There is nothing wrong with outdoor air or with automobile trips—provided your baby is comfortably dressed and allowed to rest when necessary.

Hepatitis Delta - Global Alert and Response

2009-12-26T11:48:00.001-08:00

Hepatitis is a general term meaning inflammation of the liver and can be caused by a variety of different viruses such as hepatitis A, B, C, D and E. Since the development of jaundice is a characteristic feature of liver disease, a correct diagnosis can only be made by testing patients' sera for the presence of specific antigens and anti-viral antibodies.

In 1977, a previously unrecognized nuclear antigen was detected in hepatocytes of patients with chronic hepatitis B. The antigen resembled hepatitis B core antigen (HBcAg) in its subcellular localization. Its presence was always associated with hepatitis B virus (HBV) infection, but it rarely coexisted with HBcAg. It was termed "delta antigen". Patients with delta antigen develop anti-delta antibodies.

In 1980, the delta antigen was recognized to be the component of a novel virus that was defective and required coinfection with HBV for its replication. The hepatitis delta virus (HDV) was shown to rely on HBV for transmission because it used the hepatitis B surface antigen (HBsAg) as its own virion coat.

The viruslike delta agent was subsequently shown to be associated with the most severe forms of acute and chronic hepatitis in many HBsAg-positive patients. The disease it caused was designated delta or type D hepatitis.

What causes the disease?

Hepatitis D or delta hepatitis is caused by the hepatitis delta virus (HDV), a defective RNA virus. HDV requires the help of a hepadnavirus like hepatitis B virus (HBV) for its own replication.

How is HDV spread?

HDV is transmitted percutaneously or sexually through contact with infected blood or blood products.

Blood is potentially infectious during all phases of active hepatitis D infection. Peak infectivity probably occurs just before the onset of acute disease.

Who is at risk for infection?

Chronic HBV carriers are at risk for infection with HDV.

Individuals who are not infected with HBV, and have not been immunized against HBV, are at risk of infection with HBV with simultaneous or subsequent infection with HDV.

Since HDV absolutely requires the support of a hepadnavirus for its own replication, inoculation with HDV in the absence of HBV will not cause hepatitis D. Alone, the viral genome indeed replicates in a helper-independent manner, but virus particles are not released.

Where is HDV a problem globally?

The hepatitis delta virus is present worldwide and in all age groups.

Its distribution parallels that of HBV infection, although with different prevalence rates (highest in parts of Russia, Romania, Southern Italy and the Mediterranean countries, Africa and South America). In some HBV-prevalent countries such as China, HDV infection is disproportionately low.

The natural reservoir is man, but HDV can be experimentally transmitted to chimpanzees and woodchucks that are infected with HBV and woodchuck hepatitis virus, respectively.

When is a HDV infection life-threatening?

HDV infection of chronically infected HBV-carriers may lead to fulminant acute hepatitis or severe chronic active hepatitis, often progressing to cirrhosis.

Chronic hepatitis D may also lead to the development of hepatocellular carcinoma.

Why is there no treatment for the disease?

Hepatitis D is a viral disease, and as such, antibiotics are of no value in the treatment of the infection.

There is no hyperimmune D globulin available for pre- or postexposure prophylaxis.

Disease conditions may occasionally improve with administration of a-interferon.

Since no effective antiviral therapy is currently available for treatment of type D hepatitis, liver transplantation may be considered for cases of fulminant acute and end-stage chronic hepatitis D.

The genome of HDV is unrelated to the genomes of hepadnaviruses, of which hepatitis B virus (HBV) is a member. HDV is therefore not a defective-interfering particle of HBV, and should be considered as a satellite virus, a natural subviral satellite of HBV.

Important parallels can be drawn between HDV and certain subviral agents of plants, especially the viroids, with respect to genome structure and replication mechanisms. Because of the many differences however, HDV has been classified into the separate genus Deltavirus.

The genome of HDV was cloned and sequenced in 1986.27 HDV is a replication defective, helper (HBV) dependent ssRNA virus that requires the surface antigen of HBV (HBsAg) for the encapsidation of its own genome. The envelope proteins on the outer surface of HDV are entirely provided by HBV.

The outer envelope of HDV particles actually contains lipid and all three forms (S, M, and L) of HBV surface antigen (HBsAg), but predominantly the major form of HBsAg with very few middle (pre S1) and large (pre S2) proteins. This proportion (95:5:1 of S:M:L) is different from that found in HBV particles.

There is no evidence that the HBV-derived envelope proteins are additionally modified when they become the envelope of HDV.

The internal, nucleocapsid structure of HDV is composed of the viral single stranded RNA genome and about 60 copies of delta antigen, the only HDV-encoded protein, in its large and small forms.

Synthesis of HDV results in temporary suppression of synthesis of HBV components.13

HDV does not infect established tissue culture cell lines. Complete viral replication cycles in vitro are limited to primary hepatocytes, generally of woodchucks or chimpanzees, that are coinfected with a hepadnavirus or cotransfected with hepadnavirus cDNA. When experimental conditions meet these requirements, infectious HDV particles are produced.

In nature, HDV has only been found in humans infected with HBV. Experimentally, it can be transmitted to chimpanzees and woodchucks in the presence of HBV or woodchuck hepatitis virus (WHV), respectively.

Morphology and physicochemical properties
HDV virions are 36 - 43 nm, roughly spherical, enveloped particles with no distinct nucleocapsid structure. They do not have distinct spikes on their outer surface and are possibly icosahedral.

When the virus particle is disrupted with nonionic detergents, an internal nucleocapsid is released and HDAg becomes detectable.

The 19 nm nucleocapsid contains about 60 copies of HDAg in its two forms (24 and 27 kDa) and HDV genomic RNA.25

The buoyant density of HDV particles is 1.25 g/cm3 in CsCl gradients.

Genome and proteins
The HDV genome is a single, negative stranded, circular RNA molecule nearly
1.7 kb in length containing about 60% C+G.13, 14, 18, 25

HDV RNA is the only animal virus known to have a circular RNA genome.13

A high degree of intramolecular complementarity allows about 70% of the nucleotides to be basepaired to each other to form an unbranched, double-stranded, stable, rod-shaped structure.

So far, about 14 different HDV isolates from different parts of the world have been sequenced, and all range from 1670 to 1685 nucleotides in length. Based on sequence similarities, HDV isolates can be classified into three genotypes.

Genotype I is the most predominant one in most areas of the world, and is associated with a broad spectrum of chronic HDV disease. Originally found in a Japanese isolate, genotype II has been found recently to predominate in Taiwan. Disease associated with genotype II might be less severe than genotype I. Genotype III is associated with outbreaks in Venezuela and Peru. It is responsible for more severe disease in the northern South American regions.

The genome contains several sense- and antisense open reading frames (ORFs), only one of which is functional and conserved. The RNA genome is replicated through an RNA intermediate, the antigenome.

The genomic RNA and its complement, the antigenome, can function as ribozymes to carry out self-cleavage and self-ligation reactions.

A third RNA present in the infected cell, also complementary to the genome, but 800 b long and polyadenylated, is the mRNA for the synthesis of the delta antigen (HDAg).

The one and only protein expressed by HDV, the hepatitis delta antigen HDAg, is not exposed on the virion outer surface, but is present in the internal nucleocapsid.

The protein is seen as two species, of 24kD and 27kD. The two species are identical, but the 27kD protein has a 19 aa longer C-terminus. The short form (195 amino acids, HDAg-S), synthesized first, is required for RNA replication; the long form (214 amino acids, HDAg-L), becoming detectable after prolonged replication, suppresses viral RNA replication and is required for packaging of the HDV genome by HBsAg.

The relative ratios of these two species vary from patient to patient. Two separate ORFs on different RNAs encode HDAg-S and HDAg-L. A single nucleotide at the termination codon for HDAg-S is altered by a specific posttranscriptional RNA editing event in some RNAs, so that the ORF extends for 19 additional amino acids.13

HDAg is a non-glycosylated phosphoprotein. It has an RNA-binding activity and appears to bind specifically to HDV RNA in the virus particle. In infected cells, HDAg is localized in the nuclei.

Functional domains present in HDAg include the nuclear localization signal located within the N-terminal one-third of the protein, the RNA-binding motif present in the middle one-third of the protein and a third domain, consisting of the C-terminal 19 amino acids, possibly involved in interactions with the HBsAg during virion assembly, and in the inhibition of HDV RNA assembly.

The other protein present in HDV particles is HBsAg. This protein is derived from the coinfection with HBV and is essential for HDV virion assembly and virus transmission.

Antigenicity

The intact virus particle is reactive with anti-HBsAg antibody, but not with anti-HDAg antibody.

Despite the sequence heterogeneity observed in HDV isolates from different geographical regions, there appear to be no serological differences among these isolates.

All HDV are antigenically related, and antibodies to HDAg do not neutralize HDV.

Surface epitopes unique to HDV have not been detected.

Under experimental conditions, HDV can use different hepadnaviruses as helpers. In each case, the envelope of HDV has both the physical and antigenic characteristic of the helper virus.

Stability
Because of its double-strandedness, the HDV RNA is relatively stable.

The hepatitis delta virus survives dry heat at 60°C for 30h.
Hepatitis Delta virus replication cycle
To replicate efficiently, a virus requires the cooperation of the host cell at all stages of the replicative cycle: attachment, penetration, uncoating, provision of appropriate metabolic conditions for the synthesis of viral macromolecules, the final assembly of viral subunits and the release of new virions. HDV also requires the presence of a helper hepadnavirus to provide the protein components for its own envelope.

How HDV enters hepatocytes is still not known, but it may involve the interaction between HBsAg-L and a cellular receptor. The incoming HDV RNA is then transported into the nucleus, the site of genome replication, probably by the small form of delta antigen, HDAg-S. Binding of HDAg to RNA also protects the HDV RNAs from degradation.

HDV RNA replication is carried out by cellular RNA polymerase II, without a DNA intermediate, and without the help of HBV. Replication proceeds via a double rolling-circle model. The genomic strand which is of negative polarity yields an oligomeric linear structure with site-specific autocatalytic cleavage and ligation. This structure generates circles of the opposite positive strand polarity, which again replicate in the same way and produce the genomic negative RNA. The only functional open reading frame which codes for the two HDV structural phosphoproteins occurs in the antigenomic strand at one end of the HDV RNA rod. It is 800 bases long and terminates at a polyadenylation site.

RNA transcription is regulated: initially, mRNA(s) is(are) transcribed from the incoming minus-strand genome and later, after the translation of the mRNA to make essential replication proteins, there is a switch in the mode of RNA-directed RNA synthesis to facilitate replication of the RNA genome.

Translation of the 800 b RNA transcript yields a small and a large form of HDAg. These two proteins, known as short (HDAg-S) and long form (HDAg-L) of HDAg, have very different functional roles during viral replication. The HDAg-S is a transactivator of HDV RNA replication, while the HDAg-L inhibits RNA synthesis and initiates virion assembly with HBsAg.

The production of HDAg-S, as opposed to HDAg-L, depends on the extent of HDV RNA editing. A specific modification at nucleotide position 1012 from A to G changes the UAG stop codon of the transcript to UGG (tryptophan), allowing translation to continue for another 19 amino acids. The target of editing is the antigenomic strand; the adenosine is converted to guanosine via inosine by a cellular double-stranded RNA adenosine deaminase. The intracellular ratio of p24/p27 will determine the extent of viral replication, assembly and transport.

Since HDV particles consist of HBsAg, HDAg-S and HDAg-L, and RNA, they are assembled only in the presence of the helper virus, HBV. HBsAg and HDAg-L are necessary and sufficient for virus assembly, whereas HDV RNA or HDAg-S are not required, but are certainly present, in viral particles.25 The basis of selectivity of RNA packaging in vivo is not yet clear, and although HDAg can interact with both genomic- and antigenomic-sense HDV RNA, only genomic-sense RNA is found in viral particles.

The primary initiation event for HDV assembly is the interaction of HDAg-L with HBsAg, which is determined by the presence of the C-terminal 19 amino acids of HDAg-L and the prenylation of the cystein residue 211 on HDAg-L.9, 25 However, HDAg is localized in the nuclei, and HBsAg is present in the cytoplasm of the infected cells. How these two proteins in different cellular compartments come into direct contact remains a puzzling issue.

A speculation is that the genomic RNA, assembled into a ribonucleoprotein (RNP) involving both HDAg-S and HDAg-L, interacts with HBsAg already inserted in the membranes of the endoplasmic reticulum. This would then be followed by the passage of assembled particles onto the Golgi apparatus, and the release of virions from the cell, without direct toxicity.

Genome replication model

Proposed models of HDV RNA transcription and replication. (A) The previously accepted model of HDV RNA transcription and replication. The initial product of replication from the genomic HDV RNA template is the 0.8 kb HDAg-encoding mRNA (arrow 1). HDAg produced from this mRNA suppresses the HDV polyadenylation signal, allowing synthesis of multimeric RNA (arrow 2)., which is processed into full-length antigenomic HDV RNA (arrow 3). Subsequent rounds of replication bypass the polyadenylation signal due to the presence of HDAg and directly synthesize full-length antigenomic HDV RNA (arrow 4). (B) Proposed new model for HDV RNA transcription and replication. The syntheses of 0.8 kb mRNA (a) and 1.7 kb monomer RNA (b) are independent and occur in parallel.

A model for RNA editing of HDV

Reprinted by permission from Nature (Polson AG, et al. RNA editing of hepatitis delta virus antigenome by dsRNA-adenosine deaminase.

A model for RNA editing of HDV. Replication-competent genomes are transcribed to produce an mRNA encoding HDAg-p24. HDAg-24 enables replication of the genome by RNA polymerase II, generating antigenomic RNA. dsRAD (double-stranded-RNA-adenosine deaminase) acts on antigenomic RNA to convert the adenosine at the amber/W site to an inosine. Like G, inosine prefers to pair with C; thus, after replication, the genome has a C at the amber/W site instead of a U. The edited genome is transcribed to yield an mRNA encoding HDAg-p27. HDAg-p27, which contains a 19 amino acid extension (shaded), inhibits replication and helps packaging of the HDV genome by HBV surface antigen.
Schematic representation of viral particles found in serum of HBV - HDV infected people

Infectious HBV particle:

* 42 nm outer envelope containing lipid and three forms of HBsAg
* 27 nm nucleocapsid containing 180 copies of core protein and reverse transcriptase and HBV DNA

Infectious HDV particle:

* 36 - 43 nm outer envelope containing lipid and three forms of HBsAg
* 19 nm nucleocapsid containing 60 copies of delta antigen and HDV genomic RNA

Empty noninfectious particles:

* 22 nm filaments and spheres made of lipid and mainly one form of HBsAg

Schematic representation of viral particles found in serum of HBV - HDV infected people

Infectious HBV particle:

* 42 nm outer envelope containing lipid and three forms of HBsAg
* 27 nm nucleocapsid containing 180 copies of core protein and reverse transcriptase and HBV DNA

Infectious HDV particle:

* 36 - 43 nm outer envelope containing lipid and three forms of HBsAg
* 19 nm nucleocapsid containing 60 copies of delta antigen and HDV genomic RNA

Empty noninfectious particles:

* 22 nm filaments and spheres made of lipid and mainly one form of HBsAg

An HDV infection absolutely requires an associated HBV infection. The outcome of disease largely depends on whether the two viruses infect simultaneously (coinfection), or whether the newly HDV-infected person is a chronically infected HBV carrier (superinfection).

Coinfection of HBV and HDV (simultaneous infection with the two viruses) results in both acute type B and acute type D hepatitis. The incubation period depends on the HBV titre of the infecting inoculum. Depending on the relative titres of HBV and HDV, a single bout or two bouts of hepatitis may be seen. Coinfections of HBV and HDV are usually acute, self-limited infections. The chronic form of hepatitis D is seen in less than 5% of HBV - HDV coinfected patient.

Acute hepatitis D occurs after an incubation period of 3 - 7 weeks, and a preicteric phase begins with symptoms of fatigue, lethargy, anorexia and nausea, lasting usually 3 to 7 days. During this phase, ALT and AST activities become abnormal. The appearance of jaundice is typical at the onset of the icteric phase. Fatigue and nausea persist, clay-colored stools and dark urine appear, and serum bilirubin levels become abnormal. In patients with acute, self-limiting infection, convalescence begins with the disappearance of clinical symptoms. Fatigue may persist for longer periods of time.

