The results  of a large Cancer Research UK trial have set a new gold standard for treating thyroid cancer, reducing radiation doses to just one third of the current level, according to research in The new England Journal of Medicine.

The HiLo trial of 438 patients at hospitals across the UK, led by researchers at UCL (University College London), showed that giving selected patients a much lower dose of radioactive iodine taken in a single oral capsule, has similar treatment success to the current higher dose – destroying all thyroid gland cells remaining after surgery, with fewer side effects.

Currently patients have surgery to remove the entire thyroid gland and a few weeks later they take a capsule containing radioactive iodine. The iodine destroys any remaining healthy thyroid gland tissue and any potential cancer cells.  but improvements in surgery mean more of the thyroid gland is removed initially leaving fewer remaining cells to be ‘mopped up’ – so lower radiation doses are adequate and equally effective.  

Previously the higher doses of radioactive iodine meant that patients stayed in a hospital isolation unit for at least two days while the radiation left their bodies, without physical contact from family and friends. The high doses can have several side effects – the more serious occur later in life, such as a permanent dry mouth, and a small chance that a new cancer will develop.but patients taking the lower dose capsule can be treated more easily as an outpatient in hours and experience fewer side effects.

The thyroid gland makes and releases hormones and after removal patients require thyroid hormone tablets for the rest of their lives. Radioactive iodine works best when patients stop taking thyroid hormone tablets two to four weeks beforehand, but this leads to side effects such as lethargy, fatigue and weight gain, reducing patients’ quality of life and their ability to function at home and at work.

The HiLo study also showed that patients can avoid these symptoms if they continue with the thyroid tablets and are given an injection of Thyroid Stimulating Hormone (Thyrogen) just before they take the low dose radioactive iodine.Lead study author, Dr Ujjal Mallick, at the Freeman Hospital in Newcastle, said: “We’re delighted that this study of thyroid cancer will change international approaches to treat the disease more safely, by reducing the chance of another cancer developing later in life and other side effects.

“Patients will have a much better quality of life. They’ll be treated much more quickly, which will keep the disruption to their lives to a minimum, as well as saving the NHS money.”

Amy Horton, 24, from Scarborough took part in the HiLo trial after she was diagnosed with thyroid cancer in 2008.

Amy, who is currently studying medicine at Newcastle University, said: “It’s wonderful news that thyroid cancer patients can now be treated as outpatients. I was lucky to be on the trial and I received the lower dose of radio Iodine.

“Thankfully I didn’t experience too many side effects and was able to return to my studies almost straight away.“It was great not to have to stay at hospital or spend a long time feeling really unwell and I’m very pleased I could be part of research that means that future patients will now all have this quicker and safer treatment.”

Kate Law, director of clinical research at Cancer Research UK, said: “This pivotal study – which is the first for thyroid cancer in the UK – heralds a vastly improved treatment for the disease.

“Being treated as an outpatient means that patients should be able to be in their home surroundings on the same day as the treatment. The lower dose of radiation and thyrogen will help them carry on with their lives as usual at work or at home quicker without requiring several days to recover.

“More than 2,100 people are diagnosed with thyroid cancer in the UK every year – and it has the fastest rising incidence rate of the most common cancers in the UK. And we’re continuously striving to improve treatments and reduce side effects for this type of cancer.”

Note: The low dose was 1.1GBq compared with the previous higher dose of 3.7GBq. GBq is the symbol for the gigabecquerel unit of radioactivity. The patients were recruited between 2007 and 2010.

Reference: Low-dose radioiodine and thyrotropin alfa for thyroid cancer. The new England Journal of Medicine.

Contact: The Press Office, Tel: 020 3469 8300, Email: uk

Source: Cancer Research UK

Give Oprah Winfrey the credit — or blame.

