A Guide on Hepatitis (A, B, C)

What Is Hepatitis?

Hepatitis is an inflammation of the liver. It may be caused by drugs, alcohol use, or certain medical conditions. But in most cases, it's caused by a virus. This is known as viral hepatitis, and the most common forms are hepatitis A, B, and C.

Hepatitis Symptoms

Sometimes there are no symptoms of hepatitis in the first weeks after infection -- the acute phase. But when they happen, the symptoms of types A, B, and C may include fatigue, nausea, poor appetite, belly pain, a mild fever, or yellow skin or eyes (jaundice). When hepatitis B and C become chronic, they may cause no symptoms for years. By the time there are any warning signs, the liver may already be damaged

Hepatitis A: What Happens

Hepatitis A is highly contagious and can spread from person to person in many different settings. It typically causes only a mild illness, and many people who are infected may never realize they're sick at all. The virus almost always goes away on its own and does not cause long-term liver damage.

Hepatitis A: How Does It Spread?

It usually spreads through food or water. Food can be tainted when it's touched by a person with hepatitis who did not wash his hands after using the bathroom. This transfers tiny amounts of infected stool to the food. Raw shellfish, fruits, vegetables, and undercooked foods are common culprits in hepatitis A outbreaks. The virus can also spread in daycare centers if employees aren't careful about washing hands after changing diapers.

Hepatitis A: Who Is at Risk?

A prime risk factor for hepatitis A is traveling to or living in a country with high infection rates. You can check the CDC's travel advisories to learn about recent outbreaks. Eating raw foods or drinking tap water can raise your risk while traveling. Children who attend daycare centers also have a higher risk of getting hepatitis A.

Hepatitis B: What Happens

Many adults who get hepatitis B have mild symptoms for a short time and then get better on their own. But some people are not able to clear the virus from the body, which causes a long-term infection. Nearly 90% of infants who get the virus will carry it for life. Over time, hepatitis B can lead to serious problems, such as liver damage, liver failure, and liver cancer.

Hepatitis B: How Does It Spread?

You can get it through contact with the blood or body fluids of an infected person. In the U.S., it's most often spread through unprotected sex. It's also possible to get hepatitis B by sharing an infected person's needles, razors, or toothbrush. And an infected mother can pass the virus to her baby during childbirth. Hepatitis B is not spread by hugging, sharing food, or coughing.

Hepatitis B: Who Is at Risk?

Anyone can get hepatitis B, but people who have multiple sex partners or inject illegal drugs have a higher risk. Other risk factors include being a health care worker who is exposed to blood, or living with someone who has chronic hepatitis B.

Hepatitis C: What Happens

About 25% of people who get hepatitis C defeat the virus after a short-term infection. The rest will carry the virus in their body for the long term. Chronic hepatitis C can cause very serious complications, including liver failure and liver cancer. There are effective treatments for the virus, though. 

Hepatitis C: How Does It Spread?

It spreads through infected blood. In the U.S., sharing needles or other items used to inject drugs is the most common cause of infection. Getting a tattoo or body piercing with an infected needle is another means of exposure. A mother may pass the virus to her child at birth. In rare cases, unprotected sex spreads hepatitis C, but the risk appears small. Having multiple sex partners, HIV, or rough sex seems to raise risk for spreading hepatitis C.

Hepatitis C: Who Is at Risk?

People who have injected illegal drugs at any time, even one time, many years ago, could be walking around with chronic hepatitis C. Because there are often no symptoms, many former drug users may not realize they have the infection. People who received a blood transfusion before 1992 also have a higher risk. Before that year, donated blood was not screened for the hepatitis C virus.

How Is Hepatitis Diagnosed?

Chronic hepatitis can quietly attack the liver for years without causing any symptoms. Unless the infection is diagnosed, monitored, and treated, many of these people will eventually have serious liver damage. Fortunately, blood tests can determine whether you have viral hepatitis, and if so, which kind.

Who Should Be Tested for Hepatitis?

Testing is important for anyone with the risk factors we've mentioned, particularly injected drug users and people who have had multiple sex partners. Health advocates are also urging people of Asian heritage to get tested. Stanford University's Asian Liver Center estimates that 1 in 10 Asians living in the U.S. has chronic hepatitis B. Many of them have probably had the virus since birth.

Also, the U.S. Preventive Services Task Force recommends that health care providers offer a one-time hepatitis C screening for anyone born between 1945 and 1965

What if You Test Positive?

