A Simple Guide to Dengue Fever

A Simple Guide to Dengue Fever
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What is dengue fever?
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Dengue fever is a acute viral infection caused by the dengue virus which is transmitted by the bite of an infected female Aedes msoquito.

What are the Types of Dengue Fever?
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The dengue virus has 4 strains called serotypes 1, 2, 3 and 4.

An infection with one serotype does not protect you from the other serotypes.

A second dengue infection, especially with serotype 2, can cause an even worse infection such as Dengue Haemorrhagic Fever and Dengue Shock Syndrome which can be fatal.

What are the Symptoms of Dengue Fever?
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The incubation period in mosquito is 8-12 days and 3-14 days in humans.

Symptoms usually last 3-14 days.

1.High, acute, prolonged fever (usually lasts for 5 to 7 days)

2.Severe headache

3.Pain behind the eyes

4.Muscle and joint pains

5.Rashes

6.Nausea , vomiting

7.Abdominal discomfort

8.Loss of appetite

9.Fatigue

10.Diarrhoea

A rash usually appears 3-4 days after the fever.

There are 3 types of dengue rash.

1.Petechial Rash:
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This is the most common with the petechial rash appearing as red dots under the skin.
The rashes are usually found on the limbs and lower abdomen and is due to the bleeding under the skin.

2.Diffuse erythematous rash with areas of normal skin:
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The whole skin becomes reddish with scattered, small areas of normal skin .

3.Maculopapular rash:
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The last type of rash appears as red flat or raised leisons(Maculopaular).
The rash can be itchy .

What are the Complications of Dengue Fever?
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The complications of Dengue Fever are:

1.Dengue Hemorrhagic Fever
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a. Fever

b.bleeding likely to occur from the nose, mouth, and gums.
Bruises and ecchymosis may appear as a sign of bleeding under the skin.
There are small red spots on the skin.

c.the urine may contain blood.

d.vomiting of blood and malena(black stools) indicate bleeding in the stomach.

e.low plalelet count of <100,000

f.Hypoalbuminaemia

g.pleural effusion

h.neurological disturbances(seizures,cranial nerve signs and coma) may indicate bleeding in the brain

2. Dengue Shock Syndrome
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Without prompt treatment for the bleeding, the person can go into

a.shock

b.hypotension

c.narrowed pulse pressure(< 2omm Hg)

d.impaired organ perfusion which result in organ failure and death.

Dengue Haemorrhagic Fever and Dengue Shock Syndrome is fatal in about 5 percent of the cases, mostly among children and young adults.

How do you diagnose Dengue Fever?
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1.History of acute fever and bleeding signs

2.A low platelet count (<100,000)is suggestive of dengue fever.

3.Specific blood test(IgG and IgM antibody) for dengue virus can also be conducted. IgM antibodies occur on the 5th day of illness and last for 2 months.

What is the treatment of dengue fever?
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There is no specific anti-viral drug to treat the disease or a vaccine to prevent a person from being infected with the dengue virus.

Treatment is mainly supportive.

1. Rest

2.drinking lots of water to prevent dehydration will help.

3.Paracetamol for fever, severe headaches and body aches( Avoid aspirin and NSAIDs due to the risk of bleeding) to reduce the discomfort.

4. Intravenous fluids for hypotension and dehydration.

5.Daily blood tests (platelets and hematocrit)may be necessary to monitor the risk of bleeding

6. Platelets transfusion when the the platelet count is less than 20,000.


The illness can last up to 10 days, but complete recovery can take as long as a month.

How is dengue fever spread?
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Dengue Fever is spread only through the bite of the infected Aedes mosquitoes.

The transmission cycle for dengue starts when:

1.Infected Aedes mosquito bites a healthy person.

2.4-7 days later,the infected person develops fever

3..When fever starts, the person is infectious for about 5 days.

4.If an Aedes mosquito bites the person during this time when he is infectious, it will be infected by the the dengue virus.

5.The virus will multiply in the second mosquito for 5-7 days.

6.The mosquito then becomes infective.

7.The cycle starts again when it bites another person.


How can you prevent being infected with the dengue virus?
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To prevent dengue fever, you must prevent the breeding of its carrier, the Aedes mosquitoes.