Superinfection of HBV and HDV (HDV infection of a chronically infected HBV carrier) causes a generally severe acute hepatitis with short incubation time that leads to chronic type D hepatitis in up to 80% of cases. Superinfection is associated with fulminant acute hepatitis and severe chronic active hepatitis, often progressive to cirrhosis.

During the acute phase of HDV infection, synthesis of both HBsAg and HBV DNA are inhibited until the HDV infection is cleared.

Fulminant viral hepatitis is rare, but still about 10 times more common in hepatitis D than in other types of viral hepatitis. It is characterized by hepatic encephalopathy showing changes in personality, disturbances in sleep, confusion and difficulty concentrating, abnormal behavior, somnolence and coma. The mortality rate of fulminant hepatitis D reaches 80%. Liver transplantation is indicated.

Chronic viral hepatitis D is usually initiated by a clinically apparent acute infection. Symptoms are less severe than in acute hepatitis, and while serum ALT and AST levels are elevated, bilirubin and albumin levels and prothrombin time may be normal. In chronic hepatitis D, the HBV markers are usually suppressed.

Progression to cirrhosis usually takes 5 - 10 yrs, but it can appear 2 years after onset of infection. About 60 to 70% of patients with chronic hepatitis D develop cirrhosis. A high proportion of these patients die of hepatic failure.

Hepatocellular carcinoma (HCC) occurs in chronically infected HDV patients with advanced liver disease with the same frequency as in patients with ordinary hepatitis B. HCC may actually be more a secondary effect of the associated cirrhosis than a direct carcinogenic effect of the virus.

Taken together, three phases of chronic hepatitis D have been proposed: a) an early active phase with active HDV replication and suppression of HBV, b) a second moderately active one with decreasing HDV and reactivating HBV, c) a third late one with development of cirrhosis and hepatocellular carcinoma caused by replication of either virus or with remission resulting from marked reduction of both viruses.10

The mortality rate for HDV infections lies between 2% and 20%, values that are ten times higher than for hepatitis B.21

Diagnosis
Hepatitis D should be considered in any individual who is HBsAg positive or has evidence of recent HBV infection.21

The diagnosis of acute hepatitis D is made after evaluation of serologic tests for the virus. Total anti-HDV are detected by commercially available radioimmunoassay (RIA) or enzyme immunoassay (EIA) kits.

The method of choice for the diagnosis of ongoing HDV infection should be RT-PCR, which can detect 10 to 100 copies of the HDV genome in infected serum.

- acute HBV-HDV coinfection:

* appearence of HBsAg, HBeAg and HBV DNA in serum during incubation
* appearence of anti-HBc at onset of clinical disease
* appearence of IgM anti-HD, HDV RNA, HDAg in serum
* anti-HDV antibodies develop late in acute phase and usually decline after infection to subdetectable levels
* if HDAg is detectable early during infection, it disappears as anti-HDV appears
* all markers of viral replication disappear in early convalescence, and both IgM and IgG anti-HD disappear within months to years after recovery

- HBV-HDV superinfection:

* usually results in persistent HDV infection
* HDV viremia appears in serum during preacute phase
* high titres of IgM and IgG anti-HDV are detectable in acute phase, persisting indefinitely
* titre of HBsAg declines when HDAg appears in serum
* progression to chronicity is associated with persisting high levels of IgM anti-HD and IgG anti-HD
* HDAg and HDV RNA remain detectable in serum and liver
* viremia is associated with active liver disease

Each of the markers of HDV infection, including IgM and IgG antibodies, disappears within months after recovery. In contrast, in chronic hepatitis D, HDV RNA, HDAg, and IgM and IgG anti-HD antibodies persist.

Host immune response
Both humoral and cellular immunity are induced in patients infected with HDV.

These immune responses may provide protection from HDV re-infection, or simply modulate clinical symptoms. However, second cases of hepatitis D have not been reported.

Anti-HD antibodies do not always persist after acute infection is cleared. The serological evidence of past HDV infection is therefore not easy to demonstrate.

Prevalence
Areas of high prevalence include the Mediterranean Basin, the Middle East, Central Asia, West Africa, the Amazon Basin of South America and certain South Pacific islands.

Severe, often fatal, acute and chronic type D hepatitis occurs among indigenous people of Venezuela, Colombia, Brazil, and Peru, all regions with high chronic HDV infection rates.

Hepatitis D is less common in Eastern Asia, but is present in Taiwan, China and India.

Pathogenesis
Infection with both HBV and HDV is associated with more severe liver injury than HBV infection alone.

Pathologic changes in hepatitis D are limited to the liver, the only organ in which HDV has been shown to replicate. The histologic changes consist of hepatocellular necrosis and inflammation.

HDV genome replication is not acutely cytopathic, and both humoral and cellular immune mechanisms may be involved in the pathology of hepatitis D. More experimental data are needed to unravel the underlying mechanisms of HDV-induced disease.

HBV is an essential cofactor in the evolution of hepatocellular damage.

Transmission
Transmission is similar to that of HBV:

* bloodborne and sexual
* percutaneous (injecting drug use, haemophiliacs)
* permucosal (sexual)
* rare perinatal

Superinfections increase the chance of HDV spread, and at the peak of an acute infection, the amount of HDV in the serum can exceed 1012 RNA-containing particles per ml.

During an HDV superinfection, the titre of HDV reaches a peak between 2 and 5 weeks postinoculation, after which it declines in 1 to 2 weeks.

The probability of being productively coinfected, with the coinfection resulting in clinical disease, depends on both the relative and absolute amounts of the two inoculated viruses.

The main route of transmission is infected blood and blood products.

Risk groups
Here is a list of groups of people who are at risk of contracting HDV

* intravenous drug users using HDV-contaminated injection needles
* promiscuous homosexual and heterosexual groups (although HDV infections are less frequent than HBV or HIV infections)
* people exposed to unscreened blood or blood products
* °haemophiliacs
* °persons with clotting factor disorders

° the risk has decreased in recent years due to better control of blood sources
Incidence/Epidemiology
Seroprevalence studies of anti-HD in HBsAg-positive patients has shown a worldwide but not uniform distribution.

Epidemics of HDV infections have been described in the Amazon Basin, the Mediterranean Basin and Central Africa.

Two epidemiologic patterns of hepatitis D infections exist: in Mediterranean countries infection is endemic among HBV carriers, and the virus is transmitted by close personal contact. In Western Europe and North America, HDV is confined to persons exposed to blood or blood products, like e.g. intravenous drug addicts sharing unsterilized injection needles.

Worldwide, more than 10 million people are infected with HDV.

Trends
New foci of high HDV prevalence continue to be identified as in the case of the island of Okinawa in Japan, of areas of China, Northern India and Albania.

There is a decreasing prevalence of both acute and chronic hepatitis D in the Mediterranean area and in many other parts of the world, which has been attributed to a decline in the prevalence of chronic HBsAg carriers in the general population.

Immune prophylaxis
Immune prophylaxis against HDV is achieved by vaccination against HBV because HDV uses the envelope proteins of HBV. This mode of prevention is possible only for coinfections in HBV susceptible individuals.

Immunoglobulin (Ig), hepatitis B (HB) specific Ig and HB vaccine do not protect HBV carriers from infection with HDV.

Vaccines
No vaccines exist against HDV; however, vaccination against HBV of patients who are not chronic HBV carriers, provides protection against HDV infection.

Prevention
Since HDV is dependent on HBV for replication, control of HDV infection is achieved by targeting HBV infections. All measures aimed at preventing the transmission of HBV will prevent the transmission of hepatitis D. HBV vaccination is therefore recommended to avoid HBV-HDV coinfection.

However, there is no effective measure to prevent HDV infection of chronic HBV carriers, and prevention of HBV-HDV superinfection can only be achieved through education to reduce risk behaviors.
Promising research results indicate that in some woodchucks immunized with recombinant purified HDAg-S complete protection is possible.

Hepatitis B Ig and HB vaccine do not protect HBV carriers from infection by HDV.

Treatment
Currently there is no effective antiviral therapy available for treatment of acute or chronic type D hepatitis.21

For infected patients, massive doses of a-interferon (9 million units three times a week for 12 months or 5 million units daily for up to 12 months) have yielded remissions, but most patients remained positive for HDV RNA despite the improved disease conditions.

The effect of interferon is considered to be most likely an indirect one, possibly via an effect on the helper hepadnavirus and/or on the immune response to the infections.
Acyclovir, ribavirin, lamivudine and synthetic analogues of thymosin have proved ineffective.
Immunosuppressive agents do not have any effect on hepatitis D.

Liver transplantation has been helpful for treating fulminant acute and end-stage chronic hepatitis. In one study, the 5-year survival rate of transplant patients for terminal delta cirrhosis was 88% with reappearance of HBsAg only in 9% under long-term anti-HBs prophylaxis.

Guidelines for epidemic measures 1.) When two or more cases occur in association with some common exposure, a search for additional cases should be conducted.
2.) Introduction of strict aseptic techniques. If a plasma derivative like antihaemophilic factor, fibrinogen, pooled plasma or thrombin is implicated, the lot should be withdrawn from use. 3.) Tracing of all recipients of the same lot in search for additional cases.

Future considerations
Whether or not immunization with HDAg can confer protection against superinfection or slow the progression of liver disease in the over 350 million HBV carriers who are at risk of contracting type D hepatitis, needs to be determined.
Glossary

albumin a water soluble protein. Serum albumin is found in blood plasma and is important for maintaining plasma volume and osmotic pressure of circulating blood. Albumin is synthesized in the liver. The inability to synthesize albumin is a predominant feature of chronic liver disease.

ALT alanine aminotransferase an enzyme that interconverts L-alanine and D-alanine. It is a highly sensitive indicator of hepatocellular damage. When such damage occurs, ALT is released from the liver cells into the bloodstream, resulting in abnormally high serum levels. Normal ALT levels range from 10 to 32 U/l; in women, from 9 to 24 U/l. The normal range for infants is twice that of adults.

amino acids the basic units of proteins, each amino acid has a NH-C(R)-COOH structure, with a variable R group. There are altogether 20 types of naturally occurring amino acids.

antibody a protein molecule formed by the immune system which reacts specifically with the antigen that induced its synthesis. All antibodies are immunoglobulins.

antigen any substance which can elicit in a vertebrate host the formation of specific antibodies or the generation of a specific population of lymphocytes reactive with the substance. Antigens may be protein or carbohydrate, lipid or nucleic acid, or contain elements of all or any of these as well as organic or inorganic chemical groups attached to protein or other macromolecule. Whether a material is an antigen in a particular host depends on whether the material is foreign to the host and also on the genetic makeup of the host, as well as on the dose and physical state of the antigen.

antigenome RNA molecule complementary to the viral single stranded RNA genome.

AST aspartate aminotransferase the enzyme that catalyzes the reaction of aspartate with 2-oxoglutarate to give glutamate and oxaloacetate. Its concentration in blood may be raised in liver and heart diseases that are associated with damage to those tissues. Normal AST levels range from 8 to 20 U/l. AST levels fluctuate in response to the extent of cellular necrosis.
bilirubin is the chief pigment of bile, formed mainly from the breakdown of hemoglobin. After formation it is transported in the plasma to the liver to be then excreted in the bile. Elevation of bile in the blood causes jaundice.
capsid the protein coat of a virion, composed of large multimeric proteins, which closely surrounds the nucleic acid.

carcinoma a malignant epithelial tumour. This is the most frequent form of cancer.

cDNA complementary DNA. DNA synthesized by RNA-directed DNA polymerase as a copy of RNA, usually isolated mRNA or viral genomic RNA. It differs in sequence from eukaryotic chromosomal DNA by the absence of introns.

cirrhosis a chronic disease of the liver characterized by nodular regeneration of hepatocytes and diffuse fibrosis. It is caused by parenchymal necrosis followed by nodular proliferation of the surviving hepatocytes. The regenerating nodules and accompanying fibrosis interfere with blood flow through the liver and result in portal hypertension, hepatic insufficiency, jaundice and ascites.

codon the smallest unit of genetic material that can specify an amino acid residue in the synthesis of a polypeptide chain. The codon consists of three adjacent nucleotides.

cytopathic effects include morphological changes in the cell appearance (rounding up of cells), agglutination of red blood cells (haemagglutination assay with influenza virus), zones of cell lysis on monolayers of tissue culture or finally immortalization of animal cell lines (foci formation).

cytoplasm the protoplasm of the cell which is outside of the nucleus. It consists of a continuous acqueous solution and the organelles and inclusions suspended in it. It is the site of most of the chemical activities of the cell.

encephalopathy an acute reaction of the brain to a variety of toxic or infective agents, without any actual inflammation such as occurs in encephalitis.
endemic continuously prevalent in some degree in a community or region.

endoplasmic reticulum a network or system of folded membranes and interconnecting tubules distributed within the cytoplasm of eukaryotic cells. The membranes form enclosed or semienclosed spaces. The endoplasmic reticulum functions in storage and transport, and as a point of attachment of ribosomes during protein synthesis.

enzyme any protein catalyst, i.e. substance which accelerates chemical reactions without itself being used up in the process. Many enzymes are specific to the substance on which they can act, called substrate. Enzymes are present in all living matters and are involved in all the metabolic processes upon which life depends.

epidemic an outbreak of disease such that for a limited period a significantly greater number of persons in a community or region suffer from it than is normally the case. Thus an epidemic is a temporary increase in incidence. Its extent and duration are determined by the interaction of such variables as the nature and infectivity of the casual agent, its mode of transmission and the degree of preexisting and newly acquired immunity.
epitope or antigenic determinant. The small portion of an antigen that combines with a specific antibody. A single antigen molecule may carry several different epitopes.

fulminant describes pathological conditions that develop suddenly and are of great severity.

genome the total genetic information present in a cell. In diploid cells, the genetic information contained in one chromosome set.

Golgi apparatus a cytoplasmic organelle which is composed of flattened sacs resembling smooth endoplasmic reticulum. The sacs are often cup-shaped and located near the nucleus, the open side of the cup generally facing toward the cell surface. The function of the Golgi apparatus is to accept vesicles from the endoplasmic reticulum, to modify the contents, and to distribute the products to other parts of the cell or to the cellular environment.

hepadnavirus family of single stranded DNA viruses of which hepatitis B virus (HBV) and woodchuck hepatitis virus (WHV) are members.

hepatocytes liver cells.

humoral pertaining to the humors, or certain fluids, of the body.

icterus jaundice.

IgA antibodies IgA has antiviral properties. Its production is stimulated by aerosol immunizations and oral vaccines.

IgG antibodies IgG is the most abundant of the circulating antibodies. It readily crosses the walls of blood vessels and enters tissue fluids. IgG also crosses the placenta and confers passive immunity from the mother to the fetus. IgG protects against bacteria, viruses, and toxins circulating in the blood and lymph.

