On 31 December 2019, there was an unknown cause that gave rise to pneumonia cases in Wuhan City, China. It was not long until the World Health Organization (WHO) was informed of a new Coronavirus Disease, which is known as COVID-19, until present 2021.

This infectious disease infects human beings, leading to them experiencing mild to moderate respiratory illness and recovering without requiring special treatment. 

However, there are cases where elderly and population with underlying medical conditions such as cardiovascular disease, diabetes mellitus, respiratory disease, and cancer are more prone to develop serious symptoms.

Covid-19 has been existing from 2019 until the present day, there have been plenty of questions and doubts regarding this disease. Here are 8 myths and facts about this highly infectious disease that were found to be closely related to our daily life.

1. Can Covid-19 virus be transmitted through goods, cash and groceries?

• Yes. Covid viruses can stay on the surface for many hours and up to days. Examples such as metal products can have the virus survive up to 9 days, woods up to 4 days, plastic surface up to 3 days and etc.
• Thus, it is better to be safe than sorry. It is strongly suggested to disinfect items’ surfaces and frequently-touched objects using a disinfecting spray or wipe.
• As for groceries such as fruits and vegetables, rinsing them in cold water or cleaning with vegetable brushes are adequate. Using disinfecting spray, wipe or soap can lead to possible food poisoning.

3. Is the virus able to stick to our clothes and shoes?

• There’s not much research about how long the virus lives on fabric.
• The possibility of COVID-19 being spread on shoes and infecting individuals is very low as well. As a safeguard, especially when there are infants and small children crawling or playing on floors, do remove the shoes before entering home.
• It is also recommended that proper hygiene needs to be practised, besides from showering every day, clothes should be washed with detergent or soap in 60-90 ⁰C water, drying clothes under a hot sun or in a high temperature dryer can help to kill the virus as well.

4. Can Covid-19 be prevented by rinsing the nasal cavity with saline solution? Besides, is gargling with mouthwash, warm water with salt or vinegar solution proven to prevent viruses and other things to travel into the throat and lung?

• Evidence has shown that rinsing the nose with saline solution can help the patient to recover faster from the common cold symptoms, but unable to prevent Covid-19 and other infectious respiratory diseases such as pneumonia.
• Moreover, the Centers for Disease Control and Prevention (CDC) suggested that gargling with warm salty water can help with soothing a sore throat, but not effective in stopping infection with Covid-19.

5. Are there any medications that can prevent and cure Covid-19? 

• There has been news where medications such as oral steroids, hydroxychloroquine, azithromycin and Ivermectin are claimed to be able to treat or prevent Covid-19.
• Oral steroids such as Dexamethasone have anti-inflammatory and immunosuppressive effects, which only should be used for Covid-19 patients with severe and critically ill conditions. For some Covid-19 patients on ventilators, a daily 6 mg dose of dexamethasone for 10 days may improve their health.
• Dexamethasone provides no improvement for patients with mild symptoms.
• As for hydroxychloroquine and azithromycin, randomized clinical trials and studies have been conducted to evaluate the safety and efficacy of these medications.
• In conclusion, The COVID-19 Treatment Guidelines Panel does not recommend the use of azithromycin, chloroquine, or hydroxychloroquine for the treatment of COVID-19 in both hospitalised and non-hospitalised patients.
• On the other hand, while initial research is still ongoing, FDA has neither approved nor supported the use of ivermectin to treat or to prevent COVID-19.
• All in all, currently there is no drug approved that is able to prevent and treat Covid-19 disease and taking a drug for an unapproved use can be very dangerous. Misinformation and misuse of medications can lead to overdose, side effects and contraindications that can be fatal. Patients with covid symptoms should receive proper and supportive care to alleviate the symptoms.

6. Can drinking alcohol or eating garlic help to prevent Covid-19?

• Drinking alcoholic beverages, such as wine, beer or liquor doesn’t help to prevent Covid-19. Besides, alcohol is known to harm human health and is associated with a range of diseases. Alcohol can also compromise one’s immune system; increase the risk of adverse health outcomes, leading to the person more vulnerable to Covid virus. 
• Garlic, though is known to have antimicrobial properties and used in public to prevent disease such as cold, there has been no evidence that it can help to prevent or cure Covid-19.

