HEALTH MATTER

All posts tagged HEALTH MATTER

2016: the year of the dengue vaccine

Published มกราคม 11, 2016 by SoClaimon

ศาสตร์เกษตรดินปุ๋ย : ขอบคุณแหล่งข้อมูล : หนังสือพิมพ์ The Nation

http://www.nationmultimedia.com/life/2016-the-year-of-the-dengue-vaccine-30276091.html

HEALTH MATTER

Considered the most important mosquito-borne viral disease, dengue today affects at least 50 to 100 million people every year, with about one per cent or 500,000 of those affected suffering from potentially deadly haemorrhagic manifestations.

Considered the most important mosquito-borne viral disease, dengue today affects at least 50 to 100 million people every year, with about one per cent or 500,000 of those affected suffering from potentially deadly haemorrhagic manifestations. In the AEC region, dengue is one of the leading causes of severe illness among children and one of the most serious health concerns for expatriates. Now, with the availability of the first vaccine against dengue, 2016 could be a milestone year in the fight against this disease.

Dengue is caused by a virus transmitted by mosquitoes. Quite aggressive, these mosquitoes can bite throughout a 24-hour period but do so more frequently during daylight hours and can be recognised by the white markings on their legs.

There are four different strains (or serotypes) of dengue virus (from 1 to 4). Infestation with one strain confers lifelong immunity but only to that strain. It is thus possible to contract up to four dengue infections during one’s life.

The incubation period is usually from four to seven days. Most dengue infections cause no or few minor symptoms such as transitory fever for a few days. Typical dengue symptoms include severe headache, high fever, extreme weakness and back pain. There is often a measles-like, non-itchy rash over the face, thorax and limbs. The symptoms subside within 10 days but marked fatigue persists for a few more weeks.

About five to 10 per cent of infected patients develop the severe form of dengue, called dengue haemorrhagic fever, which is responsible for multiple bleeding. The first indication of bleeding is a haemorrhagic rash with small red spots found on any part of the skin. Bruising, bleeding from the nose or gums and, more worryingly, intestinal bleeding may occur. About 10 per cent of patients suffering from patent haemorrhagic complications progress to life-threatening dengue shock syndrome – popular Thai actor Tridsadee “Por” Sahawong is a recent case in point – and should immediately be admitted to a well-equipped intensive care unit.

Importantly, individuals who have suffered dengue a first time have an increased risk of a more severe dengue syndrome in the future compared with those who have not been previously exposed to the disease. This unusual and still poorly known phenomenon is referred to “antibody dependent enhancement” and represents an additional challenge in vaccine development.

Accurate diagnosis requires a simple test to detect the presence of dengue virus in whole blood through immunologic techniques.

There is no specific treatment for the dengue virus itself. Besides blood transfusion in high-risk patients, supportive therapy is provided to maintain the vital functions.

In a proper medical environment, the dengue mortality rate is below one per cent as long as the illness is recognised early. Dengue awareness among newly arrived expats is thus essential.

After 20 years of laudable research by the French pharmaceutical firm Sanofi, a vaccine is now available. It was registered in three countries last month and should hopefully be available this year throughout the whole AEC region.

Administered through three injections at six-month intervals, the vaccine efficacy rates vary from 50 per cent to 78 per cent depending on the causal viral strains.

When pooling the results of trials, the vaccine prevented the dengue infection in 60.3 per cent for all ages but was more pronounced among children aged nine years and older (65 per cent) than younger children (45 per cent). More importantly, vaccine efficacy against hospitalisation for dengue (admission due to more severe manifestations) was 80.3 per cent. There were no safety concerns.

However, in younger children (the under-nines), from the third to fourth year of follow-up after vaccination, it appeared that the risk of dengue infection became higher among those who were vaccinated compared with those who did not get the vaccine shots. As a result, the dengue vaccine is unfortunately indicated for adults and children above nine years of age only.

Even though the number of individuals over the age of nine is much higher than those younger than nine, these findings, if confirmed, might represent a significant drawback, not least because the severe forms of dengue are found predominantly in infants four to nine months of age and in children aged five to nine years.

That said, taking account of the potential complications of dengue infection and while waiting for the completion of follow-up studies, the available data show that vaccination is justified for individuals above nine living in endemic regions.

As dengue is indeed a public health concern, its effective control will now depend on the successful implementation of government-sponsored immunisation programmes throughout the country. |And this in turn will mainly depend on the political commitment of country’ health authorities to effectively control this endemic disease.

DR GERARD LALANDE is managing director of |CEO-Health, which provides medical referrals for expatriates and customised executive medical |check-ups in Thailand. He can be contacted at gerard.lalande@ceo-health.com.

The misery of incontinence

Published ธันวาคม 21, 2015 by SoClaimon

ศาสตร์เกษตรดินปุ๋ย : ขอบคุณแหล่งข้อมูล : หนังสือพิมพ์ The Nation

http://www.nationmultimedia.com/life/The-misery-of-incontinence-30274909.html

HEALTH MATTER

Incontinence is the accidental or involuntary loss of urine from bladder (urinary incontinence) or bowel motion, faeces, or wind (flatus) from the bowel (faecal or bowel incontinence).

Incontinence is the accidental or involuntary loss of urine from bladder (urinary incontinence) or bowel motion, faeces, or wind (flatus) from the bowel (faecal or bowel incontinence).

People of all ages, cultures and backgrounds may experience incontinence. Women are prone to bladder and bowel problems earlier in life than men as a result of pregnancy and childbirth. Amongst older men and women, however, the number of people with incontinence is fairly even for both sexes. Incontinence can be investigated and managed. Treatment may help you to improve or possibly cure the incontinence.

