Free Medical Blog

By: John Layton

Let's face it, everyone of us could be in better shape. By getting in better shape we lower our risk for many disorders and ailments. This can extend your life and improve its quality. One simple way to start a simple fitness workout routine is to set aside a mere half hour a day. After some time with that routine it would be possible to focus on areas you are specifically interested in improving.

It is best for people who are unfit to start with lower impact, and body weight resistance exercises. So there is no need to run out and buy so many thousands of dollars of equipment for your new fitness workout routine. Wait until you know better what you will need. Exercises such as push-ups, squats, and crunches, which use the bodies own weight to provide resistance can be done by anyone. Small hand weights can be used for light weight high repetition overhead presses with the arms. Suitable weights for this should be just a few pounds, one, three, and five pound are the most common. These can be found very nearly everywhere that would sell any exercise or sports equipment.

Always remember to warm up and warm down. It's very important to set aside five minutes at the start and finish of your fitness workout routine. If you don't warm up and down each and every time you exercise you put yourself at risk for pain. Not taking the few minutes required can cause you potentially serious injury. During both the warm up and warm down you need to stretch the muscle groups that you will be using with in your fitness workout routine that day. You should feel a light stretching sensation in the muscle you are intending to stretch, do not force the movement to cause pain, this can cause injury as well. Some light walking is also a good warm up and warm down if your routine includes any running.

A good routine also includes a bit of intense cardio exercise. Any thing that really gets your heart going is the key here. The most common would have to be running, as people can run absolutely anytime with nothing more then decent shoes. There are any number of other exercises that can fulfill the cardio requirement of you routine. Activities such as jumping rope, or pedaling an exercise bike are great. The point is to get your heart rate up and then to keep it up for about five minutes. Don't over exert yourself at the beginning, do what you can, but make sure it is a little more each time. Your fitness workout routine will show results over the next short weeks.

Source: diet articles .info

By: Nitin Chhoda


Which is the world's most common, inexpensive and enjoyable fitness activity?

It is a form of exercise that anyone can do, does not require any investment, special gear or even a fixed time commitment. It can be done anytime, anywhere, and you can do it with friends, while enjoying nature. Its plain-old walking. All you have to do is to find a good location, put on a pair of shoes, find a friend if you can, grab an MP3 player (if you prefer music) and just do it.

Here's a suggestion - Set a simple goal. For example, "I will walk for 30-40 minutes, 5 days a week from Monday to Friday." Make a note of it in your dairy, since writing down goals makes them more achievable. Stick with it. With a few simple variations, walking can become fun and provide a 'total body workout.

TIPS FOR A PERFECT WALK:

1. Invest in a good pair of shoes, preferably cross trainers.
2. Start with a slow-walking warm-up and pick up the pace as you go. Slow down to cool down as you finish.
3. Drink water after your walk. This will help hydrate the body and replace the fluids lost in sweat.
4. Feel free to sing, whistle, or hum as you walk. This develops breath control. It also monitors the vigor of your workout: If you're too breathless to maintain a song, then reduce the pace. If you can maintain a long conversation with a friend while you walk, then the intensity or pace of your walk is on the lower side. So speed up slightly.

POINTS TO REMEMBER WHILE WALKING.

To make your walk a little more exciting, try the following variations on occasions. You can add movements, stretches and resistance.

Movements:
1. Quicksteps. Take short, brisk steps, advancing only inches per step; or march in place.
2. Right-left-back. Step sideways 1-2 paces to the left, then to the right. An occasional backward walk works to engage the opposing muscles, and aid in flexibility and fluidity.

Stretches:
1. Overheads -Extend the arms above head while walking. Maintain the stretch for 5 to 10 paces, then relax and repeat.
2. Long strides - Maintaining a slow pace, stretch the legs as far ahead as you can and take long, slow giant steps to firm the calves, thighs, and hamstrings. .

Resistance:
1. Imagine you are pushing a wall with both hands, while walking for 4-5 steps. Push two walls as they close in on both sides, for the next 4-5 steps.
2. Clench the hands for 3-4 steps, slowly unclench them for the next 3-4 steps.

Don't be concerned that all of this will look funny when you actually implement it in the park, then think about it this way - If you do it right, then you could set a trend for those around you. Try these techniques and you could become a trendsetter for other walkers / joggers in your area!

Source: diet articles .info

Almost everyone gets a little "depressed" at times in their lives, and a brief attack of the blues isn't necessarily anything to worry about. But if the symptoms of depression persist then it could be clinical depression, whether a severe or mild form of depression. Any persistant depressive symptoms need prompt medical investigation by a medical professional.

In some cases, the term "depression" will refer to full clinical depression. Other uses of the term may refer to the cluster of depressive disorders of which clinical depression is the most severe type. As mentioned above, the term "depression" may simply refer to depressive symptoms like sadness or down moods.

Diagnosis of depression is not always easy and an underlying cause is always possible. Depressive symptoms could be caused by an emotional upset (e.g. grief, divorce, job loss, etc), by drug abuse, or several other causes. Feeling "depressed" a few days after a major life crisis does not warrant a diagnosis of depression, and in fact taking antidepressants may be an inappropriate treatment in this case (e.g. they may avoid the healthy sequence of coping with grief or loss). However, over-diagnosis of depression and over-prescription of antidepressants in such situations is known to occur. Another possible over-diagnosis of depression is caused by the cycle of emotional symptoms that arise from premenstrual syndrome (PMS).

Depressive symptoms may also indicate some type of underlying physical medical disorder. Various related depression-like physical symptoms (e.g. fatigue, lethargy, weakness, tiredness) could be symptoms of an underlying condition such as chronic fatigue syndrome, diabetes, fibromyalgia, Parkinson's disease or several other possible underlying conditions and alternative diagnoses.

List of symptoms of Depression:

The list of signs and symptoms mentioned in various sources for Depression includes the 62 symptoms listed below:

* Depressed mood and other emotional problems

• Persistent sadness
• Inappropriate crying
• Feelings of worthlessness
• Hopelessness
• Empty feeling
• Misery
• Inappropriate guilt
• Loss of confidence
• Loss of interest in activities
• Sluggishness
• Agitation
• Lack of energy
• Tiredness
• Restlessness
• Thoughts of death or suicide
• Irritability
• Losing your temper
• Anxiety
• Thoughts of suicide
• Suicide attempts
• Despair worse at night

* Eating pattern changes - you might eat more or less than usual

• Appetite loss
• Weight loss
• Overeating
• Weight gain

* Sleep pattern changes

• Difficulty sleeping
• Oversleeping
• Waking too early

* Mental changes

• Forgetfulness
• Difficulty thinking
• Difficulty concentrating
• Difficulty making decisions
• Fear of the future

* Social problems

• Relationship difficulty
• Isolation
• Alcohol problems
• Drug problems
• Sex problems
• Loss of interest in sex
• Loss of enjoyment of recreation
• Staying in bed
• Social withdrawal

* Physical problems

• Headaches
• Backaches
• Body aches
• Stomach aches
• Joint aches
• Muscle aches
• Constipation

* Other signs of childhood or adolescent depression:

• Poor school grades
• Poor school attendance
• Getting into trouble
• Running away from home
• Substance abuse
• Reckless behavior

Note that Depression symptoms usually refers to various symptoms known to a patient, but the phrase Depression signs may refer to those signs only noticable by a doctor.

Treatment list for Depression:

The list of treatments mentioned in various sources for Depression includes the following list. Always seek professional medical advice about any treatment or change in treatment plans.

* Lifestyle changes - helpful but often not adequate without other treatments.

• Love and care of family and friends

* Psychotherapy

• Cognitive-behavioral therapy (CBT)
• Interpersonal therapy (IPT)
• Psychodynamic therapies

* Antidepressant medications

• Tricyclic antidepressants (tricyclics)
• Selective serotonin reuptake inhibitors (SSRIs) - mainly used if panic disorder with depression.

