Tag Archives: Fever

leukonychia

Description::
Leukonychia (or leuconychia), also known as white nails or milk spots, is a medical term for white discoloration appearing on nails. It is derived from the Greek words leuko (“white”) and onux (“nail”). The most common cause is injury to the base of the nail (the matrix) where the nail is formed…..CLICK & SEE

It is harmless and most commonly caused by minor injuries that occur while the nail is growing. Contrary to popular belief, leukonychia is not a sign of excess or deficiency of calcium and zinc or other vitamins in the diet but rather less commonly a medical sign of hypoalbuminemia or chronic liver disease. It is more commonly found on fingernails than toenails. There is no effective treatment for leukonychia. However, the white marks and spots gradually disappear as the nail grows outward from the matrix with the nail plate.

Leukonychia is a nail condition. It manifests as the nail changing color either partially or fully. This disease can be caused by systemic problems or most commonly, it is a genetic disorder. The nail appears to have the standard shape and appearance, except for the fact that the nail turns white. This is caused by the presence of “parakeatotic cells”. These cells have an undeveloped and bulky nucleus, which contain ‘keratohyalins’. This cell variation causes the nail to reflect light and makes the nail appear opaque white.

Types:
Leukonychia totalis :
This condition is a whitening of the entire nail. This may be a clinical sign of hypoalbuminaemia (low albumin), which can be seen in nephrotic syndrome (a form of kidney failure), liver failure, protein malabsorption and protein-losing enteropathies. A genetic condition, and a side effect of sulphonamides, a family of antibiotics can also cause this appearances.

Leukonychia partialis:
This condition is whitening of parts of the nail plate in form of small white dots. There are several types of this condition. There are three variations of partial leukonychia; punctate, transverse and longitudinal leukonychia. Some more serious variations of leukonychia partialis may lead to Leukonychia totalis.

Leukonychia striata:
Leukonychia striata, transverse leukonychia, or Mees’ lines are a whitening or discoloration of the nail in bands or “stria” that run parallel the lunula (nail base). This is commonly caused by physical injury or disruption of the nail matrix. Common examples include excessive tapping of the nails, slamming a car door or extensive use of manicure. It may also occur in great toenails as a result of trauma from footwear. Alternatively, the condition can be caused by heavy metal poisoning most commonly by lead or arsenic. It can also be caused by cirrhosis or chemotherapy. The tendency toward leukonychia striata is sometimes inherited in an autosomal dominant fashion. In other cases, it can be attributed to vigorous manicuring and trauma aforementioned, or to a wide variety of systemic illnesses. Serious infections known for high fevers, measles, malaria, herpes, and leprosy may also cause this condition. In many patients, there is no obvious cause, and the streaks resolve spontaneously. There is a similar condition called Muehrcke’s lines (apparent leukonychia) which differs from leukonychia in that the lines fade with digital compression and does not migrate with the growth of the nail.

Leukonychia punctata:
Also known as “true” leukonychia, this is the most common form of leukonychia, in which small white spots appear on the nails. Picking and biting of the nails are a prominent cause in young children and nail biters. Besides parakeratosis, air that is trapped between the cells may also cause this appearance. It is also caused by trauma. In most cases, when white spots appear on a single or a couple of fingers or toes, the most common cause is injury to the base (matrix) of the nail. When this is the case, white spots disappear after around eight weeks, which is the amount of time necessary for nails to regrow completely. The pattern and number of spots may change as the nail grows.

Longitudinal leukonychia:
Longitudinal leukonychia is far less common and features smaller 1mm white longitudinal lines visible under the nail plate. It may be associated with Darier’s disease.

Symptoms :
Some of the obvious signs of leukonychia are white spots on the fingernail. It is observed in the form of small white lines on the nails and change in color of the nails which become totally white. The white spots may also occur on toenails. The nails become colorless and brittle losing the original texture. The nail may change its color to fully white (leukonychia totalis) or half white (leukonychia partialis).
Apart from the above signs, the person affected with leukonychia may also have problems like deafness, gingivitis, and hyperkeratosis and hammer toes if they are suffering from systemic disorders.

Causes:
It can be due to nail injury or infection. Sometimes it can be due to nail disorder or bacterial infection on the nail-bed. The white spots and change of nail to full-white color is due to the presence of para-karyotic cells that contains a compound called keratohyalins. On reflection to the light the normal color of the nail looks fully white.

Leukonychia can also occur due to heavy poisoning, heart problem, kidney disease, malnutrition, vitamin deficiency and stress.
Lack of essential nutrients like zinc and protein can also cause discoloration of nails. Ulcer in advance form can affect the fingernails. Further it can be caused due to pneumonia and hepatic cirrhosis and various other skin problems.People with diseases like typhoid, cholera, rheumatic fever, and colitis may also show this symptom of white spots on fingernails.

Individuals with family history of leukonychia have more chance of developing this problem than others. Patients who are undergoing chemotherapy or radiation treatment for cancer may also get this disease. Prolonged use of nail enamels and nail hardeners can be the reason for white spots on the fingernail. Bacterial or fungal infection on the nails can cause this problem.

