PLAGUE PREVENTION AND CONTROL

IDENTIFICATION AND DEFINITION

It is a disease of rats being primarily. It comes to man as blood infection medically diagnosed as septicemia which shows in two types called bubonic is the common type occurring in epidemics, and other form is the pneumonic is a rare type occurring endemically during plague epidemic of bubonic.It is sudden onset of high fever, head ache, back ache, flushed face and delirium. It develops in the groin or armpit and toxemia develops proclaiming the fatal end. In pneumonic attack blood in sputum is found while coughing which is painful and toxemia is more seen and death is quick. The causative agent is pasteurella pestis, lives and multiplies in the tissues and blood of the infected animal or man. The incubation period of bubonic plague is about 2-3 days. Man possess no natural immunity.

SOURCE OF INFECTION

The disease is one of the established style of examples of animal borne diseases. The rat the  known reservoir of infection and always act as a source for human infection of bubonic plague. Rats suffer from and die in both acute and chronic forms. Rats most concerned in the spread of plague to human population some species of rats are supposed to be permanent reservoir in nature. Plague can infect  people by the droplet mode of transmission. There blood is also infectious. Fleas which have fed on a case of plague could also spread the disease.  The immediate source of infection to man is always the ineffective vector flea which has fed on an infected rodent host.

MOD OF TRANSMISSION

The epidemics are always preceded by an animal borne disease/epizootic in urban or rural house rats.
That is usually conveyed by epizootic in jungle rodents. The transmission cycle is in the animal borne diseases

is rat flea rat. The rat flea become infected after taking a blood meal from their infected rodent host. They leave the cooling body of the dying host and infest another rat. This cycle is repeated. The infection in house rats reduce their number and the fleas start attacking human beings and transmit infection. Wherever it occurs, plague is likely to be endemic. Plague was formally world. It was confined mainly to some parts of India, Burma, Srilanka, China, Java and parts of the African continent. An extensive use of residual insecticides has reduced the severity of plague in the endemic areas in India. At present the incidence of among population is very low.

PREVENTION AND CONTROL OF PLAGUE

Anti-rat hygiene and rat destruction and anti-rat engineering are the only long term effective measures to prevent the out breaks,in order to maintain low endemic potential. Strict all anti-rat measures at the ports, railway stations, flour mills, stores, go downs, slaughter houses, etc, and in crowded localities to prevent entry to the rats and infection an area , and maintain if free from epizootics. BHC, DDT and other organoposphurus insecticides keep flea index low. On occurrence of a case following action should be taken.

                      The patient must be admitted to hospital and isolated in a special ward and patient must wear a mask. Disinfection of ward linen,clothing, and bedding should be carried out. Sputum should be received in 5 percentage of cresol solution and all upper respiratory discharges should be treated similarly in case of plague or even on suspicious on it. Notification to higher authorities like the director of public health of the state, and liaison with the civil authorities is necessary.

       Persons working in the plague wards, houses, and disinfecting articles suspected to contain the plague bacteria, should be inoculated against plague and must wear protective clothing made of smooth strong linen. Rubber gloves should be worn on the wrist and hands. These garments must be disinfected with insecticides daily. A fresh mask should be used at each visit of the ward when nursing a case of plague. contacts living in same place/premises should be immunized and put under medical supervision for 10 days as they might have been bitten by infected fleas. Contacts of plague must be segregated and inspected daily for 10 days. Insecticidal method of control of plague is rapidly effective which is safer, cheaper and easier than destruction of rodents. Use of protective clothing. repellents and a bed with mosquito net to sleep during night increase personal protection against flea bite. When plague is found in more than 5 percent of trapped rats, there is a strong clearness to expect an out break  in the human population in that area.

CORONARY RISK FACTORS PREVENTION AND CONTROL

DEFINITION OF CORONARY DISEASES

Coronary or ischaemic heart disease occur due to lack of blood supply to heart muscle by an increased demand or decreased coronary supply. Both elements are complimentary in hastening the actual attack. Death may occur any time before the complete recovery of the damaged cardiac muscle, which may take about 6 to 8 weeks or more.

RISK FACTORS

Hypertension, cigarette smoking, diabetes, over weight and obesity, physical inactivity, stress making mental activity and psychological environment, a positive family history of premature heart and vascular diseases, for example,starting of diseases before age 40 and abnormal electro cardiogram. The other abnormalities having are thyroid dysfunction, kidney disease and sedentary living habits. The important risk factors are given below.