+ Fluoxetine
+ Sertraline
+ Fluvoxamine
+ Paroxetine
+ Citalopram

• Monoamine oxidase inhibitors (MAOIs)

* Antianxiety drugs
* Sedatives
* Lithium
* Electroconvulsive therapy (ECT)
* St. John's wort (Hypericum perforatum)
* Biotin - possibly used for treatment of related biotin deficiency
* Magnesium - possibly used for related magnesium deficiency
* Vitamin B3 - possibly used for related vitamin B3 deficiency
* Vitamin B6 - possibly used for related vitamin B6 deficiency
* Vitamin B12 - possibly used for related vitamin B12 deficiency

Source: wrong diagnosi s.com

Depression has many features which are intensely physical in nature. Many of these symptoms and signs are very similar to symptoms seen in diseases which are known to have an identifiable physical cause. These physical symptoms of depression include aches and pains, weight loss, constipation, tiredness always tired, loss of appetite, loss of interest in sex and others. It can therefore be difficult for both patients and doctors to be certain whether a physical symptom is representative of depression, or suggests an entirely different disorder requiring a different treatment.

In addition because it is sometimes considered unacceptable to be psychologically ill, physical symptoms are often used as substitutes for psychological ones, particularly the more minor variations in mood. Many cultures express mood changes in concrete body terms, including descriptions of pains, for example. Many patients feel that doctors are trained to respond to bodily complaints and hence present these unconsciously to their doctors.

It is well known that common physical complaints can have a psychological contribution. Headaches, for instance, can be made worse by the increase in muscular tension of the neck and scalp muscles which are a physical accompaniment of a state of anxiety. In the more severe forms of depression not only are very physical symptoms such as slowness and constipation present, but worries about their physical state can increase in patients until they imagine they are ill when they are not, sometimes to the point of delusion.

Source: web 4 health.info

Many medical and psychiatric disorders go along with symptoms of fatigue or reduced activity. So it is very important to make a good clinical examination before thinking of Chronic Fatigue Syndrome.

Maybe the most relevant clinical diagnoses that exclude CFS are

• Sleep apnea! This is rather common for patients with severe obesity! Any other sleep disorder can cause fatigue the next morning.
• Hypothyroidism (reduced function of the thyroid gland)
• Chronic heart problems (low output, cardiomyopathia)
• Side effects of medication (some medication for high blood pressure, sleeping pills, pills for muscle relaxation and many more!)
• chronic alcohol abuse / addiction to drugs. Even some months after severe alcohol exposure symptoms of fatigue or reduced interest can interfere with the quality of life
• Some chronic infections (e.g. Hepatis B or C) or malignancies (including Hodgkin's lymphoma) can also cause fatigue
• Use of and abstinence from caffeine (coffee, tea, chocolate).
• For women with large menstruations: Iron insufficiency.

Many psychiatric disorders and/or the medical treatment can cause symptoms of fatigue! Fatigue (and reduced sleep) is a common symptom of depression and dysthymia or bipolar disorders. Any subtype of schizophrenia or delusional disorder can cause fatigue, and so can, of course, severe eating disorders like anorexia or bulimia nervosa.

A good medical and psychiatric examination is necessary to exclude these disorders.

Source: web 4 health.info

If you are overweight, you are not alone. Sixty-six percent of adults in the U.S. are overweight or obese. Achieving a healthy weight can help you control your cholesterol, blood pressure and blood sugar. It might also help you prevent weight-related diseases, such as heart disease, diabetes, arthritis and some cancers.

Eating too much or not being physically active enough will make you overweight. To maintain your weight, the calories you eat must equal the energy you burn. To lose weight, you must use more calories than you eat. A weight-control strategy might include

• Choosing low-fat, low-calorie foods
• Eating smaller portions
• Drinking water instead of sugary drinks
• Being physically active

People are generally optimistic, believing they'll do better in the future than they've done in the past. This time around, I'll actually use that gym membership. I'm sticking to the diet this time. Now is the time to start saving for a down payment on a house. However, a new study in the Journal of Consumer Research reveals that this "optimism bias" can lead us to make immediate choices that go against our long-term goals.

Ying Zhang, Ayelet Fishbach (both of the University of Chicago), and Ravi Dhar (Yale University) identify how different mindsets work in conjunction with an optimistic attitude. They found that when people think about the goal in terms of progress, they are more likely to make a detrimental decision - such as eating an unhealthy snack. However, when people focus on commitment to a goal, they are more likely to choose an action consistent with its attainment.

"For example, when [a] workout is framed as progress toward the goal of being healthy, going to the gym elicits the perception of partial goal attainment and suggests that it is justified to enjoy a tasty but fatty cake," the researchers explain. "In contrast, when [a] workout is framed as commitment to the goal of being healthy, going to the gym signals being healthy is important and thus suggests that one should refrain from the tasty but fatty cake to ensure the final goal can be attained."

In the first study, the researchers asked one group of participants to indicate how often they went to the gym last year. Another group was asked to predict how often they expected to go to the gym next year - a yet-to-be-achieved goal. Those who were asked to think about exercise as a future endeavor were more likely to take a bottle of spring water over a can of sugared soda than those who were asked to think about the exercise they had already completed.

Similarly, in another experiment, participants were asked to visualize and write about either the process or completion of a gym workout session, a manipulation of the optimism bias. Then, participants were asked to estimate the duration of their next workout and to complete a survey that measured their interest in healthy foods.

"Relatively little is understood about how thinking optimistically about future goal pursuit can impact the immediate decision to pursue the ongoing goal, and what the direction of the impact would be," the researchers write. "Accordingly, this research suggests that marketers should consider not only the tradeoffs among the alternatives when making a choice, but also the relationship of this choice to past or future choices."

Source: medicalnews today.com

Hormone therapy (HT) was once the mainstay of treatment for osteoporosis. But because of concerns about its safety and because other treatments are available, the role of hormone therapy in managing osteoporosis is changing. Most problems have been linked to certain oral types of HT, either taken in combination with progestin or alone. If you're interested in hormone therapy, other forms are available, including patches, creams and the vaginal ring.

Discuss the various options with your doctor to determine which might be best for you.

If HT isn't for you, and lifestyle changes don't help control your osteoporosis, prescription drugs can help slow bone loss and may even increase bone density over time. They include:

• Bisphosphonates. Much like estrogen, this group of drugs can inhibit bone breakdown, preserve bone mass, and even increase bone density in your spine and hip, reducing the risk of fractures.

  Bisphosphonates may be especially beneficial for men, young adults and people with steroid-induced osteoporosis. They're also used to prevent osteoporosis in people who require long-term steroid treatment for a disease such as asthma or arthritis.

  Side effects, which can be severe, include nausea, abdominal pain, and the risk of an inflamed esophagus or esophageal ulcers, especially if you've had acid reflux or ulcers in the past. Bisphosphonates that can be taken once a week or once a month may cause fewer stomach problems. If you can't tolerate oral bisphosphonates, your doctor may recommend periodic intravenous infusions of bisphosphonate preparations.

  A small number of cases of osteonecrosis of the jaw have been reported in people taking oral bisphosphonates — such as Fosamax — for osteoporosis. These cases have been primarily associated with active dental disease or a recent dental procedure, such as a tooth extraction. If your doctor recommends a bisphosphonate for osteoporosis, consider getting any needed dental work done before starting this medication. If you currently take an oral bisphosphonate and need a dental procedure, discuss this with your doctor and dentist.

• Raloxifene. This medication belongs to a class of drugs called selective estrogen receptor modulators (SERMs). Raloxifene mimics estrogen's beneficial effects on bone density in postmenopausal women, without some of the risks associated with estrogen, such as increased risk of uterine and, possibly, breast cancers. Hot flashes are a common side effect of raloxifene, and you shouldn't use this drug if you have a history of blood clots. This drug is approved only for women with osteoporosis and is not currently approved for use in men.
• Calcitonin. A hormone produced by your thyroid gland, calcitonin reduces bone resorption and may slow bone loss. It may also prevent spine fractures, and may even provide some pain relief from compression fractures. It's usually administered as a nasal spray and causes nasal irritation in some people who use it, but it's also available as an injection. Because calcitonin isn't as potent as bisphosphonates, it's normally reserved for people who can't take other drugs.
• Teriparatide. This powerful drug, an analog of parathyroid hormone, treats osteoporosis in postmenopausal women who are at high risk of fractures. Unlike other available therapies for osteoporosis, it works by stimulating new bone growth, as opposed to preventing further bone loss. Teriparatide is given once a day by injection under the skin on the thigh or abdomen. Long-term effects are still being studied, so the Food and Drug Administration recommends restricting therapy to two years or less.
• Tamoxifen. This synthetic hormone is used to treat breast cancer and is given to certain high-risk women to help reduce their chances of developing breast cancer. Although tamoxifen blocks estrogen's effect on breast tissue, it has an estrogen-like effect on other cells in your body, including your bone cells. As a result, tamoxifen appears to reduce the risk of fractures, especially in women over age 50. Possible side effects of tamoxifen include hot flashes, stomach upset and vaginal dryness or discharge.