Normal urinary function is defined as emptying the bladder 4-8 times each day. The bladder can hold up to 400-600 ml of urine, but usually feels quite full at about half this amount (200-300 ml). You may wake you up once at night to pass urine, twice if you are older

Bladder problems and urinary incontinence can happen for many reasons, so there are different types of incontinence. The following are the most common.

Stress incontinence

Stress incontinence is urine leakage with physical exertion or effort – coughing, sneezing, laughing, exercising, walking or when lifting things.

Both men and women may develop stress incontinence, although it is mainly women who suffer from it as the bladder outlet (urethra) is very close to the birth canal (vagina). Both the urethra and vagina pass through the pelvic floor muscles. Pregnancy and childbirth can stretch and weaken the pelvic floor muscles which support the urethra.

Oestrogen, a female hormone, is important to the pelvic floor muscles and the pelvic organs and assists in keeping the lining of the vagina and urethra thick. The thickness of the lining keeps the urethra sealed after passing urine, much like a washer seals water from leaking in a tap. Less oestrogen is produced after the menopause and the lining of the urethra thins. As a result, in some women the urethra does not close fully. A chronic cough, constipation and being overweight all strain the pelvic floor and can eventually lead to stress incontinence.

Urge incontinence

Urge incontinence occurs with a sudden, strong urge to pass urine. It is very often associated with frequency, the need to pass urine more often than usual. It is also associated with nocturia (waking several times at night to pass urine). Some people have such a strong urge and so little warning that they wet the bed or their clothing.

Urge incontinence is often caused by an over-active or unstable bladder. This can happen at any age, but becomes more common as people get older. Often the cause of an unstable bladder is unknown.

It can happen following a stroke, in Parkinson’s disease, Multiple Sclerosis (MS) and other health problems which interfere with the brain’s ability to send messages to the bladder via the spinal cord. T|his affects a person’s ability to continue to hold and store urine.

Overflow incontinence

Overflow incontinence happens when urine leaks out from an already over-full bladder. The bladder does not empty completely. Urine continues to fill the bladder and then overflows with little |sensation or warning.

Symptoms include:

l Little or no warning when you need to pass urine

l Passing urine while asleep

l Frequent urinary tract infections or cystitis

l Dribbling” more urine after visiting the toilet.

Causes include

A blockage to the urethra by a rectum full of very hard faeces |(this puts pressure on the urethra, making it difficult to pass urine)

A prolapse of pelvic organs in women (which also can block the urethra)

Damages to nerves that control the bladder, urethra sphincter and pelvic floor muscles ( so that the bladder cannot empty properly)

Diabetes, MS, stroke and Parkinson’s disease (these conditions can interfere with the sensation of a full bladder and with bladder emptying)

Some medicines can interfere with bladder function, including herbal products

Other problems can cause or worsen urinary incontinence:

l Urinary tract infections are usually associated with pain or burning when passing urine. They cause urgency and frequency during and sometimes following the infection.

l Not drinking enough makes urine more concentrated. This irritates the bladder to give a feeling of urgency and causing it to contract or squeeze.

l Going to the toilet more often than you need to or “just in case” trains the bladder to store less than it should be able to store.

l Constipation puts pressure on pelvic floor organs. This can obstruct the urethra or move the bladder or bladder-neck into a |position where it cannot completely empty, or causes frequency.

l Caffeine drinks (such as tea, coffee and cola) upset the bladder lining.

l Alcohol increases production of urine and causes frequency.

l Medicines can affect your bladder and bowel. For example, water tablets (diuretics) make the kidneys produce urine more |quickly, increasing urgency.

What you can do if you have urinary incontinence?

l Do drink normally- – 6-8 cups of fluid per day are recommended unless you have been advised differently by your doctor.

l Drink more if the weather is hot or when exercising. Drink |mostly water.

l Reducing your fluid intake definitely makes things worse not better.

l Cut down on caffeine drinks, carbonated beverages, |and alcohol.

l Avoid constipation through regular exercise and this promotes bowel activity and try to maintain an ideal body weight.

ASST PROF DUANGMANI THANAPPRAPASR is an Obstetrician-Gynaecologist at Samitivej Sukhumvit Hospital. Call (02 711 8555.

New hope for colorectal cancer patients

Published ตุลาคม 26, 2015 by SoClaimon

ศาสตร์เกษตรดินปุ๋ย : ขอบคุณแหล่งข้อมูล : หนังสือพิมพ์ The Nation

http://www.nationmultimedia.com/life/New-hope-for-colorectal-cancer-patients-30270243.html

HEALTH MATTER

One of the most common cancers in the Western world and rapidly increasing in frequency in Asia, colorectal cancer no longer carries the death sentence it did even just a few years ago.

One of the most common cancers in the Western world and rapidly increasing in frequency in Asia, colorectal cancer no longer carries the death sentence it did even just a few years ago. Indeed, the Thai Society of Clinical Oncology says that biomarkers as well as targeted therapy can successfully treat even stage IV colorectal cancer, curing or at least extending the patients’ life by three to five years.

Part of the success, says Associate Professor Virote Sriuranpong, a medical expert from Chulalongkorn Hospital’s Faculty of Medicine, stems from the adoption of personalised therapy. Biomarkers are now used to help doctors find specific genes, which determine which treatment technique is effective for the colon cancer sufferer. In analysing biomarkers, doctors take a small sample of tissue in the area affected by cancer for a test, which takes around one to two weeks. This method allows doctor to choose the right medication for the individual patient and accurately predict how responsive the patient will be to the medication. This diagnosis technique is widely available in public hospitals as well as some private hospitals.

