- Malignant Mesothelioma.

Malignant Mesothelioma.

Def:-

It is a rare form of cancer that develops from the protective lining that covers many of the body's internal organs,known as the mesothelium.

(CXR demonstrating Mesothelioma of left lower lung)

Sites:-

• Pleura. (is the most common form of the disease, accounting for roughly 70% of cases).
• Peritoneum.
• The pericardium (1).
• The tunica vaginalis.

- Meosthelioma Symptoms.

Meosthelioma Symptoms

Dr. Michael Milano explains what mesothelioma is and its symptoms..

- Asbestos Lung Cancer.

Asbestos Lung Cancer.

Dr. Michael Milano explains how lung cancer can be caused by asbestos exposure.

-Congenital Rubella Syndrome.

Congenital Rubella Syndrome

Aetiology:-
Maternal infection by rubella leads to Maternal viremia which lead to transplacental spread of the virus to the fetus causing fetal viremia whcih in turn leads to infection invloving many fetal organs and hence congenital anomalies.

N.B:- Newborn discharge virus in his secretions for 12-18 months after birth so he is infectious.
Incidence:-
*In the 1st trimester:- 15-20%.
*In the 4th month:- 5%.   

- Mesothelioma Treatment Options.

Mesothelioma Treatment Options.

Dr. Michael Milano, consulting oncologist, discusses the various treatment options available to an asbestos cancer patient..

- What are the symptoms of peritoneal mesothelioma?

What are the symptoms of peritoneal mesothelioma?

Mary Hesdorffer, MS, APRN, nurse practitioner with the Mesothelioma Applied Research Foundation discusses the symptoms of peritoneal mesothelioma.

- Metabolic syndrome (Syndrome X).

 Metabolic syndrome

-Def :- It is a combination of medical disorders that increase the risk of developing cardiovascular disease and diabetes (1).

-Synonyms :-syndrome X, insulin resistance syndrome, Reaven's syndrome or dysmetabolic syndrome.

 

- How is the metabolic syndrome diagnosed or defined?
The metabolic syndrome be identified by presence of three or more of these components:

• Elevated waist /hip ratio (i.e Abdominal obesity).
• Elevated triglycerides:Equal to or greater than 150 mg/dL, or specific treatment for this
  lipid abnormality.
• Reduced HDL or specific treatment for this lipid abnormality.
• Elevated blood pressure or treatment of previously diagnosed hypertension.
• Elevated fasting glucose levels or previously diagnosed type 2 diabetes.

-Prevention:-  life style modification which is considered the first line of prevention.

• Increased physical activity e.g walking 30 minutes every day (2).
• Healthy, reduced calorie diet (3).

Return to list of medical syndromes here

*References:-
(1) MedlinePlus:Metabolic Syndrome.
(2)Lakka TA, Laaksonen DE (2007). "Physical activity in prevention and treatment of the metabolic syndrome". Applied physiology, nutrition, and metabolism = Physiologie appliquée, nutrition et métabolisme 32 (1): 76–88. doi:10.1139/h06-113.PMID 17332786.
(3)Feldeisen SE, Tucker KL (2007). "Nutritional strategies in the prevention and treatment of metabolic syndrome". Appl Physiol Nutr Metab 32 (1):46–60. doi:10.1139/h06-101.PMID 17332784

- What are the symptoms of pleural mesothelioma?

What are the symptoms of pleural mesothelioma?

Mary Hesdorffer, MS, APRN, nurse practitioner with the Mesothelioma Applied Research Foundation discusses symptoms of pleural mesothelioma.

- What does a pleural mesothelioma diagnosis mean?

What does a pleural mesothelioma diagnosis mean?

Mary Hesdorffer, MS, APRN, nurse practitioner at the Mesothelioma Applied Research Foundation talks about the importance of consulting with a pleural mesothelioma expert when discussing a diagnosis.

- Breast feeding.

Breast feeding

(International Breastfeeding Symbol)

- Breastfeeding is the feeding of an infant or young child with breast milk directly from human breasts.