If a test says you have viral hepatitis, you can take steps to protect the ones you love. For hepatitis A, wash hands frequently. For hepatitis B and C, avoid sharing nail clippers, razors, or toothbrushes. Hepatitis B, and sometimes hepatitis C, can be passed through sexual contact. Make sure everyone in your household gets the hepatitis B vaccine. An important step is to see a specialist to discuss treatment options.

Treatment: Hepatitis A

Hepatitis A almost always goes away on its own, and no medication is needed. If nausea is a problem, try eating several small meals throughout the day instead of three large ones. Drink water, juice, or sports drinks to stay hydrated. And avoid hard exercise until you're feeling better.

Treatment: Chronic Hepatitis B

The goal of treating chronic hepatitis B is to control the virus and keep it from damaging the liver. This begins with regular monitoring for signs of liver disease. Antiviral medications may help, but not everyone can take them or needs to be on medication. Be sure to discuss the risks and benefits of antiviral therapy with your doctor.

Treatment: Chronic Hepatitis C

The latest drug to be approved by the FDA is glecaprevir and pibrentasvir (Mavyret). This medication offers a shorter treatment cycle of 8 weeks for adult patients with all types of HCV who don’t have cirrhosis and who have not been previously treated. The length of treatment is longer for those who are in a different disease stage. The prescribed dosage for this medicine is 3 tablets daily.

There are several other combination drugs available, as well as some single drugs that may be used in combination. Your doctor will choose the right one for you depending on the type of hepatitis C you have, how well your liver is functioning and any other medical problems you may have. Also be sure to discuss your insurance coverage since these medications are expensive

Monitoring Chronic Hepatitis

To manage chronic hepatitis B or C, your doctor will order regular blood tests to check how well your liver is working. Ultrasounds and CT scans can also reveal signs of damage. If the virus is not causing any liver problems, you may not need treatment. But it's important to have regular tests to watch for changes. Complications are easiest to treat when found early.

Complications: Cirrhosis

One of the most common complications of chronic hepatitis is cirrhosis. This is a scarring of the liver that can be found with a biopsy. Cirrhosis makes it difficult for the liver to do its job and can lead to liver failure, a life-threatening condition. Symptoms include fatigue, nausea, weight loss, and swelling in the belly and legs. In severe cases, patients may experience jaundice and confusion.

Complications: Liver Cancer

Viral hepatitis is the top cause of liver cancer, so people with chronic hepatitis B or C need monitoring even if they feel healthy. Blood tests can detect proteins that suggest the presence of liver cancer. Ultrasounds, CT scans, and MRIs can reveal abnormal lesions in the liver (seen here in green). A biopsy is needed to determine if these areas are cancerous. Tumors that are found early may be surgically removed. But most liver cancers are difficult to treat.

Liver Transplant

The liver is a vital organ that aids in metabolism, digestion, detoxifying, and the production of many proteins needed by the body. If a large part of the liver is damaged beyond repair, it will no longer be able to perform these important jobs. People cannot live without a working liver. In this case, a liver transplant may be the best hope. This option provides the patient with a healthy liver from a donor.

Hepatitis A and B Vaccines

There are vaccines to protect against hepatitis A and B. The CDC recommends hepatitis A vaccination for all children ages 12 to 23 months and for adults who plan to travel or work in areas with hepatitis A outbreaks or who have other risk factors. People with chronic hepatitis B or C should also get the hepatitis A vaccine if they don't already have immunity to the disease. The hepatitis B vaccine is recommended for all infants at birth and for adults who have any of the risk factors we discussed earlier. There is no vaccine for hepatitis C.

Protecting Your Liver

If you have chronic hepatitis, there are steps you can take to keep your liver resilient. Avoid alcohol, which can cause additional liver damage. Check with your doctor before taking any medications or supplements, because some are tough on the liver or may not be safe in people with liver disease. Most importantly, keep your appointments for regular monitoring. By watching for any changes in your liver, you and your health care provider can stay one step ahead of the virus.

COURTESY FROM: WEBMD

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ZIKA VIRUS - HOW WE GET INFECTED

What is the Zika virus? How do you catch it?