True Leukonychia:
This type of Leukonychia is broken into two variations, total leukonychia and partial leukonychia. The difference seems to lie in the nail being either fully white, or only two thirds discolored as it takes a while for the maturation of the keratin to occur and change.

Total Leukonychia is an autosomal dominant condition. Other circumstances that may cause total leukonychia to occur are;
*Leprosy
*Typhoid
*Cytotoxic drugs
*Nail Biting
*Partial Leukonychia is viewed as a phase of total leukonychia. The most common causes of partial leukonychia are:

*Metastatic carcinoma
*Tuberculosis
*Leprosy

There are three different variants of partial leukonychia.

1.Transverse leukonychia – This causes the nail plate to be multi colored in its opacity. It is seen mostly in women’s fingernails. Possible causes are:
*Acute respiratory infections
*High fever
*Malaria
*Leprosy

2.Punctuate leukonychia This is the most common form and can happen to anyone. The telltale symptom is that the nail appears to have tiny opaque spots which fade with time.

3.Longitudinal leukonychia – A small white line under the nail plate
Pseudo Leukonychia

*This occurs when a discoloration in the nail appears due to a change in the nail bed. Pseudo leukonychia has three different forms:

*Terry’s nails – This affects the majority of the nail and makes it multi-colored. The majority of the nail is white, the rest, pink or brown.
Muhrecke’s nails – The nail appears to have several white transverse bands

*Half and half nails – This is seen as a larger part of the nail being dull white and the rest being brownish in color.

Diagnoses :
It is easy to identify this disease by physically examining the nails of the person affected. If needed, your doctor will ask you to do blood culture and other test for measuring the nutrients like zinc and vitamins. The doctor will take a thorough medical history, and may take blood tests as well as examining liver and kidney function.

Treatment :
You can get some relief from the symptoms by including lot of nutrition in your daily diet. Proteins, vitamins and zinc are essential elements that are to be added in daily food. You can eat nuts and green leafy veggies that carry lot of zinc.

The white spots on the fingernail will gradually diminish if you start taking zinc in daily food.In case if the problem is due to anemia then you will be given folic acid and iron supplement pills. If the symptoms are due to renal failure, then your doctor will initiate treatment for the condition. Suitable medicines will be given for treating the underlying disease like liver problem or ulcer or anemia.

Do not change your nail polish frequently and always use trusted brands. Limit the usage of nail enamels and polish to certain occasions. Avoid biting your nails since it may worsen the condition.

In case if the white spots or white coloration on the fingernails does not improve for more than 2 months, you can consult your doctor who would help you to find the actual cause.

Almost in many cases, the symptoms of leukonychia are due to deficiency of nutrients and zinc and only in rare cases, it will be due to underlying systemic disorders.

Increasing the quantity of grains, vegetables and nuts and even taking a zinc supplement (as zinc deficiency is a cause of leukonychia) is a good preventative and treatment, as is keeping affected nails out of harms way when using chemicals of any kind as they can further damage the nail.

Resources:
http://en.wikipedia.org/wiki/Leukonychia
http://www.nailsfungus.org/nail-fungus/leukonychia.html

Leukonychia

Anemarrhena asphodeloides

Botanical Name :Anemarrhena asphodeloides
Family: Asparagaceae
Subfamily: Agavoideae
Genus: Anemarrhena
Species: A. asphodeloides
Kingdom: Plantae
Order: Asparagales

Common Names :Zhi Mu

Habitats: Anemarrhena asphodeloides is native to  E. Asia – N. China and Japan. Grows in  Mountain woodlands. Exposed slopes and hills. Scrub, grassy slopes, steppes, sunny and sandy hillsides from near sea level to 1500 metres.

Description:
Anemarrhena asphodeloides is an evergreen Perennial growing to 0.5 m (1ft 8in) by 1 m (3ft 3in). It is in flower from Aug to September. The flowers are hermaphrodite (have both male and female organs)

click to see the pictures.
The plant prefers light (sandy), medium (loamy) and heavy (clay) soils.The plant prefers acid and neutral soils..It can grow in semi-shade (light woodland).It requires moist soil.The plant can tolerates strong winds but not maritime exposure.

Cultivation:
Requires a rich moist neutral to acid soil that is rich in organic matter, in a position in partial or dappled shade. Plants are tolerant of strong winds. Plants can be naturalized in wild or woodland gardens and other moist shaded situations that approximate to their natural wooded mountain habitats. This species is not hardy in all parts of Britain, it tolerates temperatures down to at least -5°c. This plant is occasionally cultivated in China as a medicinal herb. The fragrant flowers open in the evening.

