Mumps: Causes, Symptoms, Complication and Prevention

An acute infectious disease caused by a specific virus which has a predilection for glandular and nervous tissues. Clinically, the disease is recognized by non-suppurative enlargement and tenderness of one or both the parotid glands. Other organs may also be involved. Constitutional symptoms vary, or may be in apparent. The diseases occurs throughout the world. Although morbidity rate tends to be high, mortality rate negligible.

Causative agent: The causative agent, Myxovirus parotiditis is RNA virus of the myxovirus family. The virus can be grown readily in chick embryo ot tissue culture. There is only one serotype

Host of causative agent: Mumps is the most frequent cause of parotitis in children in the age groups 5-15 years. The average age of incidence of mumps in higher than with measles, chickenpox or whooping cough. However, no age is exempt if there is no previous immunity. The disease tends to be more severe in adults than in children. Mumps is largely an endemic disease. Cases occur throughout the year, but the peak incidence is in winter and spring. Epidemics are often associated with overcrowding.

Mode of transmission. The disease is spread mainly by droplet infection and after direct contact with an infected person.

Incubation period: It is varied from 2-3 weeks, usually 18 days.

Sign and Symptoms

Mumps is generalized viral infection. In 30-40 percent of cases mumps infection is clinically non apparent. In clinically apparent cases, it is characterized by pain and swelling in either one or both the parotid glands but may also involve the sublingual and submandibular glands. Often the child complains of “ear ache” on the affected side prior to the onset of swelling of the glands is evident. Mumps may also affect the testes, pancreas , CNS, ovaries , prostate etc. In severe cases, there may be fever, headache and other constitutional symptoms which may last from 3-5 days. The swelling subsides slowly over 1-2 weeks.

Complication: Though frequent are not serious. These include orchitis, ovaritis, pancreatitis, meningo-encephalitis and mycarditis. Bilateral orchitis is rare and assumption that mumps orchitis may lead to sterility is ill founded. While some instances of diabetes have occurred in children following mumps infection, a causal relationship has yet to be demonstrated . Rarer complications include nerve deafness, polyarthritis and hydrocephalus.

Prevention and Control

1- Vaccination : A highly effective live attenuated vaccine is now available for the prevention of mumps . A single dose (0.5ml) intramuscularly produces detectable antibodies in 95 percent of vaccine is also available as combined vaccine, viz. combined measles-mumps- rubella vaccine/rubella-mumps vaccine. The use of mumps vaccine is an unsettled question although it has been recommended for children over one year of age. Some argue that there is no good reason for trying to interfere natural exposure during childhood. Its use may be considered primarily in susceptible adults , especially males who had not had mumps, inasmuch as the disease tends to be severe should it occur in adult. As with most other live vaccines, mumps, vaccines should not be administered to pregnant women, patients receiving immunosuppressive therapy or those who have severely ill.

2- Immunoglobulin : A specific immunoglobulin is available, but its protective effect has not been established, as antibody studies have not been carried out on receipients.

3- To control of mumps is difficult because the diseases is infectious before a diagnosis can be made. The long and variable incubation period and the occurrence of subclinical cases make the control of spread difficult. However, cases should be taken to disinfect the articles used by the patient. Contacts should be kept under surveillance.


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Gastric: Causes, Symptoms, Treatment and Prevention

Gastritis is an inflammation of the stomach lining. Many things can cause gastritis. Most often the cause is infection with the same bacteria -- Helicobacter pylori -- that causes stomach ulcers. An autoimmune disorder, a backup of bile into the stomach, or long term use of nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, can also cause gastritis. In some cases, the stomach lining may be "eaten away," leading to sores (peptic ulcers) in the stomach or first part of the small intestine. Gastritis can occur suddenly (acute gastritis) or gradually (chronic gastritis). In most cases, gastritis does not permanently damage the stomach lining.


Causes of Gastritis:

Gastritis can be caused by infection, irritation, autoimmune disorders (where the body’s immune system mistakenly attacks the stomach), or backflow of bile into the stomach (bile reflux). Gastritis can also be caused by a blood disorder called pernicious anemia.

