Glaucoma is a disease involving the optic nerves of the eyes- usually affecting both of the eyes. It usually occurs when there is an escalation of pressure in the eyes. Our eyes usually produce a protective fluid (that surrounds the tissues of the eyes) also known as aqueous humour. An optimum eye pressure is achieved when the amount of fluid produced is equivalent to the amount of fluid being drained out of the eyes. If there is any slight blockage in the outflow channel, the pressure in the eyes rises due to the accumulation of the fluid surrounding the eyes.

            There are several distinguished types of glaucoma; one being acute or close-angle glaucoma that is rare and occurs due to a sudden, high increment in the eye pressure which causes pain. Another type being chronic or open-angle glaucoma which occurs gradually and is often left undetected due to the absence of any signs or symptoms. Next, secondary glaucoma is caused by an inflammation of the middle layer of the eyes. Another type of glaucoma would be childhood or congenital glaucoma which is extremely rare and only occurs in very young children due to abnormalities in the eyes.

            A few risk factors increase the chances of developing glaucoma. One of them is family history which means if your parents or siblings have glaucoma, you have a significant risk of developing it as well. Another risk factor would be age– the older you are, the higher the risk of developing glaucoma. Ethnic groups also play a role in increasing the chance of developing glaucoma, in which people who are of Afro-Caribbean and African descent will have a higher risk of developing glaucoma. Other than that, short sightedness can also make you more prone to develop glaucoma. Diabetes also appears to be another risk factor of developing glaucoma.

            Oftentimes, glaucoma goes undetected due to absence of signs and symptoms in the early stages. Given the situation that you have acute or open-angle glaucoma, it will take a long time before your eyesight deteriorates. When a person experiences blurred vision, dull pain around the head, nausea or vomiting or seeing a glare or shadow around the light of a lamp, he or she is usually at a severe level and require guidance from an ophthalmologist with urgency. Therefore for those that have a higher risk for developing glaucoma, it would be advisable to undergo an eye examination yearly. After all, prevention is better than cure.

            Thus, eye tests that are simple and painless should be performed regularly for early detection. Firstly, an eye pressure test in which a local anesthetic eye drop will be placed in both of the eyes before a small instrument is gently placed against your eye to measure the intraocular pressure of the eyes.

                                                                         Eye pressure test  

                            Next, optic nerve examination can be conducted to examine the condition of your optic nerves.

Once damage is done to the vision by glaucoma, it is hardly reversible. However, there are treatments that can prevent the eye-sight from going worse. The go-to treatment for acute or open-angle glaucoma is eye drops that patients need to use for lifelong. In the early stages of glaucoma, these eye drops can help control the eye pressure and therefore prevent further damage to the eyes. The effectiveness of the eye drop will be determined by the ophthalmologist upon regular glaucoma checks. If the use of eye drops is unable to control glaucoma, laser procedures can help to drain the fluid out of the eye effectively or surgery on the draining channel can be performed as well. 

            Certain lifestyle habits can be easily adapted to reduce the severity of glaucoma. Firstly, limit caffeine intake as caffeine can increase the pressure of the eyes. Next, limit alcohol intake as excessive drinking of alcohol can damage optic nerves. Fish oil supplements can help to improve eye health as well. Exercising cautiously can help to improve glaucoma and general health. Other than that, sleeping with your head on a pillow can help to reduce eye pressure as well.

References

1. Ow Yong, S.E. (2021). [Comparison of normal eye with glaucoma eye]. Vista Eye Specialist. https://www.vista.com.my/pages/2021/02/17/glaucoma/
2. Salmon, J. (2015) Glaucoma information for patients. Available at: https://www.ouh.nhs.uk/patient-guide/leaflets/files/11826Pglaucoma.pdf
3. NHS. (2021). Glaucoma. Available at: https://www.nhs.uk/conditions/glaucoma/
4. Glaucoma UK. (2021). Living with Glaucoma. Available at: https://glaucoma.uk/care-support/living-with-glaucoma/
5. Othman, S. (2019). Glaukoma. Available at: http://www.myhealth.gov.my/dewasa-glaukoma/

Gout is a crystal-induced arthritis. A condition that resulted from deposition of monosodium urate (MSU) crystals in various tissues (eg joints, connective tissue, kidney) due to elevated serum urate level. 

Gout is always associated with the symptoms of sudden, severe attacks of pain, swelling, redness and tenderness in one or more joints. In patients with acute gout attack, joints of the lower limbs are more affected than upper limbs. It will usually last for few days to 3 weeks with a gradual complete resolution of the inflammation.
The normal uric acid level for adult male is 2.5-7.0 mg/dL. whereas for adult female is 1.5-6.0 mg/dL.

RISK FACTOR

1) Diet

Diet with purine-rich food will cause body to produce too much uric acids which form MSU crystal and gout.
Example of purine rich food: red meat, shellfish, drinking beverages sweetened with fruit sugar (fructose), alcohol consumption, especially of beer.

2) Weight

It is likely that higher BMI increases the risk of gout by increasing the serum uric acid level. Hyperuricemia has been associated with obesity via both increased production and decreased renal excretion of urate.

3) Medical Conditions

Some underlying medical conditions can increase the risk of developing gout, including:
– High blood pressure
– Diabetes
– Kidney disease
– High levels of cholesterol in blood

4) Certain Medications

Certain medications can increase your uric acid levels and your risk of developing gout. These include:
– Diuretics: used to treat high blood pressure or an abnormal build-up of fluid in your body
– Certain medicines used to treat high blood pressure: Beta-blockers and ACE inhibitors
– Low-dose aspirin: used to reduce the risk of blood clots

5) Family History

Gout is caused by a combination of genetic and environmental factors. Patients with family history of gout will have an increase risk of developing gout too.

SIGN AND SYMPTOMS

Gout is always associated with the symptoms of sudden, severe attacks of pain, swelling, redness and tenderness in one or more joints. In patients with acute gout attack, joints of the lower limbs are more affected than upper limbs. It will usually last for few days to 3 weeks with a gradual complete resolution of the inflammation. For acute gout attack, it is usually monoarticular. However, gout will progress into chronic gout when the patients does not have a good control on their diet or uric acid level. For chronic gout, it is usually polyarticular arthritis and the formation of tophi.

STAGES OF GOUT

1) Acute Gout

Acute gout commonly present as an acute, self-limiting, mono-articular inflammatory arthritis. Joint at the lower limbs are more affected than the upper limbs. The affected joints will have erythema (redness of the skin), warmth and swelling over the joint. Fever may be present.
Attack of acute gout last for a few days to 2-3 weeks, with a gradual complete resolution of all inflammatory sign

2) Chronic Gout

Chronic gout present with polyarticular arthritis and the formation of tophi. Tophi are chalky deposits of MSU crystal. They are subcutaneous and painless. They will appear as a firm, nodular or fusiform swellings. Tophaceous disease more likely occur in patients where serum urate level more than 9mg/dl.
Sites of tophi includes digit of the hands and feet (most common), pinna of the ear, bursa around elbows and knees, achilles tendon (tendon that connect calf muscle to heel).

DIAGNOSIS OF GOUT

Clinical diagnosis of gout is based on whether the patients experience two or more of the following criteria:

1. Presence of clear history of at least two attacks of painful joint swelling with complete resolution within 2 weeks.
2. A clear history or observation of podagral
3. Presence of tophus
4. Rapid response to colchicine within 48 hours of starting treatment. 

TREATMENT

A) Medications

– NSAIDs
Non-steroidal anti-inflammatory drugs (NSAIDs) are usually recommended as the first treatment for gout. They work by reducing pain and inflammation during an attack.
Example: Indomethacin, Naproxen, Diclofenac, Celecoxib

– Colchicine
If NSAIDs are ineffective, a medicine called colchicine can be used instead.
Colchicine reduces some of the swelling and pain associated with a gout attack. When taken in high doses, side effects of colchicine include feeling sick, abdominal pain and diarrhea.

– Corticosteroids
Corticosteroids are sometimes used to treat severe cases of gout if other treatments don’t work or unable to take an NSAIDs or colchicine.
A short course of steroid tablets often provides relief, but they can’t be used long-term in high doses as they cause side effects, including weight gain, osteoporosis, muscle weakness.

– Allopurinol
Allopurinol helps reduce the production of uric acid. It can help prevent gout attacks, although it won’t help relieve symptoms during an attack.

B) Alternative treatment

– Urinary Alkalinizer
Sodium citrate is metabolized to bicarbonates which increases urinary pH by increasing the excretion of free bicarbonate ions without producing systemic alkalosis when administered in recommended doses. (Ural: 1-2 sachet dissolved in water for four times a day)
 A rise in urinary pH increases the solubility of cystine in the urine and the ionization of uric acid to more soluble urate ion. By maintaining an alkaline urine, the actual dissolution of uric acid stones may be accomplished.

– Cherry Juice
According to studies, tart cherry reduce uric acid because of the ingredients anthocyanins. Anthocyanin have its anti-inflammatory effect which makes cherry juice a natural anti-inflammatory. Hence, this will help to resolve gout swelling in patient.

– Celery Extract
Studied shown that celery extract have significantly reduced the serum uric acid, lipid peroxidation, and increase activity of antioxidant enzyme levels in gouty rats. This may be due to the inhibition of xanthine oxidase activity.

– Juniper Berry
Juniper is traditionally known as a diuretic, it was valued as a urinary and kidney remedy in Europe and the Mediterranean. The American ethnic physicians used Juniper berry to treat arthritic gout because of the inhibition of xanthine oxidase. Juniper berry is noted to exert powerful antioxidant activity. It also has anti-inflammatory, analgesic, and hepatoprotective effects.

LIFESTYLE ADVICES

Certain lifestyle changes can also help reduce your risk of experiencing further attacks of gout, including:

– Avoiding foods containing high levels of purine such as red meat, offal, oily fish, seafood and foods containing yeast extract.

– Avoid alcohol intake.
Alcohol disrupts the removal of uric acid from the body. Normally, purines would break down into uric acid and get flushed out of the body through urine. However, this process is interrupted when uric acid levels get too high. Crystals form around the joints, and gout develops.
To prevent gout attack, avoid alcohol during attack and avoid beer.

– Avoid sugary drinks and snacks – these are associated with an increased risk of gout.

– Maintain a healthy weight – follow a balanced diet with high-protein, low-carbohydrate diets.

– Drink plenty of water – keep yourself well-hydrated will reduce the risk of crystals forming in your joints.

– Take regular exercise – try activities that do not put too much strain on your joints, such as swimming.

What is Menopause?

Menopause is the end of a woman’s menstrual cycles, occurs when the ovaries stop producing  hormones that drive menstrual cycle. It is a natural process of aging and it is not a disease or disorder.  Menopause is diagnosed when you have not had a period for 12 consecutive months. This usually happens between the ages of 45 and 55. But some women can go through menopause early. It can be the result of surgery, for example if their ovaries are removed in a hysterectomy or if there have been damage to their ovaries, such as from chemotherapy. If it happens before age 40, for any reason, it’s called premature menopause.

