Influenza

For Your Information: Influenza Video

1. What is flu?

Flu, or influenza, is a highly contagious acute respiratory illness caused by the Influenza virus. Flu season generally occurs annually all over the world, during the cold season (October to January).

Influenza infects over 30 million people in the U.S. each year, which is roughly 10% to 20% of the U.S. population. Flu and its complications is the sixth leading cause of death in the U.S., killing 20,000 – 40,000 people a year. As of 1997, it is the fourth leading causes of morbidity or illness in the Philippines. Flu is the most common cause of absenteeism in both school and work.

2. What causes flu?

Flu is caused by the Influenza virus that invades and multiplies in the respiratory tract. Influenza viruses are divided into three types: A, B, and C. This classification is based on the capability of their components to cause disease. Influenza types A and B are the primary causes of the disease and responsible for epidemic outbreaks. Influenza type C is a sporadic cause of predominantly upper respiratory tract disease such as the common cold and pharyngitis.

The influenza virus is unique in that its structure changes each year. Major changes cause worldwide epidemics called pandemics. Minor changes cause the annual local outbreaks. Pandemics are estimated to occur every 10 to 20 years while local outbreaks occur every 2 to 3 years.

In the pandemic of 1918 – 1919, the Influenza a virus caused over 20 million deaths worldwide. In 1997, an entirely new variety of human influenza virus surfaced and caused the Hong Kong bird flu in which one-third of the first 18 confirmed cases died.

Other viruses that known to cause flu-like illness are the respiratory syncyctial virus (RSV) and adenovirus.

3. Who are at risk of getting flu?

Any person is at risk of getting flu. The risks are higher if you belong to any of the following groups:

Those who belong to extremes of age generally have low immune functions to fight the virus.
Those with chronic debilitating illnesses (e.g., asthma, emphysema, kidney disease, diabetes).
Smokers and chronic alcoholics with secondary liver dysfunction.
Children in day-care centers and adoption homes.
Children on long-term aspirin therapy.
Women in their 2nd or 3rd trimester of pregnancy.
Residents of nursing homes.

4. How do you get flu?

Flu is highly contagious and spreads through inhalation of air droplets containing respiratory secretions from persons with flu. These secretions are aerosols of viruses that contaminate the air, hands and surfaces of our environment. You can get these aerosols when the person with flu coughs and sneezes. You can even get flu when you handle objects contaminated by these secretions such as tissue paper.

The incubation period of flu is 1 to 4 days. Transmission through a community is rapid, with the highest incidence of illnesses occurring within 2 to 3 weeks of introduction, and with the outbreak lasting for 6 to 10 weeks.

5. How do you know that you have flu?

Once you get infected with the virus. It takes 1 to 4 days for you to feel symptoms due to the disease.

The most common signs and symptoms are:

1. Headaches, muscle aches, joint pains, body malaise and fatigue that can be severe during the first few days but will slowly improve.

2. Sore throat which is more common in older children (because young ones cannot complain) and adults.

3. Cough which starts as dry and hacking and progresses by the 3rd day to wet with thick mucus. Your cough can worsen during the next 4-7 days and can last for over 2 weeks. You have a higher risk to develop bronchitis and pneumonia if you smoke.

4. Fever with a temperature of 38'C to 40'C, with or without chills, within 12 hours from onset of infection. Fever is higher in children and can reach to as high as 41oC.

5. Nasal congestion, watery eyes or runny nose. Vomiting and/or diarrhea. Diarrhea is more common in children less than 6 years of age.

6. What are the precautions to take to avoid flu?

The most logical way to avoid flu is for you to avoid persons with the disease. Adults with flu are typically contagious for 5-7 days from fever onset. In children, they are contagious for 7-10 days and even longer (up to 4 weeks) in patients with low natural defense mechanism.

However, since this is not entirely possible, a flu vaccine is available which can help give you immunity against flu. The vaccine has 70-90% efficacy and varies from year to year because the Influenza virus strains change every year. Flu shots are given each year so that you can get protection against newer strains of the virus.

Inquire from your physician about the availability of the flu vaccine. The vaccine is indicated for most individuals especially those included in the high-risk groups. You can have yourself vaccinated any time during the flu season. It takes one to two weeks for you to develop antibodies that provide protection against flu. The only time you should not get the vaccine is if you are allergic to eggs, which are a component of the vaccine of the vaccine, or thimerosal, which is the vaccine preservative.

7. How do you treat flu?

The treatment of flu is divided into nonspecific and specific treatment.

Non-specific treatment includes the following:

1. To prevent complications and to allow your immune system to work:

A. Rest
B. Comfortable room temperature
C. Increased fluid intake

2. Symptomatic drug treatment:

A. For fever, headache, muscle and joint pains: Analgesic/Antipyretic agents – Paracetamol, Ibuprofen
B. For runny and stuffy nose: cold Medications – Phenylpropanolamine
C. For dry cough – Dextromethorphan
D. For productive cough: Guiafenesin, Carbocisteine, Bromhexine, Ambroxol

Specific treatment for flu include:

1. Older agents that are very efficacious only against the Influenza A virus:

Amantadine
Rimantadine

2. Newer agents that are used for the treatment of Influenza A and B:

Zanamir for inhalation
Oseltamivir
One drawback against these drugs is their high cost. Side effects include headache, dizziness, insomnia, irritability, difficulty in concentrating, and anxiety.

Antibiotics should not be given unless there are bacterial complications.

8. What are the complications of flu?

Pneumonia and otitis media are the most common complications of flu. Otitis media can present as earache or fluid coming out of your ears. Pneumonia can manifest as high-grade fever, brassy cough, lack of appretite, drowsiness, difficulty in breathing, and increased phlegm and mucus production. These are usually viral in origin but oftentimes, secondary bacterial complications set in. When bacterial infection sets in, antibiotics are warranted. Prolonged muscle weakness and pain are less frequent complications. In rare instances, Reye’s Syndrome occurs. This is marked by delirium, seizures, stupor, coma, and death.