Propagation
Seed – best sown as soon as it is ripe in a cold frame, it usually germinates in the spring. Stored seed should be sown in late winter or early spring in a cold frame. It sometimes germinates within 1 – 3 months at 15°c, but may take a year. The seed should be completely separated from the fruit and should only just be covered by soil. If the seed has been sown thinly enough, then it is possible to leave the seedlings in the pot for their first growing season, dividing them after they become dormant. Make sure to give them liquid feeds at intervals through the spring and summer. Otherwise prick out the seedlings when they are large enough to handle. Plant out in late spring or early summer at the beginning of their second or third years growth. Division in spring as new growth is just commencing

Medicinal Uses:
Antifungal;  Antiseptic;  Bitter;  Diuretic;  Expectorant;  FebrifugeHypoglycaemic;  Laxative;  Lenitive;  Sedative;  Tonic.

The rhizome is anti-fungal, antiseptic, bitter, diuretic, expectorant, febrifuge, hypoglycaemic, laxative, lenitive, sedative and tonic. It has an antibacterial action, inhibiting the growth of Bacillus dysenteriae, B. typhi, B. paratyphi, Proteus and Pseudomonas. It is taken internally in the treatment of high fevers in infectious diseases, TB, chronic bronchitis, diabetes and urinary problems. It should not be given to patients with diarrhoea and should be administered with caution since when taken in excess it can cause a sudden drop in blood pressure. Externally, it is used as a mouthwash in the treatment of ulcers. The rhizome is harvested in the autumn and dried for later use

Internally used for high fever in infectious diseases, tuberculosis, chronic bronchitis, and urinary problems.  Zhi mu is used in Chinese herbal medicine for “excess heat” – fever, night sweats, and coughs.  It has a bitter taste and a “cold temperament,” and is used to treat canker sores, particularly in combination with rehmannia and Scrophularia ningpoensis.  Externally as a mouthwash for mouth ulcers. Therapeutic action is slightly altered by cooking with wine or salt. It has an antibacterial action, inhibiting the growth of Bacillus dysenteriae, B. typhi, B. paraatyphi, Proteus and Pseudomonas. It is taken internally in the treatment of high fevers in infectious diseases, TB, chronic bronchitis and urinary problems. It should not be given to patients with diarrhea and should be administered with caution since when taken in excess it can cause a sudden drop in blood pressure. Externally, it is used as a mouthwash in the treatment of ulcers. The rhizome is harvested in the autumn and dried for later use.

You may click to learn more

Other Uses
Soap.

The root contains about 6% saponins. Saponins make an excellent soap, having a gentle cleansing effect on the skin and clothes without removing the natural body oils from the skin. To extract the saponins it is usually sufficient to cut the root into thin slices and then gently simmer in water.

Known Hazards : It should not be given to patients with diarrhoea and should be administered with caution since when taken in excess it can cause a sudden drop in blood pressure.

Disclaimer:The information presented herein is intended for educational purposes only. Individual results may vary, and before using any supplements, it is always advisable to consult with your own health care provider

Resources:
http://en.wikipedia.org/wiki/Anemarrhena_asphodeloides
http://www.pfaf.org/user/Plant.aspx?LatinName=Anemarrhena+asphodeloides
http://www.nature-s-health.com/products/theproduct1.asp?pid=218&cid=1
http://saludbio.com/imagen/anemarrhena-asphodeloides-mtc

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Severe Acute Respiratory Syndrome (SARS)

Definition::
Severe acute respiratory syndrome  is a respiratory disease in humans which is caused by the SARS coronavirus (SARS-CoV). There was one near pandemic, between the months of November 2002 and July 2003, with 8,422 known infected cases and 916 confirmed human deaths (a case-fatality rate of 10.9%) worldwide being listed in the World Health Organization’s (WHO) 21 April 2004 concluding report. Within a matter of weeks in early 2003, SARS spread from Hong Kong to rapidly infect individuals in some 37 countries around the world.

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As of today, the spread of SARS has been fully contained, with the last infected human case seen in June 2003 (disregarding a laboratory induced infection case in 2004). However, SARS is not claimed to have been eradicated (unlike smallpox), as it may still be present in its natural host reservoirs (animal populations) and may potentially return into the human population in the future.

Mortality by age group as of 8 May 2003 is below 1% for people aged 24 or younger, 6% for those 25 to 44, 15% in those 45 to 64 and more than 50% for those over 65. For comparison, the case fatality rate for influenza is usually around 0.6% (primarily among the elderly) but can rise as high as 33% in locally severe epidemics of new strains. The mortality rate of the primary viral pneumonia form is about 70%.

Symptoms:
The main symptoms of SARS are:

•High fever (above 38°C)
•Dry cough
•Breathing difficulties
*Other breathing symptoms
•Headache
•Muscular aches and stiffness
•Loss of appetite
•Malaise or tiredness
•Confusion
•Rash

The most common symptoms are:
*Chills and shaking
*Cough — usually starts 2-3 days after other symptoms
*Fever
*Headache
*Muscle aches

Less common symptoms include:
*Cough that produces phlegm (sputum)
*Diarrhea
*Dizziness
*Nausea and vomiting
*Runny nose
*Sore throat

These symptoms are typical of many severe respiratory infections. There have only ever been a few cases of SARS reported in the UK, so if you’ve similar symptoms, it’s far more likely to be a more typical form of pneumonia. Even if you’ve recently returned from south-east Asia, there’s little risk that you have SARS as the virus has been contained.

