Gout is sometimes referred to as the “disease of kings.” This is because people long have incorrectly linked it to the kind of overindulgence in food and wine only the rich and powerful could afford. In fact, gout can affect anyone, and its risk factors vary.

Fortunately, it is possible to treat gout and reduce its very painful attacks by avoiding food and medication triggers and by taking medicines that can help.

The base of the big toe and ankle are red, swollen, and extremely painful due to an acute attack of gout. As the attack subsides, the superficial skin may peel.

 

FAST FACTS

Intensely painful joint swelling, most often in the big toe or other part of the foot, may indicate gout.

Treatments exist, but therapy should be tailored for each person.

By avoiding alcohol and certain fish and meats, you may help prevent further gout attacks.

Patients may need medications to lower their elevated blood uric acid levels that predispose to gout. The goal is a uric acid level less than 6 milligrams per deciliter (mg/dL).

WHAT IS GOUT?

Gout is a painful and potentially disabling form of arthritis that has been around since ancient times. The first symptoms usually are intense episodes of painful swelling in single joints, most often in the feet, especially the big toe. The swollen site may be red and warm.

Treatments are available to control most cases of gout. However, diagnosing gout can be hard, and treatment plans often must be tailored for each person.

WHAT CAUSES GOUT?

Gout occurs when excess uric acid (a normal waste product) collects in the body, and needle‐like urate crystals deposit in the joints. This may happen because either uric acid production increases or, more often, the kidneys cannot remove uric acid from the body well enough. Certain foods and drugs may raise uric acid levels and lead to gout attacks. These include the following:

Foods such as shellfish and red meats

Alcohol in excess

Sugary drinks and foods that are high in fructose

Some medications

low-dose aspirin (but because it can help protect against heart attacks and strokes, we do not recommend that people with gout stop taking low-dose aspirin)

certain diuretics (“water pills”) such as hydrochlorothiazide (Esidrix, Hydro‐D)

immunosuppressants used in organ transplants such as cyclosporine (Neoral, Sandimmune) and tacrolimus (Prograf)

Over time, increased uric acid levels in the blood may lead to deposits of urate crystals in and around the joints. These crystals can attract white blood cells, leading to severe, painful gout attacks and chronic arthritis. Uric acid also can deposit in the urinary tract, causing kidney stones.

WHO GETS GOUT?

Gout affects more than 3 million Americans. This condition and its complications occur more often in men, women after menopause, and people with kidney disease. Gout is strongly linked to obesity, hypertension (high blood pressure), hyperlipidemia (high cholesterol and triglycerides) and diabetes. Because of genetic factors, gout tends to run in some families. Gout rarely affects children.

In patients with chronic undertreated gout crystals can be found in deposits (called tophi) that can damage joints & can appear under the skin.

HOW IS GOUT DIAGNOSED?

Some other kinds of arthritis can mimic gout, so proper diagnosis (detection) is key. Health care providers suspect gout when a patient has joint swelling and intense pain in one or two joints at first, followed by pain‐free times between attacks. Early gout attacks often start at night.

Diagnosis depends on finding the distinguishing crystals. The physician may use a needle to extract fluid from an affected joint and will study that fluid under a microscope to find whether urate crystals are present. Crystals also can be found in deposits (called tophi) that can appear under the skin. These tophi occur in advanced gout. Uric acid levels in the blood are important to measure but can sometimes be misleading, especially if measured at the time of an acute attack. Levels may be normal for a short time or even low during attacks. Even people who do not have gout can have increased uric acid levels.

X-rays may show joint damage in gout of long duration. Ultrasound and dual energy computed tomography (commonly called dual energy CT) can show early features of gouty joint involvement. These imaging techniques also can help suggest the diagnosis.

HOW IS GOUT TREATED?

Treatment of acute attacks. One treatment for active flares of gout is colchicine. This medicine can be effective if given early in the attack. However, colchicine can cause nausea, vomiting, diarrhea and other side effects. Side effects may be less frequent with low doses. Patients with kidney or liver disease, or who take drugs that interact (interfere) with colchicine, must take lower doses or use other medicines. Colchicine also has an important role in preventing gout attacks (see below).

Nonsteroidal anti‐inflammatory drugs—commonly called NSAIDs—are aspirin‐like medications that can decrease inflammation and pain in joints and other tissues. NSAIDs, such as indomethacin (Indocin) and naproxen (Naprosyn), have become the treatment choice for most acute attacks of gout. (The fact sheet on NSAIDs lists the types of patients who cannot take NSAIDs.) There is no proof that any one NSAID is better than others. High doses of short‐acting NSAIDs give the fastest relief of symptoms. These medicines may cause stomach upset, ulcers or diarrhea but, if used for the short term, are well tolerated by most people.

Some people cannot take NSAIDs because of health conditions such as ulcer disease or impaired kidney function or the use of blood thinners. Corticosteroids such as prednisone and triamcinolone are useful options for patients who cannot take NSAIDs. Given orally (by mouth) or by injection (shot) into the muscle, these medicines can be very effective in treating gout attacks. If only one or two joints are involved, your doctor can inject a corticosteroid directly into your joint.

Some home remedies may help ease gout pain. Rest the affected joint and apply ice packs or cold compresses (cloths soaked in ice water and wrung out) to that spot.

Treatment to remove excess uric acid. Patients who have repeated gout attacks, abnormally high levels of blood uric acid, or tophi or kidney stones should strongly consider medicines to lower blood uric acid levels. These medications do not help the painful flares of acute gout, so most patients should start taking them after acute attacks subside. The drug most often used to return blood levels of uric acid to normal is allopurinol (Lopurin, Zyloprim). It blocks production of uric acid. A recent option, febuxostat (Uloric), also acts by blocking uric acid production.

Probenecid (Benemid) helps the kidneys remove uric acid. Only patients with good kidney function who do not overproduce uric acid should take probenecid.

Pegloticase (Krystexxa) is given by injection and breaks down uric acid. This drug is for patients who do not respond to other treatments or cannot tolerate them. New drugs to lower uric acid levels and to treat gouty inflammation are under development.

If you are taking a uric acid-lowering drug, your doctor should slowly raise the dose and keep checking your blood uric acid levels. Once your uric acid levels drop below 6 mg/dL (normal), crystals tend to dissolve and new deposits of crystals can be prevented. You probably will have to stay on this medicine long term to prevent gout attacks.