Advantages of Breast Feeding
( the breast is the best)

(1)For Infants:-

"Human breast milk is the healthiest form
of milk for human babies" (1) How?

*It is biochemically the most suitable for infant feeding at any stage (colostrum,transitional and mature milk).
*It contain various elements required for nutrition of infant.
*It is hypoallergic (2) and may reduce subsequent atopic diseases .
*Naturally stored at room temperature.
*Available whenever needed and automatically adjusted to infant needs.
*Anti infective properties how?
- It is naturally sterile as no preparation nor contamination.
- It contain various antimicrobial factors :-

- What is mesothelioma?

What is mesothelioma?

Mary Hesdorffer, MS, APRN, nurse practitioner at the Mesothelioma Applied Research Foundation explains mesothelioma.

- Influenza virus.

- Influenza virus belongs to Orthomyxoviridae family (single-stranded, negative-sense RNA,enveloped viruses and replicate by nuclear replication).

- Genera which are identified by antigenic differences in their nucleoprotein and matrix protein :-

• Influenza A virus.
• Influenza B virus.
• Influenza C virus.

*Influenza Virus Morphology*

- The particles are mostly spherical, 80-120 nm diameter,its core diameter 9 nm and has helical nucleoprotein.

-Nucleoprotein(RNA + nucleoprotein, NP)is any protein which is structurally associated with nucleic acid.

-Matrix proteins(M1,M2)are structural proteins linking the viral envelope with the virus core.

- The virus has a lipid envelope from which project 500 prominent glycoprotein spikes 10 - 14 nm from the surface and are of two types:-

1. Haemagglutinin (HA or H)"the major" which is a sugar-binding protein that mediates binding of the virus to target cells and entry of the viral genome into the target cell.

2. Neuraminidase (NA or N) which is an enzyme involved in the release of virus progeny from infected cells, by cleaving sugars that bind the mature viral particles.

-Ratio of HA to NA is about 4-5 to 1.

(Simplified cartoon showing structure of influenza virus image from Nature)

*Virus Mutation*

-Every 10 - 15 years a major new pandemic strain appears in man, with a totally new H and sometimes a new N as well (Antigenic Shift) which means complete change in HA and NA.

-This new variant may cause a major epidemic around the world.

- Over the subsequent years this strain undergoes minor changes (Antigenic Drift) every two to three years which means incomplete change in HA and NA.

*serotypes:-

- Influenza A viruses are further classified, based on the viral surface proteins (HA or H) and (NA or N) into 16 H subtypes (or serotypes) and 9 N subtypes giving a large number of subtypes due to different associations.

-Influenza B: Known only in man and seals and is less common than influenza A Undergoes relatively slow change in HA with time,consequently is less genetically diverse, with only one influenza B serotype as a result of this lack of antigenic diversity, a degree of immunity to influenza B is usually acquired at an early age.

-Influenza C: Uncommon strain, known only in man and pigs and can cause severe illness and local epidemics.

-Influenza A viruses have an importance nowadays due to lack of specificity to a single host tissue and genome re-assortment which leaded to a panic in the world as for example human Influenza A H1N1 was causing seasonal flu in man and Swine Influenza A H1N1 was causing endemic flu in pigs,swine H1N1 made re-assortment in pig to be transmitted to man leading to pandemic of swine flu in world.

Dr Ibrahim...

- Integrated Management of Childhood Illness (Imci).

- Def:-
An integrated approach to child health which focuses on the well being of whole child.

- Aims (Broad goals-الأهداف العامة):-

• Reduce death, illness and disability
• Promote improved growth and development among children under five years of age.
• Includes both preventive and curative elements implemented by families,communities and health facilities.

-Objectives(الأهداف الصغيرة-underlying goals):-

1- In Health facilities,IMCI strategy promotes:-

• The accurate diagnosis of childhood illnesses in outpatient clinics.
• Appropriate combined treatment of all major illnesses.
• Improving skills of PHC staff.
• Speeding up the referral of severely ill children.

2- In the home setting,IMCI strategy promotes:-

• Appropriate care seeking behaviours
• Improved nutrition and preventative care.
• Correct implementation of prescribed care/and drugs.

