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23 million Nigerians live with hepatitis B — Expert

by - Sep 20, 2017

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A Professor of Clinical Pharmacy, Department of Clinical Pharmacy and Pharmacy Management, University of Nigeria, Okonta Matthew, talks about hepatitis B and ways to avoid it.

What is hepatitis B?

The liver is a vital organ in the body; it is responsible for the biotransformation of nutrients and chemical substances like drugs and alcohol into acceptable forms the body can utilise or excrete as wastes. The liver can be affected or inflamed by any of these chemical substances, viruses or both at anytime to cause this vital organ to be unable to properly carry out its biotransformation role.

When the liver becomes inflamed, the person is said to suffer hepatitis. Hepatitis B refers to an inflammatory disease of the liver caused by hepatitis-B virus.

Who are those at risk of the virus?

Anybody could be at risk of hepatitis B; adult or children. In highly endemic area like Nigeria, risk of hepatitis B infection is increased by somebody having unprotected sex with multiple sex partners such as commercial sex workers, having sex with known hepatitis B infected person(s); scarification with unsterilised sharp blades, needles and knives, such as tattooing, circumcision and piercings of the skin; sharing of blades used for hair cutting, injection needles used by drug addicts, in some health facilities especially the ones operated by quacks; having sexual relationship with men, and people that indulge in oral sex; and somebody receiving blood transfusion especially from an infected source.

The age at which a person is infected with hepatitis B influences the extent to which the disease can become chronic. Infants who are infected with hepatitis B have higher tendencies of developing the chronic form of the disease than children. Less than five percent of normal adolescents and adults infected with hepatitis B develop the chronic infection.

Are there different types of hepatitis B?

Yes, hepatitis B infection is of two different types -the acute hepatitis B and chronic or long-lived type. Acute hepatitis B symptoms can last for a few days to six months and most of these symptoms are mild. In most people with acute hepatitis, symptoms resolve over weeks to months and they are cured of the infection. Chronic hepatitis B is more severe than the acute hepatitis form. Chronic inflammation of the liver can lead to scarring of liver tissue, liver failure, and liver cancer. Chronic hepatitis B is not curable, but it is treatable. The goal of therapy is to reduce the risk of complications, including premature death.

What are the symptoms of hepatitis B?

Most people that suffer from hepatitis B infection do not know that they have such infection until the symptoms begin to manifest or through general screening during recruitment exercise, before blood donation, or any other circumstances. Before some of the symptoms of the infection are manifested, the liver may have been damaged. This is why it is called silent killer. If somebody is with/without symptoms, such a person can be screened for hepatitis B surface antigen (a protein on the surface of the hepatitis B virus). A positive test means the person has an acute or chronic hepatitis B virus infection and can pass the virus to others; hence such a person needs to be treated. Some common symptoms of hepatitis B are abdominal pain, dark urine, clay-coloured bowel movements, joint pain and jaundice (yellow colour of the skin or the eyes) among others.

Any positively tested person requires the attention of gastroenterologist or an appropriately trained physician to further evaluate and treat them properly.

How is hepatitis B diagnosed?

Based on patient’s presentation, the difference between hepatitis B and other viral hepatitis may not be too obvious. It is essential that laboratory confirmation is done to differentiate between acute and chronic infections.

It can be diagnosed by detection of hepatitis B surface antigen in the blood sample of the person. The laboratory diagnosis can also be used to differentiate the hepatitis B infection types into acute and chronic infection.

How is it treated?

The treatment of hepatitis B is complex, life-long and expensive once diagnosed. Treatment is based on the type of hepatitis B.

Patient needs to be properly counselled before and during the treatment especially when it is the chronic type. Patients must be fully informed of the possibility of passing on the infection to their loved ones if there is any failure in treatment compliance.

Chronic hepatitis B infection can be treated with anti-viral agents to slow down the disease progression to cirrhosis and reduction of liver cancer incidence and improve patient survival.

The drugs that are needed to manage the disease must be prescribed, administered and monitored by a gastroenterologist or any other trained and certified healthcare professional. A patient with acute hepatitis B infection, most times, requires no specific treatment. The patient must be kept in a comfortable state, reduce liver load such as proteinous meal, maintaining adequate nutritional balance and fluid replacement to cover for fluid lost from vomiting and diarrhoea.

Can hepatitis B be cured?

No, but it is treatable. Until this moment, no drug in use has been able to cure patients of hepatitis B but it can be managed. Available medications have only been able to slow down the progression of liver cirrhosis due to chronic hepatitis B infection.

Can one be vaccinated for hepatitis B?