Key facts

1. Zika virus disease is caused by a virus transmitted primarily by Aedes mosquitoes, which bite during the day.
2. Symptoms are generally mild and include fever, rash, conjunctivitis, muscle and joint pain, malaise or headache. Symptoms typically last for 2–7 days. Most people with Zika virus infection do not develop symptoms.
3. Zika virus infection during pregnancy can cause infants to be born with microcephaly and other congenital malformations, known as congenital Zika syndrome. Infection with Zika virus is also associated with other complications of pregnancy including preterm birth and miscarriage.
4. An increased risk of neurologic complications is associated with Zika virus infection in adults and children, including Guillain-Barré syndrome, neuropathy and myelitis.

Zika virus, first identified in Uganda in 1947, is transmitted by the same type of mosquito that carries dengue fever, yellow fever, and chikungunya virus. A mosquito bites an infected person and then passes those viruses to other people it bites. Outbreaks did not occur outside of Africa until 2007, when it spread to the South Pacific

There are two lineages of the Zika virus: the African lineage, and the Asian lineage.

it may be spread through sexual contact or blood transfusions. In early February, a case of Zika spreading through sexual contact was reported in Dallas County, TX. There, a person who'd traveled to an area that had cases of the virus infected a partner who had not traveled.

It was reported that Brazilian scientists have found the virus in the saliva and urine of infected people.

What are the symptoms of Zika virus?

The disease can cause fever, rash, joint pain, and conjunctivitis, also called pinkeye. But most people won’t know they have it.

All can cause a variety of flu-like symptoms that range in severity and can last from a few days to more than a week. As with Zika, few people infected with dengue or West Nile will show any symptoms

SEXUAL TRANSMISSION

Zika virus can be transmitted through sexual intercourse. This is of concern due to an association between Zika virus infection and adverse pregnancy and fetal outcomes.

For regions with active transmission of Zika virus, all people with Zika virus infection and their sexual partners (particularly pregnant women) should receive information about the risks of sexual transmission of Zika virus.

WHO recommends that sexually active men and women be correctly counselled and offered a full range of contraceptive methods to be able to make an informed choice about whether and when to become pregnant in order to prevent possible adverse pregnancy and fetal outcomes

How is Zika virus treated?

There’s no treatment, but Adalja says most people with symptoms do well with over-the-counter medications for aches and pains. The disease usually runs its course within a week or so.

What is the connection between Zika, microcephaly, and pregnancy?

Zika has been tied to cases of microcephaly in babies born to infected pregnant women. Microcephaly stunts a baby’s head growth, causing devastating, sometimes-fatal brain damage, and it can result in miscarriage or stillbirth. A cause-and-effect link with the Zika virus hasn’t been definitely established, though.

The virus has caused panic in Brazil since it first appeared there in May. More than 4,000 babies in Brazil have reportedly been born with microcephaly. Brazil and several other nations have advised women to postpone pregnancy.

Reference from WEDMD, WIKIPEDIA AND WHO HEALTH ORGANISATION

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LASSA FEVER - Key facts, symptoms and prevention

   Key facts

• Lassa fever is an acute viral haemorrhagic illness of 2-21 days duration that occurs in West Africa.
• The Lassa virus is transmitted to humans via contact with food or household items contaminated with rodent urine or faeces.
• Person-to-person infections and laboratory transmission can also occur, particularly in hospitals lacking adequate infection prevention and control measures.
• Lassa fever is known to be endemic in Benin, Ghana, Guinea, Liberia, Mali, Sierra Leone, and Nigeria, but probably exists in other West African countries as well.
• The overall case-fatality rate is 1%. Observed case-fatality rate among patients hospitalized with severe cases of Lassa fever is 15%.
• Early supportive care with rehydration and symptomatic treatment improves survival.                                          

Lassa fever or Lassa hemorrhagic fever (LHF) is an acute viral hemorrhagic fever caused by the Lassa virus and first described in 1969 in the town of Lassa, in Borno State, Nigeria. Lassa fever is a member of the arenaviridae virus family. Similar to Ebola, clinical cases of the disease had been known for over a decade but had not been connected with a viral pathogen. The infection is endemic in West African countries, and causes 300,000–500,000 cases annually, with approximately 5,000 deaths. Outbreaks of the disease have been observed in Nigeria, Liberia, Sierra Leone, Guinea, and the Central African Republic, but it is believed that human infections also exist in Democratic Republic of the Congo, Mali, and Senegal. The primary animal host of the Lassa virus is the Natal Multimammate Mouse (Mastomys natalensis), an animal indigenous to most of Sub-Saharan Africa. The virus is probably transmitted by contact with the feces or urine of animals accessing grain stores in residences. 

