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Wednesday, December 1, 2010

>Acute Myocardial Infarction (MI)

Acute Myocardial Infarction

Of all the different types of heart diseases in this cardiovascular diseases list, acute myocardial infarction, which is commonly known as a heart attack, is one of the most common medical emergency conditions, which comes with a high mortality rate. A large number of myocardial infarction cases occur at rest, during sleep or sometimes after heavy exertion.

Causes:
  • Coronary artery blockage is by far the most common cause of acute myocardial infarction. Partial or complete blockage of one or more coronary arteries leads to an attack of myocardial infarction which may even culminate in sudden cardiac arrest and death.
  • Other factors that may lead to an acute myocardial infarction attack include unstable angina, variant angina and hypoglycemia.

Warning sign of MI
Warning Sign of MI:

Most heart attacks are also asymptomatic in nature and are known as silent heart attacks. Such attacks are common in patients suffering from diabetes mellitus.

The most common warning signs of a heart attack are related to chest discomfort. This discomfort if accompanied with or without breathing difficulty, demands emergency medical attention. This may include crushing pain due to extreme force on and squeezing of the chest. The person may have a feeling of fullness in his chest and this is accompanied by a chest pain or heart burn.

Before a heart attack, certain kinds of discomforts arise in the upper part of the body. The person may feel the pain extending into the jaw and to the left arm or shoulder. There will be pain in the back and feeling of uneasiness in one or both the arms and also in the neck area and stomach.

Severe heart attack warning signs include loss of consciousness and absence of pulse. The pupils of the person may get dilated; and cyanosis ( a bluish discoloration of the skin and mucous membranes. It a sign that oxygen in the blood is critically diminished ) or pallor (Unnatural lack of color in the skin) may also occur. These symptoms are usually 'not-to-be-avoided' alerts for a full cardiac arrest.
    Symptoms:
    • Chest pain, which is severe, constricting and resembles an angina attack. Also, the patient may seem restless, profusely sweating and be in a state of panic. These also sometimes manifest as heart attack warning signs.
    • There maybe symptoms of left heart failure, cardiac arrhythmias, ventricular tachycardia, fibrillation or supraventricular tachycardia.
    • Weak peripheral pulse, with cold and sweating extremities and visible pallor, accompanied by hypotension. The heart sound maybe muffled.
      Treatment:
      • The first line of action in heart attack treatment is pain relief. A subcutaneous injection of pain reliever is given. If that fails to act, then a slow intravenous or subcutaneous injection of morphine is given.
      • Oxygen is given via a mask. Continuous oxygen administration provides relief by improving myocardial oxygen supply.
      • Certain drugs are used for the cure and treatment of heart attack.This includes low dose aspirin, certain sedative drugs, and even anti-anxiety drugs.
      • Fibrinolytic therapy is given to patients so as reduce the infarct size. These agents reduce the infarct size and the ventricular damage. They help restore coronary blood flow, thus, salvaging the myocardium. Streptokinase is the most commonly used fibrinolytic agent.
      • Complete bed rest is enforced for the first 48 hours after an attack. Also, the patient should be preferably on a low fat diet, which should be a liquid diet for the first few days, and then should be slowly shifted to a semi-solid diet.
      • If all these measures fail, then the only option left for a patient of myocardial infarction is surgery. The various surgery options include angioplasty and coronary artery bypass surgery.

      >New Anti-cancer Therapy

      Anti-cancer Therapy


      Chemotherapy
      Presently, there are three primary ways of treating cancer at present, and these have undergone very little fundamental change in 30 years. In the case of solid tumors, surgery is used to cut out the cancerous tissue, while radiation therapy can kill the malignant cells, and chemotherapy stops them dividing. An enzyme called Topoisomerase IB that plays a key role in some of the molecular motors involved in the processes of DNA and RNA copying during cell division targets cancer cells much more specifically than traditional chemotherapy, can cut off the genetic information flow that tumors need to grow.

      Chemotherapy

      ... molecular copying machinery, constructed mostly out of proteins, in effect walks along the DNA double helix reading the genetic code so that it can be copied accurately into new DNA during division. Other components of the machinery are responsible for slicing and assembling the DNA itself. All of these are potential targets for anti-cancer therapy, providing it is possible to single out the tumor cells. Most existing chemotherapy targets all dividing cells, and the aim to find more sensitive techniques.

      >Congestive Heart Failure(CCF)

      Congestive Heart Failure

      Congestive heart failure is one of the most common conditions affecting the heart, thus, cementing its place in one of the top slots of cardiovascular diseases list. It is the failure of the heart to meet the body demands of adequate circulation for its metabolizing tissues. The different types of congestive heart failure are acute or chronic heart failure, high output or low output heart failure and left sided or right sided biventricular failure. There can also be compensated or decompensated heart failure.



      Causes:
      • Myocardial causes, where there is myocardial dysfunction leading to reduced contractile force of the heart. The causes of this include viral infections like viral pneumonia, rheumatic fever, beri-beri, coronary heart disease, hypertension, diphtheria, amyloidosis, and degenerative diseases involving the heart.
      • Mechanical lesions of the heart where there is a volume overload, as seen in valvular heart disease (aortic and mitral disease), syphilitic heart disease, as seen in the third stage of syphilis.
      • Diseases interfering with diastolic filling of the heart, like constrictive pericarditis, pericardial effusion restrictive cardiomyopathy.
      • Rhythm disturbances, especially in a compromised heart, since they reduce the end diastolic volume due to reduction in diastolic interval. These include atrial tachycardias, atrial flutter, atrial fibrillation and heart block.
      • Conditions where there is an increased pressure on the heart to pump out more blood, like high fever, pregnancy or thyrotoxicosis.
      Signs of Congestive Heart Failure:

      One of the earliest signs of congestive heart failure is fatigue, accompanied by the affected person’s diminished capacity to exercise. In fact, most people don’t even realize this reduction, with them usually compensating subconsciously by reducing their activities in order to adapt to this limitation.

      With the body becoming congested with fluid, and the lungs becoming affected, resulting in shortness of breath, which impairs the ability to exercise and also when lying down flat. Sometimes, the affected person may wake up at night gasping for breath. Some even have to sleep sitting in an upright position. The excessive fluid in the body also results in an increase in urination, especially at night. When the fluids accumulate in the intestines and liver, it may result in a decrease in the appetite, pain in the abdomen, and nausea.
        Symptoms:

        Left Heart Failure Symptoms
        • Progressive breathlessness, that is more marked on exertion.
        • Paroxysmal nocturnal dyspnea attacks.
        • Weakness, fatigue, palpitation and pain in the chest.
        • Acute left heart failure is characterized by basal crepitations, tachycardia, cold extremities, facial pallor, hypertension and a galloping rhythm.
        Right Heart Failure Symptoms
        • Generalized fatigue and weakness including cough, breathlessness, anorexia, abdominal distension, pain and dragging sensation in the right hypochondrium.
        • Headache, restlessness, insomnia, weight gain, swelling of legs and feet, oliguria and nocturia.
        • Physical signs include cyanosis, warm extremities, engorged neck veins, elevated jugular venous pressure, enlarged liver and edema over legs and feet.
        • The size of the heart is generally within normal limits. Pulmonary diastolic murmur is seen due to pulmonary hypertension. Signs of pleural effusion maybe present.
        Treatment:
        • Take adequate rest but maintain a certain minimum level of physical activity.
        • A nutritious diet that is well balanced and is low in calories and salt is very important. Frequent but small meals should be consumed. Evening meals should be light and adequate time interval should be maintained between the evening meals and the time of sleep.
        • Often after being diagnosed with congestive heart failure, the patient is confined to bed and the diet is either light and semi-solid or liquid. So a daily movement of bowels is desirable. Straining at stools must be avoided.
        • In most cases there is need to take to drug therapy. They are mostly inotropic drugs that have a direct effect on the myocardium, by increasing the systolic contraction of the heart and thus increasing the cardiac output. Other drugs that are also used include diuretics and vasodilators.