Causes:
Coronaviruses are positive-strand, enveloped RNA viruses that are important pathogens of mammals and birds. This group of viruses cause enteric or respiratory tract infections in a variety of animals including humans, livestock and pets.

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Initial electron microscopic examination in Hong Kong and Germany found viral particles with structures suggesting paramyxovirus in respiratory secretions of SARS patients. Subsequently, in Canada, electron microscopic examination found viral particles with structures suggestive of metapneumovirus (a subtype of paramyxovirus) in respiratory secretions. Chinese researchers also reported that a Chlamydophila-like disease may be behind SARS. The Pasteur Institute in Paris identified coronavirus in samples taken from six patients, so did the laboratory of Malik Peiris at the University of Hong Kong, which in fact was the first to announce (on 21 March 2003) the discovery of a new coronavirus as the possible cause of SARS after successfully cultivating it from tissue samples and was also amongst the first to develop a test for the presence of the virus. The CDC noted viral particles in affected tissue (finding a virus in tissue rather than secretions suggests that it is actually pathogenic rather than an incidental finding). Upon electron microscopy, these tissue viral inclusions resembled coronaviruses, and comparison of viral genetic material obtained by PCR with existing genetic libraries suggested that the virus was a previously unrecognized coronavirus. Sequencing of the virus genome — which computers at the British Columbia Cancer Agency in Vancouver completed at 4 a.m. Saturday, 12 April 2003 — was the first step toward developing a diagnostic test for the virus, and possibly a vaccine. A test was developed for antibodies to the virus, and it was found that patients did indeed develop such antibodies over the course of the disease, which is highly suggestive of a causative role.

On 16 April 2003, the WHO issued a press release stating that a coronavirus identified by a number of laboratories was the official cause of SARS. Scientists at Erasmus University in Rotterdam, the Netherlands demonstrated that the SARS coronavirus fulfilled Koch’s postulates thereby confirming it as the causative agent. In the experiments, macaques infected with the virus developed the same symptoms as human SARS victims.

An article published in The Lancet identifies a coronavirus as the probable causative agent.

In late May 2003, studies from samples of wild animals sold as food in the local market in Guangdong, China found that the SARS coronavirus could be isolated from palm civets (Paguma sp.), but the animals did not always show clinical signs. The preliminary conclusion was that the SARS virus crossed the xenographic barrier from palm civet to humans, and more than 10,000 masked palm civets were destroyed in Guangdong Province. Virus was also later found in raccoon dogs (Nyctereuteus sp.), ferret badgers (Melogale spp.) and domestic cats. In 2005, two studies identified a number of SARS-like coronaviruses in Chinese bats. Phylogenetic analysis of these viruses indicated a high probability that SARS coronavirus originated in bats and spread to humans either directly, or through animals held in Chinese markets. The bats did not show any visible signs of disease, but are the likely natural reservoirs of SARS-like coronaviruses. In late 2006, scientists from the Chinese Centre for Disease Control and Prevention of Hong Kong University and the Guangzhou Centre for Disease Control and Prevention established a genetic link between the SARS coronavirus appearing in civet cats and humans, bearing out claims that the disease had jumped across species

Viral replication:
Coronavirus (CoV) genome replication takes place in the cytoplasm in a membrane-protected microenvironment and starts with the translation of the genome to produce the viral replicase. CoV transcription involves a discontinuous RNA synthesis (template switch) during the extension of a negative copy of the subgenomic mRNAs. The requirement for base pairing during transcription has been formally demonstrated in arteriviruses and CoVs. The CoV N protein is required for coronavirus RNA synthesis and has RNA chaperon activity that may be involved in template switch. Both viral and cellular proteins are required for replication and transcription. CoVs initiate translation by cap-dependent and cap-independent mechanisms. Cell macromolecular synthesis may be controlled after CoV infection by locating some virus proteins in the host cell nucleus. Infection by different coronaviruses cause in the host alteration in the transcription and translation patterns, in the cell cycle, the cytoskeleton, apoptosis and coagulation pathways, inflammation and immune and stress responses. The balance between genes up- and down-regulated could explain the pathogenesis caused by these viruses. Coronavirus expression systems based on single genome constructed by targeted recombination, or by using infectious cDNAs, have been developed. The possibility of expressing different genes under the control of transcription regulating sequences (TRSs) with programmable strength and engineering tissue and species tropism indicates that CoV vectors are flexible. CoV based vectors have emerged with high potential vaccine development and possibly for gene therapy

Possible Complications:
*Respiratory failure
*Liver failure
*Heart failure
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Diagnosis:
SARS may be suspected in a patient who has:

1.Any of the symptoms, including a fever of 38 °C (100.4 °F) or higher, and
2.Either a history of:
…..1.Contact (sexual or casual) with someone with a diagnosis of SARS within the last 10 days OR
…..2.Travel to any of the regions identified by the WHO as areas with recent local transmission of SARS (affected regions as of 10 May 2003[13] were parts of China, Hong Kong, Singapore and the province of Ontario, Canada).