Emerging therapies
A new physical therapy program has been shown to significantly reduce back pain, improve posture and reduce the risk of falls in women with osteoporosis who also have curvature of the spine. The program combines the use of a device called a spinal weighted kypho-orthosis (WKO) — a harness with a light weight attached — and specific back extension exercises. The WKO is worn daily for 30 minutes in the morning and 30 minutes in the afternoon and while performing 10 repetitions of back extension exercises.

Source:mayoclinic.com

What is osteoporosis?
In osteoporosis, the inside of the bones becomes porous from a loss of calcium (see the picture below). This is called losing bone mass. Over time, this weakens the bones and makes them more likely to break.

Osteoporosis is much more common in women than in men. This is because women have less bone mass than men, tend to live longer and take in less calcium, and need the female hormone estrogen to keep their bones strong. If men live long enough, they are also at risk of getting osteoporosis later in life.

Once total bone mass has peaked—around age 35—all adults start to lose it. In women, the rate of bone loss speeds up after menopause, when estrogen levels fall. Since the ovaries make estrogen, faster bone loss may also occur if both ovaries are removed by surgery.
Normal bone versus bone affected by osteoporosis

What are the signs of osteoporosis?
You may not know you have osteoporosis until you have serious signs. Signs include broken bones, low back pain or a hunched back. You may also get shorter over time because osteoporosis can cause your vertebrae (the bones in your spine) to collapse. These problems tend to occur after a lot of bone calcium has already been lost.


Am I at risk for osteoporosis?
See the box to the right for a list of things that put you at risk for osteoporosis. The more of these that apply to you, the higher your risk is. Talk to your family doctor about your risk factors.


Will I need a bone density test?
Check with your doctor. For many women, osteoporosis (or the risk of it) can be diagnosed without testing. When testing is appropriate, doctors use equipment that takes a “picture” of the bones to see if they are becoming porous.


What about hormone replacement therapy?
Hormone replacement therapy (HRT) is one way to prevent osteoporosis or keep it from getting worse.

In HRT, you take hormones (estrogen and progestin together, or estrogen alone) to counteract the drop in estrogen that happens at menopause or when the ovaries are removed by surgery.

Women who take HRT are at an increased risk for breast cancer, heart attack, stroke, serious blood clots and Alzheimer's disease.

Many physicians now recommend that their patients on HRT stop taking it to prevent osteoporosis.

Factors such as your health history and your family’s health history will be important when weighing the risks and benefits of HRT. Talk to your doctor about whether it’s right for you.


What is calcitonin?
Calcitonin (some brand names: Calcimar, Miacalcin) is a hormone that helps prevent further bone loss and reduces the pain that some people have with osteoporosis.

Calcitonin can be taken as a shot or as a nasal spray. Its most common side effect is nausea.


What is ibandronate sodium?
Ibandronate sodium (brand name: Boniva) is a new drug that is taken once a month. It is not a hormone, but it slows bone loss and increases bone density. Some of the possible side effects include upset stomach, heartburn, nausea and diarrhea.


What are alendronate and risedronate?
Alendronate (brand name: Fosamax) and risedronate (brand name: Actonel) are not hormones, but are used to help prevent and treat osteoporosis. These drugs help reduce the risk of fractures by decreasing the rate of bone loss. Their most common side effect is an upset stomach.


What is raloxifene?
Raloxifene (brand name: Evista) is a drug used to prevent and treat osteoporosis by increasing bone density. It is not a hormone, but it mimics some of the effects of estrogen. Side effects may include hot flashes and a risk of blood clots.


What is teriparatide?
Teriparatide (brand name: Forteo) is a new injectable synthetic hormone used once a day for the treatment of osteoporosis. It causes new bone growth. Common side effects may include nausea, dizziness and leg cramps.


How much calcium do I need?
Before menopause, you need about 1,000 mg of calcium per day. After menopause, you need 1,000 mg of calcium per day if you're taking estrogen and 1,500 mg of calcium per day if you're not taking estrogen.

It’s usually best to try to get calcium from food. Nonfat and low-fat dairy products are good sources of calcium. Other sources of calcium include dried beans, sardines and broccoli.

About 300 mg of calcium are in each of the following: 1 cup of milk or yogurt, 2 cups of broccoli, or 6 to 7 sardines.

If you don’t get enough calcium from the food you eat, your doctor may suggest taking a calcium pill. Take it at meal time or with a sip of milk. Vitamin D and lactose (the natural sugar in milk) help your body absorb the calcium.



Tips to keep bones strong

1. Exercise.
2. Eat a well-balanced diet with at least 1,000 mg of calcium a day.
3. Quit smoking. Smoking makes osteoporosis worse.
4. Talk to your doctor about HRT or other medicines to prevent or treat osteoporosis.
   

source:familydoctor.org

What are sinuses?
The air chambers in the bone behind your cheeks, eyebrows and jaw are called sinuses. They make mucus, a fluid that cleans bacteria and other particles out of the air you breathe. Tiny hairs called cilia (say: “sill-ee-ah”) sweep mucus out of your sinuses so it can drain out through your nose.

What is sinusitis?
Sinusitis (say: “sine-you-site-iss”) is the name for a condition in which the lining of your sinuses becomes inflamed.

What causes sinusitis?
Anything that causes swelling in your sinuses or keeps the cilia from moving mucus can cause sinusitis. This can occur because of changes in temperature or air pressure. Using decongestant nasal sprays too much, smoking, and swimming or diving can also increase your risk of getting sinusitis. Some people have growths called polyps (say: “pawl-ips”) that block their sinus passages.

When sinusitis is caused by a bacterial or viral infection, you get a sinus infection. Sinus infections sometimes occurs after you’ve had a cold. The cold virus attacks the lining of your sinuses, causing them to swell and become narrow. Your body responds to the virus by producing more mucus, but it gets blocked in your swollen sinuses. This built-up mucus makes a good place for bacteria to grow. The bacteria can cause a sinus infection.


What are the signs of acute sinusitis?
A cold that starts to get better and then gets worse may be a sign of acute sinusitis. Pain or pressure in some areas of the face (forehead, cheeks or between the eyes) is often a sign of blocked sinus drainage and can be a sign of acute sinusitis. Pain in your forehead that starts when you lean forward can also be a sign. Other symptoms may include a stuffy nose, fever and an ache in your upper teeth.


How is acute sinusitis treated?
Your doctor may prescribe an antibiotic (medicine that kills bacteria). You may take an antibiotic for 10 to 14 days, but you will usually start feeling better a couple of days after you start taking it. It is important to take this medicine exactly as your doctor tells you and to continue taking it until it is gone, even after you’re feeling better. If you have sinus pain or pressure, your doctor may prescribe or recommend a decongestant to help your sinuses drain.

See the box below for other things you can do to feel better when you have acute sinusitis.


Tips on taking care of sinusitis

1. Get plenty of rest. Lying down can make your sinuses feel more stopped-up, so try lying on the side that lets you breathe the best.
2. Sip hot liquids and drink plenty of fluids.
3. Apply moist heat by holding a warm, wet towel against your face or breathing in steam through a cloth or towel.
4. Talk with your doctor before using an over-the-counter cold medicine. Some cold medicines can make your symptoms worse or cause other problems.
5. Don’t use a nose spray with a decongestant in it for more than 3 days. If you use it for more than 3 days, the swelling in your sinuses may get worse when you stop the medicine.
6. Use an over-the-counter medicine such as acetaminophen (one brand name: Tylenol) for pain.
7. Rinse your sinus passages with a saline solution. You can buy an over-the-counter saline solution or ask your doctor how to make one at home.
   

Source: familydoctor.org

Got a soda habit? Here's some advice on how to cut back.

