Health Watch

Dengue prevention month from June 25 to July 25:

Dengue fever: what you should know

Dengue fever, Dengue haemorrhagic fever ( Break bone fever ), Dengue shock syndrome

There is a range of disease according to the severity

Dengue Haemorrhagic fever is a mosquito-borne viral infection endemic in the tropical and sub-tropical regions. The female Ae.aegypti (the most important vector) mosquito is semi-domesticated, preferring to lay its eggs in man-made water containers, resting indoors and feeding in the early morning or late afternoon. There are 4 serotypes of Dengue virus. Dengue usually occurs as epidemics in Sri Lanka following monsoon seasons.

Causative agents

Dengue virus; There are 4 serotypes of the single-stranded RNA virus (flaviviridae).

Pathogenesis / Action in the body

Patients become infected once bitten by mosquitos.

The virus passes to lymph nodes and replicates which is followed by spread to the circulation and other tissues. It is thought that infection with a secondary serotype is what leads to severe haemorrhagic disease.

Symptoms and signs

Disease varies in severity

* Incubation period is 2-7 days.

* All haemorrhagic fever syndromes begin with abrupt onset of fever (39.5-41ºC) and myalgia.

* Fever is often biphasic with two peaks.

* Fever is associated with frontal or retro-orbital headache lasting 1-7 days, accompanied by generalised macular, blanching rash.

* Initial rash usually fades after 1-2 days.

* Symptoms regress for a day or two then rash reappears in maculopapular, morbilliform pattern, sparing palms and soles of feet. Fever recurs but not as high. There may be desquamation.

* DF cases experience severe bony and myalgic pain in legs, joints and lower back which may last for weeks (hence breakbone fever).

* Nausea, vomiting, cutaneous hyperaesthesia, taste disturbance and anorexia are common.

* Abdominal pain may occur and if severe suggests DHF pattern.

The signs of dengue fever/ Dengue haemorrhagic fever are

* High fever, rash, hypotension and narrow pulse pressure, poor capillary refill.

* There may be hepatomegaly and lymphadenopathy.

* A tourniquet placed on an arm may induce petechiae in early DHF cases. DHF sufferers exhibit a bleeding tendency as evidenced by petechiae, purpura, epistaxis, gum bleeding, GI haemorrhage and menorrhagia.

There may be pleural effusion, ascites and pericarditis due to plasma leakage.

* Petechiae are best visualised in the axillae.

* Flushing of head and neck.

* Tender muscles on palpation.

* Periorbital oedema and proteinuria may be present.

* Maculopathy and retinal haemorrhages may also occur.5

* DSS pattern cases progress through DHF until profound shock due to severe hypotension is present.

* CNS involvement e.g. encephalopathy, coma, convulsions.

Complications

* Hepatic failure - Means failure of the liver

* Encephalopathy - Means damage to the brain causing fits, loss of consciousness and confusion

* Myocarditis - Inflamation of heart muscles

* Disseminated intravascular coagulation - Damage to blood vessels and blood cells causing problematic bleeding and clotting

Dengue can cause death Investigations

* FBC - low platelets and high packed cell volume if haemoconcentrated. Usually white cell count will fall

* Infection may be confirmed by isolation of virus in serum and detection of IgM and IgG antibodies for Dengue by ELISA, monoclonal antibody or haemagglutination.

* Molecular diagnostic methods such as reverse-transcriptase-PCR are increasingly being used.

* Chest X-ray may show pleural effusion.

Management

* Bed rest

* Nutritious diet and lot of liquids, But avoid red and brown foods and drinks like coffee, chocolate, grapes etc as it may misinterpret vomiting as blood stained vomitus.

* Fever control with paracetamol, tepid sponging and fans. Aspirin should be avoided.

* Need to seek advice from a qualified medical practitioner if fever lasts for more than 2 days

* Hospital managemnt includes intravenous fluid resuscitation with close monitoring. Haemorrhage and shock will require Fresh Frozen Plasma, platelets and blood. Intensive management with inotropes of the shock syndrome may be required in severe DHF/DSS cases.

Prevention and promotion

* Vaccines are being researched

* Anti-mosquito public health measures such as reducing breeding sites ( flower pots, fish tanks,tires, coconut shells, tins, water collecting plants, gutters which can collect water) and good sewage management

* Insecticides to destroy the larvae

* Mosquito nets can be used during day time as the Aedes mosquitoes is day-biting.

* Mosquita repellents

There is a bacteria called Bacillus thuringiensis which destroy the mosquito larvae.

- Courtesy: Health Education Bureau,Ministry of Health

Loss of self-confidence, a sign of depression too

Edward Arambewala

In a leaflet on depression published by Sahanaya among the signs of depression, loss of self confidence too is indicated as one among the signs that a person should take care of. The other signs indicated are:

What are the signs to look for ?

