CPH 3

DENGUE

SOURCE OF INFECTION

 Immediate source is a vector mosquito, the Aedes aegypti or the common household mosquito. (Aedes albopictus also)

 Common in Tropical and subtropical areas, urban and semi-urban areas

 Aedes aegypti breeds mostly in man-made containers, day-time feeder (its peak biting periods are early in the morning and in the evening before sunset)

 Aedes albopictus is more adaptive to colder conditions, used tires and bamboo are their breeding habitats

 Range from a mild flu-like syndrome to the most severe forms of the disease, which are characterized by coagulopathy, increased vascular fragility, and permeability.

 may progress to hypovolemic shock

 GRADE I

DENGUE CLASSIFICATION:

bruising and (+) torniquet test in persons with fever (20 or more petechiae per inch2)

 GRADE II

DENGUE CLASSIFICATION:

 spontaneous bleeding into skin and elsewhere

 GRADE III

DENGUE CLASSIFICATION:

 clinical evidence of shock

 GRADE IV

DENGUE CLASSIFICATION:

severe shock (blood pressure and pulse cannot be detected)

 An acute febrile infection of sudden onset with clinical manifestation of 3 stages.

 First 4 days- invasive stage starts abruptly as high fever, abdominal pain and headache

 4th to 7th days- toxic or hemorrhagic stage-lowering of temperature, severe abdominal pain, vomiting, frequent bleeding, death may occur

 7th to 10th day- convalescent or recovery

DENGUE DENGUE CLASSIFICATION:

 TORNIQUET TEST (RUMPEL-LEEDE TEST)

 test is a marker of capillary fragility

 Platelet count

DENGUE DIAGNOSTIC TEST:

1\. Take the patient's blood pressure and record it, for example, 110/70.

2\. Inflate the cuff to a point midway between SBP and DBP and maintain for minutes. (110 + 70) ÷ 2 = 90 mm H

3\. Reduce and wait 2 minutes.

4\. Count petechiae below antecubital fossa.

5\. A positive test is 10 or more petechiae per 1 square inch.

HOW TO DO A TOURNIQUET TEST (RUMPEL-LEEDE TEST)

 Paracetamol, analgesic for fever, muscle pain or headache.

 Rapid replacement of body fluids

DENGUE SUPPORTIVE AND SYMPTOMATIC TREATMENT:

SARS (SEVERE ACUTE RESPIRATORY SYNDROME)

 It is a newly recognized form of a typical pneumonia that had been described in patient in Asia, North America and Europe.

 The earliest known cases were identified in Guangdong Province, China in November 2002

 The WHO issued the global alert on the outbreak on March 2003 and instituted worldwide surveillance.

PRODROMAL PHASE

 Body temperature of more than 38 C sometimes with chill, malaise and headache

 During this stage the infectivity is none or low RESPIRATORY PHASE

 Within 2 to 7 days the illness may proceed to this stage characterized by dry nonproductive cough with or without respiratory distress.

 Common findings include hypoxia, dullness on percussion and decreased breath sounds on Physical examination.

 Infectivity is highest during this phase.

SARS (SEVERE ACUTE RESPIRATORY SYNDROME) SIGNS AND SYMPTOMS:

MERS-COV

 first reported in Saudi Arabia in September 2012

 all cases of MERS have been linked through travel to, or residence in, countries in and near the Arabian Peninsula.

 The largest known outbreak of MERS outside the Arabian Peninsula occurred in the Republic of Korea in 2015

PROTOZOA

microscopic, one-celled organisms that can be freeliving or parasitic in nature

HELMINTHS

large, multicellular organisms that are generally visible to the naked eye in their adult stages, that can be free-living or parasitic in nature

ECTOPARASITES

ticks, fleas, lice, and mites that attach or burrow into the skin and remain there for relatively long periods of time

SCHISTOSOMIASIS (BILHARIASIS OR SNAIL FEVER)

 Also known as the Bilhariaisis or snail fever has a long been one of the important tropical disease on our country.

