Thursday, June 19, 2008
Is it true?=)
AQUARIUS - The Sweetheart ~ ( Jan 20 - Feb 18 )
Optimistic and honest. Sweet personality. Very independent. Inventive and intelligent. Friendly and loyal. Can seem unemotion al. Can be a bit rebellious. Very stubborn, but original and unique. Attractive on the inside and out. Eccentric personality.
PISCES - The Dreamer ~ ( Feb 19 - Mar 20 )
Generous, kind, and thoughtful. Very creative and imaginative. May become secretive and vague. Sensitive. Don't like details. Dreamy and unrealistic. Sympathetic and loving. Kind. Un selfish.Good kisser. Beautiful.
ARIES - The Daredevil (Mar 21 - April 19 )
Energetic. Adventurous and spontaneous. Confident and enthusiastic. Fun. Loves a challenge. EXTREMELY impatient. Sometimes selfish. Short fuse. (easily angered.) Lively, passionate, and sharp wit. Outgoing. Lose interest quickly - easily bored. Egotistical. courageous and assertive. Tends to be physical and athletic.
TAURUS - The Enduring One ~ ( April 20 - May 20th )
Charming but aggressive. Can come off as boring, but they are not. Hard workers. Warm-hearted. Strong, has endurance. Solid beings who are stable and sec u re in their ways. Not looking for shortcuts.Take pride in their beauty. Patient and reliable. Make great friends and give good advice . Loving and kind. Loves hard - passionate. Express themselves emotionally. Prone to ferocious temper-tantrums. Determined. Indulge themselves often. Very generous.
GEMINI - The Chatterbox ~ ( May 21 - June 20 )
Smart and witty. Outgoing, very chatty. Lively, energetic. Adaptable but needs to express themselves. Argumentative and outspoken. Likes change. Versatile. Busy, sometimes nervous and tense. Gossips. May seem superficial or inconsistent. Beautiful physically and mentally.
CANCER - The Protector ~ (June 21 - July 22 )
Moody, emotional. May be shy. Very loving and caring. Pretty/handsome. Excellent partners for life. Protective. Inventive and imaginative. Cautious. Touchy-feely kind of person. Needs love from others. Easily hurt, but sympathetic.
LEO - The Boss ~ ( July 23 - Aug 22 )
Very organi z ed. Need order in their lives - like being in control. Likes boundaries. Tend to take over everything. Bossy. Like to help others. Social and outgoing. Extroverted. Generous, warm-hearted. Sensitive. Creative energy. Full of themselves. Loving. Doing the right thing is important to Leo's. Attractive.
VIRGO - The Perfectionist ~ Dominant ~ ( Aug 23 - Sept 22)
In relationships, very conservative. Always wants the last word. Argumentative. Worries. Very smart. Dislikes noise and chaos. Eager. Hardworking. Loyal. Beautiful. Easy to talk to. Hard to please. Harsh. Practical and very f us sy. Often shy. Pessimistic.
LIBRA - The Harmonizer ( Sept 23 - Oct 22 )
Nice to everyone they meet. Can't make up their mind. Have own unique appeal. Creative, energetic, and very social. Hates to be alone. Peaceful, generous. Very loving and beautiful. Flirtatious. Give in too easily. Procrastinators. Very gullible.
SCORPIO - The Intense One ~ Very Energetic ~ (Oct 23 - Nov 21 )
Intelligent. Can be jealous and/or possessive. Hardworking. Great kisser. Can become obsessive or secretive. Holds grudges. Attractive. Determined. Loves being in long Relationships. Talkative. Romantic. Can be self-centered at times. Passionate and Emotional.
SAGITTARIUS - The Happy-Go-Lucky One ~ (Nov 22 - Dec 21 )
Good-natured optimist. Doesn't want to grow up (Peter Pan Syndrome ). Indulges self. Boastful. Likes luxuries and gambling. Social and out going . Doesn't like responsibilities. Often fantasizes. Impatient. Fun to be around. Having lots of friends. Flirtatious. Dislikes being confined - tight spaces or even tight clothes. Beautiful inside and out
CAPRICORN - The Go-Getter ~ ( Dec 22 - Jan 19 )
Patient and wise. Practical and rigid. Ambitious. Tends to be Good-looking. Humorous and funny. Can be a bit shy and reserved. Often pessimistic. Capricorns tend to act before they think and can be unfriendly at times. Hold grudges. Like competition. Get what they want.
Optimistic and honest. Sweet personality. Very independent. Inventive and intelligent. Friendly and loyal. Can seem unemotion al. Can be a bit rebellious. Very stubborn, but original and unique. Attractive on the inside and out. Eccentric personality.
PISCES - The Dreamer ~ ( Feb 19 - Mar 20 )
Generous, kind, and thoughtful. Very creative and imaginative. May become secretive and vague. Sensitive. Don't like details. Dreamy and unrealistic. Sympathetic and loving. Kind. Un selfish.Good kisser. Beautiful.
ARIES - The Daredevil (Mar 21 - April 19 )
Energetic. Adventurous and spontaneous. Confident and enthusiastic. Fun. Loves a challenge. EXTREMELY impatient. Sometimes selfish. Short fuse. (easily angered.) Lively, passionate, and sharp wit. Outgoing. Lose interest quickly - easily bored. Egotistical. courageous and assertive. Tends to be physical and athletic.
TAURUS - The Enduring One ~ ( April 20 - May 20th )
Charming but aggressive. Can come off as boring, but they are not. Hard workers. Warm-hearted. Strong, has endurance. Solid beings who are stable and sec u re in their ways. Not looking for shortcuts.Take pride in their beauty. Patient and reliable. Make great friends and give good advice . Loving and kind. Loves hard - passionate. Express themselves emotionally. Prone to ferocious temper-tantrums. Determined. Indulge themselves often. Very generous.
GEMINI - The Chatterbox ~ ( May 21 - June 20 )
Smart and witty. Outgoing, very chatty. Lively, energetic. Adaptable but needs to express themselves. Argumentative and outspoken. Likes change. Versatile. Busy, sometimes nervous and tense. Gossips. May seem superficial or inconsistent. Beautiful physically and mentally.
CANCER - The Protector ~ (June 21 - July 22 )
Moody, emotional. May be shy. Very loving and caring. Pretty/handsome. Excellent partners for life. Protective. Inventive and imaginative. Cautious. Touchy-feely kind of person. Needs love from others. Easily hurt, but sympathetic.
LEO - The Boss ~ ( July 23 - Aug 22 )
Very organi z ed. Need order in their lives - like being in control. Likes boundaries. Tend to take over everything. Bossy. Like to help others. Social and outgoing. Extroverted. Generous, warm-hearted. Sensitive. Creative energy. Full of themselves. Loving. Doing the right thing is important to Leo's. Attractive.
VIRGO - The Perfectionist ~ Dominant ~ ( Aug 23 - Sept 22)
In relationships, very conservative. Always wants the last word. Argumentative. Worries. Very smart. Dislikes noise and chaos. Eager. Hardworking. Loyal. Beautiful. Easy to talk to. Hard to please. Harsh. Practical and very f us sy. Often shy. Pessimistic.
LIBRA - The Harmonizer ( Sept 23 - Oct 22 )
Nice to everyone they meet. Can't make up their mind. Have own unique appeal. Creative, energetic, and very social. Hates to be alone. Peaceful, generous. Very loving and beautiful. Flirtatious. Give in too easily. Procrastinators. Very gullible.
SCORPIO - The Intense One ~ Very Energetic ~ (Oct 23 - Nov 21 )
Intelligent. Can be jealous and/or possessive. Hardworking. Great kisser. Can become obsessive or secretive. Holds grudges. Attractive. Determined. Loves being in long Relationships. Talkative. Romantic. Can be self-centered at times. Passionate and Emotional.
