Rabies can be defined as  ‘ A fatal viral infection, is usually acquired through the bite of an infected animal to the human beings’. Nearly all morbidity in human beings worldwide is due to the bite of a rabid dog, and rabies infection. The rabies occurs from the rabdo virus. Rabies vaccine has reduced the incidence of rabies morbidity.

Rabies vaccination is the active immunizing agent  used to prevent the infection caused by the rabies virus that carried by the animals. It is a killed rabies virus vaccine.

There are two types of rabies vaccinations:-

1. Pre-exposure prophylaxis : this type of rabies vaccination is done for the persons who are at high risk of getting infected. Animal handlers, veterinarians, travelers, the persons who are in contact with the wild animals are likely to get infected.
2. Post-exposure prophylaxis : this type of rabies vaccination prophylaxis is done to the patients who are exposed to the animal bites, indicated by bite, scratch, or lick.

Facts related to rabies vaccine:-

* The rabies  spreads through the pet animals as well as wild animals; dogs, bats, raccoons, skunks, cats, horses, swine, foxes and cattle are the usual ones. So it is better to immunize the domestic animals with rabies vaccine.
* A person who is bitten by the infected animal  should receive the rabies vaccine after the animal bite. If patient is known to be hypersensitive to the rabies vaccine, then the rabies vaccine should be administered under supervision with all the immediate measures for managing anaphylactic shock.
* Prophylactic use of the rabies vaccination should be avoided in children, adolescents, antenatal mother & adults on treatment for any acute illness.
* Pre exposure rabies vaccine is to be avoided if person is known to be allergic to rabies vaccine.
* The further rabies vaccination or  immunization is avoided in persons who had complications on rabies vaccine administration.

The immunization schedule is classified under some grades as:-

* Grade I : when the person is in contact with the animal but not in contact with the saliva or blood. For this kind scheduled rabies vaccination is not needed.
* Grade II : If the animal has licked or if any other kind of expose to the saliva and superficial, non- bleeding scratches made by the animal, immediate rabies vaccine immunization should be given according to the schedule B.
* Grade III :  includes all bites, bleeding scratches, all wounds on the head, neck, scapular region, extremities. Direct contact of animal saliva with mucous membrane of patient, immediate concomitant prophylaxis with rabies vaccine is needed according to schedule C.

The classification according to severity of expose to animal:-

Schedule A: In this type one injection of rabies vaccine of Prophylactic immunization prior to exposure is given. One injection is given IM on days 0,7,28 and 365.

Schedule B: Immunization vaccine  should be given after exposure but it is of somewhat long  coarse. One injection of  rabies vaccine IM is given on days 0,3,7,14,30 & if necessary it is given on day 90.

Special precautions for rabies vaccine administration:-

The person who has received rabies vaccine of doubtful potency and who has discontinued the course of injections has to receive the entire course of rabies vaccine according to exposure.  In case the person is re-exposed after 5 yrs., entire course should be completed according to grade of exposure.

Dosage and administration of rabies vaccine:-

There is no difference in the dose for children & adults. 1ml of rabies vaccine is given by intramuscular injection in the deltoid muscle (arm) or in the thigh in small children. The prescribed schedule should be followed strictly  even if some time has passed since the exposure.

rabies vaccine side effects:-

* This rabies vaccine doesn’t cause that much vital side effects, but it will cause generally mild and non serious side effects.
* There will be a mild pain, redness and swelling may occur at injection spot as a side effect.
* Rarely arthritis, gastrointestinal disorders or lymph node swelling may occur as  rabies vaccine side effects.
* Sometimes anaphylactic shock may occur.

Contraindications for rabies vaccine:-

If there are hypersensitivity reactions to the vaccine or acute febrile illness the rabies vaccine is contraindicated for pre-exposure prophylaxis. In case of pregnancy vaccine should be given if the level of risk is high for pre-exposure prophylaxis.

