CONCEPT OF DISEASE 8.
MULTIFACTORIAL THEORY
DEFINITION
 A condition of the body or some part or
organ of the body in which its functions are
deranged.
 It is a mal-adjustment of human organism to
the environment.
 I t is deviation from normal function.
CAUSATION OF DISEASE
1.DEMONISTIC THEORY
 Disease was produced by demons, one or
more demons have fixed their abode in a
human body
 Cure is usually achieved after series of
incantation and sorcery
2. DEVILISTIC THEORY
 Disease was a punishment meted out by an
outraged God for the sin of an individual
 Cure can be achieved by propitiating the
deity either by repentance of sin, prayer and
sacrifice
3. TRIDOSHA THEORY
 three doshas or three energetic forces control
the activities of the body.
Vata Pitta Kapha
 If these doshas get imbalanced the body
succumbs to diseases
4.HUMOURS THEORY
 humours existed as liquids within the body
and were identified as
A. blood
B. phlegm
C. black bile
D. yellow bile
 When all the humours are properly balanced
and mingled, he feels the most perfect
health.
 Illness occurs when one of the humours is in
excess, or is reduced in amount, or is
entirely missing from the body.
5. YANG & YIN THEORY
 a belief that there exist two complementary
forces in the universe
 Yang which represents everything positive
or masculine and the other is Yin which is
characterized as negative or feminine
6. GERM THEORY OF DISEASE
 Microorganisms are the cause of disease
 Authored by LOUIS PASTEUR and
ROBERT KOCH
 Henle-Koch’s Postulates
1. The agent should be present in every case of
the disease under appropriate condition
2. The agent should not be present in any other
disease as a fortuitous and Non-Pathogenic
agent
3. The agent must be isolated from the body of
the individual in pure culture
4. It should induce disease in a new susceptible
experiment animal
 Henle-Koch’s Postulates
7. EPIDEMIOLOGICAL TRIAD
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 single cause idea or the germ theory of
disease causation was not adequate to
explain the actual causation of diseases.
 There are aetiological factors such as social,
economic, cultural, genetic and
psychological which are importan
WHEEL OF CAUSATION
NATURAL HISTORY OF DISEASE
 description of the uninterrupted progression
of a disease in an individual from the
moment of exposure to causal agents until
recovery or death
PRE PATHOGENIC PHASE
 period preliminary to onset of disease.
 During this phase the factors which favor
the interaction of causative agent with the
man already exist but disease process has
not yet begun.
 Example: malnutrition, fatigue, habits,
lifestyle, occupation, chemotherapy and
emotional disturbance
PATHOGENIC PHASE
1. INCUBATION PERIOD
 interval between the initial infection and the
first appearance of any signs and symptoms
influenza – 1-3 days
common colds – 1-3 days
measles – 9-12 days
german measles – 14-21 days
chicken pox – 14-16 days
2. PRODROMAL PERIOD
 the period during which premonitory
symptoms of a disease or condition appear.
 In the prodromal period of infections, the
symptoms may be nonspecific, such as
weakness, headache, and mild fever,
3. PERIOD OF ILLNESS
 the time of greatest symptomatic experience
 When the disease is not treated, the patient
dies during this period
4. PERIOD OF DECLINE
 The period of decline occurs as pathogen
replication is brought under control either by
host immune response or through outside
intervention.
 A subsidence of symptoms is experienced
during this period.
 That is, the patient is getting better.
5. PERIOD OF CONVALESCENCE
 the pathogen replication has been stopped.
 This cessation of pathogen replication
occurs either by the killing of all pathogens
present or by killing all actively replicating
individuals (i.e., all but latently infecting in
the latter case).
 The body regains its pre-illness strength.
FACTORS AFFECTING THE GRADIENT OF
INFECTION
1. INFECTIVITY
 ability of a pathogen to establish an
infection
2. VIRULENCE
 The ability of an agent of infection to
produce disease.
 The virulence of a microorganism is a
measure of the severity of the disease it
causes.
3. PATHOGENECITY 3. PORTAL OF EXIT
 ability of a particular disease agent of A) Urinary
known virulence to produce disease in a B) Intestinal
range of hosts under a range of C) Respiratory
environmental conditions. FEATURES OF CARRIER
4. ANTIGENICITY 1. Presence of specific microbes in the body
 the capacity to stimulate the production of 2. Absence of apparent symptoms and signs
antibodies or the capacity to react with an 3. Shedding of micro-organisms in the discharges or
antibody. excretions
TYPE OF INFECTION 4. As a source of infection to others
1. LATENT INFECTION LATENT PERIOD
 A lingering infection that may lie dormant in IT HAS BEEN DEFINED AS THE PERIOD FROM
the body for a period of time but may DISEASE INITIATION TO DISEASE
become active under certain conditions. DETECTION
2. SUBCLINICAL INFECTION GENERATION TIME
 refers to an inapparent, asymptomatic IT IS DEFINED AS THE INTERVAL OF TIME
infection , or an infection that has such a BETWEEN RECEIPT OF INFECTION BY A
mild course that it does not alert the patient HOST AND MAXIMAL INFECTIVITY OF THAT
enough to consult with a physician. HOST
3. ATYPICAL INFECTION SERIAL INTERVAL
 An infection which does not manifest it’s THE GAP IN TIME BETWEEN THE ONSET OF
usual sign and symptoms THE PRIMARY CASE AND THE SECONDARY
4. CLINICAL INFECTION CASE
 An infection manifesting sign and symptoms COMMUNICABLE PERIOD
of the disease The time during which an infectious agent may be
MODES OF TRANSMISSION transferred directly or indirectly from an infected
A. DIRECT TRANSMISSION person to another person, from an infected animal to
 DIRECT CONTACT humans, or from an infected person to animals,
 DROPLET INFECTION including arthropods. SECONDARY ATTACK
 CONTACT WITH SOIL RATE
 INOCULATION INTO SKINOR It is defined as the number of exposed persons
MUCOSA developing the disease within the range of the
 TRANSPLACENTAL incubation period, following exposure to the primary
B. INDIRECT TRANSMISSION case
 VECHICLE BORNE HERD IMMUNITY
 VECTOR BORNE
A) mechanical IT IS THE LEVEL OF RESISTANCE OF A
B) biological COMMUNITY OR GROUP OF PEOPLE TO A
 AIR-BORNE PARTICULAR DISEASE
 FOMITE BORNE BEHAVIOUR OF DISEASE IN THE
 UNCLEAN HANDS AND FINGERS COMMUNITY
SOURCE OF INFECTION 1. Exotic diseases
It is defined as the person, animal, object or  are those which are imported into a country
substance from which an infectious agent passes or is in which they do not otherwise occur
disseminated to the host ex: rabies in UK
RESERVOIR 2. Sporadic diseases
 Any person, animal, plant, soil or substance  cases occur irregularly, haphazardly from
in which an infectious agent normally lives time to time, and generally infrequently
and multiplies. Ex: leptospirosis
 The reservoir typically harbors the Foot and mouth disease
infectious agent without injury to itself and 3. Endemic diseases
serves as a source from which other  constant presence of a disease or infectious
individuals can be infected agent within a given geographic area or
CARRIER population group
 a human being who is infected with and thus Ex. diarrhea
can transmit the causative agent of an common colds
infectious disease in the absence of visible 4. Epidemic diseases
symptoms of that disease  unusual occurrence in a community of
CARRIERS disease, specific health related behavior, or
1. TYPE other health related events clearly in excess
A) Incubatory of expected occurrence
B) Convalescent ex. cholera
C) Healthy 5. PANDEMIC
2. DURATION  epidemic usually affecting a large
A)Temporary proportion of the population, occuring over
B)Chronic a wide geographic area such as a section of a
nation, the entire nation, a continent or the
world Ex.SARS

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6. OUTBREAK
 occurrence of more cases of disease than
normally expected within a specific place or
group of people over a given period of time.
EPIDEMIOLOGICAL TERMS
• agent A causative factor, such as a
biological or chemical agent that must be
present (or absent) in the environment for
disease occurrence in a suspectible host.
• analytic epidemiologic studies Study
designs that examine groups of individuals
in order to make comparisons and
associations and to determine causal
relationships; also known as cohort, cross-
sectional, and case-control studies.
• attack rate The number of cases of
disease in a specific population divided by
the total population at risk for a limited time
period, usually expressed as a percentage.
• attributable risk percentage (AR
percentage) A statistical measure that
estimates the number of cases of a disease
attributable to the exposure of interest
• bias An error in the study design caused
by the tendency of researchers to expect
certain conclusions on the basis of their own
personal beliefs that results in incorrect
conclusions regarding the association
between potential risk factors and disease
occurrence.
• case fatality rate Refers to deaths from a
specific disease.
• case reports Client (case) history studies
used in epidemiologic descriptive studies.
• case series A compilation of case
reports.
• case-control study An analytic
epidemiologic study design that assembles
study groups after a disease has occurred;
also called a retrospective study.
• cause-specific death rate Number of
deaths from a specific cause; expressed as a
number per 100,000 population
• chemical agents Includes poisons and
allergens.
• cohort study An analytic epidemiologic
study design that assembles study groups
before disease occurrence to observe and
compare the rates of a health outcome over
time; also called a prospective study.
• correlational study A descriptive
epidemiologic study design used to compare
aggregate populations for potential
exposures of disease.
• cross- sectional survey A descriptive
epidemiologic study design that uses a
representative sample of the population to
collect information on current health status,
personal characteristics, and potential risk
factors or exposures at one point in time.
