Dengue Fever

What is Dengue fever?

Dengue fever (pronounced Den-gay) is a viral infection caused by the female mosquito (Aedes aegypti and Aedes albopictus). Dengue fever
occurs in tropical and sub-tropical regions and usually increases in the hot and humid months. Dengue fever is not a new disease. It was
discovered several hundred years ago. In recent years, dengue fever has become a major international public health concern.
Dengue fever nicknamed "breakbone fever" because dengue patients usually express contorted movements due to intense joint and muscle
pain. Benjamin Rush from Philadelphia, US, first described "breakbone fever" in 1780. Slaves who developed dengue fever in the West Indies
were said to have "dandy fever" because of their posture and gait.
Dengue fever lasts for approximately 7 days, despite its sudden and acute onset. However, extra precautions should be taken after the recovery
period. These precautions will help prevent severe illness from occurring in some people, such as dengue haemorrhagic fever (DHF) or dengue
shock syndrome (DSS). These illnesses are potentially lethal and are today the leading cause of childhood mortality in several Asian countries.
There are two types of dengue fever:
Dengue fever which manifests itself as a flu-like illness.
Dengue hemorrhagic fever which is a severe, often fatal, complication of dengue fever.

Dengue Outbreak
Aside from the Philippines, dengue problem is also being experienced in countries that have tropical climate like in neighboring Asian countries
such as Malaysia, Indonesia, Laos, India, Taiwan;
Dengue is also found in South American countries such as Brazil, Puerto Rico, El Salvador, Guatemala, Mexico and the continent country
Australia.
Even Singapore which is known for its clean surroundings have not been spared of an outbreak.

How is Dengue fever transmitted?

Dengue viruses are transmitted to humans (host) through the bites of the female striped Aedes aegypti mosquito (vector). This variety of
mosquito breeds easily during the rainy seasons but can flourish in peridomestic fresh water, e.g. water that is stored in plastic bags, cans,
flowerpots and old tires. The dengue virus is transmitted to its host during probing and blood feeding. The mosquito may carry the virus from
one host to another host and the mosquito is most active in the early morning and later afternoon. A mosquito bite can cause the disease.
Incubation period occurs when the viruses has been transmitted to the human host. The period ranges from 3 to 15 days (usually lasting for 5-8
days) before the characteristics of dengue appear. During incubation time, the dengue viruses multiply.

What are the characteristics of Dengue fever?

The Dengue virus travels to various glands in the body where it multiples. It then travels to the bloodstream, affecting some changes to these
blood vessels. The virus may cause the blood vessels to swell and leak. The spleen and lymph nodes may also become swollen. Patches of liver
tissue may die. Furthermore, a process known as disseminated intravascular coagulation (DIC) occurs. During this process, chemicals used to
clot blood are used up, and thus severe bleeding (hemorrhage) occurs internally as well as the skin.

The signs and symptoms of Dengue fever are as follows:

- High fever (104 F, 40C)

- Loss of appetite

- Red eyes, pain in the eyes

- Chills

- Nausea and vomiting

- Enlarged lymph nodes

- Headache

- Low blood pressure and heart rate

- Deep muscle and joint pains (during

first hours of illness)

- Red eyes, pain in the eyes

- Extreme fatigue- High fever (104 F,

40C)

- Loss of appetite

- Chills

- Nausea and vomiting

- Headache

- Low blood pressure and heart rate

- Enlarged lymph nodes

- Deep muscle and joint pains (during
first hours of illness)

- Extreme fatigue
Basically, dengue commences with high fever and other signs as listed above for 2 to 4 days. Then, the temperature drops rapidly and intense
sweating takes place. After about a day with normal temperature and a feeling of well-being, the temperature rises abruptly again. Rashes
(small red bumps) show up on the arms, legs and the entire body simultaneously along with fever. However, rashes rarely occur on the face.
The palms of the hands and soles of the feet may be swollen and bright red. Although the patient may feel exhausted for several weeks, most
cases of dengue take approximately one week to recover. Once a person recovers from dengue, he or she will have antibodies in their
bloodstream which will prevent them from having a relapse for about a year.

Treatment
There is no specific treatment to shorten the course of dengue fever. Medications are given to alleviate the signs and symptoms. Aspirin should
not be given to patients. It will cause severe bleeding. Hence, it is advisable to take paracetamol to relieve muscle and joint aches, fever and
headache. The patient may be required to be sponged down with water at room temperature using a wet, squeezed out towel for about 20
minutes at a time. This will help to help lower the high temperature. Ice water should not be used for this purpose. However, bed rest is
essential to a speedy recovery and the patient should consume plenty of water which will help to alleviate the illness. Patients should be kept in
a room that has screens to prevent mosquitoes from entering or else under mosquito netting until the second period of fever has subsided.
Hence, mosquitoes cannot bite them. If the patient is bitten then the dengue virus may be transmitted to the mosquito and then to another
host.

Immunization
There is no vaccine to protect against dengue. Developing a vaccine against dengue/severe dengue has been challenging although there has
been recent progress in vaccine development. WHO provides technical advice and guidance to countries and private partners to support
vaccine research and evaluation. Several candidate vaccines are in various phases of trials.

What is Dengue Hemorrhagic Fever (DHF)?

Dengue hemorrhagic fever occurs when the dengue virus re-infects a person who previously has experienced dengue fever. In this case, the
previous infection teaches the immune system to recognize the virus, resulting in the immune system over reacting. DHF is also known as
dengue shock syndrome (DSS) and the symptoms in this case are severe. It is a potential fatal immunological reaction and tends to affect
children under 15 years old.

The signs and symptoms of DHF are as follows:

- Abdominal pain

- Sore throat and cough

- Hemorrhage (severe bleeding)

- Pneumonia

- Circulatory collapse (shock)

- Inflammation of the heart

- Nausea and vomiting

- Blood in the stool

- Bleeding of the nose and gums

- High fever (40 -41 C)

The initial symptoms of DHF are high fever and severe headache. Small purplish spots (petechiae) can be seen on the skin. This is because blood
is leaking out of the vessels. Large bruised areas appear due to severe bleeding. Sometimes, patients may begin to vomit a substance that
appears as coffee grounds. This is actually a sign of bleeding in the stomach. The severe hemorrhage results in a decrease of blood in the body.
The low blood flow will unable to maintain adequate supply of blood to meet the metabolic requests of the cells in the body. This state of low
blood flow is the defined as Dengue shock syndrome (DSS).
Patients with DHF must be closely monitored for the first few days until their condition is stabilized. The patient's condition may suddenly
worsen after few days if the fever has not subsided. The temperature will then suddenly drop and the patient shows signs of circulatory failure.
The patient may rapidly go into a critical state of shock (DSS) and die within 12 to 24 hours. However, he or she may recover quickly after
appropriate volume replacement therapy. Fluids are infused to patients to avoid dehydration. Sometimes, blood transfusions may be necessary
if severe bleeding occurs. In addition, oxygen is given to cyanotic (bluish) patients.

Prevention and Control

At present, the only method of preventing and controlling dengue fever is to eradicate the mosquito population. They are a number of ways to
combat the vector mosquitoes:
- Improved water storage practices. Cover all containers to prevent egg laying female mosquitoes access to it.

- Implement proper solid waste disposal.

- Eliminate any sources that may collect water such as tins, bottles, plastic food containers and old tires. Mosquitoes breed easily in any source
of standing water.
- Appropriate insecticides, such as larvicide's can be added to water containers and man-made ponds. The insecticides can prevent mosquitoes
breeding for several weeks. However, they must be re-applied as per directions.
- Always clean and check drains to ensure they are not blocked especially during the rainy season.
- Breed small mosquito-eating fishes in an artificial pond to eradicate the mosquito larvae.
In addition to the above, there are a number of factors to help prevent the mosquito being attracted to human prey.
- Avoid wearing dark and tight clothing because mosquitoes are attracted to dark colours. Wear loose, white and long clothes, which cover the
whole body. Mosquitoes find it difficult to bite through loose clothes than tight fitting clothes.
- Environmental conditions. It is suggested to sleep under mosquito netting or in a room which has mosquito screens on the windows.
Mosquitoes are unlikely to bite in an air-conditioned room and under strong fans. Mosquito coils are also useful to help prevent mosquitoes
from entering the room.
- Apply mosquito repellants.
- Avoid reduce outdoor activities during morning and late afternoon because Aedes mosquitoes are daytime feeders.

#THE USE OF FOGGING MEASURES

Fogging, using the nauseous gas Malathion, is used to kill the Aedes aegypti mosquito, the carrier of the dengue virus, to stop transmission of
the disease.
The chemical contains toxins that may cause intestinal problems, brain damage, respiratory problems, among others.
Fogging does not totally eradicate the dengue-carrying mosquito as it just transfers to other place which had not been fogged
Fogging just kills the adult mosquito but leaves the kiti-kiti (larvae) to thrive
Fogging is only advisable in highly-concentrated areas where there are already outbreaks in the dengue case. To declare an outbreak, there
must be clustering of cases in significant areas.

HOW TO FIGHT THE DENGUE VIRUS

The best way to fight dengue fever is prevention and the way to do this is to arm yourself with information regarding this disease.
Knowing how to protect one's self from mosquito bites will keep you and your family from getting sick.
More effective dengue prevention and controlling programs are needed, rather than using the fogging method which is highly risky to health
and environment.
There are four strategies to fight dengue:
1) search and destroy mosquito breeding sites

3) seeking early treatment

2) the use of self protection measures

4) no indiscriminate fogging

like using mosquito nets

WHO response
WHO responds to dengue in the following ways:
supports countries in the confirmation of outbreaks through its
collaborating network of laboratories;

provides training on clinical management, diagnosis and vector

control at the regional level with some of its collaborating centres;

provides technical support and guidance to countries for the

effective management of dengue outbreaks;

formulates evidence-based strategies and policies;

develops new tools, including insecticide products and

application technologies;

publishes guidelines and handbooks for case management,

dengue prevention and control for Member States.

gathers official records of dengue and severe dengue from over

100 Member States;

Warning signs of Dengue Shock Syndrome are

Severe abdominal pain,
Vomiting,

Change in temperature,
Mental irritability.

#Note:
Jawatan orang y buat fogging=PKA(pembantu kesihatan awam)
Dengue mosquitoes do not breed in swamps or drains. They tend to breed in containers of stagnant water inside and outside the home.
Aedes aegypti mosquitoes generally known as a container breeder normally breed in pure water which is not very deep. Sometimes it could
breed even in slightly polluted or slightly brackish water.
Abandoned water tank
Mosquitos breeding in a quart jar ..
The common breeding places of the Aedes mosquito are so varied and so many:
We normally speak about discarded plastic cups, coconut shells, empty bottles, containers used as ant traps in houses, tree holes, drums and
containers used for collection and store water.
They also breed in cans, buckets, jars, blocked roof gutters and tarps, sheaths of some plants like bromeliad and bananas etc.
Other productive containers for dengue are discarded tyres, toilet tanks, flower vases and pots.
If you remove these sources, your risk of being bitten by a Dengue mosquito is significantly reduced.
Water collected under the flower pot.
All households are also urged to constantly check any collection of water in their dish drains and water dispensers because in inspections, many
dengue-carrier mosquitoes lay their eggs in these containers.
A research study conducted by the International Health for Tropical Medicine showed that productive containers for dengue breeding sites are
mostly found indoors.
Tyres kept outdoors collect rain water ..
Many breeding places of the mosquitoes are found right inside of houses and yards.
In some places families who cannot afford water pumps often end up storing water in large water receptacles like jugs, cans, drums and plastic
jars.
These stored water become stockpile of most families for several days becoming good breeding places of mosquitoes.
Flower pot with water collection ..
Huge water storing containers without tight fitting lids
that cannot be emptied easily..
There are also so many unsuspected places in our garden where water remains for more than 7 days and these could be Aedes mosquito
breeding place.
Always throw away stagnant water that collects in every possible container that you can find in your surroundings.

Malaria
Overview
Malaria is a mosquito-borne infectious disease of humans and other animals caused byprotists (a type of microorganism) of the genus
Plasmodium. It begins with a bite from an infected female Anopheles mosquito, which introduces the protists through saliva into thecirculatory
system. In the blood, the protists travel to the liver to mature and reproduce. Malaria causes symptoms that typically include fever and
headache, which in severe cases can progress to coma or death. The disease is widespread in tropical andsubtropical regions in a broad band
around the equator, including much of Sub-Saharan Africa, Asia, and the Americas.
Five species of Plasmodium can infect and be transmitted by humans. The vast majority of deaths are caused by P. falciparum and P. vivax,
while P. ovale, and P. malariae cause a generally milder form of malaria that is rarely fatal. The zoonotic species P. knowlesi, prevalent in
Southeast Asia, causes malaria in macaques but can also cause severe infections in humans. Malaria is prevalent in tropical and subtropical
regions because rainfall, warm temperatures, and stagnant waters provide habitats ideal for mosquito larvae. Disease transmission can be
reduced by preventing mosquito bites by distribution ofmosquito nets and insect repellents, or with mosquito-control measures such as
sprayinginsecticides and draining standing water.
Malaria is typically diagnosed by the microscopic examination of blood using blood films, or with antigen-based rapid diagnostic tests. Modern
techniques that use the polymerase chain reaction to detect the parasite's DNA have also been developed, but these are not widely used in
malaria-endemic areas due to their cost and complexity. The World Health Organization has estimated that in 2010, there were 219 million
documented cases of malaria. That year, between 660,000 and 1.2 million people died from the disease (roughly 20003000 per day),[1] many
of whom were children in Africa. The actual number of deaths is not known with certainty, as accurate data is unavailable in many rural areas,
and many cases are undocumented. Malaria is commonly associated with poverty and may also be a major hindrance to economic
development.
Despite a need, no effective vaccine currently exists, although efforts to develop one are ongoing. Several medications are available to prevent
malaria in travellers to malaria-endemic countries (prophylaxis). A variety ofantimalarial medications are available. Severe malaria is treated
with intravenous or intramuscular quinine or, since the mid-2000s, theartemisinin derivative artesunate, which is superior to quinine in both
children and adults and is given in combination with a second anti-malarial such as mefloquine. Resistance has developed to several
antimalarial drugs; for example, chloroquine-resistant P. falciparumhas spread to most malarial areas, and emerging resistance to artemisinin
has become a problem in some parts of Southeast Asia.

Signs and symptoms

The signs and symptoms of malaria typically begin 825 days following infection;however, symptoms may occur later in those who have taken
antimalarial medications as prevention.Initial manifestations of the diseasecommon to all malaria speciesare similar to flu-like symptoms,
and can resemble other conditions such assepticemia, gastroenteritis, and viral diseases.The presentation may includeheadache, fever,
shivering, arthralgia (joint pain), vomiting, hemolytic anemia, jaundice,hemoglobinuria, retinal damage, and convulsions. Approximately 30% of
people however will no longer have a fever upon presenting to a health care facility. Owing to the non-specific nature of disease presentation,
diagnosis of malaria in non-endemic countries requires a high degree of suspicion, which might be elicited by any of the following: recent travel
history, splenomegaly (enlarged spleen), fever without localizing signs, thrombocytopenia, and hyperbilirubinemia combined with a normal
peripheralblood leukocyte count.

The classic symptom of malaria is paroxysma cyclical occurrence of sudden coldness followed by rigor and then fever and sweating, occurring
every two days (tertian fever) in P. vivax and P. ovale infections, and every three days (quartan fever) forP. malariae. P. falciparum infection can
cause recurrent fever every 3648 hours or a less pronounced and almost continuous fever.
Severe malaria is usually caused by P. falciparum (often referred to as falciparum malaria). Symptoms of falciparium malaria arise 930 days
after infection. Individuals with cerebral malaria frequently exhibit neurological symptoms, including abnormal posturing,nystagmus, conjugate
gaze palsy (failure of the eyes to turn together in the same direction), opisthotonus, seizures, or coma.

Complications
There are several serious complications of malaria. Among these is the development of respiratory distress, which occurs in up to 25% of adults
and 40% of children with severe P. falciparum malaria. Possible causes include respiratory compensation of metabolic acidosis, noncardiogenic
pulmonary oedema, concomitant pneumonia, and severe anaemia. Acute respiratory distress syndrome (ARDS) may develop in 525% in adults
and up to 29% of pregnant women but it is rare in young children. Coinfection of HIV with malaria increases mortality. Renal failure is a feature
of blackwater fever, where hemoglobin from lysed red blood cells leaks into the urine.
Infection with P. falciparum may result in cerebral malaria, a form of severe malaria that involves encephalopathy. It is associated with retinal
whitening, which may be a useful clinical sign in distinguishing malaria from other causes of fever. Splenomegaly, severe headache,
hepatomegaly (enlarged liver), hypoglycemia, and hemoglobinuria with renal failure may occur.
Malaria in pregnant women is an important cause of stillbirths, infant mortality and low birth weight,particularly in P. falciparuminfection, but
also with P. vivax.

Cause
Malaria parasites belong to the genus Plasmodium (phylum Apicomplexa). In humans, malaria is caused by P. falciparum, P. malariae,P. ovale,
P. vivax and P. knowlesi.Among those infected, P. falciparum is the most common species identified (~75%) followed by P. vivax (~20%).
Although P. falciparum traditionally accounts for the majority of deaths,recent evidence suggests thatP. vivax malaria is associated with
potentially life-threatening conditions about as often as with a diagnosis of P. falciparuminfection.P. vivax proportionally is more common
outside of Africa.There have been documented human infections with several species of Plasmodium from higher apes; however, with the
exception of P. knowlesia zoonotic species that causes malaria inmacaquesthese are mostly of limited public health importance.