- Why is IMCI better than single-condition approaches?

• Children brought for medical treatment in the developing world are often suffering from more than one condition, making a single diagnosis impossible.
• IMCI ensures the combined treatment of the major childhood illnesses, emphasizing prevention of disease through immunization and improved nutrition.

-Rationale of IMCI in developing countries:-

1-More than10million deaths/year among children under 5 years of age in developing countries.

2-70% of these deaths are due to just 5 preventable and treatable
conditions (pneumonia,diarrhea
malaria,measles and malnutrition).

3-Surveys show that many sick children aren't properly treated by healthcare providers as their parents are poorly advised.

4-In developing countries diagnostic aids (Radiology or lab) are minimal or absent.

5-In developing countries drugs and equipment are limited.

6-These limitations leave doctors helpless,they often rely on history,signs and symptoms to determine the management with least cost.

- Components :-

The strategy includes three main components:-

• Improving case management skills of health-care staff(health-worker component).
• Improving overall health systems(health-service component).
• Improving family and community health practices(community component).

-The department responsible for IMCI in WHO is called "Child and adolescent health department"(CAH) here.

-Benefits of Integrated Management of Childhood Illness (IMCI)(3):-

• Addresses major child health problems by addressing the most important causes of childhood death and illness.
• Responds to demand – Every day millions of parents take their sick children to hospitals and health centres,pharmacists and community health care providers. At least three out of four of these children are suffering from one of the five conditions that are the focus of IMCI.
• Promotes prevention as well as cure .
• Is cost-effective – Investing in Health ranked IMCI among the 10 most cost-effective interventions in both low- and middle-income countries.
• Promotes cost saving – Inappropriate management of childhood illness wastes scarce resources. Although increased investment will be needed initially for training and reorganization, the IMCI strategy will result in cost savings.
• Improves equity – Nearly all children in the developed world have ready access to simple and affordable preventive and curative care which protects them from death due to ARI, diarrhoea, measles, malaria and malnutrition. Millions of children in the developing world, however, do not have access to this same life-savingcare. The IMCI strategy addresses this inequity in global health care.

-Implementation of IMCI:-
(How does IMCI achieve these goals?)
1-Adopting this strategy in the national health policy.
2-Adapting the standard IMCI clinical guidelines to the country's needs,Available drugs,policies,and to local foods.
3-Upgrading care in PHC units by training staff in new methods of management of children.
4-Implementation of the concept of the essential drug list.
5-strengthening the referral system.
6-Implementation of IMCI is done in conjugation with other health strategies (e.g Roll back malaria,Nutrition,EPI,IMPAC).


- Some WHO publications concerned with IMCI:-

*IMCI chart booklet - standard,

• Page here
• Download here.

* Handbook:IMCI integrated management of childhood illness.

• Page here
• Download here.

* Integrated Management of Childhood Illness (Imci) Photographs:-

• Download here.

-References:-

(1)Mohammed Kamel Farag ,community medicine, non communicable disorders & management in health care ,Ch 14 ,Child health care services, p.g 181-183.
(2)About Integrated Management of Childhood Illness (IMCI), Pan American Health Organizationn here.
(3)IMCI information package (here) ,WHO/CHS/CAH/98.1 A-M Rev.1 1999, BOX 1,p.g 4.
(Figer 1)UNICEF:The state of the worlds children 2008: child survival(here)UNICEF/HQ07-0108/Thierry Delvigne Jean
(Figer 2)UNICEF:The state of the worlds children 2008: child survival(here)New York: UNICEF; 2007.

- Medical syndromes.