SAGITTARIUS - The Happy-Go-Lucky One ~ (Nov 22 - Dec 21 )
Good-natured optimist. Doesn't want to grow up (Peter Pan Syndrome ). Indulges self. Boastful. Likes luxuries and gambling. Social and out going . Doesn't like responsibilities. Often fantasizes. Impatient. Fun to be around. Having lots of friends. Flirtatious. Dislikes being confined - tight spaces or even tight clothes. Beautiful inside and out
CAPRICORN - The Go-Getter ~ ( Dec 22 - Jan 19 )
Patient and wise. Practical and rigid. Ambitious. Tends to be Good-looking. Humorous and funny. Can be a bit shy and reserved. Often pessimistic. Capricorns tend to act before they think and can be unfriendly at times. Hold grudges. Like competition. Get what they want.
In and Out of GeorgeTown
George Town, named by the British after King George III, is Penang capital city. The government centre and its financial heart, George Town is an interesting and bustling city with modern high rise buildings, cathedrals, mosques, government offices, temples, bazaars, shops and cafes. A myriad of delights, George Town is very compact ? the older part of the city is a labyrinth of narrow lanes and alleyways, which makes it a pleasure to walk and sight-see.
Indeed, walking is highly recommended ? a leisurely stroll will enable one to slowly drink in the many details that would otherwise be lost in a hurried tour. If walking is considered tiring, try a ride on the old but exciting trishaw.
The clock tower was presented to Penang by local millionaire Cheah Chen Eok in 1897 to commemorate the Diamond Jubilee of Queen Victoria.
It towers 60 feet in high ? one foot for each year of Her Majesty's reign. The Queen had died by the time the clock tower was finally completed in 1920.
Next to Fort Cornwallis is the Esplanade, a popular waterfront promenade which stretches from the hawker stalls at one end to the clock tower at the other. Central in the Esplanade is the Padang, a huge square of town green.
Standing proudly beside is the City Hall, a stately colonial building which is a fine example of British palladian architecture featuring magnificent Corinthian columns and huge windows. It was once the seat of local government.
Fort Cornwallis is situated at the spot where Captain Francis Light was supposed to have landed in 1786. Originally a wooden structure, the fort was rebuilt between 1808 and 1810 with convict labour. It was named after Charles Marquis Cornwallis, a distinguished Governor General of India, and designed to protect the harbour from possible French attacks.
Today, much of the old fort remains, but its precincts have been converted into a public park and an open air theater. It is still guarded by old cannons, which were retrieved by the British from pirates who had captured them from the Johore Sultanate. The most famous of the cannons is Seri Rambai, which dates back to 1613. Local beliefs have it that childless women can become fertile by placing flowers in the barrel of the cannon and offering special prayers.
P. Ramlee's Birthplace & Gallery, Jalan P. Ramlee
Located at Lebuh Farquhar, the Penang Museum and Art Gallery is one of the most popular attractions in Malaysia. The building which houses the museum was built in 1821 and was formerly the Penang Free School. It showcases old photographs, maps, charts, historical relics, paintings of early Penang, all of which provide an insight to Penang's history.
If you want to know what life was like in Penang during wartime, you'll find some of the answers at the Penang War Museum. Housed in what was once a British fort built during World War II, the museum is the only one of its kind in the country.
Indeed, walking is highly recommended ? a leisurely stroll will enable one to slowly drink in the many details that would otherwise be lost in a hurried tour. If walking is considered tiring, try a ride on the old but exciting trishaw.
Clock Tower, Pesiaran King Edward
The clock tower was presented to Penang by local millionaire Cheah Chen Eok in 1897 to commemorate the Diamond Jubilee of Queen Victoria.
It towers 60 feet in high ? one foot for each year of Her Majesty's reign. The Queen had died by the time the clock tower was finally completed in 1920.
Esplanade
Next to Fort Cornwallis is the Esplanade, a popular waterfront promenade which stretches from the hawker stalls at one end to the clock tower at the other. Central in the Esplanade is the Padang, a huge square of town green.
Standing proudly beside is the City Hall, a stately colonial building which is a fine example of British palladian architecture featuring magnificent Corinthian columns and huge windows. It was once the seat of local government.
Fort Cornwallis, Padang Kota Lama
Fort Cornwallis is situated at the spot where Captain Francis Light was supposed to have landed in 1786. Originally a wooden structure, the fort was rebuilt between 1808 and 1810 with convict labour. It was named after Charles Marquis Cornwallis, a distinguished Governor General of India, and designed to protect the harbour from possible French attacks.
Today, much of the old fort remains, but its precincts have been converted into a public park and an open air theater. It is still guarded by old cannons, which were retrieved by the British from pirates who had captured them from the Johore Sultanate. The most famous of the cannons is Seri Rambai, which dates back to 1613. Local beliefs have it that childless women can become fertile by placing flowers in the barrel of the cannon and offering special prayers.
P. Ramlee's Birthplace & Gallery, Jalan P. Ramlee
P. Ramlee's house is located at Lot 2180, Jalan P. Ramlee, Penang. P. Ramlee was born in this house which was built in 1926 by his father and uncle, Rejab bih Hussein. The house was twice renovated by the latter ? once during the Japanese Occupation and the other in 1948.
The national Archives accquired the house and carried out restoration works in 1991. The original form of the house is still intact. Today, a small gallery stands next to Ramlee's birthplace, displaying memorabilia of all kinds.
The national Archives accquired the house and carried out restoration works in 1991. The original form of the house is still intact. Today, a small gallery stands next to Ramlee's birthplace, displaying memorabilia of all kinds.
Penang Museum and Art Gallery, Lebuh Farquhar
Located at Lebuh Farquhar, the Penang Museum and Art Gallery is one of the most popular attractions in Malaysia. The building which houses the museum was built in 1821 and was formerly the Penang Free School. It showcases old photographs, maps, charts, historical relics, paintings of early Penang, all of which provide an insight to Penang's history.
War Museum, Batu Maung
If you want to know what life was like in Penang during wartime, you'll find some of the answers at the Penang War Museum. Housed in what was once a British fort built during World War II, the museum is the only one of its kind in the country.
