A Simple Guide to Coronary Heart Disease Part 2

A Simple Guide to Coronary Heart Disease Part 2
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What is the treatment of Coronary Heart Disease?
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Any heart attack is an EMERGENCY!
Immediate treatment is urgent!

While waiting for the ambulance, lie the patient in a slightly inclined position.
Give nitroglycerin tablet under the tongue if available.
Admit to hospital as an emergency.

Severe cases are admitted to Cornary care unit(CCU) for constant monitoring of the heart, blood pressure and abnormal rhythm of heart rate.

Risk factors for Coronary heart disease like hypertension, high cholesterol, diabetes must be treated.

Medicine:
-----------

Anticoagulants such as warfarin, aspirin, Plavix,should be given to
prevent blood clots .

Vasodilators like isorbide are given to help dilate the artery to the heart

Any abnormal rhythm of the heart must also be treated with medications or pacemaker if severe as damage to heart may affect the conduction of the electrical impulse of the heart to the cardiac muscles.

Because of the psychological effect of a heart attack on the patient, sometimes antidepressant or tranquilliser may be necessary.

Interventional Procedures:
--------------------------

Once stable the patient may be requred to have a ballooning of the narrowed artery or a stent inserted in the narrowed artery.
This can be done during the cardiac catheterisation.

1.balloon angioplasty
balloon is inflated to compress fatty matter to the wall of narrowed artery and open the blood vessel

2.Stent:
balloon angioplasty is performed in combination with placement of a stent which is a small, metal mesh tube that provide support inside the coronary artery.

3.Drug eluting stents (DES):
Drug-eluting stents contain a medication that is actively released at the stent implantation site to prevent recurrence of narrowing of the artery

4.Rotablation
The Rotoblation special catheter, with an acorn-shaped, diamond-coated tip, spins around at a high speed and grinds away the heavily calcified plaque on the arterial walls.

5.cutting balloon
The cutting balloon catheter has a balloon tip with small blades which are activated when the ballon is inflated. The small blades remove the plaque and the balloon compresses the fatty matter into the arterial wall.

Surgery :
-------------

If the narrowing involved too many arteries, then a coronary artery bypass graft (CABG) surgery will have to be done.

Stay in Hospital and Rehabilation:
---------------------------------

Usually a heart attack patient stays in hospital for 2-4 weeks depending on the severity of his condition.

Mild exercise is started once his condition is stable.
Exercise is good for the patient because it helps the blood circulation.

However strenous exercise including sexual inercourse should start until at least 4-6 weeks later.

Most patients should be able to drive or fly after 2 months.

What can I do to prevent Coronary Heart Disease?
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Prevention of a heart attack is the same as prevention of a stroke as both involve the avoiding the blockage of a major artery to the brain or heart.

1.Control the Blood Pressure
Have your blood pressure checked at least once a year from the age of 40 years.
If there is high blood pressure, lifelong treatment with monthly checkups will keep it under control.

2.Control the Diabetes
Check for diabetes starting from the age of 40 years. If there are risk factors for diabetes, screening should start earlier.
If there is diabetes, take the medicine or injections regularly.
Monitor the sugar levels daily.
Control the diet.
Check with the doctor regularly.

3.Watch Your Diet
Reduce consumption of fat, high-cholesterol food, sugar and salt.
Take more fruit, vegetables and moderate servings of carbohydrates.
Eat more beancurd, dried peas, dried beans, fish and chicken instead of red meat.
Drink low-fat milk.
Avoid full cream milk.
Avoid alcohol.
Drink less coffee, tea and cola drinks.

4.Don't Smoke
Stop smoking immediately.
Don't start smoking if you are not a smoker.

5.Physical Activity
Regular exercise is good for you.
Do moderate intensity physical activity for 30 minutes such that you sweat and breathe deeply without getting breathless.
Examples include brisk walking, swimming, cycling.

6.Learn To Relax
Have adequate rest especially when you feel tense or tired.
Take up a hobby.
Do relaxation exercises such as yoga or deep breathing exercises.
Time management is important.

What is the prognosis of Coronary Heart Disease?
---------------------------------------------------

The outlook following a coronary heart attack is generally good.
About 80% of patients are alive after 3 years and 70% after 6 years.

The outlook varies depending on the age of the patient and severity of the heart attack.

However with new treatment and a healthy lifestyle, the prognosis has improved tremendously.

Medication such as Aspirin or warfarin may have to be taken permanently to prevent a recurrent attack.

A Simple Guide to Coronary Heart Disease

A Simple Guide to Coronary Heart Disease
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What is Coronary Heart Disease?
--------------------------------------

Coronary Heart Disease occurs when the coronary arteries become blocked. The blood supply to the part of the heart cannot provide the oxygen and nutrients to the muscles of the heart.
The cells in that part of the heart died off and that part of the heart is unable to function properly.
This is called a heart attack.

Coronary Heart Disease can lead to sudden death.

What causes Coronary Heart Disease?
-----------------------------------

Coronary Heart Disease occurs when

1.there is a blockage of an artery in the heart by a blood clot, piece of fat or air bubble travelling in the blood from another part of the body.
This leads to lack of supply of oxygen and nutrients to the heart muscle.
As a result the heart cells died leading to loss of function of the part of the heart.

2.narrowing of the blood vessel due to fat deposit in the walls of the artery supplying blood to the heart.
This reduce the blood supply of oxygen and nutrients to the heart muscles cells and affects its function.

What are the risk factors in Coronary Heart Disease:
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1.High Blood pressure-
Hypertension narrows the arteries of the heart and causes blockage

2.High cholesterol-
Cholesterol deposit thickens the walls of the arteries, making them narrow and reducing blood flow.

3.Diabetes mellitus
The high blood sugar level thickens the arteries and make the blood thick so that less blood is able to flow through them.

4.Obesity
A BMI of 23.0kg/m² and above increases the risk of getting high blood pressure, diabetes and heart attack.

5.Smoking
Tobacco smoke narrows arteries and reduces oxygen supply to the heart.

6.Drinking of Alcohol
Alcohol can cause liver and kidney damage. increase blood pressure and affect diabetes

7.Stress
Repeated stress, if poorly controlled, can lead to high blood pressure.

What is a Angina Pectoris?
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It is a early warning sign of a ischemic heart disease.
Angina occurs when the blood supply of the heart is partially blocked by narrowing of the blood vessel.

1.It occurs during exertion when the supply of the blood to the heart is insufficient to keep up with the increase demands of the heart muscles.

2.It can also occurs when anger or fear causes the heart muscles to pump faster to supply the body with oxygen.

3.Stress can also causes spasm of the cornonary arteries reducing oxygen to the heart tissues.

4.Smoking can also constrict the blood arteries to the heart.

The symptoms of Angina Pectoris are:
1. Crushing heavy pain in the sternal area of the chest or chest discomfort lasting 2-10 mins

2.It occurs during exertion, anger or stress

3.It is relieved by rest or taking sublingual
nitroglycerin.

4. The major sign is ST depression in the ECG (electrocardiogram) during the attack which becomes normal after the attack.

5.Threadmill examination can spark off an attack of angina because of the exertion involved in doing the threadmill so it is not advisable to do a threadmill at this stage.

What are the symptoms of Coronary Heart Disease?
----------------------------------------------------

The symptoms of Coronary Heart Disease are :

1.Crushing heavy (not sharp) chest pains in the mid sternal region of the chest which may radiate to the Left jaw, neck, shoulder and down the inside of the left arm and hand.
This pain occurs when not enough oxygen is supplied to the heart muscles.
The pain is usually not relieved by rest or nitroglycerin.

2.Breathing difficulty is usually associated with the chest pain due to the lack of oxygen being pumped from the heart to the lungs. The patient finds difficulty in lying flat and needs to sit up or in a inclined position.

3.Cold sweats may also be associated with the chest pain

4.Paleness of the face due to poor flow of blood from the heart

5.Fatique and tiredness

6.Confusion, dizziness, depression,

7. Difficulty in movement and speaking

How is the diagnosis of Coronary Heart Disease done?
----------------------------------------------------

Diagnosis of coronary heart disease is usually confirmed by:
1.History of chest pain and physical examination of the heart and blood pressure

2.ECG(electrocardiogram)shows typical features of depression in Q wave, ST segment and raised RS segment.
A 12 leads ECG may showed the presence of Coronary heart disease more clearly

3.Threadmill -Features of ECG is enhanced during exertion on the threadmill

4.CAT scan of the heart- a new technology where the complete scan of the heart with the movement of dye through the coronary ateries can show presence of narrowing or blockage of the arteries.

