Psoriasis

Psoriasis

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Pneumonia

Pneumonia

Overview

Pneumonia is an infection caused by microorganisms like bacteria, viruses or fungi. It occurs in the lower respiratory tract. The symptoms of pneumonia can range from being moderate to life-threatening.

Although pneumonia is known to occur in individuals of any age group, severe pneumonia is more common in children who are very young and adults over 65 years. As reported by the WHO, pneumonia is the leading cause of death in children below 5 years of age. Pregnant women, people with underlying serious illness and those with a weak immune system are at a higher risk for severe pneumonia. Research also proves that individuals on mechanical ventilation or chemotherapy and those who have received an organ donation are prone. People who have AIDS are also extremely susceptible to pneumonia.

Microorganisms are constantly present in the environment around an individual. In a healthy individual, the body defense mechanisms are capable of protecting the lungs and respiratory tract from severe infections. The body defenses against respiratory infections include the coverings of the respiratory tract, the mucous and the hair-like structures that trap and remove many disease-causing germs from the airways. If these disease-causing germs or pathogens pass through these initial defense systems, they are then destroyed by immune system cells that identify them as foreign bodies and prevent them from creating further damage. Pneumonia occurs when these defense systems are damaged, weakened or when the pathogens that invade overpower the defense systems.

Some types of pneumonia are more common in some seasons. Seasonal changes and climatic conditions make some microorganisms more prevalent in nature than usual. Therefore, pneumonia becomes more common in some seasons.

Types of Pneumonia

  • Lobar Pneumonia: A form of infection that affects only one part (lobe) of the lung.
  • Bronchopneumonia: An infection that affects the air passages (bronchi) of the lungs
  • Atypical Pneumonia:   This type of pneumonia is caused by organisms like Mycoplasma, Chlamydia, and Legionella. These are called atypical because they have unusual symptoms and uncommon findings on chest X-ray.
  • Aspiration Pneumonia: A form of pneumonia that is caused by inhaling one’s own gastric juices or food particles. It is also called anaerobic pneumonia as it is caused by the good bacteria that live in our digestive tract and can survive without oxygen.

Causes

Pneumonia is caused most commonly by bacteria and viruses and less commonly by fungi or parasites. The causes differ according to the age of the person, time of the year, the health status of the person and also the place from where the infection has occurred.

Most common causative agents  of pneumonia are as follows:

Bacterial causes

Pneumonia can be caused by various types of bacteria. Bacterial pneumonia is more common in adults.

Elderly, who suffer viral respiratory infection, can have additional infection due to bacteria that leads to pneumonia. These are called secondary pneumonia.

The most common causes of bacterial pneumonia is Streptococcus pneumoniae also called pneumococci. Pneumonia caused by Streptococcus pneumoniae is called pneumococcal pneumonia.

These bacteria are easily spread through direct contact or by coughing and sneezing.

The less common causes of bacterial pneumonia are:

  • Haemophilus influenza type B (Hib) causes pneumonia in children less than 5 years of age. It can also cause other infections like meningitis, and ear infections. However, due to Hib vaccinations, these infections are now less common.
  • Moraxella catarrhalis is seen as a part of the harmless bacteria of our mouth and throat. But it can cause pneumonia in children and adults with other lung diseases like Asthma and COPD. Usually, It causes ear infections and sinusitis in children.
  • Staphylococcus aureus pneumonia is more common in hospitalized patients or following the viral flu. These infections can become severe and difficult to treat as they are resistant to multiple antibiotics.
  • Klebsiella pneumonia can cause pneumonia in hospitalized patients on a ventilator. It can also cause pneumonia in alcoholics.
  • Streptococcus agalactiae (Group B strep) is a bacteria seen in the female vagina. They can be passed from a pregnant woman to her baby during childbirth and cause severe infections in the newborns. They can also cause infections in the elderly who have diabetes or neurological disease.
  • Pseudomonas aeruginosa can cause pneumonia in individuals with decreased lung function like cystic fibrosis, individuals with low immunity and hospitalized individuals.

Based on the geographical location of the individual, the type of bacteria causing the infection could vary. In such cases, travelers and tourists who migrate from certain countries may be exposed to bacteria types that are less common in their own geographical location. In some cases, a person may be exposed and become vulnerable to a rare type of bacterial pneumonia due to his weakened immune system or an underlying health condition.

Viral causes

About one-third of all pneumonia cases occur due to viruses that infect the respiratory system. Viral causes are usually the most common cause of pneumonia in children. Viral causes are also very common in adults over 60-65 years of age.

Depending on the type of virus, age and the immunity of the individual affected, viral pneumonia can range from mild to severe infections.

The most common viruses that cause pneumonia are

  • Influenza Virus is the most common cause of viral pneumonia.
  • Parainfluenza Virus can also cause respiratory infections in infants, which further develop into pneumonia.
  • Respiratory Syncytial Virus is the most common cause of pneumonia in children below 1 year of age.
  • Other viruses which cause pneumonia include adenoviruses, cytomegalovirus, measles, and rhinoviruses.

Fungal causes

Pneumonia due to fungi is less common. Fungal pneumonia is more commonly seen in people who have a weak immune system. These include recipients of organ transplants, individuals with AIDS, diabetes and those on chemotherapy treatment for cancer. The fungi that cause infection in these people are usually referred to as “opportunistic.”

Some examples of opportunistic fungi are

  • Aspergillus species common cause for aspergillosis and fungal masses in the sinus and lungs. They can cause lung infections in individuals with asthma or COPD.
  • Rhizopus and Mucor they commonly cause sinus infections in diabetes
  • Pneumocystis jirovecii is very common in individuals with AIDS
  • Certain fungi, called endemic fungi, can also cause pneumonia and severe infections in healthy adults. These fungi are less common but are highly prevalent in areas with caves and rivers. The examples include
  • Histoplasma
  • Coccidiodes
  • Sporothrix

Parasitic pneumonia

Pneumonia due to parasites is the least common. They are more common in individuals with severe defects in their immunity. Examples include

  • Toxoplasma
  • Hookworms, pinworms and flukes
  • Filariasis

Symptoms

Symptoms of pneumonia vary based on the age of the affected individual, his or her health condition and the type of microorganism that is causing the infection.

In newborn babies, the common symptoms are wheezing, grunting, breathing rapidly, irritability and lethargic behavior. Mild symptoms of pneumonia resemble that of a regular cold or flu but they tend to last longer.

Common symptoms of pneumonia include:

  • Fever, chills, and sweating
  • Cough, with or without phlegm
  • Chest pain
  • Difficulty in breathing
  • Nausea and vomiting
  • Bronchitis treatment
  • Muscle pains
  • Headache
  • Fatigue
  • Confusion

Pneumonia can progress and become life-threatening in some individuals. And hence, with medical assistance must be initiated as early as possible.

Risk Factors

Pneumonia can occur in anyone but the following individuals are at highest risk.

  • Children below 2 years of age
  • Adults over 65 years of age
  • Hospitalized individuals: Hospitalisation increases the risk of exposure to micro-organisms, especially in those who require a ventilator.
  • Presence of chronic diseases: Having chronic diseases like asthma, chronic obstructive pulmonary disease (COPD), or heart diseases can make an individual more vulnerable to pneumonia.
  • Smoking: Smoking usually results in the damage of the body’s natural defense systems against bacteria and viruses, making individuals more prone to infections like pneumonia.
  • Weak immune system: People with severe underlying health conditions like HIV/AIDS, those who have had an organ transplant, those on chemotherapy regimen or long-term usage of steroids are at higher risk for pneumonia.

Diagnosis

Diagnostic tests for pneumonia detect the presence of pneumonia, the microorganism causing the infection and the extent of damage tothe lungs. Diagnosis is also essential to limit the spread of infection, to understand its severity and also as a guide to the treatment that is to be given.

Common infectious organisms are usually difficult to be identified, and therefore the medical history or the patient, identification of common agents in the community and the patient’s clinical presentation are taken into consideration. In cases where symptoms do not resolve after a primary treatment, additional testing may be performed to diagnose and identify less common causes of pneumonia.

Based on the symptoms displayed by the person and his health status, various laboratory tests may be performed for accurate diagnosis. Commonly prescribed diagnostic tests that can be done in a laboratory include:

  • Complete Blood Count (CBC): The presence of infection may be detected by the number of white blood cells or WBC present in the blood.
  • Basic Metabolic Panel (BMP): Tests for sodium, potassium and other elements in order to determine the severity of the infection.
  • Arterial Blood Gases or ABG: This test measures pH and the amount of oxygen and carbon dioxide in the blood. This is an indication of lung function.

In order to diagnose the presence of bacteria, the common tests prescribed are:

Sputum Culture/Gram Stain: Primary test to identify the bacterial cause of pneumonia. Culture can also identify the antibiotics to which the bacterial agent is susceptible.

AFB Smear and Culture: Tuberculosis can also present like pneumonia. This test is required to identify tuberculosis bacteria in the lungs.

Blood Culture: This test is done when it is suspected that infection has spread from lungs to blood or from blood to the lungs.