洗手間裡的晚宴
有一位 女傭 ，住在主人家附近一片破舊平房中的一間。
她是單親母親，獨自帶一個四歲的男孩。
每天她早早幫主人收拾完畢，然後返回自己的家。
主人也曾留她住下，卻總是被她拒絕。
因為她是女傭，她非常自卑。
那天主人要請很多客人吃飯。客人們個個光彩照人。
主人對女傭說，今天您能不能辛苦一點兒晚一些回家。
女傭說當然可以，不過我兒子見不到我會害怕的。
主人說，那您把他也帶過來吧。
女傭急匆匆回家，拉了自己的兒子往主人家趕去。
兒子問，我們要去哪裡？
女傭說，帶你參加一個晚宴。
四歲的兒子， 並不知道自己的母親是一位傭人………
女傭有些不安。
到處都是客人，她的兒子無處可藏。
她不想讓兒子破壞聚會的快樂氣氛。
更不想讓年幼的兒子知道主人和傭人的區別，富有和貧窮的區別。
後來她把兒子關進了主人的洗手間。
主人的豪宅有兩個洗手間，一個主人用，一個客人用。
她看看兒子，指指洗手間裏的馬桶。
這是單獨給你準備的房間，她說，這是一個凳子。
然後她再指指大理石的洗漱台，這是一張桌子。
她從懷裏掏出兩根香腸，放進一個盤子裏。
這是屬於你的，母親說，現在晚宴開始了。
盤子是從主人的廚房裏拿來的。
香腸是她在回家的路上買的，她已經很久沒有給自己的兒子買過香腸了。
女傭說這些時，努力抑制著淚水。
男孩在貧困中長大，他從沒見過這麼豪華的房子，更沒有見過洗手間。
他不認識抽水馬桶，不認識漂亮的大理石洗漱台。
他聞著洗滌液和香皂的香氣，幸福得不能自拔。
他坐在地上，將盤子放在馬桶蓋上。
他盯著盤子裏的香腸和麵包，為自己唱起快樂的歌。
晚宴開始的時候，主人突然想起女傭的兒子。
他去廚房問女傭，女傭說她也不知道，也許是跑出去玩了吧。
主人看女傭躲閃著的目光，就在房子裏靜靜地尋找。
終於，他順著歌聲找到了洗手間裏的男孩。
那時男孩正將一塊香腸放進嘴裏。
他楞住了，他問，你躲在這裏幹什麼？
男孩說，我是來這裏參加晚宴的，現在我正在吃晚餐。
他問，你知道你是在什麼地方嗎？
男孩說，我當然知道，這是晚宴的主人單獨為我準備的房間。
他說，是你媽媽這樣告訴你的吧？
男孩說，是的，其實不用媽媽說，我也知道，晚宴的主人一定會為我準備最好的房間。
不過，男孩指了指盤子裏的香腸，我希望能有個人陪我吃這些東西。
主人的鼻子有些發酸，用不著再問，他已經明白了眼前的一切。
他默默走回餐桌前，對所有的客人說，
對不起，今天我不能陪你們共進晚餐了，我得陪一位特殊的客人。
然後，他從餐桌上端走兩個盤子。
他來到洗手間的門口，禮貌地敲門。
得到男孩的允許後，他推開門，把兩個盤子放到馬桶蓋上。
他說，這麼好的房間，當然不能讓你一個人獨享，我們將一起共進晚餐。
那天他和男孩聊了很多。
他讓男孩堅信，洗手間是整棟房子裏最好的房間。
他們在洗手間裏吃了很多東西，唱了很多歌。
不斷有客人敲門進來，他們向主人和男孩問好，
他們遞給男孩美味的蘋果汁和烤成金黃的美食。
他們露出誇張和羡慕的表情，
後來他們乾脆一起擠到小小的洗手間裏，給男孩唱起了歌。
每個人都很認真，沒有一個人認為這是一場鬧劇。
多年後男孩長大了。
他有了自己的公司，有了附帶兩個洗手間的房子。
他步入上流社會，成為富人。
每年他都拿出很大一筆錢救助一些窮人，
可是他從不舉行捐贈儀式，更不讓那些窮人知道他的名字。
有朋友問及理由，
他說，我始終記得許多年前，
有一天，有一位富人，有很多人，
小心地維繫了一個四歲男孩的自尊
她是單親母親，獨自帶一個四歲的男孩。
每天她早早幫主人收拾完畢，然後返回自己的家。
主人也曾留她住下，卻總是被她拒絕。
因為她是女傭，她非常自卑。
那天主人要請很多客人吃飯。客人們個個光彩照人。
主人對女傭說，今天您能不能辛苦一點兒晚一些回家。
女傭說當然可以，不過我兒子見不到我會害怕的。
主人說，那您把他也帶過來吧。
女傭急匆匆回家，拉了自己的兒子往主人家趕去。
兒子問，我們要去哪裡？
女傭說，帶你參加一個晚宴。
四歲的兒子， 並不知道自己的母親是一位傭人………
女傭有些不安。
到處都是客人，她的兒子無處可藏。
她不想讓兒子破壞聚會的快樂氣氛。
更不想讓年幼的兒子知道主人和傭人的區別，富有和貧窮的區別。
後來她把兒子關進了主人的洗手間。
主人的豪宅有兩個洗手間，一個主人用，一個客人用。
她看看兒子，指指洗手間裏的馬桶。
這是單獨給你準備的房間，她說，這是一個凳子。
然後她再指指大理石的洗漱台，這是一張桌子。
她從懷裏掏出兩根香腸，放進一個盤子裏。
這是屬於你的，母親說，現在晚宴開始了。
盤子是從主人的廚房裏拿來的。
香腸是她在回家的路上買的，她已經很久沒有給自己的兒子買過香腸了。
女傭說這些時，努力抑制著淚水。
男孩在貧困中長大，他從沒見過這麼豪華的房子，更沒有見過洗手間。
他不認識抽水馬桶，不認識漂亮的大理石洗漱台。
他聞著洗滌液和香皂的香氣，幸福得不能自拔。
他坐在地上，將盤子放在馬桶蓋上。
他盯著盤子裏的香腸和麵包，為自己唱起快樂的歌。
晚宴開始的時候，主人突然想起女傭的兒子。
他去廚房問女傭，女傭說她也不知道，也許是跑出去玩了吧。
主人看女傭躲閃著的目光，就在房子裏靜靜地尋找。
終於，他順著歌聲找到了洗手間裏的男孩。
那時男孩正將一塊香腸放進嘴裏。
他楞住了，他問，你躲在這裏幹什麼？
男孩說，我是來這裏參加晚宴的，現在我正在吃晚餐。
他問，你知道你是在什麼地方嗎？
男孩說，我當然知道，這是晚宴的主人單獨為我準備的房間。
他說，是你媽媽這樣告訴你的吧？
男孩說，是的，其實不用媽媽說，我也知道，晚宴的主人一定會為我準備最好的房間。
不過，男孩指了指盤子裏的香腸，我希望能有個人陪我吃這些東西。
主人的鼻子有些發酸，用不著再問，他已經明白了眼前的一切。
他默默走回餐桌前，對所有的客人說，
對不起，今天我不能陪你們共進晚餐了，我得陪一位特殊的客人。
然後，他從餐桌上端走兩個盤子。
他來到洗手間的門口，禮貌地敲門。
得到男孩的允許後，他推開門，把兩個盤子放到馬桶蓋上。
他說，這麼好的房間，當然不能讓你一個人獨享，我們將一起共進晚餐。
那天他和男孩聊了很多。
他讓男孩堅信，洗手間是整棟房子裏最好的房間。
他們在洗手間裏吃了很多東西，唱了很多歌。
不斷有客人敲門進來，他們向主人和男孩問好，
他們遞給男孩美味的蘋果汁和烤成金黃的美食。
他們露出誇張和羡慕的表情，
後來他們乾脆一起擠到小小的洗手間裏，給男孩唱起了歌。
每個人都很認真，沒有一個人認為這是一場鬧劇。
多年後男孩長大了。
他有了自己的公司，有了附帶兩個洗手間的房子。
他步入上流社會，成為富人。
每年他都拿出很大一筆錢救助一些窮人，
可是他從不舉行捐贈儀式，更不讓那些窮人知道他的名字。
有朋友問及理由，
他說，我始終記得許多年前，
有一天，有一位富人，有很多人，
小心地維繫了一個四歲男孩的自尊
PLACING PENANG ON UNESCO'S WORLD HERITAGE LIST
The World Heritage Convention defines "cultural heritage" as a monument, group of buildings or site of historical, aesthetic, archaeological, scientific, ethnological or anthropological value. Georgetown in Penang surely falls well within this definition as Georgetown has a group of buildings that are steep in history, beautiful and reflect more than a century of culture unique to this Pearl of the Orient.
I am not specifically referring to "famous landmarks" like the Khoo Kongsi, Cheong Fatt Tze Mansion, Assumption Cathedral, Kapitan Keling Mosque etc etc. I am talking about Georgetown's rows and rows of pre-war "shophouses" where generations of Penangites have lived in and conducted business as well. These shophouses and their occupants truly reflect a significant part of Penang's history and in my view, without them, Penang would have lost a great part of its charm.