Life cycle
The life cycle of malaria parasites: A mosquito causes infection by taking a blood meal. First, sporozoites enter the bloodstream, and migrate to
the liver. They infect liver cells, where they multiply into merozoites, rupture the liver cells, and return to the bloodstream. Then, the
merozoites infect red blood cells, where they develop into ring forms, trophozoites and schizonts that in turn produce further merozoites.
Sexual forms are also produced, which, if taken up by a mosquito, will infect the insect and continue the life cycle.
In the life cycle of Plasmodium, a female Anopheles mosquito (the definitive host) transmits a motile infective form (called the sporozoite) to a
vertebrate host such as a human (the secondary host), thus acting as a transmission vector. A sporozoite travels through the blood vessels to
liver cells (hepatocytes), where it reproduces asexually (tissueschizogony), producing thousands of merozoites. These infect new red blood cells
and initiate a series of asexual multiplication cycles (blood schizogony) that produce 8 to 24 new infective merozoites, at which point the cells
burst and the infective cycle begins anew.Other merozoites develop into immature gametes, or gametocytes. When a fertilised mosquito bites
an infected person, gametocytes are taken up with the blood and mature in the mosquito gut. The male and female gametocytes fuse and form
zygotes (ookinetes), which develop into new sporozoites. The sporozoites migrate to the insect's salivary glands, ready to infect a new
vertebrate host. The sporozoites are injected into the skin, alongside saliva, when the mosquito takes a subsequent blood meal.
Only female mosquitoes feed on blood; male mosquitoes feed on plant nectar, and thus do not transmit the disease. The females of
theAnopheles genus of mosquito prefer to feed at night. They usually start searching for a meal at dusk, and will continue throughout the night
until taking a meal.Malaria parasites can also be transmitted by blood transfusions, although this is rare.

Recurrent malaria
Symptoms of malaria can reappear (recur) after varying symptom-free periods. Depending upon the cause, recurrence can be classified as
either recrudescence, relapse, or reinfection. Recrudescence is when symptoms return after a symptom-free period. It is caused by parasites
surviving in the blood as a result of inadequate or ineffective treatment. Relapse is when symptoms reappear after the parasites have been
eliminated from blood but persist as dormant hypnozoites in liver cells. Relapse commonly occurs between 824 weeks and is commonly seen
with P. vivax and P. ovale infections. P. vivax malaria cases in temperate areas often involveoverwintering by hypnozoites, with relapses
beginning the year after the mosquito bite. Reinfection means the parasite that caused the past infection was eliminated from the body but a
new parasite was introduced. Reinfection cannot readily be distinguished from recrudescence, although recurrence of infection within two
weeks of treatment for the initial infection is typically attributed to treatment failure.

Pathogenesis

Malaria infection develops via two phases: one that involves the liver (exoerythrocytic phase), and one that involves red blood cells, or
erythrocytes (erythrocytic phase). When an infected mosquito pierces a person's skin to take a blood meal, sporozoites in the mosquito's saliva
enter the bloodstream and migrate to the liver where they infect hepatocytes, multiplying asexually and asymptomatically for a period of 830
days.
After a potential dormant period in the liver, these organisms differentiate to yield thousands of merozoites, which, following rupture of their
host cells, escape into the blood and infect red blood cells to begin the erythrocytic stage of the life cycle.The parasite escapes from the liver
undetected by wrapping itself in the cell membrane of the infected host liver cell.
Within the red blood cells, the parasites multiply further, again asexually, periodically breaking out of their host cells to invade fresh red blood
cells. Several such amplification cycles occur. Thus, classical descriptions of waves of fever arise from simultaneous waves of merozoites
escaping and infecting red blood cells.
Some P. vivax sporozoites do not immediately develop into exoerythrocytic-phase merozoites, but instead produce hypnozoites that remain
dormant for periods ranging from several months (710 months is typical) to several years. After a period of dormancy, they reactivate and
produce merozoites. Hypnozoites are responsible for long incubation and late relapses in P. vivax infections, although their existence in P. ovale
is uncertain.
Micrograph of a placenta from a stillbirthdue to maternal malaria. H&E stain. Red blood cells are anuclear; blue/black staining in bright red
structures (red blood cells) indicate foreign nuclei from the parasites
The parasite is relatively protected from attack by the body's immune system because for most of its human life cycle it resides within the liver
and blood cells and is relatively invisible to immune surveillance. However, circulating infected blood cells are destroyed in thespleen. To avoid
this fate, the P. falciparum parasite displays adhesive proteins on the surface of the infected blood cells, causing the blood cells to stick to the
walls of small blood vessels, thereby sequestering the parasite from passage through the general circulation and the spleen.The blockage of the
microvasculature causes symptoms such as in placental malaria.Sequestered red blood cells can breach the bloodbrain barrierand cause
cerebral malaria.
Although the red blood cell surface adhesive proteins (called PfEMP1, for P. falciparumerythrocyte membrane protein are exposed to the
immune system, they do not serve as good immune targets because of their extreme diversity; there are at least 60 variations of the protein
within a single parasite and even more variants within whole parasite populations. The parasite switches through a broad repertoire of PfEMP1
surface proteins, thereby avoiding detection by protective antibodies.

Genetic resistance
Due to the high levels of mortality and morbidity caused by malariaespecially the P. falciparum speciesit has placed the greatestselective
pressure on the human genome in recent history. Several genetic factors provide some resistance to it including sickle cell trait, thalassaemia
traits, glucose-6-phosphate dehydrogenase deficiency, and the absence of Duffy antigens on red blood cells.
The impact of sickle cell trait on malaria immunity is of particular interest. Sickle cell trait causes a defect in the hemoglobin molecule in the
blood. Instead of retaining the biconcave shape of a normal red blood cell, the modified hemoglobin S molecule causes the cell to sickle or
distort into a curved shape. Due to the sickle shape, the molecule is not as effective in taking or releasing oxygen. Infection causes red cells to
sickle more, and so they are removed from circulation sooner. This reduces the frequency with which malaria parasites complete their life cycle
in the cell. Individuals who are homozygous (with two copies of the abnormal hemoglobin beta allele) have sickle-cell anaemia, while those who
are heterozygous (with one abnormal allele and one normal allele) experience resistance to malaria. Although the shorter life expectancy for
those with the homozygous condition seems to be unfavourable to the trait's survival, the trait is preserved because of the benefits provided by
the heterozygous form.

Malarial hepatopathy
Liver dysfunction as a result of malaria is rare and is usually a result of a coexisting liver condition such as viral hepatitis or chronic liver disease.
The syndrome is sometimes called malarial hepatitis, although inflammation of the liver (hepatitis) does not actually occur. While traditionally
considered a rare occurrence, malarial hepatopathy has seen an increase, particularly in Southeast Asia and India. Liver compromise in people
with malaria correlates with a greater likelihood of complications and death.

Diagnosis
Malaria is usually diagnosed by the microscopic examination of blood films (gold standard )or by antigen-based rapid diagnostic tests (RDT).
Microscopy is the most commonly used method to detect the malarial parasiteabout 165 million blood films were examined for malaria in
2010.Despite its widespread usage, diagnosis by microscopy suffers from two main drawbacks: many settings (especially rural) are not
equipped to perform the test, and the accuracy of the results depends on both the skill of the person examining the blood film and the levels of
the parasite in the blood. The sensitivity of blood films ranges from 7590% in optimum conditions, to as low as 50%. Commercially available
RDTs are often more accurate than blood films at predicting the presence of malaria parasites, but they are widely variable in diagnostic
sensitivity and specificity depending on manufacturer, and are unable to tell how many parasites are present.

In regions where laboratory tests are readily available, malaria should be suspected, and tested for, in any unwell patient who has been in an
area where malaria is endemic. In areas that cannot afford laboratory diagnostic tests, it has become routine to use only a history of subjective
fever as the indication to treat for malariaa presumptive approach exemplified by the common teaching "fever equals malaria unless proven
otherwise". The drawback of this practice, however, is overdiagnosis of malaria and mismanagement of non-malarial fever, which wastes
limited resources, erodes confidence in the health care system, and contributes to drug resistance.[39]Although polymerase chain reactionbased tests have been developed, these are not widely implemented in malaria-endemic regions as of 2012, due to their complexity.

Classification
Malaria is classified into either "severe" or "uncomplicated" by the World Health Organization (WHO).[3] Malaria is diagnosed as severe when
any of the following criteria are present, otherwise it is considered uncomplicated.[40]

Decreased consciousness

Kidney failure or hemoglobin in the urine

walk

Significant weakness such that the person is unable to

Bleeding problems, or hemoglobin less than 5 g/dL

Pulmonary edema

Inability to feed

Blood glucose less than 2.2 mmol/L (or 40 mg/dL)

Two or more convulsions

Acidosis or lactate levels of greater than 5 mmol/L

Low blood pressure (less than 70 mmHg in adults or 50

mmHg in children)

Breathing problems

A parasite level in the blood of greater than 100,000

per microlitre (L) in low-intensity transmission areas, or 250,000
per L in high-intensity transmission areas

Circulatory shock
According to the WHO, cerebral malaria is defined as a severe P. falciparum-malaria presenting neurological symptoms, including coma (with a
Glasgow coma scale rating of greater than 11, or a Blantyre coma scale greater than 3), or with a coma that lasts longer than 30 minutes after a
seizure.

Prevention
#An Anopheles stephensi mosquito shortly after obtaining blood from a human (the droplet of blood is expelled as a surplus). This mosquito is
a vector of malaria, and mosquito control is an effective way of reducing its incidence.
Methods used to prevent malaria include medications, mosquito elimination and the prevention of bites. The presence of malaria in an area
requires a combination of high human population density, high mosquito population density and high rates of transmission from humans to
mosquitoes and from mosquitoes to humans. If any of these is lowered sufficiently, the parasite will eventually disappear from that area, as
happened in North America, Europe and much of the Middle East. However, unless the parasite is eliminated from the whole world, it could
become re-established if conditions revert to a combination that favours the parasite's reproduction.
Many researchers argue that prevention of malaria may be more cost-effective than treatment of the disease in the long run, but the capital
costs required are out of reach of many of the world's poorest people. There is a wide disparity in the costs of control (i.e. maintenance of low
endemicity) and elimination programs between countries. For example, in Chinawhose government in 2010 announced a strategy to pursue
malaria elimination in the Chinese provincesthe required investment is a small proportion of public expenditure on health. In contrast, a
similar program in Tanzania would cost an estimated one-fifth of the public health budget.

Vector control
Walls where indoor residual spraying of
DDT(dichlorodiphenyltrichloroethane is an organochlorine
insecticide which is a colorless, crystalline solid, tasteless and
almost odorless chemical compound) has been applied. The
mosquitoes remain on the wall until they fall down dead on the
floor.

Vector control refers to preventative methods used to decrease malaria and morbidity and mortality by reducing the levels of transmission. For
individual protection, the most effective chemical insect repellents to reduce human-mosquito contact are those based on DEET andpicaridin.

Insecticide-treated mosquito nets (ITNs) and indoor residual spraying (IRS) have been shown to be highly effective vector control interventions
in preventing malaria morbidity and mortality among children in malaria-endemic settings. IRS is the practice of spraying insecticides on the
interior walls of homes in malaria-affected areas. After feeding, many mosquito species rest on a nearby surface while digesting the bloodmeal,
so if the walls of dwellings have been coated with insecticides, the resting mosquitoes can be killed before they can bite another victim and
transfer the malaria parasite. As of 2006, the World Health Organization advises the use of 12 insecticides in IRS operations, includingDDT and
the pyrethroids cyfluthrin and deltamethrin). This public health use of small amounts of DDT is permitted under the Stockholm Convention on
Persistent Organic Pollutants (POPs), which prohibits the agricultural use of DDT.[49]
One problem with all forms of IRS is insecticide resistance via evolution. Mosquitoes that are affected by IRS tend to rest and live indoors, and
due to the irritation caused by spraying, their descendants tend to rest and live outdoors, meaning that they are not as affectedif affected at
allby the IRS, which greatly reduces its effectiveness as a defense mechanism.
Mosquito nets help keep mosquitoes away from people and significantly reduce infection rates and transmission of malaria. The nets are not a
perfect barrier and they are often treated with an insecticide designed to kill the mosquito before it has time to search for a way past the net.
Insecticide-treated nets are estimated to be twice as effective as untreated nets and offer greater than 70% protection compared with no
net.Between 2000 and 2008, the use of ITNs saved the lives of an estimated 250,000 infants in Sub-Saharan Africa.Although ITNs prevent
malaria, only about 13% of households in Sub-Saharan countries own them. A recommended practice for usage is to hang a large "bed net"
above the center of a bed to drape over it completely with the edges tucked in. Pyrethroid-treated nets and long-lasting insecticide-treated
nets offer the best personal protection, and are most effective when used from dusk to dawn.

Other methods
Community participation and health education strategies promoting awareness of malaria and the importance of control measures have been
successfully used to reduce the incidence of malaria in some areas of the developing world.Recognizing the disease in the early stages can stop
the disease from becoming fatal. Education can also inform people to cover over areas of stagnant, still water, such as water tanks that are
ideal breeding grounds for the parasite and mosquito, thus cutting down the risk of the transmission between people. This is generally used in
urban areas where there are large centers of population in a confined space and transmission would be most likely in these areas. Intermittent
preventive therapy is another intervention that has been used successfully to control malaria in pregnant women and infants, and in preschool
children where transmission is seasonal.

Medications
Several drugs, most of which are used for treatment of malaria, can be taken to prevent contracting the disease during travel to endemic areas.
Chloroquine may be used where the parasite is still sensitive.[59] However, due to resistance one of three medicationsmefloquine (Lariam),
doxycycline (available generically), or the combination of atovaquone and proguanil hydrochloride (Malarone)is frequently needed.
Doxycycline and the atovaquone and proguanil combination are the best tolerated; mefloquine is associated with death, suicide, and higher
rates of neurological and psychiatric symptoms.
The prophylactic effect does not begin immediately upon starting the drugs, so people temporarily visiting malaria-endemic areas usually begin
taking the drugs one to two weeks before arriving and should continue taking them for four weeks after leaving (with the exception of
atovaquone proguanil that only needs to be started two days prior and continued for seven days afterwards). Use of prophylactic drugs is
seldom practical for full-time residents of malaria-endemic areas, and their use is usually restricted to short-term visitors and travellers to
malarial regions. This is due to the cost of purchasing the drugs, negative adverse effects from long-term use, and because some effective antimalarial drugs are difficult to obtain outside of wealthy nations. The use of prophylactic drugs where malaria-bearing mosquitoes are present
may encourage the development of partial immunity.

Treatment
The treatment of malaria depends on the severity of the disease. Uncomplicated malaria may be treated with oral medications. The most
effective strategy for P. falciparum infection is the use of artemisinins in combination with other antimalarials (known asartemisinincombination therapy, or ACT), which reduces the ability of the parasite to develop resistance to any single drug component. These additional
antimalarials include amodiaquine, lumefantrine, mefloquine or sulfadoxine/pyrimethamine.Another recommended combination is
dihydroartemisinin and piperaquine. ACT is about 90% effective when used to treat uncomplicated malaria. To treat malaria during pregnancy,
the WHO recommends the use of quinine plus clindamycin early in the pregnancy (1st trimester), and ACT in later stages (2nd and 3rd
trimesters). In the 2000s (decade), malaria with partial resistance to artemisins emerged in Southeast Asia.
Severe malaria requires the parenteral administration of antimalarial drugs. Until the mid-2000s the most used treatment for severe malaria
was quinine, but artesunate has been shown to be superior to quinine in both children and adults. Treatment of severe malaria also involves
supportive measures that are optimally performed in a critical care unit, including management of high fevers (hyperpyrexia) and the
subsequent seizures that may result from it, and monitoring for respiratory depression, hypoglycemia, andhypokalemia. Infection with P. vivax,
P. ovale or P. malariae is usually treated on an outpatient basis (while a person is at home). Treatment of P. vivax requires both treatment of
blood stages (with chloroquine or ACT) as well as clearance of liver forms withprimaquine.

Prognosis

When properly treated, people with malaria can usually expect a complete recovery. However, severe malaria can progress extremely rapidly
and cause death within hours or days. In the most severe cases of the disease, fatality rates can reach 20%, even with intensive care and
treatment. Over the longer term, developmental impairments have been documented in children who have suffered episodes of severe
malaria. Chronic infection without severe disease can occur, a form of acquired immunity where the immune system is also less responsive to
Salmonella and the EpsteinBarr virus.
Malaria causes widespread anemia during a period of rapid brain development, and also direct brain damage. This neurologic damage results
from cerebral malaria to which children are more vulnerable. Some survivors of cerebral malaria have an increased risk of neurological and
cognitive deficits, behavioural disorders, and epilepsy. Malaria prophylaxis was shown to improve cognitive function and school performance in
clinical trials when compared to placebo groups.

Epidemiology
Based on documented cases, the WHO estimates that there were 219 million cases of malaria in 2010 resulting in 660,000 deaths. This is
equivalent to roughly 2000 deaths every day. A 2012 study estimated the number of documented and undocumented deaths in 2010 was 1.24
million. The majority of cases (65%) occur in children under 15 years old. Pregnant women are also especially vulnerable: about 125 million
pregnant women are at risk of infection each year. In Sub-Saharan Africa, maternal malaria is associated with up to 200,000 estimated infant
deaths yearly. There are about 10,000 malaria cases per year in Western Europe, and 13001500 in the United States.About 900 people died
from the disease in Europe between 1993 and 2003. Both the global incidence of disease and resulting mortality have declined in recent years.
According to the WHO, deaths attributable to malaria in 2010 were reduced by over a third from a 2000 estimate of 985,000, largely due to the
widespread use of insecticide-treated nets and artemisinin-based combination therapies.
Malaria is presently endemic in a broad band around the equator, in areas of the Americas, many parts of Asia, and much of Africa; however, it
is in Sub-Saharan Africa where 8590% of malaria fatalities occur. An estimate for 2009 reported that countries with the highest death rate per
100,000 of population were Ivory Coast with 86.15, Angola (56.93) and Burkina Faso (50.66). An estimate for 2010 said the deadliest countries
per population were Burkina Faso, Mozambique and Mali.The Malaria Atlas Project aims to map global endemic levels of malaria, providing a
means with which to determine the global spatial limits of the disease and to assessdisease burden.[83][84] This effort led to the publication of
a map of P. falciparum endemicity in 2010.[85] As of 2010, about 100 countries have endemic malaria. Every year, 125 million international
travellers visit these countries, and more than 30,000 contract the disease.
The geographic distribution of malaria within large regions is complex, and malaria-afflicted and malaria-free areas are often found close to
each other.Malaria is prevalent in tropical and subtropical regions because of rainfall, consistent high temperatures and high humidity, along
with stagnant waters in which mosquito larvae readily mature, providing them with the environment they need for continuous breeding.In
drier areas, outbreaks of malaria have been predicted with reasonable accuracy by mapping rainfall. Malaria is more common in rural areas
than in cities. For example, several cities in the Greater Mekong Subregion of Southeast Asia are essentially malaria-free, but the disease is
prevalent in many rural regions, including along international borders and forest fringes.In contrast, malaria in Africa is present in both rural
and urban areas, though the risk is lower in the larger cities.

