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H5N1 Avian Flu
Definition:
Bird flu is an infection caused by avian (bird) influenza (flu) viruses. These flu viruses occur naturally among birds. Wild birds worldwide carry the viruses in their intestines, but usually do not get sick from them. However, bird flu is very contagious among birds and can make some domesticated birds, including chickens, ducks, and turkeys, very sick and kill them. The H5N1 virus does not usually infect humans. In 1997, however, the first case of spread from a bird to a human was seen during an outbreak of bird flu in poultry in Hong Kong. The virus caused severe respiratory illness in 18 people, 6 of whom died. Since that time, there have been other cases of H5N1 infection among humans. Most recently, human cases of H5N1 infection have occurred in Thailand, Vietnam and Cambodia during large H5N1 outbreaks in poultry. A recent outbreak of H5N2 among the poultry also occurred in Japan.
Who is at risk?
- Individuals with direct contact with poultry;
- Individuals with physical contacts with the infected person.
Symptoms:
The incubation period is usually 3 to 7 days, depending upon the isolate, the dose of inoculum, the species of the bird. The reported symptoms of avian influenza in humans have ranged from typical influenza-like symptoms (e.g. fever, cough, sore throat, and muscle aches) to eye infections (conjunctivitis), pneumonia with acute respiratory distress, viral pneumonia, and other severe and life-threatening complications.
Treatment:
The H5N1 virus currently infecting birds in Asia that has caused human illness and death is resistant to amantadine and rimantadine, two antiviral medications commonly used for influenza. Two other antiviral medications, oseltamavir (Tamiflu) and zanamavir, would probably work to treat flu caused by the H5N1 virus, though studies still need to be done to prove that they work.
Prevention:
- Travelers to countries with documented H5N1 outbreaks should avoid contact with poultry farms and avoid any other surfaces that appear to be contaminated with feces from poultry or other animals.
- Advise travelers to wash their hands with soap and water and alcohol-based hand-rubs to help prevent the transmission of disease.
- All foods from poultry, including eggs, should be thoroughly cooked.
- A specific vaccine for humans that is effective against avian influenza has not been developed, however the centre of disease control (CDC) has suggested that the anti-viral medication oseltamavir (brand name - Tamiflu) may be effective against avian influenza.
- If the H5N1 virus were able to infect people and spread easily from person to person, a worldwide outbreak of disease could begin. No one can predict when a pandemic might occur. However, experts from around the world are watching the H5N1 situation in Asia very closely and are preparing for the possibility that the virus may begin to spread more easily and widely from person to person.
Haemophilia
Definition:
Hemophilia is a congenital disorder of the blood-clotting system. In order for our blood to clot so as to put a stop to bleeding, nearly 20 different proteins, called clotting factors, need to be involved. Hemophilia is caused by a deficiency in one of the proteins. There are several types of hemophilia depending on which protein is affected.
Who is at risk?
Hemophilia is a genetic disorder. Those with a family history would be at risk. This does not mean that a patient must have an affected relative because about one third of new cases are caused by a new mutation of the gene in the mother or the child.
Different types of hemophilia are inherited differently. The most common and most severe forms of hemophilia affect almost only males because the gene is carried in the X chromosome. Women has two X chromosomes. The defective gene may be "balanced off" by a normal gene carried in the other X chromosome. "
Symptoms:
A patient with hemophilia could bleed to death from small wounds. Spontaneous bleeding can occur in the internal organs, including the gut or the brain. Bleeding inside the joints is one of the most common symptoms. This can result in joint pain and deformity.
Other common symptoms include:
- Big spontaneous bruises on the skin.
- Bleeding after minor injuries, such as bleeding inside muscles after injections, after tooth extraction, or after minor surgery.
- Bleeding inside joints, especially the knees, elbow, and ankles.
- Sudden bleeding inside the body for no reason. This can occur in vital organs with serious consequence.
Treatment:
Hemophilia is treated by replacing the missing clotting factor into the blood. Clotting factor concentrates or other blood products prepared from donated blood from normal people may be given to stop bleeding.
Blood products pose the risk of transmitting infections such as hepatitis and HIV. Nowadays clotting factors may be synthesized by genetic engineering technology, eliminating such risks.
If pain killers are needed for painful joints, avoid aspirin or related drugs that may impair clotting.
Prevention:
In the past clotting factors are only given in symptomatic patients. Now some experts recommend regular injection of clotting factor concentrates to prevent bleeding from starting. This has improved the quality of life of adult hemophiliacs.
Hallux Valgus
Definition:
Hallux is the big toe and valgus means turning outward. Hallux valgus occurs when the deviation is more than 15 to 20 degrees. The big toe joint often becomes enlarged with a bony prominence, called a bunion. The condition tends to be progressive with age.
Who is at risk?
People inherited with certain foot type that have faulty foot mechanics are prone to develop Hallux valgus. It is more common in women. Wearing shoes that are too tight, too narrow or too pointed doesn't actually cause hallux valgus, but aggravates the condition in those vulnerable.
Hallux valgus is also common in people with flatfoot and those suffering from arthritis affecting the big toe joint.
