Monday, March 28, 2022

Praziquantel (PZQ) - side effect and pregnancy

Praziquantel (PZQ) is a medication used to treat a number of types of parasitic worm infections in mammals, birds, amphibians, reptiles, and fish. In humans specifically, it is used to treat schistosomiasis, clonorchiasis, opisthorchiasis, tapeworm infections, cysticercosis, hydatid disease, and other fluke infections. It should not be used for worm infections of the eye.

Praziquantel-side-effect-and-pregnancy

The majority of side effects develop due to the release of the contents of the parasites as they are killed and the consequent host immune reaction. The heavier the parasite burden, the heavier and more frequent the side effects normally are :- 

Central nervous system (CNS)

Frequently occurring side effects are - 

  • Dizziness
  • Headache
  • Malaise
  • Drowsiness, somnolence, fatigue, and vertigo have also been seen. 
  • Almost all patients with cerebral cysticercosis experience CNS side effects related to the cell-death of the parasites (headache, worsening of pre-existing neurological problems, seizures, arachnoiditis, and meningism). These side effects may be life-threatening and can be reduced by co-administration of corticosteroids. All patients with cerebral cysticercosis are strongly recommended to be hospitalized during treatment.
Praziquantel-side-effect-and-pregnancy

Gastrointestinal tract: -  About 90% of all patients have abdominal pain or cramps with or without nausea and vomiting. Diarrhea may develop and may be severe with colic. Sweating, fever, and sometimes bloody stools may occur together with diarrhea.

Liver: - Asymptomatic and transient increases of liver enzymes (AST and ALT) are noted frequently (up to 27%). No case of symptomatic liver damage has been seen so far.

Sensitivity reactions: - Urticaria, rash, pruritus and eosinophilia in white blood cell counts
Other locations/body as a whole: - Lower back pain, myalgia, arthralgia, fever, sweating, various cardiac arrhythmias, and hypotension.
 
Pregnancy

The WHO states praziquantel is safe during pregnancy. Animal studies have failed to reveal evidence of fetal harm. Praziquantel is effective in reducing schistosomiasis during pregnancy. Another trial found that treatment with praziquantel did not increase the rates of low birthweight, fetal death, or congenital anomalies.

Can pregnant women be treated with praziquantel?

Praziquantel is extremely safe and WHO recommends that pregnant women infected with the disease should be treated. But as a general precaution, WHO recommends treatment should be taken after the first trimester.

Praziquantel-side-effect-and-pregnancy

Schistosomiasis (bilharzia) - cause, transmission mode, symptoms, types, treatment and pregnancy

Schistosomiasis is an acute and chronic parasitic disease caused by blood flukes (trematode worms) of the genus Schistosoma.

What is schistosomiasis or bilharzia?

Schistosomiasis is an acute and chronic disease caused by parasitic worms. It is transmitted when larval forms released by freshwater snails penetrate human skin during contact with infested water.

Schistosomiasis-causes-types-symptoms

In which regions is the disease mostly found?

Schistosomiasis is prevalent in tropical and subtropical areas of the world. It is more prevalent in poor communities without access to safe drinking water and adequate sanitation. It is estimated that at least 90% of those requiring treatment for schistosomiasis live in Africa.

Schistosomiasis

Schistosomiasis transmission mode 

Bilharzia is transmitted when people suffering from schistosomiasis contaminate freshwater sources with their excreta containing parasite eggs, which hatch in water. In the body, the larvae develop into adult worms. These worms live in the blood vessels where the females release eggs. Some of the eggs are passed out of the body in the faeces or urine to continue the parasite’s life cycle. Others become trapped in body tissues, causing immune reactions and progressive damage to organs.

two-major-forms-of-schistosomiasis

Types of Schistosomiasis

There are two major forms of schistosomiasis: 

  1. Intestinal Schistosomiasis 
  2. Urogenital Schistosomiasis 

Both forms affect mainly poor and rural communities, particularly agricultural and fishing populations.