9. When should you call your physician?

Call your physician if you note the following:

A. Fever recurs after it has gone for1-2 days, or you continue to have high-grade fever after 4 or 5 days.
B. Cough becomes wheezy, with difficulty in breathing and the presence of bloody or yellow green mucus and phlegm.
C. You have chronic illness (e.g., asthma, cancer, diabetes, kidney problems) or your chronic condition worsens.
D. Ear pain and/or ear discharge.
E. Prolonged headache, confusion, frequent muscle twitching, seizures or convulsions and general body weakness.
F. Bleeding in any part of your body.
G. Rapid or irregular heartbeat.

Pneumonia

Getting the idea!

What is Pneumonia?

Pneumonia is a serious infection and/or inflammation of your lungs. The air sacs in the lungs fill with pus and other liquid. Oxygen has trouble reaching your blood. If there is too little oxygen in your blood, your body cells can't work properly. Because of this and spreading infection through the body pneumonia can cause death.

Until 1936, pneumonia was the No.1 cause of death in the U.S. Since then, the use of antibiotics brought it under control. In 2003, pneumonia and influenza combined ranked as the seventh leading cause of death.

Pneumonia affects your lungs in two ways. Lobar pneumonia affects a section (lobe) of a lung. Bronchial pneumonia (or bronchopneumonia) affects patches throughout both lungs.

Causes of Pneumonia

Pneumonia is not a single disease. It can have over 30 different causes. There are five main causes of pneumonia:

• Bacteria
• Viruses
• Mycoplasmas
• Other infectious agents, such as fungi -- including pneumocystis
• Various chemicals

Bacterial Pneumonia

Bacterial pneumonia can attack anyone from infants through the elderly. Alcoholics, the debilitated, post-operative patients, people with respiratory diseases or viral infections and people who have weakened immune systems are at greater risk.

Pneumonia bacteria are present in some healthy throats. When body defenses are weakened in some way, by illness, old age, malnutrition, general debility or impaired immunity, the bacteria can multiply and cause serious damage. Usually, when a person's resistance is lowered, bacteria work their way into the lungs and inflame the air sacs.

The tissue of part of a lobe of the lung, an entire lobe, or even most of the lung's five lobes becomes completely filled with liquid (this is called "consolidation"). The infection quickly spreads through the bloodstream and the whole body is invaded.

The organism streptococcus pneumoniae is the most common cause of bacterial pneumonia. It is one form of pneumonia for which a vaccine is available.

Symptoms: The onset of bacterial pneumonia can vary from gradual to sudden. In the most severe cases, the patient may experience shaking chills, chattering teeth, severe chest pain, and a cough that produces rust-colored or greenish mucus.

A person's temperature may rise as high as 105 degrees F. The patient sweats profusely, and breathing and pulse rate increase rapidly. Lips and nailbeds may have a bluish color due to lack of oxygen in the blood. A patient's mental state may be confused or delirious.

Viral Pneumonia

Half of all pneumonias are believed to be caused by viruses. More and more viruses are being identified as the cause of respiratory infection, and though most attack the upper respiratory tract, some produce pneumonia, especially in children. Most of these pneumonias are not serious and last a short time but some may be.

Infection with the influenza virus may be severe and occasionally fatal. The virus invades the lungs and multiplies, but there are almost no physical signs of lung tissue becoming filled with fluid. It finds many of its victims among those who have pre-existing heart or lung disease or are pregnant.

Symptoms: The initial symptoms of viral pneumonia are the same as influenza symptoms: fever, a dry cough, headache, muscle pain, and weakness. Within 12 to 36 hours, there is increasing breathlessness; the cough becomes worse and produces a small amount of mucus. There is a high fever and there may be blueness of the lips.

In extreme cases, the patient has a desperate need for air and extreme breathlessness. Viral pneumonias may be complicated by an invasion of bacteria, with all the typical symptoms of bacterial pneumonia.

Mycoplasma Pneumonia

Because of its somewhat different symptoms and physical signs, and because the course of the illness differed from classical pneumococcal pneumonia, mycoplasma pneumonia was once believed to be caused by one or more undiscovered viruses and was called "primary atypical pneumonia."

Identified during World War II, mycoplasmas are the smallest free-living agents of disease in humankind, unclassified as to whether bacteria or viruses, but having characteristics of both. They generally cause a mild and widespread pneumonia. They affect all age groups, occurring most frequently in older children and young adults. The death rate is low, even in untreated cases.

Symptoms: The most prominent symptom of mycoplasma pneumonia is a cough that tends to come in violent attacks, but produces only sparse whitish mucus. Chills and fever are early symptoms, and some patients experience nausea or vomiting. Patients may experience profound weakness that lasts for a long time

.
Other kinds of Pneumonia

Pneumocystis carinii pneumonia (PCP) is caused by an organism believed to be a fungus. PCP may be the first sign of illness in many persons with AIDS.

PCP can be successfully treated in many cases. It may recur a few months later, but treatment can help to prevent or delay its recurrence.

Other less common pneumonias may be quite serious and are occurring more often. Various special pneumonias are caused by the inhalation of food, liquid, gases or dust, and by fungi. Foreign bodies or a bronchial obstruction such as a tumor may promote the occurrence of pneumonia, although they are not causes of pneumonia.

Rickettsia (also considered an organism somewhere between viruses and bacteria) cause Rocky Mountain spotted fever, Q fever, typhus and psittacosis, diseases that may have mild or severe effects on the lungs. Tuberculosis pneumonia is a very serious lung infection and extremely dangerous unless treated early.

Treating Pneumonia

If you develop pneumonia, your chances of a fast recovery are greatest under certain conditions: if you're young, if your pneumonia is caught early, if your defenses against disease are working well, if the infection hasn't spread, and if you're not suffering from other illnesses.

In the young and healthy, early treatment with antibiotics can cure bacterial pneumonia, speed recovery from mycoplasma pneumonia, and a certain percentage of rickettsia cases. There is not yet a general treatment for viral pneumonia, although antiviral drugs are used for certain kinds. Most people can be treated at home.

The drugs used to fight pneumonia are determined by the germ causing the pneumonia and the judgment of the doctor. After a patient's temperature returns to normal, medication must be continued according to the doctor's instructions, otherwise the pneumonia may recur. Relapses can be far more serious than the first attack.