Loss of interest in activities once found enjoyable

Lack of drive and motivation, that makes even simple tasks and decisions difficult

Feeling tired

Anxiety and restlessness

Loss or gain in appetite and weight

Sleeplessness or excessive sleeping

Loss of interest in sex

Loss of self confidence and feeling helpless and hopeless

Feeling worse at a particular time of the day, usually mornings

Physical complaints with no identifiable cause e.g. Headaches, aches and pains

Thoughts of suicide, these are very common during depression and are much better admitted than covered up, as they are a sign that help is needed.

Everyone experiences these feelings temporarily at one time or another but they often overcome it in a short time. If these feelings persist over a long period of time help is needed.

Causes

A number of factors have been found to play a part in the development of depression.

Depression can set in due to biochemical changes in the brain, personal losses, unwelcome changes in life patterns, stress and physical illness. Some people may be more prone to develop depression due to the nature of their personality. Some women develop depression after child birth.

One type of depression can be experienced as a continuous “low mood” while bi-polar depression or manic depressive disorder involves dramatic changes in mood.

Who can get depression?

People of all ages ranging from children to the elderly can develop depression. However, depression in children under the age of twelve is rare.

Often depression goes unrecognised because attention is focused on the physical complaints. A person may also hesitate to seek help thinking it is their fault or a sign of weakness to admit what they are feeling.

Seeking help

If you suspect that a person you know may be suffering from depression, the first step to take is to consult a doctor experienced in treating such disorders.

Depression has been found to be very responsive to the medication and psychological methods that are commonly used for its treatment. Given the appropriate treatment, care and support a person can soon return to a productive life.

Anxiety therapy doesn’t work as well in elderly

Cognitive behavioral therapy was most effective at easing anxiety in older adults, but it did not work as well as it typically does in younger and middle-aged adults, according to a new study.

A form of talk therapy called cognitive behavioral therapy appears to help older adults battle anxiety disorders slightly better than other approaches, but not as well as in younger adults, according to a new study.

“Cognitive behavioral therapy is the mainstay for treating anxiety disorders in younger adults. Its lower effect in older adults in this study is concerning,” said Dr. Eric Lenze, a professor at Washington University School of Medicine, who was not involved in this study.

Anxiety disorders, which include panic disorder, phobias, post-traumatic stress and generalized anxiety disorder, are common in adults over age 55.

The authors write in the Journal of the American Geriatrics Society that three to 14 out of every 100 older adults has an anxiety disorder. While earlier studies have shown that cognitive behavioral therapy works well for younger and middle-aged adults, there has not been as much research into the treatment for seniors.

“The prevailing assumption tends to be that what works with working-age people will work with older people, but this might not actually be the case,” said Rebecca Gould, the lead author of the study and a researcher at King's College London.

Gould's team gathered up the results from 12 previous studies on people over age 55 with an anxiety disorder.

Half of the studies compared cognitive behavioral therapy to other treatments, such as medications or group discussions, while the other half compared the therapy to no treatment.

Cognitive behavioral therapy (CBT) often involves one-on-one meetings with a therapist, with the ultimate goal of solving the defective thinking process that's causing the disorder.

On average in the studies, people went through 12 sessions of therapy.Compared to doing nothing, cognitive behavioral therapy had a “moderate” effect on helping people's anxiety.

Compared to medications or group discussions, the therapy relieved the disorder slightly better.Gould's team noted that the improvement over other treatments was small. “What this might mean clinically is that the client in the CBT condition might be a little less severely or moderately anxious relative to the client in the active control condition,” Gould wrote in an email to Reuters Health.

Gould says therapy might work better than drugs because it seeks to fix the causes of anxiety rather than the symptoms.

“If we can address the causes of symptoms of anxiety (e.g. by changing how we think about or interpret things) then we can stop them coming back in the future. If we only address the symptoms of anxiety then we can't,” she said.

Though Gould's analysis and those of studies in younger adults agree that cognitive behavioral therapy helps treat anxiety, the effect in older adults is small while the effect seen in younger adults is moderate or large, the authors wrote. Gould said she doesn't know why the therapy seems less effective in older adults, but it's possible that talk therapy might take longer to work for them.

Lenze said that cognitive behavioral therapy is still worthwhile in older adults.“Until better treatments are developed there are somewhat limited options,” he told Reuters Health.

He added that anxiety can take a toll on the mental and physical health of adults if it's not treated.Gould said more studies that compare cognitive behavioral therapy to other treatments are needed in older adults, and her group is planning a study that explores the benefit of “mindfulness-based” cognitive therapy, which includes practices such as meditation.

Lenze said he and his colleagues are also exploring this approach, as well as combining cognitive behavioral therapy with medications.

-Reuters

Genetic link between diabetes and Alzheimer’s disease

Scientists say they have identified a possible genetic link between diabetes and Alzheimer’s disease.

It has been known for some time that people with diabetes have a much higher risk of developing Alzheimer’s, but not why this is so.

Now US researchers writing in Genetics say a study of worms has indicated a known Alzheimer’s gene also plays a role in the way insulin is processed.