An American magazine, "Utne Reader", in a recent article about Penang says, "This port on the Straits of Malacca shows that booming cities can compete in the world economy without sacrificing their soul. Penang feels far more relaxed than most Asian cities and looks much the way it did decades ago, with bustling marketplaces and winding streets lined by traditional "shophouses". Once common throughout Southeast Asia, this appealing architectural style incorporates housing above a first-floor storefront, fostering both commerce and lively street life". For illustration they commissioned me to take the pic below.
From the above pic, you can see that the upstairs of such shophouses are living quarters while business is done downstairs and in this case, business spills on to the road with other street vendors setting up their stalls in this "morning street market".
I am not specifically referring to "famous landmarks" like the Khoo Kongsi, Cheong Fatt Tze Mansion, Assumption Cathedral, Kapitan Keling Mosque etc etc. I am talking about Georgetown's rows and rows of pre-war "shophouses" where generations of Penangites have lived in and conducted business as well. These shophouses and their occupants truly reflect a significant part of Penang's history and in my view, without them, Penang would have lost a great part of its charm.
An American magazine, "Utne Reader", in a recent article about Penang says, "This port on the Straits of Malacca shows that booming cities can compete in the world economy without sacrificing their soul. Penang feels far more relaxed than most Asian cities and looks much the way it did decades ago, with bustling marketplaces and winding streets lined by traditional "shophouses". Once common throughout Southeast Asia, this appealing architectural style incorporates housing above a first-floor storefront, fostering both commerce and lively street life". For illustration they commissioned me to take the pic below.
From the above pic, you can see that the upstairs of such shophouses are living quarters while business is done downstairs and in this case, business spills on to the road with other street vendors setting up their stalls in this "morning street market".
你對「信生活」滿意嗎？
你對「信生活」滿意嗎？
以轉發或收取e-mail 消磨時間的可稱為有「信生 活」。
因此 靠e-mail 交往的叫「信交」。
互相分享e-mail 笑話的叫「信伴侶」。
只收不發叫「信冷感」。
發錯對象是「信騷擾」。
發不出去是「信功能障 礙」。
看著e-mail 傻笑的，基本上已達到了 「信高潮」。
當然， 你如果連e-mail 都不會操作，就鐵定是「信 無能」！
哈哈哈....
再說：
能感動人心的! e-mail 叫(信感)
向人家要e-mail 地址就是想建立(信關係)
用e-mail 購物或買賣股票叫(信交易)
在e-mail 傳送的資訊叫(信知識)
有教導作用的信叫(信教育)
Junk mail一大堆叫(信氾濫)
內容讓人想入非非的叫(信挑逗)
有些莫名其妙的e-mail 可稱(信變態)
若受病毒入侵就是得了(信病)
如因而使得收發e-mail 困難遲緩叫(信功能衰退)
那就要請教高人指點叫(信諮詢)
熟悉e-mail運作之高人就是(信問題專家)
須要加裝軟硬體以加強病毒 防衛就叫(信治療)
有些e-mail圖文並茂，又有動畫，又有配音，這叫(信技巧)
瞭解以上各種(信花樣)你就能處變不驚，莊重自強，對(信生活) 自然就有信心了
原來我們每天都在發生「信 關係」~>"<~
以轉發或收取e-mail 消磨時間的可稱為有「信生 活」。
因此 靠e-mail 交往的叫「信交」。
互相分享e-mail 笑話的叫「信伴侶」。
只收不發叫「信冷感」。
發錯對象是「信騷擾」。
發不出去是「信功能障 礙」。
看著e-mail 傻笑的，基本上已達到了 「信高潮」。
當然， 你如果連e-mail 都不會操作，就鐵定是「信 無能」！
哈哈哈....
再說：
能感動人心的! e-mail 叫(信感)
向人家要e-mail 地址就是想建立(信關係)
用e-mail 購物或買賣股票叫(信交易)
在e-mail 傳送的資訊叫(信知識)
有教導作用的信叫(信教育)
Junk mail一大堆叫(信氾濫)
內容讓人想入非非的叫(信挑逗)
有些莫名其妙的e-mail 可稱(信變態)
若受病毒入侵就是得了(信病)
如因而使得收發e-mail 困難遲緩叫(信功能衰退)
那就要請教高人指點叫(信諮詢)
熟悉e-mail運作之高人就是(信問題專家)
須要加裝軟硬體以加強病毒 防衛就叫(信治療)
有些e-mail圖文並茂，又有動畫，又有配音，這叫(信技巧)
瞭解以上各種(信花樣)你就能處變不驚，莊重自強，對(信生活) 自然就有信心了
原來我們每天都在發生「信 關係」~>"<~
Tuesday, June 17, 2008
Is lowering LDL cholesterol enough?
Unfortunately, the prevention and treatment of atherosclerosis are more complicated than just lowering LDL cholesterol levels. LDL cholesterol reduction is only half of the battle against atherosclerosis. Individuals who have normal or only mildly elevated LDL cholesterol levels can still develop atherosclerosis and heart attacks even in the absence of other risk factors such as cigarette smoking, high blood pressure, and diabetes mellitus.
Additionally, successfully lowering elevated LDL cholesterol levels cannot always prevent atherosclerosis and heart attacks.
In many clinical trials to lower LDL cholesterol, there were patients who adhered to their assigned diets, faithfully took their cholesterol-lowering medications, and successfully lowered their LDL cholesterol to target levels, yet still suffered progressive atherosclerosis and heart attacks. It is clear that while lowering LDL cholesterol below NCEP target levels is an important step, there are other factors involved.
Additionally, successfully lowering elevated LDL cholesterol levels cannot always prevent atherosclerosis and heart attacks.
In many clinical trials to lower LDL cholesterol, there were patients who adhered to their assigned diets, faithfully took their cholesterol-lowering medications, and successfully lowered their LDL cholesterol to target levels, yet still suffered progressive atherosclerosis and heart attacks. It is clear that while lowering LDL cholesterol below NCEP target levels is an important step, there are other factors involved.
Does lowering LDL cholesterol prevent heart attacks and strokes?
Lowering LDL cholesterol is currently the primary focus in preventing atherosclerosis and heart attacks. Most doctors now believe that the benefits of lowering LDL cholesterol include:
* Reducing or stopping the formation of new cholesterol plaques on the artery walls;
* Reducing existing cholesterol plaques on the artery walls;
* Widening narrowed arteries;
* Preventing the rupture of cholesterol plaques, which initiates blood clot formation;
* Decreasing the risk of heart attacks;
* Decreasing the risk of strokes. The same measures that retard atherosclerosis in coronary arteries also benefit the carotid and cerebral arteries (arteries that deliver blood to the brain).
* Reducing or stopping the formation of new cholesterol plaques on the artery walls;
* Reducing existing cholesterol plaques on the artery walls;
* Widening narrowed arteries;
* Preventing the rupture of cholesterol plaques, which initiates blood clot formation;
* Decreasing the risk of heart attacks;
* Decreasing the risk of strokes. The same measures that retard atherosclerosis in coronary arteries also benefit the carotid and cerebral arteries (arteries that deliver blood to the brain).
What are LDL and HDL cholesterol?
LDL cholesterol is called "bad" cholesterol, because elevated levels of LDL cholesterol are associated with an increased risk of coronary heart disease. LDL lipoprotein deposits cholesterol on the artery walls, causing the formation of a hard, thick substance called cholesterol plaque. Over time, cholesterol plaque causes thickening of the artery walls and narrowing of the arteries, a process called atherosclerosis.