Besides antibiotics, patients are given supportive treatment: proper diet and oxygen to increase oxygen in the blood when needed. In some patients, medication to ease chest pain and to provide relief from violent cough may be necessary.

The vigorous young person may lead a normal life within a week of recovery from pneumonia. For the middle-aged, however, weeks may elapse before they regain their accustomed strength, vigor, and feeling of well-being. A person recovering from mycoplasma pneumonia may be weak for an extended period of time.

Adequate rest is important to maintain progress toward full recovery and to avoid relapse. Remember, don't rush recovery!

Preventing Pneumonia is possible

Because pneumonia is a common complication of influenza (flu), getting a flu shot every fall is good pneumonia prevention.

A vaccine is also available to help fight pneumococcal pneumonia, one type of bacterial pneumonia. Your doctor can help you decide if you, or a member of your family, need the vaccine against pneumococcal pneumonia. It is usually given only to people at high risk of getting the disease and its life-threatening complications.

The greatest risk of pneumococcal pneumonia is usually among people who:

1. Have chronic illnesses such as lung disease, heart disease, kidney disorders, sickle cell anemia, or diabetes.

2. Are recovering from severe illness
2. Are in nursing homes or other chronic care facilities
4. Are age 65 or older

If you are at risk, ask your doctor for the vaccine.

Ask your doctor about any revaccination recommendations. The vaccine is not recommended for pregnant women or children under age two.

Since pneumonia often follows ordinary respiratory infections, the most important preventive measure is to be alert to any symptoms of respiratory trouble that linger more than a few days. Good health habits, proper diet and hygiene, rest, regular exercise, etc., increase resistance to all respiratory illnesses. They also help promote fast recovery when illness does occur.

If you have symptoms of Pneumonia

Call your doctor immediately. Even with the many effective antibiotics, early diagnosis and treatment are important.

Follow your doctor's advice. In serious cases, your doctor may advise a hospital stay. Or recovery at home may be possible.

Continue to take the medicine your doctor prescribes until told you may stop. This will help prevent recurrence of pneumonia and relapse.

Remember, even though pneumonia can be treated, it is an extremely serious illness. Don't wait, get treatment early.

Diabetes Mellitus (Hyperglycemia)

Diabetes Video



Hyperglycemia

You have diabetes, which means you have to deal with some of the problems that go along with having the disease. One of those problems is hyperglycemia. Hyperglycemia happens from time to time to all people who have diabetes.

Hyperglycemia can be a serious problem if you don't treat it. Hyperglycemia is a major cause of many of the complications that happen to people who have diabetes. For this reason, it's important to know what hyperglycemia is, what its symptoms are, and how to treat it.

Hyperglycemia is the technical term for high blood glucose (sugar). High blood glucose happens when the body has too little, or not enough, insulin or when the body can't use insulin properly.

A number of things can cause hyperglycemia. For example, if you have type 1 diabetes, you may not have given yourself enough insulin. If you have type 2 diabetes, your body may have enough insulin, but it is not as effective as it should be.

The problem could be that you ate more than planned or exercised less than planned. The stress of an illness, such as a cold or flu, could also be the cause. Other stresses, such as family conflicts or school or dating problems, could also cause hyperglycemia.

What are the symptoms of hyperglycemia?

The signs and symptoms include: high blood glucose, high levels of sugar in the urine, frequent urination, and increased thirst.

Part of managing your diabetes is checking your blood glucose often. Ask your doctor how often you should check and what your blood glucose levels should be. Checking your blood and then treating high blood glucose early will help you avoid the other symptoms of hyperglycemia.

It's important to treat hyperglycemia as soon as you detect it. If you fail to treat hyperglycemia, a condition called ketoacidosis (diabetic coma) could occur. Ketoacidosis develops when your body doesn't have enough insulin. Without insulin, your body can't use glucose for fuel. So, your body breaks down fats to use for energy.

When your body breaks down fats, waste products called ketones are produced. Your body cannot tolerate large amounts of ketones and will try to get rid of them through the urine. Unfortunately, the body cannot release all the ketones and they build up in your blood. This can lead to ketoacidosis.

Ketoacidosis is life-threatening and needs immediate treatment. Symptoms include:

1. Shortness of breath
2. Breath that smells fruity
3. Nausea and vomiting
4. A very dry mouth

Talk to your doctor about how to handle this condition

How do you treat hyperglycemia?

Often, you can lower your blood glucose level by exercising. However, if your blood glucose is above 240 mg/dl, check your urine for ketones. If you have ketones, do NOT exercise.

Exercising when ketones are present may make your blood glucose level go even higher. You'll need to work with your doctor to find the safest way for you to lower your blood glucose level.

Cutting down on the amount of food you eat might also help. Work with your dietitian to make changes in your meal plan. If exercise and changes in your diet don't work, your doctor may change the amount of your medication or insulin or possibly the timing of when you take it.

How do you prevent hyperglycemia?

Your best bet is to practice good diabetes management. The trick is learning to detect and treat hyperglycemia early -- before it can get worse.

Diabetes Mellitus (Hypoglycemia)

Diabetes Video

Hypoglycemia

Part of living with diabetes is learning to cope with some of the problems that go along with having the disease. Hypoglycemia or low blood glucose (sugar) is one of those problems. Hypoglycemia happens from time to time to everyone who has diabetes.
Hypoglycemia, sometimes called an insulin reaction, can happen even during those times when you're doing all you can to manage your diabetes. So, although many times you can't prevent it from happening, hypoglycemia (low blood glucose) can be treated before it gets worse. For this reason, it's important to know what hypoglycemia is, what symptoms of hypoglycemia are, and how to treat hypoglycemia.

What are the symptoms of hypoglycemia?

The symptoms of hypoglycemia include:

1. Shakiness
2. Dizziness
3. Sweating
4. Hunger
5. Headache
6. Pale skin color
7. Sudden moodiness or behavior changes, such as crying for no apparent reason
8. Clumsy or jerky movements
9. Seizure
10. Difficulty paying attention, or confusion
11. Tingling sensations around the mouth

Causes of Hypoglycemia

In people taking certain blood-glucose lowering medications, blood glucose can fall too low for a number of reasons:

1. Meals or snacks that are too small, delayed, or skipped
2. Excessive doses of insulin or some diabetes medications, including sulfonylureas and meglitinides (Alpha-glucosidase inhibitors, biguanides, and thiazolidinediones alone should not cause hypoglycemia but can when used with other diabetes medicines.)
3. Increased activity or exercise
4. Excessive drinking of alcohol

How do you know when your blood glucose is low?