• Demography The statistical science or
study of populations, related to age-specific
categories, birth and death rates, marital
status, and ethnicity.
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• descriptive epidemiologic studies
Epidemiologic study designs that contribute
to the description of a disease or condition
by examining the essential features of
person, place, and time.
• disease frequency Occurrence of disease
as measured by various rates such as
morbidity rate.
• ecology The study of relations and
interactions among all organisms within the
total environment; in community health, the
individual’s interaction with his or her
social, cultural, and physical environments.
• environment Internal and external
factors that constitute the context for agent-
host interactions; the aspect of existence
perceived outside the self; this perception
changes with alterations in awareness and
expansion of consciousness; one of the
concepts of nursing metaparadigm.
• epidemic A number of cases of an
infectious agent or disease (outbreak) clearly
in excess of the normally expected
frequency of that disease in that population.
• epidemiology An applied science that
studies the distribution and determinants of
health-related states or events in
populations.
• false-negative test A screening test result
that is negative when the individual actually
has the disease of interest.
• false-positive test A screening test result
that is positive when the individual does not
have the disease of interest.
• host A person or living species capable of
being infected.
• incidence rate The rate of new cases of a
condition or disease in a population in a
specified time period; provides an estimate
of the condition/disease risk in that
population.
• infectious agents Bacteria, fungi,
viruses, metazoa, and protozoa.
• intervention study Epidemiologic study
design that is experimental in nature and
used to test a hypothesis about a cause-and-
effect relationship.
• levels of prevention A three-level model
of intervention (primary, secondary, tertiary)
used in the epidemiologic approach,
designed to prevent or to halt or reverse the
process of pathological change as early as
possible in order to prevent damage.
• maternal mortality rate Deaths of
mothers at time of birth, expressed as a
number per 100,000 live births.
• measures of association Statistical
analysis methods used to investigate the
relationship between two or more variables
or events.
• morbidity rate A disease rate, specifically
prevalence and incidence rates of diseases in
a population in a specified time period.
• mortality rate The number of deaths from
all causes divided by the total population at
a particular time and place.
 • natural history of a disease The course
that a disease would take from onset to
resolution without intervention by humans.
• nutritive elements Substances such as
vitamins or proteins that, if excessive or
deficient, act as an agent of disease.
• observational studies Non-experimental
studies that describe, compare, and explain
disease occurrence.
• odds ratio A statistical measure of
association reflecting the ratio of two odds
reflecting the relative risk (RR) when the
specific risk of disease of both the exposed
and the unexposed groups is low. Calculated
when incidence rates are unavailable.
• physical agents Agents of disease that
must be present or absent for a problem to
occur. Examples include radiation, excessive
sun exposure, and mechanical agents.
• point prevalence The total number of
persons with a disease at a specific point of
time.
• PRECEDE-PROCEED model A
health–promotion planning framework
useful in applying the epidemiologic
approach to community health planning.
• prevalence rate A proportion or
percentage of a disease or condition in a
population at any given time.
• prevention trials An epidemiologic
intervention study design used to compare
measures or interventions aimed at the
prevention of disease.
• prospective study An epidemiologic
study design that assembles study groups
before disease occurrence.
• relative risk An epidemiologic measure
of association that indicates the likelihood
that an exposed group will develop a disease
or condition relative to those not exposed.
• retrospective study An epidemiologic
study design that assembles study groups
after disease occurrence.
• risk The probability that an event,
outcome, disease, or condition will develop
in a specified time period.
• sensitivity The probability that an
individual who has the disease of interest
will have a positive screening test result.
• specificity The probability that an
individual who does not have the disease of
interest will have a negative screening test
result.
• Surveillance The systematic collection
and evaluation of all aspects of disease
occurrence and spread, resulting in
information that may be useful in the control
of the disease.
• therapeutic trials An epidemiologic
intervention study design used to compare
measures or interventions aimed at
therapeutic benefits.
• vital statistics Systematically tabulated
data on vital events such as births, deaths,
marriages, divorces, adoptions, annulments,
separations, and health events that are based
on registration of these events.
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LIMITATIONS OF EPIDEMIOLOGY
1. EPIDEMIOLOGY DEPENDS ON A VALID
DATA. Often in emergencies, the ability to gather
data is severely restricted. This may be due to
insecurity preventing survey workers from carrying
out data collection or lack of resources preventing
health workers from submitting surveillance data.
Lack of access may also be due to difficulties in
communication and transport to remote areas.
2. Epidemiology is also constrained by the rapid
changes in the health and nutritional status of many
emergency-affected populations. By the time
appropriate data and collected and analyzed, the
conclusions and recommendations derived from these
analyses may be out of date.
3. Another major limitation of epidemiology is in
program evaluation.
4. Finally, perhaps the most important limitation of
epidemiology is that epidemiology and the data
gathered by epidemiologic methods are routinely
ignored.
DIABETES MELLITUS
FACTS ABOUT DIABETES
1. The most common endocrine disease
2. It is characterized by metabolic
abnormalities
3. It has a long term complications involving
the eyes, kidneys, nerves and blood vessels
4. At present there are about 3M Filipinos
who are diabetics.
RISK FACTORS
1. Family History
2. Race or Ethnic background
3. Obesity
4. Hypertension
5. Abnormal cholesterol level
6. Age
7. Smoking
8. Alcohol use
9. History of Gestational diabetes
DIAGNOSIS
1.Fasting Blood glucose-
Venous plasma glucose concentration >
7.8 mmol/L (140 mg/dl) on at
least two occasions
2. Following ingestion of 75 g of
glucose-venous plasma glucose
concentration > 11.1 mmol/L (
200 mg/dl) at 2 hrs.
CLASSIFICATION OF DIABETES
1. TYPE 1 – Insulin dependent diabetes
mellitus
2. TYPE 2 – Non-insulin dependent diabetes
mellitus
3. Secondary form of diabetes
a. caused by pancreatic
disease
b. caused by hormonal
abnormalities
c. caused by drugs or
chemicals
PATHOGENESIS OF IDDM
> There is rapid destruction of the beta cells of the
pancreas which produces insulin.
Genetic predisposition → environmental insult→
autoimmune destruction of beta cells → diabetes
mellitus
  it usually begins with anorexia, nausea and
PATHOGENESIS OF NIDDM vomiting with increased urination.
> There are two physiologic  abdominal pain may be present
defects:  if not treated, coma may follow
a. abnormal insulin mainstay of therapy is insulin and IVF
secretion HYPEROSMOLAR NON KETOTIC COMA
b. there is resistance to insulin action a complication of NIDDM
in target tissues  a syndrome of severe dehydration resulting
CLINICAL FEATURES OF DIABETES from excessive urination with the patient
1. excessive thirst – polydipsia becoming too weak to drink water thus
2. increased appetite - becoming dehydrated
polyphagia  the most important measure to treat this
3. excessive urination – polyuria condition is rapid administration of large
4. Progressive weight loss amounts of IVF
5. Fatigue (weak, tired LATE COMPLICATIONS OF DIABETES
feeling) CIRCULATORY ABNORMALITIES
6. Blurring of vision ATHEROSCLEROSIS – more extensive and occurs
7. Slow healing cuts or sores earlier in diabetic patients
8. Itching of the skin (usually in the vaginal INTERMITTENT CLAUDICATION
or groin area) GANGRENE
9. Yeast infection FOURNIER’S GANGRENE
10. Recent weight gain GANGRENE OF BIG TOE
11. Numbness or tingling of the hands and IMPOTENCE
feet > Sometimes called “ erectile
12. Impotence or erectile dysfunction dysfunction”
GENERAL CHARACTERISTICS OF IDDM > It is the failure to achieve erection
AND NIDDM > Usually impotence develops within 6
PHARMACOLOGIC TREATMENT years of the onset of diabetes
1. INSULIN THERAPY MYOCARDIAL INFARCTION
> required for ALL patients with IDDM STROKE
and MANY patients with NIDDM DIABETIC RETINOPATHY
2. ORAL AGENTS leading cause of blindness
a. SULFONYLUREAS – stimulate the two types: background AND
release of insulin from the beta cells of proliferative
the pancreas DIABETIC NEPHROPATHY
b. METFORMIN- leading cause of death and disability in
 inhibit hepatic gluconeogenesis diabetes mellitus
 enhance glucose disposal in muscle and in IDDM – 35% develop
adipose tissue in NIDDM – 15-60% develop
 daily dose of 1500-2500 mg DIABETIC NEUROPATHY
 taken 1- 2 doses per day DIABETIC FOOT ULCERS
 duration of action is up to 24 hrs MALIGNANT OTITIS EXTERNA
c. THIOZOLIDINEDIONE RHINOCEREBRAL MUCORMYCOSIS
> lower blood levels of glucose, free NECROBIOSIS LIPOIDICA DIABETICORUM
fatty acids and triglycerides
> reduce insulin resistance HYPERTENSION
ACUTE METABOLIC COMPLICATIONS TOP TEN LEADING CAUSES OF
HYPOGLYCEMIA MORTALITY
 sudden drop in plasma glucose level to ≤ 3 1. HEART DISEASES
mmol/L ( 50-55mg/dl) 2. VASCULAR SYSTEM DISEASES
 maybe caused by missing a meal, doing 3. MALIGNANCIES
unexpected exercise, failure to take meal 4. ACCIDENTS
after insulin or oral diabetic agent intak 5. PNEUMONIA
 symptoms include nervousness, sweating, 6. TUBERCULOSIS
tremor and hunger. During sleep, can cause 7. ILL DEFINED
night sweats, unpleasant dreams and early 8. CHRONIC LOWER RESPIRATORY
morning headache DISEASE
 If the patient is conscious, give the patient 9. DIABETES MELLITUS
candy, sugar and sugar containing beverage 10. OTHER PERINATAL CONDITIONS
 If the patient is unconscious, give DEFINITION
intravenous glucose Hypertension is defined as SYSTOLIC
DIABETIC KETOACIDOSIS BLOOD PRESSURE of 140 mm Hg or greater
 complication of Type 1 diabetes mellitus and/or DIASTOLIC BLOOD PRESSURE of 90 mm
 there is insulin deficiency with relative or Hg or greater
absolute increase in glucagon What is systolic blood pressure?
 caused by cessation of insulin intake or as a It is the measurement of how much blood
result of physical or emotional stress presses against the blood vessel wall when the heart
contracts.