Yes. It is the major way of preventing hepatitis B infection for a normal or uninfected person that has been proven through negative HBsAg from blood sample screening. If you are at increased risk for hepatitis B virus infection vaccination is very necessary especially if you belong to any of the categories below: if you are a sex partners of hepatitis B surface antigen -positive persons; if you are sexually active and have had multiple sex partners in the last six months; if you have sexual intercourse with men (gay relationship); if you inject drug and share devices with other users; if you are from susceptible household contacts of HBsAg-positive persons; and if you are a health care and public safety workers at risk of exposure to blood or blood-contaminated body fluids.

Can hepatitis B cause liver cancer?

Yes, people with hepatitis B have an increased risk of liver cancer. And these people with hepatitis B are at risk of liver cancer even if they do not have cirrhosis. The most common primary liver cancer in adults is hepatocellular carcinoma called hepatoma. It is caused majorly by hepatitis B worldwide. The common risk factors are chronic hepatitis B infection. Cirrhosis is linked to more than 80 percent of all HCC.

How common is hepatitis B in Nigeria?

Nigeria is an area of high endemicity for HBV with over 70 percent of the population showing evidence of past infection of the virus while average of 13.7 percent still has serological evidence of current infection. Since the current population of Nigeria is about 170 million according to the 2006 national census, the level of current infection is estimated to be 23 million in Nigeria according to current Nigerian treatment guidelines. The ratio of HBV infection in Nigeria is estimated at one in every eight persons. The prevalence of the disease is estimated at three times more than HIV/AIDS according to specialists.

If this disease spread must be arrested and reversed, the following steps may need to be adopted: awareness of the fatality of this HBV infection must be created among Nigerians with every available opportunity, in all institutions, service delivery and gathering points of all sorts; every Nigerian must be encouraged to be screened for HBV at any given opportunity free of charge; all recruitment points must include opportunities to screen for HBV and be willing to do the needful by not discriminating against people who are found to be positive. The government must be able to put up structures such as policies and health facilities to help control and prevent this disease. Thus, vaccine for the immunisation of those infected with HBV albi initio.

Can hepatitis B cause cirrhosis of the liver?

Yes, chronic hepatitis B virus is one of the major causes of liver cirrhosis. It was estimated that more than 200,000 chronic HBV carriers worldwide die of liver cirrhosis annually. Chronic hepatitis B infection contributes to the scarring of the liver tissue and distortion of the liver structure with the associated blood circulatory system leading to liver cirrhosis. These changes develop over time.

Is it true that one can develop cirrhosis even if one doesn’t take alcohol?

Yes, liver cirrhosis is majorly caused by chronic hepatitis B infection, and a greater percentage of hepatitis is caused by viral agents. The majority of the cirrhosis patients that are seen in the hospitals do not consume alcohol yet are cirrhotic. But most of them have HBsAg present in their blood samples, an indication that they have hepatitis B virus infection.

Cirrhosis can also be caused by excessive amount of fat in the liver. Two other common types of liver disease include non-alcoholic fatty liver disease and non-alcoholic steatohepatitis. These are conditions in which the liver contains excessive amounts of fat. People who have non-alcoholic steatohepatitis have excessive amounts of fat in their livers and also have inflammation and scarring of liver tissue. Risk factors of these conditions include: obesity, high blood cholesterol levels, high triglyceride (blood fat) levels and diabetes

Even if excessive alcohol consumption can cause liver cirrhosis, this liver disease can also be developed in non-consumer of alcohol.

8 Habits That Harm Your Brain

by - Sep 19, 2017

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It’s funny that “the one organ in our brain that thinks is often the one we think less about”. The brain is the most important organ in our body and it’s time we pay more attention to its health and welfare. Here are 8 habits that harm your brain.

Not Sleeping Well

Lack of proper sleep is a bad habit that can significantly hurt your brain. It negatively affects the hippocampus causing a deficit that leads to forgetfulness.

Having Too Much Time to Yourself

Alone time can be great for thinking, reflection and mapping out your dreams and goals. However, when the solitude is too much it can damage the mind and body. It can typically cause brain decline, affect the quality and efficiency of sleep making it less restorative, erode arteries, create high blood pressure, undermine learning and memory and generally take a toll on health; although, most of these effects are gradual and experienced over the course of time.

Eating Too Much Junk Food

Regardless of the fact that you are the kind of person that can eat whatever you like and remain in shape, it is important not be excessive in your intake of junk foods. This is because parts of the brain linked to learning, memory and mental health are smaller and less developed in people who excessively consume junk foods. Natural foods like berries, whole grains, nuts, green leafy vegetables preserve the brain function and slow mental decline.

You Play Loud Music with Earphones or Headphones

Placing the volume of your earphone or headphone at full volume can permanently damage your hearing. It can also cause brain problems involving loss of memory or inability to remember things easily, and loss of brain tissue in your later years. This is most likely because the brain has to work so hard to understand what’s being said around you that it can hardly store what you’ve heard into your memory.