IgM antibodies IgMs are the first circulating antibodies to appear in response to an antigen. However, their concentration in the blood declines rapidly. This is diagnostically useful, because the presence of IgM usually indicates a current infection by the pathogen causing its formation. IgM consists of five Y-shaped monomers arranged in a pentamer structure. The numerous antigen-binding sites make it very effective in agglutinating antigens. IgM is too large to cross the placenta and hence does not confer maternal immunity.

immunoglobulin (Ig): is a sterile preparation of concentrated antibodies (immunoglobulins) recovered from pooled human plasma processed by cold ethanol fractionation. Only plasma that has tested negative for a) hepatitis B surface antigen (HBsAg), b) antibody to human immunodeficiency virus (HIV), and c) antibody to hepatitis C virus (HCV) is used to manufacture IG. IG is administered to protect against certain diseases through passive transfer of antibody. The IGs are broadly classified into five types on the basis of physical, antigenic and functional variations, and labelled respectively IgM, IgG, IgA, IgE and IgD.

incidence the number of cases of a disease, abnormality, accident, etc., arising in a defined population during a stated period, expressed as a proportion, such as x cases per 1000 persons per year.
interferon a class of proteins processing antiviral and antitumour activity produced by lymphocytes, fibroblasts and other tissues. They are released by cells invaded by virus and are able to inhibit virus multiplication in noninfected cells. Interferon preparations have been shown to have some clinical effect as antiviral agents. The preparations so far available have produced side effects, such as fever, lassitude, and prostration, not dissimilar from those accompanying acute virus infection itself.
jaundice is a yellow discoloration of the skin and mucous membranes due to excess of bilirubin in the blood, also known as icterus.

lymphocyte a leukocyte of blood, bone marrow and lymphatic tissue. Lymphocytes play a major role in both cellular and humoral immunity. Several different functional and morphologic types must be recognized, i.e. the small, large, B-, and T-lymphocytes, with further morphologic distinction being made among the B-lymphocytes and functional distinction among T-lymphocytes.

necrosis death of tissue.

nucleotide a molecule formed from the combination of one nitrogenous base (purine or pyrimidine), a sugar (ribose or deoxyribose) and a phosphate group. It is a hydrolysis product of nucleic acid.

nucleus a membrane-bounded compartment in an eukaryotic cell which contains the genetic material and the nucleoli. The nucleus represents the control center of the cell. Nuclei divide by mitosis or meiosis.

peptide a compound of two or more amino acids linked together by peptide bonds.

pleomorphic distinguished by having more than one form during a life cycle.

prenylation the enzymic addition of prenyl moieties to proteins as a post-translational modification.

prevalence is the number of instances of infections or of persons ill, or of any other event such as accidents, in a specified population, without any distinction between new and old cases.

prophylaxis is the prevention of disease, or the preventive treatment of a recurrent disorder.

protein large molecule made up of many amino acids chemically linked together by amide linkages. Biologically important as enzymes, structural protein and connective tissue.

prothrombin time a test used to measure the activity of clotting factors I, II, V, VII, and X. Deficiency of any of these factors leads to a prolongation of the prothrombin time. The test is basic to any study of the coagulation process, and it helps in establishing and maintaining anticoagulant therapy.

reverse transcriptase RNA-directed DNA polymerase. Enzyme that synthesizes DNA according to instructions given by an RNA template.

ribozyme an RNA molecule with catalytic activity.

RT-PCR reverse transcriptase - polymerase chain reaction. A technique commonly employed in molecular genetics through which it is possible to produce copies of DNA sequences rapidly.

self-limited denoting a disease that tends to cease after a definite period; e.g., pneumonia.

sense and antisense strands of the two strands that comprise the double helix of a DNA molecule, only sense strand contains a sequence of nucleotides that can be read out to form a protein. The complementary strand, termed the antisense strand, has a sequence of nucleotides that, if read out, would give either a garbled or a totally lacking messenger RNA.2 An artificial, antisense, single stranded RNA molecule of messenger RNA or of some other specific RNA transcript of a gene can hybridize with the specific RNA and thus interfere with the latter's actions or reactions.

serum is the clear, slightly yellow fluid which separates from blood when it clots. In composition it resembles blood plasma, but with fibrinogen removed. Sera containing antibodies and antitoxins against infections and toxins of various kinds (antisera) have been used extensively in prevention or treatment of various diseases.
titre a measure of the concentration or activity of an active substance.

translation the process of forming a specific protein having its amino acid sequence determined by the codons of messenger RNA. Ribosomes and transfer RNA are necessary for translation.

vaccine an antigenic preparation used to produce active immunity to a disease to prevent or ameliorate the effects of infection with the natural or "wild" organism. Vaccines may be living, attenuated strains of viruses or bacteria which give rise to inapparent to trivial infections. Vaccines may also be killed or inactivated organisms or purified products derived from them. Formalin-inactivated toxins are used as vaccines against diphtheria and tetanus. Synthetically or genetically engineered antigens are currently being developed for use as vaccines. Some vaccines are effective by mouth, but most have to be given parenterally.
viremia the presence of viruses in the blood, usually characterized by malaise, fever, and aching of the back and extremities.

virion a structurally complete virus, a viral particle.

viroid any of a class of infectious agents consisting of a single-stranded closed circular RNA lacking a capsid. The RNA does not code for proteins and is not translated; it is replicated by host cell enzymes. Viroids are known to cause several plant diseases.

virus any of a number of small, obligatory intracellular parasites with a single type of nucleic acid, either DNA or RNA and no cell wall. The nucleic acid is enclosed in a structure called a capsid, which is composed of repeating protein subunits called capsomeres, with or without a lipid envelope. The complete infectious virus particle, called a virion, must rely on the metabolism of the cell it infects. Viruses are morphologically heterogeneous, occurring as spherical, filamentous, polyhedral, or pleomorphic particles. They are classified by the host infected, the type of nucleic acid, the symmetry of the capsid, and the presence or absence of an envelope.

Hepatitis E ?

2009-12-26T11:37:00.000-08:00

Hepatitis is a general term meaning inflammation of the liver. Hepatitis is a disease that can be caused by a variety of different viruses such as hepatitis A, B, C, D and E. Since the development of jaundice is a characteristic feature of liver disease, a correct diagnosis can only be made by testing patients' sera for the presence of specific viral antigens and/or anti-viral antibodies.

Hepatitis E (HEV) was not recognized as a distinct human disease until 1980. Hepatitis E is caused by infection with the hepatitis E virus, a non-enveloped, positive-sense, single-stranded RNA virus.

Although man is considered the natural host for HEV, antibodies to HEV or closely related viruses have been detected in primates and several other animal species.
How is HEV transmitted?

HEV is transmitted via the faecal-oral route. Hepatitis E is a waterborne disease, and contaminated water or food supplies have been implicated in major outbreaks. Consumption of faecally contaminated drinking water has given rise to epidemics, and the ingestion of raw or uncooked shellfish has been the source of sporadic cases in endemic areas. There is a possibility of zoonotic spread of the virus, since several non-human primates, pigs, cows, sheep, goats and rodents are susceptible to infection. The risk factors for HEV infection are related poor sanitation in large areas of the world, and HEV shedding in faeces.

Person-to-person transmission is uncommon. There is no evidence for sexual transmission or for transmission by transfusion.
Where is HEV a problem?

The highest rates of infection occur in regions where low standards of sanitation promote the transmission of the virus. Epidemics of hepatitis E have been reported in Central and South-East Asia, North and West Africa, and in Mexico, especially where faecal contamination of drinking water is common. However, sporadic cases of hepatitis E have also been reported elsewhere and serological surveys suggest a global distribution of strains of hepatitis E of low pathogenicity.
When is a HEV infection life-threatening?

In general, hepatitis E is a self-limiting viral infection followed by recovery. Prolonged viraemia or faecal shedding are unusual and chronic infection does not occur.

Occasionally, a fulminant form of hepatitis develops, with overall patient population mortality rates ranging between 0.5% - 4.0%. Fulminate hepatitis occurs more frequently in pregnancy and regularly induces a mortality rate of 20% among pregnant women in the 3rd trimester.
The disease

The incubation period following exposure to HEV ranges from 3 to 8 weeks, with a mean of 40 days. The period of communicability is unknown. There are no chronic infections reported.

Hepatitis E virus causes acute sporadic and epidemic viral hepatitis. Symptomatic HEV infection is most common in young adults aged 15-40 years. Although HEV infection is frequent in children, it is mostly asymptomatic or causes a very mild illness without jaundice (anicteric) that goes undiagnosed.

Typical signs and symptoms of hepatitis include jaundice (yellow discoloration of the skin and sclera of the eyes, dark urine and pale stools), anorexia (loss of appetite), an enlarged, tender liver (hepatomegaly), abdominal pain and tenderness, nausea and vomiting, and fever, although the disease may range in severity from subclinical to fulminant.
Diagnosis

Since cases of hepatitis E are not clinically distinguishable from other types of acute viral hepatitis, diagnosis is made by blood tests which detect elevated antibody levels of specific antibodies to hepatitis E in the body or by reverse transcriptase polymerase chain reaction (RT-PCR). Unfortunately, such tests are not widely available.

Hepatitis E should be suspected in outbreaks of waterborne hepatitis occurring in developing countries, especially if the disease is more severe in pregnant women, or if hepatitis A has been excluded. If laboratory tests are not available, epidemiologic evidence can help in establishing a diagnosis.
Surveillance and control

Surveillance and control procedures should include

* provision of safe drinking water and proper disposal of sanitary waste
* monitoring disease incidence
* determination of source of infection and mode of transmission by epidemiologic investigation
* detection of outbreaks
* spread containment

Vaccines

At present, no commercially available vaccines exist for the prevention of hepatitis E. However, several studies for the development of an effective vaccine against hepatitis E are in progress.
Prevention

As almost all HEV infections are spread by the faecal-oral route, good personal hygiene, high quality standards for public water supplies and proper disposal of sanitary waste have resulted in a low prevalence of HEV infections in many well developed societies.

For travelers to highly endemic areas, the usual elementary food hygiene precautions are recommended. These include avoiding drinking water and/or ice of unknown purity and eating uncooked shellfish, uncooked fruits or vegetables that are not peeled or prepared by the traveler.
Treatment

Hepatitis E is a viral disease, and as such, antibiotics are of no value in the treatment of the infection. There is no hyperimmune E globulin available for pre- or post-exposure prophylaxis. HEV infections are usually self-limited, and hospitalization is generally not required. No available therapy is capable of altering the course of acute infection.

As no specific therapy is capable of altering the course of acute hepatitis E infection, prevention is the most effective approach against the disease. Hospitalization is required for fulminant hepatitis and should be considered for infected pregnant women.
Guidelines for epidemic measures

* Determination of the mode of transmission.
* Identification of the population exposed to increased risk of infection.
* Elimination of a common source of infection.
* Improvement of sanitary and hygienic practices to eliminate faecal contamination of food and water.

What One Should Need to Know About Hepatitis C

2009-12-25T11:15:00.000-08:00

Hepatitis C is an infectious disease affecting the liver, caused by the hepatitis C virus (HCV).The infection is often asymptomatic, but once established, chronic infection can progress to scarring of the liver (fibrosis), and advanced scarring (cirrhosis) which is generally apparent after many years. In some cases, those with cirrhosis will go on to develop liver failure or other complications of cirrhosis, including liver cancer.

The hepatitis C virus (HCV) is spread by blood-to-blood contact. Most people have few, if any symptoms after the initial infection, yet the virus persists in the liver in about 85% of those infected. Persistent infection can be treated with medication, peginterferon and ribavirin being the standard-of-care therapy. 51% are cured overall. Those who develop cirrhosis or liver cancer may require a liver transplant, and the virus universally recurs after transplantation.

An estimated 270-300 million people worldwide are infected with hepatitis C. Hepatitis C is a strictly human disease. It cannot be contracted from or given to any other animal. Chimpanzees can be infected with the virus in the laboratory, but do not develop the disease, which has made research more difficult. No vaccine against hepatitis C is available. The existence of hepatitis C (originally "non-A non-B hepatitis") was postulated in the 1970s and proved conclusively in 1989. It is one of five known hepatitis viruses: A, B, C, D, and E.

Signs and symptoms

Acute

Acute hepatitis C refers to the first 6 months after infection with HCV. Between 60% to 70% of people infected develop no symptoms during the acute phase. In the minority of patients who experience acute phase symptoms, they are generally mild and nonspecific, and rarely lead to a specific diagnosis of hepatitis C. Symptoms of acute hepatitis C infection include decreased appetite, fatigue, abdominal pain, jaundice, itching, and flu-like symptoms.

The hepatitis C virus is usually detectable in the blood within one to three weeks after infection by PCR, and antibodies to the virus are generally detectable within 3 to 15 weeks. Spontaneous viral clearance rates are highly variable and between 10–60% of persons infected with HCV clear the virus from their bodies during the acute phase as shown by normalization in liver enzymes (alanine transaminase (ALT) & aspartate transaminase (AST)), and plasma HCV-RNA clearance (this is known as spontaneous viral clearance). However, persistent infections are common and most patients develop chronic hepatitis C, i.e., infection lasting more than 6 months.

Previous practice was to not treat acute infections to see if the person would spontaneously clear; recent studies have shown that treatment during the acute phase of genotype 1 infections has a greater than 90% success rate with half the treatment time required for chronic infections.

Chronic

Chronic hepatitis C is defined as infection with the hepatitis C virus persisting for more than six months. Clinically, it is often asymptomatic (without symptoms) and it is mostly discovered accidentally.

The natural course of chronic hepatitis C varies considerably from one person to another. Although almost all people infected with HCV have evidence of inflammation on liver biopsy, the rate of progression of liver scarring (fibrosis) shows significant variability among individuals. Accurate estimates of the risk over time are difficult to establish because of the limited time that tests for this virus have been available.

Recent data suggest that among untreated patients, roughly one-third progress to liver cirrhosis in less than 20 years. Another third progress to cirrhosis within 30 years. The remainder of patients appear to progress so slowly that they are unlikely to develop cirrhosis within their lifetimes. In contrast the NIH consensus guidelines state that the risk of progression to cirrhosis over a 20-year period is 3-20 percent.

Factors that have been reported to influence the rate of HCV disease progression include age (increasing age associated with more rapid progression), gender (males have more rapid disease progression than females), alcohol consumption (associated with an increased rate of disease progression), HIV coinfection (associated with a markedly increased rate of disease progression), and fatty liver (the presence of fat in liver cells has been associated with an increased rate of disease progression).

Symptoms specifically suggestive of liver disease are typically absent until substantial scarring of the liver has occurred. However, hepatitis C is a systemic disease and patients may experience a wide spectrum of clinical manifestations ranging from an absence of symptoms to a more symptomatic illness prior to the development of advanced liver disease. Generalized signs and symptoms associated with chronic hepatitis C include fatigue, flu-like symptoms, joint pains, itching, sleep disturbances, appetite changes, nausea, and depression.

Once chronic hepatitis C has progressed to cirrhosis, signs and symptoms may appear that are generally caused by either decreased liver function or increased pressure in the liver circulation, a condition known as portal hypertension. Possible signs and symptoms of liver cirrhosis include ascites (accumulation of fluid in the abdomen), bruising and bleeding tendency, varices (enlarged veins, especially in the stomach and esophagus), jaundice, and a syndrome of cognitive impairment known as hepatic encephalopathy. Hepatic encephalopathy is due to the accumulation of ammonia and other substances normally cleared by a healthy liver.

Liver enzyme tests show variable elevation of ALT and AST. Periodically they might show normal results. Usually prothrombin and albumin results are normal, but may become abnormal, once cirrhosis has developed. The level of elevation of liver tests do not correlate well with the amount of liver injury on biopsy. Viral genotype and viral load also do not correlate with the amount of liver injury. Liver biopsy is the best test to determine the amount of scarring and inflammation. Radiographic studies such as ultrasound or CT scan do not always show liver injury until it is fairly advanced. However, non-invasive tests (blood sample) are coming, with FibroTest and ActiTest, respectively estimating liver fibrosis and necrotico-inflammatory. These tests are validated and recommended in Europe (FDA procedures initiated in USA)

Chronic hepatitis C, more than other forms of hepatitis, can be associated with extrahepatic manifestations associated with the presence of HCV such as porphyria cutanea tarda, cryoglobulinemia (a form of small-vessel vasculitis) and glomerulonephritis (inflammation of the kidney), specifically membranoproliferative glomerulonephritis (MPGN). Hepatitis C is also rarely associated with sicca syndrome (an autoimmune disorder), thrombocytopenia, lichen planus, diabetes mellitus and with B-cell lymphoproliferative disorders.

Virology

The Hepatitis C virus (HCV) is a small (50 nm in size), enveloped, single-stranded, positive sense RNA virus. It is the only known member of the hepacivirus genus in the family Flaviviridae. There are six major genotypes of the hepatitis C virus, which are indicated numerically (e.g., genotype 1, genotype 2, etc.).

The hepatitis C virus (HCV) is transmitted by blood-to-blood contact. In developed countries, it is estimated that 90% of persons with chronic HCV infection were infected through transfusion of unscreened blood or blood products or via injecting drug use or sexual exposure. In developing countries, the primary sources of HCV infection are unsterilized injection equipment and infusion of inadequately screened blood and blood products. There has not been a documented transfusion-related case of hepatitis C in the United States for over a decade as the blood supply is vigorously screened with both EIA and PCR technologies.

