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

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