Lassa fever is a viral hemorrhagic fever in West Africa. Studies show up to half a million cases of Lassa fever per year in West Africa, with about 5,000 resulting in death. Results Lassa virus was detected in 25 of 60 (42%) patients in northern and central Edo. The Lassa Virus affects adults and children alike; no matter your age you can be at risk for Lassa.

Like other hemorrhagic fevers, Lassa fever can be transmitted directly from one human to another. It can be contracted by an airborne route or with direct contact with infected human blood, urine, or semen. Transmission through breast milk has also been observed.

Symptoms

In 80% of cases, the disease is inapparent, but in the remaining 20%, it takes a complicated course. It is estimated that the virus is responsible for about 5,000 deaths annually. The fever accounts for up to one third of deaths in hospitals within the affected regions and 10 to 16% of total cases.

After an incubation period of six to twenty-one days, an acute illness with multiorgan involvement develops. Non-specific symptoms include fever, facial swelling, and muscle fatigue, as well as conjunctivitis and mucosal bleeding. The other symptoms arising from the affected organs are:

·         Gastrointestinal tract

·         Nausea

·         Vomiting (bloody)

·         Diarrhea (bloody)

·         Stomach ache

·         Constipation

·        (difficulty swallowing)

·         Hepatitis

·         Cardiovascular system

·         Pericarditis

·         Hypertension

·         Hypotension

·         Respiratory tract

·         Cough

·         Chest pain

·         Dyspnoea

·         Pharyngitis

·         Nervous system

·         Encephalitis

·         Meningitis

·         Unilateral or bilateral hearing deficit

·         Seizures

Clinically, Lassa fever infections are difficult to distinguish from other viral hemorrhagic fevers such as Ebola and Marburg, and from more common febrile illnesses such as malaria.

Diagnosis 

There is a range of laboratory investigations that are performed to diagnose the disease and assess its course and complications. ELISA test for antigen and IgM antibodies gives 88% sensitivity and 90% specificity for the presence of the infection. Other laboratory findings in Lassa fever include lymphopenia (low white blood cell count), thrombocytopenia(low platelets), and elevated aspartate amino transferase (AST) levels in the blood. Lassa fever can also be found in cerebrospinal fluid. In West Africa, where Lassa is most prevalent, it is difficult for doctors to diagnose due to the absence of proper equipment to perform tests. In cases with abdominal pain, diagnoses in endemic countries are often made for other illnesses, such as appendicitis and intussusceptions, delaying treatment with Ribavirin.

Research has been done in the last few years by a team of specialists in order to diagnose the Lassa fever on a molecular level.

Prognosis

About 15%-20% of hospitalized Lassa fever patients will die from the illness. It is estimated that the overall mortality rate is 1%, however during epidemics mortality can climb as high as 50%. The mortality rate is greater than 80% when it occurs in pregnant women during their third trimester; fetal death also occurs in nearly all those cases. Abortion decreases the risk of death to the mother.

Prevention

Control of the Mastomys rodent population is impractical, so measures are limited to keeping rodents out of homes and food supplies, as well as maintaining effective personal hygiene. Gloves, masks, laboratory coats, and goggles are advised while in contact with an infected person.

·    In health-care settings, staff should always apply standard infection prevention and control precautions when caring for patients, regardless of their presumed diagnosis. These include basic hand hygiene, respiratory hygiene, use of personal protective equipment (to block splashes or other contact with infected materials), safe injection practices and safe burial practices.

·     Health-care workers caring for patients with suspected or confirmed Lassa fever should apply extra infection control measures to prevent contact with the patient’s blood and body fluids and contaminated surfaces or materials such as clothing and bedding. When in close contact (within 1 metre) of patients with Lassa fever, health-care workers should wear face protection (a face shield or a medical mask and goggles), a clean, non-sterile long-sleeved gown, and gloves (sterile gloves for some procedures).

·     Laboratory workers are also at risk. Samples taken from humans and animals for investigation of Lassa virus infection should be handled by trained staff and processed in suitably equipped laboratories under maximum biological containment conditions.

Treatment

There is currently no vaccine that protects against Lassa fever.

All persons suspected of Lassa fever infection should be admitted to isolation facilities and their body fluids and excreta properly disposed of.

