Hepatitis C

Hepatitis C is a contagious liver disease that results from infection with the hepatitis C virus. It can range in severity from a mild illness lasting a few weeks to a serious, lifelong illness.

The hepatitis C virus is usually spread when blood from an infected person enters the body of a susceptible person. It is among the most common viruses that infect the liver.

Every year, 3–4 million people are infected with the hepatitis C virus. About 150 million people are chronically infected and at risk of developing liver cirrhosis and/or liver cancer. More than 350 000 people die from hepatitis C-related liver diseases every year.

Geographical distribution

Hepatitis C is found worldwide. Countries with high rates of chronic infection are Egypt (15%), Pakistan (4.8%) and China (3.2%). The main mode of transmission in these countries is attributed to unsafe injections using contaminated equipment.

Transmission

The hepatitis C virus is most commonly transmitted through exposure to infectious blood. This can occur through:

• receipt of contaminated blood transfusions, blood products and organ transplants;
• injections given with contaminated syringes and needle-stick injuries in health-care settings;
• injection drug use;
• being born to a hepatitis C-infected mother.

Hepatitis C may be transmitted through sex with an infected person or sharing of personal items contaminated with infectious blood, but these are less common.

Hepatitis C is not spread through breast milk, food or water or by casual contact such as hugging, kissing and sharing food or drinks with an infected person.

Symptoms

The incubation period for hepatitis C is 2 weeks to 6 months. Following initial infection, approximately 80% of people do not exhibit any symptoms. Those people who are acutely symptomatic may exhibit fever, fatigue, decreased appetite, nausea, vomiting, abdominal pain, dark urine, grey-coloured faeces, joint pain and jaundice (yellowing of skin and the whites of the eyes).

About 75-85 % of newly infected persons develop chronic disease and 60–70% of chronically infected people develop chronic liver disease; 5–20% develop cirrhosis and 1–5% die from cirrhosis or liver cancer. In 25 % of liver cancer patients, the underlying cause is hepatitis C.

Diagnosis

Diagnosis of acute infection is often missed because a majority of infected people have no symptoms. Common methods of antibody detection cannot differentiate between acute and chronic infection. The presence of antibodies against the hepatitis C virus indicates that a person is or has been infected. The hepatitis C virus recombinant immunoblot assay (RIBA) and hepatitis C virus RNA testing are used to confirm the diagnosis.

Diagnosis of chronic infection is made when antibodies to the hepatitis C virus are present in the blood for more than six months. Similar to acute infections, diagnosis is confirmed with an additional test. Specialized tests are often used to evaluate patients for liver disease, including cirrhosis and liver cancer.

Getting tested

Early diagnosis can prevent health problems that may result from infection and prevent transmission to family members and other close contacts. Some countries recommend screening for people who may be at risk for infection.

These include:

• people who received blood, blood products or organs before screening for hepatitis C virus was implemented, or where screening was not yet widespread;
• current or former injecting drug users (even those who injected drugs once many years ago);
• people on long-term hemodialysis;
• health-care workers;
• people living with HIV;
• people with abnormal liver tests or liver disease;
• infants born to infected mothers.

Treatment

Hepatitis C does not always require treatment. There are 6 genotypes of hepatitis C and they may respond differently to treatment. Careful screening is necessary before starting the treatment to determine the most appropriate approach for the patient.

Combination antiviral therapy with interferon and ribavirin has been the mainstay of hepatitis C treatment. Unfortunately, interferon is not widely available globally, it is not always well tolerated, some virus genotypes respond better to interferon than others, and many people who take interferon do not finish their treatment. This means that while hepatitis C is generally considered to be a curable disease, for many people this is not a reality.

Scientific advances have led to the development of new antiviral drugs for hepatitis C, which may be more effective and better tolerated than existing therapies. Two new therapeutic agents telaprevir and boceprevir have recently been licensed in some countries. Much needs to be done to ensure that these advances lead to greater access and treatment globally.

