When a patient comes with a problem:
STEP 1: Assess
-See/inspect.
-Ask (what went wrong, what made him/her to seek medical support)
-History (brief, precise, to the point. No leading question. Take help from the attendant if the patient is minor, dumb, unconscious or psychologically unstable.)
-detect the major symptoms (from the clinical features. This helps to check & elicit the important signs)
-check the vitals: pulse, BP, respiratory rate, temperature.
STEP 2: Examine
>> Local.
>> Systemic.
>> Lab (blood, urine, stool, collections, pus, secretions etc) {consider the financial condition of patient.}
>> Imaging (x-ray, USG, scan, ECG etc) {consider the financial condition of patient.}
STEP 3: Manage
>>GENERAL:
-rest
-remove the factor that caused the disease.
-assurance
>>MEDICAL
-Analgesic (pain, acute inflammation etc)
-Antibiotic (systemic, local and topical: on the basis of lab finding.)
-Antihistamine (allergy, urticaria, mild hypersensitivity, hyper secretion.)
-Steroid (auto-immune, hypersensitivity, chronic inflammation, atrophy etc.)
-Fluid & electrolyte
-others.
Use of drugs is a bit complicated. Such as, there may be circulatory overload or insufficiency. What you going to do? In case of overload you can find edema, lung crepitations etc. You make the heart to beat slowly, use diuretic (if kidney & liver act normal) and monitor vitals, specially input and output. In case of insufficiency infuse fluid and electrolyte orally or I/V and monitor vitals, input, output. There is so much to write about this. But above mentioned are common.
STEP 4: Surgical Intervention
Only if the pathology is non-responsive to medical treatment or it is not treatable medically.
STEP 5: Follow Up & Re-assess
routine follow-up, re-assessment and re-evaluation is good for both, the patient & the doctor. It helps in better prognosis and necessary early intervention to the things that are going other than the normal track.
Md. Mukit Osman Chawdhury
Sunday, 11 July 2010
Chittagong
Saturday, November 20, 2010
Wednesday, November 10, 2010
Rumors are killers
Seasonal Flu is a common phenomenon. Since ages people are being affected by seasonal flu and the best thing is it heals spontaneously.
The media says now-a-days, 25-90 people are being affected by H1N1 virus (responsible for Swine Flu). But, hey, can you remember of any one affected by this? Rather you can see that people are affected by normal seasonal flu.
What are the Sign and Symptoms????
1. Fever, in various degrees but persistent. Not below 100 degree.
2. Sore throat.
3. Pain all over the body.
4. Running nose.
5. Breathing problem is considered as the sign to differ from other types of flu. Though a person having asthma, may also present with breathing problem.
What to do???
1. Don't panic. Stay calm and quite and observe the situation.
2. This is somewhat hot, humid season going on. So better to stay indoor as long as you can. Because as long as you will be outside, you will be vulnerable to dehydration, electronic imbalance, sun stroke and infections.
3. Take enough rest, water, sleep and food.
4. Maintain personal hygiene.
What if you are affected by any type of Flu????
1. Stay home.
2. Take symptomatic treatment. i mean treatment for fever, running nose, sore throat and body ache.
3. Have adequate amount of food and water. Remember, if your body is weak, you can't resist even the simplest of infections.
4. Don't sneeze or cough over another person.
5. Consult any physician and don't go for any treatment via internet or any other media.
Stay fine and safe. Kill the rumors.
The media says now-a-days, 25-90 people are being affected by H1N1 virus (responsible for Swine Flu). But, hey, can you remember of any one affected by this? Rather you can see that people are affected by normal seasonal flu.
What are the Sign and Symptoms????
1. Fever, in various degrees but persistent. Not below 100 degree.
2. Sore throat.
3. Pain all over the body.
4. Running nose.
5. Breathing problem is considered as the sign to differ from other types of flu. Though a person having asthma, may also present with breathing problem.
What to do???