KLINIK 1 MALAYSIA
Bertepatan dengan gagasan 1Malaysia Rakyat Didahulukan Pencapaian Diutamakan, 50 buah klinik 1Malaysia telah dibina dengan
peruntukan sebanyak RM10 juta. Klinik 1Malaysia merupakan sebuah projek klinik yang telah dilancarkan oleh Perdana Menteri Malaysia, Dato'
Sri Mohd Najib Tun Abdul Razak di Flet Kampung Kerinchi, Kuala Lumpur pada 7 Januari 2010. Usaha ini merupakan salah satu bukti kerajaan
prihatin dengan golongan berpendapatan rendah .
Sebanyak 48 daripada 50 buah klinik 1Malaysia telah beroperasi. Hanya terdapat 3 hingga 4 klinik ini di setiap negeri. Klinik ini bertujuan
memudahkan penjagaan kesihatan golongan miskin bandar di mana mereka, tidak lagi perlu berkenderaan ke Klinik-klinik Kesihatan yang
jauhnya sehingga 10 kilometer dari rumah.
Klinik 1Malaysia dikendalikan oleh pembantu hospital (HA). Kerajaan membenarkan HA memberikan ubat bagi sakit yang ringan. Antaranya
ialah demam, batuk dan menjalani pemeriksaan darah dan tahap kandungan gula. Bagaimanapun, Klinik ini dipantau oleh Jabatan Kesihatan
bagi memastikan segala kemudahan dan bekalan ubat sentiasa mencukupi. Kes-kes yang di luar bidang perkhidmatan penolong pegawai
perubatan atau kes-kes yang perlu dilihat oleh pegawai perubatan akan dirujuk ke klinik kesihatan atau hospital berdekatan.

OBJEKTIF KLINIK 1MALAYSIA

Menyediakan perkhidmatan rawatan perubatan ringan kepada penduduk setempat.

SKOP PERKHIDMATAN
* Perkhidmatan rawatan ringan seperti demam, batuk, selsema dan penyakit-penyakit ringan yang lain.
* Rawatan susulan kes pesakit kronik yang stabil dan terkawal seperti Diabetes, Darah Tinggi dan Asma.
* Prosedur rawatan ringan seperti mencuci luka dan membuka jahitan
* Membuat notifikasi bagi penyakit berjangkit seperti Demam Denggi.
* Khidmat Nasihat/Pendidikan kesihatan.

MASA OPERASI

Tujuh hari seminggu

10.00 pagi hingga 10.00 malam (termasuk cuti sekolah atau perayaan)

BAYARAN

Warganegara -RM1

Bukan Warganegara - RM15

Senarai Klinik 1 Malaysia:

1.

Klinik 1Malaysia Kangar, Perlis

2.
Klinik 1Malaysia Bandar Puteri Jaya, , Sungai
Petani,Kedah
3.

Klinik 1Malaysia Taman Kota Kenari, Kulim,kedah

4.

Klinik 1Malaysia Jelutong,Pulau Pinang

5.
Pinang

Klinik 1Malaysia Teluk Air Tawar, Butterworth,Pulau

8.
Pinang

Klinik 1Malaysia Alma Jaya, Bukit Mertajam,Pulau

9.

Klinik 1Malaysia Teluk Intan,Perak

10.
Klinik 1Malaysia Bandar Seri Iskandar, Perak
Tengah,Perak
11.

Klinik 1Malaysia Aulong, Taiping,Perak

12.

Klinik 1Malaysia Bercham,Ipoh,Perak

6.
Klinik 1Malaysia Batu Kawan, Seberang Perai
Selatan,Pulau Pinang

13.
Klinik 1Malaysia Lembah Subang, Petaling
Jaya,Selangor

7.

14.

Klinik 1Malaysia Seri Setia, Petaling Jaya,Selangor

15.

Klinik 1Malaysia Puchong Intan,Selangor

Klinik 1Malaysia Sungai Ara, Bayan Lepas,Pulau Pinang

16.

Klinik 1Malaysia Kota Kemuning,Shah Alam,Selangor

33.

Klinik 1Malaysia Taman Seri Lambak, Kluang,Johor

17.

Klinik 1Malaysia Taman Samuder, Batu Caves,Selangor

34.

Klinik 1Malaysia Kempadang, Kuantan,Pahang

18.
Lumpur

Klinik 1Malaysia Perkasa, Kampung Pandan,Kuala

35.

Klinik 1Malaysia Padang Jaya, Kuantan,Pahang

36.

Klinik 1Malaysia Temerloh, Temerloh,Pahang

19.

Klinik 1Malaysia Kerinchi, Lembah Pantai

37.

Klinik 1Malaysia Bukit Payong, Marang,Terengganu

20.

Klinik 1Malaysia Taman Melati,Kuala Lumpur

38.

Klinik 1Malaysia Wakaf Baru, Kuala Terengganu

21.

Klinik 1Malaysia Intan Baiduri,Kuala Lumpur

39.

Klinik 1Malaysia Binjai, Kemaman,Terengganu

22.

Klinik 1Malaysia Desa Rejan, Setapak,Kuala Lumpur

40.

Klinik 1Malaysia Sri CemerlangKota Bharu,Kelantan

23.

Klinik 1Malaysia Taman Rasah Jaya, Negeri Sembilan

41.

Klinik 1Malaysia JelawatBachok,Kelantan

42.

Klinik 1Malaysia Pengkalan Batu, Pasir Mas,kelantan

43.

Klinik 1Malaysia Bandar Sri Indah Tawau, Tawau,Sabah

24.
Klinik 1Malaysia Taman Seremban Jaya, Negeri
Sembilan
25.
Klinik 1Malaysia Taman Semarak 2,Nilai,Negeri
Sembilan

44.

Klinik 1Malaysia Bundusan Square,Sabah

26.
Klinik 1Malaysia Taman Merdeka, Batu Berendam, No
39, Jalan M1, Batu Berendam,Melaka

45.

Klinik 1Malaysia Sandakan,Sabah

27.

Klinik 1Malaysia Bukit Katil, 17,Melaka

46.

Klinik 1Malaysia Kota Kinabalu,Kota Kinabalu,Sabah

28.

Klinik 1Malaysia Sri Pengkalan, Alor Gajah, Melaka

47.

Klinik 1Malaysia Jalan Teku, Sibu,Sarawak

29.

Klinik 1Malaysia Taman Megah Ria Johor

48.

Klinik 1Malaysia Matang Jaya, Kuching,Sarawak

30.

Klinik 1Malaysia Taman Manis, Kulai,Johor

49.

Klinik 1Malaysia Taman Tunku, Miri,Sarawak

31.

Klinik 1Malaysia Stulang Laut, Johor Baru,Johor

50.

Klinik 1Malaysia Sungai Plan, Bintulu,Sarawak

32.

Klinik 1Malaysia Bandar Sri Alam, Johor Baru,Johor

MENTERI-MENTERI DI MALAYSIA

Menteri Pelancongan,

YAB DATO' SRI MOHD. NAJIB BIN TUN HAJI ABDUL RAZAK

YB DATUK SERI HAJI NOH BIN OMAR

Perdana Menteri Merangkap Menteri Kewangan dan

Menteri Pertanian dan Industri Asas Tani,

Menteri Pembangunan Wanita, Keluarga dan Masyarakat,

YB DATO' SERI DR. AHMAD ZAHID BIN HAMIDI

YAB TAN SRI DATO' HAJI MUHYIDDIN BIN MOHD. YASSIN

Menteri Pertahanan,

Timbalan Perdana Menteri Merangkap Menteri Pelajaran,

YB DATO' SERI SHAZIMAN BIN ABU MANSOR

YB SENATOR DATUK SERI PALANIVEL A/L K.GOVINDASAMY

Menteri Kerja Raya,

Menteri di Jabatan Perdana Menteri,

YB DATO' SRI LIOW TIONG LAI

YB DATO' SRI PETER CHIN FAH KUI

Menteri Kesihatan

Menteri Tenaga, Teknologi Hijau dan Air,

YB DATO' SRI AHMAD SHABERY BIN CHEEK

YB SENATOR TAN SRI DR. KOH TSU KOON

Menteri Belia dan Sukan

Menteri di Jabatan Perdana Menteri,

YB DATUK SERI DR. S. SUBRAMANIAM

YB TAN SRI BERNARD GILUK DOMPOK

Menteri Sumber Manusia,

Menteri Perusahaan Perladangan dan Komoditi,

YB DATO' SRI ISMAIL SABRI BIN YAAKOB

YB DATO' SERI MOHAMED NAZRI BIN ABDUL AZIZ

Menteri Perdagangan Dalam Negeri, Koperasi dan Kepenggunaan,

Menteri di Jabatan Perdana Menteri,

YB DATO' SERI AHMAD HUSNI BIN MOHAMAD HANADZLAH

YB DATO' SERI HISHAMMUDDIN BIN TUN HUSSEIN

Menteri Kewangan (II),

Menteri Dalam Negeri,

YB DATO' SERI KONG CHO HA

YB DATO' SERI UTAMA DR. RAIS BIN YATIM

Menteri Pengangkutan,

Menteri Penerangan, Komunikasi dan Kebudayaan,

YB DATO' SRI ANIFAH BIN AMAN

YB TAN SRI NOR MOHAMED BIN YAKCOP

Menteri Luar Negeri,

Menteri di Jabatan Perdana Menteri,

YB SENATOR DATO' RAJA NONG CHIK BIN DATO' RAJA ZAINAL

ABIDIN

YB DATO' SERI HJ. MOHD SHAFIE BIN HJ. APDAL

Menteri Kemajuan Luar Bandar dan Wilayah,

Menteri Wilayah Persekutuan Dan Kesejahteraan Bandar,

YB DATO' SERI MOHAMED KHALED BIN NORDIN

YB SENATOR MEJAR JENERAL DATO' SERI JAMIL KHIR BIN

BAHAROM (B)

Menteri Pengajian Tinggi,

Menteri di Jabatan Perdana Menteri,

YB DATO' SRI MUSTAPA BIN MOHAMED

YB SENATOR DATO' SRI IDRIS JALA

Menteri Perdagangan Antarabangsa dan Industri,

Menteri di Jabatan Perdana Menteri,

YB DATUK SERI PANGLIMA DR. MAXIMUS JOHNITY ONGKILI

YB DATO' SERI CHOR CHEE HEUNG

Menteri Sains, Teknologi dan Inovasi,

Menteri Perumahan dan Kerajaan Tempatan,

YB DATO SRI DOUGLAS UGGAH EMBAS

Menteri Sumber Asli dan Alam Sekitar,
YB DATO' SRI DR. NG YEN YEN

SENARAI NAMA TIMBALAN MENTERI

YB TAN SRI DATUK SERI PANGLIMA JOSEPH KURUP
Timbalan Menteri Sumber Asli dan Alam Sekitar,
YB DATUK LIEW VUI KEONG
Timbalan Menteri di Jabatan Perdana Menteri,

Timbalan Menteri Perdagangan Dalam Negeri, Koperasi dan

Kepenggunaan,
YB DATO' DEVAMANY A/L S. KRISHNASAMY
Timbalan Menteri di Jabatan Perdana Menteri,
YB DATUK SARAVANAN A/L MURUGAN

YB DATUK DR. HAJI ABD. LATIFF BIN AHMAD

Timbalan Menteri Wilayah Persekutuan Dan Kesejahteraan

Bandar,

Timbalan Menteri Pertahanan,

YB SENATOR TUAN A. KOHILAN PILLAY A/L G. APPU

YB DATO' JOSEPH SALANG ANAK GANDUM

Timbalan Menteri Luar Negeri,

Timbalan Menteri Penerangan, Komunikasi dan Kebudayaan,

YB DATO' DR. HOU KOK CHUNG

YB DATUK JOSEPH ENTULU ANAK BELAUN

Timbalan Menteri Pengajian Tinggi,

Timbalan Menteri Kemajuan Luar Bandar dan Wilayah,

YB DATO' HAMZAH BIN ZAINUDIN

YB DATO' WIRA MOHD. JOHARI BIN BAHARUM

Timbalan Menteri Perusahaan Perladangan dan Komoditi,

Timbalan Menteri Pertanian dan Industri Asas Tani,

YB DATO' SAIFUDDIN BIN ABDULLAH

YB DATUK WIRA ABU SEMAN BIN HAJI YUSOP

Timbalan Menteri Pengajian Tinggi,

Timbalan Menteri Dalam Negeri,

YB DATO' HASAN BIN MALEK

YB SENATOR DATO' DR. MASHITAH BINTI IBRAHIM

Timbalan Menteri Kemajuan Luar Bandar dan Wilayah,

Timbalan Menteri di Jabatan Perdana Menteri,

YB SENATOR DATO' MAZNAH BINTI MAZLAN

YB DATO' YONG KHOON SENG

Timbalan Menteri Sumber Manusia,

Timbalan Menteri Kerja Raya,

YB DATUK ABD RAHIM BIN BAKRI

YB DATUK HAJAH ROHANI BINTI ABDUL KARIM

Timbalan Menteri Pengangkutan,

Timbalan Menteri Perdagangan Dalam Negeri, Koperasi dan

Kepenggunaan,

YB SENATOR DATO' DR. AWANG ADEK HUSSEIN

YB DATO' NORIAH BINTI KASNON

Timbalan Menteri Kewangan,

YB DATUK ROSNAH BINTI HAJI ABDUL RASHID SHIRLIN

Timbalan Menteri Pembangunan Wanita, Keluarga dan

Masyarakat,

Timbalan Menteri Kesihatan,

YB DATO JACOB DUNGAU SAGAN

YB DR. HAJI MOHD PUAD BIN ZARKASHI

Timbalan Menteri Perdagangan Antarabangsa dan Industri,

Timbalan Menteri Pelajaran,

YB DATUK IR. DR. WEE KA SIONG

YB DATO' RAZALI HJ. IBRAHIM

Timbalan Menteri Pelajaran,

Timbalan Menteri Belia dan Sukan,

YB TUAN JELAING ANAK MERSAT

YB DATO' MUKHRIZ BIN TUN DR. MAHATHIR

Timbalan Menteri Pengangkutan,

Timbalan Menteri Perdagangan Antarabangsa dan Industri,

YB DATUK HAJI FADILLAH BIN YUSOF

YB DATUK HAJI AHMAD BIN HAJI MASLAN

Timbalan Menteri Sains, Teknologi dan Inovasi,

Timbalan Menteri di Jabatan Perdana Menteri,

YB DATO' TAN LIAN HOE

YB DATO' LEE CHEE LEONG

Timbalan Menteri Dalam Negeri,

YAB TUAN GURU DATO' BENTARA SETIA HAJI NIK ABDUL AZIZ
BIN NIK MAT

YB DATO DR. JAMES DAWOS MAMIT

Menteri Besar Kelantan,
Timbalan Menteri Pelancongan,
YAB DATO' SERI USTAZ AZIZAN BIN ABDUL RAZAK
YB SENATOR DATO' IR. DONALD LIM SIANG CHAI
Menteri Besar Kedah,
Timbalan Menteri Kewangan,
YAB TAN SRI PEHIN SRI HAJI ABDUL TAIB MAHMUD
YB SENATOR DATUK MAGLIN DENNIS D'CRUZ
Ketua Menteri Sarawak,
Timbalan Menteri Penerangan, Komunikasi dan Kebudayaan,
YAB TUAN LIM GUAN ENG
YB SENATOR TUAN GAN PING SIEU
Ketua Menteri Pulau Pinang,
Timbalan Menteri Belia dan Sukan,
YAB DATUK SERI HAJI MOHD. ALI BIN MOHD. RUSTAM
YB DATUK RICHARD RIOT ANAK JAEM
Ketua Menteri Melaka,
Timbalan Menteri Luar Negeri,
YAB DATUK SERI PANGLIMA MUSA BIN HAJI AMAN
YB DATUK CHUA TEE YONG
Ketua Menteri Sabah,
Timbalan Menteri Pertanian dan Industri Asas Tani,

SENARAI NAMA DAN ALAMAT MENTERI BESAR

DAN KETUA MENTERI MENGIKUT SUSUNAN
KEKANANAN RAJA-RAJA DAN TYT YANG DI PERTUA
NEGERI

YAB DATO' SRI DIRAJA HAJI ADNAN BIN HAJI YAAKOB

Menteri Besar Pahang,
YAB DATO' SERI DIRAJA DR. ZAMBRY BIN ABDUL KADIR
Menteri Besar Perak,
YAB DATO' SERI AHMAD BIN SAID
Menteri Besar Terengganu,
YAB DATO' SERI DR. MD. ISA BIN SABU
Menteri Besar Perlis,
YAB TAN SRI DATO' SERI ABDUL KHALID BIN IBRAHIM
Menteri Besar Selangor,
YAB DATO' SERI UTAMA HAJI MOHAMAD BIN HAJI HASAN
Menteri Besar Negeri Sembilan,
YAB DATO' HAJI ABDUL GHANI BIN OTHMAN
Menteri Besar Johor,

MAKLUMAT BERKAITAN KEMENTERIAN KESIHATAN MALAYSIA(KKM)

Objektif kkm
Untuk membantu seseorang individu untuk mencapai dan mengekalkan satu taraf kesihatan bagi membolehkannya menjalankan kehidupan
ekonomi dan sosial yang produktif
Ini boleh dicapai dengan menyediakan perkhidmatan bercorak penggalakan, pencegahan, rawatan dan pemulihan yang cekap, sesuai dan
berkesan dengan memberi penekanan kepada golongan-golongan yang kurang bernasib baik.

