INFLUENZA ATTACK: PART THREE

In part three of the Influenza Attack series, let's look at how we as blogger and reader can do something to prevent, avoid or manage this crucial scenario.



As mentioned in Part One and Part Two, Swine Flu is beginning to spread in an unusually high across the borders of Mexico, thus prompting a pandemic outbreak may just beginning to threatening us. But, before you hit any panic button, please make sure you are ready when things like this happen.

SYMPTOMS OF SWINE FLU

Like any other common flu or Avian Flu in the past, the symptoms can be very similar and may varied from one to another. In general, these symptoms include:

• Fever
• Cough
• Sore throat
• Runny nose
• Body ache
• Lethargy (feeling tired or fatigue)
• Lack of appetite
• Diarrhea and vomiting also been reported increasingly in swine flu

TREATMENTS

The swine flu can be treated by using several influenza antiviral drugs that have been approved for use in United States by Center For Disease Control And Prevention (CDC). These drugs are:

• osletamivir (known as Tamiflu - approved to both treat and prevent influenza A and B virus infection in people one year of age and older)
• zanamivir (known as Relenza - approved to treat influenza A and B virus infection in people 7 years and older and to prevent influenza A and B virus infection in people 5 years and older)
• amantadine
• rimantadine

These drugs help to relieve the symptoms, making the illness become milder while in long term, help to prevent serious influenza complications such as pneumonia (infection of the lower respiratory track).

Besides that, do take special care and consult with physician if you are pregnant or have a health condition (diabetes, heart disease, asthma or emphysema). Ensure the people with swine flu (like any other flu) to stay home for 7 days after the symptoms arise and get plenty of rest. Symptomatic treatments like drinking clear fluids and medications like Panadol to curb fever are the best to provide relieve.

PREVENTION IS BETTER THAN CURE

The main way that influenza viruses are thought to spread is from person to person in respiratory droplets of coughs and sneezes. Here are several ways you can do to prevent the spread of swine flu:

• Always maintain a high standard of infection control - frequent washing of hands with soap and water or with alcohol-based hand sanitizer.
• Get yourself a trivalent influenza vaccination although standard vaccination provides only minimal protection against H1N1 due to its new strain nature.
• Cover coughs and sneezes with paper tissue and throw it away into trash can.
• Avoid close contact with the others.
• Seek for immediate health care and stay home if you show symptoms of swine flu.
• Avoid touching your eye, nose or mouth because the disease can spread that way.

With the three part series on "Influenza Attack", I hope the readers will benefit the most. Be cautious when you are at outdoor, do not panic and remain calm! Although Swine Flu is spreading, as long as you take preventive measures and know what to do when emergency arrives, you will be okay!!

INFLUENZA ATTACK - PART TWO

(NOTE: This post/article is heavily-fuel. If you are unsure of what you are reading, it is absolutely normal. Please contact the author if you have found any inquiries about the topic. Questions are welcome]

To read the previous article regarding the introduction, read here.

SWINE FLU: THE OUTBREK BEGIN

After some introduction regarding the virus itself, where on the last part, I talked about the common influenza virus, let's talk about the outbreak. Due to the current condition where the concern of an outbreak of a new pandemic influenza virus is beginning to plague the world community. However, contrary to normal flu where hospitalization and deaths are common in high-risk groups like elderly and chronically ill patients, the Swine Flu affected the normal healthy people more severely.

The 2009 Swine Flu, or more appropriately H1N1 or Mexican Flu began back in the early of this month. In early reports, many thought that it is a common winter-seasonal flu of the subtype of H1 that annually hit the northern hemisphere during the winter. Early outbreak has been reported but not until April 24 that the scientist had it confirmed as a new strain of influenza virus. Analysis done at the US Centers for Disease Control (CDC) has identified four different genetic assortment components in this new strain, from human flu, avian flu and swine flu viruses.

STATUS OF OUTBREAK

The centre of outbreak, La Gloria in Mexico has initially reported an unusual respiratory illness back in February. The first suspected case of H1N1 was recognized on March 18, while it was uncertain and difficult to predict how great the outbreak would be.

April 13, the first person died of the swine flu and WHO was later been notified about the outbreak to maintain a pandemic alert. However, after the report of the first death case in USA, confirmed as a H1N1 Swine flu, World Health Organization raised its pandemic alert to Phase 5.

Due to the gravity of the outbreak, the Swine Flu is regarded as a major threat and possesses high chances for another major global pandemic.

HOW BAD IS SWINE FLU

So far, Mexico as the epicentre of the outbreak has reported the most number of cases and deaths so far. While its neighbouring nations have also taking the toll of its effect, the flu has spread to several nations outside the Northern America continent but no cases of death recorded yet.

