Make Chiangmai Mail | your Homepage | Bookmark

Chiangmai 's First English Language Newspaper

Pattaya Blatt | Pattaya Mail | Pattaya Mail TV

 
 

Doctor's Consultation  by Dr. Iain Corness

 

Update February 27, 2016

Is it a case of crying wolf?

We have a new disease to be afraid of. Another strange name, and another we have known of, but don’t fully understand, it would seem.
This is another viral illness caused by the Zika virus, who travels the globe on the wings of our old friend, the Aedes aegypti mosquito. This blight upon our doorsteps also carried Dengue virus, Chikungunya, and Yellow fever.
Zika is not new having been first noted in the late 1940’s, and it was not considered to be dangerous as opposed to Dengue, for example.
From the US Center for Disease Control, only about 1 in 5 people infected with Zika virus become ill (i.e., develop Zika).
The most common symptoms of Zika are fever, rash, joint pain, or conjunctivitis (red eyes). Other common symptoms include muscle pain and headache. The incubation period (the time from exposure to symptoms) for Zika virus disease is not known, but is likely to be a few days to a week. The illness is usually mild with symptoms lasting for several days to a week.
Another important factor is people usually don’t get sick enough to go to the hospital, and they very rarely die of Zika, so the statistics are skewed.
Zika virus usually remains in the blood of an infected person for about a week but it can be found longer in some people, which makes it even harder to diagnose.
The symptoms of Zika are similar to those of Dengue and Chikungunya and spread through the same mosquitoes.
So how do we even know to look for accurate figures, when more than half the time the infected patient has no symptoms?
With the WHO hot on the trail and stirring up the planet’s interest, the CDC suggests see your healthcare provider if you develop the symptoms described above and have visited an area where Zika is found.
This came about after the World Health Organization (WHO) chaired a meeting to assess the level of threat. 18 experts and advisers looked in particular at the strong association, in time and place, between infection with the Zika virus and a rise in detected cases of congenital malformations and neurological complications. The experts agreed that a causal relationship between Zika infection during pregnancy and microcephaly is strongly suspected, though not yet scientifically proven. All agreed on the urgent need to coordinate international efforts to investigate and understand this relationship better.
If you have been in an area known for Zika, your healthcare provider may order specialized blood tests to look for Zika or other similar viruses like dengue or chikungunya.
Treatment is equally vague. There is no vaccine to prevent or specific medicine to treat Zika infections.
The advice is to treat the symptoms:
Get plenty of rest.
Drink fluids to prevent dehydration.
Take medicine such as acetaminophen (TylenolŪ) to relieve fever and pain.
Do not take aspirin and other non-steroidal anti-inflammatory drugs.
If you are taking medicine for another medical condition, talk to your healthcare provider before taking additional medication.
If you have Zika, prevent mosquito bites for the first week of your illness. During the first week of infection, Zika virus can be found in the blood and passed from an infected person to a mosquito through mosquito bites. An infected mosquito can then spread the virus to other people.
So we have a “new” virus to scare people with. Unfortunately, that is the situation. We are getting so much negative publicity about a virus we never even thought to look for, but now, we are chasing a virus that gives no symptoms for 4 out of 5 cases and we still don’t have definitive tie – in between the virus and other medical conditions.
Areas with active mosquito-borne transmission of Zika virus
Prior to 2015, Zika virus outbreaks occurred in areas of Africa, Southeast Asia, and the Pacific Islands. (But nothing here!)
In May 2015, the Pan American Health Organization (PAHO) issued an alert regarding the first confirmed Zika virus infections in Brazil.
Zika virus will continue to spread and it will be difficult to determine how and where the virus will spread over time.
(I think the most important thing to do is to give up reading!)


