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Polio: Types, Causes, Symptoms & Prevention

How poliovirus spreads and what are its symptoms, treatment, and prevention??

INTRODUCTION OF POLIOMYELITIS:

Poliomyelitis (polio) is a dangerous infectious disease, caused by a virus, which can affect many persons but mainly affects Young children. Generally, it is caused by infection with the poliovirus.

SPREADING OF POLIO VIRUS:

Poliovirus spreads by direct person to person contact, also by contact with infected mucus or phlegm from the nose or mouth of the infected person which then multiplies in the throat and intestinal tract, and then it is absorbed through blood and lymph system.

INCUBATION PERIOD OF POLIO VIRUS:

The time for developing symptoms of the disease, i.e incubation ranges from 5-35 days which is taken 7-14 days as average.

SIGNS OF POLIO VIRUS:

Polio (paralytic polio) as its name implies, causes muscle paralysis which can even lead to death.

SYMPTOMS OF POLIO VIRUS:

In paralytic polio attacks nerves by leaving the intestinal tract and enters the bloodstream. In asymptomatic polio the virus does not pass through the intestinal tract, as usual, it may infect nerves of muscles in limbs and that muscle which is necessary for breathing, so it then causes respiratory difficulty and even paralysis of arms and legs.

GOAL OF TREATMENT OF POLIO VIRUS:

The goal of treatment is to control symptoms of poliovirus. People with severe cases may need lifesaving measures, such as breathing help.

TREATMENT OF POLIO VIRUS:

Polio treatment include ;

ANTIBIOTICS:

-Antibiotics for urinary tract infection.

MEDICATION:

-Medications such as bethanechol.

HEAT TREATMENT:

-Moist heat(heating pads, warm towels to reduce muscle pain.

PAINKILLERS:

-Pain killers to reduce headaches.
MOST IMPORTANT TREATMENT:
-And the most important is physical therapy and braces or corrective shoes etc.

PREVENTION OF POLIO VIRUS:

The most important prevention is POLIO IMMUNIZATION (vaccine) effectively prevents poliomyelitis in most people.

EFFECTIVENESS OF POLIO IMMUNIZATION VACCINE:

This immunization is over 90% effective.

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Tonsillitis - causes, symptoms, treatment

TONSILS:

Tonsillitis

Definition:

Inflammation or infection of tonsils or lymph nodes

Tonsils are lymph nodes present in pharynx and oral cavity.

Classification of tonsils:

Based on location
On the basis of location tonsils may be of three types;
Palatine tonsils
Pharyngeal tonsils
Lingual tonsils

Palatine tonsils:

Inflammation of palatine tonsils are called palatine tonsils. Palatine tonsils are located in parterior and lateral wall of oropharynx.
Pharyngeal tonsils:
Inflammation of the pharyngeal tonsils are called pharyngeal tonsils. They are located in the posterior wall of the nasopharynx.

Lingual tonsils:

Lingual tonsils are located at the base of the tongue. It infection is called lingual tonsillitis. Pharynx is the tubular structure that connects the naal cavity and oral cavity with esophagus. Pharynx is also called throat.

Based on severity:

On the basis of severity, tonsils are classified as;

• Acute tonsillitis 
• Sub-acute tonsillitis 
• Chronic tonsillitis 

Acute tonsillitis:

Onset is rapid and self-limiting and after 3 or 4 days it gradually subside as;
Causative agents are Group “A” abrororor and streptococus pyrogenous bacteria are involved.
Viruses like epatain per virus are also involved.
 require treatment after 3 to 4 days.

Sub-acute tonsillitis:

It is mostly bacterial in origin and causative agents are streptococcus pyrogene and epstain bar virus.
It is bothersome and require therapy i.e. sore throat, fever, pain.
It untreated, sub-acute tonsillitis progress towards chronic tonsillitis.

Chronic tonsillitis:

It is very much complicated and ranges from days to months and streptococcus pyrogene are involved.
It is mostly bacterial in origin and require immediate therapy.