Immobility

The body was made to move and the longer you remain unmoving and inactive the more likely you are to suffer from diseases like diabetes, heart disease, stroke, dementia and high blood pressure which can all negatively affect the brain in the long run. You don’t have to start high-intensity workouts or start running marathons, just take a walk around your house more often or engage in an activity that gets you moving.

Smoking

At this point, it has already been established that smoking is bad for your body. Aside causing lung problems, smoking also shrinks the brain. It makes your memory worse, makes you more forgetful and leads to problems like heart disease, dementia, diabetes, stroke, high blood pressure, lung cancer etc.

Overeating

We are familiar with the saying, “too much of anything is bad”. Too much food, even of the right and healthy kind of food, can hinder the brain from building up a strong network of connections to help you think and remember. Overeating can also lead to obesity which is linked to a number of brain problems like food addiction, impulsive and disinhibited eating and in some cases cognitive problems.

Staying Indoor or In the Dark for Prolonged Periods

For the optimum health of the brain, it is important you expose yourself to natural light as often as you can. This helps to prevent depression and keep your brain working well. Staying in the dark or without natural light for prolonged periods, can slow your brain and cause a decline in the brain.

Five ways to quit smoking

by - Sep 19, 2017

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Deciding that you are now ready to quit smoking is only half the battle. Knowing where to start on your path to becoming smoke-free can help you to take the leap. We have put together some effective ways for you to stop smoking today.

Tobacco use and exposure to second-hand smoke are responsible for more than 480,000 deathseach year in the United States, according to the American Lung Association.

Most people are aware of the numerous health risks that arise from cigarette smoking and yet, “tobacco use continues to be the leading cause of preventable death and disease” in the U.S.

Quitting smoking is not a single event that happens on one day; it is a journey. By quitting, you will improve your health and the quality and duration of your life, as well as the lives of those around you.

To quit smoking, you not only need to alter your behavior and cope with the withdrawal symptoms experienced from cutting out nicotine, but you also need to find other ways to manage your moods.

With the right game plan, you can break free from nicotine addiction and kick the habit for good. Here are five ways to tackle smoking cessation.

1. Prepare for quit day

Once you have decided to stop smoking, you are ready to set a quit date. Pick a day that is not too far in the future (so that you do not change your mind), but which gives you enough time to prepare.

Choose your quit date and prepare to stop smoking altogether on that day.

There are several ways to stop smoking, but ultimately, you need to decide whether you are going to:

quit abruptly, or continue smoking right up until your quit date and then stop
quit gradually, or reduce your cigarette intake slowly until your quit date and then stop

Research that compared abrupt quitting with reducing smoking found that neither produced superior quit rates over the other, so choose the method that best suits you.

Here are some tips recommended by the American Cancer Society to help you to prepare for your quit date:

Tell friends, family, and co-workers about your quit date.
Throw away all cigarettes and ashtrays.
Decide whether you are going to go “cold turkey” or use nicotine replacement therapy (NRT) or other medicines.
If you plan to attend a stop-smoking group, sign up now.
Stock up on oral substitutes, such as hard candy, sugarless gum, carrot sticks, coffee stirrers, straws, and toothpicks.
Set up a support system, such as a family member that has successfully quit and is happy to help you.
Ask friends and family who smoke to not smoke around you.
If you have tried to quit before, think about what worked and what did not.

Daily activities – such as getting up in the morning, finishing a meal, and taking a coffee break – can often trigger your urge to smoke a cigarette. But breaking the association between the trigger and smoking is a good way to help you to fight the urge to smoke.

On your quit day:

Do not smoke at all.
Stay busy.
Begin use of your NRT if you have chosen to use one.
Attend a stop-smoking group or follow a self-help plan.
Drink more water and juice.
Drink less or no alcohol.
Avoid individuals who are smoking.
Avoid situations wherein you have a strong urge to smoke.

You will almost certainly feel the urge to smoke many times during your quit day, but it will pass. The following actions may help you to battle the urge to smoke:

Delay until the craving passes. The urge to smoke often comes and goes within 3 to 5 minutes.
Deep breathe. Breathe in slowly through your nose for a count of three and exhale through your mouth for a count of three. Visualize your lungs filling with fresh air.
Drink water sip by sip to beat the craving.
Do something else to distract yourself. Perhaps go for a walk.

Remembering the four Ds can often help you to move beyond your urge to light up.

2. Use NRTs

Going cold turkey, or quitting smoking without the help of NRT, medication, or therapy, is a popular way to give up smoking. However, only around 6 percent of these quit attempts are successful. It is easy to underestimate how powerful nicotine dependence really is.