Pleural Fluid Analysis: Sometimes fluid collects around the lungs between its coverings. This fluid is tested for identifying the cause of pneumonia.

Special Test:  Special tests can identify specific causes of pneumonia. These include those which cannot be cultured Examples are

  • Mycoplasma
  • Legionella
  • Influenza Tests
  • RSV Testing
  • Fungal Tests

Chest X-ray: Chest X-ray detects and evaluates the severity of a lung infection. When a patient has pneumonia, the affected lung may show up on the chest X-ray as patches.

Computed Tomography Scan (CT Scan)  is used to detect and evaluate the structure of the lung and the changes due to pneumonia.

Treatment

Treatment for pneumonia varies depending on the type and severity of the infection. Various medications for pneumonia include:

  • Antibiotics: These medicines work on the bacteria. Antibiotics are prescribed by the doctor based on the type of bacteria causing pneumonia. If the symptoms fail to ease, replacement of antibiotics is done.
  • Cough Medicine: Severe coughing can be troublesome for patients. Cough medication reduces cough and helps the patient rest. A cough is sometimes required to remove fluid from the lungs. in such cases, the low dose of cough medicine might be reduced.
  • Antipyeretics: When a person is experiencing discomfort due to fever and pain during the infection, medications to reduce fever and pain, like paracetamol, are prescribed.
  • Admission into the hospital may be required in severe infections, individual over 65 years of age, or if they have variations in blood pressure, damage to kidney function, rapid breathing, confusion, low/high heart rate and breathing difficulties.
  • Children may require hospitalization if they are younger than 2 months of age or if they are lethargic, having a high fever and experiencing breathing difficulties. If the child appears dehydrated, it is also a sign to get them hospitalized.
  • For those who have been infected with pneumonia, getting plenty of rest, staying hydrated and taking medicines as prescribed can help decrease the risk of complications and aid in speedy recovery.

Prevention

Some practices can help prevent pneumonia and serious illness.

  • Vaccination: The most common types of pneumonia can be prevented by vaccination. The vaccine available include
  • Pneumococcal Vaccine: This vaccine protects the individual from serious infections of Streptococcus pneumonia. Two types of pneumococcal vaccine are available. These are the pneumococcal polysaccharide vaccine(PPSV23) and pneumococcal conjugate vaccine (PCV 13).
  • Hemophilus influenza vaccine or Hib vaccine prevents pneumonia due to Hemophilus influenza.
  • Other relevant vaccines include influenza vaccine, chicken pox vaccine, MMR

Some other preventive measures include:

  • Thorough and frequent washing of hands
  •  Covering of the nose while sneezing
  • Cleaning and disinfecting surfaces like door knobs, handles, keyboards, remotes, mobile phones and other items that are frequently touched by hands.
  • Avoiding touching face, eyes, nose and mouth without washing hands
  • Avoiding close contact with those who have cold and cough respiratory infections
  • Stop smoking

FAQs

How can I prevent my baby from pneumonia?

Vaccinations are the safest preventive measures against pneumonia and other fatal infections in infants.

Does pneumonia result in death?

Untreated pneumonia can be fatal for babies under 2 months of age and also for adults with underlying health conditions.

How long does it take to recover from pneumonia?

Pneumonia can be considered as a mild illness in people who are healthy and can, therefore, be cleared in 2 to 3 weeks of time. In those with other health issues and in older adults, it can take upto 2 months or more.

What are the early signs of pneumonia?

A cough and fever is an early sign of pneumonia. Usually, the cough is associated with phlegm or sputum that comes from the lungs during the infection.

Piles

Piles

PCOD

PCOD

Causes

Polycystic ovary disorder (PCOD) is a hormonal disorder in women,  which can affect the functioning of a woman’s ovaries. However, the cause of PCOD is unknown. But the common causes may include family history, insulin resistance, inflammation, lifestyle or environment which are causes of excess androgen production.

Family History

There is a 50% possibility of getting PCOD among the women whose immediate female relatives do suffer from PCOD. As you grow older,  this PCOD may lead to Type 2 diabetes which considered being common among the women with PCOD. Till now, a single gene has not yet found to be the cause of PCOD and it is likely to be complex and involve multiple genes.

Insulin resistance & Lifestyle

Women with PCOD have insulin resistance, Up to 70%. Which means that their cells can’t use insulin properly. The pancreas produces Insulin, which is a hormone to help the body use sugar from foods for energy.

In insulin resistance, cells can’t use insulin properly and the body’s demand for insulin increases. To compensate, the pancreas makes more insulin.

Factors of Insulin Resistance:

  • Insulin resistance as a result of genetic factors
  • Insulin resistance as a result of being overweight (related to diet and inactivity)
  • A combination of both of these factors

Inflammation

PCOS can lead to increased levels of inflammation in women. And being overweight also can contribute to inflammation. Studies have shown in PCOD that excess inflammation is linked to higher androgen levels.

Weight

Sometimes, a higher weight may worsen insulin resistance and the symptoms of the polycystic ovarian syndrome. Some women with PCOD report that they had never experienced symptoms such as menstrual irregularity or excessive hair growth and are a healthy weight. However, these symptoms only appear once they gain weight.

What are the Treatments for PCOD?

There is no cure for PCOD. But you can manage the symptoms that affect an individual.

Polycystic ovary disorder (PCOD) exhibits a variety of symptoms due to which your health care providers may consider different treatment options for treating this condition and its symptoms.

The treatment options suggested by your healthcare provider depend on:

  • Your symptoms
  • Other health problems
  • The desire to become pregnant

Conclusion

There is no clear cause for PCOD. However early detection or diagnosis of PCOD will be constructive in relieving the symptoms as well as to reduce the complications involved.

PCOD treatment helps you to manage your individual concerns including infertility, hirsutism, acne or obesity. However,

specific treatment might involve lifestyle changes or medication.

What are the common diseases of the eyes?

What are the common diseases of the eyes?

Most people face eye problems at some point of time in life. Some may be minor which will go away on their own or can be treated easily at home, while the others can be major which need Ophthalmologist specialist for care. 

There are many diseases which don’t exhibit any symptoms or warnings. However, these diseases can be detected and managed by your eye specialist before they damage your anatomy. Therefore, it is mandatory to have regular eye checkups.

The following are some of the common eye diseases which your ophthalmologist  may uncover:

 Dry Eye When you cry, the tiny tear glands form the tears that surround the eye. Dry eye happens is a condition where the tiny glands become unstable which results in the production of fewer tears than normal. The common symptoms exhibited by this disease are redness, watery eyes, pain, grit, and fluctuating vision. It is more prevalent in women compared to men. However, this can be treated with eye drops or in more serious cases, minor surgery. 

Glaucoma: Glaucoma is a common eye disorder that becomes more apparent in patients 50 and older, causing vision loss gradually. During this condition, there will be an increase in pressure within the eye which causes damage to the optic nerve. Symptoms exhibited during Glaucoma include eye pain, blurred vision, and reddening of the eye.

Cataracts: Cataracts are one of the most common eye diseases that develop over time and cause cloudy vision. It makes it hard to read or see things normally and is very common as you get older. It can be cured with simple outpatient cataract surgery. During cataract surgery, your doctor may remove cataracts so that your vision will be restored to normal. However, delayed cataract surgery may make simple day-to-day activities bothersome, but it wouldn’t cause any ongoing damage to your eyes.

Ocular Allergies: These are simply known as eye allergies and may differ from patient to patient. The symptoms are relatively the same which include redness, itching, swelling, and sometimes a pain for which your Eye doctors may prescribe medicine or eye drops to make the allergies less bothersome.

Diabetic Retinopathy Diabetic retinopathy is a very common condition in patients with diabetes for a large part of their life. Patients with diabetic retinopathy will experience blurred vision and/or vision loss because of having too much sugar in their blood. This is due to the high amount of sugar which can cut off the blood supply to the back of the retina and can hinder new blood vessels from growing. 

Eyestrain Lymphoma: Eyestrain is a very common condition among people who read for hours, work at a computer, or drive long distances. It happens when you strain your eyes. This is because your eyes get tired and need rest, just like other parts of your body.

Color & Night Blindness: Night blindness is often a symptom, not a problem. This may be due to nearsightedness, cataracts, keratoconus, and a lack of vitamin A which your doctors may fix.

Retinal Disorders: Retinal disorders occur when the thin lining on the back of your eye that is made up of cells that collect images and pass them on to your brain gets affected. 

The above listed are the most common issues that eye doctors find in patients. There are no apparent symptoms in some eye diseases due to which your eye doctor doesn’t have the opportunity to detect a problem and these remain untreated.

How Can an Obese Person Lose Weight

How Can an Obese Person Lose Weight

Obesity is a medical condition where the accumulation of excess body fat takes place to an extent which may have a negative effect on your health. Obesity is a worldwide problem because more than one billion adults around the world, are overweight and about 300 million of them are obese.

Obesity Treatment

No two people are alike. As a result, it is important to create a weight-loss plan that best suits and works for you. However, irrespective of the obesity treatment plan you follow, losing weight slowly will be more effective and healthy compared to faster weight loss. This is because over the long term quick weight loss often prompts weight to regain.