After the biomarker test, doctors are able to choose and plan customised treatment, thus increasing the chances for a successful outcome.

Some of stage III and IV colorectal cancer patients can choose targeted therapy, which does not require chemotherapy.

This medical innovation can also effectively enable colorectal cancer patients, who failed with other medical treatments earlier, to live longer. Studies on final-stage cancer patients provide a large body of evidence that half of the patients who received targeted therapy continued to enjoy a good quality of life in the following years.

During the early stages of colorectal cancer, it is hard to see or observe any symptoms. Precise planning is therefore needed to increase the response rate for patients. Fifty years ago, when medical treatment was not so advanced, all cancer patients received the same treatment, which did not yield effective results in all cases.

For example, chemotherapy kills both good and bad cells at the same time. However, over the past 10 years, doctors have started to learn and understand that different patients need different treatment although they are suffering from the same disease. The biomarker test helps make it easier for doctors to make a sound decision on the right treatment.

In colon cancer patients, malignant cells generally accumulate on colon tissue. In anal cancer patients, meanwhile, malignant cells pile up on the tissue at the end of colon, close to anus. Cancer is developed from normal cells that are quickly divided and become malignant cells.

Many times, tumours are found in the colon and anus. Although there is no clear cause of the disease, age is considered an important risk because colorectal cancer occurrence usually increases when people are getting older. In general, people aged below 40 have very low risk of colorectal cancer. Then the risk will double when the person turns 50 years old. If there are more risk factors, the chances of developing cancer will be higher.

The development of colon cancer is complicated and there is no clear evidence on what causes colon cancer. However, risk factors can range from age (over 50 years old), those who earlier diagnosed with colon cancer, ovarian cancer, cervical cancer, breast cancer, polyps and inflammatory bowel disease. Obesity and smoking are also considered key risk factors. However, it doesn’t mean that every case with history of such diseases or symptoms will actually develop cancer.

Risk factors that cannot be altered include genetic heredity and family history of colorectal cancer as well as those who are once diagnosed with inflammatory bowel disease and have suffered from such diseases for longer than seven years. Those who suffer from colorectal cancer usually find no symptoms in the early stages. Later, they may find other symptoms, such as blood in stool, bleeding through anus and unusually frequent defaecation. Daily routine may have been changed, such as from daily defaecation to constipation and diarrhoea. Other symptoms are inflammatory bowel syndrome, bloated stomach, chronic stomach pain and lump in the stomach, usually on the lower right of the stomach. If such symptoms continue for at least two weeks, the person should consult a doctor.

 

Why screening should be a priority

Published ตุลาคม 2, 2015 by SoClaimon

ศาสตร์เกษตรดินปุ๋ย : ขอบคุณแหล่งข้อมูล : หนังสือพิมพ์ The Nation

http://www.nationmultimedia.com/life/Why-screening-should-be-a-priority-30269715.html

HEALTH MATTER

How do you find out if you will be healthy or sick in the future? Do you ask an astrologer? Or a tarot card reader?

How do you find out if you will be healthy or sick in the future? Do you ask an astrologer? Or a tarot card reader? How about going to the hospital for a screening instead? Screenings are very useful for diseases that are slow-cooking and show little or no symptoms to begin with – such as the Big C. During a screening, doctors look for diseases that are just beginning to take root in your body and treat them even before you start feeling sick or show any symptoms. Regular screenings are as important as, well, eating and sleeping regularly, more so for women.

Breast cancer, cervical cancer and growths in the abdominal organs can all be spotted by doctors in their early stages. Neither cervical not breast cancer have symptoms in the first stage. With screenings, doctors can usually catch the disease when it is merely a few cells old. The screening process can be followed by further diagnostics such as ultrasound, MRI and biopsy respectively. Treatment can quickly follow and a complete cure is possible. In contrast, by the time symptoms appear, the cancer is in the third stage and has usually begun to spread.

Breast cancer

The frequency of scanning depends entirely on each person, their family history and their own medical history. In case of breast cancer, a high-risk patient with a history of precancerous lesions or a strong family history of breast cancer, needs an annual mammogram as early as in her 40s. A patient without both these indicators could begin her mammograms by age 50. An ultrasound scan of the breasts usually accompanies a mammogram to confirm the results.

There are also a few things you can do at home including observing the shape, size, skin texture and colour of your breasts in a mirror. If you notice any of the following abnormalities, consult your doctor immediately:

l Visible lump

l Swelling, redness and warmth

l Changes in the size or shape of your breasts

l Dimpling or retracted nipples (if this is not the case previously)

l The skin on the breasts has the appearance of orange peel

l Rashes, scaling or itching around the nipple

l Abnormal discharge from the nipple such as blood-like fluid, or pus-like fluid

l The skin on the breast or nipples pulled inward

Cervical cancer

Cervical cancer screening is done through a pap smear and is recommended for all sexually active women annually. Between the ages of 21 and 29, a pap smear is recommended every three years. From the age of 30, co-testing – a pap smear combined with an HPV test – is recommended every five years. This should continue until age 65. Cervical cancer is mostly slower and takes five to 10 years after being infected by HPV virus to become cancer. In the case of a high-risk patient, a precancerous lesion might progress an aggressive cervical cancer in as little as three years, making the need for annual screenings and close follow-up even more vital. Symptoms to watch out for include abnormal discharge, irregular bleeding and bleeding after sexual intercourse.

