Hepatitis

Hepatitis:

Hepatitis is an inflammation of the liver, most commonly caused by a viral infection. There are five main hepatitis viruses, referred to as types A, B, C, D and E.
Hepatitis A and E are typically caused by ingestion of contaminated food or water. Hepatitis B, C and D usually occur as a result of parenteral contact with infected body fluids (e.g. from blood transfusions or invasive medical procedures using contaminated equipment). Hepatitis B is also transmitted by sexual contact.
The symptoms of hepatitis include jaundice (yellowing of the skin and eyes), dark urine, extreme fatigue, nausea, vomiting and abdominal pain.

What is hepatitis?

Hepatitis means inflammation of the liver, and the most common cause is infection with one of 5 viruses, called hepatitis A,B,C,D, and E. All of these viruses can cause an acute disease with symptoms lasting several weeks including yellowing of the skin and eyes (jaundice); dark urine; extreme fatigue; nausea; vomiting and abdominal pain. It can take several months to a year to feel fit again. Hepatitis B virus can cause chronic infection in which the patient never gets rid of the virus and many years later develops cirrhosis of the liver or liver cancer. HBV is the most serious type of viral hepatitis and the only type causing chronic hepatitis for which a vaccine is available.

Hepatitis E:

Hepatitis is a general term meaning inflammation of the liver. Hepatitis is a disease that can be caused by a variety of different viruses such as hepatitis A, B, C, D and E. Since the development of jaundice is a characteristic feature of liver disease, a correct diagnosis can only be made by testing patients' sera for the presence of specific viral antigens and/or anti-viral antibodies.
Hepatitis E (HEV) was not recognized as a distinct human disease until 1980. Hepatitis E is caused by infection with the hepatitis E virus, a non-enveloped, positive-sense, single-stranded RNA virus.
Although man is considered the natural host for HEV, antibodies to HEV or closely related viruses have been detected in primates and several other animal species

How is HEV transmitted?

HEV is transmitted via the faecal-oral route. Hepatitis E is a waterborne disease, and contaminated water or food supplies have been implicated in major outbreaks. Consumption of faecally contaminated drinking water has given rise to epidemics, and the ingestion of raw or uncooked shellfish has been the source of sporadic cases in endemic areas. There is a possibility of zoonotic spread of the virus, since several non-human primates, pigs, cows, sheep, goats and rodents are susceptible to infection. The risk factors for HEV infection are related poor sanitation in large areas of the world, and HEV shedding in faeces.
Person-to-person transmission is uncommon. There is no evidence for sexual transmission or for transmission by transfusion.

Where is HEV a problem?

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

When is a HEV infection life-threatening?

In general, hepatitis E is a self-limiting viral infection followed by recovery. Prolonged viraemia or faecal shedding are unusual and chronic infection does not occur.
Occasionally, a fulminant form of hepatitis develops, with overall patient population mortality rates ranging between 0.5% - 4.0%. Fulminate hepatitis occurs more frequently in pregnancy and regularly induces a mortality rate of 20% among pregnant women in the 3rd trimester.

The disease!

The incubation period following exposure to HEV ranges from 3 to 8 weeks, with a mean of 40 days. The period of communicability is unknown. There are no chronic infections reported.
Hepatitis E virus causes acute sporadic and epidemic viral hepatitis. Symptomatic HEV infection is most common in young adults aged 15-40 years. Although HEV infection is frequent in children, it is mostly asymptomatic or causes a very mild illness without jaundice (anicteric) that goes undiagnosed.
Typical signs and symptoms of hepatitis include jaundice (yellow discoloration of the skin and sclera of the eyes, dark urine and pale stools), anorexia (loss of appetite), an enlarged, tender liver (hepatomegaly), abdominal pain and tenderness, nausea and vomiting, and fever, although the disease may range in severity from subclinical to fulminant.

Diagnosis!