Early and aggressive treatment using Ribavirin was pioneered by Joe McCormick in 1979. After extensive testing, it was determined that early administration is critical to success. Additionally, Ribavirin is almost twice as effective when given intravenously as when taken by mouth. Ribavirin is a prodrug which appears to interfere with viral replication by inhibiting RNA-dependent nucleic acid synthesis, although the precise mechanism of action is disputed. The drug is relatively inexpensive, but the cost of the drug is still very high for many of those in West African states. Fluid replacement, blood transfusion and fighting hypotension are usually required. Intravenous interferon therapy has also been used.

When Lassa fever infects pregnant women late in their third trimester, it is necessary to induce delivery for the mother to have a good chance of survival. This is because the virus has an affinity for the placenta and other highly vascular tissues. The fetus has only a one in ten chance of survival no matter what course of action is taken; hence focus is always on saving the life of the mother. Following delivery, women should receive the same treatment as other Lassa fever patients.

            

COURTESY FROM: World Health Organization and Wikipedia 

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PRIMARY CARE ON BREAST CYST

A breast cyst is a fluid-filled sac within the breast. One breast can have one or more breast cysts. They're often described as round or oval lumps with distinct edges. In texture, a breast cyst usually feels like a soft grape or a water-filled balloon, but sometimes a breast cyst feels firm.

Breast cysts can be painful and may be worrisome but are generally benign. They are most common in pre-menopausal women in their 30s or 40s. They usually disappear after menopause, but may persist or reappear when using hormone therapy. They are also common in adolescents. Breast cysts can be part of fibrocystic disease. The pain and swelling is usually worse in the second half of the menstrual cycle or during pregnancy.

Treating breast cysts is usually not necessary unless they are painful or cause discomfort. However, most cysts, regardless of their size cannot be identified during physical exams.

Breast cysts are not to be confused with "milk cysts" (galactoceles), which usually appear during weaning.

DIAGNOSIS

A breast lump can be confirmed by ultrasound examination, aspiration (removal of contents with needle), or mammogram. Ultrasound can also show if the cyst contains solid nodules, a sign that the lesion may be pre-cancerous or cancerous. Examination by a cytopathologist of the fluid aspirated from the cyst may also help with this diagnosis. In particular, it should be sent to a laboratory for testing if it is blood-stained.

Needle biopsy being performed to determine nature of lump either fluid-filled cyst or solid tumor

Breast cysts may remain stable for many years or may resolve spontaneously. Most simple cysts are benign and do not require any treatment or further diagnostic workup. Some complex cysts may require further diagnostic measures such as fine needle aspiration or biopsy to exclude breast cancer however the overwhelming majority is of benign nature. That is, cysts will usually resolve on their own after the fluid is drained.

Symptoms

Signs and symptoms of breast cysts include:

A smooth, easily movable round or oval breast lump with distinct edges

Breast pain or tenderness in the area of the lump

Increased lump size and tenderness just before your period

Decreased lump size and resolution of other signs and symptoms after your period

Having one or many simple breast cysts doesn't increase your risk of breast cancer.

Lumps in the breast are often not found during self-examinations or physical exams.

Treatment

Breast cysts do not require treatment unless a cyst is large and painful or otherwise uncomfortable. In that case, draining the fluid from a breast cyst can ease your symptoms.

Typical treatment involves a Needle aspiration biopsy. Aspirated cysts often recur (come back); definitive treatment may require surgery.

Draining the fluid and then waiting for the cyst to resolve it is the main treatment applied in these cases. Moreover, cysts that are aspirated and the fluid looks normal do not require any other medical attention apart from following-up to make sure it completely disappeared. Yet, hormone therapy by the means of oral contraceptives is sometimes prescribed to reduce their recurrence and to regulate the menstrual cycle of the patient (which is likely to cause them in the first place). 

Surgical removal of a breast cyst is necessary only in a few unusual circumstances. If an uncomfortable breast cyst recurs month after month, or if a breast cyst contains blood-tinged fluid and displays other worrisome signs, surgery may be considered

Prevention

The development of breast cysts may be prevented to some degree, according to the majority of the specialists. The recommended measures one is able to take in order to avoid the formation of the cysts include practicing good health and avoiding certain medications, eating a balanced diet, taking necessary vitamins and supplements, getting exercise, and avoiding stress

Although caffeine consumption does not have a scientifically proved connection with the process of cyst development, many women claim that their symptoms are relieved if avoiding it. Some doctors recommend reducing the amount of caffeine in one's diet in terms of both beverages and foods (such as chocolate). Also reducing salt intake may help in alleviating the symptoms of breast cysts, although, again, there is no scientific linkage between these two. Excessive sugar consumption as well as undetected food allergies, such as to gluten or lactose, may also contribute to cyst development.