A probable case of SARS has the above findings plus positive chest X-ray findings of atypical pneumonia or respiratory distress syndrome.

With the advent of diagnostic tests for the coronavirus probably responsible for SARS, the WHO has added the category of “laboratory confirmed SARS” for patients who would otherwise fit the above “probable” category who do not (yet) have the chest x-ray changes but do have positive laboratory diagnosis of SARS based on one of the approved tests (ELISA, immunofluorescence or PCR).

The chest X-ray (CXR) appearance of SARS is variable. There is no pathognomonic appearance of SARS but is commonly felt to be abnormal with patchy infiltrates in any part of the lungs. The initial CXR may be clear.

White blood cell and platelet counts are often low. Early reports indicated a tendency to relative neutrophilia and a relative lymphopenia — relative because the total number of white blood cells tends to be low. Other laboratory tests suggest raised lactate dehydrogenase and slightly raised creatine kinase and C-Reactive protein levels.

With the identification and sequencing of the RNA of the coronavirus responsible for SARS on 12 April 2003, several diagnostic test kits have been produced and are now being tested for their suitability for use.

Three possible diagnostic tests have emerged, each with drawbacks. The first, an ELISA (enzyme-linked immunosorbent assay) test detects antibodies to SARS reliably but only 21 days after the onset of symptoms. The second, an immunofluorescence assay, can detect antibodies 10 days after the onset of the disease but is a labour and time intensive test, requiring an immunofluorescence microscope and an experienced operator. The last test is a polymerase chain reaction (PCR) test that can detect genetic material of the SARS virus in specimens ranging from blood, sputum, tissue samples and stools. The PCR tests so far have proven to be very specific but not very sensitive. This means that while a positive PCR test result is strongly indicative that the patient is infected with SARS, a negative test result does not mean that the patient does not have SARS.

The WHO has issued guidelines for using these diagnostic tests.  There is currently no rapid screening test for SARS and research is ongoing.

Treatment:
Antibiotics are ineffective as SARS is a viral disease. Treatment of SARS so far has been largely supportive with antipyretics, supplemental oxygen and ventilatory support as needed.

Suspected cases of SARS must be isolated, preferably in negative pressure rooms, with complete barrier nursing precautions taken for any necessary contact with these patients.

There was initially anecdotal support for steroids and the antiviral drug ribavirin, but no published evidence has supported this therapy.

Researchers are currently testing all known antiviral treatments for other diseases including AIDS, hepatitis, influenza and others on the SARS-causing coronavirus.

There is some evidence that some of the more serious damage in SARS is due to the body’s own immune system overreacting to the virus – a cytokine storm. Research is continuing in this area.

In December 2004 it was reported that Chinese researchers had produced a SARS vaccine, it has been tested on a group of 36 volunteers, 24 of whom developed antibodies against the virus.

A 2006 systematic review of all the studies done on the 2003 SARS epidemic found no evidence that antivirals, steroids or other therapies helped patients. A few suggested they caused harm.

The clinical treatment of SARS has been relatively ineffective with most high risk patients requiring artificial ventilation. Currently, corticosteroids and Ribavirin are the most common drugs used for treatment of SARS (Wu et al., 2004). In vitro studies of Ribavirin have yielded little results at clinical, nontoxic concentrations. Better combinations of drugs that have yielded a more positive clinical outcome (when administered early) have included the use of Kaletra, Ribavirin and corticosteroids. The administration of corticosteroids, marketed as Prednisone, during viral infections has been controversial. Lymphopenia can also be a side effect of corticosteroids even further decreasing the immune response and allowing a spike in the viral load; yet physicians must balance the need for the anti-inflammatory treatment of corticosteroids (Murphy 2008). Clinicians have also noticed positive results during the use of human interferon and Glycyrrhizin. No compounds have yielded inhibitory results of any significance. The HIV protease inhibitors Ritonavir and Saquinavir did not show any inhibitory effect at nontoxic levels. Iminocyclitol 7 has been found to have an inhibitory effect on SARS-CoV in that it disrupts the envelope glycoprotein processing. Iminocyclitol 7 specifically inhibits the production of human fucosidase and in vitro trials yielded promising results in the treatment of SARS, yet one problem exists. A deficiency of fucosidase can lead to a condition known as fucosidosis in which there is a decrease in neurological function.

Prognosis:
The death rate from SARS was 9 to 12% of those diagnosed. In people over age 65, the death rate was higher than 50%. The illness was milder in younger patients.

Many more people became sick enough to need breathing assistance. And even more people had to go to hospital intensive care units.