Dementia experts said more work in humans was now needed.

Alzheimer’s is the most common cause of dementia, which affects 820,000 people in the UK.

There are medications which can slow the progress of the disease, but none that can halt its progress.

A key indication of Alzheimer’s, which can only be seen after death, is the presence of sticky plaques of amyloid protein in decimated portions of patients’ brains.

Scientists have already found mutations in a gene involved in the processing of amyloid protein in Alzheimer’s which run in families.

‘Open new doors’

In this study, a team from the City College of New York looked at a similar gene in the nematode worms (C. elegans).

As this research looked at the effects of a gene in worms, studies are now needed to discover whether the equivalent gene in people has the same effect”

These worms are often studied because they, perhaps surprisingly, a useful model for human research.

The researchers, led by Prof Chris Li, found the gene in the worms also affected the insulin pathway - the chemical reactions involved in its production and processing. Prof Li said: “People with type 2 diabetes have an increased risk of dementia.

“The insulin pathways are involved in many metabolic processes, including helping to keep the nervous system healthy.”

She said more work was needed to investigate this potential link and its effects further.

Mark Johnston, editor-in-chief of the journal Genetics, said it was “an important discovery”.

“We know there’s a link between Alzheimer’s and diabetes, but until now it was somewhat of a mystery.

“This finding could open new doors for treating and preventing the disease.”

Dr Marie Janson, director of development at Alzheimer’s Research UK, which has itself funded studies looking at the link between diabetes and Alzheimer’s said: “This early-stage study may provide an interesting clue to help scientists unravel how diabetes and Alzheimer’s are linked, but questions still remain to be answered.

“As this research looked at the effects of a gene in worms, studies are now needed to discover whether the equivalent gene in people has the same effect, and exactly what mechanisms may be involved.”

-BBC

Yoga helps breast cancer survivors curb fatigue

Andrew M. Seaman

Research shows that yoga can help breast cancer survivors with the chronic fatigue associated with cancer treatment.

About one third of breast cancer survivors experience fatigue that can affect their quality of life, but a small new study finds that doing yoga might help restore some lost vitality.

After three months of twice-weekly yoga classes, a group of breast cancer survivors in California reported significantly diminished fatigue and increased “vigor.” A control group of women who took classes in post-cancer health issues, but didn’t do yoga, had no changes in their fatigue or depression levels.

Dr. Maira Campos, a research scholar at the University of Miami’s Miller School of Medicine who was not involved in the study, said the findings echo similar results from past studies that looked at yoga and cancer patients.

Persistent fatigue lasting years after cancer treatment is a common problem whose origin is unknown, and for which there are no validated treatments.

Some studies have shown that stress-reduction techniques or exercise classes can help reduce fatigue among cancer patients and survivors in general. But none of them has specifically targeted cancer survivors experiencing fatigue to see if a potential therapy reverses the problem, according to Julienne Bower, an associate professor in the psychology department of the University of California, Los Angeles, and her colleagues.

They recruited 31 breast cancer survivors to undergo “treatment” for their fatigue over 12 weeks at the UCLA Medical Center. Each woman was randomly assigned to participate in either two 90-minute yoga classes every week or a two-hour health class once a week.

At the start of the study, each group of women had similar scores on a questionnaire that gauges fatigue levels.

The group taking the educational classes experienced about the same amount of fatigue and energy throughout the initial study period. However, the group taking the yoga class reported about a 26 percent drop in fatigue and a 55 percent increase in energy after the 12-week yoga regimen.

The women in the yoga group also continued to report significant improvements in fatigue levels three months after the classes stopped.

The findings, published in the journal Cancer, do not prove that yoga caused the improvements in fatigue levels. The researchers note, however, that both groups of women had similar expectations that their assigned “treatment” would help them, so a placebo effect is not a likely explanation for the benefits seen in the yoga group.

Jacquelyn Banasik, an associate professor in the College of Nursing at Washington State University, also noted improvements in cancer fatigue after yoga classes in a study she published in the Journal of the American Academy of Nurse Practitioners in 2010.

“I can’t say that yoga is the only way to achieve the results seen in ours and other studies,” Banasik told Reuters Health in an email. “A beginning ballet class -- with (its) emphasis on form and positioning -- might have similar effects. Gaining a sense of control over one’s physical body, when one has a disease like breast cancer, might be an important part of the benefit.”

Both of the studies by Bower and Banasik used Inyengar yoga, which, according to Banasik, emphasizes taking poses slowly and paying close attention to maintaining correct form.

Campos told Reuters Health that acupuncture, exercise and physical therapy are sometimes used to treat cancer survivors suffering from fatigue, without a prescription if their symptoms are mild.

She added that she would not prescribe yoga based just on the new study, however.

She said it would be better to compare yoga to another exercise instead of a health- class setting.

Campos also emphasized that it’s important for patients to talk to their doctors about fatigue during and after cancer treatments.

“The patient should not be suffering or impaired just because they had cancer,” Campos said.

-Reuters.