Giardiasis

Giardiasis

Giardiasisas causes by Giardia. Giardiasis is characterized by diarrhea, dysentery and abdominal pain. Giardia is a flagellate protozoan, occurring in the intestine of man and many other vertebrates. Giardia intestinalis is first seen by leeuwenhoek 1681 while examing his own stool. Geographical distribution worldwide. Habitat duodenum and the upper part of the jejunum.

Morphology:
Parasite is dimorphic found in two phases: trophozoite and cyst.

Trophozoite:

i. It is tennis or badminton racket like.
ii. Dorsal surface convex while ventral surface concave with a sucking disc.
iii. It is bilaterally symmetrical and all the organs of the body are paired. There are two axostyles, two nunlei and four pair of lflegea.

Cyst:

i. It is oval in shape. There are four nuclei-clusyered at one end or lie in pairs at the opposite poles.
ii. The flagella and the margin of the sucking disc may be seen in the cytoplasm. Infective stage is Quadrinucleate cyst.

Life Cycle:

It the trophozoite stage the parasite multiples in the intestine of man by binary fission. When the condition in the duodenum is favorable, encysment occurs usually in the large intestine. Infection of men is brought about by infection of cysts. Within 30 minuts of ingestion, the cyst hatches out two trophozoites which then multiply in enormous numbers and colonise in the duodenum.

Ascariasis

Ascariasis

Ascariasis is highly prevalent dieses caused by the largest nematode (round worm). Ascariss lumbricoides. When fresh from the intestine, it is light brown or pink in color but it gradually changes to white. It is most frequently seen in the stool Children .The male lumbricoides measures about 15 to 25 cm in length. The female is longer and stouter measuring 25 to 40 cm in length. The egg laying capacity of mature female ascariasis has been found to be enormous, liberating about 200, 000 eggs daily. The eggs liberated by a fertilized female pass out the human host with the faces and many remain alive for several days.

Infection

By swallowing ripe eggs (embryonated eggs) with raw vegetables culative on a soil fertilized by infected human excreta. Infection also occurs by drinking contaminated water. Among children playing in the contaminated soil, there is also hand to hand transfer of eggs by dirty fingers. Infection may also occur by inhalation of desiccated eggs in the dust reaching the pharynux and swallowed. A rhabditiform larva is desiccated eggs in the dust reaching the pharynx and swallowed. A rhabditiform larva is developed form unsegmented ovum within the egg-shell in 10 to 40 days in the soil. A rhabditiform larva is developed from (1st Juvenile Larva) is infective to man.

MOT and rout if migration
When ingested with food, drink or raw vegetables, the embryonated eggs pass down to the Duodenum where the digestive juices weaken the eggs-shell. Splitting of the egg-shell occurs and the rhabditiform larvae are liberated in the upper part of the small intestine. The newly hatched larvae burrow their way through the mucous membrane of the small intestine and are carried by the portal circulation. Breaking through the capillary wall they reach the lung alveoli. Form the lung alveoli the larvae crawl up the bronchi and trachea, then are propelled into larynx and are once more swallowed. The larvae pass down the oesophagus to the stomach and localized in the upper part of the intestine. The larvae pass down the oesophagus to the stomach and localize in the upper part of the intestine. The larvae on reaching habitat grow into adult worms and become sexually mature in about 6 to 10 weeks time. Four moulting of the larvae occur-one outside while within the eggs-shell, two in the lungs and one in the intestine . Symptoms of ascaris infection those produced by migrating larvae and those produced by the adult worms.

1. Symptoms due to the migrating larvae:
In heavy infections typical symptoms of pneumonia such as fever, cough and dyspnoea may appear. Urticarial rash and eosinophilia are seen in such cases. Disturbances have been reported due to their presence in the brain, spinal cord, heart and kidneys.

2. Symptoms due to the adult worms:
With the adult worms inhabiting the intestine the patient complains of abdominal pains, vomiting salivation. Often the patient grits his teeth in his sleep. When the adult worms migrate through the intestinal wall they severe peritonitis. Wandering Ascaris may enter the lumen of the appendix, causing appendicitis. Obstructive jaundice and acute haemorrhagic pancreatitis have been known to occur when the worm has entered into the biliary passage. At times it penetrates high up in the liver causing one or more abscesses. Treatment of ascariasis piperazine citrate syrup, Thiobendazole and mebendazole. Chinopodium oil is very much effective in Ascariasis.