Sign and symptoms:

Following are the sign and symptoms of tonsillitis;

• Pain in throat.
• Dyrophgia (difficulty is swallowing)
• Chills 
• High grade fever
• Cough 
• Head ache
• Tonsil exudote\
• Complications of tonsillitis:
• It includes;
• Sinusitis (due to bacterial movement into sinusitis)
• Otitis media (middle ear infection)
• Peritonsiller absess (serious one)
• Reiro pharyngeal absess/infection
• Glamerula nephritis
• Sleep ophea (disturbed sleep)
• Septic phlebitis
• Shirring

Sinusitis:

Inflammation of the sinus
Sinuses are cavities air spaces present in cranium and it reduces the weight of the cranium.

Otitis media:

Middle or external ear infection. In this condition yellowish exudate formation occur which causes the severe pain of ear.

Peritonsiller Abcess:

Chronic inflammation of tonsils characterized by exudate formation. In this case tonsils are covered by white exudate and tonsils are dislocated come forward, move forward, move toward downward and to the midline of the oral cavity and tonsils become hypertophia.

Retropharyngeal abcess:

Infection of area behind the pharynx;

Sign and symptoms:

• Severe neck pain
• High grade fever
• Lymph aderopathy
• Hypertrophy of pharynx
• Dyshpagia’
• In retropharyngeal abcess bacteria gain acess to the cerrical vertebra and cause meningitis.
• Bacteria also gain acess to the jugular vein and can result in septic phlebitis.

Glomerulonephritis:

Mostly arises from viral tonsillitis. Due to Ig antibody formation, which form immune complex and this complex is then deposited in the nephron.

Snoring:

Hypertrophy of tonsils leads to snoring.

Apner/disturbed sleep:

Nasal cavities are blacked due to hypertrophy of tonsils. Patients is on mouth breathing, blood level of oxygen decrease because of closed nasal cavity and leds to apnea.

Prevertebral infection:

If bacteria gain access to prevertebral space i.e. spinal cord, there are chances of spinal cord infection and damage,
While if bacteria gain access to the neck muscles and jugular vein ( internal jugular vein or external jugular vein) it causes septic phobitor.

Diagnosis:

Based on physical examination i.e.
Swallowed tonsils
Physical signs and symptoms
Take exudation of the tonsils by swab and check for bacterial infection.

Treatment:

Symptomatic treatment:

To relieve the pain, head ache and to prevent the spread of infection or the complication of the tonsillitis.

Causative treatment:

First line drugs:

Penicillin’s are the first line therapy (Augmentin may also be given in severe condition)
Second line drugs:
Macrolides like azithromycin is a drug of choice due to short duration of time i.e. 3 days.
Dose=250mg bid for 3 days.
Pain killer:
Ibuprofen
Antipyretic:
Paractemol

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HYPOTHYROIDISM

HYPOTHYROIDISM:

Hypothyroidism

DEFINITION:

Decrease secretion of thyroid hormone is called hypothyroidism.

HORMONES OF THYROID GLAND:

The thyroid gland secrets:

• Tetra iodothyronin T4 (thyroxin)
• Tri iodothyroinin T3

HALF LIFE:
T4 has a longer half-life while T3 has a short half-life.

CLASSIFICATION OF HYPOTHYROIDISM:

BASIC CONCEPT:

When the gland is not functioning properly, the gland will produce less amount of T3 & T4, so pituitary gland will secrete more and more TSH. This more and more secretion of TSH will try to maintain normal T3 & T4 level.

SUBCLINICAL HYPOTHYROIDISM:

The initial state of hypothyroid where TSH is increase & T3T4 is normal is known as subclinical hypothyroidism.

PRIMARY HYPOTHYROIDISM:

In the latter stage of the disease, T3/T4 level will also reduce and TSH will remains high, so when the disease occurs at thyroid level (primary hypothyroid).

