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.