Pertussis:-

Pertussis is also called as whooping cough. Pertussis is an  important communicable disease caused by bacteria,  results in uncontrollable, violent cough. Especially children are affected with pertussis.  As the sound comes during cough and taking air in, is called as whooping cough.  Nearly 5000 to 10000 children in united states are dieing every year because of pertussis.

Causes of pertussis:-

Bordetella pertussis, the bacteria causes pertussis infection. Pertussis is the disease of upper respiratory tract, if not treated causes permanent disability in children and may lead to death. Pertussis transmitted when an infected person sneezes or coughs, the bacteria spreads to air, and the person who inhales pertussis infected air droplets becomes infected with pertussis. Hence pertussis is an infectious disease easily spreads from person to person. Cough, sneezing, runny nose are the early symptoms of pertussis. After the pertussis bacteria multiplies in body, severe cough starts. Children experience weakness, fatigue and discomfort as the cough becomes severe. The continuous cough leads to impaired breathing and the children make whoop sound after coughing, is called whooping cough. Whooping sound is absent in infants less than 8 months. Some children vomits along with small amount of sputum. Coughing and vomiting simultaneously may lead to chocking in infants. Pertussis infection usually lasts for a period of 6 weeks. Whooping cough affects not only children but elder people can also get infected with pertussis. Now the incidence of pertussis is reduced as children are immunized during infancy, and higher rate pertussis is seen in  adolescents and elders.

Symptoms of pertussis:-

* Runny nose, sneezing
* mild fever up to 102 °F.
* Severe, continuous cough
* difficulty in  breathing
* both night and day cough,
* vomiting with sputum and cough,
* dry cough develops after some days,
* presence of whooping sound after cough while taking breath,
* generalized weakness and fatigue,
* Some children will have diarrhoea,
* Choking may occur in infants.

Diagnosis of pertussis:-

The initial diagnosis is the physical examination and history collection. The symptoms of pertussis are similar to pneumonia and the careful examination is needed to diagnose pertussis.

* Sputum test for bacterial culture,
* Nasal secretions test in laboratory,
* Chest x ray is also taken to differentiate from pertussis.
* Blood test is done to check elevated white blood cells.

Treatment of Pertussis:-

Antibiotics such as erythromycin and amoxicillin are the choice of drugs for pertussis treatment. Analgesics and antipyretics  are given to reduce fever and body ache. Incentive care should be taken to treat the infants infected with pertussis, and careful monitoring of progress of diseases and prognosis of treatment is needed. Hospitalization is needed in severe pertussis infected children. An oxygen tent with high humidity is used for infants have breathing difficulty. Intravenous fluids administration is also done to maintain water and electrolyte balance. Sedatives  may be given by the pediatrician for young children to avoid crying and induce sleep. Expectorants, and cough suppressants are  not helpful in treating pertussis.

Prevention of pertussis:-

The DPT vaccine ( diphtheria, pertussis,tetanus) or only pertussis vaccine Helps lot in preventing pertussis. Immunization schedule n most of countries  recommended for DPT-vaccine in infancy itself. The booster shot of pertussis is given after some months in infants. In adults also booster dose of pertussis is given to prevent pertussis in adolescents and adults. Pertussis affected children should follow the measures to prevent spread of pertussis infection by wearing face mask, or avoiding school for some days. The vaccination also given to elders aged above 65 years to prevent pertussis.

Mouth sore:-

Number of factors causes bacterial, viral or fungal infections of mouth. The mouth sore are the painful infections or rupture of the mucus membrane of mouth is called as mouth sore. A loose orthodontic wire, improper implantation of denture, sharp edge of broken teeth causes mouth sore.  Mouth sore are the common mouth problem that makes an individual very difficult to eat and even to drink hot or cold drinks.   Mouth sore may occur as  symptoms of a particular disease or disorder. Examination of mouth by  a dentist is needed to visualize  mouth sore that lasts a week or longer.