Visi dan Misi

VISI:Negara menggembleng tenaga ke arah kesihatan yang lebih baik.
MISI:Misi Kementerian Kesihatan adalah untuk menerajui dan berusaha bersama-sama:
i. untuk memudahkan dan membolehkan rakyat:

mencapai sepenuhnya potensi mereka dalam kesihatan

menghargai kesihatan sebagai aset paling berharga
mengambil tanggungjawab dan tindakan positif demi kesihatan mereka

ii. untuk memastikan sistem kesihatan berkualiti tinggi iaitu:

mengutamakan pelanggan
saksama
tidak membebankan
cekap
wajar mengikut teknologi
boleh disesuaikan mengikut persekitaran
inovatif

iii. dengan menekankan:

sifat penyayang, profesionalisme dan kerja berpasukan

sifat menghormati maruah insan
penglibatan masyarakat

Budaya Korporat

LOGO
MOTO
Kami Sedia Membantu
Kami - Semua anggota Kementerian Kesihatan Malaysia bekerja sebagai satu pasukan untuk mencapai matlamat yang sama.
Sedia - Sentiasa bersiap sedia untuk memberi perkhidmatan secara profesional.

Membantu - Ikhlas semasa memberi bantuan dan menjalankan tugas.

NILAI-NILAI TERAS
Penyayang
Kami komited untuk menerima pelanggan dengan sikap ramah mesra dan penuh perhatian. Kami bersedia memberi layanan dengan bersopan
santun, responsif dan menghormati hak individu. Kami bertanggungjawab memberi perkhidmatan yang mesra pelanggan.
Profesionalisme
Kami komited untuk memberi perkhidmatan yang terbaik merangkumi etika dan taraf kerja yang dikehendaki serta prinsip anggota yang
bertanggungjawab. Kami percaya dalam memberikan perkhidmatan cemerlang dan sentiasa bersedia memenuhi harapan masyarakat.
Kerja Berpasukan
Kami komited untuk bekerja sebagai satu pasukan dengan harmoni bagi mencapai matlamat yang sama.

Bajet 2013 utk kesihatan

Kesihatan Asas Kesejahteraan
Kerajaan akan terus memastikan rakyat dapat menikmati perkhidmatan kesihatan yang memuaskan. Bagi tahun 2013, Kerajaan
memperuntukkan sebanyak 19.3 bilion ringgit untuk perkhidmatan mengurus dan pembangunan.
Pembukaan Klinik 1Malaysia telah mendapat sambutan baik dan memberi manfaat dalam meringankan kos rawatan selain memudahkan akses
bagi mendapatkan rawatan. Justeru, Kerajaan akan memperuntukkan 20 juta ringgit bagi membuka tambahan 70 klinik pada tahun 2013. Klinik
1Malaysia juga akan mula menyediakan perkhidmatan ujian kolesterol dan glukosa serta ujian urin kepada mereka yang memerlukan. Selain itu,
sebanyak 100 juta ringgit akan diperuntukkan untuk membaik pulih 350 klinik di seluruh negara, di samping menambah 150 buah mesin dialisis
di pusat hemodialisis Kerajaan seluruh negara.

Penyakit Tangan, Kaki Dan Mulut (HFMD)

Penyakit HFMD disebabkan oleh virus yang dikenali sebagai enterovirus meliputi Coxsackie Virus A16 (Cox A16) dan Enterovirus 71 (EV 71).
Penularan penyakit/virus HFMD adalah melalui sentuhan langsung dengan cecair hidung, air liur, lepuh (blister) dan najis kanak-kanak yang
dijangkiti serta sentuhan pada permukaan dan alatan permainan yang tercemar dengan virus HFMD. Mereka yang dijangkiti akan menunjukkan
satu atau lebih tanda seperti demam, luka (ulcer) di mulut, ruam atau lepuh di tapak tangan dan kaki. HFMD selalunya menyebabkan jangkitan
ringan dan sembuh dengan sendiri. Namun begitu, segelintir jangkitan HFMD yang disebabkan oleh jangkitan EV71 boleh menyebabkan
komplikasi seperti radang otak dan jantung.
Bagi memastikan keberkesanan langkah-langkah kawalan dan pencegahan yang diambil, Kementerian Kesihatan Malaysia ingin mengingatkan
orang ramai bahawa:
i)
Langkah pencegahan terbaik adalah menjaga kebersihan diri dan persekitaran. Penularan jangkitan HFMD sangat berkait rapat
dengan amalan kebersihan diri dan persekitaran di mana ia mudah berlaku di tempat sesak serta mutu kebersihan yang rendah.

ii)
Ibu bapa atau penjaga perlu membawa kanak-kanak dengan gejala HFMD mendapatkan rawatan dan tidak membawa kanak-kanak
tersebut ke tempat awam termasuk sekolah dan pusat jagaan kanak-kanak.

iii)
Pengurus pusat jagaan kanak-kanak perlu menjalankan aktiviti pembersihan premis dan saringan terhadap kanak-kanak di bawah
jagaan mereka sepertimana yang disarankan dalam Garis Panduan Pengendalian Kanak-Kanak di Taska dan Prasekolah serta Pelan Tindakan
Bersepadu Bagi Mencegah Dan Mengawal Penyakit Tangan, Kaki Dan Mulut.
_____________________________________________________________________________________________
Institut Penyelidikan Perubatan
Kementerian Kesihatan Malaysia
Jalan Pahang 50588
Kuala Lumpur
Institut Penyelidikan Perubatan (IMR)

Institut Penyelidikan Perubatan(IMR) berfungsi sebagai pusat penyelidikan yang menyediakan perkhidmatan diagnostik selain membekalkan
kemahiran dan perkhidmatan konsultasi mengenai masalah kesihatan serta penyakit berjangkit. IMR juga bertindak sebagai Pusat Serantau
SEAMEO-TROPMED bagi Mikrobiologi, Parasitologi dan Entornologi, Pusat Serantau Kesihatan Sedunia (WHO) bagi Penyelidikan dan Latihan
dalam Penyakit-Penyakit Tropika. IMR juga telah menjadi Makmal Rujukan Kebangsaan bagi pelbagai jenis penyakit berjangkit seperti Sindrom
Pernafasan Akut Teruk (SARS) dan selsema burung. Selain itu, IMR menjalankan ujian diagnostik lain seperti ujian bagi demam denggi berdarah,
penyakit tangan, mulut dan kaki (HFMD) dan lain-lain.

Pap Smear
Apakah itu ujian Pap Smear?
merupakan suatu ujian untuk memeriksa kesihatan servik.
Ia boleh menyelamatkan nyawa anda
Ia adalah satu saringan untuk mengesan keadaan pra-kanser (sebelum terjadi) iaitu terdapat sel serviks luar biasa yang boleh mengakibatkan
kanser.
Ia adalah sempena orang yang pertama menjumpai cara ini pada tahun 1940 iaitu DR. GEORGE PAPANICOLAOU.
Ia adalah satu prosidur yang mudah dimana sedikit sel diambil dari servik dan dihantar ke makmal untuk kajian.
Tidak perlu ubat atau bius.
Mengambil masa beberapa minit sahaja.
Adakah ujian itu menyakitkan?
Tidak menyakitkan.
Jika anda merasa tegang semasa prosidur dijalankan, anda mungkin rasa tidak selesa, cuba relak dan tarik nafas panjang.
Siapakah yang harus menjalani ujian tersebut?
Wanita berumur diantara 20 - 65 tahun, mereka yang pernah atau aktif dalam hubungan seksual.
Siapakah yang akan menjalankan ujian tersebut?
Doktor atau jururawat yang terlatih akan menjalankannya.
Apakah yang sebenar berlaku semasa ujian tersebut dilakukan?
Tanggalkan seluar dalam.
Berbaring di atas katil.
Doktor atau jururawat akan memasukkan alat kecil yang dinamakan spekulum ke dalam vagina dengan lembut supaya servik boleh dilihat.
Sejenis kayu 'wooden spatula' dan berus yang kecil 'cytobrush' dimasukkan ke dalam pangkal rahim (keseluruhan servik 360o) untuk
mengambil sedikit sel.
Sampel ini disapu di atas slaid dan dihantar ke makmal untuk diperiksa di bawah mikroskopi dimana lapuran akan dibuat.
Ujian ini mengambil masa beberapa minit sahaja.
Apakah persediaan awal yang patut dilakukan?
Ujian ini tidak dapat dijalankan semasa anda kedatangan haid.
Pastikan dapat tarikh temujanji sebelum atau selepas haid.
Waktu yang sesuai adalah pertengahan atau selepas 10 hari kitaran haid.
Bagaimana dengan hubungan seksual sebelum ujian?
Anda tidak digalakkan melakukan hubungan seks 24 jam sebelum ujian dijalankan kerana ia menyebabkan keputusan yang tidak tepat.
Jangan lakukan 'duoche' atau gunakan spermicid, perancang keluarga, kaedah halangan atau penggunaan jelly 'lubricant' 2 hari sebelum ujian
dijalankan.
Bahan kimia yang terdapat dalam bahan tersebut mungkin boleh memberi kesan kepada kualiti sampel.
Bilakah saya mendapat keputusannya?

Bila anda melakukan ujian tersebut, anda akan diberitahu masa dan tempat untuk mendapatkan keputusan..
Biasanya dalam 3 minggu hingga 3 bulan bergantung kepada beban kerja makmal dan klinik tersebut.
Berapa kerap saya perlu membuat ujian Pap Smear?
Sekiranya anda berumur antara 20 - 65 tahun, pernah atau aktif dalam hubungan seksual, anda digalakkan untuk menjalani ujian ini setiap
tahun selama 2 tahun.
Sekiranya keputusan itu negatif, anda digalakkan mengulangi setiap 3 tahun sekali.
Dimanakah saya boleh mendapatkan ujian tersebut?
Di semua klinik dan hospital kerajaan
Di klinik/hospital swasta
Federation of Family Planning Association Of Malaysia (FFPAM)
Lembaga Penduduk Perancang Keluarga Negara (LPPKN)
Apakah makna keputusan tersebut?
Keputusan yang normal bermaksud tiada keadaan luarbiasa atau masalah yang dikesan.
Keputusan yang luarbiasa bermaksud, anda dan anggota kesihatan perlu berunding untuk rawatan selanjutnya.
Keputusan luarbiasa adalah seperti berikut :

Kesan mikroorganisma atau virus (Jangkitan penyakit kelamin) boleh dikesan pada smear.
Sel-sel itu mungkin berubah akibat jangkitan (perubahan ini sementara dan setempat ('benign' - bukan menunju
Sel-sel di servik mungkin menunjukkan perubahan seperti keadaan pra-kanser (sebelum berlaku kanser).

Apa yang patut dilakukan seterusnya :

Rawatan susulan
Ulangi ujian pap smear dalam 3-6 bulan
Jalani pemeriksaan kolposkopi
Apakah itu kolposkopi?
Satu alat diagnostik yang membolehkan doktor melihat saiz dan kawasan servik yang luarbiasa.
Ia adalah kaca pembesar yang membolehkan kkan kanser supaya doktor melihat dengan jelas perubahan pada servik.
Alat ini tidak dimasukkan ke dalam tubuh badan.
Kurang menyakitkan.
Sesetengah orang merasa tidak selesa.
Sampel tisu biopsy mungkin diambil untuk ujian selanjutnya.
Kawasan itu mungkin dirawat dengan 'electro coagulation', 'laser' atau 'cryosurgery' untuk memusnahkan tisu-tisu yang terlibat.
Apakah persediaan awal yang patut saya lakukan?
Tidak boleh dilakukan semasa kedatangan haid.
Pastikan mendapat tarikh temujanji sebelum atau selepas haid.
Waktu yang sesuai ialah pertengahan atau selepas 10 hari kitaran haid.

TUBERCULOSIS
Overview
Tuberculosis (TB) is caused by a bacterium calledMycobacterium tuberculosis. The bacteria usually attack the lungs, but TB bacteria can attack
any part of the body such as the kidney, spine, and brain. If not treated properly, TB disease can be fatal.
Not everyone infected with TB bacteria becomes sick. As a result, two TB-related conditions exist: latent TB infection and TB disease. Both
latent TB infection and TB disease can be treated. Learn more about the difference between latent TB infection and TB disease.

Treatment of tuberculosis (TB)

Treatment for Latent TB Infection:
People with latent TB infection have TB bacteria in their bodies, but they are not sick because the bacteria are not active. People with latent TB
infection do not have symptoms, and they cannot spread TB bacteria to others. However, if TB bacteria become active in the body and multiply,
the person will go from having latent TB infection to being sick with TB disease. For this reason, people with latent TB infection are often
prescribed treatment to prevent them from developing TB disease. Treatment of latent TB infection is essential for controlling and eliminating
TB in the United States.
Because there are less bacteria in a person with latent TB infection, treatment is much easier.Four regimens are approved for the treatment of
latent TB infection. The medications used to treat latent TB infection include:

isoniazid (INH)

rifapentine (RPT)

rifampin (RIF)
Certain groups of people (such as people with weakened immune systems) are at very high risk of developing TB disease once infected with TB
bacteria. Every effort should be made to begin appropriate treatment and to ensure completion of the entire course of treatment for latent TB
infection.

Treatment for TB Disease

TB bacteria become active (multiplying in the body) if the immune system can't stop them from growing. When TB bacteria are active, this is
called TB disease. TB disease will make a person sick. People with TB disease may spread the bacteria to people with whom they spend many
hours.
TB disease can be treated by taking several drugs for 6 to 9 months. There are 10 drugs currently approved by the U.S. Food and Drug
Administration (FDA) for treating TB. Of the approved drugs, the first-line anti-TB agents that form the core of treatment regimens include:

isoniazid (INH)

ethambutol (EMB)

rifampin (RIF)

pyrazinamide (PZA)

Regimens for treating TB disease have an initial phase of 2 months, followed by a choice of several options for the continuation phase of either
4 or 7 months (total of 6 to 9 months for treatment). Learn more about the continuation phase of treatment.
It is very important that people who have TB disease finish the medicine, taking the drugs exactly as prescribed. If they stop taking the drugs
too soon, they can become sick again; if they do not take the drugs correctly, the TB bacteria that are still alive may become resistant to those
drugs. TB that is resistant to drugs is harder and more expensive to treat.

Treatment Completion
Treatment completion is determined by the number of doses ingested over a given period of time. Although basic TB regimens are broadly
applicable, there are modifications that should be made under special circumstances (such as people with HIV infection, drug resistance,
pregnancy, or treatment of children).

Anesthetic
Not to be confused with aesthetics.
An anesthetic (American English) (or anaesthetic, (Commonwealth English) see spelling differences) is a drug that causesanesthesiareversible
loss of sensation. They contrast with analgesics (painkillers), which relieve pain without eliminating sensation. These drugs are generally
administered to facilitate surgery. A wide variety of drugs are used in modern anesthetic practice. Many are rarely used outside of anesthesia,
although others are used commonly by all disciplines. Anesthetics are categorized into two classes:general anesthetics, which cause a reversible
loss of consciousness, and local anesthetics, which cause a reversible loss of sensation for a limited region of the body while maintaining
consciousness. Combinations of anesthetics are sometimes used for their synergistic and additive therapeutic effects. Adverse effects,
however, may also be increased.

Local anesthetics
Each of the local anesthetics have the suffix "-caine" in their names.

procaine

bupivacaine

amethocaine

levobupivacaine

cocaine

ropivacaine

lidocaine (also known as Lignocaine)

mepivacaine

prilocaine

dibucaine

Local anesthetics are agents that prevent transmission of nerve impulses without causing unconsciousness. They act by binding to fastsodium
channels from within (in an open state). Local anesthetics can be either ester or amide based.
Ester local anesthetics (e.g., procaine, amethocaine, cocaine,benzocaine,tetracaine) are generally unstable in solution and fast-acting, and
allergic reactions are common.
Amide local anesthetics (e.g., lidocaine, prilocaine, bupivicaine, levobupivacaine, ropivacaine, mepivacaine, dibucaine and etidocine) are
generally heat-stable, with a long shelf life (around 2 years). They have a slower onset and longer half-life than ester anesthetics, and are
usually racemic mixtures, with the exception of levobupivacaine (which is S(-) -bupivacaine) and ropivacaine (S(-)-ropivacaine). These agents are
generally used within regional and epidural or spinal techniques, due to their longer duration of action, which provides adequate analgesia for
surgery, labor, and symptomatic relief.
Only preservative-free local anesthetic agents may be injected intrathecally.

General anesthetics
1)Inhaled agents

Desflurane

Methoxyflurane

Enflurane

Nitrous oxide

Halothane

Sevoflurane

Isoflurane

Xenon (rarely used)

Volatile agents are specially formulated organic liquids that evaporate readily into vapors, and are given by inhalation for induction and/or
maintenance of general anesthesia. Nitrous oxide and xenon are gases at room temperature rather than liquids, so they are not considered
volatile agents. The ideal anesthetic vapor or gas should be non-flammable, non-explosive, and lipid-soluble. It should possess low blood gas
solubility, have no end-organ (heart, liver, kidney) toxicity or side-effects, should not be metabolized, and should not be an irritant to the
respiratory pathways of the patient.
No anesthetic agent currently in use meets all these requirements. The agents in widespread current use are isoflurane, desflurane,sevoflurane,
and nitrous oxide. Nitrous oxide is a common adjuvant gas, making it one of the most long-lived drugs still in current use. Because of its low
potency, it cannot produce anesthesia on its own but is frequently combined with other agents. Halothane, an agent introduced in the 1950s,
has been almost completely replaced in modern anesthesia practice by newer agents because of its shortcomings.Partly because of its side
effects, enflurane never gained widespread popularity.

In theory, any inhaled anesthetic agent can be used for induction of general anesthesia. However, most of the halogenated anesthetics are
irritating to the airway, perhaps leading to coughing, laryngospasm and overall difficult inductions. For this reason, the most frequently used
agent for inhalational induction is sevoflurane[citation needed]. All of the volatile agents can be used alone or in combination with other
medications to maintain anesthesia (nitrous oxide is not potent enough to be used as a sole agent).
Volatile agents are frequently compared in terms of potency, which is inversely proportional to the minimum alveolar concentration. Potency is
directly related to lipid solubility. This is known as the Meyer-Overton hypothesis. However, certain pharmacokinetic properties of volatile
agents have become another point of comparison. Most important of those emergence from the anesthetic state upon discontinuing their
administration. In fact, newer volatile agents (e.g., sevoflurane, desflurane) have been popular not due to their potency (minimum alveolar
concentration), but due to their versatility for a faster emergence from anesthesia, thanks to their lower bloodgas partition coefficient.