Below listed are the popular obesity treatment options you can consider:

Diet for Obesity

Limiting the number of calories you consume is one of the most effective ways to lose weight. However, the successful long-term weight loss programs don’t consider the actual composition of the diet rather rely more on how many calories you burn through exercise and daily activity.

Consult a registered dietician who can help you through an individualized diet plan based on your particular situation. Follow certain basic dietary recommendations which may result in weight loss:

  • Include a variety of foods and healthy juices in your diet to help attain adequate nutrients, vitamins, and minerals.
  • Limit fried food items in your diet, due to it being unhealthy for your health and heart.
  • Sugary food and beverages also shouldn’t be included in your daily diet, as these food products are high in fat and add no nutritional value.
  • Take fats like polyunsaturated and monosaturated as they provide health benefits such as helping to keep the heart healthy.
  • Nuts, seeds and some types of oils, such as olive, safflower, and canola can be a part of a healthy eating plan.
  • Choose whole grains such as brown rice and whole wheat bread rather than white rice and white bread because they are richer in nutrients and higher in fiber, so the body absorbs them more slowly.
  • Include whole-grain rice, bread, and pasta instead of the normal white versions.
  • Consider fruit, nuts, and seeds instead of high-sugar snacks and substitute unhealthy snacks.
  • Consume herb teas and fruit-infused water instead of high-sugar sodas.
  • Get at least five servings daily of a variety of fruits and vegetables as they contain varying amounts and types of nutrients.
  • Avoid super-sized selections when you order take-out food because many restaurant portions are too large for one person.
  • Read food labels carefully and pay particular attention to the number of servings contained in the product and the serving size.

Exercise for Weight loss

Some people lose weight by themselves. But it is always advisable to seek help from a health care provider who will recommend the right type of exercise for you. The goal of exercise plans is to help you lose 1 to 2 kilograms per week.

Your provider may suggest that you the following ways which can gradually increase your physical activity:

  • Walk every day.
  • Take the stairs instead of the elevator.
  • Do errands on foot, if possible
  • Park your vehicle farther away and walk to your destination
  • Go to a spa, gym, or exercise class.
  • Water aerobics classes are especially good if you have back, knee, or joint problems.
  • Do some form of strength training using gym equipment or your own body weight
  • Consult your physician before setting up any exercise plans.

Environmental Changes

Our typical days encourage an inactive lifestyle, and it also takes a bit of effort to become active on a daily basis. The activities that contribute to an inactive, sedentary lifestyle include driving to the office, working at a desk, watching television, which doesn’t require any physical effort as such.

Here are a few simple changes which you can adapt to increase daily activity and productivity:

  • Avoid the elevator or escalator and take the stairs
  • If possible park the car farther and walk to the store or the office
  • Get dropped one stop before from your bus stop
  • Stop watching the television or video game and head outdoors
  • Wash the car or just take a walk
  • Consider activities such as tennis, roller-blading or hiking
  • Find ways to pack more activity into your day in addition to exercising
  • Take cut fruits and vegetables, to have on hand when you get hungry
  • Avoid the temptation of high-calorie treats like  cake and cookies

Non-Surgical Treatment for Obesity

Non-Surgical treatment could be the best treatment option when your other efforts to lose weight have disappointed you. Your physician may suggest a non-surgical treatment, based on your medical conditions and medicine intake.

The following treatments may include:

  • Intake of medications for treating obesity & malabsorptive surgeriesrelated health issues.
  • Adapt behavioral changes that improvise regular diet and lifestyle habits.
  • Medications that can help address any eating disorders.

Surgical Treatment for Obesity

Weight-loss surgery is also known as bariatric surgery, which is a surgical treatment to treat obesity. It is for the people who have failed at conservative measures including diet, exercise, and medication.

The target group for this Weight-loss surgery includes:

  • People with a BMI greater than 40
  • Men who are 100 pounds above their ideal body weight
  • Women who are 80 pounds above their ideal body weight
  • Persons with another condition precipitated by obesity such as obesity-related Type 2 diabetes, sleep apnea or heart disease.

But it is best to consider all your options before opting for surgery, ensure you speak to your doctor about all the pros and cons before going ahead with surgical treatment for obesity.

Migraine Causes, Symptoms, Risk Factors and Treatment

Migraine Causes, Symptoms, Risk Factors and Treatment

Overview

A migraine is a neurological condition or disorder which is characterized by severe headaches accompanied by symptoms like nausea, vomiting, speaking difficulties, numbness or tingling, light and sound sensitivity.  Migraines could be genetic and can affect people of almost all ages. In young children, migraine goes undiagnosed as it is misunderstood to be a common headache or weakness.

The duration of migraine varies between individuals. Most of the attacks last for a minimum of 4 hours. If an attack of a migraine lasts longer than three days, it has to be treated in a hospital setting.

Migraine headaches can include a wide range of debilitating neurological symptoms. A headache usually occurs on one side of the head and is typically throbbing in nature.

The most common types of migraine are

  • Classic Migraine: Also called as a migraine with aura, it occurs with specific warning signs before the attack begins. It is seen in 25% of people with migraine. It is also termed as complicated migraine and hemiplegic migraine. An aura is the initial phase of the migraine attack accompanied by distinct symptoms like flashing lights, loss of vision, dizziness, confusion and weakness.
  • Migraine without aura:  occurs without any warning signs and is the most common type.

Migraine aura without headache: The symptoms of aura occur but the person does not develop headache.  This is also known as a silent migraine.

The characteristic symptoms of migraine without aura are

1) Any two of the symptoms –

  • A one-sided headache
  • Pulsating or throbbing pain
  • Moderate to severe pain level
  • Worsening of pain during movement (walking, climbing stairs)

2) At least one symptom from the following –

  • Sensitivity to light
  • Sensitivity to sound
  • Nausea with or without vomiting or diarrhea

Other types include

  • Retinal migraine or Ocular migraine
  • Abdominal migraine

Certain types of headaches which closely resemble a migraine attack but are not categorized as a migraine include

  • Cluster headache
  • Tension-type headache
  • Sinus headache

Migraine pain is usually described as

  • Pulsating
  • Throbbing
  • Perforating
  • Debilitating

Migraine pain mostly affects the forehead area. It is usually on one side but can occur on both sides or shift from one side to another.

While people suffering from migraine may experience the attack frequently, up to several times in a week, there are some cases where an occasional experience of a migraine attack is experienced. At times, it could take up a gap of a few years for one to experience a migraine again. Migraine is widely addressed by neurologists and specialists who come from a variety of backgrounds.

Migraines could affect the quality of life and stop one from carrying out normal daily activities.

Causes

The causes of migraine may vary from person to person.

Genetics and environmental factors play a major role in the cause of migraine.

Migraine could be caused by changes in the brainstem and the trigeminal nerve, which is the major pathway for pain.

An imbalance of chemical in the brain like serotonin could also be the cause of a migraine. Serotonin helps regulate pain in the nervous system. The role of serotonin in migraine is still being studied by researchers. In a migraine attack, there is a drop in the level of serotonin, causing the trigeminal nerves to release substances called neuropeptides, which travel to the outer covering of the brain or the meninges. The results in headaches.

Certain substances and habits are known to make an individual more vulnerable to migraines. The common factors that trigger migraines are as follows:

  • Hormonal Fluctuations: Changes or fluctuations in the levels of estrogen trigger headaches in women. Many women have headaches immediately before or during their periods.
  • Hormonal changes in pregnancy and menopause also cause migraine.
  • Medications like oral contraceptives and hormone replacement therapies can worsen migraines. Oral contraceptives and vasodilators are known to trigger migraine attacks as they change the hormone levels in the body. However, some women find migraines reduce when they take these medications.
  • Skipping meals or being on a fast can trigger migraine attacks. Consuming salty foods, aged cheese, and processed foods could also trigger migraines.
  • Food additives like monosodium glutamate (MSG) in food and aspartame may also trigger migraines.
  • Consuming alcohol, especially wine and beverages with high amounts of caffeine may trigger migraines.
  • Stress at work or home can trigger migraine attacks.
  • Bright lights, loud sounds and sun glare can induce migraines. Sometimes a strong smelling perfume, paint thinner, passive smoke, etc. can also trigger migraines.
  • A migraine could also be triggered by an altered sleep pattern like sleeping too much or too little. A jet lag could also be a trigger.
  • Physical Factors: Intense physical activity or sexual activity can trigger migraines.
  • Environment Change: A change in climate and weather conditions can trigger a migraine.

Symptoms

Symptoms of migraine and its severity can vary from person to person. A throbbing headache is the most common symptom of a migraine attack. This usually occurs on one side. Alongside headache, a person may experience one or more of the following symptoms –

  • Nausea
  • Vomiting
  • Sensitivity to light
  • Sensitivity to sound
  • Sensitivity to smell
  • Visual disturbances
  • Dizziness
  • Fatigue
  • Numbness
  • Tingling
  • Pain on one side of the head
  • Vertigo
  • Puffy eyelids
  • Fatigue
  • Difficulty in concentrating
  • Mood swings
  • Food cravings
  • Fever
  • Neck pain
  • Aura
  • Weakness

Throbbing/pulsating pain and sensitivity to light are the two most common symptoms. A typical migraine attack progresses through four stages and symptoms of the attack vary from stage to stage.

