Celiac Disease

Celiac Disease

If you have celiac disease and eat foods with gluten, your immune system responds by damaging the small intestine. Gluten is a protein in wheat, rye and barley. It is found mainly in foods but may also be in other products like medicines, vitamins and even the glue on stamps and envelopes.

Celiac disease affects each person differently. Symptoms may occur in the digestive system, or in other parts of the body. One person might have diarrhea and abdominal pain, while another person may be irritable or depressed. Irritability is one of the most common symptoms in children. Some people have no symptoms.

Celiac disease is genetic. Blood tests can help your doctor diagnose the disease. Your doctor may also need to examine a small piece of tissue from your small intestine. Treatment is a diet free of gluten.

Diverticulosis and Diverticulitis

Diverticulosis and Diverticulitis

Diverticula are small pouches that bulge outward through the colon, or large intestine. If you have these pouches, you have diverticulosis. This condition becomes more common as people age. About half of all people over age 60 have it. Doctors believe the main cause is a low-fiber diet.

Most people with diverticulosis don't have symptoms. Sometimes it causes mild cramps, bloating or constipation. A high-fiber diet and mild pain reliever will often relieve symptoms.

If the pouches become inflamed or infected, you have diverticulitis. The most common symptom is abdominal pain, usually on the left side. If the diverticula are infected, you may also have fever, nausea, vomiting, chills, cramping and constipation. In serious cases, diverticulitis can lead to bleeding tears, or blockages. Treatment focuses on clearing up the infection with antibiotics, resting the colon and preventing future problems. A serious case may require a hospital stay.

What is Klippel-Trenaunay Syndrome ?

Klippel-Trenaunay Syndrome (congenital dysplastic angiopathy) is a congenital vascular disorder of unknown cause. Klippel-Trenaunay (KT) is characterized by a triad of symptoms: Port Wine Birthmark ( capillary malformation) covering one or more limbs, congenital vascular anomalies, usually venous varicosities, absence or duplication of a venous structure, malformation and hypertrophy (enlargement of the limb) or atrophy (withering or smaller limb). KTS involves the lower limbs in approximately 90% of the cases.

In rare instances there is an absence of Port Wine Birthmark and not all three symptoms need to be present for the syndrome to exist. Each case of KT is different, with patients having varying symptoms and severity. Symptoms associated with KT can include internal organ involvement, hematuria (blood in the urine) rectal bleeding, vaginal bleeding and cellulitis (infection within the skin ) Bleeding from the affected limb is also common. Patients may have problems including anemia, coagulation problems (blood clots) and platelet trapping in the affected limb. Some patients can develop a very serious clotting abnormality called DIC (disseminated intravascular coagulation).

This can develop after trauma, pregnancy or surgery. Seizures are also associated with KT. There have been reports of learning disorders and KT in some patients. Most patients report pain in the affected limb.

Many women report an increase in symptoms during times of hormonal change like PMS, puberty, menopause, perimenopause and pregnancy. These symptoms may include increased swelling, tingling sensation, change in color and heaviness in the affected limb, fatigue, headache, heart palpitations, exercise intolerance and increase in clotting times. It is recommended that women with KT not use hormone replacement therapy. Women with KT who are pregnant should be carefully managed.

Klippel-Trenaunay-Weber is an old term. KT used to be called "KTW Syndrome", but the Weber has been dropped to avoid confusion with the Parkes/Weber Syndrome. Parkes Weber Syndrome is characterized by one or more high-flow arteriovenous malformations leading to extremity overgrowth similar to but usually more severe than with KT. KT does not include AV malformations. An angiogram will be normal in KT and abnormal in Parkes Weber.

The appearance of the limb is usually pinker and warmer due to the fistulas (AV malformations) These fistulas are abnormal connections between the arteries and veins and are lesions that can affect the prognosis of the patient and can lead to cardiac involvement. Parkes Weber Syndrome is more likely than KT to affect an upper limb but may still affect the lower limb. The occurrence of Parkes Weber Syndrome is rarer than KT.

Port Wine Birthmark

The most apparent marker of KT is the Port Wine Birthmark, present at birth and typically covering a large area of the affected limb. The trunk can be affected with the most typical pattern being from hip to toe involving the buttocks on one side. The Port Wine Birthmark may be dark pink to purple in color and can be raised with "nodules" that bleed easily.