Last year, Penrose Cancer Center signed up about 80 people for its first-ever free screening for oral, head and neck cancers. In the days before the screening, Winfrey’s show featured actor and producer Michael Douglas, who discussed his battle with throat cancer and helped publicize the screening campaign that was taking place nationwide. Penrose ended up with another 70 unscheduled patients because of it.

“it was crazy-busy,” said Dr. Joel Ernster, a Colorado Springs head and neck surgeon who performed some of the screenings last year. “the show scared the bejeezus out of people.”

Oprah’s show might not be around anymore, but cases of head and neck cancer are, to the tune of about 50,000 a year in the U.S. so with or without Oprah’s help, the Head and Neck Cancer Alliance is spearheading another round of screenings nationwide the last full week of April. Penrose Cancer Center, one of only two sites in Colorado to participate, will hold its screening April 25.

Ernster said head and neck cancers are the sixth most common types of cancers in the U.S., and while their numbers might not be as high as, say, lung cancer, with more than 200,000 cases a year, the effects can be disproportionately devastating.

“you can have a mastectomy and live a relatively normal life,” Ernster said. “you can have prostate radiation. But when you start taking tongues off and jaws off, and you can’t eat again, the impact is overwhelming on people.”

Most victims of head and neck cancers are long-time smokers who also drink a lot.“the classic person smoked for 30 to 40 years and drinks heavily,” Ernster said. “But I don’t want to overemphasize that.”

Because there’s another group whose numbers are on the rise: Men in their 40s and 50s, who contracted the human papilloma virus from having oral sex as long as 25 years ago. It’s the same virus that causes cervical cancer in women, said Ernster, who conducted a study on the link between HPV and the rise of a type of throat cancer in men.

“There are papers that describe it as an epidemic,” said Ernster, whose study was published in 2007 and was one of the first to recognize the increase in oropharyngeal cancer cases in the U.S.

A smaller group of people, most of them older, also gets head and neck cancers, but the cause is unknown.

Because symptoms of head and neck cancers often go unrecognized, detection and treatment can come too late. the alliance says that 66 percent of the time, oral cancers will be found as late-stage three and four diseases. about 12,000 people a year die from the cancers, and thousands more lose tongues, jaws and other parts of their face and neck. It’s why experts recommend people become familiar with symptoms and get screened.

The screenings last about 10 to 15 minutes, with doctors examining the mouth, neck, nose and maybe ears.

“It’s nothing fancy,” Ernster said.

But you could, literally, save face — and your life.

ARLINGTON HEIGHTS, Ill. — in preparation for spring, the American College of Allergy, Asthma and Immunology on Friday noted that avoiding certain fruits and vegetables, installing the proper air filters, closing the windows, filling any allergy prescriptions and consulting with an allergist can all prevent the delay of allergy symptom relief for more than 35 million Americans who suffer from seasonal allergies.

“People with spring allergies often don’t realize how many things can aggravate their allergy symptoms so they just muddle along and hope for an early end to the season,” stated Myron Zitt, past president of the ACAAI. “but there’s no reason to suffer. A few simple adjustments in habits and treatment can make springtime much more enjoyable.”

Following are the five factors ACAAI identified that can aggravate suffering:

1. Fruits and vegetables — Many people with seasonal allergies also suffer from pollen food allergy syndrome (also called oral allergy syndrome), a cross-reaction between the similar proteins in certain types of fruits, vegetables (and some nuts) and the allergy-causing pollen. One-in-5 people with grass allergies and as many as 70% of people with birch tree allergies suffer from the condition, which can make the lips tingle and swell and the mouth itch. The trick is to determine which problematic produce is causing the symptoms and then avoid eating it, although that fruit or vegetable might be able to be eaten if it’s peeled, cooked or canned. if the allergen is either a birch or alder tree, the reaction might come out of consuming celery, cherries or apples. if it’s grass allergies, then tomatoes, potatoes or peaches may be the trigger. Up to 9% of people have reactions that affect a part of their body beyond their mouth, and 1.7% can suffer a life-threatening allergic reaction called anaphylactic shock;