Non- Communicable Diseases

Cancer

Cancer is the name of crab which is used as a symbol to denote the disease. The study of cancer is called 'Oncology'. The cancer is unregulated and uncontrolled proliferation of cells or it is breakdown of regularity mechanism that governs normal cell division. The tumor or neoplasm formed by uncontrolled cell division can be of 2-types.

a. Benign Tumors b. Malignant Tumors a. Benign Tumors- They are localized tumors and are bound within a connectivity tissues coating. They do not spread over the surrounding tissues. They are not fatal or harmful E.g. Moles and warts.
b. Malignant Tumors
They are cancerous of harmful and spread into surrounding tissues by 2-means-invasion and Metastasis.

Invasion is the penetration of the cells of malignant tumor into the neighboring tissue where they form invasion tumors.
Metastasis is the penetration of the cells of into the blood capillaries form where they are carried to different parts of the body.
Types of cancer

1. Carcinoma 2. Sarcoma 3. Leukemia

Carcinoma- It is the cancer of epithelial lining, which can be ectodermic, mesoderm in origin. This
type of cancer can develop in the gut living, glands (exocrine or endocrine) or skin etc. About 80% of the cancers are carcinomas. E.g. Lung cancer, breast cancer, colon cancer, skin cancer, cervix cancer etc.
Sarcoma- it is the cancer of connective tissues of muscles, and is mesoderm in organic. Only 1-2%of the cancers are of this type. e.g. cancer of bone and cartilage.
Leukemia- It is the cancer of blood particularly of granulocytes. (WBCS), and is so called Granulocytic Leukemia. It is related to the 22nd chromosome (auto some), the philadedelphia chromosome.
The above three are the major categories of cancer. The other sub categories can be-
i. Lipoma- It is the cancer of adipose tissue.
ii. Lymphoma- It is the cancer of lymphatic tissue/lymphocytes. The most common lymphoma is Hodgkin's disease.

iii. Melanoma- It is the cancer of melanocytes of skin.

iv. Teratoma- It is the cancer of embryonic or fetal tissue. It is a tumor like embryo like tumor.
v. Myeloma- It is the cancer of bone marrow.
vi. Myoma- It is the cancer of muscles.

Causes of Cancer
The cancer causing agents of factors (physical or chemical) are called Carcinogens.
1. Physical agents (Radiations)
UV rays, X-rays, infra-red or Gama-rays can cause gene mutation and produce oncogenic transformation. The cancer can also develop due to radiation of nuclear bomb.
2. Biological agents (Virus)
Virus do not cause cancer as pathogens but alter DNA- sequence which produces abnormal proteins. The viruses are called oncovirus which do not cause cancer but can be their causes.
3. Chemical agents-

Certain chemicals may cause cancer e.g. n-nitroso-di-methylene (in cigarette smoke) and Asbestos dust for lung cancer. Cadmium oxide for cancer of prostate gland; PVC (Polyvinyl chloride) and Alfa toxin (from fungus, Aspergilla) for cancer of liver. Nitrosamine for colon cancer, and diethylstilbestrol for vaginal cancer etc. Carcinogens can also be categorized on the basis of their mode of action as-

1. DNA –Transformers – These agents can cause alternation in DNA that leads to cancer.
2. Tumor- promoters –These agents (e.g. Growth factor or hormones) promote the proliferation of cells which have already undergone genetic alternation.
3. Tumor-Virus – Such viruses are capable of making oncogenic transformations.

Prevention of Cancer
1. Vitamin supplements- Vitamin-A prevents carcinoma; vitamin-E, an anti-oxidant, Vitamin-C and vitamin-B17 are also anti-cancer.
2. Roughage-Fiber-rich food stimulates peristalsis and prevents gut cancer (particularly of colon).
3. Low-calorie diet –Reduction in calorie intake prevents the occurrence of cancer.

Symptoms (warning signs)
1. In colon cancer the nature of stool keeps changing with unexplained weight loss.
2. In breast cancer there can be lump on node indicating the presence of cancer of tumor.
3. In case of wart or mole the nature of tissues from time to time.
4. In case of throat cancer there in persistent hoarseness and coughing.
5. Pap smear test- It is the test for cervical cancer. The epithelial lining of cervix (neck of uterus) is taken out for biopsy. The malignant cells show overlapping and have abnormal nuclei.



