AIDS

What is AIDS?

AIDS stands for: Acquired Immune Deficiency Syndrome

AIDS is a medical condition. A person is diagnosed with AIDS when their immune system is too weak to fight off infections.

Since AIDS was first identified in the early 1980s, an unprecedented number of people have been affected by the global AIDS epidemic. Today, there are an estimated 33.3 million people living with HIV and AIDS worldwide.

 

What causes AIDS?

AIDS is caused by HIV.

HIV is a virus that gradually attacks immune system cells. As HIV progressively damages these cells, the body becomes more vulnerable to infections, which it will have difficulty in fighting off. It is at the point of very advanced HIV infection that a person is said to have AIDS. If left untreated, it can take around ten years before HIV has damaged the immune system enough for AIDS to develop. 

What are the symptoms of AIDS?

A person is diagnosed with AIDS when they have developed an AIDS related condition or symptom, called an opportunistic infection, or an AIDS related cancer. The infections are called ‘opportunistic’ because they take advantage of the opportunity offered by a weakened immune system.

It is possible for someone to be diagnosed with AIDS even if they have not developed an opportunistic infection. AIDS can be diagnosed when the number of immune system cells (CD4 cells) in the blood of an HIV positive person drops below a certain level. 

Is there a cure for AIDS?

Worryingly, many people think there is a 'cure' for AIDS - which makes them feel safer, and perhaps take risks that they otherwise wouldn't. However, there is still no cure for AIDS. The only way to stay safe is to be aware of how HIV is transmitted and how to prevent HIV infection.


How many people have died from AIDS?

Since the first cases of AIDS were identified in 1981, more than 30 million people have died from AIDS. An estimated 1.8 million people died as a result of AIDS in 2009 alone.

Although there is no cure for AIDS, HIV infection can be prevented, and those living with HIV can take antiretroviral drugs to prevent or delay the onset of AIDS. However, in many countries across the world access to prevention and treatment services is limited. Global leaders have pledged to work towards universal access to HIV prevention and care, so that millions of deaths can be averted.


How is AIDS treated?

Antiretroviral treatment can significantly prolong the lives of people living with HIV. Modern combination therapy is highly effective and someone with HIV who is taking treatment could live for the rest of their life without developing AIDS.

An AIDS diagnosis does not necessarily equate to a death sentence. Many people can still benefit from starting antiretroviral therapy even once they have developed an AIDS defining illness. Better treatment and prevention for opportunistic infections have also helped to improve the quality and length of life for those diagnosed with AIDS.

Treating some opportunistic infections is easier than others. Infections such as herpes zoster and candidiasis of the mouth, throat or vagina, can be managed effectively in most environments. On the other hand, more complex infections such as toxoplasmosis, need advanced medical equipment and infrastructure, which are lacking in many resource-poor areas.

It is also important that treatment is provided for AIDS related pain, which is experienced by almost all people in the very advanced stages of HIV infection. 

ISCHAEMIC HEART DISEASE

Ischemic Heart Disease

Ischemic heart disease, also known as myocardial ischemia, is a condition of the heart where the heart muscles are damaged or do not work as efficiently due to a reduced blood supply to the heart. The decreased blood flow is most often caused by narrowing of the coronary arteries, a condition called atherosclerosis. The risk of getting this disease increases with age, and is more prevalent among smokers than non-smokers. Also at risk are people with diabetes, high blood cholesterol levels, high blood pressure (people suffering from hypertension), and individuals who have family history of the disease. 

Ischaemic Heart Disease (coronary artery disease or CAD) is a condition in which atheroma (fatty deposits) builds up in the linings of the walls of the coronary arteries. This causes a narrow artery and reduced blood flow to the heart muscle. This process can occur in other arteries of the body. Important arteries which, if affected can have medical consequences, are the carotid arteries in the neck, (which supply blood to the brain), and the femoral /popliteal arteries in the legs. In these situations a bruit (noise) may be heard over the area affected (i.e. carotid or femoral arteries), through a stethoscope.

What is good care for heart disease?

Effective treatment of coronary heart disease (CHD) saves lives. Since 2000, there has been a 40% reduction in deaths from heart disease in people under 75. A national review of heart disease services set out standards that define good heart disease care:

    tackling the factors that increase the risk of heart disease, such as smoking, poor diet and little physical exercise
    preventing CHD in high-risk patients and where patients have CHD, avoiding complications and tackling the progression of the disease
    rapid treatment for heart attack, including the choice of angioplasty in a specialist cardiac centre
    rapid diagnosis of heart disease and access to diagnostic tests
    rapid access and choice of treatment centre for specialised cardiac care

Treatment overview 
CHD cannot be cured but it can be managed effectively with a combination of lifestyle changes, medicine and in some cases surgery. With the right treatment, the symptoms of CHD can be reduced and the functioning of the heart improved.