2. Using the wrong air filter — Using an air filter to keep the home pollen-free is a good idea, but be sure it’s the right kind. Studies show inexpensive central furnace/air conditioning filters and ionic electrostatic room cleaners aren’t helpful — and in fact, the latter releases ions, which can be an irritant. Whole-house filtration systems do work, but only if the filters are changed regularly;

3. Opening windows — When windows are open, the pollen can drift inside, settle into the carpet, furniture and car upholstery, and continue to torture the allergy sufferer. So keep the house and car windows shut during allergy season;

4. Procrastinating — Don’t put off or do without medication this spring. instead, get the jump on allergies by taking any allergy medication before the season gets under way; and

5. Avoiding the allergist — Seeing an allergist can help determine just what’s triggering symptoms, and that can lead to a more effective treatment protocol.

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“Literally, it can be minutes between life and death,” he said.

Shank said 10 school systems in Maryland have policies on epinephrine and eight do not. Six did not respond to a survey.

Washington County Public Schools do not have a formal policy. School board member Jacqueline B. Fischer said the district is aware that Shank’s bill would require one.

In September, Sharpsburg mother Sarah Price urged Washington County’s school system to focus on how to deal with students who have food allergies.

She said that when her son, who has a potentially life-threatening peanut allergy, entered pre-kindergarten in 2009, he initially had access to an epi pen at school, but couldn’t have one on his school bus.

Shank said that about a quarter of the anaphylactic allergies previously were undiagnosed, according to a study in Massachusetts. Epi pens need to be available for students who didn’t expect to need one.

Last month in Virginia, a girl in first grade died after an allergic attack. CNN reported that the girl ate a peanut she received at school from another child who didn’t know about her allergy.

Ellen Flynn of Ellicott City, Md., testified Wednesday that she’s had to administer epinephrine four times to her daughter, who is now 4, after the girl was exposed to foods thought to be safe.

During the first reaction, at age 11 months, her daughter’s mouth was swollen and she couldn’t breathe, Flynn said.

“she was in a panic,” she said.

Tony Hopko, 11, of Jefferson, Md., told the committee he is allergic to peanut and tree nuts.

Someone could die if epinephrine isn’t administered quickly, Tony said, testifying along with his mother, Dawn Neelan-Hopko.

Published: 2:00 AM – 01/25/12

While an old saying advises that “the eyes are the window to the soul,” modern dental research says the mouth provides an even better view of the body as a whole.

Some of the earliest signs of diabetes, cancer, immune disorders, hormone imbalances and drug issues show up in the gums, teeth and tongue long before a patient knows anything is wrong. and there’s growing evidence that oral health problems, particularly gum disease, raise the risk of some illnesses.

Some 20 million Americans – including 6 percent of children and 9 percent of adults – saw a dentist but not a doctor in 2008, according to a study in the December 2011 issue of American Journal of Public Health.

“It’s an opportunity to tell a patient, ‘You know, I’m concerned. I think you really need to see a primary-care provider,’ so you are moving in the direction of better health,” said the study’s lead researcher, Shiela Strauss, co-director of statistics and data management for new York University’s Colleges of Nursing and Dentistry.

A thorough mouth exam may also allow a dentist to see cancer, bulimia and certain drug addictions, such as methamphetamine use. In 32 years of practice, Dr. George Kivowitz, a restorative dentist with offices in Manhattan and Newtown, Pa., said he has spotted seven cases of cancer in 32 years of practice, as well as cases of bulimia, because of the telltale erosion of enamel on the back of the upper front teeth – as well as methamphetamine addiction.

“We call it ‘meth mouth,’” he said. “The outer surface of teeth just rots in a way that’s like nothing else.”

Dr. Thomas Littner of Cornerstone Dental in Middletown explains the concept called the “oral systemic connection.” the mouth is connected to the whole body, he says. “I review my patients’ medical history, medications … examine their teeth, gums, X-rays. … An oral cancer exam and neck palpation are important.”