        >Chlamydia

        Introduction of Chlamydia

        Chlamydia, often misspelt Clamidia, is one of the most commonly reported bacterial sexually transmitted diseases (STDs). Global chlamydia statistics show that an estimated 92 million new chlamydia infections occur each year, affecting more women (50 million) than men (42 million).
        Chlamydia is caused by the bacterium chlamydia trachomatis. This bacteria can infect the cervix in women and the urethra and rectum in both men and women. Occasionally chlamydia can also affect other parts of the body, including the throat and eyes.
        Chlamydia often has no symptoms, especially among women. If left untreated, chlamydia can cause serious problems later in life.


        Chlamydia symptoms and signs:

        Chlamydia symptoms usually appear between 1 and 3 weeks after exposure but may not emerge until much later. Chlamydia is known as the ‘silent’ disease as in many people it produces no symptoms. It is estimated that 70-75% of women infected with chlamydia are asymptomatic (have no symptoms) and a significant proportion of men also have no symptoms. Those who do have symptoms of chlamydia may experience:


               In Women
        • An increase in vaginal discharge caused by an inflamed cervix;
        • the need to urinate more frequently, or pain whilst passing urine;
        • pain during sexual intercourse or bleeding after sex;
        • lower abdominal pains;
        • irregular menstrual bleeding.


              In Men
        • A white/cloudy and watery discharge from the penis that may stain underwear;
        • a burning sensation and/or pain when passing urine;
        • pain and swelling in the testicles.
        • Men are more likely to notice chlamydia symptoms than women, though they too may be asymptomatic.
        In both men and women a chlamydia infection in the rectum will rarely cause symptoms.

        Transmission of chlamydia:

        Chlamydia can be transmitted:
        • By having unprotected vaginal, anal or oral sex with someone who is infected;
        • from a mother to her baby during vaginal childbirth;
        • by transferring the infection on fingers from the genitals to the eyes, although it is rare for this to happen.

        "I think I may have chlamydia..."

        If you have any symptoms or are worried you may have been infected with chlamydia, there are a number of places you can go for help.
        • You can visit your doctor, who may be able to test you for chlamydia. If they do not have the facilities to do this, they will probably be able to refer you to a place where you can get tested.
        • Some countries also have specific sexual health clinics that can help you directly. Have a look at our help and advice page or your local telephone directory to see if you have a clinic near you.
        • In some countries, local pharmacies and chemists may offer chlamydia testing kits that allow a person to take a sample themselves for analysis by the pharmacy.

        Chlamydia testing:

        Chlamydia testing is the only way to find out for certain whether a person is infected.
        A woman can provide a urine sample, which is sent to a laboratory for testing. Alternatively a swab can be taken from the vagina (either by a doctor or nurse, or by the woman herself) that is sent to a laboratory. Results for the chlamydia test are usually available within one week, though this may vary depending on location.
        For men, either a urine sample is taken, or a swab is taken from the opening of the urethra at the tip of the penis. Many testing sites now just take a urine sample. This is an easier and less painful procedure, but is slightly less reliable than a swab.
        A modern 'rapid' urine test for men has also been developed, which provides the results within the hour and eliminates the need for laboratory testing.

        Treatment of chlamydia:

        The treatment of chlamydia is simple and effective once the infection has been diagnosed. It consists of a short course of antibiotic tablets, which if taken correctly, can be more than 95 percent effective.
        If a patient is allergic to any antibiotics, or if there is a possibility they may be pregnant, it is important that the doctor is informed as this may affect which antibiotics are prescribed. Treatment must not be interrupted once a course of antibiotics has been started, otherwise it may be necessary to start again from the beginning.
        The doctor or health advisor will discuss the chlamydia infection and answer any questions. They will also ask about any partners the patient has had sexual contact with in the past six months, as they may also have chlamydia and will need to get tested.
        It is important that the patient returns for a check-up once the treatment has been completed to make sure they have no recurring infection. The patient should not have penetrative sex until they have received a negative test result following the check-up.

        Complications of chlamydia:

        If chlamydia is left undiagnosed and untreated it can cause serious health problems. Early diagnosis and treatment means that chlamydial infection can be easily cleared up, but if left unchecked it can lead to:


              In Women
        • Pelvic inflammatory disease (PID) - an infection of the uterus, ovaries and fallopian tubes. PID increases the future risk of ectopic pregnancy (a pregnancy outside the womb) or premature birth. If the fallopian tubes are scarred, it can also lead to problems with fertility.
        • Cervicitis - an inflammation of the cervix. Symptoms include a yellowish vaginal discharge and pain during sex. In long-term cervicitis the cervix becomes very inflammed and cysts can develop and become infected. This can lead to deep pelvic pain and backache.


            In Men

        • Epididymitis - painful inflammation of the tube system that is part of the testicles, which can lead to infertility.
        • Urethritis - inflammation of the urine tube (urethra), causing a yellow or clear pus-like discharge to collect at the tip of the penis. Left untreated it can lead to a narrowing of the urethra, which can affect the ability to urinate easily and can potentially cause kidney problems.
        • Reactive arthritis - symptoms include inflammation of the joints, urethra and eyes. 
        • Complications of chlamydia are less common in men than women.
        If a pregnant woman has untreated chlamydia, the infection can potentially be passed on to a baby during pregnancy, giving it an eye or lung infection. Chlamydia can be safely treated during pregnancy provided the correct antibiotics are prescribed.

        Chlamydia prevention:

        Using condoms greatly reduces the risk of chlamydia being passed on during sex. Getting tested for STDs at a sexual health clinic, and encouraging new partners to get tested before having sexual intercourse, also helps to prevent transmission.
        If you think you may have any of the symptoms listed above then having a chlamydia test is highly recommended. Visit the nearest GUM (genitourinary medicine) clinic, sexual health clinic or doctor as soon as possible to avoid complications. In countries such as the USA and UK, all pregnant women are offered a test for STDs such as chlamydia, and it is recommended that all sexually active women under the age of 25 get screened for STDs at least once a year.

        >Genital warts: HPV, symptoms and treatment

        Introduction
        Structure of HPV

        Genital warts, caused by some types of HPV (human papilloma virus), can appear on the skin anywhere in the genital area as white or flesh-coloured, smooth, small bumps, or larger, fleshy, cauliflower-like lumps (see genital warts pictures). There are more than 100 different subtypes of HPV, and around 30 of them specifically affect the genitals. Other HPV subtypes cause warts to grow on different parts of the body, such as the hands.

        Life cycle of HPV

        Not everyone infected with HPV will develop genital warts. Some people will be infected with a strain that does not produce warts, or they will remain asymptomatic (i.e. no warts will appear), even though the virus is present in the skin or mucous membranes around the genital area, or on the cervix in women. Those who do go on to develop genital warts will usually notice them 1 to 3 months after initial infection.

        Symptoms of genital warts

        If symptoms do appear then the infected person may notice pinkish/white small lumps or larger cauliflower-shaped lumps on the genital area. Genital warts can appear on or around the penis, the scrotum, the thighs or the anus. In women genital warts can develop around the vulva or inside the vagina and on the cervix. If a woman has warts on her cervix, this may cause slight bleeding or, very rarely, an unusual coloured vaginal discharge. Warts may occur singly or in groups. The warts may itch, but they are usually painless. Sometimes genital warts can be difficult to spot. In severe cases, it is possible for genital warts to spread from the genitals to the area around the anus, even if anal intercourse has not occurred.
        Occasionally, people can confuse skin problems caused by other STDs (such as genital herpes, syphilis or molluscum) with genital warts. Other people may become very worried because they mistake perfectly normal and non-infectious lumps and bumps for genital warts. Conditions that may be confused with genital warts include:
        • Pearly penile papules - small white or skin-coloured bumps that, when numerous, appear in a ring around the edge of the head of the penis. More rarely, similar papules may be found on the vulva.
        • Angiokeratomas - bright red or purple spots that look a little like blood blisters.
        • Sebaceous glands (also known as 'Fordyce spots') - hard white, yellowish or skin-coloured little bumps that may be found all over the skin of the penis and scrotum in men, and the vulva in women. Sebaceous glands produce a substance called sebum, which keeps the skin healthy.
        • Pimples or spots - caused by blocked sebaceous glands. Pimples and spots can form just as easily around the genital area as they do on the face, and may become sore and inflamed in a similar way.
        All of the above are common, non-infectious skin manifestations that are not sexually transmitted.
        Any doubt about lumps and bumps on the genitals can usually be resolved by a visit to a doctor or sexual health clinic.