SECONDARY HYPOTHROIDISM:

If the disease occur at pituitary gland level, this is called secondary hypothyroidism.

TERTIARY HYPOTHROIDISM:

When the disease occur at the level of hypothalamus, this is called tertiary hypothyroidism.

CAUSES:

Hashimotothroiditis: 

• A Chronis lymphocytic thyroiditis that is consider to be an autoimmune disorder.
• As a result treatment of hyperthyroidism.
• Surgical excision of thyroid gland
• Goiter

Drug induced: 

Lithium, amioderone.

CLINICAL FEATURES:

CARDIOUASCULAR SYSTEM:

Hypothyroidism can lead to decrease in the heart rate and can cause bradycardia.
Thyroid hormones increases the force of contraction of the heart, so in the absence of thyroid hormone, it decrease the force of contraction & cardiac output.

GROWTH AND DEVELOPMENT:

What you are finding that the brain growth occurs in first 3-4 years of life.
For example, a child have hypothyroidism even if we go for replacement therapy, the child may develop normal somatic growth/sexual growth but he will be mentally retorted because the maximum brain growth occurs in the first 3-4 years of the life that’s why hypothyroid patients are

• Mental retardation
• Growth retardatio

SEXUAL FUNCTIONS:

MALE: 

hypothyroidism leads to loss of libido/sexual drive what happen to menstruation. (Abnormal menstrual flow)

FEMALE:

 menstruation/menorrhagia (excess of bleeding occur).

BLOOD: 

• Microcytic anemia (Due to menorrhagia).
• Macrocytic anemia (autoimmune).
• Deficiency of vitamin-B12/folic acid.
• Sideroblastic anemia.

GIT:

• Pt might come with chronic constipation
• Pt might come with weight gain.
• Hypothyroidism is often confused with obesity & depression.
• Thyroid function test will give accurate diagnosis
• Abdominal distension
• Loss of appetite.

CNS:

• Dementia 
• Reversible dementia   -    hypothyroid
• Vitamin-B12 deficiency 
• Cerebral ataxia      -    subdural hematoma 

OTHER CLINICAL FEATURES:

• LDH (pronto coronary artery disease
• LDH
• DIAGNOSIS:
• Thyroid function test,
• Serum total thyroxin TT4 (<5 )
• Serum tri iodothronine
• Serum thyrotropin TSH assay 

TREATMENT:

All the pts with symptomatic hypothyroidism require replacement therapy.
Initial dose of T4 depends on pts age, severity and duration of the disease and co-existence of cardiac disease.

ADULTS: 

Start with the lowest possible dose and gradually increase why because if we suddenly give full dose the heart rate will be increase.
In adult they also have increase LDH and have atherosterosis that can precipitated.

CHILDREN: 

we give full dose because,
We have not concern with the heart but with the brain
T4  dose:50-100 g daily
Longer half-life so given once daily in morning
After 6 weeks----thyroid function test
TSH concentration is the best indicator.
As TSH increase----inadequate treatment

DOSE FOR ADULTS: 

25 g and increasing slowly after 4-6 weeks and progress should be daily monitor.
Some recommends T3 because if adverse effect occurs, these can be alleviated by dose reduction due to shorter half-life of T3.

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How To Learn All Of These Ridiculous Drug Interactions.

 How To Learn All Of These Ridiculous Drug Interactions:

How To Learn All Of These Ridiculous Drug Interactions. 

The term drug- drug interaction may be define as the alteration in pharmacokinetics or effects of a drug by the presence of another drug or when we administered one drug that effect another drug .

Explanation:

When we take two drugs with same time then they produce undesirable change in the body which may lead to increase in toxicity and unfortunate effects of many drugs e.g. the use of two drugs such as acetaminophen along with isoniazid can leads to higher risk of liver toxicity. 

On the other hand DDIs may also affect the therapeutic response of a drug e.g. rifampicin reduces the antimicrobial effect of clarithromycin when given together. 