What works well for one person may not work as well for another. Therefore, decisions about when to start treatment and what drugs to use should be tailored for each patient. Treatment choices depend on kidney function, other health problems, personal preferences and other factors.

What you eat can increase uric acid levels. Limit the amount of high-fructose drinks, such as nondiet soda. Also, do not drink alcohol, especially beer. Restrict eating foods that are rich in purines, compounds that break down into uric acid. These compounds are high in meat and certain types of seafood. Purines in vegetables appear to be safe, new research has found. Low‐fat dairy products may help lower uric acid levels.

In almost all cases, it is possible to successfully treat gout and bring a gradual end to attacks. Treatment also can decrease the number and size of tophi.

Lifestyle changes such as controlling weight, limiting alcohol consumption, and limiting meals with meats and fish rich in purines, can be helpful in controlling gout.

BROADER HEALTH IMPACTS OF GOUT

Gout often is associated with high blood pressure, heart and kidney disease, or the use of medications that increase uric acid levels. Therefore, health care providers should test for these related health problems. Researchers are studying whether lowering blood uric acid levels can help heart disease and kidney disease.

LIVING WITH GOUT

Gout affects quality of life by both the intermittent attacks and the potential for chronic (lasting) arthritis. Compliance with your treatment plan is critical.

Lifestyle changes may make it easier to manage this lifelong disease. Suggestions include gradual weight loss, avoidance of alcohol and reduced consumption of fructose‐containing drinks and foods high in purines.

 

THE RHEUMATOLOGIST’S ROLE IN THE TREATMENT OF GOUT

Treatment of gout can be difficult because of coexisting illnesses and other medications. As experts in the treatment of arthritis, rheumatologists examine patients to learn whether gout is the cause of their arthritis and to educate them about the role and proper use of medications and other treatments for gout. They also act as a resource to primary care doctors.

POINTS TO REMEMBER

Bouts of arthritis that come and go are a sign of gout.

Finding the characteristic crystals in the fluid of joints allows health care providers to correctly diagnose gout.

There are two types of medicine for gout. First, for control of acute attacks of joint pain, there are NSAIDs, colchicine and corticosteroids. Second, after attacks have resolved, there are medications that can lower the level of uric acid over time, to prevent or cause the attacks to occur less often.

People with chronic gout usually require lifetime treatment with drugs to lower uric acid levels.

Lifestyle changes such as controlling weight, limiting alcohol intake and limiting meals with meats and fish rich in purines also can help control gout.

 

KigaliHe.com

Managing Your Cholesterol – The Best Way To Prevent Hearth Attacks
By: Richard Clement
Cholesterol is one of the most familiar medical words today. Everyone knows “something” about it , but mostly cholesterol is associated in our mind with something “bad” and “unwanted” that happens to old and overweight people.The facts show that about 20 percent of the U.S. population has high blood cholesterol levels.

Actually holesterol is a waxy, fatlike substance (lipid) that your body needs for many important functions, such as producing new cells , some hormones, vitamin D, and the bile acids that help to digest fat. It is present in cell walls or membranes everywhere in the body, including the brain, nerves, muscle, skin, liver, intestines, and heart.

In fact our bodies need cholesterol to function normally, but too much cholesterol can be bad for our health. Why ? Cholesterol and other fats can’t dissolve in the blood. They have to be transported to and from the cells by special carriers. Cholesterol travels through your blood attached to a protein. This cholesterol-protein package is called a lipoprotein. Lipoproteins are high density or low density depending on how much protein there is in relation to fat.

Low-density lipoprotein (LDL) is the major cholesterol carrier in the blood. If too much LDL cholesterol circulates in the blood, it can slowly build up in the walls of the arteries feeding the heart and brain. Together with other substances it can form plaque, a thick, hard deposit that can clog those arteries. When the coronary arteries become narrowed or clogged by cholesterol and fat deposits (a process called atherosclerosis) and cannot supply enough blood to the heart, the result is coronary heart disease. If the blood supply to a portion of the heart is completely cut off by total blockage of a coronary artery, the result is a heart attack. This is usually due to a sudden closure from a blood clot forming on top of a previous narrowing. Low-density lipoprotein cholesterol is called “bad” cholesterol because it can cause cholesterol buildup and blockage of your arteries. LDL is mostly fat with only a small amount of protein.

About one-third to one-fourth of blood cholesterol is carried by high-density lipoprotein (HDL). Medical experts think HDL tends to carry cholesterol away from the arteries and back to the liver, where it’s passed from the body. Some experts believe HDL removes excess cholesterol from plaques and thus slows their growth. HDL is called “good” cholesterol because it helps prevent cholesterol from building up in your arteries. It is mostly protein with only a small amount of fat.

Since there is good cholesterol and bad cholesterol it is not only necessary to know your cholesterol level ,it is also important to know your levels of LDL and HDL.

The fact is that there are no symptoms of high cholesterol. Your first symptom of high cholesterol could be a heart attack or a stroke. The level of cholesterol can be measured only with a blood test.The results come as three main numbers:
Total Cholesterol
LDL
HDL
The level of LDL should be less than 160.
Total cholesterol should be less than 200.
The level of HDL should be more than 35.

Most Important: Your LDL level is a good indicator of your risk for heart disease. Lowering LDL is the main aim of treatment if you have high cholesterol. In general, the higher your LDL level, the greater your chance of developing heart disease.

Remember : Regular cholesterol tests are recommended to find out if your cholesterol level is within normal range.

WHAT CAN YOU DO ABOUT YOUR LDL CHOLESTEROL LEVELS?
The main cause of high blood cholesterol is eating too much fat, especially saturated fat. Saturated fats are found in animal products, such as meats, milk and other dairy products that are not fat free, butter, and eggs. Some of these foods are also high in cholesterol. Fried fast foods and snack foods often have a lot of fat.

Being overweight and not exercising can make your bad cholesterol go up and your good cholesterol go down. Regular physical activity can help lower LDL (bad) cholesterol and raise HDL (good) cholesterol levels. It also helps you lose weight. You should try to be physically active for 30 minutes on most, if not all, days.

Cigarette smoking damages the walls of your blood vessels, making them likely to have cholesterol rich plaques rupture and have heart attacks. Smoking may also lower your level of HDL cholesterol by as much as 15 percent.