Symptoms:
Patients may complain of the deformity. More often patients are troubled by pain and swelling of the bunion. Pain and swelling can be severe, making it difficult to walk in normal shoes. The skin and deeper tissue around the bunion may also be affected.
Treatment:
Only the extreme cases need to undergo surgery by orthopedic surgeons to correct the deformity. Most patients require only conservative treatments.
A painful episode can be treated with pain killers and drugs against inflammation. Physical therapy such as ultrasound and heat treatment can alleviate pain. Pads placed over the area of the bunion may relieve discomfort with walking, and prescribed shoe devices or appliances, called orthotics, may stop the progression of deformity.
Prevention:
Wear comfortable shoes that fit well with a wide toe box. Avoid high heels and pointed toes. Your shoes should conform to the shape of your feet without causing undue pressure, with a half-inch of space between the tip of your longest toe and the end of the shoe. This is especially important if your family has a history of flatfoot or foot deformity.
Hand-foot-mouth Disease
Definition:
A common infectious disease of infants and children with fever, ulcers in the mouth, and a characteristic rash caused by a highly infectious group of viruses called enterovirus. The disease is very common in summer or early autumn.
Who is at risk?
Patients pass large number of viral particles in their stool and saliva, and these can survive for days on surfaces of toys and furniture. Infants and young children 2 weeks to 10 years old are most frequently affected. Those who are living in overcrowded condition or are attending daycare centres are most vulnerable. These viruses can withstand water treatment procedure and have been found in recycled waste water.
Symptoms:
The disease often starts with fever after an incubation period of 3 to 7 days. The condition is often not diagnosed until 1 to 2 days later, when oral ulcers appear and a rash is developing in the palms and soles. They appear as tiny discreet pink spots with small blisters. The oral ulcers can be very painful and the rash mildly itchy. On rare occasions, the virus can cause complications by affecting the heart and the brain with fatal consequences, especially with a virulent strain of enterovirus called EV71.
Treatment:
The child may refuse food and drink because of mouth sores. Parents need to ensure that the child is taking enough fluids to prevent dehydration. Aspirin must be avoided. The disease is usually self-limiting and symptoms would disappear after about 7 days.
Prevention:
Schools and kindergartens should maintain strict hygienic standards and avoid overcrowding. Contaminated surfaces should be disinfected, and shared toys cleaned frequently. Sick children should stay at home. Those taking care of children should wash their hands frequently, especially after contact with them or their secretions.
Helicobacter Pylori
Definition:
Helicobacter pylori is a spiral-shaped bacterium that infects the mucus lining of the stomach and duodenum. Its helical shape and its flagella (hence the name helicobacter) help the germ move through gastric acid and drills into the lining of the stomach. It can thrive in the stomach because it is equipped with enzymes that produce ammonia and carbon dioxide to neutralize the stomach acid.
Who is at risk?
The bacteria are found everywhere in the world. Up to a quarter of the adult population are infected with the germ in Western countries. Figures in the U.S. show that it is more common in older people and amongst the poor. The germ is more common in Third World countries, where infection can occur in children.
Symptoms:
Up to 70% of people infected with the bacterium do not show any symptoms of disease. In others the germ can cause gastritis, duodenitis (inflammation of the duodenum) or peptic ulcer disease.
- The patient may experience nausea, vomiting, and pain in the abdomen usually in the area below the ribs and above the navel.
- The pain can occur periodically and can either be aggravated or relieved by food.
- Some patients may present with complications internal bleeding that results in vomiting of altered blood or passing black or bloody stools.
Treatment:
Doctors usually treat the bacterial infection with a combination of antibiotics. It is important to take the prescribed antibiotic medicine on schedule for as long as your doctor has directed. Antacids and acid-suppressing drugs to neutralize or block production of stomach acids.
Prevention:
- Research suggests that infection can be passed from person to person.
- Infection seems to run in families and is more common where people live in crowded or unsanitary conditions.
- Observe personal hygiene and do not share personal items, such as chopsticks and toothbrushes.
Hemorrhoids
Definition:
Hemorrhoids are swollen blood vessels in and around the anus and lower rectum. They stretch under pressure and are similar to varicose veins in the legs. Hemorrhoids are either internal (develop inside the anus) or external (develop under the skin around the anus and can easily be felt or seen as a lump).
Another clinical classification of hemorrhoids is:
- First degree: Bleeding only, no prolapse (Meaning: fall down or slip out of place).
- Second degree: Prolapse reduced spontaneously.
- Third degree: Prolapse requiring manual reduction.
- Fourth: Prolapse not reducible.
Who is at risk?
- Individuals with diet low in fibre;
- Those who have more causes for raised abdominal pressure, such as:
- People with heavy lifting jobs;
- Straining when trying to pass a stool;
- Chronic constipation or diarrhea;
- Sitting on the toilet for long periods of time;
- Pressure on the veins from pregnancy and childbirth;
- Obesity;
- Chronic cough;
- Liver disease;
- Chronic use of enemas or laxatives.
Symptoms:
In most cases, symptoms will go away within several days.
Common symptoms include:
- Bleeding from the anus that may appear:
- On the stool
- On the toilet paper
- In the toilet bowel
- Anal itching and burning
- Swelling and pain during bowel movements
- Sensitive lumps of various sizes around the anus
- A particularly tender, hardish lump if the haemorrhoid at the outside of the anus gets a blood clot in it (thrombosed external pile)
Treatment:
Many will settle down over a matter of days without any treatment.