This will be explained another time

A Simple Guide to Stroke 2

A Simple Guide to Stroke 2
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What is the treatment of Stroke?
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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?
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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:
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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:
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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?
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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
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What is a Stroke?
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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?
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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:
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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)?
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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?
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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 Cerebral aneurysm

A Simple Guide to Cerebral aneurysm

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What is Cerebral aneurysm?

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A cerebral aneurysm is an abnormal ballooning of a section of a blood vessel in the brain.

What is the causes of cerebral aneurysm?

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Cerebral aneurysms occur when there is a weakened area in the wall of a blood vessel in the brain.

1.They may occur as a congenital (before birth) defect or may develop later in life.

About 5% of the population has some form of aneurysm in the brain.

2.Trauma and infection, which can injure the blood vessel wall, can cause such aneurysms.

What are the Symptoms of cerebral aneurysm?

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Cerebral aneurysm usually cause no symptoms until they rupture and cause bleeding into the brain.

Often, an aneurysm is found when a CT scan or MRI is performed for another reason. If the unruptured swollen aneurysm presses on the brain , it can cause the following symptoms:
1.Headaches

2.Eye pain

3.Neck pain

4.Double vision

5.Loss of vision

Symptoms of an aneurysm that have ruptured are:
1.Sudden occurrence of a severe headache (often described as "worst headache of my life")

2.Headaches with nausea or vomiting

3.Stiff neck

4.Muscle weakness, difficulty moving any part of the body

5.Numbness or decreased sensation in any part of the body

6.Vision changes like blurring of vision,double vision

7.Eyelid drooping

8.Confusion,

9. Sudden onset of irritability, impulsivity, or poor temper control

10.Slow, sluggish movement

11.Speech impairment

12.Seizures

A ruptured aneurysm is a medical emergency.

What are the investigations done in cerebral aneurysm?

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The following tests may be used to diagnose cerebral aneurysm:

1.CT scan of the head can identify bleeding and usually locate the aneurysm.

2.MRI of the head may be an alternative to a CT scan but may be as good at showing bleeding in the brain.

3.Cerebral angiography or spiral CT scan angiography of the head is used to pinpoint the location and size of the aneurysm.

4.cerebrospinal fluid examination via a spinal tap may confirm bleeding.

5.EEG (electroencephalogram) should be performed if there are seizures.

What is the Treatment of cerebral aneurysm?

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Symptoms often do not appear until bleeding of a cerebral aneurysm occurs.

A ruptured cerebral aneurysm is an emergency condition.

The goal of treatment is to prevent further bleeding.

Lowering of blood pressure can decrease the risk of further bleeding.

Neurosurgery is the primary treatment for cerebral aneurysm.

The base of the aneurysm is closed off with clamps or sutures.

Special coils or stents can be placed into the aneurysm through the arteries to prevent rupture.
A blood clot then forms in the aneurysm and prevents further bleeding. This is considered a less invasive approach than brain surgery. It is regarded as the best form of treatment.

If surgery is not feasible because of the location or size of the aneurysm or the condition of the person, medical treatment is:

1.restricting activity (often complete bedrest is advised),

2.treating symptoms such as headache,

3.controlling blood pressure, and

4.prescribing of antiseizure medications.

After the aneurysm is repaired, prevention of stroke due to blood vessel spasm is necessary. This may include intravenous fluids, certain medications, and controlling the blood pressure.

What is the Prognosis of cerebral aneurysm?

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The prognosis depends on the severity of the condition.
Ruptured cerebral aneurysms are often serious.

In severe cases, about 25% of people die within 1 day, and another 25% die within about 3 months. Of those who survive, more than half will have some sort of permanent disability.

In small leaks of ruptured cerebral aneurysm, early treatment of the condition can be very effective with little loss of neurological deficit.

Unruptured aneurysms can be treated very effectively before causing problems.

The decision to repair an unruptured cerebral aneurysm is based on the size and location of the aneurysm, and the patient's age and general health.

What are the Possible Complications of cerebral aneurysm?

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1.Subarachnoid hemorrhage

2.Stroke

3.Seizures, epilepsy

4.Paralysis of any part of the body

5.Permanent loss of sensation of any part of the face or body

6.Other neurologic deficits (such as vision changes, loss of speech ability, cognitive decline)

What is the Prevention of cerebral aneurysm?

