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The Star Online: Lifestyle: Health

The dengue menace

Posted: 08 Feb 2014 08:00 AM PST

Early assessment and appropriate treatment in dengue fever is critical to prevent serious complications and death.

DENGUE fever has been in the news quite regularly for the past few years. Many people have either been infected (and survived) or know of others who have had the infection.

Dengue is endemic here, and the mosquito that is responsible for transmitting the virus, Aedes aegypti, is living amongst us.

So, how can we prevent ourselves from getting infected?

Recent statistics of dengue cases and fatalities in Malaysia are ringing alarm bells across the country. From Jan 1 to 22, 2014, 6,155 dengue cases were reported, compared to 1,792 cases within the same period in 2013 (an alarming six-fold increase). The number of deaths has doubled from five deaths in 2013 to 10 deaths in 2014, all within the same period.

There is no running away from the problem as dengue cases have increased in 12 states across the country.

Signs and symptoms

Dengue fever is a viral infection. Its carrier – the female Aedes aegypti mosquito – spreads the virus by biting a person already infected with dengue fever. An infected mosquito can continue to transmit the virus for the rest of its life.

One bite is enough to infect a person. The virus usually takes five to eight days to incubate before symptoms begin to appear.

There is no antibiotic, anti-viral medication or vaccine to cure dengue fever. Treatment is mainly to alleviate the symptoms.

The usual symptoms of dengue are sudden and acute onset of high fever (40°C/104°F) for up to a week, followed by any of the following symptoms – chills, severe headache, pain behind the eyes, muscle and joint pain, nausea and vomiting, as well as fatigue.

Rashes may appear a few days later.

These symptoms will last for two to seven days. Most people will recover completely within two weeks, but may continue to feel tired and depressed for a little longer before they feel normal again.

In some people, complications can set in – dengue haemorrhagic fever (DHF) or dengue shock syndrome (DSS).

In DHF, the symptoms are high or very high fever, spontaneous bleeding, especially from the gums, bleeding under the skin (petechial spots), bleeding in the gut, and liver damage.

DHF is often fatal if left untreated. Most deaths reported have been in young adults, but children can easily succumb if not properly managed.

The symptoms of DSS include very high fever, severe bleeding, weak pulse, drop in blood pressure, restlessness, and cold clammy skin (with signs of shock). At this stage, fatality rates can be as high as 50%. Two-thirds of all DSS fatalities occur in children.

Filename : shutterstock_33.2ff7c122747.original.jpg - To go with

The symptoms of dengue shock syndrome (DSS) include very high fever, severe bleeding, weak pulse, drop in blood pressure, restlessness, and cold clammy skin (with signs of shock). Two-thirds of all DSS fatalities occur in children. – AFP

Dengue fever in children

Children, especially toddlers and infants, are particularly vulnerable to diseases because their immune systems have not yet matured. Parents must take precautions to ensure that the early onset of dengue fever symptoms in young children are monitored carefully and treated properly.

Dengue in infants and toddlers presents symptoms similar to the flu – fever, running nose, cough and mild skin rash. Older children may have high fever, pain behind the eyes and joints, headache and backache.

This may be followed by a reddish skin rash with white patches, loss of appetite, nausea, vomiting, and itchiness on the palms and/or soles of the feet. Your child will feel weak and listless.

If the above symptoms with fever are noted, it is best to see a doctor immediately. A blood test will confirm if your child has been infected with the dengue virus.

If dengue fever is confirmed, your doctor will prescribe medication for the fever and pain (most likely paracetamol), and other supportive medications if needed. Medications containing aspirin must be avoided as they will exacerbate bleeding and cause other problems.

Once diagnosed, blood tests will be done every day to check on platelet and haematocrit levels. Give your child plenty of fluids, at least a litre a day if your child is a year old and below 10 kg.

The prescribed fluid intake for children above 40 kg and adults is two litres a day.

Fluids help to rehydrate the body as the fever increases water loss and poor appetite depletes fluids. Dengue also causes blood vessels to leak and increase water loss from blood circulation. Lack of appetite, vomiting and diarrhoea also exacerbates dehydration.

Therefore, keep your child hydrated with fluids such as water, soups, juices and fruits.

If your child's condition worsens, i.e. if any of the following symptoms are present – bleeding without injury, drowsiness, difficulty breathing, lethargy, excessive vomiting, poor intake of fluids, abdominal pain and giddiness, then waste no time in getting your child admitted to a hospital.

These are signs that your child may be at risk of DHF or DSS.

At the hospital, your child will be put on an intravenous fluid drip and their vital signs will be monitored.