Symptoms of intestinal schistosomiasis

Intestinal schistosomiasis can cause :- 

  • Abdominal pain
  • Diarrhoea
  • Blood in the stool. 
  • Liver enlargement is common in advanced cases and is frequently associated with an accumulation of fluid in the peritoneal cavity and hypertension of the abdominal blood vessels.
  • In such cases there may also be enlargement of the spleen.
Symptoms-of-intestinal-schistosomiasis


Symptoms of urogenital schistosomiasis

The classic sign is :- 

  • Presence of blood in urine (haematuria). 
  • Fibrosis of the bladder and ureter, and kidney damage are sometimes diagnosed in advanced cases. 
  • Bladder cancer is another possible complication in the later stages. 
  • In women, urogenital schistosomiasis may present with genital lesions, vaginal bleeding, pain during sexual intercourse, and nodules in the vulva. 
  • In men, urogenital schistosomiasis can induce pathology of the seminal vesicles, prostate, and other organs.

Is the disease more complicated in women?

Women doing domestic chores in infested water, such as washing clothes in areas endemic for the disease, are greatly at risk. Women can also develop female genital schistosomiasis – which can cause genital lesions, vaginal bleeding, pain during sexual intercourse, and nodules in the vulva. Female genital schistosomiasis is also considered to be a risk factor for HIV infection, especially in women.


How do children get exposed and how can the disease affect them?

Lack of hygiene and certain play habits of school-aged children such as swimming or fishing in infested water make them especially vulnerable to infection. Schistosomiasis can also cause anaemia and stunting and a reduced ability to learn among children.

Treatment of schistosomiasis 

All forms of schistosomiasis can be treated effectively by the WHO-recommended medicine praziquantel. It is effective, safe, and low-cost. 


Even though re-infection may occur after treatment, the risk of developing severe disease is diminished and even reversed when treatment is initiated and repeated in childhood. As part of its global strategy to control the disease, WHO focuses on reducing the disease through periodic, targeted treatment with praziquantel through the large-scale treatment (preventive chemotherapy) of affected populations. This involves regular treatment of all at-risk groups.

Can pregnant women be treated with praziquantel?

Praziquantel is extremely safe and WHO recommends that pregnant women infected with the disease should be treated. But as a general precaution, WHO recommends treatment should be taken after the first trimester.

Should tourists be concerned when traveling to countries that have schistosomiasis?

Tourists can easily avoid infection by not swimming in fresh water in areas where schistosomiasis is likely to occur. Even if infected, the worms do not cause a life-threatening disease for someone who is generally healthy. The disease is only serious for people living in endemic areas who become constantly re-infected and have no access treatment. If infected, treatment with praziquantel is easy, efficacious and safe.

Saturday, July 10, 2021

Weight Loss

Whether your weight-loss goals involve trying to lose 5 pounds or more than 50, the same principles determine how much weight you lose and how fast your weight loss will occur. Remembering the following simple healthy eating diet tips and putting them into practice can lead to weight reduction without the aid of any special diet plans, weight loss programs, fitness books, or medications.

Our body weight is determined by the amount of energy that we take in as food and the amount of energy we expend in the activities of our day. Energy is measured in calories. Metabolism is the sum of all chemical processes within the body that sustain life. Your basal metabolic rate is the number of calories (amount of energy) you need for your body to carry out necessary functions. If your weight remains constant, this is likely a sign that you are taking in the same amount of calories that you burn daily. If you're slowly gaining weight over time, it is likely that your caloric intake is greater than the number of calories you burn through your daily activities.


What Should Eat During Weight Loss Diet

Every adult is in control of the amount of food he or she consumes each day, so our intake of calories is something we can control. To a major degree, we can also control our output of energy, or the number of calories we burn each day. The number of calories we burn each day is dependent upon the following:

What-Should-Eat-During-Weight-Loss-Diet

Our basal metabolic rate (BMR), the number of calories we burn per hour simply by being alive and maintaining body functions.


Physical activity For Weight Loss

For some people, due to genetic (inherited) factors or other health conditions, the resting metabolic rate (RMR) can be slightly higher or lower than average. Our weight also plays a role in determining how many calories we burn at rest -- the more calories are required to maintain your body in its present state, the greater your body weight. A 100-pound person requires less energy (food) to maintain body weight than a person who weighs 200 pounds.

