Healthpedia

Cancer of Blood and Bone Marrow Carpal Tunnel Syndrome Cerebrovascular Accident (Stroke) Cervical Dysplasia Chicken Pox Cholangitis Chronic bronchitis Conjunctivitis (Pinkeye) Cushing's Syndrome

Cardiac Disease Cataracts Cervical Cancer Cervical Spondylosis Cholera Colorectal Cancer Coronary Heart Disease Cellulitis Cat scratch disease

 

Cancer of Blood and Bone Marrow

 

Definition:

All cancers have cells that become abnormal and are produced in excessive amounts. The abnormal growth interferes with the body's production of healthy blood cells, thus making the body unable to protect itself against infections.

Leukemia is cancer of the blood cells - usually the white blood cells. Leukemic cells look different than normal cells and do not function properly.

Lymphoma is a cancer of the lymphoid tissues. Although lymphoma usually begins in a lymph node, it can also originate in the stomach, intestines, skin or any other organ that contains lymphoid tissue.

Multiple myeloma is cancer of the bone marrow, which results from an uncontrolled growth of plasma cell. The plasma cell is part of the immune system that is responsible for forming antibodies against foreign organisms and substances that invade the body. The disease process occurs when one of these cells escapes from the control of the master immune system and behaves erratically by forming dysfunctional antibodies and dividing into numerous cells that the body does not need.

 

Who is at risk?

For Leukemia:

• Adults are more prone to leukemia than children;
• People who've had certain types of chemotherapy and radiation therapy for other cancers have a slightly greater risk of developing certain types of leukemia many years later;
• People with certain genetic diseases, such as Down's syndrome, are associated with increased risk of leukemia;
• People with exposure to radiation and certain chemicals such as benzene, which is found in unleaded gasoline, tobacco smoke and the chemical industry may also have a greater risk of leukemia.

For Lymphoma:

• People with previous history of infectious mononucleosis or HIV infection;
• The elderly, men;
• People with family history.

For Multiple myeloma:

• The elderly male and black have higher risk.

 

Symptoms:

The common symptoms are:

• Fever
• Night sweats
• Fatigue
• Weight loss
• Itching of the skin
• Recurrent infections such as flu and diarrhea
• Bleeding of gums or nose and slow healing cuts or frequent bruises

Specific symptoms include:

• Multiple myeloma: Kidney problems, bone pain and a general numbness of the skin
• Lymphoma: Swelling of lymph nodes in the neck, the armpits or in the groin

 

Treatment:

Chemotherapy and radiation therapy have always been used to treat all blood cancer effectively. Bone-marrow transplants are more frequently used to treat lymphoma and leukemia and tend to be more successful for younger patients and when the disease is in the early stage. Patients have to be made aware of the great dangers and side effects of bone-marrow transplants that include death.

 

Prevention:

• Genetic testing: For people with family history of leukemia.
• Personal protection equipment: Respirators and protective clothing to avoid contact of chemical or irritant substances.
• Avoiding the risk of HIV and infectious mononucleosis: The threat of contracting lymphoma can be reduced.

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Cardiac Disease

 

Definition:

Cardiac diseases are any disorder that affects the heart's ability to function normally. The most common cause of heart disease is narrowing or blockage of the coronary arteries that can be complicated by heart attacks. Some heart diseases can be present from birth (congenital heart diseases). Other causes include the following:

• Abnormal function of the heart valves (e.g. narrowing or dilatatation of the mitral or aortic valves).
• Abnormal electrical rhythm of the heart (e.g. atrial fibrillation).
• Abnormal cardiac muscle (e.g. cardiomyopathy).
• Weakening of the heart's pumping function caused by infection or toxins (e.g. cardiogenic shock, alcoholic heart disease).

 

Who is at risk?

1. For Congenital heart disease: Hereditary (e.g. Down's syndrome), medication (e.g. alcohol and retinoic acid) and viral infection during pregnancy (Rubella infection);
2. For coronary disease: Men over the of age 45; Women Over 55; Smokers; Hypertension, High cholesterol; Diabetes Mellitus; Family History of heart attack (before age 55 in male or before 65 in female). Others factors include obesity, metabolic syndrome, sedentary lifestyle and Type A personality and low birth weight;
3. For valve disease: Individual with congenital heart disease, untreated throat infection and aging;
4. For abnormal electrical rhythm: Individuals who have structural heart diseases, overactive thyroid, medications (including drugs to treat abnormal heart rhythms) and alcohol;
5. Heart failure: Individuals with structural heart disease and alcohol problems.

 

Symptoms:

• Central chest pain that might radiate to shoulder and jaw, with or without exercise
• Shortness of breath while lying down
• Waking up in the night with breathing difficulties
• Palpitations with fluttering
• Slow heart rate with dizziness
• Fainting or near fainting
• Reduction in exercise tolerance (cannot maintain the same intensity of exercise as was possible previously)

 

Treatment:

1. Lifestyle changes (reduce weight with a low fat diet, cardiovascular exercise programme, quit smoking etc.).
2. Medication: Relevant to the nature of the condition with common aim to restore the function of the heart.
3. Electrical devices such as automatic defibrillator: "Shock" the heart back into a normal heart rhythm.
4. Electrophysiological ablation: Energy destroys very small areas of tissue that give rise to abnormal electrical signals.
5. Angioplasty: To restore the lumen diameter of the coronary arteries.
6. Surgery: Bypass operation for severe coronary disease; corrective surgeries for congenital heart diseases.
7. Seek treatment for underlying health problems that may contribute to heart disease and arrhythmias (e.g. high cholesterol, heart valve damage, high blood pressure, diabetes and thyroid disease).