        How is HPV passed on?

        Genital HPV is transmitted by genital skin-to-skin contact, or through the transfer of infected genital fluids. This is usually during vaginal or anal sex, but it is also possible to pass it on through non-penetrative sexual activity.
        In rare circumstances, a woman can pass HPV on to her baby during vaginal child birth.

        "I think I may have genital warts"

        If you have any symptoms or are worried you may have been infected with an STD, there are a number of places you can go for help.
        • You can visit your doctor, who may be able to tell whether you have genital warts just by looking closely at the affected area. If you would prefer, they will probably be able to refer you to a specialist clinic to get tested.
        • Some countries also have specific sexual health clinics that can test for a range of STDs. Have a look at our help and advice page or your local telephone directory to see if you have a clinic near you.
        If genital warts are suspected but are not obvious, the doctor or nurse may apply a weak vinegar-like solution to the genital area; this turns any warts white and makes them more visible. To check for hidden genital warts, the doctor may carry out an internal examination of the vagina, cervix and/or anus.
        If a person suspects they have been exposed to HPV, but does not yet have symptoms, their doctor may be able to take a swab to test for high-risk strains of the virus (this isn't available in all countries). In women, this may be performed alongside a cervical Pap smear test (see below).
        Not everyone diagnosed with HPV will develop warts, and patients may be asked to come back for another examination at a later date if nothing is yet visible.

        Treatment for genital warts

        There is no treatment that can completely eliminate genital warts once a person has been infected. Often outbreaks of genital warts will become less frequent over time, until the body naturally clears the virus and the warts disappear of their own accord. However, in some people the infection may linger.
        A doctor can give patients various treatments to clear genital warts, but they may reappear even after treatment. Genital warts are caused by a virus, not a bacterium, so antibiotics will not get rid of them. Common treatments include:
        • Podophyllin resin – a brown liquid that removes genital warts by stopping cell growth. Podophyllin resin and podofilox lotion is painted on to the wart(s) by a doctor or nurse and must be washed off 4 hours later (or sooner, if the area is irritated). It has to be applied by a medical professional to avoid damaging the healthy tissue around the wart and may have to be applied several times to work effectively.
        • Podopfilox lotion/gel – can be applied to the wart(s) by the patient at home. The usual schedule is twice a day for 3 days, followed by 4 days without any lotion. This cycle is repeated for 4 weeks. It has few side effects and is well-suited for treatment at home.
        • Cryocautery (also called cryotherapy) – uses liquid nitrogen to freeze more persistent warts every 1 to 3 weeks for a short period.
        • Laser treatments – this approach, which uses an intense beam of light, can be expensive and is usually reserved for very extensive and tough-to-treat warts.
        • Electrocautery – an electrical current is used to super-heat a needle which burns the wart cells and cauterises the blood vessels. A local anesthetic is used to prevent any pain and the procedure is usually carried out at a doctor's surgery. Electrocautery is used only after other treatments have failed.
        • Surgical excision – the doctor will perform minor surgery to remove the wart under local anesthetic.
        The doctor or nurse should give the patient advice about having sex whilst receiving treatment.
        There are some non-prescription treatments available for genital HPV, but it is advisable to always seek medical advice. Never try to treat genital warts by yourself.
        It is important that a woman who is pregnant, or trying to become pregnant, informs her doctor. Podophyllin treatment could harm the developing baby and an alternative treatment should be used.

        Follow-up

        It is important to return regularly for treatment until all of the genital warts have gone so the doctor or nurse can check progress and make any necessary changes in your treatment. Sometimes treatment can take a long time.
        The majority of people whose genital warts initially disappear will get a recurrence.
        In the majority of cases, the immune system keeps the virus under control and eventually destroys it a few years after the initial infection.

        Taking care of yourself and your partner

        If you have genital warts, following these suggestions will make an outbreak easier to deal with, and will help protect your partner.
        • Use condoms when having sex. But remember that condoms will only prevent the transmission of genital warts if they cover the affected areas. Talk to your doctor or nurse for more advice on safer sex.
        • Make sure that your partner has a check-up too, as they may have warts that they haven't noticed.
        • Keep your genitals clean and dry.
        • Don't use scented soaps and bath oils or vaginal deodorants, as these may irritate the warts.

        HPV and cervical Pap smear tests

        Some types of the human papilloma virus (notably types 16 and 18) have been linked to changes in cervical cells that can lead to cancer. This is why it is important that all sexually active women have a regular cervical Pap smear test.
        A smear test is performed by opening the vagina using a speculum (a metal instrument that gently stretches the entrance and the walls of the vagina) and taking a small sample of cells from the cervix with a special swab. The cells will then be looked at under a microscope. If any changes to the cells are noted, the woman may be asked to repeat the test or will be referred for treatment that can prevent the cells from developing into cervical cancer. It is important to note that cell changes (also called cervical dysplasia) DO NOT indicate that a woman already has cancer. Most of these changes will go away on their own, or with treatment. However, it is very important to monitor the cell changes closely, as there is a risk that they may turn precancerous if they do not clear.
        A woman who has received an abnormal Pap smear result may sometimes be given a colposcopy to look at cells on the cervix. A colposcope is a kind of small microscope with a light which is used to view the cervix. The scope magnifies the cervix so the doctor can see any changes or problems. The doctor may take a small sample of cells (called a biopsy), which will be looked at in a laboratory. The colposcopy may feel slightly uncomfortable. If the patient has a biopsy taken then they may have a dull ache like a mild period cramp, with slight bleeding.
        Treatment to remove abnormal cells on the cervix will usually consist of cryocautery (freezing the cells using a special cold probe), electrocautery (heating the cells with electricity) or using laser treatment to 'zap' the cells. None of these procedures should be painful, but they may lead to dull aching (like period pains) and watery vaginal discharge that may last several weeks.
        A woman who has had visible genital warts in the past is not necessarily at any greater risk of cervical cancer, as genital warts tend to be linked to non-cancer causing subtypes of HPV.

        Pap smear tests of the anus and rectum

        The subtypes of HPV that can lead to cervical cancer may also pose a risk for men and women who have regular anal sex. Though few countries offer regular screening for anal and rectal cancer, many doctors recommend that people who have frequent anal sex (such as gay or bisexual men) should still receive a regular Pap smear test of the rectum and anus. As with cervical cell changes, early detection and treatment can help to prevent cancer from developing.

        Is there a vaccine against genital warts?

        Two vaccines are currently used to prevent cervical, vulvar and vaginal cancers, and genital warts caused by some of the major subtypes of HPV.
        Gardasil®, marketed by Merck, was first approved by the Food and Drug Administration (FDA) for use in the United States of America in June 2006.1 The vaccine is now approved in over 100 countries. Gardasil® has also been found to provide protection for men against anal disease caused by some types of HPV.2
        The other FDA approved vaccine, Cervarix® (marketed by GlaxoSmithKline), is used in the UK's HPV vaccination programme for girls run by the National Health Service.
        The vaccines are not recommended for pregnant women and a very small number of people may not be able to have the vaccine due to specific medical reasons. The vaccines may also be less effective in women who are already sexually active, as they may have already been infected with HPV.
        HPV vaccines do not protect against all cervical cancers, so it is important for women to continue attending cervical Pap smear tests.

        Friday, October 22, 2010

        >Hepatitis C

        Hepatitis C

        Hepatitis C, caused by Hepatitis C virus,like other forms of hepatitis, causes inflammation of the liver. The hepatitis C virus is transferred primarily through blood, and is more persistent than hepatitis A or B.