Bone Mineral Density

Bone Mineral Density tests are important for post-menopausal women as loss of bone density is a significant concern. If the bone is thinner than usual, the doctor will prescribe hormones and calcium supplements. Annual follow-up is usually recommended to keep track of the progression of the disease. Osteoporosis happens when you lose too much bone, make too little bone or both. This bone disease is often called a silent disease because you can’t feel your bones getting weaker. Breaking a bone is often the first sign that you have osteoporosis or you may notice that you are getting shorter, feel cramps, muscle aches, your upper back may curve forward or you might have bone pain.

Do discuss these with your doctor right away as the disease may be already be advanced.

Chantarat Suratanakavikul, MD is an Obstetrician-Gynecologist and Maternal-Foetal Medicine Specialist at the Women’s Health Centre of Samitivej Sukhumvit Hospital.

Call (02) 711 8555-6 or visit http://www.Facebook.com/samitivej.

Mother’s milk is life giving

Published สิงหาคม 27, 2015 by SoClaimon

ศาสตร์เกษตรดินปุ๋ย : ขอบคุณแหล่งข้อมูล : หนังสือพิมพ์ The Nation

http://www.nationmultimedia.com/life/Mothers-milk-is-life-giving-30266293.html

HEALTH MATTER

Breastfeeding is supposedly a natural phenomenon, as natural as childbirth itself.

Breastfeeding is supposedly a natural phenomenon, as natural as childbirth itself. However, for most new mothers, it can prove to be rather frustrating since dealing with helpless newborns can be daunting, especially with no experience to fall back on. Thankfully, unlike parenting, which does not come with a manual, there is now a wealth of information available for young mothers. In light of declining rates for exclusive breastfeeding, support groups and organisations such as the World Health Organisation (WHO) are also offering support systems to guide the new mother through the process of breastfeeding. A paediatrician specialising in neonatology and lactation from Samitivej Sukhumvit Hospital laments that the average rate of exclusive breastfeeding in Thailand has dropped to 33 per cent.

“If you leave a mother and child alone in the first hour after birth, what we call the golden hour, the baby will find the breast and suckle. Once you lose that instinct, you have to re-learn and it becomes a struggle.”

Hospital policies, c-sections to cater to convenience and superstitions, lack of knowledge about breastfeeding among medical staff, and the overall medicalisation of the reproductive process have disrupted the natural rhythm of the mother and child.

Myths surrounding breastfeeding and the rampant popularity of breast milk substitutes do not help matters either. Working mums give up breastfeeding and switch to substitutes when they return to work after maternity leave. Some women even believe that breast milk substitutes are more beneficial to infants. In some countries, tradition has it that a few days after birth the infant must be started on other foods. Some mothers fear that they might not produce enough milk for their babies.

Breastfeeding mothers can, with the help of encouraging employers, express milk and store it. Like many food products, breast milk can be safely stored in a refrigerator and used later. So, breastfeeding need not stop when mothers return to work at the end of their maternity leave. A paediatrician explains, “It needs very little effort on the part of the employer to provide a room where mothers can pump milk and a refrigerator where this can be stored. Mothers can take the refrigerated milk home at the end of the day and leave it at home for the infant to be fed the next day.”

Colostrum, or the first milk that a lactating mother produces, is thick and yellow in colour. In many cultures this is considered dirty or unhealthy and mothers are warned not to breastfeed their baby for the first few days after birth. Doctors point out that this milk is actually rich with nutrients essential to a newborn. Over time, the milk thins and changes colour but is still packed with helpful antibodies. Doctors advocate feeding babies nothing but breast milk for the first six months of their life because no breast milk substitute can provide the same amount of nutrients.

The important difference between breast milk and any substitutes is that breast milk is “live” food while formula is processed food. Breast milk has no expiry date. It is always fresh, always good, and always safe for the child. It is difficult for an infant to process the additives in substitutes.

Doctors say that the amount of milk a mother produces is not restricted by the size of her breasts. In fact, when a woman is breastfeeding, her body produces hormones that, in turn, produce the milk the baby needs. So, in the absence of a medical condition, a mother should be able to produce enough milk for her baby. Hospitals today are staffed with lactation consultants who can help with such problems.

Every government hospital in Thailand now has a lactation clinic and many offices have breastfeeding spaces. Such spaces should also be part of public places like malls and attitudes to breastfeeding mothers need to change. Breastfeeding is not indecent exposure; it is a caring, bonding experience.

“Mothers need support immediately after birth,” says a nurse specialising in newborn care. “There is a lot of work and very little education. They are told that babies sleep 10-12 hours a day, but they don’t understand that babies probably do so in 10 small instalments.

“Mothers complain that babies are too sleepy, not latching on, not sucking. Often mothers do not know what they are doing wrong. Formula manufacturers say feed every 4 hours and that’s what people do, whereas it would be more natural to feed the baby whenever it is hungry.”

Mothers with genuine health problems and infants who are unable to nurse must, of course, have recourse to alternative measures. However, healthy mothers should not miss out on the experience of breastfeeding. New mothers might face physical problems or emotional problems but help is at hand.

“The smell of the baby, the feel of the baby, the bonding that occurs as a mother holds a child close and nurses it at her breast — this is good for mothers and for children. When a mother breastfeeds her child, she gives it more than just nutrition, she gives it life.”

For more information, contact Samitivej International Children’s Hospital, Sukhumvit Campus at (02) 711 8236-7.