Signs and Symptoms

Every woman experiences menopause differently. Some women barely have any complaints, while some woman may have very severe menopausal symptoms that could impact their life, including relationships, social life, family life and work. In the months or years leading up to menopause (peri-menopause), you might experience these signs and symptoms:

• Hot Flushes – A sudden feeling of heat in the upper part or all of your body, often with blushing and heavy sweating. Hot flashes can be very mild or strong enough to wake you up (called night sweats).
• Irregular Periods – They may be shorter or last longer. You might bleed more or less than usual. 
• Emotional symptoms – Such as mood swings, anxiety, depression, low self-esteem and problems with memory or concentration.
• Sleep disturbances – Often due to hot flushes, insomnia, stress or depression and make you feel tired and irritable during the day
• Vaginal dryness – The walls of the vagina lose volume and moisture and become thin, dry, and easily irritated due to lack of oestrogen. This can lead to painful sex, an increase in vaginal infections, and chronic vaginal discomfort.
• Palpitations
• Reduced sex drive
• Dry and itchy skin
• Thinning of hair
• Muscle ache and joint pain

Complications

Once you have gone through menopause, the risk of the development of a number of medical conditions increases. Some examples of possible complications include:

• Heart and blood vessel (cardiovascular) disease. When your estrogen levels decline, your risk of heart disease increases. So it’s important to get regular exercise, eat a healthy diet and maintain a normal weight.
• Osteoporosis. This condition causes bones to become brittle and weak, leading to an increased risk of fractures. Postmenopausal women with osteoporosis are especially susceptible to fractures of their spine, hips and wrists.
• Urinary incontinence. As the tissues of your vagina and urethra lose elasticity, you may experience frequent, sudden, strong urges to urinate, followed by an involuntary loss of urine, or the loss of urine with coughing, laughing or lifting. You may have urinary tract infections more often.
• Weight gain. Many women gain weight during the menopausal transition and after menopause because metabolism slows down. You may need to eat less and exercise more, just to maintain your current weight.

Treatment

There is no specific medical treatment for menopause. The treatments instead focus on the relief of symptoms and preventing or managing chronic conditions that may occur with aging. Common treatments include:

• Hormone replacement therapy (HRT). You take medications to replace the hormones that your body isn’t producing anymore. HRT comes in several different forms including tablet, implants, and skin patches. They can help with hot flashes and vaginal symptoms, as well as making your bones stronger.

• Topical hormone therapy. This is an estrogen cream that can be applied into vagina to help with dryness, discomfort with intercourse and some urinary symptoms.
• Non-hormone medications. Certain anti-depression drug related to the class of drugs called selective serotonin reuptake inhibitors (SSRIs) may decrease menopausal hot flashes. Gabapentin, which is used to treat seizures and the blood pressure drug clonidine has also been shown to help reduce hot flushes.
• Medications to prevent or treat osteoporosis. Depending on individual needs, doctors may recommend medication to prevent or treat osteoporosis. Several medications are available that help reduce bone loss and risk of fractures. Vitamin D supplements can also be used to help strengthen bones.

Lifestyle and home remedies

Lifestyle changes help many women deal with menopause symptoms. These steps may help relieving symptoms and improving quality of life during this transition.

• If you’re having hot flashes, drink cold water, dress lightly, take a cool shower and fan yourself; Avoid hot drinks, spicy food and caffeine.
• Use an over-the-counter vaginal moisturizer or lubricant for dryness.
• Exercise regularly to sleep better and prevent conditions like heart disease, diabetes, and osteoporosis.
• Strengthen your pelvic floor muscles with Kegel exercises to prevent bladder leaks.
• Stay socially and mentally active to prevent memory problems.
• Don’t smoke. Tobacco might cause early menopause and increase hot flushes.
• Limit intake of alcohol, to lower your chance of getting breast cancer and help you sleep better.
• Maintain a healthy weight and eat low-salt, low-fat, low-sugar, high-fiber diet that’s rich in a variety of fruits and vegetables.
• Practice things like yoga, deep breathing, or massage to help you relax.

Herbs and Supplements for Menopause

A number of supplements and multivitamins are available that may help ease these symptoms. Examples are:

• Evening Primrose Oil
• Calcium Supplements
• Dong Quai
• Ginseng
• Black Cohosh
• Red Clover
• Flaxseed
• Soy
• Valerian root
• St. John’s Wort

References

1. Menopause. NHS.[Internet].NHS.UK.2022[Cited 15 July 2022]. Available from: https://www.nhs.uk/conditions/menopause/#:~:text=Menopause%20is%20when%20your%20periods,chemotherapy%2C%20or%20a%20genetic%20reason.

• Menopause. Symptoms and Causes[Internet].Mayo Clinic.[Cited15 July 2022]. Available from: https://www.mayoclinic.org/diseases-conditions/menopause/symptoms-causes/syc-20353397

• Clinical Practice Guidelines on Hormone Therapy during Menopause in Malaysian Women. MOH/P/PAK/207.10(GU) [Accessed on 15 July 2022]

• Gabriela Pichardo, M. June 2022. Menopause. [Internet]. Available from: https://www.webmd.com/menopause/guide/menopause-basics

• Menopause: Understanding the menopausal transition. [Internet]National Institutes of Health (NIH). [Cited 15 July 2022] Available from: https://www.nia.nih.gov/health/what-menopause

• Jade Poole. How is menopause diagnosed and treated. [Internet]. MyMed. [Cited 15 July 2022] Available from: https://www.mymed.com/diseases-conditions/menopause/how-is-menopause-diagnosed-and-treated

• 10 Herbs and Supplements for Menopause. [Internet] Healthline. [Cited 15 July 2022]. Available from: https://www.healthline.com/nutrition/menopause-herbs

• 11 Supplements for Menopause. [Internet]. WebMD [Cited 15 July 2022]. Available from: https://www.webmd.com/menopause/ss/slideshow-menopause

Body weight is one of many determinants of health. Maintaining a healthy body weight can lower your risks towards many weight-related diseases and health issues. However, each person’s healthy weight range will vary and depend on factors such as age, gender, genetics, body frame, existing medical history and lifestyle habits. So, weight management is a process of adopting long-term lifestyle modification to maintain a healthy body weight on the basis of these factors.

You may assess your body weight status via two simple physical examination methods:

Body mass index (BMI)

BMI is a person’s weight in kilograms divided by the square of height in meters. A high BMI can indicate high body fatness, and a low BMI can indicate too low body fatness.

• If your BMI is less than 18.5, it falls within the underweight range.
• If your BMI is 18.5 to 24.9, it falls within the normal or healthy weight range.
• If your BMI is 25.0 to 29.9, it falls within the overweight range.
• If your BMI is 30.0 or higher, it falls within the obese range.

Waist Circumference

Another way to estimate your potential disease risk is to measure your waist circumference. It is also a good estimate of visceral fat, the dangerous internal fat that coats the organ. Waist circumference measurement correlates well with abdominal fat content irrespective of the BMI. It is most useful in individuals who are in the normal and overweight categories of BMI. Your waistline may be telling you that you have a higher risk of developing obesity-related conditions if you are:

• A man whose waist circumference is more than 40 inches
• A non-pregnant woman whose waist circumference is more than 35 inches

Being too thin (underweight) or obese (overweight), both may impact your health condition. Maintaining a healthy weight is not only important for improving your physical appearance but is also beneficial for your overall well-being. Prioritizing weight management not only lowers the health risks but can also lead to an improved quality of life.

Underweight is a condition when energy intake is less than energy expenditure, it may lead to health risks such as malnutrition, decreased immune function, osteoporosis, infertility, developmental delays, and increased risk of surgical complications 2. A person may be underweight due to genetics, improper metabolism, lack of appetite, over-exercising, certain medicines, and underlying medical problems such as overactive thyroid, anorexia, etc 3.

Overweight and obesity are consequence of an energy imbalance where energy intake has exceeded energy expenditure over a considerable period of time, lead to abnormal or excessive fat accumulation that presents a risk to health. Obesity is one side of the double burden of malnutrition, and today more people are obese than underweight in every region. It once considered a problem only in high-income countries, overweight and obesity are now dramatically on the rise in low- and middle-income countries, particularly in urban settings. The World Health Organization (WHO) reported one in five Malaysian adults will be obese by 2025 4. Obese and overweight people are more prone to illnesses and conditions such as diabetes, hypertension, heart diseases, gall bladder diseases and osteoarthritis. Obesity may influence the risk of cancers of the colon, rectum, prostate, gall bladder, cervix, endometrium and ovary. Obesity also affects mobility, physical endurance and other functional measures. Obese people may also have low self-esteem 5.

Factors Weight Gain

Poor diet and overeating

Poor eating habits are probably the leading cause of obesity among all others. More often than not, people are likely to gain weight when they consume more calories than they burn through physical activity. Examples of unhealthy eating choices that directly lead to weight gain include:

• Eating more portions than your body needs
• Eating excessive amounts of processed or fast food
• Consuming beverages with too much sugar content
• Drinking too much alcohol 6

Physical inactivity

Another important factor is the lack of physical exercise. Nowadays, most people’s work desk jobs that consist of sitting and staring at a computer for long hours every day. When it comes to leisure activities, many of us prefer to lounge around and binge-watch or scroll endlessly on our phones instead of heading out to exercise. If you fail to incorporate exercise into your daily lives, the energy provided by the food you eat will only be stored by the body to become fat, which can lead to excessive weight gain 6.

Stress, emotional factors, and poor sleep

Some people eat more than usual when they are bored, angry, upset, or stressed. This “stress eating” are due to secretion of stress hormone called cortisol in our body. It increases appetite and may ramp up desire to eat fatty, salty or sugary “comfort foods” 7.  Studies also have found that the less people sleep, the more likely they are to have overweight or obesity. This is partly because hormones that are released during sleep help control appetite and the body’s use of energy 8.

Health Conditions

On fairly rare occasions, obesity could be caused by certain health conditions. Examples of medical conditions that commonly contribute to weight gain include hormonal imbalance, hypothyroidism and Cushing’s syndrome. Other medical problems such as arthritis can hinder one from engaging in physical activity, which can ultimately result in weight gain as well. Certain medicines also may cause weight gain, including some corticosteroids, antidepressants, and seizure medicines 8.

Ways to Achieve Healthy Weight

Healthy eating

Healthy eating features a variety of healthy foods. Fad diets may promise fast results, but such diets limit your nutritional intake, can be unhealthy, and tend to fail in the long run. A healthy eating plan shall:

• Emphasize fruits, vegetables, whole grains, and fat-free or low-fat milk and milk products
• Include a variety of protein foods such as seafood, lean meats and poultry, eggs, legumes (beans and peas), soy products, nuts, and seeds.
• Is low in added sugars, sodium, saturated fats, trans fats, and cholesterol.
• Stay within your daily calorie needs 9.