Physical-activity-For-Weight-Loss

Lifestyle and work habits partially determine how many calories we need to eat each day. Someone whose job involves heavy physical labor will naturally burn more calories in a day than someone who sits at a desk most of the day (a sedentary job). For people who do not have jobs that require intense physical activity, exercise or increased physical activity can increase the number of calories burned.


Weight Loss Calories For Woman

As a rough estimate, an average woman 31-50 years of age who leads a sedentary lifestyle needs about 1,800 calories per day to maintain a normal weight. A man of the same age requires about 2,200 calories. Participating in a moderate level of physical activity (exercising three to five days per week) requires about 200 additional calories per day. 

Weight-Loss-Calories-For-Woman

More strenuous exercise programs, such as those with cardio focus, can burn even more.


Weight Loss Diet

Healthful meals and snacks should form the foundation of the human diet. A simple way to create a meal plan is to make sure that each meal consists of 50 percent fruit and vegetables, 25 percent whole grains, and 25 percent protein. Total fiber intake should be 25–30 grams (g) daily.

Weight-Loss-Diet

Eliminate trans fats from the diet, and minimize the intake of saturated fats, which has a strong link with the incidence of coronary heart disease.

Instead, people can consume monounsaturated fatty acids (MUFA) or polyunsaturated fatty acids (PUFA), which are types of unsaturated fat.

Weight-Loss-Food

Weight Loss Food

The following foods are healthful and often rich in nutrients:

fresh fruits and vegetables

  • fish
  • legumes
  • nuts
  • seeds
  • whole grains, such as brown rice and oatmeal

Foods to avoid eating include:

  • foods with added oils, butter, and sugar
  • fatty red or processed meats
  • baked goods
  • bagels
  • white bread
  • processed foods

In some cases, removing certain foods from the diet might cause a person to become deficient in some necessary vitamins and minerals. A nutritionist, dietitian, or another healthcare professional can advise a person how to get enough nutrients while they are following a weight loss program.

Intermittent fasting (IF) is a pattern of eating that involves regular short-term fasts and consuming meals within a shorter time period during the day.


Weight Loss Fasting

Several studies Trusted Source have indicated that short-term intermittent fasting, which is up to 24 weeks in duration, leads to weight loss in overweight individuals.

Weight-Loss-Fasting

The most common intermittent fasting methods include the following:

Alternate day fastingTrusted Source (ADF): Fast every other day and eat normally on non-fasting days. The modified versionTrusted Source involves eating just 25–30 percent of the body’s energy needs on fasting days.

The 5:2 Diet: Fast on 2 out of every 7 days. On fasting days eat 500–600 calories.

The 16/8 method: Fast for 16 hours and eat only during an 8-hour window. For most people, the 8-hour window would be around noon to 8 p.m. A study on this method found that eating during a restricted period resulted in the participants consuming fewer calories and losing weight.

It is best to adopt a healthy eating pattern on non-fasting days and to avoid over-eating.

Get off to the best possible start on the NHS weight loss plan with these 12 diet and exercise tips.


Do not skip breakfast

Skipping breakfast will not help you lose weight. You could miss out on essential nutrients and you may end up snacking more throughout the day because you feel hungry.


Eat regular meals

Eating at regular times during the day helps burn calories at a faster rate. It also reduces the temptation to snack on foods high in fat and sugar.


Eat plenty of fruit and veg

Fruit and veg are low in calories and fat, and high in fibre – 3 essential ingredients for successful weight loss. They also contain plenty of vitamins and minerals.


Get more active

Being active is key to losing weight and keeping it off. As well as providing lots of health benefits, exercise can help burn off the excess calories you cannot lose through diet alone.


Drink plenty of water

People sometimes confuse thirst with hunger. You can end up consuming extra calories when a glass of water is really what you need.


Eat high fibre foods

Foods containing lots of fibre can help keep you feeling full, which is perfect for losing weight. Fibre is only found in food from plants, such as fruit and veg, oats, wholegrain bread, brown rice and pasta, and beans, peas and lentils.