1. Don't panic. Stay calm and quite and observe the situation.
2. This is somewhat hot, humid season going on. So better to stay indoor as long as you can. Because as long as you will be outside, you will be vulnerable to dehydration, electronic imbalance, sun stroke and infections.
3. Take enough rest, water, sleep and food.
4. Maintain personal hygiene.
What if you are affected by any type of Flu????
1. Stay home.
2. Take symptomatic treatment. i mean treatment for fever, running nose, sore throat and body ache.
3. Have adequate amount of food and water. Remember, if your body is weak, you can't resist even the simplest of infections.
4. Don't sneeze or cough over another person.
5. Consult any physician and don't go for any treatment via internet or any other media.
Stay fine and safe. Kill the rumors.
Friday, August 15, 2008
MEASLES: RESULTING IMPOTENCY IF IGNORED
Measles is an acute infection and highly communicable viral disease of childhood. The virus is mixo-virus group. The clinical feature is characterized by prodromal catarrhal symptoms; fever, koplik’s spots on the buccal mucosa and typical dusky-red blotchy rash.
The typical maculo-papular rash develops first at the back of the ears and at the junction of the forehead and hairline and then whole of the face; within a few hours the rash spreads rapidly to involve the skin of the rest of the body. At first the rash is discrete but later it may become confluent and patchy especially in the face and neck.
Epidemiological Determinants:
Occurrence: It is endemic in most part of the world. The disease is universal.
Agent: It is caused by an RNA para-myxovirus. It is only one serotype. The virus cannot live outside the human body for any length of time.
Source of infection: The only source of infection is a case of measles carrier is not known to occur.
Infective Material: Secretions of nose, throat and respiratory tract of a case of measles during the prodromal period and the early stages rash.
Communicability: It is highly infectious during the prodromal period and at the time of eruption. Communicability declines rapidly after the appearance of the rash. The period of communicability is approximately 4 days before and 5 days after the appearance of the rash.
Host factor: Attacks everyone in infancy or childhood. In developing country the environmental condition is poor so 6 months to 3 years of children are more susceptible. Now it is declined due to vaccination.
Sex: Incidence is equal in both sexes.
Immunity: No age group is immune if there was no previous immunity. One attack of measles generally confers lifelong immunity. Second attack is rare. Infants are protected by maternal antibodies up to 9 months of age.
Nutrition: Measles tends to be very severe in the undernourished child. Mortality is very high in undernourished child then the well nourished child.
Environmental factor: It may occur in any season. Epidemic of measles is in winter season and early spring in our country (January & April). It is common in less socio-economic condition.
Transmission: It occurs directly from person to person mainly by droplet infection from 4 days before onset of rash until 5 days there thereafter. The portal of entry is the respiratory tract.
Incubation period: 10-14 days.
Clinical features: There are three stages in the natural history of measles. These are:
(1) Prodromal or Pre-eruptive stage:
o Begins 10 days after infection.
o Lasts until 14th day.
o Characterized by fever, coryza with sneezing with nasal discharge, cough redness of eyes, lacrimation and often photophobia.
o Vomiting and diarrhoea may be present.
o A day or two before the appearance of the rash, Kaplik’s spots appear on the buccal mucosa opposite the first and second upper molars. They are small, bluish-white spots on a red base, smaller than the head of a pin.
(2) Eruptive stage
o This stage is characterized by a typical, dusky-red, macular or maculo-papular rash which begins behind the ears and spreads rapidly in a few hours over the face and neck and extends down the body taking 2 to 3 days to progress to the lower extremities.
(3) Post-measles stage
o The child will remain weak for a few days and lose weight to a great extent.
o The child will become susceptible to suffer from other viral or bacterial infection.
o There may be growth retardation, diarrhoea, cancrum oris, pyogenic infections, candidosis, reactivation of pulmonary tuberculosis etc.
Prevention:
By vaccination. (EPI)
Complications: Complications with measles are relatively common. Some complications are:
Relatively mild and less serious diarrhea
Pneumonia
Encephalitis (sub-acute sclerosing panencephalitis)
Corneal ulceration leading to corneal scarring.
