Shingles

~ shingles in a skin rash caused by the virus that also causes chicken pox .
~ also called herpes zoster .
~ the virus is called varicella zoster .
~it belongs to herpes group .
~ shingles usually occurs years after getting chickenpox .
~ once you have had chickenpox , you are immune to get chickenpox again .
~ but the varicella virus may still remain in the body's nervous system - in particular , the nerves .
~ when the body's immune system is suppressed the virus can then be reactivated and cause shingles .
~and once you have suffered from shingles , you are more likely to get it again . ( recurrence )
~ commonly occur in people above age 60 .
~ shingles is contagious . it spread it to another person who has not had chickenpox . they catch chickenpox instead , and not shingles .
~ chickenpox - the rash appears over the body .
~ shingles - rash appear only in one patch of the skin .
~ before rash appears , you may feel a burning pain on a patch of the skin and it may become very sensitive .( go on for several days or up to a week ) during this time , you are actually not sure what you are getting .
~ then small blisters on a red patch begin to appear .
~ new blisters come up . ( 3 - 5 days )
~ the patch of skin involved is the patch serviced by a particular nerve , the same nerve that hosts the varicella virus that has lain dormant all these years in the body .
~ shingles is likely to affect the nerves of the body that service the patches / bands of skin on your trunk or back .
~ these bands are called dermatomes , so the blisters will only appear on the dermatome .
~ usually only one dermatome is involved .
~ like chickenpox , the blisters itch , pop , ooze out liquid , and then crust over as healing begin .
~ this whole process may last up to 4 weeks .
~ there is one variant of shingles where pain is present , but the blisters never appear .
~ usually no complications ( depend on where the shingles is affecting you )
~ when scratch too much and bleed , blisters can get infected with bacteria , then you can have cellulitis .
~ if shingles affect your face , particularly in the region of your forehead and nose , ( a dermatome serviced by fifth cranial nerve ) , eye can be affected .
~ antiviral medication for shingles ( Acyclovir ) should be taken early . ( within three days of the first appearance of the rash .)

Chickenpox ( or Varicella )

~ is highly contagious disease.
~ caused by the varicella-zoster virus.
~ once the virus enters the body, it starts replicating in the respiratory region, ( its route of entry ) and the regional lymph nodes within 2-3 days.
~ then enters the bloodstream and further replicates in the liver, spleen and other organs.
~ symptoms starts 10- 21 days after exposure to virus.
~ fever, headache, sore throat, loss of appetite and tiredness, then pimple-like red bumps pop up all over the body, causing itching.
~ these bumps develop into blister, which burst and dry after a few days, then turn into brown scabs.
~ scratching predisposes to secondary bacterial infection and causes scarring.
~ 12 years above and adults suffer more severe form of chickenpox.
~ develop a lifetime immunity against chickenpox after the first infection.
~ the virus stays in the nerve cells near the spinal cord long after the illness remaining dormant.
~ it may reactivate later in life and move along the nerves to the surface of the skin causing shingles. ( herpes zoster )
~ shingles is a rash of painful blisters last for 2-3 weeks.
~ not dangerous but very painful and cause lingering nerve pain for months after the rash is gone.
~ 10-20% had chickenpox develop shingles ( age of 50 years ).
~ prevent chickenpox through varicella vaccination.
~ varicella vaccine contains weakened live varicella-zoster virus.
~ 95% effective in preventing the infection.
~ vaccinated people get milder form of the illness, with fewer blisters and symptoms.
~ 7-8% several small bumps may develop at the area where the shot was give.
~ vaccine not recommended for people with impaired immune systems, those allergic to gelatin or the antibiotic neomycin and pregnant women those taking steroids or aspirin should not be given the vaccine until after stopping the medicine, asthmatics and children recovering from kawasaki disease.
~ it spreads easily through direct contact with the infected person, through a sneeze or cough by touching the fluid from a chickenpox blister.
~ also spread indirectly through contact with contaiminated surfaces.
~ can also catch chickenpox from someone with shingles.
~ it is contagious 2 days before the rash appears up to the time when all the blisters have dried up.
~ Acyclovir, an antiviral agent is effective when given during the early stages of the infection.
~ never use aspirin to reduce pain or fever in patient with chickenpox.
~ chickenpox infection during early pregnancy leads to birth defects, low birth rate, or limb abnormalities in the foetus.
~ catch chickenpox one week before and after delivery can lead to severe chickenpox in the newborn baby who is not immunologically protected.
~ if the mother gets infected within 10 days after delivery, the newborn baby may suffer a life-threatening infection.
~ an immune mother can protect her baby from infection within baby's first few months of life, as her immunity can pass to the baby through the placenta and breast milk.