LATEST
DEATH: 177 (9 CONFIRMED)
ILL: 3,872+ (244 CONFIRMED)
COUNTRIES WITH DEATH: 2
COUNTRIES AFFECTED WITH CONFIRMED CASES: Mexico, USA, Canada, Spain, UK, New Zealand, Germany, Israel, Costa Rica, Peru, Switzerland, Austria, Netherlands

** Sorry for the long lectures that leave many clueless. Again, this post is not made to confuse but should be used as merely to point out how deadly an influenza virus can be. Although in normal cases of influenza can still kill about 1% of those who catches it. In a severe and deadly types; H5N1 can kills half of those who catches it.

In part three of the series, we will look at how to prevent and protect yourself from Swine Flu.

@@(Sources from Wikipedia, CDC)

INFLUENZA ATTACKS - PART ONE

(NOTE: This post/article is heavily-fuel. If you are unsure of what you are reading, it is absolutely normal. Please contact the author if you have found any inquiries about the topic. Questions are welcome]

I am sure many readers out there have heard about the report of the latest pandemic disease - Swine Flu. Over this decade alone, there are several reported cases of such diseases; started with 2003's SARS Virus, and later that year, Avian Flu, another half global pandemic disease which killed many and destroyed the poultry industry; accompanied with few others small-scaled epidemics and pandemics thereafter.

THE GLOSSARY

Before we start, here are some glossary terms you need to clarify before hand:

EPIDEMIC = "New cases of a certain disease occur in a human population, during a given period, substantially exceed what is "expected," based on recent experience. It is an infectious; may be restricted to one locale (an outbreak), more general (an epidemic) or even global (pandemic)."

PANDEMIC = "An epidemic of infectious disease that spreads through populations across a large region; for instance a continent, or even worldwide."

INFLUENZA = "An infectious disease caused by RNA viruses of the family Orthomyxoviridae (the influenza viruses), that affects birds and mammals. This term is too general to describe each of it."

AVIAN FLU = "Refers to influenza caused by viruses adapted to birds. This is particularly caused by Influenza A Virus"
SWINE FLU = "Refers to influenza cases that are caused by Orthomyxoviruses endemic to populations of pigs. This is particularly caused by Influenza C or some subtypes of Influenza A Virus."
HUMAN FLU = "Refers to influenza cases caused by Orthomyxoviridae that are endemic to human populations (as opposed to infection relying upon zoonosis). It can caused by vast variant of Influenza Virus of subtypes A, B and C."

PARAINFLUENZA = "Refers to lower respiratory tract infection, caused by a group of four distinct serotypes of single-stranded RNA viruses belonging to the paramyxovirus family."

INFLUENZA VIRUSES

In general, influenza virus derived has the following characteristics:

GROUP: V (five) due to its negative single-stranded RNA
FAMILY: Orthomyxoviridae
GENERAS: [Influenza A] - causes pandemic and attacks humans, birds and mammals; [Influenza B] - attacks humans; [Influenza C] - attacks humans and pigs; [Thogotovirus] - attacks other vertebrates and invertebrates; [Isavirus] - attacks Atlantic salmon

Due to the nature of calamity, we shall focus our attention solely into Influenza Virus A. Over the years, researches have found out that while the type B and C had caused some serious pandemic outbreaks, both types show some significant lower degree of disease nature and lower mutation ability. Looking on historical dark era in human epidemeology, incidents like Spanish Flu 1918, Asian Flu 1957 and the recent Avian Flu had pointed directly to the Influenza A Virus.

INFLUENZA VIRUS TYPE A

Influenza A viruses occur in many variants that therefore can only be identified by using a special tests that will allow viral surface proteins to be recognized. There are two types of proteins on the surface:

• Hemagglutinin (HA) component is a substance that causes red blood cell to agglutinate (clumps). Consisting of 16 subtypes, that is where you have the H1 to H16 nomenclature. HA is useful as it helps to vitus to target at specific human cells and entry of the viral genetic into them.
• Neuraminidase (NA) is a glycoside hydrolase enzymes that cuts the glycosidic linkages of neuraminic acid. Consisting of 9 subtypes, that is where you have the N1 to N9 nomenclature. NA is useful to help the virus to bud out of the host target cells and releasing its danger particles into the body.

With 16 possibles of HA and a further 9 NA, that leaves us with a possible 144 variants with further genetic alteration on a higher level will produces even more variants. The virus genetic information is stored within the 8 single RNA strands (human is DNA which is a reverse - DNA produces RNA proteins to live, while RNA proteins in virus produce proteins that alter the original DNA) capable of releasing 11 types of proteins including HA and NA.

NAMING AN INFLUENZA

An Influenza virus can be named based on the following:
Virus Type - Type A, B or C
Geographic - Origin of the discovery of a certain flu virus
Strain number -
Years of isolation -
Virus subtype - Based on its HA and NA components

** Sorry for the long lectures that leave many clueless. Again, this post is not made to confuse but should be used as merely to point out how deadly an influenza virus can be. Although in normal cases, flus can still kill about 1% of those who catches it. In a severe and deadly types; H5N1 can kills half of those who catches it.