Also, after women go through menopause, their bad cholesterol levels tend to go up. There is also a rare type of inherited high cholesterol that often leads to early heart disease.Some people inherit a condition called familial hypercholesterolemia, which means that very high cholesterol levels run in the family.Other people, especially people for whom diabetes runs in the family, inherit high triglyceride levels. Triglycerides are another type of blood fat that can also push up cholesterol levels. People with high blood triglycerides usually have lower HDL cholesterol and a higher risk of heart attack and stroke. Progesterone, anabolic steroids and male sex hormones (testosterone) also lower HDL cholesterol levels.

So we can make a conclusion that the main therapy is to change your lifestyle. This includes controlling your weight, eating foods low in saturated fat and cholesterol, exercising regularly, not smoking and, in some cases, drinking less alcohol.

But , depending on your risk factors, if healthy eating and exercise don’t work after about 6 months to 1 year, your doctor may suggest medicine to lower your cholesterol level.

Now there are very effective medications called “statins”,such as Lipitor.

The drug works by helping to clear harmful low density lipoprotein (LDL) cholesterol out of the blood and by limiting the body’s ability to form new LDL cholesterol. Each tablet Lipitor includes 20mg Atorvastatin. It is in a class of medications called HMG-CoA reductase inhibitors. It works by slowing the production of cholesterol in the body. Lipitor has shown the ability to halt, not just slow, the potentially fatal buildup of plaque in clogged arteries. While a handful of drugs now available slow the buildup of new plaque, or atherosclerosis, in coronary arteries, no drug on the market has been proven to both stop new build-up and clear existing plaque.

So if you are loosing the battle with LDL levels , you can visit my site www.craforhealth.com/cholesterol.html, dedicated in the effective medical care, to find the proper treatment for your disease.

Author Bio
Richard Clement is an online publisher dedicated in helping online users getting appropriate and effective medical care. Visit my site www.craforhealth.com/cholesterol.html for more info.

Article Source: http://www.ArticleGeek.com – Free Website Content

Mining companies must dig deep in the fight against Ebola

By Adam Kamradt-Scott, University of Sydney

The current outbreak of Ebola virus in West Africa shows no signs of halting. More than 4,500 people have died and many thousands more are infected. Despite the creation of a new United Nations mission to tackle Ebola and commitments of thousands of western military personnel to help combat the disease, the virus is still “winning the race”.

In September, UN Secretary-General Ban Ki-moon called on the international community to donate US$1 billion to help fight Ebola. Yet one month later, despite dire predictions that we could see 10,000 cases a week by December and 1.4 million cases by January 2015, the UN has received less than 40% of the funds needed.

While the main focus is on what governments are or are not doing, the role the corporate sector can play in the current crisis has received very little attention.

Is the mining sector doing enough to fight Ebola?

With six of the world’s ten fastest growing economies in Africa and rich mineral resources that include major iron ore deposits, the region has attracted considerable foreign investment over the past decade from some of the world’s largest resources companies.

Yet while such companies continue to promote their corporate social responsibility credentials, the response to the current Ebola crisis has been utterly inadequate.

For example, according to the UN Financial Tracking Service, Rio Tinto, which operates two mines in Guinea and boasts that it has worked in Guinea for more than 50 years, has donated just US$100,000 to the UN Ebola Virus Outbreak – West Africa Appeal. Guinea remains one of three countries in the region most severely affected by Ebola.

In a statement obtained for this article, a Rio Tinto spokesman said the company had donated GNF$1.5 billion (US$220,000) to date to health organisations, as well as or including (the statement is unclear) donating 10,000 prevention kits containing soap and chlorine for hand-washing, constructing latrines and conducting public awareness campaigns in the Guinean “sous-prefectures” of Boola, Beyla and Kouankan.

Another Australian resources company, BHP Billiton, which has mining operations in Guinea and Liberia, has donated a total of US$400,000.

The London Mining Company, which owns an iron ore mine in Sierra Leone that generated US$299 million in revenue in 2013, has claimed to be assisting with the construction of a 130-bed Ebola treatment facility. This assistance, though, equates to the loan of a surveyor and fuel to help clear the land – the actual construction of the facility will be “at cost” and operated by the United States and Irish governments.

Beyond this, in terms of financial contributions, the London Mining Company joined a consortium of businesses that collectively donated US$279,643, but independently the company has donated just US$122,100 to the UN Ebola Appeal.

Yet even these extremely modest contributions compare favourably to some Canadian-based firms such as Aureus Mining Inc, which has offered equipment (on loan) but has donated just US$30,000; while IMAGOLD has donated a mere US$35,000.

For their part, mining companies have stressed their efforts to protect employees and contractors, citing the initiation of public education campaigns and testing regimes underway at various operations.

However, the media focus has invariably been on how the Ebola crisis is affecting business, rather than asking what larger role these companies – many of which stress their ties to local communities – may make.

It seems clear that many of these companies see it primarily as a government role and their own as using influence to lobby. Aureus chief executive David Reading was one a number of senior resource company executives who co-signed a letter calling for a stronger global response to the crisis.

What about the rest of the corporate sector?

This contrasts to the efforts of other corporate donors. By any measure, the leading private sector contributor to the Ebola crisis has been the IKEA Foundation which, according to the UN, has donated over US$6.7 million to the Ebola Virus Outbreak – West Africa Appeal. This is followed by General Electric which has donated US$2 million, and Kaiser Permanente and GlaxoSmithKline, which have donated US$1 million each.

A number of other corporations have made either in-kind or cash donations to the UN Fund. Some of the companies that have donated cash include the Bridgestone Group (US$500,000), Coca-Cola (US$248,000), DuPont (US$250,000), and Exxon Mobile (US$225,000).

In-kind contributions have also been received from companies like the Chevron Corporation (ambulances), Ericsson (collecting donations), FedEx (shipping logistics), the McKesson Corporation (medical supplies), 3M (medical supplies), and the Shell Oil Company (petroleum and vehicles), among others.

Time to step up

Certainly the UN has encouraged the corporate sector to donate resources, even publishing an Ebola Business Engagement Guide.