Vascular Abnormalities

KT usually involves either an absence or duplication of a venous structure and concerns relate to the proper development of the affected limb. Hypertrophy of the limb is the most common problem often impairing function of the limb and affecting mobility. Leg length discrepancies can be common. Sometimes surgery is necessary to balance the lengths of the legs. It is important that children with KT be monitored for these types of growth abnormalities.

Bleeding and cellulitis (infections in the skin) are commonplace with KT and can be very problematic. Pain is a major concern with most patients.

Patients with KT may rarely require amputation when the limb is grossly enlarged. Amputation of toes and debulking (making the limb smaller surgically) may be necessary. Internal organ involvement should be ruled out in any patient presenting with KT or Parkes Weber Syndrome.

Therapy

Laser treatment is available to lighten or remove the port wine birthmark in children and adults. Compression garments can be worn on the limb to alleviate pain and swelling. Sequential extremity pumps are often prescribed to aid in compression of the limb. Antibiotic therapy for cellulitis infections and iron supplements to combat anemia are used. Sclerosing therapy, injecting a chemical agent into the vein is used to destroy veins in some patients. Vein stripping that was once standard treatment is less common place. Any surgical intervention should be carefully considered. Patients with KT have a tendency to heal more slowly in the affected limb and can suffer post surgery complications.

Resources: http://radiopaedia.org/images/1886942 
                   http://www.sturge-weber.org/medical-matters/klippel-trenaunay-syndrome.html

Key Facts You should know About Ebola Virus

Ebola Outbreak is currently happening in West Africa. For us to know about this Virus as a health care provider. Below are the key factors about Ebola Virus.

Key facts

• Ebola virus disease (EVD), formerly known as Ebola haemorrhagic fever, is a severe, often fatal illness in humans.
• EVD outbreaks have a case fatality rate of up to 90%.
• EVD outbreaks occur primarily in remote villages in Central and West Africa, near tropical rainforests.
• The virus is transmitted to people from wild animals and spreads in the human population through human-to-human transmission.
• Fruit bats of the Pteropodidae family are considered to be the natural host of the Ebola virus.
• Severely ill patients require intensive supportive care. No licensed specific treatment or vaccine is available for use in people or animals.

Ebola first appeared in 1976 in 2 simultaneous outbreaks, in Nzara, Sudan, and in Yambuku, Democratic Republic of Congo. The latter was in a village situated near the Ebola River, from which the disease takes its name.

Genus Ebolavirus is 1 of 3 members of the Filoviridae family (filovirus), along with genus Marburgvirus and genus Cuevavirus. Genus Ebolavirus comprises 5 distinct species:

• Bundibugyo ebolavirus (BDBV)
• Zaire ebolavirus (EBOV)
• Reston ebolavirus (RESTV)
• Sudan ebolavirus (SUDV)
• Taï Forest ebolavirus (TAFV).

BDBV, EBOV, and SUDV have been associated with large EVD outbreaks in Africa, whereas RESTV and TAFV have not. The RESTV species, found in Philippines and the People’s Republic of China, can infect humans, but no illness or death in humans from this species has been reported to date.

Transmission

Ebola is introduced into the human population through close contact with the blood, secretions, organs or other bodily fluids of infected animals. In Africa, infection has been documented through the handling of infected chimpanzees, gorillas, fruit bats, monkeys, forest antelope and porcupines found ill or dead or in the rainforest.

Ebola then spreads in the community through human-to-human transmission, with infection resulting from direct contact (through broken skin or mucous membranes) with the blood, secretions, organs or other bodily fluids of infected people, and indirect contact with environments contaminated with such fluids. Burial ceremonies in which mourners have direct contact with the body of the deceased person can also play a role in the transmission of Ebola. Men who have recovered from the disease can still transmit the virus through their semen for up to 7 weeks after recovery from illness.

Health-care workers have frequently been infected while treating patients with suspected or confirmed EVD. This has occurred through close contact with patients when infection control precautions are not strictly practiced.

Among workers in contact with monkeys or pigs infected with Reston ebolavirus, several infections have been documented in people who were clinically asymptomatic. Thus, RESTV appears less capable of causing disease in humans than other Ebola species.

However, the only available evidence available comes from healthy adult males. It would be premature to extrapolate the health effects of the virus to all population groups, such as immuno-compromised persons, persons with underlying medical conditions, pregnant women and children. More studies of RESTV are needed before definitive conclusions can be drawn about the pathogenicity and virulence of this virus in humans.

Signs and symptoms

EVD is a severe acute viral illness often characterized by the sudden onset of fever, intense weakness, muscle pain, headache and sore throat. This is followed by vomiting, diarrhoea, rash, impaired kidney and liver function, and in some cases, both internal and external bleeding. Laboratory findings include low white blood cell and platelet counts and elevated liver enzymes.