Although injection drug use is the most common routes of HCV infection, any practice, activity, or situation that involves blood-to-blood exposure can potentially be a source of HCV infection. The virus may be sexually transmitted, although this is rare, and usually only occurs when an STD that causes open sores and bleeding is also present and makes blood contact more likely.

Transmission

Sexual activities and practices were initially identified as potential sources of exposure to the hepatitis C virus. More recent studies question this route of transmission. Currently it is felt to be a means of rare transmission of hepatitis C infection. These are simply the current known modes of transmission and due to the nature of Hepatitis there may be more ways that it is transmitted than the current known methods.

Injection drug use

Those who currently use or have used drug injection as their delivery route for drugs are at increased risk for getting hepatitis C because they may be sharing needles or other drug paraphernalia (includes cookers, cotton, spoons, water, etc.), which may be contaminated with HCV-infected blood. An estimated 60% to 80% of intravenous recreational drug users in the United States have been infected with HCV.[15] Harm reduction strategies are encouraged in many countries to reduce the spread of hepatitis C, through education, provision of clean needles and syringes, and safer injecting techniques. For reasons that are not clear transmission by this route currently appears to be declining in the USA.

The VA Testimony before the Subcommittee on Benefits Committee on Veterans’ Affairs, U.S. House of Representatives, April 13, 2000, Gary A. Roselle, M. D., Program Director for Infectious Diseases, Veterans Health Administration, Department of Veterans Affairs, state, "One in 10 US Veterans are infected with HCV", a rate 5 times greater than the 1.8% infection rate of the general population."

A study conducted in 1999, by the Veterans Health Administration (VHA), and involving 26,000 veterans shows that up to 10% of all veterans in the VHA system tested positive for hepatitis C.

Of the total number of persons who were hepatitis C antibody positive, and reported an era of service, 62.7% were noted to be from the Vietnam. The second most frequent group is listed as post-Vietnam at 18.2%, followed by 4.8% Korean conflict, 4.3% post-Korean conflict, 4.2% from WWII, and 2.7% Persian Gulf era veterans.

Blood products

Blood transfusion, blood products, or organ transplantation prior to implementation of HCV screening (in the U.S., this would refer to procedures prior to 1992) is a decreasing risk factor for hepatitis C.

The virus was first isolated in 1989 and reliable tests to screen for the virus were not available until 1992. Therefore, those who received blood or blood products prior to the implementation of screening the blood supply for HCV may have been exposed to the virus. Blood products include clotting factors (taken by hemophiliacs), immunoglobulin, Rhogam, platelets, and plasma. In 2001, the Centers for Disease Control and Prevention reported that the risk of HCV infection from a unit of transfused blood in the United States is less than one per million transfused units.

Iatrogenic medical or dental exposure

People can be exposed to HCV via inadequately or improperly sterilized medical or dental equipment. Equipment that may harbor contaminated blood if improperly sterilized includes needles or syringes, hemodialysis equipment, oral hygiene instruments, and jet air guns, etc. Scrupulous use of appropriate sterilization techniques and proper disposal of used equipment can reduce the risk of iatrogenic exposure to HCV to virtually zero.

Occupational exposure to blood

Medical and dental personnel, first responders (e.g., firefighters, paramedics, emergency medical technicians, law enforcement officers), and military combat personnel can be exposed to HCV through accidental exposure to blood through accidental needlesticks or blood spatter to the eyes or open wounds. Universal precautions to protect against such accidental exposures significantly reduce the risk of exposure to HCV.

Recreational exposure to blood

Contact sports and other activities, such as "slam dancing" that may result in accidental blood-to-blood exposure are potential sources of exposure to HCV.

Sexual exposure

Sexual transmission of HCV is considered to be rare. Studies show the risk of sexual transmission in heterosexual, monogamous relationships is extremely rare or even null.The CDC does not recommend the use of condoms between long-term monogamous discordant couples (where one partner is positive and the other is negative).However, because of the high prevalence of hepatitis C, this small risk may translate into a non-trivial number of cases transmitted by sexual routes. Vaginal penetrative sex is believed to have a lower risk of transmission than sexual practices that involve higher levels of trauma to anogenital mucosa (anal penetrative sex, fisting, use of sex toys).

Body piercings and tattoos

Tattooing dyes, ink pots, stylets and piercing implements can transmit HCV-infected blood from one person to another if proper sterilization techniques are not followed. Tattoos or piercings performed before the mid 1980s, "underground," or non-professionally are of particular concern since sterile techniques in such settings may have been or be insufficient to prevent disease. Despite these risks, it is rare for tattoos to be directly associated with HCV infection and the U.S. Centers for Disease Control and Prevention's position on this subject states that, "no data exist in the United States indicating that persons with exposures to tattooing alone are at increased risk for HCV infection."

Shared personal care items

Personal care items such as razors, toothbrushes, cuticle scissors, and other manicuring or pedicuring equipment can easily be contaminated with blood. Sharing such items can potentially lead to exposure to HCV. Appropriate caution should be taken regarding any medical condition which results in bleeding such as canker sores, cold sores, and immediately after flossing.HCV is not spread through casual contact such as hugging, kissing, or sharing eating or cooking utensils.

Vertical transmission

Vertical transmission refers to the transmission of a communicable disease from an infected mother to her child during the birth process. Mother-to-child transmission of hepatitis C has been well described, but occurs relatively infrequently. Transmission occurs only among women who are HCV RNA positive at the time of delivery; the risk of transmission in this setting is approximately 6 out of 100. Among women who are both HCV and HIV positive at the time of delivery, the risk of transmitting HCV is increased to approximately 25 out of 100.

The risk of vertical transmission of HCV does not appear to be associated with method of delivery or breastfeeding.

Diagnosis

The diagnosis of "hepatitis C" is rarely made during the acute phase of the disease because the majority of people infected experience no symptoms during this phase of the disease. Those who do experience acute phase symptoms are rarely ill enough to seek medical attention. The diagnosis of chronic phase hepatitis C is also challenging due to the absence or lack of specificity of symptoms until advanced liver disease develops, which may not occur until decades into the disease.

Chronic hepatitis C may be suspected on the basis of the medical history (particularly if there is any history of IV drug abuse or inhaled substance usage such as cocaine), a history of piercings or tattoos, unexplained symptoms, or abnormal liver enzymes or liver function tests found during routine blood testing. Occasionally, hepatitis C is diagnosed as a result of targeted screening such as blood donation (blood donors are screened for numerous blood-borne diseases including hepatitis C) or contact tracing.

Hepatitis C testing begins with serological blood tests used to detect antibodies to HCV. Anti-HCV antibodies can be detected in 80% of patients within 15 weeks after exposure, in >90% within 5 months after exposure, and in >97% by 6 months after exposure. Overall, HCV antibody tests have a strong positive predictive value for exposure to the hepatitis C virus, but may miss patients who have not yet developed antibodies (seroconversion), or have an insufficient level of antibodies to detect. Rarely, people infected with HCV never develop antibodies to the virus and therefore, never test positive using HCV antibody screening. Because of this possibility, RNA testing (see nucleic acid testing methods below) should be considered when antibody testing is negative but suspicion of hepatitis C is high (e.g. because of elevated transaminases in someone with risk factors for hepatitis C).

Anti-HCV antibodies indicate exposure to the virus, but cannot determine if ongoing infection is present. All persons with positive anti-HCV antibody tests must undergo additional testing for the presence of the hepatitis C virus itself to determine whether current infection is present. The presence of the virus is tested for using molecular nucleic acid testing methods such as polymerase chain reaction (PCR), transcription mediated amplification (TMA), or branched DNA (b-DNA). All HCV nucleic acid molecular tests have the capacity to detect not only whether the virus is present, but also to measure the amount of virus present in the blood (the HCV viral load). The HCV viral load is an important factor in determining the probability of response to interferon-based therapy, but does not indicate disease severity nor the likelihood of disease progression.

In people with confirmed HCV infection, genotype testing is generally recommended. HCV genotype testing is used to determine the required length and potential response to interferon-based therapy.

Prevention

According to Centers for Disease Control, hepatitis C virus is spread by exposure to large quantities of blood, either through the skin or by injection:

* Injection drug use (currently the most common means of HCV transmission in the United States)
* Receipt of donated blood, blood products, and organs (once a common means of transmission but now rare in the United States since blood screening became available in 1992)
* Needlestick injuries in healthcare settings
* Birth to an HCV-infected mother

HCV can also be spread infrequently through

* Sex with an HCV-infected person (an inefficient means of transmission)
* Sharing personal items contaminated with infectious blood, such as razors or toothbrushes (also inefficient vectors of transmission)
* Other healthcare procedures that involve invasive procedures, such as injections (usually recognized in the context of outbreaks)

Proponents of harm reduction believe that strategies such as the provision of new needles and syringes, and education about safer drug injection procedures, greatly decreases the risk of hepatitis C spreading between injecting drug users.

No vaccine protects against contracting hepatitis C, or helps to treat it. Vaccines are under development and some have shown encouraging results.

Treatment

There is a very small chance of clearing the virus spontaneously in chronic HCV carriers (0.5% to 0.74% per year). However, the majority of patients with chronic hepatitis C will not clear it without treatment.

Current treatment is a combination of Pegylated interferon-alpha-2a or Pegylated interferon-alpha-2b (brand names Pegasys or PEG-Intron) and the antiviral drug ribavirin for a period of 24 or 48 weeks, depending on hepatitis C virus genotype. Treatment is generally recommended for patients with proven hepatitis C virus infection and persistently abnormal liver function tests. Sustained cure rates (sustained viral response) of 75% or better are seen in people with HCV genotypes 2 and 3 with 24 weeks of treatment. Sustained responses are rarer with other genotypes, at about 50% in patients with HCV genotype 1 given 48 weeks of treatment and 65% in those with genotype 4 given 48 weeks of treatment. Approximately 80% of hepatitis C patients in the United States have genotype 1. Genotype 4 is more common in the Middle East and Africa.

In patients with HCV genotype 1, if treatment with pegylated interferon + ribavirin does not produce a 2-log viral load reduction or complete clearance of RNA (termed "early virological response") after 12 weeks the chance of treatment success is less than 1%. Early virological response is typically not tested in non-genotype 1 patients, as the chances of attaining it are greater than 90%. The mechanism of cure is not entirely clear, because even patients who appear to have a sustained virological response still have actively replicating virus in their liver and peripheral blood mononuclear cells.

The evidence for treatment in genotype 6 disease is currently sparse, and the evidence that exists is for 48 weeks of treatment at the same doses as are used for genotype 1 disease.[29] Physicians considering shorter durations of treatment (e.g., 24 weeks) should do so within the context of a clinical trial.

Treatment during the acute infection phase has much higher success rates (greater than 90%) with a shorter duration of treatment; however, this must be balanced against the 15-40% chance of spontaneous clearance without treatment (see Acute Hepatitis C section above).

Those with low initial viral loads respond much better to treatment than those with higher viral loads (greater than 400,000 IU/mL). Current combination therapy is usually supervised by physicians in the fields of gastroenterology, hepatology or infectious disease.

The treatment may be physically demanding, particularly for those with a prior history of drug or alcohol abuse. It can qualify for temporary disability in some cases. A substantial proportion of patients will experience a panoply of side effects ranging from a 'flu-like' syndrome (the most common, experienced for a few days after the weekly injection of interferon) to severe adverse events including anemia, cardiovascular events and psychiatric problems such as suicide or suicidal ideation. The latter are exacerbated by the general physiological stress experienced by the patient.

Current guidelines strongly recommend that hepatitis C patients be vaccinated for hepatitis A and B if they have not yet been exposed to these viruses, as infection with a second virus could worsen their liver disease.

Alcoholic beverage consumption accelerates HCV associated fibrosis and cirrhosis, and makes liver cancer more likely; insulin resistance and metabolic syndrome may similarly worsen the hepatic prognosis. There is also evidence that smoking increases the fibrosis (scarring) rate.

Host genetic factors

For genotype 1 hepatitis C treated with Pegylated interferon-alpha-2a or Pegylated interferon-alpha-2b (brand names Pegasys or PEG-Intron) combined with ribavirin, it has been shown that genetic polymorphisms near the human IL28B gene, encoding interferon lambda 3, are associated with significant differences in response to the treatment. This finding, originally reported in Nature [30], showed that genotype 1 hepatitis C patients carrying certain genetic variant alleles near the IL28B gene are more possibly to achieve sustained virological response after the treatment than others. Later report from Nature [31] demonstrated that the same genetic variants are also associated with the natural clearance of the genotype 1 hepatitis C virus.

Pregnancy and breastfeeding

If a woman who is pregnant has risk factors for hepatitis C, she should be tested for antibodies against HCV. About 4% infants born to HCV infected women become infected. There is no treatment that can prevent this from happening. There is a high chance of the baby ridding the HCV in the first 12 months.

In a mother who also has HIV, the rate of transmission can be as high as 19%. There are currently no data to determine whether antiviral therapy reduces perinatal transmission. Ribavirin and interferons are contraindicated during pregnancy. However, avoiding fetal scalp monitoring and prolonged labor after rupture of membranes may reduce the risk of transmission to the infant.

HCV antibodies from the mother may persist in infants until 15 months of age. If an early diagnosis is desired, testing for HCV RNA can be performed between the ages of 2 and 6 months, with a repeat test done independent of the first test result. If a later diagnosis is preferred, an anti-HCV test can performed after 15 months of age. Most infants infected with HCV at the time of birth have no symptoms and do well during childhood. There is no evidence that breast-feeding spreads HCV. To be cautious, an infected mother should avoid breastfeeding if her nipples are cracked and bleeding.

Alternative therapies

Several alternative therapies aim to maintain liver functionality, rather than treat the virus itself, thereby slowing the course of the disease to retain quality of life. As an example, extract of Silybum marianum and Sho-saiko-to are sold for their HCV related effects; the first is said to provide some generic help to hepatic functions, and the second claims to aid in liver health and provide some antiviral effects. There has never been any verifiable histologic or virologic benefit demonstrated with any of the alternative therapies.

Epidemiology

It is estimated that Hepatitis C has infected nearly 200 million people worldwide, and infects 3-4 million more people per year. There are about 35,000 to 185,000 new cases a year in the United States. It is currently a leading cause of cirrhosis, a common cause of hepatocellular carcinoma, and as a result of these conditions it is the leading reason for liver transplantation in the United States. Co-infection with HIV is common and rates among HIV positive populations are higher. 10,000-20,000 deaths a year in the United States are from HCV; expectations are that this mortality rate will increase, as those who were infected by transfusion before HCV testing become apparent. A survey conducted in California showed prevalence of up to 34% among prison inmates; 82% of subjects diagnosed with hepatitis C have previously been in jail, and transmission while in prison is well described.

Prevalence is higher in some countries in Africa and Asia. Egypt has the highest seroprevalence for HCV, up to 20% in some areas. There is a hypothesis that the high prevalence is linked to a now-discontinued mass-treatment campaign for schistosomiasis, which is endemic in that country. Regardless of how the epidemic started, a high rate of HCV transmission continues in Egypt, both iatrogenically and within the community and household.

Co-infection with HIV

Approximately 350,000, or 35% of patients in the USA infected with HIV are also infected with the hepatitis C virus, mainly because both viruses are blood-borne and present in similar populations. In other countries co-infection is less common, and this is possibly related to differing drug policies.[citation needed] HCV is the leading cause of chronic liver disease in the USA. It has been demonstrated in clinical studies that HIV infection causes a more rapid progression of chronic hepatitis C to cirrhosis and liver failure. This is not to say treatment is not an option for those living with co-infection.

History

In the mid 1970s, Harvey J. Alter, Chief of the Infectious Disease Section in the Department of Transfusion Medicine at the National Institutes of Health, and his research team demonstrated that most post-transfusion hepatitis cases were not due to hepatitis A or B viruses. Despite this discovery, international research efforts to identify the virus, initially called non-A, non-B hepatitis (NANBH), failed for the next decade. In 1987, Michael Houghton, Qui-Lim Choo, and George Kuo at Chiron Corporation, collaborating with Dr. D.W. Bradley from CDC, utilized a novel molecular cloning approach to identify the unknown organism. In 1988, the virus was confirmed by Alter by verifying its presence in a panel of NANBH specimens. In April of 1989, the discovery of the virus, re-named hepatitis C virus (HCV), was published in two articles in the journal Science.