Read food labels

Knowing how to read food labels can help you choose healthier options. Use the calorie information to work out how a particular food fits into your daily calorie allowance on the weight loss plan.


Use a smaller plate

Using smaller plates can help you eat smaller portions. By using smaller plates and bowls, you may be able to gradually get used to eating smaller portions without going hungry. It takes about 20 minutes for the stomach to tell the brain it's full, so eat slowly and stop eating before you feel full.


Do not ban foods

Do not ban any foods from your weight loss plan, especially the ones you like. Banning foods will only make you crave them more. There's no reason you cannot enjoy the occasional treat as long as you stay within your daily calorie allowance.


Don't Eat Junk food

To avoid temptation, do not stock junk food – such as chocolate, biscuits, crisps and sweet fizzy drinks – at home. Instead, opt for healthy snacks, such as fruit, unsalted rice cakes, oat cakes, unsalted or unsweetened popcorn, and fruit juice.


Should I Cut down on alcohol For Weight Loss

A standard glass of wine can contain as many calories as a piece of chocolate. Over time, drinking too much can easily contribute to weight gain.

Should-I-Cut-down-on-alcohol-For-Weight-Loss

Plan your meals

Try to plan your breakfast, lunch, dinner and snacks for the week, making sure you stick to your calorie allowance. You may find it helpful to make a weekly shopping list.


Diet For Weight Loss In USA

A healthy weight is an important element of good health. How much you eat—and what you eat—play central roles in maintaining a healthy weight or losing weight. Exercise is the other key actor.

Diet-For-Weight-Loss-In-USA

For years, low-fat diets were thought to be the best way to lose weight. A growing body of evidence shows that low-fat diets often don't work, in part because these diets often replace fat with easily digested carbohydrates.

Hundreds of diets have been created, many promising fast and permanent weight loss. Remember the cabbage soup diet? The grapefruit diet? How about the Hollywood 48 Hour Miracle diet, the caveman diet, the Subway diet, the apple cider vinegar diet, and a host of forgettable celebrity diets?

The truth is, almost any diet will work if it helps you take in fewer calories. Diets do this in two main ways:

Getting you to eat certain "good" foods and/or avoid "bad" ones.

The best diet for losing weight is one that is good for all parts of your body, from your brain to your toes, and not just for your waistline. It is also one you can live with for a long time. In other words, a diet that offers plenty of good tasting and healthy choices, banishes few foods, and doesn't require an extensive and expensive list of groceries or supplements.

How-Time-take-to-Weight-Loss

One diet that fills the bill is a Mediterranean-type diet. Such a diet—and there are many variations—usually includes:

  • several servings of fruits and vegetables a day
  • whole-grain breads and cereals
  • healthy fats from nuts, seeds, and olive oil
  • lean protein from poultry, fish, and beans
  • limited amounts of red meat

moderate wine consumption with meals (no more than two glasses a day for men; no more than one a day for women

A Mediterranean-style diet is a flexible eating pattern. People who follow such diets tend to have lower rates of heart disease, diabetes, dementia, and other chronic conditions.

It’s natural for anyone trying to lose weight to want to lose it very quickly. But people who lose weight gradually and steadily (about 1 to 2 pounds per week) are more successful at keeping weight off. Healthy weight loss isn’t just about a “diet” or “program”. It’s about an ongoing lifestyle that includes long-term changes in daily eating and exercise habits.

Once you’ve achieved a healthy weight, rely on healthy eating and physical activity to help you keep the weight off over the long term.

Losing weight is not easy, and it takes commitment. But if you’re ready to get started, we’ve got a step-by-step guide to help get you on the road to weight loss and better health.

Even modest weight loss can mean big benefits.


How Time take to Weight Loss

Even a modest weight loss of 5 to 10 percent of your total body weight is likely to produce health benefits, such as improvements in blood pressure, blood cholesterol, and blood sugars.

For example, if you weigh 200 pounds, a 5 percent weight loss equals 10 pounds, bringing your weight down to 190 pounds. While this weight may still be in the “overweight” or “obese” range, this modest weight loss can decrease your risk factors for chronic diseases related to obesity.