Common mouth sores and treatment:-

Canker ulcers : these are small ulcers which have red border and white or grey base. These mouth sore appear on the mucus membrane of the mouth and are not contagious. Number of ulcers may vary from one or more mouth sore. No exact cause of canker ulcer is known. it is believed that stress, fatigue, allergy to certain substances causes mouth ulcer. No specific treatment is needed to treat mouth sore or Canker ulcers. Topical anesthetics and antimicrobial mouth rinses  are used to treat mouth sore of this type. Avoid hot and spicy food until the healing of mouth sore.

Cold sore : These  sore are called as herpes simplex or fever blisters. Usually occurs on the soft membrane of lips, or under the nose. Cold or flu infection of mouth is the common cause of cold sore of mouth. Mouth pain is common with cold sore and is the recurring mouth problem in some individuals. The sore heals normally and in some recurring cases antivirals are prescribed.

Leukoplakia : these are white, thick patches appears inside the cheeks, mouth gums and tongue. Tobacco users are more prone to have such mouth sore and excess cell growth occurs on the sores. Biopsy of mouth sore is done for further diagnosis and treatment. Advice the patients to avoid tobacco and cause of lesion is found and treated.

Candidiasis : Is the fungal infection of mouth because of infection of candida albicans, which reproduce in the mucus wall of mouth. Denture wearers are more prone to have candidiasis mouth infection is the common problem of mouth. Antibiotic treatment is needed to reduce the symptoms and to treat the mouth sore. Provide oral hygiene to prevent the further complications.

Thalassemia:-

Thalassemia is a autosomal recessive blood disease, is an inherited genetic disorder. Thalassemia is a group of genetic disorders of blood, characterized by abnormal hemoglobin production. Due to abnormal hemoglobin, the number of hemoglobin decreases in the blood and destruction of RBC takes place due to genetic inheritance. Thalassemia is also called as Mediterranean anaemia.

Description of Thalassemia:-

Thalassemia is a blood disorder in which quantitative abnormal hemoglobin, i.e. very less number of globin in hemoglobin. Genes which produce the protein present in hemoglobin called GLOBINS are altered in case of Thalassemia. Hemoglobin is produced from two  sets of genes present on different chromosomes and produces two different pairs of protein.  One set of protein is alpha and another is Beta.

Every hemoglobin molecule has both alpha and beta protein. Connection of two alpha proteins to two beta proteins in the hemoglobin enhances binding and releasing of oxygen. Alpha protein is controlled by chromosome number 16 and beta protein is controlled by chromosome number 11. In thalassemia, when any one of these genes fails to produce any one of the protein, leads to Thalassemia. In alpha Thalassemia, one or more genes are missed and in case of beta thalassemia, genes are present but fails to produce normal hemoglobin.

Types of Thalassemia:-

Alpha thalassemia : Usually found southeast Asia . In this type of thalassemia, alpha protein synthesis is blocked due to genetic abnormality, resulting in abnormal hemoglobin production. Chinese, people form Asia and black people are usually affected form Alpha Thalassemia. Untreated, severe form of alpha thalassemia leads to still birth.

Beta thalassemia : Commonly found in mediterranean region and instead of beta protein is present, it becomes unable to produce beta protein, and causes beta thalassemia.

Causes of Thalassemia:-

* Genetic inheritance,
* Gene mutation,
* Children may show the anaemia after age of two, due to inherited genes from parents,
* Alteration in the hemoglobin chain,
* Family history of thalassemia, etc.

Symptoms of Thalassemia:-

* Fatigue,
* Shortness of breath,
* Icterus or Jaundice,
* Facial bone deformity.

Diagnostic Tests of Thalassemia:-

On physical examination confirms Enlarged spleen,

Peripheral blood smear test shoes abnormal, small red blood cells,

Anaemia is confirmed from complete blood count.

Abnormal hemoglobin are found on Hemoglobin electrophoresis

Treatment of thalassemia:-

Regular blood transfusion are necessary to treat severe Thalassemia. Folate supplements are also provided. Iron supplements and oxidative drugs are avoided in patients who receive blood transfusion.

Chelation Therapy : Is needed to remove iron form the body, from the patient who received regular blood transfusion.

Bone marrow transplantation is also used as a super speciality treatment of Thalassemia.