HDL cholesterol is called the "good cholesterol" because HDL cholesterol particles prevent atherosclerosis by extracting cholesterol from the artery walls and disposing of them through the liver. Thus, high levels of LDL cholesterol and low levels of HDL cholesterol (high LDL/HDL ratios) are risk factors for atherosclerosis, while low levels of LDL cholesterol and high level of HDL cholesterol (low LDL/HDL ratios) are desirable.
Total cholesterol is the sum of LDL (low density) cholesterol, HDL (high density) cholesterol, VLDL (very low density) cholesterol, and IDL (intermediate density) cholesterol.
What determines the level of LDL cholesterol in the blood?
The liver not only manufactures and secretes LDL cholesterol into the blood; it also removes LDL cholesterol from the blood. A high number of active LDL receptors on the liver surfaces is associated with the rapid removal of LDL cholesterol from the blood and low blood LDL cholesterol levels. A deficiency of LDL receptors is associated with high LDL cholesterol blood levels.
Both heredity and diet have a significant influence on a person's LDL, HDL and total cholesterol levels. For example, familial hypercholesterolemia (FH) is a common inherited disorder whose victims have a diminished number or nonexistent LDL receptors on the surface of liver cells. People with this disorder also tend to develop atherosclerosis and heart attacks during early adulthood.
Diets that are high in saturated fats and cholesterol raise the levels of LDL cholesterol in the blood. Fats are classified as saturated or unsaturated (according to their chemical structure). Saturated fats are derived primarily from meat and dairy products and can raise blood cholesterol levels. Some vegetable oils made from coconut, palm, and cocoa are also high in saturated fats.
HDL cholesterol is called the "good cholesterol" because HDL cholesterol particles prevent atherosclerosis by extracting cholesterol from the artery walls and disposing of them through the liver. Thus, high levels of LDL cholesterol and low levels of HDL cholesterol (high LDL/HDL ratios) are risk factors for atherosclerosis, while low levels of LDL cholesterol and high level of HDL cholesterol (low LDL/HDL ratios) are desirable.
Total cholesterol is the sum of LDL (low density) cholesterol, HDL (high density) cholesterol, VLDL (very low density) cholesterol, and IDL (intermediate density) cholesterol.
What determines the level of LDL cholesterol in the blood?
The liver not only manufactures and secretes LDL cholesterol into the blood; it also removes LDL cholesterol from the blood. A high number of active LDL receptors on the liver surfaces is associated with the rapid removal of LDL cholesterol from the blood and low blood LDL cholesterol levels. A deficiency of LDL receptors is associated with high LDL cholesterol blood levels.
Both heredity and diet have a significant influence on a person's LDL, HDL and total cholesterol levels. For example, familial hypercholesterolemia (FH) is a common inherited disorder whose victims have a diminished number or nonexistent LDL receptors on the surface of liver cells. People with this disorder also tend to develop atherosclerosis and heart attacks during early adulthood.
Diets that are high in saturated fats and cholesterol raise the levels of LDL cholesterol in the blood. Fats are classified as saturated or unsaturated (according to their chemical structure). Saturated fats are derived primarily from meat and dairy products and can raise blood cholesterol levels. Some vegetable oils made from coconut, palm, and cocoa are also high in saturated fats.
Cholesterol
Cholesterol is a fatty substance (a lipid) that is an important part of the outer lining (membrane) of cells in the body of animals. Cholesterol is also found in the blood circulation of humans. The cholesterol in a person's blood originates from two major sources; dietary intake and liver production. Dietary cholesterol comes mainly from meat, poultry, fish, and dairy products. Organ meats, such as liver, are especially high in cholesterol content, while foods of plant origin contain no cholesterol. After a meal, cholesterol is absorbed by the intestines into the blood circulation and is then packaged inside a protein coat. This cholesterol-protein coat complex is called a chylomicron.
The liver is capable of removing cholesterol from the blood circulation as well as manufacturing cholesterol and secreting cholesterol into the blood circulation. After a meal, the liver removes chylomicrons from the blood circulation. In between meals, the liver manufactures and secretes cholesterol back into the blood circulation.
The liver is capable of removing cholesterol from the blood circulation as well as manufacturing cholesterol and secreting cholesterol into the blood circulation. After a meal, the liver removes chylomicrons from the blood circulation. In between meals, the liver manufactures and secretes cholesterol back into the blood circulation.
Do high triglyceride levels cause atherosclerosis?
Whether elevated triglyceride levels in the blood lead to atherosclerosis and heart attacks is controversial. While most doctors now believe that an abnormally high triglyceride level is a risk factor for atherosclerosis, it is difficult to conclusively prove that elevated triglyceride by itself can cause atherosclerosis. However, it is increasingly recognized that elevated triglyceride is often associated with other conditions that increase the risk of atherosclerosis, including obesity, low levels of HDL- cholesterol, insulin resistance and poorly controlled diabetes mellitus, and small, dense LDL cholesterol particles.
What are the causes of elevated triglyceride levels?
In some people, abnormally high triglyceride levels (hypertriglyceridemia) are inherited. Examples of inherited hypertriglyceridemia disorders include mixed hypertriglyceridemia, familial hypertriglyceridemia, and familial dysbetalipoproteinemia.
Hypertriglyceridemia can often be caused by non-genetic factors such as obesity, excessive alcohol intake, diabetes mellitus, kidney disease, and estrogen- containing medications such as birth control pills.
How can elevated blood triglyceride levels be treated?
The first step in treating hypertriglyceridemia is a low fat diet with a limited amount of sweets, regular aerobic exercise, loss of excess weight, reduction of alcohol consumption, and stopping cigarette smoking. In patients with diabetes mellitus, meticulous control of elevated blood glucose is also important.
When medications are necessary, fibrates (such as Lopid), nicotinic acid, and statin medications can be used. Lopid not only decreases triglyceride levels but also increases HDL cholesterol levels and LDL cholesterol particle size. Nicotinic acid lowers triglyceride levels, increases HDL cholesterol levels and the size of LDL cholesterol particles, as well as lowers the levels of Lp (a) cholesterol.
The statin drugs have been found effective in decreasing triglyceride as well as LDL cholesterol levels and, to a lesser extent, in elevating HDL cholesterol levels. A relatively new medicine, fenofibrate (Tricor), shows promise as an effective agent in lowering serum triglyceride levels as well as raising HDL levels, particularly in patients who have had suboptimal responses to Lopid. In some patients, a combination of Lopid or Tricor with adjunctive statin therapy (see below) may be prescribed. While this combination is often effective in patients with complex lipid disorders, the potential for side effects may be increased and such patients should be under strict medical supervision.
What are the causes of elevated triglyceride levels?
In some people, abnormally high triglyceride levels (hypertriglyceridemia) are inherited. Examples of inherited hypertriglyceridemia disorders include mixed hypertriglyceridemia, familial hypertriglyceridemia, and familial dysbetalipoproteinemia.
Hypertriglyceridemia can often be caused by non-genetic factors such as obesity, excessive alcohol intake, diabetes mellitus, kidney disease, and estrogen- containing medications such as birth control pills.
How can elevated blood triglyceride levels be treated?
The first step in treating hypertriglyceridemia is a low fat diet with a limited amount of sweets, regular aerobic exercise, loss of excess weight, reduction of alcohol consumption, and stopping cigarette smoking. In patients with diabetes mellitus, meticulous control of elevated blood glucose is also important.
When medications are necessary, fibrates (such as Lopid), nicotinic acid, and statin medications can be used. Lopid not only decreases triglyceride levels but also increases HDL cholesterol levels and LDL cholesterol particle size. Nicotinic acid lowers triglyceride levels, increases HDL cholesterol levels and the size of LDL cholesterol particles, as well as lowers the levels of Lp (a) cholesterol.