So even if the overall goal seems large, see it as a journey rather than just a final destination. You’ll learn new eating and physical activity habits that will help you live a healthier lifestyle. These habits may help you maintain your weight loss over time.

For example, the National Weight Control Registryexternal icon noted that study participants who maintained a significant weight loss reported improvements in physical health as well as energy levels, physical mobility, general mood, and self-confidence.

How-Time-take-to-Weight-Loss

The most important component of an effective weight-management program must be the prevention of unwanted weight gain from excess body fat. The military is in a unique position to address prevention from the first day of an individual's military career. 

Because the military population is selected from a pool of individuals who meet specific criteria for body mass index (BMI) and percent body fat, the primary goal should be to foster an environment that promotes maintenance of a healthy body weight and body composition throughout an individual's military career. 


Training For Weight Loss

There is significant evidence that losing excess body fat is difficult for most individuals and the risk of regaining lost weight is high. From the first day of initial entry training, an understanding of the fundamental causes of excess weight gain must be communicated to each individual, along with a strategy for maintaining a healthy body weight as a way of life.

Weight-Loss

Mucormycosis or Black Fungus - Cause, Transmission, Symptoms, Types, Diagnosis, Treatment and Prevention

Mucormycosis also known as Black Fungus. 

Black-Fungus-Cause-Transmission-Symptoms-Types-Diagnosis-Treatment-and-Prevention

Mucormycosis (previously called zygomycosis) is a rare but serious angio-invasive infection caused by a group of fungi called mucormycetes. 

Spores of these ubiquitous fungi (commonly found in soil, fallen leaves, compost, animal dung and air) can be inhaled and then infect the lungs, sinuses, and extend into the brain and eyes. Less often, infection may develop when the spores enter the body through a cut or an open wound. 

Mucormycosis is not a contagious disease, it cannot be spread from one person to another.  

Mucormycosis mainly affects people who are immunocompromised, or patients already infected with other diseases. High risk groups include people with diabetes (especially diabetic ketoacidosis), solid organ transplantation, neutropenia (low neutrophils, a type of white blood cells), long-term systemic corticosteroid use, and iron overload (hemochromatosis). The risk is high for people living with HIV, and those using immunomodulating drugs, including the anti-fungal voriconazole in some high-risk groups. 

Clinical presentation is classified according to the organ involvement. It can be rhino-orbital cerebral, pulmonary, cutaneous, gastrointestinal, or disseminated. 

Mucormycosis is an aggressive, life-threatening infection requiring prompt diagnosis and early treatment. Treatment usually consists of antifungal medications and surgery. 


COVID-19 Associated Mucormycosis

Fungal infections, including mucormycosis, aspergillosis and invasive candidiasis, have been reported in patients with severe COVID-19 or those recovering from the disease and have been associated with severe illness and death. 

COVID-19-Associated-Mucormycosis

India has reported a recent surge in mucormycosis cases. Prevention of COVID-19 associated mucormycosis needs to focus on aiming for better glycaemic control in COVID-19 patients and monitoring the use of systemic corticosteroids in treating severe cases. 

Outpatient use of systemic corticosteroids/other immunomodulating drugs for mild or moderate patients with COVID-19 should be avoided. Health care facilities need to strengthen their infection prevention and control (IPC) programmes to prevent healthcare-associated outbreaks.


Disease Burden

The incidence rate of mucormycosis globally varies from 0.005 to 1.7 per million population.

In India, prevalence of mucormycosis is estimated as 140 per million population, which is about 80 times higher than the prevalence in developed countries.

In a systemic review and meta-analysis of 851 cases reports published in 2018, death was reported in 389/851 (46%) patients. Case fatality was observed to be highest among patients with disseminated mucormycosis (68%) and lowest in those with cutaneous disease (31%).

Following the surge of COVID-19 associated mucormycosis and the Government of India directive, several states in India made mucormycosis a notifiable disease in May 2021. This will provide better insights into the disease burden, population characteristic, risk factors, clinical spectrum and outcomes of these patients.

Current trends indicate that the surge is higher in those with pre-existing diabetes, those on systemic corticosteroids, and is being observed in both people with COVID-19, and those recovering from the disease. 