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There is no known way to prevent the formation of a cerebral aneurysm because most of them are congenital.

If sudden or severe headache occurs, particularly if you also have nausea, vomiting, seizures, or any other neurological symptoms, early admission to hospital and appropriate investigation can detect an unruptured aneurym or one which has just started to bleed.

Treatment can be initiated and prognosis is good.

A Simple Guide to Laceration

A Simple Guide to Laceration
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What is a laceration?
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A laceration is an injury to the skin and its underlying soft tissue when you are cut or hit by something.
A laceration is usually called a cut when the injury is caused by a sharp object breaking the skin. It may a clean cut without bleeding or if it damages the blood vessels in the skin, it can cause visible bleeding.
Lacerations can occur at any part of the body.
Healing time for a laceration depends on where it is on your body.
A laceration usually take longer to heal if it is over a joint such as the knee or elbow.

What are the signs and symptoms of a laceration?
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1.Lacerations may appear in all shapes and sizes.

2.It may look like a cut, tear, or gash.

3.The wound may hurt, bleed, bruise, or swell.

4.Lacerations may bleed a lot in areas of the skin which has a lot of blood vessels such as the scalp.

5.The wound may have edges that are close together, or gaping apart.

6.Sometimes there may be numbness around the wound due to a cut of the nerve endings.

7.Similarly there may be decreased movement in an area below the wound due to loss of nerve endings or tear of muscle fibres.

What are the complications arising from a laceration?
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Even with proper treatment, a laceration can become infected:

1.Increased warmth to the area.

2.Redness or swelling to the area which becomes worse.

3.Pain in the area that increases over time.

4. pus or bad-smelling discharge from the wound.
Pus is milky and may be white, yellow, green, or brown.
It is the result of the white blood cells fighting the bacteria or virus.

Other complications may be:

1.the presence of foreign bodies

2.Injury to the bone( fracture)

3.Injury to the nerve

4.Injury to the blood vessels

5.Injury to muscles

What investigations may be necessary in Laceration?
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If there is suspected foreign objects in your laceration, an x-ray may be required.

Foreign objects include things like metal, gravel, and glass.

If you have many wounds from a car accident, tests may include an ultrasound, a MRI, or a CT scan.

What is the treatment for a laceration?
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The doctor will want to
1.control the bleeding if your wound is bleeding a lot.

2.clean the wound with disinfectant.
This will remove dirt and other small objects and reduce the chance of infection.

3.look in the wound for foreign objects like dust, metal or glass splinters.

4.explore (probe) or close the wound under local anesthesia.
An anesthetic is a medicine which numbs the area so that there is no pain during the probe or surgery.

Closing the wound:
The laceration may need stitches, staples, other treatments to close the wound:
1.if it is deep or bleeds a lot.
2.if your wound is gaping open or
3.if the wound is in an area that moves a lot, such as the hands, feet, and joints.

Stitches also keep the wound from getting infected.
Stitches may decrease the amount of scarring.

If the wound is too old, it can not be stitched.
Some lacerations may heal better without stitches.

Special care:
Some lacerations need special care.
Laceration caused by bites from fish or marine life may need special medicines like antibiotics and antitoxins.
Antibiotics are not needed for most wounds.
Antibiotics are given if your wound has a high risk of infection.

If the laceration injure a bone, nerves, or blood vessels, there may be need for microsurgery to join the torn nerve or blood vessel.
A broken bone may also need to be treated conservatively or with surgery.

Tetanus injection:
Tetanus infection, or "lockjaw," can happen after any deep break in your skin. Tetanus can kill you. It is important for adults to get a tetanus shot at least every 10 years.
After an injury, a tetanus injection may be given if:
1. it has been longer than five years since your last one.
2.any wound that may have dirt or saliva in it.
3.Deep wounds also have a high risk for tetanus infection.

If necessary, tetanus injection should be given as soon as possible (within 72 hours of the injury).

What are the risks in the care of laceration?
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A sharp object which passed through your clothing before cutting your skin may have caused small threads or bits of clothing to be pushed under your skin.
The risk of getting an infection is higher if there are foreign bodies in the wound.
Sometime even with the best care, there may still problems such as infection with your wound.
People who have diabetes have a higher chance of getting a serious infection in a wound.