 

Prevention:

1. Make healthy lifestyle choices. Exercise regularly and eating a healthy, low-fat diet with plenty of vegetables, fruits and other vitamin-rich foods are the cornerstones. Maintain a healthy weight.
2. Stop smoking and avoid secondhand smoke. Tobacco contributes to as much as one-third of all cardiovascular disease.
3. Avoid or limit the intake of caffeine, alcohol and other substances that may contribute to arrhythmias or heart disease.
4. Avoid unnecessary stress, such as anger, anxiety or fear, and find ways to manage or control stressful situations that cannot be avoided.
5. Have regular physical exams and promptly report any unusual symptoms to a physician.

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Carpal Tunnel Syndrome

 

Definition:

The carpal tunnel is a rigid narrow tunnel formed by the bones, ligaments and soft tissues in the wrist. The median nerve, which supplies the small muscles and gives sensations to the thumb and first three fingers, goes through the carpal tunnel. The nerve can get compressed when tissues in the carpal tunnel are swollen or inflamed, giving rise to symptoms of the syndrome.

 

Who is at risk?

Carpel tunnel syndrome is most common in people who require repetitive movements in their hands and wrist, such as:

1. Certain occupations, such as musicians, typists and assembly-line workers
2. People spending a lot of time on the computer, either at work or playing games

It is also more common in:

• Women after middle age
• Overweight
• Pregnancy
• Previous injury to the wrist
• Patients with diabetes, thyroid disease or rheumatoid arthritis

 

Symptoms:

Symptoms appear gradually. A patient may experience numbness or tingling in the thumb, the index and middle fingers. Many feel that their hands are swollen. Symptoms often first appear at night or in early morning.

Other symptoms include:

• Pain-- in the wrist, palm or forearm.
• Weakness in the thumb
• Trouble gripping objects.

 

Treatment:

• When the hand and wrist are acutely painful, ice packs may provide temporary relief. Rest your hand and wrist.
• Doctors may prescribe a splint on the wrist to keep it in a correct position to avoid further injury to the soft tissue.
• Try propping the hand up at night if symptoms tend to appear during sleep.
• Underlying medical problems such as diabetes must be taken good care of.
• Doctors can prescribe oral medications such as pain-killers and nonsteroidal anti-inflammatory drugs.
• Some patients respond to diuretics (a drug that help a patient to excrete excess fluids).
• Resistant cases may be treated with local injections given directly into the wrist to stop inflammation.
• Some may require surgery to relieve compression in the carpal tunnel.

 

Prevention:

Avoid repetitive tasks involving the hands and fingers. Workers should watch their position and posture and employers should provide the correct tools for the job and allow breaks at work.

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Cataracts

 

Definition:

A cataract is a clouding of the whole or part of the lens inside the eye, resulting in blurred or distorted vision. It may be caused by normal aging (age-related), exposure to the sun's ultraviolet radiation over many years, injury (traumatic) or disease (secondary). Most cataracts occur and develop after age 55 slowly but some babies are born with cataracts (congenital). The majority of congenital cataracts (those present at birth) are present in children who also have other eye problems or other health problems. In approximately 25 percent of children born with congenital cataracts, the condition is due to a genetic cause such as a metabolic disorder or a chromosome abnormality (i.e., Down's syndrome).

 

Who is at risk?

• Age is the single greatest risk factor;
• People with history of diabetes;
• People with family history of cataracts;
• People with previous eye injury or inflammation;
• People with previous eye surgery;
• People with prolonged use of corticosteroids;
• People with excessive exposure to sunlight;
• Smokers.

 

Symptoms:

Common symptoms are:

• Hazy, blurred or distorted vision
• Dark spots or shadows that seem to move with the eye
• An increasing need for more light to see clearly
• Double vision
• Loss of color vision
• A stage where it is easier to see without glasses
• Lights appear too bright and/or present a glare or a surrounding halo
• Colors seem faded
• Increased nearsightedness - increasing the need to change eyeglass prescriptions

 

Treatment:

Non-surgical:

• If you have eyeglasses or contact lenses, make sure they're the most accurate prescription possible.
• Use a magnifying glass to read.
• Improve the lighting in your home with more or brighter lamps.
• When you go outside during the day, wear sunglasses to reduce glare.
• Limit your night driving.

Surgical:

Cataract surgery involves removing the clouded lens and then either replacing it with a plastic lens inserted in the eye during surgery or wearing a contact lens or special cataract glasses. Current surgical approaches include extracapsular cataract extraction and intracapsular cataract extraction.

• Decision based on your degree of vision loss and your ability to function in daily life. Some people with only minor vision loss from a cataract might want surgery because of problems with glare or double vision.
• Sometimes a cataract should be removed even if it doesn't cause major problems with vision i.e. preventing the treatment of another eye problem such as age-related macular degeneration, diabetic retinopathy or retinal detachment.
• If you have cataracts in both eyes and decide to have surgery, your eye doctor typically removes the cataract in one eye at a time. This allows time for the first eye to heal before the second eye surgery.

 

Prevention:

1. In general, there is no way to prevent age-related cataracts.
2. People with diabetes may decrease their risk of developing cataracts by controlling their blood sugar.
3. Women should check with their doctors about the need for rubella immunizations before becoming pregnant to prevent infection-related cataracts.

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Cerebrovascular Accident (Stroke)

 

Definition:

1. A stroke or cerebrovascular accident (CVA) occurs when the blood supply to a part of the brain is suddenly interrupted by occlusion (an ischemic stroke- approximately 90% of strokes), by hemorrhage (a hemorrhagic stroke - less than 10% of strokes).
2. Ischemia is a reduction of blood flow most commonly due to occlusion (an obstruction) by blood clot that can be formed slowly at the local site (thrombosis) or slough off from other site (embolus). On the other hand, hemorrhagic stroke occurs when a blood vessel in the brain bursts, spilling blood into the spaces surrounding the brain cells or when a cerebral aneurysm ruptures. A small proportion of strokes are watershed strokes caused by hypoperfusion (usually due to hypotension) or other causes including vasculitis, encephalitis and brain cancer.
3. Loss of function may be temporary, such as in a "transient ischemic attack" (TIA) or a stroke can cause severe or permanent disabilities and even death depending on the area of the brain involved. Risk of developing stroke is ~15% within 1 year after the initial transit ischemic attack.
4. Stroke is the third most common cause of death after heart disease and cancer in Hong Kong and accounts for approximately 9.4% of all deaths.