Chiron filed for several patents on the virus and its diagnosis. A competing patent application by the CDC was dropped in 1990 after Chiron paid $1.9 million to the CDC and $337,500 to Bradley. In 1994 Bradley sued Chiron, seeking to invalidate the patent, have himself included as a co-inventor, and receive damages and royalty income. He dropped the suit in 1998 after losing before an appeals court.

In 2000, Drs. Alter and Houghton were honored with the Lasker Award for Clinical Medical Research for "pioneering work leading to the discovery of the virus that causes hepatitis C and the development of screening methods that reduced the risk of blood transfusion-associated hepatitis in the U.S. from 30% in 1970 to virtually zero in 2000."

In 2004 Chiron held 100 patents in 20 countries related to hepatitis C and had successfully sued many companies for infringement. Scientists and competitors have complained that the company hinders the fight against hepatitis C by demanding too much money for its technology.

Research

The drug viramidine, which is a prodrug of ribavirin that has better targeting for the liver, and therefore may be more effective against hepatitis C for a given tolerated dose, is in phase III experimental trials against hepatitis C. It will be used in conjunction with interferons[disambiguation needed], in the same manner as ribavirin. However, this drug is not expected to be active against ribavirin-resistant strains, and the use of the drug against infections which have already failed ribavirin/interferon treatment, is unproven.

There are new drugs under development like the protease inhibitors (including VX 950) and polymerase inhibitors (such as NM 283), but development of some of these is still in the early phase. VX 950, also known as Telaprevir is currently in Phase 3 Trials. One protease inhibitor, BILN 2061, had to be discontinued due to safety problems early in the clinical testing. Some more modern new drugs that provide some support in treating HCV are Albuferon, Zadaxin, and DAPY.[citation needed] Antisense phosphorothioate oligos have been targeted to hepatitis C. Antisense Morpholino oligos have shown promise in preclinical studies[54] however, they were found to cause a limited viral load reduction.

Immunoglobulins against the hepatitis C virus exist and newer types are under development. Thus far, their roles have been unclear as they have not been shown to help in clearing chronic infection or in the prevention of infection with acute exposures (e.g. needlesticks). They do have a limited role in transplant patients.

In addition to the standard treatment with interferon and ribavirin, some studies have shown higher success rates when the antiviral drug amantadine (Symmetrel) is added to the regimen. Sometimes called "triple therapy", it involves the addition of 100 mg of amantadine twice a day. Studies indicate that this may be especially helpful for "nonresponders" - patients who have not been successful in previous treatments using interferon and ribavirin only. Currently, amantadine is not approved for treatment of Hepatitis C, and studies are ongoing to determine when it is most likely to benefit the patient and when it is a risk due to their liver deterioration.

Among the more novel treatments under development is the Hemopurifier(R),a first-in-class medical device that selectively removes infectious viruses and immunosuppressive proteins from the bloodstream. In HCV care, the Hemopurifier(R) inhibits viral replication through selective adsorption of circulating HCV and augments the immune response by removing toxic proteins shed from HCV to kill-off immune cells. Recent clinical data validates the mechanical removal of HCV through blood filtration in combination with SOC therapy can increase HCV cure rates by greater than 50%.

Hepatitis B

2009-12-24T11:35:00.000-08:00

Key facts

* Hepatitis B is a viral infection that attacks the liver and can cause both acute and chronic disease.
* The virus is transmitted through contact with the blood or other body fluids of an infected person - not through casual contact.
* About 2 billion people worldwide have been infected with the virus and about 350 million live with chronic infection. An estimated 600 000 persons die each year due to the acute or chronic consequences of hepatitis B.
* About 25% of adults who become chronically infected during childhood later die from liver cancer or cirrhosis (scarring of the liver) caused by the chronic infection.
* The hepatitis B virus is 50 to 100 times more infectious than HIV.
* Hepatitis B virus is an important occupational hazard for health workers.
* Hepatitis B is preventable with a safe and effective vaccine.
Hepatitis B is a potentially life-threatening liver infection caused by the hepatitis B virus. It is a major global health problem and the most serious type of viral hepatitis. It can cause chronic liver disease and puts people at high risk of death from cirrhosis of the liver and liver cancer.

Worldwide, an estimated two billion people have been infected with the hepatitis B virus (HBV), and more than 350 million have chronic (long-term) liver infections.

A vaccine against hepatitis B has been available since 1982. Hepatitis B vaccine is 95% effective in preventing HBV infection and its chronic consequences, and is the first vaccine against a major human cancer.

Symptoms

Hepatitis B virus can cause an acute illness with symptoms that last several weeks, including yellowing of the skin and eyes (jaundice), dark urine, extreme fatigue, nausea, vomiting and abdominal pain. People can take several months to a year to recover from the symptoms. HBV can also cause a chronic liver infection that can later develop into cirrhosis of the liver or liver cancer.
Who is most at risk for chronic disease?

The likelihood that an HBV infection will become chronic depends upon the age at which a person becomes infected, with young children who become infected with HBV being the most likely to develop chronic infections. About 90% of infants infected during the first year of life develop chronic infections; 30% to 50% of children infected between one to four years of age develop chronic infections. About 25% of adults who become chronically infected during childhood die from HBV-related liver cancer or cirrhosis.

About 90% of healthy adults who are infected with HBV will recover and be completely rid of the virus within six months.
Where is hepatitis B most common?

Hepatitis B is endemic in China and other parts of Asia. Most people in the region become infected with HBV during childhood. In these regions, 8% to 10% of the adult population are chronically infected. Liver cancer caused by HBV is among the first three causes of death from cancer in men, and a major cause of cancer in women. High rates of chronic infections are also found in the Amazon and the southern parts of eastern and central Europe. In the Middle East and Indian sub-continent, an estimated 2% to 5% of the general population is chronically infected. Less than 1% of the population in western Europe and North American is chronically infected.
Transmission

Hepatitis B virus is transmitted between people by contact with the blood or other body fluids (i.e. semen and vaginal fluid) of an infected person. Modes of transmission are the same for the human immunodeficiency virus (HIV), but HBV is 50 to 100 times more infectious Unlike HIV, HBV can survive outside the body for at least 7 days. During that time, the virus can still cause infection if it enters the body of a person who is not infected.

Common modes of transmission in developing countries are:

* perinatal (from mother to baby at birth)
* early childhood infections (inapparent infection through close interpersonal contact with infected household contacts)
* unsafe injections practices
* blood transfusions
* sexual contact

In many developed countries (e.g. those in western Europe and North America), patterns of transmission are different than those mentioned above. Today, the majority of infections in these countries are transmitted during young adulthood by sexual activity and injecting drug use. HBV is a major infectious occupational hazard of health workers.

HBV is not spread by contaminated food or water, and cannot be spread casually in the workplace.

The virus incubation period is 90 days on average, but can vary from about 30 to 180 days. HBV may be detected 30 to 60 days after infection and persist for widely variable periods of time.

Treatment

There is no specific treatment for acute hepatitis B. Care is aimed at maintaining comfort and adequate nutritional balance, including replacement of fluids that are lost from vomiting and diarrhoea.

Chronic hepatitis B can be treated with drugs, including interferon and anti-viral agents, which can help some patients. Treatment can cost thousands of dollars per year and is not available to most patients in developing countries.

Liver cancer is almost always fatal, and often develops in people at an age when they are most productive and have family responsibilities. In developing countries, most people with liver cancer die within months of diagnosis. In higher income countries, surgery and chemotherapy can prolong life for up to a few years in some patients.

Patients with cirrhosis are sometimes given liver transplants, with varying success.
Prevention

All infants should receive the hepatitis B vaccine: this is the mainstay of hepatitis B prevention.

The vaccine can be given as either three or four separate doses, as part of existing routine immunization schedules. In areas where mother-to-infant spread of HBV is common, the first dose of vaccine should be given as soon as possible after birth (i.e. within 24 hours).

The complete vaccine series induces protective antibody levels in more than 95% of infants, children and young adults. After age 40, protection following the primary vaccination series drops below 90%. At 60 years old, protective antibody levels are achieved in only 65 to 75% of those vaccinated. Protection lasts at least 20 years and should be lifelong.

All children and adolescents younger than 18 years old and not previously vaccinated should receive the vaccine. People in high risk groups should also be vaccinated, including:

* persons with high-risk sexual behaviour;
* partners and household contacts of HBV infected persons;
* injecting drug users;
* persons who frequently require blood or blood products;
* recipients of solid organ transplantation;
* those at occupational risk of HBV infection, including health care workers; and
* international travellers to countries with high rates of HBV.

The vaccine has an outstanding record of safety and effectiveness. Since 1982, over one billion doses of hepatitis B vaccine have been used worldwide. In many countries where 8% to 15% of children used to become chronically infected with HBV, vaccination has reduced the rate of chronic infection to less than 1% among immunized children.

As of December 2006, 164 countries vaccinate infants against hepatitis B during national immunization programmes - a major increase compared with 31 countries in 1992, the year that the World Health Assembly passed a resolution to recommend global vaccination against hepatitis B.

Hepatitis A

2009-12-23T11:34:00.000-08:00

Key facts

* Hepatitis A is a viral liver disease that can cause mild to severe illness.
* It is spread by faecal-oral (or stool to mouth) transmission when a person ingests food or drink contaminated by an infected person's stool.
* The disease is closely associated with poor sanitation and a lack of personal hygiene habits, such as hand-washing.
* An estimated 1.4 million cases of hepatitis A occur annually.
* Epidemics can be explosive in growth and cause significant economic losses: 300 000 were affected in one Shanghai outbreak in 1988.
* Improved sanitation and the Hepatitis A vaccine are the most effective ways to combat the disease.

Hepatitis A is a liver infection caused by the hepatitis A virus (HAV). The virus is spread when an uninfected (or unvaccinated) person eats or drinks something contaminated by the stool of an HAV-infected person: this is called faecal-oral transmission. The disease is closely associated with inadequate sanitation and poor personal hygiene. Unlike hepatitis B and C, hepatitis A infection does not cause chronic liver disease and is rarely fatal, but it can cause debilitating symptoms.
Hepatitis A occurs sporadically and in epidemics worldwide, with a tendency for cyclic recurrences. Worldwide, HAV infections account for an estimated 1.4 million cases annually. Epidemics related to contaminated food or water can erupt explosively, such as an epidemic in Shanghai in 1988 that affected about 300 000 people.

The disease can wreak significant economic and social consequences in communities. It can take weeks or months for people recovering from the illness to return to work, school or daily life. The impact on food establishments identified with the virus, and local productivity in general, can be substantial.
Symptoms

The symptoms of hepatitis A range from mild to severe, and can include fever, malaise, loss of appetite, diarrhoea, nausea, abdominal discomfort, dark-colored urine and jaundice (a yellowing of the skin and whites of the eyes). Not everyone who is infected will have all of the symptoms. Adults have signs and symptoms of illness more often than children, and the severity of disease and mortality increases in older age groups. Infected children under six years of age do not usually experience noticeable symptoms, and only 10% develop jaundice. Among older children and adults, infection usually causes more severe symptoms, with jaundice occurring in more than 70% of cases. Most people recover in several weeks - or sometimes months - without complications.
Who is at risk?

Anyone who has not had been infected previously or been vaccinated can contract hepatitis A. People who live in places with poor sanitation are at higher risk. In areas where the virus is widespread, most HAV infections occur during early childhood. Other risk factors for the virus include injecting drugs, living in a household with an infected person, or being a sexual partner of someone with acute HAV infection.
Transmission

HAV is usually spread from person to person when an uninfected person ingests food or beverages that have been contaminated with the stool of a person with the virus. Bloodborne transmission of HAV occurs, but is much less common. Waterborne outbreaks, though infrequent, are usually associated with sewage-contaminated or inadequately treated water. Casual contact among people does not spread the virus.
Treatment

There is no specific treatment for hepatitis A. Recovery from symptoms following infection may be slow and take several weeks or months. Therapy is aimed at maintaining comfort and adequate nutritional balance, including replacement of fluids that are lost from vomiting and diarrhoea.
Prevention

Improved sanitation and Hepatitis A immunization are the most effective ways to combat the disease.

Adequate supplies of safe-drinking water and proper disposal of sewage within communities, combined with personal hygiene practices, such as regular hand-washing, reduce the spread of HAV.

Several hepatitis A vaccines are available internationally. All are similar in terms of how well they protect people from the virus and their side-effects. No vaccine is licensed for children younger than one year of age.

Nearly 100% of people will develop protective levels of antibodies to the virus within one month after a single dose of the vaccine. Even after virus exposure, one dose of the vaccine within two weeks of contact with the virus has protective effects. Still, manufacturers recommend two vaccine doses to ensure longer-term protection of about 5 to 8 years after vaccination. Millions of people have been immunized with no serious adverse events. The vaccine can be given as part of regular childhood immunizations programmes and with vaccines commonly given for travel.

Where is the disease found?

Geographic areas can be characterized as having high, intermediate or low levels of HAV infection.

* High: In developing countries with very poor sanitary conditions and hygienic practices, the lifetime risk of infection is greater than 90%. Most infections occur in early childhood and those infected do not experience any noticeable symptoms. Epidemics are uncommon because older children and adults are generally immune. Disease rates in these areas are low and outbreaks are rare.
* Intermediate: In developing countries, countries with transitional economies and regions where sanitary conditions are variable, children escape infection in early childhood. Ironically, these improved economic and sanitary conditions may lead to higher disease rates, as infections occur in older age groups, and large outbreaks can occur.
* Low: In developed countries with good sanitary and hygienic conditions infection rates are low. Disease may occur among adolescents and adults in high-risk groups, such as injecting-drug users, homosexual men, persons travelling to high-risk areas, and in isolated populations, e.g. closed religious communities.

Immunization efforts

Planning for large-scale immunization programmes should involve careful economic evaluations and consider alternative or additional prevention methods, such as better sanitation and health education for improved hygiene.

Whether or not to include the vaccine in routine childhood immunizations depends on the local context, including the level of risk for children . Several countries, including Argentina, China, Israel and the United States have introduced the vaccine in routine childhood immunizations. Other countries recommend the vaccine for persons at increased risk of hepatitis A, including travellers to countries where the virus is endemic, men who have sex with men, or persons with chronic liver disease (because of their increased risk of serious complications if they acquire HAV infection).

Recommendations for hepatitis A vaccination in outbreaks should also be site-specific, including the feasibility of rapidly implementing a widespread immunization campaign. Vaccination to control community-wide outbreaks is most successful in small communities, when the campaign is started early and when high coverage of multiple age groups is achieved. Vaccination efforts should be supplemented by health education to improve sanitation and hygiene practices.

High Blood Pressure

2009-12-22T10:43:00.000-08:00

It’s a well known fact that fast food diets contribute a lot in raising the blood pressure in the body. Most people love fast foods isn’t it? Foods from well known establishments contain high in cholesterol that triggers not just the raise in blood pressure but also contributes to other ailments. One of the easiest ways to lower it down is through starvation from fast food diet. You need to stick to the basic foods, avoid red meat and those high in fat. Eliminating these foods from your diet will surely hate your taste buds but not your stomach.

There’s a study that shows that the human’s digestive tract recognizes the green foods and not much of the red meats and fatty foods you keep on munching. It has been proven that when you stop eating all these foods the amount of cholesterol on your blood will simply go down and this will enable your blood vessels to be more elastic. A very healthy diet composed of vegetables and fruits are the most ideal diet you need to have. If you want to live a longer and happy life in this world, you should go back to basics and start eating 100% all natural foods. Health experts say that a diet composed of fiber, potassium, calcium., magnesium, vitamin C and A is the perfect component you need to lower down your blood pressure naturally.

Endurance training is one of the most effective ways that you can combine with healthy diet to lower down your blood pressure quickly. There are times when you need to combine exercise, proper diet and anti-hypertensive drugs according to your doctor’s prescription. Your doctor will tell you what will be best for you according to your blood pressure level. There are instances when you only need to adjust your diet and increase your exercise to lower it down. You still need to refer to your doctor’s advice to meet the best of your health. These tips will help you a lot with your diet modification:

• You need to do strength exercise such as aerobics, walking, sprints, yoga
and other exercises to be able to lower down your blood pressure level. It will be best if you will do it regularly to be able to bring back your blood pressure into its normal range.