Exercise regularly and stay physically active

Engaging in physical activity is one of the simplest ways to get rid of excess weight on your body. The more you exercise, the more calories your body burns off. On top of burning fat, exercising also increases your metabolism significantly 6. The World Health Organization (WHO) recommended regular exercise 60 minutes per day for children and 150 minutes per week for adults, to lower the risk or overweight and obesity 4.

Set smart weight goals

Losing or gaining weight does not happen overnight. A good and healthy weight loss or weight gain should adopt the concept of energy balance as its guiding principle. Setting a SMART goal should be specific, measurable, achievable, relevant and timely. For example, if your BMI is 23 kg/m2 and above, losing 10% to 15% of your current body weight over 6 months at a rate of 0.5 kg to 1 kg a week is a healthy target 10.

Last but not least, a heathy and successful weight management include regular monitoring of your progress and maintenance of healthy weight in the long term. Making lifestyle modifications goes beyond the physical aspects, this requires you to tap into your mental stamina as well. Believe it or not, your outlook or mindset can play an essential role in your weight management journey.

Reference:

1. Assessing Your Weight. (2022, June 3). Centers for Disease Control and Prevention. Retrieved September 10, 2022, from https://www.cdc.gov/healthyweight/assessing/index.html
2. Marcin, A. (2017, May 15). 6 Health Risks of Being Underweight. Healthline. Retrieved September 10, 2022, from https://www.healthline.com/health/underweight-health-risks
3. Underweight | Office on Women’s Health. (n.d.). Retrieved September 10, 2022, from https://www.womenshealth.gov/healthy-weight/underweight
4. Obesity. (2020, February 21). Retrieved September 10, 2022, from https://www.who.int/health-topics/obesity#tab=tab_1
5. Surainee bt. Wahab. (2012, April 20). Weight Management. PORTAL MyHEALTH. Retrieved September 10, 2022, from https://www.cdc.gov/healthyweight/assessing/index.html
6. Homage. (2022, January 4). Weight Management Programmes by Doctors in Singapore. Retrieved September 10, 2022, from https://www.homage.sg/resources/weight-management/
7. Harvard Health. (2021, February 15). Why stress causes people to overeat. Retrieved September 10, 2022, from https://www.health.harvard.edu/staying-healthy/why-stress-causes-people-to-overeat
8. National Heart, Lung, and Blood Institute. (2012). What causes overweight and obesity? Retrieved September 10, 2012, from https://www.nhlbi.nih.gov/health-topics/overweight-and-obesity
9. Physical Activity for a Healthy Weight. (2022, June 16). Centers for Disease Control and Prevention. Retrieved September 10, 2022, from https://www.cdc.gov/healthyweight/physical_activity/index.html
10. HealthHub. (n.d.). Retrieved September 10, 2022, from https://www.healthhub.sg/live-healthy/410/Healthy%20Weight

Glucose-6-phosphate dehydrogenase (G6PD) deficiency is a genetic disorder caused due to a defect in an enzyme called glucose-6-phosphate dehydrogenase that causes red blood cells to break down prematurely.

G6PD is an enzyme that protects the red blood cells from damage and destruction by harmful and toxic compounds that form in the body under certain conditions like stress, fever, or following the ingestion of certain foods or drugs. The enzyme generates compounds that can neutralize the toxic compounds formed in the body.

Causes of G6PD

It is an X-linked disorder that may be inherited from mother (usually a healthy carrier) or affected father to son or daughter. G6PD cannot be spread from one person to another. [1]

Sign and Symptoms of G6PD

People with G6PD deficiency do not display any signs of the disease until they are exposed to certain chemicals in food or drugs whereby their RBC being broken down in excess.

Other symptoms:

• Sudden rise of body temperature
• Dark yellow-orange urine
• Weak and rapid pulse rate.

It is common for babies to have jaundice (yellowing of the skin and eyes) in the first week of life, but some babies with G6PD deficiency have jaundice for longer than usual.

Diagnosis of G6PD

• Blood tests

Blood tests may reveal low red blood cell count, increased bilirubin levels, and increased plasma hemoglobin levels. Other blood tests may confirm presence of intravascular hemolysis. However, the blood tests may be normal between the attacks.

• Blood film examination

Examination of a stained blood film under the microscope may show abnormal broken red cells (hemolytic RBCs). Special stains show denatured hemoglobin within red cells (Heinz bodies) and increased immature red cells (reticulocytes) due to formation of new red cells (erythropoiesis) by the bone marrow as compensatory response. If the abnormal cells have the appearance of a bitten piece they are termed bite cells.

• Urine tests

The urine specimen during the attack is dark colored and positive for hemoglobin and hemosiderin

• Screening tests to detect low G6PD levels

Several screening tests are available that demonstrate the decreased capacity of G6PD deficient cells to reduce dyes. The enzyme can also be directly assayed.

Drugs to Avoid

Foods and Chemical to Avoid

• Fava Beans (broad beans)
• Red wine
• Henna dyes used for tattoo & Hair
• Blueberries [also yogurts containing these]
• Soya products
• Tonic water
• Naphthalene (moth balls)

References:

1. The Royal Children’s Hospital Melbourne. (n.d.). Retrieved from https://www.rch.org.au/kidsinfo/fact_sheets/g6pd_deficiency/
2. Schick P. (Dec 2018) Glucose-6-Phosphate Dehydrogenase Deficiency. Medscape. Available from http://emedicine.medscape.com/article/200390- overview.
3. MIMS 158th Edition Sep 2019 Malaysia. Drugs and Other Substances to Avoid in G6PD Deficiency. Pg 174-177

CHICKENPOX

Chicken pox, a common infection in children caused by a virus known as varicella-zoster virus. It is a highly contagious disease that spread from person to person causing the infected person to develop fever and a blister like rash. The rash crops up first on the face and trunk and can spread over the entire body. It can be transmitted through the air when someone with chicken pox sneezing or coughing or by touching the watery stuff that comes out from the chicken pox blisters.

Symptoms of chickenpox

1. Fever
2. Loss of appetite
3. Tiredness
4. Headache
5. Rash starting as small, itchy red spots like pimples all over the body including the mouth

Chicken pox infection generally will results in lifelong immunity. But the virus may remain hidden and reactivate as shingles in a proportion of adults and sometimes children.

SHINGLES

Shingles is an acute infection caused by the herpes zoster virus, the same virus as causes chickenpox. Shingles occurs because of exposure to chickenpox or reactivation of the herpes zoster virus. The virus remains latent (dormant) in nerve roots for many years following chickenpox. Thus, shingles only happens in people who already had chicken pox. Usually adults age ≥ 50yo will be affected.

Symptoms

1. Pain in the affected nerve area, ranging from a tingling sensation to very severe burning pain that indicating nerve damage.
2. Mild fever
3. Tiredness
4. Unilateral, localized rash that become blisters

DIFFERENCES OF CHICKENPOX AND SHINGLES

How is chicken pox and shingles being treated?  

General:

• Keep the infected child at home (about 7 days from the onset of rash).
• Drink plenty of water to prevent dehydration.
• Take analgesic (eg.paracetamol, mefenamic acid, diclofenac) for fever or to  reduce pain.
• Stay cool and wear loose-fitting clothes, preferably made of cotton.
• Take balanced meals
• Keeps hands clean

For itchiness:

• Apply cooling gel or calamine lotion on the rash.
• Keep fingernails short and clean to prevent scratching and possible scarring.
• Use a cool compress to soothe the itch
• Antihistamine medications (eg. Cetirizine, loratadine or chlorpheniramine) may be prescribed if the itch is very bad.

Antiviral medication to slow down the progression and stop the growth of virus. Example : acyclovir, famicyclovir , valacyclovir. It is usually prescribed for those at risk for severe disease, such as:

• Those older than 12 years old.
• Those with chronic lung disease/skin disease.
• Those on long term salicylate therapy (like aspirin).
• Those receiving short, intermittent, or aerosolized course of steroid therapy.
• Some groups of pregnant mother.

Antiviral topical treatment to speed up the healing of the sores and decrease the symptoms (like tingling, pain, burning or itching).

• Apply the antiviral cream 6 times per day for at least 5 days to stop the growth of virus.
• Apply the cream onto the affected area and rub in gently. Make sure the cream is enough to cover all affected area.
• Apply to skin only. Do not apply this medication in the eyes or nose, inside the mouth, or inside the vagina.                                                           

SUPPLEMENTS

Multivitamin and mineral

A high-potency multivitamin and mineral supplement may help to protect against cell damage. Look for a supplement with all the key ingredients, including vitamins C, E and selenium for antioxidant support. Vitamin B12 may help to support the formation of  myelin (a layer that cover the nerves). Keeping the myelin sheath healthy may even make the reactivation of the virus – which causes the symptoms of shingles – less likely.

Lysine

Lysine play an important role in the immune system. Combined supplement of lysine and zinc may help to reduce infection in people with compromised immune system. Lysine is also important for the body’s production of collagen, a protein that’s essential for healthy skin.

Probiotic

Probiotics are made of good live bacteria and/or yeasts that naturally live in our body. When you get an infection, there is more bad bacteria knocking the system out of balance. Good bacteria then works to fight off the extra bad bacteria and restore the balance within the body. Therefore, probiotic supplements are a way to add good bacteria to the body, supporting the immune system and controlling inflammation.

References

1. Morgan, C. and Slater, O., n.d. Chickenpox and Shingles. [online] Natures Best. Available at: <https://www.naturesbest.co.uk/pharmacy/pharmacy-health-library/chickenpox-and-shingles/> [Accessed 20 June 2021].
2. PORTAL MyHEALTH. 2012. Chickenpox – PORTAL MyHEALTH. [online] Available at: <http://www.myhealth.gov.my/en/chickenpox/> [Accessed 4 July 2021].
3. PORTAL MyHEALTH. 2017. Varicella-Zoster Viral Infection – PORTAL MyHEALTH. [online] Available at: <http://www.myhealth.gov.my/en/varicella-zoster-viral-infection/> [Accessed 5 July 2021].

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

As the science and technology become more and more developed nowadays, people are unable to live without digital devices like smartphones, laptops etc. Even students are also using smartphone, tablets or laptops for online classes, especially during COVID-19 pandemic, which has increased the exposure to digital devices. The usage of these digital devices has become a huge part of modern life.

But, do you know that, looking at these digital devices for many hours per day can actually cause a significant stress to your eyes and eventually develop into an eye disease. This is known as digital eye strains. This has increased the threat of digital eye strain (DES), making it an emerging public health problem.

Digital eye strains (DES) which also known as computer vision syndrome is defined by American Optometric Association, includes a range of visual and ocular symptoms occurred due to prolonged use of digital devices. Many studies suggest that the following factors are associated with DES, such as:

• screen glare (reflection from the digital display),
• poor lighting from the room or extensively exposure of lighting from the digital display,
• viewing digital screen from a wrong angle or distance,
• uncorrected vision problem (presbyopia, astigmatism, farsightedness),
• smaller font size

Viewing a digital screen for a few hours or more a day, or being too close to the digital device screen or having eye problems but did not correct with glasses or contact lenses, all these can worsen DES or causing recurrent of DES.