In part two of the series, we will look at the real problem - Swine Flu.

@@(Sources from Wikipedia, CDC)

WHY QUIT SMOKING NOW?

Smoking is a pleasure for some people and for others it is a symbol of elegant, coolness and so on. However, many realize the dangers behind smoking, yet, the number of smokers continue to rise every year. It is estimate that 1 in 5 of us smokes. When 28 million Malaysian are been used as a data, now you got 5.6 million smokers in Malaysia alone; while it reaches more than 1.4 billion worldwide.

Once you light up a cigarette, the heat helps to release thousands of chemical compounds in the list of name such as carbon monoxide, hydrogen cyanide, nicotine, tar, at least 43 carcinogens and numerous mutagens. Carcinogens are agents that induce the process of cancer in our body and mutagens are agents that induce mutation of genes in the body.

Nicotine is found naturally in tobacco leaves as an alkaloid that used widely as an insecticide in the past. With low concentration in a stick of cigarette, it reaches the brain in within 10 seconds and full body after 15 seconds upon inhalation. Nicotine raises the blood pressure, heart rate and increase alertness and relaxation. However, once the nicotine level dropped, smokers will take another stick to hit the desire, thus the need for maintaining the kicking level causes addiction.

Tar in the cigarette similar from those used to pave the road! Tar tends to accumulate on the branchial tubes leading to the lungs and burn the tiny hairlike projection of cilia that trap harmful particles before they enter the lungs. Thus, the chances of getting lung cancer is high.

Carbon monoxide is a poisonous gas that quickly absorbed into the blood to reduce oxygen capacity. Therefore, smoker has to exert more physical effort to attain a task than non-smoker, causing heart to work harder. The gas also causes vision impair, impairing perception of time and coordination.

So, why not stop smoking? Over the years of research, many points out the great benefits from smoking cessation. In dentistry, we also deal with cases that need smoking cessation in the clinic. Below are the good effects of quitting your cigarette packs.

WITHIN THE PERIOD OF STOP SMOKING

20 minutes Blood pressure, pulse rate and temperature of hands and feet return to normal.

8 hours Nicotine level is now fallen to only 6.25% of normal peak during smoking.

12 hours Blood oxygen level returns to normal.

24 hours Anxieties peak but should normalize within 2 weeks - this is the most critical part, where success depends on this 2 weeks period.

48 hours Damaged nerve endings start to regrow while your smell and taste return to normal; anger and irritability peaks.

72 hours Breathing becomes easier and lungs functional abilities increase with 100% nicotine-free and almost 90% of its by products should have been passed down via urine; symptoms of chemical withdrawal syndrome like restlessness peak.

10 to 14 days Recovery is likely where addiction no longer in place; blood circulation to gum and teeth normalize.

2 weeks to 3 months The risk for heart attack starts to drop and lungs functional begins to improve.

3 weeks to 3 months Blood circulation improves substantially and any chronic cough would have disappear.

1 to 9 months No more fatigue and shortness of breath; cilia have regrow to help to keep your lungs clean and reducing risk of lung infection.

1 year Risk of coronary heart disease dropped to half of a smoker.

1 to 5 years Risk of stroke declined to half of a non-smoker.

10 years Risk of lung cancer declined by half of an average smoker

15 years Risk of coronary heart disease is now that of a person who never smoked.


SO STOP SMOKING NOW. IT'S NEVER BEEN TOO LATE.

Source: http://whyquit.com/whyquit/A_Benefits_Time_Table.html, http://en.wikipedia.org/wiki/Nicotine,

DENTINAL HYPERSENSITIVITY

You are enjoying a craftly delicious ice cream that you have just bought from the store. It looks so tasty and tempting, yet you want to savour the moment first. Then, you took the first bite. Alas! A sudden short and sharp pain struck your teeth and you feel irritated by it. Fortunately, the pain did not last long. Now, you take the second bite. Ouch!! The cycle repeats again.

The scenario is so obvious as many may have know that you possibly know what is wrong with that. In general, this condition is known as teeth sensitivity. In more scientific approach, this condition is called dentinal hypersensitivity.

Dentinal hypersensitivity is a short, sharp pain upon stimulation of cold or hot food and environment. It has several degree of pain which may range in between irritation all the way to shooting pain, depending on individuals. This condition affects most on young adults around the age of 20 to 40, with more on female. It affects roughly a third of all adults in Malaysia.