 It is caused by a blood fluke that is transmitted by a tiny snail Oncomelania hupensi quadrasi.

 Since it affects mostly farmers and their families in the rural area it results in manpower losses and lessened agricultural productivity.

 There is a high prevalence of Schistosomiasis in Region 5 (Bicol). Region 8 (Samar and Leyte) and region 11 (Davao)

SIGNS AND SYMPTOMS

 Cough of long duration

 Hemoptysis

 Chest/back pain

 PTB like symptoms, but not responding to anti-TB medications

DIAGNOSIS:

 Sputum collection

 Immunology

 Cerebral Paragonimaisis

 Eosinophilia in CSF

PREVENTION AND CONTROL

 Treatment of infected person

 Sanitary disposal of excreta

 Education of the public regarding the sign and symptoms and mode of transmission of the parasite

 Avoid eating insufficient or raw cooked crabs.

TREATMENT

 Praziquantel is the drug of choice given 25mg/kg body weight three times daily for 3 days

 Bithionol is the alternative drug.

PARAGONIMIASIS SIGNS AND SYMPTOMS, DIAGNOSIS, PREVENTION AND CONTROL, & TREATMENT

1\. ASCARIS LUMBRICOIDES  (GIANT INTESTINAL ROUNDWORM)

2\. TRICHURIS TRICHIURA  (WHIPWORM)

3\. HOOKWORM

4\. ANCYCLOSTOMA DUODENALE  (OLD WORLD HOOKWORM)

5\. NECATOR AMERICANUS  ( NEW WORLD HOOKWORM)

SOIL TRANSMITTED HELMINTHIASIS (STH) CAUSATIVE AGENTS

 S. MANSONI

 S. JAPONICUM

INTESTINAL SCHISTOSOMIASIS

 S. HAEMATOBIUM

UROGENITAL SCHISTOSOMIASIS

 Anemia

 Malnutrition (due to competition of worms with nutrients or impairment of absorption)

 Cramping abdominal pain, nausea, and vomiting (due to Bowel or biliary obstruction)

 Cough (during migration of larvae to lungs)

ASCARIASIS SIGNS AND SYMPTOMS:

 pruritic papulovesicular rash (ground itch) at the site of penetration

 Cough and hemoptysis (during migration of larvae to lungs)

 Chronic, heavy, intestinal infection can lead to iron deficiency anemia, causing pallor, dyspnea, weaknesS

HOOKWORM INFECTION SIGNS AND SYMPTOMS:

 rectal bleeding and abdominal pain

 painful passage of stools, abdominal discomfort, and mucus discharge

 anemia, growth deficiencY

TRICHURIASIS SIGNS AND SYMPTOMS

1\. WUCHERERIA BANCROFTI  majority of the cases

2\. BRUGIA MALAYI AND/OR BRUGIA TIMORI

3. LOA LOA

FILARIASIS/LYMPHATIC FILARIASIS

CHRONIC PARASITIC INFECTION CAUSED BY NEMATODE PARASITES FILARIAL WORMS

 Developed 10-15 years from the onset of first attack

 HYDROCOELE  swelling of the scrotum

 LYMPHEDEMA

 swelling of the upper and lower extremities

 ELEPHANTIASIS

 enlargement or thickening of the skin of the lower and/or upper extremities, scrotum, breast

FILARIASIS/LYMPHATIC FILARIASIS

CLINICAL COURSE : CHRONIC STAGE

 Lymphadenitis

 inflammation of the lymph nodes

 Lymphangitis

 inflammation of lymph vessels in some cases, the male genitalia is affected

FILARIASIS/LYMPHATIC FILARIASIS

CLINICAL COURSE :ACUTE STAGE

 Characterized by the presence of microfilariae in the peripheral blood

 No clinical signs and symptoms of the disease

FILARIASIS/LYMPHATIC FILARIASIS

CLINICAL COURSE: ASYMPTOMATIC STAGE

The drug of choice is Diethylcarbamazine (DEC)

FILARIASIS/LYMPHATIC FILARIASIS:TREATMENT

1\. PLASMODIUM FALCIPARUM

 most responsible to drug resistant malaria

2\. PLASMODIUM VIVAX

3\. PLASMODIUM OVALE

4\. PLASMODIUM MALARIAE

MALARIA INFECTIOUS AGENTS:

 refer to chronic conditions that do not result from an (acute) infectious process and hence are “not communicable.”