The statin drugs have been found effective in decreasing triglyceride as well as LDL cholesterol levels and, to a lesser extent, in elevating HDL cholesterol levels. A relatively new medicine, fenofibrate (Tricor), shows promise as an effective agent in lowering serum triglyceride levels as well as raising HDL levels, particularly in patients who have had suboptimal responses to Lopid. In some patients, a combination of Lopid or Tricor with adjunctive statin therapy (see below) may be prescribed. While this combination is often effective in patients with complex lipid disorders, the potential for side effects may be increased and such patients should be under strict medical supervision.
What are triglycerides?
Triglyceride is a fatty substance that is composed of three fatty acids. Like cholesterol, triglyceride in the blood either comes from the diet or the liver. Also, like cholesterol, triglyceride cannot dissolve and circulate in the blood without combining with a lipoprotein. Thus, after a meal, the triglyceride and cholesterol that are absorbed into the intestines are packaged into round particles called chylomicrons before they are released into the blood circulation.
A chylomicron is a collection of cholesterol and triglyceride that is surrounded by a lipoprotein outer coat. (Chylomicrons contain 90% triglyceride and 10% cholesterol.)
The liver removes triglyceride and chylomicrons from the blood, and it synthesizes and packages triglyceride into VLDL (very low-density lipoprotein) particles and releases them back into the blood circulation.
A chylomicron is a collection of cholesterol and triglyceride that is surrounded by a lipoprotein outer coat. (Chylomicrons contain 90% triglyceride and 10% cholesterol.)
The liver removes triglyceride and chylomicrons from the blood, and it synthesizes and packages triglyceride into VLDL (very low-density lipoprotein) particles and releases them back into the blood circulation.
How can levels of HDL cholesterol be raised?
The first step in increasing HDL cholesterol levels (and decreasing LDL/HDL ratios) is therapeutic life style changes. When these modifications are insufficient, medications are used. In prescribing medications or medication combinations, doctors have to take into account medication side effects as well as the presence or absence of other abnormalities in cholesterol profiles.
Regular aerobic exercise, loss of excess weight (fat), and cessation of smoking cigarettes will increase HDL cholesterol levels. Regular alcohol consumption (such as one drink a day) will also raise HDL cholesterol. Because of other adverse health consequences of excessive alcohol consumption, alcohol is not recommended as a standard treatment for low HDL cholesterol.
Medications that are effective in increasing HDL cholesterol include nicotinic acid (niacin), gemfibrozil (Lopid), estrogen, and to a much lesser extent, the statin drugs (discussed below). A newer medicine, fenofibrate (Tricor) has shown much promise in selectively increasing HDL levels and reducing serum triglycerides
Regular aerobic exercise, loss of excess weight (fat), and cessation of smoking cigarettes will increase HDL cholesterol levels. Regular alcohol consumption (such as one drink a day) will also raise HDL cholesterol. Because of other adverse health consequences of excessive alcohol consumption, alcohol is not recommended as a standard treatment for low HDL cholesterol.
Medications that are effective in increasing HDL cholesterol include nicotinic acid (niacin), gemfibrozil (Lopid), estrogen, and to a much lesser extent, the statin drugs (discussed below). A newer medicine, fenofibrate (Tricor) has shown much promise in selectively increasing HDL levels and reducing serum triglycerides
Why is HDL the good cholesterol?
HDL is the good cholesterol because it protects the arteries from the atherosclerosis process. HDL cholesterol extracts cholesterol particles from the artery walls and transports them to the liver to be disposed through the bile. It also interferes with the accumulation of LDL cholesterol particles in the artery walls.
The risk of atherosclerosis and heart attacks in both men and is strongly related to HDL cholesterol levels. Low levels of HDL cholesterol are linked to a higher risk, whereas high HDL cholesterol levels are associated with a lower risk.
Very low and very high HDL cholesterol levels can run in families. Families with low HDL cholesterol levels have a higher incidence of heart attacks than the general population, while families with high HDL cholesterol levels tend to live longer with a lower frequency of heart attacks.
Like LDL cholesterol, life style factors and other conditions influence HDL cholesterol levels. HDL cholesterol levels are lower in persons who smoke cigarettes, eat a lot of sweets, are overweight and inactive, and in patients with type II diabetes mellitus.
HDL cholesterol is higher in people who are lean, exercise regularly, and do not smoke cigarettes. Estrogen increases a person's HDL cholesterol, which explains why women generally have higher HDL levels than men do.
For individuals with low HDL cholesterol levels, a high total or LDL cholesterol blood level further increases the incidence of atherosclerosis and heart attacks. Therefore, the combination of high levels of total and LDL cholesterol with low levels of HDL cholesterol is undesirable whereas the combination of low levels of total and LDL cholesterol and high levels of HDL cholesterol is favorable.
The risk of atherosclerosis and heart attacks in both men and is strongly related to HDL cholesterol levels. Low levels of HDL cholesterol are linked to a higher risk, whereas high HDL cholesterol levels are associated with a lower risk.
Very low and very high HDL cholesterol levels can run in families. Families with low HDL cholesterol levels have a higher incidence of heart attacks than the general population, while families with high HDL cholesterol levels tend to live longer with a lower frequency of heart attacks.
Like LDL cholesterol, life style factors and other conditions influence HDL cholesterol levels. HDL cholesterol levels are lower in persons who smoke cigarettes, eat a lot of sweets, are overweight and inactive, and in patients with type II diabetes mellitus.
HDL cholesterol is higher in people who are lean, exercise regularly, and do not smoke cigarettes. Estrogen increases a person's HDL cholesterol, which explains why women generally have higher HDL levels than men do.
For individuals with low HDL cholesterol levels, a high total or LDL cholesterol blood level further increases the incidence of atherosclerosis and heart attacks. Therefore, the combination of high levels of total and LDL cholesterol with low levels of HDL cholesterol is undesirable whereas the combination of low levels of total and LDL cholesterol and high levels of HDL cholesterol is favorable.
How can LDL cholesterol levels be lowered
Therapeutic lifestyle changes to lower cholesterol
Lowering LDL cholesterol involves losing excess weight, exercising regularly, and following a diet that is low in saturated fat and cholesterol.
Medications to lower cholesterol
Medications are prescribed when lifestyle changes cannot reduce the LDL cholesterol to desired levels. The most effective and widely used medications to lower LDL cholesterol are called statins. Most of the large controlled trials that demonstrated the heart attack and stroke prevention benefits of lowering LDL cholesterol used one of the statins. Other medications used in lowering LDL cholesterol and in altering cholesterol profiles include nicotinic acid (niacin), fibrates such as gemfibrozil (Lopid), resins such as cholestyramine (Questran), and ezetimibe, Zetia.
Lowering LDL cholesterol involves losing excess weight, exercising regularly, and following a diet that is low in saturated fat and cholesterol.
Medications to lower cholesterol
Medications are prescribed when lifestyle changes cannot reduce the LDL cholesterol to desired levels. The most effective and widely used medications to lower LDL cholesterol are called statins. Most of the large controlled trials that demonstrated the heart attack and stroke prevention benefits of lowering LDL cholesterol used one of the statins. Other medications used in lowering LDL cholesterol and in altering cholesterol profiles include nicotinic acid (niacin), fibrates such as gemfibrozil (Lopid), resins such as cholestyramine (Questran), and ezetimibe, Zetia.