- High-fiber Diet: eating more whole fresh fruit and vegetables, and whole grains to help reduce constipation.
- Fluids: drinking at least 2 litres of non-alcoholic fluid daily to soften stools.
- Cold compress: Putting on the anus for short durations to relieve pain and swelling.
- Sitz Baths (Hip bath): Sitting in plain, warm water two to three times a day for about 10 minutes each time. This would relax the anal sphincter and reduce spasm at the anus.
- Cream or suppositories (Meaning: medicines that are inserted into the rectum): Soothe itching and pain, and cause swelling and bleeding to diminish.
- Rubber band ligation: A rubber band placed around the base of the hemorrhoid to cut off circulation.
- Sclerotherapy: A chemical solution is injected around the blood vessel to shrink the hemorrhoid.
- Coagulation: By electrical, laser or infrared light devices to burn off the hemorrhoid.
- Hemorrhoidectomy: permanent removal of hemorrhoids by cutting the hemorrhoidal tissue away.
Prevention:
The best way to prevent hemorrhoids is to keep stools soft so they pass easily. The following practices can help:
- Eating a high fiber diet.
- Drink at least 2 litres of non-alcoholic fluid.
- Exercising regularly, especially walking.
- Emptying bowels as soon as possible after the urge occurs.
- Avoiding the overuse of laxatives.
Hepatitis A
Definition:
- Hepatitis A is an inflammation (irritation and swelling) of the liver caused by the Hepatitis A virus. The virus can survive in water for more than a year and also in food for few days, hence it can be transmitted by eating contaminated food without proper cooking especially shellfish like oysters, clams, cockles and mussels; drinking contaminated water and close, personal contact with an infected person.
- About half of the adults who catch Hepatitis A get sick, and only a few children get sick when they catch Hepatitis A. But all people who catch the virus can spread it to others.
- The Hepatitis A virus is shed in the stools of an infected person during the incubation period of 6 days to 6 weeks days before symptoms occur. Most patients have a complete recovery but in a few cases, the damage on the liver may be prolonged. Immunity is usually life-long and there is no chronic carrier state.
Who is at risk?
In general, anyone can get Hepatitis A if they have not had it before unless they have been vaccinated.
- People who travel frequently to places with a high prevalence of Hepatitis A will have a higher chance of getting infected;
- People who frequently eat uncooked shellfish also have a higher chance of being infected;
- Infected food handlers stand the high chance of spreading the infection to others;
- Male homosexuals and bisexuals have a higher chance of being infected probably because of the practicing of "rimming" and anal sex;
- Persons with risky occupations-Laboratory researchers, animal handlers and daycare personnel fall within this group;
- Daycare workers have higher chance of infection as they might have close contact with people and hence more susceptible for the transmission of disease.
Symptoms:
- Yellow skin and eyes (jaundice)
- Brown, tea-colored urine
- Diarrhea or light-colored stool
- Fever
- Loss of appetite
- Stomach pain
- Nausea
- Fatigue (tired)
Treatment:
Once acquired the infection, the treatment is mainly symptomatic and resting.
Prevention:
Avoid unclean food and water and thoroughly wash your hands after using the restroom. If there is any contact with an affected person's blood, feces, or any other bodily fluid ensure thorough cleansing. Always practice safe sex and never share needles with other people.
Daycare facilities and other institutions: Thorough hand-washing and good hygenic practices before and after each diaper change, before serving food, and after using the restroom may help to reduce institutional outbreaks. Immune globulin and Hepatitis A vaccinations should be given to people in close contact with people with Hepatitis A.
Hepatitis A vaccine is available as either stand alone or in combination with Hepatitis B. People who should consider the vaccination include:
- Those traveling to areas or countries with high levels of Hepatitis A.
- Those who engage in rimming and anal sex.
- Intravenous drug users.
- Those with chronic Hepatitis B or C infection.
- Chronic liver disease sufferers includes those with cirrhosis and individuals awaiting liver transplants.
- People with blood clotting disorders - People with hemophilia who receive replacement therapy should be vaccinated to decrease the risk of transmission from clotting factor concentrates.
- Those who have close contact with other people such as daycare and institutional workers.
Hepatitis B
Definition:
The virus can cause acute Hepatitis. Fewer than 5% of infected children under 5 years of age and 30-60% of infected adults are symptomatic. The incubation period usually lasts from 6 weeks to 6 months. Approximately 5-10% of adults and 95% of perinatally infected infants are unable to clear the virus and become chronic carriers. A Chronic Hepatitis B carrier has 100 times the chances of developing cirrhosis and cancer of liver. Death from chronic liver disease occurs in up to 25% of chronically infected persons. It is transmitted via blood and body fluids through:
- Contact with blood in healthcare settings: Physicians, nurses, dentists etc.
- Unsafe sex with an infected person.
- Blood transfusions.
- Sharing needles during drug use.
- Receiving a tattoo or acupuncture with contaminated instruments.
- Birth - An infected mother can transmit the virus vertically to the baby during delivery.
Who is at risk?