CEREBROVASCULAR DISEASE

What are cardiovascular diseases?

Cardiovascular diseases (CVDs) are a group of disorders of the heart and blood vessels and include:

1. coronary heart disease – disease of the blood vessels supplying the heart muscle
    
2.    cerebrovascular disease - disease of the blood vessels supplying the brain
    
3.   peripheral arterial disease – disease of blood vessels supplying the arms and legs
     
4.  rheumatic heart disease – damage to the heart muscle and heart valves from rheumatic fever, caused by streptococcal bacteria
     
5.  congenital heart disease - malformations of heart structure existing at birth
       deep vein thrombosis and pulmonary embolism – blood clots in the leg veins, which can dislodge and move to the heart and lungs.

Heart attacks and strokes are usually acute events and are mainly caused by a blockage that prevents blood from flowing to the heart or brain. The most common reason for this is a build-up of fatty deposits on the inner walls of the blood vessels that supply the heart or brain. Strokes can also be caused by bleeding from a blood vessel in the brain or from blood clots.

At what age are people affected?
Cerebrovascular disease becomes more common as people get older, and is a common disorder of the elderly.  However, it can occur in younger people, affecting some people in middle age. It is slightly more prevalent in men than in women.

What is the cause?
The brain is irrigated by a complex structure of blood vessels, which supply different areas of the brain with the oxygen and nutrients they need to function properly. When a blood vessel in the brain bursts or is obstructed by a clot, the brain tissue normally supplied with oxygen by this blood vessel deteriorates.  This is often called a stroke. In Cerebrovascular Disease, these strokes may be so small that no one may have noticed their occurrence. However, they can be detected on brain scans.

Is Cerebrovascular disease inherited?
No, not typically. Inherited cases are cerebrovascular disease are extremely rare.

 Treatment:

    Early treatment of streptococcal sore throat can stop the development of rheumatic fever. Regular long-term penicillin treatment can prevent repeat attacks of rheumatic fever which give rise to rheumatic heart disease and can stop disease progression in people whose heart valves are already damaged by the disease.


There are several treatment options available:

    Effective and inexpensive medication is available to treat nearly all CVDs.
    People at high risk can be identified using simple tools such as specific risk prediction charts. If people are identified early, inexpensive treatment is available to prevent many heart attacks and strokes.
    Survivors of a heart attack or stroke are at high risk of recurrences and at high risk of dying from them. The risk of a recurrence or death can be substantially lowered with a combination of drugs – statins to lower cholesterol, drugs to lower blood pressure, and aspirin.
    Operations used to treat CVDs include coronary artery bypass, balloon angioplasty (where a small balloon-like device is threaded through an artery to open the blockage), valve repair and replacement, heart transplantation, and artificial heart operations.
    Medical devices are required to treat some CVDs. Such devices include pacemakers, prosthetic valves, and patches for closing holes in the heart.

There is a need for increased government investment through national programmes aimed at prevention and control of CVDs and other noncommunicable diseases.

LOWER RESPIRATORY INFECTIONS

Lower respiratory tract infections

Cases of pneumonia make up the vast majority of debilitating lower respiratory tract infections, which affect the trachea, lungs and bronchi, according to the World Health Organization. Bronchitis and bronchiolitis, which cause inflammation of the bronchi, also fall into the same category.

Pneumonia, an inflammation of the lungs, can be deadly if that inflammation fills the air sacs in the lungs and interferes with breathing. In some cases, the infection can invade the bloodstream and spread quickly to other organs.

Global Impact

An estimated 4 million people died in 2004 from lower respiratory infections. Worldwide, pneumonia is the leading cause of death in children. About 20 percent of all deaths in children under 5 years old are due to acute lower respiratory tract infections and 90 percent of these deaths are due to pneumonia, according to the World Health Organization.

In the United States, more than 60,000 Americans die of pneumonia each year, according to the Mayo Foundation for Medical Education and Research. 

Causes

Pneumonia can be caused by bacteria, viruses or fungi, and can follow acute or chronic bouts of bronchitis. It is also possible to get pneumonia by accidentally inhaling a liquid or chemical.

Transmission of pneumonia from person-to-person through direct contact with infectious secretions can occur, however most infections are not caught from another person but are a product of a weakened immune system. Hospital patients are at an especially high risk of pneumonia.

A bacterium is the most common cause of pneumonia in adults and children over the age of three. Bacterial pneumonias tend to be the most serious and among the elderly can be brought on after influenza or the common cold.