        Hepatitis C virus

        Transmission of hepatitis C:

        The hepatitis C virus (HCV) can be spread in the following ways:
        • By sharing drug-injecting equipment (needles, heating spoons, etc). This is the primary transmission route for HCV outside sub-Saharan Africa.
        • By using non-sterilised equipment for tattooing, acupuncture or body piercing. This can be a problem in countries where tattooing or scarification is a traditional ritual practice.
        • Through exposure to blood during unprotected sex with an infected person. Blood may be present because of genital sores, cuts or menstruation. Sexual transmission is an uncommon way of becoming infected with hepatitis C.
        • Rarely, from an infected mother to her baby during childbirth. The risk may be greater if the mother is also infected with HIV.
        • Through blood transfusion. In many developing countries blood is not screened (tested) for the hepatitis C virus. All blood for transfusion in the UK and USA is tested.
        • By sharing equipment used to snort cocaine. Usually this is a rolled banknote, which can become contaminated with blood from a person’s nose.
        Hepatitis C cannot be passed on by hugging, sneezing, coughing, sharing food or water, sharing cutlery, or casual contact.

        Signs and symptoms of hepatitis C:

        Many people do not have symptoms when they become infected with hepatitis C. Symptoms may emerge later, taking anywhere between 15 and 150 days to develop. Occasionally a person will not develop any symptoms and their immune system will successfully clear the virus without their knowledge. An infected person without symptoms can still act as a carrier and pass the virus on to others.
        Symptoms may include:
        • A short, mild, flu-like illness;
        • nausea and vomiting;
        • diarrhoea;
        • loss of appetite;
        • weight loss;
        • jaundice (yellow skin and whites of eyes, darker yellow urine and pale faeces);
        • itchy skin.
        About 20% of individuals who become infected with HCV will clear the virus from their body within 6 months, though this does not mean they are immune from future infection with HCV.
        The other 80% of people will develop chronic hepatitis C infection, during which the virus may cause mild symptoms or no symptoms at all. These people will however carry the hepatitis C virus for the rest of their lives and will remain infectious to others.
        If a person lives with hepatitis C infection for a number of years then they may develop the following complications:
        • chronic hepatitis
        • liver cirrhosis
        • liver cancer
        If symptoms become severe then a person with hepatitis C may be admitted to hospital for monitoring and treatment.

        The tests for hepatitis C:

        Tests for the hepatitis C virus have only been available since 1989. A doctor can diagnose hepatitis C by carrying out blood tests that detect HCV antibodies in the blood.

        What does a positive test result mean?

        The first test searches for HCV antibodies in the patient’s blood. A positive result shows that the person has been exposed to the hepatitis C virus and their immune system has responded by producing antibodies.
        This may mean that the patient is a carrier of the hepatitis C virus. Alternatively, the patient may have recently cleared an HCV infection and still have antibodies in their blood. Further tests will be conducted to find out whether the patient has a current infection.
        A specialist will carry out a blood test that looks for the genetic material of the hepatitis C virus itself instead of the antibodies. This test will identify whether the virus is still present.
        If the patient has successfully cleared the virus, this does not mean they are immune to reinfection.

        What does a negative test result mean?

        A negative result generally means the patient has never been infected with HCV. However, as the tests rely on the detection of antibodies to HCV, and the antibodies can take some months to develop, the doctor may advise the patient to take a repeat test if they believe they may have been recently exposed to the virus.

        Treatment for hepatitis C:

        To determine the extent to which the liver has been affected by hepatitis C, other tests may be carried out. These include liver function tests, which measure substances (specific proteins and enzymes) in the patient’s blood, showing how effectively the liver is working. A liver biopsy may also be carried out. A fine hollow needle is passed through the skin into the liver and a small sample is taken. The sample is then examined under a microscope to gauge the amount of liver damage (inflammation, scarring and cirrhosis).
        Treatment combines the antiviral drugs interferon and ribavirin. Although treatment has improved in recent years, the success rates vary depending on which genotype the patient has and how long they have had hepatitis C.
        The antiviral drugs may cause significant side effects that may be intolerable for some people. These include:
        • headaches
        • flu-like symptoms
        • nausea
        • tiredness
        • body aches
        • depression
        • skin rashes
        A patient will also require regular check-ups to monitor their progress. It is important to remember that if HCV treatment is effective and the infection is cleared, this does not mean the patient has future immunity to hepatitis C.

        Follow-up:

        If a patient has been diagnosed with hepatitis C infection, they will be advised to have regular blood tests and physical check-ups.
        The infected person should limit the amount of alcohol they drink as alcohol puts strain on the liver. The doctor may also advise avoiding fatty foods and following a low-salt diet.

        Prevention:

        Currently, there is no vaccine for hepatitis C, but research is in progress. Like HIV, HCV can mutate easily, which makes vaccine development complicated. As no vaccine exists, all measures should be taken to prevent HCV transmission.
        Injecting drug users should never share any needles, syringes or mixing spoons, as blood can be transferred between users.
        Infection through penetrative sex does occur, although it is not common. If a person is infected with HCV, it is advisable for them to use a condom for penetrative sex to ensure they do not pass on the virus to their partners through any open genital cuts or sores.
        People should avoid sharing toothbrushes, shaving equipment (especially razors), or anything else that may be contaminated with infected blood.
        The doctor will advise the patient of any precautions necessary to avoid infecting others with the virus.

        Thursday, October 21, 2010

        >Hepatitis B

        Hepatitis B
        Hepatitis B is caused by Hepatitis B virus and similar to hepatitis A in its symptoms, but is more likely to cause chronic long-term illness and permanent damage to the liver if not treated.

        Hepatitis B virus

        Transmission of hepatitis B:

        The hepatitis B virus (HBV) is very common worldwide, with more than 350 million people infected. Those with long term HBV are at high risk of developing liver cirrhosis or liver cancer.
        Hepatitis B is most frequently passed on through the exchange of bodily fluids with an infected person. HBV is estimated to be 50 to 100 times more infectious than HIV.
        HBV can be spread in the following ways:
        • By unprotected (without a condom) penetrative sex (when the penis enters the anus, vagina or mouth) with someone who is infectious. Also by sex that draws blood with someone who is infected.
        • By sharing contaminated needles or other drug-injecting equipment.
        • By using non-sterilised equipment for tattooing, acupuncture or body piercing.
        • From an infected mother to her baby, most commonly during delivery. Immunisation of the baby at birth prevents the transmission of hepatitis B.
        • Through a blood transfusion in a country where blood is not screened for blood-borne viruses such as HBV.
        Hepatitis B cannot be spread through sneezing, coughing, hugging or coming in contact with the faeces of someone who is infected.

        Signs and symptoms of hepatitis B:

        Many people who become infected with HBV experience mild symptoms or no symptoms at all, but they may still carry the infectious virus and pass it on to others. When symptoms do appear they are similar to those of hepatitis A and may include:
        • A short, mild, flu-like illness;
        • nausea, vomiting and diarrhoea;
        • loss of appetite;
        • weight loss;
        • jaundice (yellow skin and whites of eyes, darker yellow urine and pale faeces);
        • itchy skin.
        If symptoms become severe then a person with hepatitis B may be admitted to hospital.
        Most adults infected with the hepatitis B virus fully recover and develop life-long immunity. Between 2% and 10% of individuals infected as adults will become chronic carriers, which means they will be infectious to others and can develop chronic liver damage. Infected children, especially newborn babies, are much more likely to become chronic carriers.
        If a person lives with hepatitis B infection for a number of years then they may develop the following complications:
        • chronic hepatitis
        • liver cirrhosis
        • liver cancer.

        What does a positive test result mean?

        A positive test result could indicate either of the following:
        • A past infection. This means the patient has already been in contact with hepatitis B and their immune system has succeeded in fighting off the virus. The patient will then have a natural immunity to the virus.
        • The patient is a carrier. This means the patient is carrying HBV and can pass it on to others. The person may not display any symptoms but could be at risk of developing chronic liver disease.
        A doctor may perform a number of different types of test to distinguish between current and past infections, and to estimate how infectious a patient with a current infection may be.