There are many possible causes for this condition. The most popular acceptance is that the dentine area of the tooth, which located inner of the outer layer enamel. Once the dentine has been exposed to the oral environment, there are direct connection between the nerves inside the pulp and the surrounding. Next, you must have a trigger. Most commonly hot, cold, sour and sugarly food; air pressure and physical biting force can cause the condition.

According to the famous Brannstrom's hydrodynamic theory, dentine area is not solid in composition, rather it contains numerous tunnels that connect right into the pulp nerves. These tunnels or also known as dentinal tubules contains liquid that travel into the nerve receptor. Once food or stimuli acts on the tooth surface, there will be disturbance on the liquid, a hydrodynamic flow and disturbance will trigger the nerves in it. Therefore you have pain.

The other causes can be due to excessive force inserted on the teeth when brushing. Brushing too hard can cause not only gum bleeding, but also erosion of the tooth surface. Decaying teeth (caries) or any root tooth expose can lead to the condition.

There are many ways to treat this condition, where most popularly, any dentist will recommend you Sensodyne. [visit the web here]

In the market there are various types of Sensodyne toothpaste that will do different actions to stop different cases. The most common product is in fact the SENSODYNE ORIGINAL. It was the first ever Sensodyne product, helps to seal a layer of protection against pain from hypersensitivity. It contains strontium chloride which helps to seal off the tubules, thus relief the symptoms better. It is used daily for teeth and gum health maintenance It also has potassium nitrate that helps to desensitize the nerve ending.

BACTERIA

When Alexander Fleming found penicillin accidentally in 1928, the world was pleased to know that they have found a remedy to all the hell broke loose by many bacterial infections and diseases back then.

The breakthrough gave Alexander Fleming together with his associates of Ernst Boris Chain and Howard Walter Florey were celebrated with a Nobel Prize in Physiology and Medicine in 1945. Since then penicillin was renowned as the primary remedy for any cases of bacterial infection and diseases related to it.

Bacteria is a large group of unicellular microorganisms that ranges from different size, shape, physiology and functions. All thanks to Antoine van Leeuwenhoek, the first person to observe bacteria using a microscope. Together with the rapid changes in the world of science, we have seem to know more about them.

There are approximately ten times as many as bacterial cells as human cells in the body. Majority are harmless, friendly and protected against human cells by our very own immune system. Some caused potential deadly infection to very mild degree of infections. Our skin, digestive system, respiratory system and mouth were a bulk-pool of bacteria infestation site and therefore infections are commonly seen here.

Bacteria is classified in generally to include those under gram positive (no outer membrane) and gram negative (with outer membrane), which were based on test using gram staining. Other unrecognized types of bacteria were also noted.

Let's look at some of the most commonly talked about bacteria in our life. It may be as famous as syphillis or it can be some historic lesson as in Bubonic plague.

#1 - Bacillus anthracis >> Anthrax

This bacteria of rod-shaped Gram-positive causes an acute disease called anthrax. It was the oldest recorded disease among the grazing animals such as sheep and cattle and have some to believe it was the reference to the Sixth Plague mentioned in the Book of Exodus. In 1877, Robert Koch discovered this bacteria can cause disease in human and was later awarded a Nobel Prize. Anthrax is spread via ingestion into intestines, inhalation into the lungs or via skin.

Prevention: cannot spread from person to person but dead body is a potential infection source, vaccination available

Treatment: Fluoroquinolones, doxycycline, penicillin, erythromycin or vancomycin

#2 - Treponema pallidum >> Syphillis

Sexually transmitted disease, syphillis is caused by this gram-negative spiral-shaped. Predominantly, syphillis is acquired by sexual contact with the infectious person and in some case via congenitally from mother-to-children. Syphillis occured in three stages; primary, secondary and tertiary. Traditionally, the disease was dubbed as the 'Great Imitator' due to its confusing nature with other disease, especially in the tertiary stage. Syphillis remain to occur in the world today despite introduction of condom and promotion of safe sex practise.

Prevention: safe sex, no vaccination available

Treatment: Penicillin G, ceftriaxone

#3 - Yersinia pestis >> Bubonic plague

The bubonic plague is an infection of the lymphatic system resulting from the bite of flea. Fleas are commonly found in rodents and poor hygiene is one of the factor why it was once so wide-spread occurred. Experts believe that the Black Death that swept through Europe in the 1340s were actually due to this. Black Death causes the deadliest human pandemic disease in history, killing about 75 million people, mostly in Europe. The bacteria is a Gram-negative rod-shaped.

Treatment: Streptomycin, gentamicin, ciprofloxacin, doxycycline

#4 - Mycobacterium tuberculosis >> Tuberculosis

Tuberculosis (TB) is a disease that attacks the lung and may later spread elsewhere in the body. The culprit is this typical mycobacterium strain which is requires high level of oxygen; neither Gram positive nor negative, rather a special acid-fast technique is used to recognize it. The disease is spread via sputum or inhalation, or even via close contact. Although the disease can be controlled, it still claims more than 1.5 million life annually.