- People who engage in sex with multiple partners;
- People who engage in sexual activities with a carrier or chronically infected person;
- Men who have sexual intercourse with other men;
- Any sexual contacts with infected people;
- Household contacts of chronically infected persons;
- Injection drug users;
- Infants born to infected mothers;
- Infants/children of immigrants from areas with high rates of HBV infection;
- Doctors, dentists and laboratory workers;
- Public safety workers such as policeman;
- Hemodialysis patients;
- Who received a blood transfusion (might be contaminated);
- Hemophilic: Increase risk of contamination of blood transfusion;
- Persons who work or are incarcerated in a prison;
- Persons who travel to countries with a high incidence of Hepatitis B;
- Ethnic groups with a high rate of infection are: Blacks, Asians, and Pacific Islanders.
Symptoms:
- About 30% of persons have no signs or symptoms
- Signs and symptoms are less common in children than adults
- Fatigue, malaise, joint aches, and low-grade fever
- Nausea, vomiting, loss of appetite, and abdominal pain
- Jaundice and dark urine due to increased bilirubin
Treatment:
- HBV infected persons should be evaluated by their doctor for liver disease.
- Medication such as alpha interferon, lamivudine and entecavir might be indicated when the patient have persistent elevation of liver enzymes (especially ALT).
- These drugs are contraindicated in pregnant women.
Prevention:
- An effective vaccine against Hepatitis B infection is available. The standard vaccination scheme is a 3-dose schedule administered at 0, 1, 6 months. All babies born in Hong Kong are vaccinated. The first dose is administered at birth in the hospital, while the second and third doses are given in Maternal & Child Health Centres.
- Avoid tattoo or body piercing.
- Practice safe sex. The efficacy of latex condoms in preventing infection is unknown, but their proper use may reduce transmission.
- Do not shoot drugs & never share drugs, needles or syringes. Get vaccinated against Hepatitis A and B.
- Avoid sharing of syringes, razors, toothbrushes and other objects that may be contaminated with blood.
- Disinfect objects contaminated with blood using household bleach diluted 49 times.
- If you are a health care or public safety worker, get vaccinated against Hepatitis B, and always follow routine universal barrier precautions and handle needles and other sharp objects safely. Wear gloves whilst handling blood and body fluids.
- Things Hepatitis B carriers can do to keep from infecting other people:
- Carriers should tell close contacts about their infection. Anyone who has contact with blood, semen, or other body fluids of a carrier is a "close contact." e.g. sexual partners, people living in the same house as the carrier, and babies born to women who are carriers.
- Pregnant women who are Hepatitis B carriers should tell their doctor about their infection. For babies born to carrier mothers, an additional Hepatitis B immunoglobulin is given within 24 hours of birth to prevent transmission of infection from their mothers. It is safe to breastfeed the baby after the protective shot.
- Hepatitis B carriers who have sex should always use a latex condom. Never share syringes or needles for ear and body piercing or for shooting drugs.
- Never donate blood, plasma, body organs, tissue, or sperm if you are a Hepatitis B carrier.
- People who are not close contacts are not at risk for getting Hepatitis B.
Hepatitis C
Definition:
Hepatitis C is inflammation of liver caused by the hepatitis C virus (HCV). It is the commonest reason for liver transplant in the US and Europe. The virus is found in the blood of the person who has the disease.
Who is at risk?
Hepatitis C is spread by contact with blood of an infected person. The risk of contracting HCV is the highest amongst intravenous drug users who share needles and patients who received transfusion of blood products before 1990.
The disease can also occur in:
- Patients on long term hemodialysis
- Sexual contact with infected individuals
- Needlestick injury
- Babies born from infected mothers.
For most patients however, the source of infection cannot be traced.
Symptoms:
- Most patients do not experience symptoms when first infected with hepatitis C.
- Instead, the virus stays in the liver and cause chronic damage, such as cirrhosis and liver cancer.
- Chronic HCV infection may cause nonspecific symptoms such as fatigue, poorly localized right upper quadrant pain.
- More often the disease is found in health checks or routine blood tests.
Treatment:
- Combination therapy of anti-viral drugs such as ribavirin and certain types of Interferon are effective in preventing continuing damage to the liver.
- Treatment can be costly and unpleasant. Doctors may recommend specific treatment only when there are signs of deterioration.
- Patients need to be followed up regularly to have their condition monitored. They should eat a healthy diet and start exercising regularly.
- Some over the counter medicine may increase the speed of liver damage.
- Excessive alcohol intake can also worsen the condition.
Prevention:
- Avoid the known risk factors as much as possible. If you have hepatitis C, you must not donate blood.
- Avoid sharing personal items like razors and toothbrushes.
- Always use a condom when you have sex. Your sex partners should be tested to see if they also have it.
- At present there is no vaccine available to prevent hepatitis C.
- Patients should receive vaccination against hepatitis A and B to avoid further damage to the liver caused by these viruses.
Hernias of all types
Definition:
A hernia is the protrusion of an organ or tissue out of the body cavity in which it normally lies as a result of an abnormal opening or weakness in the walls of the cavity. Different types of hernias are classified by where the swellings are protruding out.