Infections can be caused by:
-Bacteria (usually Helicobacter pylori)
-Virus (including herpes simplex virus)
-Parasite
-Fungus

A number of things can cause irritation, including:
-Long term use of NSAIDs, such as ibuprofen (Advil, Motrin) or naproxen (Aleve)
-Alcohol use
-Cigarette smoking
-Chronic vomiting
-Coffee and acidic beverages
-Too much stomach acid (such as from stress)
-Eating or drinking caustic or corrosive substances (such as poisons)
-Trauma (for example, radiation treatments or having swallowed a foreign object)

Other causes for gastritis are very rare. which are:
-Systemic disease (for example, Crohn's disease)
-Sarcoidosis

Sign and Symptoms of Gastritis

The most common symptoms of gastritis are stomach upset and pain. Other possible symptoms include:
-Indigestion (dyspepsia)
-Heartburn
-Abdominal pain
-Hiccups
-Loss of appetite
-Nausea
-Vomiting, possibly of blood or material that looks like coffee grounds
-Dark stools

Treatment of Gastritis :

Treatment of gastritis depends on the cause of the problem. Some cases of gastritis may resolve by themselves over time, or be relieved when you stop drinking alcohol, smoking cigarettes, or taking NSAIDs. You may need to change your diet, although doctors now know that a bland diet isn’t required. If your gastritis is due to H. pylori infection, you will be given antibiotics.


Prevention of Gastritis:

Making lifestyle changes, such as avoiding the long term use of alcohol, NSAIDs, coffee, and drugs, may help prevent gastritis and its complications (such as a peptic ulcer). Reducing stress through relaxation techniques -- including yoga, tai chi, and meditation -- can also be helpful.

Note :- Generally it is said that Gastritis  is problem and sign of poorness !

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Development of Health Care Facilities in Nepal

The health-care delivery network in Nepal was poorly developed. Health-care practices in the country could be classified into three major categories: popular folk medical care, which relied on a jhankri (medicine man or shaman); Ayurvedic treatment; and allopathic (modern) medicine. These practices were not necessarily exclusive; most people used all three, depending on the type of illness and the availability of services, sometimes even simultaneously.    

Popular folk medicine derived from a large body of commonly held assumptions about magical and supernatural causes of illness. Sickness and death often were attributed to ghosts, demons, and evil spirits, or they were thought to result from the evil eye, planetary influences, or the displeasures of ancestors. Many precautions against these dangers were taken, including the wearing of charms or certain ornaments, the avoidance of certain foods and sights, and the propitiation of ghosts and gods with sacrificial gifts. When illness struck or an epidemic threatened, people went to see a jhankri for treatment. Such pseudomedical practices were ubiquitous; in many parts of Nepal, a jhankri was the only source of medical care available. Nepalese also regularly saw jotishi (Brahman astrologers) for counseling because they believed in planetary influence on their lives, resulting from disalignments of certain planetary signs. Jotishi were commonly relied on even in urban areas, and even by those who were well educated and frequently used modern medicine. And, virtually no arranged marital union was proposed and concluded without first consulting a jotishi.

The Ayurvedic system of medicine was believed to have evolved among the Hindus about 2,000 years ago. It originally was based on the Ayur-Veda (the Veda of Long Life), but a vast literature since has accumulated around this original text. According to the Ayurvedic theory, the body, like the universe, consists of three forces--phlegm, bile, and wind--and physical and spiritual wellbeing rests on maintaining the proper balance among these three internal forces. A harmonious existence between body and mind results. Ayurvedic pharmacopoeia--based on medicinal plants, plant roots, and herbs--remained a major source of medical treatment in Nepal. This school of medical practice also applies the hot-and- cold concept of foods and diets. In the late 1980s, there were nearly 280 practicing Ayurvedic physicians, popularly known as vaidhya, 145 Ayurvedic dispensaries, and a national college of Ayurvedic medicine in Kathmandu.

In 1991 the most commonly used form of medical treatment, especially for major health problems, was modern medicine whenever and wherever accessible. Within the domain of modern medicine, providing public health-care facilities was largely the responsibility of the government. Private facilities also existed in various regions. Modern medical service generally was provided by trained doctors, paramedics, nurses, and other community health workers. The government-operated health-care delivery system consisted of hospitals and health centers, including health posts in rural areas.

Hospitals were located mostly in urban areas and provided a much wider range of medical services than health centers. They were attended by doctors, as well as by nurses, and equipped with basic laboratory facilities. Small health centers and posts in rural areas--most of them staffed by paramedical personnel, health aides, and other minimally trained community health workers--served the needs of the scattered population. Even though these rural facilities were more accessible than urban hospitals, they generally failed to provide necessary services on a regular and consistent basis. The majority of them were barely functional because of such problems as inadequate funding; lack of trained staff; absenteeism; and chronic shortages of equipment, medicines, and vaccines.

Nepal had a total of 123 hospitals, eighteen health centers, and 816 health posts in 1990. There was one hospital bed for every 4,283 persons, an improvement since 1977, when there was one hospital bed for every 6,489 persons. The number of doctors totaled 879 in 1988, or one physician available for about 20,000 people. For the same period, other medical personnel included 601 nurses, 2,062 assistant nurses and midwives, 2,790 senior and assistant auxiliary health workers and health assistants, and 6,808 villagebased health workers.