Prevention: Vaccination with Bacillus Calmette-Guerin (BCG), avoid close contact
Treatment: Rifampicin, isoniazid, pyrazinamide, streptomycin

#5 - Escherichia coli >> Food poisoning, diarrhea

This Gram negative oblongated bacterium is commonly found in lower intestine, mostly harmless. However certain strains are known to cause the disease. Found in 1885 by Theodor Escherich, the bacterium is in fact the most studied micro-organisms due to its simplicity in genome and genetic modification. Food poisoning is usually due to its toxin, however may cause notorious complications like hemolytic-uremic syndrome.

Prevention: Personal hygiene, food hygiene
Treatment: Amoxicillin, cephalosporins, trimethoprim-sulfamethoxazole, ciprofloxacin

There are many more bacterial infection which are common in human body. This include Pseudomonas aeruginosa which causes generalized inflammation and sepsis; Helicobacter pylori which causes peptic ulcer or gastric; Streptococcus pyogenes which causes cellulitis, erysipelas and rheumatic fever;and the list just goes on and on.

It is hard to know all but at least if we know a handful of them, it may be vital for knowing how to manage cases of bacterial infection and what are the precautions. I am sure you heard about the Brazilian model whom died last month due to septic shock originated from a simple undiagnosed bacterial infection. Again, a boy was died due to another bacterial infection following fever while waiting for his plane home to Hong Kong in KLIA.

Well, not to frighten you with all of these threatful pictures of how nasty bacteria can be but precautions must be taken, don't you agree! [Credits to related articles from Wikipedia, my Microbiology notes and bible]

What I Got From This Week

This morning (on 08/01/09), I was in this cold-refrigerator-room. Well - not really, but that is what Dewan Kuliah 4 (DK 4 in short) is always been referred as. DK 4 is a super-duper cold lecture hall in my campus, as if it gives you some kind of cold environment, similar as if like you are studying in England. Anyway, back to the business on what I learnt on this week.

One: I found out that one of my lecturer have read my blog before and I'm wondering on what occasion was that. She is an expert in endodontics. She was mentioning something about this website called Nicenet, a website dedicated to encourage more interaction and intellectual discussion between students and teachers, regardless of age, level and background. Suddenly she looked straight at me and said, "Yeah you as well, I have been to your website (meaning this blog) before. So how long have you been writing it?" I was startled but I was still able to give a simple answer, "Since two years". Then the other eyes inside the hall were either staring at me as well or giving me some surprise look. You see, since I started this blog, I have never introduce, advertise or promoting it within my fellow course-mates.

Two: I found out that been a dentist is not human enough. While pointing out the lecture slides that discussing on how to take a proper history on a patient, she also said,"You guys as a future dentist should be more 'human'." This is not the first time I heard of such statement. All these while, dentist is not been like a normal person when they try to communicate or examine their patient which indicated that we are not so 'human' at all! Taking history from a patient may seems troublesome but that is how we derive a proper diagnosis, treatment and prognosis. History taking requires a substantial amount of knowledge, good communication and examination.

"You should be like Sherlock Holmes or just nice to be like the CSI," she added later. It is true, the concept of investigation and examination are important in dentistry as an overall. Sometimes we do misdiagnosed a certain disease or condition because of lack of information, improper technique and so on. This does not only applied to myself but also to others. Been a human does not made you perfect. Sometimes we do made mistakes but all of these are part of our life. Therefore, I believe in that we should prepare ourselves even in what ever we do. But in a nutshell, does been a dentist seems 'inhuman' enough?

On the next day, I have a clinical session. 

Three: I came across a patient with tooth crack syndrome. She complaint of the tooth (47 - Lower right second molar) been in pain while biting but relief after release the biting. Therefore, she felt very uncomfortable when eating. There is a large tooth-coloured (composite) filling on that tooth that is large and extended from a side to another (Mesi0-occluso-distal) restoration. My partner and I conducted a few examination over her problematic tooth.

First, a radiographic features a widening of PDL area with no signs of caries and dislodged previous restoration seen. Following pulp sensibility testing reveals the tooth is still on vital with delayed exaggerated response to electrical pulp test, suggesting a dying pulpal tissue. Last but not least, we applied a blue-coloured dye called Canal Blue which detects the crack line on the tooth.

Treating a cracked tooth is not simple. The list of treatment options are as follows - crown, root canal treatment or removed the tooth. But we just leave her tooth untreated since she does not have much time and seldom came for an appointment. She also refused a molar band around the tooth to protect the tooth from further cracking. What I learned from this case? Simple, people will never visit a dentist if he or she feels nothing wrong about it, at least YET!!

In next post, I would like to discuss a matter that one of my reader did complaint about her difficulties she had when she done a dental treatment under my junior last time. Well, another classic example of tales from people undergoing dental treatment!!

