A Family Doctor's Tale - YELLOW FEVER

DOC I HAVE YELLOW FEVER

YELLOW FEVER fever is a acute viral infection caused by the YELLOW FEVER virus which is usually transmitted by the bite of an infected female Aedes msoquito.

The YELLOW FEVER virus is a flavivirus which are spherically enveloped RNA-containing particles.

2 epidemiologic forms of Yellow fever are present:
1.urban which has a human-mosquito-human cycle


2.jungle whivh has a monkey-mosquito-monkey cycle.
Humans get infected when accidentally bitten by the mosquito.

The incubation period in mosquito is 8-12 days and 3-6 days in humans.
Symptoms usually last 3-14 days.

A.Mild form:

1.Mild non specific fever
2.Headache
3.Pain behind the eyes
4.Muscle and joint pains
5.Nausea , vomiting
6.last several days with eventual recovery

B.Severe form

1.High, acute, prolonged fever  
2.Severe headache
3.Myalgia and bodyaches
4.nausea, vomiting
5.loss of appetite
6.anxious and distressed
7.Abdominal discomfort
8.gum hemorrhages and epistaxis
9.Fatigue

This stage called the viremic stage lasts about 3 days folled by a period of remission for 24 hours.

C.Recurrent Stage:

1.The fever then returns even higher
2.severe vomiting
3.epigastric pain
4.jaundice (hence the name yellow fever)
5.hematemesis
6.melena

Diagnosis of Yellow Fever:
1.characteristic fever, jaundice and vomiting in the later stages

2.inflammation of nerves and meninges

3.contraction of muscles of face, scalp and neck

4.neuralgia

5.MRI of the brain

6.blood tests for antibodies

The complications of YELLOW FEVER  are:
1.Hemorrhages in the stomach
a.hematemesis
b.melena

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

3.Dilatation and distension of the cranial arteries

4.Inflammation of the cranial nerves, meninges, neuralgia

Treatment of Yellow Fever:
There is no specific anti-viral drug to treat the disease or a vaccine to prevent a person from being infected with the YELLOW FEVER 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 hyto 10 days, but complete recovery can take as long as a month.potension and dehydration.
5. Antidepressant medicines are helpful

The illness can last up to one month before recovery

Prevention of Yellow Fever:

1.A vaccine against Yellow Fever was developed in 1951 and is effective against Yellow Fever for 10 or more years.

2.YELLOW FEVER Fever is spread only through the bite of the infected Aedes mosquitoes.

To prevent YELLOW FEVER fever, it is important to prevent the breeding of its carrier, the Aedes mosquitoes, identified by their black and white stripes on the body .
A puddle of water about the size and depth of 20-cent coin is sufficient for an Aedes mosquito to breed in.

The Aedes mosquitoes are commonly found breeding in clear stagnant water in flower vases, flower pot plates, roof gutters, earthen jars for water storage or decorative purposes, watering cans, and bamboo pole holders.

The Aedes mosquito can also breed in unusual places such as water trapped in the hardened soil in potted plates, and the rim of unwanted pails

 

A Family Doctor's Tale - HEMOPHILIA

DOC I HAVE HEMOPHILIA

Hemophilia is an inherited disorder of bleeding associated with deficiency of Factor VIII (a clotting factor) in the blood.

The cause of Hemophilia is:
It is an inherited X-linked recessive disorder.

Women are carriers .
50 per cent of the sons of carriers will get the disease and 50 per cent of the daughters will be carriers.

This condition is present in the Royal family of England.

It is also associated with Christmas disease which is a deficiency of Factor IX and von Willebrand disease (deficiciency of Factor VIII and platelet abnormalities leading to prologed skin bleeding)

It is a lifelong disease and there is no cure for it.

In Hemophilia patients, the deficiency of a clotting factor can lead to severe bleeding during injury or spontaneous bleeding into the joints.

The Symptoms of Hemophilia are:
1.excessive bleeding during mild trauma(example: tooth extraction)

Sometimes internal bleeding may occur without the knowledge of the patient because the injury is so mild.

2.soft tissue hematomas (big blood clots) which can cause nerve compression

3.Hemarthroses (bleeding in the joints) and joint contactures

4.hematuria (bleeding in the urine) or epistaxis (nose bleeds)


Diagnosis of Hemophilia is often based on
1. family history of Hemophilia

2. history of bleeding following minor trauma

3. Blood clotting Factor VIII low on testing

4.Skin bleeding time and blood clotting time abnormal

The complications of Hemophilia are:
1. Anemia

2. damage to bleeding joints

3. shock and death

The treatment of Hemophilia is by:

1.Blood transfusion or replacement of blood clotting factors VII cryoprecipitates

2.Aspiration of blood from bleeding joints

3.Avoid joint immobility to prevent contractures

4.Avoidance of injury

5.Careful preparation for dentistry or surgery

6.Proper genetic counseling

The prognosis of Hemophilia is:
Prognosis is good for hemophilia patients with modern therapy.

Most patients are able to live normal lives.

Rarely life threatening bleeding may occur.