 

Who is at risk?

Those who have controllable risk factors:

• High blood pressure (High = greater than 140/90);
• Atrial fibrillation;
• Uncontrolled diabetes;
• High total cholesterol (greater than 200);
• Smoking;
• Alcohol (more than one drink per day);
• Sedentary lifestyle with inadequate physical activity;
• Being overweight;
• Existing carotid and/or coronary artery disease. People with asymptomatic carotid stenosis (narrowing of one of the arteries in the neck);
• Hormone Replacement Therapy (HRT). The risk of stroke increased.

Those who have uncontrollable risk factors:

• Age (>65);
• Gender (Men have more strokes, women have deadlier strokes);
• Race (African-Americans are at increased risk);
• Family history of stroke and diabetes;
• Sickle cell anaemia, a blood disorder that forms abnormal red blood cells;
• High blood levels of homocysteine, a blood component sometimes associated with a higher risk of stroke.

 

Symptoms:

• Numbness or weakness of one side of the body involving the arm, leg or face.
• Temporary loss of vision in one eye.
• Problems with balance or coordination. Sometimes falling for no apparent reason.
• Blurred or double vision with a return to normal vision in a short time.
• Difficulty speaking or understanding spoken or written words.
• Loss of memory for brief periods of time that cannot be recalled.
• Pain, numbness or odd sensations.
• Problems with mental activities, such as memory, thinking, attention or learning.
• Difficulty with swallowing.
• Problems with bowel or bladder control.
• Emotional outbursts, such as laughing, crying or anger.
• Depression - It is only natural for someone to feel sad about his or her new physical limitations; however, some people experience a major depression, which should be diagnosed and treated as soon as possible.

 

Treatment:

1. Medication:
   Antiplatelet: Decrease blood clot formation by preventing the smallest blood cells (platelets) from sticking together and forming blood clots. Examples are low dose asprin, Ticlopidine or clopidogrel.
   
   Anticoagulant: Warfarin and heparin are often used instead of or in combination with antiplatelets, such as aspirin or clopidogrel. Anticoagulants are used for people who are at risk for stroke because of abnormal heart rhythms (atrial fibrillation), post heart attack with clot in the atriums of the heart.
   
   
2. Surgery:
   • Carotid endarterectomy to remove plaque buildup in the arteries. This surgery can help prevent additional strokes.
   • Surgery to remove blood in the brain that was caused by a bleeding vessel.
   • Endovascular coil embolization to repair a brain aneurysm that is the cause of a hemorrhagic stroke. A small coil is inserted into the aneurysm to block it off.
   • Surgery to repair abnormally formed blood vessels (arteriovenous malformations) that have caused bleeding in the brain.

 

Prevention:

1. Control high blood pressure.
2. Control cholesterol problems: Statins are effective at preventing stroke.
3. Evaluate the heart rhythm: The most important treatment for stroke prevention caused by atrial fibrillation is blood thinning with the medication warfarin (Coumadin). Blood thinners are also called anticoagulants.
4. Use clot-prevention medicine: Anticoagulant medicine warfarin (Coumadin) or an antiplatelet medicine (aspirin or one of its relatives).
5. Eat a healthy diet.
6. Keep alcohol consumption modest.
7. Exercise: At a moderately intense level, such as walking briskly, bicycling or swimming, for at least 30 minutes on most days of the week.
8. Quit smoking.
9. Consider surgery when appropriate.
   • Carotid endarterectomy: Indicated when carotid arteries are narrowed by more than 70 percent. This can reduce the two-year risk of stroke by 80 percent.
   • Carotid artery stenting to be as effective as carotid endarterectomy in preventing stroke, heart attack, and other complications in people who are at high risk of stroke.

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Cervical Cancer

 

Definition:

Cervical cancer is the fifth most common cancer amongst females in Hong Kong. Cancer of the cervix occurs when the cells of the cervix change in a way that leads to abnormal growth and invasion of other tissues or organs of the body. One of the key features of cervical cancer is its slow progression from normal cervical tissue, to precancerous changes in the tissue, to invasive cancer. The slow progression through numerous precancerous changes is very important because it provides opportunities for prevention and early detection and treatment.

 

Who is at risk?

It affects women of all ages who have been sexually active:

• Women of less than 20 years of age at time of first sex;
• Women who have sex with multiple partners;
• Cigarette smokers;
• Women with a Pap smear test that is abnormal or showing dysplasia;
• Women with sexually transmitted diseases such as human papilloma virus (HPV), Herpes, or cytomegalovirus (CMV);
• Women infected with HIV which reduces the body's ability to fight off HPV infection and early cancers.

 

Symptoms:

Cervical cancer in its earliest stages often causes no symptoms. That is the reason why it is so important to have regular Pap test as screening. When symptoms do occur, they may include the following:

• Pain or bleeding during or after intercourse
• Unusual discharge from the vagina
• Blood spots or light bleeding other than a normal period

 

Treatment:

1. For Early Cervical Cancers that are confined to the cervix (Stages I-IIA):
   • Radical trachelectomy: If laparoscopic removal lymph nodes in the pelvis are free of cancer cells, only a portion of the cervix needs to be removed, rather than the entire uterus. This would preserve the fertility of the woman.
   • Hysterectomy (removal of the uterus): If the cancer is associated with "high-risk" features such as involvement of the pelvic lymph nodes or involvement of the tissue along the uterus, chemotherapy combined with radiation therapy would be recommended.
   Using a special radioactive substance that can be traced with imaging techniques, doctors can identify the first lymph node (the sentinel node) to which cancer cells would travel after leaving the cervix. If this node is free of cancer cells, no additional lymph nodes need be removed.
   