 It is a disease that has a prolonged course, that does not resolve spontaneously, and for which a complete cure is rarely achieved

NONCOMMUNICABLE DISEASES

1\. Uncertain etiology (complex causality)

2\. Multiple risk factors

3\. Long latency period

4\. Prolonged course of illness

 Take time to become fully established

5\. Non-contagious origin

6\. Functional impairment or disability

7\. Incurability (in most cases)

 Required long, systematic and often expensive approaches to treatment

8\. Many opportunities for prevention

CHRONIC DISEASES ARE CHARACTERIZED BY THE FOLLOWING:

 CVD

 Diabetes

 Cancer

 chronic respiratory diseases

4 PROMINENT NCDS:

 Economic growth will improve all health conditions

 Chronic diseases affect only affluent

 Chronic diseases of the elderly

 Chronic diseases result from individual behaviors

 Benefits of CD control are for individuals only

 Infectious disease models apply to chronic diseases

 Chronic diseases should only be addressed in the health sector

MYTHS ON CHRONIC DISEASES

MODIFIABLE RISK FACTOR

\
A behavioral risk factor that can be reduced or controlled by intervention, thereby reducing the probability of disease.

NON-MODIFIABLE RISK FACTOR

A risk factor that cannot be reduced or controlled by intervention

METABOLIC RISK FACTOR

 “Metabolic" refers to the biochemical processes involved in the body's normal functioning

1\. Physical inactivity

2\. Unhealthy diet (increased fat and sodium, with low fruit and vegetable intake).

3\. Smoking/tobacco use

4\. Alcohol consumption

4 MODIFIABLE RISK FACTORS

1\. Raised blood pressure

2\. Raised total cholesterol

3\. Elevated blood glucose

4\. Obesity and overweigh

METABOLIC RISK FACTORS

1\. Age

2\. Sex

3\. Race

4\. family history

NON-MODIFIABLE RISK FACTORS

1\. Cancer

2\. Coronary heart disease

3\. Diseases of the lungs

4\. Peripheral vascular disease

5\. Stroke

6\. Fetal complications and stillbirth

TOBACCO USE/SMOKING

HEALTH EFFECTS Among smokers:

1\. Heart disease

2. heart attack

3. Lung cancer

TOBACCO USE/SMOKING

HEALTH EFFECTS Among Second-hand smoke causes:

1\. Diminished brain function

2\. Loss of body heat

3\. Fetal damage

4\. Risk for unintentional injuries

5\. Risk for violence

6\. Coma and death

HARMFUL USE OF ALCOHOL IMMEDIATE EFFECTS:

1\. Liver diseases

2\. Cancers

3\. Hypertension

4\. Gastrointestinal disorders

HARMFUL USE OF ALCOHOL LONG-TERM EFFECTS:

BLOOD PRESSURE

 is the force of blood pushing against the walls of your arteries, which carry blood from your heart to other parts of your body

 less than 5 grams or approximately 2,000 milligrams of sodium, per person per day

 This level was recommended for the prevention of cardiovascular diseases

RECOMMENDED SALT INTAKE:

CHOLESTEROL

 is waxy, fat-like substance made in the liver, and found in the blood and in all cells of the body. It is also obtained from food. it is important for good health and is needed for making cell walls, tissues, hormones, vitamin D, and bile acid.

 Too much of it in the blood may build up in blood vessel walls, block blood flow to tissues and organs, and increase the risk of developing heart disease and stroke.