Part of managing diabetes is checking blood glucose often. Ask your doctor how often you should check and what your blood glucose levels should be. The results from checking your blood will tell you when your blood glucose is low and that you need to treat it.

You should check your blood glucose level according to the schedule you work out with your doctor. More importantly though, you should check your blood whenever you feel low blood glucose coming on. After you check and see that your blood glucose level is low, you should treat hypoglycemia quickly.

If you feel a reaction coming on but cannot check, it's best to treat the reaction rather than wait. Remember this simple rule: When in doubt, treat.

How do you treat hypoglycemia?

The quickest way to raise your blood glucose and treat hypoglycemia is with some form of sugar, such as 3 glucose tablets (you can buy these at the drug store), 1/2 cup of fruit juice, or 5-6 pieces of hard candy.

Ask your health care professional or dietitian to list foods that you can use to treat low blood glucose. And then, be sure you always have at least one type of sugar with you.

Once you've checked your blood glucose and treated your hypoglycemia, wait 15 or 20 minutes and check your blood again. If your blood glucose is still low and your symptoms of hypoglycemia don't go away, repeat the treatment. After you feel better, be sure to eat your regular meals and snacks as planned to keep your blood glucose level up.

It's important to treat hypoglycemia quickly because hypoglycemia can get worse and you could pass out. If you pass out, you will need IMMEDIATE treatment, such as an injection of glucagon or emergency treatment in a hospital.

Glucagon raises blood glucose. It is injected like insulin. Ask your doctor to prescribe it for you and tell you how to use it. You need to tell people around you (such as family members and co-workers) how and when to inject glucagon should you ever need it.

If glucagon is not available, you should be taken to the nearest emergency room for treatment for low blood glucose. If you need immediate medical assistance or an ambulance, someone should call the emergency number in your area (such as 911) for help. It's a good idea to post emergency numbers by the telephone.

If you pass out from hypoglycemia, people should:

1. NOT inject insulin.
2. NOT give you food or fluids.
3. NOT put their hands in your mouth.
4. Inject glucagon.
5. Call for emergency help.

How do you prevent low blood glucose?

Good diabetes control is the best way we know to prevent hypoglycemia. The trick is to learn to recognize the symptoms of hypoglycemia. This way, you can treat hypoglycemia before it gets worse.

Hypoglycemia Unawareness

Some people have no symptoms of hypoglycemia. They may lose consciousness without ever knowing their blood glucose levels were dropping. This problem is called hypoglycemia unawareness.

Hypoglycemia unawareness tends to happen to people who have had diabetes for many years. Hypoglycemia unawareness does not happen to everyone. It is more likely in people who have neuropathy (nerve damage), people on tight glucose control, and people who take certain heart or high blood pressure medicines.

As the years go by, many people continue to have symptoms of hypoglycemia, but the symptoms change. In this case, someone may not recognize a reaction because it feels different.
These changes are good reason to check your blood glucose often, and to alert your friends and family to your symptoms of hypoglycemia. Treat low or dropping sugar levels even if you feel fine. And tell your team if your blood glucose ever drops below 50 mg/dl without any symptoms.

Hepatitis B (Serum Hepatitis)

Hepatitis Video



DESCRIPTION

Hepatitis B is a serious disease caused by a virus that attacks the liver. The virus, which is called hepatitis B virus (HBV), can cause lifelong infection, cirrhosis (scarring) of the liver, liver cancer, liver failure, and death.

Hepatitis B vaccine is available for all age groups to prevent hepatitis B virus infection.

SIGNS & SYMPTOMS

About 30% of persons have no signs or symptoms. Signs and symptoms are less common in children than adults.

1 jaundice
2 fatigue
3 abdominal pain
4 loss of appetite
5 nausea, vomiting
6 joint pain

CAUSE

Hepatitis B virus (HBV)

TRANSMISSION

1. Occurs when blood from an infected person enters the body of a person who is not infected.

2. HBV is spread through having sex with an infected person without using a condom (the efficacy of latex condoms in preventing infection with HBV is unknown, but their proper use might reduce transmission), by sharing drugs, needles, or "works" when injecting drugs, through needlesticks or sharps exposures on the job, or from an infected mother to her baby during birth.

Persons at risk for HBV infection might also be at risk for infection with hepatitis C virus (HCV) or HIV.

RISK GROUPS

1. Persons with multiple sex partners or diagnosis of a sexually transmitted disease
2. Men who have sex with men
3. Sex contacts of infected persons
4. Injection-drug users
5. Household contacts of chronically infected persons
6. Infants born to infected mothers
7. Infants/children of immigrants from areas with high rates of HBV infection (country listing)
8. Health-care and public safety workers with exposure to blood(View current post-exposure prophylaxis recommendations)
9. Hemodialysis patients

PREVENTION

1. Hepatitis B vaccine is the best protection.

2. If you are having sex, but not with one steady partner, use latex condoms correctly and everytime you have sex. The efficacy of latex condoms in preventing infection with HBV is unknown, but their proper use might reduce transmission.

3. If you are pregnant, you should get a blood test for hepatitis B. Infants born to HBV-infected mothers should be given HBIG (hepatitis B immune globulin) and vaccine within 12 hours after birth.

4. Do not shoot drugs; if you shoot drugs, stop and get into a treatment program; if you can't stop, never share drugs, needles, syringes, water, or "works", and get vaccinated against hepatitis A and B.

5. Do not share personal care items that might have blood on them (razors, toothbrushes).

6. Consider the risks if you are thinking about getting a tattoo or body piercing. You might get infected if the tools have someone else's blood on them or if the artist or piercer does not follow good health practices.

7. If you have or had hepatitis B, do not donate blood, organs, or tissue.

8. If you are a health-care or public safety worker, get vaccinated against hepatitis B, and always follow routine barrier precautions and safely handle needles and other sharps (view current post-exposure prophylaxis recommendations).