Hepatitis B
Hepatitis B is one of the major diseases of mankind and is a serious global public health problem. It is preventable with safe and effective vaccines that have been available since 1982. Of the 2 billion people who have been infected with the hepatitis B virus (HBV), more than 350 million have chronic (lifelong) infections. These chronically infected persons are at high risk of death from cirrhosis of the liver and liver cancer, diseases that kill about one million persons each year. Although the vaccine will not cure chronic hepatitis, it is 95% effective in preventing chronic infections from developing, and is the first vaccine against a major human cancer. In 1991, the World Health Organization (WHO) called for all children to receive the hepatitis B vaccine, and 116 countries have added this vaccine to their routine immunization programmes. However, the children in the poorest countries, who need the vaccine the most, have not been receiving it because their governments cannot afford it. Fortunately, hepatitis B vaccine will soon be available in these countries with the assistance of the Global Alliance for Vaccines and Immunization (GAVI) and the Global Fund for Children's Vaccines.
What is hepatitis?
Hepatitis means inflammation of the liver, and the most common cause is infection with one of 5 viruses, called hepatitis A,B,C,D, and E. All of these viruses can cause an acute disease with symptoms lasting several weeks including yellowing of the skin and eyes (jaundice); dark urine; extreme fatigue; nausea; vomiting and abdominal pain. It can take several months to a year to feel fit again. Hepatitis B virus can cause chronic infection in which the patient never gets rid of the virus and many years later develops cirrhosis of the liver or liver cancer. HBV is the most serious type of viral hepatitis and the only type causing chronic hepatitis for which a vaccine is available.
Who gets hepatitis B?
In much of the developing world, (sub-Saharan Africa, most of Asia, and the Pacific), most people become infected with HBV during childhood, and 8% to 10% of people in the general population become chronically infected. In these regions liver cancer caused by HBV figures among the first three causes death by cancer in men.
High rates of chronic HBV infection are also found in the Amazon and the southern parts of Eastern and Central Europe. In the Middle East and Indian sub-continent, about 5% are chronically infected. Infection is less common in Western Europe and North America, where less than 1% are chronically infected.
Young children who become infected with HBV are the most likely to develop chronic infection. About 90% of infants infected during the first year of life and 30% to 50% of children infected between 1 to 4 years of age develop chronic infection. The risk of death from HBV-related liver cancer or cirrhosis is approximately 25% for persons who become chronically infected during childhood.
How do people get infected?
Hepatitis B virus is transmitted by contact with blood or body fluids of an infected person in the same way as human immunodeficiency virus (HIV), the virus that causes AIDS. However, HBV is 50 to 100 times more infectious than HIV.
The main ways of getting infected with HBV are:
* Perinatal (from mother to baby at the birth)
* Child-to-child transmission
* Unsafe injections and transfusions
* Sexual contact
Worldwide, most infections occur from infected mother to child, from child to child contact in household settings, and from reuse of unsterilized needles and syringes. In many developing countries, almost all children become infected with the virus.
In many industrialized countries (e.g. Western Europe and North America), the pattern of transmission is different. In these countries, mother-to-infant and child-to-child transmission accounted for up to one third of chronic infections before childhood hepatitis B vaccination programmes were implemented. However, the majority of infections in these countries are acquired during young adulthood by sexual activity, and injecting drug use. In addition, hepatitis B virus is the major infectious occupational hazard of health workers, and most health care workers have received hepatitis B vaccine.
Hepatitis B virus is not spread by contaminated food or water, and cannot be spread casually in the workplace.
Can chronic hepatitis B and liver cancer be treated?
Liver cancer is almost always fatal, and usually develops between 35 and 65 years of age, when people are maximally productive and with family responsibilities. The loss of a mother or a father in a developing country can devastate the entire family. In developing countries, most people with liver cancer die within months of diagnosis. In industrialized countries, surgery and chemotherapy can prolong life up to a few years. Chronic hepatitis B in some patients is treated with drugs called interferon or lamivudine, which can help some patients. However, interferon or lamivudine therapy costs thousands of dollars and will never be available to most patients in developing countries. Patients with cirrhosis are sometimes given liver transplants, with varying success. It is preferable to prevent this disease with vaccine than to try and cure it.
How safe and effective is the vaccine?
Hepatitis B vaccine has an outstanding record of safety and effectiveness. Since 1982, over one billion doses of hepatitis B vaccine have been used worldwide. The vaccine is given as a series of three intramuscular doses. Studies have shown that the vaccine is 95% effective in preventing children and adults from developing chronic infection if they have not yet been infected. In many countries where 8% to 15% of children used to become chronically infected with HBV, the rate of chronic infection has been reduced to less than 1% in immunized groups of children.
How is WHO trying to control hepatitis B?
Since 1991, WHO has called for all countries to add hepatitis B vaccine into their national immunization programmes. As of March 2000, 116 countries had included hepatitis B vaccine in their national programmes including most countries in Eastern and South- East Asia, the Pacific Islands, Australia, North and South America, Western Europe and the Middle East. However, many low income countries in sub-Saharan Africa, the Indian subcontinent and in the Newly Independent States do not use the vaccine. The price of the hepatitis B vaccine has been one of the main obstacles to its introduction in many of these countries.
The Global Alliance for Vaccines and Immunization (GAVI) was created in 1999. It is a unique coalition of public and private institutions where WHO has taken a leading role. The main mission of GAVI is to vaccinate as many children as possible against vaccine-preventable diseases. GAVI has introduced a new approach to international health funding: the Global Fund for Children's vaccines (GFCV). This fund will help 74 low-income countries to reinforce their national vaccine programmes and introduce hepatitis B, yellow fever and haemophilus influenzae type b(Hib) vaccines into their national immunization programmes.
What is hepatitis?
Hepatitis means inflammation of the liver, and the most common cause is infection with one of 5 viruses, called hepatitis A,B,C,D, and E. All of these viruses can cause an acute disease with symptoms lasting several weeks including yellowing of the skin and eyes (jaundice); dark urine; extreme fatigue; nausea; vomiting and abdominal pain. It can take several months to a year to feel fit again. Hepatitis B virus can cause chronic infection in which the patient never gets rid of the virus and many years later develops cirrhosis of the liver or liver cancer. HBV is the most serious type of viral hepatitis and the only type causing chronic hepatitis for which a vaccine is available.
Who gets hepatitis B?
In much of the developing world, (sub-Saharan Africa, most of Asia, and the Pacific), most people become infected with HBV during childhood, and 8% to 10% of people in the general population become chronically infected. In these regions liver cancer caused by HBV figures among the first three causes death by cancer in men.
High rates of chronic HBV infection are also found in the Amazon and the southern parts of Eastern and Central Europe. In the Middle East and Indian sub-continent, about 5% are chronically infected. Infection is less common in Western Europe and North America, where less than 1% are chronically infected.
Young children who become infected with HBV are the most likely to develop chronic infection. About 90% of infants infected during the first year of life and 30% to 50% of children infected between 1 to 4 years of age develop chronic infection. The risk of death from HBV-related liver cancer or cirrhosis is approximately 25% for persons who become chronically infected during childhood.
How do people get infected?
Hepatitis B virus is transmitted by contact with blood or body fluids of an infected person in the same way as human immunodeficiency virus (HIV), the virus that causes AIDS. However, HBV is 50 to 100 times more infectious than HIV.
The main ways of getting infected with HBV are:
* Perinatal (from mother to baby at the birth)
* Child-to-child transmission
* Unsafe injections and transfusions
* Sexual contact
Worldwide, most infections occur from infected mother to child, from child to child contact in household settings, and from reuse of unsterilized needles and syringes. In many developing countries, almost all children become infected with the virus.
In many industrialized countries (e.g. Western Europe and North America), the pattern of transmission is different. In these countries, mother-to-infant and child-to-child transmission accounted for up to one third of chronic infections before childhood hepatitis B vaccination programmes were implemented. However, the majority of infections in these countries are acquired during young adulthood by sexual activity, and injecting drug use. In addition, hepatitis B virus is the major infectious occupational hazard of health workers, and most health care workers have received hepatitis B vaccine.