Multi-billion dollar corporations – those with the financial capacity to do much more – however, have been slow to respond. And without exception, even the contributions that have been made pale into insignificance against the contribution by the founder of Facebook, Mark Zuckerberg, who personally donated US$25 million to combating Ebola.

In the meantime, the virus continues to spread. World leaders, including former UN Secretary-General Kofi Annan, have expressed “bitter disappointment” at the international community’s lack of response. While much of the focus may appropriately be on governments, the corporate sector also has a responsibility to step up.

In launching a fresh campaign for funds, Ban Ki-moon recently declared:

This is not just a health crisis; it has grave humanitarian, economic and social consequences that could spread far beyond the affected countries.

Let’s hope the message is heard.

Adam Kamradt-Scott owns shares in Rio Tinto. He has previously received funding from the European Research Council.

This article was originally published on The Conversation.
Read the original article.

Health Check: what to eat and avoid during pregnancy

By Clare Collins, University of Newcastle and Michelle Blumfield, University of Newcastle

As soon as women announce “I’m having a baby!”, the congratulations are quickly followed by long lists of dos and don’ts about food. Try ginger for morning sickness. Avoid soft cheese because of listeria. Eat more meat to boost your iron. Eat this fish – but not that one, because of mercury.

Pregnant women are understandably confused. So, how do you strike the balance between nutrition and safety, when so many things are off the menu?

During pregnancy, women need to consume a variety of different foods and need more of the main pregnancy nutrients: protein, folate, calcium, iron, zinc, iodine, and fibre. Here’s a quick guide to the best sources.

Protein: lean meat, chicken, seafood, dairy products, legumes, nuts, eggs

Folate: fortified bread and breakfast cereal, green leafy vegetables, legumes, seeds, chicken, eggs, oranges

Calcium: dairy foods, fortified soy milks, green leafy vegetables, nuts, seeds, canned fish with bones

Iron: red meat, fortified cereals, egg yolks, green leafy vegetables, legumes, nuts

Zinc: meat, eggs, seafood, nuts, tofu, miso, legumes, wheat germ, wholegrain foods

Iodine: canned salmon and tuna, other fish, oysters, bread fortified with iodine

Fibre: wholemeal and wholegrain breads and high fibre cereals, oats, vegetables and fruit with the skin on.

We have recently shown that a moderate intake of protein (18-20% of a total energy intake) allows pregnant women to eat the best range of foods across all the healthy core groups in the Australian Guide to Healthy Eating, while optimising vitamin and mineral intakes.

Interestingly, the protein to carbohydrate ratio was related to the amount of muscle and fat tissue in the developing baby. While more research is needed, it may contribute to the risk of developing diabetes in the future.

How much?

The Australian dietary guidelines advise pregnant women to consume the following number of servings from the five core food groups each day.

Vegetables and legumes/beans: five servings. One serve = 75g or 100-350kJ, for example, half a cup cooked green or orange vegetables, one cup of raw salad vegetables, half a medium potato, one tomato.

Fruit: two servings. One serve = 150g or 350kJ, for example, one medium piece (apple, banana, orange), two small pieces (apricots, kiwi fruit), one cup diced or canned fruit.

Grain (cereal) foods, mostly wholegrain or high-fibre varieties: eight-and-a-half servings. One serve = 500kJ, for example, one slice of bread, half a cup of cooked rice, pasta or porridge, one-quarter of a cup muesli, three crispbreads.

Lean meats and poultry, fish, eggs, tofu, nuts and seeds, legumes and beans: three-and-a-half servings. One serve = 500-600kJ, for example, 65g cooked lean meat, 80g cooked lean poultry, 100g cooked fish, two eggs, 170g tofu, 30g nuts, one cup of cooked beans.

Milk, yoghurt, cheese or alternatives, mostly reduced fat: two-and-a-half servings. One serve = 500-600kJ, for example, 250ml milk, 200g yoghurt, two slices (40g) of cheese.

Morning (noon and night) sickness

Nausea and vomiting affects about three in four pregnancies. While the data on fetal risks associated with drug treatment are controversial, non-drug approaches are a good place to start.

Limit exposure to food odours by having foods that do not smell as much during cooking or by reducing cooking time, with stir-frys or a BBQ cooked outdoors.

Nausea can be worse in the presence of hunger, so avoid an empty stomach by having small, frequent meals and snacks comprised of foods that you can tolerate and don’t have much smell, such as fruit or nuts, or raisin bread or sandwiches, or yoghurt. Very cold drinks can help with the nausea and prevent dehydration.

You could try ginger as a ginger tablet, cold ginger beer or ginger cordial. While only some evidence supports the use of ginger and/or vitamin B6 supplements to relieve nausea of pregnancy, they’re unlikely to cause harm.

Mercury and fish

Fish and seafood are important sources of protein and minerals. They are low in saturated fat and are a major source of omega-3 fatty acids.

During pregnancy, omega-3s play an important role in the baby’s developing central nervous system, the brain and retina in eyes. Research shows that maternal omega-3 fatty acid consumption during pregnancy is associated with increased birth weight and improved brain development in the child.

Deficiency of omega-3s is associated with irreversible visual and behaviours deficits in children, as well as an increased risk of depression, pre-eclampsia and pregnancy hypertension in the mother.

Population surveys in the United Kingdom and United States show that pregnant women don’t eat enough fish and therefore omega-3s, partly due to fears about adverse effects of mercury and other toxins (such as polychlorinated biphenyls).

We have shown that pregnant women in Australia also eat less fish than is recommended. But when we estimated what their weekly exposure to mercury would be from eating two to three serves a week, it was well below the targets. Pregnant women in Australia can safely eat fish.

Listeria risk

Due to changes in the immune system during pregnancy, women are more susceptible to food poisoning. But by avoiding all foods that carry a risk for harbouring listeria, women are consuming fewer nutrients.

You don’t have to go without. For every item on the “no” list, there are a number of alternatives:

Avoid pre-packaged cold meats. This includes deli meats and sandwich bars. Instead, choose freshly cooked seafood one to two times per week and/or canned fish up to four times a week. Choose home-cooked meat instead and make it into homemade sandwiches.

Avoid ready-to-eat pre-cooked chicken pieces, especially if cold. Instead, choose home-cooked chicken or hot take-away whole chicken or large pieces – but eat it immediately.