1. On the basis of blood or biopsy (remember, that the histological test after death of the organism is called autopsy).
2. X-ray studies.
3. CT-scan or MRI for internal organs, like pancreas, liver, gall bladder etc.
4. By using monoclonal antibodies (called magic bullets).
5. The cancer causing genes called oncogenes, are present in the normal cells but they remain suppressed.
6. According to some oncologists the photo-oncogens in the present in normal cells but they change into oncogens in the presence of carcinogens.

7. Still others believe that the cancer develops due to suppression of antioncogenes present in the normal cells.
8. However the cancer associated genes can be divided into three categories.
i. Genes including cell proliferation
ii. Genes inhabiting cell proliferation
iii. Genes regulating programmed cell-death. The alternation (mutations) in any of the above category of genes causes cancer.

Treatment

1. Surgery
It is used for localized cancer of larynx, uterus, breast etc. The disadvantage of the surgery is the recurrence of malignancy due to the cells left-out. The layers can also be used for killing of surgically removing the malignant tissue.
2. Radiations
The ??radiations can be used to kill the cancerous cells. The disadvantage of this technique is that some of the neighboring cells (non-cancerous) can be damaged.
3. Chemotherapy
Two types of chemicals can be used to treat the cancer if the metastasis has already set in. They can either mimic the chemicals which prevent DNA republication, or prevent translation of the proteins. As the cell division is stopped the growth of secondary tumor does not occur. The problem with chemotherapy is that the cell division of normal cell is also affected and some side-effects, like nausea, hair fall etc, do occur.
4. Grafting or transplantation
In the case of Myeloma, the cancer of home marrow, the marrow can be transplanted from a donor to the cancer patient.
5. In certain type of cancers, the immunotherapy, use of monoclonal antibodies, can be very effective.

Mental Illness and Phobias

Mental Illness and Addiction

A person who lives in harmony with the other person and can face the strain of the environment is called mentally sound. A person who is physically healthy and mentally ill is called mental illness. About 10% the people are mentally ill and 1% severely ill.
Symptoms of Mental Illness
1. Loss of sleep(Insomnia) 2. Loss of Memory(Amnesia) 3. Chance of perception, i.e. illusions or delusions. 4. Unreasonable Phobias and anxiety. 5. Depression and strong feelings of hopelessness. 6. There are 3-major categories of mental illness.
Psychosis
It is most sever type of mental illness. Such persons are called 'mad'. They are not touch with reality and do not accept their illness. They do not prefer to take treatment of medication. They also have sudden shift of mood can be violent at time.
Neurosis
It is a mild type of mental illness. The person knows that he or she if sick and prefers to take treatment. It may include several disorders like 'anxiety disorder', 'obsessive compulsive disorder', 'inferiority complex', 'mode disorder', 'phobias' etc. In 'Anxiety disorder' there is over reactions to stressful events. This may causes tremors, high palpitation, sweating and slight trembling etc. In 'obsessive compulsive disorder' the person has irresistible impulse of doing a particular action. The persons may show obsession for cleanliness, dieting or looking young. In 'Border line personality disorder' the person is emotionally unstable and unpredictable. He or she may be highly reactive is irritating.

Important Phobias
1. Acrophobia ( fear of lights) 2. Anglo-phobia (fear of pain) 3. Heamatophobia (fear of blood) 4. Hydrophobia (fear of water) 5. Mysophobia (fear of contamination) 6. Pyrophobia (fear of fire) 7. Xenophobia (fear of strangers) Cause of mental illness 1 Hereditary Schizophrenia (split personality) is an autosomal recessive disorder. Person lives in two personalities and blows strange behavior distorted thoughts and rapid shift of emotions. 2 Deficiuency disorder
The mental illness can also develop due to deficiency of vitamins B1, B6, B12. It can also develop due to insufficient supply of blood/glucose to the brain, or even due to high fever (febrile).
3 Family Atmosphere
The lack of love affections or encouragement can be a major factor which may case mental illness. The children who feel insecure or neglected can also be the victims of mental illness.
4 Injury to the brain
Brain stroke, brain hemorrhage or other injury can produce similar effects.
5. Disease
The disease like brain tumor, meningitis, encephalitis or infection of Taenia solium (Tape Worm) can cause mental illness.
6. Special factors

Injustice, unpleasant incidents, wrong judgment, poverty, cruelty etc. can also produce the effects of mental illness.