People are infectious as long as their blood and secretions contain the virus. Ebola virus was isolated from semen 61 days after onset of illness in a man who was infected in a laboratory.

The incubation period, that is, the time interval from infection with the virus to onset of symptoms, is 2 to 21 days.

Diagnosis

Other diseases that should be ruled out before a diagnosis of EVD can be made include: malaria, typhoid fever, shigellosis, cholera, leptospirosis, plague, rickettsiosis, relapsing fever, meningitis, hepatitis and other viral haemorrhagic fevers.

Ebola virus infections can be diagnosed definitively in a laboratory through several types of tests:

• antibody-capture enzyme-linked immunosorbent assay (ELISA)
• antigen detection tests
• serum neutralization test
• reverse transcriptase polymerase chain reaction (RT-PCR) assay
• electron microscopy
• virus isolation by cell culture.

Samples from patients are an extreme biohazard risk; testing should be conducted under maximum biological containment conditions.

Vaccine and treatment

No licensed vaccine for EVD is available. Several vaccines are being tested, but none are available for clinical use.

Severely ill patients require intensive supportive care. Patients are frequently dehydrated and require oral rehydration with solutions containing electrolytes or intravenous fluids.

No specific treatment is available. New drug therapies are being evaluated.

Natural host of Ebola virus

In Africa, fruit bats, particularly species of the genera Hypsignathus monstrosus, Epomops franqueti and Myonycteris torquata, are considered possible natural hosts for Ebola virus. As a result, the geographic distribution of Ebolaviruses may overlap with the range of the fruit bats.

Ebola virus in animals

Although non-human primates have been a source of infection for humans, they are not thought to be the reservoir but rather an accidental host like human beings. Since 1994, Ebola outbreaks from the EBOV and TAFV species have been observed in chimpanzees and gorillas.

RESTV has caused severe EVD outbreaks in macaque monkeys (Macaca fascicularis) farmed in Philippines and detected in monkeys imported into the USA in 1989, 1990 and 1996, and in monkeys imported to Italy from Philippines in 1992.

Since 2008, RESTV viruses have been detected during several outbreaks of a deadly disease in pigs in People’s Republic of China and Philippines. Asymptomatic infection in pigs has been reported and experimental inoculations have shown that RESTV cannot cause disease in pigs.

Prevention and control

Controlling Reston ebolavirus in domestic animals

No animal vaccine against RESTV is available. Routine cleaning and disinfection of pig or monkey farms (with sodium hypochlorite or other detergents) should be effective in inactivating the virus.

If an outbreak is suspected, the premises should be quarantined immediately. Culling of infected animals, with close supervision of burial or incineration of carcasses, may be necessary to reduce the risk of animal-to-human transmission. Restricting or banning the movement of animals from infected farms to other areas can reduce the spread of the disease.

As RESTV outbreaks in pigs and monkeys have preceded human infections, the establishment of an active animal health surveillance system to detect new cases is essential in providing early warning for veterinary and human public health authorities.

Reducing the risk of Ebola infection in people

In the absence of effective treatment and a human vaccine, raising awareness of the risk factors for Ebola infection and the protective measures individuals can take is the only way to reduce human infection and death.

In Africa, during EVD outbreaks, educational public health messages for risk reduction should focus on several factors:

• Reducing the risk of wildlife-to-human transmission from contact with infected fruit bats or monkeys/apes and the consumption of their raw meat. Animals should be handled with gloves and other appropriate protective clothing. Animal products (blood and meat) should be thoroughly cooked before consumption.
• Reducing the risk of human-to-human transmission in the community arising from direct or close contact with infected patients, particularly with their bodily fluids. Close physical contact with Ebola patients should be avoided. Gloves and appropriate personal protective equipment should be worn when taking care of ill patients at home. Regular hand washing is required after visiting patients in hospital, as well as after taking care of patients at home.
• Communities affected by Ebola should inform the population about the nature of the disease and about outbreak containment measures, including burial of the dead. People who have died from Ebola should be promptly and safely buried.

Pig farms in Africa can play a role in the amplification of infection because of the presence of fruit bats on these farms. Appropriate biosecurity measures should be in place to limit transmission. For RESTV, educational public health messages should focus on reducing the risk of pig-to-human transmission as a result of unsafe animal husbandry and slaughtering practices, and unsafe consumption of fresh blood, raw milk or animal tissue. Gloves and other appropriate protective clothing should be worn when handling sick animals or their tissues and when slaughtering animals. In regions where RESTV has been reported in pigs, all animal products (blood, meat and milk) should be thoroughly cooked before eating.