By Elaine Magee, MPH, RD
WebMD Weight Loss Clinic - Expert Column

Soda -- it's everywhere! Even if you wanted to drink something else, you'd be hard-pressed to find it as prominently displayed in vending machines, at fast-food chains, and supermarket checkouts. You might not realize how ubiquitous Coke, Pepsi, and the like are in our society until you try to stop drinking soda.

For some people, drinking several sodas a day is a fierce habit. You know drinking soda is a habit when you find yourself going to the grocery store at 10 p.m. because your refrigerator is tapped out, or you feel like having a tantrum when the drive-through attendant tells you the soda machine is broken. If the idea of drinking one token soda a day is unfathomable, you just might have a serious soda habit.

Why Stop Drinking So Much Soda?

So why would you want to make the effort to kick the soda habit? As the beverage industry out, soft drinks, in and of themselves, aren't necessarily a dietary "don't."

"All of our industry's beverages -- including regular or diet soft drinks -- can be part of a healthy way of life when consumed in moderation and as part of a balanced lifestyle," says Tracey Halliday, a spokesperson for the American Beverage Association.

The problem, say many health experts, is that Americans don't always drink their sodas in moderation. Many believe we should cut back on our intake of the two sweeteners used in sweetened soda: fructose (like the high-fructose corn syrup often used in sodas) and sugar. Calories from beverages make up 21% of the total daily calories consumed by Americans over 2 years old, according to a 2004 article in the American Journal of Preventive Medicine. And the proportion of calories Americans consume from sweetened soft drinks and fruit "drinks" has tripled between 1977 and 2001.

"Many people either forget or don't realize how many extra calories they consume in what they drink, yet beverages are a major contributor to the alarming increase in obesity," Barry Popkin, PhD, director of the University of North Carolina Interdisciplinary Obesity Program, says in an email interview.

In 2006, a panel of experts assembled by Popkin developed the first Healthy Beverage Guidelines, which recommended people should drink more water and limit or eliminate high-calorie beverages with little or no nutritional value.

So is simply switching to diet soda the answer? Not necessarily, some experts believe.

Popkin has said there's no proof that artificial sweeteners are bad for you, but because the data are slim, the Beverage Guidance Panel was uneasy about recommending them.

Michael Jacobson, executive director of the advocacy group Center for Science in the Public Interest (CSPI), suggests that people who drink diet sodas should choose those sweetened with Splenda when possible.

Of the alternative sweeteners used in soda, CSPI gives the "avoid" label to Acesulfame-K, aspartame, and saccharin, but the "appears to be safe" label to sucralose (Splenda). All these sweeteners have received FDA approval. And, in a 100-page report published in Critical Reviews in Toxicology in September, an expert panel said it was confident aspartame poses no health risks. But CSPI believes those on its "avoid" list need more or better testing.

Still, while Jacobson believes "less is better" when it comes to alternative sweeteners, he concedes that drinking diet soda is better than gulping down the equivalent of 10 teaspoons of sugar -- which is what you'll get in a can of regular soda.

And just how do you go about kicking a soda habit? If you want to stop drinking so much soda, it basically comes down to four steps, according to the experts:

1. Make Up Your Mind. You have to make up your mind to give it up, notes Jacobson. Even if you're just trying to cut back on your soda consumption, it can take a firm commitment to make it happen.

2. Switch to Diet Sodas. Gradually make the switch to diet sodas, suggests Paul Rozin, PhD, a psychology professor at the University of Pennsylvania. "Just make a small decrease at a time, like one sugared soda a day," he says in an email interview. If you're drinking much more than one soda a day, work toward decreasing the amount of diet sodas you drink as well -- eventually.

3. Go Caffeine-Free. Popkin and Jacobson believe that caffeine, and the fact that it is mildly addictive, is part of the reason soda is such a hard habit to break. Look for caffeine-free soft drinks, and gradually decrease the number of caffeinated drinks you have each day as you work toward kicking the soda habit completely. If you're addicted to the caffeine in soda, you're really kicking two habits -- the soda habit and the caffeine habit. "It takes a few weeks to truly forget the craving," Popkin says.

4. Stock Up on Alternatives. Keep plenty of tasty non-soda drinks on hand to make giving up soda as convenient as possible.

What Are Some Soda Alternatives?

Here is a list of non-soda beverage possibilities to consider. You'll notice the drinks that contain calories also contribute important nutrients like calcium or vitamin C.

1. Give Soy Milk a Chance. If you'd like to work in a serving of soy a day, give soy milk a try. Lots of brands and flavors are available. If calories are an issue, try one of the lower-calorie options.
2. Don't Skimp on Skim Milk. Skim milk is a great way to boost your intake of protein, calcium, vitamin D, and other important nutrients. One cup of skim milk has only around 85 calories. The Beverage Guidance Panel recommends up to two servings a day of nonfat or 1% milk and fortified soy beverages.
3. Pimp Your Water. To an avid soda drinker, water can seem a little unexciting. One of the best ways around that is to add noncaloric flavors to your water. A sprig of mint or a slice of lemon or lemon will do wonders. If you like subtler flavors, try a slice or two of cucumber or a frozen strawberry.
4. Make Green or Black Tea Your New Drink Habit. Popkin says tea is a healthy alternative to water for people who prefer flavored beverages. Tea is calorie free and contains powerful phytochemicals like the antioxidant in green tea, epigallocatechin gallate (EGCG). Great-tasting green and black teas abound in supermarkets and specialty stores. If you're cutting back on caffeine, look for caffeine-free teas.
5. Think Outside the Juice Box. Although 100% fruit or vegetable juice contains important nutrients, the Beverage Guidance Panel recommends having no more than one serving a day because they can also contain plenty of calories (about 100 in 1 cup of fresh orange or carrot juice). One way to cut those calories is by making a homemade juice spritzer: Combine one or two parts seltzer, mineral water, or club soda with one part 100% fruit juice (try fresh orange juice). Or try the new vegetable juice flavors in your supermarket, as well as fruit and vegetable juice blends. While they're not super low in calories, each serving contains a serving of fruit and a serving of vegetable.
6. Discover the Coffee Cure. For java lovers, coffee can be a calorie-free, flavorful alternative to soda. And you can easily find lower-caffeine coffees in coffee shops and supermarkets. But to keep coffee low-calorie, be sure to keep it simple -- skip the syrups, whipped cream, and whole milk.
7. Make Good Old H2O Convenient. The Beverage Guidance Panel recommends at least 4 servings a day of water for women and at least 6 servings for men. When you need to quench thirst or hydrate your body, nothing does it better than water. If cold, refreshing water was more convenient, and if we were reminded to drink it during our day, a lot more people would reach this daily goal. So keep water bottles ready to go in your refrigerator, and every time you leave the house, take a bottle with you. If chilled water is sitting in your car or on your desk at work, you'll be more likely to get into the water-drinking habit.

Source: medicinenet.com

Claire Keeton

Johannesburg

A new report finds that innovative programmes around the world are helping men to change sexist, risky and violent behaviour that harms the health and well-being of women and the communities in which they live.

Men can and do change their behaviour towards women, a number of projects have shown, according to a report commissioned by the Department of Gender, Women and Health at the World Health Organization (WHO).

The report, Engaging men and boys in changing gender-based inequity in health, found that almost a third of the 58 programmes evaluated were successful in encouraging men to end violence against women, to care for their pregnant wives and children, and to take steps to prevent infecting their partners with HIV or becoming infected themselves.

One shortcoming identified by the report, released in May, was that even successful programmes were limited to a pilot or short timeframe.

"Gender [behaviour] transformation allowing women and men to discuss and decide on health, when that may not typically be the case, is the gold standard," said Dr Peju Olukoya, Integrating Gender into Public Health unit coordinator.

Unequal power relations between the sexes affect womens health, she said: "In some places women cannot even seek health care unless they get permission from a man."

The WHO-commissioned report evaluated projects in North America (24), sub-Saharan Africa (9), Latin America and the Caribbean (9), Asia and the Pacific (9), north Africa and the Middle East (5) and Europe (2).

In South Africa, where sexual violence against women is a widely-recognized problem, community programmes and media campaigns have started to address this problem by engaging and involving men.