A Day In Paeds Clinic

Today is 23th December...meaning the clock is ticking even closer to the Christmas day itself. It is only 2 days left on the calender, yet the mood for some holiday season had already begun since like last Friday. Today I have a great time in the children dental clinic since today it is my turn to be there and I have an appointment with one of my children. Due to medical and legal etiquette, I will not post or upload any pictures of the clinic itself here. Just let the words tell it all.

I have an scheduled appointment with one of my patient today. His father brought him a bit late than usual and requested me to deal with their son's carious teeth. Since this is my first time encountering him, I was surprised that the child had some sort of genetic disorder disease. No matter what the child had, it was my responsible to treat his case too.

I never heard of the disease and it did nothing to ring any of my bells because simply because I never learn it before. The child is 6 years-old, a happy-go-lucky boy but unfortunately suffered from a rare genetic disorder called Noonan Syndrome. This disease is not fatal and does not possesses any harm to the child himself. during the treatment, he seems to be not in any state of anxiety but as time goes by he get a bit tired and irritated, as in all case of children that attends the dental clinic.

I managed his carious front tooth for about half an hour and then before he left, I gave him some cookies and water for him and his siblings. Watching them left, I felt the warmness in their family. Although they may not be celebrating Christmas because they are Indian Muslim, I still think of how appropriate the timing for me to post this up. A family warmness during hard time or great time were shared among all others.

I may not be able to go back during this Christmas but I do hope those who are able to do so to really use the time to reflect on the year that we have just been through. 2008 is raising its curtain soon. So what have your year been? Good or bad are just part of it. Lets look forward for a brand new year.

Today I learnt a few thing:

1) The warmness family relation is what it matters - it doesn't matter if one of them are less unfortunate than the others, the essential part is the familyhood itself. A family endures good and bad time together.

2) Noonan Syndrome is a relatively common genetic disorder which affects every 1 in 1000 to 2500 live births. It is regarded as a male version of Turner syndrome. he principal features include congenital heart malformation, short stature, learning problems, indentation of the chest, impaired blood clotting, and a characteristic configuration of facial features of webbed neck, wide spaced eye and low set ear. These kids are not asked to born in such a way...I really pity them!!

World AIDS Day - A Vigil For The Victims

1st December every year is designated to celebrate and to remember the World's AIDS Day. On this day, it is the day when we dedicate this day to raise awareness regarding the significant and impact of AIDS pandemic disease to the world population.

When it was first incepted in 1988, the day has become so significantly to recognize all those souls who had perished succumbed to AIDS, those who are embattled with AIDS and those who are struggling to find the cure for AIDS. To these peoples, let us raise our arms to reach them and comfort them with our love and care, with our ability to help to battle the human destruction.

2008 signifies the two decades of journey through the darkness of AIDS. This year's theme is "STOP AIDS. KEEP THE PROMISES - LEAD - EMPOWER - DELIVER". Maybe it is time for the us to lead the human march and really do something for the world to change. Like Obama said, Let's Change.

AIDS or Acquired Immune Deficiency Syndrome is a syndrome that results from the destruction of human immune system by Human Immunodeficiency Virus (HIV) that may lead the sufferer exposed to many susceptible opportunistic infections and tumors. HIV is transmitted via direct contact to mucous membrane or bloodstreams, or bodily fluids (like blood, semen, vagina fluid, preseminal fluid and breast milk). As we all known, there are three possible way of transmittion mode; sexual intercourse, syringe sharing especially in drug addicts and mother-baby mode.

In 2007, 33 million people including 2.5 million children are estimated to live with the disease worldwide, with about 2.1 million (including 330,000 children under the age of 15) are dead. About three-quarter of them are living in Sub-Saharan region of Africa. 2.5 million new cases are reported in 2007

AIDS can cause many health problems related to severed immune system, thus body is unable to fight against infections, even the slighly commonest micro-organisms in our body. Therefore, opportunistic infections are so common and HIV can virtually strikes every where and every organ that it possibly reach.

AIDS patient can develops:

• Systemic infections of fever, sweats at night, swollen gland, chills and weakness
• Kaposi's sarcoma (due to Human Herpes virus, HHV-8)
• Cervical cancer (due to Human papillomavirus, HPV)
• Lymphomas - cancer of the immune system
• Burkitt's lymphoma (associated to Epstein-Barr virus)
• Certain cancers: anal and rectal carcinoma, Hodgkin;s disease
• Penicilliosis (due to Penicillium marneffei) **third commonest opportunistic infection
• Pneumocystis pneumonia (due to Pneumocystis jirovecii) **common causes of death
• Tuberculosis (TB) with possible multidrug resistance and atypical types
• Esophagitis (due to fungal candidiasis, viral Herpes Simplex Virus or cytomegalovirus)
• Chronic diarrhea (due to common bacteria and parasites)
• Colitis
• Toxoplamosis encephalitis - infection of brain (due to Toxoplasma gondii)
• Cryptococcal meningitis - infection of meninges of spinal cord (due to Cryptococcus neoformans)
• Progressive multifocal leukoencephalopathy - gradual destruction of myelin on nerves (due to John Cunningham or JC virus)
• AIDS dementia complex, ADC
• Others.......