7. Do UV bulbs, disinfectants such as bleach or chlorine help to kill Covid-19 viruses on our body?

• First of all, it does not help with killing the virus inside the body. Besides, do not use UV bulbs, high concentration alcohol or chlorine on your hands or any part of the body because it can irritate your skin, damage body tissues such as eyes and lips.
• As advised by the Centers for Disease Control and Prevention (CDC), the best way to prevent the spread of coronavirus and reduce the likelihood of getting infected is by washing our hands with soap and water for at least 20 seconds, especially after going to the bathroom; before and after meals; and after coughing, sneezing, or blowing one’s nose.
• If soap and water are not available, alcohol-based hand sanitizer that contains at least 60% alcohol should be used.

8. Do vitamin and mineral supplements contribute to preventing and healing patients from Covid-19?

• Micronutrients, such as vitamin B, C, D, E, zinc and magnesium, are important to maintain a well-functioning immune system and play a vital role in promoting health and nutritional well-being. 
• However, there is currently no guidance on the use of micronutrient supplements as a treatment of COVID-19.

In summary, prevention is better than cure. Always protect yourself by following the standard operation procedure (SOP) such as wear mask properly, stay at least 1m from others, get vaccinated, avoid crowds and unventilated area, practice washing and sanitizing hands often, cover coughs and sneezes with hands, clean and disinfect frequently touched area, monitor your health daily and seek for health professionals if required.

Benign Prostatic Hyperplasia (BPH)

Benign prostatic hyperplasia (BPH) is a condition in men where the prostate gland is enlarged but non-cancerous. As the prostate enlarges, the gland presses and pinches against the urethra. The bladder wall becomes thicker (Figure 1). Eventually, the bladder may become weaken and lose the ability to empty completely, leaving some urine in the bladder.

Figure 1: Normal prostate vs enlarged prostate

BPH affects about 50 percent of men between the ages of 51 and 60 and up to 90 percent of men older than 80, evidence clearly shows that the morbidity of BPH increase with age. In addition, BPH can be induced by a range of risk factors, including obesity, hyperlipidemia, type 2 diabetes, genetic factor and certain hormonal disorders.

The common symptoms of BPH includes:

•  Difficulty starting to urinate despite pushing and straining
• A weak stream of urine; several interruptions in the stream
• Dribbling at the end of urination
• A sudden strong desire to urinate
• Frequent urination
• The sensation that the bladder is not empty after urination is completed
• Frequent awakening at night to urinate (nocturia)
• Pain while urinating

How is benign prostatic hyperplasia (BPH) treated?

At present, the primary goals of BPH treatment are to improve quality of life, inhibit disease progression, and reduce complications. BPH is usually treated with alpha-adrenergic blockers and 5-alpha reductase inhibitors. Alpha blocker helps to relax the smooth muscles of the prostate and bladder neck to improve urine flow and reduce bladder blockage. It has faster onset of action so it is recommended as first line treatment for men with mild to moderate symptoms. Examples of alpha blockers are terazosin (Hytrin), doxazosin (Cardura) (Kamiren XL), tamsulosin (Harnal OCAS) and alfuzosin (Xatral). 5-alpha-reductase inhibitors are medicines that can stop the prostate from growing further or even cause it to shrink by decreasing the production of hormone, dihydrotestosterone (DHT) which affects the growth of prostate gland. Finasteride (Proscar) and dutasteride (Avodart) are example of alpha-reductase inhibitors.

Apart from medications, behavioural modifications and therapies may be helpful, particularly as an adjunct to medications. Lifestyle changes include nightly fluid restriction, timed bladder voiding, double-voiding techniques, regular physical activity, pelvic floor muscle training and avoiding caffeine, alcohol, and highly seasoned food.

*Double voiding – it involves passing urine twice each time you go to toilet. Firstly, urinate as usual then wait for 20-30 seconds, urinate again. This technique is effective for those who feel like their bladder is not empty or who return quickly to the bathroom after voiding.

