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Spread of HIV/AIDS |
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Young people are increasingly responsible for the spread of HIV/AIDS around the world. Every 14 seconds a person between 15 and 24 is infected with the virus. They now account for half all new cases of the disease, the U.N. Population Fund said in its annual State of the World’s Population report.
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Botulism is a disease that occasionally strikes people who eat badly canned food or fish in which the bacteria has grown. The bacteria for botulism are also found in soil. The bacteria produce an extremely toxic substance, botulinum that causes blurred vision, dry mouth, difficulty in swallowing or speaking, weakness, paralysis, respiratory
failure and death.
The organism causing this disease is Clostridium botulinum.
The disease may be classified as
(1) food-borne botulism, from ingestion of preformed toxin in food contaminated with C. botulinum
(2) wound botulism, from toxin produced in wounds contaminated with the organism
(3) infant botulism, from ingestion of spores and production of toxin in the intestine of infants
C. botulinum, is a group of anaerobic gram-positive organisms that form spores, is found in soil and marine environments throughout the world and produces the most potent bacterial toxin known. These are all neurotoxins.
Toxin can be inactivated during home cooking by exposure to a temperature of 100°C for 10 min. In the gastrointestinal tract, toxin resists degradation. Spores are highly heat-resistant, and their inactivation requires exposure to a temperature of 120°C (e.g., in steam sterilizers or pressure cookers).
Clinical Features
Food-Borne Botulism
After ingestion of food containing toxin, the illness may be a mild condition for which no medical advice is sought or it may also be a very severe disease that can result in death within 24 h. The onset of symptoms is with Cranial nerve involvement, which produces
Weakness progresses, often rapidly, from the head to involve the neck, arms, thorax, and legs. The weakness is mostly symmetrical but may occasionally be asymmetric. Nausea, vomiting, and abdominal pain may precede or follow the onset of paralysis.
Patients are generally alert and oriented, but they may be drowsy, agitated.
Ptosis (drooping of eyelids) is frequent. Fixed or dilated pupils are noted in half of patients.
Paralytic ileus, severe constipation, and urinary retention may be present.
Wound Botulism
When wounds are contaminated with C. botulinum spores, the spores may germinate into vegetative organisms that produce toxin. This rare condition resembles food-borne illness except that the incubation period is longer, averaging about 10 days, and gastrointestinal symptoms are lacking. Wound botulism has been seen after traumatic injury involving contamination with soil, in chronic drug abusers, and after cesarean delivery. The illness has occurred even after antibiotics have been given to prevent wound infection. The wound may appear benign.
Infant Botulism
In infant botulism the most common form of the disease the Toxin is produced in and absorbed from the intestine after the germination of ingested spores. The severity ranges from mild illness with failure to thrive to fulminant severe paralysis with respiratory failure and may be one cause of sudden infant death. Contamination of honey with spores has been found to be one of the causes. This has led to the recommendation that honey not be fed to children less than 12 months of age. Most cases cannot be attributed to a particular food source. Cases usually involve infants less than 6 months of age.
There is another group in which the disease resembles the infant botulism in that the toxin is produced in the intestine of a person colonized with the organism. In such cases the toxin and the spores may be found in the stool for a prolonged period. Gastrointestinal disease or surgery may predispose to such an illness.
DIAGNOSIS
A diagnosis of botulism is suspected in a person a febrile ( no fever ), mentally intact patients who have symmetric descending paralysis without sensory findings.
Conditions often confused with botulism include myasthenia gravis and Guillain-Barre syndrome, which is characterized by ascending paralysis, sensory abnormalities, and elevation of the protein concentration in cerebrospinal fluid. Other conditions resembling botulism are Lambert-Eaton syndrome, poliomyelitis, tick paralysis, diphtheria, and intoxications from mushrooms, medications, or chemicals.
PROGNOSIS
Mortality in botulism is higher among patients above age 60 than among younger patients. With improved respiratory and intensive care, the case-fatality rate in food-borne illness has been reduced.
BOTULINUM TOXIN THERAPY
Botulinum toxin is being used as therapy for strabismus, blepharospasm, and other dystonias.
Bed wetting or Enuresis is a psychosomatic disorder. Its an emotional disturbance causing dysfunction of organs controlled by autonomic nervous system. Many children with this disorder also have behavioural disorders. Such children are usually timid and nervous. By age 5, one in five still wets the bed and at age 6, the numbers drop to one in 10. Boys are more likely than girls to wet their beds.
Stages of Bladder Control in children
It is also suspected that bed-wetting may be caused by slow development of the nerves that control the bladder. Among other less common causes is Small Bladder. Even a small bladder unable to hold the urine produced during the night can result in bed-wetting. Bed-wetting can be a symptom of a serious illness (e.g., diabetes or a urinary tract infection), especially if it starts in a child who has previously been dry through the night.
Large majority of children who wet the bed have no underlying disease. In fact, a true organic cause is identified in only about 1% of children who wet the bed.
Secondary bedwetting is bedwetting that starts again after the child has been dry at night for a significant period of time (at least six months). Secondary bedwetting can be a sign of an underlying medical or emotional problem. The child with secondary bedwetting is much more likely to have other symptoms, such as daytime wetting.
Common causes of secondary bedwetting are:
It is probably a good time to seek medical help when the child is 5-7 years of age.
Bedwetting is typically seen more as a social disturbance than a medical disease. It creates embarrassment and anxiety in the child and sometimes conflict with parents. The single most important thing parents can and should do is to be supportive and reassuring rather than blaming and punishing. Primary nocturnal enuresis has a very high rate of spontaneous resolution.
Some Tips:
Desmopressin, Imipramine, Oxybutynin and Hyoscyamine
Desmopressin acetate is a synthetic form of antidiuretic hormone (ADH), a substance that occurs naturally in the body and is responsible for limiting the formation of urine.
Imipramine is a tricyclic antidepressant that has been used to treat bedwetting for about more than 30 years. How it works is not clear, but it is known to have a relaxing effect on the bladder and to decrease the depth of sleep in the last third of the night.
Congenital Generalized Lipodystrophy is a rare genetic disease. It is characterized by near complete absence of body fat. It is inherited as an autosomal recessive disorder. It is a disease involving the adipose tissue (fat tissue) of the body.
Parents are carriers of the genes but are not affected. There is a 25% chance of transmission of both defective genes to the affected children. The ratio of affected to unaffected children is 1:4.
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Acquired Generalized Lipodystrophy
Familial Partial Lipodystrophy
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