Public health policies have been effective at controlling outbreaks. Many nations have stopped the epidemic in their own countries. All countries must continue to be careful to keep this disease under control. Viruses in the coronavirus family are known for their ability to change (mutate) in order to spread among humans.
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Prevention:
The WHO set up a network for doctors and researchers dealing with SARS, consisting of a secure web site to study chest x-rays and a teleconference.

A SARS-treating hospital in Taiwan.Attempts were made to control further SARS infection through the use of quarantine. Over 1200 were under quarantine in Hong Kong, while in Singapore and Taiwan, 977 and 1147 were quarantined respectively. Canada also put thousands of people under quarantine.[14] In Singapore, schools were closed for 10 days and in Hong Kong they were closed until 21 April to contain the spread of SARS.

On 27 March 2003, the WHO recommended the screening of airline passengers for the symptoms of SARS.

In Singapore, a single hospital, Tan Tock Seng Hospital, was designated as the sole treatment and isolation centre for all confirmed and probable cases of the disease on 22 March. Subsequently, all hospitals implemented measures whereby all staff members were required to submit to temperature checks twice a day, visitorship was restricted only to pediatric, obstetric and selected other patients, and even then, only one person was allowed to visit at a time. To overcome this inconvenience, videoconferencing was utilised. A dedicated phoneline was designated to report SARS cases, whereupon a private ambulance service was dispatched to transport them to Tan Tock Seng Hospital.

On 24 March, Singapore’s Ministry of Health invoked the Infectious Diseases Act, allowing for a 10-day mandatory home quarantine to be imposed on all who may have come in contact with SARS patients. SARS patients who have been discharged from hospitals were under 21 days of home quarantine, with telephone surveillance requiring them to answer the phone when randomly called up. Discharged probable SARS patients and some recovered cases of suspected SARS patients are similarly required to be home quarantined for 14 days. Security officers from CISCO, a Singaporean auxiliary police force, were utilised to serve quarantine orders to their homes, and installed an electronic picture (ePIC) camera outside the doors of each contact. Sparked in particular by the news surrounding an elderly man who disregarded the quarantine order, flashing it to the public as he strolled to eating outlets and causing a minor exodus of patrons which persisted until the fears over the disease abated, the Singapore government called for an urgent meeting in Parliament on 24 April to amend the Infectious Disease Act and include penalties for violations, revealing at least 11 other violators of quarantine orders. These amendments included:

…*the requirement of suspected persons of infectious diseases to be brought to designated treatment centres, and their prohibition from going to public places;

…*the designation of contaminated areas and the restriction of access to them, and the destruction of suspected sources of infection;

…*the introduction of the power to tag offenders who break home quarantine (persons who failed to be contacted three times by phone consecutively) with electronic wrist tags, and the imposition of fines without court trial;

…*the ability to charge repeated offenders in court which may lead to imprisonment; and

…*the prosecution of anyone caught lying to health officials about their travel to SARS-affected areas or contacts with SARS patients.

Thermal imaging at Taoyuan Airport’s International checkpoint.On 23 April the WHO advised against all but essential travel to Toronto, noting that a small number of persons from Toronto appear to have “exported” SARS to other parts of the world. Toronto public health officials noted that only one of the supposedly exported cases had been diagnosed as SARS and that new SARS cases in Toronto were originating only in hospitals. Nevertheless, the WHO advisory was immediately followed by similar advisories by several governments to their citizens. On 29 April WHO announced that the advisory would be withdrawn on 30 April. Toronto tourism suffered as a result of the WHO advisory, prompting The Rolling Stones and others to organize the massive Molson Canadian Rocks for Toronto concert, commonly known as SARSstock, to revitalize the city’s tourism trade.

Also on 23 April, Singapore instituted thermal imaging scans to screen all passengers departing Singapore from Singapore Changi Airport. It also stepped up screening of travelers at its Woodlands and Tuas checkpoints with Malaysia. Singapore had previously implemented this screening method for incoming passengers from other SARS affected areas but was to include all travelers into and out of Singapore by mid- to late May.

In addition, students and teachers in Singapore were issued with free personal oral digital thermometers. Students took their temperatures daily, usually two or three times a day, but the temperature-taking exercises were suspended with the waning of the outbreak.

Taiwan Taoyuan International Airport also added SARS checkpoints with an infrared screening system similar to Singapore’s Changi Airport.

Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose.

Resources:
http://en.wikipedia.org/wiki/Severe_acute_respiratory_syndrome
http://health.nytimes.com/health/guides/disease/severe-acute-respiratory-syndrome-sars/overview.html
http://www.bbc.co.uk/health/physical_health/conditions/sars1.shtml

http://www.wpro.who.int/NR/rdonlyres/464C8256-9D58-44B3-B292-DB3518117CA8/0/SchematicdrawingsofSARS.jpg

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Roseola

Alternative Names: Exanthem subitum; Sixth disease

Definition:
Roseola is a generally mild infection that usually affects children by age 2. It occasionally affects adults. Roseola is extremely common — so common that most children have been infected with roseola by the time they enter kindergarten.
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Two common strains of herpes viruses cause roseola. The condition typically causes several days of fever, followed by a rash.