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What is diastolic blood pressure? SYMPTOMS
When the heart relaxes, the heart’s chambers 1. Headache
get filled with blood and blood pressure falls, this is 2. Nape pain
called diastolic blood pressure. 3. Easy fatigability
4. Breathlessness
5. Blurring of eyesight
APPARATUS TO MEASURE BLOOD COMPLICATIONS
PRESSURE HYPERTROPHIC CARDIOMYOPATHY
MERCURY SPHYGMOMANOMETERANEROID MYOCARDIAL INFARCTION
SPHYGMOMANOMETER CEREBROVASCULAR ACCIDENT
DIGITAL SPHYGMOMANOMETER HYPERTENSIVE NEPHROPATHY
JNC VII CLASSIFICATION OF BLOOD PERIPHERAL ARTERIAL DISEASE
PRESSURE HYPERTENSIVE RETINOPATHY
NORMAL - < 120/80 mmHg LIFESTYLE MODIFICATION
PREHYPERTENSION – 120-139mmHg 1. Lose weight if overweight
80-89 mmHg 2. Increasing physical activity with regular
HYPERTENSION exercise such as running, brisk walking
STAGE 1 – 140-159 mm Hg as well as sports
90 – 99 mmHg 3. Limit alcohol intake
STAGE 2 - > 160 mmHg 30 ml ethanol
> 100 mmHg 720 ml beer
TYPES OF HYPERTENSION 300 ml wine
1. Essential or Primary HPN 60 ml of whiskey
- main and the most 4. Moderation of salt intake
common form of 5. Lower intake of oily foods
hypertension 6. Increase potassium intake
- 95% of all HPN cases 7. Quitting smoking or keeping away from
- no single cause could be second hand smoke
pinpointed 8. Learn how to relax and release stress
2. Secondary hypertension PHARMACOLOGIC THERAPY
- a kind of hypertension 1.DIURETICS
brought on by another medical - Ideal for patients with heart failure
problem or treatment - Good for patients with isolated systolic
hypertension
CAUSES OF SECONDARY - Not to be given to patients with diabetes
HYPERTENSION mellitus and gout
1. Chronic kidney disease 2. ADRENERGIC INHIBITORS
2. Coarctation of the aorta - Methyldopa in this class is drug of
3. Cushings syndrome choice for pregnant hypertensive
4. Drug induced - Clonidine can be used sublingually
- Terazosin is useful in hypertensive
5. Obstructive uropathy patients with high cholesterol and
6. Pheochromocytosis benign prostatic hypertrophy
7. Sleep apnea 3.BETA BLOCKERS
8. Thyroid or parathyroid disease - ideal for patients with myocardial infarction,
3. Isolated systolic HPN angina, dysrhythmia , hyperthyroidism, and migraine
- systolic blood pressure is elevated but the - not to be given to patients who are asthmatic,
diastolic blood pressure is normal diabetic, bradycardic, and congestive heart failure
4.Isolated diastolic HPN 4. CALCIUM CHANNEL BLOCKERS
- systolic blood pressure is normal but - ideal for patients with angina,
diastolic blood pressure is elevated diabetes,migraine,asthmatic
5. “ White –coat” HPN - involves the elevation of - can cause edema of the
BP due to the stress of being in the presence or in the ankle, headache and
company of a doctor or nurse gingival hypertrophy
RISK FACTORS FOR HYPERTENSION 5. ACE INHIBITORS
1. Age - ideal for diabetes mellitus, heart failure, myocardial
2. Race infarction
3. Family history - not to be given in pregnant women and patients
4. Obesity with renal failure
5. Sedentary lifestyle - cough is the most common side effect
6. Smoking 6. ANGIOTENSIN 11 RECEPTOR BLOCKERS
7. Dyslipidemia - ideal for patients with heart failure , diabetes
8. Diabetes mellitus mellitus and patients with hypertensive nephropathy
8. Too much salt in diet COMBINATION DRUG THERAPY
9. Too little potassium 1. BETA BLOCKERS + DIURETICS
10. Drinking too much alcohol 2. ACE INHIBITORS+ DIURETICS
11. Stress 3. CALCIUM BLOCKERS +ACE INHIBITORS

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 SYMPTOMS OF ALCOHOL DEPENDENCE
ALCOHOLISM 1.NEGLECT OF OTHER ACTIVITIES
DEFINITION 2. EXCESSIVE USE
 a primary, chronic disease characterized by 3. IMPAIRED CONTROL
impaired control over drinking, 4. PERSISTENCE OF USE
preoccupation with the drug alcohol, use of 5. LARGE AMOUNT OF TIME SPENT ON
alcohol despite adverse consequences, and ALCOHOL RELATED ACTIVITY
distortions in thinking 6. WITHDRAWAL
 drinking alcoholic beverages at a level that 7. TOLERANCE
interferes with physical health, mental SIGNS AND SYMPTOMS OF ALCOHOLISM
health, and social, family, or job Drinking alone or in secret
responsibilities. Being unable to limit the amount of alcohol you drink
SCREENING TEST Not remembering conversations or commitments,
– Have you felt you should Cut down sometimes referred to as "blacking out"
on your drinking? Making a ritual of having drinks before, with or after
– Have people Annoyed you by dinner and becoming annoyed when this ritual is
criticizing your drinking? disturbed or questioned
-Have you ever felt you ought to cut Losing interest in activities and hobbies that used to
down on your drinking? bring pleasure
- Have you ever had a drink first Feeling a need or compulsion to drink
thing in the morning to steady Irritability when your usual drinking time nears,
your nerves? especially if alcohol isn't available
TYPES OF ALCOHOL PROBLEM Keeping alcohol in unlikely places at home, at work
1. BINGE DRINKING or in the car
-consumption of five or more drinks at one Gulping drinks, ordering doubles, becoming
sitting for males and three or more drinks at one intoxicated intentionally to feel good or drinking to
sitting for females feel "normal"
WHAT COUNTS AS ONE Drink? Having legal problems or problems with
Beer (regular) -350 ML relationships, employment or finances
Beer (light) -350 ML Building a tolerance to alcohol so that you need an
White Wine – 150 ML increasing number of drinks to feel alcohol's effects
Red Wine – 150 ML Experiencing physical withdrawal symptoms — such
Sweet Dessert Wine- 85 ML as nausea, sweating and shaking — if you don't drink
Proof Distilled Spirits (gin, rum, vodka, whiskey)- CAUSES
60 ML 1. GENETICS
SAFE LEVEL OF DRINKING 2. EMOTIONAL STATE
720 ML – BEER 3. PSYCHOLOGICAL FACTORS
300 ML – WINE 4. SOCIAL AND CULTURAL FACTORS
60 ML – WHISKY, RHUM, GIN RISK FACTORS
2. ALCOHOL ABUSE 1. AGE
It means you engage in excessive drinking that 2. GENETICS
causes health or social problems, but you aren't 3. SEX
dependent on alcohol and haven't fully lost control 4. FAMILY HISTORY
over the use of alcohol. 5. EMOTIONAL DISORDERS
3. ALCOHOL DEPENDENCE SHORT TERM HEALTH EFFECTS OF
a chronic and often progressive disease that includes ALCOHOL
a strong need to drink despite repeated problems. 1.NAUSEA AND DIZZINESS
ADDITIONAL CRITERIA: 2. HANG OVERS
1. NARROWING OF THE DRINKING 3.LOSS OF MUSCLE CONTROL
REPERTOIRE 4. ADVERSE INTERACTIONS WITH
2. DRINK-SEEKING BEHAVIOUR MEDICINES
3. ALCOHOL TOLERANCE COMPLICATIONS OF CHRONIC ALCOHOL
4. WITHDRAWAL SYMPTOMS USE
5. DRINKING TO AVOID OR RELIEVE HEPATOCELLULAR CARCINOMA
WITHDRAWAL SYMPTOMS CIRRHOSIS OF THE LIVER
5. SUBJECTIVE AWARENESS OF THE GASTROINTESTINAL PROBLEMS
COMPULSION TO DRINK GASTRITIS
6. A RETURN TO DRINKING AFTER A PERIOD PANCREATITIS
OF ABSTINENCE CARDIOVASCULAR PROBLEMS
OTHER COMPLICATIONS
EARLY SIGNS OF A PROBLEM  DIABETES COMPLICATIONS
 Frequent intoxication  SEXUAL FUNCTION AND
 Establish pattern of heavy drinking MENSTRUATION
 Drinking in dangerous situation - ERECTILE DYSFUNCTION
 Black out drinking IN MEN
 Drastic change in demeanor while drinking - INTERRUPT MENSTRUATION
IN WOMEN

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BONE LOSS – INCREASED THINNING OF THE CIGARETTE SMOKING
BONE AND FRACTURE ORIGIN OF SMOKING
NEUROLOGIC COMPLICATIONS > Nicotiana tabacum