DIET

A habitual dietary pattern with high intake of total calories , total fats, saturated fats, cholesterol, refined carbohydrates and salt is a ischaemic risk factor. More intake of fats.especially saturated fats,contributes significantly to the growth of the 4 important coronary-risk  factors high blood pressure, diabetes, obesity and disturbance of lipid metabolism and causes thrombosis. Imbalance in lipid metabolism and katabolism leaves extra extra cholesterol and triglycerides which gets stored  in fat depots and in other organs and tissues. Arteries also share this burden and get deposits of cholesterol crystals. Coronary arteries suffer the most due to their developed  intimal layer. The thrombus contains cholesterol, calcification also shows cholesterol crystals, and individuals with thrombotic tendencies show hypercholesterolaemia. High fat contents in diet,specially the animal fats and hydrogenated fat produce hypercholestrolaemia. More people in countries and communities consuming high fat diet show high incidence of coronary diseases, as compared with people in poorer countries and communities consuming low fat in their diets.In USA where the general diet yields forty percent calories from fats has the highest incidence in the world.

SMOKING

Heavy smoking is shown to be to the occurrence of cardiac diseases in young age. Cigarette smoking is specially correlated with smoking in association of heart diseases. Nicotine causes vasospasm. A heavy smoking is associated with a high stung personality, and heavy smoking usually occurs during mental strain in otherwise light smokers.This fact may be responsible for the association of smoking with other stress diseases in addition to coronary cardiac diseases.

BODY BUILD

Obesity and overweight are considered to be high coronary risk factor. The observations have made and continues:- The incidence of coronary heart diseases is two and half times more among those who had more than twenty per cent increase on their young adult age weight. And also, insurance actuarial studies shows that overweight persons show 36 per cent higher mortality due to coronary diseases and cerebra vascular diseases. Death rates due to hypertension and diabetes are 75 per cent higher among obese persons than among those who are free from obesity. Obesity increases incidence of hypertension and diabetes ans hyperlipidaemia, the 3 ischaemic risk factors. The cardiac muscle itself gets its share of fact deposition and reduces the chance of establishing ischaeimc collateral circulation in times of physical, emotional or cardiac emergency. Obesity decreases exercise tolerance and increases cardiac demand due to the body-burden. Obesity increases peripheral circulatory resistance and predisposes the person to hypertension increasing the coronary cardiac risk.

HEREDITY 

It is also plays a part. Anatomical defects or congenital  or hereditary, specially causing disease in young age with out thrombosis or other a etiological and risk factors. The likely hood of sub lings of parents suffering from atherosclerosis or a history of coronary episodes having ischaemic cardiac diseases is observed to be much more than the others. Diabetes, hypertension and obesity are known to be transmissible.

ANATOMICAL VARIATIONS

Anatomical peculiarities and distribution of the coronary arteries may show variations in such a way that it may be easier for blood clot in arteries or it may be anatomical peculiarities which may decide the establishment of collateral circulation when thrombosis occurs.  

BODY ACTIVITY 

Sedentary work always acts as a high coronary risk due to the following reasons.

It reduces the ability of the ischaemic collateral circulation when the coronary blockage occurs or the myocardial demand increases, minute coronary occlusions occurs,very often through adult and middle age with out showing any signs and symptoms due to the simultaneous coronary capillary collateral circulations are established quickly. Constant exertion provides constant coronary circulation during a healthy life and serves well during the episodic periods when the artery gets blocked. Sedentary habits deprive the myocardium  of these stimuli. It produces and increases the obesity which decreases the ability and threshold for exertion and myocardial efficiency and creates imbalance in lipid metabolism. Physical activity and exertion balance the fat anabolic process with adequate katabolism, thus protecting the body from increasing obesity and the arteries from cholesterol deposits,etc. A habitual sedentary worker is more likely to be a person doing highly strenuous work causing 'stress'. It seems that the disease is more prevalent in urban than in rural farm workers,may be due to fat-rich diet in western countries where they show low cholosterolaemia, atherosclerosis, ischaemic diseases low rate. Regular exercise provides relaxation and freedom mental stress , at least for a few hours in the day.