Blood tests will be done at regular intervals to check on the platelet count and blood concentration.

If there is spontaneous bleeding and the platelet level decreases to below 20,000 and continues dropping, a platelet or blood transfusion will be given.

Your child will only be discharged if the platelet count goes up and shows an upward trend. After discharge, your child will still be weak and tired, and will need to rest well and avoid active play.

A repeat blood test may be done after one to two weeks to confirm that the platelet count has returned to normal.

Precautions for children

In addiction to taking the precautions advised by the Health Ministry in eradicating the breeding grounds of the Aedes mosquito in your homes and surroundings, parents can also reduce the risk of mosquito bites by:

·Installing mosquito screens in windows and doors.

·Applying insect repellent on children when they go out to play.

·Keeping children indoors during the early mornings and late evenings when the Aedes mosquito is most likely to strike.

·Dressing children in long-sleeved tops and long pants when playing outdoors.

·Keeping children away from neighbourhoods where individuals have been infected with dengue fever, as there is a high likelihood that Aedes mosquitoes are still present.

·Taking precautions when holidaying in other dengue fever endemic countries in South-East Asia, Latin America and the Caribbean. Dengue does not only happen in Malaysia!

Though your child will gain immunity to the particular strain of dengue virus that caused the infection, there are three other strains (with a fifth strain, dengue V, recently described in Sarawak) of dengue viruses that can cause re-infection.

Therefore, any person faces the possibility of getting dengue fever four or five times in their lifetime.

With these odds, it is best to take as many precautions as possible from getting bitten by the Aedes mosquito.

Intensive research has been conducted on a vaccine for dengue infection, and it may be available sooner than we think.


1. The Star at http://www.thestar.com.my/News/Nation/2014/01/25/Dengue-cases-skyrocket-Number-of-infected-increases-by-threefold-nationwide/

2. Healthcare Malaysia at http://healthcaremalaysia.com/dengue-fever

3. Expat Malaysia at http://www.expat.com.my/dengue.htm

4. Malaysia Kurnia at http://malaysia.kurnia.com/Lifestyle/Health/17/Default.aspx

5. WebMd at http://www.webmd.com/a-to-z-guides/dengue-fever-reference

6. Kids Health at http://kidshealth.org/parent/infections/bacterial_viral/dengue.html#

7. Mayo Clinic at http://www.mayoclinic.com/health/dengue-fever/DS01028

8. World Health Organization at http://www.who.int/mediacentre/factsheets/fs117/en/

9. KK Women's and Children's Hospital at http://www.kkh.com.sg/HealthPedia/Pages/ChildhoodIllnessesDengueFever.aspx

  • Datuk Dr Zulklifi Ismail is a consultant paediatrician and paediatric cardiologist This article is courtesy of Malaysian Paediatric Association's Positive Parenting programme in collaboration with expert partners. This article is supported by an educational grant from Vitagen. The opinion expressed in the article is the view of the author. For further information, please visit www.mypositiveparenting.org. The information provided is for educational and communication purposes only and it should not be construed as personal medical advice. Information published in this article is not intended to replace, supplant or augment a consultation with a health professional regarding the reader's own medical care.

ReLEx, it's a new procedure

Posted: 08 Feb 2014 08:00 AM PST

ReLEx SMILE is a new, 'flap-less' form of laser eye surgery that can be used to treat short-sightedness, often even for those with very high prescriptions, drier eyes, contact lens intolerance and thinner corneas.

VISION correction surgery, also called refractive and laser eye surgery, is any surgical procedure used to correct vision problems.

Over the past few decades, refractive surgery has improved the quality of life of over 30 million patients, with a more than 95% patient satisfaction rate.

This has made it one of the most popular elective surgical procedures in all medicine.

It is considered very safe, with predictable results. After refractive and laser eye surgery, many patients report seeing better than they had at any other time in their lives.

ReLEx SMILE: The lenticule is removed through the small incision. The disruption to the biomechanics of the cornea is minimal. No flap is created. - do not reuse

2. The lenticule is removed through the small incision. The disruption to the biomechanics of the cornea is minimal. No flap is created.

Extensive research has provided invaluable refinements and advancements of laser technology and diagnostic tools to develop safe and appropriate treatment options for patients with a myriad of refractive disorders.

Laser-assisted in situ keratomileusis (LASIK) is presently the most performed elective procedure in the modern world.

In recent years, tremendous advancements have been made in this field. A new procedure called ReLEx (Refractive Lenticule Extraction) SMILE (SMall Incision Lenticule Extraction) is now gaining popularity in the refractive arena worldwide, and is potentially changing the practice of refractive surgery for the next decade.