Pancreatic cancer – the silent killer

Published เมษายน 23, 2015 by SoClaimon

ขอบคุณแหล่งข้อมูล : ศาสตร์เกษตรดินปุ๋ย : หนังสือพิมพ์ The Nation

http://www.nationmultimedia.com/life/Pancreatic-cancer–the-silent-killer-30257499.html

HEALTH MATTER

The ninth most common cancer in the Western world, pancreatic cancer has probably the lowest survival rate of any cancer known to man.

The ninth most common cancer in the Western world, pancreatic cancer has probably the lowest survival rate of any cancer known to man.

Often referred to as a silent disease because it does not cause identifiable symptoms, patients will usually experience abdominal bloating, a sense of fullness, weight loss and back pain. But these are not specific symptoms of pancreatic cancer, and thus it is hard to detect it early. It is mostly detected in suspected cases. Sometimes the tumour will grow in a way that it blocks the bile duct or the main pancreatic duct, causing yellowing of the eyes and skin. When pancreatic cancer is in the middle or tail of the pancreas and does not block anything, symptoms are not usually present. The cancer is often already advanced and surgery cannot be performed by the time symptoms appear, among them upper abdominal pain radiating to the back, loss of appetite, unexplained weight loss and fatigue.

Pancreatic cancer, which is more common in people aged 40 and over than younger individuals, has 4 stages.

In stage 1, the cancer is smaller than 2 cm and is confined to the pancreas. In stage 2, the cancer has grown larger than 2 cm and has spread beyond the pancreas or to the lymph nodes near the pancreas. By stage 3, the cancer has spread to the major blood vessels around the pancreas. In stage 4, the cancer has spread to other organs, such as the liver or lungs, or even to bones that are far from the original point of the cancer.

The exact cause of pancreatic cancer is unknown. However, the factors thought to increase risk include a history of chronic inflammation of the pancreas caused by long-term alcohol consumption and a family history of pancreatic cancer.

A radiology procedure is used to assess the pancreas for the presence of cancer because a blood test cannot clearly identify the disease. An ultrasound can show only part of the pancreas because it is hidden behind the stomach. A CT Scan or MRI can be used to look for the cancer, but the pancreas is small making it hard to diagnose cancer. As a result, only about 80 to 90 per cent of small tumours can be seen. Large tumours can be clearly seen but mostly in the advanced stages 3 and 4 when surgery cannot be performed. At stage 1, all malignant tumours can be removed, but there is a high chance of recurrence. For malignant tumours in stages 2 to 4, there is little chance of curing the cancer. In these cases, chemotherapy is used to slow the growth.

EUS is an innovative screening option for pancreatic cancer and involves the insertion of an endoscope with an ultrasound probe attached through the mouth, stomach and small intestine. This procedure is used to view the pancreas from the head to tail, as well as the spleen, bile duct and blood vessels around these areas. It provides more than 90-per-cent accuracy.

If the doctor suspects pancreatic cancer, a biopsy can be conducted by removing a small sample of tissue or cells from the pancreas for examination. The EUS procedure takes only 60 to 90 minutes and because the |camera is quite large, patients are given an anaesthetic.

If pancreatic cysts are found, the doctor will examine the type of cysts and risk of cancer. The cysts need to be monitored carefully as they can get bigger or turn cancerous. Removing cancer from the head of the pancreas is a major and open operation.

The risk of complications is higher than general surgery and recovery may take a long time. If the cancer is in the tail of the pancreas, a portion of the pancreas will be removed.

Pancreatic tail surgery can also be conducted by laparoscopy technique through the belly button and 3-4 holes with a width of 1 cm in the abdominal wall allowing for insertion of the surgical device. It is a minimally invasive surgical procedure with quick recovery time.

If you experience unexplained chronic stomach pain or bloating, particularly in the upper stomach or the stomach pain radiating to the back, it may be a sign of pancreatic problems.

And if you have consumed alcohol over a long period, have lost your appetite, and/or have unexplained weight loss, don’t wait before consulting a doctor for appropriate advice and diagnosis.

DR PITULAK ASWAKUL is a specialist in gastroenterology and hepatology |at Samitivej Sukhumvit Hospital. Call (02) 711 8822-4.

A new option in assisted reproduction

Published ธันวาคม 26, 2014 by SoClaimon

ขอบคุณแหล่งข้อมูล : ศาสตร์เกษตรดินปุ๋ย : หนังสือพิมพ์ The Nation

http://www.nationmultimedia.com/life/A-new-option-in-assisted-reproduction-30250416.html

HEALTH MATTER

WOMEN wanting to preserve their future ability to have children now have a new option: oocyte cryopreservation

WOMEN wanting to preserve their future ability to have children now have a new option: oocyte cryopreservation – or egg freezing – is a new technology in which a woman’s eggs (oocytes) are extracted, frozen and stored. Later, when she is ready to become pregnant, the eggs can be thawed, fertilised, and transferred to the uterus as embryos.

Oocyte cryopreservation is aimed at women diagnosed with cancer who have not yet begun chemotherapy or radiotherapy; those undergoing treatment with assisted reproductive technologies who do not consider embryo freezing an option and those women who, for the purpose of education, career or other reasons, desire to postpone childbearing.

Additionally, women with a family history of early menopause often have an interest in fertility preservation. With egg freezing, they will have a frozen store of eggs, in the likelihood that their eggs are depleted at an early age.

The egg retrieval process for oocyte cryopreservation is the same as that for in-vitro fertilisation. This includes one to several weeks of hormone injections that stimulate the ovaries to ripen multiple eggs. When the eggs are mature, a medication to trigger ovulation is given and the eggs are removed from the body using an ultrasound-guided needle through the vagina. The procedure is usually conducted under sedation. The eggs are immediately frozen using a new freezing process known as vitrification.