-NUMBNESS OF HANDS AND FEET - scientific name of tobacco plant
- DEMENTIA > Originated in North America and Europe
FETAL ALCCOHOL SYNDROME CHEMICALS FOUND IN TOBACCO SMOKE
1.Nicotine 6. Carbon dioxide
NON-MEDICAL COMPLICATIONS 2.Tar 7. Hydrogen cyanide
1. A GREATER SUSCEPTIBILITY TO 3.Acetone 8. Methane
ACCIDENTAL INJURIES FROM OTHER 4.Ammonia 9. Benzopyrene
CAUSES 5.Carbon Monoxide
2. DOMESTIC ABUSE AND DIVORCE EFFECTS OF NICOTINE IN THE BODY
3. POOR PERFORMANCE AT WORK AND IN POSITIVE EFFECTS
SCHOOL - enhancement of memory and alertness
4. A HIGHER INCIDENCE OF SUICIDE AND - improvement of skills and work
MURDER performance
TREATMENT - alteration of mood, reduced
DETOXIFICATION AND WITHDRAWAL – 4- stress,inc.sociability, euphoria
7DAYS NEGATIVE EFFECTS
STAGES OF ALCOHOL WITHDRAWAL > SHORTNESS OF BREATH
STAGE 1 –ONSET IS 6 TO 8 HRS > CHRONIC COUGH
- AGITATION - ANXIETY > INC. HEART RATE AND B.P
- HYPERTENSION - NAUSEA > ULCER LIKE STOMACH
- ANOREXIA - HEADACHE PAINS
- INSOMNIA - CRAVING > REDUCTION OF FERTILITY
STAGE II – ONSET 24 HRS > EARLY ONSET OF
- HALLUCINATION - ILLUSION MENOPAUSE
-DISORDERED PERCEPTION IN WOMEN
- STAGE 1 CONTINUES • NEGATIVE EFFECTS
C. STAGE III – ONSET 7-48 HRS >SWEATING WITH THE SMELL
- GRAND MAL SEIZURES OF NICOTINE
D. STAGE IV – ONSET 3-5 MORE DAYS- >GASTRO-INTESTINAL
DELIRIUM TREMENS EFFECTS:
MEDICAL ASSESMENT AND TREATMENT 1. Appetite suppression
PSYCHOLOGICAL SUPPORT AND 2. Inability to smell food
PSYCHIATTRIC TREATMENT 3. Decreased efficiency of
DRUG TREATMENTS food digestion and
1.DISULFIRAM metabolism
2. NALTREXONE ( REVIA) SECOND HAND SMOKE
3. ACAMPROSATE SMOKE EXHALED BY A SMOKER AND
( CAMPRAL) INHALED BY OTHER PEOPLE
4. VIVITROL IV FORM EFFECTS OF SECOND HAND SMOKE
WHO SHOULD NOT DRINK? > INCREASED RISK OF HEART
Women who are pregnant or trying to DISEASE
become pregnant > INCREASED RISK OF LUNG
People who plan to drive or engage in other CANCER
activities that require alertness and skill > INCREASED FREQUENCY OF
(such as driving a car) RESPIRATORY INFECTIONS IN
People taking certain over-the-counter or INFANTS AND CHILDREN
prescription medications > CHRONIC IRRITATION OF EYES,
People with medical conditions that can be NOSE AND THROAT
made worse by drinking LONG TERM EFFECTS OF CIGARETTE
Recovering alcoholics SMOKING
People younger than age 21. 1. NICOTINE ADDICTION
HOW TO STOP DRINKING? 2. CORONARY ARTERY DISEASE
1. Write your reasons for cutting down or stopping. 3. HEART DISEASE
2. Set a drinking goal. 4. HARDENING OF ARTERIES
3. Keep a "diary" of your drinking 5. STROKE
4. Watch it at home. . 6. PEPTIC ULCER DISEASE
5. Drink slowly. 7. LUNG DISEASES
6. Take a break from alcohol. 8. CANCERS
7. Learn how to say NO. 9. DISEASES OF ORAL CAVITY
8. Stay active. 10. DELAYED WOUND HEALING
9. Get support.
10. Watch out for temptations.
CORONARY ARTERY DISEASE
20% IS CAUSED BY SMOKING

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HEART DISEASE 10 THINGS TO AVOID WHEN QUITTING
5X MORE IN SMOKERS 1.Being impatient
STROKE 2.Being worried about the future
1 PK A DAY INC.2.5X OF HAVING 3.Negativity
STROKE 4.Neglecting yourself
PEPTIC ULCER DISEASE 5.Drinking alcohol
CHRONIC BRONCHITIS/EMPHYSEMA 6. Overdoing it
CANCERS 7. Taking yourself too seriously
ORAL CAVITY 8. Being hesitant to ask for help
LUNG CANCER 9. Believing that you can smoke just one cigarette
BLADDER CANCER 10. Forgetting why you quit on the first place
RENAL CANCER
BUERGER’S DISEASE FAMILY PLANNING
FETAL SMOKING SYNDROME Definition
BENEFITS OF QUITTING SMOKING
 WITHIN 20 MINUTES  a program to regulate the number and
B.P and H.R NORMALIZE spacing of children in a family through the
TEMP.OF HANDS and FEET – NL. practice of contraception and other methods
 WITHIN 8 HRS of birth control
Carbon monoxide decreases Importance of family planning
Oxygen increases  gives the couple the advantage of choosing
 WITHIN 24 HRS. the desired family size and helps in spacing
DECREASED RISK OF SUDDEN HEART their children
ATTACK  improves the health of the mother as well as
 WITHIN 48 HRS ABILITY TO the children
TASTE and SMELL NL.  prevents sexually transmitted disease
 WITHIN 2 WEEKS to 3 MONTHS Family planning methods
BLOOD CIRCULATION IMPROVES  1.Barrier methods
LUNG FUNCTION INCREASES a. male condom
 WITHIN 1 TO 9 MONTHS b. female condom
OVER-ALL ENERGY INCREASES c. cervical cap
 WITHIN 1 YEAR RISK OF d. diaphragm
CORONARY HEART DISEASE  2. Intrauterine device
DECREASED BY 50%  3. Hormonal method
 WITHIN 5 YEARS a. Oral contraceptives
RISK OF DYING FROM LUNG CA. AND b. Patches
ORAL CA. DEC BY 50% c. Injectables
 WITHIN 10 YEARS  4. Voluntary sterilization
RISK OF DYING FROM LUNG CA, a. Tubal ligation
STROKE AND HEART ATTACK SAME b. No scalpel vasectomy
AS THAT OF NON SMOKER  5. Natural Family Planning
WAYS TO QUIT SMOKING a. Cervical mucus method
1. SCHEDULED REDUCTION b. Basal body temperature
2. NICOTINE REPLACEMENT THERAPY c. Calendar / rhythm method
3. SUDDEN STOPPAGE d. Cycle beads
WHAT SHOULD SMOKERS DO WHILE e. Lactational Amenorrhea
QUITTING f. Withdrawal
1. EXERCISE Male condoms
2. DRINK PLENTY OF WATER Advantages of male condom
3. EAT FRUIT AND VEGETABLES • prevents the spread of sexually transmitted
4. TAKE NAPS,WARM BATHS DURING infections, including HIV and AIDS.
INTENSIVE CRAVINGS • Birth control for men.
5. TELL FRIEMDS THAT YOU HAVE STOPPED • Available without a prescription.
SMOKING • No hormonal side effects.
6. CHANGE ACTIVITIES OR HABITS • Use can be part of sex play.
ASSOCIATED WITH SMOKING • Easy to use.
5 REASONS WHY THERE IS RELAPSE • Does not affect future fertility.
1. SELF PITY • May decrease women's risk for developing
2. SELF DEPRECATION pre-cancerous cells on the cervix.
3. BLAMING OTHERS Disadvantages of Male Condom
4. OVER CONFIDENCE Must be readily available.
5. IMPATIENCE Can interrupt sex play.
DEFEAT THE URGES TO SMOKE Can break or leak.
1. HUNGER Possible allergic reaction.
2. ANGER Decreased sensation for some people. Intra-
3. LONELINESS/ BOREDOM
4. TIREDNESS/FATIGUE

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uterine device Advantages of patch
 small, plastic, T-shaped device with a 1. You don't have to remember a pill each day
string attached to the end. It is placed inside 2. Since the Patch releases a steady, consistent dose
the uterus to prevent pregnancy. The of hormones each month, it produces a lower
placement can be done during an office visit incidence of side effects
How does it work? 3. The Patch causes fewer hormonal ups and downs
• The IUD prevents pregnancy by not than most hormonal methods.
allowing a fertilized egg to attach itself to 4. Doesn't require any interruption of sex or
the wall of the uterus. If a fertilized egg foreplay to protect against pregnancy.
cannot attach and grow, it is unable to Disadvantages of a patch
develop into a fetus 1. The Patch requires a prescription and a
Advantages gynecological exam before you can get it
• It's very effective in preventing pregnancy, 2. Cigarette smoking increases the risk of high blood
because you're always protected from pressure and heart disease; women who use
pregnancy and there's nothing to remember combination hormonal contraceptives are strongly
to do (for example, there are no pills to advised not to smoke.
take). 3. The patch does not protect you from HIV or other
• It's inexpensive. infections.