• Pick an activity you like best. It will also be helpful to you if you would try to join a group of people who do regular exercise each day. There are also times when you need to join a group of individuals to be able to encourage you to do the regular regimen you need to lower down your blood pressure and bring you back into shape again.

• Lose extra pounds and watching your waist line will help you a lot in lowering down your blood pressure. Carrying so much weight and fats can increase your risk of having a heart problem later on in life other than having a high blood pressure.

Converting Friendship Into Love

2009-12-20T06:50:00.000-08:00

Disclaimer: these tips will only work if your friend is of the opposite sex...

Okay, now that’s out of the way we can continue on with the article. Developing a crush on a friend is a difficult thing but chances are it’s happened to everyone at one point or another. On the one hand it’s the perfect scenario – you know loads about each other, you’re used to spending lots of time in each others company and you know you like each other. On the other however it couldn’t be more fraught with difficulties, how do you get out of the dreaded ‘friend zone’?

We just mentioned the positive aspects of going from friend to lover so take advantage of those first. Pull out all the stops and be a really good friend, make sure you do lots of fun things together and try to do more of whatever it is that makes her like you. You basically just want to up the ante as a friend to start with so start treating her like a best friend – the more time you spend with her the more she’ll become attached to you and used to having you around. Everyone has at some point thought how much easier it would be if their best mate was the opposite sex – so just elevate yourself to that status and it’ll seem temptingly convenient.

You may now also want to up the sweetness factor. So maybe get the odd gift for your crush, nothing massive so as to give yourself away, but rather something small and spontaneous that reminds you of them. Another sweet thing to do is to text them to let them know if there’s something on TV that they’ll like. If you get it right demonstrating thoughtfulness and a real understanding of what they find interesting then they should be really touched by the gesture.

You should also start calling more, particularly in the evenings and mornings. Now you’re kind of edging over the friendship line and into relationship status and both parties should feel it. If they aren’t interested you should pick up on a reluctance to spend so much time with you, if this is the case then back off and move onto phase two below, at least you haven’t lost face. If however they start calling you randomly and want to spend more time together it’s time to make your move and ask them out (or less awkward would be to try and pull them in a club).

If your attempts don’t seem to be working then you have a trickier case on your hands and it’s time to pull back in case you start to look needy or desperate. Phase two then, for code red situations, is to now withdraw all your attentions. Become aloof and start flirting with other girls etc. After so much time spent together your friend should start to miss you and it’s only natural to want what you can’t have. Remember – all’s fair in love and war, and very soon they’ll start pining after you. You’ve slowly wriggled your way into her psyche, then teased her and flirted with other women until she can’t stand it… ah, young love.

Breast cancer - An Overview

2009-12-19T07:34:00.000-08:00

Breast cancer refers to cancers that originate from breast tissue, most commonly from the inner lining of milk ducts or lobules. There are different types of breast cancer, with different stages (spread), aggressiveness, and genetic makeup. Survival varies greatly depending on those factors; with best treatment, 10-year disease-free survival varies from 98% to 10%. Treatment includes surgery, drugs (hormonal therapy and chemotherapy), and radiation

Worldwide, breast cancer comprises 10.4% of all cancer incidence, making it the second most common type of cancer (after lung cancer) and the fifth most common cause of cancer death.[2] In 2004, breast cancer caused 519,000 deaths worldwide (7% of cancer deaths; almost 1% of all deaths).[3] Breast cancer is about 100 times more common in women than in men, but survival rates are equal in both sexes.

Some breast cancers require the hormones estrogen and progesterone to grow, and have receptors for those hormones. After surgery those cancers are treated with drugs that interfere with those hormones, usually tamoxifen, and with drugs that shut off the production of estrogen in the ovaries or elsewhere; this may damage the ovaries and end fertility. Low-risk, hormone-sensitive breast cancers may be treated with hormone therapy and radiation alone. Breast cancers without hormone receptors, or which have spread to the lymph nodes in the armpits, or which express certain genetic characteristics, are higher-risk, and are treated more aggressively. One standard regimen, popular in the U.S., is cyclophosphamide plus doxorubicin (Adriamycin), known as CA; these drugs damage DNA in the cancer, but also in fast-growing normal cells where they cause serious side effects. Sometimes a taxane drug, such as docetaxel, is added, and the regime is then known as CAT; taxane attacks the microtubules in cancer cells. An equivalent treatment, popular in Europe, is cyclophosphamide, methotrexate, and fluorouracil (CMF).[7] Monoclonal antibodies, such as trastuzumab, are used for cancer cells that have the HER2 mutation. Radiation is usually added to the surgical bed to control cancer cells that were missed by the surgery, which usually extends survival, although radiation exposure to the heart may cause damage and heart failure in the following years Classification
Main article: Breast cancer classification

Breast cancers are classified by four different schemes:

* Stage. The TNM classification for breast cancer is based on the size of the tumor (T), whether or not the tumor has spread to the lymph nodes (N) in the armpits, and whether the tumor has metastasized (M) or spread to a more distant part of the body. Larger size, nodal spread, and metastasis have a worse prognosis.

* Pathology. Most often, breast cancer cells are derived from the epithelium lining the ducts. Frequently they are derived from the epithelial lining of the lobules. Less commonly, they are derived from nonepithelial tissue. Carcinoma in situ is proliferation of cancer cells within ducts or lobules and without invasion of the surrounding tissue. Invasive carcinoma invades the surrounding tissue.

* Grade (Bloom-Richardson grade). When cells become differentiated, they take different shapes and forms to function as part of an organ. Cancerous cells lose that differentiation. Cells that normally line up in an orderly way to make up the milk ducts become disorganized. Cell division becomes uncontrolled. Cell nuclei become less uniform. Pathologists describe cells as well differentiated (low grade), moderately differentiated (intermediate grade), and poorly differentiated (high grade). Poorly-differentiated cancers have a worse prognosis.
* Receptor status. Breast cancer cells have receptors on their surface. Chemical messengers such as hormones bind to receptors, and this causes changes in the cell. Breast cancer cells may or may not have three important receptors: estrogen receptor (ER), progesterone receptor (PR), and HER2/neu. Cells with these receptors are called ER positive (ER+), ER negative (ER-) PR positive (PR+) PR negative (PR-) HER2 positive (HER2+) and HER2 negative (HER2-). Cells with none of these receptors are called basal-like or triple negative. ER+ cancer cells depend on estrogen for their growth, so they can be treated with drugs to reduce estrogen, and generally have a better prognosis. HER2+ cancer cells respond to drugs such as trastuzumab. Generally, HER2+ has a worse prognosis. These receptors are identified by immunohistochemistry.

Receptor status is used to divide breast cancer into four molecular classes: (1) Basal-like, which are ER-, PR- and HER2- (triple negative, TN). Most BRCA1 breast cancers are basal-like TN. (2) Luminal A, which are ER+ and low grade (3) Luminal B, which are ER+ but often high grade (4) HER2+, which have amplified ERBB2.

DNA microarrays have compared normal cells to breast cancer cells and found differences in hundreds of genes, but the significance of most of those differences is unknown. Several screening tests are commercially marketed, but the evidence for their value is limited. The only test supported by Level II evidence is Oncotype DX, which is not approved by the U.S. Food and Drug Administration (FDA) but is endorsed by the American Society of Clinical Oncology. MammaPrint is approved by the FDA but is only supported by Level III evidence. Two other tests have Level III evidence: Theros and MapQuant Dx. No tests have been verified by Level I evidence (a prospective, randomized controlled trial in which patients who used the test had a better outcome than those who did not). In a review, Sotirou concluded, "The genetic tests add modest prognostic information for patients with HER2-positive and triple-negative tumors, but when measures of clinical risk are equivocal (e.g., intermediate expression of ER and intermediate histologic grade), these assays could guide clinical decisions."

Breast cancer is usually, but not always, primarily classified by its histological appearance. Rare variants are defined on the basis of physical exam findings. For example, inflammatory breast cancer (IBC), a form of ductal carcinoma or malignant cancer in the ducts, is distinguished from other carcinomas by the inflamed appearance of the affected breast.[11] In the future, some pathologic classifications may be changed.
Signs and symptoms

The first symptom, or subjective sign, of breast cancer is typically a lump that feels different from the rest of the breast tissue. According to the The Merck Manual, more than 80% of breast cancer cases are discovered when the woman feels a lump.According to the American Cancer Society, the first medical sign, or objective indication of breast cancer as detected by a physician, is discovered by mammogram. Lumps found in lymph nodes located in the armpits can also indicate breast cancer.

Indications of breast cancer other than a lump may include changes in breast size or shape, skin dimpling, nipple inversion, or spontaneous single-nipple discharge. Pain ("mastodynia") is an unreliable tool in determining the presence or absence of breast cancer, but may be indicative of other breast health issues.

When breast cancer cells invade the dermal lymphatics—small lymph vessels in the skin of the breast—its presentation can resemble skin inflammation and thus is known as inflammatory breast cancer (IBC). Symptoms of inflammatory breast cancer include pain, swelling, warmth and redness throughout the breast, as well as an orange-peel texture to the skin referred to as peau d'orange.

Another reported symptom complex of breast cancer is Paget's disease of the breast. This syndrome presents as eczematoid skin changes such as redness and mild flaking of the nipple skin. As Paget's advances, symptoms may include tingling, itching, increased sensitivity, burning, and pain. There may also be discharge from the nipple. Approximately half of women diagnosed with Paget's also have a lump in the breast.

Occasionally, breast cancer presents as metastatic disease, that is, cancer that has spread beyond the original organ. Metastatic breast cancer will cause symptoms that depend on the location of metastasis. Common sites of metastasis include bone, liver, lung and brain.[16] Unexplained weight loss can occasionally herald an occult breast cancer, as can symptoms of fevers or chills. Bone or joint pains can sometimes be manifestations of metastatic breast cancer, as can jaundice or neurological symptoms. These symptoms are "non-specific", meaning they can also be manifestations of many other illnesses.
Most symptoms of breast disorder do not turn out to represent underlying breast cancer. Benign breast diseases such as mastitis and fibroadenoma of the breast are more common causes of breast disorder symptoms. The appearance of a new symptom should be taken seriously by both patients and their doctors, because of the possibility of an underlying breast cancer at almost any age.
Causes and risk factors
Main article: Risk factors of breast cancer

The primary risk factors that have been identified are sex,age, childbearing, hormones, a high-fat diet, alcohol intake, obesity, and environmental factors such as tobacco use, radiation , endocrine disruptors and shiftwork.
Well established risk factors account for 47% of cases while 5% are attributable to hereditary syndromes.[28] In particular, carriers of the breast cancer susceptibility genes, BRCA1 and BRCA2, are at a 30-40% increased risk for breast and ovarian cancer, depending on in which portion of the protein the mutation occurs.
* Personal history of breast cancer: A woman who had breast cancer in one breast has an increased risk of getting cancer in her other breast.
* Family history: A woman's risk of breast cancer is higher if her mother, sister, or daughter had breast cancer. The risk is higher if her family member got breast cancer before age 40. Having other relatives with breast cancer (in either her mother's or father's family) may also increase a woman's risk.
* Certain breast changes: Some women have cells in the breast that look abnormal under a microscope. Having certain types of abnormal cells (atypical hyperplasia and lobular carcinoma in situ [LCIS]) increases the risk of breast cancer.
* Race: Breast cancer is diagnosed more often in Caucasian women than Latina, Asian, or African American women.
* No physical activity: Women who are physically inactive throughout life may have an increased risk of breast cancer. Being active may help decrease risk.

Abortion has not been found to be a risk factor for breast cancer. The breast cancer abortion hypothesis however continues to be promoted by some pro-life groups. Bras and tight fitting clothing has not been found to be related to breast cancer.
United Kingdom being member of International Cancer Genome Consortium is leading efforts to map breast cancer's complete genome.
Pathophysiology
Main article: Carcinogenesis

Breast cancer, like other forms of cancer, is the outcome of multiple environmental and hereditary factors. Some of these factors include:

1. Inherited defects in DNA repair genes, such as BRCA1, BRCA2 and TP53.
2. Lesions to DNA such as genetic mutations. Mutations that can lead to breast cancer have been experimentally linked to estrogen exposure.
3. Failure of immune surveillance, a theory in which the immune system removes malignant cells throughout one's life.
4. Abnormal growth factor signaling in the interaction between stromal cells and epithelial cells can facilitate malignant cell growth.[citation needed]

People in less-developed countries report lower incidence rates than in developed countries.
In the United States, 10 to 20 percent of patients with breast cancer and patients with ovarian cancer have a first- or second-degree relative with one of these diseases. Mutations in either of two major susceptibility genes, breast cancer susceptibility gene 1 (BRCA1) and breast cancer susceptibility gene 2 (BRCA2), confer a lifetime risk of breast cancer of between 60 and 85 percent and a lifetime risk of ovarian cancer of between 15 and 40 percent. However, mutations in these genes account for only 2 to 3 percent of all breast cancers.
Diagnosis
While screening techniques discussed above are useful in determining the possibility of cancer, a further testing is necessary to confirm whether a lump detected on screening is cancer, as opposed to a benign alternative such as a simple cyst.

In a clinical setting, breast cancer is commonly diagnosed using a "triple test" of clinical breast examination (breast examination by a trained medical practitioner), mammography, and fine needle aspiration cytology. Both mammography and clinical breast exam, also used for screening, can indicate an approximate likelihood that a lump is cancer, and may also identify any other lesions. Fine Needle Aspiration and Cytology (FNAC), which may be done in a GP's office using local anaesthetic if required, involves attempting to extract a small portion of fluid from the lump. Clear fluid makes the lump highly unlikely to be cancerous, but bloody fluid may be sent off for inspection under a microscope for cancerous cells. Together, these three tools can be used to diagnose breast cancer with a good degree of accuracy.

Other options for biopsy include core biopsy, where a section of the breast lump is removed, and an excisional biopsy, where the entire lump is removed.
Screening
Main article: Breast cancer screening
Mammograms showing a normal breast (left) and a breast cancer (right).

Breast cancer screening refers to testing otherwise-healthy women for breast cancer in an attempt to achieve an earlier diagnosis. The assumption is that early detection will improve outcomes. A number of screening test have been employed including: clinical and self breast exams, mammography, genetic screening, ultrasound, and magnetic resonance imaging.

A clinical or self breast exam involves feeling the breast for lumps or other abnormalities. Evidence however does not support its use. Mammographic screening for breast cancer is also controversial. It uses x-rays to examine the breast for any uncharacteristic masses or lumps. The Cochrane collaboration in 2009 concluded that it is unclear whether screening does more good than harm.[39] Many national organizations however recommend it. If mammography is decided upon it should only be done every two years in women between the ages of 50 and 74.

In women at high risk, such as those with a strong family history of cancer, additional testing may include genetic screening and / or magnetic resonance imaging. Genetic screening involves testing for mutations in the BRCA genes.
Management
Main article: Breast cancer treatment
Chest appearance after right breast mastectomy.

The mainstay of breast cancer treatment is surgery. Adjuvant hormonal therapy (with tamoxifen or an aromatase inhibitor) is given when the tumor expresses estrogen receptors or progesterone receptors. Chemotherapy is given for more advanced stages of disease. Monoclonal antibodies are sometimes used, especially for HER2-positive tumors. Radiotherapy is given after surgery to the region of the tumor bed, to destroy microscopic tumors that may have escaped surgery. Treatments are constantly being evaluated in randomized, controlled trials, to evaluate and compare individual drugs, combinations of drugs, and surgical and radiation techniques. The latest research is reported annually at scientific meetings such as that of the American Society of Clinical Oncology, San Antonio Breast Cancer Symposium,and the St. Gallen Oncology Conference in St. Gallen, Switzerland. These studies are reviewed by professional societies and other organizations, and formulated into guidelines for specific treatment groups and risk category.