Medical syndrome is defined as :-
A group of symptoms and signs that collectively indicate or characterize a disease, psychological disorder, or other abnormal condition.
There are a lot of medical syndromes and we try to list some of them:-
1-Down syndrome (click here).
2-Plummer-Vinson syndrome (click here).
3-Ramsay Hunt syndrome (click here).
4-Wolf-Hirschhorn Syndrome (click here).
5-Cri-du-chat syndrome (click here).
6-YY syndrome (click here).
7-Klinefelter's syndrome (click here).
8-Turner's syndrome (click here).
9- Fanconi syndrome (click here).
10-Abderhalden-Kaufmann-Lignac syndrome (click here) .
11-Light Wood-Albright syndrome(Lightwood syndrome)(click here).
12-Oculo-cerebro-renal Syndrome (click here).
13-Metabolic syndrome (click here).
14-Pickwickian syndrome (click here).
15- Kallmann syndrome (click here).
16-Sertoli-cell-only syndrome (click here).
17-Lambert-Eaton syndrome (click here).
18-Guillain Barré syndrome (click here).
19-Horner's syndrome (click here).
20-Brown-Séquard syndrome. (click here).
21-Carpal tunnel syndrome. (click here).
22-Sjögren's syndrome (click here).
23-Felty's syndrome (click here).
24-Caplan's syndrome (click here).
25-Congenital Rubella Syndrome  (click here).
26-Caroli's syndrome.  (click here).
27-Malabsorption syndrome.  (click here).
28-Duhin-Johnson syndrome.  (click here).
29-Exploding head syndrome. (click here). 

If you have other syndromes plz tell us...
Dr Ibrahim,,

- Components of Quality of health care.

components of Quality of health care are collected in the word

" Re-cast"

- Interpersonal Relationship which refers to the inter-action between providers and clients, health team and community and in between medical staff.

- Effectivness.

- Efficiency.

- Continuity:- client recieve ccomplete health service without interruption,cessation or unneccessary repetition of diagnosis or treatment.

- Accessibility:- health care must be unrestricted.

- Amenities ( Non medical aspect of Quality) .

- Safety = minimizing risk of danger

( infection,injury,harmfuk side effects)

for both clients & providers.

- Technical compotence = clinical skills.

see you,
Dr Ibrahim

- Tuberculin non reactors high risk groups.

One of the indications for administration of BCG vaccine is

"Tuberculin non reactors high risk groups"

they are "Dig camp"

- Dangerous group of the community who deal with large number of people transmitting infection to them ..e.g food handlers,teachers,nurses,wet nurses,hair dressers.

- Industrial workers especially exposure to silica dust as T.B follow silicosis as its shadow.

- Geriatric homes .


- Contacts with cases.

- Camps.

- Cases of D.M & chronic debilitating diseases.


- Agricultural workers and farmers.

- Adolescents with symptoms > 4 weeks.


- Medical and Paramedical persons.

- Military groups.

- Malnutrition syndrome.


- People of underdeveloped countries and living in slums.

- Non typhoidal salmonella.

-Non typhoidal salmonella are bacteria which cause

salmonellosis in human which is a type of

food poisoning...

- While typhoidal salmonella lead to Typhoid

-Non typhoidal salmonella are collected in word

"sect"

- Salmonella Sonnei.

- Salmonella Enteritidis.

- Salmonella Cholerae suis.

- Salmonella Typhimurium.

See you,

Dr Ibrahim.

- causes of re-emerging of T.B.

causes of re-emerging of T.B

Or

why does the burden of T.B increases?!

"Dim shape"

- Demographic changes e.g poor housing and overcrowding.


- Immuno-suppressive drugs.


- Microbial adaptation.

- Multi-drug resistant for T.B.

- Malnutrition.


- Smoking.


- HIV.


- Addiction.


- Increase Prevalence of T.B diagnosis than expected.


- Environmental factors e.g air pollution.

- Decrease Effectiveness of BCG.

see you,

- Malarial triad.

Malaria is charachterized by 3 symptoms with each other:-

1-Enlarged spleen: which is tender and soft.

2-Intermittent febrile paroxysms in which the intervals are usually regular and the patient
is ill between the attacks.

3-Destruction of RBC's leading to 2ry Aneamia.

Return to other triads here.

- Ecological triad.

Ecological triad (epidemiological triad)

Ecological triad of disease is composed of:-

1- Causative Agent.

2- Host.

3- Environment.

Return to other triads here.