NRTs can help you to fight the withdrawal symptoms associated with quitting smoking.

NRT can reduce the cravings and withdrawal symptoms you experience that may hinder your attempt to give up smoking. NRTs are designed to wean your body off cigarettes and supply you with a controlled dose of nicotine while sparing you from exposure to other chemicals found in tobacco.

The U.S Food and Drug Administration (FDA) have approved five types of NRT:

skin patches
chewing gum
lozenges
nasal spray (prescription only)
inhaler (prescription only)

If you have decided to go down the NRT route, discuss your dose with a healthcare professional before you quit smoking. Remember that while you will be more likely to quit smoking using NRT, the goal is to end your addiction to nicotine altogether, and not just to quit tobacco.

Contact your healthcare professional if you experience dizziness, weakness, nausea, vomiting, fast or irregular heartbeat, mouth problems, or skin swelling while using these products.

3. Consider non-nicotine medications

The FDA has approved two non-nicotine-containing drugs to help smokers quit. These are bupropion (Zyban) and varenicline (Chantix).

Bupropion and varenicline are non-nicotine medications that may help to reduce cravings and withdrawal symptoms.

Talk to your healthcare provider if you feel that you would like to try one of these to help you to stop smoking, as you will need a prescription.

Bupropion acts on chemicals in the brain that plays a role in nicotine craving and reduces cravings and symptoms of nicotine withdrawal. Bupropion is taken in tablet form for 12 weeks, but if you have successfully quit smoking in that time, you can use it for a further 3 to 6 months to reduce the risk of smoking relapse.

Varenicline interferes with the nicotine receptors in the brain, which results in reducing the pleasure that you get from tobacco use, and decreases nicotine withdrawal symptoms. Varenicline is used for 12 weeks, but again, if you have successfully kicked the habit, then you can use the drug for another 12 weeks to reduce smoking relapse risk.

Risks involved with using these drugs include behavioural changes, depressed mood, aggression, hostility, and suicidal thoughts or actions.

4. Seek behavioural support

The emotional and physical dependence you have on smoking makes it challenging to stay away from nicotine after your quit day. To quit, you need to tackle this dependence. Trying counselling services, self-help materials, and support services can help you to get through this time. As your physical symptoms get better over time, so will your emotional ones.

Individual counselling or support groups can improve your chances of long-term smoking cessation.

Combining medication – such as NRT, bupropion, and varenicline – with behavioural support has been demonstrated to increase the chances of long-term smoking cessation by up to 25 percent.

Behavioral support can range from written information and advice to group therapy or individual counselling in person, by phone, or online. Self-help materials likely increase quit rates compared with no support at all, but overall, individual counseling is the most effective behavioral support method.

The National Cancer Institute (NCI) provide help to anyone who wants to stop smoking through their support services:

LiveHelp online chat
Smoke-free website
SmokefreeTXT text messaging service
Twitter
Facebook
Instagram

Support groups, such as Nicotine Anonymous (NicA), can prove useful too. Nica applies the 12-step process of Alcoholics Anonymous to tobacco addiction. You can find your nearest NicA group using their website.

5. Try alternative therapies

Some people find alternative therapies useful to help them to quit smoking, but there is currently no strong evidence that any of these will improve your chances of becoming smoke-free, and, in some cases, these methods may actually cause the person to smoke more.

Some alternative methods to help you to stop smoking might include:

man comparing e-cigarette and cigarettes

E-cigarettes have had some promising research results in helping with smoking cessation.

filters
smoking deterrents
electronic cigarettes (e-cigarettes)
tobacco strips and sticks
nicotine drinks, lollipops, straws, and lip balms
hypnosis
acupuncture
magnet therapy
cold laser therapy
Herbs and supplements
yoga, mindfulness, and meditation

E-cigarettes

E-cigarettes are not supposed to be sold as a quit smoking aid, but many people who smoke view them as a method to give up the habit.

E-cigarettes are a hot research topic at the moment. Studies have found that e-cigarettes are less addictive than cigarettes, that the rise in e-cigarette use has been linked with a significant increase in smoking cessation, and that established smokers who use e-cigarettes daily are more likely to quit smoking than people who have not tried e-cigarettes.

The gains from using e-cigarettes may not be risk-free. Studies have suggested that e-cigarettes are potentially as harmful as tobacco cigarettes in causing DNA damage and are linked to an increase in arterial stiffness, blood pressure, and heart rate.

Quitting smoking requires planning and commitment – not luck. Decide on a personal plan to stop tobacco use and make a commitment to stick to it.

Weigh up all your options and decide whether you are going to join a quit-smoking class, call a quitline, go to a support meeting, seek online support or self-help guidance, or use NRTs or medications. A combination of two or more of these methods will improve your chances of becoming smoke-free.