Hepatitis

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Hepatitis
Hepatitis is a type of Liver disease. Most commonly caused by viral infections which are of different types – Hepatitis A virus, B virus, Delta virus, C virus, Non-A, Non –B virus, Cytomegalovirus, Epstein-Bar virus, Herpes simplex virus, Yellow fever virus.

 Hepatitis A virus

Is highly infectious. Spreads by faeco oral route. Poor sanitation aids in its spread. In occasional out breaks water, milk, and shellfish has been the source of spread. In this form a carrier state does not exist. The disease is usually mild as compared to Hepatitis B infection.

Hepatitis B virus

In this type of hepatitis the main source of infection is blood, and the spread my follow transfusion of infected blood or blood products or infection with contaminated needles. Tattooing and acupuncture can also spread this disease. Close personal contacts such as sexual intercourse and especially in the homosexuals is also an important cause of infection. It can be also spread to child from mother at or soon after birth.

Hepatitis B vaccines are available to protect against this infection. This vaccine is ineffective in those already infected with this disease. Vaccination against Hepatitis B forms part of compulsory vaccination of infants in the first year of life. Three doses are needed at 0, 1 and 6 months interval.

Hepatitis B infected individuals carry this infection throughout life. Some are just carriers without having any symptoms of any illness. Some may have acute illness and some develop chronic liver diseases. These persons are at a much high risk of developing Liver cancer in later life.

Delta virus

The delta virus is an RNA containing partial virus which has no independent existence. It requires the hepatitis B virus for replication and has the same source and mode of spread. It causes progressive chronic hepatitis and eventually cirrhosis.

Non-A, Non-B, C and E viruses

Non-A, Non-B and C hepatitis is caused by several viruses. The mode of transmission in humans is similar to those of hepatitis B virus. In developed countries Non-A and Non-B & C hepatitis is now cause of 90 % of the post transfusion hepatitis. It can also be spread by other blood products.

Hepatitis E virus is an entericlly transmitted virus that occurs primarily in India, Asia, Africa, and Central America. This agent has epidemiologic features resembling those of hepatitis A. The virus has been detected in stool, bile, and liver from infected patients as well as from experimentally infected nonhuman primates. Studies in humans and experimental animals have shown that HEV is excreted in the stool during the late incubation period.

The commonly recognized cases occur after contamination of water supplies such as after monsoon flooding. An epidemiologic feature that distinguishes HEV from other enteric agents is the rarity of secondary person-to-person spread from infected persons to their close contacts. In outbreaks of waterborne hepatitis E in India and Asia, the case-fatality rate is 1 to 2 percent and up to 10 to 20 percent in pregnant women. The most feared complication of viral hepatitis is fulminant hepatitis (massive hepatic necrosis).

Hepatitis B Vaccination
Until 1982, prevention of viral hepatitis-B was based on passive immunoprophylaxis, either with standard IgG containing modest levels of anti-HBs or hepatitis B immune globulin (HBIG) containing high titre of anti-HBs.

Initially the vaccine for active immunisation was prepared from the plasma of healthy HBsAg carriers. The vaccine was subjected to 3 different chemical inactivation steps which cumulatively destroy the infectivity of every known virus without harming the host. The plasma derived vaccine in 1987 was substituted by the genetically engineered vaccine derived from recombinant yeast. This genetically engineered vaccine (Engerix B and Recombivax – HB) consists of HBsAg particles that are non- glycosylated but is otherwise indistinguishable from natural HBsAg. It is equally immunogenic, protective and safe as the first generation plasma-derived vaccine.

Indications for hepatitis B vaccination include pre-exposure and post-exposure cases.

Pre-exposure prophylaxis is advised in the following cases:

  • Health workers exposed to blood.
  • Haemodialysis patients and staff.
  • Intravenous drug abusers.
  • Promiscuous homosexual men.
  • Promiscuous heterosexuals.
  • People requiring repeated blood transfusions.
  • Household and sexual contacts of HBsAg carriers.

Pregnancy is not a contraindication for hepatitis B vaccination.

Site of administration:

The vaccination is indicated at 0, 1 and 6 months in the deltoid region or the anterolateral aspect of the thigh and not in the glutial region as it may reduce the efficacy of the vaccine.

Dosage:

1 . Engerix B. (i) 10 micog in children below 10 years; (ii) 20 micog for immunoincompetent children below 10 years; and Adults. (iii) 40 micog for patients on dialysis and other immuno- compromised persons.

2. Recombivax-HB. (i) 2.5 micog for children below 11 years of HBsAg-negative mothers; (ii) 5 micog for infants of HBsAg-positive mothers and children and-adolescents between 11 and 19-yrs; (iii) 10 micg for immunoincompetent adults; and 40 micog for patients on dialysis and other immunocompromised persons.

3. Heppacine-B (plasma derived): 1 ml IM at 0, 1 and 6 months.

For unvaccinated persons sustaining exposure to HBV, treatment comprises:

1. HBIG for immediate action.

2. Hepatitis B vaccination for prolonged action.

Special precautions:

One should be careful during febrile illness infections and in patients on immunosuppressive therapy.

Adverse side effects may include: tenderness and indurations at the site of the injection, fatigue, fever, headache, dizziness and arthralgia.

 

Hyperhydrosis

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Hyperhydrosis
Sweating is a natural process by which body regulates an individual’s body temperature. The system that regulates all this is known as Sympathetic Nervous system.In approximately 1% of the population this system is working at a higher level and thus this problem of Hyperhydrosis.