The four stages of migraine attack are as follows

  • Prodrome
  • Aura
  • Headache
  • Postdrome

In the prodrome stage, the individual experiences difficulty in speaking, constipation or diarrhea, difficulty in concentrating, fatigue, hyperactivity, food cravings, increased urination, mood changes and neck pain.

In the aura phase of a migraine, varied symptoms occur which include sensitivity to touch/feel, difficulty to talk, auditory or olfactory hallucinations (hearing or smelling things that are not there), paralysis of a side of the body, dizziness, vertigo and paraesthesias. About 5 % of the general population experiences migraine with aura. Not every migraine attack comes with an aura. Among those that suffer from migraine, about 19% tend to experience an aura with every attack.

The headache phase of migraine is characterized by headache occurring on one side of the head. The pain is made worse by physical activity and lasts for four or more hours.

Postdrome or the last phase of migraine can lead to a feeling of “hungover” and is usually characterized by symptoms like fatigue, mood swings, difficulty to concentrate, etc.

Individuals who suffer from migraine are advised to maintain a journal of symptoms experienced during each attack and the activity they were doing just before the attack started. It is important to note the duration of pain as well. Writing the symptoms down each time will give the patient an idea of the pattern of pain being experienced and also what activities he/she must refrain from in order to prevent migraine attacks in the future.

Risk Factors

Migraines can occur due to several factors. Some of the factors associated with migraine include:

  • Family History: Migraines can be genetic and hence if one person in a family suffers from migraine, there is an increased probability for others in the family to have it too.
  • Age: Migraines begin at any age. The first attack of migraine is usually experienced during adolescence. Migraines tend to peak in a person’s life during his 30s and gradually tend to be less severe in the following decades.
  • Sex: Women are three times more likely to have migraine than men.  Among children, the headaches are more common in boys than girls. But by puberty, girls are more affected. This could be due to the fluctuations in the hormonal levels for a menstrual cycle to occur. In later stages, conditions like pregnancy, menopause, etc. become a reason for migraine attacks in women.
  • Hormonal Changes: Many women complain of a headache at the onset on menstruation. Menopause is known to improve migraines. For some women, migraine attacks increase during pregnancy. However, the attacks may be absent in the later stages of pregnancy and return during the postpartum period.

Diagnosis

A doctor diagnoses a migraine in a person by analyzing the symptoms. Tests may be done to detect unusual, complex or severe conditions. The doctor might recommend the following tests.

  • Blood Tests: These tests are used to identify problems in blood vessels and also to diagnose infections in spinal cord and brain.
  • Magnetic Resonance Imaging (MRI): A strong magnetic field and radio waves are used in MRI test to produce detailed images of the brain and blood vessels. MRIs can diagnose tumours, strokes, bleeding in the brain, infections and other neurological conditions.
  • Computerized Tomography (CT) Scan: A CT scan uses a series of x-rays to create detailed cross-sectional images of the brain. Using a CT scan, a doctor can identify infections, brain damage, bleeding in the brain and spinal tumors, and other issues that cause headaches.
  • Spinal Tap (Lumbar Puncture): This test may be recommended if an individual is suspected to have an infection or bleeding in the brain. This procedure involves the insertion of a thin needle between two vertebrae in the lower back to draw a sample of the cerebrospinal fluid (brain fluid) for further laboratory analysis.

Treatment

Treatment of migraine is required to relieve the symptoms and prevent attacks in the future. The medications that are used to treat migraine are classified into two broad categories:

  • Pain-relieving medications
  • Preventive medications
  • Pain-relieving medications are also known as acute or abortive treatment. The drugs falling under this category are taken during the migraine attack and are designed to minimize or eliminate the symptoms.

Common pain-relieving medications include:

  • Pain Relievers: used in migraine include aspirin, ibuprofen and paracetamol. These drugs may be taken as combinations with caffeine. These drugs are however not effective for severe migraines.
  • Triptans: Triptans make blood vessels contract and block pathways of pain in the brain. These drugs are effective in relieving pain and other symptoms associated with migraines. They are available in the form of a pill, nasal spray and injection. Triptan medications include sumatriptan, rizatriptan, etc.
  • Ergots: Less effective than triptans are ergots, which are a combination of ergotamine and caffeine. Ergots are more effective when taken soon after an attack of migraine starts.
  • Anti-nausea Medications: Chlorpromazine, metoclopramide and other medications are frequently prescribed for nausea in combination with other medications.
  • Opioid Medications: These medications contain narcotics, primarily codeine. These are used to treat migraine pain in patients who cannot take triptans and ergots.
  • Glucocorticoids: A glucocorticoid is used in combination with other medications to improve pain relief.

Preventive medications are drugs that have to be taken regularly to reduce the severity or frequency of migraine attacks. Preventive medication is recommended if a patient suffers from four or more debilitating attacks in a month and if the attacks last longer than 12 hours.

The most common preventive medications for a migraine include:

  • Cardiovascular Drugs: Beta-blockers like propranolol, metoprolol and timolol and calcium channel blocker can prevent migraines.
  • Antidepressants: Tricyclic antidepressants can reduce the frequency of migraine by affecting the level of serotonin and other brain chemicals.
  • Anti-Seizure Drugs: To reduce the frequency of migraine attacks, certain anti-seizure drugs like valproate and topiramate are used.
  • Onabotulinum Toxin A (Botox): Botox treatment is also helpful in treating chronic migraines in adults.
  • Pain Relievers: NSAIDs or non-steroidal anti-inflammatory drugs like naproxen may prevent migraines and minimize symptoms.

The treatment strategy depends on the frequency of a headache and its severity. It also depends upon the degree of disability caused by the attack and other underlying health conditions of the patient.

Treatment varies in certain conditions like pregnancy and breastfeeding. The doctor should be informed of such conditions, as some medicines aren’t recommended during these stages.

Prevention

Identifying the pattern of migraine is a good way to prevent its repetition. Maintaining a journal of activities and keeping a track of symptoms that are experienced each time will help an individual understand the triggers of a migraine attack. Abstaining from such tasks will eventually help the individual to prevent attacks in the future.

Apart from this, the following lifestyle modifications may help prevent migraines

  • Regular schedule for eating
  • Regular schedule for sleeping
  • Avoiding foods that trigger migraine
  • Drinking plenty of water and keeping oneself hydrated
  • Exercise may promote muscle relaxation and help manage pain during migraine.
  • Relaxation strategies
  • Prompt medication schedule
  • Some foods are known to trigger migraine. Avoiding them can also help prevent migraines
  • Red wine
  • Aged cheese
  • Preserved, smoked meat foods
  • Monosodium glutamate
  • Aspartame and artificial sweeteners
  • Chocolate
  • Dairy products
  • Alcoholic beverages
  • Highly-caffeinated beverages

Apart from these, daily use of medications and being stress-free are effective tips in the prevention of migraine. Apart from medications prescribed by the doctor, hot packs and heating pads can help relax tense muscles. Having a warm bath can also soothe a migraine attack.

FAQs

Is migraine permanent?

Migraine is a chronic condition which can be effectively controlled by treatment measures.

What are the treatment measures for migraines?

Medications prescribed by the doctor and preventive measures can help treat migraine.

Why do I get a migraine pain when I wake up?

A migraine is often triggered when you miss meals or delay them. If you are experiencing migraine attacks every morning you wake, you might have to add a short meal just before you go to bed so that you do not stay long on an empty stomach.

Measles

Measles

Overview

Measles or rubeola is a viral infection that affects the respiratory system. Measles is a very contagious disease can spread through contact with infected mucus or saliva. An infected person can release the infection into the atmosphere through their cough or sneeze. The measles virus can live on surfaces for several hours. When the infected particles enter the air & settle on surfaces, anyone nearby can get infected. Drinking from an infected person’s glass or sharing eating utensils with an infected person increases your risk of infection.

Measles is also a cause of death among children. Of the 114,900 global deaths related to measles in 2014, the World Health Organization (WHO) reported that the majority were below the age of 5. The number of measles cases in the US has significantly dropped in recent years due to immunizations. However, the disease has not been fully eliminated. There were 189 cases of measles in 2015, according to the Centers for Disease Control & Prevention (CDC).

If the person has any doubt of having measles, he must contact the doctor immediately. If the person has not received a measles vaccine & has contact with an infected person, visit the doctor to get measles vaccine within 72 hours of contact to prevent infection. The person can also prevent infection if immunoglobulin is taken within six days of contact with an infected person.

Causes

Measles is caused by infection with the rubeola virus. The virus lives in the mucus of the nose & throat of an infected child or adult. The disease is contagious for four days before the rash appears, & continues to be contagious for about 4 to 5 days after.

The infection spreads through:

  • Physical contact with an infected person
  • Being near infected people if they cough or sneeze
  • Touching a surface that has contaminated droplets of mucus & then putting fingers into the mouth or rubbing the nose or eyes

The virus remains active on an object for two hours.