Respiratory viruses are the most common cause of pneumonia in young children, according to the National Institutes of Health.

Bronchitis, which is an inflammation of the main air passages to the lungs, is generally caused by viral respiratory infections. The main cause of chronic bronchitis is cigarette smoke, or long-term exposure to secondhand smoke. The affliction usually clears up on its own, but it can lead to pneumonia in some severe cases.

Symptoms 
Pneumonia has similar symptoms to a cold or the flu at its onset, with a cough and fever. The main signs and symptoms are often shaking, chills, a high fever, sweating, shortness of breath, chest pain, and coughing greenish or yellow phlegm.

Additional symptoms can include headache, excessive sweating, loss of appetite, excessive fatigue and confusion, especially in the elderly.

Prevention 
Vaccines can help prevent pneumonia in children, the elderly and those with chronically debilitating conditions or diseases such as HIV. The pneumococcal vaccine prevents the most common form of bacterial pneumonia, Streptococcus pneumoniae. Getting a flu vaccination can help prevent an illness that would develop into pneumonia, while the Hib vaccine prevents pneumonia in children from Haemophilus influenzae type b.

Smoking is discouraged because it damages the lungs' natural defenses against disease. Not smoking, or quitting smoking are recommended to prevent both pneumonia and bronchitis, as well as limiting exposure to air pollutants and washing hands regularly to avoid spreading infections and viruses.

Treatment 
Pneumonia treatments vary depending on the cause and severity. Bacterial pneumonia is treated with antibiotics, while most viral pneumonias are treated the same way as the flu, with rest and fluids. Pneumonia caused by a fungus is usually treated with antifungal medication.

Severe pneumonia leads to hospitalization and treatment with intravenous antibiotics and oxygen.

Sources: National Library of Medicine, National Institutes of Health, the Mayo Clinic, the New England Journal of Medicine, University of Maryland Medical Center

ATRIAL FIBRILLATION

ATRIAL FIBRILLATION:
In this type of arrhythmia, the atria beat rapidly, chaotically and ventricles respond at irregular intervals. So, pulse rhythm is irregularly irregular and average rate   is about 100-180/minute.

Cause:
1.    Mitral valve disease- commonest cause (in young and middle aged patient).
2.    Acute or chronic ischaemic heart  disease.
3.    Systemic hypertension
4.    Thyrotoxicosis
5.    Subacute bacterial endocarditis
6.    Pericarditis
7.    Atrial septal defect
8.    After thoracic  operation
9.    Alcohol drink
10.    Cardiomyopathy
11.    Pulmonary embolism
12.    Pneumonia
13.    Idiopathic


 

















 Clinical features:
1.    May be asymptomatic- commonly in the elderly.
2.    Palpitation and exertional dyspnoea.
3.    Pulse- irregularly irregular, average rate   is about 100-180/minute; pulse deficit may be present.
4.    ECG findings-
  (a)    Absence of p wave
  (b)    No change in QRS complex
  (c)    The baseline shows irregular fibrillation waves.

Investigations:
1.    X-ray chest p/a view
2.    ECG (special)


Complications:
1.    Cardiac failure
2.    Pulmonary oedema
3.    Stasis, thrombosis and then systemic thrombo-embolism.

Treatment:
1.    Digitalisation is the treatment of choice, may be combined (if necessary) with diuretice and oxygen.
2.    Digoxin dose should be continued at a rate the ventricular beast can be maintained in between 70-80/minute. Atrial fibrillation due to thyrotoxicosis is usually no responsive to digoxin therapy, in that case B-blockers may be better to be used.
3.    Elective Dc cardioversion- if fibrillation persists after correction of thyrotoxicosis.
4.    Flecanide (if digoxin is not effective)2mg/kg in i.v infusion may be given.
5.    Warfarin- as longterm anticoagulant therapy to reduce the risk of systemic embolism.
6.    Treatment of underlying causes (e.g thyrotoxicosis, post- operative chest infection, pneumonia etc).

VIRAL HEPATITIS

VIRAL HEPATITIS:

Hepatitis caused by viruses known as viral hepatitis. Common responsible viruses are:
1.    Hepatitis A virus [HAV]
2.    Hepatitis B virus [HBV]
.     3.  Hepatitis C virus [HCV]
4.    Hepatitis  D virus [delta agent]
5.    Hepatitis E virus [HEV]
6.    hepatitis G virus [HGV] others- in immunocompromised hosts some times cytomegalovirus, Epstein- Barr virus, herpes simplex virus, yellow fever virus may also cause hepatitis.
                                                            