Prevention

Primary prevention

There is no vaccine for hepatitis C. The risk of infection can be reduced by avoiding:

• unnecessary and unsafe injections;
• unsafe blood products;
• unsafe sharps waste collection and disposal;
• use of illicit drugs and sharing of injection equipment;
• unprotected sex with hepatitis C-infected people;
• sharing of sharp personal items that may be contaminated with infected blood;
• tattoos, piercings and acupuncture performed with contaminated equipment.

Key facts

• Hepatitis C is a liver disease caused by the hepatitis C virus.
• The disease can range in severity from a mild illness lasting a few weeks to a serious, lifelong condition that can lead to cirrhosis of the liver or liver cancer.
• The hepatitis C virus is transmitted through contact with the blood of an infected person.
• About 150 million people are chronically infected with hepatitis C virus, and more than 350 000 people die every year from hepatitis C-related liver diseases.
• Hepatitis C is curable using antivirals.
• There is currently no vaccine for hepatitis C; however, research in this area is ongoing.

Hepatitis B

What Is Hepatitis B?

You may have heard of hepatitis, but many people are not sure what it is. Hepatitis is an infection of the liver. The group of viruses that infect the liver are called hepatitis viruses. Some types of hepatitis can cause very serious diseases and — in extreme cases — may lead to death.

Three types of hepatitis virus can be sexually transmitted. The type of hepatitis most likely to be sexually transmitted is hepatitis B (HBV). Hepatitis B is spread through semen, vaginal fluids, blood, and urine.

About 46,000 American women, men, and children become infected with HBV each year. Most of these infections occur among people who are age 20 to 49.

What Are the Symptoms of Hepatitis B?

Because hepatitis B often has no symptoms, most people are not aware that they have the infection. About 1 out of 2 adults who have it never have hepatitis B symptoms. When hepatitis B symptoms do occur, they usually appear between six weeks and six months after infection.

When hepatitis B symptoms do develop, the ones most likely to happen first include

• extreme tiredness
• tenderness and pain in the lower abdomen
• loss of appetite
• nausea, vomiting
• pain in the joints
• headache
• fever
• hives

Later hepatitis B symptoms include

• more severe abdominal pain
• dark urine
• pale-colored bowel movements
• jaundice — yellowing of the skin and eyes

Is There a Cure for Hepatitis B?

No, there is no medicine that can cure hepatitis. But in most cases, hepatitis B goes away by itself within 4 to 8 weeks. More than 9 out of 10 adults with HBV recover completely.

However, about 1 out of 20 people who get HBV as adults will be "carriers" and have chronic (long-term) infection with HBV. Nine out of 10 infants who get HBV at birth will have chronic infection unless they receive immediate treatment. Most HBV carriers remain contagious for the rest of their lives. There are about one and a quarter million HBV carriers in the U.S.

HBV carriers are more likely to pass the infection to other people. Chronic HBV infections can lead to severe liver disease — including liver damage (cirrhosis) and liver cancer. About 1 out of 5 people with chronic HBV infection die from the infection.

There are drugs that can help treat chronic hepatitis B. Keep in mind that pregnant women can't use these drugs.

How Is Hepatitis B Spread?

Hepatitis B is very contagious. It is passed through an exchange of semen, vaginal fluids, blood, and urine by

• having sexual intercourse without a latex or female condom
• having unprotected oral sex
• sharing needles and other "works" to inject drugs
• sharing personal hygiene utensils such as toothbrushes and razors
• accidental pricks with contaminated needles in the course of health care

HBV can also be passed from mother to infant during birth.

Pregnancy and Hepatitis B

Pregnant women who know they may have been exposed to hepatitis B should be tested before giving birth. Other women should consider testing. Talk with your health care provider to see if testing may be right for you either before you get pregnant, or during your pregnancy.

Unless treated at birth, 9 out of 10 infants born to women with HBV will carry the virus. Immediate treatment of the infant can be 90 to 95 percent effective. Treatment includes a shot at birth, followed by two more shots given during the next six months.