Radiation therapy is also used to help destroy cancer cells that may linger after surgery. Radiation therapy can be delivered as external beam radiotherapy or as brachytherapy (internal radiotherapy). Radiation can reduce the risk of recurrence by 50-66% (1/2 - 2/3rds reduction of risk) when delivered in the correct dose.
Prognosis

A prognosis is the medical team's "best guess" in how cancer will affect a patient. There are many prognostic factors associated with breast cancer: staging, tumor size and location, grade, whether disease is systemic (has metastasized, or traveled to other parts of the body), recurrence of the disease, and age of patient.

Stage is the most important, as it takes into consideration size, local involvement, lymph node status and whether metastatic disease is present. The higher the stage at diagnosis, the worse the prognosis. The stage is raised by the invasiveness of disease to lymph nodes, chest wall, skin or beyond, and the aggressiveness of the cancer cells. The stage is lowered by the presence of cancer-free zones and close-to-normal cell behaviour (grading). Size is not a factor in staging unless the cancer is invasive. Ductal Carcinoma in situ throughout the entire breast is stage zero.

Grading is based on how biopsied, cultured cells behave. The closer to normal cancer cells are, the slower their growth and the better the prognosis. If cells are not well differentiated, they will appear immature, will divide more rapidly, and will tend to spread. Well differentiated is given a grade of 1, moderate is grade 2, while poor or undifferentiated is given a higher grade of 3 or 4 (depending upon the scale used).

Younger women tend to have a poorer prognosis than post-menopausal women due to several factors. Their breasts are active with their cycles, they may be nursing infants, and may be unaware of changes in their breasts. Therefore, younger women are usually at a more advanced stage when diagnosed. There may also be biologic factors contributing to a higher risk of disease recurrence for younger women with breast cancer.

The presence of estrogen and progesterone receptors in the cancer cell, while not prognostic, is important in guiding treatment. Those who do not test positive for these specific receptors will not respond to hormone therapy.

Likewise, HER2/neu status directs the course of treatment. Patients whose cancer cells are positive for HER2/neu have more aggressive disease and may be treated with trastuzumab, a monoclonal antibody that targets this protein.

Elevated CA15-3, in conjunction with alkaline phosphatase, was shown to increase chances of early recurrence in breast cancer.Psychological aspects

The emotional impact of cancer diagnosis, symptoms, treatment, and related issues can be severe. Most larger hospitals are associated with cancer support groups which provide a supportive environment to help patients cope and gain perspective from cancer survivors. Online cancer support groups are also very beneficial to cancer patients, especially in dealing with uncertainty and body-image problems inherent in cancer treatment.

Not all breast cancer patients experience their illness in the same manner. Factors such as age can have a significant impact on the way a patient copes with a breast cancer diagnosis. Premenopausal women with estrogen-receptor positive breast cancer must confront the issues of early menopause induced by many of the chemotherapy regimens used to treat their breast cancer, especially those that use hormones to counteract ovarian function.

On the other hand, a recent study conducted by researchers at the College of Public Health of the University of Georgia showed that older women may face a more difficult recovery from breast cancer than their younger counterparts. As the incidence of breast cancer in women over 50 rises and survival rates increase, breast cancer is increasingly becoming a geriatric issue that warrants both further research and the expansion of specialized cancer support services tailored for specific age groups.Epidemiology
Age-standardized death from breast cancer per 100,000 inhabitants in 2004.[48]
no data less than 2 2-4 4-6 6-8 8-10 10-12 12-14 14-16 16-18 18-20 20-22 more than 22

Worldwide, breast cancer is the most common cancer in women after skin cancer representing 16% of all female cancers. The rate is more than twice that of colorectal cancer and cervical cancer and about three times that of lung cancer.[citation needed] Mortality worldwide is 25% greater than that of lung cancer in women.[2] In 2004, breast cancer caused 519,000 deaths worldwide (7% of cancer deaths; almost 1% of all deaths).[3] The number of cases worldwide has significantly increased since the 1970s, a phenomenon partly attributed to the modern lifestyles.

The incidence of breast cancer varies greatly around the world, being lower in less-developed countries and greatest in the more-developed countries. In the twelve world regions, the annual age-standardized incidence rates per 100,000 women are as follows: in Eastern Asia, 18; South Central Asia, 22; sub-Saharan Africa, 22; South-Eastern Asia, 26; North Africa and Western Asia, 28; South and Central America, 42; Eastern Europe, 49; Southern Europe, 56; Northern Europe, 73; Oceania, 74; Western Europe, 78; and in North America, 90.

Breast cancer is strongly related to age with only 5% of all breast cancers occur in women under 40 years old.
United States

The lifetime risk for breast cancer in the United States is usually give as 1 in 8 (12.5%) with a 1 in 35 (3%) chance of death.[54] A recent analysis however has called this estimate into question when it found a risk of only 6% in healthy women.

The United States have the highest annual incidence rates of breast cancer in the world; 128.6 per 100,000 in whites and 112.6 per 100,000 among African Americans.It is the second-most common cancer (after skin cancer) and the second-most common cause of cancer death (after lung cancer). In 2007, breast cancer was expected to cause 40,910 deaths in the US (7% of cancer deaths; almost 2% of all deaths).
This figure includes 450-500 annual deaths among men out of 2000 cancer cases.

In the US, both incidence and death rates for breast cancer have been declining in the last few years in Native Americans and Alaskan Natives. Nevertheless, a US study conducted in 2005 by the Society for Women's Health Research indicated that breast cancer remains the most feared disease, even though heart disease is a much more common cause of death among women. Many doctors say that women exaggerate their risk of breast cancer.

Racial disparities

Several studies have found that black women in the U.S. are more likely to die from breast cancer even though white women are more likely to be diagnosed with the disease. Even after diagnosis, black women are less likely to get treatment compared to white women. Scholars have advanced several theories for the disparities, including inadequate access to screening, reduced availability of the most advanced surgical and medical techniques, or some biological characteristic of the disease in the African American population. Some studies suggest that the racial disparity in breast cancer outcomes may reflect cultural biases more than biological disease differences. Research is currently ongoing to define the contribution of both biological and cultural factors.
UK

45,000 cases diagnosed and 12,500 deaths per annum. 60% of cases are treated with Tamoxifen, of these the drug becomes ineffective in 35%.
Developing countries

As developing countries grow and adopt Western culture they also accumulate more disease that has arisen from Western culture and its habits (fat/alcohol intake, smoking, exposure to oral contraceptives, the changing patterns of childbearing and breastfeeding, low parity). For instance, as South America has developed so has the amount of breast cancer. “Breast cancer in less developed countries, such as those in South America, is a major public health issue. It is a leading cause of cancer-related deaths in women in countries such as Argentina, Uruguay, and Brazil. The expected numbers of new cases and deaths due to breast cancer in South America for the year 2001 are approximately 70,000 and 30,000, respectively.” However, because of a lack of funding and resources, treatment is not always available to those suffering with breast cancer.
History

Breast cancer may be one of the oldest known forms of cancerous tumors in humans. The oldest description of cancer was discovered in Egypt and dates back to approximately 1600 BC. The Edwin Smith Papyrus describes 8 cases of tumors or ulcers of the breast that were treated by cauterization.The writing says about the disease, "There is no treatment." For centuries, physicians described similar cases in their practises, with the same conclusion. It was not until doctors achieved greater understanding of the circulatory system in the 17th century that they could establish a link between breast cancer and the lymph nodes in the armpit. The French surgeon Jean Louis Petit (1674–1750) and later the Scottish surgeon Benjamin Bell (1749–1806) were the first to remove the lymph nodes, breast tissue, and underlying chest muscle. Their successful work was carried on by William Stewart Halsted who started performing mastectomies in 1882. The Halsted radical mastectomy often involved removing both breasts, associated lymph nodes, and the underlying chest muscles. This often led to long-term pain and disability, but was seen as necessary in order to prevent the cancer from recurring. Radical mastectomies remained the standard until the 1970s, when a new understanding of metastasis led to perceiving cancer as a systemic illness as well as a localized one, and more sparing procedures were developed that proved equally effective.

Prominent women who died of breast cancer include Empress Theodora, wife of Justinian; Anne of Austria, mother of Louis XIV of France; Mary Washington, mother of George, and Rachel Carson, the environmentalist.

The first case-controlled study on breast cancer epidemiology was done by Janet Lane-Claypon, who published a comparative study in 1926 of 500 breast cancer cases and 500 control patients of the same background and lifestyle for the British Ministry of Health.
Society and culture
Pink ribbon.svg

In the fall of 1991, Susan G. Komen for the Cure handed out pink ribbons to participants in its New York City race for breast cancer survivors.[75]

The widespread acceptance of second opinions before surgery, less invasive surgical procedures, support groups, and other advances in patient care have stemmed, in part, from the breast cancer advocacy movement.[76]

In the month of October, the National Breast Cancer Awareness Month is recognized by survivors, family and friends of survivors and/or victims of the disease. A pink ribbon is worn to recognize the struggle that sufferers face when battling with the cancer.

Pink for October is an initiative started by Matthew Oliphant, which asks that any sites willing to help make people aware of breast cancer, change their template or layout to include the color pink, so that when visitors view the site, they see that the majority of the site is pink. Then after reading a short amount of information about breast cancer, or being redirected to another site, they are aware of the disease itself.

The patron saint of breast cancer is Agatha of Sicily.

The pink and blue ribbon was designed in 1996 by Nancy Nick, President and Founder of the John W. Nick Foundation to bring awareness that "Men Get Breast Cancer Too!"
In 2009 Out of the Shadow of Pink, A Man's Pink and the Brandon Greening Foundation for Breast Cancer in Men joined together to globally establish the third week of October as Male Breast Cancer Awareness Week

Symptoms of Hyperactivity

2009-12-18T10:15:00.000-08:00

The occurrence of hyperactivity in children has been increasing over the years. A major reason behind this can be the social status and the present tensions existing in the society. There are various medical professionals who believe that hyperactivity in children can be a genetic syndrome and some link it to the overuse of video games, television and inappropriate diet that is mixed with excess sugar and artificial colors. There are a number of symptoms that can be associated with hyperactivity among children and this indicates that a change in the lifestyle and habits can put things in order. Some of the symptoms include:

• Inability of the child to focus. It is seen that children with hyperactivity often find it difficult to focus on finishing their tasks and the normal activities. This becomes more visible as the child starts going to school and faces focusing problems in completing the schoolwork, which is a priority at that age. A difficulty can result in lack of coping with peers and the pressure keeps on mounting which leads to several other symptoms.

• The inability to relax. Another symptom that children face is to calm themselves and relax their nerves. This is seen in the form of restlessness and kinetic behavior accompanied by nervousness. A problem can interfere with daily life like sitting down for mealtime or in attending church. Overactive and nervous behavior can put the body under stress and leave the nervous and the immune system of the child stressed.

• Excessive talking. If you observe a child who talks excessively in situations that are inappropriate for him or her to talk then the child is possibly hyperactive. This can become a problem specially when the child is attending class or has to sit quietly. Controlling such a behavior becomes difficult especially in the younger children.

• Temper problems. It is commonly observed that hyperactive children also suffer from outbursts of anger. This happens in situations that are emotional and something that they love doing has been stopped. However, this should not be confused with the normal temper tantrums that are seen in toddlers and young children. A hyperactive child will tend to carry their temper problem until adolescence. Self-control is often absent and it becomes difficult for them to have a control over their temper in places where they should be calm and composed like in the grocery store, social gatherings, and the like.

• The inability to listen. Hyperactive children have a problem in listening and following instructions or even concentrating on a conversation. This often prevents these children from carrying out a friendship that would last for long and can also lead to misbehavior. It is often observed that hyperactive children who have a problem in concentrating on listening have been said to have hearing problems. These children basically do not wish to listen to others and do what they want.

To help a hyperactive child, it is important for the parents to handle them with patience and understanding.

Droopy Eyes

2009-12-15T10:09:00.000-08:00

Droopy eyes may be a naturally occurring feature in some people, creating a characteristic ’sleepy eye’ look. However, in other cases, it can extend beyond just the cosmetic aspect and contribute to difficulty with vision, especially in cases of ptosis. The medical term, ptosis, refers to the drooping of the upper eyelids when it is markedly obvious and uncharacteristic for the person in question. Naturally droopy eyelids, that have been present from birth and do not hamper vision in any way, is not considered to be ptosis. Similarly ptosis should not be confused with angioedema, which is the swelling of the dermis of the skin due to an allergic reaction. Angioedema affects the dermis of the cheek and orbit thereby creating a swelling of the eyelid and not drooping.

In cases of ptosis, the drooping eyelids can obstruct the vision when looking upwards. If the eyelid droop is severe, it may even cause a visual obstruction when looking straight ahead. Looking downwards when engaged in tasks like reading may become a problem because the eyelids may droop even more when looking down. Headaches may occur if the forehead muscles are used to raise the eyebrows in an effort to raise the eyelids. Eye fatigue may also occur due to the effort needed to keep the eyes open. If ptosis occurs due to a nerve problem, the eyelid of only one side may droop and it may get worse with time. It may also be accompanied by diplopia or double vision. The head may have to be tilted back in an effort to see properly.

Causes of Droopy Eyes and Eyelids

There are various causes for droopy eyes, the most common being non-pathological like age and lifestyle factor. However muscle or nerve disorders, injury, and birth defects in newborns may cause droopy eyelid(s) , which is considered a sign of an underlying disorder.

Congenital (From Birth) Droopy Eyes

Congenital droopy eyes are at times seen in a newborn baby and may be due to underdevelopment of the levator muscle of the eye (the muscle that lifts the upper eyelids). It may be associated with strabismus (crossed/misaligned eye or squint). If left uncorrected, it can lead to amblyopia (poor vision development) or astigmatism (vision distortion). In cases where the eyelid covers the pupil, surgery is definitely indicated.

Droopy Eyes in Adulthood

Droopy eyes occurs more frequently in adults. There are various causes for the eye drooping and these conditions may also be present in children.

Aging

Age is one of the most common causes of droopy eyes and affects both sides, although it may be worse on one side. Aging causes stretching of the levator muscle of the eye and stretching and wrinkling of the skin around the eyes. This may be accompanied by fatty deposits beneath the skin, causing the upper eyelids to sag. It gives an indication of age and may make a person look older than their actual age. It also creates the impression of tiredness or sadness, sometimes referred to as ‘weepy eyes’. This condition prompts many patients to consider cosmetic surgery to lift the upper eyelid and accentuate the eyes.

Injury

Trauma to the eye such as a assault or an accidental injury to the eye may result in ptosis. Any injury to the oculomotor nerve which supplies the levator muscle can also cause drooping of the eyelids.

Muscle Disorders

Occulopharyngeal muscular dystrophy is an inherited muscle disease which affects movement of the eyes and may also cause problems with swallowing. Ptosis may be one of the symptoms of this disease.

Another group of muscle diseases, called progressive external opthalmoplegia, occur more often in young adults and may cause bilateral ptosis (affecting both sides). There may be associated problems with eye movement and other symptoms include conditions with the muscles of the heart and throat.

Myasthenia gravis is a rare disease where there is weakness and fatigue of the voluntary muscles as a result of a communication problems between the muscles and nerves. The symptoms may increase by repeated use of the muscle and improve on rest. There is no cure for myasthenia gravis and medication may only help to relieve the symptoms. The eye muscles are affected in most cases, causing ptosis, diplopia (double vision) and blurred vision. Other muscles may be affected too, such as muscles of the face, throat, arms and legs, which may cause abnormal facial expressions and difficulty in speaking, swallowing or walking.

Nerve Disorders

Brain injury or cranial nerve injuries due to any cause can cause ptosis by affecting the nerve supply to the muscles of the eyes and eyelids. Stroke, brain tumor, aneurysm, or long-term diabetes may also be involved.

Horner’s syndrome is a rare disorder that occurs due to damage of the sympathetic nerves (which control circulation and perspiration) supplying the face and eyes. The typical symptoms usually occur on one side and are ptosis (drooping of the upper eyelid), constricted pupil (decreased pupil size), and anhydrosis (absent or decreased sweating of the face) on the affected side.

Horner’s syndrome may occur as a result of stroke, tumor, or injury to the spinal cord, but in some cases no cause may be found. There is no definite treatment for Horner’s syndrome except treatment and management of the underlying cause.