Natural remedies for enlarged prostate (BPH)

• Saw palmetto

Remedy that comes from fruit of palm tree. It is an inhibitor of 5 alpha reductase. It has anti-inflammatory and hormone-blocking properties. Saw palmetto is used to relieve urinary symptoms caused by benign prostatic hyperplasia (BPH).

• Pygeum bark

It contains a wide range of fatty acids, alcohols and sterols such as beta-sitosterol. It has an antioxidant and anti-inflammatory effect on urogenital system. Able to improve symptoms of benign prostatic hyperplasia.

• Tomato

It consists of lycopene, a powerful antioxidant that protect cells from damage and improve prostate health.

• Pumpkin seed

It consists of zinc which is able to decrease the production of dihydrotestosterone (DHT) and inhibit this androgen from binding to receptors, potentially reducing BPH symptoms.

• Cranberry

It contains phytonutrients with anti-inflammatory properties. It is used to prevent bladder and urinary tract infection by preventing bacteria from sticking to the wall of the bladder. Shown improvement in urinary flow.

References:

1. Information H, Diseases U, Problems P, Hyperplasia) P, Hyperplasia) P, Health N. Prostate Enlargement (Benign Prostatic Hyperplasia) | NIDDK [Internet]. National Institute of Diabetes and Digestive and Kidney Diseases. 2021 [cited 18 October 2021]. Available from: https://www.niddk.nih.gov/health-information/urologic-diseases/prostate-problems/prostate-enlargement-benign-prostatic-hyperplasia
2. Egan K. The Epidemiology of Benign Prostatic Hyperplasia Associated with Lower Urinary Tract Symptoms. Urologic Clinics of North America. 2016;43(3):289-297.
3. Calogero A, Burgio G, Condorelli R, Cannarella R, La Vignera S. Epidemiology and risk factors of lower urinary tract symptoms/benign prostatic hyperplasia and erectile dysfunction. The Aging Male. 2018;22(1):12-19.
4. Yoo S, Oh S, Park J, Cho S, Cho M, Jeong H et al. The impacts of metabolic syndrome and lifestyle on the prevalence of benign prostatic hyperplasia requiring treatment: historical cohort study of 130 454 men. BJU International. 2018;123(1):140-148.
5. Yu Z, Yan H, Xu F, Chao H, Deng L, Xu X et al. Efficacy and Side Effects of Drugs Commonly Used for the Treatment of Lower Urinary Tract Symptoms Associated With Benign Prostatic Hyperplasia. Frontiers in Pharmacology. 2020;11.
6. Fonseca J, Martins da silva C. The diagnosis and treatment of lower urinary tract symptoms due to benign prostatic hyperplasia with α-blockers: focus on silodosin. Clin Drug Investig. 2015;35(suppl 1):7-18.
7. 10 natural remedies for enlarged prostate and lifestyle tips [Internet]. Medicalnewstoday.com. 2021 [cited 4 November 2021]. Available from: https://www.medicalnewstoday.com/articles/321231#lifestyle-tips

COVID-19 has been existing for more than one and half years now. At the outset of COVID-19 pandemic, the symptoms and the risks of it had been emphasized from time to time to all the citizens. However, new variants of coronavirus are always out there as these coronaviruses are constantly changing themselves rapidly through a process known as mutation.

The cycle of mutation will occur continuously leading to the emergence of new variants. As these viruses change, they will become more diverse and the symptoms if infected will be changed as well. A major concern right now in our country is the highly transmissible and fast-spreading Delta variant. Delta variant was first documented in India in October 2020. Delta variant is believed to be up to 60% more contagious compared to the Alpha variant and it will become the dominant variant of the coronavirus soon. It was first identified in Malaysia in early July 2021 and has led to another wave of COVID-19 here. This Delta variant may cause a higher hospitalization rate and more severe complications to humans. The incubation period will be shortened to 3 to 7 days compared to 2 weeks in the Alpha variant. Delta variant usually attacks the elderlies and people with weakened immune response. Infection caused by Delta variant will progress quickly leading to severe cases in just 3 to 4 days. Some might even be admitted into the ICU in 24 hours. The Delta variant is so much more contagious as it has higher viral load, it is better at infecting people who are not sufficiently immuned. Delta variant is transmitting at a very high speed with a ratio of 1:4, meaning that 1 infected person might spread the viruses to 4 persons and so on in the same space, same unit or even same building. In order to break the chain of transmission, ones should practice social distancing at a distance of at least 2.5m.