Avoid raw and chilled seafood including oysters, sashimi or sushi, smoked salmon, ready-to-eat peeled prawns, prawn cocktails, sandwich fillings, and prawn salads. Don’t eat shark (flake) or billfish (swordfish, broadbill and marlin). Limit orange roughy (deep sea perch) or catfish to once per week. Instead choose other fish species, including canned salmon and tuna two to three times a week.

Avoid salads (fruit and vegetables) that are pre-prepared or pre-packaged or from salad bars or smorgasbords. Instead, choose freshly prepared homemade salads (with leafy greens or other salad vegetables), fresh fruit, or canned or frozen fruits and vegetables.

Avoid soft, semi-soft and surface-ripened cheeses such as brie, Camembert, ricotta, feta and blue cheese. Instead, choose hard cheeses such as Cheddar or tasty, processed cheese, cheese spreads, or plain cottage cheese if packaged by the manufacturer.

Avoid soft serve ice cream and unpasteurised dairy products such as raw goat’s milk. Instead choose packaged frozen ice cream and pasteurised dairy products such as milk, yoghurt, custard and dairy desserts.

Listeria can live in lower temperatures, so take extra care with foods served cold, and avoid buffets and smorgasbords altogether. Cooking, however, kills listeria but the food needs to be heated until steam rises. And remember to always wash your hands before handling food or starting to prepare foods.

Constipation

Up to 40% of pregnant women develop constipation. This is caused by rising levels of progesterone and oestrogen, and the relaxation of muscles of the bowel. Low fluid and fibre intakes can also play a role.

Mild constipation can be self-treated by increasing high-fibre foods, including soluble (oats, lentils, dried peas and beans, psyllium) and insoluble (wholemeal and wholegrain breads and cereals, wheat bran, vegetables and fruit) fibres. To counter constipation in pregnancy aim for 25 to 28 grams of fibre per day, drink plenty of water (1.5 to two litres per day) and exercise regularly.

Some oral iron supplements can cause constipation. If medication is required, only use what your doctor prescribes as not all laxatives are safe during pregnancy.

Multivitamins

Women planning or in early pregnancy are likely to need a folic acid supplement to reduce the risk of the baby having a neural-tube defect, and iodine for the developing brain and nervous system.

Multivitamin supplements may be recommended when there is a fairly high chance of not meeting nutrient needs from food. This is more likely for pregnant adolescents, vegetarians, those on pre-existing special diets, individuals with drug, tobacco and alcohol addictions, or obese pregnant women on medically restricted diets to limit weight gain.

Pregnancy is an important time to focus on what you eat. The food-based recommendations in the Australian Dietary Guidelines will help you enjoy a variety of foods while getting the best mix of nutrients important at this time.

Clare Collins receives or has received funding from NHMRC, ARC, Hunter Medical researcg Institute, The University of Newcastle, Meat and Livestock Australia.

Michelle Blumfield does not work for, consult to, own shares in or receive funding from any company or organisation that would benefit from this article, and has no relevant affiliations.

This article was originally published on The Conversation.
Read the original article.

 

 

Hepatitis B is a viral infection that attacks the liver and can cause both acute and chronic disease.

The virus is transmitted through contact with the blood or other body fluids of an infected person.

More than 780 000 people die every year due to the consequences of hepatitis B.

Hepatitis B is an important occupational hazard for health workers.

Hepatitis B is preventable with the currently available safe and effective vaccine.

Hepatitis B is a potentially life-threatening liver infection caused by the hepatitis B virus. It is a major global health problem. It can cause chronic liver disease and chronic infection and puts people at high risk of death from cirrhosis of the liver and liver cancer.

 

More than 240 million people have chronic (long-term) liver infections. More than 780 000 people die every year due to the acute or chronic consequences of hepatitis B.

 

A vaccine against hepatitis B has been available since 1982. Hepatitis B vaccine is 95% effective in preventing infection and its chronic consequences, and was the first vaccine against a major human cancer.

 

Hepatitis B virus can cause an acute illness with symptoms that last several weeks, including yellowing of the skin and eyes (jaundice), dark urine, extreme fatigue, nausea, vomiting and abdominal pain. Hepatitis B prevalence is highest in sub-Saharan Africa and East Asia. Most people in these regions become infected with the hepatitis B virus during childhood and between 5–10% of the adult population is chronically infected.

 

High rates of chronic infections are also found in the Amazon and the southern parts of eastern and central Europe. In the Middle East and the Indian subcontinent, an estimated 2–5% of the general population is chronically infected. Less than 1% of the population in western Europe and North America is chronically infected.

 

Transmission

In highly endemic areas, HBV is most commonly spread from mother to child at birth, or from person to person in early childhood.

 

Perinatal or early childhood transmission may also account for more than one third of chronic infections in areas of low endemicity, although in those settings, sexual transmission and the use of contaminated needles, especially among injecting drug users, are the major routes of infection.

 

The hepatitis B virus can survive outside the body for at least 7 days. During this time, the virus can still cause infection if it enters the body of a person who is not protected by the vaccine.

 

The hepatitis B virus is not spread by contaminated food or water, and cannot be spread casually in the workplace.

 

The incubation period of the hepatitis B virus is 75 days on average, but can vary from 30 to 180 days. The virus may be detected 30 to 60 days after infection and persists for variable periods of time.

 

Symptoms

Most people do not experience any symptoms during the acute infection phase. However, some people have acute illness with symptoms that last several weeks, including yellowing of the skin and eyes (jaundice), dark urine, extreme fatigue, nausea, vomiting and abdominal pain.

 

In some people, the hepatitis B virus can also cause a chronic liver infection that can later develop into cirrhosis of the liver or liver cancer.

 

More than 90% of healthy adults who are infected with the hepatitis B virus will recover and be completely rid of the virus within 6 months.

 

Who is at risk for chronic disease?

The likelihood that infection with the hepatitis B virus becomes chronic depends upon the age at which a person becomes infected. Children less than 6 years of age who become infected with the hepatitis B virus are the most likely to develop chronic infections:

 

80–90% of infants infected during the first year of life develop chronic infections;

30–50%% of children infected before the age of 6 years develop chronic infections.

In adults:

 

<5% of otherwise healthy adults who are infected will develop chronic infection;

15–25% of adults who become chronically infected during childhood die from hepatitis B-related liver cancer or cirrhosis.