Evidence shows that fertilisation and pregnancy rates are similar to IVF/ICSI with fresh oocytes when vitrified/thawed oocytes are used as part of IVF/ICSI in young infertility patients and oocyte donors. No increases in chromosomal abnormalities, birth defects, or developmental deficits have been noted in the children born from cryopreserved oocytes. This technique is no longer considered experimental.

Approximately 70 per cent of embryos produced either through natural conception or IVF are lost before birth. The vast majority of embryos are lost within the first three months of pregnancy, most of these even before implantation. A major cause of embryo loss, including miscarriage, is a chromosome anomaly (known as “aneuploidy”) where there is either a loss of a chromosome or a gain. Some of these anomalies are compatible with full-term delivery, such as three copies of chromosome 21 (known as Down syndrome) or three copies of chromosome 18 (Edward Syndrome). Some are not compatible with full-term delivery; and others cause the embryo to arrest its development before implantation.

The rate of aneuploidy in eggs also increases with a woman’s age, with Down syndrome being the most commonly known. The incidence of Down syndrome rises from 1 in 900 at age 30, through 1 in 230 at age 37 to 1 in 20 at 46.

Assisted reproduction technology (ART) incorporates genetic tools for genetic testing of pre-implantation embryos and was initially performed to diagnose patients who were known to carry a high risk for monogenic disorders or chromosomal structural abnormalities. It was then applied to treat fertility patients with increased risk for aneuploid embryos.

Pre-implantation genetic screening (PGS) was introduced into clinical practice for screening and discarding aneuploid embryos, thus improving the chance of healthy conceptions after infertility treatment with poor prognoses, such as advanced maternal age, repeated implantation failure, recurrent miscarriage and previous pregnancy with a chromosome abnormality.

In the past, fluorescence in situ hybridisation (FISH) for PGS enabled screening of embryos for chromosome aneuploidies but it has many limitations, among them human error and a limited number of chromosomes tested. Today, the new genetic analysis method aims to increase the number of chromosomal testing from 5 to 23 pairs of chromosomes (22 pairs of autosomes and the sex chromosomes or 24 chromosomes). Array comparative genomic hybridisation (Array-CGH) was the first technology to be widely available for reliable, accurate and relatively fast 24-chromosome copy number analysis and is now used extensively around the world. It is routinely proposed in order to overcome the technical difficulties that beset earlier PGS studies.

Recent data from over the world have confirmed that using array CGH can improve the success rate in IVF patients.

Dr Nutchada Kaewkoet is an Obstetrician-Gynaecologist specialising in Reproductive Medicine at Samitivej Srinakarin Hospital. Call (02) 378 9129-3,

Living happily in the ‘golden years’

Published พฤศจิกายน 13, 2014 by SoClaimon

ขอบคุณแหล่งข้อมูล : ศาสตร์เกษตรดินปุ๋ย : หนังสือพิมพ์ The Nation

http://www.nationmultimedia.com/life/Living-happily-in-the-golden-years-30247414.html

HEALTH MATTER

Menopause, or the “Golden Years”, is the phase of a woman’s life when her ovaries stop working and menstruation is ended.

Menopause, or the “Golden Years”, is the phase of a woman’s life when her ovaries stop working and menstruation is ended. Menopause can occur as a natural part of the ageing process or as a result of the uterus being surgically removed. However, it always results in a decrease in levels of the female hormone, oestrogen.

Menopause has a variety of symptoms, the occurrence and severity of which can vary greatly. However, in the more severe cases, these symptoms can have such an impact on the ability to carry on with normal routines that they adversely affect the quality of life.

Women will typically experience hot flashes, night sweats and insomnia, which leads to increased fatigue and irritability. Other possible symptoms include palpitations, headaches, an aching body, anxiety, decreased self-confidence, depression, and loss of libido. The urinary tract and vagina may also develop problems, such as vaginal dryness, vaginal inflammation, frequent urination and urinary incontinence. Not surprisingly, menopause can place a strain on a woman’s relationship with her spouse.

The loss of oestrogen is a major cause of problems during menopause. As the oestrogen levels fall, the hair becomes dry and some women experience hair loss. The skin becomes thin and dry, causing wrinkles, while the fingernails also become brittle.

In addition to the symptoms mentioned above, menopausal women are at increased risk of the following conditions:

– Osteoporosis

Because oestrogen helps to maintain appropriate levels of calcium in the bones, the shortage of oestrogen caused by menopause leads to the bones thinning and becoming more brittle over time. This heightens the risk of hip fractures, broken arms, and broken legs. As there are no obvious symptoms, menopausal women are advised to undergo a bone density test every two years.

– Cardiovascular diseases

Because oestrogen also protects a woman from the time she begins menstruation until menopause by reducing her cholesterol levels, the risk of heart disease and strokes increases during menopause. Even women with previously strong and healthy hearts are exposed to a greater risk of cardiovascular disease during menopause. Some of the early warning signs to watch out for include fatigue, insomnia, difficulty breathing, pain in the neck and shoulder area, stomach indigestion, and nausea.

However, it should also be noted that women with heart diseases often do not experience any chest pain during atherosclerosis (blocked arteries).