5.Angiogram( cardiac catheterisation)- a small catheter is entered into the artery at the groin.
The catheter is guided through the blood vessel to the coronary arteries with the aid of a special x-ray machine.
A radio-opaque dye is injected into the artery and its passage is recorded on a screen.
Occlusion or narrowing of any of the coronary arteries can be seen.

6.intravascular ultrasound (IVUS) and fractional flow reserve (FFR), may be performed together with cardiac catheterization to obtain more detailed images of the walls of the blood vessels.

7.Blood cardiac enzymes and ESR may be raised.

All acute Coronary Heart Disease attacks are Emergencies and should be admitted to hospital as soon as possible for proper treatment.

The treatment of Coronary Heart Disease will be discussed in the Simple Treatment of Coronary Heart Disease Part 2.

A Simple Guide to Stroke 2

A Simple Guide to Stroke 2
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What is the treatment of Stroke?
--------------------------------

Stroke is an emergency.

Purpose of treatment is to:

1. preserve life

2. limit the amount of brain damage

3. lessen the extent of disability and deformity

4. prevent recurrence of a stroke.

Admission to hospital is necessary to determine

1. the cause of the stroke

2. the extent of damage to the brain using MRI of the brain

3. immediate treatment with medicines(usually anticoagulant,blood circulation,nerve vitamins).

4. whether Surgery is necessary to stop bleeding or remove a blood clot

5. risk factors for stroke are investigated and treated (diabetes, high blood pressure etc)

During the acute phase of stroke:
1. A clear airway must be maintained

2. Sufficient fluid and electrolyte intake must be maintained

3. Adequate nutrition in the form of glucose, proteins and calories must be given

4. Adequate nursing care is provided to prevent bed sores etc

5. Proper medicines are given

Once the stroke is stable:
The stroke patient is started on a rehabilitation programme.

This will include
a.exercises to strenthen his muscles,

b.speech training for patients with dysphasia (difficulty in talking)

c.training on how to carry out his daily activities.

d.advice about his diet

Immediate care improves the chance of a complete recovery.

How to care for a Stroke Patients?
----------------------------------------

A stroke can be very devastating and depressing for a patient.

He will feel that part of his body and brain function is incapacitated.

Therefore he need all the support from everyone involved in the treatment of his condition:
1.doctors,
2.nurses,
3.physiotherapist,
4.speech therapist
5.occupational therapists
6.family members and friends

Family members can provide the most important means of support.
They should be familiar with his disabilities and help him accordingly:

Please do:
--------------
1.be understanding and patient.

2. keep the patient cheerful and hopeful

3.learn how to help him with the diet, daily exercises and other care necessary for him

4.allow the person more time to do any task

5.encourage and praise the patient to do as much as possible for himself at his own pace.

6.involve the person in family discussions and activities.

7.be encouraging and praise his daily efforts.

8.encourage the person to look at, touch, and move his affected limbs.

Do not:
----------
1.ignore him or treat him like a child .

2.encourage the person to do things using the good side only.

3.pull on the affected arm or leg as it can be extremely painful.

4.interrupt or speak up for him.

5.make discouraging remarks.

6.allow the person to squeeze rubber balls as this may tighten his hand muscles.

7.let him be depressed

8.let him develop bed sores. Try to turn his body regularly.

In order to help the person be as independent as possible, there are
special aids(such as tripod walking cane) and
appliances(wheelchairs) which can be used to help him with his daily activities.

There are also special clothes and shoes which uses velcro instead of buttons or zips.

Make the home a safe place with non-slipmats and grab bars

How to Prevent Stroke?
----------------------

Prevention of a stroke is the same as the prevention of a heart attack as both involve the avoiding the blockage or bleeding of a major artery to the brain or heart.

1.Control the Blood Pressure
Have your blood pressure checked at least once a year from the age of 40 years.
If there is high blood pressure, lifelong treatment with monthly checkups will keep it under control.

2.Control the Diabetes
Check for diabetes starting from the age of 40 years.
If there are risk factors for diabetes, screening should start earlier.
If there is diabetes, take the medicine or injections regularly.
Monitor the sugar levels daily.
Control the diet.
Check with the doctor regularly.

2.Watch Your Diet
Reduce consumption of fat, high-cholesterol food, sugar and salt.
Take more fruit, vegetables and moderate servings of carbohydrates.
Eat more beancurd, dried peas, dried beans, fish and chicken instead of red meat.
Drink low-fat milk.
Avoid full cream milk.
Avoid alcohol.
Drink less coffee, tea and cola drinks.

3.Don't Smoke
Stop smoking immediately.
Don't start smoking if you are not a smoker.

4.Physical Activity
Regular exercise is good for you.
Do moderate intensity physical activity for 30 minutes such that you sweat and breathe deeply without getting breathless.
Examples include brisk walking, swimming, cycling.

6.Learn To Relax
Have adequate rest especially when you feel tense or tired.
Take up a hobby.
Do relaxation exercises such as yoga or deep breathing exercises.
Time management is important.

A Simple Guide to Stroke

A Simple Guide to Stroke
-------------------------------

What is a Stroke?
---------------------

A stroke is also known as a cerebrovascular accident(CVA).
It happens when the blood vessel to a part of the brain is blocked(due to a blood clot) or burst.
The brain cells in that part cannot get the oxygen and nutrients so they are damaged and unable to function.

What Causes Stroke?
-------------------

A stroke occurs when:

1.there is a blockage of an artery in the brain by a blood clot, piece of fat or air bubble travelling in the blood from another part of the body.
This leads to lack of supply of oxygen and nutrients to the brain cells.
As a result the brain cells died leading to loss of function of the part of the body controlled by the brain cells.

2.there is a rupture of an artery in the brain leading to internal bleeding and damage to the brain cells.
This can be caused by high blood pressure, head injury or a weak artery wall from birth(aneurym).

3.there is compression by a brain tumour or tightening of the artery wall.

What are the risk factors in Stroke:
-------------------------------------

1.High Blood pressure-
Hypertension damages the arteries of the brain by causing bleeding or blockage

2.High cholesterol-
Cholesterol deposit thickens the walls of the arteries, making them narrow and reducing blood flow.

3.Diabetes mellitus
The high blood sugar level thickens the arteries hard and make the blood thick so that less blood is able to flow through them.

4.Heart disease
People with heart disease are more likely to have poor blood flow to the brain.
Some heart disease like atrial fibrillation can throw out blood clots which can block the blood supply of the brain

5.Obesity
A BMI of 23.0kg/m² and above increases the risk of getting high blood pressure, diabetes and stroke.
6.Smoking
Tobacco smoke narrows arteries and reduces oxygen supply to the brain.

7.Drinking of Alcohol
Alcohol can cause liver and kidney damage. increase blood pressure and affect diabetes

8.Cerebral aneurysm, tumour,cancer metastasis,
These can cause blockage and bleeding in the arteries of the brain

9.Trauma or surgery of the brain
These can cause bleeding or form blood clots in the arteries of the brain

10.Stress
Repeated stress, if poorly controlled, can lead to high blood pressure.

What is a temporary Stroke or Transient ischaemic attack(TIA)?
--------------------------------------------------------------

It is a early warning sign of a stroke .
TIA occurs when blood supply to a part of the brain is temporarily cut off causing slight damage to the brain cell.

It may last seconds to up to 24 hours.

The symptoms of a TIA are often vague and temporary:

1.temporary numbness or weakness occurring suddenly in one arm or leg or on one side of the face

2.temporary difficulty in speaking or slurring of speech

3.sudden difficulty in seeing or 'blackout' in one eye

4.temporary dizziness or fainting or loss of balance

5.Temporary confusion, poor coordination or understanding

6.unexplained headaches or a change in the usual headache pattern

Early treatment of a TIA can help prevent a stroke from occurring in the future.

What are the symptoms and signs of a Stroke?
--------------------------------------------

The affected person may have:

1.sudden numbness or weakness, usually on one side of the body,often with loss of feeling

2.difficulty in speaking or understanding

3.difficulty in swallowing

4.loss of concentration and memory

5.sudden difficulty walking

6.loss of control of passing urine or passing motion

7.behaviour changes such as laughing or crying at the wrong time, feeling depressed or showing bad temper.

8.sudden severe giddiness, loss of balance and coordination

9.sudden severe headache with no known cause

10.sudden vision loss in one eye

Treatment and caring for stroke patient will be in the Simple Guide to Stroke 2.