Diagnosis

It is not possible, on clinical grounds, to differentiate hepatitis B from hepatitis caused by other viral agents and, hence, laboratory confirmation of the diagnosis is essential. A number of blood tests are available to diagnose and monitor people with hepatitis B. They can be used to distinguish acute and chronic infections.

 

Laboratory diagnosis of hepatitis B infection focuses on the detection of the hepatitis B surface antigen HBsAg. WHO recommends that all blood donations are tested for this marker to avoid transmission to recipients.

 

Acute HBV infection is characterized by the presence of HBsAg and immunoglobulin M (IgM) antibody to the core antigen, HBcAg. During the initial phase of infection, patients are also seropositive for HBeAg.

Chronic infection is characterized by the persistence (>6 months) of HBsAg (with or without concurrent HBeAg). Persistence of HBsAg is the principal marker of risk for developing chronic liver disease and hepatocellullar carcinoma (HCC) later in life.

The presence of HBeAg indicates that the blood and body fluids of the infected individual are highly contagious.

Treatment

There is no specific treatment for acute hepatitis B. Care is aimed at maintaining comfort and adequate nutritional balance, including replacement of fluids that are lost from vomiting and diarrhoea.

 

People with chronic hepatitis B who require treatment can be given drugs, including oral antiviral agents, such as tenofovir and entecavir, but also interferon injections . Treatment can slow the progression of cirrhosis, reduce incidence of HCC and improve long term survival. Treatment, however, is not readily accessible in many resource-constrained settings.

 

Liver cancer is almost always fatal and often develops in people at an age when they are most productive and have family responsibilities. In developing countries, most people with liver cancer die within months of diagnosis. In high-income countries, surgery and chemotherapy can prolong life for up to a few years.

 

People with cirrhosis are sometimes given liver transplants, with varying success.

 

Prevention

 

The hepatitis B vaccine is the mainstay of hepatitis B prevention. WHO recommends that all infants receive the hepatitis B vaccine as soon as possible after birth, preferably within 24 hours.

 

The birth dose should be followed by 2 or 3 doses to complete the primary series. In most cases, 1 of the following 2 options is considered appropriate:

 

a 3-dose schedule of hepatitis B vaccine, with the first dose (monovalent) being given at birth and the second and third (monovalent or combined vaccine) given at the same time as the first and third doses of DTP vaccine; or

4 doses, where a monovalent birth dose is followed by 3 monovalent or combined vaccine doses, usually given with other routine infant vaccines.

The complete vaccine series induces protective antibody levels in more than 95% of infants, children and young adults. Protection lasts at least 20 years and is possibly lifelong.

 

All children and adolescents younger than 18 years old and not previously vaccinated should receive the vaccine if they live in countries where there is low or intermediate endemicity. In those settings it is possible that more people in high risk groups may acquire the infection and they should also be vaccinated. They include:

 

– people who frequently require blood or blood products, dialysis patients, recipients of solid organ transplantations;

– people interned in prisons;

– injecting drug users;

– household and sexual contacts of people with chronic HBV infection;

– people with multiple sexual partners, as well as health-care workers and others who may be exposed to blood and blood products through their work; and

travellers who have not completed their hepatitis B vaccination series should be offered the vaccine before leaving for endemic areas.

The vaccine has an excellent record of safety and effectiveness. Since 1982, over one billion doses of hepatitis B vaccine have been used worldwide. In many countries, where 8–15% of children used to become chronically infected with the hepatitis B virus, vaccination has reduced the rate of chronic infection to less than 1% among immunized children.

 

As of 2012, 183 Member States vaccinate infants against hepatitis B as part of their vaccination schedules and 79% of children received the hepatitis B vaccine. This is a major increase compared with 31 countries in 1992, the year that the World Health Assembly passed a resolution to recommend global vaccination against hepatitis B. Furthermore, as of 2012, 94 Member States have introduced the hepatitis B birth dose.

 

In addition, implementation of blood safety strategies, including quality-assured screening of all donated blood and blood components used for transfusion can prevent transmission of HBV. Safe injection – unnecessary as well as unsafe injections – practices can protect against HBV transmission. Furthermore, safer sex practices, including minimizing the number of partners and using barrier protective measures (condoms), protect against transmission.

 

WHO response

 

WHO is working in the following areas to prevent and control viral hepatitis:

 

– raising awareness, promoting partnerships and mobilizing resources;

– formulating evidence-based policy and data for action;

– preventing of transmission; and

– promoting access to screening, care and treatment services.

WHO also organizes World Hepatitis Day on July 28 every year to increase awareness and understanding of viral hepatitis.

 

Bat’s immunity may hold key to preventing future Ebola outbreaks

By Michelle Baker, CSIRO

Bats are the natural host species for Ebola and a variety of viruses, many of which can be fatal when transmitted to humans. More than 100 viruses have been identified in bats and this number is rising each year.

African fruit bats first transmitted Ebola virus to primates and other species through contact with bat droppings, half-eaten fruit or bodily fluids of diseased bats. People are thought to have contracted the virus through contact with infected bats and primates. Subsequent person–to-person transmission occurs through direct contact with infected body fluids: blood, saliva, mucus, vomit, urine or faeces.

Interestingly, bats have the ability to harbour viruses such as Ebola and don’t display clinical signs of disease. Yet once the virus infects other species, it has the potential to cause widespread death and disease. How is it that bats are resistant to a disease that kills up to 90% of people it infects?

Ebola virus infection

The impact of Ebola virus in people is largely the result of the activation of the immune system, rather than the virus itself. During the initial stages of infection, Ebola shuts off the immune response to the virus, resulting in rapid viral replication and a delay in the production of antibodies.

The immune system is initiated only once the virus is out of control and then results in over-activation of the immune response. Although the role of the immune system is to eliminate the virus, when it is activated at extreme levels it becomes damaging to the host – in this case, an infected patient.

Like all haemorrhagic fevers, this results in widespread tissue damage, leading to internal and external bleeding, decreased kidney and liver function and ultimately, in many cases, death.

Therapies

The Ebola outbreak in West Africa is the largest ever recorded and is continuing to accelerate. Researchers and drug companies are racing to develop treatments and vaccines targeting the Zaire ebolavirus, the strain that is causing the current outbreak.