        What does a negative test result mean?

        This result generally means the patient has never been infected with HBV and therefore has no natural immunity against the virus. If the person suspects they may have been recently exposed to HBV, the doctor may advise them to take a repeat test to confirm their negative status, and may also advise immunisation against hepatitis B.

        Treatment for hepatitis B:

        In most countries a patient with a positive test result will be referred to a specialist who will carry out further tests to determine the degree to which hepatitis B may be affecting the liver, and what may be the best treatment options. In these tests a small sample of liver tissue may need to be taken (a liver biopsy).
        In the majority of patients with active HBV, symptoms will not be severe and treatment will not be required. The patient will be monitored and after a few months the patient’s immune system should fight off the virus, giving the patient natural immunity.
        In around 5% of adults, 30-50% of young children (aged 1-4), and 90% of infants, HBV infection will become chronic. The virus is more deadly to the young and those that are infected at birth have a 25% chance of developing a life-threatening liver-related illness.
        Antiviral medication is given as treatment to those with chronic symptoms to help prevent further liver damage. These medications may be injected or given in pill form. Examples are Interferon Alpha, Lamivudine and Baraclude. Treatment usually lasts 6 months, during which time the patient will be carefully monitored.
        Regardless of whether the infection is producing symptoms or not, the patient will be advised to avoid alcohol, get plenty of rest and maintain a healthy diet.

        Hepatitis B immunisation:

        Three immunisation injections are given over a period of 3-6 months. A blood test is taken once the course of injections is completed to check they have worked. Immunity should last for at least 5 years.

        Follow-up

        A patient with an active infection will be advised to have regular blood tests and physical check-ups to monitor the virus, even if they are not receiving treatment. All carriers of HBV should expect to be referred to specialist services.
        The doctor or nurse may advise the patient to avoid alcohol, fatty foods and follow a low-salt diet. They will also describe any precautions necessary to ensure the patient avoids infecting others with the virus, such as not sharing toothbrushes or shaving equipment.
        It is important to use a condom for penetrative sex to prevent passing on the virus. Sexual partners of the patient should be tested and immunised against HBV (if not already infected).

        >Hepatitis A

        Hepatitis
        'Hepatitis' refers to viral infections that cause inflammation of the liver. Hepatitis A, B and C are the most common types. Each have different causes and symptoms.


        Hepatitis A 

        Hepatitis A is the most common of the seven known types of viral hepatitis. Infection with the hepatitis A virus leads to inflammation of the liver, but complications are rarely serious.
        Hepatitis A virus

        Transmission of hepatitis A:

        The hepatitis A virus (HAV) is found in the faeces of someone infected with the virus. It only takes a tiny amount of faeces getting inside another person’s mouth to cause hepatitis A infection. Personal hygiene, such as careful hand washing, can minimise the risk of the virus being passed on.
        HAV is a common infection in many parts of the world where sanitation and sewage infrastructure is poor. Often people become infected with HAV by eating or drinking contaminated food or water.
        Hepatitis A is also classed as a sexually transmitted disease (STD) because it can be passed on sexually, particularly during activities such as anilingus (rimming). The washing of genital and anal areas before sex, and the use of condoms or dental dams can help to prevent this risk.
        Hepatitis A can affect all age groups. Once a person is exposed to the virus it takes between 2 and 6 weeks to produce symptoms.

        Signs and symptoms of hepatitis A:

        It is possible to experience mild or no symptoms whatsoever, but even if this is the case the person’s faeces will still be infectious to others. Many people who become infected with HAV will have symptoms that include:
        • A short, mild, flu-like illness;
        • nausea, vomiting and diarrhoea;
        • loss of appetite;
        • weight loss;
        • jaundice (yellow skin and whites of eyes, darker yellow urine and pale faeces);
        • itchy skin;
        • abdominal pain.
        The infection usually clears in up to 2 months, but may occasionally recur or persist longer in some people. Once a person has been infected and their body has fought off the virus they are permanently immune. Occasionally symptoms may be severe and require monitoring in hospital.
        There are rarely any complications with hepatitis A infection. Permanent damage to the liver is very unlikely, but in extremely rare cases the infection can be fatal, particularly in older people.


        What does a positive test result mean?

        HAV is tested for using a blood test. A positive test result means the patient has either had a past infection or is currently infected. The type of antibody detected in the test will indicate whether the infection is current or has been cleared. A patient who tests positive may be asked about recent contacts and sexual partners that may need to be tested too. A patient who has already had the infection and fought it off is naturally immune to HAV.

        What does a negative test result mean?

        A negative test result means the patient is not infected with Hepatitis A. If the patient is believed to be at high or ongoing risk of infection, a doctor may advise immunisation.

        Treatment for hepatitis A:

        There is no specific treatment for HAV and most people fight off the virus naturally, returning to full health within a couple of months. The doctor will advise avoiding alcohol and fatty foods as these can be hard for the liver to process and may exacerbate the inflammation.
        Patients should get plenty of rest and eat a nutritious diet. They should also ensure they do not spread HAV by washing their hands after using the toilet and before preparing food. Patients with more severe symptoms may be monitored in hospital for a short period.

        Hepatitis A immunisation

        Hepatitis A immunisation is given in a series of injections. The first single injection in the arm gives protection for a year. The second booster injection at 6 to 12 months extends protection for up to 10 years.
        The hepatitis A vaccine may be routinely recommended for young children living in areas with high incidence of hepatitis A, and anyone travelling to countries where hepatitis A is endemic. In addition, immunisation may be recommended for people whose sexual practices are likely to put them at risk.
        Immunisation may also be recommended to prevent hepatitis A developing if a person suspects they have been exposed to the virus.

        Follow-up

        Someone who is infected with hepatitis A should limit the amount of alcohol they drink. Their doctor may also offer dietary advice.
        The doctor will advise about any precautions necessary to avoid infecting others with the virus.

        Wednesday, October 20, 2010

        >AIDS (Acquired immuno deficiency syndrome)

        AIDS Introduction

        AIDS stands for: Acquired Immune Deficiency Syndrome

        AIDS is a medical condition. A person is diagnosed with AIDS when their immune system is too weak to fight off infections.
        Since AIDS was first identified in the early 1980s, an unprecedented number of people have been affected by the global AIDS epidemic. Today, there are an estimated 33.4 million people living with HIV and AIDS and each year around two million people die from AIDS related illnesses.

        Causes of AIDS:

        AIDS is caused by HIV.
        HIV and Immune cells

        HIV is a virus that gradually attacks immune system cells. As HIV progressively damages these cells, the body becomes more vulnerable to infections, which it will have difficulty in fighting off.  It is at the point of very advanced HIV infection that a person is said to have AIDS. It can be years before HIV has damaged the immune system enough for AIDS to develop.

        Symptoms of AIDS:

        A person is diagnosed with AIDS when they have developed an AIDS related condition or symptom, called an opportunistic infection, or an AIDS related cancer. The infections are called ‘opportunistic’ because they take advantage of the opportunity offered by a weakened immune system.
        It is possible for someone to be diagnosed with AIDS even if they have not developed an opportunistic infection. AIDS can be diagnosed when the number of immune system cells (CD4 cells) in the blood of an HIV positive person drops below a certain level.

        Is there a cure for AIDS?

        Worryingly, many people think there is a 'cure' for AIDS - which makes them feel safer, and perhaps take risks that they otherwise wouldn’t. However, there is still no cure for AIDS. The only way to stay safe is to be aware of how HIV is transmitted and how to prevent HIV infection.

        How many people have died from AIDS?

        Since the first cases of AIDS were identified in 1981, more than 25 million people have died from AIDS. An estimated two million people died as a result of AIDS in 2008 alone.
        Although there is no cure for AIDS, HIV infection can be prevented, and those living with HIV can take antiretroviral drugs to delay the onset of AIDS. However, in many countries across the world access to prevention and treatment services is limited. Global leaders have pledged to work towards universal access to HIV prevention and care, so that millions of deaths can be averted.