Until today, no vaccine and effective therapy are available for curing AIDS. The only known methods of prevention are based on avoiding the viral exposures and antiretroviral therapy following highly significant exposures. The current treatment of HIV consists of highly active antiretroviral therapy, HAART cocktails of many types of antiretroviral drugs.

Looking back over the history since the AIDS was first discovered in early 1980s, stigmas had become a public misconception and misunderstanding over the diseases itself. If you are fascinated by the history of AIDS itself, you will not missed the part ot the history with repeated mention of ostracism, rejection, deiscrimination and avoidance of people with HIV. Just read about the story of people like Ryan White, the Ray brothers, NBA star Magic Johnson or Freddie Mercury of the band Queen himself. This day, let us pour our hope, raise our hand, and together walk through this parade calling on for support to curb AIDS.





For more, go to:
www.worldaidsday.org
www.ptfmalaysia.org/images/HIV-AIDS 1986-2004 Statictics.pdf
www.worldaidscampaign.org

OUCH!! IT'S AN ULCER!!

Ouch!! It's an ulcer on my mouth!!

Ever wonder why on Earth there are always been ulcer here and there on your mouth? Ulcer as defined as the loss of epithelium (skin cells outermost layer) integrity, continuity and thickness, is one of the most annoying things any patient can complained to a dentist. I'm sure you still remember that toothache (pain) as I featured before is quite a common complaint. (Lost? Click here and here)

Scary, annoying but true, ulcer in mouth caused by many reasons. Oral ulcer also known as canker sores in some dictionary. If you are having lichen planus, anemia, immune defect, some hand-foot-and-mouth disease or simply you accidently bite on any part of your mouth (trauma), you are likely to develop ulcer in your mouth. There are a lot more reasons that can cause it, too many that deriving a diagnosis based on causes can be difficult.

Most commonly, ulcers in mouth can be due to these several diagnosis in general:

(1) Traumatic ulcer
As the name suggests, it is caused by accidental biting on any parts of you mouth, let says your tongue or maybe due to eating hot stuff and you get your tongue burned. Usually it heals in within 10 days. You know how to get it heal by yourself - Bonjela!!

(2) Recurrent aphthous ulcer or RAU in short
This is way too common. The annoying thing is that in this features, the ulcer tends to recur again and again, although not on same site all the time, but the recurrence can give a bad experience. Ulcers are painful, no doubt! Therefore pain can persists long enough and may disturbs patient's daily routine.

It doesn't have imminent causes, but likely due to stress, hypersensitivity, autoimmune, hormonal changes and etc. This ulcers can manifest in three forms: minor (small) in a few numbers, major (big) that most likely to be single sore or herpetic (smaller but can fused to become one). Depending on types of RAU, healing can take longer than normal traumatic ulcers.

Treatment of ulcers can be done in many regiments. Steroids, antiseptic mouthwash or antibiotic mouthwash, or even local anaethestic can work to relieve the pain and other symptoms..

And last but not least, some studies say that you can ry to prevent mouth ulcer by taking these food: orange, lime, tomato, nuts, barley, soy and vinegar. Yes, kind of true.

Know Your Common Toothache!! (Part 2)

Our lesson regarding toothache covered the most commonly caries and pulp infection on the first part. This week, I see another three patients complaining the main problem of pain from tooth. The previous sentence means nothing but to tell you that toothache is somehow annoying and very common occur. So beware if the signs of toothache arise suddenly or may slowly creeping in, as it may indicates some problems over your tooth.

Remember this?

Here are the common cause of toothache:

• Dental caries or cavity
• Infected dental pulp that required some form of root canal treatment or extraction (removal)
• Gum disease
• Emergence of wisdom tooth
• Cracked tooth
• Jaw disease
• Exposed root of tooth
• Dry socket following removal of tooth

This part we will look at the causes from the bold one above - Gum disease and emergence of wisdom tooth.

GUM DISEASE

Gum disease in the mild to moderate condition is known as gingivitis. Gingivitis is the inflammation or swelling that occurs around your gum which primary induced by dental plaque. Commonly people with gingivitis will complained of swelling gum, mouth sores or ulcers, severe oral odour, painless gum except when pressure is applied and, bleeding gum occurs easily especially when brushing and flossing. Gingivitis is a preventable disease and curable as well. To prevent gingivitis, make proper oral hygiene that includes toothbrushing and flossing daily. Mouthwash is optional, usually using (saline) salt water or chlorhexidine. If gingivitis is not treated, it can progress to cause periodontitis, a even more severe form of gum disease.