– Stroke

Low oestrogen levels also adversely affect the LDL level, and this is another risk factor for menopausal women as it can lead to a stroke. One of the main early warning signs to watch out for is a numbness or weakness in one part of the body, which then disappears in 30 minutes. Other indicators of an imminent stroke include feeling disoriented and having difficulty seeing, speaking or walking. When any of these symptoms occur, medical advice should be sought immediately to minimise the risk of a stroke and subsequent paralysis.

Because of the potential dangers, all women are recommended to visit their doctor for a full health examination as they enter menopause. While screening for cervical cancer, ovarian cancer and breast cancer are the most common tests performed on menopausal women, it is also advised that they undergo a more thorough examination.

To overcome the loss of oestrogen, Hormone Replacement Therapy (HRT) can be administered to replace the lost oestrogen with substances that have a similar molecular structure. While this can significantly improve the quality of life for menopausal women experiencing extreme symptoms, it is not necessary in all cases. Whether HRT is prescribed should be decided by the doctor after taking into consideration each woman’s particular situations and condition. For example, HRT should not be prescribed if a woman has breast cancer, endometrial cancer, deep vein thrombosis, or liver disease. Also, HRT should be used with caution if the patient has gallbladder stones, diabetes, high blood pressure, tumour in the uterus, asthma, SLE or migraine. In addition to deciding whether a woman is suitable for HRT, the doctor will also determine which type of HRT to recommend in order to improve the woman’s quality of life.

In addition to HRT, there are some steps that all women can take to maintain good health during menopause. A nutritious diet, regular exercise, sufficient rest, and a stress-free lifestyle can all play an important role in minimising the negative impacts of menopause. Menopausal women should try to eat a varied diet from all 5 major food groups. Foods that are high in calcium and naturally occurring oestrogen, such as soybeans, are strongly recommended, while fatty foods, alcohol, caffeine and smoking should all be avoided. Women should also aim to exercise at least 3 times a week.

Understanding menopause and managing its risks can go a long way to helping women carry on as normal a life as possible during their “golden years”. Eating nutritious food, exercising regularly, and getting plenty of rest can minimise the risks and effects of menopause.

However, the most important step of all is to take a thorough annual health check-up which includes a mammogram, a Pap smear test, a bone density test, and a blood test, as required so that any potential complications can be identified and treated before they develop.

Dr Yaowaluk Rapeepattana is attached to the

Women’s Health Centre at Samitivej Sukhumvit Hospital. Call ((02) 711 8555-6.

Settling in to a new life

Published กันยายน 9, 2014 by SoClaimon

ศาสตร์เกษตรดินปุ๋ย-ขอบคุณแหล่งข้อมูล : หนังสือพิมพ์ The Nation

http://www.nationmultimedia.com/life/Settling-in-to-a-new-life-30242799.html

HEALTH MATTER

Expat wife syndrome (EWS), sometimes referred to spouse trailing syndrome

Expat wife syndrome (EWS), sometimes referred to spouse trailing syndrome, is a term often used to describe the stress-related condition that often affects the wife or partner of an expatriate who is relocated overseas.

EWS, which comes in various intensities, represents the difficulties and/or inability to effectively adjust to important cultural, environmental, linguistic, professional and familial changes occurring in the new location.

This lack of adjustment can lead to the spouse – in the majority of the cases the wife or female partner – to suffer psychological and health issues that can compromise the whole expatriate experience and can even lead to the break-up of the relationship.

EWS is not clearly established in medical literature despite the fact that it is not infrequent among foreign communities living in Southeast Asia and elsewhere in the world.

It is perfectly normal to face some emotional troubles when setting up in an exotic country. Certain assignments are obviously more complex than others: the language barrier, inappropriate healthcare or educational system, extreme climatic changes, unusual food and uncomfortable housing among are the most common and significant pressing issues. The demands of the partner’s job and travelling may cause numerous problems that the wife is left to solve and this can lead to a perceived (or true) sense of lack of spousal support and loneliness.

Any spouse may face such a syndrome but highly educated and/or career businesswomen usually face more significant challenges because of the difficulties in finding a job – at a commensurate level – in the new location. Going almost overnight to “housewife with a doctorate degree” and handling tedious domestic tasks can be extremely frustrating.

Schematically EWS evolves through three successive phases: First, a more serious-than-expected cultural shock a few weeks or months after arrival impacts on quality of life. Negative feelings about the “local environment” begin to outweigh any advantages linked to the relocation and generate emotional stress that might trigger withdrawal from other people. Stress-related symptoms such as continuous tension headache, irritability, insomnia and fatigue further aggravate the overall distress. Fortunately, after the initial difficulties and struggles, many spouses are able to successfully handle or cope with the unfavourable aspects of the local setting and start benefiting from its positive features.

The second stage corresponds to the person’s inability to return to normal social interactions despite increasing boredom. Persistent isolation translates into anxiety disorders and possibly depression. A chronic existential crisis takes place with loss of self-esteem and a feeling of worthlessness that may require professional support. Sadly, serious emotional pain may be challenging to address, as finding effective psychological care from qualified professionals – in the mother tongue – is scarce in many Asian countries. However, with adequate mental support from the partner and from various sources including telemedicine, most spouses can at least partially neutralise harmful factors and evolve into a more positive state of mind momentum after several months.

The third step happens when the psychological suffering continues to worsen and does not respond to therapy or support. With the occurrence of morbid thoughts, one of the few alternatives left is to return home Indeed, a few weeks or months stay in a familiar setting is often salutary, allowing the spouse to reflect on expatriate life and return with appropriate expectations. In very rare cases, an overwhelming conflict can lead to shattered family relationships.