There was no doubt in the late 1980s that considerable progress had been made in health care, but the available facilities were still inadequate to meet the growing medical needs of the population. The majority of people lacked easy access to modern medical centers, partly because of the absence of such facilities in nearby locations and partly because of the physical barrier posed by the country's rugged terrain. Because there were very few modern means of transportation in rural areas, particularly in the hills and mountains, people had to walk on average about half a day to get to health posts. Such a long walk was not only difficult (especially when the patient needed medical attention), but also meant economic hardship for the majority who rarely could afford to be absent for the whole day from their daily work. As a result, many minor illnesses went untreated, and some of them later developed into major illnesses.

In the early 1990s, Nepal's geographical limitations continued to play a large part in the country's social and economic problems. Moreover, despite twenty-five years of family planning programs, the population growth rate continued to outpace agricultural production and parts of the country continued to be food deficit areas. The educational base was also limited; only one-third of the population was literate. The generally poor health of the population and a lack of adequate health-care facilities also hindered social and economic improvements.

Data as of September 1991

Source :-www.mongabay.com

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Ecology of Health: Philosophical Part

Ecology is a key word in present- day health philosophy. It comes from the Greek “Oikos” meaning a house. Ecology is defined as the science of mutual relationship between living organism and their environments. Human ecology is a subset of more general science of ecology. A full understanding of health requires that humanity be seen as part of an ecosystem. The human ecosystem includes in addition to the natural environment, all the dimensions of the man-made environment that – physical, chemical, biological, psychological; in short, our culture and all its product. Disease is embedded in the ecosystem of man. Health, according to ecological concept, is visualized as a state of dynamic equilibrium between man and his environment.

By constantly altering his environment or ecosystem by such activities as urbanization, industrialization, deforestation, land reclamation, construction of irrigation canals and dams, man has created for himself new health problems. For example the greatest threat to human health in India today is the ever increasing, unplanned urbanization, growth of slums and deterioration of environment. As a result, disease at one time thought to be primarily “ rural” ( e.g. Filariasis, Laprosy) have acquired serious urban dimensions. The agents of a number of disease, for example; malaria and kala-azzar, which were effectively controlled have shown a recrudescence. The reason for this must be sought in changes in the human ecology. Man’s intrusion into ecological cycles of disease has resulted in zoonotic diseases such as; Kyasanur forest disease, Rabies, yellow fever, Monkey Pox, Lassa fever , etc. The Bhopal gas tragedy in 1984 high lights the danger of locating industries in urban Area of India. The nuclear disaster in Soviet Russia in april 1986 ad is another green reminder of enviroenmental pollution. The construction of Dams,Irrigation, Systems and artificial lakes has created ecological niches favoring the breeding of mosquitos, snells and spread of Filariasis, Schistosomiasis and Japanese encephalitis. In fact, ecological factors are at the route of the geographic distribution of diseases. Therefore; it has been said that good public health is basically good ecology.

Some have equated ecology with epidemiology. The main distinction between epidemiology and ecology is that while epidemiology is the study of the relationship between variations in man’s environment and his state of health or (Diseases), ecology embraces the interrelationship of all living things. In this regard, epidemiology constitutes a special application of human ecology or that part of ecology relating to the state of human health.

It is now being increasingly recognized that environmental factors and ecological considerations must be built into the total planning process to prevent degradation of eco system. Prevention of diseases through ecological or environmental manipulations or interventions is much safer, cheaper and more effective rational approach then all the other means of control. It is through environmental manipulations that diseases such as cholera, typhoid, malaria and hookworm diseases could ne brought under control or eliminated. Greatest improvement in human health thus may be expected from an understanding and modification of the factors that favor disease occurrence in the human ecosystem. Professor Rene Dubos believes that man’s capacity to adopt himself to ecological changes is not unlimited. Man can adopt himself only in so far as the mechanism of adaptation are potentially present in his genetic code.

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Roman Medicine:An Ancient Practice

By the first century BC, the centre of civilization shifted to Rom. The Romans borrowed their medicine largely from the Greeks whom they had conquered. While the politics of the world became Roman, medicine remained Greek. In the political philosophy of the romans the state and not the individual was supreme. The Romans were a more practical- minded people than the Greeks. They had a keen since of sanitation. Public health was born in Rom with development of Baths, sewers and Aqueducts . The Romans made fine roads through out their empire, Brought pure water to all their cities. Through Aqueducts, drained marshes to combat Malaria, Boilt sewerage systems and established hospitals for the sick.