Some children develop only a very mild case of roseola and never show any clear indication of illness, while others experience the full range of symptoms.

Roseola typically isn’t serious. Rarely, complications from a very high fever can result. Treatment of roseola includes bed rest, fluids and medications to reduce fever.

It is frequently called roseola, although this term could be applied to any rose-colored rash.

Symptoms:
The child may have a runny nose, sore throat, and eye redness.

A fever usually occurs before the rash appears. It lasts for 3 (sometimes up to 7) days. The fever may be as high as 105° Fahrenheit, and it generally responds well to acetaminophen (Tylenol).

Between the second and fourth day of the illness, the fever drops and a rash appears (often as the fever falls).

•The rash starts on the trunk and spreads to the limbs, neck, and face. The rash is pink or rose-colored, and has fairly small sores that are slightly raised.
•The rash lasts from a few hours to 2 – 3 days. It usually does not itch.
Other symptoms include:
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•Irritability
•High fever that comes on quickly

Causes:
Until recently, its origin was unknown, but it is now known to be caused by two human herpesviruses, HHV-6 (Human herpesvirus 6) and HHV-7, which are sometimes referred to collectively as Roseolovirus. There are two variants of HHV-6 and studies in the US, Europe and Japan have shown that exanthema subitum is caused by HHV-6B which infects over 90% of infants by age 2. Current research indicates that babies congenitally infected with the HHV-6A virus can have inherited the virus on a chromosome

The virus is spread through the faecal-oral route (poor hygiene after using the toilet) or by airborne droplets. Careful handwashing can help prevent its spread.

Occasionally other viruses cause an illness very similar to roseola.

Like other viral illnesses, such as a common cold, roseola spreads from person to person through contact with an infected person’s respiratory secretions or saliva. For example, a healthy child who shares a cup with a child who has roseola could contract the virus.
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Roseola is contagious even if no rash is present. That means the condition can spread while an infected child has only a fever, even before it’s clear that the child has roseola. Watch for signs of roseola if your child has interacted with another child who has the illness.

Unlike chickenpox and other childhood viral illnesses that spread rapidly, roseola rarely results in a communitywide outbreak. The infection can occur at any time of the year.
Roseola occurs throughout the year. The time between becoming infected and the beginning of symptoms (incubation period) is 5 to 15 days.

Risk Factors:
Older infants are at greatest risk of acquiring roseola because they haven’t had time yet to develop their own antibodies against many viruses. While in the uterus, babies receive antibodies from their mothers that protect them as newborns from contracting infections, such as roseola. But this immunity fades with time. The most common age for a child to contract roseola is between 6 and 15 months.

Complications:
Seizures in children
Occasionally a child with roseola experiences a seizure brought on by a rapid rise in body temperature. If this happens, your child might briefly lose consciousness and jerk his or her arms, legs or head for several seconds to minutes. He or she may also lose bladder or bowel control temporarily.

If your child has a seizure, seek emergency care. Although frightening, fever-related seizures in otherwise healthy young children are generally short-lived and are rarely harmful.

Complications from roseola are rare. The vast majority of otherwise healthy children and adults with roseola recover quickly and completely.

Concerns for people with weak immune systems
Roseola is of greater concern in people whose immune system is compromised, such as those who have recently received a bone marrow or organ transplant. They may contract a new case of roseola — or a previous infection may come back while their immune system is weakened. Because they have less resistance to viruses in general, immune-compromised people tend to develop more severe cases of infection and have a harder time fighting off illness.

People with weak immune systems who contract roseola may experience potentially serious complications from the infection, such as pneumonia or encephalitis — a potentially life-threatening inflammation of the brain.

Diagnosis:
Roseola is usually diagnosed from the history and symptoms, especially if the infection has recently been reported in the community.
•Physical exam of rash
•Swollen lymph nodes on the neck (cervical nodes) or back of the scalp (occipital nodes)

Clinical features:
Typically the disease affects a child between six months and two years of age, and begins with a sudden high fever (39–40 °C; 102.2-104 °F). This can cause, in rare cases, febrile convulsions (also known as febrile seizures or “fever fits”) due to the sudden rise in body temperature, but in many cases the child appears normal. After a few days the fever subsides, and just as the child appears to be recovering, a red rash appears. This usually begins on the trunk, spreading to the legs and neck. The rash is not itchy and may last 1 to 2 days.  In contrast, a child suffering from measles would usually appear more infirm, with symptoms of conjunctivitis and a cough, and their rash would affect the face and last for several days. Liver dysfunction can occur in rare cases.

The rare adult reactivates with HHV-6 and can show signs of mononucleosis.

Treatment:
The disease usually gets better without complications.
Most children recover fully from roseola within a week of the onset of the fever. With your doctor’s advice, you can give your child over-the-counter medications to reduce fever, such as acetaminophen (Tylenol, others) or ibuprofen (Advil, Motrin, others). However, don’t give aspirin to a child who has a viral illness because aspirin has been associated with the development of Reye’s syndrome, which can be serious.