HDL: HIGH DENSITY LIPOPROTEINS;

 often called “GOOD CHOLESTEROL”

 scavenge cholesterol from the bloodstream, from LDL, and from artery walls and ferry it back to the liver for disposal.

 measure of the proportion of “good” cholesterol in your total cholesterol

LDL: LOW DENSITY LIPOPROTEINS

 often called “bad cholesterol”

carry cholesterol from the liver to the rest of the body.

TRIGLYCERIDES:

 Type of fat found in your blood (stored in fat cells)

 make up most of the fat that a person eats and that travels through the bloodstream

SKINFOLD THICKNESS TEST

 measures the thickness (in mm) of subcutaneous fat at various sites of the body from which total body fat and hence contribution of fat to body mass can be estimated

 involves using a device called a caliper

 most common sites where measurements are obtained are triceps, biceps, subscapular and suprailiac.

CORONARY HEART DISEASE

 disease of blood vessels supplying heart muscle

CEREBROVASCULAR DISEASE (STROKE)

 Disease of the blood vessels supplying the brain

PERIPHERAL ARTERIAL DISEASE

 Disease of blood vessels supplying the arms and legs

CONGENITAL HEART DISEASE

 Malformations of heart structure existing at birth

ATHEROSCLEROSIS

A condition that develops when a substance called plaque builds up in the walls of the arteries. This buildup narrows the arteries, making it harder for blood to flow through. If a blood clot forms, it can block the blood flow. This can cause a heart attack or stroke

HEART ATTACK

Occurs when the blood flow to a part of the heart is blocked by a blood clot. If this clot cuts off the blood flow completely, the part of the heart muscle supplied by that artery begins to die

Hemorrhagic Stroke

occurs when a blood vessel within the brain bursts. This is most often caused by uncontrolled hypertension (high blood pressure)

Ischemic Stroke

(the most common type of stroke) occurs when a blood vessel that feeds the brain gets blocked, usually from a blood clot.

 When the blood supply to a part of the brain is cut off, some brain cells will begin to die. This can result in the loss of functions controlled by that part of the brain, such as walking or talking.

ARRHYTHMIA

 refers to an abnormal heart rhythm. There are various types of arrhythmias. The heart can beat too slow, too fast or irregularly.

 Bradycardia, or a heart rate that’s too slow, is when the heart rate is less than 60 beats per minute. Tachycardia, or a heart rate that’s too fast, refers to a heart rate of more than 100 beats per minute.

1\. HIGH BLOOD PRESSURE

 arteries will stiffen and be damaged with the increased pressure/force

2\. ABNORMAL BLOOD LIPIDS

 may cause buildup of plaques (atherosclerosis)

3\. TOBACCO USE

 components of tobacco can harden the arteries and increase heart rate

4\. PHYSICAL INACTIVITY

5\. OBESITY

6\. UNHEALTHY DIET (SALT)

 sodium attracts water in the body, therefore the blood volume is increased, which increases blood pressure

7\. DIABETES

STROKE RISK FACTORS

 Low socioeconomic status

 Mental ill health (depression)

 Psychosocial stress

 Heavy alcohol use

 Use of certain medication

 Lipoprotein(a)

STROKE OTHER MODIFIABLE RISK FACTORS

 EXCESS HOMOCYSTEINE IN BLOOD

 protein from eating meat

 INFLAMMATORY MARKERS

 (CREACTIVE PROTEIN)

 swelling/inflammation of blood vessels

 ABNORMAL BLOOD COAGULATION

 (ELEVATED BLOOD LEVELS OF FIBRINOGEN)

 blood clots may form that will impede blood flow

STROKE “NOVEL” RISK FACTORS

INSULIN

hormone made by the pancreas, helps glucose from food get into your cells to be used for energy.

DIABETES

 chronic disease that occurs either when the pancreas does not produce enough insulin or when the body cannot effectively use the insulin it produces.

 It is a disorder of metabolism the way the body uses digested food for growth and energY

TYPE 1 DIABETES

previously called insulin-dependent or juvenile diabetes

 Onset is acute-symptomatic.