Since cases of hepatitis E are not clinically distinguishable from other types of acute viral hepatitis, diagnosis is made by blood tests which detect elevated antibody levels of specific antibodies to hepatitis E in the body or by reverse transcriptase polymerase chain reaction (RT-PCR). Unfortunately, such tests are not widely available.
Hepatitis E should be suspected in outbreaks of waterborne hepatitis occurring in developing countries, especially if the disease is more severe in pregnant women, or if hepatitis A has been excluded. If laboratory tests are not available, epidemiologic evidence can help in establishing a diagnosis.

Surveillance and control:

Surveillance and control procedures should include

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

Treatment:

Hepatitis E is a viral disease, and as such, antibiotics are of no value in the treatment of the infection. There is no hyperimmune E globulin available for pre- or post-exposure prophylaxis. HEV infections are usually self-limited, and hospitalization is generally not required. No available therapy is capable of altering the course of acute infection.
As no specific therapy is capable of altering the course of acute hepatitis E infection, prevention is the most effective approach against the disease. Hospitalization is required for fulminant hepatitis and should be considered for infected pregnant women.

Hepatitis B:

Hepatitis B is one of the major diseases of mankind and is a serious global public health problem. It is preventable with safe and effective vaccines that have been available since 1982. Of the 2 billion people who have been infected with the hepatitis B virus (HBV), more than 350 million have chronic (lifelong) infections. These chronically infected persons are at high risk of death from cirrhosis of the liver and liver cancer, diseases that kill about one million persons each year. Although the vaccine will not cure chronic hepatitis, it is 95% effective in preventing chronic infections from developing, and is the first vaccine against a major human cancer. In 1991, the World Health Organization (WHO) called for all children to receive the hepatitis B vaccine, and 116 countries have added this vaccine to their routine immunization programmes. However, the children in the poorest countries, who need the vaccine the most, have not been receiving it because their governments cannot afford it. Fortunately, hepatitis B vaccine will soon be available in these countries with the assistance of the Global Alliance for Vaccines and Immunization (GAVI) and the Global Fund for Children's Vaccines.

Who gets hepatitis B?

In much of the developing world, (sub-Saharan Africa, most of Asia, and the Pacific), most people become infected with HBV during childhood, and 8% to 10% of people in the general population become chronically infected. In these regions liver cancer caused by HBV figures among the first three causes death by cancer in men.
High rates of chronic HBV infection are also found in the Amazon and the southern parts of Eastern and Central Europe. In the Middle East and Indian sub-continent, about 5% are chronically infected. Infection is less common in Western Europe and North America, where less than 1% are chronically infected.
Young children who become infected with HBV are the most likely to develop chronic infection. About 90% of infants infected during the first year of life and 30% to 50% of children infected between 1 to 4 years of age develop chronic infection. The risk of death from HBV-related liver cancer or cirrhosis is approximately 25% for persons who become chronically infected during childhood.

How do people get infected ?

Hepatitis B virus is transmitted by contact with blood or body fluids of an infected person in the same way as human immunodeficiency virus (HIV), the virus that causes AIDS. However, HBV is 50 to 100 times more infectious than HIV.
The main ways of getting infected with HBV are:

1: Perinatal (from mother to baby at the birth)
2: Child-to-child transmission
3: Unsafe injections and transfusions
4: Sexual contact

Hepatitis C:

The hepatitis C virus (HCV) is spread by direct contact with an infected person's blood. The symptoms of the hepatitis C virus can be very similar to those of the hepatitis A and B viruses. However, infection with the hepatitis C virus can lead to chronic liver disease and is the leading reason for liver transplant in the United States.

The hepatitis C virus can be spread by:

1: sharing drug needles
2: getting a tattoo or body piercing with unsterilized tools
3: blood transfusions (especially ones that occurred before 1992; since then the U.S. blood supply has been routinely screened for the disease)
4: transmission from mother to newborn
5: sexual contact (although this is less common)

Diagnosis:

All of these viral hepatitis conditions can be diagnosed and followed through the use of readily available blood tests.