Inguinal Hernia: A condition in which soft tissue - usually part of the intestine - protrudes through a weak point in the groin, where the abdomen meets the thigh.
Another type of inguinal hernia, Congenital Inguinal Hernia which is present from birth occurs through the inguinal canal. The testicles in the male fetus develop originally in the loin. It is through the inguinal canal that they migrate to where they are at birth. The canals are closed after birth; when the closure is incomplete then this type of hernia occurs.
Umbilical Hernia: at the navel (belly button).
Epigastric Hernia: in between the longitudinal abdominal muscles between the belly button and the chest.
Incisional Hernia: through surgical scars after operations in the abdomen.
Hiatus Hernia: through a hole (hiatus) in the diaphragm, which is the piece of muscle separating the abdomen and the chest.
Who is at risk?
Hernias are common in babies, toddlers, when they are born with a weak spot in their body cavities. The aged and the obese are also prone to hernias. Over-stretching of the abdominal wall may contribute to hernias in pregnant women. Hernias can also develop in patients with a chronic cough.
Symptoms:
Most cases, with the exception of hiatus hernias, present sufferers with an abnormal swelling. Hernias can take a long time to be developed, or it could happen overnight. The noticeable bulge contains fat, intestine or other tissue normally contained in the abdomen. Characteristically the swelling can change in size with posture or straining as its contents slide in and out of the body cavity. However, the contents may get trapped when the opening is too narrow, and their blood supply may be compromised. The patient would then suffer from intense pain and may vomit incessantly if the bowel is obstructed.
Treatment:
Most umbilical hernias would disappear as the child grows, and treatment is seldom necessary. This is not true for inguinal hernias, where the chances of complications are high. Surgery is the only effective method to repair a hernia. This involves making a small cut in the abdominal wall around the hernia, moving the contents back into the abdomen, and then repairing the abdominal wall. Most cases would need general anesthesia.
Prevention:
Maintain a healthy weight and ensure fruits, vegetables and whole grains make up a regular part of your diet. Be careful when lifting heavy objects, and quit smoking.
Herpes
Definition:
Herpes is a localized disease of the skin or mucous membrane characterized by collections of multiple small blisters. The condition is caused by viruses, of which there are several types affecting different parts of the body.
- Herpes simplex
Also known as cold sore or fever blisters, they usually appear on the lips, but occasionally can occur on the nostrils, chin or fingers or inside the mouth. This is caused by a virus called "Herpes simplex virus type 1 (HSV-1)". - Genital herpes
Multiple blisters appear in the genital area, causing pain, itching and sores. This is caused by a virus called "Herpes simplex virus type 2 (HSV-2)". - Herpes zoster
Also called "shingles", a band of blisters appears on one side of the body, most typically on one side of the chest from the middle of the back around one side of the chest to the breastbone. This is caused by a virus called varicella-zoster virus - the same virus that causes chickenpox.
Who is at risk?
Once infected, our body cannot get rid of the viruses that cause herpes. They stay dormant. The typical lesions appear (usually in the same location) when the viruses are reactivated.
Cold sores are often triggered by stress, increased exposure to the sun, viral infections and local trauma. Attacks of herpes zoster tend to occur in patients with lowered immunity, such as cancer patients undergoing chemotherapy.
Genital herpes is a sexually transmitted disease, and all those who practice unsafe sex are at risk. The other types of herpes are very common and can occur in anyone.
Symptoms:
The virus resides in the nerves. Herpes lesions tend to start with abnormal local sensations such as pain, burning, tingling, itching, numbness or extreme sensitivity. A rash then appears, followed by collections of fluid-filled blisters. The blisters soon break and ooze. Then a yellow crust forms and finally sloughs off. Some patients may experience systemic symptoms such as fever, headache and tireness. Systemic symptoms are more common in herpes zoster. Patients with genital herpes may experience pain with urination and with urges to void.
Treatment:
Mild cases may not require treatment. When severe, specific antiviral drugs may be given orally, by injection, or applied topically. Symptoms such as pain and fever may respond to symptomatic treatment.
Prevention:
Practice safe sex to avoid genital herpes. Have adequate of sleep, a good diet, and proper stress management would limit the number of attacks of cold sores.
HIV Infection
Definition:
The infection is caused by Human immunodeficiency virus (HIV), which infects certain white blood cells responsible for human immune response. This results in infections that are hard for the body to fight. The definition of AIDS includes all HIV-infected people who have fewer than 200 CD4+ cells per microliter of blood. The definition also includes conditions that are common in advanced HIV disease but that rarely occur in healthy people.
Who is at risk?
- Intravenous drug users who share needles;
- Bisexual and homosexuals (anal intercourses have higher chances of contact of body fluid);
- Sex workers (female workers);
- Transfusion of contaminated blood or blood products;
- Babies born to a HIV positive mother vaginally;
- Babies breast-feeding on HIV positive mother.
Regular social contact such as shaking hands, kissing (without sores) or sharing toilet facilities do NOT transmit HIV. Neither does saliva nor mosquito bites.
Symptoms:
Acute HIV infection may be associated with symptoms resembling mononucleosis or the flu within 2 to 4 weeks of exposure. Converting from HIV negative to HIV positive usually occurs within 3 months of exposure. People who become infected with HIV may have no symptoms for up to 10 years, but they can still transmit the infection to others. The virus destroys the cells that are the primary infection fighters, called CD4+ or T4 cells.