As soon as the virus enters into the body, it multiplies in the back of the throat, lungs & the lymphatic system. It later infects & replicates in the urinary tract, eyes, blood vessels, respiratory distress syndrome & central nervous system. The symptoms appear between nine & eleven days after initial infection.

Any person who has never been infected or vaccinated is likely to become ill if they breathe in infected droplets or are in close physical contact with an infected person.

Approximately 90% of people who are not immune will develop measles if they share a house with an infected person.

Symptoms

Symptoms will appear about nine to eleven days after the initial infection.

The symptoms of measles always include fever and at least one of the three C’s:

  • A cough
  • Coryza or a runny nose
  • Conjunctivitis

The other Symptoms may include:

  • Watery eyes
  • Photophobia or sensitivity to light
  • Sneezing
  • A reddish-brown rash
  • Koplik’s spots or very small grayish-white spots with bluish-white centers in the mouth, insides of cheeks, & throat
  • Generalized body aches

Fever can range from mild-severe. It can last for several days. It may fall & then rise again when the rash appears. The reddish-brown rash appears around three to four days after initial symptoms. It can last for over a week.

The rash normally begins behind the ears & spreads over the head & neck. After a few days, it spreads to the rest of the body, including the legs. As the spots grow, they often join together.

Most childhood rashes are not measles, but a child should see a doctor if:

  • A parent suspects the child may have measles
  • If the symptoms do not improve or worsen
  • The fever rises to above 38oC or 100.4oF
  • Other symptoms resolve, but the fever persists.

Risk Factors

Being Unvaccinated: Measles primarily occurs in unvaccinated children. Most children & adults who receive a measles vaccine do not experience side effects. In exceptional cases, the vaccine has been linked to seizures, deafness, brain damage & coma. It is necessary to note that these dangerous side effects from the measles vaccine occur in less than one out of every million doses of the vaccine given. Numerous studies have confirmed that there is no link between autism & immunizations.

Vitamin A deficiency is also a risk factor for measles. Children with too little vitamin A in their diets have a higher risk of catching the virus.

International Travel: If an unvaccinated person travels to a country where measles is highly prevalent,  they are at a higher risk of developing the disease.

Diagnosis

The diagnosis of measles is mostly clinical. The appearance & clinical history of the patient suggests the diagnosis. Measles should always be considered in a patient who has a high fever & characteristic rash. Until the rash appears, the presence of Koplik’s spots should help in diagnosis. It is recommended that the diagnosis is confirmed using a blood test for IgM, a type of antibody against the virus.

Treatment

Treatment for an established measles infection is mostly symptomatic. However, some measures can be taken to protect vulnerable individuals who have been exposed to the virus.

Post-exposure vaccination: Non-immunized people, including infants, may be given the measles vaccination within 72 hours of exposure to the measles virus to protect against the disease. If measles still develops, the illness usually has milder symptoms & lasts for a shorter time.

Immune serum Globulin: Pregnant women, infants & people with weakened immune systems who are exposed to the virus may get an injection of proteins (antibodies) called immunoglobulin. When given within six days of exposure to the virus, these antibodies can prevent measles or make symptoms less severe.

Medications

Fever Medicines: The person can take over-the-counter medications such as paracetamol to relieve the fever that accompanies measles.

Use caution when administering aspirin to children or teenagers. Though aspirin is recommended for use in children older than age three, it has been linked to Reye’s syndrome, a rare but potentially life-threatening condition in children.

Antibiotics: If a bacterial infection, like pneumonia or an ear infection develops while you or your child has measles, your doctor may give an antibiotic.

Vitamin A: People with lower levels of vitamin A are more likely to have a more severe case of measles. Giving vitamin A may reduce the severity of the measles. It is given as a large dose of 200,000 international units (IU) for two days.

If you or your child has measles, always keep in touch with your doctor as you monitor the progress of the disease & watch for complications. Also, try these comfort measures:

  • Get plenty of rest
  • Drink plenty of water, fruit juice & herbal tea to replace fluids lost by fever & sweating.
  • Use a humidifier to relieve cough & sore throat.
  • If you or your child find bright light bothersome, as do many people with measles, put the lights low or wear sunglasses. Also, avoid reading or viewing television.

What to expect from your doctor

Your doctor may ask that you come in before or after office hours to reduce the risk of exposing others to the measles. Also, if the doctor believes that you or your child has the measles, he or she must report the findings to the local health department.

Your doctor is likely to ask you some questions, such as:

  • Have you or your child has been vaccinated for the measles? If so, do you know when?
  • Have you traveled out of the country newly?
  • Does anyone else live in your household? If yes, have they been vaccinated for measles?

Make sure that you or your child stay well-hydrated. Pediatric electrolyte solutions or sports drinks can help you stay hydrated & maintain your electrolyte balance.

Prevention

If someone in your family has measles, take these precautions to protect vulnerable family & friends:

  • Isolation: Because measles is highly contagious from about four days before to four days after the rash breaks out, people with measles should reduce activities in which they interact with other people during this period. It may also be important to keep non-immunized people — siblings, for eg, away from the infected person.
  • Vaccinate: Be certain that anyone who is at risk of getting the measles and who hasn’t been vaccinated, gets the measles vaccine as soon as possible. Measles can be prevented by giving the measles, mumps, and rubella (MMR) vaccine.
  • If the MMR vaccine is not suitable for the person, human immunoglobulin is used if the person is at risk for measles.

MMR vaccine

Routine vaccination

The MMR vaccine is given as a part of the routine vaccination program. One dose is usually given at 12-13 months and a second dose is given between three and five years of age.

Special circumstances

If they’re an immediate risk of measles, a dose of the MMR vaccine is given to anyone over six months of age. These situations include

There is an outbreak of measles in that particular area

If in contact with someone who got measles

Planning to travel to an area where the infection is present.

Children who have the vaccine before their first birthday should receive a further booster dose at around 13 months of age and before they start school.

Human normal immunoglobulin

Human normal immunoglobulin (HNIG) gives short-term and immediate protection against measles. It is usually given for people exposed to measles:

Babies who are under six months of age.

Pregnant women who are not fully vaccinated or did not have measles before

People with Weak immune systems: HIV or a person undergoing treatment for leukemia.

HNIG should be given within six days of exposure.

FAQs

1) What is measles?

Measles is a viral disease that spreads easily.

2) What are the symptoms of measles?

The symptoms of measles are a runny nose, fever, cough, rash all over the body.

3) How is measles treated?

There is no precise treatment for measles. Medications are given to reduce the symptoms

4) How is measles prevented?

Measles can be prevented by giving the measles, mumps, and rubella (MMR) vaccine. If the MMR vaccine is not suitable for the person, a treatment called normal human immunoglobulin (HNIG) is used if the person is at risk of developing measles.

Malaria – It’s Symptoms, Causes, Risk Factors and Treatment

Malaria – It’s Symptoms, Causes, Risk Factors and Treatment

In this blog, you will be getting an insight into the risk factors, causes and symptoms of malaria. Also the best treatment of malaria for quick relief for the disease.

Overview

Malaria is a life-threatening disease transmitted by a mosquito bite. The causative organism is a parasite called Plasmodium. While the disease is rare in temperate climates, malaria is still prevalent in tropical & subtropical countries. It is transmitted to humans by the bite of the Anopheles mosquito. There are five different types of malaria-causing parasites that can affect humans.

When the mosquito bites, the parasite is released into the bloodstream. Inside the body, parasites travel to the liver, where they develop and mature. After several days, the mature parasites enter the bloodstream & begin to infect RBC’s. In 48 to 72 hours, the parasites grow inside the RBC’s, causing the infected cells to burst open. The parasites continue to infect other RBC’s, resulting in symptoms that occur in cycles that last two to three days at a time. These symptoms include recurrent attacks of chills & fever.

In rare situations, malaria is transmitted from the mother to the unborn child during pregnancy, by blood transfusions, or when intravenous-drug users share needles.

Worldwide approximately 6,60,000 are killed due to malaria each year. The increase in international travel and migration of population, the risk has increased in areas where it does not commonly occur.

It is very common in developing countries, areas with high humidity & moderate temperatures. These include parts of Central & South America, Haiti, The Dominican Republic, Africa, Eastern Europe, and South & Southeast Asia. The deadliest types of malaria are more common in Africa. According to the World Health Organization (WHO), each year 300-500 million cases of malaria occur & more than 1 million people die of malaria, particularly in developing countries. Most of the deaths are of young children. In Africa, a child dies from malaria every 30 seconds. Because malaria causes severe illness & death, the disease causes a drain on national economies. The disease maintains a vicious cycle of disease & poverty in the poorer nations.

Causes

Malaria is caused by a type of parasite known as Plasmodium.  The Plasmodium parasite is mainly spread by female Anopheles mosquitoes, which mainly bite at dusk & at night.

There are different types of Plasmodium parasite, but only five types cause malaria in humans.