Treatment
1. Electric shock treatment
Electro convulsive therapy (ECT) is used for the patients of psychosis who become violent. ECT makes them calm down.
2. Psychotherapy
Physical treatment, consolation or rehabilitation can help the person of mental illness.
3. Drugs
Tranquillizer, sedatives and stimulants can be given for suppressing or coring the diseases.

Communicable Diseases

HIV/AIDS
AIDS –Acquired Immune Deficiency Syndrome, recognized first in USA with several reports in 1981. It is caused by HIV (Human Immuno deficiency Virus), a retro virus discovered by Montaginer et. al. and formally called HCLV III (Human cell leukemia virus) or HTLV (human T-lymphocyte virus).
Structure of HIV
Virus has 2-stands RNA, with reserve transcriptase enzyme. The virus is believed to be mutant of a strain that infected the African green monkey. Virus infects HT-cells or T4 cells (having T4 receptor on cell surface), and paralyses the immune system. It can also infect microphages or brain cells. About 65% of total causes in USA are homosexuals, 28% are intravenous drug abuser and few develop the diseases through blood transfusion. The diseases can also pass to infants through placenta (Tranplacental) or mother's milk. Virus is present in vaginal secretions and seminal fluid (semen), and the maximum transmission occurs through sexual route.
Three Stages of AIDS infection
i. Asymptomatic carrier: Some of the newly infected persons develop fever, chill, ache, swollen, lymph glands and the symptoms soon disappear.
ii. ARC (Aids related complex): It is mild from AIDS and the symptoms are swollen lymph nodes, prestige cough, recurrent fever, night sweats and nervous impairment.
iii. Full blown AIDS: Serve weight loss and weakness due to persistent diarrhea. Opportunistic infections cause death.
Note: Shaking hands, social kissing, coughing, sneezing, etc do not transmit HIV virus.
AIDS can be prevented by using latex condoms, avoiding intravenous drugs and refraining from multiple sex partners (polygamy).
1. HIV test-ELISA (Enzyme Linked Immune Sorbant Assay). Since the test is for HIV- 1 antibody, it cannot detect persons who are infectious with HIV-2.
2. The other test for HIV is 'Western Bolt'. AZT (Azidothymidine) is the drug that used to treat the disease. It prevents the reproduction of HIV in the T-cells.
3. SCID (Severe Combined Immune Deficiency Syndrome) is a genetic disorder in which both B-cells and T-cells are either absent in deficient in infants.
4. It develops due to deficiency of adenosine demines (enzymes).
5. Such children cannot survive outside germs free suits.

TUBERCULOSIS

TUBERCULOSIS

Tuberculosis is a communicable chronic granulomatous disease. It usually involves the lungs but may affect any organ or tissue into the body. Typically the centers
of tubercular granulomas undergo caseous necrosis (i.e. death of cells or injury or failure of the blood supply.) it is a very serious chronic bacterial disease and an important cause of death in the most part of the world. It is caused by Mycobacterium tuberculosis. It is more common in over crowed city and slum (inhabited by poor people) areas with unhygienic conditions. Parasite mainly attacks lungs so called pulmonary tuberculosis. Extra Pulmonary tuberculosis is much less common than pulmonary. It includes meningitis, millary tuberculosis, and involvement of bones and joints, lymph nodes, kidneys, intestine, larynx or skin. Tuberculosis is the worldwide i.e. cosmopolitan in distribution. Very common in uneducated society where cigarette smoking tobacco chewing is very common.

Causative organism
Tuberculosis is caused by Mycobacterium tuberculosis, (tubercle bacillus). It attacks all age group but epidemics have been reported among mine workers, factory, garments and children in crowded classroom.