There are several ways to help prevent getting hepatitis B or spreading it to other people.

• You can abstain from sexual intercourse.
• If you choose to have sex, use female or latex condoms every time.
• Get the hepatitis B vaccine.
• Don't "shoot" drugs, especially with "unclean" needles or "works."
• Don't share items such as razors or toothbrushes — they may have infected blood on them.
• Emergency Prevention
  If you are exposed to the semen, vaginal fluids, blood, or urine of someone with HBV and you have not already received the HBV vaccine, see your health care provider right away. You can reduce your risk of infection by getting treatment within 14 days of being exposed.
  The vaccine protects against the hepatitis B virus by making your body's immune system develop antibodies. The antibodies will protect you by fighting off the virus if you ever come in contact with it in the future.
  The hepatitis B vaccine is given in a series of three shots. The first and second shot are given one month apart. The third shot is usually given six months after the first shot. If you miss your second or third shot, get it as soon as possible.
  The vaccine has been very successful. In fact, the number of people who get HBV each year has dropped from 260,000 in the 1980s to 46,000 in 2006.
  Extra Protection
  There is a vaccine for people at risk for hepatitis A, too. And there is a vaccine against both hepatitis A and B that can be used for people 18 and older. The combination vaccine reduces the total number of shots from 5 to 3. Ask your health care provider about your options.

  Should I Get the Hepatitis B Vaccine? Should My Child Get It?

  Today, the hepatitis B vaccine is routinely given to infants and children up to 18 years of age. But adults who are at risk for getting HBV should also get vaccinated.

  Hepatitis B is passed through an exchange of semen, vaginal fluids, blood, and urine by

  • having sexual intercourse without a latex or female condom
  • having oral sex without a condom or dental dam
  • sharing needles and other "works" to inject drugs
  • sharing personal hygiene utensils such as toothbrushes and razors
  • getting accidentally pricked with contaminated needles in the course of health care

  If you have done any of these things, talk to your health care provider about whether the hepatitis B vaccine is right for you.

  Can I Get Hepatitis from the Hepatitis B Vaccine?

  No. There is no live virus in the vaccine, so it cannot give you an infection.

  Key facts

  • Hepatitis B is a viral infection that attacks the liver and can cause both acute and chronic disease.
  • The virus is transmitted through contact with the blood or other body fluids of an infected person.
  • Two billion people worldwide have been infected with the virus and about 600 000 people die every year due to the consequences of hepatitis B.
  • The hepatitis B virus is 50 to 100 times more infectious than HIV.
  • Hepatitis B is an important occupational hazard for health workers.
  • Hepatitis B is preventable with the currently available safe and effective vaccine.

Hepatitis A

Hepatitis A is a highly contagious liver disease caused by the hepatitis A virus. Spread primarily by the fecal-oral route or by ingestion of contaminated water or food, the number of annual infections worldwide is estimated at 1.4 million. Symptoms include fever, fatigue, jaundice, and dark urine. Although those exposed usually develop lifelong immunity, the best protection against Hepatitis A is vaccination.

Key facts

• Hepatitis A is a viral liver disease that can cause mild to severe illness.
• Globally, there are an estimated 1.4 million cases of hepatitis A every year.
• The hepatitis A virus is transmitted through ingestion of contaminated food and water, or through direct contact with an infectious person.
• Hepatitis A is associated with a lack of safe water and poor sanitation.
• Epidemics can be explosive in growth and cause significant economic losses.
• Improved sanitation and the hepatitis A vaccine are the most effective ways to combat the disease.

---

Hepatitis A is a liver disease caused by the hepatitis A virus. The virus is primarily spread when an uninfected (and unvaccinated) person ingests food or water that is contaminated with the faeces of an infected person. The disease is closely associated with a lack of safe water, inadequate sanitation and poor personal hygiene.

Unlike hepatitis B and C, hepatitis A infection does not cause chronic liver disease and is rarely fatal, but it can cause debilitating symptoms and fulminant hepatitis (acute liver failure), which is associated with high mortality.