These are:

  1. Plasmodium falciparum – It is mainly found in Africa. It is the most dangerous type of malaria parasite & is responsible for most malaria deaths worldwide.
  2. Plasmodium vivax – It is mainly found in Asia & South America. The parasite causes milder symptoms than Plasmodium falciparum. This parasite can stay in the liver for up to three years and result in relapses.
  3. Plasmodium ovale – It is uncommon & usually found in West Africa. It can remain in your liver for several years without producing any symptoms.
  4. Plasmodium malariae – This is found in Africa.
  5. Plasmodium knowlesi – This is found in parts of southeast Asia

Symptoms

Malaria symptoms can be divided into two categories: uncomplicated or complicated malaria.

Uncomplicated malaria

In this condition symptoms are present, but there are no signs of severe infection or dysfunction of the vital organs. This form can become severe if left untreated, or if the host has lower or no immunity. Symptoms of this type of malaria typically last 6 to 10 hours & reappear every second day. Some strains of this parasite can have a longer cycle or cause mixed symptoms. As symptoms resemble those of flu, they may be undiagnosed or misdiagnosed in areas where malaria is less common.

In uncomplicated malaria, symptoms include:

  • Sensation of cold with shivering
  • Fever, headaches, & vomiting
  • Seizures may occur in younger people
  • Sweating followed by a recovery to normal temperature

Severe malaria

In severe malaria, clinical or laboratory evidence shows signs of vital organ dysfunction.

Symptoms of severe malaria include:

  • Fever & chills
  • Loss of or impaired consciousness
  • Prostration and exhaustion
  • Multiple convulsions
  • Deep breathing & respiratory distress
  • Abnormal bleeding & signs of anemia
  • Clinical jaundice & other evidence of vital organ dysfunction

Severe malaria can be fatal without treatment.

Risk Factors

The main risk factor for acquiring malaria is living in or visiting tropical areas where the disease is common. Various subtypes of malaria parasites exist. The varieties that cause the most deadliest complications are usually found in:

  • African countries, south of the Sahara Desert
  • The Asian sub-continent
  • Solomon Islands, Papua New Guinea & Haiti

Risk of severe disease

People at risk of serious disease include:

  • Young children & infants
  • Travelers coming from areas with no malaria
  • Pregnant women & their unborn children

Poverty, lack of knowledge, & limited or no access to health care further contribute to malaria deaths worldwide.

Residents of a malaria region may be exposed to the disease so frequently that they acquire partial immunity, which can reduce the severity of malaria symptoms. But, this partial immunity can fade away if you move to a country where you’re no longer constantly exposed to the parasite.

Diagnosis

  • The symptoms of malaria can imitate many other diseases, including influenza or viral syndrome. It is hence important to ask about a history of recent travel to an endemic area or other potential exposures.
  • You must seek medical help right away if you become ill while traveling in an area where malaria is found, or after returning from traveling, even if you’ve been taking antimalarial tablets.
  • Malaria can get worse very fast, so it is necessary that it is diagnosed & treated as soon as possible.
  • If you see the symptoms of malaria while still taking antimalarial tablets, either while you’re traveling or in the days & weeks after you return, remember to tell the doctor which type you have been taking. The same type of antimalarial shouldn’t be used to treat you as well.
  • If you see the symptoms after returning home, visit your general physician or a hospital doctor & tell them which countries you’ve traveled to in the last 12 months.
  • The correct diagnosis is made by looking at the blood of an infected patient under the microscope (blood smear) & identifying the presence of the parasite. The patient’s blood is prepared under a slide with a specific stain to help recognize the parasite. This is the most widely performed & accepted test.
  • Rapid diagnostic tests (antigen tests) are available that can give the diagnosis in a few minutes. It is advised that a positive test is followed by a blood smear examination.

Treatment

If malaria is diagnosed & treated promptly, a full recovery can be expected. Treatment should begin as soon as the blood test confirms malaria.

Several antimalarial medicines are used to treat the disease. They can also be used to prevent malaria.

The type of antimalarial medicine & how long you must take it will depend on

  • The type of malaria
  • Where you got malaria
  • The severity of symptoms
  • Whether you used preventative antimalarial tablets
  • Age
  • Whether you’re pregnant

Your doctor may suggest using a combination of different antimalarial to treat types of malaria parasites that have become resistant to particular types of medication.

Antimalarial medication is normally given as tablets or capsules. If someone is seriously ill, it will be given as an injection or infusion in the arm in the hospital. Treatment for malaria can make you feel very tired & weak for many weeks.

The most common antimalarial drugs include

  • Chloroquine (Aralen)
  • Hydroxychloroquine (Plaquenil)
  • Quinine sulfate (Qualaquin)
  • Mefloquine
  • Combination of atovaquone and proguanil (Malarone)

Preventive treatment

In few cases, you may be prescribed medicatio for malaria before you travel. This is done if there is a risk of you becoming infected with malaria while traveling to an area with high prevalence of malaria and limited access to medical care.

Antimalarials in pregnancy

If you’re pregnant, it’s suggested to avoid traveling to areas wherever there is a risk of malaria.

Pregnant women have an enhanced risk of developing severe malaria, & both the baby & mother could encounter severe complications. It is important to take the right antimalarial medicine if you’re pregnant & unable to postpone/cancel your tour to an area where there is a malaria risk. Some of the medicines used to prevent & treat malaria are unsuitable for pregnant women because they can cause side effects for both mother & baby.

These include

  • Mefloquine – not normally prescribed during the first trimester of pregnancy. Pregnancy should be avoided during the first three months after the preventative antimalarial medication is stopped.
  • Doxycycline – never advised for pregnant or breastfeeding women as it could harm the baby.
  • Atovaquone plus proguanil – not advised in pregnancy or breastfeeding. Nevertheless, if the risk of malaria is high, they may be advised if there is no suitable alternative.
  • Chloroquine along with proguanil is suitable during pregnancy, but it is not always used as it is not so effective against the most common & dangerous type of malaria parasite.

Prevention

There is a risk of getting malaria if you travel to an affected area. It is important to take care to prevent the disease. Malaria can usually be avoided using the ABCD approach for prevention:

  • Awareness of risk – check out the risk of getting malaria.
  • Bite prevention – avoid mosquito bites by using insect repellent, covering your arms & legs, or by using a mosquito mesh.
  • Check if you need to take malaria prevention tablets – if you do, make sure you take the right antimalarial tablets at the right dose & complete the course.
  • Diagnosis – ask immediate medical advice if you have malaria symptoms up to a year after you return from traveling.

Awareness of risk

Check whether you need to take preventative malaria treatment for the countries you’re visiting. It is also necessary to visit your general physician or local travel clinic for malaria information as soon as you know where you are going to be traveling. You still need to take precautions to protect yourself from infection if you’re traveling to a risk area, even if you grew up in a country where malaria is common. Nobody has complete immunity to malaria & any level of natural protection you may have had is quickly lost when you move out of a risk area.

Bite prevention

To avoid being bitten by the mosquitoes:

  • Stay around areas that have efficient air conditioning & screening on doors & windows. If this isn’t possible, make sure doors & windows close properly.
  • Use insect repellent on your skin & in sleeping environments. Remember to reapply it frequently. The most effective repellents contain diethyltoluamide (DEET) and are available in sprays, roll-ons, sticks & creams.
  • Wear light, loose-fitting trousers rather than shorts, & shirts with long sleeves. This is particularly important during early evening & at night when mosquitoes prefer to feed.

Check if you need to take malaria prevention tablets

There is currently no vaccine readily available that offers protection against malaria, so it is necessary to take antimalarial medication to reduce your chances of getting the disease.

Antimalarials only reduce your risk of infection by about 90%. Therefore taking steps to avoid bites is also important.

Types of antimalarial medication used to prevent malaria

Antimalarial medication is used to prevent malaria. The types of antimalarials used to treat or prevent malaria are given below.

Atovaquone + proguanil

  • Dosage – The adult dosage is one adult-strength tablet a day. Dosage for children depends on the child’s weight. It should be started one or two days before your trip & taken every day you’re in a risk area. The tablets must be continued for seven days after returning.
  • Recommendations – not advised in pregnant or breastfeeding women. It’s also not advised for people with severe kidney problems.
  • Possible side effects – stomach upset, headaches, skin rash & mouth ulcers.

Doxycycline

  • Dosage – the dose is 100mg daily as a tablet/capsule. You should start the medicines two days before you travel & take them each day you’re in a risk area, & for four weeks after you return.
  • Recommendations – not suitable for pregnant or breastfeeding women, children under the age of 12 (because of the risk of permanent tooth discoloration), people who are sensitive to tetracycline antibiotics, or people with liver problems.
  • Possible side effects – stomach upset, heartburn, thrush & sunburn as a result of light sensitivity.

Mefloquine

  • Dosage – the adult dose is one tablet weekly. Child dosage is also once a week, but the amount will depend on their weight. It should be started three weeks before you travel & taken all the time you’re in a risk area, & continued for four weeks after returning.
  • Recommendations – it’s not recommended if the person is suffering from epilepsy, seizures, depression or other mental health issues, or if a close relative has any of these conditions. It is not usually advised for people with severe heart or liver problems.
  • Possible side effects – dizziness, headache, sleep disturbances (insomnia & vivid dreams) & psychiatric reactions (anxiety, depression, panic attacks & hallucinations). It is important to tell the doctor of any previous mental health problems, including mild depression. Don’t take this medicine if you have a seizure disease.