• An IUD can be removed by your doctor at Injectable hormones
any time. DEPO PROVERA
• It starts working right away. Advantages of DEPO
• There's a low risk of side effects. 1. very effective
• Mothers who use an IUD can breast-feed 2. safe
safely. 3.long lasting effect per injection
• Neither you nor your partner can feel it. 4.temporary method
Disadvantages of I.U.D 5.prevents anemia
 1. Expertise of a doctor , nurse or a midwife 6. prevents ectopic pregnancy
is needed in it’s insertion 7. prevents pelvic infection
 2. The danger of being misplaced or 8.acts as protection against
expulsion is always there endometrial and ovarian cancer
 3. Does not offer protection against sexually Disadvantages of DEPO
transmitted disease 1.Causes loss of bone density and risk
 4. Heavy menses are noted among it’s users of osteoporosis.
Oral Contraceptive pills 2 .Does not protect against sexually
HOW DOES IT WORK? transmitted infections, including
1. Suppress ovulation HIV/AIDS.
2. Reduce sperm transport in the fallopian 3. Requires injections every 3 months.
tube 4. Delay of return to fertility.
3. Change endometrial lining making 5. Irregular bleeding.
implantation less likely 6. Most women experience weight
4. Thickens cervical mucus gain
ADVANTAGES OF ORAL CONTRACEPTIVES Tubal ligation
1. Highly effective when taken daily Tubal ligation (informally
2. Effective immediately if started by known as getting one'"tube tied") is a permanent
day 7 of the menstrual cycle form of female sterilization,in which
3. Pelvic examination not needed to the fallopian tubes are severed and sealed or
initiate use "pinched shut", in order to prevent fertilization
4. Does not interfere with intercourse Advantages of tubal ligation
5. Few side effect • Permanent birth control.
6. Convenient and easy to use • Immediately effective.
7. Client can stop the use • Allows sexual spontaneity.
Disadvantages of oral contraceptives • Requires no daily attention.
1. irregular bleeding for the first few months • Not messy.
2. increased appetite • Cost-effective in the long run.
3. depression or moodiness Disadvantages of tubal ligation
4.headaches/dizziness • Does not protect against sexually
5.weight change transmitted infections, including HIV/AIDS.
6.small or missed periods • Requires surgery.
7.breast tenderness • Has risks associated with surgery.
8.no protection against STDs • More complicated than
Hormonal Patch male sterilization.
Mechanism of action • May not be reversible.
1. It helps prevent ovulation • Possible regret.
2.It thickens cervical mucus • Possibililty of Post Tubal Ligation syndrome
3.It causes changes in the endometrium to
reduce the likelihood of implantation.

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NO SCALPEL VASECTOMY
A vasectomy is a safe, simple and effective surgical
procedure that makes a man sterile (unable to
father a child).
"No-scalpel" is a special technique for performing a
vasectomy that often results in less swelling and pain
than the traditional method.
NO SCALPEL VASECTOMY
Advantages of no scalpel vasectomy
1. No Incision
2. No Stitches
3. Less Discomfort
4. Faster Recovery
5. Less Chance of Bleeding and complications
Disadvantages of no scalpel vasectomy
1. permanence
2. offers no protection against sexually
transmitted disease
NATURAL FAMILY PLANNING METHODS
CERVICAL MUCUS METHOD
This method involves looking at the
discharge or cervical mucus during your monthly
cycle. During different stages of your cycle, your CM
will change in various ways.
Basal Body Temperature
It is the body temperature at the time you
wake up each day. By measuring this temperature
each day and noting the day that it changes, a woman
can determine when she's least and most likely to
ovulate and conceive.
CYCLE BEADS METHOD
It is a family planning method that uses a
visual tool that keeps track of the women’s cycle and
clearly identify the days when pregnancy is very
likely
Cycle beads are based on a family planning
method that is 95% effective in preventing
pregnancy when used correctly CALENDAR
METHOD
The rhythm method is based on three ideas.
Firstly, that women ovulate 14 days before
menstruation begins, give or take two days.
Secondly, that sperm can survive inside a woman for
three days. And lastly, that an egg can only be
fertilized within 24 hours of being released from the
ovaries.
Lactational Amenorrhea
The Lactation Amenorrhea Method of birth control is
98% effective when the following conditions are met:
• Periods have not yet returned (spotting
during the first two months doesn’t count).
• The baby is exclusively breastfed, with no
supplementation.
• The baby is less than six months old.
• Effectiveness of the LAM method drops if
the baby receives supplementation
BREASTFEEDING INFANT
• Withdrawal
A form of family planning in
which the penis is withdrawn from the
vagina when it is about to ejaculate
Advantages of natural family planning
• Have no medical side effects
• Immediate return to fertility
• Free and readily available
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Disadvantages of natural family planning
1. High failure rate
2. Require high motivation and ability to
follow instructions
3. Require partner's cooperation
4. Couple practicing periodic abstinence
must abstain from intercourse for a significant
period of time every month
5. No protection from STIs/HIV
6. May be difficult to detect a woman's
fertile period (close to menarche, close to menopause,
during breastfeeding, or in women with irregular
cycles)
WHO CAN PRACTICE NATURAL FAMILY
PLANNING ?
1.Couples willing to learn how to observe, record
and interpret the woman's fertility signs
2. Couples who accept the potential for unintended
pregnancy
3. Couples with no/little access to modern
contraceptive methods
4. Couples with religious/philosophical reasons
not to use other methods
5. Women with regular menstrual cycles
6. Women unable to use other contraceptive
methods
7. Men willing to practice withdrawal
RESPIRATORY TRACT INFECTION
Respiratory tract infections
Infections can affect any part of the respiratory
system. They are traditionally divided into upper
respiratory tract infections and lower respiratory tract
infections.
Upper respiratory tract infection
The most common upper respiratory tract infection is
the common cold however, infections of specific
organs of the upper respiratory tract such as sinusitis,
tonsillitis, otitis media, pharyngitis and laryngitis are
also considered upper respiratory tract infection
Lower respiratory tract infection
The most common lower respiratory tract infection in
is pneumonia, a lung infection. Pneumonia is usually
caused by bacteria, particularly Streptococcus
pneumoniae in Western countries. Worldwide,
tuberculosis is an important cause of pneumonia.
Other pathogens such as viruses and fungi can cause
pneumonia for example severe acute respiratory
syndrome and pneumocystis pneumonia.
TUBERCULOSIS
Definition:
 Is a chronic bacterial infection characterized
by granuloma formation, necrosis, and
calcification of involved tissues
 Fairly common among low-income,
congested families
TB Statistics
According to the WHO, more than two billion people
– one third of the world’s total population – are
infected with TB bacilli. One in every 10 of those
people will become sick with active TB in his or her
lifetime. People living with HIV are at a much
greater risk.
A total of 1.77 million people died from TB in 2007 The PPD is injected intradermally usually in
(including 456,000 people with HIV), equal to about the inner aspect of the lower forearm about 4 inches
4,800 deaths a day. TB is a disease of poverty, below the elbow.
affecting mostly young adults in their most The test is read 48 to 72 hours after
productive years. When left untreated, each person injection.
with active TB disease will infect on average Interpretation of result:
between 10 and 15 people every year.  (+) Mantoux Test is induration of 10 mm
The Philippines is among the 22 high burden or more . But for HIV positive clients,
countries for tuberculosis, according to the WHO. TB induration of about 5 mm is considered
is the 6th leading cause of illness and the 6th leading positive
cause of deaths among Filipinos. According to the  (+) Mantoux test signifies exposure to
2nd National Prevalence Survey done in 1997, most Mycobacterium Tubercle bacilli
TB patients belong to the economically productive Classification of pulmonary tuberculosis
age-group (15-54 years old). o Class 0 – no exposure, no infection
Causative Agent: Mycobacterium tuberculosis o Class 1 – ( + ) exposure; no
 Acid-fast bacilli evidence of infection
 Aerobic o Class 2 – ( + ) exposure; ( + ) PPD;
Incubation Period: 3 – 8 weeks no clinical evidence of active TB
Mode of Transmission: o Class 3 – ( + ) exposure; ( + ) PPD;
1 .Airborne ( + ) symptoms
2. Nasopharyngeal secretions  Active TB
3. Droplet nuclei infection o Class 4 – disease; not clinically
Clinical manifestations: active
 Fever – low-grade, late afternoon or early o Class 5 – diagnosis pending
evening  PTB suspect
 Anorexia – loss of appetite Medical management:
 Weight loss 1.Rifampicin (RIF) – 10mg/kg/day
 Nocturnal sweating  Taken with food to
 Chest and back pains prevent GI upset
 Chronic cough > 2 weeks duration  Reddish – orange
 Dyspnea and hemoptysis  discoloration of urine
Risk Factors:  Causes hepatotoxicity
1. Weakened immune system 2. Isoniazid (INH) – 5-20mg/kg/day
 HIV/AIDS  Taken on an empty
 Diabetes stomach for maximum
 End-stage kidney disease absorption
 Cancer treatment, such as chemotherapy  Causes PERIPHERAL
 Drugs to prevent rejection of transplanted NEUROPATHY
organs  Given with
 Some drugs used to treat rheumatoid PYRIDOXINE (Vit. B6)
arthritis, Crohn's disease and psoriasis  Avoid alcohol
 Malnutrition consumption
 Advanced age 3. Ethambutol (EMB) – 15/mg/kg/day
2. Poverty and substance abuse  Causes OPTIC NEURITIS
characterized by blurring
 Lack of medical care. If you are on a low
of vision
or fixed income, live in a remote area, you
4. Pyrazinamide (PZA) – 15-30 mg/kg/day
may lack access to the medical care needed
 Causes hepatotoxicity and
to diagnose and treat TB.
hyperuricemia
 Substance abuse. Long-term drug or
 Protect drug from light
alcohol use weakens your immune system
o Streptomycin – 15-20mg/kg/day
and makes you more vulnerable to
 Must weigh patient daily
tuberculosis.
and monitor kidney
Diagnostic examinations:
function;
1. Chest x – ray
 Causes OTOTOXICITY
2 Sputum AFB – 3 consecutive mornings;
and NEPHROTOXICITY
to identify if the client is communicable
To help people stick with their treatment, a program
3. Bronchoscopy
called directly observed therapy (DOT) is sometimes
4. Mantoux test – or PPD; exposure to TB
recommended. In this approach, a health care worker
5. Sputum Microscopy – gold standard
administers your medication so that you don't have to
remember to take it on your own.