Bell’ palsy is usually accompanied by a facial droop due to a one-sided (unilateral) partial or complete paralyis of the facial muscles. Refer to Facial Droop Causes for more information.

Multiple sclerosis is a condition that arises from degeneration of the fatty sheath surrounding the nerves. Ptosis may be a symptom along with muscle weakness and lack of coordination.

Dermatochalasis

This is a type of connective tissue disease where the skin on the upper or lower eyelid loses its elasticity so that it hangs down in folds and gives the impression of droopy eyes. Dermatochalasis is usually associated with old age and there may be a genetic predisposition. Other conditions such as certain skin disorders, injury to the eye and surrounding tissues, thyroid disease or chronic renal disease may also be involved. It may cause problems with vision besides giving a tired look to the eyes and may also be a cause for cosmetic concern. Besides treating the underlying cause, the loose skin around the eyes may need to be surgically tightened or removed completely.

Local Eye Problems

Tumor in the eye socket or of the eyelid
Eyelid and surrounding tissues – infection (orbital cellulitis) or inflammation (blepharitis)

Systemic Conditions, Lifestyle & Induced Causes

Long-term diabetes can affect the nerves supplying the eyes and eyelids and cause ptosis.
Fatigue, lack of sleep and eye strain can lead to baggy eyes and baggy eyelids and give the impression of droopy eyes.
Fluid retention and allergies, even if angioedema is not present, can also contribute to droopy eyes but does not cause ptosis.
Previous eye surgery – ptosis may occur as a complication following cataract surgery.
Over-exposure to the sun
Alcohol abuse
Smoking
Poor nutrition
Hereditary factors
Facial palsy which may be accompanied by a facial droop.

Staying Sniffle-Free In Winter

2009-12-11T11:13:00.000-08:00

Summer’s fun has faded and now it’s time to crank up the heat, grab a cozy throw, wrap your cold hands around a cup of hot tea and perhaps curl up with a good book.

Well, that would be nice in a parallel universe. The thing is, you have to jump up early, make sure the family has a healthy breakfast, and get everyone out the door in one piece. And… you’re faced with frigid weather conditions.

The last thing you need to worry about is the oh-so-dreadful sniffles, which then turn into a sore throat, accompanied by a nasty cough and fever, which inevitably represents lost wages you were counting on. Let’s not even talk about the growing pile of dirty laundry you can‘t bring yourself to do.

So, how do you stay sniffle-free? What can you do to increase your chances of breezing through the winter healthy and strong, immune to the sea of sickness surrounding you?

I’ve decided to share what works for my family. Following are seven ways to keep your body’s defenses on the up and up. These tips will help keep you on your feet performing all the duties beckoning to you.

1. Take probiotics. Available at your local health food store, this supplement boosts your immune system’s defenses. Swallow a capsule or two each morning before you head out the door. It’s a simple and quick way to help fight the flu by preventing it.

2. Add a teaspoon of organic apple cider vinegar to a glass of water, 1-3 times a day. The vinegar kills the bacteria that can make you sick. It also has been known to give one an overall feeling of increased energy and well-being.

3. Eat garlic. A natural antibiotic, this often-avoided food has medicinal value that will not only keep the vampires away, but the doctor, too. The body doesn’t become immune to garlic as it would a prescription antibiotic, therefore you can reap the positive benefits continually.

4. Take a good multivitamin. Provide your body with all the ammunition you can to combat the germs it will come into contact with. In our polluted environment, we need all the help we can get.

5. Make healthy food choices. Fuel your body with balanced nutrition so it will be strong and function properly. The more nutrition you consume, the stronger your immune system will be. Treat your body well and it will do the same for you.

6. Wash your hands! Germs are on the rampage these days and cleanliness is vital to your health. You never know what illness lurks on doorknobs or shopping carts. Keep a big bottle of hand sanitizer in your car as well as a small one in your purse or pocket.

7. Rest. Get to sleep early and stay well rested. Enough sleep cannot only enhance your immune system, but give you that extra ‘pep in your step’ you need to make it through the day.

These seven suggestions should carry you through winter’s cold and flu season sniffle-free.

Sinus Headache

2009-12-06T07:00:00.000-08:00

All around the year, once or twice people do complain about sinus headache. It mostly gets you with the changing season and the change in temperatures getting warm to cold. Sinus headache basically forms due to a small cavity that is behind the nose that gets filled with loads mucus when some virus or bacteria attacks it. It puts a lot of pressure around the nose area and the eyes. This pressure can get really painful at times giving an uncomfortable feeling. There are few things you can look out for just to know if sinus headache is heading your way.

Sinus headache symptoms include high burning fever, serious dry coughing, a stuffed or runny nose, and extreme fatigue along with a sore throat. The patient experiences continuous pain while blowing the nose or sneezing. If you are going through these problems then you may get exposed or already exposed to sinus headache. Understanding sinus headache symptoms is really important since many people mis-drug themselves thinking that a normal headache or migraine is a sinus headache.

People often get confused between a migraine and sinus headache since both of them have quite similar symptoms like the pain worsens when laying down or leaning forward. When you get up in the morning having a sinus headache your cheeks, forehead and brow experience a lot of pain and heaviness. You need to take immediate medication in order to cure sinus headache because once it forms to a dull ache, never-ceasing, then it might become chronic.

Other sinus headache symptoms can be experiencing discharge, severe nasal congestion and a lot of facial pressure. Nausea is also found in some cases that get increased when exposed to bright light and loud noise. You can even get a stiff neck. People often with asthma and having a weaker immune system are exposed to sinus headache more easily. Sinus headache also increases the level of stress, making the person stay confused all the time.

Leaving a sinus headache untreated for a long time can turn out to be very dangerous and life taking at some point. Doctors often prescribe decongestants or antibiotics for sinus headache. Intake of cold juices and humidifiers can be a wise choice to prevent sinus as well.

I hope that the above mentioned information is enough for you to understand about the sinus headache symptoms.

Swine Flu

2009-12-04T11:38:00.000-08:00

Multiple new cases of a new strain of Swine flu (Swine Influenza A, H1N1) have been reported in Mexico and in the United States. Multiple deaths have been reported to the World Health Organization, currently assessing the accuracy of the incoming reports.

Historically, the CDC receives approximately one report of Swine flu case per 1 - 2 years in the United States but over the past four years, these numbers have tripled. Reports are updated daily at on the numbers the CDC is receiving including both national and international cases.

International officials are on alert and airports have begun to screen arriving passengers. Officials are surveying arriving passengers for any viral signs and symptoms. One airport in Chiba, Japan (Narita) is screening passengers arriving from Mexico utilizing thermographic imaging for increases in body temperature.

Transmission of Swine Flu (How is Swine Flu spread?)

As with other flu like illnesses, Swine flu is spread as follows:

Coughing
Sneezing
Kissing
Touching infected objects
Touching nose, mouth and/or eyes with infected hands

Swine Flu Symptoms

Symptoms of Swine flu may including all or some of the following:

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Fever
Muscle aches
Lethargy
Coughing
Headache
Sore throat
Runny nose
Nausea
Vomiting
Diarrhea
Lack of appetite

Complications Of Swine Flu And Higher Risk Individuals

Those at higher risk include those with the following:

Age of 65 years or older
Chronic health problems (such as asthma, diabetes, heart disease)
Pregnant women
Young children

Complications (for all patients but especially for those at higher risk) can include:

Pneumonia
Bronchitis
Sinus infections
Ear infections
Death

Diagnosis And Treatment Of Swine Flu

A respiratory sample collected within the first five days of illness will be collected.
The sample is sent to the CDC for laboratory analysis and confirmation.

At this time the CDC is recommending the use of oseltamivir (Tamiflu) or zanamivir (Relenza) for treatment and/or prevention of Swine flu.

Prevention of Swine Flu

Covering nose and mouth with a tissue upon coughing and sneezing followed by proper disposal of the tissue.
Avoiding contact with ill persons.
Avoiding the urge to touch nose, mouth and eyes in general.
Staying home form work and/or school upon onset and for the duration of symptoms.
Assuring adequate and thorough handwashing and use of alcohol based hand cleansers (in the absence of proper handwashing facilities).
Providing tissues in common areas of homes, common and public areas.
Encouraging pursuit of medical evaluation at earliest onset of symptoms.
Use of masks to those who are exhibiting symptoms or who are ill.
Maintenance of a 3 to 6 foot perimeter around a coughing patient.

Calm analysis coupled with accurate and proper public education is the key to identifying, treating and minimizing a worldwide outbreak.

Diabetes information

2009-12-02T05:21:00.000-08:00

What Is It?
Diabetes is a chronic condition in which the body loses its ability to process glucose, the raw sugar that serves as the source of energy to your cells. The formal name for the condition is Diabetes Mellitus from the Greek "diabetes", meaning "siphon" or "flowing through" and "mellitus" referring to the sweetness of honey. If untreated, diabetes causes a buildup of glucose in the bloodstream. As a response, the body tries to rid itself of the glucose through frequent urination. This is the reason for the elevated glucose levels in the urine. High glucose levels can lead to long-term health problems. There are three types of diabetes: Type 1, Type 2 and Gestational Diabetes.

Type 1 Diabetes
Type 1 diabetes was once called "juvenile diabetes" because it most often occurred in children or young adults. With this type, the pancreas, a small organ near the stomach, stops producing insulin, usually after a bout of some kind of illness. Insulin is the hormone that cells use to convert glucose to energy. Without insulin, a person could, in effect, starve to death on a full stomach.

A person with Type 1 diabetes will often show the symptoms quickly and some may even blackout due to a condition called "ketoacidosis". Once diagnosed, Type 1 diabetes can be treated successfully with injected insulin (it must be injected because it breaks down in the stomach if taken in tablet form).

Type 2 Diabetes
By far the most common form, 90 percent of all people with diabetes have Type 2; this was once called "adult onset" diabetes. In this condition, the pancreas continues to produce insulin, sometimes at a reduced rate, but the cells in the body lose their sensitivity, so the insulin fails to work properly. However, because some insulin is still available, the symptoms of Type 2 are not always immediately obvious and many people go for years, risking the dangers of continuing high blood-glucose levels, without knowing they have the condition.

Roughly 40 percent of people with Type 2 diabetes can manage their condition through changes in diet and increased exercise, which improves the body's sensitivity to insulin. The rest must take oral medication or, in some cases, injected insulin.

Gestational Diabetes
Four percent of pregnant women develop Gestational Diabetes Mellitus (GDM); they then have a 40-percent chance of developing Type 2 diabetes within the next 10 years. Women with gestational diabetes are twice as likely to give birth to a very large baby and three to four times as likely to give birth by Cesarean section.

Complications

Diabetes is the leading cause of new blindness in adults.
40 to 50 percent of people with diabetes have nerve damage; it is the leading cause of amputations in adults.
The risk of cardiac problems increases by two-fold for men with diabetes, three-fold for women.
Hypertension is twice as common among seniors with diabetes.
50 to 60 percent of men with diabetes experience erection dysfunction (impotence).

A New Epidemic
The World Health Organization estimates that the prevalence of diabetes will jump from the current 1 person in 20 to 1 in 10 over the next 10 years, and the increase will be worse in the developed world, where the high incidence of obesity and the aging population increases the risk factors. In Canada, diabetes will affect 1 in 11 adults over the age of 20.

This could be a public health catastrophe, but if those at risk recognize the warning signals and act accordingly, the savings will be counted in thousands of lives and millions of dollars.

Diabetes: Are you at risk?*
The risk factors are different for Type 1 diabetes and Type 2 diabetes. If you are of Aboriginal, Hispanic, Asian or African decent, your chances of developing Type 1 diabetes are higher than those who are not. A family history of diabetes is another risk factor for Type 1 diabetes. In the cases of Type 2 diabetes, the risk factors are:

Age over 45.
Overweight.
Previous problems with glucose tolerance.
Having given birth to a baby over 9 lbs/4 kg.

Symptoms*
For Type 1 diabetes, the symptoms include:

Excessive appetite.
Excessive thirst.
Excessive urination.
Fatigue.
Weight loss.

Those with Type 2 diabetes may also experience some of the same symptoms as those with Type 1 diabetes. There are also other symptoms that may be evident in Type 2 diabetes, which include:

Slow healing of cuts.
Skin infections.
Bladder infections.
Blurred vision.
Numbness or tingling in the hands and feet.

It is also important to note that Type 2 diabetes, the most common type, can occur with little or no symptoms. Fully half of the Canadians who have diabetes don't yet know it. Getting a diagnosis is the first step toward managing your diabetes. If you are over 45 years of age, you should be getting your blood sugar levels tested every 3 years. If you have known risk factors, you should be checked every year.

*Information has been provided by the Canadian Diabetes Association.

Diabetes Management
There are a number of steps in managing your condition, each to help you lead a full and active life. These steps include:

· Educate yourself. Diabetes education is very important and plays a big role in helping you manage your condition as well as making lifestyle choices.

· Make a dietary plan. Work with a dietician to design the best meal plan for you. If you have Type 1 diabetes, your plan will aim to provide you with a healthy diet and a steady level of carbohydrates. If you have Type 2 diabetes, your plan will aim to reduce your blood sugar levels and your weight (if applicable).

· Exercise regularly. Exercise and diet work hand in hand. Exercise can help you lose excess weight, lower your blood sugar level and improve insulin sensitivity³. You should consult your doctor before beginning any exercise program.

· Monitor your own blood sugar. You can test your own blood sugar levels at home with a blood glucose meter. There are a variety of blood glucose monitors on the market, and your pharmacist can help you pick out the one that's most suited to your needs. You should keep your own record of your blood sugar levels, because it can help you determine your need for adjusting your medication, food or exercise⁵. When to test and the number of tests vary from person to person, so you and your doctor will determine the best schedule for you.

Drug Therapy
Type 1 diabetes
All those with Type 1 diabetes need to be treated with injected insulin. Insulin comes in many forms varying in how fast they start working, how long it takes for them to reach maximum efficiency and how long they last. There are rapid acting, short acting, intermediate acting, long acting and premixed combinations of short and intermediate acting insulin on the market⁴. Your doctor will work with you to formulate a regimen that is best for you. For those of you who find using syringes and vials inconvenient, insulin pens offer a more portable and convenient way of giving your insulin.

Type 2 diabetes
When blood sugar levels cannot be controlled through diet and exercise, oral medications can help. These include: sulfonyureas, biguanides, Alpha glucosidase, thiazolidinediones and meglitinide.

Sulfonylureas stimulate your pancreas to make more insulin, and may also lower the blood sugar production in your liver and help your body use insulin better. Glyburide and Gliclazide are examples of this class.

Biguanides help your muscle take in more blood sugar and reduce blood sugar production by your liver. An example is Metformin.

Alpha Glucosidase inhibitors slow down the absorption of carbohydrates in your small intestines, hence, lowering your blood sugar. Acarbose is an example of this class of medication.

Thiazolidinediones help your muscle and fat tissues take up and use more blood sugar and lower the amount of blood sugar produced. An example of this class is Rosiglitazone.

Meglitinide is a new chemical class of medications that reduce blood glucose by stimulating the release of insulin from the pancreas. This mechanism is the same as that of the sulfonylureas. Repaglinide is an example of this class.

A combination of these pills or a combination of a pill and insulin may be prescribed if just one medicine doesn't lower the blood sugar levels to an adequate level.

Crisis Management
Some people with diabetes could be in danger if their blood-glucose level drops below a critical point, a condition called hypoglycemia. The symptoms are sweating, tremors, fatigue, confusion and weakness. Untreated, this condition can lead to death. If someone you know has diabetes, or if you come upon someone wearing a diabetes Medic Alert® bracelet while in this condition, you should immediately call for medical assistance and then administer sugar in the form of a sweet drink (soft drink containing sugar or a fruit juice) or a sugar syrup or candy.

Seeking Information
If you have any questions about diabetes or about your treatment, talk to your doctor or Save-On-Foods pharmacist.

Our pharmacists can also introduce you to the benefits of the Health computer kiosk - an easily accessible, user-friendly and authoritative source of the latest knowledge on health and medicines at the touch of your fingertips. Health kiosks are located in all of our pharmacies. And when you have found the information you're looking for, you can print it and take it with you.