Once the immune system weakens, a person infected with HIV can develop the following symptoms:
- Lack of energy
- Weight loss
- Sore throat with mouth sores
- Frequent fevers and sweats
- Persistent or frequent yeast infections
- Persistent skin rashes or flaky skin including seborrheic dermatitis
- Short-term memory loss
- Mouth, genital, or anal sores from herpes infections
People with AIDS are prone to develop various opportunistic infections and cancers such as Kaposi sarcoma, cervical cancer, and cancers of the immune system known as lymphomas.
Treatment:
Antiretroviral drugs do not cure people of HIV infection or AIDS. They stop viral replication and delay the development of AIDS. There is better chance of control if the appropriate medications are taken early enough and consistently. Currently, a combination of several drugs called highly active antiretroviral therapy (HAART) is used to treat people with HIV.
- Reverse transcriptase inhibitors: These drugs may slow the spread of HIV in the body and delay the onset of opportunistic infections.
- Non-nucleoside reverse transcriptase inhibitors (NNRTIS): These medications are used in combination with other drugs to help keep the virus from multiplying.
- Protease inhibitors: These medications interrupt virus replication at a later step in its life cycle.
- Fusion inhibitors: This is the newest class of anti-HIV drugs. Fusion inhibitors block HIV from entering the human immune cell.
These drugs also have side effects including: Decrease of red or white blood cells, inflammation of the pancreas, enlarged and fatty liver that may result in liver failure and death.
People infected with HIV are prone to opportunistic infections. Various drugs are available to treat these infectious complications. These drugs include gancyclovir to treat cytomegalovirus eye infection, fluconazole to treat yeast infections, and Bactrim, to treat Pneumocystis carinii pneumonia. Treatments for Kaposi sarcoma or other cancers include radiation, chemotherapy, and injections of alpha-interferon.
Prevention:
Currently there is no vaccine against HIV infection. Preventive measures include:
- Practice safe sex.
- Never ever share needles and syringes.
- Never uses other people's toothbrushes, razor blades or other objects that may have contaminated with blood.
- Adopt Cesarean section in HIV positive pregnant women.
- Avoid breast-feeding if mother is HIV positive.
Human Papilloma Virus (HPV)
Definition:
Human Papilloma Virus is common virus that can cause abnormal cell growth. The virus causes warts. The strain of the virus that affects the sex organs has attracted most attention because it causes genital warts and is related to cancer of the cervix in women (the lower part of the uterus).
Who is at risk?
Genital warts are mainly spread through sexual contact. People practicing unsafe sex or sex workers are at risk. Both men and women can be infected with the virus without knowing about it for years.
Symptoms:
In men, HPV can cause warty growths on the penis. Women infected with HPV are often asymptomatic. But two kinds of abnormal tissue growths may be happening in the cervix.
- GENITAL WARTS are wart-like growths found in the genital area, most commonly on the outside or vulva. They are usually painless, but may cause itching, burning or slight bleeding.
- DYSPLASIA is the presence of abnormal cells that can turn into cancer if not treated.
Treatment:
Genital warts are treated by local applications of chemicals. They may also be removed by freezing with liquid nitrogen or by burning with electric wires. Surgery is occasionally needed to remove very large warts that have not responded to other treatment.
HPV can cause dysplasia in the cervix, which is the bottom part of the female uterus. The only way to tell dysplasia is by taking a Pap smear or a biopsy (piece of tissue). Dysplasia can also be evaluated through a magnifying glass called a colposcope.
Prevention:
Practice safe sex. Use a condom if you or your partner cannot stay monogamous. Women should receive annual gynecological checkups.
Hydrocele
Definition:
A hydrocele is a painless fluid filled sac in the scrotum. The testicle on the side looks swollen, and feels like a balloon filled with water. Sometimes both sides are affected.
Who is at risk?
About 5% of full-term boys are born with a hydrocele. The incidence is higher in premature babies.
A hydrocele can also develop if there is fluid blocking the sperm tube. It can also occur after the testicle becomes inflamed, damaged, or has a tumor. Very large hydroceles are sometimes seen in elderly men.
Symptoms:
Hydroceles present as painless swellings in the scrotum. In children, they may fluctuate in size if there is a communication with the abdominal cavity. It is important to exclude a hernia in such cases.
Treatment:
Most hydroceles found in newborns resolve by themselves. Surgery is recommended if the hydrocele is still present after 12 - 18 months of age. Hydroceles that continue to get larger or are symptomatic should be operated on. A hydrocele that fluctuates in size also requires surgery to prevent an inguinal hernia from occurring.
The fluid in a hydrocele may be removed with a needle and syringe, but recurrence is common. Elderly patients are sometimes treated in this way.
Prevention:
There is no known way to prevent congenital hydroceles. In adults, preventing infections of the genital tract and avoiding trauma to the testicles may help.