6. . TB culture – confirmatory
Prevention:
Skin test- MANTOUX TEST
1.Protect your family and friends
This is used to determine if a person has
If you have active TB, keep your germs to yourself. It
been infected or has been exposed to the TB bacillus.
generally takes a few weeks of treatment with TB
This utilizes the PPD (Purified Protein
medications before you're not contagious anymore.
Derivatives)
Follow these tips to help keep your friends and
family from getting sick:

12 | P a g e
  Stay home. Don't go to work or school or
sleep in a room with other people during the
first few weeks of treatment for active
tuberculosis.
 Ventilate the room. Tuberculosis germs
spread more easily in small closed spaces
where air doesn't move. If it's not too cold
outdoors, open the windows and use a fan to
blow indoor air outside.
 Cover your mouth. Use a tissue to cover
your mouth anytime you laugh, sneeze or
cough. Put the dirty tissue in a bag, seal it
and throw it away.
 Wear a mask. Wearing a surgical mask
when you're around other people during the
first three weeks of treatment may help
lessen the risk of transmission.
Finish your entire course of medication
This is the most important step you can take
to protect yourself and others from tuberculosis.
When you stop treatment early or skip doses, TB
bacteria have a chance to develop mutations that
allow them to survive the most potent TB drugs. The
resulting drug-resistant strains are much more deadly
and difficult to treat.
Vaccinations
In countries where tuberculosis is more
common, infants are vaccinated with bacillus
Calmette-Guerin (BCG) vaccine because it can
prevent severe tuberculosis in children.
DIPTHERIA
Definition: An acute contagious bacterial infection
characterized by a general systemic toxemia from a
localized inflammatory focus
Causative agent: Corynbacterium diphtheria (Klebs-
loffler’s bacillus) - Elaborates a powerful diphtheria
toxin that results to toxemia
Incubation Period:
 1 – 7 days
Mode of transmission:
 Direct contact with the patient
 Airborne transmission
 direct contact with articles
Clinical Manifestations
 Low-grade fever
 “ Pseudomembrane formation”
(thin gray-colored structure, highly adherent
and bleeds on manual manipulation)
 Bullnecked appearance due to neck edema
and cervical adenopathy
Hoarseness and croupy cough
( laryngeal diphtheria )
 Can lead to MYOCARDITIS
Diagnostic examination:
 Nose and throat culture
o Must be 3 negative results
 Schick test
o Determines susceptibility and
immunity to diphtheria
o A small amount (0.1 ml) of diluted
diphtheria toxin is injected
intradermally into the arm of the
person.
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Results can be interpreted as
 Positive: when the test results in a wheal of
5–10 mm diameter
 Pseudo-positive: when there is only a red
colored inflammation and it disappears
rapidly
 Negative reaction:
 pseudo negative reaction:
 Maloney test
o Hypersensitivity to diphtheria anti-
toxin
Medical Management
1. Diphtheria anti-toxin
To neutralize the toxins
2.Antibiotics
 Penicillin
Usual adult dose –
Aqueous penicillin G 2 to 3 million
units IV per day in divided doses
every 4 to 6 hours for 10 to 12 days
Usual Pediatric dose
Aqueous penicillin G:
Neonates:
- 0 to 4 weeks, birthweight less
than 1200 g: 25,000 to 50,000
units/kg IV or IM every 12 hours
-Less than 1 week, birthweight
1200 to 2000 g: 25,000 to 50,000
units/kg IV or IM every 12 hours
-Less than 1 week, birthweight
greater than 2000 g: 25,000 to
50,000 units/kg IV or IM every 8
hours
-1 to 4 weeks, birthweight 1200 to
2000 g: 25,000 to 50,000 units/kg
IV or IM every 8 hours
-1 to 4 weeks, birthweight greater
than 2000 g: 25,000 to 50,000
units/kg IV or IM every 6 hours
Greater than 1 month:
Mild to moderate infections: 6250
to 12,500 units/kg IV or IM every 6
hours
Severe infections: 250,000 to
400,000 units/kg per day IV or IM
in 4 to 6 divided doses
Maximum dose: 24 million units
 Erythromycin – 30-50 mg/ kg per
day in divided doses
Prevention
The only method of preventing diphtheria is to
immunize susceptible people. The substance used in
immunizing an individual is diphtheria toxoid
(toxoid is a weaker form of toxin that is used in
vaccine to protect people and animals from
contracting the actual disease)
A child should have received four DPT shots by 18
months of age, with a booster shot at age 4 years to 6
years. After that, diphtheria and tetanus boosters
should be given every 10 years to provide continued
protection.
 PERTUSSIS Mode of transmission:
(whooping cough)  Inhalation of respiratory secretions from an
Definition: an acute contagious bacterial infection infected individual
characterized by paroxysms of repeated cough and  Aspiration of oropharyngeal secretions –
ends in a whooping sound ASPIRATION PNEUMONIA
Causative agent:  Through the bloodstream
Bordetella pertussis  From direct spread as a result of surgery or
Incubation Period: trauma
7 – 21 days Risk factors for pneumonia
Mode of transmission:  Smoke.
o Direct contact by nasopharyngeal secretions  Abuse alcohol.
o Indirect contact thru airborne transmission  Have other medical conditions, such as
Clinical manifestations: chronic obstructive pulmonary disease
Invasive Stage – or catarrhal stage (COPD), emphysema, asthma, or
 7 – 14 days HIV/AIDS.
 fever  Are younger than 1 year of age or older than
 watery eyes and sneezing 65.
 nocturnal coughing  Have a weakened or impaired immune
 restlessness or irritable system.
Spasmodic stage – 4 – 12 weeks  Take medicines for gastroesophageal reflux
 forceful successive coughing with peculiar disease (GERD).
crowing sound or “whoop”
 Have recently recovered from a cold or
 5 – 20 coughing
influenza infection.
 protrusion of tongue and eyeballs during
 Are malnourished.
coughing
 Have been recently hospitalized in an
 swollen face and neck
intensive care unit.
 Involuntary micturition
Convalescent stage  Have been exposed to certain chemicals or
 Symptoms subsides pollutants.
Diagnostic examinations:  Have any increased risk of breathing mucus
o Cough plate – or agar plate or saliva from the nose or mouth, liquids, or
Bordet-Gengou test food from the stomach into the lungs.
o Direct Immunoflourescent Assay Clinical Manifestations
o Polymerase chain reaction  Sudden onset of fever, high-grade with
Medical Management: chills
Drug of choice:  Productive cough
Erythromycin 30-50 mg/kg/ day for 14 days  Dyspnea
Alternatives  Pleuritic chest pain aggravated by coughing
Clarithomycin for 7 days or breathing
azithromycin for 5 days  Tachypnea accompanied by grunting, nasal
Prevention: DPT vaccination flaring, use of accessory muscles and fatigue
PNEUMONIA  Rapid, bounding pulse
Definition: a lung infection that can be caused by Diagnostic Examination
different types of microorganisms, including bacteria,  CBC
viruses, and fungi  Chest x-ray – to show presence of
Causative agents: pneumonic infiltrates and the extent of
Bacterial pneumonia pneumonia
 Streptococcus pneumoniae - most common  Sputum Gram’s Stain – may indicate
cause of bacterial pneumonia offending microorganism
 Staphylococcus aureus  Sputum culture and sensitivity
 Gram-negative bacteria  Blood culture – to confirm the presence of
(Klebsiella,Pseudomonas, Escherichia) bacterial pneumonia
 Hemophilus influenzae – common among  Immunologic test detecting microbial
alcoholics antigens in serum, sputum, and urine
Atypical pneumonia Medical management:
 Legionella pneumophila – found in  Antimicrobial therapy – depends on
contaminated water and airconditioners laboratory identification of causative agents
 Mycoplasma pneumonia and its sensitivity
 Chlamydia trachomatis  O2 therapy
Viral pneumonia  Mucolytic and other cough medicines
 Influenza viruses  Bronchodilators
 Parainfluenza  Steroid therapy
 RSV Prevention:
 Adenoviruses  Smoking cessation
Fungal pneumonia  Vaccination
 Aspergillus fumigatus
 Pneumocystis carinii – common among
AIDS patients

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 URINARY TRACT INFECTIONS
Definition
A urinary tract infection is an infection that begins in
your urinary system. Your urinary system is
composed of the kidneys, ureters, bladder and
urethra. Any part of your urinary system can become
infected, but most infections involve the lower
urinary tract — the bladder and the urethra.