A Simple Guide to Hepatitis - Update

A Simple Guide to Hepatitis - Update
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Hepatitis Update:
--------------------

There are now 7 types of Hepatitis viruses: A, B, C, D, E, F, G.

The most common are Type A, B and C.

All hepatitis viruses can cause acute hepatitis.

Viral hepatitis types B, C, and D can cause chronic hepatitis.

Hepatitis B together with D has been found to cause more complications in patients than Hepatitis B alone.

New drugs like
lamivudine,
adefovir,
entecavir and
telbivudine
has been approved by FDa for treatment of hepatitis B.

Hepatitis C is now curable with the new drugs.

There are also many drugs on trial at the moment which can potentially cure HBV and HCV

A Simple Guide to Cholecystitis

A Simple Guide to Cholecystitis
--------------------------------------

What is Cholecystitis?
--------------------------

Cholecystitis is an acute or chronic inflammation of the gallbldder.

What are the causes of Cholecystitis?
--------------------------------------------

Cholecystitis is usually caused by the following:

1. obstruction of the cystic duct by a gallstone -most common cause 80-90% of cases

2. bacterial infection following obstruction in 50% of cases

3. bacterial or viral infection following gastroenteritis-
germs from gut going up the cystic duct into gallbladder.

4. chronic disease follows attacks of acute infection.

Cholecystitis is more common in
the female,
>forty years of age,
fat,
flatulent person.

What are the symptoms and signs of Cholecystitis?
------------------------------------------------------------

Persons who has Acute Cholecystitis has the following symptoms:

1.gradual onset of abdominal pain starting from the epigastrium,
moving to the right subcostal area,
may be felt in the back at the subscapular region.

2.nausea and vomiting

3.loss of appetite

4.mild fever and bodyaches

5.slight jaundice

Signs:

1.Tenderness at the right subcostal area with involuntary muscle spasm

2.Murphy Sign positive: sharp increase of tenderness at the subcostal area on palpation with thumbs pressed inwards below the ribs when the patient is asked to breathe deeply

3.Gallbladder may sometimes be felt(palpable)

In chronic Cholecystitis, there may recurrent biliary colic which may be mistaken for signs of gastritis.

How do you diagnose Cholecystitis?
-------------------------------------------

Diagnosis can usually be made by :
1.Physical examination -a positive Murphy's sign suggest Cholecystitis.

2.Plain X-rays can show the presence of gallstones in 10-15%

3.Oral cholecystogram is 95% accurate if the liver and intestinal functions are normal but may unreliable during the acute attack.

4.Ultrasound is highly reliable in showing up the presence of gallstones

5.Intravenous,transhepatic and endoscopic retrograde cholangiography may be more accurate in diagnosing the gallbladder function and stones

What is the complications of Cholecystitis?
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1.gangrene of the gallbladder due to obstruction of blood supply

2.perforation of the gallbladder due to obstruction of the cystic duct

3.cholangitis - infection of the bile duct which can lead to hepatitis and intestinal infection

What is the treatment of Cholecystitis?
-----------------------------------------------

Acute Cholecystitis:
----------------------
Admission to hospital

Gastric suction and fluid replacement

Analgesic or antispasmodic medicine usually by injection

Antibiotics for infections

Cholecystectomy -surgical removal of the gallbladder and stones now usually done through 4 holes in the abdomen.

Chronic Cholecystitis:
--------------------------
Cholecystectomy

What is the prognosis of Cholecystitis?
---------------------------------------------

Prognosis is usually good after surgery.

However some pain may persists after surgery due to scar tissue.

A Simple Guide to Burns & Scalds

A Simple Guide to Burns & Scalds
--------------------------------

What are burns and scalds?
------------------------------

A burn is skin which is damaged most commonly by

1.fire or heat.
2.chemicals,
3.electricity
4.light including sunlight
5.radiation.

A scald is a burn caused by hot liquids or steam.

How do you determine the severity of the burn?
------------------------------------------------------

The following are considered when determining the severity of the burn:

1.Degree of burn

2.Extent of the burn

3.Age of patient

4.Body region burned

5.Other illnesses and injuries

What are the degree of burns and scalds?
--------------------------------------------

First degree Burn:
----------------------

superficial injury only affecting the epidermis
The skin is red, hot and painful.
Damage is superficial and temporary.
There is no blisters.

Second degree burn:
------------------------

first layer of skin is burned through, second layer is damaged
The underlying tissues are not damaged..
The skin is red, hot, swoolen and intensely painful and there is blister formation.

Third degree Burn:
-----------------------

The full thickness of the skin is damaged including sometimes the underlying tissues.
The skin may appear pale and leathery or charred.
Because the nerves are damaged, there may not be pain.

How do you estimate the extent of the Burn or scald?
-----------------------------------------------------

The rule of nines give a rough estimate of the extent of the burn:
Each of the following represents 9% of body surface:
head and neck
each upper limb
the front of each lower limb
the back of each lower limb
the chest
the abdomen
the upper back
the lower back and buttocks

These constitute 99% of the body surface.
The remainder 1% is assigned to the genitals.

Age of the Patient:
----------------------

The infant and young child have a surface area greater in proportion to the whole body compared with a older child or adult. There is therefore more body fluid loss and more danger.

An older adult above 55 years has less ability for his tissues to heal from any burns as compared to an younger adult.

Region of body burned
----------------------

Face- burn to the face is serious because it may involve the airway or injury to the eyes.
Hands and feet - burns are also of special concern because scarring may mean loss of movement of the fingers and toes.
Groins,buttocks- burns here are particularly prone to bacterial infection
Circumferential burns- encircle the body or body part and can block circulation to the tissues distal to the burn.

Other illnesses and injuries
----------------------------

Illness such as those below can aggravate the severity of the burns and affect the healing:

Respiratory diseases
Diabetes
Heart disease
Injuries like fractures

The source of the Burn-
is also important.
A minor burn caused by nuclear radiation is more dangerous than one caused by heat.
Chemical burns are particularly more serious because the chemicals may remain on the skin and burn for hours and may enter the bloodstream causing toxic reactions.

What is the treatment for burns and scalds?
---------------------------------------------------

Superficial(first degree) burns and scalds, and partial-thickness(2nd degree) ones which does not involve an area smaller than that of the victim's palm can be treated at home:
1.Remove all jewelry and clothing at the burn area

2.Put the injured part under cold running water for a few minutes to ease the pain.
Dry by patting with a clean cloth.

3.Apply a soothing cream or lotion for scalds and burns.

4.Try not to break a blister. If a blister is already broken, apply an antiseptic lotion.

5.Painkillers may be necessary for pain.

More severe cases should be treated in a hospital:

1.the burn or scald is full-thickness (3rd degree).

2.the mouth or throat, eyes, ears, entire face or genital area is involved .

3.chemical or any corrosive substance burns.

4.electric current or lightning burns .

5.thick smoke or hot air inhalation with breathing difficulty

6.the burn or scald gets infected(fever, pus formation and increasing pain, redness and swelling).

7.partial-thickness burn affects an area larger than the victim's palm.

8.medical illnesses such as diabetes, heart attack and stroke are present

A Simple Guide to Poliomyelitis

A Simple Guide to Poliomyelitis
-------------------------------------

What is Poliomyelitis?
---------------------------

Poliomyelitis is an acute highly contagious viral illness with a wide range of severity caused by the poliovirus.
It attacks the muscles and nerves throughout the body resulting in possible permanent paralysis or death.

What causes Poliomyelitis?
---------------------------------

The polio virus is an enteric virus classified into type 1, 2 and 3 according to tissue culture.

The disease is transmitted by human contact with discharges from the nose, mouth or faeces of an infected person.

From the nose and mouth, the virus proliferates in the nose and intestinal tract.

Once in the body it can spread through the blood and lymphatic system to attack the muscles and nerves.
The incubation period is 7 -14 days.

What are the symptoms of Poliomyelitis?
---------------------------------------

There are 3 patterns of polio infection;
1.subclinical -does not involve the central nervous system(CNS),
95% are subclinical infections which go unnoticed.

2.non-paralytic-involve the CNS but without paralysis

3.paralytic -involve the CNS with paralysis.
Bulbar Poliomyelitis affects the cranial nerves affecting paralysis of the facial movement,swallowing and larynx

Sufferers of polio have the following symptoms:

1.mild cases -
headache,
slight fever,
nausea and vomiting for up to 3 days.

2.slightly more severe cases -
moderate fever,
muscle pain,
stiff neck and back
fatigue.