Complications are usually more severe amongst adults who catch the virus.
The fatality rate from measles for otherwise healthy people in developed countries is low: approximately 1 death per thousand cases. In underdeveloped nations with high rates of malnutrition and poor healthcare, fatality rates of 10 percent are common. In immunocompromised patients, the fatality rate is approximately 30 %.
Vaccination can prevent this disease. So immunize your child against this as per schedule.
The typical maculo-papular rash develops first at the back of the ears and at the junction of the forehead and hairline and then whole of the face; within a few hours the rash spreads rapidly to involve the skin of the rest of the body. At first the rash is discrete but later it may become confluent and patchy especially in the face and neck.
Epidemiological Determinants:
Occurrence: It is endemic in most part of the world. The disease is universal.
Agent: It is caused by an RNA para-myxovirus. It is only one serotype. The virus cannot live outside the human body for any length of time.
Source of infection: The only source of infection is a case of measles carrier is not known to occur.
Infective Material: Secretions of nose, throat and respiratory tract of a case of measles during the prodromal period and the early stages rash.
Communicability: It is highly infectious during the prodromal period and at the time of eruption. Communicability declines rapidly after the appearance of the rash. The period of communicability is approximately 4 days before and 5 days after the appearance of the rash.
Host factor: Attacks everyone in infancy or childhood. In developing country the environmental condition is poor so 6 months to 3 years of children are more susceptible. Now it is declined due to vaccination.
Sex: Incidence is equal in both sexes.
Immunity: No age group is immune if there was no previous immunity. One attack of measles generally confers lifelong immunity. Second attack is rare. Infants are protected by maternal antibodies up to 9 months of age.
Nutrition: Measles tends to be very severe in the undernourished child. Mortality is very high in undernourished child then the well nourished child.
Environmental factor: It may occur in any season. Epidemic of measles is in winter season and early spring in our country (January & April). It is common in less socio-economic condition.
Transmission: It occurs directly from person to person mainly by droplet infection from 4 days before onset of rash until 5 days there thereafter. The portal of entry is the respiratory tract.
Incubation period: 10-14 days.
Clinical features: There are three stages in the natural history of measles. These are:
(1) Prodromal or Pre-eruptive stage:
o Begins 10 days after infection.
o Lasts until 14th day.
o Characterized by fever, coryza with sneezing with nasal discharge, cough redness of eyes, lacrimation and often photophobia.
o Vomiting and diarrhoea may be present.
o A day or two before the appearance of the rash, Kaplik’s spots appear on the buccal mucosa opposite the first and second upper molars. They are small, bluish-white spots on a red base, smaller than the head of a pin.
(2) Eruptive stage
o This stage is characterized by a typical, dusky-red, macular or maculo-papular rash which begins behind the ears and spreads rapidly in a few hours over the face and neck and extends down the body taking 2 to 3 days to progress to the lower extremities.
(3) Post-measles stage
o The child will remain weak for a few days and lose weight to a great extent.
o The child will become susceptible to suffer from other viral or bacterial infection.
o There may be growth retardation, diarrhoea, cancrum oris, pyogenic infections, candidosis, reactivation of pulmonary tuberculosis etc.
Prevention:
By vaccination. (EPI)
Complications: Complications with measles are relatively common. Some complications are:
Relatively mild and less serious diarrhea
Pneumonia
Encephalitis (sub-acute sclerosing panencephalitis)
Corneal ulceration leading to corneal scarring.
Complications are usually more severe amongst adults who catch the virus.
The fatality rate from measles for otherwise healthy people in developed countries is low: approximately 1 death per thousand cases. In underdeveloped nations with high rates of malnutrition and poor healthcare, fatality rates of 10 percent are common. In immunocompromised patients, the fatality rate is approximately 30 %.
Vaccination can prevent this disease. So immunize your child against this as per schedule.
Sunday, August 10, 2008
Tetanus: Are you Immunized?