A thorough exam “can display manifestations of systemic diseases,” says Dr. Bruce Weiner of the Smile Place in Middletown and Cornwall. some of those include measles, Rubella, diphtheria, AIDS, mononucleosis, blood diseases, vitamin deficiencies and metabolic disorders such as diabetes and other chronic diseases. “They may show up as lesions, sores, discoloration, coatings and yeast infections.”

Such findings are fueling a push for dentists to play a greater role in a patient’s health.

Littner explains that periodontal disease “involves pathogens (strong damage-causing bacteria) that form a coating around the teeth and inside the gum line, creating inflammation, infection and bone loss.”

It’s not something easily beaten, he adds. “Once you have periodontal disease, you’re never officially rid of it, you only manage it,” he says. he even suggests that patients see the dentist every three months because “every six months is just not enough to keep the levels of inflammation down.” For those fortunate enough to have dental insurance, Littner says that more frequent cleanings and exams may be covered if there is documented proof of necessity.

And, Weiner cautions, “Nothing is as good as prevention. Meticulous oral hygiene is best, coupled with professional measures and exams. a proper and balanced diet also helps maintain oral health.”

An estimated 6 million Americans have diabetes but don’t know it. and a 2009 study from new York University found that 93 percent of people who have periodontal disease are at risk for diabetes.

Inflammation from infected gums makes it difficult for people with diabetes to control their blood-sugar level, and high blood sugar accelerates tooth decay and gum disease, creating more inflammation.

And, says Weiner, “A large percentage of people with diabetes will develop periodontal disease. This is attributed to the fact that they are more susceptible to infections. Uncontrolled diabetics are particularly at risk.”

The good news? recent studies show that treating gum disease improves circulation, reduces inflammation and may even reduce the need for insulin in people with diabetes. “The less inflammation, the easier it is to control your sugar level, and when your sugar is under control, you may need less insulin,” says Littner.

While poor oral hygiene carries a risk for just about everyone, certain people are more susceptible than others. For pregnant women, periodontal disease “can create complications, namely early-term and low birth-weight babies,” says Littner.

There’s also growing evidence of the link between periodontal disease and cardiovascular problems. Inflammation in the gums raises C-reactive protein, thought to be a culprit in heart disease.

“They’ve found oral bacteria in the plaques that block arteries. It’s moved from a casual relationship to a risk factor,” says mark Wolff, chairman of the Department of Cariology and Comprehensive Care at NYU College of Dentistry.

That risk, says Weiner, happens because “the mouth has very high concentrations of bacteria. Insult, injury and even brushing introduce bacteria into the usually sterile bloodstream. This creates a systemic inflammatory response that has been shown to play a role in heart disease, and is also the theory behind bacterial pneumonia.”

Mouth bacteria traveling through the bloodstream can cause problems elsewhere, which is why people contemplating elective surgery are advised to have necessary dental work performed beforehand. the American Heart Association, American Medical Association and American Orthopedic Association all urge people who have had full-joint replacement to take an antibiotic before any dental visit — for the rest of their lives. It reduces the risk of post-surgical infections.

Dentists also need up-to-date information on their patients’ medications, supplements and over-the-counter drugs. Blood thinners can create excess bleeding, and osteoporosis drugs called bisphosphonates can severely weaken jaw bones. Calcium-channel blockers, drugs for high blood pressure and some anti-inflammatory drugs can cause gum ulcerations.

“Medications are a tough topic and challenge because they generally cause dry mouth,” says Littner. “If you bump your brush on the gum, cheek or lip, or your denture is real dry and rubs … it can cause a sore or ulcer. Dry mouth also increases the risk of dental decay.” he advises discussing side effects with your doctor to see if an alternative medication is available, and also suggests products to reduce dry mouth such as nonalcoholic fluoride rinses and xylitol — an ingredient in many sugarless gums — which is actually good for your teeth. Of course, there’s always water.