When one drug increase the effect of other drug then this term is refer to as synergistic effect. When one drug cancels the effect of another drug then it is called antagonistic effect. In hospital patients there is issue of DDIs which needs more attention due to severity of disease, chronic diseases, poly pharmacy, complex therapeutic regimen, and frequent modification in therapy 

. If a patient receives two drugs and one of them increase the effect of another drug then overdosing occurs which may cause serious problem in patient and increase the risk of side effect. on the other hand when one of these drug decrease the effect of other drug then this lead to under dosing of drug which cannot produce effect. 

So it is necessary to controlled drug-drug interaction in population. Example of these drug include the use of acetaminophen with codeine increase the analgesic effect of drug or the combination of amoxicillin with clavulanic acid in order to overcome resistance of bacteria to that antibiotic [5].

A DDI can also be some time beneficial e.g. co-administration of penicillin with probenecid   inhibits the renal excretion of the antibiotic and thus prolongs its half-life in plasma. Some of the known DDIs are harmful and can lead to not only undesirable and even toxic reactions but also loss of therapeutic effect. 

These latter interactions are tougher to notice because the lack of efficiency can be described by other factors such as poor compliance. In a study show among elder out patients the risk of a sub therapeutic effect as a DDI was as common as the risk of harmful reactions. Besides these important DI may occur with other pharmacologically active drug such as alcohol and nicotine.

Classification:

1.2 Classification:

Drug-drug interaction was categorized into different levels as follow:

1.2.1 On the basis of onset:

It may be divided into two sub class.1.2.1.1 Rapid:

In this type of interaction the sign and symptoms is appeared after 24 hour of drugs administration.

1.2.1.2 Delayed:

In this sign and symptoms appeared after 1 week administration of drug.

1.2.2 On the basis of severity:

They are classified into 4 sub types as follow.

1.2.2.1 Contraindicated:

In this type of DDI the combination of drugs is contraindicated to use.

1.2.2.2 Major:

In this type of DI there is risk of death and medical intrusion is required to prevent, control or minimize serious negative result.

1.2.2.3 Moderate:

In this the effect of DI can worsen patient’s state and may require change in therapy.

1.2.2.4 Minor:

In this type of DI little effects are formed that do not harm therapeutic outcome and there is no need to change in therapy .

1.3 Pharmacokinetic drug-drug interation:

When one drug change the absobtion, distribution, metabolism and excretion of another drug then this is called Pk DDIs.

1.3.1 Absorbtion interation:

This mainly occure when patient take two drug or poly pharmacy and one of them effect absorbtion of drug.

1.3.1.1 pH:

Drug present in the stomach may be either in ionized form or non ionized form depend upon pka value. The non-ionized form of drug easly cross cell membrance because they cannot effect by  lipid bylayer and most of drug are absorbed by passive diffusion. So increase in the absorbtion of drug may also increse its bioavailibilty.

Changing the two state i.e ionized or non ionized may be useful or not for the drug. Some drug need acidic PH while other need basic PH of intestine so any change can lead to increase or decrese absorbtion. Example the use of antacid can increase the stomach PH which inhibit absorbtion of drug such as zalsatabin absrbtion is 25% is decreased, tipranavir 25 % and amprenavir decreased up to 35%.

1.3.1.2 Solubility:

Drug solubilty may be effected by when two drug given togher to form comlexation. This

Mainly occur with food substance. Example when tetracycline take along with milk a chealting agent form. Most of drugs are binding with protien when given together. Example sucralfate when teke with food .

1.3.2 Distribution interaction:

Drug is transported by binding with plasma or with tissue protien. Many drug are interect with plasma protien most common with albumin, glycoprotien and lipoprotien. The acid drug are bound with albumin while basic drug are bound with glycoprotien and lipoprotien.

 Only unbound drug is availible for passive diffusion to reach extravascular and tissue sites. When paracetamol is given by a patient which is 90% bind to plasma protien and binding site is not free for other drug so liver toxicity is cause because of delayed metabolism .

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