The form of arthritis with inflammation of joints is known as Gout. Even a small touch can cause severe pain  . Gout pain is a pain of high intensity and highly difficult to bear pain in gout arthritis. Big toe is the mainly affected joint with Gout. Ankle joint, wrist joint, knee joint, fingers and elbow are also affected with Gout.

Gout causes, what causes Gout ?

* Increased uric acid level in the body,
* Overproduction uric acid by the body
* Reduced uric acid excretion from the kidneys,
* Inherited genes form parents to children cause  gout.
* Eating foods rich in purines, such as meat etc causes gout.

Mono sodium urate crystals formed from excess uric acid accumulation in joints and connective tissue leads to sever joint inflammation and severe gout pain.

Gout diet:-

* Orange juice and water is recommended for first week of gout attack. Fasting with orange juice is recommended to treat gout naturally with gout diet.

* Gout diets include fruits such as grapes, apples, pears, peaches, oranges and pineapples.

* Vegetables in gout diet include beets, celery, watercress, turnips, squash, carrots, tomatoes, cabbage and potatoes etc.

* foods low in purine and doesn’t stimulate excess uric acid production.

* wheat tortilla made wholly of  wheat flour, cottage cheese and buttermilk.

Patient should avoid purine and uric acid producing foods in diet such as meats, eggs and fish.

Gout patients should also avoid tea, coffee, sugar, white flour and their products.

Gout attack:-

Gout attack is the sudden intense single joint inflammation with severe gout pain. Redness and swelling are present at the inflammation site of gouty arthritis. Gout attack may last from four to six days. Subsequent attacks are rare and gout attacks do not last for weeks, months or years. Gout attack disappears after a week even with no treatment. Severe recurrent gout attack causes injury to joints.

Acute gout attack : Acute gout attack may last for a week. Gout medicines such as Colchicine Corticosteroids NSAIDS relives acute Gout pain.

Gout treatments:-

* Gout medicine are highly beneficiary in gout treatment. Food modification also prevents further gout attacks. Medicine used to treat Gout are

* Acetaminophen : An analgesic to reduce joint pain.

* Non steroidal anti inflammatory drugs inhibit prostaglandin synthesis and reduces gout pain.

* Colchicine : Reduces inflammation and attacks are reduced.

* Corticosteroids : Reduces inflammation at the joint by suppressing immune system.

* Probenecid : Excretes excess uric acid through urine and decreases uric acid levels in blood. Probenecid is good gout medicine.

* Colbenemid : the drug is the combination of Probenecid, Colchicine and uricosuric agent, prevents constipation.

* Allopurinol is the gout medicine, lowers blood uric acid level by inhibiting uric acid synthesis in body. Allopurinol is best gout medicine as it blocks the conversion of purine present in foods into uric acid.

* Even though gout cure is not completely possible, temporary gout cure is achieved with gout medicines. Gout treatment relieves pain, and reduces further inflammation of joints.

Gout prevention:-

Got prevention is the best method of relieving pain related to arthritis. Weight reduction helps in prevention of Gout by reducing weight on the Joint. Drink enough water to excrete excess uric acid from the body and it helps lot in gout prevention. Reduce hyperuricemia with medications and decreased uric acid level prevents gout arthritis. Dietary changes include consuming diets with less purines, as Purine rich diet causes gout. avoid purine rich foods.

Polio:-

Polio is also called as poliomyelitis or infantile paralysis. Polio is a viral infectious disease, contagious in nature. The highly infectious virus, polio virus causes polio the historically devastating disease. Polio has been eliminated from western countries during the later period of 20th century.

The word polio is derived from Greek word polio which means grey and myelin which means spinal cord. so the meaning of poliomyelitis is infection of grey matter of spinal cord. usually 90 % of polio affected individuals does not show any symptoms. Affected individuals shows some symptoms after the polio virus enters the blood stream. Only one percent of effectively infected individuals with polio virus shows the flaccid paralysis, after the central nervous system or spinal cord is affected.