Hepatitis A occurs sporadically and in epidemics worldwide, with a tendency for cyclic recurrences. Every year there are an estimated 1.4 million cases of hepatitis A worldwide.

The hepatitis A virus is one of the most frequent causes of foodborne infection. Epidemics related to contaminated food or water can erupt explosively, such as the epidemic in Shanghai in 1988 that affected about 300 000 people. Hepatitis A viruses persist in the environment and can resist food-production processes routinely used to inactivate and/or control bacterial pathogens.

The disease can wreak significant economic and social consequences in communities. It can take weeks or months for people recovering from the illness to return to work, school or daily life. The impact on food establishments identified with the virus, and local productivity in general, can be substantial.

Geographical distribution

Geographical areas can be characterized as having high, intermediate or low levels of hepatitis A infection.

Areas with high levels of infection

In developing countries with very poor sanitary conditions and hygienic practices, most children (90%) have been infected with the hepatitis A virus before the age of 10 years old. Those infected in childhood do not experience any noticeable symptoms. Epidemics are uncommon because older children and adults are generally immune. Symptomatic diseases rates in these areas are low and outbreaks are rare.

Areas with intermediate levels of infection

In developing countries, countries with transitional economies, and regions where sanitary conditions are variable, children often escape infection in early childhood. Ironically, these improved economic and sanitary conditions may lead to a higher susceptibility in older age groups and higher disease rates, as infections occur in adolescents and adults, and large outbreaks can occur.

Areas with low levels of infection

In developed countries with good sanitary and hygienic conditions, infection rates are low. Disease may occur among adolescents and adults in high-risk groups, such as injecting-drug users, homosexual men, people travelling to areas of high endemicity, and in isolated populations such as closed religious communities.

Transmission

The hepatitis A virus is transmitted primarily by the faecal-oral route. This is when an uninfected person ingests food or water that has been contaminated with the faeces of an infected person. Waterborne outbreaks, though infrequent, are usually associated with sewage-contaminated or inadequately treated water.

The virus can also be transmitted through close physical contact with an infectious person, although casual contact among people does not spread the virus.

Symptoms

The incubation period of hepatitis A is usually 14–28 days.

Symptoms of hepatitis A range from mild to severe, and can include fever, malaise, loss of appetite, diarrhoea, nausea, abdominal discomfort, dark-coloured urine and jaundice (a yellowing of the skin and whites of the eyes). Not everyone who is infected will have all of the symptoms.

Adults have signs and symptoms of illness more often than children, and the severity of disease and mortality increases in older age groups. Infected children under six years of age do not usually experience noticeable symptoms, and only 10% develop jaundice. Among older children and adults, infection usually causes more severe symptoms, with jaundice occurring in more than 70% of cases.

Who is at risk?

Anyone who has not been vaccinated or previously infected can contract hepatitis A. In areas where the virus is widespread (high endemicity), most hepatitis A infections occur during early childhood. Risk factors include:

• poor sanitation
• lack of safe water
• injecting drugs
• living in a household with an infected person
• being a sexual partner of someone with acute hepatitis A infection
• travelling to areas of high endemicity without being immunized.

Treatment

There is no specific treatment for hepatitis A. Recovery from symptoms following infection may be slow and take several weeks or months. Therapy is aimed at maintaining comfort and adequate nutritional balance, including replacement of fluids that are lost from vomiting and diarrhoea.

Prevention

Improved sanitation, food safety and immunization are the most effective ways to combat hepatitis A.

The spread of hepatitis A can be reduced by:

• adequate supplies of safe drinking water
• proper disposal of sewage within communities
• personal hygiene practices such as regular hand washing with safe water.

Several hepatitis A vaccines are available internationally. All are similar in terms of how well they protect people from the virus and their side-effects. No vaccine is licensed for children younger than one year of age.