Signs and Symptoms:

Hepatitis, in its early stages, may cause flu-like symptoms, including:

1: malaise (a general ill feeling)
2: fever
3: muscle aches
4: loss of appetite
5: nausea
6: vomiting
7: diarrhea
8: jaundice (a yellowing of the skin and whites of the eyes)

But some people with hepatitis may have no symptoms at all and may not even know they're infected. Children with hepatitis A, for example, usually have mild symptoms or have no symptoms.
If hepatitis progresses, its symptoms begin to point to the liver as the source of illness. Chemicals normally secreted by the liver begin to build up in the blood, which causes:

Breast Cancer

How Breast Cancer Happens

Breast profile:

A Ducts

B Lobules

C Dilated section of duct to hold milk

D Nipple

E Fat

F Pectoralis major muscle

G Chest wall/rib cage

Enlargement

A Normal duct cells

B Basement membrane

C Lumen (center of duct)

The breast is a gland designed to make milk. The lobules in the breast make the milk, which then drains through the ducts to the nipple.
Like all parts of your body, the cells in your breasts usually grow and then rest in cycles. The periods of growth and rest in each cell are controlled by genes in the cell's nucleus. The nucleus is like the control room of each cell. When your genes are in good working order, they keep cell growth under control. But when your genes develop an abnormality, they sometimes lose their ability to control the cycle of cell growth and rest.

Breast cancer is an uncontrolled growth of breast cells.

Cancer has the potential to break through normal breast tissue barriers and spread to other parts of the body. While cancer is always caused by a genetic "abnormality" (a "mistake" in the genetic material), only 5–10% of cancers are inherited from your mother or father. Instead, 90% of breast cancers are due to genetic abnormalities that happen as a result of the aging process and life in general.
While there are things every woman can do to help her body stay as healthy as possible (such as eating a balanced diet, not smoking, minimizing stress, and exercising regularly), breast cancer is never anyone's fault. Feeling guilty, or telling yourself that breast cancer happened because of something you or anyone else did, is counterproductive.

Who Gets Breast Cancer?

Breast cancer is the most common cancer to affect women. In 2007, it is estimated that there will be about 178,480 new cases of invasive breast cancer diagnosed in the United States, along with 62,030 new cases of non-invasive breast cancer.
Every woman is at SOME risk for breast cancer—this is merely the "risk" of living as a woman. But there are many risk factors that can make one woman's picture differ substantially from another's. When you understand your own particular risk profile, you are in a better position to manage it and don't have to fear the unknown.
The medical experts for Who Gets Breast Cancer? are:
Carol Cherry, R.N., O.C.N., oncology nurse, Fox Chase Cancer Center, Pennsylvania
Marisa C. Weiss, M.D., breast radiation oncologist, Thomas Jefferson University Health System, Philadelphia, Pennsylvania

