SCABIES

Scabies is a parasitic disease caused by colonization of skin by the mite Sarcoptes scabei. These may mimic other skin diseases. Itching and visible lesions may occur several days after the infection ,since it takes some time before the mite can penetrate the skin .There are three types of skin lesions endema,redness and vesicle formation which appear on the lower part of the body, reddish nodules may be seen on the upper part of the trunk, linear or serpiginous tracks of burrows formed by the female mite are the most frequent on the distal arm and wirst.Cutaneous inflammation is not unusual on the face ,neck and scalp in children. The best treatment for this disease is 5 percent permethrin topical cream in children beyond 2 months of age. A single application cures more than 90 percent of cases. There is no systemic toxicity. It is more effective than antibiotics like lindane or crotamiton.Permethrin is applied locally overnight and allowed to remain on the lesions for at least 10 hours and this may be repeated one or two weeks later. In children below 2 months of age, sulpher creams are safer yet less effective choices. Oral vaccination is very effective in children above 5 years of age. All members of the family should be treated concurrently even when there are no apparent skin lesions of scabies. After the treatment is completed, all clothes and bed linen should be boiled, put out in the sun and subjected to hot ironing.

ONCHOCERCIASIS

Onchocerciasis is the result of infection by the filarial Onchocerca volvulus.The infection is conveyed by flies of the genus .The flies breed in rapid flowing, well-aerated water, the larvae being attached to rocks or crabs. Infective larvae are introduced in the skin by the bite of an infected Simulium fly. Innumerable microfilaria discharged by the female O.volvulus more actively in these nodules and in the adjacent tissues ,are widely distributed in the skin and may invade the skin. The infection may remain for months or years .The first symptom is usually itching, localized to one quadrant of the body and later becoming generalized and involving the eyes. This is difficult to see on the dark skin, in which the most common signs are chronic changes of a rough, thickened or inelastic skin. Eye disease is most common in highly endemic areas and in associated with chronic heavy infection and nodules on the head. Early manifestations like itching, lacrimation, conjunctival infection. The findings of nodules or characteristic lesions of the skin or eyes in a patient from an endemic area are suggestive. Filarial antibodies may be detected in up to 95 percent of patients, but antibody positivity can be lower in highly infected expatriates. Mass treatment in a single dose kills microfilariae and prevents their return for 9 months. Simulium can be destroyed in its larval stage by the application of insecticide to streams. Long trousers, skirts and sleeves discourage the fly from biting.

THYPHOID

Typhoid fever is primarily caused by Salmonella enteric. This fever is endemic in India and several tropical countries where standards of personal hygiene and sanitation are poor and it is common in the hot summer months but may occur throughout the year. Infection is transmitted by ingestion of the infected food, milk or water. Epidemics of typhoid fever are associated with overcrowding and breakdown in safe water supply and sewage disposal systems. The incubation period is 14 days with a range of 3 to 60 days. No age is exempt but typhoid fever is less common in children under 2 years due to less chances of exposure to infected food from outside the house. The main complications of this disease are respiratory problems, neurological, gastrointestinal manifestation, and hemorrhagic, severe malnutrition. In the endemic areas, typhoid fever should be a diagnostic possibility in all fevers of more than 7 days of duration especially those without localizing signs. This treatment should be continued for 7-10 days. Some supportive treatment like good nursing care, nutritious diet, fluid, electrolyte, antipyretics should be used. Preventive measures like isolation of patients, feces and urine should dispose off hygienically and soiled articles should be disinfected. Apart from vaccination importance should be given to hygienic methods for food handling and preparation, sanitary water supply, sanitary sewage disposal and adequate maintenance of hand washing and personal food hygiene. Community should be educated regarding the potential hazards of using contaminated food or water.

ACUTE REHUMATIC FEVER

Acute rheumatic fever usually affects children or young adults and has become very rare in Western Europe and North America. The condition is triggered by an immune –mediated delayed response to infection with specific strains of group .A streptococci that posses antigens which may cross-react with cardiac myosin and membrane protein. Antibodies produced against the streptococcal antigens mediate inflammation in the endocardium as well as the joints and skin. Symptoms are characteristically occurring 2-3 weeks after the initial attack but the patients may give no history of sore throat. Echocardiography typically shows dilution of the mitral annulus and other common findings are aortic regurgitation and pericardial effusion. A single dose of benzyl penicillin should be given diagnosis to eliminate any residual streptococcal infection. If the patient is penicillin –allergic erythromycin is used. Treatment is then directed towards limiting cardiac damage and relieving symptoms. Bed rest is important as it lessens joint pain and reduces cardiac workload. The duration of bed rest should be guided by symptoms and markers of inflammation and should be continued until these have settled. Cardiac failure should be treated as necessary. If the heart failure does not respond to medical treatment in these cases, valve replacement may be necessary and is often associated with dramatic decline in rheumatic activity. Patients with residual heart disease prophylaxis should continue until 10 years after the episode or 40years of age, whichever is longer.