Update February 20, 2016

More on Zika

Last week I touched on the “epidemic” caused by the Zika virus and the WHO. This came about after the World Health Organization (WHO) chaired a meeting to assess the level of threat. 18 experts and advisers looked in particular at the strong association, in time and place, between infection with the Zika virus and a rise in detected cases of congenital malformations and neurological complications. The experts agreed that a causal relationship between Zika infection during pregnancy and microcephaly is strongly suspected, though not yet scientifically proven. All agreed on the urgent need to coordinate international efforts to investigate and understand this relationship better.
I pointed out last week that this resulted in one of these where the WHO is sliding down a knife edge, as if the microcephaly issue turns out not to be a Zika effect, the WHO becomes accused of scaremonger tactics for having brought attention to it. If however it is shown to be a vector in the condition, the WHO becomes accused of not giving the world enough of a warning! Damned if you do and Damned if you don’t.
The Center for Disease Control (CDC) now recommends that all pregnant women consider postponing travel to areas in which the transmission of the Zika virus remains active. The infection is currently most prevalent in Central America and South America.
Aedes aegypti mosquitoes bite mostly during the daytime. Persons who must travel to areas of active Zika infections should practice advanced mosquito prevention strategies. The authors note that insect repellants containing DEET, picaridin, and IR3535 are safe to use during pregnancy.
Healthcare providers should query all pregnant women about recent travel. However, only symptomatic women with symptoms within 2 weeks of travel should be tested for infection with the Zika virus. These women should be evaluated for dengue and chikungunya virus as well.
There are no commercially available tests for the Zika virus infection. Available tests use RT-PCR technology as well as antibody testing. State and local health departments may be necessary to help interpret test results.
Fetal ultrasonography should be ordered regardless whether the test result for the Zika virus is positive among symptomatic women. Ultrasonography should also be performed among asymptomatic women with a history of travel to areas of active Zika virus infection.
If microcephaly or intracranial calcifications are present on fetal ultrasound, women should have the option to undergo amniocentesis and counseling. The Zika virus can be isolated from amniotic fluid, but the sensitivity and specificity of this testing are unknown.
If results on fetal ultrasonography are normal in a woman with a positive test result for the Zika virus, the clinician and patient should consider serial fetal ultrasounds every 3 to 4 weeks to monitor fetal anatomy and growth.
Any positive test result for the Zika virus should prompt a referral to a maternal-fetal medicine specialist or an infectious disease specialist with expertise in pregnancy.
After delivery in a case of maternal Zika virus infection, the placental and cord tissue and cord serum should be tested for the Zika virus. The CDC is developing guidelines for the management of infants infected with the Zika virus.
There is no treatment for infection with the Zika virus beyond supportive care.
Approximately 80 percent of individuals infected with the Zika virus remain asymptomatic. The duration of symptoms is usually less than 1 week in the remainder of infected patients, and hospitalization and mortality are rare with Zika infection.
The current guidelines by the CDC suggest that pregnant women avoid travel to areas of active Zika virus infection. For those individuals who must travel to such areas, insect repellants can be safe during pregnancy. Women who return from areas of active Zika virus infection should undergo fetal ultrasonography to detect cranial abnormalities, but only symptomatic women and women with abnormal ultrasound findings should undergo serologic testing for the Zika virus.
Travel history is not typically at the forefront of issues in completing the history of prenatal patients, but the potentially devastating effects of the Zika virus infection mean that the healthcare team should be actively searching for at-risk patients.
The above is again jumping the gun – it has not yet been proved there is a causal relationship!


Update February 13, 2016

WHO sounds a warning

The WHO Director-General, Dr Margaret Chan, published a statement on the first meeting of the International Health Regulations (2005) Emergency Committee on Zika virus and observed increase in neurological disorders and neonatal malformations.
Dr Chan convened an Emergency Committee, under the International Health Regulations, to gather advice on the severity of the health threat associated with the continuing spread of Zika virus disease in Latin America and the Caribbean. The Committee met in February by teleconference.
In assessing the level of threat, the 18 experts and advisers looked in particular at the strong association, in time and place, between infection with the Zika virus and a rise in detected cases of congenital malformations and neurological complications. The experts agreed that a causal relationship between Zika infection during pregnancy and microcephaly is strongly suspected, though not yet scientifically proven. All agreed on the urgent need to coordinate international efforts to investigate and understand this relationship better.
The experts also considered patterns of recent spread and the broad geographical distribution of mosquito species that can transmit the virus.
The lack of vaccines and rapid and reliable diagnostic tests, and the absence of population immunity in newly affected countries were cited as further causes for concern.
After a review of the evidence, the Committee advised that the recent cluster of microcephaly cases and other neurological disorders reported in Brazil, following a similar cluster in French Polynesia in 2014, constitutes an “extraordinary event” and a public health threat to other parts of the world.
In their view, a coordinated international response is needed to minimize the threat in affected countries and reduce the risk of further international spread.
Members of the Committee agreed that the situation meets the conditions for a Public Health Emergency of International Concern.
Dr Chan has now declared that the recent cluster of microcephaly cases and other neurological disorders reported in Brazil, following a similar cluster in French Polynesia in 2014, constitutes a Public Health Emergency of International Concern.
A coordinated international response is needed to improve surveillance, the detection of infections, congenital malformations, and neurological complications, to intensify the control of mosquito populations, and to expedite the development of diagnostic tests and vaccines to protect people at risk, especially during pregnancy.
The Committee found no public health justification for restrictions on travel or trade to prevent the spread of Zika virus.
At present, the most important protective measures are the control of mosquito populations and the prevention of mosquito bites in at-risk individuals, especially pregnant women.
This shows the way public health is being monitored in the world by the WHO (World Health Organization) and I commend them for their attention to this latest public health threat, without hysteria, as has sometimes been the case in the past. It certainly does look as if there is an association with this Zika virus and microcephaly (small head).
Zika, usually mild and rarely fatal with symptoms often mistaken for other mosquito-borne viruses such as dengue and chikungunya, has “widespread distribution” across Thailand, according to an article last year in the American Journal of Tropical Medicine and Hygiene. But Thailand has only reported one case this year. But that does not mean there has only been one case -
Zika virus is spread by the Aedes aegypti mosquito, the culprit responsible for dengue, yellow fever and other tropical diseases. Since we have not been that successful in combating Aedes aegypti which breeds in standing water (and there has been plenty of water recently), the potential for an epidemic is quite obviously there.
The big problem here, and one where the WHO is sliding down a knife edge, is if the microcephaly issue turns out not to be a Zika effect, the WHO becomes accused of scaremonger tactics for having brought attention to it. If however it is shown to be a vector in the condition, the WHO becomes accused of not giving the world enough of a warning!
Damned if you do and damned if you don’t!