Epidemiology
Acute community-acquired UTIs
 Incidence
Occur in 1–3% of schoolgirls
Increase markedly in incidence with onset of
sexual activity
0.5–0.7 infections per patient-year in young
women
 Age
 Symptomatic infection is most
common among young women
after the onset of sexual activity.
 Asymptomatic bacteriuria is more
common among the elderly, with
rates as high as 40–50% in some
studies.
 Sex
 Primarily affect women
2–8% of pregnant women
 Unusual in men under age 50
Catheter-associated (nosocomial) UTIs
 Nearly 1 million nosocomial UTIs per year
in the U.S.
 Vast majority caused by indwelling
catheters
 Bacteriuria develops in at least 10–15% of
hospitalized patients with indwelling
urethral catheters.
 risk of infection is ~3–5% per day of
catheterization
 Urinary tract catheterization accounts for
~30% of cases of gram-negative bacteremia
in hospitalized patients.
Clinical Manifestations
Urinary tract infections don't always cause signs and
symptoms, but when they do they can include:
 A strong, persistent urge to urinate
 A burning sensation when urinating
 Passing frequent, small amounts of urine
 Urine that appears cloudy
 Urine that appears bright pink or cola
colored — a sign of blood in the urine
 Strong-smelling urine
 Pelvic pain, in women
 Rectal pain, in men
Types of urinary tract infection
Each type of urinary tract infection may result in
more-specific signs and symptoms, depending on
which part of your urinary tract is infected.
Part of urinary tract
Signs and symptoms
affected
 Upper back and
side (flank) pain
 High fever
Kidneys (acute
 Shaking and
pyelonephritis)
chills
 Nausea
 Vomiting
15 | P a g e
 Pelvic pressure
 Lower abdomen
discomfort
Bladder (cystitis)
 Frequent, painful
urination
 Blood in urine
 Burning with
Urethra (urethritis)
urination
Risk factors
 Being female. Urinary tract infections are
very common in women, and many women
will experience more than one. A key reason
is their anatomy. Women have a shorter
urethra, which cuts down on the distance
bacteria must travel to reach the bladder.
 Being sexually active. Women who are
sexually active tend to have more urinary
tract infections than women who aren't
sexually active.
 Using certain types of birth control.
Women who use diaphragms for birth
control also may be at higher risk, as may
women who use spermicidal agents.
 Undergoing menopause. After menopause,
urinary tract infections may become more
common because the lack of estrogen causes
changes in the urinary tract that make it
more vulnerable to infection.
 Having urinary tract abnormalities.
Babies born with urinary tract abnormalities
that don't allow urine to leave the body or
cause urine to back up in the urethra have an
increased risk of urinary tract infections.
 Having blockages in the urinary tract.
Kidney stones or an enlarged prostate can
trap urine in the bladder and increase the
risk of urinary tract infection.
 Having a suppressed immune system.
Diabetes and other diseases that impair the
immune system — the body's defense
against germs — can increase the risk of
urinary tract infections.
 Using a catheter to urinate. People who
can't urinate on their own and use a tube
(catheter) to urinate have an increased risk
of urinary tract infections. This may include
people who are hospitalized, people with
neurological problems that make it difficult
to control their ability to urinate and people
who are paralyzed.
Etiologic agent
The most common etiologic agents are gram-
negative bacilli.
 Escherichia coli
o Causes ~80% of acute UTIs in
patients without catheters, urologic
abnormalities, or calculi
o Most E. coli strains that cause
symptomatic UTIs in
noncatheterized patients belong to a
small number of specific O, K, and
H serogroups.
 Proteus
 Klebsiella
 Occasionally Enterobacter
  In addition to the above pathogens, Serratia
and Pseudomonas cause recurrent infections
and infections associated with urologic
manipulation, catheters, calculi, or
obstruction.
 Factors that predispose to periurethral
colonization with gram-negative bacilli
remain poorly understood.
Gram-positive etiologic agents of UTI play a
lesser role.
 Staphylococcus saprophyticus causes 10–
15% of acute symptomatic UTIs in young
women.
 Enterococci are common among
catheterized patients.
 Staphylococcus epidermidis is a common
cause of catheter-associated UTI.
Infecting strains in catheter-related infection
display markedly greater antimicrobial resistance
than organisms that cause community-acquired UTIs.
The causative role of several more unusual
bacterial and nonbacterial pathogens in UTIs remains
poorly defined, including:
 Ureaplasma urealyticum
 Mycoplasma hominis
 Mycoplasma genitalium
 Candida and other fungal species
o Commonly colonize the urine of
catheterized or diabetic patients
o Colonization sometimes progresses
to symptomatic invasive infection.
 Mycobacteria
 Adenoviruses
o Cause acute hemorrhagic cystitis in
children and in some young adults,
often in epidemics
Chlamydia trachomatis, Neisseria gonorrhoeae,
and herpes simplex virus cause urethritis.
Other viruses (e.g., cytomegalovirus) can
be isolated from urine but are thought not to
cause acute UTI.
Diagnostic evaluation
Urine Tests
Urinalysis A urinalysis is an evaluation of various
components of a urine sample. It involves looking at
the urine color and clarity, using a special dipstick to
do different chemical testing, and possibly inspecting
some of the urine underneath a microscope. A
urinalysis usually provides enough information for a
doctor or nurse to start treatment.
Urine Culture. If necessary, the doctor may order a
urine culture, which involves incubating and growing
the bacteria contained in the urine. A urine culture
can help identify the specific bacteria causing the
infection, and determine which type of antibiotics to
use for treatment. A urine culture may be ordered if
the urinalysis does not show signs of infection but the
doctor still suspects a UTI is causing the symptoms.
It may also be ordered if the doctor suspects
complications from the infection.
Clean-Catch Sample. To obtain an untainted urine
sample, doctors usually request a so-called
midstream, or clean-catch, urine sample. To provide
this, the following steps are taken:
16 | P a g e
 Patients must first wash their hands
thoroughly, then wash the penis or vulva and
surrounding area four times, with front-to-
back strokes, using a new soapy sponge each
time.
 The patient must then begin urinating into
the toilet and stop after a few ounces.
 The patient then positions the container to
catch the middle portion of the stream.
Ideally, this urine will contain only the
bacteria and other evidence of the urinary
tract infection.
 The patient then urinates the remainder into
the toilet.
 The patient securely screws the container
cap in place without touching the inside of
the rim.
The sample is generally given to the doctor or sent to
the laboratory for analysis.
Collection with a Catheter. Some patients (small
children, elderly people, or hospitalized patients)
cannot provide a urine sample. In such cases, a
catheter may be inserted into the bladder to collect
urine. This is the best method for providing a
contaminant-free sample.
Medical Management
Simple infection
Drugs commonly recommended for simple urinary
tract infections include:
 Sulfamethoxazole-trimethoprim
 Amoxicillin
 Nitrofurantoin
 Ampicillin
 Ciprofloxacin
Severe infection
For severe urinary tract infections, hospitalization
and treatment with intravenous antibiotics may be
necessary.
Ways to Prevent Urinary Tract Infections
 Water helps flush your urinary tract, so
make sure you drink plenty of plain water
daily.
 Don't hold it when you need to urinate!
 You should wipe from front to back after a
bowl movement. This is especially
important to help prevent bacteria from the
anus from entering the vagina or urethra.
 Taking showers instead of baths helps
prevent bacteria from entering the urethra
and causing a UTI.
 Always wash your genital area both before
and after sexual intercourse to help prevent
transferring bacteria to the urethra or vaginal
area, which can create a breeding ground for
a UTI.
 Feminine hygiene sprays and douches,
particularly scented douches, can irritate the
urethra and possibly lead to a UTI
 Drinking cranberry juice is a fairly well-
known and natural way to both help prevent
urinary tract infections, as well as help speed
the recovery process when a UTI develops.
  Another nutritional route that may help
prevent UTI is regularly taking vitamin C
supplements. Vitamin C increases the
acidity level of urine, which in turn helps
decrease the number of harmful bacteria that
may be present in your urinary tract system.
 Always wear panties with a cotton crotch
 If you are one of a large number of women
who suffers from frequent, recurrent urinary
tract infections, a change in your position
during sexual intercourse may help reduce
the number of UTIs that you experience
GASTROINTESTINAL INFECTIONS
Anatomy and associated host defense factors
ORAL CAVITY (mouth), pharynx , esophagus
 physical – mucus, sloughing epithelium,
saliva, peristalsis
 chemical - enzymes in saliva, mucus
 cellular - phagocytes (PMN), normal flora
STOMACH
 physical – mucus , sloughing epithelium ,
peristalsis
 chemical - HCl (pH ~2), pepsin (digestive
enzymes)
 cellular - none (?)
SMALL INTESTINE
 physical – mucus , sloughing epithelium,
peristalsis
 chemical – digestive enzymes (pancreas),
bile (gallbladder)
 cellular - none (?)
LARGE INTESTINES- includes colon, rectum and
anus
 physical – mucus, sloughing epithelium ,
peristalsis
 chemical - anaerobic conditions
 cellular – phagocytes ; normal flora(100
billion bacteria per gram of fecal material in
large intestine)
 2.2 million children will die from diarrhoea
and related diseases this year.
80% of them in the first two years of their
life;
42,000 a week,
6,000 a day,
four every minute,
one every fourteen seconds.
 Gastroenteritis
 Inflammation of the mucous membrane of
both the stomach and intestine, usually
causing nausea, vomiting, and diarrhea.