Tetanus is an acute disease caused by exo-toxin produced Clostridium tetani. It is characterized by painful muscular rigidity which persists throughout illness. The painful spasms of the muscles specially the Masseters resulting in Trismus or lock-jaw; muscle of the face resulting Risus Sardonicus; muscle of neck, back, abdomen and lower limbs resulting Opisthotomus. Case fatality rate is quite high; varying from 30 to 90%.
Agent Factors:
Agent Clostridium Tetani is a Gram-positive anaerobic, spore-bearing organism. The spores are terminal and give the organism a drum-stick appearance. The spores are highly resistant to a number of injurious agents; including boiling, phenol, cresol etc. It is destroyed by autoclaving for 20 minutes at 120°C & by irradiation. They germinate under anaerobic conditions & produce a potent exotoxin. It is one of the important causes of infant mortality. It produces potent neurotoxin which acts on nervous system. The spores remain viable for months in warm moist soil.
Period of communicability:
Not transmitted from person to person.
Reservoir of infection:
The natural habitat is many herbivorous animals e.g. cattle, sheep, horses, goats etc. They excrete it through their feces. The spores can survive for years in nature. The spores are blown through air with dust.
Host Factors:
The disease affects all ages and both sexes equally. The tetanus occurring in the new-born is known as “Tetanus Neonatum”.
The neonate typically contact with the disease at birth; because most of the delivery occurs or taken place in non-specific conditions i.e. unclean/ unsterilized space, untrained TBA, and specially when the umbilical cord is cut with unsterilized instruments or when the umbilical cord is stumped or dressed with ashes, soil or cow dung.
Sex:
Both sexes are affected. The males are more affected then the female. The males are more exposed to their occupation. Tetanus is common among agricultural workers, in neonate and in female during puerperal tetanus.
Immunity:
No age group is immune if not immunized by vaccination or immunoglobulin. The immunity resulting from two doses of injections of Tetanus Toxoid is highly effective and lasts for several years. After recovery from tetanus, one should be actively immunized, because the amount of toxin that causes Tetanus is not enough to stimulate protective immunity in side the human body. This is a disease in which Herd Immunity does not protect the individual.
Environmental and Social Factor:
It is one of the environmental hazards. Its occurrence depends upon human’s physical & ecological surroundings; the soil, agriculture, animal and not on the presence or absence of infection in the population. Environmental factors are accompanied by social factor; such as unhygienic customs and habits, application of cow dung in wounds; unhygienic delivery practices; using of unsterilized instruments for cutting of umbilical cord. Ignorance is one of the most important causes in case of infection and lack of Primary Health Care services.
In UK, USA and Germany the incidence is reduced.
Mode of Transmission:
Infection is acquired by contamination of wounds with tetanus spores. The range of injuries and accidents which may lead to tetanus comprises a trivial pin prick, skin abrasion, puncture wounds, burns, human bite, animal bite, unsterile surgery, intrauterine death, bowel surgery, dental extracting, injections, unsterile division of umbilical cord, compound fracture, otitis media, chronic skin ulcers, eye infections, gangrenous limbs etc.
Incubation Period:
The incubation period is usually 6 to 10 days. It may be short like one day or as long as several months.
Types of Tetanus:
(1) Traumatic
(2) Puerperal
(3) Otogenic
(4) Idiopathic
(5) Tetanus Neonatum
Prevention:
(1) Active immunization in EPI: Scheduled administration of Tetanus Toxoid. All persons should be immunized regardless of age.
(2) Passive Immunization: By Anti-tetanus Serum (ATS)
Prevention of Tetanus after injury:
All wounds must be thoroughly cleaned soon after injury, removal of foreign body, soil, dust, necrotic tissue. In this way anaerobic condition is abolished.
ATS is given in divided doses.
Agent Factors:
Agent Clostridium Tetani is a Gram-positive anaerobic, spore-bearing organism. The spores are terminal and give the organism a drum-stick appearance. The spores are highly resistant to a number of injurious agents; including boiling, phenol, cresol etc. It is destroyed by autoclaving for 20 minutes at 120°C & by irradiation. They germinate under anaerobic conditions & produce a potent exotoxin. It is one of the important causes of infant mortality. It produces potent neurotoxin which acts on nervous system. The spores remain viable for months in warm moist soil.