The symptoms of DES include eye dryness, eye fatigue, eye discomfort, eye redness, eye itching, blurred vision and headaches etc. The severity of visual symptoms of DES is based on the level of visual abilities and the amount of time spent on looking on the digital screen. Certain visual symptoms are temporary and will go away after the person stop using the digital devices, but some individual may still experience visual symptoms like blurred vision even after stop using digital devices. Symptoms may get worse if no steps taken to resolve the problem.

Treatments maybe vary for DES, but the symptoms can be relieved through optimal eye care and making changes in how the digital screen is viewed. Treatments include:

• After 2 hours of usage of digital devices, rest your eyes for at least 15 minutes
• Every 20 minutes, look into the distance at least 20 feet away from the computer or digital device. Do this for at least 20 seconds.
• Font size used in digital device should be enlarged.
• Digital devices should be positioned in a way to avoid glare, particularly from lighting of the room or lighting from windows.
• Digital devices should be viewed with the eyes looking downward. The digital screens are best to viewed at a 15 to 20 degrees below eye level and a distance of 20 to 28 inches from the screen (about an armlength)
• Remember to blink your eyes more frequently in order to minimize the risk of developing dry eyes when using a digital device as blinking can keep moisture on the eye’s surfaces.

Besides the changes which were stated above, management of eye dryness can help to treat or prevent the recurrent of DES due to dry eyes. For example, the use of lubricating eye drops to relieve the symptom of dry eyes. Lubricating eye drops can help to relieve symptoms of dry eyes, watery eyes or tired eyes, but it cannot completely cure DES, so only use eye drops when the symptoms are persistent. Some studies suggested dietary supplements such as omega-3 fatty acids and bilberry extract can help in relieving the symptoms of DES. These supplements have an important role in preserving the moisture levels in dry eyes conditions.

In conclusion, prevention is the most important step in management of DES. It involves the ensuring of an ergonomic work environment and practice as well as visual examination and eye care to treat visual disorders. Regular visual examinations can help to prevent or reduce the development of DES.

References

1. Chaitra Jayadey, Puja Sarbajan, and Anand Vinekar (2020 Nov) Impact of the COVID-19 pandemic on digital eye strain in children. Indian Journal of Ophthalmology. 68(11): 2383-2384.
2. Gammoh Y (February 26, 2021) Digital Eye Strain and Its Risk Factors Among a University Student Population in Jordan: A Cross-Sectional Study. Cureus 13(2): e13575. doi:10.7759/cureus.13575
3. Pratyusha Ganne, Shaista Najeeb, Ganne Chaitanya, Aditya Sharma, and Nagesha C Krishnappa (2021) Digital Eye Strain Epidemic amid COVID-19 Pamdemic- A cross-sectional Survey. OPHTHALMIC EPIDEMIOLOGY 2021, VOL. 28, NO. 4, 285–292 https://doi.org/10.1080/09286586.2020.1862243
4. Association AO. Computer vision syndrome. Accessed October 14 2020; Available from: https://www.aoa.org/healthy-eyes/eye-and-vision-conditions/computer-vision-syndrome?sso=y
5. Mark Rosenfield (Jan 2016) Computer vision syndrome (a.k.a. digital eye strain). Optometry in Practice 2016 Volume 17, Issue 1, 1–10
6. Chantal Coles-Brennan, Anna Sulley and, Graeme Young. (2019) Management of digital eye strain. Clinical and Experimental Optometry 2019 ;102: 18-29

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.

Intermittent fasting is a dietary approach that involves interspacing planned periods of fasting with regular eating. It is an eating pattern that cycle between periods of eating and    fasting. It focuses more on when to eat rather than what to eat.

Intermittent fasting works by prolonging the period when the body has burned through the calories consumed from the last meal and begins to burn fat. The body will use up its sugar stores and starts to burn fat after hours of fasting, this process is known as metabolic switching.

Benefits of Intermittent Fasting

Help Lose Weight and Visceral Fat

Intermittent fasting can support hormone function to facilitate weight loss. Lower insulin levels, higher Human Growth Hormone (HGH) levels, and increased amounts of noradrenaline can assist in the breakdown of body fat and facilitate its use for energy. Because of this, fasting actually increases the body metabolic rate and eventually help to burn more calories. According to a 2014 review of the scientific literature, intermittent fasting can cause weight loss of 3–8% over 3–24 weeks.

Lowering risk for Type II Diabetes

Intermittent fasting has been shown to have major benefits for insulin resistance, leading to an impressive reduction in blood sugar levels. In human studies on intermittent fasting, fasting blood sugar has been reduced by 3–6% over the course of 8–12 weeks in people with prediabetes. Fasting insulin has been reduced by 20–31%.

Beneficial for Heart Health

Intermittent fasting improves heart health by controlling the risk factors that lead to heart diseases. The risk factors include blood sugar levels, blood pressures, cholesterol levels and inflammatory markers.

Improve Sleep

Research suggests that intermittent fasting may improve sleeping quality by reinforcing the circadian rhythms.

Types of Intermittent Fasting

Time-Restricted Fasting (16/8 method)

The 16/8 method involves choosing of an eating window (about 8 hours) everyday and fast during the remaining 16 hours. It is also known as the Leangains protocol and can be very simple as we only have to skip our breakfast and not eating anything after dinner.

The easiest way to practice 16/8 method is to choose a 16-hours fasting period which include the time we spent sleeping. For example:

• 9 a.m. to 5 p.m.
• 10 a.m. to 6 p.m.
• 12 a.m. to 8 p.m.

Fast Diet (5:2 method)

It involves eating normal diet 5 days a week and restricting the calorie intake to 500 – 600 in the other 2 days. During the fast, the calorie intake is limited to 500 for women and 600 for men respectively.

For example, we may have normal diet every day of the week except Friday and Saturday. For those 2 days, we can eat 2 or 3 small meals with total calories not exceeding the limit.

Eat Stop Eat

Following this method, one has to practice a 24-hours fast once or twice per week. Important tip here is to eat responsibly after the fast. Eating responsibly refers to eating normal diet where we don’t binge because we just fasted, but we also don’t restrict ourselves with an extreme diet (eating more or less than we need).

For example, if we finish our dinner at 7p.m., then the next meal should be on 7.pm. the next day. By this, we have completed a 24-hours fast. Water, coffee, and zero-calories beverages are allowed during this period to help with the fast.

This method may be difficult for many people to follow. However, we can start with 14 hours fast and slowly increase to 24 hours.

Alternate Day Fasting

There are several different versions of this method. Some of them allow 500 calories (about 25% of calorie need) during the fast and eat normally during the non-fasting days. A full fast every other day can be rather extreme and is not recommended to beginners.

Fasting Tips

1. Drink cinnamon tea during the fast to help suppress the appetite.
2. Exercise just before or during the eating window.
3. Meditation during the fasting period to pass the hunger pangs.
4. Practice balance and healthy diet.
5. Always check with your primary care provider before starting any restrictive eating plan.

Who Should Avoid Intermittent Fasting

1. Teenagers under 18 years old.
2. Pregnant or breastfeeding women.
3. People with diabetes mellitus.
4. People with eating disorders such as anorexia.

References

1. Mosley M, Spencer M. The FastDiet: Lose Weight, Stay Healthy, and Live Longer with the Simple Secret of Intermittent Fasting. Atria Books. 2013
2. Williams KV, Mullen ML, Kelley DE, Wing RR. The effect of short periods of caloric restriction on weight loss and glycemic control in type 2 diabetes. Diabetes Care. 1998;21:2–8.
3. Varady KA, Bhutani S, Klempel MC, et al. Alternate day fasting for weight loss in normal weight and overweight subjects: a randomized controlled trial. Nutr J. 2013;12:146.
4. LeCheminant JD, Christenson E, Bailey BW, Tucker LA. Restricting night-time eating reduces daily energy intake in healthy young men: a short-term cross-over study. Br J Nutr. 2013;110:2108–2113.
5. Ekmekcioglu C, Touitou Y. Chronobiological aspects of food intake and metabolism and their relevance on energy balance and weight regulation. Obesity Reviews. 2011;12:14– 25.

It’s normal to lose hair and we can lose between 50 and 100 hairs a day, often without noticing. Hair loss is not usually anything to be worried about, but occasionally it can be a sign of a medical condition. Baldness typically refers to excessive hair loss from your scalp. Hereditary hair loss with age is the most common cause of baldness. Some types of hair loss are permanent, like male and female pattern baldness.

Types of Alopecia

Signs and Symptoms

1. Gradual thinning on top of head. This is the most common type of hair loss, affecting people as they age. In men, hair often begins to recede at the hairline on the forehead. Women typically have a broadening of the part in their hair.
2. Circular or patchy bald spots. Some people lose hair in circular or patchy bald spots on the scalp, beard or eyebrows. Your skin may become itchy or painful before the hair falls out.
3. Sudden loosening of hair. A physical or emotional shock can cause hair to loosen. Handfuls of hair may come out when combing or washing your hair or even after gentle tugging. This type of hair loss usually causes overall hair thinning but is temporary.
4. Full-body hair loss. Some conditions and medical treatments, such as chemotherapy for cancer, can result in the loss of hair all over your body. The hair usually grows back.
5. Patches of scaling that spread over the scalp. This is a sign of ringworm. It may be accompanied by broken hair, redness, swelling and, at times, oozing.

Causes

• Family history

The most common cause of hair loss is a hereditary condition that happens with aging. This condition is called androgenic alopecia, male-pattern baldness and female-pattern baldness. It usually occurs gradually and in predictable patterns — a receding hairline and bald spots in men and thinning hair along the crown of the scalp in women.

• An Ilness

A variety of conditions can cause permanent or temporary hair loss, including hormonal changes due to pregnancy, childbirth, menopause and thyroid problems.

• Stress

Many people experience a general thinning of hair several months after a physical or emotional shock. This type of hair loss is temporary.

• Cancer treatment
• Weight loss
• Iron deficiency

Prevention

Most baldness is caused by genetics (male-pattern baldness and female-pattern baldness). This type of hair loss is not preventable.

These tips may help you avoid preventable types of hair loss:

• Be gentle with your hair. Use a detangler and avoid tugging when brushing and combing, especially when your hair is wet. A wide-toothed comb might help prevent pulling out hair. Avoid harsh treatments such as hot rollers, curling irons, hot-oil treatments and permanents. Limit the tension on hair from styles that use rubber bands, barrettes and braids.
• Ask your doctor about medications and supplements you take that might cause hair loss.
• Protect your hair from sunlight and other sources of ultraviolet light.
• Stop smoking. Some studies show an association between smoking and baldness in men.
• Avoid high-heat hair styling tools.
• Don’t chemically treat or bleach your hair.
• Use a shampoo that’s mild and suited for your hair

Treatment

Most hair loss does not need treatment and is either temporary and it’ll grow back or a normal part of getting older. However, effective treatments for some types of hair loss are available. Treatments for hair loss include medications and surgery.