Nearly 100% of people develop protective levels of antibodies to the virus within one month after a single dose of the vaccine. Even after exposure to the virus, a single dose of the vaccine within two weeks of contact with the virus has protective effects. Still, manufacturers recommend two vaccine doses to ensure a longer-term protection of about five to eight years after vaccination.

Millions of people have been immunized worldwide with no serious adverse events. The vaccine can be given as part of regular childhood immunizations programmes and can also be given with other vaccines for travellers.

Immunization efforts

Vaccination against hepatitis A should be part of a comprehensive plan for the prevention and control of viral hepatitis. Planning for large-scale immunization programmes should involve careful economic evaluations and consider alternative or additional prevention methods, such as improved sanitation, and health education for improved hygiene practices.

Whether or not to include the vaccine in routine childhood immunizations depends on the local context, including the proportion of susceptible people in the population and the level of exposure to the virus. Several countries, including Argentina, China, Israel and the United States of America have introduced the vaccine in routine childhood immunizations.

While the two-dose regimen of inactivated hepatitis A vaccine is used in many countries, other countries may consider inclusion of a single-dose inactivated hepatitis A vaccine in their immunization schedules. Some countries also recommend the vaccine for people at increased risk of hepatitis A, including:

• travellers to countries where the virus is endemic
• men who have sex with men
• people with chronic liver disease (because of their increased risk of serious complications if they acquire hepatitis A infection).

Regarding immunization for outbreak response, recommendations for hepatitis A vaccination should also be site-specific, including the feasibility of rapidly implementing a widespread immunization campaign.

Vaccination to control community-wide outbreaks is most successful in small communities, when the campaign is started early and when high coverage of multiple age groups is achieved. Vaccination efforts should be supplemented by health education to improve sanitation, hygiene practices and food safety.