The Centers for Disease Control and Prevention recommends that dentists offer HIV testing because some of the first symptoms appear in the mouth. Weiner says, “HIV is sometimes diagnosed after finding Karposi’s sarcoma, which can turn up as a lesion in the mouth or skin. It’s confirmed by biopsy and a test for HIV if no history is indicated.”

A gleaming white smile is a sign of a healthy mouth, right? not necessarily. In fact, many dentists worry that people who whiten their teeth, and even people who have no cavities, can still be harboring tooth decay and serious gum disease. “Pearly whites are just that,” says Weiner. “It’s what’s underneath that counts.”

In fact, using whitening products more often than recommended can erode some of the enamel and cause teeth to appear translucent. “A lot of the whitening products are harsh,” says Littner. “If someone brushes with a hard toothbrush and brushes real hard and fast, it’s possible to get some enamel erosion. the abrasives in the pastes can also contribute to this problem.”

Freelance writer Carol Montana contributed to this story.

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Nepal, Dec. 26 — Whenever I open my mouth, people either lean away, cover their nose or have an unpleasant expression on their face because of my bad breath. It’s so distressing,” I remember one of my patients telling me. another complained that her husband had the problem and that it was becoming really difficult to deal with. in fact, two out of ten patients coming into the dental clinic express similar issues with bad breath. Breath malodor is a rather embarrassing social problem; it has been documented that almost US $1 billion a year is spent in the US on mouth rinses and mints to counter bad breath. Wouldn’t it be better to spend this money on a proper diagnostic treatment instead of short-term and ultimately inefficient masking attempts?

Halitosis, in medical terms, can be defined as chronic, long-term bad breath, caused by anaerobic sulfur-producing bacteria breeding beneath the surface of the tongue and often in the throat and tonsils. the causes can be intra oral or extra oral. Intra oral causes mostly deal with poor dental habits leading to food impaction and infection, associated with gingivitis and periodontitis. Besides that, xerostomia (dry mouth) or the accumulation of food remnants intermingled with exfoliated cells and bacteria causing a coating on the surface of the tongue can also lead to halitosis. Extra oral causes could be owing to Eye-Nose-Throat (ENT) infections, pulmonary problems such as chronic bronchitis, bronchiectasis and bronchial carcinoma, liver diseases, renal diseases, systemic metabolic disorders such as Type-1 diabetes, hereditary metabolic conditions such as trimethylaminuria and hormonal disorders.

The process of halitosis begins when there is proteolytic degradation of peptides present

in saliva, food debris, inter dental plaque,

postnatal drip and blood by gram-negative anaerobic bacteria. Thus wherever the cause is located, a common pathophysiology effect is tissue destruction and putrefaction of amino acids.

Due to the varied etiological factors that cause halitosis, a proper diagnostic approach is necessary. Clinicians must consider relevant medical history and note the frequency of occurrence-daily, weekly or monthly;

time of appearance within the day to exclude other associated diseases; any medications the patient might be on; and dryness of the mouth or any other symptoms, so that a complete picture can be drawn and appropriate treatment given. Lastly, the clinician must be able to differentiate between intra oral and extra oral origins.

While there are different instruments available in the market through which the level of halitosis can be analysed such as the portable volatile sulfide monitor, gas chromatography, phase contrast microscope etc, these are too cumbersome for a small clinical setup. this is why most clinics employ the ‘Organoleptic Rating’ method. in organoleptic rating, a trained judge smells the expired air and rates its intensity ranging from 0 to 5 (where 0=no odor and 5=extremely foul odor). Although it is entirely based on the olfactory faculties of the clinician, it is considered the standard. another method is through self-examination. A patient is asked to smell a plastic spoon after scraping the back of his/her tongue. Similarly, licking one’s wrist and allowing it to dry and then smelling it, or inserting a toothpick between one’s teeth and testing the smell can very well reflect one’s level of malodor. Of course, these aren’t foolproof methods or completely accurate, but they generally work in detecting whether there is cause for concern.