VACCINE RECOMMENDATIONS

1. Hepatitis B vaccine has been available since 1982.
2. Routine vaccination of 0-18 year olds
3. Vaccination of risk groups of all ages

LONG-TERM EFFECTS WITHOUT VACCINATION

Chronic infection occurs in:

1. 90% of infants infected at birth
2. 30% of children infected at age 1–5 years
3. 6% of persons infected after age 5 years

Death from chronic liver disease occurs in:

1. 15%–25% of chronically infected persons

CONTRAINDICATIONS TO VACCINE

A serious allergic reaction to a prior dose of hepatitis B vaccine or a vaccine component is a contraindication to further doses of hepatitis B vaccine. The recombinant vaccines that are licensed for use in the United States are synthesized by Saccharomyces cerevisiae (common bakers' yeast), into which a plasmid containing the gene for HBsAg has been inserted. Purified HBsAg is obtained by lysing the yeast cells and separating HBsAg from the yeast components by biochemical and biophysical techniques. Persons allergic to yeast should not be vaccinated with vaccines containing yeast.

TREATMENT & MEDICAL MANAGEMENT

HBV infected persons should be evaluated by their doctor for liver disease.
Adefovir dipivoxil, interferon alfa-2b, pegylated interferon alfa-2a, lamivudine, entecavir, and telbivudine are six drugs used for the treatment of persons with chronic hepatitis B.
These drugs should not be used by pregnant women.
Drinking alcohol can make your liver disease worse.

TRENDS & STATISTICS

1. Number of new infections per year has declined from an average of 260,000 in the 1980s to about 60,000 in 2004.
2. Highest rate of disease occurs in 20-49-year-olds.
3. Greatest decline has happened among children and adolescents due to routine hepatitis B vaccination.
4. Estimated 1.25 million chronically infected Americans, of whom 20-30% acquired their infection in childhood.

Understanding Asthma

Asthma Video

Bottom Line!

• Asthma is a chronic disease that affects your airways, the tubes that carry air in and out of your lungs.

• In asthma, the inside walls of your airways are inflamed, or swollen. The inflammation makes them very sensitive, and they tend to react strongly to things that you are allergic to or find irritating. When they react, they get narrower and less air flows through to your lungs. This causes symptoms like wheezing, coughing, chest tightness, and trouble breathing, especially at night and in the early morning.

• Asthma cannot be cured, but most people with asthma can control it so that they have few and infrequent symptoms and can live normal, active lives.

• When your asthma symptoms become worse than usual, it is called an asthma episode or attack. In a severe asthma attack, the airways can close so much that not enough oxygen can get to your vital organs. People can die from severe asthma attacks.

• Taking care of your asthma is an important part of your life. Controlling it means working closely with your doctor to learn how to manage your condition, staying away from things that bother your airways and bring on asthma symptoms, taking medicines as directed by your doctor, and monitoring your asthma so you can respond quickly to signs of an attack. Ask your doctor for a written daily asthma self-management plan and an emergency action plan for asthma attacks, and make sure you understand and know how to use them.

• Researchers still do not know what causes asthma, although they do know that if other people in your family have asthma, you are more likely to develop it. Being exposed early in your life to things like tobacco smoke, infections, and some allergens may also increase your chances of developing asthma.

• Some of the more common things that bring on asthma symptoms include exercise, allergens, irritants, and viral infections.

• Common asthma symptoms include coughing, wheezing, chest tightness, shortness of breath, and faster or noisy breathing.

• Doctors find out whether you have asthma by looking at your family history of asthma and allergies, exploring the things that seem to cause your symptoms or make them worse, and giving you a test, called spirometry, that measures how much air you can blow out of your lungs after taking a deep breath and how quickly you can do it. They may also perform tests to find out if you have allergies, to see how your airways react to exercise, to find out whether you have gastroesophageal reflux disease or sinus disease, and to rule out heart disease and other lung diseases.

• Asthma is treated with two kinds of medicines: quick-relief medicines to stop asthma symptoms and long-term control medicines to prevent symptoms.

• Short-acting inhaled beta-agonists are the preferred quick-relief medicine. The most effective, long-term control medicine is an inhaled corticosteroid, which reduces inflammation in your lungs. Most long-term control medicines must be taken daily, even when you do not have symptoms.

• Other long-term control medicines include inhaled long-acting beta-agonists, leukotriene modifiers, cromolyn, and theophylline.

• Most asthma medicines are inhaled. As a result, they go straight to your lungs where they are needed. It is important to learn how to use your inhalers correctly.

• Many people with asthma need to monitor their condition with a peak flow meter. This is a hand-held device that measures how well your lungs are working. A peak flow meter can help you detect early changes in your condition, especially if you change your medicines, and warn you of a possible attack even before you feel symptoms.

• Parents of children with asthma need to help them manage their asthma, including making sure the child uses his or her medicines properly and watching for any signs of an attack.

• Older people with asthma may need to adjust their treatment because of other diseases or conditions that they have. Some medicines that many older people take can interfere with asthma medicines or even cause asthma attacks.

• It is especially important for pregnant women with asthma to control their asthma. Uncontrolled asthma can limit the supply of oxygen to the fetus. Doctors recommend that it is safer to take asthma medicines during pregnancy than to take the chance that you will have an attack.

• Regular physical activity is just as important for people with asthma as for the rest of the population. If exercise brings on your asthma symptoms, talk to your doctor about the best ways to control your asthma when you are active.

Your Kidneys and How They Work

Normal kidney function video

Your two kidneys are vital organs that perform many functions to keep your blood clean and chemically balanced. Understanding how your kidneys work can help you to keep them healthy.

What do my kidneys do?

The kidneys remove wastes and extra water from the blood to form urine. Urine flows from the kidneys to the bladder through the ureters.

Your kidneys are bean-shaped organs, each about the size of your fist. They are located near the middle of your back, just below the rib cage. The kidneys are sophisticated reprocessing machines. Every day, your kidneys process about 200 quarts of blood to sift out about 2 quarts of waste products and extra water. The waste and extra water become urine, which flows to your bladder through tubes called ureters. Your bladder stores urine until you go to the bathroom.

