Monthly Archives: May 2016

Zika Virus Infection and Cancer Care Indication

By Hui Xie-Zukauskas

Zika in USA map_smAre you worried about Zika virus infection? Are you ready for Zika outbreak?

Consider again − after learning the public health threat highlighted here with eyes on the U.S. region.

Let’s start with a snapshot on the crucial timeline to see how Zika epidemic has been evolved after the 1st Zika case identified in Brazil in April 2015.

Snapshot on Timeline of Zika Outbreak

As you may know, Zika virus is transmitted to people primarily through the bite of an infected mosquito. Travel-associated cases imply individuals infected abroad and then returned to the country. No immediately mosquito-transmitted Zika infection has been reported in the 50 US states so far, but the CDC has alerted the epidemic is likely to change with mosquito season’s arrival.

How should you be concerned?

Birth defects (e.g. microcephaly, fetal malformations) have been linked to Zika virus. Thus, pregnant women are particularly vulnerable to this emerging infectious disease.

If you are a healthy adult, you’re still not Zika-proof. In most cases, Zika virus causes a brief, mild flu-like illness. As documented, adults have also suffered from severe neurological disorders such as meningitis, meningoencephalitis and Guillain-Barre syndrome. A rare complication may be internal bleeding, which caused the first US Zika-related death.

Here are a few key points:

  • There is no vaccine or effective treatment for this disease.
  • Zika-specific tests could be expensive and not readily available.
  • There is a lot of UNKNOWN, though more research is underway.

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How would you possibly be impacted?

With summer approaching, mosquitoes are coming. But don’t panic, not all mosquitoes spread this disease.

Two mosquito species may carry Zika virus: 1) Aedes aegypti; and 2) Aedes albopictus, the latter is also known as Asian Tiger mosquito. However, there is no way to tell if a mosquito is Zika-infected.

Next, where would Zika-carrier mosquitoes likely to be found?

Places like Florida, Texas and Louisiana are home of the Aedes aegypti mosquito, whereas the Midwest and much of the East Coast happen to be climate or environment for Aedes albopictus (Asian tiger) mosquito. So, a “New Bug” is expected to be around.

What can you do?

Current strategic measure is Self-Prevention and Self-Protection, as briefly summarized in the following areas:

Travel cautions: Pregnant women are advised against travel to the affected countries, and if a trip is required, test the positivity of Zika virus presence once returning.

Personal protection: Extra vigilance and care for pregnant women, wearing long-sleeved clothes, gearing up with mosquito repellent (EPA-certified), and remember – The mosquito-biting time could be daytime!

Note that other routes of Zika infection include sexual or maternal-fetal transmission or blood transfusion.

Environmental prevention: Eliminate potential mosquito’s egg-laying sites by emptying or drying water buckets, water storage units and other plant pots.

Medication alert: Although analgesics is a part of supportive management, avoid Aspirin and Non-steroidal anti-inflammatory drugs because of the risk for hemorrhage among patients with cancer or dengue or taking specific therapies at elevated danger of bleeding.

Last but not the least, because it’s unclear as how the course of Zika infection influences that of cancer, cancer patients should maintain close check-up or follow-up with your physicians and specialists, particularly for those with an immune-suppressed condition or with significant comorbidity.

Zika outbreak may come rapidly, so get prepared and get ready!

 

References: 1) Hepner and del Pilar Estevez Diz: Journal of Global Oncology. April 2016; and 2) Plourde and Bloch: EID journal. Vol.22, 2016

Image credit: physio-pedia.com and CPD

Skin Cancer and Aging: Causes and Solutions

By Hui Xie-Zukauskas

UV radition n Ozone layerHere comes the sun! And we all enjoy it. You may be heading for sunny beaches soon. I’d like to remind you of damage from the sun overexposure. By providing some key insights into harmful effects of the sun, and reflecting on skin aging, I am diving a little deeper into this subject, and will equip you with a sun protection tool kit – 5 Essentials or “SHADE”.

Numbers and Notions

First, do you know that more people suffered from skin cancer than all other cancers combined over the past three decades? Breaking down the statistics, it reveals approximately 40-50% of Americans who live to age 60+ will have one type of common skin cancers, and more than 90% of skin cancer is caused by excessive or unnecessary exposure to the sun?