STRESS

Emotional strain produces stress so the emotional strain producing experience can hasten a clinical coronary episode in persons with advanced  atherosclerosis. Continued uncontrolled stress and strain develops the rigidity of vascular system and also produces systemic hypertension. The stress effects coronaries more than any other arteries and among men more than among women. The stress mechanism makes the cardiovascular system, especially the coronaries more sensitive to autonomic and hormonal stimuli and it responds above normal to precipitate the cardiac ischaemia through an increased spasm and myocardial demand. Psychological stress is shown to increase serum cholesterol and a prolonged psychological strain and tension play a roll in the long term regulation of the serum cholesterol level.

DISEASES AND CONDITIONS

Certain diseases and conditions show a high connection with the occurrence of coronary heart disease or with the conditions leading to it. Hypertension, gall bladder diseases, diabetes, kidney diseases, thyroid diseases, decreased vital capacity, abnormal electrocardiogram such as non-specific T wave abnormalities, complete bundle-branch block and left ventricular preponderance and premature cessation of ovarian activity among women, tendencies leading to thrombosis anywhere in the body have been noted to have such a high condition with the occurrence of coronary cardiac diseases and also cause more deaths in the first attack. But also can cause among survivors more earlier and worse second attacks after the first ones. The diabetic increases the diseases more often, more severely and prematurely than the non-diabetics. A cardiac failure directly due to the primary malignant hypertension should be differentiated from development of a coronary heart condition, although other factors may co-exist. High blood pressure levels are definitely associated with the cardiac disease.In many case it is the most important single complimentary factor to produce final coronary occlusion.

PREVENTION AND CONTROL

Diet control is necessary to prevent obesity  to balance anabolism and katabolism. Serum cholesterol and triglyceride concentrations are controlled by diets moderate in total calories,with moderate carbohydrates,and total fat yielding less than 20% of total calories and with low saturated fat contents less than 5% of the total calories and low in cholesterol means less than 200 mg per day.Regular exercise against obesity. This keeps the myocardium in training to meet the additional demands in times of stress. Men who are sedentary workers must adopt habits of regular exercise like clergy men, soft ware engineers,etc. Weight regulation by avoiding obesity by diet restriction and regular exercise must be practiced as above. Moderation in drinking, and smoking should be stopped. Such persons have to be more careful and vigilant. Drugs are available to cut out smoking. The risk of cardiac arrest and infarct in myocardium is increased by heavy smoking, it is ,therefore, must be stopped among persons with existing risk factors. Persons with sedentary works continuously for more hours require relaxations of appropriate periods after sustained period of intense and intellectual and emotional activity, specially for all vulnerable groups is a valuable preventive measure against sustained strain of high intensity of work.

Regular medical check up to ensure that the cardiovascular and urinary systems are working normally. Control of thrombotic tendencies is a difficult one because we have no measure of detection of persons with such tendencies in the population and we have not therapeutic measures to find out or check thrombosis altogether. Anticoagulants make only marginal benefits in the management of frank and massive arterial thrombosis. They can not be used for prevention of coronary heart diseases. Habitual dietary controls may decrease the progression of the conditions by keeping the serum cholesterol at a low level. Among the vulnerable socio-economically well off communities, the doctors, lowers, judges, clergymen bank officials, business executives, industrial organizers, etc, show a high tendency to get disease most commonly. Therefore, the steps should be taken to detect vulnerable groups and individuals among those groups and then control the contributory factors relevant to them. Research in all aspects beginning from per-ischaemic conditions, to histopathological examination of autopsy materials is an important per-requisite to the formulation of authentic preventive measures. While the position can be summarized by saying that keeping the metabolism balanced, avoiding obesity by diet control and regular exercise, relaxation and maintenance of tranquility of mind and avoiding extra emotional stress producing activity and a control of smoking and alcohol consumption should be relied upon. Early diagnosis and treatment of all the antecedent conditions is essential to enhance of all our knowledge, to give us epidemiological data, to find out further deterioration hypercholesterolaemia to atherosclerosis, from arthrosis to thrombosis, from thrombosis to infarction, from infraction to aneurysm or rupture and death or a long period of invalided sickness.