The wastes in your blood come from the normal breakdown of active tissues and from the food you eat. Your body uses the food for energy and self-repair. After your body has taken what it needs from the food, waste is sent to the blood. If your kidneys did not remove these wastes, the wastes would build up in the blood and damage your body.

The actual filtering occurs in tiny units inside your kidneys called nephrons. Every kidney has about a million nephrons. In the nephron, a glomerulus—which is a tiny blood vessel, or capillary—intertwines with a tiny urine-collecting tube called a tubule. A complicated chemical exchange takes place, as waste materials and water leave your blood and enter your urinary system.

At first, the tubules receive a combination of waste materials and chemicals that your body can still use. Your kidneys measure out chemicals like sodium, phosphorus, and potassium and release them back to the blood to return to the body. In this way, your kidneys regulate the body’s level of these substances. The right balance is necessary for life, but excess levels can be harmful.




In the nephron (left), tiny blood vessels intertwine with urine-collecting tubes. Each kidney contains about 1 million nephrons.

In addition to removing wastes, your kidneys release three important hormones:

1. Erythropoietin (eh-RITH-ro-POY-eh-tin), or EPO, which stimulates the bone marrow to make red blood cells

2. Renin (REE-nin), which regulates blood pressure

3. Calcitriol (kal-suh-TRY-ul), the active form of vitamin D, which helps maintain calcium for bones and for normal chemical balance in the body

What is renal function?

Your health care team may talk about the work your kidneys do as renal function. If you have two healthy kidneys, you have 100 percent of your renal function. This is more renal function than you really need. Some people are born with only one kidney, and these people are able to lead normal, healthy lives. Many people donate a kidney for transplantation to a family member or friend. Small declines in renal function may not cause a problem.

But many people with reduced renal function have a kidney disease that will get worse. You will have serious health problems if you have less than 25 percent of your renal function. If your renal function drops below 10 to 15 percent, you cannot live long without some form of renal replacement therapy—either dialysis or transplantation.

Why do kidneys fail?

Most kidney diseases attack the nephrons, causing them to lose their filtering capacity. Damage to the nephrons may happen quickly, often as the result of injury or poisoning. But most kidney diseases destroy the nephrons slowly and silently. Only after years or even decades will the damage become apparent. Most kidney diseases attack both kidneys simultaneously.

The two most common causes of kidney disease are diabetes and high blood pressure. If your family has a history of any kind of kidney problems, you may be at risk for kidney disease.

Diabetic Nephropathy. Diabetes is a disease that keeps the body from using glucose (sugar) as it should. If glucose stays in your blood instead of breaking down, it can act like a poison. Damage to the nephrons from unused glucose in the blood is called diabetic nephropathy. If you keep your blood glucose levels down, you can delay or prevent diabetic nephropathy.

High Blood Pressure. High blood pressure can damage the small blood vessels in your kidneys. The damaged vessels cannot filter wastes from your blood as they are supposed to.

Your doctor may prescribe blood pressure medication. Blood pressure medicines called angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs) have been found to protect the kidneys even more than other medicines that lower blood pressure to similar levels. The National Heart, Lung, and Blood Institute (NHLBI), one of the National Institutes of Health, recommends that people with diabetes or reduced kidney function should keep their blood pressure below 130/80 mm Hg.

Glomerular Diseases. Several different types of kidney disease are grouped together under this category, including autoimmune diseases, infection-related diseases, and sclerotic diseases. As the name indicates, glomerular diseases attack the tiny blood vessels (glomeruli) within the kidney. The most common primary glomerular diseases include membranous nephropathy, IgA nephropathy, and focal segmental glomerulosclerosis. Protein, blood, or both in the urine are often the first signs of these diseases. They can slowly destroy kidney function. Blood pressure control is important with any kidney disease. Treatments for glomerular diseases may include immunosuppressive drugs or steroids to reduce inflammation and proteinuria, depending on the specific disease.

Inherited and Congenital Kidney Diseases. Some kidney diseases result from hereditary factors. Polycystic kidney disease (PKD), for example, is a genetic disorder in which many cysts grow in the kidneys. PKD cysts can slowly replace much of the mass of the kidneys, reducing kidney function and leading to kidney failure.

Some kidney problems may show up when a child is still developing in the womb. Examples include autosomal recessive PKD, a rare form of PKD, and other developmental problems that interfere with the normal formation of the nephrons. The signs of kidney disease in children vary. A child may grow unusually slowly, may vomit often, or may have back or side pain. Some kidney diseases may be “silent” for months or even years.

If your child has a kidney disease, your child’s doctor should find it during a regular checkup. Be sure your child sees a doctor regularly. The first sign of a kidney problem may be high blood pressure, a low number of red blood cells (anemia), or blood or protein in the child’s urine. If the doctor finds any of these problems, further tests may be necessary, including additional blood and urine tests or radiology studies. In some cases, the doctor may need to perform a biopsy—removing a tiny piece of the kidney to examine under a microscope.

Some hereditary kidney diseases may not be detected until adulthood. The most common form of PKD was once called "adult PKD" because the symptoms of high blood pressure and renal failure usually do not occur until patients are in their twenties or thirties. But with advances in diagnostic imaging technology, doctors have found cysts in children and adolescents before any symptoms appear.

Other Causes of Kidney Disease. Poisons and trauma, for example a direct and forceful blow to your kidneys, can lead to kidney disease.

Some over-the-counter medicines can be poisonous to your kidneys if taken regularly over a long period of time. Products that combine aspirin, acetaminophen, and other medicines such as ibuprofen have been found to be the most dangerous to the kidneys. If you take painkillers regularly, check with your doctor to make sure you are not putting your kidneys at risk.

How do kidneys fail?

Many factors that influence the speed of kidney failure are not completely understood. Researchers are still studying how protein in the diet and cholesterol levels in the blood affect kidney function.

Acute Renal Failure
Some kidney problems happen quickly, like an accident that injures the kidneys. Losing a lot of blood can cause sudden kidney failure. Some drugs or poisons can make your kidneys stop working. These sudden drops in kidney function are called acute renal failure (ARF).

ARF may lead to permanent loss of kidney function. But if your kidneys are not seriously damaged, acute renal failure may be reversed.