   
2. For Advanced Cervical Cancer (Stages IIB-IVA)
   If cervical cancer has spread beyond the cervix and into the surrounding pelvic tissues, surgery alone is usually not an effective cure. The standard of care for regionally advanced cervical cancer is now chemotherapy combined with radiation therapy. When anticancer drugs (such as cisplatin and 5-fluorouracil) are given with radiation therapy, the tumors are made more sensitive to the effects of the radiation.
   
   
3. Stage IVB & Recurrent Cervical Cancer
   For women whose cancer spreads beyond the pelvis or who have recurrent disease, treatment is aimed at reducing cancer-related symptoms in order to improve a patient's quality of life. Chemotherapy is the primary modality of treatment for these patients. Extensive surgery may sometimes be the only curative option.

 

Prevention:

• Although all women can help protect themselves from disease by having their sexual partners use condoms, condoms do not provide complete protection from HPV infection because this virus (unlike HIV) can be spread by contact with any infected area of the body.
• Stopping cigarette smoking can help reduce the risk of cervical dysplasia and cancer.
• Regular medical check ups with pelvic examinations and Pap smears can help positive women and their doctors respond to signs of cervical dysplasia and cancer as soon as possible.

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Cervical Dysplasia

 

Definition:

Cervical dysplasia is an abnormal growth or change in the cells that make up the surface of the cervix. Cervical dysplasia is also called Cervical intraepithelial neoplasia "CIN". CIN itself is not cancer, but it is possible for these abnormal cells to turn into cancer over a period of time.

Following are the 3 types of CIN:

1. CIN I. This is also called mild dysplasia.
2. CIN II. This is also called moderate dysplasia.
3. CIN III. This is also called severe dysplasia.

 

Who is at risk?

Any women might acquire cervical dysplasia, but the following may put you at a higher risk

• Women less than 20 years of age at time of first sex;
• Women with sexually transmitted diseases such as human papilloma virus (HPV), Herpes, or Cytomegalovirus (CMV);
• Women with an abnormal Pap smear;
• Cigarette smokers.

 

Symptoms:

Usually, there are no physical symptoms of cervical dysplasia. Genital warts are a sign that someone has been exposed to HPV. The warts should be treated as soon as possible and the cervix should be checked for signs of cervical dysplasia.

• The best way to learn if you have dysplasia is a Pap smear test. A Pap smear is a screening test to check for early cancer of the cervix. Most women should have a Pap test every year.
• A negative Pap test means that you probably do not have cancer. A positive Pap test means that your test results were not normal. This could mean that you have an infection or cancer on your cervix. You may need a colposcopy if the Pap test shows dysplasia. Colposcopy means "looking at the cervix". Often a biopsy of the tissue would be done at the same time and send to the laboratory to check for evidence cancer cells.

 

Treatment:

Treatment for cervical dysplasia varies from one woman to another, depending on the location and size of the lesion, and whether it's low grade or high grade. Sometimes no treatment is needed. The doctor may just want you to have more frequent Pap tests to see if the cells have changed more. But it is also possible that you may need one of the following treatments.

• Cautery: A small metal rod puts electric current on the cervix to burn away abnormal cervical cells.
• Cryotherapy: Destroys the lesion by freezing so that they cannot grow and spread.
• Laser treatment: Destroys the lesion with an intense beam of light. This procedure is often done in a day-surgery clinic.
• Loop Electrosurgical Excisional Procedure (LEEP): The lesion is surgically removed by an electrical current that passes through a very fine wire and the tissues are sent to a lab for tests.
• Cone biopsy: Removes a cone-shaped piece of tissue from the opening of the cervix and sent to a lab for tests. The wound is repaired with stitches.

 

Prevention:

• Practice safer sex by using condoms can help reduce (but not completely) the risk of becoming infected with HPV.
• Stopping cigarette smoking can help reduce the risk of cervical dysplasia.
• Regular medical check ups with pelvic examinations and Pap smears can help positive women and their doctors respond to signs of cervical dysplasia as soon as possible.

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Cervical Spondylosis

 

Definition:

Cervical spondylosis is a chronic degenerative disease of the bones (vertebrae) and the cushions separating the bones (the disks) in the spine. Abnormal bony outgrowths (bone spurs) often appear on the spine, which can press on the spinal nerves and may infringe on the spinal cord.

 

Who is at risk?

• Increasing age
• Improper posture
• Excessive use, such as carrying loads on the head
• Work related e.g. dancers and sportsmen
• History of neck injury

 

Symptoms:

• Neck pain
• Stiffness in the neck
• Headache, especially in the back of the head
• Pain, numbness or muscle weakness in the arms, hands and fingers, the pain may be described as stabbing, or appear as dull aches

In late cases the spinal cord may be compressed and result in numbness or weakness in the legs and incontinence.

 

Treatment:

• Mild cases may be improved by wearing a neck collar or a brace, so as to rest the neck and reduce irritation to the nerves.
• Many patients are relieved by taking pain relievers, muscle relaxants or nonsteroidal anti-inflammatory drugs, Physical therapy (physiotherapy) may also provide relief.
• Patients severely affected may need to be admitted for bed rest and neck traction treatment.
• Some orthopedic specialists may recommend local injections into the joints between the vertebral bones.
• If symptoms continue, surgery on the spine to relieve the compression may be necessary.

 

Prevention:

• Always maintain good posture with your neck and shoulders in correct alignment
• Take breaks on prolonged sedentary work, such as working on a computer, watching TV, or playing Mahjong
• Do regular exercise to maintain strength and flexibility of your neck muscles
• Protect your neck from injuries

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Chicken Pox

 

Definition:

Chickenpox is a highly contagious infection in children that causes a characteristic itchy, blistering rash that heals after becoming scabbed. It is caused by the varicella-zoster virus.