EMERGENCE of WISDOM TOOTH

Wisdom tooth or third molar is not actually wisdom. As wisdom it maybe, as painful it will be to endure the process of it to come out. The reason behind the pain is that it is the last to erupt, having relatively inadequate space to squeeze itself out from the jaw and may have many problems in terms of positioning.

Because of these, the third molar especially the lower one will always cause impaction on the adjacent tooth. Impaction can be classified into mesioangular, distoangular, vertical or horizontal.
Diagnosis depends on the way the position of the third molar, for example...the radiograph below, it looks like the third molar is in a horizontal position in relative to all the teeth. Thus, it is known as horizontal impaction of third molar.

Another problem arise with regards of the wisdom tooth is pain due to failure to erupt completely through the gum bed and the gum at the back of the wisdom tooth extends over the biting surface, forming a soft tissue flap around the tooth called an operculum. Teeth covered by an operculum can be difficult to clean in which allow accumulation of debris which may cause pericoronitis, a common infection problem in young adults with partial impaction.

In removing the wisdom tooth, there are guidelines in which we can determine in which condition we can or we cannot remove the impacted wisdom tooth. The list is in here. So the preferable treatment for this condition is to remove it but the patient should always be aware of the possible complications due to the treatment.

Know Your Common Toothache!! (Part 1)

Toothache can be a very annoying experience and sensation that ones can get. Unfortunately, everyday in my clinic I always see many cases of patient coming into the dental clinic to seek for dental treatment to relieve their toothache. In some stage of our life, toothache may occur due to certain conditions pretty much related to our teeth or general health, where they can be avoided.

Simply looking at its meaning, toothache or also known as odontalgia is the pain of the tooth and around it. As annoying as it is, we should know a little bit regarding its causes, so that you will know what to expect and how to deal about it. For the first part, we will look at the pain due to caries and infected pulp.

Here are the common cause of toothache:

• Dental caries or cavity
• Infected dental pulp that required some form of root canal treatment or extraction (removal)
• Gum disease
• Emergence of wisdom tooth
• Cracked tooth
• Jaw disease
• Exposed root of tooth
• Dry socket following removal of tooth

Dental caries and infected dental pulp are two very common condition. I see it everyday. Some other form of toothache are also caused heart disease (heart attack, chest pain)

CARIES or CAVITY

Dental caries is a very common mouth disease that affected over 90% of the adults worldwide. Dental caries involved damaging the tooth structures that may resulting holes on the tooth. The damage occurs first at outer hard layer called enamel, which then goes into dentin and cementum.

If left untreated, the cavity which mainly contain bacteria will continue to destroy more tooth structures until when it reach the dentin. The dentin consists of tubules that connect deep into the pulp. The tubule is sort of like a tunnel and when the cavity passes through it into the pulp, where the nerves are, the nerve inside the pulp will inflammed or swollen to cause pain. As for this, i recommend you to get it treated by removing the infected caries and placing some filling material to fill the tooth.

INFECTED DENTAL PULP

When the dental pulp is affected usually due to caries process, the pulp will undergoes changes into inflammatory (swelling) status accompanied with pain. The pain is usual because the inflamed pulp cause increase in pressure and the surrounding tissue. The pain can spread to adjacent tooth, thus we may feel pain but confused to pin point the exact pain location. This is called pulpitis.

Pulpitis can be divided into two condition - reversible pulpitis and irreversible pulpitis.

When I get reversible pulpitis?

• When you have sharp and transient pain but does not disturb your sleep
• Pain occurs with taking cold, sweet or sour food
• Caries or cavitated tooth
• Upon examination, the dentist will notice that your infected tooth is not tender to percussion (when the dentist lightly knocking your tooth), respond to cold and hot test, respond to tooth vitality (still alive) and no tooth mobility (loosening)

How we deal it? Simple, we relieve pain with prescribing medication, remove the caries and do pulp capping...we seal the pulp basically.

When I get irreversible pulpitis?

• When you have sharp, throbbing and lingering pain that truly disturbs your sleep
• Pain occurs spontaneously but get worsen with hot, sweet and sour food - some get comfort from taking cold food
• Upon examination, the dentist will notice that your infected tooth may or may not have localized swelling, not respond well to cold and hot test, not respond to tooth vitality (stage of dying tooth)
• and no tooth mobility

How we deal it? Because the tooth is in dying stage, it should be manage accordingly. Pain control, do root canal treatment or optionally extraction (removal). Do forge out more money for the former option and do prepare to lost a tooth for the latter option.

That's all for now...next time...the series will continue with toothache from other causes....