Comparison Among Different Coronavirus Variants
There are 4 main variants of coronaviruses around the world right now which are Alpha (B.1.17), Beta (B.1.35), Gamma (P.1) and Delta (B.1.617) variants. The following shows some differences among these strains of virus:

Figure 2: Differences Among Alpha, Beta, Gamma and Delta Variant

 Common Symptoms Caused by Delta Variant

The symptoms of COVID-19 will evolve in pace with the evolution of the virus strains. Other than the usual symptoms like fever and cough, there are some additional symptoms of the Delta variant that we need to pay attention at such as:

Effectiveness of Vaccines on Delta Variant        
Vaccination appears to show some benefits against Delta variant, even though there is less protection provided by the vaccine compared to other variants of coronaviruses. The following data show the efficacy rates of the vaccine against the symptomatic infections caused by Delta variant by some studies.

Furthermore, vaccinated people are less likely to get hospitalized against Delta variant. The efficacy rates against hospitalization are showed below:

The best way to combat the Delta surge is still the vaccination as fully vaccinated people are having lower risk to be threatened by Delta variant. However, new variants will continue to appear as long as there are large number of unvaccinated people around the world and a new version of the Delta variant, known as Delta Plus is already circulating in other part of the world. If this Delta Plus abroad our country, the unvaccinated communities in our country remain at risk of getting infection.

Reference:
1. The symptoms of the Delta variant appear to differ from traditional COVID symptoms. Here’s what to look out for [Internet]. The Conversation. 2021 [cited 17 July 2021]. Available from: https://theconversation.com/the-symptoms-of-the-delta-variant-appear-to-differ-from-traditional-covid-symptoms-heres-what-to-look-out-for-163487

2. Jay Hilotin S, Shyam A. Krishna S, Alex Abraham S, Seyyed Llata S. Alpha, Beta, Gamma, Delta COVID-19 variants: How dangerous? [Internet]. Gulfnews.com. 2021 [cited 17 July 2021]. Available from: https://gulfnews.com/special-reports/alpha-beta-gamma-delta-covid-19-variants-how-dangerous-1.1624872935207

3. How effective are coronavirus vaccines against the Delta variant? [Internet]. Ft.com. 2021 [cited 17 July 2021]. Available from: https://www.ft.com/content/5a24d39a-a702-40d2-876d-b12a524dc9a5

4. Coronavirus Disease 2019 (COVID-19) [Internet]. Centers for Disease Control and Prevention. 2021 [cited 17 July 2021]. Available from: https://www.cdc.gov/coronavirus/2019-ncov/variants/variant.html

5. How effective are COVID-19 vaccines against the Delta variant? [Internet]. Los Angeles Times. 2021 [cited 17 July 2021]. Available from: https://www.latimes.com/science/story/2021-07-02/how-well-do-covid-19-vaccines-cover-the-delta-variant

6. Effectiveness of an Inactivated SARS-CoV-2 Vaccine in Chile | NEJM [Internet]. New England Journal of Medicine. 2021 [cited 17 July 2021]. Available from: https://www.nejm.org/doi/full/10.1056/NEJMoa2107715?fbclid=IwAR0ITkADdmafRq8Bx_ce33cDrA72htAxooODiEd6dhFXf1WDyCQw1qoK3O8

Erectile dysfunction (ED) refers to the inability to get or keep an erection firm enough to have sexual intercourse. Erectile dysfunction is usually caused by low blood flow to the penis or problem with the nerves that control erections. Having trouble erecting for short period of time is not necessarily a cause for concern but it can cause stress, affect your self-confidence and contribute to relationship problems if it becomes an ongoing issue.

What are the symptoms of erectile dysfunction (ED)?

The symptoms include persistent:

• Trouble getting an erection
• Trouble keeping an erection
• Reduced sexual desire

What causes erectile dysfunction (ED)?