Medication

• Minoxidil (Regro, Minox). Products with minoxidil help many people regrow their hair or slow the rate of hair loss or both. It’ll take at least six months of treatment to prevent further hair loss and to start hair regrowth. It may take a few more months to tell whether the treatment is working for you. If it is helping, you’ll need to continue using the medicine indefinitely to retain the benefits. Possible side effects include scalp irritation and unwanted hair growth on the adjacent skin of the face and hands.

• Finasteride (Propecia). This is a prescription drug for men. You take it daily as a pill. Many men taking finasteride experience a slowing of hair loss, and some may show new hair growth. It may take a few months to tell whether it’s working for you. You’ll need to keep taking it to retain any benefits. Finasteride may not work as well for men over 60. Rare side effects of finasteride include diminished sex drive and sexual function and an increased risk of prostate cancer. Women who are or may be pregnant need to avoid touching crushed or broken tablets.

• Other medications. Other oral options include spironolactone and oral dutasteride (Avodart).

Hair Transplant Surgery

In the most common type of permanent hair loss, only the top of the head is affected. Hair transplant, or restoration surgery, can make the most of the hair you have left. During a hair transplant procedure, a dermatologist or cosmetic surgeon removes hair from a part of the head that has hair and transplants it to a bald spot. Each patch of hair has one to several hairs (micrografts and minigrafts). Sometimes a larger strip of skin containing multiple hair groupings is taken. This procedure doesn’t require hospitalization, but it is painful so you’ll be given a sedation medicine to ease any discomfort. Possible risks include bleeding, bruising, swelling and infection. You may need more than one surgery to get the effect you want. Hereditary hair loss will eventually progress despite surgery.

Supplements

• Biotin

Biotin (vitamin B7) is important for cells inside your body. Low levels of it can cause hair loss, skin rashes, and brittle nails.

• Zinc

Zinc can play a key role in making proteins in your hair and other cells. Your body can’t make it, so you need to get it from food or supplements. Signs of low zinc levels include hair loss, poor wound healing, and a weak sense of taste or smell. 

References

1. Androgenetic alopecia. Retrieved from: https://medlineplus.gov/genetics/condition/androgenetic-alopecia/#references
2. Hair loss. Retrieved from: https://www.mayoclinic.org/diseases-conditions/hair-loss/symptoms-causes/syc-20372926
3. Wasserman D, Guzman‐Sanchez DA, Scott K, McMichael A. Alopecia areata. International journal of dermatology.

Pneumonia is an infection that causes inflammation of the air sacs in one or both lungs. The air sacs may be filled with fluid or pus (purulent material) which causes cough with phlegm or pus, fever, chills, and difficulty in breathing. There are a variety of organisms that can cause pneumonia which includes bacteria, viruses and fungi.

Pneumonia can be mild or even life-threatening. It can cause most serious damage to infants and young children, people older than age 65, and people with health problems or weakened immune systems.

Symptoms

The signs and symptoms of pneumonia may vary for different individuals. It depends on factors such as the type of bacteria causing the infection, the patient’s overall health. Besides, the signs and symptoms can range from mild to severe. Mild signs and symptoms usually are almost identical to those of a common cold or flu; however, they will last longer.

Most of the pneumonia patients will experience chest pain when breathing or coughing, having confusion, productive cough (with phlegm), fatigue, fever, sweating, chills, nausea, vomiting, diarrhea and shortness of breath. For patients age 65 and above, they also experience signs and symptoms such as changes in mental awareness and lower body temperature. There may be no signs or symptoms at all in newborns and infants. However, some newborns and infants may vomit, fever, cough, lethargy and have difficulty in breathing and eating if they are infected.

Causes

The common causes of pneumonia include viruses, bacteria and fungi. For example, the common causes of viral pneumonia are influenza, respiratory syncytial virus (RSV), and SARS-CoV-2 (the virus that causes COVID-19). On the other hand, the common cause of bacterial pneumonia is Streptococcus pneumoniae (pneumococcus). However, it is hard for the physicians to detect which bacteria causes the pneumonia in patients.

We also say it is community-acquired pneumonia when someone got the pneumonia in the community (not in a hospital). While if someone develops pneumonia in a healthcare setting (hospital, long-term care facilities, dialysis centre), that would be considered as healthcare-associated pneumonia. Ventilator-associated pneumonia is when someone develop pneumonia after using ventilator (a machine that supports breathing).

Risk Factors

Pneumonia can affect anyone regardless of the age; however, children under 2 years old and adult above 65 years old are at the highest risk to get pneumonia. Even the signs and symptoms are more severe in this age group.

There are few risk factors that may contribute to developing of pneumonia, such as being in hospital as the patient’s immune system is already weakened especially if the patient is using a ventilator, the risk is even greater. Having a chronic disease such as COPD, asthma, heart disease, diabetes will pose a greater risk to the patient. People with suppressed immune system either due to disease or taking immunosuppressants will also have a greater risk of contracting pneumonia. 

There are some lifestyles that will increase the risk of getting pneumonia. For example, smoking will compromise the immune system’s ability to defend itself. Drug or excessive alcohol use will also increase the risk of developing pneumonia as one may aspirate food, drink or vomit into the lungs. Being malnutrition also contributes to a higher risk of contracting pneumonia and a higher death risk.

Treatment

A mild pneumonia can be usually treated at home with rest and antibiotics (if the cause is bacteria). Drinking plenty of fluid is also necessary in recovery from pneumonia. Antibiotics should be taken as prescribed by doctors following the course even if the patient already feels better. This is because if stopped half way without finishing the antibiotic course, it will create an antibiotic resistant in the bacteria which help the bacteria to evolve and become stronger. There is a general guideline for the recovery of pneumonia.

• 1 week: high temperature should have reduced
• 4 weeks: chest pain and mucus production should have slowly decreased
• 6 weeks: cough and breathlessness should have substantially reduced
• 3 months: most symptoms should have reduced, just the patient may still feel fatigue
• 6 months: many people will feel back to normal

However, if there is no improvement after three days of starting antibiotics, the patient should go to doctor. This may due to the bacteria causing the infection is actually resistant to the antibiotic prescribed by the doctors or the pneumonia is not caused by bacteria rather it is caused by virus.

Painkillers such as paracetamol and ibuprofen usually will be given also to cope with the pain and fever. Cough medicine can also help to relive the cough and phlegm so that the patient can have a good rest.

There will usually be a follow up with doctor after 6 weeks of starting an antibiotics course. A chest X-Ray may be needed for patient whose symptoms have no improvement at all or the symptoms come back after they have gone away.

Hospitalization may be needed for patient who is older than 65 years old, having signs of confusion, declined kidney function, low blood pressure, rapid breathing, need breathing assistance, low body temperature or a rapid heart rate.

Prevention

Pneumonia can be prevented by getting vaccination. Taking a flu shot every year can help to prevent seasonal flu. It is important as flu is a common cause of pneumonia. Certain group of people should also take vaccination against pneumococcal pneumonia as it is a common form of bacterial pneumonia. This group of people includes children younger than 2, children aged 2 to 5 but with chronic disease, adults aged 19 to 64 with chronic disease such as asthma, COPD, diabetes and also includes all adults older than 65 years old.

Regularly hand washing especially after coughing or blowing your nose can also reduce the risk of getting pneumonia. Avoid smoking as tobacco damages the lungs’ ability to fight infection, which will expose the smoker to higher risk of getting pneumonia.

Good habits such as eating healthy diet, having sufficient rest and exercise regularly can keep one from illness. They also help to boost the recovery from respiratory illness such as cold and flu. Patient with existing respiratory health conditions such as asthma, COPD, diabetes and heart disease should also manage their condition well to lower the risk of getting pneumonia.

Reference

– Pneumonia. https://www.mayoclinic.org/diseases-conditions/pneumonia/symptoms-causes/syc-20354204#:~:text=Pneumonia%20is%20an%20infection%20that,and%20fungi%2C%20can%20cause%20pneumonia. Mayo Clinic. June 13, 2020.
– Causes of Pneumonia. https://www.cdc.gov/pneumonia/causes.html#:~:text=Common%20Causes%20of%20Pneumonia,is%20Streptococcus%20pneumoniae%20(pneumococcus). Centers for Disease Control and Prevention. October 22, 2020.
– Causes and Risk Factors of Pneumonia. https://www.verywellhealth.com/pneumonia-causes-risk-factors-770691. Verywell Health. Accessed April 8, 2022.
– The impact of childhood malnutrition on mortality from pneumonia: a systematic review and network meta-analysis – World. https://reliefweb.int/report/world/impact-childhood-malnutrition-mortality-pneumonia-systematic-review-and-networkmeta#:~:text=We%20estimated%20a%20median%2018.3,dramatically%20increases%20with%20malnutrition%20severity. ReliefWeb. Accessed April 8, 2022.
-https://www.nhs.uk/conditions/pneumonia/treatment/#:~:text=Mild%20pneumonia%20can%20 usually%20be,cases%20may%20need%20hospital%20treatment. NHS Choices. Accessed April 8, 2022.
– Preventing Pneumonia. https://www.lung.org/lung-health-diseases/lung-disease-lookup/pneumonia/preventing-pneumonia#:~:text=Get%20a%20flu%20shot%20every,Children%20younger%20than%202. American Lung Association. Accessed April 9, 2022.

Superfood is a term that is commonly used to describe foods that offers multiple health benefits through its nutrient contents, beyond providing energy. Consumption of these foods is linked with disease prevention and improved quality of life.

The idea of superfoods offers longevity and vitality has long been described in various cultures. Recent findings on essential fatty acids, dietary fibers, essential micronutrients and antioxidants make them the main substances related to superfoods.

Superfood such as Omega-3 and Omega-6 fatty acids must be obtained in diet as the human body does not produce them naturally. Better known types of omega-3 fatty acids, Eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) are mainly associated with benefits for the heart. They reduce inflammation, improve blood flow, prevent formation of fat deposit in blood vessel, and reduce triglyceride levels. Consuming a diet enriched with EPA and DHA can lead to less frequent and milder headache in patients with migraine, while moderate intakes may also delay cognitive function decline in elderly men. Some studies suggest that dietary interventions combined with pharmacological treatments might have an additive benefit in prevention of such condition.

Micronutrients are vitamins and minerals which are consumed in small quantities but are nonetheless essential for physical and mental development. There is a long list of essential micronutrients, however the ones that are particularly deficient in diets include iron, zinc, calcium, iodine, vitamin A, B-vitamins, and vitamin C. Effects of these micronutrient deficiency includes night blindness, eyesight problems, anemia and stunted growth.

Some superfoods confer benefit to digestive health via dietary fibers. These includes soluble fibers (inulin) and non-digestible carbohydrates (oligosaccharides), better known as prebiotics that helps nourish microflora in the intestines. Insoluble fibers help with bowel movement, reduces risk of intestinal diseases and helps in weight control.