The first human trial to establish the safety of the vaccine and assess the immune responses of volunteers is underway. The researchers hope that by November there will be enough data to make an informed decision about whether to deploy the vaccine in Western Africa.

So far, studies in monkeys have demonstrated that the vaccine provides protective immunity for up to ten months.

Unlocking the bat immune system

Studying how bats control viral replication may unlock alternative mechanisms for tackling Ebola as well as other new and emerging infectious diseases. Increasing antimicrobial resistance of viruses, bacteria and fungi, for instance, is becoming a global concern and we need to think creatively to find solutions.

Bats and viruses have achieved an equilibrium that allows them to co-exist. Clues from studies of bat genomes have revealed differences in genes associated with the very early immune response that could help bats respond to infections. These genes appear to be evolving at a faster rate in bats compared with other species, providing evidence that they are likely co-evolving with the viruses that bats carry.

Functional differences in the immune system may also play a role. Unlike humans and mice, which activate their immune systems only in response to an infection, bats appear to have certain components of their immune system constantly switched on. This may allow bats to control viral replication much more efficiently compared with other species.

If we can redirect the immune responses of other species to behave in a similar manner to that of bats, the high death rate associated with diseases such as Ebola could be a thing of the past.

It’s tempting to look to culling as the answer to deal with bats as the natural hosts of Ebola. This suggestion was made during the spillover of Hendra virus from bats to horses in Australia. But it is not the answer; bats are an extremely successful group of mammals, making up 20% of all mammalian diversity. They are critical to ecosystems, with roles in insect control and pollination.

Rather than persecuting bats, we need to unravel the secrets of the success of this group of mammals. Understanding how bats control viral replication would not only assist in developing future therapeutics but may also help predict transmission events from bats into human and animal populations.

Michelle Baker receives funding from The Australian Research Council

This article was originally published on The Conversation.
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How are nurses becoming infected with Ebola?

By C Raina MacIntyre

American nurse Nina Pham is the second health worker to contract Ebola outside of West Africa while caring for patients with the virus, despite using personal protective equipment. Authorities were quick to attribute lapses in protocol for Pham’s and Madrid nurse Teresa Romero Ramos’ infection. But inadequate guidelines for personal protective equipment (PPE) may equally be to blame.

The World Health Organization (WHO), United States Centers for Disease Control (CDC), Australia and many countries recommend health workers treating Ebola wear surgical masks for protection, along with other personal protective equipment such gowns, gloves and goggles.

A glaring inconsistency of these guidelines is that lab scientists working with Ebola are recommended to use respirators, which offer more protection than surgical masks, while masks are deemed adequate for doctors and nurses at the front line. The hospital ward, however, is a far more contaminated and volatile environment than the sterile, highly controlled lab.

Nurses have the closest contact with patients, and deserve all available protection for their occupational health and safety. This means higher personal protective equipment, including respirators.

The CDC’s most recent guideline update for putting on and removing protective wear suggest the second glove can be removed by hooking a bare finger under the glove (risking contact with the outside of the glove which could be contaminated), and does not mention protective boots at all.

Non-government organisations such as Medecins Sans Frontieres (MSF), however, have more comprehensive Ebola-specific protocols on glove removal, footwear and the use of respirators.

Ebola kills 50% to 90% of people who become infected, which is much higher than any other infection we are used to dealing with. The 2009 influenza pandemic killed less than 0.01% of those infected, and SARS killed 15%.

The price of getting it wrong with flu guidelines might be a week in bed, but for Ebola it is far more likely to be death. The risk analysis equation we need to use must consider not only the probability of Ebola turning up on our shores, but also the consequences.

Unprecedented epidemic

The current West African Ebola outbreak has caused more than 8000 cases and more than 4000 deaths, with the epicentre being Guinea, Sierra Leone and Liberia. Official figures are underestimated because many cases are not reaching health-care facilities or being reported.

As the epidemic increases exponentially in West Africa there is a risk of imported cases occurring around the world. The first of these was in Dallas, Texas, but countries everywhere are on the alert for suspected cases. Experts have estimated that the risk of a travel-related case being imported into Europe is up to 75% by the end of October.

This epidemic is unprecedented because:

1. It is the largest and longest in history;
2. It is the first time Ebola has occurred in more than one country simultaneously;
3. It is the first time Ebola has affected urban areas and capital cities; and
4. It is the first time Ebola has been transmitted from person to person outside of Africa.

Health authorities such as the US CDC are conveying certainty that Ebola cannot be transmitted by any means other than direct contact. But it’s a very poorly studied infection compared with other diseases and the sum of the evidence shows significant uncertainty around transmission.

The prevailing view is that infections can only be transmitted by one of three mutually exclusive routes – contact, droplet or airborne. But this is based on experiments from the 1940s and 50s using blunt instruments. There is plenty of evidence that pathogen transmission is far more complex than this, and that most pathogens can be transmitted by several modes. Take influenza, for example.

While the predominant mode of transmission of Ebola is contact, some scientists believe it could also be spread by aerosols. Studies in monkeys (here, here, here and here) and pigs have demonstrated non-contact transmission of Ebola, which could be airborne or aerosol.

There is little research in humans, but in a 1995 outbreak in the Democratic Republic of Congo, five people contracted Ebola without reporting any direct contact with the index patient.

Health worker infections

The estimated infectious potential of Ebola in West Africa is similar to influenza. Each person with Ebola infects, on average, two other people, which is similar to estimates for the last pandemic of flu. It is a mystery why an infection that is supposedly only transmitted by contact has such a high infection rate.

Around 400 health-care workers have contracted Ebola during this outbreak, many of whom are unsure how they were infected. Dr Kent Brantley, for instance, is certain he did not get infected in the Ebola ward, as he used strict personal protective equipment. He guesses he might have been infected elsewhere, such as the emergency room.

Dr Sheikh Hummar Khan was the leading viral haemorrhagic fever expert of Sierra Leone, who had already treated over 100 Ebola patients using full personal protective equipment when he died from Ebola.

Why then are so many health workers contracting Ebola when it is supposedly so “hard to catch”? There are three possible explanations:

1. Lapses in infection control protocols, such as mistakes when putting protective equipment on or taking it off.
2. Inadequate guidelines that are failing to protect against other (non-contact) modes of transmission.
3. Health workers are becoming infected somewhere other than where they’re in direct patient contact (where they do not expect to be at risk). This is possible in West Africa with such a large scale epidemic, but is unlikely in the United States and Spain.