Chronic Kidney Disease
Most kidney problems, however, happen slowly. You may have “silent” kidney disease for years. Gradual loss of kidney function is called chronic kidney disease (CKD) or chronic renal insufficiency. People with CKD may go on to permanent kidney failure. They also have a high risk of dying from a stroke or heart attack.

End-Stage Renal Disease
Total or nearly total and permanent kidney failure is called end-stage renal disease (ESRD). People with ESRD must undergo dialysis or transplantation to stay alive.

What are the signs of kidney disease?

People in the early stages of kidney disease usually do not feel sick at all.

If your kidney disease gets worse, you may need to urinate more often or less often. You may feel tired or itchy. You may lose your appetite or experience nausea and vomiting. Your hands or feet may swell or feel numb. You may get drowsy or have trouble concentrating. Your skin may darken. You may have muscle cramps.

What medical tests will my doctor use to detect kidney disease?

Since you can have kidney disease without any symptoms, your doctor may first detect the condition through routine blood and urine tests. The National Kidney Foundation recommends three simple tests to screen for kidney disease: a blood pressure measurement, a spot check for protein or albumin in the urine (proteinuria), and a calculation of glomerular filtration rate (GFR) based on a serum creatinine measurement. Measuring urea nitrogen in the blood provides additional information.

Blood Pressure Measurement
High blood pressure can lead to kidney disease. It can also be a sign that your kidneys are already impaired. The only way to know whether your blood pressure is high is to have a health professional measure it with a blood pressure cuff. The result is expressed as two numbers. The top number, which is called the systolic pressure, represents the pressure when your heart is beating. The bottom number, which is called the diastolic pressure, shows the pressure when your heart is resting between beats. Your blood pressure is considered normal if it stays below 120/80 (expressed as “120 over 80”). The NHLBI recommends that people with kidney disease use whatever therapy is necessary, including lifestyle changes and medicines, to keep their blood pressure below 130/80.

Glomerular Filtration Rate (GFR) Based on Creatinine Measurement
GFR is a calculation of how efficiently the kidneys are filtering wastes from the blood. A traditional GFR calculation requires an injection into the bloodstream of a substance that is later measured in a 24-hour urine collection. Recently, scientists found they could calculate GFR without an injection or urine collection. The new calculation requires only a measurement of the creatinine in a blood sample.

Creatinine is a waste product in the blood created by the normal breakdown of muscle cells during activity. Healthy kidneys take creatinine out of the blood and put it into the urine to leave the body. When kidneys are not working well, creatinine builds up in the blood.

In the lab, your blood will be tested to see how many milligrams of creatinine are in one deciliter of blood (mg/dL). Creatinine levels in the blood can vary, and each laboratory has its own normal range, usually 0.6 to 1.2 mg/dL. If your creatinine level is only slightly above this range, you probably will not feel sick, but the elevation is a sign that your kidneys are not working at full strength. One formula for estimating kidney function equates a creatinine level of 1.7 mg/dL for most men and 1.4 mg/dL for most women to 50 percent of normal kidney function. But because creatinine values are so variable and can be affected by diet, a GFR calculation is more accurate for determining whether a person has reduced kidney function.

The new GFR calculation uses the patient’s creatinine measurement along with weight, age, and values assigned for sex and race. Some medical laboratories may make the GFR calculation when a creatinine value is measured and include it on their lab report.

Blood Urea Nitrogen (BUN)
Blood carries protein to cells throughout the body. After the cells use the protein, the remaining waste product is returned to the blood as urea, a compound that contains nitrogen. Healthy kidneys take urea out of the blood and put it in the urine. If your kidneys are not working well, the urea will stay in the blood.

A deciliter of normal blood contains 7 to 20 milligrams of urea. If your BUN is more than 20 mg/dL, your kidneys may not be working at full strength. Other possible causes of an elevated BUN include dehydration and heart failure.

Additional Tests for Kidney Disease

If blood and urine tests indicate reduced kidney function, your doctor may recommend additional tests to help identify the cause of the problem.

Renal imaging. Methods of renal imaging (taking pictures of the kidneys) include ultrasound, computed tomography (CT scan), and magnetic resonance imaging (MRI). These tools are most helpful in finding unusual growths or blockages to the flow of urine.

Renal biopsy. Your doctor may want to see a tiny piece of your kidney tissue under a microscope. To obtain this tissue sample, the doctor will perform a renal biopsy—a hospital procedure in which the doctor inserts a needle through your skin into the back of the kidney. The needle retrieves a strand of tissue about 1/2 to 3/4 of an inch long. For the procedure, you will lie on your stomach on a table and receive local anesthetic to numb the skin. The sample tissue will help the doctor identify problems at the cellular level.

What are the stages of kidney disease?

Your GFR is the best indicator of how well your kidneys are working. In 2002, the National Kidney Foundation published treatment guidelines that identified five stages of CKD based on declining GFR measurements. The guidelines recommend different actions based on the stage of kidney disease.

Increased risk of CKD. A GFR of 90 or above is considered normal. Even with a normal GFR, you may be at increased risk for developing CKD if you have diabetes, high blood pressure, or a family history of kidney disease. The risk increases with age: People over 65 are more than twice as likely to develop CKD as people between the ages of 45 and 65. African Americans also have a higher risk of developing CKD.

Stage 1: Kidney damage with normal GFR (90 or above). Kidney damage may be detected before the GFR begins to decline. In this first stage of kidney disease, the goals of treatment are to slow the progression of CKD and reduce the risk of heart and blood vessel disease.

Stage 2: Kidney damage with mild decrease in GFR (60 to 89). When kidney function starts to decline, your health care provider will estimate the progression of your CKD and continue treatment to reduce the risk of other health problems.

Stage 3: Moderate decrease in GFR (30 to 59). When CKD has advanced to this stage, anemia and bone problems become more common. Work with your health care provider to prevent or treat these complications.

Stage 4: Severe reduction in GFR (15 to 29). Continue following the treatment for complications of CKD and learn as much as you can about the treatments for kidney failure. Each treatment requires preparation. If you choose hemodialysis, you will need to have a procedure to make a vein in your arm larger and stronger for repeated needle insertions. For peritoneal dialysis, you will need to have a catheter placed in your abdomen. Or you may want to ask family or friends to consider donating a kidney for transplantation.