Phytochemicals found in plants provide their colors and characteristic smell. There are multiple different types of known phytochemicals which includes tannins, flavonoids, and saponins. These chemicals are produced by plants for their own benefit and do not have nutritional value for human. Yet, they have been found to provide multiple health benefits via antioxidant properties, hailed for preventing cancer, protecting cells from damage, and reducing signs of ageing.

One popular example of superfood would be the Goji berry, originating from China. Also known commonly as Wolfberry, they contain phytochemicals zeaxanthin dan carotene which are important in maintaining healthy eyesight. They can be taken as part of the diet, providing energy through complex sugar and protein contents. Carbohydrates betaine, cerebroside, beta-sitosterol in Goji berry help counter nerve damage in neurodegenerative diseases and protect the eyes from glaucoma –both are important especially in ageing populations.

A lot of wholegrains have also been discussed to have superfood property. An analysis of more than 3000 middle- and older-aged American adults over years indicates taking more whole grains in diet may protect against heart disease. Person who ate at least 3 servings of whole grains daily had smaller increases in blood sugar levels, blood pressure, and waist size compared with persons who ate less than one-half serving per day.

An excellent example of super grain is Quinoa. It provides a rich supply of protein, dietary fibers, several B vitamins, dietary minerals, magnesium, phosphorus, and manganese. Quinoa seeds also have low glycemic index, it provides energy source in small, lasting amount, which makes it a good staple food item. Raw quinoa seeds provide polyphenols at a higher level compared to many fruits and vegetables. Polyphenols are known to have powerful anti-inflammatory benefits for the body, and it is believed that they could help to reduce the risk of some cancers, cardiovascular disease and other illnesses too. Indigestible carbohydrate fibres called oligosaccharides found in the grain act as prebiotic, they provide nutrients for intestinal microflora.

Pumpkin, a fruit that is more nutritionally similar to vegetables, is a filling, nutrient-dense food with multiple health benefit. It’s very high in antioxidants, such as alpha-carotene, beta-carotene and beta-cryptoxanthin. These can neutralize free radicals, stopping them from damaging human cells. High content of vitamins A, C, and E, iron and folate help strengthen immunity. Pumpkins’ high vitamin A, lutein and zeaxanthin contents can protect the eyes against sight loss, which becomes more common with age. Pumpkin is also a good source of fiber and helps suppress appetite. It has mildly diuretic property, eating a lot of pumpkin may induce a “water pill”-like reaction, increasing the amount of water and salt the body expels through urine. This is particularly beneficial for people concerned with their blood pressure.

The beetroot is the taproot portion of a beet plant, one of several cultivated varieties of Beta vulgaris. Beetroot had been used as part of traditional remedy for multiple health benefits, particularly relating to blood and heart health. Studies have shown that beetroot juice can modestly help reduce blood pressure. Beetroot can be eaten raw, used for juice extraction, baked or boiled. Polyphenols and dietary fiber in red beetroot juice helps diminish blood cholesterol level by stimulating excretion of cholesterol in intestines. It has also been studied to stop weight gain and reduce cholesterol in obese individuals. Beetroot is rich in soluble dietary fiber that provide moderate increase in blood sugar level post-meal, and especially beneficial in pre-diabetic.  Regular consumption as part of diet also appears to positively influence physiological response to exercise. Therefore, beet root is an especially valuable super food for people concerned with their body weight and cardiovascular risks.

Although a lot of superfoods are from plant origin, fatty fishes are one of the exceptions. They provide essential proteins not commonly found in plants, which the human body use for energy production, growth, and repair. Fatty fishes found in cold water such as salmon, trout, and sardines contain higher level of omega-3 fatty acids compared to their warm-water counterparts. These benefits are however offset by risk of heavy metal contamination in larger fish. Thus, it is only recommended to take one to two servings of the fish weekly.

To get the best result from superfoods, is it best to consume them raw, cooked, or processed? The answer depends on which superfood one is referring to. In general, taking them as closely to their natural form is preferable to retain its nutrients. Juicing of beetroots, natural drying of goji berries, and removing the outermost shell of quinoa helps improve palatability and ease consumption. However, excessive consumption beyond dietary recommendation exposes to other risks. Red beet root, for example, accumulates oxalic acid responsible for causing kidney stones. Larger fatty fish may also have heavy metal content in their muscle tissue and may adversely affect some populations proportionately. In these cases, taking pre-processed food or supplements focusing on their benefit may be the wiser choice.

Most of the studies that display theoretical health benefits of these food products would use extracts in laboratory. In experimental studies, the method to gain the extract themselves are usually more vigorous than is possible in human digestive system. Therefore, a lot of the supporting studies may overestimate or underestimate the actual health benefit when we consume the food as part of our diet.

It is also important to note that phytochemical content may vary among species, cultivation method, and food handling prior to consumption. The magnitude of potential risks that may be associated with phytochemicals is still unclear, especially when taken in large doses as supplements. These extracted substances may have possible side effects or may interact with other substances in the body, e.g., medications. There are only few documented cases suggesting that certain phytochemicals may also be harmful. For instance, some studies have shown that overdosing on beta-carotene may increase the risk of lung cancer in smokers. Therefore, you should always speak to your healthcare provider before taking phytochemical supplements. Taking it as functional food in moderation is probably safer in the long run.

To quote the 2021 Dietary Guidance to Improve Cardiovascular Health scientific statement, developed under chair of the American Heart Association’s writing group, one can improve cardiovascular health and reduce cardiovascular risk with an emphasis on dietary patterns and food-based guidance beyond naming individual foods or nutrients. It is important to first emphasize on balanced diet, and to take superfoods strategically to enrich our nutrient consumption.

References

1. Quinoa – Wikipedia [Internet]. En.wikipedia.org. 2022 [cited 18 April 2022]. Available from: https://en.wikipedia.org/wiki/Quinoa
2. 9 Super Grains With Health Benefits You Need to Try [Internet]. HubPages. 2022 [cited 18 April 2022]. Available from: https://discover.hubpages.com/health/Super-Grains-Your-Guide-To-The-Newest-Hollywood-Superfoods
3. Superfoods or Superhype? [Internet]. The Nutrition Source. 2022 [cited 18 April 2022]. Available from: https://www.hsph.harvard.edu/nutritionsource/superfoods/
4. Barsby J, Cowley J, Leemaqz S, Grieger J, McKeating D, Perkins A et al. Nutritional properties of selected superfood extracts and their potential health benefits. PeerJ. 2021;9:e12525.
5. The Role of Proteins, Fats and Carbohydrates in Our Diet and Health [Internet]. Healthpedian.org. 2022 [cited 18 April 2022]. Available from: https://www.healthpedian.org/the-role-of-proteins-fats-and-carbohydrates-in-our-diet-and-health/
6. Omega-3-enriched diet cuts headache days | Latest news for Doctors, Nurses and Pharmacists | Pharmacy [Internet]. MIMS News. 2022 [cited 4 April 2022]. Available from: https://specialty.mims.com/topic/omega-3-enriched-diet-cuts-headache-days-in-migraine-
7. Kendall C, Esfahani A, Jenkins D. The link between dietary fibre and human health. Food Hydrocolloids. 2010;24(1):42-48.
8. Ritchie H, Roser M. Micronutrient Deficiency [Internet]. Our World in Data. 2022 [cited 3 February 2022]. Available from: https://ourworldindata.org/micronutrient-deficiency?utm_medium=syndication&utm_source=scribd#hidden-hunger-index
9. Goji berries a potential arsenal against age-related macular degeneration | Latest news for Doctors, Nurses and Pharmacists | Multidisciplinary [Internet]. MIMS News. 2022 [cited 18 April 2022]. Available from: https://specialty.mims.com/topic/goji-berries-a-potential-arsenal-against-age-related-macular-degeneration?channel=multi-specialty&utm_medium=email&_hsmi=202393192&_hsenc=p2ANqtz-9bZXdq_h6_uBQH5DFoIcHXH-iS6Za-A0TknP3rGbXfJvYHIX78OtHoVU4MvlP-E88nUmrjbXdxANrUdkqdI0dmHTgCVQ&utm_content=202393192&utm_source=hs_email
10. Phytochemicals and their Potential Health Benefits [Internet]. Healthpedian.org. 2022 [cited 18 April 2022]. Available from: https://www.healthpedian.org/phytochemicals-and-their-potential-health-benefits/
11. Sawicki C, Jacques P, Lichtenstein A, Rogers G, Ma J, Saltzman E et al. Whole- and Refined-Grain Consumption and Longitudinal Changes in Cardiometabolic Risk Factors in the Framingham Offspring Cohort. The Journal of Nutrition. 2021;151(9):2790-2799.
12. Barsby J, Cowley J, Leemaqz S, Grieger J, McKeating D, Perkins A et al. Nutritional properties of selected superfood extracts and their potential health benefits. PeerJ. 2021;9:e12525.
13. Saravanan V, Manokaran S. Physico-chemical studies and evaluation of diuretic activity of &lt;i&gt;Cucurbita maxima&lt;/i&gt;. Bangladesh Journal of Pharmacology. 2012;7(4).
14. Beetroot – Wikipedia [Internet]. En.wikipedia.org. 2022 [cited 18 April 2022]. Available from: https://en.wikipedia.org/wiki/Beetroot
15. Siervo M, Lara J, Ogbonmwan I, Mathers J. Inorganic Nitrate and Beetroot Juice Supplementation Reduces Blood Pressure in Adults: A Systematic Review and Meta-Analysis. The Journal of Nutrition. 2013;143(6):818-826.
16. Vega C. What Is a Heart-Healthy Diet? American Heart Association Weighs in With New Dietary Recommendations. Presentation presented at; 2021; Medscape.org.

Types

Technically there is a huge difference between sunblock and sunscreen. Sunblock, as its name suggested, uses physical blockers like zinc or titanium oxide to guard the skin against UV rays. On the other hand, sunscreen uses active ingredients that readily absorb the sun’s rays. The active ingredients of sunscreens are more easily absorbed into the skin.

Choose The Right One

1. Broad Spectrum Sunscreen

This type of sunscreen protects against both UVA and UVB rays. UVA rays are the one that contribute to skin cancer and premature aging while UVB rays can cause sunburn. Only products that pass a certain test can be labeled “broad spectrum.” Most of the products aren’t broad spectrum hence they can only protect against sunburn, not skin cancer or skin aging.

2. Sun Protection Factor (SPF)

SPF is a measure of how much UVB light can be filtered out by a sunscreen. The American Dermatology Association (ADA) recommends using an SPF of at least 30. SPF 15 blocks about 93 percent of UVB rays, while SPF 30 blocks about 97 percent of UVB rays. 

3.Your Skin Type

For those who have dry skin should pick a sunscreen that doubles as a moisturizer.

For those who have oily and acne-prone skin, a water-based sunscreen instead of oil-based sunscreen is recommended.

On the other hand, for those with skin that is more sensitive and prone to irritation, they shall avoid products with alcohol, preservatives, fragrances, and oxybenzone.