CAUSES OF GASTROENTERITIS
Viral 50-70%
Norwalk virus
Caliciviruses
Rotavirus
Adenovirus
Parvovirus
Astrovirus
Bacterial 15-20%
Salmonella
Shigella
Campylobacter species
Vibrio Cholera
Staphylococcus aureus
17 | P a g e
Bacillus cereus
Clostridium botulinum
Parasitic 10-15%
Others
VIRAL GASTROENTERITIS
1. Infantile Gastroenteritis
 An endemic viral infection of young
children (6 mo-12 yrs)
 is especially widespread during
rainy season
 caused by strains of rotavirus
 the incubation period is 2-4 days
 with symptoms lasting 3-5 days
 including abdominal pain, diarrhea, fever,
and vomiting.
 treatment: fluids
2. Epidemic Gastroenteritis
 An epidemic, highly communicable but
rather mild disease of sudden onset,
 caused by the epidemic gastroenteritis virus
(especially Norwalk agent)
 with an incubation period of 16-48 hrs
 and a duration of 1-2 days,
 affects all age groups;
 infection is associated with some fever,
abdominal cramps, nausea, vomiting,
diarrhea, and headache
BACTERIAL GASTROENTERITIS
Alternative Names
 Infectious diarrhea
 Acute gastroenteritis
MECHANISMS INVOLVED IN BACTERIAL
GASTROENTERITIS
1. from ingestions of bacterial toxins that have
been secreted into foods
2. non-invasive bacteria that secretes toxin
while adhering to intestinal wall
3. follow an intracellular invasion of the
intestinal epithelial cells
4. bacteria that enter the bloodstream via
the intestinal tract
INGESTION OF PREFORMED BACTERIAL
TOXIN
1. Staph food poisoning
 caused by Staphylococcus aureus
(S. aureus) bacterium.
 the bacteria multiply in foods and produce
toxins especially if food is kept at room
temperature.
 Foods that are associated with staph food
poisoning include:
 Poultry and egg products.
 Salads such as egg, tuna, chicken, potato,
and macaroni.
 Milk and dairy products.
 Symptoms:
1. severe diarrhea
2. abdominal pain
3. vomiting
 Outstanding diagnostic aid – short
incubation period ( 1-6 hrs)
 Duration of acute symptoms - < 24 hrs
2. Bacillus cereus
2 distinct forms of food poisoning
a. emetic form of the disease
incubation of 1-6 hrs
characterized by profuse vomiting with
or without mild diarrhea lasting 6-24
hrs
b. diarrheal form
incubation period – 10 -12
hrs
characterized by profuse diarrhea and
occasional vomiting
lasts 6-24 hrs.
source if infection
A variety of foods, particularly rice and
leftovers, as well as sauces, soups, and
other prepared foods that have sat out
too long at room temperature.
3. Botulism
 a rare but serious illness caused by a
bacterium which occurs in soil.
 It produces a toxin that affects your nerves.
 Sources
 Infants: Honey, home-canned vegetables
and fruits, corn syrup
 Children and adults: Home-canned foods
with a low acid content, improperly canned
commercial foods, home-canned or
fermented fish, herb-infused oils, baked
potatoes in aluminum foil, cheese sauce,
bottled garlic, foods held warm for extended
periods of time
 Incubation Period
Infants: 3-30 days
Children and adults: 12-72
hours
 Duration of Illness ;Variable
 Symptoms
 Infants: Lethargy, weakness, poor feeding,
constipation, poor head control, poor gag
and sucking reflex
 Children and adults: Double vision, blurred
vision, drooping eyelids, slurred speech,
difficulty swallowing, dry mouth and muscle
weakness
4. Clostridium perfringens
 often occur when foods are
prepared in large quantities and are then
kept warm for a long time before serving.
 Sources
 Beef
 Poultry
 Gravies
 Incubation Period
 6-24 hours
 Symptoms
 Diarrhea and abdominal cramps (not fever
or vomiting)
 Duration of Illness
 24 hours or less
In severe cases, symptoms may last for 1-2
weeks.
18 | P a g e
BACTERIA THAT ADHERE TO INTESTINAL
MUCOSA
1. Escherichia coli
E. coli is the name of a type of
bacteria that lives in your intestines and in the
intestines of animals. Although most types of E. coli
are harmless, some types can make you sick.
 3 different strains
a. enterotoxigenic E. coli
 the leading cause of travelers'
diarrhea.
 ETEC is transmitted by food or water
contaminated with animal or human feces..
b. enterohemorrhagic E.coli
 The worst type of E. coli, known
as E. coli O157:H7, causes bloody diarrhea
and can sometimes cause kidney failure and
even death.
 E. coli O157:H7 makes a toxin called Shiga
toxin.
 produces severe abdominal cramps and
bloody diarrhea
c. enteropathogenic e. coli
Enteropathogenic Escherichia coli (EPEC)
is one of the five virotypes (classes) of pathogenic E.
coli and is known to be the cause of diarrheal
diseases
 Incubation Period 1-10 days
 Symptoms
Severe diarrhea that is often bloody, severe
abdominal pain, and vomiting. Usually, little or no
fever is present.
Symptoms of HUS include decreased
urine production, dark or tea-colored
urine, and facial pallor.
 Duration of Illness :5-10 days
 Most people will be better in 6-8 days.
 If HUS develops, it usually occurs after
about 1 week.
2. Vibrio cholerae
Cholera (frequently called Asiatic
cholera or epidemic cholera) is a severe diarrheal
disease caused by the bacterium Vibrio cholerae.
Transmission to humans is by water or food
 Source of infection
a. spread by poor sanitation resulting in
contaminated water supplies.
b. shellfish harvested from fecally polluted
coastal waters are consumed raw.
 incubation periods : 6 hours to 5 days.
 Symptoms
 Sudden onset and large amounts of watery
diarrhea. Diarrhea is usually painless.
 Vomiting.
 Muscle cramps.
 Stool that has a characteristic "rice-water"
appearance -- grey, slightly cloudy with
flecks of mucus, and a slightly sweaty odor
 Washerwoman’s hands
3. Vibrio Infections
 V. parahaemolyticus typically causes non-
bloody diarrhea.
 In persons with liver disease, cancer, or
another immune-compromising condition,
V. vulnificus typically infects the
bloodstream, causing a life-threatening
illness. About half of V.
vulnificus bloodstream infections are fatal,
and death can occur within two days. In
addition to transmission by raw shellfish, V.
vulnificus can enter the body via a wound
that is exposed to warm seawater.
 Sources
Raw or undercooked shellfish, particularly
raw oysters
 Incubation Period
V. vulnificus: 1-7 days
V. parahaemolyticus: 2-48
hours
 Symptoms
In healthy individuals: Diarrhea,
vomiting, abdominal pain
In high-risk individuals: Sudden chills,
fever, shock, skin lesions
 Duration of Illness2-8 days
 How Can I Prevent Illness?
Avoid eating raw or undercooked
shellfish.
BACTERIA THAT INVADES CELLS LINING
THE DIGESTIVE TRACT
1. Shigella dysenteriae
- causative agent of bacillary dysentery
 Sources
 Contaminated food or water, or contact with
an infected person.
 Foods most often associated with Shigella
outbreaks are salads and sandwiches that
involve a lot of hand contact in their
preparation, and raw vegetables
contaminated in the field.
 Incubation Period
 1 -7 days (usually 1-3 days)
 Symptoms
 Sudden abdominal cramping, fever, diarrhea
that may be bloody or contains mucus,
nausea and vomiting
 Duration of Illness 2-7 days
 Who’s at Risk?
 Children, especially toddlers aged 2-4
2. Salmonella spp.
Salmonella, the name of a group of bacteria,
is one of the most common causes of food poisoning
in developing countries
 Sources
 Food: Contaminated eggs, poultry, meat,
unpasteurized milk or juice, cheese,
contaminated raw fruits and vegetables
(alfalfa sprouts, melons), spices, and nuts
 Incubation Period 12-72 hours
 Symptoms
Diarrhea, fever, abdominal cramps,
vomiting
 Duration of Illness 4-7 days
19 | P a g e
PROTOZOA N GASTROENTERITIS
1. Amebiasis
 Caused by Entamoeba histolytica
 Alternative Names
Amebic dysentery
Intestinal amebiasis
 it invades the colon wall, causing
colitis, acute dysentery, or long-
term (chronic) diarrhea. The
infection can also spread through
the blood to the liver and, rarely, to
the lungs, brain or other organs.
 is spread through food or water
contaminated with stools.
 This is common when human waste is used
as fertilizer.
 It can also be spread from person to person -
- particularly by contact with the mouth or
rectal area of an infected person.
 Symptoms
 Usually, the illness lasts about 2 weeks, but
it can come back if treatment is not given.
 Mild symptoms:
 Abdominal cramps
 Diarrhea
 Passage of 3 - 8 semiformed stools
per day
 Passage of soft stools with mucus
and occasional blood
 Fatigue
 Intestinal gas (excessive flatus)
 Rectal pain while having a bowel movement
(tenesmus)
 Severe symptoms:
 Abdominal tenderness
 Bloody stools
 Passage of liquid stools with
streaks of blood
 Passage of 10 - 20 stools per day
 Fever
 Vomiting
 Note: In 90% of people with amebiasis there
are no symptoms.
 Possible Complications
 Liver abscess
 Medication side effects, including nausea
 Spread of the parasite through the blood to
the liver, lungs, brain, or other organs