Causes of Polio:-

Member of the genus enterovirus, POLIO virus causes POLIO. Polio virus is a RNA virus inhabited in the human intestine and infects only the human beings.Three serotypes of polio virus are present type 1, type 2, and type 3. All the three serotypes are covered with capsid protein and all are extremely virulent. Type 1 polio virus is most commonly infecting the human beings and leads to paralysis. Till the vaccination for polio was invented in 1955, the polio affected millions of children world wide.

Polio can infect human beings at any age but, children are most infected as the immunity is not completely developed.

Effective vaccination against polio was invented in 1955 and due to vaccination, polio was eliminated from USA in the year 1979 and from the western hemisphere in 1991.

Signs and symptoms of polio:-

Nearly 90 % individuals infected with polio virus shows no symptoms and polio infection becomes Asymptomatic. Only 4 to 8 % of infected with polio virus shows the following symptoms.

Abortive polio : is the mild form of polio infection, and the individuals nervous system is not affected. Polio infected individuals shows mild symptoms such as flu like fever, upper respiratory tract infection, diarrhea, sore throat , etc..

Non paralytic Polio : is a serious form of polio infection, leads to aseptic meningitis. The symptoms such as sensitivity to light, heaviness of head are common with this type of polio infection.

Paralytic polio : is a severe debilitating form of polio, leads to paralysis. Only 0.1 to 1.8 % of human are affected with this type polio infection and severe mobility problems and neurological problems are observed.

People with abortive polio and/or non-paralytic polio recovers fast from polio infection. In case of paralytic polio, the polio virus enters blood stream from intestinal tract, and infects nervous system. When the nervous system is affected muscles becomes paralysed and even the severe polio virus infection may lead to Death.

Occupational cancer:-

Cancer caused from the occupation, or due to nature of work is called as Occupational cancer. Occupational cancer is a serious problem of the industry. The sites of the body usually affected by occupational exposure are skin, lungs, urinary bladder, and blood forming organs such as spleen etc.

Studies conducted from the different associations on occupational exposure and cancer, provides the approximate data that, 20000 cancer deaths, and 40000 new cancer cases in the United States are due to occupational exposure.

Millions of workers are working in the industries, and being exposed to occupational hazards even after those substances are carcinogenic.

Types of occupational cancer:–

Skin Cancer : It is found that cancer of scrotum and the skin in the other part of body was caused by coal tar, X- rays, certain oils and dyes. According to statistics, nearly 75 % of occupational cancers are skin cancer.Skin cancer are an occupational hazard among gas workers, tar distillers, oil refiners, dye, stuff makers, road makers, and in industries associated with the use of mineral oil, pitch, tar,and related compounds.

Lung cancer : is a occupational hazard in the gas industry, asbestos industry, nickel and chromium work, arsenic roasting plants, and mining of radio active substances causes occupational lung cancer. Lung cancer is also associated with smoking.

Bladder cancer : is normally caused in aniline industry and rubber industry. Bladder cancer or occupational bladder cancer is caused due to exposure aromatic amines. Bladder cancer is also caused by exposure to chemicals in dyeing industries, rubber, gas and electric cables industries.

Leukaemia :  it is the another name of blood cancer. Exposure to roentgen rays, an radioactive substances causes leukemia.

these are the main occupational cancer or occupational hazards.

Drowsiness:-

Drowsiness is the strong feel to sleep in the day time, the drowsiness compels to actual sleep, at right time or at inappropriate time, when the body feels so. Drowsiness is also called as Hypersomnia or Somnolence.

Drowsiness during day, even with sufficient sleep at night indicates sleeping disorder. Drowsiness due to fatigue is of short term and is experienced rarely. Some psycho-physical symptoms such as depression, Anxiety, Stress, and boredom also leads to Drowsiness.

Drowsiness is not a serious disorder but drowsiness leads to laziness and work output is very less. Proper health maintenance with exercise and healthy food keeps away the Drowsiness.