2)Intravenous agents (non-opioid)

While there are many drugs that can be used intravenously to produce anesthesia or sedation, the most common are:

Barbiturates

Diazepam

Amobarbital (trade name: Amytal)

Lorazepam

Methohexital (trade name: Brevital)

Midazolam

Thiamylal (trade name: Surital)

Etomidate

Ketamine

Propofol

Thiopental (trade name: Penthothal, referred to as

thiopentone in the UK)

Benzodiazepines

The two barbiturates mentioned above, thiopental and methohexital, are ultra-short-acting, and are used to induce and maintain anesthesia.
However, though they produce unconsciousness, they provide no analgesia (pain relief) and must be used with other agents.Benzodiazepines
can be used for sedation before or after surgery and can be used to induce and maintain general anesthesia.When benzodiazepines are used to
induce general anesthesia, midazolam is preferred.Benzodiazepines are also used for sedation during procedures that do not require general
anesthesia.Like barbiturates, benzodiazepines have no pain-relieving properties. Propofol is one of the most commonly used intravenous drugs
employed to induce and maintain general anesthesia.It can also be used for sedation during procedures or in the ICU.Like the other agents
mentioned above, it renders patients unconscious without producing pain relief.[3] Because of its favorable physiological effects, "etomidate
has been primarily used in sick patients".Ketamine is infrequently used in anesthesia because of the unpleasant experiences that sometimes
occur on emergence from anesthesia, which include "vivid dreaming, extracorporeal experiences, and illusions."However, like etomidate it is
frequently used in emergency settings and with sick patients because it produces fewer adverse physiological effects.Unlike the intravenous
anesthetic drugs previously mentioned, ketamine produces profound pain relief, even in doses lower than those that induce general
anesthesia.[3] Also unlike the other anesthetic agents in this section, patients who receive ketamine alone appear to be in a catalepticstate,
unlike other states of anesthesia that resemble normal sleep. Ketamine-anesthetized patients have profound analgesia but keep their eyes
open and maintain many reflexes.
Neonatal and infant neurotoxicity concerns
Concerns have been raised as to the safety of general anesthetics, in particular ketamine and isoflurane in neonates and young children due to
significant neurodegeneration. The risk of neurodegeneration is increased in combination of these agents with nitrous oxide and
benzodiazepines such as midazolam. This has led to the FDA and other bodies to takes steps to investigate these concerns.[5] These concerns
have arisen from animal studies involving rats and non-human primates. Research has found that anesthetics which enhance GABA or block
NMDA can precipitate neuronal cell death. The developing central nervous system is most vulnerable to these potential neurotoxic effects
during the last trimester of pregnancy and shortly after birth[citation needed]. Melatonin, a free oxygen radical scavenger and indirect
antioxidant is known to reduce the toxicity of a range of drugs has been found in a rat study to reduce the neurotoxicity of anesthetic agents to
the early developing brain.[6] Recent research in animals has found that all sedatives and anesthetics cause extensive neurodegeneration in the
developing brain. There is also some evidence in humans that surgery and exposure to anesthetics in the early developmental stages causes
persisting learning deficits.

3)Intravenous opioid analgesic agents

While opioids can produce unconsciousness, they do so unreliably and with significant side effects.So, while they are rarely used to induce
anesthesia, they are frequently used along with other agents such as intravenous non-opioid anesthetics or inhalational anesthetics.
Furthermore, they are used to relieve pain of patients before, during, or after surgery. The following opioids have short onset and duration of
action and are frequently used during general anesthesia:

Alfentanil

Fentanyl

Remifentanil

Levorphanol

Sufentanil (Not available in the UK)

Meperidine, also called pethidine in the UK, New

Zealand, Australia and other countries

The following agents have longer onset and duration of action and
are frequently used for post-operative pain relief:

Methadone

Buprenorphine

Morphine

Butorphanol

Nalbuphine

Oxycodone, (not available intravenously in U.S.)

Oxymorphone

Pentazocine

Diamorphine, (diacetyl morphine, also known as

heroin, not available in U.S.)

Hydromorphone

Muscle relaxants
@ Neuromuscular blocking drugs
Muscle relaxants do not render patients unconscious or relieve pain. Instead, they are sometimes used after a patient is rendered unconscious
(induction of anesthesia) to facilitate intubation or surgery by paralyzing skeletal muscle.

Depolarizing muscle relaxants

Rocuronium

Succinylcholine (also known as suxamethonium in the

UK, New Zealand, Australia and other countries, "Celokurin" or
"celo" for short in Europe)

Vecuronium

Long acting

Decamethonium

Alcuronium

Non-depolarizing muscle relaxants

Doxacurium

Short acting

Gallamine

Mivacurium

Metocurine

Rapacuronium

Pancuronium

Intermediate acting

Pipecuronium

Atracurium

Tubocurarine

Cisatracurium

Adverse effects
1)Depolarizing Muscle Relaxants i.e. Suxamethonium
Hyperkalemia A small rise of 0.5 mmol/l occurs normally, this is of little consequence unless potassium is already raised such as in renal
failure
Hyperkalemia Exaggerated potassium release in burn patients (occurs from 24 hours after injury, lasting for up to 2 years), neuromuscular
disease and paralyzed (quadraplegic, paraplegic) patients. The mechanism is reported to be through upregulation of acetylcholine receptors in
those patient populations with increased efflux of potassium from inside muscle cells. May cause life threatening arrhythmia
Muscle aches, commoner in young muscular patients who mobilize soon after surgery
Bradycardia, especially if repeat doses are given
Malignant hyperthermia, a potentially life threatening condition in susceptible patients

Suxamethonium Apnea, a rare genetic condition leading to prolonged duration of neuromuscular blockade, this can range from 20 minutes to
a number of hours. Not dangerous as long as it is recognized and the patient remains intubated and sedated, there is the potential for
awareness if this does not occur.
Anaphylaxis
2)Non-depolarizing Muscle Relaxants
Histamine release e.g. Atracurium & Mivacurium
Anaphylaxis
Another potentially disturbing complication where neuromuscular blockade is employed is 'anesthesia awareness'. In this situation, patients
paralyzed may awaken during their anesthesia, due to an inappropriate decrease in the level of drugs providing sedation and/or pain relief. If
this fact is missed by the anesthesia provider, the patient may be aware of his surroundings, but be incapable of moving or communicating that
fact. Neurological monitors are increasingly available that may help decrease the incidence of awareness. Most of these monitors use
proprietary algorithms monitoring brain activity via evoked potentials. Despite the widespread marketing of these devices many case reports
exist in which awareness under anesthesia has occurred despite apparently adequate anesthesia as measured by the neurologic
monitor.[citation needed]

Intravenous reversal agents

Flumazenil, reverses the effects of benzodiazepines

Naloxone, reverses the effects of opioids

Neostigmine, helps reverse the effects of non-depolarizing muscle relaxants

Sugammadex, new agent that is designed to bind Rocuronium therefore terminating its action

HIV
What are HIV and AIDS?
HIV is the human immunodeficiencyvirus. It is the virus that can lead toacquired immune deficiencysyndrome, or AIDS. CDC estimates that
about 56,000 people in the United States contracted HIV in 2006.
There are two types of HIV, HIV-1 and HIV-2. In the United States, unless otherwise noted, the term HIV primarily refers to HIV-1.
Both types of HIV damage a persons body by destroying specific blood cells, called CD4+ T cells, which are crucial to helping the body fight
diseases.
Within a few weeks of being infected with HIV, some people develop flu-like symptoms that last for a week or two, but others have no
symptoms at all. People living with HIV may appear and feel healthy for several years. However, even if they feel healthy, HIV is still affecting
their bodies. All people with HIV should be seen on a regular basis by a health care provider experienced with treating HIV infection. Many
people with HIV, including those who feel healthy, can benefit greatly from current medications used to treat HIV infection. These medications
can limit or slow down the destruction of the immune system, improve the health of people living with HIV, and may reduce their ability to
transmit HIV. Untreated early HIV infection is also associated with many diseases including cardiovascular disease, kidney disease, liver disease,
and cancer. Support services are also available to many people with HIV. These services can help people cope with their diagnosis, reduce risk
behavior, and find needed services.
AIDS is the late stage of HIV infection, when a persons immune system is severely damaged and has difficulty fighting diseases and certain
cancers. Before the development of certain medications, people with HIV could progress to AIDS in just a few years. Currently, people can live
much longer - even decades - with HIV before they develop AIDS. This is because of highly active combinations of medications that were
introduced in the mid 1990s.
No one should become complacent about HIV and AIDS. While current medications can dramatically improve the health of people living with
HIV and slow progression from HIV infection to AIDS, existing treatments need to be taken daily for the rest of a persons life, need to be
carefully monitored, and come with costs and potential side effects. At this time, there is no cure for HIV infection. Despite major advances in
diagnosing and treating HIV infection, in 2007, 35,962 cases of AIDS were diagnosed and 14,110 deaths among people living with HIV were
reported in the United States.

Where did HIV come from?

Scientists identified a type of chimpanzee in West Africa as the source of HIV infection in humans. They believe that the chimpanzee version of
the immunodeficiency virus (called simian immunodeficiency virus or SIV) most likely was transmitted to humans and mutated into HIV when
humans hunted these chimpanzees for meat and came into contact with their infected blood. Over decades, the virus slowly spread across
Africa and later into other parts of the world.

HIV-2
In 1986, a second type of HIV, called HIV-2, was isolated from AIDS patients in West Africa. HIV-2 has the same modes of transmission as HIV-1
and is associated with similar opportunistic infections and AIDS. In persons infected with HIV-2, immunodeficiency seems to develop more
slowly and to be milder, and those with HIV-2 are comparatively less infectious early in the course of infection. As the disease advances, HIV-2
infectiousness seems to increase; however, compared with HIV-1, the duration of this increased infectiousness is shorter.
HIV-2 infections are predominantly found in Africa. West African nations with a prevalence of HIV-2 of more than 1% in the general population
are Cape Verde, Cte d'Ivoire (Ivory Coast), Gambia, Guinea-Bissau, Mali, Mauritania, Nigeria, and Sierra Leone. Other West African countries
reporting HIV-2 are Benin, Burkina Faso, Ghana, Guinea, Liberia, Niger, So Tom, Senegal, and Togo. Angola and Mozambique are other
African nations where the prevalence of HIV-2 is more than 1%.
The first case of HIV-2 infection in the United States was diagnosed in 1987. Since then, the Centers for Disease Control and Prevention (CDC)
has worked with state and local health departments to collect demographic, clinical, and laboratory data on persons with HIV-2 infection.

How is HIV spread?

You may have heard rumors or myths about how HIV is transmitted. Learn the facts by reading our questions and answers about HIV
Transmission.

HIV is spread primarily by:

Not using a condom when having sex with a person who has HIV. All unprotected sex with someone who has HIV contains some risk.
However:

Unprotected anal sex is riskier than unprotected vaginal sex.

Among men who have sex with other men, unprotected receptive anal sex is riskier than unprotected insertive anal sex.

Having multiple sex partners or the presence of other sexually transmitted diseases (STDs) can increase the risk of infection during
sex. Unprotected oral sex can also be a risk for HIV transmission, but it is a much lower risk than anal or vaginal sex.

Sharing needles, syringes, rinse water, or other equipment used to prepare illicit drugs for injection.

Being born to an infected motherHIV can be passed from mother to child during pregnancy, birth, or breast-feeding.

Less common modes of transmission include:

Being stuck with an HIV-contaminated needle or other sharp object. This risk pertains mainly to healthcare workers.

Receiving blood transfusions, blood products, or organ/tissue transplants that are contaminated with HIV. This risk is extremely
remote due to the rigorous testing of the U.S. blood supply and donated organs/tissue.

HIV may also be transmitted through unsafe or unsanitary injections or other medical or dental practices. However, the risk is also
remote with current safety standards in the U.S.

Eating food that has been pre-chewed by an HIV-infected person. The contamination occurs when infected blood from a caregivers
mouth mixes with food while chewing. This appears to be a rare occurrence and has only been documented among infants whose caregiver
gave them pre-chewed food.

Being bitten by a person with HIV. Each of the very small number of cases has included severe trauma with extensive tissue damage
and the presence of blood. There is no risk of transmission if the skin is not broken.

Contact between broken skin, wounds, or mucous membranes and HIV-infected blood or blood-contaminated body fluids. These
reports have also been extremely rare.

There is an extremely remote chance that HIV could be transmitted during French or deep, open-mouth kissing with an HIVinfected person if the HIV-infected persons mouth or gums are bleeding.

Tattooing or body piercing present a potential risk of HIV transmission, but no cases of HIV transmission from these activities have
been documented. Only sterile equipment should be used for tattooing or body piercing.

There have been a few documented cases in Europe and North Africa where infants have been infected by unsafe injections and
then transmitted HIV to their mothers through breastfeeding. There have been no documented cases of this mode of transmission in the U.S.
HIV cannot reproduce outside the human body. It is not spread by:

Air or water.

insects.

Insects, including mosquitoes. Studies conducted by CDC researchers and others have shown no evidence of HIV transmission from

Saliva, tears, or sweat. There is no documented case of HIV being transmitted by spitting.

Casual contact like shaking hands or sharing dishes.

Closed-mouth or social kissing.

All reported cases suggesting new or potentially unknown routes of transmission are thoroughly investigated by state and local health
departments with assistance, guidance, and laboratory support from CDC.

How do HIV tests work?

The most commonly used HIV tests detect HIV antibodies the substances the body creates in response to becoming infected with HIV. There
are tests that look for HIV's genetic material or proteins directly; these may also be used to find out if someone has been infected with HIV.
It can take some time for the immune system to produce enough antibodies for the antibody test to detect, and this window period between
infection with HIV and the ability to detect it with antibody tests can vary from person to person. During this time, HIV viral load and the
likelihood of transmitting the virus to sex or needle-sharing partners may be very high. Most people will develop detectable antibodies that can
be detected by the most commonly used tests in the United States within 2 to 8 weeks (the average is 25 days) of their infection. Ninety-seven
percent (97%) of persons will develop detectable antibodies in the first 3 months. Even so, there is a small chance that some individuals will

take longer to develop detectable antibodies. Therefore, a person should consider a follow-up test more than three months after their last
potential exposure to HIV. In extremely rare cases, it can take up to 6 months to develop antibodies to HIV.
Conventional HIV tests are sent to a laboratory for testing, and it can take a week or two before the test results are available. There are also
rapid HIV tests available that can give results in as little as 20 minutes. A positive HIV test result means that a person may have been infected
with HIV. All positive HIV test results, regardless of whether they are from rapid or conventional tests, must be verified by a second
confirmatory HIV test.

How can HIV be prevented?

Because the most common ways HIV is transmitted is through anal or vaginal sex or sharing drug injection equipment with a person infected
with HIV, it is important to take steps to reduce the risks associated with these. They include:

Know your HIV status. Everyone between the ages of 13 and 64 should be tested for HIV at least once. If you are at increased risk for
HIV, you should be tested for HIV at least once a year.

If you have HIV, you can get medical care, treatment, and supportive services to help you stay healthy and reduce your ability to
transmit the virus to others.
If you are pregnant and find that you have HIV, treatments are available to reduce the chance that your baby will have HIV.
Abstain from sexual activity or be in a long-term mutually monogamous relationship with an uninfected partner.

Limit your number of sex partners. The fewer partners you have, the less likely you are to encounter someone who is infected with
HIV or another STD.

Correct and consistent condom use. Latex condoms are highly effective at preventing transmission of HIV and some other sexually
transmitted diseases. Natural or lambskin condoms do not provide sufficient protection against HIV infection.

Get tested and treated for STDs and insist that your partners do too.

Male circumcision has also been shown to reduce the risk of HIV transmission from women to men during vaginal sex.

Do not inject drugs. If you inject drugs, you should get counseling and treatment to stop or reduce your drug use. If you cannot stop
injecting drugs, use clean needles and works when injecting.

Obtain medical treatment immediately if you think you were exposed to HIV. Sometimes, HIV medications can prevent infection if
they are started quickly. This is called post-exposure prophylaxis.

Participate in risk reduction programs. Programs exist to help people make healthy decisions, such as negotiating condom use or
discussing HIV status. Your health department can refer you to programs in your area.

GENERAL PRE-TEST AND POST-TEST INFORMATION

Counseling before and after an HIV test is important because it provides critical information about HIV itself and about the testing process.
While counseling services may not be available in all health care settings, many testing sites do offer these services. If you would like access to
pre-test and post-test counseling, be sure to inquire about the availability of these services at your chosen test site. If they do not have them
readily available, the staff may be able to direct you to alternate service providers who do.

Pre-test counseling sessions generally include the following:

Information about the HIV testwhat it tests for, what it might NOT tell you, and how long it will take you to get your results

Information about how HIV is transmitted and how you can protect yourself from infection

Information about the confidentiality of your test results

A clear, easy-to-understand explanation of what your test results mean

Once the results are available, you will usually be given the results in private and in person. Post-test counseling
generally includes:

Clear communication about what your test result means

HIV prevention counseling, if your results are negative

weeks.

A confirmatory test, called a Western blot test, if your results are positive. The results of that test should be available within 2

IF YOUR HIV TEST IS POSITIVE

Your counselor will discuss what it means to live a healthy life with HIV and how you can keep from infecting others.

Your counselor will also talk about treatments for HIV and can link you to a physician for immediate care. Getting into treatment
quickly is importantit can help you keep your immune system healthy and keep you from progressing to AIDS.

All HIV-positive test results must be reported to your state health department for data tracking. Many states then report data to the
CDC, but no personal information (name, address, etc.) is ever shared when those data are reported.

HIV PRE-TEST AND POST TEST COUNSELING FOR PREGNANT WOMEN

CDC has outlined these recommendations for HIV counseling and testing of pregnant women:

All pregnant women should be tested for HIV as early as possible during pregnancy, and HIV screening should be included in the
routine panel of prenatal screening tests.

Patients should be informed that HIV screening is recommended for all pregnant women and that it will be performed unless they
decline (opt-out screening).