Individual Risk Factors

Growing older is the biggest risk for breast cancer. The longer you live, the higher your risk:
From birth to age 39, 1 woman in 231 will get breast cancer (<0.5% risk).
From ages 40–59, the chance is 1 in 25 (4% risk).
From ages 60–79, the chance is 1 in 15 (nearly 7%).
The risk of getting breast cancer over the course of an entire lifetime, assuming you live to age 90, is one in 7, with an overall lifetime risk of 14.3%.
Risk increases with age because the wear and tear of living increases the risk that a genetic abnormality, or "mistake," will develop that your body doesn't find and fix.
Personal history of breast cancer is a risk factor for breast cancer recurrence or the formation of a new breast cancer. In other words, if you have already been diagnosed with breast cancer, your risk of developing it again is higher than if you had never had the disease. The risk is about 1% per year, so that over a 10-year period, your risk would be about 10%. However, there is medication available to help you reduce that risk.
Family history of breast cancer can have a significant impact on your risk, but don't automatically assume that any case of breast cancer in your family means you are a high-risk candidate. For example, if your grandmother was diagnosed with breast cancer at age 75, this does NOT mean your risk of the disease is increased. Your grandmother was most likely just one of the 1 in 15 women in that age bracket who gets breast cancer from the wear and tear of aging.
Other patterns of family history may strongly suggest an inherited gene abnormality that is independent of normal aging, and is associated with a relatively higher risk of breast cancer. The following signs suggest that there may be an inherited gene abnormality in your family (These apply to either your mother's OR your father's side of the family):
having a mother, sister, or daughter with breast cancer
having multiple generations of family members affected by breast or ovarian cancer
having relatives who were diagnosed with breast cancer at a young age (under 50 years old)
having relatives who had both breasts affected by cancer
You can inherit a breast cancer gene abnormality from your mother OR your father. If one of your parents has a gene abnormality, you have a 50% risk of inheriting the gene from him or her. If you do inherit a gene abnormality, your risk of developing the disease depends on the specific abnormality found, the pattern of its behavior in your family, plus the uniqueness of your own body. The risk of breast cancer in these families ranges greatly—from 40–80% over the course of a lifetime. Keep in mind that breast cancer caused by an inherited gene abnormality is not necessarily any more severe or less treatable than other types of breast cancer.
Certain types of breast cancer gene abnormalities are also associated with a higher risk of ovarian cancer (from 20–60%).
Genetic counseling can help you better define and understand the significance of your own family history.

Prolonged Estrogen Exposure

Prolonged, uninterrupted exposure to estrogen can increase breast cancer risk. Breast cell growth—both normal and abnormal—is stimulated by the presence of estrogen. This includes estrogen that your own body produces normally, as well as estrogen you might take as a pill (for example, menopause hormone therapy). The following risk factors for breast cancer are related to prolonged exposure to estrogen without any breaks or interruptions:
starting menstruation at a young age (more years of the body producing estrogen)
going through menopause at a late age (more years of the body producing estrogen)
taking menopause hormone replacement therapy for over five years with estrogen alone, or with estrogen and progesterone (risk increases by 5–40%, but most breast cancers that are diagnosed in women on hormone therapy tend to be very early stage and very treatable)
never having had a full-term pregnancy
having a first full-term pregnancy after age 30 (more years of the body producing estrogen without the break from regular cycles)
being overweight, which increases the production of estrogen outside the ovaries and adds to the overall level of estrogen in the body
exposure to estrogens in the environment (such as estrogen fed to fatten up beef cattle, or the breakdown products of the pesticide DDT, which mimic the effects of estrogen in the body)
having more than two alcoholic drinks per week, which can limit your liver's ability to regulate blood estrogen levels.

Breast Cellular Changes

Breast cellular changes may be associated with an increased risk of breast cancer. These are found when a breast biopsy (tissue sample) is taken and the breast cells are examined under a microscope. Two cellular changes associated with breast cancer risk are:
atypical ductal hyperplasia—an overactive growth of cells lining the breast ducts
lobular carcinoma in situ—an uncontrolled growth of lobular cells, the cells that make breast milk

Smoking, Diet, and Stress

Smoking is associated with a small increase in breast cancer risk.
Diet plays an important role in your level of risk for breast cancer. Some say that 30% of all cancers can be attributed to an inadequate or unhealthy diet. Many strong opinions have been expressed on this subject, and books claiming to have "the answer" have been on the bestseller list.
The truth is, we don't yet know the answers. Several large medical studies have not been able to demonstrate a clear connection between eating high-fat foods and having a higher risk of breast cancer. Ongoing studies are attempting to clarify this issue further. We CAN say that avoiding high-fat foods is a healthy choice for many reasons: It lowers the "bad" cholesterol (low-density lipoproteins) and increases the "good" cholesterol (high-density lipoproteins); it makes more room in your diet for healthier foods; and it helps keep your weight at a healthier level. Being overweight IS a known factor for an increased risk of breast cancer.
Stress has not been clearly associated with increased breast cancer risk. But you can say with confidence that stress stinks. It's not good for your overall health and well-being.