Unlike conventional LASIK, the ReLEx SMILE procedure does not create a flap and involves the use of only one laser (the femtosecond laser).

Instead of vaporising cornea tissue to correct the underlying short-sightedness and astigmatism, ReLEx SMILE carves out a small piece of corneal tissue called a lenticule in the cornea.

Then the lenticule is removed through a small keyhole incision (about 2.5 to 4mm).

This single-step, all-in-one-laser operation only takes about 30 seconds to perform on one eye, and the entire procedure can be completed in about 15 minutes for both eyes.

This laser is extremely fast and uses very low energy.

The procedure is odourless and silent, so there is less discomfort for patients.

The patient also feels more comfortable because the suction on the eye during the treatment is gentler. There is no frightening "blackout", no bleeding (no red eye) during the procedure, or swelling of the eye after the procedure.

Light blackout is a phenomenon in which the laser beam the patient is told to focus on during the procedure vanishes when the procedure begins. This temporary disappearance of the focal point can cause panic.

ReLEx SMILE: The removal of the lenticule changes the form of the cornea, creating the required change to refraction. - do not reuse

3. The removal of the lenticule changes the form of the cornea, creating the required change to refraction.

Foreign body sensations and mild discomfort may be experienced by some patients after the procedure, but this usually lasts for just a few hours.

Due to the smaller wound, there's less immediate postoperative discomfort and tearing.

The use of a small incision also means that fewer corneal nerves are severed during the procedure, which also means less dry eyes.

Flap displacement or dislodgement is not an issue as no flap is being created.

Most patients will experience a dramatic improvement in their vision a day after the surgery, remaining stable days after the surgery.

All excimer laser procedures are subject to inconsistency based on differences in corneal hydration, laser fluence projection, reflection losses, temperature and humidity in the laser room, and other environmental factors that are hard to control.

In the ReLEx SMILE procedure, the only variable affecting tissue removal is the accuracy of the femtosecond laser's optomechanics, which are unaffected by environmental conditions. It is likely that with the procedure, there will be less need to develop personalised nomograms for different machines, locations or surgeons.

If the present direction and volume of research is any guide, a large proportion of tomorrow's femtosecond technological advances and discoveries will be based on our mastery of treating refractive errors without even touching the cornea. All treatments will be intrastromal, and ReLEx SMILE is the most current procedure available.

Choosing laser eye correction to fix your eyesight problems is not a decision you should take lightly. Keep in mind that laser vision correction is still a surgical procedure that carries a risk, although the risk involved is very small and the success rate is very high.

You are advised to have your eyes properly evaluated and examined by the eye surgeon prior to surgery. Be sure you discuss all options and potential risks in detail with your eye surgeon or eye care provider before making any final choices.

Prostate cancer and PSA

Posted: 08 Feb 2014 08:00 AM PST

Prostate specific antigen (PSA) in the blood is commonly used to aid in the diagnosis of cancer. Should it be adopted as a routine screening test for the cancer?

THE word "cancer" strikes fear in everyone's hearts. Among men, prostate cancer ranks as the most common cancer worldwide. In Malaysia, it is the fourth most common cancer diagnosed in men.

For prostate cancer, a test measuring the levels of prostate specific antigen (PSA) in the blood is commonly used to aid in the diagnosis of cancer.

However, the PSA test is increasingly being touted as a routine screening test for men above a certain age. This issue is shadowed by many questions, foremost among them: Should all men take the PSA test? Is it the best method for early cancer detection?

This article will attempt to clear up some of the confusion surrounding PSA testing.

How to know if you have prostate cancer

Most of the time, there are no clear symptoms related to prostate cancer. Some of the symptoms that may develop are not always clear-cut in pointing to prostate cancer as they may also be attributed to other conditions.

For instance, some men with prostate cancer may notice blood in their urine or semen, a need to urinate more frequently, slower than normal urine flow, and difficulty in getting an erection.

These symptoms can also be present in cases of an enlarged prostate, infection and bladder stones. Thus, they are not the most reliable indicators of cancer.

However, if these symptoms are present, your doctor should suspect cancer and conduct several tests to confirm the diagnosis: a digital rectal examination (DRE), a PSA test and/or a prostate biopsy.

A DRE is performed with the doctor inserting a finger into the patient's anus to feel the prostate. Since the prostate is in front of the rectum, the prostate will be easily felt by pressing the finger on the rectal wall. The surface of the prostate tumour will usually feel irregular and hard.

At the same time, the doctor may also recommend a PSA test. The PSA is a protein produced by cells of the prostate gland. Certain medical conditions, like prostate cancer, prostatitis, urinary tract infection, enlarged prostate, injury and sexual activity, can increase PSA levels.