The best sunscreen for kids should be at least SPF50. Choose sunscreens that are specifically made for kids as adult sunscreens can sometimes irritate their gentle skin. Babies need even stronger sun protection, as their skin is thinner and more. sensitive.

4.Level Of Sun Exposure

Duration of exposure to sunlight, the weather, and type of activities while being exposed to the sun are the factors that need to be taken into consideration. Typically, the strength of the sun is measured by the Ultraviolet (UV) Index, which ranges from 1 (low) to 11+ (extreme). These UV rays are the strongest from 10 a.m. to 4 p.m., and when the UV Index is at 8 or above, our unprotected skin can burn in 15 minutes or less.

For instances,

– Outdoors: choose sunscreen with at least SPF 30 or higher if you are mostly outdoors for an extended period (two hours or more), depending on your skin color.

– Sports/swimming: choose a sweat-resistant or water-resistant sunscreen with at least SPF 30 or higher, depending on your skin color, and reapply every 40 to 60 minutes.

– Every day: choose sunscreen with at least SPF 15 on regular basis if you will be in the sun and shade.

5. Types of Formulation and Packing

Sunscreen formulation refers to how a sunscreen is formulated either an oil-in-water or water-in-oil emulsion. It can be formulated in lotion, gel or cream thus it will give different textures and looks on an individual’s skin.

There are few common sunscreen formulations available on the market such as sunscreen sprays, sunscreen lotion and sunscreen stick. In general, all sunscreens have a shelf life of three years from the date of manufacture.

6. Water Resistance

There is a myth saying that “water resistant” means “waterproof.” No sunscreens are waterproof or “sweatproof,” you’ll need to reapply once you expose your skin to water with the product on, after a stipulated amount of time. Usually, reapplication of sunscreen at least every 2 hours is most favorable. If a product’s label makes claims of being water resistant, it must indicate whether it lasts for 40 minutes or 80 minutes while swimming or sweating.

Tips for sun-safe

• Wear clothing and wide-brimmed hat to protect the skin as much as possible. Pair up with sunglasses that block at least 99 percent of UV light to protect your eyes
• Look for shade. Limit direct exposure to the sun, especially between the hours of 10 a.m. and 4 p.m., when UV rays are the strongest.
• Avoid tanning beds and sunlamps. 
• Always remember to apply sunscreen or sunblock 15 minutes before you go outdoor to maximize the benefit of sunscreen.

References

1. How to choose the best sunscreen, according to these dermatologists. [Internet]. Better By Today. 2019 [cited 5th June 2022]. Available from: https://www.nbcnews.com/better/lifestyle/how-choose-best-sunscreen-according-these-dermatologists-ncna1002451?featureFlag=true#anchor-NextconsidertheSunProtectionFactorSPF
2. How to Choose Sunscreen. [Internet]. StyleCraze. 2022 [cited 5th June 2022]. Available from https://www.stylecraze.com/articles/things-to-consider-when-choosing-a-sunscreen/
3. How Does Sunscreen Work to Protect Your Skin? [Internet]. Colorescience. 2018.[cited 5th June 2022]. Available from https://www.colorescience.com/blogs/learn/how-does-sunscreen-work-to-protect-your-skin
4. Sunscreen: How to Help Protect Your Skin from the Sun. [Internet]. FDA. 2021. [cited 5th June 2022]. Available from https://www.fda.gov/drugs/understanding-over-counter-medicines/sunscreen-how-help-protect-your-skin-sun
5. Choose the Right Sunscreen. [Internet]. cancer.org 2018. [cited 5th June 2022]. Available from https://www.cancer.org/latest-news/choose-the-right-sunscreen.html
6. How To Choose Sunscreen To Suit Your Skin Type. [Internet]. Dermaster. 2021.  [cited 5th June 2022]. Available from https://dermaster-thailand.com/en/resource/how-to-choose-sunscreen-to-suit-your-skin/

Hepatitis is an inflammation of the liver that is caused by a variety of infectious viruses and non-infectious agents such as drugs, toxic agents, alcohol or certain genetic disorders leading to a range of health problems, some of which can be fatal. In some cases hepatitis is also the result of auto-immune reaction when the immune system mistakenly attacks the liver.

There are five main viral classifications of hepatitis, which are hepatitis A, B, C, D, and E. Different virus is responsible for each type of viral hepatitis. The World Health Organization (WHO) estimates that around 354 million people are currently living with hepatitis B and C.

Hepatitis A

Hepatitis A is caused by hepatitis A virus (HAV). It can be spread through contaminated food and water. It is the easiest to be transmitted from one person to another person, especially among children, but is also the least likely to damage the liver. This type of infection is a short-term disease and is completely resolved within six months.

Hepatitis B

Hepatitis B is caused by hepatitis B virus (HBV). It can be spread through exposure to contaminated blood, needles, syringes or bodily fluids and from mother to baby. This is a chronic condition, in some cases it may lead to liver damage, liver cancer and cirrhosis in long term.

Hepatitis C

Hepatitis C is caused by hepatitis C virus (HCV). Hepatitis C is only transmitted through infected blood or from mother to baby during childbirth. It also can lead to cirrhosis and liver cancer in long term.

Hepatitis D

Hepatitis D is only found in people who are also infected with hepatitis B.

Hepatitis E

Hepatitis E is a waterborne disease that results from exposure to the hepatitis E virus (HEV). Hepatitis E is usually spread via contact with food or water that was contaminated with an infected person’s stool.

Autoimmune Hepatitis

In some cases, the immune system mistakes the liver cells as harmful invaders and attacks them. This causes ongoing inflammation that can range from mild to severe, often hindering liver function. It’s three times more common in women than in men.

Symptoms

Fever, malaise, loss of appetite, diarrhea, nausea, abdominal discomfort, dark-coloured urine and jaundice.

Causes

• Viral hepatitis can be caused by several viruses such as hepatitis viruses A, B, C, D, and E. 
• Alcoholic hepatitis can be caused by excess alcohol consumption.
• Toxic hepatitis can be caused by certain medicines, chemicals, poisons.
• Autoimmune happens when the immune system attacks liver cells, this condition is usually chronic.

Risk of Hepatitis

• Sharing needles or other objects that might be contaminated with hepatitis viruses
• Engaging in unsafe sexual contact, such as not using a condom during sex, having rough sex, or having multiple sexual partners
• Working around toxic chemicals. Examples of occupations routinely exposed to such chemicals include dry cleaners, painters, healthcare providers, or farm workers.
• Drinking untreated water or eating food that has not been safely or properly prepared (ex. unwashed produce)
• Drinking large quantities of alcohol over a long period of time
• Taking medications believed to be linked to hepatitis
• Not being vaccinated against viral hepatitis, specifically HAV and HBV
• Having an acute or chronic infection with one or more hepatitis viruses
• Having an autoimmune disorder, such as autoimmune polyendocrinopathy candidiasis ectodermal dystrophy (APECE)
• Being born to a mother who is infected with a hepatitis virus, particularly hepatitis B

Diagnosis of Hepatitis

• Doctor will first take your medical history and symptoms.
• Physical exam will be done, which may or may not reveal a swollen, enlarged liver.
• Liver function tests, blood test (to check the presence of viral hepatitis) or ultrasound
• A liver biopsy to check for liver damage.

Treatment of Hepatitis

Treatment for hepatitis depends on which type of hepatitis you have and whether it is acute or chronic.

• Bed rest, refraining from alcohol, and taking medication to relieve symptoms.
• Most people who have hepatitis A and E get well on their own after a few weeks.
• Chronic Hepatitis B can be treated with antiviral medications
• Hepatitis C can be treated with a combination of antiviral drugs.
• Liver transplant may be needed if patient’s chronic hepatitis may lead to liver failure or liver cancer.

Prevention of Hepatitis

Get vaccines for hepatitis A and hepatitis B

Vaccination for hepatitis A is available and can help to prevent the contraction of HAV. The hepatitis A vaccine is a series of two doses and most children will be vaccinated at age 12 to 23 months. This vaccination is also available for adults and can also include the hepatitis B vaccine.
The CDC recommends hepatitis B vaccinations for all newborns. Doctors typically administer the series of three vaccines over the first 6 months of childhood.
The CDC also recommends the vaccine for all healthcare and medical personnel. Vaccination against hepatitis B can also prevent hepatitis D.
There are currently no vaccines that can prevent contraction of hepatitis C or E.

• Wash your hands after going to the bathroom and before handling food or eating.
• Use latex condoms, which may lower the risk of transmission.
• Don’t share drug needles.
• Don’t share personal items such as toothbrushes, razors and nail clippers with an infected person.
• Avoid raw or undercooked shellfish and oysters
• Take precautions when getting any tattoos or body piercings.
• Take precaution when traveling to areas of the world with poor sanitation. (Make sure to get vaccinated before your trips.)
• Drink bottled water when traveling.

References

World Health Organization (WHO). Hepatitis. Available at  https://www.who.int/health-topics/hepatitis#tab=tab_1
Healthline. Hepatitis. Available at https://www.healthline.com/health/hepatitis
MedlinePlus. Hepatitis. Available at https://medlineplus.gov/hepatitis.html
Johns Hopkins medicine. Health. Hepatitis. Available at https://www.hopkinsmedicine.org/health/conditions-and-diseases/hepatitis
Verywell health. Causes and risk factors of hepatitis. Available at  https://www.verywellhealth.com/hepatitis-causes-and-risk-factors-4689127#:~:text=Environmental%20risk%20factors%20associated%20with,blood%20infected%20with%20hepatitis%20viruses
Cleveland clinic. Viral hepatitis. Available at https://my.clevelandclinic.org/health/diseases/4245-hepatitis-viral-hepatitis-a-b–c#:~:text=There%20are%20many%20ways%20you,washing%20with%20soap%20and%20water

What is acne? Acne or pimples can present as whiteheads or blackheads (close and open comedones) or inflamed papules, nosules or cysts. (1)

The severity of acne is often categorized as:

• Mild which is mostly whiteheads and blackheads, with a few papules and pustules;
• Moderate which is more widespread whiteheads and blackheads, with many papules and pustules;
• Severe which has lots of large, painful papules, pustules, nodules or cysts and you may also have some scarring! (2)

So, how is acne formed? There are three main factors for acne formation. Let’s see the factors as belows:

1. The skin cells are not shredded properly which cause plugging of pores.
2. Androgen hormones which are present in both males and females regulate oil production in the skin. During adolescence, increased androgens or increased response to androgen can cause increased oil or sebum production.
3. Overgrowth of Propionibacterium acnes bacteria within hair follicles.
4. All the above factors will eventually cause inflammation and swelling of the hair follicles, result in acne formation. (1)

Do you know what factors that may worsen acne?

• Milk and foods with high glycemic index such as white rice, glutinous rice, white bread, cornflakes, fried noodles, boiled potato, watermelon and the tarik may worsen acne.
• Stress may also worsen acne. In some studies, exam stress worsens their acne.
• Smoking may worsen acne too when smoker has lower level Vitamin E and cause higher level of oxidized sebum.