Types of viral hepatitis:
1.    viral hepatitis A
2.    viral hepatitis B
3.    viral hepatitis C
4.    viral hepatitis D
5.    viral hepatitis E
6.    viral hepatitis G
7.    SEN- V or Non A-E viral hepatitis
8.    Cytomegalovirus hepatitis
9.    Epstein- Barr virus hepatitis
10.    herpes simplex virus hepatitis
11.    Yellow fever virus hepatitis

ACUTE HEPATITIS A 1, 2
       It is the most common type of viral hepatitis, caused by the picornavirus of enter virus group. The hepatitis A virus is very infection and spreads mainly by the faucal- oral route, through ingestion of contaminated food or water. Overcrowding and poor sanitation helps in spreading the disease. After infection, the viruses replicate in the liver, excreted in the bile and then in the faces of the infected patient for about 2 weeks before the onset of clinical illness and up to 7 days after. There are no carrier state of hepatitis period is about 30 days. It is also called infectious or epidemic or short- incubation hepatitis;
Clinical features:

Symptoms:
1.    The prodromal symptoms are gradual onset of fever with chills, headache and malaise.
2.    Gastrointestinal symptoms are anorexia, distaste for cigarettes, nausea, vomiting and diarrhea.
3.     A steady upper abdominal pain occurs in upper right quadrant.
4.      Patients may complain of dark urine & pale stools.

Physical signs:
1.    Appearance of jaundice with yellow discoloration of skin, sclera & mucus membrane.
2.     The liver is usually tender, may or may not be readily palpable.
3.    Cervical lymph nodes enlarged & may be palpable.
4.    Splenomegally may occur.
5.     Dark yellow urine & pale stool.
         The intensity of symptoms and signs gradually diminishes & in occurs of 3 to 6 weeks duration, the great majority of cases recover.
 

                                                                                                                                                               

CHECKEN POX

Chicken pox:

A viral disease due to varicella zoster virus infection mostly transmitted by respiratory route . It may also spread by contact with ruptured lesion or with herpes zoster.

Incubation period is from 10 to 20 days. Herpes zoster is caused by the same virus .Onset is associated with fever and malaise.




















Chicken pox is more rash changes to vesicles within few hours and is more severe in adults than in children. About 90% of adults develop pneumonia.

In children there may be acute cerebellar ataxia developing 3 to 21 days after the rash appears. The recovery is usual. In innunosuppressed patients the disease may be fatal. Congenital malformations in the fetus may result if the disease occurs during first and second trimester of pregnancy.

Zoster immune globulin (ZIG) is effective in preventing the disease in exposed persons when given within 72 hoursa of exposure.

Varicella live attenuated vaccine is now available. It should be given to-
(a)    All children above 12 months
(b)    Susceptible adults
(c)    Household contacts and health workers as they run high risk of fatality even though the disease is rare.


Treatment:

1.    Patient should be isolated till the crusts have disappeared.
2.    Antiseptic baths to reduce secondary bacterial infection.
3.    Antihistaminics in adequate doses for pruritus.
4.    If there us secondary infection use appropriate antibiotics orally.
5.    Bacitracin-neomycin ointment may be used locally.
6.    Corticosteriods may be used for.
7.    Adenine arabinoside or acyciovir when administered during the first 6 days of the disease, may be effective.

ANTHRAX

Anthrax:

This is an infectious disease of dpmestic herbivores viz cattle, sheep, goats, horses and swine, ingested by these animals when grazing. Causative organism Bacillus anthrax which lives in topsoil .

Human infection is acquired during handling infected hides, wool, hair and carcasses. Transmission can occur through direct contact, the organism infecting skin.

This is most common in farmers, veterinarians and tannery, may also occur in wool-workers.

Cutaneous anthrax or malignant pustule characteristically consists of three zone.After 5 of 6 days the regional lymph nodes. Pyrexia of variable degree, headach, nausea, vomiting and malaise, may be present. Smear from the lesion shows the organisms.

Haematogenous seread may lead to haemorrhagic meningitis or shock, cyanosis and collapse. Blood cultures are often positive.

Pulmonary anthrax results from inhalation of spores from wool,  hides and bristles .It is characterized by fever, headache, malaise, cough and dyspmoea. There may be haemoptysis. Auscultatory and radiological findings, suggest pneumonia.


Infection occurs from poorly cooked meat of in fected animals. Patient may develop features of acute abdomen like cholear or massive diarrhea. The condition is usually fatal.  



Treatment::

1.    Penicillin G 2,000,000 units i.m. or i.v followed by1,000,000 units 4 hourly Or,
2.    tetracycline, 500 mg 6 hourly daily or ,
3.    Amoxycillin 500 mg 8 hourly daily or ,
4.    Erythromycim, 500 mg 6 hourly daily or,
        Continue treatment for 7 days.