3.severe cases -
high fever,
muscle pain or spasms,
muscle weakness,
stiffness of neck and body muscles,
constipation,
tremor
difficulty with swallowing.
difficulty in breathing

Symptoms post-polio( after the fever subsided):
---------------------------------------------------------

1.progressive muscular weakness in muscles affected during the original infection.
Other muscles not to be affected during the original infection may also become weak.

2.Joint pain

3.extended periods of fatigue

4.Memory and concentration levels may be poorer.

5.Muscles may become smaller (atrophy) in some cases.

6.Difficulty with swallowing

7.Difficulty in breathing

8.Difficulty in walking

What are the investigation needed in Poliomyelitis?
-------------------------------------------------

1.CSF fluid-high leucocytes and protein

2.blood virological studies

What is the treatment for Poliomyelitis?
-------------------------------------------

There is no cure for polio so treatment is symptomatic.
1.Bed rest

2.antibiotics are used to treat urinary tract infections.

3.Bethanechol can help reduce urine retention.

4.Analgesics are used to reduce headaches and muscle pain.

5.Assisted breathing with tracheostomy and respirator and intravenous fluids may be required in severe cases.

How can Poliomyelitis be prevented?
----------------------------------

Vaccination against polio using oral doses or injection is recommended for all children from every month from 3rd to 5th month and a booster at 18 months of age.

Booster doses are also given at 6 years and 12 years of age.

Since immunisation with polio vaccines started, the cases of poliomyelitis has declined worldwide.

What is the prognosis of Poliomyelitis?
---------------------------------------

Majority of patients has subclinical and non-paralytic Poliomyelitis and recovered completely.

The remainder has paralytic Poliomyelitis.
Half has complete recovery in 4-6 weeks.

25% has mild disability.

The last 25% suffer severe permanent damage of muscles and nerves.
These patients are usually crippled with difficulty in walking and may need special aids such as wheelchairs,walking sticks etc to help them in their everyday life.

Mortality is in children is 1-3%.
Bulbar Poliomyelitis and adult patients have higher mortality.

A Simple Guide to Cellulitis

A Simple Guide to Cellulitis
-----------------------------------------

What is a Cellulitis?
--------------------------

Cellulitis is a condition where bacterial infection and inflammation spread through the skin and subcutaneous tissues.

What are the causes of Cellulitis?
--------------------------------

The bacteria that attack the skin and subcutaneous tissues are usually streptococci and staphylococci.
Rarely the bacteria can be clostridia.

Spread occurs as a result of
1.tissue damage

2.lower body immunity (eg, diabetes,AIDS)

3.virulence of the bacteria

What are the symptoms and signs of Cellulitis?
---------------------------------------------

1.Red painful hot and swollen skin with ill defined borders

2.Pain and tenderness on palpation

3.In anaerobic infections, crepitation may be present.

4.Pussy discharge may be foul smelling

5.Lymphangitis and lymphadenitis ma be present

What investigations are necessary in Cellulitis?
-----------------------------------------------

Wound swabs may be necessary to determine the bacteria and their resistance to antibiotics

Deep cellulitis may required Xrays and ultrasound scans to see the spread.

What is the treatment of Cellulitis?
------------------------------------

The underlying disease such as diabetes must be treated.

Cool compress may relieve local discomfort.

Analgesics and painkillers may help to relieve pain

Appropriate antibiotics may be taken orally or by skin applications.

Anaerobic infections require systemic antibiotics.

If fascilitis (infection of the fascia of muscles) is present, surgical debridement
(removal of damaged tissues and pus) is necessary.

What is the prognosis of Cellulitis?
-------------------------------------

The prognosis of Cellulitis is good with early detection and treatment.

A Simple Guide to Carpal Tunnel Syndrome

A Simple Guide to Carpal Tunnel Syndrome
-----------------------------------------

What is Carpal Tunnel Syndrome?
----------------------------------

Carpal Tunnel Syndrome is the compression of the median nerve in the carpal tunnel of the wrist.
The carpal tunnel is a ligamentous sheath which provides protection for the median nerve as it travels across the carpal bones in the wrist.

What are the causes of Carpal Tunnel Syndrome?
------------------------------------------------

Carpal Tunnel Syndrome occur as a result of pressure on the median nerve between the tranverse carpal ligament and the flexor tendons with their inflammed and enlarged synovium.

Local causes:
-------------
trauma including injury,fractures

tenosynovitis(inflammation of the tendon and their synovial sheath)

lipoma

ganglion

Systemic causes:
------------------
polyarthritis

myxedema (hypothyroidism)

pregnancy( due to fluid retention)

Amyloid disease

What are the symptoms and signs of Carpal Tunnel Syndrome?
------------------------------------------------------------

The onset is usually spontaneous with gradual increasing night pains which causes the patient to seek treatment:

1.Painful night tingling sensation of the fingers which can extend to the forearm-relieved by hanging the arm down or shaking

2.Parethesia and numbness of the index, middle and ring finger

3.Fingers feel clumsy

4.thenar muscle wasting and weakness may be present

5.impairment of light touch and pin prick sensation on the 3 middle fingers

6.women are more affected than men



What are the investigations required in Carpal Tunnel Syndrome?
-------------------------------------------

1.Physical examination

Phalen's test-
flex wrists so that the dorsal surfaces of the hands are in full contact with each other, hold for 1 min: tingling and numbness in median nerve distribution

Reverse Phalen's test(prayer Sign)-
extend wrists so that the palms of hands are in full contact like in prayer, hold for 1 min: tingling and numbness in median nerve distribution

Tinel's test -
tap volar surface of the wrist:tingling means positive test

2.EMG - electromyography to test movement of the muscles

3.Nerve conduction tests on median nerve

What is the treatment of Carpal Tunnel Syndrome?
-----------------------------------------------------

1.Treat underlying conditions such as myxedema, polyarthritis,amyloid

2.diuretic in mild cases and those present in pregnant women

3.NSAIDS may reduce inflammation.

4.wrist splintage in extension

5.injection of the carpal tunnel with corticosteroid (avoiding the carpal nerve)

6.Surgical decompression by division of the transverse carpal ligament.
Results are usually good.

A Simple Guide to Balanitis

A Simple Guide to Balanitis
----------------------------------

What is Balanitis?
----------------------

Balanitis is an infection of the glans and prepuce of the penis.

What are the causes of Balanitis?
---------------------------------------

It can occur because of:

1. Sexually transmitted bacterial diseases such as gonorrhea, chlamydia, candidiasis.

2. Viral diseases like genital herpes

3. Parasitic infection such as trichomoniasis

4. drug allergy and eruptions

5. Contact dermatitis,psoriasis,lichen planus,seborrheic dermatitis

6. collagen disease (Reiter's syndrome)

7. phimosis

What are the symptoms of Balanitis?
--------------------------------

1. Itchiness of the glans and prepuce with scratch marks

2. Pain and burning sensation on passing urine

3. Subpreputial(below prepuce) discharge 2-3 days after intercourse in venereal disease

4. Oedema of prepuce

5. Ulceration of the glans

6. Blisters or rashes in genital herpes

7. enlarged inguinal lymph nodes

How do you diagnose Balanitis?
--------------------------------------

Physical examination.

Blood tests for venereal disease and glucose

Urine for sugar and leucocytes

What is the treatment of Balanitis?
-----------------------------------------

1. Antibiotic

2. Hygience

3. Treat underlying cause. (eg Diabetes)

4. circumcision

What is the prognosis of Balanitis?
------------------------------------------

Prognosis is good.

Sometimes the disease may recur due to underlying causes.

Circumcision will cure any balanitis due to phimosis

A Simple Guide to Anal fissure

A Simple Guide to Anal fissure
-------------------------------------

What is Anal fissure?
--------------------------

Anal fissure is a superficial linear tear at the edge of the anus.

What are the causes of Anal fissure?
-------------------------------------------

Anal fissure occur after a tear in the posterior midline of the anus caused by the passage of hard large stools and constipation.

The tear is covered by a sentinel skin tag at the lower end(sentinel pile).

The tear may occur at any age but are more common in young children and pregnant women.

Sometime the tear may occur at the anterior midline of the anus.

What are the symptoms and signs of Anal Fissure?
------------------------------------------------------------

Symptoms:

1.Pain during and after passing motions

2.Serous discharge from tear

3.Itch (pruritis ani)

4.blood streak on stools

Signs:

1.sentinel skin tag covering a posterior midline tear of the anus

2.spasm of the anal sphincter

3.perianal infection

What are the investigations required in Anal fissure?
---------------------------------------------------------------

1.Digital examination of the anus

2.Proctoscopy to exclude piles

3.Sigmoidoscopy may be required in adults.