There is no scientific evidence to explain why health workers using personal protective equipment are becoming infected, and nor has there been a reasoned approach to trying to explain it.

Instead, the blame has been placed on the health workers for lapsing in personal protective equipment protocols. It was reported Ramos might have touched her face with a glove as she removed her personal protective equipment.

In epidemiology, we are concerned about recall bias: the tendency of people with an illness to recall perceived risks more than well people, when prompted with a leading question. It is not hard to imagine that this nurse, perplexed about how she might have been infected, would have been susceptible to such a leading question.

Rather than guesses, we need a reasoned, scientific approach to establishing which of these explanations – and it may be a combination – are responsible.

Personal protective equipment guidelines should not be based on presumed mode of transmission alone, but also on uncertainty around transmission, on the severity of the disease, on health worker factors, and on other available treatments or preventions. If MSF has more comprehensive protocols on protective wear, it is hard to understand why Western countries are not heeding them.

Protecting health workers

Many dedicated health workers around the world are assisting with the response to Ebola. Some responders are non-clinicians, and that some clinician responders do not have extensive infectious diseases training. There is a clear occupational health and safety risk to health workers from this deadly disease, which is concerning.

To better protect health workers from Ebola, the ARM network, a group of Australian epidemiologists with skills in infectious diseases, is offering a free workshop on Ebola infection control to supplement routine training provided by deploying non-government agencies.

The workshop is for people intending to deploy to West Africa for the Ebola response. But due to expressions of interest, we have opened the workshop to domestic first-line responders (GPs, nurses, paramedics, police, defence, emergency workers) in Australia who may be faced with a local case.

In most responses, lack of knowledge about infection control may not be critical, but in the case of Ebola it may cost lives. If even one person learns something at this workshop which enhances their occupational health and safety, then we would have provided something useful for Australians involved in the response.

The ARM training workshop for Ebola responders will be held in Sydney on Friday 24 October from 9am to 4.30pm. Register your interest at info@arm.org.au.

C Raina MacIntyre receives funding from the Australian Research Council Linkage Grant scheme with 3M as the industry partner. As a doctor, I have an interest in the occupational health and safety of health workers.

This article was originally published on The Conversation.
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Nine months into Ebola crisis it’s sad we’re taking more notice because of ‘threat’ to West

By Simon Rushton, University of Sheffield

Addressing the United Nations on September 25, Barack Obama described the Ebola crisis as “an urgent threat to the people of West Africa but also a potential threat to the world”.

The disease has spread at alarming speed in the countries most affected – Guinea, Liberia and Sierra Leone. And while recent cases of Ebola in the West (there has so far been only one confirmed case where infection happened outside Africa) have been garnering huge attention (near blanket coverage in UK newspapers for example), the number of people who have died in Africa number is almost 3,500 so far, including confirmed, suspected or probable cases.

Obama was keen to stress that “If ever there were a public health emergency deserving an urgent, strong and co-ordinated international response, this is it.” But he added: “This is also more than a health crisis. It is a threat to regional and global security.”

Oft-repeated cliches

Ebola has certainly created instability in the countries most affected over the past few weeks. Attempts to control the outbreak have sparked civil unrest within the region – including attacks on medical centres, breached curfews and individuals absconding from quarantine. And as if to prove Obama’s point about the global nature of the threat, Thomas Duncan, a Liberian national, was diagnosed with Ebola in the US on September 30. He has since died.

The Ebola crisis is a classic illustration of two claims that have been so often repeated about infectious diseases that they are now almost cliches: that they know no borders – a statement that has always been true, but has taken on a new resonance in today’s globalised world; and that major disease outbreaks can have effects far beyond individual health, potentially destabilising societies, economies, states and regions.

But Ebola is also emblematic of something else: that all-too often Western governments begin to take notice of health crises beyond their own borders only when they are so dramatic as to hit the headlines and make action unavoidable, or when they feel that their own security is threatened. Despite warning signs that this crisis would continue to unfold and that local health systems couldn’t cope, serious global action to support efforts to contain the virus is now only being mobilised – nine months on.

Treating symptoms not cause

What if Ebola was “just” a health crisis? And what if it did only threaten the health of West Africans, not “regional and global security”? Sadly we already know the answers to these questions because West Africa has been dealing with health crises for decades, including malaria, maternal and infant mortality and under-nutrition, while the West has largely stood by.

So while those critics who have bemoaned the slow response of the international community to Ebola have a point, the real causes of the crisis can be traced back to well before 2014. They can be traced back for decades. If you want to tackle Ebola, you don’t want to start from here.

Sierra Leone, Liberia and Guinea have resided near the bottom of all of the league tables for health indicators and health system development for many, many years. Let’s look at just two. Long before the Ebola outbreak, life expectancy in Sierra Leone was the lowest in the world. Guinea (ranked 178th) and Liberia (166th) ranked only slightly higher. A similar story becomes apparent when we look at the number of physicians per 1,000 people: Sierra Leone and Liberia jointly rank 194th in the world (at 0.03 physicians per 1,000 people), with Guinea 173rd (0.11 per 1,000).

While Obama was right when he said in his UN speech that “in Guinea, Liberia and Sierra Leone public health systems have collapsed”, this is because of the long-term weaknesses of those systems, not just the (undoubtedly real) challenge posed by Ebola.

Ebola is not a particularly difficult disease to contain. But doing so requires a properly-resourced, staffed and managed health system, something that the three countries most affected – and many others around the world – have not been able to build on their own. Nor have they received the external assistance they would need to do so.

The “surge mentality” that characterises current international efforts to address Ebola does nothing to address this. In fact it may well do precisely the opposite, drawing resources (financial and human) away from other pressing challenges facing health systems in the region. This is one of the big downsides of our tendency to see infectious disease outbreaks in security terms. A crisis arises, we pour resources and attention into combating it – and when it is all over we move on to the next crisis.

The long-term problems of underdevelopment and global inequality that precipitated the crisis in the first place are rarely acknowledged and even more rarely addressed. We need to deal with the current outbreak but we also need to make sure we really look at the causes that created the crisis.

Simon Rushton is a member of the Sheffield Institute for International Development (SIID)

This article was originally published on The Conversation.
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