The virus typically lives silently in the nervous system for the rest of a person's life after an attack of chickenpox and may reactivate as shingles (also called herpes zoster) at any time when the body's immune defenses are weakened by stress, illness or medications.

 

Who is at risk?

The disease usually occurs in late winter and early spring months. Children under 10 years of age are most often affected.

Patients whose immune systems are suppressed by drugs, or are affected by diseases such as cancer, or who have congenital or acquired immunodeficiency may die from the infection.

 

Symptoms:

Symptoms of chickenpox begin between 10 and 21 days after a person is exposed. There may be a mild fever, but often the disease present with itchy, red bumps that quickly become fluid-filled. These skin blisters appear in various stages over the next few days and eventually crust over. Any part of the skin can be affected, and blisters may sometimes be found in the throat. Blisters would continue to form over a period of 3 to 5 days and then crust over during the next 7 to 10 days.

 

Treatment:

Treatment alternatives include:

1. Symptomatic treatment:
   Medicine against fever and drugs to relieve itchiness may be enough for mild cases. You should also trim the child's fingernails to prevent scratching. Never give aspirin to a child with chickenpox.
   
   
2. Antiviral drugs
   If handled early, antiviral treatment can effectively decrease the severity and shorten the duration of the disease.
   
   
3. Immune globulin
   Antibodies may be harvested from blood collected from people who have recovered from chickenpox. This can be given to patients who are at risk of serious complications.
   
   

 

Prevention:

There is an effective vaccine available in most private clinics and hospitals in Hong Kong which can be given to children 12 months or older. This is not routinely given in government maternal and child health clinics.

A patient with chickenpox can transmit the disease from about two days before the appearance of the spots, to the end of the blister stage. A child with chickenpox should be kept out of school until all blisters have dried, usually about 1 week.

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Cholera

 

Definition:

Cholera is a highly dangerous infectious disease characterized by sudden onset of severe diarrhea that results in rapid loss of body fluid. It is caused by a bacterium called "Vibrio cholera".

 

Who is at risk?

• The germ is transmitted through infected food and water.
• The germ can live freely in brackish water in temperate climate.
• People indulged in eating raw or lightly cooked seafood are vulnerable.
• In developing countries large outbreaks are often caused by a contaminated water supply.
• Individuals infected with the bacteria may not have symptoms, and can spread the disease as carriers.
• Young children who are bottled fed are in greatest risk where milk formula is prepared in unhygienic conditions.

 

Symptoms:

After a short incubation period of a few hours to 5 days, there is severe, almost incessant diarrhea. The stool has a characteristic "rice water" appearance. Vomiting soon follows. People can lose large amount of fluid in a short period of time. Severe dehydration and death can occur.

 

Treatment:

Patients with cholera must be promptly treated by replacing the fluid and salts lost through the gastrointestinal tract. This can be done intravenously if hospital facilities are available.

In Third World countries, patients can also be treated with oral rehydration solution, which is a prepackaged mixture of sugar and salts to be mixed with water.

The patient must drink in large amounts as advised by healthcare professionals in health centers or at home or at home. Antibiotics may diminish the severity of the illness shorten the course and duration of bacterial excretion.

 

Prevention:

• Travelers to areas where cholera has occurred should be vigilant of their food and drinks.
• Hong Kong has experienced minor outbreaks from seafood imported from endemic areas.
• Only purchase from reputable vendors and avoid eating raw or undercooked seafood especially shellfish. Vaccines are available but they have limited use in controlling epidemics.

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Chronic bronchitis

 

Definition:

Chronic bronchitis is an inflammatory condition of the bronchi (the large air passages beyond the windpipe) characterized by coughing and spitting-up of sputum occurring constantly and lasting 3 months or longer for at least two consecutive years. Doctors often find signs of airflow obstruction in physical examination or function tests.

 

Who is at risk?

• Smokers
• Air pollution

People who have prolonged exposure to chemical fumes and dust that irritate their lungs can also get chronic bronchitis. Therefore the condition is more common in certain occupations such as coal miners, textile workers and grain handlers.

 

Symptoms:

• Cough and sputum which may become yellow or green if infected by bacteria
• Difficulty in breathing
• Impaired exercise tolerance
• Wheezing
• Tightness in chest
• Fever
• Fatigue
• Frequent, prolonged, and severe respiratory infections
• Cyanosis (a bluish discoloration of the skin and lips)

 

Treatment:

1. Stop smoking

Although quitting smoking cannot reverse the damage which has done to the airways, it can prevent the situation from getting worse.

2. Medication

The doctor may prescribe bronchodilators to expand the tight airways. The drug can be inhaled (breathed in) or taken as a pill. Inhaled Corticosteroids, may reduce inflammation in the airways. Antibiotics may be needed when there is bacterial infection.

3. Adjustment in Lifestyle

Eating a healthy diet would help the body's defence to fight off infections. The doctor or physical therapist may offer exercises to improve a patient's breathing technique which will help to manage shortness of breath in a sudden period.

 

Prevention:

• Never smoke
• Avoid second-hand smoke, heavy fumes and polluted air
• Use respiratory protection devices such as filter masks at dusty working environment
• Patients with Chronic Bronchitis should receive the yearly flu shot. Vaccines against certain types of pneumonia are also available.

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Colorectal Cancer

 

Definition:

Colorectal cancer is the malignant tumor that occurs in the colon (large intestine) or rectum. Colorectal cancer accounts for about 15% of all cancer new cases and is the second most common cancer in Hong Kong. It develops slowly over a long period of time, usually starting out as a small grape-size growth called a polyp on the inner wall of the colon or rectum. When polyps do develop into cancer, this process usually takes 5 to 15 years. During this time, screening tests can be used to detect the polyps, allowing their removal before cancer ever develops.

 

Who is at risk?