The Stepping Stones programme in the Eastern Cape, one of the countrys poorest provinces, is one of the reports success stories. A randomized controlled trial found that the programme brought about behavioural changes that reduced sexually transmitted infections in study participants.

On releasing the findings of the two-year study in May, chief investigator Rachel Jewkes of South Africas Medical Research Council hailed Stepping Stones as "the first HIV-prevention behavioural intervention … in South Africa … to have provided evidence of success in reducing sexually transmitted infections in women".

How did Stepping Stones bring about such profound change? It recruited about 2801 men and women aged between 15 and 26 years old to test two approaches. Half of them participated in 50 hours of gender behaviour transformation workshops over eight weeks. The other half attended a three-hour course on safe sex.

These workshops and courses - in which men and women were divided into separate groups - encouraged participants to communicate about sexual and reproductive health and to develop relationship skills. Jewkes said: "The men in the programme would decide as a group they should change … these decisions are tremendously powerful."

The men explored the problem of violence against women and understood it was wrong. One participant told Jewkes: "I saw that [beating women] is not right. When I beat a girl now at my age that means I will beat my wife - so I decided that I must stop it."

In contrast, participants in the group that did the three-hour safe sex course did not develop such insights or change their behaviour.

Jewkes, who leads the Councils Gender and Health Research Unit, said that participants had been sexual risk-takers who engaged in casual or transactional sex with multiple partners and who admitted to being violent towards those partners.

"People think we will never get men like that to change, but we did. This is very important for HIV prevention," Jewkes told the Bulletin.

In addition to the evidence of a reduction in sexually transmitted infections, the study found that more than half of male programme participants (58%) reported less severe violence towards their intimate partners. They also reported less casual and transactional sex, more condom use and less alcohol abuse.

Another community programme, Men as Partners, is run by EngenderHealth South Africa. In April, this nongovernmental organization launched its first national Men as Partners week to encourage men to give up violence against women and prevent spreading HIV.

In South Africa, with a population of 47 million people, 35% of women attending antenatal clinics were HIV positive and an estimated 5.5 million people were living with HIV in 2005, according to the WHO/UNAIDS 2006 AIDS epidemic update.

Cynthia Nhlapo, deputy director of the Gender Focal Point for the department of health, said that the South African government supports such initiatives that work with men. "Men have to be engaged in dialogue and activities that promote gender equality and social justice," Nhlapo told the Bulletin.

Men as Partners works with men and boys in homeless shelters, clinics, schools and churches. Its stated aim is to help them understand "what it means to be true partners in relationships, families and communities".

In a sun-filled room in Hillbrow this year about 15 male teenagers from a homeless shelter attended a Men as Partners workshop co-ordinated by Nhlanhla Mabizela, who was assisted by two gender behaviour transformation agents and a counsellor.

Seated in a circle with a flipchart to track their two-hour discussion, they talked about stereotypes of masculinity, HIV and other sexually transmitted diseases.

At the end of the workshops, which use a range of methods including role play and games, as well as simply talking, most participants expressed a deeper understanding of why gender equity was important and why they should practice safe sex.

One of South Africas biggest national health promotion campaigns is a popular television soap opera, Soul City, where the production team does research on health and social issues, and uses this to develop a drama. Stereotypes about masculinity and the disclosure and treatment of AIDS were among the themes of the seventh series aired by national broadcaster SABC in 2006.

"It has changed [our] culture. They have removed the perception that a woman should always be in the kitchen [and] be home early," a female viewer from Gauteng province was quoted as saying in Soul City Series 7 Qualitative Evaluation Report.

"To us, youngsters, it doesnt mean if you are the head of the family, you are the remote control. You wanted this person to be your partner and in a way you have to support each other," a young male viewer was quoted as saying in the evaluation.

The WHO-commissioned report found that such community programmes and mass media campaigns were effective approaches to triggering behavioural change in men.

Overall, 29% of the 58 programmes worldwide were assessed as effective, 38% as promising and the remaining 33% as unclear. "This is a positive finding although we had expected more of the programmes to be effective. However, we did set the criteria for categorizing the programmes rather stringently," Olukoya told the Bulletin.

"Working with men and their role in promoting gender equality is not a zero-sum game. Men and women benefit. We are gaining a lot of ground," Olukoya said.

Source: scielosp.org

LOS ANGELES (May 21, 2006) - According to recent estimates, hepatitis has become a worldwide health problem, affecting millions of people in the U.S. and abroad.

Researchers are experimenting with combinations of anti-inflammatory medicines like interferons to improve hepatitis symptoms. In research presented today at Digestive Disease Week® 2006 (DDW), new combinations of therapies are making significant progress to improve symptoms of the disease. DDW is the largest international gathering of physicians and researchers in the fields of gastroenterology, hepatology, endoscopy and gastrointestinal surgery.

Hepatitis is caused by a virus that attacks the liver, triggering painful inflammation and often leading to more serious conditions like liver failure and even death. Several different forms of hepatitis exist, including hepatitis A, B and C. Hepatitis A is generally food-borne, while hepatitis B and C are spread primarily through parenteral or sexual routes. The disease is often caused by a virus, but can also result from alcohol, toxins or drugs.

"Despite the significant number of people suffering from hepatitis, treatment options have been lagging in comparison to other major diseases," said John Vierling, M.D., FACP, president, the American Association for the Study of Liver Diseases (AASLD); professor of Medicine and Surgery at the Baylor College of Medicine in Houston, Texas; and director of Baylor Liver Health and Chief of Hepatology. "We hope that continued research like these studies will lead to more significant breakthroughs and relief for these patients."

Valopicitabine (NM283), Alone or with Peg-Interferon, Compared to Peg Interferon/Ribavirin (pegIFN/RBV) Retreatment in Hepatitis C Patients with Prior Non-Response to PegIFN/RBV: Week 24 Results [Abstract 4]

More than half of currently treated hepatitis patients are infected with strains of hepatitis C that do not respond to current interferon therapies and have no other effective treatment options. Combination treatment using a new antiviral therapy is showing promise in suppressing the virus, according to a phase II US multi-center study. The therapy, valopicitabine, has shown anti-HCV activity alone and in combination with pegIFN (pegylated interferon) in early trials, without viral breakthrough for study periods up to six months.

The current study compared the outcomes of five different treatments in patients who have not experienced remission with standard therapies: valopicitabine alone (800 mg/d), one of three combination arms with the drug at 400 mg/d, 800 mg/d or dose-ramping 400 to 800 mg/d plus pegIFN, or pegIFN with ribavirin as a control group.

For the 162 patients who have completed the trial period at 24 weeks, results show that the two higher-dose combination arms had much better response rates than the control group, experiencing on average a 2.5 to 3.0 log decrease in hepatitis RNA reductions by week 24, a significantly better response than the comparator. No viral breakthrough has been seen to date. However, vomiting and dehydration requiring hospitalization occurred in three patients taking the highest dose (800 mg), forcing the research team to halt the use of that dose and continue using only the lower doses of 200 to 400 mg of the drug.

"For patients whose disease has not responded to current therapies, this new combination treatment may produce excellent results, at the maximally acceptable dosage," according to Paul Pockros, M.D., of Scripps Clinic in California, and lead study author. "Continued treatment will determine if these encouraging early responses will result in a sustained response, hopefully improving patient quality of life and long-term survival."

Comparison of Daily Consensus Interferon versus Peginterferon alfa 2a Extended Therapy of 72 Weeks for Peginterferon / Ribavirin Relapse Patients with Chronic Hepatitis C [Abstract S1060]

In chronic diseases like hepatitis, symptoms have a tendency to fluctuate in severity. As a result, researchers are finding that the diseases may react more successfully to a longer duration of therapy. In this study, researchers at the University of Tuebingen in Germany compared two combination therapies for an extended treatment period of 72 weeks, compared to the current standard of 48 weeks, in patients with chronic hepatitis C.

Previous studies have shown that with 48 weeks of therapy, relapse rates are near 20 to 30 percent, but with an extended duration of 72 weeks, rates may be reduced. The research team compared the efficacy of daily doses of CIFN (consensus interferon) plus ribavirin (RBV) versus pegIFN (pegylated interferon alfa 2a) plus RBV for 72 weeks in patients with a prior relapse to 48 weeks of treatment. A total of 81 patients were treated with either CIFN or with pegIFN a2a for 72 weeks, both in combination with RBV.