Transmission of Mucormycosis Black Fungus

It is not contagious and does not spread by contact of person to person.

Transmission-of-Mucormycosis-Black-Fungus

This fungus is found in the environment. Transmission occurs through inhalation, inoculation, or ingestion of spores from the environment.

Although most cases are sporadic, healthcare-associated outbreaks have been linked to adhesive bandages, wooden tongue depressors, hospital linens, negative pressure rooms, water leaks, poor air filtration, non-sterile medical devices, and building construction.

It most commonly affects the sinuses or the lungs after inhaling fungal spores from the air. In such cases, it may spread to brain and eyes.

It may also occur on the skin after a cut, burn, or other type of skin injury gets infected.


Symptoms of Mucormycosis Black Fungus

The symptoms of mucormycosis depend on where in the body the fungus is growing. The most common presentation is a sinus infection (sinusitis) that is accompanied by nasal congestion, nasal discharge, and sinus pain. A fever and headache may also occur.

Symptoms-of-Mucormycosis-Black-Fungus


Type of Mucormycosis


Diagnosis of Mucormycosis Black Fungus

Early recognition, diagnosis and prompt administration of appropriate antifungal treatment and surgical debridement (as needed) are important for improving outcomes for patients with mucormycosis. 

Diagnosis-of-Mucormycosis-Black-Fungus

Diagnostic methods include biopsy and fungal staining (KOH mount), which remains the mainstay of laboratory diagnosis. Facilities where fungal culture and susceptibility testing are available can help to confirm the species of mucormycosis. Treatment initiation, however, should not wait for fungal culture results. 

Imaging tests such as a CT scan of lungs, sinuses, or other parts of body, depending on the location of the suspected infection, may also be used to support the diagnosis.


Treatment of Black Fungus Mucormycosis

Mucormycosis is difficult to treat. It may sometimes requires both intravenous antifungal therapy and surgical excision, thus necessitating a multidisciplinary team approach in a facility setting. 

Treatment-of-Black-Fungus-Mucormycosis

Liposomal amphotericin B is the drug of choice and needs to be initiated early. Other antifungals like posaconazole, or isavuconazolehave also been described for treatment. 

The Directorate General of Health Services (DGHS) has released detailed guidelines on managing mucormycosis in COVID-19 in India. 

The overall prognosis depends on several factors, including the rapidity of diagnosis and treatment, the site of infection, and the patient’s underlying conditions and degree of immunosuppression. The overall case fatality is approximately 50%,  although early diagnosis and treatment lead to better outcomes.


Prevention from Black Fungus Mucormycosis

Prevention of COVID-associated mucormycosis needs to focus on addressing the underlying risk factors:

  1. Aiming for better glycemic control in those with diabetes.
  2. Appropriate use of systemic corticosteroids.
  3. Prevention of unnecessary use of antibiotic, antifungal and other immunomodulators.
  4. IPC measures at the facility level are essential toprevent the environmental spread of this pathogen. 

These include:

Sterilization and disinfection of the equipment used by multiple patients (tracheal tubes, ventilators), ventilation systems ( if there is poor ventilation in the hospital that can contribute to dampness and dust).

Proper wound management (bandage, tape, adhesives, including  tapes to secure medical devices such as endotracheal tubes, ostomy devices must be sterilized and changed regularly),proper line management in health facilities.

Friday, July 9, 2021

Wednesday, July 7, 2021

Do dead bodies cause epidemics?

No, dead bodies from natural disasters generally do not cause epidemics. This is because victims of such disasters usually die from trauma, drowning or fire and do not normally harbour organisms which cause epidemics.

The exception to this is when deaths have occurred from highly infectious diseases (such as Ebola, Lassa fever, cholera), or when the disaster occurred in an area that is endemic for such highly infectious diseases. In these circumstances, the possibility of disease spreading from dead bodies exists.

What are the health risks for the public?

Unless the deceased has died from a highly infectious disease, the risk to the public is negligible. However, there is a risk of diarrhoea from drinking water contaminated by faecal material from dead bodies. Routine disinfection of drinking water is sufficient to prevent waterborne illness. 

The health risks to those handling dead bodies.