What is the treatment of Anal fissure?
----------------------------------------------

1.Stool softener

2.low residue diet

3.Avoid constipation -take more fruits and water

4.Give painkiller if necessary

5.Apply anti-itch cream

6.Use antibiotic cream if there is evidence of perianal infection

A Simple Guide to Appendicitis

A Simple Guide to Appendicitis
-------------------------------------

What is Appendicitis?
--------------------------

Appendicitis is an infection of the vermiform appendix, a small elongated appendage at the base of the caecum.

What are the causes of Appendicitis?
-------------------------------------------

Appendicitis may occur after:

1.obstruction of the lumen of the appendix by fecalith(small hard faeces), foreign body(eg. seeds), kinking

2.inflammatory oedema of the mucosa

3.infection of the intestine(eg. E. coli) spreading to the appendix

What are the symptoms and signs of Appendicitis?
-------------------------------------------------------------

Symptoms:

1.Pain occurs in the navel region, then moves down to right lower quadrant(McBurney's point-one third from right pelvic protrusion and two thirds from the navel)

2.nausea and vomiting

3.mild fever

4.often a history of constipation, rarely diarrhea

5. loss of appetite

Signs:

1.tenderness,guarding and rebound pain at McBurney's point

2.Positive Psoas and obturator sign in some cases

3.leucocytosis - mainly polymorphs

4.Palpable mass felt at McBurney's point may indicate presence of appendicular
abscess

5.rectal examination may show a palpable tender swelling at the right iliac fossa

What are the complications of Appendicitis?
-------------------------------------------

1.Perforation of the untreated inflammed appendix causes pus to spill into the abdominal cavity

2.Peritonitis(inflammation of the the whole of the internal abdomen) may occur as a result of a ruptured inflammed appendix

3.Septicemia may result from the bacteria entering the blood.

Death may occur in untreated peritonitis and septicemia.

What is the treatment of Appendicitis?
---------------------------------------

All confirmed appenicitis should be treated by surgical removal of the inflammed appendix.

Following surgery, antibiotics are given either intravenously or orally.

What is the prognosis of Appendicitis?
----------------------------------------------

1.Excellent with appropriate surgical intervention

2.Abscesses which developed and are surgical drained and treated with antibiotics recovered rapidly.

3.Peritonitis and septicemia treated early by surgery and antibiotics usually recovered.

Finally there is no such condition such as chronic Appendicitis.
All Appendicitis cases are acute.

A Simple Guide to Diabetes Part 2

A Simple Guide to Diabetes Part 2
----------------------------------------

What is the treatment of Diabetes?
-----------------------------------------

Control of Diabetes
-----------------------

Diabetes is a chronic disease which cannot be cured.
It can be controlled to prevent the development of the above serious complications by :
Living a healthy lifestyle
--------------------------
1.diet -

Reduce your intake of sugar and sweet food
Increase intake of more high fibre and wholegrain food like brown rice, wholemeal bread and oats
Take food with less fat content like lean meat, fish, skinless poultry and low fat milk
Have at least 2 servings of vegetables and 2 servings of fruits a day
Use healthier methods of cooking such as grilling and steaming rather than deep frying and use less salt and sauces
Take multiple (4-6) small meals a day that contains enough complex carbohydrates (e.g. rice), some lean meat or fish and vegetables.
Have regular meals and avoid skipping meals
Do not overeat

2.regular exercise-

This helps your body to use glucose more efficiently
Frequency: 3-5 days per week(daily if low intensity)
Intensity: 60-85% of maximum heart rate till the patient feels warm or sweats and breathes deeply but easily
Time: 20-60 mins each time
Type: aerobic exercises like walking, jogging, swimming, cycling

For those who have not been active for some time should start with walking first, then increase to more active exercises

3.weight control -

lose extra body weight by proper dieting and exercise
Aim for half kg loss per week
Aim for a BMI of 18.5-22.9kg/m2

Insulin works better in a lean healthy body.

4.Avoid smoking-

smoking increases all the risks associated with diabetes

5.Avoid stress -

by meditation, yoga, deep breathing exercises

Medication for Diabetes
-----------------------------

1.oral tablets:

a. Insulin secretagogues - drugs that increase insulin release from pancreas

eg. glibenclamide, repaglinide
Side effects: low blood sugar

b.Insulin sensitisers- drugs that make insulin work better especially in muscles and liver
eg.metformin
side effects: gastric discomfort, metallic taste in mouth
eg. rosiglitazone
side effect: water retention

c. Alpha-glucosidase blocker -slows digestion of carbohydrates in the intestine

eg. acarbose
side effect: stomach discomfort, bloating, diarrhea

If the oral medicines even in combination cannot bring down the blood sugar, the insulin injection may be required either alone or together with oral medication.

2.insulin injections

Insulin is destroyed in the stomach so it cannot be taken orally and has to be given as an injection.
Best place to inject the insulin is in the abdominal area where there is a lot of subcutaneous fat.
Avoid 2 fingers around the navel and below the rib cage where there is a rich nerve supply and therefore more painful.
Injection is usually done in the morning and evening.
Night injection controls the glucose when the patient sleep and avoid early morning high glucose.

a.Rapid and short acting insulin

eg. regular soluble insulin
onset 30-60min, peak 2-4 hrs, duration 6-8 hrs

b.intermediate and long acting insulin

eg. NPH insulin
onset 1-4 hrs, peak 8-12 hrs, duration 12-20hr

c.premixed or biphasic insulin

eg. NPH/regular 70/30
more convenient and less injections

Important hygience tips:

Use needles once only
Mix well by shaking bottle or injection pen 20 times
Store all unused insulin in fridge(will keep until expiry date).
Do not freeze insulin.
Insulin in use can be kept at room temprature away from sunlight and direct heat and must be discarded 4-6 weeks after use

Follow the instructions very carefully and keep detailed records of your treatment.

Home blood glucose monitoring
--------------------------------------

1. monitor your progress with the help of your daily home blood glucose records.
Monitor;
a. before and after meals
b. before and after exercise
c. when feeling giddy to confirm low blood glucose
d. when sick and not eating well

Type 1 diabetes should be monitored 3-4 times a day

Type 2 non-insulin diabetes 1-2 times a day followed by 1 every 2-3 days

Type 2 insulin diabetes 2-3 times a day followed by 2-3 days a week.

Pregnant diabetic patient should also monitor their blood glucose daily

Aim for a Fasting Blood glucose 4.0 -7.0mmol/l
Blood HbA1c 4.5 -7.0

This will check if your diabetes is under control.

If not, you need more medicines or further change in diet.

High blood pressure and high blood cholesterol level
---------------------------------------------------------------

Reducing high blood pressure and high cholesterol level help to keep diabetes under control and protect against its complications.

Aim for a blood pressure of 130/80 or less
LDL cholesterol of 2.6mmol/l

Regular checkups is important in the treatment of Diabetes
-----------------------------------------------------------------------

1. Regular monthly checkups for diabetes until fully controlled, bimonthly after that.

2. Check for hypertension and heart disease at the same time

3. Check for high blood cholesterol once a year.

4. Check eyes once a year.

5. Check for kidney problems at least once a year.

6. Check teeth once a year

7. Check you feet for signs of infection, gangrene and neuropathy.

Foot care:
-------------

1. wash feet daily with soap and water
2. After washing ,dry thoroughly especially betwwen the toes
3. keep yor toe nails short,trimming them straight across to avoid ingrowing toenails
4. moisturise feet daily to prevent dryness and cracking of skin
5. examine feet daily for scratches, cuts, blisters and corn
6. use a mirror to check the sole of your feet
7. wear shoes that fit well and wear clean cotton socks which has loose fitting elastic tops
8.Avoid going barefoot
9.Seek prompt treatment for cuts and sores
10.annual review for foot ulcers,risk of neuropathy(poor sensation), blood circiulation( palpable pulses)

Health education
---------------------

It is important to increase your knowledge of diabetes and its complications.

With knowledge, diabetes can be more easily controlled.

A well controlled diabetic patient can live a normal life.

A Simple Guide to Diabetes Mellitus

A Simple Guide to Diabetes Mellitus
-------------------------------------------


What is Diabetes?
---------------------


Diabetes mellitus literally means sweet urine.
It is a common chronic disease which happens when the hormone insulin produced by the pancreas is missing, lacking or not working well.