Causes of Drowsiness:-

* Lack of sleep during night, and continuous working without sufficient sleep,
* Tranquilizers, hypnotics or sleeping pills, and antihistamine medications causes Drowsiness.
* Short duration sleep or lack of sleep,
* Infections such as Chronic bronchitis, infectious mononucleosis,
* Diabetes and other systemic diseases,
* Stroke,
* Lack of exercise, laziness, less physical work,
* Excess alcohol consumption,
* Medical disorders such as Hypercalcemia, hypothyroidism, hyponatremia, etc.
* Narcolepsy, sleep apnea, and other sleep disorders.

Drowsiness Treatment:-

Relieving the cause of drowsiness ,

Treat any psycho-physical disorders such as Depression, anxiety, etc to relieve Drowsiness.

If Drowsiness is due to use of some medications, consult the doctor to use any alternative drugs. Don’t stop the medications without doctor’s suggestion.

Obesity induced Drowsiness can be relieved by weight reducing.

Avoid drowsiness inducing foods during day time.

Relieve emotional stress,

Medical disorders such as hypothyroidism, hypercalcemia and hypernatremia should be treated to relieve Drowsiness.

Sufficient sleep during night helps lot relieving Drowsiness.

Treat Narcolepsy, to relieve drowsiness.

Carbon monoxide monitor is used to check the excessive carbon monoxide in the surrounding air of home environment, as excess carbon monoxide induces sleep.

When to contact Doctor:-
If you feel that Drowsiness is due any above causes, you can seek medical help. Some times infections and disorders with central nervous system also causes drowsiness. to check CNS abnormality CT scan, and MRI are done. Proper history collection from the drowsiness affected person, helps in finding the cause of drowsiness and treating.

Assessment such as:-

* Sleeping duration,
* how long you sleep ?
* Do you Snore while sleeping ?
* Are you obese ?
* Taking any medications ?
* Have any other chronic diseases ?

All these questions helps in Diagnosing and treating Drowsiness, a sleep disorder.

Tongue cancer:-

Tongue cancer is the cancer type affects mouth and oropharynx.

Tongue has two parts, anterior tongue and base of tongue.

If anterior tongue gets cancer, it is known as oral cancer.

When the posterior base of tongue is affected with cancer is called as oropharyngeal cancer.

Squamous cell carcinoma is the common type of tongue cancer. Squamous cells are the flattened cells forms the mucus lining of mouth, nose, pharynx or throat.

Causes of tongue cancer:-

* The exact causes of tongue cancer is not known.

* The suspected causes of tongue cancer are

* Smoking tobacco,

* chewing tobacco, and

* excess alcohol consumption.

Symptoms of tongue cancer:-

* Red or white spot on the skin, for long time.

* Chronic sore throat,

* Numbness in tongue or mouth,

* Bleeding of unknown origin in the tongue,

* Pain while chewing or swallowing,

* Sore spot on the tongue which has not healed,

* Some times pain in ear

These are the main symptoms of tongue cancer.

Glomerulonephritis:-

Inflammation of glomerulus of kidney or nephron is called as Glomerulonephritis. Kidney has the minute units called nephrons . Nephrons are the structural and functional units of kidney.

The glomerulus apparatus is the part of nephron, which filters the blood.

Definition:-

Inflammation of the glomerulus is called as Glomerulonephritis.

Types:-
Chronic glomerulonephritis and
Acute glomerulonephritis

Chronic Glomerulonephritis :- is the gradual, progressive inflammation of glomeruli, causes Scarring, sclerosis and ultimately leads to kidney failure.

Acute Glomerulonephritis :- is of sudden onset in nature and healing is fast. Acute glomerulonephritis caused by bacterial infection. Impetigo and other skin diseases may cause Acute glomerulonephritis.

Causes of glomerulonephritis:-

Bacterial infection, such as streptococcus.

Underlying diseases,

Throat infection,

untreated urinary tract infection, etc..
Treatment of Glomerulonephritis:-

Antibiotics are the treatment of choice for glomerulonephritis.

Fluid and electrolyte balance, is important.

Bed rest, supplement of low protein diet. etc..