The Prevention of Hemophilia is through:
Genetic counseling and testing for Hemophilia

A Family Doctor's Tale - PORPHYRIA

DOC I HAVE PORPHYRIA

Porphyria is an autosomal dominant inherited disorder of hemoglobin biosynthesis.


Porphyrins are produced in the process of hemoglobin synthesis.

Because of the deficiency of enzymes in the porphyria patients, the porphyrins are not converted into hemogloblins.

As a a result excessive porphyrins accumulates and less hemoglobin is formed.

The  red blood cells formation is affected resulting in neurological dysfunction or photosensitive rashes.


The causes of Porphyria is:
It is an inherited deficiency of one or more enzymes helping to synthesize hemoglobin.

Acute intermittent porphyria can be precipitated by
1.many drugs:
a.barbiturates
b.sulphonamides
c.methyl dopa
d.oral contaceptives

2.infection

3.alcohol

4.starvation

5.hypoglycemia

Chronic cutaneous porphyria may also be precipitated by
1.the same agents as above

2.hepatotoxins

It is a lifelong disease and there is no cure for it.

The symptoms of Porphyria are:
Symptoms:


Acute intermittent porpyria
1.recurrent attacks of neurologic dysfunction affecting the autonomic nervous system:
a.fever
b.tachycardia
c.nausea
d.vomiting
e.abdominal pain -main recurring symptom
f.sweating
g.hypertension
h.leucocytosis

2.peripheral nervous system
a.mononeuritis multiplex with nerve pain
b.polyneuropathies
c.cranial neuropathies

3.central nervous system
a.psychiatric disturbance
b.seizures

Chronic cutaneous tarda:
1.bullous eruption on exposure to sunlight
2.evidence of hepatic disease

The diagnosis of Porphyria is made by:
Diagnosis of Porphyria is often based on
1. family history of Porphyria

2. porphyrins in the urine with urine turning dark red or brown on exposure to light

3. 24 hour excretion of urinary porphoblininogen and delta-aminolevulinic acid increased in acute porphyria

4. 24 hour excretion of urnary porphobilinogen and other porpyrins increased in other porphyrias

5.50 per cent reduction of uroporphyrinogen I synthesase in red blood cells diagnostic of acute intermittent porphyria

6.MRI or ultrasound of the abdomen may be necessary due to persistant recurrent abdominal pain

The complications of Porphyria are:

1. Anemia

2. damage to liver and gallstone formation


3. seizures and brain damage

4.Paralysis

5.Scarring of the skin

The treatment of Porphyria is by:
1.Blood transfusion of hematin in severe cases

2.high carbohydrate diet helps limit the production of porphyrins


3.Avoid causative agents especially medications

4.propanolol for tachycardia

5.anagesics for pain

Other treatment includes:

1.chloroquine

2.Vitamin A supplements

3.Removal of blood to reduce the porphyrins

4.Avoid alcohol

The prognosis of Porphyria is :
Prognosis is fair for Porphyria patients with modern treatment however the illness is a lifelong condition.

There is recurrence of attacks and high rates of hospitalization

The Prevention of Porphyria is by:
Genetic counseling and testing for Porphyria

A Family Doctor's Tale - NASAL POLYPS

DOC I HAVE A NOSE POLYP

Nose Polyp is a benign tumor with soft round body rising on a stalk from the nose inner lining or nasal mucosa.

It is usually the result of chronic inflammation within the nasal cavity.

Nose Polyp can occur at any age.

The causes of nasal polyps is unknown but predisposing conditions are:
1.chronic inflammation of the nasal cavity or sinuses

2.allergies as some people with nasal polyp test positive for environmental allergen

3.Asthma

4.smoking

5.Aspirin sensitivity

Symptoms :
1.Nose Polyp is a well encapsulated round swelling rising from the nasal mucosa on a stalk called the peduncle.

2.mutiple swellings may also be present.

3.They are usually painless

4.They may block the nasal passage giving rise to the sensation of nasal obstruction.

5.There is decreased sense of smell or even complete loss of smell

6.excessive nasal secretions may also be present

Diagnosis:
1.nasoendoscopy may be done to confirm the presence of nasal polyps

2.Allergy skin tests to detect if there are any allergy contributing factors

3.CT Scan of the sinuses may be done to see the extent of the nasal polyps as well as to localize their position and other possible obstructions in the nasal cavity

There can be complications such as:
1. bleeding

2. infection of sinuses

Treatment:
Medical:
1.antibiotics to treat infections

2.antihistamine to treat allergy

Surgery:
The only surgical treatment is removal of the Nose Polyp if the medications do not work or if there is suspicion of cancer.

This can be done by nasal endoscopy sugery under general anesthesia
1.Excision of the nasal polyp with a knife or scissors through the endoscpoe

2.Clearing of any obstruction which can prevent the flow of discharge from the sinuses.

3.use of nasal steroid after surgery to prevent reccurrence of polyps

4.nasal washes to prevention the accumulation of dried mucus or crusts in the nasal cavity.

The prognosis is usually excellent.

Recurrence at the same spot is rare but do occur due to regrowth of the blood vessel supplying the Polyp.

Prevention:
Avoid any irritants or allergies as much as possible

Avoid smoking

Manage asthma or allergies with medication.