EWS needs to be first prevented through optimal preparation from all perspectives, especially for the spouse and children. The future expat and his employer have to anticipate specific challenges and put in place adequate cross-cultural understanding for both the employee and his/her spouse. Upon arrival, the need to connect without delay with other people facing similar concerns is essential. Joining a “welcome to the city” event organised by an expat women’s group is effective in acquiring valuable knowledge, building friendships, understanding and learning the new culture, and finding new opportunities. These can range from a job, helping others through joining a charitable organisation, setting up one’s own business or taking on a new educational interest. Hopefully, the spouse will become involved in many interesting projects and eventually come to enjoy a fulfilling expatriate experience.

Dr Gerard Lalande is managing director of CEO-Health, which provides medical referrals for expatriates and customised executive medical check-ups in Thailand. He can be contacted atgerard.lalande@ceo-health.com.

A screen to protect against skin cancer

Published กันยายน 3, 2014 by SoClaimon

ศาสตร์เกษตรดินปุ๋ย-ขอบคุณแหล่งข้อมูล : หนังสือพิมพ์ The Nation

http://www.nationmultimedia.com/life/A-screen-to-protect-against-skin-cancer-30242249.html

HEALTH MATTER

Thailand is the land of sun, sand and smiles, making it popular with holidaymakers. But too much of that golden sunlight can be bad too.

Thailand is the land of sun, sand and smiles, making it popular with holidaymakers. But too much of that golden sunlight can be bad too. How much exactly is too much? That’s a question that has yet to be answered but we do know the amount of sunlight you can safely soak up depends on your genes and your lifestyle. We also know that the only weapons to fight llife-threatening skin cancer are knowledge, prevention, early detection and treatment.

The sun’s UV rays penetrate the skin and cause melanocytes to reproduce abnormally. This leads to melanoma. Basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) are the most common.

Melanin is responsible for the colour of our skin. Thus, lighter-skinned individuals, that is, those with lesser melanin to begin with, are at greater risk of contracting the rather aggressive malignant melanoma.

However, those with darker skin could also be affected, especially on the palms and feet. Men are slightly more likely to contract malignant melanoma than women. Such risks are exacerbated by many factors including exposure to ultraviolet (UV) rays and to radiation, which includes X-rays and hydrocarbons. Smoking, drugs and infections tend to suppress the body’s immune system and increase the risks. Exposure to chemical toxins such as arsenic found in herbal remedies, repeated sunburn, and a family history of melanoma are also considered risk factors.

Genes have been found to play a vital role in determining whether you contract skin cancer. A person with a close relative, such as parents and siblings, with melanoma is 2-3 times more likely to contract skin cancer than the rest of the population. This risk increases by 30-70 times if there are multiple close relatives with melanoma.

However, skin cancer is highly preventable and largely curable, especially if it is detected and treated early. Experts recommend that from the age of 10, people who belong to high risk groups should visit a specialist for a professional skin examination at least annually. Other high risk groups such as light-skinned males aged 50 and above and those with multiple or atypical moles should also undergo such an examination.

The Australian Cancer Network and the Skin Cancer Foundation recommends a bi-annual full body skin examination for high-risk individuals and monthly head-to-toe skin self-examination for the general public so that they can identify any new or changing lesions that might be cancerous. The monthly head-to-toe skin self-examination must be thorough and cover every inch of skin, not just those limited to areas exposed to the sun. The front and back of the ears, the scalp, between fingers and under fingernails, armpits, (for women: under the breasts), palms and soles, even the genitalia should be examined carefully.

While the examination aims to identify any skin abnormality, particular attention should be paid to moles, if any. New moles or changes in existing ones should be brought to a doctor’s attention. In this context, it is helpful to remember the ABCDE rule. Asymmetry of moles should be considered a sign that medical attention is needed. Border irregularity in moles is another indicator of trouble, so watch for jagged borders. Colour variation is also troubling; a harmless mole will be uniform in colour. Diameter is also critical; if your mole is larger than 6 mm in diameter, it should be brought to your doctor’s attention. Enlargement is another red flag; if a mole on your body has increased in size it should be medically examined.

Experts suggest that anyone who notices changes in their skin or in the appearance of moles or changes in the character of existing moles should schedule a medical screening to determine if any of this could be an indication of skin cancer. Screening techniques such as FotoFinder are continuously being developed for an approved accuracy of diagnosis.

Other preventive measures can also be adopted. Avoiding UV exposure that causes sunburn, especially at mid-day, is one such precaution. If you cannot stay out of the sun during this time of the day, wear clothes that will help protect your skin, and cover your head and face with wide-brimmed hats and UV-resistant sunglasses. The American Academy of Dermatology recommends the application of sunscreen that has a sun protection factor (SPF) of 30 or higher and that offers broad spectrum protection (from both UVA and UVB) and is water resistant as well. This is an essential tool in reducing the risk of skin cancer, especially melanoma.

The Skin Cancer Foundation cautions against prolonged exposure to the sun in order to obtain Vitamin D. For light-skinned individuals, 20-30 minutes of sunlight in a day is enough to ensure that your body gets its required amount of Vitamin D. For a darker-skinned individual, this exposure could be extended to 2-3 hours. Any longer and the risk of skin cancer increases significantly.

Quitting smoking is also a smart move since smoking is considered a risk factor for skin cancer. The use of tanning lotions instead of a sun bed and ensuring that any herbal remedy you imbibe, for whatever reason, is free of toxins such as arsenic is also advisable.

Dr Bussakorn Mahakkanukrauh, MD, is dermatologist at Samitivej Sukhumvit Hospital. Call (02) 711 8700-2.

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