We divide hyperhydrosis into Two types: Idiopathic – of which the cause is unknown and the second one is secondary to some disease process.

Causes of Secondary Hyperhydrosis

  • Hyperthyroidism or other endocrine diseases
  • Tuberculosis – night sweats
  • Severe psychiatric disorders
  • Obesity
  • Menopause
  • Infantile scurvy, Rickets, Pink disease
  • Intake of drugs – salicylates and alcohol.

Idiopathic Hyperhydrosis

This is a far more frequent condition than secondary hyperhydrosis and is generally, localized in one or several locations of the body (most often hands, feet, armpits or a combination of them). It usually starts during childhood or adolescence and persists all life. Nervousness and anxiety can elicit or aggravate sweating, but psychological/psychiatric disturbances are only rarely the cause of the disorder.

Sweating can appear suddenly or manifest itself more continuously.
It can be elicited by high outside temperatures or emotional stress, or appears without any obvious reason.
Generally, it worsens during the warm season and gets better during winter.

Treatment

In patients with primary hyperhidrosis or for symptomatic treatment of heavy sweating in patients with secondary hyperhidrosis, not treatable otherwise, the following methods have been adopted.

Anti Perspirants

Aluminium chloride (20-25%) in 70-90% alcohol, applied in the evening Alternate days.
This treatment is helpful in cases with light to moderate hyperhidrosis.
Iontophoresis

This method consists in applying low intensity electric current (15-18 mA), supplied by a D/C generator, to the palms and/or soles immersed in an electrolyte solution. It is difficult to apply in axillary, and impossible to use in diffuse hyperhidrosis of the face or the trunk/thigh region.

Drugs

There are no specific drugs available against profuse sweating. Sedatives or Anticholinergics are often tried. Anticholinergics show too many side effects.

Surgery

  • Excision of the axillary sweat glands

Patients with axillary hyperhidrosis who are unresponsive to medical therapy can be effectively treated by excision of the axillary sweat glands.

  • Sympathectomy

The principle of sympathectomy is to interrupt the nerve tracks which transmit the signals to the sweat glands.
Today, the treatment of choice for moderate to severe palmar and facial hyperhydrosis consists in a surgical procedure known as Endoscopic Thoracic Sympathectomy.

The endoscopic technique is very safe, if performed by a surgeon experienced in this type of procedure, leads to definitive cure in nearly 100% of patients, leaving only a minimal scar in the armpit.

Individuals with combined hyperhydrosis of the palms and soles have a good chance to improve the sweating of their feet after an operation aiming to suppress sweating of the hands. Isolated plantar hyperhydrosis can, however, only cured by Lumbar Sympathectomy, an open abdominal procedure.

Diffuse hyperhydrosis of the trunk or general sweating of the whole body cannot be treated by surgery.

OTHER TREATMENT METHODS

  • Hypnosis has been tried but with uncertain results.
  • Botulinum toxin

A family of toxins produced by bacteria known as Clostridium botulinum. This toxin is one of the most lethal poisons known, interfering with the effect of the transmitter substance acetylcholine at the synapses (the contact point of a nerve ending with another nerve cell or a muscle) and leading to progressive paralysis of all muscles in the body, including the respiratory muscles.
In extremely low doses, botulinus toxin has been adopted in cases with localized muscle hyperactivity (lid spasms, torticollis, etc), resulting in a reduction in transmitting impulses to the muscle. It has been tried in hyperhidrosis. It seems to work adequately in axillary hyperhidrosis.

Botox

First Rabies patient to survive !

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First Rabies patient to survive
A teenager from Wisconsin, Jeanna Giese, 15 is the first human ever to survive rabies without a vaccination.

She received a desperate and a novel type of therapy by Dr Rodney Willoughby, Associate Professor of Paediatrics.

Doctors at the Children’s Hospital of Wisconsin put the critically ill girl into a drug induced coma and gave her 4 types of antiviral drugs.

Dr Charles Rupprecht of the disease control agency called the recovery as – Historic.

The result of this treatment has to be repeated elsewhere before the therapy could be considered a cure or a treatment.

Jeanna Giese was bitten by a bat at a church service on September 12, 2004.She did not visit a doctor and was not vaccinated as is standard medical practice for such exposure. On Oct 18, 2004 she was admitted to hospital with fluctuating consciousness and other symptoms typical of Rabies. Rabies is caused by a virus in the secretions from an infected animal. The vaccine against this disease stimulated antibodies to the virus and thus prevents the development of the disease. The vaccine has to be administered within days of the exposure.

Jeanna Giese is now a 21-year-old biology major, graduate at the Lakeland College campus in Sheboygan.

Rabies

More Japanese Celebrating 100

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More Japanese Celebrating 100
Average life expectancy in Japan is 84 years for women and 77 years for men, according to the Health Ministry’s National Institute of Population and Social Security. That makes the Japanese the longest-living society in the world.The average American woman lives to 79; the average man lives to 73.Factors that are important in Japanese culture which may be important in this aspect are:

  • Japanese diet, which is rich in vegetables and seafood, helps Japanese
    live to see 100.
  • They eat less fatty food.
  • Also, the fact that Japanese culture emphasizes social harmony and not confrontation helps too.
  • And, often elderly Japanese live with families and are not excluded
    from family and social life as they get older. They’re still part of the family group. Recent research has shown elderly people with strong social connections live healthier lives.