After the initial 12 weeks, a primary response to therapy, noted as a reduction in hepatitis RNA, was observed in 83 percent of patients in the CIFN group and 78 percent of the pegIFN group. At the end of treatment at week 72, the vast majority (89 percent) of both the CIFN group and pegIFN group (76 percent) were in remission. After finishing treatment, two-thirds of the CIFN group (69 percent) experienced sustained response, but less than half of the pegIFN group (44 percent) experienced these results, indicating a significantly higher relapse rate in this group.

"While many patients did relapse after discontinuing treatment, the overall sustained response rates are nevertheless promising, showing a sustained response in up to 70 percent of patients," said Stephan Kaiser, M.D., of the University of Tuebingen, and lead study author. "We believe that extended treatment with CIFN combined with RBV may be a better option than current standards for this difficult-to-treat patient group."

The overall tolerability of the CIFN regimen was comparable to PEG IFN. Three patients experienced thrombocytopenias (reduced blood platelets), but there were no severe neutropenias (low white blood cell count) or thrombocytopenias. CIFN patients experienced a higher rate of injection site reactions and a slightly higher drop-out rate of 18 percent, compared to only 12 percent of the pegIFN group.

28 Days of the Hepatitis C Protease Inhibitor VX-950, In Combination with Peg-Interferon-Alfa-2a and Ribavirin, is Well-Tolerated and Demonstrates Robust Antiviral Effects [Abstract 686f]

Scientists are reviewing new compounds in combination with current standard hepatitis therapies to produce better patient outcomes. A new oral peptidomimetic protease inhibitor, VX-950, has previously shown substantial anti-viral effects in combination with the frequently used hepatitis therapy pegylated interferon (pegIFN). In this study, researchers evaluated the safety and antiviral response of VX-950 in combination with pegIFN and ribavirin (RBV).

The study included 12 hepatitis C patients who received 750 mg of VX-950 every eight hours, 180 ìg of pegIFN weekly, and either 1000 or 1200 mg of RBV daily. After 28 days, patients began standard therapy with pegIFN/RBV.

All patients responded to the study drug regimen and showed continual declines in hepatitis RNA throughout the treatment period. Two patients had levels of HCV RNA in their blood below the limits of detection of a highly sensitive assay after just eight days. All patients had undetectable HCV RNA by the end of 28 days. No patients experienced viral breakthrough at any time.

"These data confirm the rapid and dramatic antiviral effects of VX-950. All subjects achieving undetectable HCV RNA within 28 days of treatment is an unprecedented result with an investigational agent," said Eric Lawitz, M.D., of Alamo Medical Research, Texas, and lead author of the study. "We look forward to future studies which will evaluate the ability of VX-950 to produce sustained viral responses with as little as 12 weeks of therapy." VX-950 + pegIFN + RBV was well tolerated, with no serious adverse events and no treatment discontinuations. A detailed analysis of adverse events will be presented.

Acetaminophen as a co-factor in acute liver failure due to viral hepatitis determined by measurement of acetaminophen-protein adducts [Abstract S1002]

Acetaminophen (APAP) is a common over-the-counter medication present in more than 300 preparations for pain relief and flu-like symptoms. But for people who are suffering from viral hepatitis A or B, use of acetaminophen may play a role in accelerating liver failure, ordinarily a rare complication of viral hepatitis.

Serum samples from 72 patients with proven hepatitis A or B that had progressed to liver failure were tested for APAP adducts, which are the toxic byproducts of acetaminophen liver damage, created when a chemical (in this case, acetaminophen) binds to proteins in the liver that are then released into the blood when cells die. As a positive control group, the team also included 10 documented cases of acute liver failure (ALF) resulting directly from large APAP overdoses.

Results from the examination showed that nine of the 72 patients (12.5 percent) had detectable APAP adducts in their blood, signifying that some of their liver damage was APAP-related. All 10 known APAP-induced ALF cases had positive adducts at much higher levels than those in the viral hepatitis group (average level of 5.58 nmol/mL versus 0.45 nmol/mL, respectively). Two-thirds (67 percent) of the hepatitis patients with APAP adducts died within three weeks of study admission, compared to only 27 percent of hepatitis patients without adducts.

Most of the patients with adducts reported some APAP use in the days prior to the study, but none reported doses exceeding four grams per day. Flu-like symptoms, nausea and vomiting are common in patients with early viral hepatitis and APAP is commonly used in this setting.

"This study suggests that acetaminophen, even when taken at therapeutic dosages, is responsible for a second hit in viral hepatitis and explains why some patients develop acute liver failure and death in this setting," said William M. Lee, M.D., of the UT Southwestern Medical Center in Texas, and senior study author. "Warnings regarding use of acetaminophen should be clearly communicated to patients with acute viral hepatitis, particularly those of moderate severity, to reduce these bad outcomes from a relatively benign disease."

n March 2003 the WHO and U.S. Centers for Disease Control and Prevention issued a global alert over cases of atypical pneumonia that do not appear to respond to treatment. This happened after outbreaks have occurred in several counties over the past month. Countries include Canada, China, Hong Kong Special Administrative Region of China, Indonesia, Singapore, Thailand, and Viet Nam.

SARS or Severe Acute Respiratory Syndrome is a form of lung injury characterized by increased permeability of the alveolar-capillary membrane, diffuse alveolar damage, and the accumulation of proteinaceous pulmonary edema and rapidly leads to pulmonary failure.

Cause

Just last month it was not known if this disease is caused by a virus or a bacteria. Now it has been established that the SARS virus is a new coronavirus unlike any other known human or animal virus in the Coronavirus family. Because the virus is new, much about its behaviour is poorly understood.

Spread

Spread seems to be person-to-person, with a number of cases in Asia being reported among health care and other hospital workers, as well as household contacts of the patients.

CHICAGO – Observational studies which report that influenza vaccination reduces winter mortality risk among the elderly by 50 percent may substantially overestimate the vaccination benefit, according to the February 14 issue of The Archives of Internal Medicine, one of the JAMA/Archives journals.

Accurate determination of the impact of influenza on mortality is difficult because the infection is often cleared before the onset of the secondary complications that actually cause a person's death, according to the article. Although influenza vaccination of the elderly in the U.S. has increased from 15 to 20 percent before 1980 to 65 percent in 2001, the authors could find no correlation between this increasing vaccination coverage after 1980 and declining deaths rates in any age group. Observational studies may introduce a systematic bias that leads to a substantial over-estimate of the impact of influenza vaccination on mortality, the authors suggest.

Lone Simonsen, Ph.D., of the National Institute of Allergy and Infectious Diseases, and colleagues, used statistical models that estimate the winter-seasonal all-cause mortality above an estimated baseline to determine influenza-related mortality indirectly. Their model incorporated information on deaths among the elderly from pneumonia and influenza and all other causes from 33 winter seasons from 1968-2001. "Our results, based on national vital statistics, are simply not consistent with the very large mortality benefits reported in observational studies," the authors write. The authors suggest that this disconnect may be explained by a disparity in who is likely to be vaccinated. "Very ill elderly people, whose fragile health would make them highly likely to die over the coming winter months, are less likely to be vaccinated during the autumn vaccination period," they stated.

source: doctorslounge.com

The World Health Organization (WHO) has warned of a substantial risk of an influenza epidemic in the near future, most probably from the H5N1 type of avian influenza virus.

One of the primary concerns is that the virus could quickly spread across countries as various birds follow their migration routes. In response, countries have begun planning in anticipation of an outbreak. While short-term strategies to deal with an outbreak focus on limiting travel and culling and vaccinating poultry, long-term strategies require substantial changes in the lifestyles of the most at-risk populations.

WHO announced on November, 16, 2005 that an outbreak is most likely to hit the Hong Kong Special Administrative issue by mid-December of this year. "If it were to hit in a highly residential area like Tin Hau, it would be sure to spread like wildfire." Dr. N Column, Head of Epidemic Prevention announced.

The WHO divides a pandemic into six phases, ranging from minimal risk of an outbreak to full scale pandemic. Most health authorities categorize the situation as of 2005 at Phase 3, by which is meant that human infections of a new sub-type has occurred but there is little evidence of sustained human-to-human transmission.