Asthama Problems

Asthma is a disorder of the bronchial tubes (the smaller airways in the lungs) characterized by over sensitivity of these airways. During an asthma attack, the muscles that wrap around these bronchial tubes tighten, and there is more sticky mucous secreted. This narrowing and mucous plugging of the bronchi make it more difficult for air to move into and out of the lungs, and cause the wheezing sound and cough that is characteristic of an asthma attack. There are about two million children in the U.S. that have asthma. Causes No one really understands why certain children have overly sensitive airways. Sometimes, the tendency toward asthma is inherited, and occasionally it may be secondary to lung damage early in life as in certain premature babies that are born with severe breathing problems. It is not contagious. Often, no real cause for the asthma can be found. However, we do know that certain conditions can set off an episode of asthma in children that have the predisposition: Allergy - Most asthmatic children older than 5 years may have symptoms caused by allergy. Usually this is due to something inhaled in the air (e.g. pollen, dust, mold, animal dander). In infants, wheezing can occaisionally be caused by food allergy. Children with asthma often have other allergic problems, such as hayfever or eczema. Infection - Viral upper respiratory infections (colds) are the most common cause of episodes of asthma in children younger than 5. Some children actually seem to be "allergic" to the virus. Some doctors call this type of asthma "bronchitis", "wheezy bronchitis", "asthmatic bronchitis", or "reactive airways disease". Unlike the type of bronchitis found in adults that smoke, antibiotics will not usually help children with wheezing because the cause is not a bacteria, but a virus, allergy, or both. There is reason to be optimistic: 75% of children with viral-related wheezing will "outgrow" it as their bronchial tubes become larger. Exercise - Many children with allergic asthma can also develop "exercise-induced asthma". This usually starts 5 minutes or so after exercise starts and manifests as cough, chest tightness, and wheezing. It is more likely to happen in cold, dry air or if there are pollutants or allergens (e.g. pollens) in the air. Irritants - Though not a true allergy by medical definitions, some children wheeze when they breathe cigarette smoke, smog, hairspray, insect repellant, paint, etc. Drugs - 25% of children with chronic asthma may have more wheezing if they take aspirin. Acetaminophen (Tylenol) is usually tolerated well. Other - Some children may develop asthma if they have a sinus infection, pneumonia, or emotional upset. Asthma is often worse at night. Occasionally, nothing in particular can be pinpointed as the cause of an asthma exacerbation. Treatment Unfortunately, there is no cure for asthma. However, in almost all children, the symptoms can be controlled, and the child can lead a normal life with modern medical therapy. Environmental control - Allergens and irritants should be avoided as much as possible. There should be no cigarette smoking in the house of an asthmatic child. The bedroom should be kept dust-free. Don't use a vaporizer, as this can promote mold growth. Medication - There is now availabile a variety of medications to help the asthmatic child. You, your child and your doctor will determine which medicine or combination of medicines is best for your child based on his age, severity of symptoms, frequency of attacks, side effects, and, often, by trial and error. Bronchodilators - These work by relaxing the muscles that surround the bronchial tubes: Theophylline - This can be given as a liquid or tablet every six hours or in a long acting tablet or capsule that can be sprinkled on food every 8 to 12 hours. Adrenergics - These can be given as shots (adrenaline), "breathing treatments" (metaproterenol), pocket-sized inhalers (metaproterenol, albuterol, terbutaline), or orally as liquid or tablets (metaproterenol, albuterol). Anticholinergics - These have only recently been used for asthma. They must be inhaled. Cromolyn - This drug must be inhaled. It is not used to treat wheezing, but is used in certain patients to prevent wheezing. Steroids - Prednisone or other steroid medicines work by reducing the inflamation in the bronchial tubes. Occasional short term use of these drugs will not have significant side effects and can be of great help in stopping severe attacks and preventing hospitalizations. However, if used frequently or over a long period of time there can be severe side effects, so doctors are careful to use these only when necessary. Recently, pocket nebulizers for inhaling steroids have become available that are free of the side effects seen with oral steroids, so these are sometimes used in patients with chronic asthma. Immunotherapy ("Allergy shots")- If your doctor feels that your child's symptoms can't be adequately controlled with medication, he will refer him to an allergist for skin tests and possibly shots to "desensitize" the child. Allergy shots may be of help to some asthmatics whose symptoms are due to allergies, but will not be useful when symptoms are caused by viral infection, exercise, etc. General Health - Good nutrition and physical fitness are as important for children with asthma as they are for everyone. Children