Medical sonography

Medical sonography (ultrasonography)

is an ultrasound-based diagnostic medical imaging technique used to visualize muscles, tendons, and many internal organs, their size, structure and any pathological lesions with real time tomographic images. It is also used to visualize a fetus during routine and emergency prenatal care. Ultrasound scans are performed by medical health care professionals called sonographers. Obstetric sonography is commonly used during pregnancy. Ultrasound has been used to image the human body for at least 50 years. It is one of the most widely used diagnostic tools in modern medicine. The technology is relatively inexpensive and portable, especially when compared with modalities such as magnetic resonance imaging (MRI) and computed tomography (CT). As currently applied in the medical environment, ultrasound poses no known risks to the patient.[5] Sonography is generally described as a "safe test" because it does not use ionizing radiation, which imposes hazards, such as cancer production and chromosome breakage. However, ultrasonic energy has two potential physiological effects: it enhances inflammatory response; and it can heat soft tissue.[6] Ultrasound energy produces a mechanical pressure wave through soft tissue. This pressure wave may cause microscopic bubbles in living tissues, and distortion of the cell membrane, influencing ion fluxes and intracellular activity. When ultrasound enters the body, it causes molecular friction and heats the tissues slightly. This effect is very minor as normal tissue perfusion dissipates heat. With high intensity, it can also cause small pockets of gas in body fluids or tissues to expand and contract/collapse in a phenomenon called cavitation (this is not known to occur at diagnostic power levels used by modern diagnostic ultrasound units). The long-term effects of tissue heating and cavitation are not known.[7] There are several studies that indicate the harmful side effects on animal fetuses associated with the use of sonography on pregnant mammals. A noteworthy study in 2006 suggests exposure to ultrasound can affect fetal brain development in mice. This misplacement of brain cells during their development is linked to disorders ranging "from mental retardation and childhood epilepsy to developmental dyslexia, autism spectrum disorders and schizophrenia, the researchers said. However, this effect was only detectable after 30 minutes of continuous scanning. [8] A typical fetal scan, including evaluation for fetal malformations, typically takes 10-30 minutes.[9] There is no link made yet between the test results on animals, such as mice, and the possible outcome to humans. Widespread clinical use of diagnostic ultrasound testing on humans has not been done for ethical reasons. The possibility exists that biological effects may be identified in the future, currently most doctors feel that based on available information the benefits to patients outweigh the risks.[10] Obstetric ultrasound can be used to identify many conditions that would be harmful to the mother and the baby. For this reason many health care professionals consider that the risk of leaving these conditions undiagnosed is much greater than the very small risk, if any, associated with undergoing the scan. According to Cochrane review, routine ultrasound in early pregnancy (less than 24 weeks) appears to enable better gestational age assessment, earlier detection of multiple pregnancies and earlier detection of clinically unsuspected fetal malformation at a time when termination of pregnancy is possible.[11]
Sonography is used routinely in obstetric appointments during pregnancy, but the FDA discourages its use for non-medical purposes such as fetal keepsake videos and photos, even though it is the same technology used in hospitals.

HIV/AIDS & STDs

HIV/AIDS & STDs



Testing and treatment of sexually transmitted diseases (STDs) can be an effective tool in preventing the spread of HIV, the virus that causes AIDS. An understanding of the relationship between STDs and HIV infection can help in the development of effective HIV prevention programs for persons with high-risk sexual behaviors.
Individuals who are infected with STDs are at least two to five times more likely than uninfected individuals to acquire HIV infection if they are exposed to the virus through sexual contact. In addition, if an HIV-infected individual is also infected with another STD, that person is more likely to transmit HIV through sexual contact than other HIV-infected persons.Testing and treatment of sexually transmitted diseases (STDs) can be an effective tool in preventing the spread of HIV, the virus that causes AIDS. An understanding of the relationship between STDs and HIV infection can help in the development of effective HIV prevention programs for persons with high-risk sexual behaviors.