Epidemiology

It is estimated that 7% of women in the western world develop palpable breast cysts

There is preliminary evidence that women with breast cysts may be at an increased risk of breast cancer, especially at younger ages.

In males, the occurrence of breast cysts is rare and may (but need not) be an indication of malignancy.

Cysts and bra support

Some women experience breast pain, especially when engaging in vigorous physical activity. A properly fitted sports bra, which compresses or encapsulates breast tissue, is designed to reduce pain caused by exercise.

GUIDE ON BOILS - CAUSES - TREATMENT

A boil, also called a furuncle, is a deep folliculitis, infection of the hair follicle. It is most commonly caused by infection by the bacterium Staphylococcus aureus, resulting in a painful swollen area on the skin caused by an accumulation of pus and dead tissue. Individual boils clustered together are called carbuncles.

SIGNS AND ISSUES

Boils are bumpy, red, pus-filled lumps around a hair follicle that are tender, warm, and very painful. A yellow or white point at the centre of the lump can be seen when the boil is ready to drain or discharge pus. In a severe infection, an individual may experience fever, swollen lymph nodes, and fatigue. A recurring boil is called chronic furunculosis. Boils can be caused by other skin conditions that cause the person to scratch and damage the skin.

Boils may appear on the buttocks or near the anus, the back, the neck, the stomach, the chest, the arms or legs, or even in the ear canal. Boils may also appear around the eye, where they are called styes. A boil on the gum is called intraoral dental sinus, or more commonly, a gumboil.

CAUSES

1.    Bacteria

Usually, the cause is bacteria such as staphylococci that are present on the skin. Bacterial colonisation begins in the hair follicles and can cause local cellulitis and inflammation.

2.    Family history

People with recurrent boils are as well more likely to have a positive family history, take antibiotics, and to have been hospitalised, anemic, or diabetic; they are also more likely to have associated skin diseases and multiple lesions.

3.    Other

Other causes include poor immune system function such as from HIV/AIDS, diabetes, malnutrition,or alcoholism. Poor hygiene and obesity have also been linked. It may occur following antibiotic use due to the development of resistance to the antibiotics used.  An associated skin disease favors recurrence. This may be attributed to the persistent colonization of abnormal skin with S. aureus strains, such as is the case in persons with atopic dermatitis.

Complications

The most common complications of boils are scarring and infection or abscess of the skin, spinal cord, brain, kidneys, or other organs. Infections may also spread to the bloodstream  and become life-threatening. Unfortunately, these bacteria can reach the bloodstream and end up in many different body sites, causing infections (wound infections, abscesses, osteomyelitis, endocarditis, pneumonia) that may severely harm or kill the infected person. S. aureus strains also produce enzymes and exotoxins that likely cause or increase the severity of certain diseases. Such diseases include food poisoning, septic shock, toxic shock syndrome, and scalded skin syndrome. Almost any organ system can be infected by S. aureus.

Treatment

A boil may clear up on its own without bursting, but more often it will need to open and drain. This will usually happen spontaneously within two weeks. Regular application of a warm moist compress, both before and after a boil opens, can help speed healing. The area must be kept clean, hands washed after touching it, and any dressings disposed of carefully, in order to avoid spreading the bacteria. A doctor may cut open or "lance" a boil to allow it to drain, but squeezing or cutting should not be attempted at home, as this may further spread the infection. Antibiotic therapy may be recommended for large or recurrent boils or those that occur in sensitive areas (such as the groin, breasts, armpits, around or in the nostrils, or in the ear). Doctors that are not specialists tend to treat boils with antibiotics, a less-than-ideal but common treatment, but this method should not be used for longer than one month, with at least two months (preferably longer) between uses, otherwise it will lose its effectiveness.

Furuncles at risk of leading to serious complications should be incised and drained if antibiotics or steroid injections are not effective. These include furuncles that are unusually large, last longer than two weeks, or occur in the middle of the face or near the spine.

Staphylococcus aureus has the ability to acquire antimicrobial resistance easily, making treatment difficult. Knowledge of the antimicrobial resistance of S. aureus is important in the selection of antimicrobials for treatment.