should also drink plenty of fluids to keep the bronchial secretions loose. With appropriate medication, nearly all children with asthma can take physical education class and can participate in competitive sports. As a matter of fact, 75 members of the 1984 U.S. Olympic Team had exercised-induced asthma. As much as possible, avoid exposure to cold and flu viruses and pay attention to careful handwashing to help lessen the number of respiratory infections that might trigger an asthmatic episode. If your child has severe asthma, your doctor may recommend a yearly "flu" shot. When should I call the doctor's office? Asthma severity can range from the patient who has only a nagging cough without wheezes, to a life threatening emergency. Fortunately, in most children, asthma is mild and easily controlled with medication. However, if your child has mild symptoms that do not clear in a few days with his usual medication, please call us. Likewise, if he seems to be having difficulty breathing and is not relieved after his medication is started, call us right away. It's always better to start asthma therapy "too early" rather than too late. If you are unsure about whether to give a particular medicine, how much to give, or whether your child needs to see the doctor, please call us. When you bring your child to see the doctor for asthma, either bring his medicines with you, or write down the names and dosages. Medical Sciences Bulletin Contents Role of Vitamin C in Asthma Unclear Reprinted from the November 1994 issue of Medical Sciences Bulletin , published by Pharmaceutical Information Associates, Ltd. Unconventional therapy, which includes the use of vitamins and minerals, is on the rise in the United States. The $3 billion per year that Americans pay for vitamins indirectly increases health care costs, yet vitamin therapy has no clearly defined cost effectiveness. Great controversy surrounds the use of daily recommended doses or megadoses to combat disease and enhance health and immunity. Leonard Bielory and Rinki Gandhi, physicians at the New Jersey Medical School, Newark, have reviewed the medical literature to assess one aspect of vitamin use: vitamin C in the treatment of asthma. Asthma, an episodic disease in which air passages narrow as a secondary response to the hyperresponsiveness of the tracheobronchial tree, is either extrinsic or intrinsic. In its extrinsic, or allergic form, mucosal hyperresponsiveness triggers atopy, rhinitis, sinusitis, elevated serum Immunoglobulin E (IgE) levels, nasal polyps, and increased bronchial responsiveness to methacholine-, histamine-, or cold air-provocation. The intrinsic, or idiosyncratic form occurs in the absence of these stimuli. Antigen-antibody interaction probably occurs on the surface of pulmonary mast cells, causing degranulation of those cells and the release of major basic protein, superoxide radicals, and eosinophilic cationic protein into the air passages. Ciliary function stops, mucosal integrity is disrupted, and cells exfoliate, resulting in obstruction and bronchoconstriction. As long ago as 1803, an association was observed between vitamin C (ascorbic acid) deficiency and convulsive asthma in patients with scurvy. Found predominantly in citrus fruit, potatoes, and green vegetables, vitamin C -- a water-soluble vitamin -- is a reducing agent. In 1953, an Irish study concluded that vitamin-C deficiency was related to asthma; during acute asthma, vitamin-C excretion was reduced. During the 1970s, one study demonstrated low levels of vitamin C in asthmatics, but no significant difference in levels among different grades of asthma. Vitamin C levels were not related to atopy or the duration of asthma. More recent studies have shown that 500 mg vitamin C exerts antibronchospastic action, with significant changes in one-second forced expiratory volume (FEV1) and forced vital capacity (FVC). One double- blind randomized study reported a decrease in the frequency and severity of acute asthma; however, since the study was conducted during the rainy season, the results may stem from vitamin C's action in preventing infection. FEV1 increased with increased dietary vitamin-C intake in one large-scale study of 2526 healthy and asthmatic adults. Methacholine- induced bronchospasm decreased after vitamin-C intake, possibly because vitamin C interferes with metabolism of arachidonic acid, a mediator of asthma. Studies of histamine-induced bronchoconstriction have not demonstrated a clear effect for vitamin C. Five hundred milligrams vitamin C was found to be ineffective against ragweed antigen. Among 10 asthmatic children in an uncontrolled study, vitamin C produced an insignificant decrease in total IgE, restoration of normal chemotaxis in 2 patients, and normal lymphocytic transformation in 4 patients. A single-blind study of 16 asthmatic children showed that when 1 g ascorbic acid was administered each day, polymorphonuclear leukocyte motility improved significantly. The reviewers concluded that the medical literature does not support a definite indication for the treatment of asthma and allergy with vitamin C. However, chronic use of vitamin C may have effects that could not be measured in the short-term studies they examined. Further studies are therefore required to define the effects of vitamin C in asthma and to determine its cost-effectiveness.