Dental clinicians should not take halitosis lightly and must strive to diagnose and treat malodor, because more than 85 percent of cases of bad breath have intra oral origins. Treatment should be centered on reducing the bacterial load by effective mechanical oral hygiene procedures, which could comprise simply of teaching patients the proper way of brushing, including tongue scraping. Periodontal diseases should be treated and controlled, and as auxiliary aid, oral rinses containing chlorhexidine, triclosan, hydrogen peroxide or stannous fluoride may be prescribed to further reduce symptoms. If breath malodor persists after these approaches, it could be owing to extra oral origins and medical consultation should be sought immediately.

Dr Roy is a Dental Surgeon working in Dharan Published by HT Syndication with permission from EKantipur.com. For any query with respect to this article or any other content requirement, please contact Editor at

ASTHMA IS a common condition affecting almost 10% of the population, characterised as intermittent, reversible difficulty in breathing caused by narrowing of the airways, inflammation and excessive mucus. There are a number of triggers which can initiate an attack such as allergy, cold air, exertion (e.g. exercise), infection and stress. the main symptoms are; shortness of breath, wheezing, coughing (especially at night and early morning) and a feeling of tightness in the chest.

the aim of treatment is to keep the condition under control so as to minimise the effects on the sufferers’ lifestyle as much as possible. this is achieved using an on-going step-wise approach in order to match the treatment to the severity of the condition: the aim is to reduce the number of asthma attacks to 3 or less per week or no more than one night time episode per week.

Mild asthma can often be controlled sufficiently by the use of short acting beta-2 agonist inhalers (e.g. salbutamol = Ventolin™ or terbutaline = Bricanyl™). These act by relaxing the muscle in the airways causing them to open; they act immediately, but can cause side effects such as shaking or tremor. Unfortunately, in most cases, additional drugs are required to achieve adequate control and the next step is to add a steroid inhaler (such as beclometasone = Becotide™ or budesonide = Pulmicort™). These act by reducing the inflammatory response in the airways and can be very effective if used regularly. they must be used for several days initially before reaching their full effect.

low doses have few side effects, but can cause oral thrush so rinsing the mouth with water after each use is advised. Higher doses can result in typical steroid side effects of; weight gain, lowering the immune system (leading to infections), glaucoma and acne. More severe asthma may require other forms of treatment if high-dose inhaled steroids are still insufficient to control symptoms. the next step is to introduce a long acting beta agonist (LABA) inhaler (salmeterol = Serevent™ or formoterol = Oxis™). These act in the same way as the short acting types, but their actions lasts for several hours and are delayed. they do NOT give immediate relief and so mustn’t be used for acute attacks. There was some concern after a large study found that people using LABAs were more likely to suffer from severe asthma that required hospitalisation or caused death. it is very important to use these products correctly and in combination with other treatments, never alone. it is imperative that any worsening of asthma symptoms are reported and treated quickly.

if asthma symptoms are still troublesome the next step is to add oral medication, either; a leukotriene receptor antagonist (montelukast = Singulair™), theophylline = Uniphylline™ or a beta 2 agonist tablet (salbutamol = Ventolin™). the last step in treating unresponsive asthma is to add the oral steroid tablet prednisolone. this is often used for short periods of 5 to 10 days for asthma flair ups, such as may occur with a chest infection. Long term treatment is associated with a number of complications and patients should be monitored for; high blood pressure, osteoporosis, cataracts, adrenal suppression, diabetes and high blood fats.

the regular use of asthma drugs saves lives but it is important to use them correctly. if you have difficulty using the normal pressurised inhaler, then using a spacer device or a different type of inhaler (powder inhaler or breathe activated inhaler) may improve treatment tremendously. if asthma symptoms worsen or reliever inhalers fail to have their normal effect, medical advice must be sought without delay.  Emergency treatment with nebulised drugs, oxygen and steroid injection are not uncommon and is often avoidable if the worsening symptoms are reported early. in the UK alone three people die every day from asthma and it has been estimated that 75% of hospital emissions for asthma could be avoided.