 Body does not make insulin.

 Immune system attacks (autoimmune reaction) and destroys the beta cells in your pancreas that make insulin.

 Causes mostly due to genes (traits passed down from parents) that can trigger the autoimmune disorders. There are also viral infections that can cause destruction of pancreatic cells.

 This type of diabetes is not caused by diet

 (formerly non-insulin dependent diabetes mellitus or adult-onset DM)

 Onset is slow-often asymptomatic

 Body does not make or use insulin well

 Cells don’t respond normally to insulin, a condition called insulin resistance leading to body's pancreas to make more insulin to try to get cells to respond.

TYPE 2 DIABETES

GESTATIONAL DIABETES

 develops in some women when they are pregnant.

 Most of the time, this type of diabetes goes away after the baby is born.

 Greater chance of developing type 2 diabetes later in life. Sometimes diabetes diagnosed during pregnancy is actually type 2 diabetes.

 Effects: extra-large baby that may lead to difficulties in giving birth, having Cesarian section, high blood pressure that may lead to preeclampsia, seizures and stroke to the mother during labor and delivery)

1\. age 45 or older

2\. have a family history of diabetes

3\. Overweight

4\. physical inactivitY

5\. Race

6\. Certain health problems such as high blood pressure

DIABETES RISK FACTORS

1\. Unhealthy diets

2\. Physical Inactivity

3\. Obesity or Overweight

4\. High Blood Pressure

5\. High CholesteroL

DIABETES Major Modifiable Risk Factors

1\. Low socioeconomic status

2\. Heavy alcohol use

3\. Psychological stress

4\. High consumption of sugar and sweetened beverages

5\. Low consumption of fiber

DIABETES Other Modifiable Risk Factors

1\. Increased age

2. Family history/genetics

3\. Race

4\. Distribution of fat

Non-Modifiable Risk Factors DIABETES

1\. heart attacks

2\. Stroke

3\. kidney failure

4\. diabetic retinopathy

 cause of blindness, and occurs as a result of longterm accumulated damage to the small blood vessels in the retina

 neuropathy or nerve damage in foot - increases the chance of foot ulcers, infection and eventual need for limb amputation.

Diabetes can develop to:

CANCER

“Rapid creation of abnormal cells that grow beyond their usual boundaries, and which can then invade adjoining parts of the body and spread to other organs.” (WHO, 2012)

METASTASES

spread of cancer cells from the original (primary) tumor, travelling through the blood or lymph system, and forming a new tumor in other organs or tissues of the body

CERVICAL CANCER

Cancer of the Female Reproductive System

 Two cell types of present (squamous and glandular)

 Tend to occur where the two cell types meet

 99% of cases linked to genital infection with human papillomavirus (HPV)

 HUMAN PAPILLOMA VIRUS INFECTION (HPV)

 most common sexually transmitted infection

 HPV is a virus that can cause cervix cell changes

 Smoking

 Immune Deficiencies

 Poverty

 No access to PAP screening

 Family history of cervical cancer

RISK FACTORS OF CERVICAL CANCER

 SMALL CELL LUNG CANCER

LUNG CANCER MAIN TYPES

type of lung cancer tends to grow and spread faster than NSCLC.

 NON-SMALL CELL LUNG CANCER

LUNG CANCER MAIN TYPES

subtypes are adenocarcinoma, squamous cell carcinoma, and large cell carcinoma

ADENOCARCINOMAS

start in the cells that would normally secrete substances such as mucus. It occurs mainly in current or former smokers, but it is also the most common type of lung cancer seen in non-smokers. Usually found in the outer parts of the lungs

SQUAMOUS CELL CARCINOMAS

start in squamous cells, which are flat cells that line the inside of the airways in the lungs. They are often linked to a history of smoking and tend to be found in the central part of the lungs, near a main airway (bronchus).

LARGE CELL CARCINOMA

can appear in any part of the lung. It tends to grow and spread quickly, which can make it harder to treat.