Hepatitis B virus is not spread by contaminated food or water, and cannot be spread casually in the workplace.
Can chronic hepatitis B and liver cancer be treated?
Liver cancer is almost always fatal, and usually develops between 35 and 65 years of age, when people are maximally productive and with family responsibilities. The loss of a mother or a father in a developing country can devastate the entire family. In developing countries, most people with liver cancer die within months of diagnosis. In industrialized countries, surgery and chemotherapy can prolong life up to a few years. Chronic hepatitis B in some patients is treated with drugs called interferon or lamivudine, which can help some patients. However, interferon or lamivudine therapy costs thousands of dollars and will never be available to most patients in developing countries. Patients with cirrhosis are sometimes given liver transplants, with varying success. It is preferable to prevent this disease with vaccine than to try and cure it.
How safe and effective is the vaccine?
Hepatitis B vaccine has an outstanding record of safety and effectiveness. Since 1982, over one billion doses of hepatitis B vaccine have been used worldwide. The vaccine is given as a series of three intramuscular doses. Studies have shown that the vaccine is 95% effective in preventing children and adults from developing chronic infection if they have not yet been infected. In many countries where 8% to 15% of children used to become chronically infected with HBV, the rate of chronic infection has been reduced to less than 1% in immunized groups of children.
How is WHO trying to control hepatitis B?
Since 1991, WHO has called for all countries to add hepatitis B vaccine into their national immunization programmes. As of March 2000, 116 countries had included hepatitis B vaccine in their national programmes including most countries in Eastern and South- East Asia, the Pacific Islands, Australia, North and South America, Western Europe and the Middle East. However, many low income countries in sub-Saharan Africa, the Indian subcontinent and in the Newly Independent States do not use the vaccine. The price of the hepatitis B vaccine has been one of the main obstacles to its introduction in many of these countries.
The Global Alliance for Vaccines and Immunization (GAVI) was created in 1999. It is a unique coalition of public and private institutions where WHO has taken a leading role. The main mission of GAVI is to vaccinate as many children as possible against vaccine-preventable diseases. GAVI has introduced a new approach to international health funding: the Global Fund for Children's vaccines (GFCV). This fund will help 74 low-income countries to reinforce their national vaccine programmes and introduce hepatitis B, yellow fever and haemophilus influenzae type b(Hib) vaccines into their national immunization programmes.
Antibiotic
An antibiotic is a chemical compound that inhibits or abolishes the growth of microorganisms, such as bacteria, fungi, or protozoans. The term originally referred to any agent with biological activity against living organisms; however, "antibiotic" now is used to refer to substances with anti-bacterial, anti-fungal, or anti-parasitical activity. The first antibiotic compounds used in modern medicine were produced and isolated from living organisms, such as the penicillin class produced by fungi in the genus Penicillium, or streptomycin from bacteria of the genus Streptomyces. With advances in organic chemistry many antibiotics are now also obtained by chemical synthesis, such as the sulfa drugs.
Possible side effects are varied, depend on the antibiotics used and the microbial organisms targeted. Adverse effects can range from fever and nausea to major allergic reactions including photodermatitis. One of the more common side effects is diarrhea, sometimes caused by the anaerobic bacterium Clostridium difficile, which results from the antibiotic disrupting the normal balance of the intestinal flora, Such overgrowth of pathogenic bacteria may be alleviated by ingesting probiotics during a course of antibiotics. An antibiotic-induced disruption of the population of the bacteria normally present as constituents of the normal vaginal flora may also occur, and may lead to overgrowth of yeast species of the genus Candida in the vulvo-vaginal area. Other side effects can result from interaction with other
Possible side effects are varied, depend on the antibiotics used and the microbial organisms targeted. Adverse effects can range from fever and nausea to major allergic reactions including photodermatitis. One of the more common side effects is diarrhea, sometimes caused by the anaerobic bacterium Clostridium difficile, which results from the antibiotic disrupting the normal balance of the intestinal flora, Such overgrowth of pathogenic bacteria may be alleviated by ingesting probiotics during a course of antibiotics. An antibiotic-induced disruption of the population of the bacteria normally present as constituents of the normal vaginal flora may also occur, and may lead to overgrowth of yeast species of the genus Candida in the vulvo-vaginal area. Other side effects can result from interaction with other
Cefuroxime
Cefuroxime is a second-generation cephalosporin antibiotic that has been widely available in the USA since 1977. Cefuroxime is manufactured as tablets as well as a sodium salt, the latter designed for medical injection.
Cefuroxime is generally well tolerated and side effects are usually transient. Cefuroxime if taken with food is both better absorbed and less likely to cause its commonest upsets of diarrhea, nausea, vomiting and abdominal pain.
Cefuroxime is generally well tolerated and side effects are usually transient. Cefuroxime if taken with food is both better absorbed and less likely to cause its commonest upsets of diarrhea, nausea, vomiting and abdominal pain.
Allergy
An allergy is an abnormal, acquired sensitivity to a given substance, including pollen, drugs, or numerous environmental triggers.
Allergy is a local or systemic inflammatory response to allergens. Local symptoms are:
Nose: swelling of the nasal mucosa (allergic rhinitis)
Eyes: redness and itching of the conjunctiva (allergic conjunctivitis)
Airways: Sneezing, bronchoconstriction, wheezing and dyspnea, sometimes outright attacks of asthma, in severe cases the airway constricts due to swelling known as anaphylaxis.
Ears: feeling of fullness, possibly pain, and impaired hearing due to the lack of eustachian tube drainage.
Skin: various rashes, such as eczema, hives (urticaria) and contact dermatitis.
A headache from sinus pressure can arise if inflammation swells tissue surrounding the tiny sinus drains.
Allergy is a local or systemic inflammatory response to allergens. Local symptoms are:
Nose: swelling of the nasal mucosa (allergic rhinitis)
Eyes: redness and itching of the conjunctiva (allergic conjunctivitis)
Airways: Sneezing, bronchoconstriction, wheezing and dyspnea, sometimes outright attacks of asthma, in severe cases the airway constricts due to swelling known as anaphylaxis.
Ears: feeling of fullness, possibly pain, and impaired hearing due to the lack of eustachian tube drainage.
Skin: various rashes, such as eczema, hives (urticaria) and contact dermatitis.
A headache from sinus pressure can arise if inflammation swells tissue surrounding the tiny sinus drains.
Loratadine
Loratadine is a drug used to treat allergies, and marketed for its nonsedating properties. Loratadine is available as tablets, oral suspension and syrup, and also in combination with pseudoephedrine. Also available are quick-dissolving tablets, which are marketed as being faster to get into one's circulatory system but which require special handling to avoid degrading in the package.
Loratadine is indicated for the symptomatic relief of allergy such as hay fever (allergic rhinitis), urticaria (hives), and other skin allergies.
For allergic rhinitis (hay fever), loratadine is effective for both nasal and eye symptoms: sneezing, runny nose, itchy or burning eyes.
Drowsiness, headache, psychomotor impairment, and antimuscarinic effects such as urinary retention, dry mouth, blurred vision, and gastrointestinal disturbances are the most common side effects.
Loratadine is indicated for the symptomatic relief of allergy such as hay fever (allergic rhinitis), urticaria (hives), and other skin allergies.
For allergic rhinitis (hay fever), loratadine is effective for both nasal and eye symptoms: sneezing, runny nose, itchy or burning eyes.
Drowsiness, headache, psychomotor impairment, and antimuscarinic effects such as urinary retention, dry mouth, blurred vision, and gastrointestinal disturbances are the most common side effects.
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