Asthmatics should have their condition and treatment monitored regularly and their medication adjusted accordingly. the step approach outlined above can be used in both directions, so some drugs can be reduced or stopped if symptoms improve sufficiently. Michael Lord BPharm(hons) MRPharmS. UK Pharmacist with 20 years experience. Now at Health & Beauty Abroad, Flamenca Beach Commercial Centre, Orihuela Costa. Tel: 96 532 5116  HealthandBeautyAbroad.com

Aside loss to life and property, flooding also spawns an increased risk of infection due to exposure to contaminated and polluted waters. the prolonged flooding, now in its third month, has sparked an outbreak of infectious diseases in various parts of Thailand both from direct and indirect transmission. These diseases can be broadly divided into two major categories: viz, water-borne such as typhoid fever, cholera, leptospirosis and hepatitis a, and vector-borne such as malaria, dengue and dengue haemorrhagic fever.

VECTOR-BORNE DISEASES

Floods may indirectly lead to an increase in vector-borne diseases through the rapid increase in vector numbers due to expansion of their breeding sites. Stagnant water collecting in pools after heavy rainfall or overflow of rivers are breeding sites for mosquitoes, and therefore can put people and emergency workers in flood areas at higher risk of contacting dengue and malarial infection.

MALARIA

The number of mosquitoes may decrease at the beginning of flooding as the water flushes out mosquito larvae, but their population quickly expands after a lag time which is usually around 6-8 weeks, before the onset of a malaria epidemic.

Risk factors for an epidemic include:

- Changes in human behaviour such as avoiding using mosquito nets or insect repellent, lack of information about infectious diseases associated with flooding and high population densities in emergency centres are all examples of risk factors with potential to cause an epidemic.

- a change in environment resulting from, say, construction of roads and buildings, water reservoirs or as a result of deforestation have corresponding effect on the breeding sites and habits of these vector-borne insects.

DENGUE HAEMORRHAGIC FEVER

Dengue is transmitted by the bite of an Aedes mosquito infected with dengue viruses. Patients infected with the virus will show symptoms approximately one week after the infective bite. Symptoms can range from a mild fever (dengue), to a severe incapacitating high fever with blood vessels becoming temporarily “leaky” (dengue hemorrhagic fever: DHF) or a deadly form of the disease that causes the patient to go into shock and die (dengue shock syndrome: DSS), seen in 80%, 15%, and 5% of the cases.

Major symptoms range from high fever that can last 2-7 days, skin bleeding, enlarged liver, abdominal pain, and failure of blood circulation leading to a state of shock. the most dangerous stage is the failure of hemodynamic which occurs simultaneously with rapid decline of fever. If the patient does not receive proper medical attention in a timely manner, the conditions will continue to deteriorate, and death is possible within 12-24 hours after entering the state of shock.

While there are no specific antiviral medicines for dengue, early diagnosis and proper clinical management by experienced physicians can significantly lower the mortality rate.

1. Physician may prescribe antipyretic agents to lower high fever to prevent seizure in some patients. Use of acetylsalicylic acid (eg aspirin) and non-steroidal anti-inflammatory drugs (eg Ibuprofen) are not recommended as they cause stomach bleeding.

2. Maintain adequate hydration in patients with high fever.

3. Monitor patients closely to detect and prevent shock.

4. Periodically check the change in platelet count and hematocrit.

For patients who experience shock or bleeding, doctor will need to provide specialised treatments using plasma fluid or colloid substance to save the patient’s life and prevent other complications that may occur.

“Lowering mosquito numbers and minimising exposure to bites are important. Mosquito breeding sites must be removed, destroyed, frequently emptied and cleaned or treated with insecticides. during epidemics spray insecticide regularly to kill adult mosquitoes.