OBESITY

Obesity is widely regarded as a pandemic with potentially disastrous consequences for human health. The prevalence of obesity has increased threefold within the last 20 years and continues to rise. In developing countries, average national rates of obesity are not nearly so high, but these figures disguise high rates of obesity in many urban communities. It has adverse effects on both morality and morbidity. Changes in morality are difficult to analyze due to the cofounding effects of lower body weight in cigarette smokers. The only medical benefit of obesity is seen in osteoporosis where bone density increase in response to increased mechanical stress. Society also suffers from the effects of obesity-related disability and early retirement. Weight tends to increase throughout life as basal metabolic rate and physical activity decrease. Well documented increases have occurred in portion sizes, particularly of energy –dense foods such as drinks with high refined sugar content and high fat snacks. Obesity is correlated positively with the number of hours spent watching television and inversely with levels of physical activity. The health risks of obesity are largely reversible. All interventions which have been proven to reduce weight in well conducted studies in obese patient’s .Lifestyle advice which lowers body weight and increase physical exercise reduces the diabetes. Bariatric surgery to reduce the size of the stomach is by far the most effective long-term treatment for obesity. Obesity must not be treated in isolation and other risk factors must be addressed, including smoking, excess alcohol consumption and hypertension

HYPERTENSION

Hypertension is defined as the arterial blood pressure above the 95 percent with reference to age and sex. Blood pressure is easily influenced physical activity, anxiety, and emotions. Since many cases of high blood pressure are asymptomatic and the blood pressure is the only moderately elevated, it is difficult to estimate the true causes of hypertension. In children blood pressure is measured by ausculatatory method and blood pressure cuff should cover 3rd of the length of the arm as well as 3rd of the circumference above the elbow. Children destined to develop essential hypertension as adult belong to the group which is around 90 percent or above as indicated by tracking studies. Some common causes of persistent and transient hypertension are intrinsic renal disease, renovascular causes, endocrine causes, poliomyelitis etc.Symptoms attributed to hypertension include headache, nausea, vomiting, and dizziness, irritability.With severe hypertension patients may go into hypertensive crisis and present with visual disturbances, convolusions, nerve palsies and other neurologic defects. Weight loss due to a hyper metabolic state, attack of headache, sweating indicate the possibility of hypertension. In order to avoid hypertension ,it is necessary to undertake diagnostic studies like urinalysis, renal function, renal biopsy, x-ray of chest,renogram. All the hypertension patients should be given potassium supplements .Since hypertension is likely to be a lifelong problem ,an attempt should be made to change the life style of the patient. A diet low in salt and animal proteins combined with reduction in weight may be able to control hypertension.

HEPATITIS

Hepatitis infection is a major public health problem in India. It is caused by RNA virus. The virus is relatively resistant to heat, acid, and solvents .In infected persons, this disease multiples in liver and gets excreted in bile to stools. Mode of transmission is through fecal –oral route from a close contact between person to person, contaminated food and water also serves as source of infection. The effect of hepatitis is liver cell damage is most marked in centrilobular region and circulating antibodies help in limiting the dissemination of infection. Feces are infectious from 2 weeks before and 1 week after the onset of jaundice. The incubation period is from 15 to 50 days. Children less than 6 years are affected by hepatitis. During initial phase of illness the patient has moderate fever, severe cough, loss of appetite and upper abdominal pain. Immunity following hepatitis infection is lifelong and does not result in chronic infection or chronic liver disease. In young children it is usually subclinical, jaundice is uncommon and recovery is possible. Immunoglobulin given protects the close personal contacts and household members .Since vertical transmission from mother is known, contact isolation is recommended for the infant and breastfeeding is allowed. There is no specific therapy for acute hepatitis. Rest in bed is recommended till the certain level remains high. Good nutritious diet, rich in carbohydrates and with adequate proteins should be given .In the diet fat may be restricted but not necessarily eliminated.

MEASLES

Measles is a communicable disease caused by a virus called Morbilivirus.It is characterized with fever, cough, rashes etc.Man is the only reservoir of infection and it is transmitted by droplet spread from the secretion of the nose and throat usually 4 days before the appearance of rash. The disease is common in pre-school children and it occur in all seasons more common in winter and spring months. The incubation period is about 8-12 days. During infection some cells are activated and participate in clearance of the virus and development of rash. It is more severe and mortality due to it is higher in the malnourished children. Measles is a self-limiting disease unless it is complicated and death may occur. One-third of the patients with measles die and another one-third are left with severe neurological defects. Fever is controlled by paracetamol and hydrotherapy. Cough help in removing the mucus from the lungs. Respiratory complications are managed by the combination of antibiotics for secondary bacterial infections. Streptococcal and staphylococcal infections are the most common infections following measles. The treatment of measles is essentially symptomatic and supportive. Body and oral hygiene too included in this treatment. The patients are encouraged to give bath to the child. Mouth is washed and teeth are brushed daily. Nutrition of the patient should be maintained by good nourishing diet