Chloroquine & proguanil

A combination of antimalarial medications called chloroquine & proguanil is also available but  they’re mostly ineffective against Plasmodium falciparum.

You are always advised of taking antimalarial medicine when traveling to areas wherever there’s a risk of malaria. Visit your general physician or local travel clinic for malaria advice as soon as you know when & where you’re going to be traveling.

It’s necessary to take the correct dose & complete the course of antimalarial medication. If you’re doubtful, ask your general physician or druggist how long you should take your medication.

DEET insect repellents

The chemical DEET is often used in insect repellents. It is not advised for babies who are less than two months old. DEET is safe for older children, adults & pregnant women.

  • Use on exposed skin
  • Don’t spray directly on to your face – spray into your hands & pat on to your face
  • Avoid contact with lips & eyes
  • Wash your hands after using
  • Do not apply to damaged or irritated skin
  • Make sure you apply DEET after applying sunscreen, not before

FAQs

  1. How does one get malaria?

When a mosquito carrying the malaria parasite bites, the parasite is released into the bloodstream and cause malaria

  1. How is malaria spread?

Malaria is spread by a mosquito bite.

  1. What are the symptoms of severe malaria?

Severe malaria

In severe malaria, clinical or laboratory evidence shows signs of vital organ dysfunction.

Symptoms of severe malaria include:

  • fever & chills
  • impaired consciousness
  • prostration, or adopting a prone position
  • multiple convulsions
  • deep breathing & respiratory distress
  • abnormal bleeding & signs of anemia
  • clinical jaundice & evidence of vital organ dysfunction
  1. What are the most common antimalarial drugs used?
  • Chloroquine (Aralen)
  • Hydroxychloroquine (Plaquenil)
  • Quinine sulfate (Qualaquin)
  • Mefloquine
  • Combination of atovaquone and proguanil (Malarone)

Jaundice

Jaundice

Overview

Jaundice, also known as icterus, is a yellowish pigmentation of skin and sclera of the eyes and mucous membranes due to high bilirubin levels in the body.

The word Jaundice is derived from a French word called “jaunisse”, meaning “yellow disease”. The yellowish discoloration is due to bilirubin (a fluid secreted by the liver). Breakdown of  RBC’s, leads to the formation of bilirubin in our body. Bilirubin is normally metabolized in the liver and excreted in the bile from our body.  The disruption in the metabolism, production or excretion of bilirubin leads to deposits of an excess amount of bile in the body, causing jaundice. Due to their high elastin content, the white of the eye has a particular affinity towards bilirubin. Serum bilirubin would be at least 3 mg/dL in scleral icterus.

Types of Jaundice

Jaundice is of 3 types such as

A) HEPATOCELLULAR JAUNDICE (HEPATIC): It is usually caused by infections, drugs and alcohol.

B) HEMOLYTIC JAUNDICE (PRE-HEPATIC): occurs due to the destruction of RBC’s and overproduction of bilirubin.

  • Intraerythrocytic: RBC membrane disorders (Spherocytosis), enzyme deficiencies, Vit B12 and Folate deficiency
  • Extraerythrocytic: Physical trauma like burns, prosthetic valves and drugs, cancers and infections like malaria.

C) OBSTRUCTIVE JAUNDICE (POSTHEPATIC): It is caused by infections, alcohol, cirrhosis, lymphoma, pregnancy, cirrhosis, tumors.

In Newborns, jaundice is very commonly seen in the first week of life after birth and reduces within 2 weeks of life. If the bilirubin levels are greater than 4-20mg/dL, it can be treated with phototherapy. Exchange transfusions are done in severe cases.  Kernicterus can occur if bilirubin levels in babies are very high for a prolonged period and may lead to brain damage.

Ultrasound, CT scan, and MRI imaging are useful medical imaging to identify the cause of jaundice. Both medical and surgical management is done depending on the severity of the condition causing jaundice. Medical management involves the treatment of underlying infections. Surgical treatment is preferred in cases of obstructive jaundice.

Causes

Jaundiceis caused due to to high bilirubin levels in the body known as hyperbilirubinemia. In blood, the normal levels of bilirubin are less than 1.0 mg/dL and levels above 2–3 mg/dL result in Jaundice.

Bilirubin can be of 2 types:

1) UNCONJUGATED BILIRUBIN (INDIRECT): It is usually seen in newborn jaundice, thyroid disorders, fasting for a long time, and in Genetic conditions like Gilbert’s Syndrome.

2) CONJUGATED BILIRUBIN (DIRECT): It is commonly seen in viral hepatitis c and cirrhosis (liver diseases), blockage of the bile duct (caused due to gallstones blocking the hepatic ducts and in pancreatitis), infections of the liver and medications.

 Often Jaundice is caused by various underlying disorders that requires treatment such as :

1) Pre-hepatic Cause (before the bile is produced by the liver): The conditions that cause increased breakdown of red blood cells than the normal process like sickle cell crisis, malaria, thalassemia, drugs and other toxins.

2) Hepatocellular Cause: The transportation of the bilirubin across the hepatocytes (cells in liver) is interrupted  at any point between the cellular uptake of unconjugated bilirubin and transportation of conjugated bilirubin into bile ducts. It is caused by hepatitis, alcoholic liver disease, liver cancer and paracetamol overdose.

3) Post-Hepatic Cause (after the liver produces the bile): The normal drainage of bile (conjugated bilirubin) from the liver into the intestines is interrupted in obstructive jaundice. The conditions that cause obstructive jaundice are gallstones in the bile ducts, cancers of gall bladder/ bileduct, cholangitis (infections of the bileduct), pancreatitis(infections of the pancreas), pregnancy and newborn jaundice. This is commonly associated with dark colored urine, pale stools (clay colored stools) and Itchiness of the body. Severe Itching is seen often in patients with elevated serum cholesterol levels.

Physiological Jaundice, Breast milk jaundice, breast feeding jaundice, cephalohematoma and Maternal -fetal blood group incompatibility are also a few causes of jaundice.

  • Physiological Jaundice: It is most commonly seen in newborns and appears in the first week of life. The rapid breakdown of red blood cells that occur at this age cannot be processed by the immature liver of the newborn. Bilirubin remains in the body causing jaundice but it is harmless and gradually reduces within the first 2 weeks of life.
  • Breast milk jaundice: A harmless form of jaundice that occurs at the end of first week of life after birth. It is believed to be caused by certain chemicals present in the breast milk. Breast feeding must be stopped for 1-3 days. Phototherapy can be given. It may rarely lead to Kernicterus.
  • Breastfeeding jaundice: Seen in the newborns who are not properly breast fed by the mother’s milk. The inadequate intake of breast milk in newborn leads to fewer bowel movements causing decreased bilirubin excretion from the body.
  • Cephalohematoma: It is caused due to injury to the head of the baby during delivery. The blood gets collected under the scalp and rapid breakdown of these red blood cells can cause a surge in the bilirubin levels in the body causing jaundice.

4) Incompatibility of Maternal-fetal blood group (ABO, Rh): The rapid breakdown of red blood cells of the fetal blood due to incompatibility between the blood groups of the mother and the fetus causes jaundice due to high bilirubin levels in the body.

Other conditions that may cause jaundice includes

1) DUBLIN-JOHNSON SYNDROME: This is an inherited disorder of chronic jaundice resulting in conjugated hyperbilirubinemia secondary to a defect in the canalicular transport of organic anions. Serum bilirubin levels may rise upto 30 mg/dL. Usually, no treatment is required.

2) CRIGLER-NAJJAR SYNDROME: It is also an inherited disorder caused by a mild deficiency in UDPGT enzyme. Serum unconjugated bilirubin levels are in the range of 6-25mg/ dl. Treatment includes usage of phenobarbitone, UV light and liver transplantation.

3) PSEUDO-JAUNDICE: It is usually caused by excessive consumption of beta-carotene containing foods like carrot, pumpkin, or melons. It is usually harmless and leads to yellowish discolouration of the skin.

Symptoms

Common symptoms include yellowish colored skin and sclera, usually starting from the head and spreads down the body (sclera has more affinity towards bilirubin), dark or brown colored urine, pale stools(clay colored stools due to absence of bile pigments in stools), itchiness (pruritis and excoriation are seen in severe cases caused by the bile salts present in the bile). Other symptoms include abdominal pain, fatigue and myalgia, weight loss, fever and vomiting.

The symptoms of jaundice vary depending on the cause and the underlying diseases from one individual to individual.