Mode of Transmission
a. Contact with patients with open lesions.
b. Air-borne route may be a frequent mode of spread.
c. The disease spread mostly by the throat and nasal discharge of infected man.
d. Bovine tuberculosis results from tuberculosis course.
e. Bovine tuberculosis results from ingestion of unpasteurized of milk of dairy products of tuberculosis domestic animals.
Infection
Causative organism Bacillus tuberculosis was discovered by Robert Koch in 1882. The disease chiefly affects lungs. The germs are thrown out by cough and spitting. They survive even after the sputum dries up and spread in air, the germs get entry into the lungs of a healthy individual through the respiratory tract. It can occur in any organ but especially glands in the neck (Cervical glands) are affected. They get bigger and are called T.B. Glands. Bacteria of tuberculosis invade any part of body multiply rapidly and destroy the tissue. Lunges are the favorite site of infection where small tubercles are formed and parasite release toe a toxin called tuberculin.

Incubation Period
It is about 4 to 6 weeks. The first 6 to 12 months after infection is the most hazardous period.

Clinical Features
a. Primary infection usually goes unnoticed clinically lesion heal spontaneously, leaving no residual change except pulmonary or trachebranchial lymph node classifications, but occasionally leads to pleurisy or to dissemination of bacilli with milliard or other extra pulmonary involvement.
b. Serious manifestations develop most often in infants.
c. Other symptoms are constant coughing, chest pain, bloody sputum; low grade fever and sweating in the day and at night, loss of weight, fatigue, hoarseness of voice etc may appear.

Diagnosis
Diagnosis by roentgenogram is confirmed by demonstration of Tubercle bacilli in sputum or gastric washings, by smear concentration and culture or animal inoculation.

Treatment
a. In order to avoid multi drug resistant TB, ministry of health has lunched DOTS (Directly observed treatment short course) are very much effective.
b. DOTS programme based on six factors: rest, diet, drugs and surgery, rehabilitation and education.
c. Combination of antimicrobial drugs: Streptomycin continued for one or more years.
Prevention
1. Isolations of TB patients.
2. Avoid Smoking and working.
3. Avoid spitting on public places.
4. Burning or Buried of coughing
5. BCG (Bacillus-Calmette-Guerin) Vaccination-protection.

COMMUNICABLE DISEASES

Typhoid

Typhoid is a bacterial disease characterized by a continued classical fever. It is caused by bacillus bacterium called salmonella typhi.
It is commonly found in intestine of man, so typhoid fever is also called enteric fever. It is most communicable disease and mainly attacks
in 1-15 years age group each year of 20% people. Typhoid fever is protected disease featuring bacteremai (1st week) widespread reticuloendothelial
involvement with splenomegaly and foci of necrosis in the liver (2nd week) and ulceration of pear patches with intestinal bleeding and ulceration(3rd week).
Gall bladder colonization produces a chronic carrier state chronic infection also may affect the joints bones, meanings and other sites. It is worldwide i.e.
cosmopolitan and a common disease of rural areas(i.e. due to poor sanitation).
Causative Organism
The causative agent of typhoid is Salmonella typhi (typhoid bacillus). Salmonella species is a major cause and common source of enter colitis, producing localized
mucosal disease in the ileum and colon. S. typhimurium is the archetypal organism that invades peyer patches and produces local ulceration over massively enlarged
lymphoid tissue. Life threatening systemic illness is the hallmark of S. tyhpi, where by small intestinal invasion leads to systemic dissemination (typhoid fever).

Mode of transmission
Direct or Indirect contact with patient or carrier. The products of vehicles- spread and contaminate food and water. The germs from infected food and water get entry into the
alimentary canal and cause lesions in patches in the small intestine. Raw fruits and vegetables are important factors. Milk and milk products are also causative
agents. Beef eggs and poultry are also important factors.

Incubation period
It is able to assume different numerical values (variable). The usual amount is two weeks, average ranges 1-3 weeks.

Symptoms
Following clinical features appears during typhoid fever:
Headache, Classic typhoid fever, Pain in abdomen, Lesions of intestinal mucosa, Hemorrhage and ulceration in intestine, Tongue is coated centrally and rose colored rash on chest
and upper abdomen(during second week).

Diagnosis
Widely test comes positive during second week.

Treatment:
Antibiotics like Ampicillin and Chloramphencol.

Prevention:
1. Protection, purification and chlorination of public water supplies.
2. Construction of safe private supplies.
3. Sanitary disposal of human excreta.
4. Fly control by screening and spraying insecticides.
5. Boiling or pasteurization of milk and dairy products.
6. Health education to the general people.
7. Discovery and supervision of typhoid carriers.
8. Immunization with a vaccine of high antigen city
9. Use of boiled water and avoid hawkers' food.