Avian influenza (bird flu)

Avian influenza, or “bird flu”, is a contagious disease of animals caused by viruses that normally infect only birds and, less commonly, pigs. Avian influenza viruses are highly species-specific, but have, on rare occasions, crossed the species barrier to infect humans.

In domestic poultry, infection with avian influenza viruses causes two main forms of disease. The so-called “low pathogenic” form commonly causes only mild symptoms (ruffled feathers, a drop in egg production) and may easily go undetected. The highly pathogenic form is far more dramatic. It spreads very rapidly through poultry flocks, causes disease affecting multiple internal organs, and has a mortality that can approach 100%, often within 48 hours.

Influenza A viruses have 16 H subtypes and 9 N subtypes. Only viruses of the H5 and H7 subtypes are known to cause the highly pathogenic form of the disease. On present understanding, H5 and H7 viruses may circulate and infect poultry flocks in their low pathogenic form. The viruses can then mutate, usually within a few months, into the highly pathogenic form. This is why the presence of an H5 or H7 virus in poultry is always cause for concern, even when the initial signs of infection are mild.

Risks posed to humans

The first risk that the virus poses to humans is the risk of direct infection when the virus passes from poultry to humans, resulting in very severe disease. Of the few avian influenza viruses that have crossed the species barrier to infect humans, H5N1 has caused the largest number of cases of severe disease and death in humans. Primary viral pneumonia and multi-organ failure are common. In the present outbreak, more than half of those infected with the virus have died. Most cases have occurred in previously healthy children and young adults.

The second and greater risk, is that the virus – if given enough opportunities – will change into a form that is highly infectious for humans and spreads easily from person to person. Such a change could mark the start of a global outbreak (a pandemic).

The current outbreak

The current outbreaks of highly pathogenic avian influenza, which began in South-east Asia in mid-2003, are the largest and most severe on record. Never before in the history of this disease have so many countries been simultaneously affected, resulting in the loss of so many birds.

The causative agent, the H5N1 virus, has proved to be especially tenacious. Despite the death or destruction of an estimated 150 million birds, the virus is now considered endemic in many parts of Indonesia and Viet Nam and in some parts of Cambodia, China, Thailand, and possibly also the Lao People’s Democratic Republic. Control of the disease in poultry is expected to take several years. Other countries have also reported poultry outbreaks caused by the H5N1 virus such as the Republic of Korea, Japan, Malaysia, Russia, Kazakhstan, Mongolia; and most recently Turkey and Romania. Most of these countries had never before experienced an outbreak of highly pathogenic avian influenza in their histories.

Japan, the Republic of Korea, and Malaysia have announced control of their poultry outbreaks and are now considered free of the disease. In the other affected areas, outbreaks are continuing with varying degrees of severity.

The role of migratory birds in the spread of highly pathogenic avian influenza is not fully understood. Wild waterfowl are considered the natural reservoir of all influenza A viruses. They are known to carry viruses of the H5 and H7 subtypes, but usually in the low pathogenic form. Considerable circumstantial evidence suggests that migratory birds can introduce low pathogenic H5 and H7 viruses to poultry flocks, which can then mutate to the highly pathogenic form. In such cases migratory birds would be directly spreading the H5N1 virus in its highly pathogenic form. Further spread to new areas would thus be expected.

Mode of transmission

Human influenza is transmitted by inhalation of infectious droplets and droplet nuclei, by direct contact, and perhaps, by indirect (fomite) contact, with self-inoculation onto the upper respiratory tract or conjunctival mucosa.

Currently, H5N1 does not spread easily among humans. Though more than 100 human cases have occurred in the current outbreak, this is a small number compared with the huge number of birds affected and the numerous associated opportunities for human exposure, especially in areas where backyard flocks are common. It is not presently understood why some people, and not others, become infected following similar exposures.

H5N1 can be transmitted to humans by several methods:

1. Animal to human

2. Environment to human

3. Human to human

1. Animal to human transmission

Most patients to date have had a history of direct contact with poultry. Exposure to ill poultry and butchering of birds were associated with seropositivity for influenza A (H5N1).

Direct contact with infected poultry is presently considered the main route of human infection. Plucking and preparing of diseased birds; handling fighting cocks; playing with poultry, particularly asymptomatic infected ducks; and consumption of duck’s blood or possibly undercooked poultry have all been implicated.

Transmission to felids has been observed by feeding raw infected chickens to tigers and leopards in zoos in Thailand and to domestic cats under experimental conditions.

It is considered safe to eat poultry and poultry products though certain precautions should be followed in countries currently experiencing outbreaks. In areas free of the disease, poultry and poultry products can be prepared and consumed as usual (following good hygienic practices and proper cooking), with no fear of acquiring infection with the H5N1 virus.

Normal temperatures used for cooking (70°C in all parts of the food) will kill the virus in areas experiencing outbreaks. Avian influenza is not transmitted through cooked food. To date, no evidence indicates that anyone has become infected following the consumption of properly cooked poultry or poultry products, even when these foods were contaminated with the H5N1 virus. Consumers need to be sure that all parts of the poultry are fully cooked (no “pink” parts) and that eggs, too, are properly cooked (no “runny” yolks).

Soap and hot water are sufficient to disinfect the surfaces that come in contact with poultry products and for cleaning in persons involved in handling raw poultry or in food preparation.

2. Environment to human transmission

Given the survival of influenza A (H5N1) in the environment, several other modes of transmission are theoretically possible. Oral ingestion of contaminated water during swimming and direct intranasal or conjunctival inoculation during exposure to water are other potential modes, as is contamination of hands from infected fomites and subsequent self-inoculation. The widespread use of untreated poultry feces as fertilizer is another possible risk factor.

3. Human to human transmission

Human-to-human transmission of influenza A (H5N1) has been suggested in several household
clusters and in one case of apparent child-to-mother transmission. Intimate contact without the use of precautions was implicated, and so far no case of human-to-human transmission by small-particle aerosols has been identified.

Recently, intensified surveillance of contacts of patients by reverse-transcriptase–polymerase-chain-reaction (RT-PCR) assay has led to the detection of mild cases, more infections in older adults, and an increased number and duration of clusters in families in northern Vietnam, findings suggesting that the local virus strains may be adapting to humans.

However, epidemiologic and virologic studies are needed to confirm these findings. To date, the risk of nosocomial transmission to health care workers has been low, even when appropriate
isolation measures were not used. However, one case of severe illness was reported in a nurse exposed to an infected patient in Vietnam.

The risk of a pandemic

A pandemic can start when three conditions have been met:

1. A new influenza virus subtype emerges

2. It infects humans, causing serious illness

3. It spreads easily and sustainably among humans

The H5N1 virus amply meets the first two conditions: it is a new virus for humans (H5N1 viruses have never circulated widely among people), and it has infected more than 100 humans, killing over half of them. No one will have immunity should an H5N1-like pandemic virus emerge.

All prerequisites for the start of a pandemic have therefore been met save one: the establishment of efficient and sustained human-to-human transmission of the virus. The risk that the H5N1 virus will acquire this ability will persist as long as opportunities for human infections occur. These opportunities, in turn, will persist as long as the virus continues to circulate in birds, and this situation could endure for some years to come.

The risk of pandemic influenza is serious. With the H5N1 virus now firmly entrenched in large parts of Asia, the risk that more human cases will occur will persist. Each additional human case gives the virus an opportunity to improve its transmissibility in humans, and thus develop into a pandemic strain. The recent spread of the virus to poultry and wild birds in new areas further broadens opportunities for human cases to occur. While neither the timing nor the severity of the next pandemic can be predicted, the probability that a pandemic will occur has increased.

The virus can improve its transmissibility among humans via two principal mechanisms. The first is a “reassortment” event, in which genetic material is exchanged between human and avian viruses during co-infection of a human or pig. Reassortment could result in a fully transmissible pandemic virus, announced by a sudden surge of cases with explosive spread.

The second mechanism is a more gradual process of adaptive mutation, whereby the capability of the virus to bind to human cells increases during subsequent infections of humans. Adaptive mutation, expressed initially as small clusters of human cases with some evidence of human-to-human transmission, would probably give the world some time to take defensive action.