Stage 5: Kidney failure (GFR less than 15). When the kidneys do not work well enough to maintain life, you will need dialysis or a kidney transplant.

In addition to tracking your GFR, blood tests can show when substances in your blood are out of balance. If phosphorus or potassium levels start to climb, a blood test will prompt your health care provider to address these issues before they permanently affect your health.

What can I do about kidney disease?

Unfortunately, chronic kidney disease often cannot be cured. But if you are in the early stages of a kidney disease, you may be able to make your kidneys last longer by taking certain steps. You will also want to be sure that risks for heart attack and stroke are minimized, since CKD patients are susceptible to these problems.

1.If you have diabetes, watch your blood glucose closely to keep it under control. Consult your doctor for the latest in treatment.

2.Avoid pain pills that may make your kidney disease worse. Check with your doctor before taking any medicine.


Blood Pressure
People with reduced kidney function (a high creatinine level in the blood or a low creatinine clearance) should have their blood pressure controlled, and an ACE inhibitor or an ARB should be one of their medications. Many people will require two or more types of medication to keep their blood pressure below 130/80 mm Hg. A diuretic is an important addition to the ACE inhibitor or ARB.

Diet
People with reduced kidney function need to be aware that some parts of a normal diet may speed their kidney failure.

Protein. Protein is important to your body. It helps your body repair muscles and fight disease. Protein comes mostly from meat. As discussed in an earlier section, healthy kidneys take wastes out of the blood but leave protein. Impaired kidneys may fail to separate the protein from the wastes.

Some doctors tell their kidney patients to limit the amount of protein they eat so that the kidneys have less work to do. But you cannot avoid protein entirely. You may need to work with a dietitian to find the right food plan.

Cholesterol. Another problem that may be associated with kidney failure is too much cholesterol (koh-LES-tuh-rawl) in your blood. High levels of cholesterol may result from a high-fat diet.

Cholesterol can build up on the inside walls of your blood vessels. The buildup makes pumping blood through the vessels harder for your heart and can cause heart attacks and strokes.

Smoking. Smoking not only increases the risk of kidney disease, it contributes to deaths from strokes and heart attacks in people with CKD. You should try your best to stop smoking.

Sodium. Sodium is a chemical found in salt and other foods. Sodium in your diet may raise your blood pressure, so you should limit foods that contain high levels of sodium. High-sodium foods include canned or processed foods like frozen dinners and hot dogs.

Potassium. Potassium is a mineral found naturally in many fruits and vegetables, like oranges, potatoes, bananas, dried fruits, dried beans and peas, and nuts. Healthy kidneys measure potassium in your blood and remove excess amounts. Diseased kidneys may fail to remove excess potassium, and with very poor kidney function, high potassium levels can affect the heart rhythm.

Treating Anemia

Anemia is a condition in which the blood does not contain enough red blood cells. These cells are important because they carry oxygen throughout the body. If you are anemic, you will feel tired and look pale. Healthy kidneys make the hormone EPO, which stimulates the bones to make red blood cells. Diseased kidneys may not make enough EPO. You may need to take injections of a man-made form of EPO.

Preparing for End-Stage Renal Disease

As your kidney disease progresses, you will need to make several decisions. You will need to learn about your options for treating ESRD so that you can make an informed choice between hemodialysis, peritoneal dialysis, and transplantation.

What happens if my kidneys fail completely?

Complete and irreversible kidney failure is sometimes called end-stage renal disease, or ESRD. If your kidneys stop working completely, your body fills with extra water and waste products.

This condition is called uremia. Your hands or feet may swell. You will feel tired and weak because your body needs clean blood to function properly.

Untreated uremia may lead to seizures or coma and will ultimately result in death. If your kidneys stop working completely, you will need to undergo dialysis or kidney transplantation.

Dialysis
The two major forms of dialysis are hemodialysis and peritoneal dialysis. In hemodialysis, your blood is sent through a filter that removes waste products. The clean blood is returned to your body. Hemodialysis is usually performed at a dialysis center three times per week for 3 to 4 hours.

Kidney transplantation

A donated kidney may come from an anonymous donor who has recently died or from a living person, usually a relative. The kidney that you receive must be a good match for your body. The more the new kidney is like you, the less likely your immune system is to reject it. Your immune system protects you from disease by attacking anything that is not recognized as a normal part of your body. So your immune system will attack a kidney that appears too “foreign.” You will take special drugs to help trick your immune system so it does not reject the transplanted kidney.


Hope through Research

As our understanding of the causes of kidney failure increases, so will our ability to predict and prevent these diseases. Recent studies have shown that intensive control of diabetes and high blood pressure can prevent or delay the onset of kidney disease.

In the area of genetics, researchers supported by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) have located two genes that cause the most common form of PKD and learned that a person must have two defective copies of the PKD1 gene to develop PKD. Researchers have also found a gene in the roundworm that is identical to the PKD1 gene. This new knowledge will be used in the search for effective therapies to prevent or treat PKD.

In the area of transplantation, new drugs to help the body accept foreign tissue increase the likelihood that a transplanted kidney will survive and function properly. Scientists at NIDDK are also developing new techniques to induce tolerance for foreign tissue in patients before they receive transplanted organs. This technique will eliminate or reduce the need for immunosuppressive drugs and thereby reduce expense and complications. In the future, scientists may develop an artificial kidney for implantation.


Points to Remember

1. Your kidneys are vital organs that keep your blood clean and chemically balanced.


2. The progression of kidney disease can be slowed, but it cannot always be reversed.


3. End-stage renal disease (ESRD) is the total loss of kidney function.


4. Dialysis and transplantation can extend the lives of people with ESRD.


5. Diabetes and high blood pressure are the two leading causes of kidney failure.


6. You should see a nephrologist regularly if you have renal disease.


7. Chronic kidney disease (CKD) increases the risk of heart attacks and strokes.


If you are in the early stages of renal disease, you may be able to save your remaining renal function for many years by

1. Controlling your blood glucose
2. Controlling your blood pressure
3. Following a low-protein diet
4. Maintaining healthy levels of cholesterol in your blood
5. Taking an ACE inhibitor or an ARB
6.Quitting smoking