Insulin unlocks the cell to allow glucose from the bloodstream to enter the body cells for usage or storage.
When this mechanism fail, the high amount of glucose in the blood leads to the glucose being spilt over into the urine, causing diabetes.


What are the different types of diabetes?
-----------------------------------------


The main types of diabetes are
1.Type 1
2.Type 2.


Type 1 occurs commonly in children and young adults although it may occur at any age.
It is more serious because there is practically no insulin produced due to damaged pancreatic cells and therefore insulin injections is needed for treatment.
The cause is unknown.
Complications are more sudden and life-threatening.

Type 2 is more common.
It is found in
1.adults over 40 years old,

2.overweight and

3.physically inactive.


The insulin produced is not enough or may not be working effectively.
Type 2 diabetes can be controlled by proper dieting and exercise.
Most Type 2 diabetics will also need oral medication.


Gestational diabetes occurs only in pregnancy but may be an indicator of diabetes later in life


What are the risk factors for diabetes?
----------------------------------------------


Diabetes is more likely to occur if you have:


1.Obesity (body mass index > 23)

2.family history of diabetes

3.hypertension (>140/90 mmHg)

4.previous gestational diabetes

5.Coronary heart disease

6.polycystic ovary disease

7.Hyperlipidemia(high blood cholesterol >5.2 mmol or 220mg/dl and
tryglycerides >2.30)

8.Inadequate regular exercise

9.age above 40 years,more common in males than females

10.smoking habit

What are the Signs and Symptoms of Diabetes?
-------------------------------------------------------


The following symptoms are typical of diabetes:


1.frequent thirst even after drinking lots of water


2.passing more frequent urine during day and night


3.weight loss while having good appetite


4.constant tiredness


5.poor healing of skin wounds

6.itchy skin particularly around the genital area


7.constant hunger


8.blurred vision

Note that some diabetics may not experience any symptoms at all.

How do you made the diagnosis of Diabetes?
----------------------------------------------------

Blood glucose test:

1.Random blood glucose (anytime) is 11.1mmol/l or higher


2.Fasting blood glucose (after 8 hours of overnight fast) is 7.0mmol/l or higher.


3.Oral 75g Glucose Tolerance Test show presence of diabetes


How does diabetes cause complications in the body?
--------------------------------------------------------------


The high blood glucose concentration in diabetes reduces the blood flow to many organs and nerves resulting in many organ damage especially the kidney, heart, brain, eyes and nerves.

The high blood glucose allows germs to proliferate because the glucose provides nutrition to the germs.


All these lead to many serious complications:


1.high blood pressure,

2.heart attack,

3.stroke,

4.kidney failure,

5.blindness,

6.impotence,

7.numbness of hands and feet,

8.infections with poor healing,

9.wounds on feet that do not heal

10.coma,

Treatment of Diabetes will dealt with in the Part 2.

A Simple Guide to Beestings

A Simple Guide to Beestings
----------------------------------

What are beestings?
--------------------------

Beestings include stings by different bees, wasps and hornets.
The most common sting is by the common honeybee.
Usually the bee stings the patient skin, leaving its stinger behind and dies.

What are the symptoms of Beestings?
-------------------------------------------

1. stinger left on the skin

2. pain and mild discomfort may last a few hours

3. swelling of the skin at the sting site in sensitive patients reacting to the venom of the sting

4. itch at the site may lasts for a week

The main component of bee venom responsible for pain is the toxin melittin.
Histamine and amines in the beesting contribute to the pain and itching.
Most beesting are acidic in nature.

What is the treatment of Beestings?
------------------------------------------

1.Remove the barbed stinger.

2.Apply cold compress to reduce pain and swelling.

3.Use baking soda solution to conteract the acid.

4.Give paracetamol and antihistmines for pain and itch

For more severe reactions such as allergy and anaphylactic shock to the beestings, emergency treatment may be required:

1.Give adrenaline injection subcutaneously slowly over a minute peroid
followed by

2.antihistamine like diphenhydramine intravenously

3.Treat shock

4.Corticosteroids may be needed to counter allergy

Multiple beestings may cause severe reaction with shock and hemaglobinuria.
This may require hospitalisation.

Multiple beestings have been known to cause the kidneys and vital organs to shut down and should be treated urgently.

A Simple Guide to AIDS

A Simple Guide to AIDS
----------------------------

What is AIDS?
------------------

AIDS is an acronym for Acquired Immune Deficiency Syndrome which is the final and most serious stage of HIV.

HIV stands for the Human Immunodeficiency Virus which can dause a person infected with it up to 10 years to develop AIDS.

There are actually 2 types of HIV virus:
HIV-1 is the source of the majority of HIV infections throughout the world.
HIV-2 is not as easily transmitted and is mainly found in West Africa.

How is HIV transmitted?
------------------------------

HIV is transmitted by:

1.unprotected sexual intercourse with an infected person(semen,vaginal fluid)

2.the usage of HIV-tainted needles

3.from a mother to her baby during pregnancy and birth, also during breastfeeding

4.receiving infected blood and blood products

What is the danger of HIV?
-------------------------------

The HIV infection destroys CD4 (T-cell) lymphocytes and thus weakens the body's immune defences.

The T-cells are white blood cells which helps to protect the body from bacteria, viruses, fungi and parasites.

If the T-cells are destroyed or weakened, they are less able to defend the body effectively against infections.

Having HIV also increases the risk of getting cancers.
The HIV virus can attack every organ of the body.

AIDS which is the terminal stage of HIV infection is fatal.

Once you reach this stage, the person usually dies 1-3 years from various infections and cancers.

What are the symptoms of HIV?
--------------------------------------

Usually, a HIV-infected person may not notice any symptoms.
However, the following symptoms may be experienced subsequently:

1.fever,chills

2.Loss of weight

2.sore throat

3.muscular stiffness or aches

4.headache

5.diarrhoea

6.swollen lymph glands

7.fatigue

8.rash of various types

9.joint pain

WHO Classification Of HIV:
---------------------------------

Stage I: HIV infection is asymptomatic and not categorized as AIDS

Stage II: includes minor mucocutaneous manifestations and recurrent upper respiratory tract infections

Stage III: includes unexplained chronic diarrhea for longer than a month, severe bacterial infections and pulmonary tuberculosis

Stage IV: includes toxoplasmosis of the brain, candidiasis of the esophagus, trachea, bronchi or lungs and Kaposi's sarcoma;
these diseases are indicators of AIDS.

How do you test for HIV?
-----------------------------

Blood test for HIV Antibodies.
A negative result does not necessary mean you do not have HIV.
There is a window period of 3-6 months sometimes before the HIV antibodies show positive results.
When a test shows positive results, the blood is retested at a CDC(Communicable Disease Centre) which is able to test more specific tests for HIV.(Western Blot HIV Confirmatory Test)

Rapid HIV testing throgh oral swabs is now offered in some medical clinics.
These tests produce very quick results.
In approximately 20 minutes you may be able to know your HIV status.

New tests for HIV includes HIV-DNA and HIV-RNA testing.

Is there a cure for HIV or AIDS?
-------------------------------------

At the present moment there is no cure for HIV or AIDS.

Treatments which can improve the patient’s immune system and prevent the onset of AIDS however are available:

1.Reverse transcriptase (RT) inhibitors:
This first group of drugs approved to treat HIV infection act by preventing the replication of the HIV virus.
The HIV virus is unable to spread in the body so easily and less secondary infection may attack the body.

2.Protease inhibitors:
This second class of drugs act by stopping the replication of HIV at a later stage in the cycle.

3.Combination or cocktail therapy (using two or more drugs together) is preferred in case the HIV virus becomes resistant to both classes of drugs.

4. Some new methods involve the use of thalidomide, antimalarial and Anti-TB drugs

5. A cure For HIV will be to produce a vaccine against the HIV virus.

How can I protect myself from HIV infection?
-----------------------------------------------------

Some preventive measures are:

THE ABC method of prevention:
------------------------------------
Abstinence or delay of sexual activity, especially for youth,
Being faithful, especially for those in committed relationships,
Condom use, for those who engage in risky behavior.

The CNN method of prevention:
-------------------------------------

Condom use, for those who engage in risky behavior,
Needles, use clean ones,
Negotiating safer sex with a partner and empowering women to make smart choices

World AIDS day is on 1st December every year.