        Treatment of AIDS:

        A community health worker gives an HIV positive patient antiretroviral drugs, Kenya 
        A community health worker gives an HIV positive patient antiretroviral drugs, Kenya 
        Antiretroviral treatment can prolong the time between HIV infection and the onset of AIDS. Modern combination therapy is highly effective and someone with HIV who is taking treatment could live for the rest of their life without developing AIDS.
        An AIDS diagnosis does not necessarily equate to a death sentence. Many people can still benefit from starting antiretroviral therapy even once they have developed an AIDS defining illness. Better treatment and prevention for opportunistic infections have also helped to improve the quality and length of life for those diagnosed with AIDS.
        Treating some opportunistic infections is easier than others. Infections such as herpes zoster and candidiasis of the mouth, throat or vagina, can be managed effectively in most environments. On the other hand, more complex infections such as toxoplasmosis, need advanced medical equipment and infrastructure, which are lacking in many resource-poor areas.
        It is also important that treatment is provided for AIDS related pain, which is experienced by almost all people in the very advanced stages of HIV infection.

        Why do people still develop AIDS today?

        Even though antiretroviral treatment can prevent the onset of AIDS in a person living with HIV, many people are still diagnosed with AIDS today. There are four main reasons for this:
        • In many resource-poor countries antiretroviral treatment is not widely available. Even in wealthier countries, such as America, many individuals are not covered by health insurance and cannot afford treatment. 
        • Some people who became infected with HIV in the early years of the epidemic before combination therapy was available, have subsequently developed drug resistance and therefore have limited treatment options.
        • Many people are never tested for HIV and only become aware they are infected with the virus once they have developed an AIDS related illness. These people are at a higher risk of mortality, as they tend to respond less well to treatment at this stage.
        • Sometimes people taking treatment are unable to adhere to, or tolerate the side effects of drugs.

        Caring for a person with AIDS:

        In the later stages of AIDS, a person will need palliative care and emotional support. In many parts of the world, friends, family and AIDS organisations provide home based care. This is particularly the case in countries with high HIV prevalence and overstretched healthcare systems.
        End of life care becomes necessary when a person has reached the very final stages of AIDS. At this stage, preparing for death and open discussion about whether a person is going to die often helps in addressing concerns and ensuring final wishes are followed.

        The global AIDS epidemic

        Around 2.7 million people became infected with HIV in 2008. Sub-Saharan Africa has been hardest hit by the epidemic; in 2008 over two-thirds of AIDS deaths were in this region.
        Parc de l'espoir - AIDS Memorial Park in Montreal, Canada 
        Parc de l'espoir - AIDS Memorial Park in Montreal, Canada

        The epidemic has had a devastating impact on societies, economies and infrastructures. In countries most severely affected, life expectancy has been reduced by as much as 20 years. Young adults in their productive years are the most at-risk population, so many countries have faced a slow-down in economic growth and an increase in household poverty. In Asia, HIV and AIDS causes a greater loss of productivity than any other disease. An adult’s most productive years are also their most reproductive and so many of the age group who have died from AIDS have left children behind. In sub-Saharan Africa the AIDS epidemic has orphaned nearly 12 million children.
        In recent years, the response to the epidemic has been intensified; in the past ten years in low- and middle-income countries there has been a 6-fold increase in spending for HIV and AIDS. The number of people on antiretroviral treatment has increased, the annual number of AIDS deaths has declined, and the global percentage of people infected with HIV has stabilised.
        However, recent achievements should not lead to complacent attitudes. In all parts of the world, people living with HIV still face AIDS related stigma and discrimination, and many people still cannot access sufficient HIV treatment and care. In America and some countries of Western and Central and Eastern Europe, infection rates are rising, indicating that HIV prevention is just as important now as it ever has been. Prevention efforts that have proved to be effective need to be scaled-up and treatment targets reached. Commitments from national governments right down to the community level need to be intensified and subsequently met, so that one day the world might see an end to the global AIDS epidemic.

        >HIV(Human immuno deficiency virus)

        Introduction of HIV

        HIV and Immune cells

        HIV stands for: Human Immunodeficiency Virus

        HIV is a virus. Viruses such as HIV cannot grow or reproduce on their own, they need to infect the cells of a living organism in order to replicate (make new copies of themselves). The human immune system usually finds and kills viruses fairly quickly, but HIV attacks the immune system itself – the very thing that would normally get rid of a virus.
        With around 2.7 million people becoming infected with HIV in 2008, there are now an estimated 33 million people around the world who are living with HIV, including millions who have developed AIDS.

        The Structure of HIV:

        HIV and CD4+ cell In this computer generated image, the large object is a human CD4+ white blood cell, and the spots on its surface and the spiky blue objects in the foreground represent HIV particles. 
        HIV virus structure
        Outside of a human cell, HIV exists as roughly spherical particles (sometimes called virions). The surface of each particle is studded with lots of little spikes.
        An HIV particle is around 100-150 billionths of a metre in diameter. That's about the same as:
        • 0.1 microns
        • 4 millionths of an inch
        • one twentieth of the length of an E. coli bacterium
        • one seventieth of the diameter of a human CD4+ white blood cell.
        Unlike most bacteria, HIV particles are much too small to be seen through an ordinary microscope. However they can be seen clearly with an electron microscope.
        HIV particles surround themselves with a coat of fatty material known as the viral envelope (or membrane). Projecting from this are around 72 little spikes, which are formed from the proteins gp120 and gp41. Just below the viral envelope is a layer called the matrix, which is made from the protein p17.
        HIV structure The proteins gp120 and gp41 together make up the spikes that project from HIV particles, while p17 forms the matrix and p24 forms the core.

        The viral core (or capsid) is usually bullet-shaped and is made from the protein p24. Inside the core are three enzymes required for HIV replication called reverse transcriptase, integrase and protease. Also held within the core is HIV's genetic material, which consists of two identical strands of RNA.

        Viral class of HIV:

        HIV belongs to a special class of viruses called retroviruses. Within this class, HIV is placed in the subgroup of lentiviruses. Other lentiviruses include SIV, FIV, Visna and CAEV, which cause diseases in monkeys, cats, sheep and goats. Almost all organisms, including most viruses, store their genetic material on long strands of DNA. Retroviruses are the exception because their genes are composed of RNA (Ribonucleic Acid).
        RNA has a very similar structure to DNA. However, small differences between the two molecules mean that HIV's replication process is a bit more complicated than that of most other viruses.

        Number of genes of HIV:

        HIV has just nine genes (compared to more than 500 genes in a bacterium, and around 20,000-25,000 in a human). Three of the HIV genes, called gag, pol and env, contain information needed to make structural proteins for new virus particles. The other six genes, known as tat, rev, nef, vif, vpr and vpu, code for proteins that control the ability of HIV to infect a cell, produce new copies of virus, or cause disease.
        At either end of each strand of RNA is a sequence called the long terminal repeat, which helps to control HIV replication.

        HIV life cycle:

        Entry

        HIV can only replicate (make new copies of itself) inside human cells. The process typically begins when a virus particle bumps into a cell that carries on its surface a special protein called CD4. The spikes on the surface of the virus particle stick to the CD4 and allow the viral envelope to fuse with the cell membrane. The contents of the HIV particle are then released into the cell, leaving the envelope behind.

        Reverse Transcription and Integration

        Once inside the cell, the HIV enzyme reverse transcriptase converts the viral RNA into DNA, which is compatible with human genetic material. This DNA is transported to the cell's nucleus, where it is spliced into the human DNA by the HIV enzyme integrase. Once integrated, the HIV DNA is known as provirus.

        Transcription and Translation

        HIV provirus may lie dormant within a cell for a long time. But when the cell becomes activated, it treats HIV genes in much the same way as human genes. First it converts them into messenger RNA (using human enzymes). Then the messenger RNA is transported outside the nucleus, and is used as a blueprint for producing new HIV proteins and enzymes.

        Assembly, Budding and Maturation

        HIV budding from a cell 
        This electron microscope photo shows newly formed HIV particles budding from a human cell.