If a pregnant woman declines to be tested for HIV, her healthcare providers should explore and address her reasons for declining
HIV testing.

Pregnant women should receive appropriate health education, including information about HIV and its transmission, as a routine
part of prenatal care.

Access to clinical care, prevention counseling, and support services is essential for women with positive HIV test results.

HIV screening should be repeated in the third trimester of pregnancy for women known to be at high risk for HIV.

Repeat HIV testing in the third trimester is also recommended for all women in areas with higher rates of HIV or AIDS and for
women receiving healthcare in facilities with at least one diagnosed HIV case per 1,000 pregnant women per year.

Non-communicable disease
A non-communicable disease, or NCD, is a medical condition or disease which by definition is non-infectious and non-transmissible among
people. NCDs may be chronic diseases of long duration and slow progression, or they may result in more rapid death such as some types of
sudden stroke. They include autoimmune diseases, heart disease, stroke, many cancers, asthma,diabetes, chronic kidney disease, osteoporosis,
Alzheimer's disease, cataracts, and more. While sometimes (incorrectly) referred to as synonymous with "chronic diseases", NCDs are
distinguished only by their non-infectious cause, not necessarily by their duration. Some chronic diseases of long duration, such as HIV/AIDS,
are caused by transmissible infections. Chronic diseases require chronic care management as do all diseases that are slow to develop and of
long duration.
The World Health Organization (WHO) reports NCDs to be by far the leading cause of mortality in the world, representing over 60% of all
deaths. Out of the 36 million people who died from NCDs in 2005, half were under age 70 and half were women.[1] Of the 57 million global
deaths in 2008, 36 million were due to NCDs.That is approximately 63% of total deaths worldwide. Risk factors such as a person's background,
lifestyle and environment are known to increase the likelihood of certain NCDs. Every year, at least 5 million people die because of tobacco use
and about 2.8 million die from being overweight. High cholesterol accounts for roughly 2.6 million deaths and 7.5 million die because of high
blood pressure. By 2030, deaths due to chronic NCDs are expected to increase to 52 million per year while deaths caused by infectious diseases,
maternal and perinatal conditions and nutritional deficiencies are expected to decline by 7 million per year during the same period.

Causes and risk factors

Risk factors such as a person's background; lifestyle and environment are known to increase the likelihood of certain non-communicable
diseases. They include age, gender, genetics, exposure to air pollution, and behaviours such
The WHO's World Health Report 2002 identified five important risk factors for non-communicable disease in the top ten leading risks to health.
These are raised blood pressure, raised cholesterol, tobacco use, alcohol consumption, and overweight.[5] Other factors associated with higher
risk of NCDs include a person's economic and social conditions, also known as the "social determinants of health."
It has been estimated that if the primary risk factors were eliminated, 80% of the cases of heart disease, stroke and type 2 diabetesand 40% of
cancers could be prevented. Interventions targeting the main risk factors could have a significant impact on reducing the burden of disease
worldwide. Efforts focused on better diet and increased physical activity have been shown to control the prevalence of NCDs.[3]
"Environmental diseases" NCDs include many environmental diseases, covering a broad category of avoidable and unavoidable human health
conditions caused by external factors, such as sunlight, nutrition, pollution, and lifestyle choices. The diseases of affluence are non-infectious
diseases with environmental causes. Examples include:

Many types of cardiovascular disease (CVD)

Lower back pain caused by too little exercise

Chronic obstructive pulmonary disease (COPD) caused

by smoking tobacco

Malnutrition caused by too little food,or eating the

wrong kinds of food(e.g. scurvy from lack of Vitamin C)

Diabetes mellitus type 2

Skin cancer caused by radiation from the sun

Inherited diseases
Genetic disorders are caused by errors in genetic information that produce diseases in the affected people. The origin of these genetic errors
can be:

Spontaneous errors or mutations to the genome:

A change in chromosome numbers, such as Down

syndrome.

fibrosis.

A defect in a gene caused by mutation, such as Cystic

An increase in the amount of genetic information, such

as Chimerism or Heterochromia.

Cystic fibrosis is an example of an inherited disease that is caused by a mutation on a gene. The faulty gene impairs the normal movement of
sodium chloride in and out of cells, which causes the mucus-secreting organs to produce abnormally thick mucus. The gene is recessive,
meaning that a person must have two copies of the faulty gene for them to develop the disease. Cystic fibrosis affects the respiratory, digestive
and reproductive systems, as well as the sweat glands. The mucus secreted is very thick and blocks passageways in the lungs and digestive
tracts. This mucus causes problems with breathing and with the digestion and absorption of nutrients.

Inherited genetic errors from parents:

Dominant genetic diseases, such as Huntingtons, require the inheritance of one erroneous gene to be expressed.
Recessive genetic diseases, such as TaySachs, require the inheritance of two erroneous genes to be expressed.

NCDs and global health

Referred to as a lifestyle disease, because the majority of these diseases are preventable illnesses, the most common causes for noncommunicable diseases (NCD) include tobacco use (smoking), alcohol abuse, poor diets (high consumption of sugar, salt, saturated fats, and
trans fatty acids) and physical inactivity. Currently, NCD kills 36 million people a year, a number that by some estimates is expected to rise by
1724% within the next decade.
Historically, many NCDs were associated with economic development and were so-called a "diseases of the rich".However, with an estimated
80% of the four main types of NCDs cardiovascular diseases, cancers, chronic respiratory diseases and diabetes now occurring in low- and
middle-income countries,and with two-thirds of people who are affected by diabetes now residing in developing nations, NCD can no longer be
considered just a problem affecting affluent societies.[9][10] As previously stated, in 2008 alone, NCD's were the cause of 63% of deaths
worldwide; a number that is expected to rise considerably in the near future if measures are not taken.
If present growth trends are maintained, by 2020, NCDs will attribute to 7 out of every 10 deaths in developing countries, killing 52 million
people annually worldwide by 2030.[10] With statistics such as these, it comes as no surprise that international entities such as the World
Health Organization & World Bank Human Development Network have identified the prevention and control of NCDs as an increasingly
important discussion item on the global health agenda.
Thus, should policy makers and communities mobilize and make prevention and targeted treatment of such diseases a priority, sustainable
measures can be implemented to stagnate (and eventually even reverse) this emerging global health threat. Potential measures currently being
discussed by the World Health Organization-Food and Agriculture Organization includes reducing the levels of salt in foods, limiting
inappropriate marketing of unhealthy foods and non-alcoholic beverages to children, imposing controls on harmful alcohol use, raising taxes on
tobacco, and curbing legislation to curb smoking in public places.

NCDs and the United Nations

The World Health Organization is the specialized agency of the United Nations (UN) that acts as coordinating authority on internationalpublic
health issues, including NCDs. In May 2008, the 193 Member States of the WHO approved a six-year plan to address non-communicable
diseases, especially the rapidly increasing burden in low- and middle-income countries.The plan calls for raising the priority given to NCDs in
international development work.
During the 64th session of the United Nations General Assembly in 2010, a resolution was passed to call for a high-level meeting of the General
Assembly on the prevention and treatment NCDs with the participation of heads of state and government. The resolution also encouraged UN
Member States to address the issue of non-communicable diseases at the 2010 Review Summit for the Millennium Development Goals.
In September 2011, the UN is hosting its first General Assembly Special Summit on the issue of NCDs. Noting that NCDs are the cause of some
35 million deaths each year, the international community is being increasingly called to take important measures for the prevention and control
of non-communicable diseases, and mitigate their impacts on the world population especially on women, who are usually the primary
caregivers.

Global Non-communicable Disease Network

In order to better coordinate efforts around the globe, in 2009 the WHO announced the launch of the Global Non-communicable Disease
Network (NCDnet).NCDnet will consist of leading health organizations and experts from around the world in order to fight against diseases such
as cancer, cardiovascular disease, and diabetes. Ala Alwan, assistant director-general for Non-communicable Diseases and Mental Health at the
WHO, said: "integrating the prevention of non-communicable diseases and injuries into the national and global development agendas is not
only achievable but also a priority for developing countries."

NCD Alliance
The NCD Alliance is a global partnership founded in May 2009 by four international federations representing cardiovascular disease,diabetes,
cancer, and chronic respiratory disease. The NCD Alliance brings together roughly 900 national member associations to fight noncommunicable disease. Long term aims of the Alliance include:
1.

NCD/disease national plans for all

4.

2.

A tobacco free world

5.
Global access to affordable and good quality medicines
and technologies

3.

Improved lifestyles
6.

Strengthened health systems

Human rights for people with NCDs.

Economics of NCDs
Previously, chronic NCDs were considered a problem limited mostly to high income countries, while infectious diseases seemed to affect low
income countries. The burden of disease attributed to NCDs has been estimated at 85% in industrialized nations, 70% in middle income nations,
and nearly 50% in countries with the lowest national incomes.[3] In 2008, chronic NCDs accounted for more than 60% (over 35 million) of the

57 million deaths worldwide. Given the global population distribution, almost 80% of deaths due to chronic NCDs worldwide now occur in low
and middle income countries, while only 20% occur in higher income countries.
National economies are reportedly suffering significant losses because of premature deaths or inability to work resulting from heart disease,
stroke and diabetes. For instance, China is expected to lose roughly $558 billion in national income between 2005 and 2015 due to early deaths.
In 2005, heart disease, stroke and diabetes caused an estimated loss in international dollars of national income of 9 billion in India and 3 billion
in Brazil.

Absenteeism and presenteeism

The burden of chronic NCDs including mental health conditions is felt in workplaces around the world, notably due to elevated levels
ofabsenteeism, or absence from work because of illness, and presenteeism, or productivity lost from staff coming to work and performing
below normal standards due to poor health. For example, the United Kingdom experienced a loss of about 175 million days in 2006 to absence
from illness among a working population of 37.7 million people. The estimated cost of absences due to illness was over 20 billion pounds in the
same year. The cost due to presenteeism is likely even larger, although methods of analyzing the economic impacts of presenteeism are still
being developed. Methods for analyzing the distinct workplace impacts of NCDs versus other types of health conditions are also still being
developed.

Cancer
For the vast majority of cancers, risk factors are environmental or lifestyle-related, thus cancers are mostly preventable NCD.Greater than 30%
of cancer is preventable via avoiding risk factors including: tobacco, being overweight or obesity, low fruit and vegetable intake, physical
inactivity, alcohol, sexually transmitted infections, and air pollution. Infectious agents are responsible for some cancers, for instance almost all
cervical cancers are caused by human papillomavirus infection.

Cardiovascular disease
The first studies on cardiovascular health were performed in 1949 by Jerry Morris using occupational health data and were published in
1958.[20] The causes, prevention, and/or treatment of all forms of cardiovascular disease remain active fields of biomedical research, with
hundreds of scientific studies being published on a weekly basis. A trend has emerged, particularly in the early 2000s, in which numerous
studies have revealed a link between fast food and an increase in heart disease. These studies include those conducted by the Ryan Mackey
Memorial Research Institute, Harvard University and the Sydney Center for Cardiovascular Health. Many major fast food chains, particularly
McDonald's, have protested the methods used in these studies and have responded with healthier menu options.
A fairly recent emphasis is on the link between low-grade inflammation that hallmarks atherosclerosis and its possible interventions. C-reactive
protein (CRP) is a common inflammatory marker that has been found to be present in increased levels in patients at risk for cardiovascular
disease. Also osteoprotegerin which involved with regulation of a key inflammatory transcription factor called NF-Bhas been found to be a risk
factor of cardiovascular disease and mortality.

Diabetes
Type 2 Diabetes Mellitus is an NCD which is largely preventable and manageable but difficult to cure. Management concentrates on keeping
blood sugar levels as close to normal ("euglycemia") as possible without presenting undue patient danger. This can usually be with close dietary
management, exercise, and use of appropriate medications (insulin only in the case of type 1 diabetes mellitus. Oral medications may be used
in the case of type 2 diabetes, as well as insulin).
Patient education, understanding, and participation is vital since the complications of diabetes are far less common and less severe in people
who have well-managed blood sugar levels.[24][25] Wider health problems may accelerate the deleterious effects of diabetes. These include
smoking, elevated cholesterol levels, obesity, high blood pressure, and lack of regular exercise.

Chronic kidney disease

Although chronic kidney disease (CKD) is not currently identified as one of WHO's main targets for global NCD control, there is compelling
evidence that CKD is not only common, harmful and treatable but also a major contributing factor to the incidence and outcomes of at least
three of the diseases targeted by WHO (diabetes, hypertension and CVD).[26] CKD strongly predisposes to hypertension and CVD; diabetes,
hypertension and CVD are all major causes of CKD; and major risk factors for diabetes, hypertension and CVD (such as obesity and smoking)
also cause or exacerbate CKD. In addition, among people with diabetes, hypertension, or CVD, the subset who also have CKD are at highest risk
of adverse outcomes and high health care costs. Thus, CKD, diabetes and cardiovascular disease are closely associated conditions that often
coexist; share common risk factors and treatments; and would benefit from a coordinated global approach to prevention and control.

Infectious disease
Infectious diseases, also known as transmissible diseases or communicable diseases comprise clinically evident illness (i.e., characteristic
medical signs and/orsymptoms of disease) resulting from the infection, presence and growth of pathogenicbiological agents in an individual
host organism. In certain cases, infectious diseases may be asymptomatic for much or even all of their course in a given host. In the latter case,
the disease may only be defined as a "disease" (which by definition means an illness) in hosts who secondarily become ill after contact with an
asymptomatic carrier. An infection is notsynonymous with an infectious disease, as some infections do not cause illness in a host.
Infectious pathogens include some viruses, bacteria, fungi, protozoa, multicellularparasites, and aberrant proteins known as prions. These
pathogens are the cause of disease epidemics, in the sense that without the pathogen, no infectious epidemic occurs.

The term infectivity describes the ability of an organism to enter, survive and multiply in the host, while the infectiousness of a disease indicates
the comparative ease with which the disease is transmitted to other hosts.[2] Transmission of pathogen can occur in various ways including
physical contact, contaminated food, body fluids, objects, airborne inhalation, or through vector organisms.
Infectious diseases are sometimes called "contagious" when they are easily transmitted by contact with an ill person or their secretions (e.g.,
influenza). Thus, a contagious disease is a subset of infectious disease that is especially infective or easily transmitted. Other types of
infectious/transmissible/communicable diseases with more specialized routes of infection, such as vector transmission or sexual transmission,
are usually not regarded as "contagious," and often do not require medical isolation (sometimes loosely called quarantine) of victims. However,
this specialized connotation of the word "contagious" and "contagious disease" (easy transmissibility) is not always respected in popular use.

ENDEMIC VS PANDEMIC
Endemic: Present in a community at all times but in relatively low frequency. Something that is endemic is typically restricted or peculiar to a
locality or region.
For example, malaria is endemic in some areas of Africa. And traffic in illicit drugs is endemic in some neighborhoods.
By contrast, there are the related terms "epidemic" and "pandemic":

An epidemic is a sudden severe outbreak within a region or a group, as with AIDS in Africa or AIDS in intravenous drug users.

A pandemic occurs when an epidemic becomes very widespread and affects a whole region, a continent, or the entire world.

The word "endemic" comes from the Greek "en-", "in" + "demos", "people or population" = "endemos" = "in the population." An endemic is in
the people.
By contrast, "epi-" means "upon." An epidemic is visited upon the people. And "pan-" means "all." A pandemic affects all the people.

DIARRHEA
Diarrhea (AmE) (or diarrhoea) (BrE) (from the Greek , dia "through" + rheo "flow" meaning "flowing through") is the condition
of having three or more loose or liquid bowel movements per day.[3] It is a common cause of death in developing countriesand the second
most common cause of infant deaths worldwide. The loss of fluids through diarrhea can cause dehydration and electrolyte disturbances such as
potassium deficiency or other salt imbalances.
Diarrhea is defined by the World Health Organization as having three or more loose or liquid stools per day, or as having more stools than is
normal for that person.

Secretory
Secretory diarrhea means that there is an increase in the active secretion, or there is an inhibition of absorption. There is little to no structural
damage. The most common cause of this type of diarrhea is a cholera toxin that stimulates the secretion of anions, especiallychloride ions.
Therefore, to maintain a charge balance in the lumen, sodium is carried with it, along with water. In this type of diarrhea intestinal fluid
secretion is isotonic with plasma even during fasting.It continues even when there is no oral food intake.

Osmotic
Osmotic diarrhea occurs when too much water is drawn into the bowels. If a person drinks solutions with excessive sugar or excessive salt,
these can draw water from the body into the bowel and cause osmotic diarrhea.[6] Osmotic diarrhea can also be the result of maldigestion
(e.g., pancreatic disease or Coeliac disease), in which the nutrients are left in the lumen to pull in water. Or it can be caused by osmotic

laxatives (which work to alleviateconstipation by drawing water into the bowels). In healthy individuals, too much magnesiumor vitamin C or
undigested lactose can produce osmotic diarrhea and distention of the bowel. A person who has lactose intolerance can have difficulty
absorbing lactose after an extraordinarily high intake of dairy products. In persons who have fructose malabsorption, excess fructose intake can
also cause diarrhea. High-fructose foods that also have a high glucose content are more absorbable and less likely to cause diarrhea. Sugar
alcohols such as sorbitol (often found in sugar-free foods) are difficult for the body to absorb and, in large amounts, may lead to osmotic
diarrhea. In most of these cases, osmotic diarrhea stops when offending agent (e.g. milk, sorbitol) is stopped.

Exudative
Exudative diarrhea occurs with the presence of blood and pus in the stool. This occurs with inflammatory bowel diseases, such asCrohn's
disease or ulcerative colitis, and other severe infections such as E. coli or other forms of food poisoning.

Motility-related
Motility-related diarrhea is caused by the rapid movement of food through the intestines (hypermotility). If the food moves too quickly through
the gastrointestinal tract, there is not enough time for sufficient nutrients and water to be absorbed. This can be due to avagotomy or diabetic
neuropathy, or a complication of menstruation[citation needed]. Hyperthyroidism can produce hypermotility and lead to pseudodiarrhea and
occasionally real diarrhea. Diarrhea can be treated with antimotility agents (such as loperamide). Hypermotility can be observed in people who
have had portions of their bowel removed, allowing less total time for absorption of nutrients.