Controlling infection in health-care settings

Human-to-human transmission of the Ebola virus is primarily associated with direct or indirect contact with blood and body fluids. Transmission to health-care workers has been reported when appropriate infection control measures have not been observed.

It is not always possible to identify patients with EBV early because initial symptoms may be non-specific. For this reason, it is important that health-care workers apply standard precautions consistently with all patients – regardless of their diagnosis – in all work practices at all times. These include basic hand hygiene, respiratory hygiene, the use of personal protective equipment (according to the risk of splashes or other contact with infected materials), safe injection practices and safe burial practices.

Health-care workers caring for patients with suspected or confirmed Ebola virus should apply, in addition to standard precautions, other infection control measures to avoid any exposure to the patient’s blood and body fluids and direct unprotected contact with the possibly contaminated environment. When in close contact (within 1 metre) of patients with EBV, health-care workers should wear face protection (a face shield or a medical mask and goggles), a clean, non-sterile long-sleeved gown, and gloves (sterile gloves for some procedures).

Laboratory workers are also at risk. Samples taken from suspected human and animal Ebola cases for diagnosis should be handled by trained staff and processed in suitably equipped laboratories.

Resources: http://www.who.int/mediacentre/factsheets/fs103/en/                                http://www.rappler.com/newsbreak/iq/65032-fast-facts-ebola?gclid=CPWK3_6G0cACFQaSjgodjTMAUQ

            

Overview OF Measles Disease

Measles

• Measles is one of the leading causes of death among young children even though a safe and cost-effective vaccine is available.
• In 2012, there were 122 000 measles deaths globally – about 330 deaths every day or 14 deaths every hour.
• Measles vaccination resulted in a 78% drop in measles deaths between 2000 and 2012 worldwide.
• In 2012, about 84% of the world's children received one dose of measles vaccine by their first birthday through routine health services – up from 72% in 2000.
• Since 2000, more than 1 billion children in high risk countries were vaccinated against the disease through mass vaccination campaigns ― about 145 million of them in 2012.

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Measles is a highly contagious, serious disease caused by a virus. In 1980, before widespread vaccination, measles caused an estimated 2.6 million deaths each year.

It remains one of the leading causes of death among young children globally, despite the availability of a safe and effective vaccine. Approximately 122 000 people died from measles in 2012 – mostly children under the age of five.

Measles is caused by a virus in the paramyxovirus family. The measles virus normally grows in the cells that line the back of the throat and lungs. Measles is a human disease and is not known to occur in animals.

Accelerated immunization activities have had a major impact on reducing measles deaths. Since 2000, more than one billion children in high risk countries were vaccinated against the disease through mass vaccination campaigns ― about 145 million of them in 2012. Global measles deaths have decreased by 78% from an estimated 562 400 to 122 000.

Signs and symptoms

The first sign of measles is usually a high fever, which begins about 10 to 12 days after exposure to the virus, and lasts four to seven days. A runny nose, a cough, red and watery eyes, and small white spots inside the cheeks can develop in the initial stage. After several days, a rash erupts, usually on the face and upper neck. Over about three days, the rash spreads, eventually reaching the hands and feet. The rash lasts for 5 to 6 days, and then fades. On average, the rash occurs 14 days after exposure to the virus (within a range of seven to 18 days).

Severe measles is more likely among poorly nourished young children, especially those with insufficient vitamin A, or whose immune systems have been weakened by HIV/AIDS or other diseases.

Most measles-related deaths are caused by complications associated with the disease. Complications are more common in children under the age of five, or adults over the age of 20. The most serious complications include blindness, encephalitis (an infection that causes brain swelling), severe diarrhoea and related dehydration, ear infections, or severe respiratory infections such as pneumonia. As high as 10% of measles cases result in death among populations with high levels of malnutrition and a lack of adequate health care. Women infected while pregnant are also at risk of severe complications and the pregnancy may end in miscarriage or preterm delivery. People who recover from measles are immune for the rest of their lives.

Who is at risk?

Unvaccinated young children are at highest risk of measles and its complications, including death. Unvaccinated pregnant women are also at risk. Any non-immune person (who has not been vaccinated or was vaccinated but did not develop immunity) can become infected.