Period of communicability:
Not transmitted from person to person.
Reservoir of infection:
The natural habitat is many herbivorous animals e.g. cattle, sheep, horses, goats etc. They excrete it through their feces. The spores can survive for years in nature. The spores are blown through air with dust.
Host Factors:
The disease affects all ages and both sexes equally. The tetanus occurring in the new-born is known as “Tetanus Neonatum”.
The neonate typically contact with the disease at birth; because most of the delivery occurs or taken place in non-specific conditions i.e. unclean/ unsterilized space, untrained TBA, and specially when the umbilical cord is cut with unsterilized instruments or when the umbilical cord is stumped or dressed with ashes, soil or cow dung.
Sex:
Both sexes are affected. The males are more affected then the female. The males are more exposed to their occupation. Tetanus is common among agricultural workers, in neonate and in female during puerperal tetanus.
Immunity:
No age group is immune if not immunized by vaccination or immunoglobulin. The immunity resulting from two doses of injections of Tetanus Toxoid is highly effective and lasts for several years. After recovery from tetanus, one should be actively immunized, because the amount of toxin that causes Tetanus is not enough to stimulate protective immunity in side the human body. This is a disease in which Herd Immunity does not protect the individual.
Environmental and Social Factor:
It is one of the environmental hazards. Its occurrence depends upon human’s physical & ecological surroundings; the soil, agriculture, animal and not on the presence or absence of infection in the population. Environmental factors are accompanied by social factor; such as unhygienic customs and habits, application of cow dung in wounds; unhygienic delivery practices; using of unsterilized instruments for cutting of umbilical cord. Ignorance is one of the most important causes in case of infection and lack of Primary Health Care services.
In UK, USA and Germany the incidence is reduced.
Mode of Transmission:
Infection is acquired by contamination of wounds with tetanus spores. The range of injuries and accidents which may lead to tetanus comprises a trivial pin prick, skin abrasion, puncture wounds, burns, human bite, animal bite, unsterile surgery, intrauterine death, bowel surgery, dental extracting, injections, unsterile division of umbilical cord, compound fracture, otitis media, chronic skin ulcers, eye infections, gangrenous limbs etc.
Incubation Period:
The incubation period is usually 6 to 10 days. It may be short like one day or as long as several months.
Types of Tetanus:
(1) Traumatic
(2) Puerperal
(3) Otogenic
(4) Idiopathic
(5) Tetanus Neonatum
Prevention:
(1) Active immunization in EPI: Scheduled administration of Tetanus Toxoid. All persons should be immunized regardless of age.
(2) Passive Immunization: By Anti-tetanus Serum (ATS)
Prevention of Tetanus after injury:
All wounds must be thoroughly cleaned soon after injury, removal of foreign body, soil, dust, necrotic tissue. In this way anaerobic condition is abolished.
ATS is given in divided doses.
Thursday, May 8, 2008
Pertussis: Is your child immunized?
Pertussis is an acute infectious disease caused by Bordetella Pertussis. It involves the Tracheo-bronchial tree. It is characterized by an insidious onset with mild fever and an irritating cough, gradually becoming paroxysmal with the characteristic “whoop” (loud coughing inspiration). The Chinese call it “Hundred Day Cough”.
Occurrence: It prevails all over the world.
Agents: Bordetella Pertussis.
It is small, non-motile, Gram (-)ve bacilli. It is destroyed by drying, exposure to ultra-violet light and a temperature of 55° C.
Host: It is common in babies and toddlers. Most of the cases occur at the age between 1 to 8 years and only a few cases occur after 12 years. Infants below 6 months have the highest mortality.
Sex: all sexes are equally susceptible. But in case of female this case is more fatal.