Hydrocephalus
Definition:
Hydrocephalus means an excessive accumulation of "water" in the brain. The "water" refers to cerebrospinal fluid (CSF) - a clear fluid surrounding the brain and spinal cord. The function of this fluid is to keep the brain and spinal cord buoyant, within the safety protection of the skull and vertebral bones. When there is an obstruction to the flow of this fluid, or when its rate of production is exceeding its absorption, the volume of this fluid expands and hydrocephalus results.
Who is at risk?
Hydrocephalus can be congenital. Patients with spina bifida, a serious congenital defect where the newborn has part of the spinal cord and its coverings exposed through a gap in the backbone, is frequently associated with hydrocephalus. Patients with brain tumors, meningitis, or have had brain haemorrhages (Meaning: bleeding in the brain), can develop hydrocephalus if these are obstructing the flow or the absorption of the cerebrospinal fluid.
Symptoms:
In young infants, before the sutures of the skull bones are fused, the head size can grow to accommodate the pressure from hydrocephalus. Hence the most common symptom in this age group is an unusually large head or a rapid increase in the rate of growth of the head. Other symptoms include vomiting, sleepiness, irritability and seizures. The soft spot in the skull is also typically wide and bulging.
Older children and adults whose skulls cannot expand further would present early symptoms caused by excessive pressure on the brain cells. These include headache, vomiting, nausea, blurred vision, problems with balance and memory loss.
Treatment:
Most cases of hydrocephalus are treated surgically to relieve pressure on the brain. This can be achieved by placing a shunt system which diverts the flow of Cerebrospinal fluid to another area of the body where it can be absorbed, such as the abdomen.
Prevention:
Early diagnosis and prompt treatment of the primary conditions such as brain tumors, meningitis, brain haemorrhage and trauma may help prevent hydrocephalus. Folic acid supplements in pregnant women have been shown to reduce the risk of spina bifida, and the associated hydrocephalus. Small children should be protected against injury and have their head size and other growth parameters monitored in checkups.
Hypertension
Definition:
Hypertension means high blood pressure. This generally means that the systolic blood pressure (top reading) is consistently >140 mmHg and/or the diastolic blood pressure (bottom reading) is consistently >90 mmHg.
- Stage 1 hypertension: Systolic blood pressure between 140 and 159 mmHg and/or diastolic blood pressure between 90 and 99 mmHg.
- Stage 2 hypertension: Systolic blood pressure greater than 160 mmHg and/or diastolic blood pressure greater than 100 mmHg.
Pre-hypertension is when the systolic blood pressure is between 120 and 139 or the diastolic blood pressure is between 90 and 99 on multiple readings. If you have pre-hypertension, you might develop high blood pressure at some point in the future. 90-95% of hypertension cases have no cause found and we call this essential hypertension. 5-10% of cases are secondary to the problems of the heart, thyroid gland and the adrenal gland.
Who is at risk?
- Family history of hypertension. Some believe that primary hypertension is inherited in 30% to 60% of cases;
- Women taking contraceptive pills;
- Individuals with type 2 diabetes are twice as likely to develop high blood pressure as those who do not have diabetes;
- Smokers have a higher risk for high blood pressure and coronary heart disease;
- Obese individuals;
- Heavy drinkers;
- Individuals with gout or kidney disease have a higher risk of developing hypertension;
- Individuals with a diet high in salt.
Symptoms:
Usually there is no symptom until complication occurs. Occasionally, you may experience a mild headache. If your headache is severe, or if you experience any tiredness, confusion, dizziness, visual changes, nosebleed, chest pain or irregular heart beat, you must be seen by a doctor right away as these may be a sign of dangerously high blood pressure or a complication from high blood pressure.
Treatment:
Treatments are achieved through lifestyle change modifications including weight reduction, exercise, and dietary adjustments. Anti-hypertensive medications include ACE inhibitors (e.g. Enalaopril), angiotensin receptor blockers (e.g. Cozzar), beta-blockers (e.g. atenolol), calcium channel blockers (e.g. Nifedipine), diuretics (e.g. frusemide), and alpha-blockers (e.g. prazosin). More aggressive approach with medication is adopted in people with diabetes, kidney disease or heart problems because these people are at extra risk of developing problems from high blood pressure.
In between appointments, contact the doctors if you have any of the symptoms listed below or your blood pressure remains high even with treatment as shown by the home blood pressure machine. The symptoms to be alert of are severe headache (systolic pressure>200mgHg), excessive tiredness, confusion visual changes, chest pain, shortness of breath or significant sweating. Hypertension is controllable with treatment. It requires lifelong monitoring, and the treatment may require adjustments periodically. Untreated hypertension may lead to complications of heart failure, stroke, aortic dissection, heart attacks and kidney failures. It is also important to note that intake of excessive anti-hypertension medication can cause hypotension (low blood pressure) that might reduce the blood supply and thus oxygen to the brain, causing brain damages.
Prevention:
- Have regular checks on blood pressure.
- Lose weight if you are overweight as excess weight adds strain on the heart. In some cases, weight loss may be the only treatment needed. A reduction of as little as 5-10 pounds can be beneficial. The weight loss should occur through a reduction in calories, a healthy, balanced diet, and exercise rather than diet pills or fad diets.
- To help your heart, do cardiovascular exercise at least 3 times a week on alternative days, each for at least 30 minutes.