GUIDE ON OVARIAN CYST

An ovarian cyst is any collection of fluid, surrounded by a very thin wall, within an ovary. Any ovarian follicle that is larger than about two centimeters is termed an ovarian cyst. Such cysts range in size from as small as a pea to larger than an orange.

The vast majority of ovarian cysts are harmless (benign), most are functional cysts.

Ovarian cysts occur in women of all ages including neonatal period and infancy. They are most prevalent during infancy, adolescence and during the childbearing years. With ultrasonography ovarian cysts can be demonstrated in nearly all premenopausal and approximately 18% postmenopausal women.

Some ovarian cysts cause problems, such as bleeding and pain or may raise concerns of malignancy. Surgery may be required to remove cysts larger than 5 centimeters in diameter

SIGNS AND SYMPTOMS

Some or all of the following symptoms may be present, though it is possible not to experience any symptoms

1.    Abdominal pain. Dull aching pain within the abdomen or pelvis, especially on intercourse.

2.    Uterine bleeding. Pain during or shortly after beginning or end of menstrual period; irregular periods, or abnormal uterine bleeding or spotting.

3.    Fullness, heaviness, pressure, swelling, or bloating in the abdomen.

4.    When a cyst ruptures from the ovary, there may be sudden and sharp pain in the lower abdomen on one side.

5.    Change in frequency or ease of urination (such as inability to fully empty the bladder), or difficulty with bowel movements due to pressure on adjacent pelvic anatomy.

6.    Constitutional symptoms such as fatigue, headaches

7.    Nausea or vomiting

8.    Weight gain

Other symptoms may depend on the cause of the cysts

Symptoms that may occur if the cause of the cysts is polycystic ovarian syndrome may include increased facial hair or body hair, acne, obesity and infertility.

If the cause is endometriosis, then periods may be heavy, and intercourse painful.

HOW TO DIAGNOSE OVARIAN CYST

Ovarian cysts are usually diagnosed by either ultrasound or CT scan, with additional endocrinological tests

TREATMENT

Cysts associated with hypothyroidism or other endocrine problems are treated by treating the underlying condition.

About 95% of ovarian cysts are benign, not cancerous.

1.    Functional cysts and hemorrhagic ovarian cysts usually resolve spontaneously. However the bigger an ovarian cyst is, the less likely it is to disappear on its own. Treatment may be required if cysts persist over several months, grow or cause increasing pain.

2.    Treatment for cysts depends on the size of the cyst and symptoms.

3.    Pain associated with ovarian cysts may be treated in several ways

4.    Painrelievers,including acetaminophen/paracetamol (Tylenol or Panadol), nonsteroidal anti-inflammatory drugs such as ibuprofen (Motrin, Advil), or narcotic pain medicine (by prescription) may help reduce pelvic pain. NSAIDs usually work best when taken at the first signs of the pain.

5.    A warm bath, or heating pad, or hot water bottle applied to the lower abdomen near the ovaries can relax tense muscles and relieve cramping, lessen discomfort, and stimulate circulation and healing in the ovaries.

6.    Combined methods of hormonal contraception such as the combined oral contraceptive pill – the hormones in the pills may regulate the menstrual cycle, and prevent the formation of follicles that can turn into cysts.(American College of Obstetricians and Gynecologists, 1999c; Mayo Clinic, 2002e). However, a Cochrane review in 2011 concluded oral contraceptives are of no benefit in treating already present functional cysts.

7.    Also, limiting strenuous activity may reduce the risk of cyst rupture or torsion.

Cysts that persist beyond two or three menstrual cycles, or occur in post-menopausal women, may indicate more serious disease and should be investigated through ultrasonography and laparoscopy, especially in cases where family members have had ovarian cancer. Such cysts may require surgical biopsy. Additionally, a blood test may be taken before surgery to check for elevated CA-125, a tumour marker, which is often found in increased levels in ovarian cancer, although it can also be elevated by other conditions resulting in a large number of false positives.

For more serious cases where cysts are large and persisting, doctors may suggest surgery. This may involve removing the cyst, or one or both ovaries.

 Features that may indicate the need for surgery include

Persistent complex ovarian cysts           

Persistent cysts that are causing symptoms

Complex ovarian cysts larger than 5 cm

Simple ovarian cysts larger 10 centimeters or larger than 5 cm in postmenopausal patients

Women who are menopausal or premenopausal

Please see your doctor for more advise.

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