Because so many conditions can cause the PSA level to go up, it is not safe to presume that it's prostate cancer from this test alone. Therefore, the doctor may prescribe antibiotics before repeating the PSA test.

It is also advisable to refrain from riding a bike or ejaculating 48 hours before getting a PSA test. If the PSA remains high, a prostate biopsy is recommended.

A prostate biopsy involves inserting an ultrasound probe into the rectum to visualise the prostate. A needle is then used to take samples of prostate tissue via the rectum. The tissues will then be examined by a pathologist through a microscope.

A prostate biopsy will be able to confirm the presence of cancer. However, a negative test does not necessarily rule out cancer because there is a possibility that the biopsy missed the area of the prostate that contained the cancer.

In this situation, a saturation biopsy (where 20-30 biopsy samples are taken) may be needed.

PSA – how high is too high?

There is a lot of controversy over PSA measurements. There is actually no cut-off point for a normal PSA reading, as the level varies with age and race.

The usual upper limit of normal for PSA given by laboratories is 4 ng/ml, across the age ranges.

However, the PSA test is not a diagnostic test; it simply predicts the risk of prostate cancer. It is also worth repeating that any cause of inflammation to the prostate may result in a raised PSA level, so it does not necessarily point to prostate cancer.

There is a high false positive rate for the PSA test – for every 100 cases of raised PSA levels, there may be 76 who do not harbour any cancer!

PSA testing is also used in the treatment of prostate cancer, for active surveillance. Active surveillance is a means of monitoring the prostate cancer, using regular tests, to keep tabs on its progression and delay unnecessary treatment.

In active surveillance, the doctor will monitor the rate at which the PSA level changes (PSA velocity) or the speed at which the PSA values double (PSA doubling time). This allows doctors to determine whether they need to switch to active treatment to treat the cancer.

Do you need the PSA test?

Many men and doctors still believe that the PSA test is a beneficial tool in screening for prostate cancer. However, we need to treat the PSA test with great caution, especially when using it in men who have no signs or symptoms of cancer.

Over 90% of prostate cancers detected by screening are localised or early stage cancers. They are unlikely to cause death or disability because they are slow-growing tumours.

Yet, most of the men with early stage cancers detected through PSA testing will receive treatment for their cancer. This can cause more harm than benefit, as early treatment of prostate cancer identified through screening will lead to side effects, without actually improving survival rate.

Another concern with using PSA for screening is that it usually necessitates a prostate biopsy to confirm the diagnosis. Despite this invasive procedure, about 75% of men with abnormal PSA levels who proceeded to have a biopsy turned out not to have any cancer.

The US Preventive Services Task Force (USPSTF) does not recommend routine PSA screening for men without symptoms. Therefore, men need not be pressured to take a PSA test, unless they are above 50 years old, have lower urinary tract symptoms, and have a family history of prostate cancer.

If you are unsure whether you fall into this category, ask your doctor. You should discuss your risk factors and prostate symptoms (if any) with the doctor, and the potential harm of screening.

Do not trust anyone who claims that you can diagnose prostate cancer from a PSA test alone.

The members of the MMHI are Prof Dr Tan Hui Meng, Assoc Prof Dr Ng Chirk Jenn, Prof Dr Low Wah Yun, Prof Dr Khoo Ee Ming, Assoc Prof Dr Tong Seng Fah, Dr Verna Lee Kar Mun, Dr Lee Boon Cheok, Prof Dr George Lee Eng Geap, Assoc Prof Dr Zulkifli Md. Zainuddin, Dr Christopher Ho Chee Kong, Assoc Prof Dr Ong Teng Aik, Dr Yap Piang Kian and Dr Goh Eng Hong. For further information, e-mail starhealth@thestar.com.my. The information provided is for educational and communication purposes only and it should not be construed as personal medical advice. Information published in this article is not intended to replace, supplant or augment a consultation with a health professional regarding the reader's own medical care. The Star does not give any warranty on accuracy, completeness, functionality, usefulness or other assurances as to the content appearing in this column. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.

If you want to learn more about the prostate, you can get a copy of "Men's Health and The Prostate" published by MMHI, available at RM45 each. To obtain copies, contact Ms Poh or Mr Teo at 03-56391777; fax: 03-56391870; email:perandro@hotmail.com. Proceeds from the sale of this book go towards the research funds of the Malaysian Society of Andrology and The Study of The Aging Male. The book can be delivered to any address within Malaysia by mail or courier without any additional charge.

Kredit: www.thestar.com.my

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