        Among the strands of messenger RNA produced by the cell are complete copies of HIV genetic material. These gather together with newly made HIV proteins and enzymes to form new viral particles, which are then released from the cell. The enzyme protease plays a vital role at this stage of the HIV life cycle by chopping up long strands of protein into smaller pieces, which are used to construct mature viral cores.
        The newly matured HIV particles are ready to infect another cell and begin the replication process all over again. In this way the virus quickly spreads through the human body. And once a person is infected, they can pass HIV on to others in their bodily fluids.



        Connection between HIV and AIDS:

        HIV causes AIDS by damaging the immune system cells until the immune system can no longer fight off other infections that it would usually be able to prevent.
        It takes around ten years on average for someone with HIV to develop AIDS. However, this average is based on the person with HIV having a reasonable diet, and someone who is malnourished may well progress from HIV to AIDS more rapidly.

        Transmission of HIV:

        HIV is found in the blood and the sexual fluids of an infected person, and in the breast milk of an infected woman. HIV transmission occurs when a sufficient quantity of these fluids get into someone else's bloodstream.
        There are various ways a person can become infected with HIV:
        • Unprotected sexual intercourse with an infected person: Sexual intercourse without a condom carries the risk of HIV infection.
        • Contact with an infected person's blood: If sufficient blood from somebody who has HIV enters someone else's body, then HIV can be passed on in the blood.
        • Use of infected blood products: Many people in the past have been infected with HIV by the use of blood transfusions and blood products which were contaminated with the virus. In much of the world this is no longer a significant risk, as blood donations are routinely tested for HIV.
        • Injecting drugs: HIV can be passed on when injecting equipment that has been used by an infected person is then used by someone else. In many parts of the world, often because it is illegal to possess them, injecting equipment or works are shared.
        • From mother to child: HIV can be transmitted from an infected woman to her baby during pregnancy, delivery and breastfeeding.
        Certain groups of people, such as injecting drug users, sex workers, prisoners, and men who have sex with men have been particularly affected by HIV. However, HIV can infect anybody, and everyone needs to know how they can and can’t become infected with HIV.


        HIV symptoms:

        Some people experience a flu-like illness, develop a rash, or get swollen glands for a brief period soon after they become infected with HIV. However, although these are hiv symptoms they are also common symptoms of other less serious illnesses, and do not necessarily mean that a person has HIV.
        Often people who are infected with HIV don’t have any symptoms at all. It is important to remember that a person who has HIV can pass on the virus immediately after becoming infected, even if they feel healthy. It’s not possible to tell just by looking if someone has been infected with HIV.
        The only way to know for certain if someone is infected with HIV is for them to be tested.

        Testing for HIV:

        A sign promoting HIV testing in Livingstone, Zambia 
        A sign promoting HIV testing in Livingstone, Zambia 
         
        It is important for a person to get an HIV test if they think they may have been at risk of HIV infection.
        There are various types of HIV test, but the most commonly used - the antibody or ELISA test - detects HIV antibodies in a person’s blood. It is necessary to wait at least 3 months after the last possible exposure before having an HIV antibody test, to be certain of an accurate result.
        The prospect of receiving a positive test result (meaning that a person is infected with HIV) may be daunting, but learning that you are HIV positive is the first step to getting support and staying healthy. HIV testing is also very important for stopping the spread of HIV, as somebody who is aware of their HIV status can take steps to ensure they do not pass on the virus.

        Treatment of HIV:

        An HIV positive South African woman holding her antiretroviral drugs 
        An HIV positive South African woman holding her antiretroviral drugs 
         
        Antiretroviral drugs keep the levels of HIV in the body at a low level, so that the immune system is able to recover and work effectively. Antiretroviral drugs enable many HIV positive people to live long and healthy lives.
        Starting antiretroviral treatment for HIV infection involves commitment – drugs have to be taken every day, and for the rest of a person’s life. Adhering to HIV treatment is important, particularly because not doing so increases the risk of drug resistance. Side effects to the HIV drugs can make adherence difficult, and are sometimes very severe. There are ways of reducing the impact of these side effects, but sometimes it is necessary to change to an alternative HIV treatment regime.
        There are more than 20 antiretroviral drugs approved for the treatment of HIV infection in the US and Europe, as well as many new HIV drugs currently undergoing trials. Although treatment for HIV has become more widely available in recent years, access to antiretroviral treatment is limited in some parts of the world due to a lack of funding.

        Prevention of HIV:

        Despite considerable investment and research, there is currently no vaccine for HIV, and microbicides (designed to prevent HIV being passed on during sex) are still undergoing trials. However, there are other ways that people can protect themselves from HIV infection, which are the basis of HIV prevention efforts around the world.
        Education about HIV and how it is spread is an essential part of HIV prevention. HIV education needs to be culturally appropriate and can take place in various settings, for example lessons at school, media campaigns, or peer education.

        Preventing sexual transmission of HIV

        AIDS education for Scouts in the Central Africa Republic 
        HIV and AIDS education for Scouts in the Central African Republic 
         
        If a person has sexual intercourse with someone who has HIV they can become infected. ‘Safer sex’ refers to things that a person can do to minimise their risk of HIV infection during sexual intercourse; most importantly, using condoms consistently and correctly.
        A person can be certain that they are protected against HIV infection by choosing not to have sex at all, or by only doing things that do not involve any blood or sexual fluid from one person getting into another person's body. This kind of sexual activity is the only thing that can be considered ‘safe sex’.
        Effective sex education is important for providing young people with the knowledge and skills to protect themselves from sexual transmission of HIV. Comprehensive sex education should develop skills and attitudes that encourage healthy sexual relationships, as well as provide detailed information about how to practise ‘safer sex’.

        Preventing transmission of HIV through blood

        A person can protect him or herself against HIV infection by ensuring that HIV infected blood does not enter their body.
        Injecting drug users who share injecting equipment or works are at risk of HIV infection. Needle exchange programmes can help to prevent HIV transmission among drug users by providing clean needles and disposing of used ones.
        Health care workers can be exposed to HIV infected blood while at work. The most effective way to limit their risk of HIV infection is to use universal precautions with every patient, for example washing hands and wearing protective barriers (gloves, aprons, goggles). In the event that a healthcare worker is exposed to potentially HIV infected blood at work, PEP (Post exposure prophylaxis) is recommended as an HIV prevention measure.

        Preventing mother to child transmission of HIV

        Mother to child transmission of HIV can be prevented by using antiretroviral drugs, which reduce the chances of a child becoming infected with HIV from around 25% to less than 2%. Once a child is born, safer infant feeding practices can also greatly reduce the risk of HIV being passed on from mother to child.
        For these precautions to be taken, an HIV positive mother must firstly be aware of her status. This is why HIV testing in pregnancy is a crucial prevention measure.

        The full story of HIV and AIDS

        HIV is only half the story…
        What happens when HIV develops into AIDS? Why are approximately 2 million people dying from AIDS each year? What are the effects of the global AIDS epidemic?
        Learn about AIDS and get the full story.