An outstanding figure among Roman medical teachers was Galen (130-205AD) who was born in the Greek city of pergamon in Asia minor (now Turkey). He was physician to the Roman Emperor Marcus Aurelius. His important contributions were in the field of comparative anatomy and experimental physiology. Galen was far ahead of his time in his views about health and diseases. About health he stated; “Since both in importants and intime, health precedes disease, so we out to consider first how health may be preserved and then how one may based cure disease” about disease Galen observed that disease is due to three factors- Predisposing, exciting and environmental factors, a truly modern idea. The doctrines of Hippocrates and Galen were often in conflict since their approaches were so different- one is synthetic, the other analytic. An author of some 500 treatises on medical subjects, Galen was literally a “ Medical dictato”r in his time, and also for a long time there – after. His writings influenced Europian medicine. They were accepted as standard text books in medicine for 14 centuries till his teaching and views were challenged by the anatomist, Vesalius in 1543, and the physiologist, William Harvey in 1628, almost 1500 years after his death. 


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History of Medicine in Ancient Greek

The classic period of Greek medicine was the year 460-136 BC. The Greeks enjoyed the reputation the civilizers of the ancient old. They taught men to think in terms of “Why?” And “How?”. And early leader in Greek Medicine was Aesculapius, (1200 BC) . Aseculatius bore to daughters/ Hygia and Panasia. The medical historian Douglas Guthrie has reminded us of the legend that Hygia was worshiped as the Goddess of Health and Panasia as the Goddess of Medicine. Panasia and Hygia gave rise to dynasties of healers (Curative medicine) and hygienists ( Preventive Medicine) with different philosophies. Thus, the dichotomy between curative medicine and preventive medicine began early and we know it remains true today. Hygia (Prevention) is act present fashionable among the intellectuals. But Panasia( Cure) gets the cash Aesculapius is still cherished in medical circles- his staff, entwined by a serpent continues to be the symbol of medicine.

By far the greatest physician in Greek medicine was Hippocrates (460-370BC) which often called the father of medicine. He was born on the little Island of Cos, in the Aegean sea, about 460 BC. He studied and classified diseases based on observation and reasoning he challenged the tradition of magic in medicine and initiated a radically new approach to medicine i.e., application of clinical methods in medicine. Hippocrates lectures and writing, as compiled letter by Alexandrian scholars into the “ Corpus Hippocraticum” in compassed all branches of medicines. This 72-volume work contains the first scientific clinical case histories. Some of the saying of Hippocrates letter became favorites with physicians, such as; “Life is short, the art (of medicine) long. Opportunity fleeting, experience treacherous and Judgement difficult”, and “ where there is love for mankind, there is love for the art of healing”. His famous oath, the “ Hippocratic oath “has become the key stone medical ethics. It sets a high moral standard for the medical profession and demands absolute integrity of doctors. Hippocrates will always be regarded as one of the masters of the medical art.

Hippocrates was also an Epidemiologist. Since, he distinguished between diseases which were epidemic and those which were endemic, he was , in fact, the first true epidemiologist. He was constantly seeking the causes of diseases. He studied such things as climate, water, clothing, Diet, habits of eating and drinking and the effect they had in producing diseases. His book “Airs, water and places” is considered a treatise on social medicine and hygiene Hippocratic concept of health and diseases stressed the relation between man and his environment. In short, the Greeks gave a new directions to medical thought. They rejected the supernatural theories diseases and looked upon diseases as a natural process, not a visitation form good of immolation. The Greeks believed that matter was made up of four elements- earth,air, fire and water.These elements had the corresponding qualities of being cold, dry, hot and moist and were represented in the body by the four humors- phlegm, yellow bile, blood and black bile- similar to the “ Tridosha theory’ in Ayurbeda. The Greeks postulated that health prevailed when the four humors were in equilibrium and when the balance was disturbed, diseases was the result. The Human body was assumed to have powers of restoration of humoral equilibrium, and it was the physicians primary role to assist in this healing process. While the humoral theory of Hippocrates was based on incorrect foundations, the concept of the innate capacity of the body of responding to disturbances in the equilibrium that constitutes health is highly relevant to modern medicine. Outstanding amongst post-Hipporatic medical centre was Alexanderia’s huge museum the first University in the world which sheltered a library containing over 70000 books. To this house of learning theme eminent men. Between 300BC and 30 Bc, thousands of pupils matriculated in the schools of Alexanderia, which replaced Athens as the world’s centre of learning. In short, the Hippocratic school inspired in turn the Alexanderia school and the Arabo-Persian medicine . The Hippocratic School changed the destiny of medicine by separating it from magic and raising it to the status of a science. They had scientific method, although not scientific knowledge. The glorious greek civilization feel into decay and was succeeded by the roman civilization




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