Inflammatory
Inflammatory diarrhea occurs when there is damage to the mucosal lining or brush border, which leads to a passive loss of protein-rich fluids
and a decreased ability to absorb these lost fluids. Features of all three of the other types of diarrhea can be found in this type of diarrhea. It
can be caused by bacterial infections, viral infections, parasitic infections, or autoimmune problems such as inflammatory bowel diseases. It can
also be caused by tuberculosis, colon cancer, and enteritis.[citation needed]

Dysentery
Generally, if there is blood visible in the stools, it is not diarrhea, but dysentery. The blood is trace of an invasion of bowel tissue. Dysentery is a
symptom of, among others, Shigella, Entamoeba histolytica, and Salmonella.

DIFFERENTIAL DIAGNOSIS
Diarrhea is most commonly due to viral gastroenteritis with rotavirus, which accounts for 40% of cases in children under five. (p. 17) In travelers
however bacterial infectionspredominate. Various toxins such as mushroom poisoning and drugs can also cause acute diarrhea.
Chronic diarrhea can be the part of the presentations of a number of chronic medical conditions affecting the intestine. Common causes include
ulcerative colitis, Crohn's disease, microscopic colitis, celiac disease, irritable bowel syndrome and bile acid malabsorption.

Infections
There are many causes of infectious diarrhea, which include viruses, bacteria and parasites. Norovirus is the most common cause of viral
diarrhea in adults, but rotavirusis the most common cause in children under five years old.Adenovirus types 40 and 41, and astroviruses cause a
significant number of infections.
The bacterium Campylobacter is a common cause of bacterial diarrhea, but infections by Salmonellae, Shigellae and some strains ofEscherichia
coli (E.coli) are frequent.
In the elderly, particularly those who have been treated with antibiotics for unrelated infections, a toxin produced by Clostridium difficileoften
causes severe diarrhea.
Parasites do not often cause diarrhea except for the protozoan Giardia, which can cause chronic infections if these are not diagnosed and
treated with drugs such as metronidazole, and Entamoeba histolytica.
Other infectious agents such as parasites and bacterial toxins also occur. In sanitary living conditions where there is ample food and a supply of
clean water, an otherwise healthy person usually recovers from viral infections in a few days. However, for ill or malnourishedindividuals,
diarrhea can lead to severe dehydration and can become life-threatening.

Malabsorption
Malabsorption is the inability to absorb food fully, mostly from disorders in the small bowel, but also due to maldigestion from diseases of the
pancreas.

Causes include:

enzyme deficiencies or mucosal abnormality, as in food allergy and food intolerance, e.g. celiac disease (gluten intolerance),lactose
intolerance (intolerance to milk sugar, common in non-Europeans), and fructose malabsorption.

pernicious anemia, or impaired bowel function due to the inability to absorb vitamin B12,

loss of pancreatic secretions, which may be due to cystic fibrosis or pancreatitis,

structural defects, like short bowel syndrome (surgically removed bowel) and radiation fibrosis, such as usually follows cancer
treatment and other drugs, including agents used in chemotherapy; and

certain drugs, like orlistat, which inhibits the absorption of fat.

Inflammatory bowel disease

The two overlapping types here are of unknown origin:

Ulcerative colitis is marked by chronic bloody diarrhea and inflammation mostly affects the distal colon near the rectum.

Crohn's disease typically affects fairly well demarcated segments of bowel in the colon and often affects the end of the small bowel.

Irritable bowel syndrome

Another possible cause of diarrhea is irritable bowel syndrome (IBS) which usually presents with abdominal discomfort relieved by defecation
and unusual stool (diarrhea or constipation) for at least 3 days a week over the previous 3 months.[19] Symptoms of diarrhea-predominant IBS
can be managed through a combination of dietary changes, soluble fiber supplements, and/or medications such asloperamide or codeine.
About 30% of patients with diarrhea-predominant IBS have bile acid malabsorption diagnosed with an abnormalSeHCAT test.[20]

Other causes

Diarrhea can be caused by chronic ethanol ingestion.

Ischemic bowel disease. This usually affects older people and can be due to blocked arteries.

Microscopic colitis, a type of inflammatory bowel disease where changes are only seen on histological examination of colonic
biopsies.

Bile salt malabsorption (primary bile acid diarrhea) where excessive bile acids in the colon produce a secretory diarrhea.

Hormone-secreting tumors: some hormones (e.g., serotonin) can cause diarrhea if excreted in excess (usually from a tumor).

Chronic mild diarrhea in infants and toddlers may occur with no obvious cause and with no other ill effects; this condition is
calledtoddler's diarrhea.

Dehydration and diarrhea in children: Prevention and treatment

What are the symptoms of dehydration?
Dehydration is caused by a loss of body fluids, which are made up of water and salts. When sick children have diarrhea or are vomiting, they
can lose large amounts of salts and water from their bodies and can become dehydrated very quickly.
Dehydration can be very dangerous, especially for babies and toddlers. Children can even die if they are not treated.

What are the signs of dehydration?

Call your childs doctor or seek medical advice if you see signs of dehydration:

decreased urination (fewer than 4 wet diapers in 24 h),

faster heart beat,

increased thirst,

sunken eyes,

no tears,

grayish skin,

dry skin, mouth and tongue,

sunken soft spot (fontanelle) on babys head.

Healthy children can spit up, vomit or have a loose stool once in a while without being in danger of dehydrating.

What are the symptoms of diarrhea?

Diarrhea is a very common problem in babies and children. It is usually mild and brief. Acute diarrhea lasts less than 1 week.
A child has diarrhea if she has more bowel movements than usual, and if stools are less formed and more watery than usual. Sometimes
children with diarrhea have other symptoms, such as fever, loss of appetite, nausea, vomiting, stomach pains, cramps, and blood and/or mucus
in the bowel movement.
Diarrhea can be dangerous if not treated properly because it drains water and salts from your child. If these fluids are not put back quickly, your
child may become dehydrated and may need to be hospitalized.

How diarrhea spreads?

Diarrhea germs are easily spread from person to person, and especially from child to child. They usually spread quickly among children who
have not learned to use the toilet.

What causes diarrhea?

There are many different possible causes of diarrhea. The most common are:

Viruses, such as rotavirus, which cant be treated with antibiotics.

Bacteria, such as Campylobacter, Salmonella, Shigella and E. coli. Some bacterial diarrhea can be treated with antibiotics, but
children usually start to get better before the bacteria are identified.

Food poisoning.

Parasites, such as giardia.

Rotavirus
Rotavirus is the most common cause of acute diarrhea in babies and young children. It usually affects children between the ages of 6 months
and 2 years.
Rotavirus illness starts between 12 hours and 4 days after being exposed to the germ. The first signs are usually a high fever (40C/104F) and
vomiting. Within 12 to 24 hours, children start to pass large amounts of watery diarrhea. The illness usually lasts 3 to 7 days.
When children have rotavirus, their stools contain large numbers of germs. Rotavirus can spread directly (such as by coming in contact with an
infected diaper and not washing hands properly afterward), or indirectly (for example, coming in contact with a toy that has germs on it).

Outbreaks of rotavirus in Canada usually happen in the winter and spring, between December and May. A vaccine to prevent rotavirus is
available in Canada.

How to prevent diarrhea

Proper handwashing and safe food handling are the most important ways to prevent the spread of germs that cause diarrhea.

How to treat diarrhea

Children with diarrhea need to keep drinking the right amount of fluids to avoid dehydration.
Oral rehydration solutions
An oral rehydration solution (ORS) is an exact mixture of water, salts and sugar. These solutions can be absorbed even when your child is
vomiting. The key is to give small amounts of ORS often (for example, 1 teaspoon every 5 minutes), gradually increasing the amount until your
child can drink normally.
Oral rehydration solutions are available at pharmacies in ready-to-serve preparations, frozen popsicles and powders.
Although powders are cheaper and easier to store, they have to be mixed very carefully to work properly. It is better to buy an ORS that has
already been mixed.
Oral rehydration solutions can be used to:

keep children well hydrated when their diarrhea is serious.

put back fluids when children show signs of mild dehydration.

If you are breastfeeding, keep feeding on demand. You can also offer your child the foods he usually eats.
If you are formula feeding, you dont need to dilute the formula. Continue formula feeding, and offer your child
the food he normally eats.
If your child is not breastfeeding or formula feeding well, offer ORS as follows:
For the first 4 hours

For babies 6 months and younger: give 30 to 90 mL (1 to 3 oz.) every hour.

At 6 to 24 months: give 90 to 125 mL (3 to 4 oz.) every hour.

Children over 2 years of age: give 125 to 250 mL (4 to 8 oz.) every hour.

If an infant refuses the ORS by the cup or bottle, give the solution using a medicine dropper, small teaspoon or frozen popsicles.

If a child vomits, you may need to stop giving food and drink. But continue to give the ORS using a spoon. Give 15 mL (1 tbsp.) every
10 min to 15 min until the vomiting stops. Increase the amounts gradually until your child is able to drink the regular amounts. If vomiting does
not stop after 4 to 6 hours, take your child to the hospital.

After 4 hours until 24 hours: Recovery stage

Keep giving your child the oral rehydration solution until diarrhea is less frequent.

When vomiting decreases (and depending on your childs age), it is important to start your child breastfeeding as usual (or drinking
formula or whole milk) or eating regular food in small, frequent feedings.

After 24 to 48 hours, most children can resume their normal diet.

Stools may increase at first (1 or 2 more each day). It may take 7 to 10 days or longer for stools to become completely formed. This is part of
normal healing in a childs bowel system (intestine).

Foods to avoid

Do not give your child sugary drinks such as: fruit juice or sweetened fruit drinks, carbonated drinks (pop/soda), sweetened tea, broth or rice
water. These have the wrong amounts of water, salts and sugar and can make your childs diarrhea worse.
If your child is having frequent diarrhea, do not offer plain water. Drinking only water may lead to low blood sugar or low sodium levels in your
childs blood.
Talk to your doctor before giving over-the-counter medications to stop diarrhea.

When to call the doctor?

age.

Your child has diarrhea and is less than 6 months of

Your child has diarrhea and a fever with a temperature

higher than 38.5C (101.5F).

Your child has bloody or black stools.

Your child has signs of dehydration (as listed above)

Your child is still vomiting after 4 to 6 hours.

Your child has stomach pains that are getting worse.

Diarrhea lasting for more than 1 to 2 weeks is considered chronic. Talk to your childs doctor if this is the case.

Myocardial Infarction (Heart Attack)

A heart attack (myocardial infarction) is usually caused by a blood clot, which stops the blood flowing to a part of your heart muscle. You should
call for an ambulance immediately if you develop severe chest pain. Treatment with a clot-busting medicine or an emergency procedure to
restore the blood flow through the blocked blood vessel are usually done as soon as possible. This is to prevent or minimise any damage to your
heart muscle. Other treatments help to ease the pain and to prevent complications. Reducing various risk factors can help to prevent a
myocardial infarction.

Understanding the heart and coronary arteries

The heart is mainly made of special muscle (myocardium). The heart pumps blood into arteries (blood vessels) which take the blood to every
part of the body. Like any other muscle, the heart muscle needs a good blood supply. The coronary arteries take blood to the heart muscle. The
main coronary arteries branch off from the aorta (the large artery which takes oxygen-rich blood from the heart chambers to the body.) The
main coronary arteries divide into smaller branches which take blood to all parts of the heart muscle.

What happens to your heart with a myocardial infarction?

If you have a myocardial infarction (heart attack), a coronary artery or one of its smaller branches is suddenly blocked. The part of the heart
muscle supplied by this artery loses its blood (and oxygen) supply if the vessel is blocked. This part of the heart muscle is at risk of dying unless
the blockage is quickly removed. When a part of the heart muscle is damaged it is said to be infarcted. The term myocardial infarction (MI)
means damaged heart muscle.
If a main coronary arteries is blocked, a large part of the heart muscle is affected. If a smaller branch artery is blocked, a smaller amount of
heart muscle is affected. After an MI, if part of the heart muscle has died, it is replaced by scar tissue over the next few weeks.

Some newer terms used by doctors

A heart attack and myocardial infarction (MI) are commonly used terms, and mean the same thing. However, the term MI is used less often
now by doctors. This is because there are actually a range of conditions that can be caused by a sudden reduction in blood flow in a coronary
artery. This range of conditions has an overall term called acute coronary syndrome (ACS). Two main sub types of ACS can be diagnosed by
what is seen on your heart tracing (ECG). The two main types are called ST-elevation MI (STEMI) and non-ST-elevation MI (NSTEMI). NSTEMI can
also include unstable angina. (The ST elevation refers to a section on the ECG tracing.) In STEMI, the artery supplying an area of the heart
muscle is completely blocked. However, in NSTEMI, the artery is only partly blocked, so only part of the heart muscle supplied by the affected
artery is affected. Your treatment can depend upon which type you have - STEMI or NSTEMI.
This article mainly discusses STEMI - which is just referred to as myocardial infarction (MI) from now on. For information on NSTEMI, unstable
angina and ASC in general, see separate leaflet called Acute Coronary Syndrome.

What causes a myocardial infarction?

Blood clot (thrombosis) - the cause in most cases
The most common cause of an MI is a blood clot (thrombosis) that forms inside a coronary artery, or one of its branches. This blocks the blood
flow to a part of the heart.
Blood clots do not usually form in normal arteries. However, a clot may form if there is someatheroma within the lining of the artery. Atheroma
is like fatty patches or plaques that develop within the inside lining of arteries. (This is similar to water pipes that get furred up.) Plaques of
atheroma may gradually form over a number of years in one or more places in the coronary arteries. Each plaque has an outer firm shell with a
soft inner fatty core.
What happens is that a crack develops in the outer shell of the atheroma plaque. This is called plaque rupture. This exposes the softer inner
core of the plaque to blood. This can trigger the clotting mechanism in the blood to form a blood clot. Therefore, a build-up of atheroma is the
root problem that leads to most cases of ACS / MI. (The diagram below shows four patches of atheroma as an example. However, atheroma
may develop in any section of the coronary arteries.)
Treatment with clot-busting medication or a procedure called angioplasty (see below) can break up the clot and restore blood flow through the
artery. If treatment is given quickly enough this prevents damage to the heart muscle, or limits the extent of the damage.

Uncommon causes
Various other uncommon conditions can block a coronary artery. For example: inflammation of the coronary arteries (rare); a stab wound to
the heart; a blood clot forming elsewhere in the body (for example, in a heart chamber) and travelling to a coronary artery where it gets stuck;
taking cocaine, which can cause a coronary artery to go into spasm; complications from heart surgery and some other rare heart problems.
These are not dealt with further in this leaflet.

The rest of this leaflet deals only with the common cause - thrombosis over an atheroma plaque.

Who is at risk of having a myocardial infarction / heart attack?

MI is common. About 146,000 people in the UK have an MI every year. Most occur in people aged over 50 and it becomes more common with
increasing age. Sometimes younger people are affected.
MI is three times more common in young men than in young women. However, after the menopause, the female hormones no longer protect
the heart so the risk is then the same for men and women.
MI may occur in people known to have heart disease, such as people with angina. It can also happen out of the blue in people with no previous
symptoms of heart disease. This is because atheroma often develops without any symptoms at first.
Certain risk factors increase the risk of more atheroma forming. This can lead to ACS / MI. See separate leaflet called Preventing Cardiovascular
Diseases which discusses these in more detail.
Briefly, risk factors that can be modified and may help to prevent MI include:

Smoking. If you smoke, you should make every effort to stop.

High blood pressure. If your blood pressure is high it can be treated.

If you are overweight, losing some weight is advised. Losing weight will reduce the amount of workload on your heart and also help
to lower your blood pressure.

A high cholesterol. This should usually be treated if it is high.

Inactivity. You should aim to do some moderate physical activity on most days of the week for at least 30 minutes - for example,
brisk walking, swimming, cycling, dancing, gardening, etc.

Diet. You should aim to eat a healthy diet.

Diabetes. People with diabetes have a higher risk of having ACS. This risk can be reduced by ensuring your blood pressure,
cholesterol levels and glucose levels are well controlled.

Family history. Your risk is increased if there is a family history of heart disease or a stroke that occurred in your father or brother
aged below 55, or in your mother or sister aged below 65.

Ethnic group. Certain ethnic groups - for example, British Asians - have a higher risk of developing cardiovascular diseases.

What are the symptoms of a myocardial infarction?

The most common symptom is severe chest pain, which often feels like a heavy pressure feeling on your chest. The pain may also travel up into
your jaw and down your left arm or down both arms. You may also sweat, feel sick and feel faint. You may also feel short of breath. The pain
may be similar to angina, but it is usually more severe and lasts longer. (Angina usually goes off after a few minutes. MI pain usually lasts more
than 15 minutes - sometimes several hours.)
However, some people have only a mild discomfort in their chest. The pain can sometimes feel like indigestion or heartburn.
Occasionally, an MI happens without causing any pain. This is usually diagnosed when you have an electrocardiogram (ECG, or heart tracing) at
a later stage.
Some people collapse and die suddenly, if they have a large portion of heart muscle damaged. This is not very common.

What should I do if I think I am having a myocardial infarction?

Call for an ambulance immediately.
Then, if you have some, take one aspirin tablet (see below for the reason for this). You will normally be admitted straight to hospital.

How is a myocardial infarction diagnosed and assessed?

Many people develop chest pains that are not due to an MI. For example, you can have quite bad chest pains with heartburn, gallbladder
problems or with pains from conditions of the muscles in the chest wall. Therefore, tests are usually done to confirm an MI. These are:


An ECG. There are typical changes to the normal pattern of the heart tracing in MI. Patterns that occur include things called
pathological Q waves and ST elevation. However, it is possible to have a normal ECG even if you have had an MI.