Hair Transplant

Like good health and youth, most of us take a thick head of hair for granted -- that is, until it is gone. For many people, hair transplant procedures can help bring back the appearance of a full -- or, at least, fuller -- head of hair.

What Is a Hair Transplant?

Used in the U.S. since the 1950s, hair transplantation is surgery that involves removing a narrow strip of hair-bearing scalp from the back of the head and using it to fill an area with thin or no hair.

Most hair transplants are performed in the doctor's office under local anesthesia.

To transplant hair, the surgeon first cleans the scalp, then injects an anesthetic to numb the area where a 3- to 4-inch strip of scalp will be removed. After removing the strip of scalp with a scalpel, the surgeon sets it aside and sews the scalp closed. This area is immediately hidden by the hair around it.
 

Next, the surgeon divides the strip of removed scalp into approximately 500 to 2,000 tiny grafts containing an individual hair or just a few hairs each. The number and type of graft used depends on the hair type, quality, and color as well as the size of the area where it will be transplanted.

After the grafts are prepared, the surgeon cleans and numbs the area where the hair will be placed, creates holes or slits with a scalpel or needle, and delicately places each graft in one of the holes.

Depending on the extent of the procedure, the transplant will take approximately four to eight hours. Sometimes additional sessions are needed if you continue to lose hair or decide you want thicker hair.

Expectations and Recovery:

After hair transplant surgery, your scalp may be very tender. You may need to take pain medications for several days. Your surgeon will have you wear a surgical dressing over the scalp for at least a day or two. Your surgeon may also prescribe an antibiotic and/or anti-inflammatory drug to be taken for several days following surgery. Most people are able to return to work two to five days after surgery.

Within two to three weeks after surgery, the transplanted hair will fall out, but you should start to notice new growth within a few months. Most people will have attained 60% of new hair growth after six to nine months. Some surgeons prescribe the hair-growing drug minoxidil (Rogaine) to improve hair growth following transplantation, but it is not known how effective this is.

Risks and Costs of Treatment

The cost of hair transplantation will depend largely on the amount of hair to be transplanted, but it generally ranges from $4,000 to $15,000. The procedure is rarely covered by insurance.

As with any surgical procedure, hair transplantation carries risks, including bleeding and infection. Other risks that can occur with hair transplants include scarring and unnatural-looking new hair growth.

Around the time new hair growth starts, some people experience inflammation or infection of the hair follicles, called folliculitis. This can be relieved with antibiotics and compresses. Another potential risk is the sudden loss of transplanted hair, called shock loss. Fortunately, this hair loss is rarely permanent.

If you are bothered by thinning hair or balding, hair transplantation can significantly improve your appearance and self-confidence. However, it is important to understand that hair transplantation is just that -- transplantation of hair you already have to a place where it is more visible. It does not create new hair.

To minimize the risks and improve the success of surgery, it is important to undergo hair transplantation only if you are healthy. You should always discuss the potential risks and benefits of any surgery with your doctor.

Some of the SIDE EFFECTS of hair transplant are:

If you have had hair transplant surgery, you may be alarmed to find that the hair you already had is actually getting thinner. This is a normal post-operative condition and the thickness comes back within a few months after surgery. 

Bleeding

A side effect of hair transplant surgery may include some bleeding. Putting pressure on the area will usually stop the bleeding. In rare situations, the bleeding does not stop so it might be necessary for the surgeon to do some extra stitching to close the wounds. 

Pain

There is actually very little pain involved with the actual hair transplant surgery. About half of the people who have the procedure done will not need any pain relievers at all. Most others take a mild pain reliever such as Tylenol for a few days, and that seems to be enough for them. 

Itching

It is not unusual for itching to occur on areas affected by hair transplant surgery. Yet, it should not last more than a few days. Using shampoo to wash your hair every day will helps with this problem to diminish. 

Swelling

Just about everyone who has had hair transplant surgery has experienced swelling in the forehead and around the eyes. This lasts for only a few days with the worst being of it appearing on the fourth day. For some, a black eye may result. 

Numbness

Another common side effect of hair transplant surgery is numbness. Patients typically report feeling numbness for several weeks after the surgery. This is only temporary. 

Hiccups

Yes, your read that correctly. Interestingly, one side effect of hair transplant surgery is having a case of the hiccups after the procedure. Only about 5 percent of the patients have this problem, but it can be troublesome if it lasts more than a few days as it can keep you from eating or sleeping properly. If this does occur, doctors have medications they can prescribe to help aide with this. 

Infections

While rare, infections can also occur with hair transplant surgery. One reason they do not happen more often is that antibiotics are given before and after the procedure to prevent infections from even starting - so don't get too worried about this possible side effect. 

Cysts

Cysts can appear in the areas where hair is being transplanted, also called the recipient areas, but they do not usually last more than a few weeks and are rarely more than the size of small pimples. 

Scarring

If you have keloid scarring after hair transplant surgery, it is probably because you are genetically inclined to have it. Very infrequently, patients have scarring that takes the form of ridges.