Types of skin aging

If the above numbers cannot transmit the roles of aging and sun hazard in skin cancer, let me briefly elaborate what happened to our skin over our lifetime. As we age, our skin – the largest organ in the human body – goes through the same escalating loss of structure and function as other organs. But unlike other organs, the skin is openly exposed to environmental pollutants and lifestyle-related hazards (e.g. excessive sun, tanning, smoking, etc.). ALL is cumulative! Mostly concerning, ultraviolet (UV) radiation from sunlight causes so called “photoaging”.

I summarize here how photoaging differs from natural skin aging, to help you understand how biological evolution of the skin and adverse effects of the sun are interplayed.

Natural / Intrinsic Aging Photo- / Extrinsic Aging
Cumulative process Yes Yes
Common locations face, neck, forearm, and lower leg Yes
Cause Aging-related Sun damage overlaying natural aging
Visible characteristics Looseness, sagginess, fine wrinkles, dryness Increased pigmentation, deep wrinkles, harsh or rough skin
Structural alterations Epidermal − dermal area thinning and weakening, reduced elasticity, delay in wound healing Severe damage of dermal and connective tissues, promoting age-related skin diseases and skin cancer

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Fundamental nature of Sun Damage

UV radiation is a known human carcinogen (i.e. cancer-causing agent). Let me expand further on UV radiation as a major causal factor of skin cancer and premature skin aging at cellular and molecular levels.

  1. UV radiation can modify DNA, intensify oxidative stress, and alter cellular antioxidant and immune defense, as well as other cellular structural or signal transduction pathways.
  2. UV-induced immune suppression contributes considerably to skin malignancies.
  3. UVB can directly cause specific DNA damage, when left unrepaired, it leads to mutations, consequently predisposing individuals to any cancer.

Importantly, bear in mind that UV exposure in children under age 10 has been linked to an increased risk of developing melanoma (malignant) and non-melanoma skin cancer later in life. Thus, childhood is a susceptible window for long-term dangerous effects of sun damage.

Sun safety with 5 Essentials – SHADE

Fortunately, skin cancer is one of the most preventable types of cancer. So, how can you protect yourself and your family? Employ this tool kit, i.e. the acronym “SHADE”.

S stands for “Sunscreen application”

A wide variety of sunscreens are available on the market but not all products are created equal. Make sure to use sunscreens that block both UVA and UVB. In addition, use a moisturizer with SPF 15 or higher on a daily basis.

H stands for “Hide away from the sun”.

Whether you stroll under the sun or enjoy outdoor adventures, wear sunglasses, a hat, and cover up with loose clothing. Also, make sure your sunglasses have both UVA and UVB blocking properties. 

A stands for “Avoid the sun during its most intensive time”

Staying away from the sun is especially paramount between the hours of 11 a.m. and 3 p.m., because during this window of time, the sun is at its strongest, thereby making this time the riskiest for sun damage.

D stands for “Detect early and Defense daily”.

Skin cancer can occur just about anywhere on the skin, but most often on the areas exposed to the sun, of course, also in odd places. With that in mind, look out vigilantly for moles, bumps or spots, by following the “ABCDE” guidance from WebMD, and noticing pain or fluid as a red flag too, for early detection. Schedule an annual skin cancer screening if you are among those “high risk” individuals.

In addition, antioxidants are powerful weapons to fight or “catch” free radicals generated from UV. Hence, build up your antioxidant defense by eating plenty of fresh, colorful fruits and vegetables, and more salmon.

E stands for “Educate everyone”.

To emphasize, E is for educating, not entertaining under the sun! Start with children and young adults. Regardless of gender and age, we are all exposed to the same sun. Today, the sun is getting less merciful compared to three or more decades ago due to thinning of ozone protection.

Take home message: 

Keep a balance between sun pleasure and sun damage, and hold the value of proper skin care. At the end, healthy skin in the course of life may promote better mental and emotional health. And remember “SHADE”.

 

Reference (on the table): Quan & Fisher. Gerontology. 2015; 61:427-34.

Image credit: thezonehole.com