• All people over the age of 50;
• People with low exercise levels and a diet high in fat and red processed meat and low in calcium and fiber;
• Obesity (particularly having excess fat in the waist);
• Anyone with a family or personal history of colorectal cancer;
• Anyone with a family or personal history of inflammatory bowel disease (IBD) such as Crohn's disease & ulcerative colitis;
• Smokers: 30 to 40 % more likely than nonsmokers to die of colorectal cancer because they are more likely to develop polyps;
• People with Familial Adenomatous Polyposis (FAP): Numerous benign tumors called polyps are found in the lining of the colon;
• People with Hereditary Non-Polyposis Colon Cancer (HNPCC) or Lynch Syndrome: bowel cancers develop at an early age, sometimes in more than one place in the bowel.

 

Symptoms:

1. Early colorectal cancer: NONE - can only be detected through screening tests.
2. Advanced colorectal cancer:
   • Blood in stool. The blood may be bright red (frank rectal bleeding) or dark in colour.
   • Change in your normal bowel habit (such as diarrhoea or constipation, stools that are more narrow than normal) for no obvious reason and lasting longer than 6 weeks.
   • Feeling of not having emptied your bowel properly after a bowel motion.
   • Pain in the abdomen or back passage.
   • Unexplained anaemia (low number of red blood cells).
   • Unexplained weight loss.

 

Treatment:

• Surgery: It is an operation that involves removing the cancerous section of the colon. This is the primary treatment for colorectal cancer for most individuals. It may be used either alone, or in combination with radiotherapy and chemotherapy.
• Chemotherapy: Drugs are given intravenously or orally to kill cancer cells. It is often given to decrease the chance of the tumor returning elsewhere in the body. Like radiation therapy, chemotherapy can ease disease symptoms and increase length of survival for patients with tumors that have spread. It is usually given over time and alternated with periods of no treatment. This alleviates potential side effects, such as abnormal blood-cell counts, fatigue, diarrhea, mouth sores, and a compromised immune system.
• Radiation therapy: It is a specialized treatment using radiation to destroy rapidly growing cancer cells. This is usually given for treatment of rectal cancer and may be given before or after the surgery and can also be given in combination with chemotherapy. This treatment may shrink the tumor and improve the chances of avoiding a permanent colostomy in select persons.

 

New developments include:

• Monoclonal antibody: Proteins produced in a laboratory that can identify a cancer cell for destruction or prevent the tumor cell from dividing. It may be used to treat advanced or metastatic bowel cancer.
• Gene therapy: Involves altering genetic material. Either a new gene is introduced to enhance the ability of the body to kill cancer cells or a gene is administered directly to the cancer cells, causing them to die. This treatment is still experimental.
• Immunotherapy: Enhances the body's immune system and increases the likelihood that the cancer cells will be killed.

 

Prevention:

• Since your genes cannot be changed, if there is a family history of colon polyps or cancer, a colonoscopy should be performed to remove the polyps before they become malignant.
• Screening tests with yearly stool test for occult blood and arrange sigmoidoscopy every 3 year or colonoscopy every 3-5 year beginning at age 45 or earlier if you have any of the familial risk factors.
• Sigmoidocopy involves a thin tube inserting into the rectum. A small camera is attached outside the body and allows the doctor to look inside the rectum and the last part of the colon for polyps or cancer.
• Colonoscopy involves a longer tube being inserted into the rectum. It is connected to a video camera so the doctor can look for polyps or cancer in the entire colon. Polyps can be removed by small clippers and sent to the laboratory to see if cancer is present.
• Eat less red meat and more fibre and vegetables.
• Quit cigarette smoking.
• Calcium may have a protective role. Ask your physician about taking a calcium supplement.
• Aspirin may also have a protective role. Some, but not all, medical studies show that the incidence of cancer of the colon may be less in those people who take aspirin regularly. It is known that prostaglandin (a hormone-like substance produced by the body) may promote excessive or abnormal cell growth in the intestine. Aspirin appears to interfere with prostaglandin, which may account for a possible role in preventing colon cancer.

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Conjunctivitis (Pinkeye)

 

Definition:

The conjunctiva is the thin, clear membrane covering the white part of the eye and inner surface of the eyelids. Conjunctivitis is the inflammation of this membrane.

Conjunctivitis may be triggered by infection caused by a virus, bacteria, or by allergy to dust, pollen, pollutants or chemicals.

 

Who is at risk?

Viruses and bacteria causing conjunctivitis are highly contagious. Children, especially those who like to rub their eyes or share towels are most vulnerable, as well as patient's contacts in the school or family.

For non-infectious conjunctivitis are most common in patients suffering from allergic rhinitis or atopic eczema. People exposed to polluted, dusty or smoky environment are also vulnerable. Wearers of contact lens are also at risk of one type of allergic conjunctivitis.

 

Symptoms:

Symptoms include:

• Red, watery eyes
• Eye itchiness
• Scratchy feeling in the eyes
• Pus-like or watery discharge
• Swelling of the eyelid

Depending on its cause, conjunctivitis will usually clear up within 2-14 days. If conjunctivitis is caused by a seasonal allergy, it may continue to recur throughout the season.

 

Treatment:

Those caused by bacterial infection are often treated with antibiotic eye drops or ointment. Viral infections often resolve from a week to 10 days spontaneously, though doctors often prescribe eye drops in order to prevent bacterial infections. Those caused by allergy or irritation may be treated with antihistamines or anti-inflammatory eye preparations.

 

Prevention:

Keep hands away from your face, and do not rub your eyes. Wash hands frequently. Avoid shaking hands with others, and keep away from swimming pools.

Many serious eye conditions can cause similar symptoms. If you experience pain, blurring of vision, or find looking into bright objects hurts, you should consult your physician immediately.