What is the link between STDs and HIV infection?



Individuals who are infected with STDs are at least two to five times more likely than uninfected individuals to acquire HIV infection if they are exposed to the virus through sexual contact. In addition, if an HIV-infected individual is also infected with another STD, that person is more likely to transmit HIV through sexual contact than other HIV-infected persons (Wasserheit, 1992).
There is substantial biological evidence demonstrating that the presence of other STDs increases the likelihood of both transmitting and acquiring HIV.



Increased susceptibility:STDs appear to increase susceptibility to HIV infection by two mechanisms. Genital ulcers (e.g., syphilis, herpes, or chancroid) result in breaks in the genital tract lining or skin. These breaks create a portal of entry for HIV. Additionally, inflammation resulting from genital ulcers or non-ulcerative STDs (e.g., chlamydia, gonorrhea, and trichomoniasis) increase the concentration of cells in genital secretions that can serve as targets for HIV (e.g., CD4+ cells).



Increased infectiousness:STDs also appear to increase the risk of an HIV-infected person transmitting the virus to his or her sex partners. Studies have shown that HIV-infected individuals who are also infected with other STDs are particularly likely to shed HIV in their genital secretions. For example, men who are infected with both gonorrhea and HIV are more than twice as likely to have HIV in their genital secretions than are those who are infected only with HIV. Moreover, the median concentration of HIV in semen is as much as 10 times higher in men who are infected with both gonorrhea and HIV than in men infected only with HIV. The higher the concentration of HIV in semen or genital fluids, the more likely it is that HIV will be transmitted to a sex partner.



How can STD treatment slow the spread of HIV infection?



Evidence from intervention studies indicates that detecting and treating STDs may reduce HIV transmission.
STD treatment reduces an individual's ability to transmit HIV. Studies have shown that treating STDs in HIV-infected individuals decreases both the amount of HIV in genital secretions and how frequently HIV is found in those secretions (Fleming, Wasserheit, 1999).
Herpes can make people more susceptible to HIV infection, and it can make HIV-infected individuals more infectious. It is critical that all individuals, especially those with herpes, know whether they are infected with HIV and, if uninfected with HIV, take measures to protect themselves from infection with HIV.
Among individuals with both herpes and HIV, trials are underway studying if treatment of the genital herpes helps prevent HIV transmission to partners.



What are the implications for HIV prevention?



Strong STD prevention, testing, and treatment can play a vital role in comprehensive programs to prevent sexual transmission of HIV. Furthermore, STD trends can offer important insights into where the HIV epidemic may grow, making STD surveillance data helpful in forecasting where HIV rates are likely to increase. Better linkages are needed between HIV and STD prevention efforts nationwide in order to control both epidemics.
In the context of persistently high prevalence of STDs in many parts of the United States and with emerging evidence that the U.S. HIV epidemic increasingly is affecting populations with the highest rates of curable STDs, the CDC/HRSA Advisory Committee on HIV/AIDS and STD Prevention (CHAC) recommended the following:
Early detection and treatment of curable STDs should become a major, explicit component of comprehensive HIV prevention programs at national, state, and local levels;
In areas where STDs that facilitate HIV transmission are prevalent, screening and treatment programs should be expanded;
HIV testing should always be recommended for individuals who are diagnosed with or suspected to have an STD.
HIV and STD prevention programs in the United States, together with private and public sector partners, should take joint responsibility for implementing these strategies.
CHAC also notes that early detection and treatment of STDs should be only one component of a comprehensive HIV prevention program, which also must include a range of social, behavioral, and biomedical interventions.