Immunity: Recovery from whooping cough or adequate immunization is followed by immunity. Second attacks may occur in person with declining immunity; these attacks are mild. Infants are susceptible since birth because maternal antibody does not potent enough against this micro-organism. There is no cross immunity.
Environment: It may occur at any time of the year but the incidence is high during spring and winter. It is common in over-crowded, low socio-economic conditions and poor hygienic people. The risk of the disease is greater in the lower classes than in the well-to-do groups.
Reservoir of Infection: Healthy carrier is undetectable. Man is the only source and reservoir of the infection.
Mode of Transmission: Source of infection is respiratory discharge. It is spread by contact with infected persons by droplet infection and indirectly by contaminated fomites. It is infectious from the onset of catarrhal stage to three weeks.
Incubation Period: 7 days to 21 days.
Control of Whooping Cough:
Some measures of controlling Whooping Cough:
(1) Cases & Contacts:
• Case: Early diagnosis, isolation and treatment of cases. Disinfection of discharge from nose and throat.
• Contacts: Infants and young children should be kept away from the infected parson.
(2) Active immunization: By DPT vaccine. Three doses in EPI schedule. In EPI schedule three doses of DPT vaccine (6th, 10th & 14th weeks) providing a good protection against the disease.
Unwanted reactions: Local reaction at the site of infection, mild fever and irritability.
Contraindications: Strong family history of Epilepsy, convulsion or CNS disorder, reaction due to vaccine, febrile upset until fully recovered.
(3) Others:
Notification of cases to the health authorities.
Isolation of the patient for three weeks until the cessation of whoop.
Disinfection of the nasopharyngeal discharges with Phenol.
Complications:
Congestion of the conjunctive
Malnutrition.
Rectal prolapse.
It is said that prevention is better than cure. So by immunizing your child you ensure his/her healthful living.
Occurrence: It prevails all over the world.
Agents: Bordetella Pertussis.
It is small, non-motile, Gram (-)ve bacilli. It is destroyed by drying, exposure to ultra-violet light and a temperature of 55° C.
Host: It is common in babies and toddlers. Most of the cases occur at the age between 1 to 8 years and only a few cases occur after 12 years. Infants below 6 months have the highest mortality.
Sex: all sexes are equally susceptible. But in case of female this case is more fatal.
Immunity: Recovery from whooping cough or adequate immunization is followed by immunity. Second attacks may occur in person with declining immunity; these attacks are mild. Infants are susceptible since birth because maternal antibody does not potent enough against this micro-organism. There is no cross immunity.
Environment: It may occur at any time of the year but the incidence is high during spring and winter. It is common in over-crowded, low socio-economic conditions and poor hygienic people. The risk of the disease is greater in the lower classes than in the well-to-do groups.
Reservoir of Infection: Healthy carrier is undetectable. Man is the only source and reservoir of the infection.
Mode of Transmission: Source of infection is respiratory discharge. It is spread by contact with infected persons by droplet infection and indirectly by contaminated fomites. It is infectious from the onset of catarrhal stage to three weeks.
Incubation Period: 7 days to 21 days.
Control of Whooping Cough:
Some measures of controlling Whooping Cough:
(1) Cases & Contacts:
• Case: Early diagnosis, isolation and treatment of cases. Disinfection of discharge from nose and throat.
• Contacts: Infants and young children should be kept away from the infected parson.
(2) Active immunization: By DPT vaccine. Three doses in EPI schedule. In EPI schedule three doses of DPT vaccine (6th, 10th & 14th weeks) providing a good protection against the disease.
Unwanted reactions: Local reaction at the site of infection, mild fever and irritability.
Contraindications: Strong family history of Epilepsy, convulsion or CNS disorder, reaction due to vaccine, febrile upset until fully recovered.
(3) Others:
Notification of cases to the health authorities.
Isolation of the patient for three weeks until the cessation of whoop.
Disinfection of the nasopharyngeal discharges with Phenol.
Complications:
Congestion of the conjunctive
Malnutrition.
Rectal prolapse.
It is said that prevention is better than cure. So by immunizing your child you ensure his/her healthful living.
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