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Coronary Heart Disease

 

Definition:

While the heart is pumping hard to supply oxygen to the rest of body, the heart itself too needs its own supply of oxygen. The oxygen and nutrients are carried to the heart by arteries that lie on the outside surface of the heart. These arteries are called coronary arteries. Coronary arteries disease occurs when fats such as cholesterol build up along the inner surface of these coronary arteries. This build up is called plaques, and it narrows the artery and can eventually block it altogether. If the blood supply to the heart is cut off completely, then a person will suffer a heart attack. The part of the heart that does not receive oxygen will die and the heart will always be damaged in that area.

 

Who is at risk?

Factors you can change or modify:

• Obesity (Body mass index (BMI) range for Asians = 18.5 -23);
• Smoking;
• Diabetes;
• Low Physical Activity;
• Stress/ Type A personality;
• High Blood Pressure;
• High Blood Cholesterol.

Factors you cannot change:

• Sex (Male>female);
• Age;
• Low birth weight;
• Family History of coronary arteries disease (if heart attack < age of 55 in male and <65 in female).

 

Symptoms:

• Chest pain is the most common symptom. Typical chest pain is felt under the sternum and is characterized by a heavy or restriction/pressure feeling, and might be precipitated by exertion or emotion and relieved by rest or nitroglycerin. Atypical chest pain can be located in the left chest, abdomen, back, or arm and is sharp in nature. The atypical chest pain is also unrelated to exercise and is not relieved by rest or nitroglycerin. Atypical chest pain is more common in women.
• Shortness of breath: Heart at this point is weak because of the long-term lack of blood and oxygen, or sometimes from a recent or past heart attack. If the heart is not pumping enough blood to circulate in the body, there might also be swollen feet and ankles.
• Heart attack: In some cases, the first sign of CHD is a heart attack. This occurs when atherosclerotic plaque or a blood clot virtually completely blocks the blood flow of the coronary artery to the heart. The coronary artery was likely already narrowed from CHD. The pain associated with a heart attack is usually very severe lasting for more than half an hour and is not relieved by resting or nitroglycerin.
• Palpitation: Blockage of the coronary arteries can deprive oxygen in the heart and as a response the heart can be racing at a rapid speed.

 

Treatment:

The general treatments include lifestyle changes, medication, and occasionally surgery. Lifestyle changes may include: Regular aerobic exercise, quitting smoking, eating a healthy diet (including fish, whole grains, fruits, and vegetables), and learning to cope with emotional stress effectively. It is also important to control your diabetes, high blood pressure and high cholesterol in the event of one of these conditions.

Medication may include:

• Cholesterol-lowering medication such as Simvastatin.
• Anti-hypertensive: ACE inhibitors, beta-blockers and diuretics.
• Antiplatelet agents (e.g. aspirin, ticlopidine, or clopidogrel): To reduce the risk of blood clots.
• Glycoprotein IIb-IIIa inhibitors (e.g. abciximab): To reduce the risk of blood clots.
• Antithrombin drugs: Blood-thinners (e.g. low molecular weight heparin, unfractionated heparin) to reduce the risk of blood clots.
• Thrombolytic used in acute heart attack (e.g. streptokinase and TPA): To dissolve the blood clot that blocked the coronary arteries.
• Beta-blockers to decrease heart rate and lower oxygen use by the heart.
• Nitrates such as nitroglycerin to dilate the coronary arteries and improve blood supply to the heart.
• Calcium-channel blockers to relax the coronary arteries and all systemic arteries and thus reduce the workload for the heart.
• Angioplasty (with or without stent).
• Coronary stenting (placing a tube in the artery to keep it open).
• Coronary brachytherapy: It consists of delivering beta or gamma radiation into the coronary arteries. This new treatment is reserved for patients who have undergone stent implantation in a coronary artery and developed problems such as diffuse re-stenosis.
• Surgical procedures include conventional coronary bypass surgery and minimal invasive surgeries such as Off-Pump Coronary Artery Bypass and Minimally Invasive Coronary Artery Bypass (practiced on a beating heart and doesn't require the heart lung machine) and Laser Heart Surgery (with a unique laser delivery system to create open channels in the heart).

 

Prevention:

• A low saturated fat, low cholesterol diet to help reduce cholesterol.
• Reducing sodium (i.e. salt) to keep high blood pressure under control.
• Omega-3 fish oil might be helpful in reducing the triglyceride level, a risk factor of coronary heart disease.
• Weight reduction and maintain the body weight within the recommended body mass index. BMI = weight / height square. Reference for Asian is 18.5-23.
• Regular cardiovascular exercise, at least 3 times a week (every alternate day) and each of at least 30 minutes. Exercise must be aerobic in nature and make you sweat. Unfortunately the sauna does not count!!
• Stop smoking & learn to cope with stress emotionally.
• Some professionals may recommend taking aspirin regularly because it discourages blood clots from forming, and may also reduce inflammation. However, side effects such as stomach ulcers might be a problem.
• Have regular physical examinations and promptly report any unusual symptoms to a physician.
• EBT (Electron Beam Tomography): Used as a screening for coronary disease. The scan will detect calcium deposits in the heart's arteries. Calcium deposits cause clogging of the arteries. The amount of calcium will be scored and it will estimate the risk of suffering a coronary event. It is not recommended for people who have documented heart disease.

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Cushing's Syndrome

 

Definition:

Cushing's syndrome is a condition caused by prolonged exposure of the body to excess amount of corticosteroid hormones. These hormones are normally secreted by the adrenal glands which are regulated by a hormone secreted by the pituitary gland inside the brain. The syndrome can be caused by abnormalities in the adrenal glands, such as a tumor that is producing excess corticosteroid hormones, or a tumor of the pituitary gland that results in the over-stimulation of the adrenal glands. Rarely, the syndrome can also be caused by tumors in other parts of the body, such as the lung.

The condition, however, occurs mostly as a side effect in patients on long-term treatment of corticosteroids for severe diseases.

 

Who is at risk?

Cushing syndrome is more common in women, especially for those in 20 to 50 years of age.