Problems getting or keeping an erection can be due to various risk factors, including:

• Vascular diseases (such as atherosclerosis which means hardening of arteries): These conditions narrow the blood vessels and reduce blood flow to the penis.
• Neurological disorders (such as multiple sclerosis which is a chronic disease affecting the brain and spinal cord): Nerves that send impulses to the penis can become damaged from stroke, diabetes, or other causes.
• Psychological states: These include stress, depression, lack of stimulus from the brain as well as performance anxiety.
• Trauma: An injury could contribute to symptoms of ED.
• Chronic illness, certain medications, and operations for the prostate, bladder, and colon cancer may also be contributing factors.

How is erectile dysfunction (ED) treated?

• Get More Exercise

Regular physical activity improves blood circulation and decreases the risk of heart disease, diabetes, and obesity, all of which can have an impact on sexual function.

• Stop Smoking

Smoking affects circulation in ways that can inhibit blood flow to the penis and affect the ability to achieve or sustain an erection. Besides, smoking cessation has many other health benefits, such as reducing heart disease and diabetes which are the two major causes of ED.

• Eat Well

The risk of ED can be reduced in people who always eat diets that rich in whole-grain foods, vegetables, and fruits and low in red meat, full-fat dairy products, and sugary foods and drinks have a reduced risk of ED.

• Prescription Medications

The oral medications for erectile dysfunction enhance the effects of nitric oxide which is a natural chemical your body produces to relaxes muscles in the penis. This increases blood flow and lead to erection in response to sexual stimulation.

For Viagra, Levitra, and Stendra—eating a high-fat meal may delay the absorption of the drug, which will prolong the time for erection and diminish the drug’s overall effectiveness.

• Testosterone Replacement Therapy

A healthcare provider may prescribe testosterone replacement therapy if a man is found to have a low testosterone level, along with other symptoms, such as low libido and ED. That said, testosterone deficiency is uncommonly the primary cause of ED. Before you take testosterone, your healthcare provider will have you tested to make sure that you do indeed have a deficiency.

• Reviewing Current Medications

It is very possible that one or more of current list of medications may be causing or contributing to your erectile dysfunction. Medications that classically cause erectile dysfunction as a side effect are antidepressants, especially selective serotonin reuptake inhibitors (SSRIs), such as Zoloft (sertraline). Other potential medications linked to erectile dysfunction include certain blood pressure medications and pain medications.

• Pumps and Implants

A mechanical device may be worth trying if medications and other interventions don’t work.

One option is a vacuum pump, a plastic tube that is placed over the penis. When air is sucked out of the tube it creates pressure that causes blood to be forced into the penis. A ring can then be temporarily placed at the base of the penis to stop the blood from draining away too quickly.

A penile implant is another option. There are two types of penile implant. The first type is called a semi-rigid penis implant, it keeps the penis erect all the time, though it can be bent downward when you aren’t having sex. The other type is an inflatable two- or three-piece penis implant, it includes a pump that’s implanted in the scrotum and can be squeezed in order to make the penis erect.

• Natural Remedies

Research has found that certain natural remedies can improve ED to some extent. Here is a guide of herbs and supplements that may help improve the symptoms of erectile dysfunction:

References:

1. Michael Bihari, MD (2021) Causes and Risk Factors of Erectile Dysfunction.
   Available at: https://www.verywellhealth.com/erectile-dysfunction-causes-and-risk-factors-1124108
2. Alana Biggers (2019) Everything You Need to Know About Erectile Dysfunction (ED).
   Available at: https://www.healthline.com/health/erectile-dysfunction#_noHeaderPrefixedContent
3. US Department of Health and Human Services, National Institute of Diabetes and Digestive and Kidney Diseases (2019) Erectile Dysfunction.
   Available at: https://www.niddk.nih.gov/health-information/urologic-diseases/erectile-dysfunction/definition-facts
4. Borrelli F, et al(2018) Herbal dietary supplements for erectile dysfunction: A systematic review and meta-analysis.
   Available at: doi:10.1007/s40265-018-0897-3.
5. U.S. Food and Drug Administration (2018) ‘All natural’ alternatives for erectile dysfunction: A risky proposition.
   Available at: https://www.fda.gov/ForConsumers/ConsumerUpdates/ucm465024.htm.