  • Pre-Hepatic Causes: Patients experience abdominal pain, weight loss and fatigue due to increased breakdown of red blood cells in diseases like malaria, sickle cell crisis and thalassemia. In hemolytic jaundice, an enlarged spleen is seen.
  • Hepatocellular Cause: Symptoms like Dark colored urine, pale stools and itching are seen in cases of viral hepatitis. In alcoholic liver disease, the patient may have severe abdominal pain and discomfort, gastritis and fatigue. In liver cancers and paracetamol overdose, symptoms may vary depending on the prognosis of the patient. In cirrhosis or scarring of the liver, the patient will have portal hypertension.
  • Post-Hepatic Cause (after the liver produces the bile):  Symptoms like yellowish discolouration of skin, pale stools, abdominal pain, weight loss, malaise are seen in Obstructive jaundice caused by gallstones disease in the bile ducts, cancers of gallbladder/ bileduct, cholangitis (infection of the bileduct), pancreatitis(infection of the pancreas), pregnancy and newborn jaundice. In cases of Cholestasis and choledocholithiasis, fever and tenderness in the abdomen are present. Painless jaundice is seen in malignant biliary obstruction.

Risk Factors

Jaundice occurs due to hyperbilirubinemia (High levels of Bilirubin in the blood). Often underlying diseases or disorders are the main cause. These prevent the liver from getting rid of bilirubin from the body and it gets deposited in the tissues.

Some of the common underlying disorders that require treatment are bile duct obstruction ( Bilirubin levels increase in the body due to Obstruction in liver), Gilbert’s Syndrome ( Bile excretion from the body is impaired as enzymes that are involved in this process are affected. It is an inherited disorder), Hemolytic Anemia (when RBC’s are broken down in large amounts, then the Bilirubin production in the body is increased), Bile duct Inflammation and acute inflammation of the liver. In cholestasis, the bile flow from the liver is interrupted hence conjugated bilirubin remains in the body.

If viral hepatitis is suspected, risk factors include intravenous drug abuse, blood transfusions, the exposure to blood or body fluids of an infected person and multiple sexual partners.

Risk factors also include ingestion of potential toxins i.e certain drugs like paracetamol (overdose causes liver failure), solvents(chemicals) and wild mushrooms.

Diagnosis

Jaundice is usually diagnosed by symptoms, history given by the patient and physical examination.

1) A physical examination is usually done to look for signs and symptoms of jaundice. Swelling of the liver, ankles and feet that suggests Cirrhosis or Scarring of the liver. Liver is felt hard on examination by a doctor (on palpation).

  • In the liver cancers, liver is rock-hard on touch.
  • In haemolytic jaundice, Splenomegaly (enlarged spleen) is felt on palpation.
  • In cases of malignant biliary obstruction, the patient does not have any abdominal pain or tenderness and is commomly known as painless jaundice.
  • Excoriation is seen in cholestasis and high grade biliary obstruction.
  • Greenish Hue (due to biliverdin) can be seen in a few cases that suggests long standing liver conditions like biliary cirrhosis, sclerosing cholangitis, severe chronic hepatitis or long standing malignant obstruction.
  • If fever and tenderness in the abdomen are present it suggests Cholestasis, choledocholithiasis.
  • Palmar Erythema (Redness in palms) may suggest chronic ethanol ingestion.
  • In viral hepatitis, flu like symptoms can be seen even before the jaundice occurs in the patient.

2) The medical history of the patient must include whether the patient has travelled recently to any country or region where hepatitis or malaria is prevalent, if the patient is an alcoholic or there is any recent use of alcohol by the patient, any recent history of drug abuse like paracetamol and occupational hazards(whether he is exposed to any harmful chemicals that can affect the liver in his workplace).

Tests

BILIRUBIN TEST:  protein levels such as total protein and albumin and LIVER FUNCTION TESTS can be done to confirm Jaundice.

BILIRUBIN TEST: The levels of bilirubin in a blood test is called a bilirubin test. It measures the indirect or unconjugated bilirubin levels in the body.

In blood, the Normal Levels of bilirubin are less than 1.0 mg/dL (17 µmol/L) and levels above 2–3 mg/dL (34-51 µmol/L) result in Jaundice.

In Haemolytic Jaundice, high levels of unconjugated bilirubin is seen. Increased Heme metabolism can be seen and increased levels of urine-urobilinogen (> 2 units) can be seen with no bilirubin. Unconjugated bilirubin is not water-soluble, hence cannot be observed in the urine but it is seen only in serum. The only exceptions are newborns and infants as the gut flora has not yet developed.

LIVER FUNCTION TESTS: ALP (alkaline phosphatase), GGT and ALT, AST (aminotransferases) tests can be done.

Normal levels are  ALP (10–45 IU/L), GGT (18–85IU/L), AST (12–38 IU/L) and ALT (10–45 IU/L).

In obstructive jaundice, all four of them are very high. In cases of acute hepatocellular damage, AST levels are 15 times more than the normal value and lesser values indicate obstructive causes. ALP levels that are 10 times the normal value are seen in CMV (CYTOMEGALOVIRUS ) or chronic hepatitis infections. In Acute Hepatitis, ALT and AST levels are above (1000 IU/L). ALT and AST levels are around (1500-2250 IU/L) in Acetaminophen toxicity. GGT levels that are 5 times the normal value indicate drug toxicity.

  1. c) CBC (Complete Blood Count) : It shows the level of Red Blood Cells, White Blood Cells and Platelets in blood.
  2. d) Tests to Identify the liver infections can also be done such as Hepatitis A, B, and C tests.
  3. e) Urine test can be done to measure the levels of urobilinogen. Lower levels of urobilinogen suggest post hepatic causes and higher levels suggest pre or intrahepatic causes.
  4. f) In suspected cases for Obstruction, Imaging can be done like MRI, CT scans and Ultrasound. ULTRASOUND can be used to identify the Blockage of the Bile ducts and Gall bladder.
  5. g) ERCP( Endoscopic Retrograde Cholangio Pancreatography) is done in severe cases of Jaundice.
  6. h) Liver Biopsy (a needle is inserted into the liver and tissue sample is taken out which is examined under the microscope) is suggested in cases of fatty liver, cancer, cirrhosis and inflammation.

Prevention

Jaundice can be prevented by

  • Avoiding alcohol and sedatives drugs like hypnotics, and paracetamol.
  • Balanced diet is important to prevent jaundice(Iron rich foods are to be taken by people with jaundice induced by anemia).
  • Regular Exercise must be done.
  • In patients with a family history of Crigler-Najjar syndrome, genetic counselling can be given.
  • Patients and the family members must be educated about the possible signs and symptoms seen in the patient and to report any changes immediately.
  • Protected sexual intercourse is advised in people with hepatitis A,B,C infections.
  • Travelling to any country or region where hepatitis or malaria is prevalent must be avoided.
  • Exposure to any harmful chemicals that can affect the liver must be avoided.

Treatment of Jaundice

  • The underlying cause of Jaundice must be treated first. Medical management is done in most of the cases which involves treating the underlying infections like hepatitis, leptospirosis and malaria.
  • In cases of Hepatitis induced jaundice, Anti-viral medications are preferred.  In active hepatitis -B infections, Interferon alpha-2b  and lamivudine are used to reduce the replication of a virus. Pegylated Interferon and Ribavirin are given to treat the hepatitis-C infection. Malaria can be treated with antibiotics and hydroxychloroquine and quinolones.
  • Bed rest, Nutritious diet, glucose and fruit drinks are recommended. Certain lifestyle changes can be done like regular exercise.
  • Special diet avoiding certain foods can be taken in patients with G6PD deficiency.
  • Drugs such as Hypnotics, Sedatives and Alcohol must be avoided. Oral Contraceptive Pills used by women must be discontinued till the symptoms are decreased.
  • Corticosteroids help to improve the symptoms of autoimmune hemolytic anemia. Hydroxyurea is prescribed for patients with sickle cell anemia.
  • Blood transfusions are given to patients suffering from severe hemolytic anemia. If all the other treatments have failed, plasmapheresis is suggested to the patient.
  • Iron Supplements and Iron rich foods must be taken in cases of anemia induced jaundice.
  • surgery of the Gall Bladder can reduce the itchiness in the body in severe cases.
  • In Newborns, Jaundice can be treated with PHOTOTHERAPY (Light Therapy where the baby is placed under an artificial blue light or the baby can be exposed directly under morning sunlight for a few minutes) and EXCHANGE TRANSFUSION if bilirubin levels are greater than 421mg/dL.
  • People with hepatitis A, B, and C infections are advised to have protected sexual intercourse.
  • Intravenous immunoglobulin and bone marrow transplantation are done as required in a few genetic disorders causing jaundice.
  • In severe cases, like Bile duct obstruction, surgical management is preferred over medical management. The diseased part of the liver is removed without affecting the function of the liver.
  • In severe cases when none of the above treatments have failed, liver transplantation can be done.

FAQ’s

1) Can jaundice be cured?

Yes, Jaundice can be cured. If it is caused due to underlying infection, your doctor may suggest medical management. But in severe cases and if it occurs due to obstruction, then surgery is suggested.

2) Is jaundice serious?

Jaundice is serious only when bilirubin levels are very high in the body and it may cause complications like liver failure, sepsis and death.

3) How long will it take to get jaundice cured?

The treatment of jaundice depends on the underlying conditions. In newborns, it disappears after 2 weeks of life.