        >Anthrax

        Introduction of Anthrax

        Microscopic picture of anthrax
        Anthrax is described in the early literature of the Greeks, Romans, and Hindus. The fifth plague, described in the book of Genesis, may be among the earliest descriptions of anthrax.
        Anthrax is caused by exposure to the spores of the bacteria Bacillus anthracis that become entrenched in the host body and produce lethal poisons. It is primarily a disease of grazing animals such as cattle, sheep, goats, and horses. Pigs are more resistant, as are dogs and cats. Birds usually are naturally resistant to anthrax. Buzzards and vultures are naturally resistant to anthrax but may transmit the spores on their talons and beaks.
        The bacteria that cause anthrax are able to go into a dormant phase, in which they form spores. Spores can exist in the environment for decades. Under the right conditions, the dormant spores can germinate and multiply.
        If terrorists were to use the anthrax spores, they would most likely want to disperse it into the air for mass effect. As was seen in October 2001, terrorists could also deliver anthrax by other means, such as placing spores in letters or packages to be opened and inhaled and handled by unsuspecting recipients.People of any age may be affected. Most cases are mild and go away with treatment. Anthrax, however, can be lethal. There are several ways anthrax can cause illness. These are the 3 main ways anthrax affects humans:

        Cutaneous (skin) anthrax

        • Cutaneous (skin) anthrax causes a characteristic sore on the skin and results from exposure to the spores after handling sick animals or contaminated animal wool, hair, hides, or bone meal products. It is an occupational hazard for veterinarians, farmers, and people who handle animal products. Where the bacteria are common, human infection remains uncommon. Humans are relatively resistant, but the spores may gain access through even tiny breaks in the skin. Cutaneous anthrax is easy to cure if it is treated early with appropriate antibiotics.
        • Inhalational anthrax results from breathing anthrax spores into the lungs. People who handle animal hides infested with spores may develop inhalational anthrax, known as woolsorter's disease. Once inhaled, the organisms multiply and may spread their toxins to the bloodstream and many other organs. Infection may spread from the liver, spleen, and kidneys back into the bloodstream, thus causing an overwhelming infection and death. This type of infection (known as septicemic anthrax) most commonly follows inhalational anthrax.
        • Gastrointestinal anthrax results from eating meat products that contain anthrax. Gastrointestinal anthrax is difficult to diagnose. It can produce sores in the mouth and throat. A person who has eaten contaminated products may feel throat pain or have difficulty swallowing. This form of anthrax has a very high death rate.

        Causes of Anthrax:

        Anthrax is caused by the bacteria B anthracis. These are rod-shaped germs that can change from "normal" bacteria into spores (or single-celled seeds that can reproduce the bacteria).

        Skin lesion of anthrax on face.

        Signs and Symptoms of Anthrax:

        • Cutaneous (skin) anthrax
          • Cutaneous anthrax occurs 1-7 days (usually 2-5) after spores enter the body through breaks in the skin.
          • This form most commonly affects the exposed areas of the arms and, to a lesser extent, the head and neck.
          • The infection may spread throughout the body in up to 20% of untreated cases.
          • Cutaneous anthrax begins as a small pimplelike lesion (a sore) that enlarges in 24-48 hours to form a "malignant pustule" at the site of the infection. This sore (about 2-3 cm or about an inch) is round with a raised edge. The sore is not painful. The central area of infection is surrounded by small blisters filled with bloody or clear fluid containing many bacteria. A black scab forms at the site of the sore in 7-10 days and lasts for 7-14 days before separating. The surrounding area may be swollen and painful and may last long after the scab forms.
          • Sores that affect the neck may cause swelling that could affect breathing.

        • Inhalational anthrax
          • Inhalational anthrax begins abruptly, 1-60 days (usually 1-3 days) after inhaling large amounts of anthrax spores. The size of the spores is extremely important when it comes to causing disease, and this depends upon the techniques of the person producing the spores. Spores that are too small are inhaled but then immediately exhaled and do not remain in the lungs to cause disease. Spores that are made too large do not remain suspended in the air when released and drop to the ground and are thus never inhaled in the first place. Optimal sized spores for an anthrax biological weapon measure 1-5 micrograms in diameter.
          • A person may initially have no specific respiratory or breathing symptoms but might have a low-grade fever and a nonproductive cough. An exposed person may feel chest pain early in the illness and improve temporarily before rapidly progressing to having severe breathing problems.
          • Inhalational anthrax progresses rapidly with high fever, severe shortness of breath, rapid breathing, bluish color to the skin, a great deal of sweating, vomiting blood, and chest pain that may be so severe as to seem like a heart attack.
          • Inhalational anthrax usually causes death when the poisonous toxins produced by the bacteria overwhelm the body systems.
        • Intestinal anthrax
          • Swallowing spores may cause intestinal anthrax 2-5 days later.
          • People with intestinal anthrax may have nausea, vomiting (also vomit blood), tiredness, no appetite, abdominal pain, and bloody diarrhea, plus a fever.
          • Intestinal anthrax is difficult to recognize. Shock and death may occur 2-5 days after it begins.
        • Oropharyngeal (mouth and throat) anthrax
          • Swallowing of spores may result in anthrax appearing in the mouth and throat 2-7 days after exposure.
          • People with this type of anthrax may have a sore throat on one side or difficulty swallowing.
          • Death may occur because the person's throat may swell and cause difficulty breathing.
        • Septicemic (bloodstream) anthrax
          • Septicemic anthrax refers to an overwhelming blood infection by anthrax. This can be a complication of inhalational anthrax.
          • Internal organs may become darkly colored with widespread bleeding. The bacteria multiply in the blood and overwhelm the red blood cells. The term anthrax is derived from the Greek word for coal and was descriptive in that the lesions produced turned black.
          • Most cases of septicemic anthrax occur following inhalational anthrax. The number of organisms released from the liver or spleen into the bloodstream overwhelm the body's defenses and produce massive amounts of lethal toxin that result in shock and death.
        • Anthrax meningitis
          • This type of anthrax may complicate any form of anthrax and spread throughout the central nervous system and to the brain.
        Skin lesions of anthrax on neck

        Home Care

        There is no home care for anthrax before a doctor makes the diagnosis.

        When to Seek Medical Care

        Anthrax develops rapidly, so immediate medical attention is required. Go to a hospital's emergency department if you have been or think you have been exposed to spores.

        Physician Diagnosis:

        • The skin lesions will eventually turn black. If you have a painless ulcer (sore) that is suspected to be cutaneous anthrax, the doctor will take a small sample of the fluid and see if it grows under special conditions in the laboratory. Samples will be viewed under a microscope. The anthrax bacteria will look different than other, similar organisms. If anthrax is suspected, laboratory personnel will take special care with the sample because it is considered a biohazard. Anthrax is not contagious from person to person, however, and standard hospital practices of hygiene, known as universal precautions, will prevent spread from one person to another.
        • If you have cutaneous anthrax and have developed a fever and other symptoms throughout your body, the doctor may test your blood for the bacteria.
        • If the doctor thinks you may have inhalational anthrax, you will have a chest x-ray or a CT scan. Other tests may be performed, including a lumbar puncture (spinal tap). You will also be admitted to the hospital.
        • An infectious disease specialist may be among the doctors called in.
        Chest x-ray showing widened chest cavity resulting from inhalation anthrax.

        Anthrax Treatment:

        The preferred way to treat anthrax is with antibiotics. The goal of antibiotics is to destroy the infection and prevent complications and death.

        • Many antibiotics are effective against B anthracis and include the following:

          • Doxycycline (Vibramycin)
          • Penicillin
          • Amoxicillin (Trimox, Amoxil, Biomox)
          • Ampicillin (Marcillin, Omnipen, Polycillin, Principen, Totacillin)
          • Ciprofloxacin (Cipro)
          • Levofloxacin (Levaquin)
          • Gatifloxacin (Tequin)
          • Chloramphenicol (Chloromycetin)
        • Severely ill people may be given medications through an IV. Treatment may continue for several weeks.
        • People exposed to anthrax may be given preventive antibiotics usually to be taken for 60 days.

        Prognosis and Follow-up:

        • Prognosis: If treated early, people with cutaneous anthrax recover. Those with oropharyngeal or intestinal anthrax have a less favorable outcome, and people with inhalational anthrax have the worst outcomes. About one-half of the victims of the fall 2001 anthrax attacks died.
        • Follow-up: With cutaneous anthrax, 80% of people who are not treated will recover. If treated, they may be given medication and sent home. A permanent circular scar may remain at the site of the original lesion. For others, with inhalational, meningeal, or septicemic anthrax, hospitalization is required.

        Prevention:

        An anthrax vaccine exists but is not readily available. It consists of a series of 6 immunizations given over 18 months. A booster is then available to be given annually, especially to those who have exposure to anthrax-containing animals or animal products. A skin test can determine if the vaccine is active.
        To prevent infection from spores of B anthracis released in the air after a suspected bioterrorist attack, your doctor may prescribe ciprofloxacin or doxycycline for 60 days. Other antibiotics may be used once lab tests return showing which ones are effective.