- Adjust your diet as needed. Lower your salt intake (salt, MSG and baking soda). To reduce your risk of developing hypertension, increase your intake of fruits, vegetable and fibre.
Hyperthyroidism
Definition:
Hyperthyroidism is the medical term to describe the signs and symptoms caused by an excess of thyroid hormone. This hormone regulates the pace of metabolic functioning of various organs.
The most common reason for hyperthyroidism is known as "Graves' disease". An abnormal antibody secreted by a patient's deranged immune system is stimulating the thyroid gland in the neck to grow large and produce too much thyroid hormone. These patient's eyes may also be affected by antibodies that cause inflammation and swelling of the tissue around the eyeballs.
Occasionally, excessive thyroid hormone can be produced by benign growths in the thyroid gland, or when the gland is affected by inflammation or viral infections. It can also be caused by taking too much thyroid hormone as a drug.
Who is at risk?
Your chance of having Graves' disease, the most common cause of hyperthyroidism, is higher, if you have immediate family members suffering from thyroid problems, or if you are inherited with particular white blood cell types. Hyperthyroidism is more common in women, usually in the third to fourth decade of life. Smokers have increased risk. In areas deficient in environmental iodine, the incidence of hyperthyroidism is increased after iodine supplement.
Symptoms:
Too much thyroid hormone circulating in the blood would increase the pace of functioning in various organs, causing symptoms such as nervousness, irritability, excessive sweating. Patients would find hot weather intolerable. Despite a good appetite, they lose weight, and some may have diarrhea. Patients feel tired and turn breathless easily. Many could complain of palpitation, because of a fast heart rate or a disturbed rhythm. Some may have ankle swellings because of heart failure. Disturbances in menstruation are common with ladies.
Treatment:
Antithyroid drugs are medications which block the production of thyroid hormones. Most patients need to be on medicine for over 6 months before the disease goes to a "remission". Other drugs may be needed to treat associated symptoms such as palpitation.
Those who fail to go into a remission, or relapse repeatedly after stopping drugs, may consider radioactive iodine treatment, or surgical removal of the excess thyroid tissue.
Prevention:
The risk would be lower if we maintain a diet adequate but not excessive in iodine. Smoking is a risk factor - another reason for you to quit. Patients with a strong family history of hyperthyroidism should be made aware of its signs and symptoms, so as to diagnose and treat the condition early.
Hypospadias
Definition:
Hypospadias is a birth defect where the urethral opening does not form at the tip of the penis. It may be located anywhere along the underside of the penis. In this instance, the sufferer would have difficulty in passing a urinary stream, and may have to sit like a girl to pass urine. About 15 percent of patient would have difficulty achieving an effective erection in adulthood. Hypospadias occurs in one out of every 150 to 300 boys.
Who is at risk?
The exact cause of hypospadias is not clear though we know that genetic factors are important. In 7% of patients the fathers are similarly affected. The chance of a second son born with hypospadias is about 12 percent. The time around 9 to 12 weeks of pregnancy is crucial in the formation of the penis, which develops from the stimulation of male hormones. Any interference with the hormonal action can lead to abnormal development of the male genitals.
Symptoms:
Hypospadias can easily be noticed at birth. The urethral opening in the wrong position, and the foreskin looks like a hooded fold above the tip of the bent penis. About 8 percent of boys with hypospadias also have a testicle that is not in the right place (scrotum).
Treatment:
Hypospadias can be corrected surgically from 6 months to 2 years of age. The operation usually involves straightening the shaft of penis, creating a urinary channel with the foreskin, and positioning the urethral opening in the head of penis. Operations may be carried out in stages in complicated cases.
Prevention:
The exact cause for this congenital defect is still unknown. Pregnant women should avoid taking non-prescribed drugs. Since the foreskin would be needed for the reconstructive surgery, it is very important not to circumcise newborns with hypospadias.
Hypothyroidism
Definition:
Hypothyroidism is a disease in which the thyroid gland is not producing enough thyroid hormone.
Who is at risk?
Elderly women over 50 are most vulnerable. The risk is higher with increasing age. People are also prone to hypothyroidism if they:
- Have had history of thyroid disease in the past;
- Have been treated for excess thyroid hormone secretion (hyperthyroidism) with radioactive iodine;
- Have received radiation to the neck or chest;
- Have had thyroid surgery.
Symptoms:
The disease is often subtle and insidious. Symptoms such as fatigue and sluggishness are often attributed to ageing. Other symptoms include:
- Weight gain
- Intolerant to cold
- A puffy face with pale, dry skin, loss of hair
- Constipation
- Hoarse voice
- Muscle aches, tenderness and stiffness
- Muscle weakness
- Listlessness and depression
In younger females, menstrual periods may become heavy.
Treatment:
Treatment is with replacement dosage of a synthetic thyroid hormone. The drug needs to be taken everyday. Doctors may need to check the blood at regular intervals to adjust the dosage.
Prevention:
Patients at high risk for hypothyroidism should be checked for the disorder during routine physical examinations. Some doctors recommend routine blood tests for elderly women to screen for the disease. Hypothyroidism in small children can cause mental deficiency and growth failure. All newborns in Hong Kong are tested for the disease at birth. The screening program has largely prevented clinical cases from appearing in children.