Acne Do’s

1. Wash your face twice a day with water and gentle, oil-free cleanser.
2. If you wear make-up, preferably use oil-free and water-based products and remove them before sleep.
3. Apply acne medication to manage blemishes. Make sure you understand how to apply them correctly to get maximum benefit.
4. Use a water-based moisturizer to keep skin soft, smooth and hydrated if necessary.
5. Shampoo regularly and keep your hair off your face if you have long hair.
6. Replace cosmetic sponges and old brushes regularly to reduce bacteria.
7. Drink plenty of water, eat balanced diet and exercise regularly.
8. Stop smoking
9. Seek the advice from doctor if your skin condition doesn’t improve.

Acne Don’t

1. Do not ignore your acne as it may cause permanent scarring
2. Do not squeeze or pick your acne as this can deepen the inflammation and cause scarring.
3. Do not use harsh scrubs and cleansers that may irritate or dry your skin.
4. Do not expose your skin to extreme temperature or sunlight.
5. Do not use greasy oil-based cosmetics that can clog pores and trigger breakouts.

Treatment for Acne

Mild Acne
You may use commercial products. Otherwise, one topical agent can be considered.

Moderate Acne
A combination of 2 topical agents or if more severe, an oral antibiotic (prescription-only) to be prescribed by a doctor.

Severe Acne
In presence of nodulocystic acne or acne not responding to treatment, referral to a dermatologist is required. (1)

Reference

• Patient Information Leaflet Acne Vulgaris. Malaysia: Ministry of Health, Dermatological Society of Malaysia, Academy of Medicine Malaysia; June 2012.
• NHS. Acne [Internet]. United Kingdom; 2019 [updated 2022 July 12; cited 2022 Aug11]. Available from: https://www.nhs.uk/conditions/acne/diagnosis/

What is high altitude sickness?

Ascending to or being at a new high altitude may cause high-altitude sickness. High altitude sickness includes acute mountain sickness (AMS), high-altitude cerebral edema (HACE) and high-altitude pulmonary edema (HAPE). High altitude sickness is a condition that occurs when people ascend to high altitudes (usually above 8,000 feet or 2,400 meters) too quickly without acclimatizing properly. Altitude sickness is caused by a lack of oxygen in the air, which can lead to a range of symptoms that can range from mild to life-threatening.

Acute mountain sickness (AMS)

Acute mountain sickness (AMS) is the most common of the altitude diseases; it occurs in approximately 40 to 50 percent of people who live at a low altitude and sleep at an altitude above 10,000 feet (3000 m), and in approximately 25 percent of those sleeping above 8000 feet (2400 m). Some people can develop AMS as low as 6500 feet (2000 m).

High-altitude cerebral edema (HACE)

High-altitude cerebral edema (HACE) is a rare, life-threatening altitude disease and is a severe form of acute mountain sickness (AMS). It is caused by leaky capillaries in the brain, which causes fluid accumulation and brain swelling. You may experience confusion, lack of coordination and possibly violent behaviour.

High-altitude Pulmonary Edema (HAPE)

High-altitude pulmonary edema (HAPE) is a potentially fatal condition in which lung capillaries leak and fluid accumulates in the lungs, causing breathlessness, even when resting. You feel very fatigued and weak and may feel like you’re suffocating. HAPE is uncommon but can occur in people who rapidly ascend to altitudes above 8200 feet (2500 m).

Symptoms

The symptoms of high-altitude sickness can range from mild to severe and usually appear within 6 to 24 hours after arrival at high altitude. The most common symptoms include:

• Headache
• Nausea
• Vomiting
• Fatigue
• Loss of appetite
• Dizziness
• Insomnia
• Shortness of breath
• Rapid heart rate

In severe cases, high altitude sickness can progress to high altitude cerebral edema (HACE) or high altitude pulmonary edema (HAPE), which can be life-threatening.

Risk Factors

It is not possible to know in advance if you will become ill when traveling to a high altitude. In addition, being physically fit does not decrease your chances of developing a high-altitude illness. However, certain groups are at increased risk, including people who:

• Have a prior history of high-altitude illness
• Overexert themselves before adjusting to the change in altitude
• Ascend rapidly (eg, within one day) from low elevation to sleeping altitudes above 9000 feet (2750 m)
• Have a medical problem that affects breathing

Treatment

The treatment for high altitude sickness depends on the severity of the condition. Mild symptoms of altitude sickness can often be relieved by descending to a lower altitude, resting, oxygen therapy and taking over-the-counter pain medications such as acetaminophen or ibuprofen. However, more severe cases of altitude sickness may require medical attention. Here are some treatments for high altitude sickness:

1. Medication

• Acetazolamide (Diamox) can help alleviate symptoms of altitude sickness by stimulating breathing and reducing fluid buildup in the lungs. However, it is important to consult with a healthcare provider before taking any medication.
• Dexamethasone is a steroid medication that can be used to treat severe cases of altitude sickness, such as high altitude cerebral edema (HACE).

2. Oxygen therapy

If you experience severe altitude sickness symptoms, oxygen therapy may be necessary to alleviate symptoms and prevent further complications.

Prevention

1. Gradual ascent. The best way to prevent high altitude sickness is to acclimatize properly. This involves gradually ascending to higher altitudes over several days, allowing the body to adjust to the lower oxygen levels.
2. Staying hydrated. Dehydration can worsen altitude sickness symptoms. Drink plenty of fluids, even if you don’t feel thirsty.
3. Eating a well-balanced diet. Eat a diet that’s more than70% carbohydrate as can help provide the energy and nutrients needed to cope with the physical stress of high altitude.
4. Avoiding alcohol. Alcohol can dehydrate your body. It also has stronger effects at higher elevations, which can impair judgment.
5. Rest. Take it easy for the first few days after reaching high altitude. Avoid strenuous activity until you feel acclimatized.
6.  “Climb high and sleep low”. If you have to climb over 1,000 feet in a day, make sure you come back down to a lower altitude to sleep.
7. Recognize symptoms. Be aware of the symptoms of altitude sickness and take action if they appear. Early recognition and treatment can prevent the condition from becoming more severe.

References

1. Altitude Sickness: What to Know?. https://www.webmd.com/a-to-z-guides/altitude-sickness
2. Altitude sickness. https://www.nhs.uk/conditions/altitude-sickness/#:~:text=You%20can%20get%20altitude%20sickness,a%20medical%20emergency%20if%20ignored.
3. Patient education: High-altitude illness (including mountain sickness) (Beyond the Basics). https://www.uptodate.com/contents/high-altitude-illness-including-mountain-sickness-beyond-the-basics/print
4. Cleveland Clinic. Altitude Sickness. Available from https://my.clevelandclinic.org/health/diseases/15111-altitude-sickness

Introduction

Influenza, also known as flu is classified into seasonal influenza, avian influenza and pandemic influenza. The influenza A outbreak in Malaysia is classified as seasonal influenza. Avian influenza occurs mainly in birds and poultry (chicken and ducks) and usually do not infect other species but if virus get mutated, there will be a possibility for human to get infected. Meanwhile, pandemic influenza occurs once every 10-50 years when an animal influenza virus (avian influenza) undergoes major genetic changes and develops into a new influenza virus that will be transmitted among human, leading to a pandemic.

Seasonal influenza that affects human can be divided into:

• Type A
• Type B

Influenza A viruses are caused by RNA viruses belonging to the Orthomyxoviridae family, which is categorized into subtypes based on the types of 2 proteins on the surface if the viral envelope:

• H= hemagglutinin is a protein that causes red blood cells to agglutinate.
• N= neuraminidase is an enzyme that cleaves the glycosidic bonds of the monosaccharide sialic acid.

Avian influenza is also known as the bird flu, caused by type A strain (H5N1) of the influenza viruses. Influenza A is a subtype of the type A influenza viruses. It can be found in many species, including humans, birds, horses, and pigs, due to the breadth of potential hosts and its ability to genetically change over a short period of times, influenza A viruses are every diverse. Normally, its capable of causing a pandemic.

Unlike influenza A viruses, type B influenza viruses are only found in human. Influenza B viruses are further classified into two lineages: B/Yamagata and B/Victoria and will not cause pandemics. Influenza B virus may cause lesser reaction than influenza A virus, but it is still extremely harmful.  

Transmission

Normally, airborne transmission occurs particularly in crowded enclosed spaces, from direct contact with droplets circulated by unprotected coughs and sneezes and contamination of the hands.

Risk group

• Pregnant women
• Children under 5 years old
• Elderly above 65 years old
• Patient with chronic disease (asthma, diabetic, heart and lung illness)
• Immunocompromised patient (HIV, cancer, chemotherapy patient or with steroid treatment)
• Obese

Incubation period:

The seasonal influenza that occurs yearly is type A and B with an incubation period of 1-4 days.

Sign & Symptoms:

Once the symptoms begin, one will experience high fever for 2-3 days. Influenza symptoms can range from mild to severe and they vary person to person:

• High fever
• Chest discomfort
• Cough
• Shortness of breath
• Sore throat
• Muscle pain
• Headache
• Sneezing
• Tiredness and fatigue
• Loss of consciousness
• Diarrhea and vomit

Complication:

High risk populations may develop complications:

• Pneumonia (lung infection)
• Encephalitis (brain infection)
• Heart diseases
• Rhabdomyolysis (Inflammation of muscle tissue)

Treatment:

Home remedies:

• Drink plenty of water
• Maintain a balanced diet
• Get enough of rest
• Avoid stress as it can weaken the body immune system
• Medications such as paracetamol or ibuprofen to treat fever or muscle pain
• Medications such as expectorants or mucolytics to treat cough and cold

Medication:

For Influenza A

• Antiviral medication is available by prescription only. It can shorten the duration of symptoms or prevent complications such as pneumonia. Antiviral medications such as Tamiflu (oseltamivir) or Relenza (zanamivir) can be started within 1-2 days of onset of influenza A symptoms and given around 3-5 days. Antibiotic are not effective against influenza virus at all.

Prevention:

Vaccine:

The World Health Organization (WHO) recognizes vaccination as one most effective way to prevent the influenza. Influenza vaccination provides protection for children and adults from different virus strains and help to reduce the disease transmission and complication. Vaccination takes 2 weeks to become fully effective for protection to develop after immunization and can last up to 1 year.

Precaution:

• Cover mouth and nose with tissue or handkerchief when sneezing or coughing
• Frequent hand wash with soap
• Wear a facemask while infect with influenza
• Avoid being in public places when having influenza

Reference:

1. https://www.who.int/news-room/fact-sheets/detail/influenza-(seasonal)
2. http://www.myhealth.gov.my/en/influenza-2/
3. https://www.healthline.com/health/cold-flu/influenza-a-vs-b
4. https://www.medicalnewstoday.com/articles/326672
5. https://www.homage.com.my/health/influenza/
6. https://specialty.mims.com/influenza/treatment?channel=respirology