Update February 6, 2016

Does EBM mean increased ‘benefits’ for you?

The practice of Medicine is a fascinating story over thousands of years. “Healers” have been part of most societies, and in ancient China, for example, you paid the doctor to remain well, not for treatment of your ailment. Now there’s an incentive bonus for you!
Then there are different kinds of “medicine” given such names as “conventional”, “alternative” and “complementary”.
These different ways at looking at the same subject (making you well) can be quite confusing, and for me much hangs on the term EBM, which stands for Evidence Based Medicine.
Mind you, it has also always been the case where people like to throw stones at conventional clinical medicine. Claims of over-servicing, over-prescribing and downright fraudulent practices are thrown about, citing someone whose uncle/friend/mother (delete that which is inappropriate) suffered at the hands of “bad” doctors who misdiagnosed the illness and the patient died.
Now, there are certainly some “bad” doctors out there, just as there are “bad” lawyers, “bad” real estate agents, “bad” mechanics and just about any profession you would like to think of. But they’re not all “bad”.
And me? I am a conventionally trained British/Australian style medical practitioner who has spent a lifetime practicing EBM. Practices that have been proven to work. Call it “good” medicine, if you like.
I am also proud of my final exams taken in the Royal Colleges of Physicians and Surgeons in London. I have the honor to have my name listed in the ‘great book’ with luminaries such as Hunter, Jenner and Lister. I am also indebted to my tutors during the 12 months of ‘pre-registration’, where you apply your knowledge under the supervision of accredited specialists. An arduous road, but one that is a safeguard for you, the general public.
The ‘powers that be’ are also ensuring that we keep up to date with a process called Continuous Medical Education (CME). That medical education continues through to today, with CME lectures being attended by my hospital’s doctors, and myself. Fortunately for me, the slides are in English.
Those ‘powers that be’ also try to ensure that we prescribe drugs that are efficacious, that have been tested, and the evidence points to this. It is not anecdotal evidence, but true scientific evidence shown by research in many countries, with hundreds of thousands of patients. It is following that type of evidence, that I can recommend with all good faith, that 100 mg of aspirin a day is “good” medicine. I also know that if you are prescribed a ‘statin’ drug it will lower your cholesterol levels. They have been tested.
I am also the first to admit that we have sometimes managed to get it wrong. The Thalidomide story still has living examples of this. However, the medical world-wide network is cohesive enough to ensure that this drug was withdrawn. It is the checks and balances system that has kept conventional medicine afloat.
I am often asked my opinion on “alternative” medicine, and I try to avoid direct confrontation over this. If devotees have found that they can diagnose tumors by looking at patient’s auras through their third eye in the middle of their foreheads, then I am genuinely pleased, in fact delighted, provided that they have subjected the method to scientific scrutiny.
If various groups can actually cure cancer, epilepsy, halitosis or lock-jaw by inserting dandelions into a fundamental orifice, then again I am delighted. This is a medical break-through, but as such, must be subjected to medical scrutiny. If the method stands true scientific examination (not to be confused with anecdotal ‘evidence’) then it will be adopted by everyone, complete with thanks to those clever people who picked the dandelions in the first place. Ignore the claims that “Big Pharma” is suppressing cancer treatments. If someone has the answer, they will be multi-millionaires overnight.
As far as the majority of ‘folk’ remedies is concerned, I work on the principle that if you ‘think’ it is doing you good, then it probably is. But don’t ask me to endorse something that has not been scientifically tested.
When the ‘alternative’ group spends more time proving their methods, instead of complaining about non-acceptance, EBM practitioners will give them more credence.


HEADLINES [click on headline to view story]

Is it a case of crying wolf?

More on Zika

WHO sounds a warning

Does EBM mean increased ‘benefits’ for you?