- Early diagnosis and treatment: Monitoring laboratory confirmed cases every week allows us to detect malaria outbreak at the early stage.

- Monitoring the population of patients with fever and providing them with proper medical care in a timely manner can significantly reduce the rate of death from dengue hemorrhagic fever and malaria.

- Providing health education, promoting good hygiene and eating habits, and offering critical advice about dengue hemorrhagic fever and its symptoms can pave the way for early detection and treatment.

LEPTOSPIROSIS

It is caused by the bacteria Leptospires that affects both humans and animals. Humans become infected through direct contact with the urine of infected animals especially rodents or with a urine-contaminated environment.

Distribution

Leptospirosis is an occupational hazard for people who work outdoors or with animals and must stay in water for prolonged periods, such as farmers and sewer workers. it is also a recreational hazard to those who swim or wade through waters contaminated with the bacteria, which can gain entry through cuts and abrasions on the skin and through the mucous membrane in the eyes, nose and mouth.

Symptoms

Three to 10 days after infection patients experience acute fever, severe headache, muscle pain, chills, redness of the eyes, abdominal pain, jaundice, haemorrhages in the skin and mucous membranes, vomiting, diarrhoea, and rash.

These symptoms normally occur after wading through muddy water for prolonged periods (average 10 days). Patients need to seek medical care immediately. Do not try to treat yourself with any medicine.

Prevention

Avoid walking through dirty or muddy water especially when having sustained cuts or wounds in hands, arms, legs and feet without wearing protective gear, such as gloves and boots. Bathe immediately after wading through floods. Keep your accommodation and surrounding areas clean to control the spread of infection source (eg rodent and garbage control); eat properly and only cooked food; and store food in clean containers with protective covers.

Bangkok Health Research Center, Bangkok Hospital Group, call 1719.

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For almost 30 years, scientists have known that multiple sclerosis is more ordinary in higher latitudes than in the tropics. As sunlight is more abundant near the equator, many scientists have wondered if the high levels of vitamin D engendered by sunlight could put in plain words unusual pattern of frequency.Vitamin D may reduce the symptoms of multiple sclerosis, but in a recent study scientists have declared that the ultraviolet part of sunlight may play a bigger function than vitamin D in controlling MS.Multiple sclerosis is a sore neurological illness caused by deterioration in the nerve’s electrical conduction; approximately 400,000 people have the disabling condition in the United States. in recent years, it’s become clear the immunity systems of patients are destroying the electrical insulation on the nerve fibers.The ultraviolet portion of sunlight stimulates the body to produce vitamin D, and both vitamin D and the ultraviolet are able to control the immune system and possibly slow MS.

A mice was used in an experiment, because they are genetically susceptible to MS-like disease, the examiners triggered the disease by injecting a protein from nerve fibers. The researchers then exposed the mice to moderate levels of the ultraviolet radiation for almost a week. After they initiated disease by injecting the protein, they irradiated the mice every second or third day.The ultraviolet contact (equivalent to two hours of direct summer sun) did not change how many mice got the MS-like disease, but it did decrease the symptoms of MS, especially in the animals that were treated with the ultraviolet every other day.

The research group also found that although the ultraviolet contact did increase the level of vitamin D, that consequence, by itself, could not explain the reduced MS symptoms.

MS is a progressive neurological illness with a few effective treatments, but scientists declared that the study, however hopeful, may or may not lead to a new mode of cure. Also, scientists have mentioned that there are several ways that could go. if they could find out what the ultraviolet is producing, maybe they could give that as a medicine. in the short term, if they can define a specific wavelength of light that is active, and it does not overlap with the wavelengths that cause cancer, they could expose patients who have been diagnosed with MS to that wavelength.

However, this is just experimental study at this stage. Whether it can be translated into practical applications on MS remains to be seen.