 Smoking cigarettes, pipes, or cigars - now or in the past

 Being exposed to second-hand smoke

 Being treated with radiation therapy to the breast or chest

 Being exposed to asbestos, radon, chromium, nickel, arsenic, soot, or tar

 Living where there is air pollution

RISK FACTORS OF LUNG CANCER:

INVASIVE DUCTAL CARCINOMA

cancer cells begin in the ducts and then grow outside the ducts into other parts of the breast tissue.

INVASIVE LOBULAR CARCINOMA

Cancer cells begin in the lobules and then spread from the lobules to the breast tissues that are close by

1\. HORMONE THERAPIES

2\. WEIGHT AND PHYSICAL ACTIVITY '

3\. RACE

4\. GENETICS OR FAMILY HISTORY

5\. AGE IS THE MOST RELIABLE RISK FACTOR

 Risk increases with age

RISK FACTORS OF BREAST CANCER

PROSTATE CANCER

 2nd most common cancer among men

 The cancer develops inside of the prostate gland.

 Risk factors are

1\. AGE

2\. RAC

3\. OBESITY

4\. WEIGHT GAIN

COLORECTAL CANCER

 3rd most common type of cancer

 Forms in the LOWER PART OF THE DIGESTIVE SYSTEM (LARGE INTESTINE

1\. Lung

2\. Breast

3\. Colorectal

4\. Prostate

5\. Skin cancer

6\. Stomach

The most common cancers are:

CARCINOGEN

is an agent with the capacity to cause cancer in humans.

1\. increase avoidance of the risk factors

2\. vaccinate against HPV and hepatitis B virus;

3\. control occupational hazards;

4\. reduce exposure to ultraviolet radiation;

5\. reduce exposure to ionizing radiation (occupational or medical diagnostic imaging).

6\. Early detection and diagnosis (screenings)

CANCER PREVENTION STRATEGIES

CHRONIC RESPIRATORY DISEASES (CRDS)

 are diseases of the airways and other structures of the lung

1\. A leading cause of death

2\. High under-diagnoses rates

3\. 90% of deaths occur in low-income countries

4\. 2 of the most common CRDs are: COPD and asthma

CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD)

is the collective term used for lung diseases that prevent proper lung airflow

1\. breathlessness,

2\. excessive sputum production

3\. chronic cough.

.4 The airways in lungs become inflamed and thicken, and the tissue where oxygen exchange take place is destroyed.

5\. This decreases the flow of air in and out of the lungs.

6\. Less oxygen gets into your body tissues, and it becomes harder to get rid of the waste gas carbon dioxide.

7\. Includes the CHRONIC BRONCHITIS (long term inflammation of the airways) and EMPHYSEMA (damage to air sacs in lungs)

8\. More than just “smoker’s cough”

9\. Chronic obstructive pulmonary disease is confirmed by a spirometry test, which measures how much and how quickly a person can forcibly exhale air.

MOST COMMON SYMPTOMS OF COPD ARE

ASTHMA

 Recurrent attacks of “breathlessness and wheezing” (WHO, 2012)

 vary in severity and frequency from person to person

 Symptoms may occur several times in a day or week in affected individuals, and for some people become worse during physical activity or at night.

 Low fatality rates, but often underdiagnosed

mental health

a state of well-being in which the individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community

NUTRITION

is the sum of processes involved with intake of nutrients as well as assimilating and using them to maintain body tissue and provide energy the food people eat and how their bodies use it

DIETETICS

s the health profession responsible for applying nutrition science to promote human health and treat disease

NUTRIENTS

 Chemical substances present in food and is used in the body for 1 or more of the following functions:

1\. Provide energy

2\. Build and repair tissues

3\. Regulate life processes

1\. Carbohydrates

2\. Proteins

3\. Fats

4\. Vitamins

5\. Minerals

6\. WateR

ESSENTIAL NUTRIENTS

CARBOHYDRATES

macronutrients that are usually found in plant derived foods composed of sugars