There’s no specific treatment for roseola, although some doctors may prescribe the antiviral medication ganciclovir (Cytovene) to treat the infection in people with weakened immunity. Antibiotics aren’t effective in treating viral illnesses, such as roseola.

Like most viruses, roseola just needs to run its course. Once the fever subsides, your child should feel better soon. However, a fever can make your child uncomfortable. To treat your child’s fever at home, your doctor may recommend:

*Plenty of rest. Let your child rest in bed until the fever disappears.

*Plenty of fluids. Encourage your child to drink clear fluids, such as water, ginger ale, lemon-lime soda, clear broth or an electrolyte solution (such as Pedialyte) or sports drinks (such as Gatorade and Powerade) to prevent dehydration. Remove the gas bubbles from carbonated fluids. You can do this by letting the carbonated beverage stand or by shaking, pouring or stirring the beverage. Removing the carbonation will mean having your child avoid the added discomfort of excess burping or intestinal gas that carbonated beverages may cause.

*Sponge baths. A lukewarm sponge bath or a cool washcloth applied to your child’s head can soothe the discomfort of a fever. However, avoid using ice, cold water, fans or cold baths. These may give the child unwanted chills.There’s no specific treatment for the rash of roseola, which fades on its own in a short time

Prevention:
Because there’s no vaccine to prevent roseola, the best you can do to prevent the spread of roseola is to avoid exposing your child to an infected child. If your child is sick with roseola, keep him or her home and away from other children until the fever has broken. Once the rash appears, the virus is much less contagious.

Most people have antibodies to roseola by the time they’re of school age, making them immune to a second infection. Even so, if one household member contracts the virus, make sure that all family members wash their hands frequently to prevent spread of the virus to anyone who isn’t immune.

Adults who never contracted roseola as children can become infected later in life, though the disease tends to be mild in healthy adults. The main concern is that infected adults can pass the virus on to children.

Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose.

Resources:
http://www.mayoclinic.com/health/roseola/DS00452
http://www.nlm.nih.gov/medlineplus/ency/article/000968.htm
http://en.wikipedia.org/wiki/Exanthema_subitum
http://www.bbc.co.uk/health/physical_health/conditions/roseola2.shtml

Some Health Quaries & Answers

‘My child is too thin’ :

Q: My daughter is two years old and very thin. She is picky about her food and I feel she does not eat enough. Her weight is only 9kg. Is it a good idea to give her appetite stimulating tonics?


A: Normally, a child weighs triple its birth weight at the end of the first year and adds 2kg the next year. So your daughter may be in the normal range. It is better to try to discover why she does not eat and treat the cause rather than use tonics. Appetite stimulants can have severe side effects. Some of them contain large amounts of iodine, steroids or cyproheptadine (a banned chemical). They are best avoided.

What you can do is reduce her milk intake to 400ml a day. Give half after breakfast and the rest at tea time. Figure out what she likes to eat.

Also, get her dewormed; your paediatrician will tell you how. And remember, some children are just difficult when it comes to food.

Digital spasms :

Q: I get sudden painful spasms in my fingers and toes, especially at night. I am 34 years old.

A: Calcium deficiency can cause this. If you are not on calcium supplements, starting them may help. Consult a physician to help with the diagnosis and dosage of calcium.

Pressure pills :

Q: Is there a natural way to reduce blood pressure? Currently I am on a lot of medication for it.

A: You can reduce your dependence on tablets by achieving ideal body weight (height in metre squared multiplied by 23), walking an hour a day, reducing salt intake to 2.5gm a day, avoiding salted snacks, sleeping at regular hours and reducing stress with yoga and meditation.

Fit and fine :

Q: My son is one and a half years old and has had fits twice. The doctor says it is “fever fits”. I am worried that he may become epileptic. What is a fever fit?

A: A febrile seizure (fever fit) usually occurs in children under the age of 5 during an episode of fever. Only one third of the affected children have a second seizure. A certain percentage of children will develop epilepsy but the incidence is not greater in those who have had febrile seizures. Also, these children do not develop mental retardation nor is their intelligence affected. But a febrile fit can be frightening to watch. To prevent such seizures, fever has to be tackled immediately. Buy a digital thermometer and check the temperature by placing it in the child’s armpit (remember, your hand is not a thermometer). If the temperature is greater than 100°F, give the child 10mg/kg of paracetemol. Remove the child’s clothes and sponge him down with tap water. Turn the fan on full speed. After four hours check the temperature again. If it has risen, repeat the above process. Contact your doctor.

Feet first

Q: I have cracked feet. Not only does it look ugly, when water enters the cracks they become painful and inflamed.

 

A: You could try soaking your feet in hot water to which rock salt and liquid soap have been added. After 10 minutes, scrub the foot gently with a small plastic brush. Then apply baby oil. After a few weeks, you will see a vast improvement.

Source : The Telegraph ( kolkata, India)