A Simple guide to Diphtheria

A Simple guide to Diphtheria
------------------------------------

What is Diphtheria?
-----------------------

Diphtheria is an acute, infectious childhood disease of the respiratory tract caused by the bacillus Corynebacterium diphtheriae, a Gram positive, non-sporulating aerobic micro-organism.

How is Diphtheria transmitted?
--------------------------------------

Diphtheria is transmitted by droplets from the throat of infected patients or clothes soiled by discharges from the patients.
It is highly infectious.
Incubation period is 2-4 days.

The organism multiplies in the upper respiratory tract, secreting toxins which produce necrosis and fibrinous exudate.
This fibrinous exudate can form a leathery membrane which extends through the throat, tonsils, nasopharynx, larynx and trachea.
Through the blood, the toxin can spreadto the heart, nervous system and kidneys. Infections may also be localised in wounds in the skin,conjunctiva and rarely the vagina.
The infections occur in persons of all ages.

What are the Signs and Symptoms of Diphtheria?
----------------------------------------------------------

The incubation peroid is usually 2-4 days after contact with an infected patient.

Symptoms start off with:
1. sudden onset of malaise

2. mild fever

3. sore throat

4. Thick white or grayish tonsillar exudate

5. Membrane may spread to nasopharynx

5. cervical lymphadenopathy

6. difficult breathing

7. respiratory stridor,

8. hoarseness of voice

9. brassy cough

10.dilirium and coma

What are the complications of Diphtheria?
---------------------------------------------------

The worst affected are children below the 1 year old.

Some serious complications are:
1.myocarditis

2.cranial nerve paralysis, especially the soft palate and oculomotor nerves

3.peripheral neuritis

4.laryngeal obstruction

5.death can occur if there is obstruction to breathing.

Serious complications are less with older children or adults.

Adults rarely get Diphtheria because their immunity from vaccination usually last 10 years after the last dose.
When adults get Diphtheria, there is only slight inflammation with little or no exudates.

What are the investigations necessary to diagnose Diphtheria?
--------------------------------------------------------------------------

Pharyngeal and nasal swabs for culture in Loeffler medium
Methylene blue stain of membrane

What is the Treatment of Diphtheria?
--------------------------------------------

Isolation in hospital is necessary.

1.Antibiotics (erythromycin or Penicillin) are used in the treatment of Diphtheria.

2.Antitoxin can be given by intramuscular or intravenous injection

3.Intravenous fluids given for dehydration

4.Tracheostomy if breathing obstruction is bad

5.Oxygen therapy in cases of breathing difficulty

6.Cardiac failure should be treated


Besides antibiotics, the following will help:
Steam inhalation
cough mixtures
avoid smokes, dust, dry air,sudden temperature change

What is the Prevention for Diphtheria?
-------------------------------------------------

Vaccination against Diphtheria is the best prevention .
Since vaccination began, the worldwide incidence of Diphtheria has declined.

Vaccination against diphtheria, pertussis (whooping cough), tetanus (DPT) is usually given to a baby at 3 months of age and repeated at 4 and 5 months of age.

There is also a booster vaccination at 18 months.

What is the prognosis in Diphtheria?
-------------------------------------------

Death occurs in 10% of cases.

Mortality is highest in children under 10 and adults over 50.

One attack usually confers immunity.

A Simple Guide to Hiccups

A Simple Guide to Hiccups
-------------------------------

What is Hiccups?
---------------------

Hiccups is a symptom, not an illness.
It is the sound produced in the throat when the epiglottis flip backwards during a sudden involuntary contraction of the diaphragm

What are the causes of Hiccups?
--------------------------------------

Hiccups is initiated when a sudden involuntary movement of the diaphragm( the large muscle separating the chest from the abdomen)causes a sudden drop in air pressure in the lung.
Air rushes in through the mouth to enter the lungs.
As it rushes in , it causes the epiglottis(the valve that closes the windpipe during swallowing or drinking) to flip backwards causing the hiccup sound.

Hiccups may occur when :
1.a full stomach pressing against the nerve to the diaphragm causing an involuntary contraction of the diaphragm

2.hasty swallowing of food or air which distends the stomach and causes it to press against the nerve to the diaphragm.

3.unexplained unregulated nervous activity of the diaphragm

Most hiccups are harmless and last for a few hours to 1 day.
Some hiccups have known to last for years.

What are the treatment of Hiccups?
-------------------------------------------

1.holding the breath as long as possible and repeating it several times.
Holding the breath may prevent air from rushing into the lungs through the epiglottis.

2.breathing into a paper bag until the hiccup stop (usually within 3 minutes).
Breathing into a paper bag cause accumulation of carbon dioxide in the air in the bag.
The increased level of carbon dioxide in the blood may slow down activity of the part of the brain controlling the diaphragm hence causing the hiccup to stop.

3.Drinking a whole glass of water without stopping at one time.
This has the same effect as holding the breath because you cannot drink and breathe at the same time.

4.Taking medications such as an anti-epileptic or anti-spasmodic may be able to stop the hiccups by stopping the contraction of the diaphragm.

A Simple Guide to Typhoid Fever

A Simple Guide to Typhoid Fever
---------------------------------------

What is Typhoid Fever?
---------------------------

Typhoid Fever is an acute febrile illness caused by the Salmonella typhi bacteria.

What is the cause of Typhoid Fever?
-------------------------------------------

The bacteria which causes Typhoid Fever is the Salmonella typhi which is an extremely hardy bacteria able to live in polluted water, contaminated food and soiled clothes.
Oral ingestion of the bacteria leads to penetration of the small bowel mucosa and rapid spread to lymphatics, lymph nodes and blood stream.
Once it entered the bloodstream, fever occur.
It then enters the spleen, liver and gallbladder and penetrates into the mucosa of the rest of the intestine, causing thinning of the walls of the bowels.
Incubation period is 5-10 days.

What are symptoms of Typhoid Fever?
----------------------------------------------

The main symptoms of Typhoid Fever are
1. Fever which becomes higher and higher like a step ladder

2. headache

3. abdominal pain

4. green pea soup type of diarrhea

5. enlarged spleen and liver

6. delirium and disorientation from high fever and dehydration

7. lassitude and tiredness

8. rose spots rash on the body

Symptoms usually appear within 5-10 days after exposure to the germ and last for 3-4 weeks.

How is Typhoid Fever transmitted?
------------------------------------------

Typhoid Fever can be highly contagious.
The germs are commonly transmitted by food handlers who are typhoid carriers.
People can get the germs from contaminated food and drinks.

How is the diagnosis of Typhoid Fever made?
-----------------------------------------------------

Doctors generally diagnose Typhoid Fever based on the symptoms and a physical examination.
Confirmation is by blood tests(Widal test), blood and stool cultures.

What are the complications of Typhoid Fever?
-------------------------------------------------------

Typhoid Fever is a disease which can kill especially through its complications:
1.Intestinal hemorrhage

2.Intestinal perforation

3.Cholecystitis

4.dehydration especially in young children and the very old patients

How is Typhoid Fever treated?
-------------------------------------

Thypoid is an infectious disease which can spread to other people through soiled clothes, contaminated food.
It is therefore advisable to quarantine the patient in hospitals.

Antibiotics is the main treatment against typhoid.
The best antibiotic is chloramphenicol but because of its side effects of aplastic anemia it should be avoided especially in pregnant women and young children.
Other antibiotics used are septrin(co-timoxazole) and ampicillin.
Antibiotics should be continued for at least 2 weeks.

Symptomatic treatment includes:
1.Paracetamol for relief of fever and headache
Aspirin is to be avoided to prevent intestinal bleeding.

2.antispasmodic drug to stop abdominal cramps

3.medicine to harden the stools such as kaolin

4.slow down the intestinal movement (lomotil or loperamide).

Prompt treatment may be needed to prevent dehydration:
Dehydration can be caused by diarrhea, excessive sweating from the high fever, or by not drinking enough fluids because of loss of appetite.
Mild dehydration can be treated by drinking liquids.
Severe dehydration may require intravenous fluids.
Untreated severe dehydration can be life threatening especially in babies, young children and the elderly.

Gradually reintroduce food, starting with bland, easy-to-digest food, like porridge or soups.
Get plenty of rest.

Complications such as intestinal perforation may require surgical treatment.

How is Typhoid Fever prevented?
----------------------------------------

Prevention of typhoid is usually by vaccination of all food handlers and staff working in restaurants.

Food handlers should always wash their hands after going to the toilets and before cooking food.
They should always wear gloves when handling or cooking food.

Treatment of chronic typhoid carriers with antibiotics such as ampicillin for 6 months and removal of gallbladder which may harboured the bacteria.