Measles is still common in many developing countries – particularly in parts of Africa and Asia. More than 20 million people are affected by measles each year. The overwhelming majority (more than 95%) of measles deaths occur in countries with low per capita incomes and weak health infrastructures.

Measles outbreaks can be particularly deadly in countries experiencing or recovering from a natural disaster or conflict. Damage to health infrastructure and health services interrupts routine immunization, and overcrowding in residential camps greatly increases the risk of infection.

Transmission

The highly contagious virus is spread by coughing and sneezing, close personal contact or direct contact with infected nasal or throat secretions.

The virus remains active and contagious in the air or on infected surfaces for up to two hours. It can be transmitted by an infected person from four days prior to the onset of the rash to four days after the rash erupts.

Measles outbreaks can result in epidemics that cause many deaths, especially among young, malnourished children. In countries where measles has been largely eliminated, cases imported from other countries remain an important source of infection.

Treatment

No specific antiviral treatment exists for measles virus.

Severe complications from measles can be avoided though supportive care that ensures good nutrition, adequate fluid intake and treatment of dehydration with WHO-recommended oral rehydration solution. This solution replaces fluids and other essential elements that are lost through diarrhoea or vomiting. Antibiotics should be prescribed to treat eye and ear infections, and pneumonia.

All children in developing countries diagnosed with measles should receive two doses of vitamin A supplements, given 24 hours apart. This treatment restores low vitamin A levels during measles that occur even in well-nourished children and can help prevent eye damage and blindness. Vitamin A supplements have been shown to reduce the number of deaths from measles by 50%.

Prevention

Routine measles vaccination for children, combined with mass immunization campaigns in countries with high case and death rates, are key public health strategies to reduce global measles deaths. The measles vaccine has been in use for 50 years. It is safe, effective and inexpensive. It costs less than one US dollar to immunize a child against measles.

The measles vaccine is often incorporated with rubella and/or mumps vaccines in countries where these illnesses are problems. It is equally effective in the single or combined form.

In 2012, about 84% of the world's children received one dose of measles vaccine by their first birthday through routine health services – up from 72% in 2000. Two doses of the vaccine are recommended to ensure immunity and prevent outbreaks, as about 15% of vaccinated children fail to develop immunity from the first dose.

WHO response

The fourth Millennium Development Goal (MDG 4) aims to reduce the under-five mortality rate by two-thirds between 1990 and 2015. Recognizing the potential of measles vaccination to reduce child mortality, and given that measles vaccination coverage can be considered a marker of access to child health services, routine measles vaccination coverage has been selected as an indicator of progress towards achieving MDG 4.

Overwhelming evidence demonstrates the benefit of providing universal access to measles and rubella-containing vaccines. Globally, an estimated 562 400 children died of measles in 2000. By 2012, the global push to improve vaccine coverage resulted in a 78% reduction in deaths. Since 2000, with support from the Measles & Rubella Initiative (M&R Initiative) over 1 billion children have been reached through mass vaccination campaigns ― about 145 million of them in 2012.

The M&R Initiative is a collaborative effort of WHO, UNICEF, the American Red Cross, the United States Centers for Disease Control and Prevention, and the United Nations Foundation to support countries to achieve measles and rubella control goals.

In 2012, the MR Initiative launched a new Global Measles and Rubella Strategic Plan which covers the period 2012-2020. The Plan includes new global goals for 2015 and 2020:

By the end of 2015

• To reduce global measles deaths by at least 95% compared with 2000 levels.
• To achieve regional measles and rubella/congenital rubella syndrome (CRS) elimination goals.

By the end of 2020

• To achieve measles and rubella elimination in at least five WHO regions.

The strategy focuses on the implementation of five core components:

• achieve and maintain high vaccination coverage with two doses of measles- and rubella-containing vaccines;
• monitor the disease using effective surveillance, and evaluate programmatic efforts to ensure progress and the positive impact of vaccination activities;
• develop and maintain outbreak preparedness, rapid response to outbreaks and the effective treatment of cases;
• communicate and engage to build public confidence and demand for immunization;
• perform the research and development needed to support cost-effective action and improve vaccination and diagnostic tools.

Implementation of the Strategic Plan can protect and improve the lives of children and their mothers throughout the world, rapidly and sustainably. The Plan provides clear strategies for country immunization managers, working with domestic and international partners, to achieve the 2015 and 2020 measles and rubella control and elimination goals. It builds on years of experience in implementing immunization programmes and incorporates lessons from accelerated measles control and polio eradication initiatives.

Resources : http://www.who.int/mediacentre/factsheets/fs286/en/