Blood tests. A blood test that measures a chemical called troponin is the usual test that confirms MI. This chemical is present in
heart muscle cells. Damage to heart muscle cells releases troponin into the bloodstream. In MI the blood level of troponin increases within 3-12
hours from the onset of chest pain, peaks at 24-48 hours, and returns to a normal level over 5-14 days.
A rough idea as to the severity of the MI (the amount of heart muscle that is damaged) can be gauged by the degree of abnormality of the ECG
and the level of troponin in the blood. Another chemical that may be measured in a blood test is called creatine kinase. This too is released
from heart muscle cells during MI.
Your heart tracing will be monitored for a few days to check on the heart rhythm. Various blood tests will be done to check on your general
well-being.
Other tests may be done in some cases. This may be to clarify the diagnosis (if the diagnosis is not certain) or to diagnose complications such as
heart failure if this is suspected. For example, an echocardiogram (an ultrasound scan of the heart) or a test called myocardial perfusion
scintigraphy may be done.
Also, before discharge from hospital, you may be advised to have tests to assess the severity of atheroma in the coronary arteries. For example,
an ECG taken whilst you exercise on a treadmill or bike (exercise tolerance test). An angiography of the coronary arteries may also be
performed. In this test a dye is injected into the coronary arteries. The dye can be seen by special X-ray equipment. This shows up the structure
of the arteries (like a road map) and can show the location and severity of any atheroma.

What is the treatment for a myocardial infarction?

The following is a typical situation and mentions the common treatments that are usually offered. However, each case is different and
treatments may vary depending on your situation.
Aspirin and other antiplatelet medicines
As soon as possible after MI is suspected you will be given a dose of aspirin. Aspirin reduces the stickiness of platelets. Platelets are tiny
particles in the blood that trigger the blood to clot. It is the platelets that become stuck on to a patch of atheroma inside an artery that go on to
form the clot.
Other antiplatelet medicines called clopidogrel or ticagrelor may be given. They work in a different way to aspirin and help reduce platelet
stickiness.
Injections of heparin or a similar medicine
These are usually given for a few days to help prevent further blood clots from forming.
Pain relief
A strong painkiller such as morphine is given by injection into a vein to ease the pain.
Treatment to restore blood flow in the blocked coronary artery
The part of the heart muscle starved of blood does not die immediately. If blood flow is restored within a few hours, much of the heart muscle
that would have been damaged and die will survive. This is why MI is a medical emergency, and treatment is given urgently. The quicker the
blood flow is restored, the better the outlook.
There are two treatments that can restore blood flow back through the blocked artery:

Emergency angioplasty. Ideally this is the best treatment if it is available and can be done within a few hours of symptoms starting.
In this procedure a tiny wire with a balloon at the end is put into a large artery in the groin or arm. It is then passed up to the heart and into the
blocked section of a coronary artery, using special X-ray guidance. The balloon is blown up inside the blocked part of the artery to open it wide
again. A stent may be left in the widened section of the artery. A stent is like a wire mesh tube which gives support to the artery and helps to
keep the artery widened. See separate leaflet called Angioplastyfor details.

An injection of a clot-busting medicine is an alternative to emergency angioplasty. It can be given easily and quickly in most
situations. Some ambulance crews are trained to give this.Note: a common clot-busting medicine used in the UK is called streptokinase. If you
are given this medicine you should not be given it again if you have another MI in the future. This is because antibodies develop to it and it will
not work so well a second time. An alternative clot-busting medicine should be given.

Both the above treatments usually work well to restore blood flow and greatly improve the outlook. The most crucial factor is the speed that
one or other treatment is given after symptoms started.

A beta-blocker medicine
Beta-blocker medicines block the action of certain hormones such as adrenaline (epinephrine). These hormones increase the rate and force of
the heartbeat. Beta-blocker medicines have some protective effect on the heart muscle and they also help to prevent abnormal heart rhythms
from developing. Beta-blocker medicines will also help to prevent having another MI.

Insulin
Some people have a raised blood sugar level when they have an MI, even if they do not have diabetes. If this occurs, then your blood sugar
levels may need to be controlled with insulin. If you have diabetes then it is also likely that you will need to be treated with insulin to control
your blood glucose levels when you are in hospital.

Oxygen
You may be given oxygen which works to reduce the risk of damage to your heart muscle.

Treatment after you have had a myocardial infarction

Normally you will be advised to take regular medication for the rest of your life. See separate leaflet called Medication After a Myocardial
Infarction which discusses this more fully.
Briefly, the following four medicines are commonly prescribed to help prevent a further MI, and to help prevent complications:

Aspirin - to reduce the stickiness of platelets in the blood, which helps to prevent blood clots forming. If you are not able to take
aspirin then an alternative antiplatelet medicine such as clopidogrel or ticagrelor may be advised.

A beta-blocker medicine - to slow the heart rate and to reduce the chance of abnormal heart rhythms developing.

An angiotensin-converting enzyme (ACE) inhibitor medicine. ACE inhibitor medicines have a number of actions, including having a
protective effect on the heart.

A statin medicine to lower the cholesterol level in your blood. This helps to prevent the build-up of atheroma.

Also, you will normally be advised to take the antiplatelet medicine clopidogrel or ticagrelor in addition to aspirin. However, this is usually only
advised for a number of weeks or months, depending on the type and severity of your MI.
Many people recover well from an MI and have no complications. Before discharge from hospital, it is common for a doctor or nurse to advise
you how to reduce any risk factors (see above). This advice aims to reduce your risk of a future MI as much as possible.

Other medicines or treatments may be needed if you develop complications.

How serious is a myocardial infarction?
This often depends on the amount of heart muscle that is damaged. In many cases, only a small part of the heart muscle is damaged and then
heals as a small patch of scar tissue. The heart can usually function normally with a small patch of scar tissue. A larger heart attack is more likely
to be life-threatening or cause complications.
Even before treatments became available to restore blood flow, many people made a full recovery. With the help of modern treatment,
particularly if you are given treatment within a few hours to restore blood flow, a higher percentage of people now make a full recovery.

Some possible complications include the following:

Heart failure. If a large area of the heart muscle is damaged, then the pumping ability of the heart may be reduced. Less blood than
usual is then pumped around the body, especially when extra blood is needed when you
exercise. Symptoms such as breathlessness, tiredness, and swollen ankles may develop. Mild heart failure can often be treated with
medication. Severe heart failure can be serious and even life-threatening.

Abnormal heart rhythms may occur if the electrical activity of the heart is affected. The main risk of this happening is within the first
few hours after an MI. Sudden, chaotic, fast heartbeats may occur. This is called ventricular fibrillation and is the common cause of cardiac

arrest. This needs immediate treatment with an electrical shock given by a defibrillator. Otherwise, collapse and sudden death is likely. Other
less serious abnormal heart rhythms can also occur which can often be treated with medicines.

A further MI may occur sometime in the future. This is more likely if the coronary arteries are badly affected with atheroma, or
further build-up of atheroma continues. If the risk of this is thought to be high then surgery may be advised to bypass or widen severely
narrowed coronary arteries.
The most crucial time is during the first day or so. If no complications arise, and you are well after a couple weeks, then you have a good chance
of making a full recovery. A main objective then is to get back into normal life, and to minimise the risk of a further MI.

After having a myocardial infarction

When recovering from an MI, it is natural to wonder if there are any dos and don'ts. In the past, well-meaning but bad advice to "rest and take
it easy from now on" caused some people to become over-anxious about their hearts. Some people gave up their jobs, hobbies, and any activity
that caused exertion, for fear of straining the heart.
However, quite the opposite is true for most people who recover from an MI. Regular exercise and getting back to normal work and life are
usually advised. Much can be done to reduce the risk of a further MI.

World Health Organization (WHO)

The World Health Organization (WHO) is a specialized agency of the United Nations(UN) that is concerned with international public health. It
was established on 7 April 1948, with headquarters in Geneva, Switzerland, and is a member of the United Nations Development Group. Its
predecessor, the Health Organization, was an agency of theLeague of Nations.
The constitution of the World Health Organization had been signed by all 61 countries of the United Nations by 22 July 1946, with the first
meeting of the World Health Assemblyfinishing on 24 July 1948. It incorporated the Office International d'Hygine Publique and the League of
Nations Health Organization. Since its creation, WHO has been responsible for playing a leading role in the eradication of smallpox. Its current
priorities includecommunicable diseases, in particular, HIV/AIDS, malaria and tuberculosis; the mitigation of the effects of non-communicable
diseases; sexual and reproductive health, development, and aging; nutrition, food security and healthy eating; occupational health; substance
abuse; and drive the development of reporting, publications, and networking. WHO is responsible for the World Health Report, a leading
international publication on health, the worldwide World Health Survey, and World Health Day (7th-April of every Year).
Its links with the International Atomic Energy Agency and distribution of contraceptionhave both proved controversial, as have guidelines on
healthy eating and the 2009 flu pandemic.

Triage System at the Emergency Department

Triage is the dynamic process of categorising the patient according to treatment priority.
The Triage Center, located infront of the entrance of the Emergency Department , is manned on a 24 hour basis by well trained Triage Officers.
All cases arriving at he Emergency Department are triaged and sent to the respective areas/zones based upon the Zoning Concept.
Triage Criteria :
1. Non Critical Cases.
All walk-in and stable cases.
2. Semi-Critical Cases.
All hemodynamically stable cases but are unable to walk.
3. Critical Cases.
Critically ill cases requiring urgent treatment.

Infectious diseases common in Egypt:

Food and waterborne diseases - the number one cause

of illness in travelers

travelers' diarrhea

Escherichia coli diarrhea

hepatitis A / very common

hepatitis B

hepatitis C - highest prevalence in world see

www.hcvegypt.com

river

schistosomiasis - found in fresh water including Nile

typhoid fever

Insect borne diseases

parasitic diseases

filariasis

leishmaniasis

Rift valley fever / rare

amebiasis

diptheria - endemic to the region

West Nile fever

FOOT AND MOUTH DISEASES

Foot-and-mouth disease or hoof-and-mouth disease (Aphthae epizooticae) is aninfectious and sometimes fatal viral disease that affects clovenhoofed animals, including domestic and wild bovids. The virus causes a high fever for two or three days, followed byblisters inside the mouth
and on the feet that may rupture and cause lameness.
Susceptible animals include cattle, water buffalo, sheep, goats, pigs, antelope, deer, andbison.
The virus responsible for the disease is a picornavirus,

HAND FOOT AND MOUTH DISEASE

Hand, foot and mouth disease (HFMD) is a human syndrome caused by intestinal viruses of the picornaviridae family. The most common strains
causing HFMD arecoxsackie A virus and enterovirus 71 (EV-71).[1]
HFMD usually affects infants and children, and is quite common. It is moderately contagious and is spread through direct contact with the
mucus, saliva, or feces of an infected person. It typically occurs in small epidemics in nursery schools or kindergartens, usually during the
summer and autumn months. The usual incubation period is 37 days.
It is less common in adults, but those with immune deficiencies are very susceptible. HFMD is not to be confused with foot-and-mouth disease
(also called hoof-and-mouth disease), which is a separate disease affecting sheep, cattle, and swine (both are caused by members of the
picornaviridae family, but are not trans-communicable between humans and livestock).

Signs and symptoms

Fever

Headache

Fatigue

Malaise

Referred ear pain

Sore throat

Painful oral, nasal, or facial lesions, ulcers or blisters

Body rash, followed by sores with blisters on palms of

hand, soles of feet, and sometimes on the lips. The rash is rarely
itchy for children, but can be extremely itchy for adults [3]

Sores or blisters may be present on the buttocks of

small children and infants

Irritability in infants and toddlers

Loss of appetite.

Diarrhea

The common incubation period (the time between infection and onset of symptoms) is from three to seven days.
Early symptoms are likely to be fever often followed by a sore throat. Loss of appetite and general malaise may also occur. Between one and
two days after the onset of fever, painful sores (lesions) may appear in the mouth or throat, or both. A rash may become evident on the hands,
feet, mouth, tongue, inside of the cheeks, and occasionally the buttocks (but generally, the rash on the buttocks will be caused by the diarrhea).

Treatment
There is no specific treatment for hand, foot and mouth disease. Individual symptoms, such as fever and pain from the sores, may be eased
with the use of analgesics. HFMD is a viral disease that has to run its course; many doctors do not prescribe medicine for this illness. Infection in
older children, adolescents, and adults is typically mild and lasts approximately 1 week, occasionally longer. Fever reducers and luke-warm
baths can help bring temperature down.
Only a very small minority of sufferers require hospital admission, mainly as a result of uncommon neurological complications (encephalitis,
meningitis, or acute flaccid paralysis) or pulmonary edema/pulmonary hemorrhage.

Pneumonia - adults (community acquired)

Pneumonia is a breathing (respiratory) condition in which there is an infection of the lung.
This article covers pneumonia in people who have not recently been in the hospital or another health care facility (nursing home or rehab
facility). This type of pneumonia is called community-acquired pneumonia, or CAP.

Causes
Pneumonia is a common illness that affects millions of people each year in the United States. Germs called bacteria, viruses, and fungi may
cause pneumonia.

Ways you can get pneumonia include:

Bacteria and viruses living in your nose, sinuses, or mouth may spread to your lungs.

You may breathe some of these germs directly into your lungs.

You breathe in (inhale) food, liquids, vomit, or fluids from the mouth into your lungs (aspiration pneumonia)

Pneumonia caused by bacteria tends to be the most serious kind. In adults, bacteria are the most common cause of pneumonia.

The most common pneumonia-causing germ in adults is Streptococcus pneumoniae (pneumococcus).

Atypical pneumonia, often called walking pneumonia, is caused by certain other bacteria.

Pneumocystis jiroveci pneumonia is sometimes seen in people whose immune system is not working well.

Many other bacteria can also cause pneumonia.

Viruses are also a common cause of pneumonia, especially in infants and young children.

Risk factors that increase your chances of getting pneumonia include:

Chronic lung disease (COPD, bronchiectasis, cystic fibrosis)

Cigarette smoking

Dementia, stroke, brain injury, cerebral palsy, or other brain disorders

Immune system problem (during cancer treatment or due to HIV/AIDS or organ transplant)

Other serious illnesses, such as heart disease, liver cirrhosis, or diabetes mellitus

Recent surgery or trauma

Surgery to treat cancer of the mouth, throat, or neck

Symptoms
The most common symptoms of pneumonia are:

Cough

Shaking chills

Fever, which may be mild or high

Shortness of breath

Loss of appetite, low energy, and fatigue

Other symptoms include:

Confusion, especially in older people

Excess sweating and clammy skin

Sharp or stabbing chest pain that gets worse when you

breathe deeply or cough

Headache

Exams and Tests

If you have pneumonia, you may be working hard to breathe, or breathing fast.
The health care provider will hear crackles or abnormal breath sounds when listening to your chest with a stethoscope. Other abnormal
breathing sounds may also be heard through the stethoscope or by tapping on your chest wall (percussion).
The health care provider will likely order a chest x-ray if pneumonia is suspected.

You may need other tests, including:

Arterial blood gases to see if enough oxygen is getting

into your blood from the lungs

Culture of your sputum to look for the bacteria or virus

that is causing your symptoms

CBC to check white blood cell count

Pleural fluid culture if there is fluid in the space around

the lungs

CT scan of the chest

Less often patients may need:

Bronchoscopy--a flexible tube with a lighted camera on the end passed down to your lungs

Thoracentesis--removing fluid from the space between the outside lining of the lungs and the chest wall

Treatment
Your doctor must first decide whether you need to be in the hospital. If you are treated in the hospital, you will receive:

Fluids and antibiotics in your veins

Oxygen therapy

Breathing treatments (possibly)

It is very important that you are started on antibiotics very soon after you are admitted (unless you have viral pneumonia).
You are more likely to be admitted to the hospital if you:

Have another serious medical problem

Are older than 65 or a young child

Have severe symptoms

Have been taking antibiotics at home and are not

getting better

Are unable to care for yourself at home, or are unable

to eat or drink
However, many people can be treated at home. Your doctor may tell you to take antibiotics. Antibiotics help some people with pneumonia get
better.

Don't miss any doses. Take the medicine until it is

gone, even if you start to feel better.

Do NOT take cough medicine or cold medicine unless

your doctor says it is okay. Coughing helps your body get rid of
mucus from your lungs.

Breathing warm, moist (wet) air helps loosen the sticky mucus that may make you feel like you are choking. These things may help:

Place a warm, wet washcloth loosely over your nose

and mouth.

Drink plenty of liquids (as long as your health care provider says it
is okay):

Fill a humidifier with warm water and breathe in the

warm mist.

Drink water, juice, or weak tea

Drink at least 6 to 10 cups a day

Do NOT drink alcohol

Take a couple of deep breaths two or three times

every hour. Deep breaths will help open up your lungs.

Tap your chest gently a few times a day and lie with
your head lower than your chest. This can help bring up mucus
from the lungs.

Get plenty of rest when you go home. If you have trouble sleeping at night, take naps during the day.
Outlook (Prognosis)
With treatment, most patients will improve within 2 weeks. Elderly or very sick patients may need longer treatment.
Those who may be more likely to have complicated pneumonia include:

Older adults or very young children

People whose immune system does not work well

People with other, serious medical problems such as

diabetes or cirrhosis of the liver

Life-threatening changes in the lungs that require a

breathing machine

Fluid around the lung (pleural effusion)

Lung abscesses

In rare cases, more severe problems may develop, including:

Your doctor may want to make sure your chest x-ray becomes normal again after you are treated. However, it may take many weeks for your xray to clear up.

When to Contact a Medical Professional

Call your doctor if you have:

A cough that brings up bloody or rust-colored mucus

Night sweats or unexplained weight loss

Breathing (respiratory) symptoms that get worse

Shortness of breath, shaking chills, or persistent fevers

in

Chest pain that gets worse when you cough or breathe

Signs of pneumonia and a weak immune system (for

example such as with HIV or chemotherapy)

Fast or painful breathing

Prevention
Wash your hands often, especially after:

Blowing your nose

Diapering

Going to the bathroom

Also wash your hands before eating or preparing foods.
Don't smoke. Tobacco damages your lung's ability to ward off infection.
Vaccines may help prevent some types of pneumonia. They are even more important for the elderly and people with diabetes, asthma,
emphysema, HIV, cancer, or other long-term conditions:

Flu vaccine prevents pneumonia and other problems caused by the influenza virus. It must be given each year to protect against new
virus strains.

Pneumococcal vaccine (Pneumovax, Prevnar) lowers your chances of getting pneumonia fromStreptococcus pneumoniae.

If you have cancer or HIV, talk to your doctor about ways to prevent pneumonia and other infections.