You can avoid infection by:
Avoid eating or drinking foods or liquids that might be contaminated

Good food hygience

A Simple Guide to Athlete's Foot

A Simple Guide to Athlete's Foot
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What is Athlete's Foot
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Athlete's Foot is a common disease caused by superficial fungi infection affecting the webs and toes of the foot

What is the cause of Athlete's Foot?
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A group of fungi called dermatophytes thrive in the warm, moist environment of webs and toes of the feet caused by trapped sweats and the closed environment of the shoes.
They grow on the keratin a protein found in hair, nails and skin.

Fungal infection is mildly contagious and can spread by direct contact with the infected skin cells found on socks and other clothing.

What are the Symptoms of Athlete's Foot?
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Symptoms are:
1.Unpleasant foot odour.

2.Small itchy blisters on the soles of the feet.

3.Itchy, scaly, red rash usually in the webs of the toes.

4.cracked, blistered skin of the toes and nails

5.Dry scaly skin on the soles.

What are the complications of Athlete's foot?
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Secondary bacterial infections with cellulitis, lymphangitis and lymphadenitis may occur especially in diabetic patients.

What is the Treatment of Athlete's Foot?
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1.Antifungal powder, creams and oral medicines

2.basic good foot hygiene
It is important to prevent the fungal infection from spreading.
Avoid scratching of the infected area as this will cause the fungi to spread to other areas.

Dry the feet thoroughly after bathing and before sleep.

Socks or stockings should be changed daily.

Anti fungal powder may be placed in socks before wearing.

Clean and air shoes.

Even after treatment and clearing of the fungal infection, recurrence of the infection may take place because of the presence of spores of the fungus under the skin.

The spores are very resistant to treatment and only when they germinate to the mycelia stage, the fungus can be eliminated through the anti fungal creams, ointment, powder or oral medication.

The antifungal creams must be applied each time there is wetness or trapped sweat so as to get rid of the germinated spores.

Once the spores are completely removed from the skin, then you can be sure that the fungal infection will be unlikely to recur.

Treatment may take up to 6-8 weeks before the fungal infection disappear.

A Simple Guide to Menopause

A Simple Guide to Menopause (Part 2)
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How to Treat the symptoms of Menopause?
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In most cases of menopause, no treatment is necessary as it is a normal physiological event.
It is important that there is reassurance and psychological support from family and friends.
Menopause may mean the end of fertility but it also means the freedom from all the discomfort and inconvenience of monthly menstruation and fear of pregnancy.

Hormone replacement therapy used to be the best solution for all the symptoms and problems of menopause at one time.
They help to prevent heart disease and osteoporosis as well as to reduce the symptoms of menopause such as hot flushes, skin , breast and vaginal changes.
Oestrogen and progesterone are the two types of female hormones prescribed for and after menopause.
A combination of the two hormones is taken, as progesterone helps to protect the uterus from endometrial cancer.
If the woman have had removal of the womb, she will normally be given only oestrogen.

HRT can be taken as pills as a single oestogen tablet or as combination of oestrogen and progesterone.
Besides tablets, female hormonal patches, implants or vaginal creams can be used to help replace the level of hormones in the menopausal women.

There are benefits to the use of HRT:

1.Relieves hot flushes
2.reduce vaginal dryness.
3.Prevents osteoporosis and protects against fractures.
4.Indirectly improves mood symptoms by relieving the physical discomfort of menopause.
5.Safe for short term use.

There are also risks in using HRT:

1.increase risk for breast cancer for long term users (>5 years).
2.side effects such as vaginal bleeding, nausea, hair loss and headaches.
3.cause PMS (Pre-Menstrual Syndrome) symptoms such as bloating or irritability.
4.cause venous thrombosis due to increased coagulation of blood.

Hormone replacement therapy has recently fell out of favour due to new study which indicate higher incidence of breast and womb cancer taking HRT over a 5 year period.
It is still prescribed more as a single oestrogen tablet rather than a combination pill of oestrogen and progesterone.
Selective estrogen receptor modulators(SERM) like Evista has been used to replace HRT with good effect.
Plant based female hormones has also being used to reduce the symptoms of menopause. Alternative medicines like evening primrose oil has also been used.

For premature menopause where symptoms of menopause are more obvious due to their age, hormone replacement therapy is still given at intervals of 6 to 12 months.

Besides hormonal therapy, medicines such as:
1200mg of calcium daily
800 to 1000 IU of vitamin D daily
may be able to help prevent osteoporosis.

The current treatment for the symptoms of menopuse in the older women are:
1. A healthy life style.
Exercise
Regular exercise strengthen the muscles and bone.
Exercise also burns up calories to reduce obesity and hence prevent diabetes, hypertension and heart disease.
Walking is one of the best weight-bearing exercises to prevent osteoporosis.
Swimming and dancing are also good exercises.

Eat a balanced diet
A good balanced diet helps to prevent obesity, diabetes, osteoporosis, heart disease and colorectal cancer.
More fruit and vegetables will help reduce calories and prevent colorectal cancer.
Foods rich in calcium and Vitamin D such as fish, low fat high calcium milk can prevent osteoporosis.
Alcohol, coffee, tea, canned drinks should be avoided.
Less sugar, salt and saturated fats will reduce the risk of diabetes,hypertension and heart disease.

Control Stress
Medititation, yoga, deep breathing exercises and sufficient sleep reduces stress and heart disease.
Community service work, hobbies, time with family take the mind off work and stress.

Stay smoke-free
The risk of heart disease, lung and cervical cancer can be reduced by not smoking.

2.hot flushes:
Cool showers and cool tempreatures may help to reduce hot flushes.
Hot beverages and spicy foods should be avoided.
Thin cotton clothes are more comfortable.
Drinking a glass of cold water, loosening any tight clothing and using a small fan to cool down can stop the beginning of a hot flush.
Soy products like tofu and soya bean burns up less calories.
Meditation and mild exercise may also help by reducing stress.
hormone replacement therapy (mainly oestrogen) for a short peroid may be used as a last resort.

3.vaginal changes
Water-soluble vaginal lubricants can reduce dryness.
Oestrogen replacement creams may be prescribed to reduce the vaginal discomfort.

4.incontinence:
Doing simple pelvic floor exercises will strengthen the muscles surrounding the sphincter of the bladder opening.
Wearing a pad in the underwear may reduce the discomfort due to leaks.
Injection of collagen sometimes work to tighten the sphincter of the bladder opening.
Surgery to tighten the muscles of the bladder opening may be used as a last resort.

5.mood changes:
Many women going through menopause may become irritable,anxious or depressed.
Learn how to relax and make time for yourself.
Exercise is good for your health as it keeps your mind off emotional problems!
A hobby or volunteer work that you enjoy may take your mind off your symptoms.
Build up a good support system through talking with friends or a professional counsellor.

6.Osteoporosis:
A balanced diet with adequate calcium and active lifestyle can prevent development of osteoporosis:

Women who are at higher risk are those who
had early menopause or have ovaries removed
have a family history of osteoporosis
have a diet low in calcium and Vitamin D
smoke
are not physically active
are on steroids for long term (E.g. asthmatics)
drink coffee, tea or alcohol regularly
have certain disease such as an overactive thyroid gland

7.Breast Cancer
It is the most common cancer in menpausal women in their 50s.
Early detection by doing monthly breast self examination and a mammography once a year in your 40s and once every two years after age 50 is the best prevention.

8.Cervical Cancer
Cervical cancer is another common cancer among women.
It can be prevented by going for regular Pap smear tests.
Pap smear tests for cervical cancer once every 3 years from age 25 to 65 years if sexually active.
Pap smears can detect precancer so that early treatment can prevent full blown cancer.

9.Regular check-ups
Early detection and checkup can prevent complications such as heart disease and stroke.
A yearly blood pressure with blood sugar and blood cholesterol once every 3 years help to check for danger of heart disease and stroke.

Stay active and be confident about the future.
Take care of your health and personal appearance so that you both look and feel good.

Menopause marks a new Chapter in your life
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While menopause marks the end of fertility, it is NOT the end of health, or a satisfying and enjoyable life. Menopause means freedom from the inconvenience and discomfort of monthly menses.

Every Woman Goes Through Menopause
Knowledge about menopause is important so that you know what to expect.

Most women welcome the cessation of periods.
Others may feel a sense of loss that their childbearing ability is gone.
By understanding the physical and emotional changes of menopause, more women are able to cope with life in the golden years.