If an influenza pandemic occurs the condition can rapidly affect all countries. Once international spread begins, pandemics are considered unstoppable, caused as they are by a virus that spreads very rapidly by coughing or sneezing. The fact that infected people can shed virus before symptoms appear adds to the risk of international spread via asymptomatic air travelers.

During past pandemics, attack rates reached 25-35% of the total population. Under the best circumstances, assuming that the new virus causes mild disease, the world could still experience an estimated 2 million to 7.4 million deaths (projected from data obtained during the 1957 pandemic). Projections for a more virulent virus are much higher. The 1918 pandemic, which was exceptional, killed at least 40 million people.

Pandemics can cause large surges in the numbers of people requiring or seeking medical or hospital treatment, temporarily overwhelming health services. The high rates of illness could also have devastating effects on world commerce.

Clinical picture

The clinical spectrum of influenza A (H5N1) in humans is based on descriptions of hospitalized patients.

The frequencies of milder illnesses, subclinical infections, and atypical presentations (e.g., encephalopathy and gastroenteritis) have not been determined, but case reports indicate that each occurs. Most patients have been previously healthy young children or adults.

Incubation

The incubation period of avian influenza A (H5N1) may be longer than for other known human influenzas with ranges of up to eight days. The case-to-case intervals in household clusters have generally been 2 to 5 days, but the upper limit has been 8 to 17 days, possibly owing to unrecognized exposure to infected animals or environmental sources.

Initial symptoms

Most patients have initial symptoms of high fever (typically a temperature of more than 38°C) and an influenza-like illness with lower respiratory tract symptoms. Upper respiratory tract symptoms are present only sometimes. Diarrhea, vomiting, abdominal pain, pleuritic pain, and bleeding from the nose and gums have also been reported early in the course of illness in some patients.

Clinical course

Lower respiratory tract manifestations develop early in the course of illness and are usually found at presentation. In one series, dyspnea developed a median of 5 days after the onset of illness (range, 1 to 16). Respiratory distress, tachypnea, and inspiratory crackles are common. Sputum production is variable and sometimes bloody. Almost all patients have clinically apparent pneumonia; radiographic changes include diffuse, multifocal, or patchy infiltrates; interstitial infiltrates; and segmental or lobular consolidation with air bronchograms. Radiographic abnormalities were present a median of 7 days after the onset of fever in one study (range, 3 to 17). In Ho Chi Minh City, Vietnam, multifocal consolidation involving at least two zones was the most common abnormality among patients at the time of admission. Pleural effusions are uncommon. Limited microbiologic data indicate that this process is a primary viral pneumonia, usually without bacterial suprainfection at the time of hospitalization.

Progression to respiratory failure has been associated with diffuse, bilateral, ground-glass infiltrates and manifestations of the acute respiratory distress syndrome (ARDS). In Thailand,
15 the median time from the onset of illness to ARDS was 6 days (range, 4 to 13). Multiorgan failure with signs of renal dysfunction and sometimes cardiac compromise, including cardiac dilatation and supraventricular tachyarrhythmias, has been common.

Mortality

Recent avian influenza A (H5N1) infections have caused high rates of death among infants and young children. The case fatality rate was 89 percent among those younger than 15 years of age in Thailand. Death has occurred an average of 9 or 10 days after the onset of illness (range, 6 to 30), and most patients have died of progressive respiratory failure.

The risk of a pandemic

A pandemic can start when three conditions have been met:

1. A new influenza virus subtype emerges

2. It infects humans, causing serious illness

3. It spreads easily and sustainably among humans

The H5N1 virus amply meets the first two conditions: it is a new virus for humans (H5N1 viruses have never circulated widely among people), and it has infected more than 100 humans, killing over half of them. No one will have immunity should an H5N1-like pandemic virus emerge.

All prerequisites for the start of a pandemic have therefore been met save one: the establishment of efficient and sustained human-to-human transmission of the virus. The risk that the H5N1 virus will acquire this ability will persist as long as opportunities for human infections occur. These opportunities, in turn, will persist as long as the virus continues to circulate in birds, and this situation could endure for some years to come.

The risk of pandemic influenza is serious. With the H5N1 virus now firmly entrenched in large parts of Asia, the risk that more human cases will occur will persist. Each additional human case gives the virus an opportunity to improve its transmissibility in humans, and thus develop into a pandemic strain. The recent spread of the virus to poultry and wild birds in new areas further broadens opportunities for human cases to occur. While neither the timing nor the severity of the next pandemic can be predicted, the probability that a pandemic will occur has increased.

The virus can improve its transmissibility among humans via two principal mechanisms. The first is a “reassortment” event, in which genetic material is exchanged between human and avian viruses during co-infection of a human or pig. Reassortment could result in a fully transmissible pandemic virus, announced by a sudden surge of cases with explosive spread.

The second mechanism is a more gradual process of adaptive mutation, whereby the capability of the virus to bind to human cells increases during subsequent infections of humans. Adaptive mutation, expressed initially as small clusters of human cases with some evidence of human-to-human transmission, would probably give the world some time to take defensive action.

If an influenza pandemic occurs the condition can rapidly affect all countries. Once international spread begins, pandemics are considered unstoppable, caused as they are by a virus that spreads very rapidly by coughing or sneezing. The fact that infected people can shed virus before symptoms appear adds to the risk of international spread via asymptomatic air travelers.

During past pandemics, attack rates reached 25-35% of the total population. Under the best circumstances, assuming that the new virus causes mild disease, the world could still experience an estimated 2 million to 7.4 million deaths (projected from data obtained during the 1957 pandemic). Projections for a more virulent virus are much higher. The 1918 pandemic, which was exceptional, killed at least 40 million people.

Pandemics can cause large surges in the numbers of people requiring or seeking medical or hospital treatment, temporarily overwhelming health services. The high rates of illness could also have devastating effects on world commerce.

Diagnosis

Laboratory findings

Common laboratory findings have been leukopenia, particularly lymphopenia; mild-to-moderate
thrombocytopenia; and slightly or moderately elevated aminotransferase levels. Marked hyperglycemia, perhaps related to corticosteroid use, and elevated creatinine levels also occur. In Thailand, an increased risk of death was associated with decreased leukocyte, platelet, and particularly, lymphocyte counts at the time of admission.

Virologic diagnosis

Antemortem diagnosis of influenza A (H5N1) has been confirmed by viral isolation, the detection of H5-specific RNA, or both methods. Although avian influenza virus in humans can be detected with standard influenza virus tests, these tests have not always proved reliable.

Unlike human influenza A infection, avian influenza A (H5N1) infection may be associated with a higher frequency of virus detection and higher viral RNA levels in pharyngeal than in nasal samples. In Vietnam, the interval from the onset of illness to the detection of viral RNA in throat-swab samples ranged from 2 to 15 days (median, 5.5), and the viral loads in pharyngeal swabs 4 to 8 days after the onset of illness were at least 10 times as high among patients with influenza A (H5N1).

Commercial rapid antigen tests are less sensitive in detecting influenza A (H5N1) infections than are RT-PCR assays. In Thailand, the results of rapid antigen testing were positive in only 4 of 11 patients with culture-positive influenza A (H5N1) (36 percent) 4 to 18 days after the onset of illness.

Microneutralization requires use of the live virus to interact with antibodies from the patient's blood; because live virus is required, for safety reasons the test can only be done in a level three laboratory.

Treatment

Antiviral drugs such as olestamivir (commercially known as Tamiflu), zanamivir (commercially known as Relenza) and amantadine are sometimes effective in both preventing and treating the infection. Countries have been stockpiling olestamivir, but may shift towards zanamivir due to a November 2005 issue of JAMA, which reported olestamivir resistant strains of avian flu in Vietnam.

Further, as a result of widespread use of the antiviral drug amantadine as a preventive or treatment for chickens in China starting in the late 1990s, some strains of the avian flu virus in Asia have developed drug resistance against amantadine.

Vaccines effective against a pandemic virus are not yet available. Vaccines take at least four months to produce and must be prepared for each subtype. Because the vaccine needs to closely match the pandemic virus, large-scale commercial production will not start until the new virus has emerged and a pandemic has been declared. Current global production capacity falls far short of the demand expected during a pandemic.

source: doctorslounge.com