Pre-diabetes

~ is a problem where the blood glucose levels are higher than normal, but not high enough to be diagnosed as "diabetes"
~ pre-diabetes is reversible, but diabetes is incurable.
~ pre-diabetes is also known as borderline diabetes, this condition are in a "gray zone" between normal and diabetes.
~ no symptoms or signs.
~ the best way to combat diabetes is at the pre-diabetes stage.
~ a healthy diet ( low fat, low sugar & high fibre ) exercise and taking supplement can prevent or delay the onset of diabetes and reduce the risk of complications.
~ blood sugar levels in the body is regulated by insulin, a hormone produced in the pancreas.
~ insulin helps to transport glucose from the blood through the cell membranes and into the cells of the body.
~ in healthy individuals, the rate of insulin production the pancreas is automatically controled by the amount of glucose in the blood.
~ if the insulin produced is not enough or not used effectively, the cells cannot absorb the glucose.
~ there is then no fuel for the tissues to carry on the processes of life.
~ unsed sugar builds up in the blood ( diabetes ).
~ prolonged high levels of glucose in the blood would eventually lead to type 2 diabetes.
~ complications :- blindness, kidney diseases, gangrene ( require amputation ) heart attack, stroke and hypertension.
~ diabetic are susceptible to infections and delayed wound healing.
~ blood test - the glucose level in the body is measured after 8 hrs fast to determine if the body metabolises glucose correctly.

Fatty Liver

~ medical terms "steatosis"
~ the most common problems affect the liver is fatty liver- the accumulation of fat in liver cells.
~ healthy liver consists of 2%-5% fat.
~ fat storage in the liver cells starts with tiny droplets being deposited inside the cells themselves.
~ initially, only a few liver cells are affected by small droplet deposits but over time, the droplets become larger, eventually the size of the stored fatty droplets increases until they fill the liver cells completely.
~ as a result, the liver cells become enlarged, their internal structures destroyed and functions impaired.
~ these fatty cells also have a higher disposition to developing necrosis or "die" under even mildly toxic condition which normal healthy cells would be able to withstand.
~ factors cause fatty liver:-
(1) Alcoholic Fatty Liver Disease :
- consume more than 60g of alcohol per day over a long period of time.
-fatty infiltration of liver cells or fatty livers are found in up to 90% at all alcohol abuse cases.
-no signs and symptoms which lead to many undiagnosed cases.
-if left to progress will develop into alcoholic hepatitis and in a worst, cirrhosis.
-liver cells will be swollen, inflamed and death of cells may occurs.
-in cirrhosis, normal liver tissue are replaced with scar tissues, a process which is irreversible and potentially life-threatening if allowed to continue.
-advanced cirrhosis with liver failure, liver transplantation is the only treatment option left.
(2) Non-alcoholic Fatty Liver Disease:
-is the development of fatty liver in the absence of significant alcohol consumption.
-it is a spectrum of liver diseases ranging from simple steatosis or accumulation of fat in the liver cells to non-alcoholic steato hepatitis which can then progress to cirrhosis and lead to cancer of the liver.
-non-alcoholic steato hepatitis is more severe form of non-alcoholic fatty liver disease, is differentiated from simple fatty liver by the presence of cell inflammation and damage.
-non-alcoholic fatty liver disease is associated with clinical conditions found in the metabolic syndrome. (obesity, high blood pressure, diabetes and abnormal levels of lipid )
-fatty changes in the liver cells make the cells more susceptible to toxin and impair the cells' regenerative capacity.

Stages of Liver Damage
(1)Fatty Liver:- deposits of fat cause liver enlargement.
(2)Liver fibrosis:- scar tissue forms, more liver cell injury occurs.
(3)Cirrhosis:- ( hardening of the liver ) excessive scarring of liver tissue causes hardening of the liver, the liver fails to perform properly.

Gout

~ a form of arthritis .
~ caused by a build up of uric acid in the blood .
~ when uric acid crystallises in the joints , it causes inflammation and pain .
~ recurrent swelling in the big toe as the surrounding tissue is packed with uric acid crystals.
~ at the beginning of the disease, patients usually experience intermittent gout attacks and remissions, followed by a chronic phase where painless but firm tophi start to form in one or more joints of the body.
~ starts when one reaches 40.
~ affect more men than women.
~ after 65 years old, affects both sexes equally.
~ older patients tend to develop tophi early in the course of the illness.
~ younger ones develop tophi after years of intermittent attacks.
~ become more common because of the obesity epidmic .
~ dietary choices also raise the risk of gout.
~ consuming a lot of meat, seafood, sugar and alcohol especially beer- can trigger attacks of gout.
~ soda drinkers are also at risk, there is evidence that fructose, the main sweetener in many sugared beverages, increases uric acid levels in the blood.
~ high blood pressure is another major risk factor, get complicated because diuretic taken to lower blood pressure can also increase uric acid levels.
~ lose weight, cut back on alcohol, meat, and seafood, and eat more fruit, vegetables and low-fat dairy foods.
~ patients have to take drug to lower uric acid levels for life.
~ treatment:- (1) to reduce the patient's blood uric acid levels.
- (2) to relieve the pain and inflammation during a gout attack.
~ for surgical removal is when a patient's tophus is infected or when it puts a lot of on pressure on surrounding structures (nerve).
~ reduce blood uric acid level below 0.36mmol/L or 6mg/dL, the uric acid that is deposited will dissolve by itself with time.
~ stay away food that rich in purine, a chemical compound that break down into uric acid in the body.