 

Symptoms:

Symptoms include weight gain with fat deposits mainly in the face, trunk, upper body, and muscle weakness. Acne can be troublesome, with excess growth of body and facial hair. Blood pressure is increased. Some patients may present complications like diabetes, infections, or fractures. Some may present personality changes and psychiatric problems.

 

Treatment:

When the syndrome is caused by pharmacological treatment, the condition would be alleviated by gradual withdrawal of the offending drug. Unfortunately, this is not always possible.

In all other cases doctors need to do tests in order to confirm the diagnosis and find out the root cause before deciding the best treatment. If a tumor of the adrenal or pituitary is the culprit, the syndrome can be cured by surgical removal of the tumor. If the offending tumor is of malignant nature, radiation treatment and chemotherapy may be necessary. There are drugs that can block a patient's production of corticosteroid hormone, but they are not always effective.

 

Prevention:

Apart from those caused by drugs, most cases of Cushing's syndrome cannot be prevented.

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Cellulitis

 

Definition:

Cellulitis is an acute spreading bacterial infection of the skin and the underlying soft tissues, resulting in marked inflammation. The condition can occur after minor trauma. Germs can also enter through small abrasions in the skin after scratching and insect bites. The most common causative organisms are germs normally living on the skin, such as staphylococcus and streptococcus. The disease is common, and can be rapidly progressive with fatal consequence.

 

Who is at risk?

• Patients with diabetes mellitus
• People with impaired immune system, such as patients with cancer, patients on chemotherapy or those suffering from AIDS
• Patients with blocked arteries in the limbs, resulting in poor circulation
• After insect bites and stings
• After animal or human bites or injuries with open wounds

 

Symptoms:

• Local redness, swelling, warmth, and pain in the affected area of the skin, which is increasing in size as the infection spreads
• Fever, sweating, shaking, chills
• Tiredness, fatigue and muscle aches
• Swollen and tender lymph nodes

 

Treatment:

Cellulitis is caused by bacteria, and antibiotics are the mainstay of therapy. It is important for patients to take the medication as directed and to finish the entire course of treatment.

If the infection is severe, or involves vital structures such as the eye or tissues around the head and neck, the patient may need to be hospitalized. Complications such as gangrene or abscess formation may require surgical intervention.

 

Prevention:

• Keep personal hygiene. Having shower or bath daily.
• Do not scratch after insect bites.
• Trim fingernails regularly.
• Prevent injuries at work with protective clothing and equipment.
• Treat minor injuries and abrasions immediately. Wash the wound immediately with soap and running water, followed by the application of an antiseptic cream. Keep the wound clean and dry. Watch for signs of infection, such as increasing redness, pain and discharge.
• Patients with diabetes mellitus should maintain optimal control of their blood sugar levels and take good care of their feet.

Cholangitis

 

Definition:

Cholangitis means the inflammation of the bile ducts which are tubes that carry bile from the liver to the gallbladder and intestines. The most common cause is a bacterial infection associated with stones in the ducts.

 

Who is at risk?

• People after the age of 55
• Patients with stones in the gall bladder or bile ducts
• Alcoholics
• Patients with parasites in the liver and bile ducts
• Patients with tumors that block the flow of bile
• Patients who had surgery performed in the bile ducts, small intestine or the pancreas; those who have received endoscopic examination in the area

 

Symptoms:

• Pain in the upper abdomen, more often on the right side
• Fever and chills
• Yellowing of the skin and eyes (jaundice)
• Passing dark color urine
• Tiredness and loss of appetite

 

Treatment:

Antibiotics are necessary to control bacterial infection when the diagnosis is confirmed. They are often given intravenously since patients with cholangitis are often acutely ill. The doctor may recommend an endoscopic examination where a tube is passed from the mouth through the stomach into the upper small intestine to inject a dye into the bile ducts to reveal the blockages and stones on an X-ray. The procedure is called ERCP (Endoscopic retrograde cholangiopancreatography). During the procedure the doctor may also be able to perform minimally invasive surgery to drain away the infected bile, or to remove stones and sometimes small tumors.

 

Prevention:

• Avoid raw fish
  The Chinese liver fluke is a parasite endemic in China. It is transmitted by eating under-cooked fresh water fish. The fluke lives in the bile ducts and is a common cause for cholangitis.
• Treat stones in the gallbladder or bile ducts as advised by your doctor
• Do not drink excessive amount of alcohol

Cat scratch disease

 

Definition:

Cat scratch disease is an infection caused by a bacterium called Bartonella henselae carried in the saliva of cats. The cats are not symptomatic, but people can get the disease after being scratched or bitten.

 

Who is at risk?

• Cat owners. About 40% of cats carry the bacteria some time in their lives. Kittens are more likely to be infected and to pass on the disease to people
• People with impaired immunity system, such as those undergoing treatments for cancer, organ transplant patients, and people with HIV/AIDS

 

Symptoms:

Several days after being scratched or bitten by a cat, a blister or a small bump develops at the site. This is most often found on the arms and hands or head region and are not particularly painful. A couple of weeks later, one or more nearby lymph nodes will swell and become tender. These swellings are most often located in the underarm or neck areas, or sometimes in the groins if the legs were scratched or bitten.

Some people may develop more severe symptoms with:

• Rash
• Sore throat
• Fever
• Fatigue, loss of appetite and an overall ill feeling
• Headache

 

Treatment:

Generally, cat scratch disease is not serious. Most cases resolve without any treatment. Antibiotics can be used to treat the disease in selected cases. Rarely, a swollen lymph node becomes so large and painful that the doctor may recommend removing the fluid from the node with a needle and syringe. In people with suppressed immune systems, cat scratch disease can be more serious and early vigorous treatment is recommended.

 

Prevention:

• Wash hands after handling or playing with a cat
• Avoid "rough play" with cats and kittens
• Keep the house and your pet free of fleas
• Avoid contact with unfamiliar and stray cats
• Do not let your cat touch or lick any open wounds
• Wash the wound with soap and running water immediately after bitten or scratched by a cat

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