A Simple guide to Hemorrhoids

A Simple guide to Hemorrhoids
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What are hemorrhoids?
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Hemorrhoids or piles are distended veins inside the anus which are swollen and inflamed. Hemorrhoids are either inside the anus (internal) or under the skin around the anus (external).

What is the cause of hemorrhoids?
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Hemorrhoids usually result from straining to pass the stool out of anus. Other contributing factors include pregnancy, aging, chronic constipation or diarrhea.

What are the symptoms of hemorrhoids?
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The most common symptom of internal hemorrhoids is bleeding from the anus.Bright red blood may be seen covering the stool, on toilet paper, or dripping from the anus into the toilet bowl.
There may be pain too especially if the stool is hard. This could be due to the hard stools pressing on the swollen piles or due to a tear in the inner lining of the anus.

A painful swelling or a hard lump around the anus may occur when a blood clot forms. This condition is known as a thrombosed hemorrhoid.

In addition, excessive straining, rubbing, or cleaning around the anus may cause irritation with bleeding and/or itching.

How common are hemorrhoids?
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Hemorrhoids are very common in both men and women. About half of the population have hemorrhoids by age 50.
Hemorrhoids are also common among pregnant women. The pressure of the fetus in the abdomen, as well as hormonal changes, cause the hemorrhoidal vessels to enlarge. For most women, however, hemorrhoids caused by pregnancy are temporary.

When are hemorrhoids diagnosed?
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A thorough examination and proper diagnosis by the doctor is important any time bleeding from the rectum or blood in the stool occurs. Bleeding may also be a symptom of other digestive diseases, including colorectal cancer.

The doctor will examine the anus and rectum to look for swollen blood vessels that indicate hemorrhoids and will also perform a digital rectal exam with a gloved, lubricated finger to feel for abnormalities.

Closer evaluation of the rectum for hemorrhoids requires an exam with a proctoscope, useful for more completely examining the entire rectum.

To rule out other causes of gastrointestinal bleeding, the doctor may examine the rectum and the entire colon with colonoscopy.
Colonoscopy is a diagnostic procedure that also involve the use of lighted, flexible tube inserted through the rectum.

What is the treatment?
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a.Medical treatment of hemorrhoids is aimed initially at relieving symptoms. Measures to reduce symptoms include:

1.tub baths several times a day in plain, warm water for about 10 minutes
2.application of a hemorroidal cream or suppository to the affected area.
3. medicines such as daflon to shrink the swollen blood vessel.

b. Surgical treatment:A number of methods may be used to remove or reduce the size of internal hemorrhoids.
These techniques include
1.Rubber band ligation. A rubber band is placed around the base of the hemorrhoid inside the rectum. The band cuts off circulation, and the hemorrhoid withers away within a few days.
2.Sclerotherapy. A chemical solution is injected around the blood vessel to shrink the hemorrhoid.
3.Laser coagulation. A special device is used to burn hemorrhoidal tissue.
4.Hemorrhoidectomy. Occasionally, extensive or severe internal or external hemorrhoids may require removal by surgery known as hemorrhoidectomy.
5.A new method is the Longo technique. It involve using a circular stapling device which removes a ring of tissue in the lower anus pulling the enlarged piles up within the anus. The staples also interrupt the blood supply to the piles

How do you prevent hemorrhoids?
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The best way to prevent hemorrhoids is to keep stools soft so they pass easily, thus decreasing pressure and straining, and to empty bowels as soon as possible after the urge occurs.

Drink lots of water at least eight glasses a day.

Eating the right amount of fiber result in softer, bulkier stools. A softer stool makes emptying the bowels easier and lessens the pressure on hemorrhoids caused by straining. Good sources of fiber are fruits, vegetables, bran bread, and whole grains.

Avoid food which cause local irritation of anus (spicy food,alcohol) or bowel excitation (coffee,tea)

Exercise, including walking, swimming, help reduce constipation and straining by producing stools that are softer and easier to pass.
Avoid certain sports such as cycling and horse -riding because of the pressure exerted on the anal region.

Avoid sitting in hot places for too long.

Use the toilet at a fixed time eg. after drinking a big glass of water, when you wake up.