MENTAL BREAK DOWN SYNDROMES - PREVENTION AND CONTROL

MENTAL BREAK DOWN SYNDROMES

Acute conditions are hysteria, anxiety state, confusional states, Exhaustion, psychosomatic disorders, Reactive depression, mixed reactions, psychosis, chronic reactions, schizophrenia, depression, paranoid escape, etc. Mental health is an important component of the total positive health. It comprises the wellbeing of of the intellectual and emotional components of the mind . The intellectual break down of the individual deprive him of logical and rational thinking, and the decision taken may be faulty affecting the wellbeing of the individual. Even the community or nation may suffer due to such faulty decisions if such an individual happens to be a leader. Emotional imbalance affects reactions of individual, ability to withstand the strains and stress of the life situations affecting the general health, and the ability to conform to the conventional social morale. A few of them are are given below.

Hysteria.

This may be defined as a functional disorder of the mind characterized by the unconscious production of mental and physical symptoms which enable the individual to escape from some difficulty or to gain some real or imaginary advantage. The historical syndrome may show by the development of symptoms such as paralysis of various parts of body, sensory disturbances, vomiting, deafness, hysterical seizures and somnambulism, etc. In most cases of fits no precipitating cause is apparent. 

Depression.

Individuals with depression become quiet, inactive, and not interested to take part in normal social activities, sleeplessness, anxiety dreams, fits of crying, and excessive smoking and drinking are common symptoms in severe cases.

Schizophrenia.

It is the commonest form of psychosis among the adolescents and young adults and is characterized by lack of interest, self-absorption and withdrawal. The patients may suffer also from auditory and visual hallucinations and delusions of persecution. those cases of psychosis  should be transfered to psychiatrist for admission and treatment.

Paranoid escape

In order to make their own gloom some persons make project their feelings on to others and look for evidence of evil and distrust around them. They become suspicious with out any convincing evidence and are disgruntled, cynical and bitter. They are not easily amicable to discipline. 

Psychosomatic disorders.

Due to depression and anxiety may find expression in somatic cases such as loss of physical energy, head ache, disturbance of vision, sleeplessness, feeling of vomiting, memory difficulties, and a secondary hysterical fixation of minor injuries. the commonest sign and symptoms of mental distress are as under.

Warning signal of psychiatric break down

Changes from normal behavior and habits as noticed by friends  and relatives. Sleep disturbances and nightmares to be observed. Changes in eating, drinking, and increased usage of tobacco and alcohol may be noticed. Alteration in temperament and personality may be noticed. The calm and quiet retiring person becomes garrulous and vivacious or a good humored and social man becomes morose, sullen, solitary, and apathetic, not taking interest in what is going on around him. Emotional instability is manifested by sudden out bursts of weeping for no reasons, or sudden displays of violence. Offenses of trivial nature may be committed by a person of previous good character. There is often gradual deterioration in the standard of work and efficiency. there may be inability to concentrate in normal activities and this may intensifies his sense of restlessness and depression.

Prevention and control of psychiatric breakdown.

For the conservation of manpower and promotion of working efficiency it is imperative that all possible preventive measures  to reduce morbidity from psychiatric break disorders in factories and other institutions are adopted while recruitment for employment.The important preventive measures are selection, screening, man-management, training, morale building and early recognition and early treatment of mental break down. The individual should think that he is an integral part of of his institution and also he should feel his welfare and that of his family are the active concern of the governing body and his own superior officers in particular. He should be made to feel that efficient and prompt medical aid is available at all times. Early diagnosis, proper treatment, and proper transfer to specialist hospitals, are important measures for the maintenance of mental health of the such cases.

INFECTIOUS HEPATITIS AND ITS PERVENTION

Identification and definition of Jaundice

A sub-acute or sudden febrile infectious  disease due to virus, characterized by a sudden onset abdominal discomfort, nausea, feeling to vomit and symptoms to hepatitis which is the main feature of this disease. Jaundice is normally present in this disease but may be absent. Serum hepatitis is transmitted through transfusion, vaccination,  and inoculation and not give to rise to initial gastrointestinal symptoms. Case fatality is low but case mortality is high and prolonged. The diagnosis is confirmed by various serological tests or even biopsy by liver puncture; serum enzyme and biopsy are the most reliable tests.

Causative organism 

It is due to a virus, out of them two are important. The virus of infective hepatitis is called virus A, and that of serum hepatitis is called virus B, and they are indistinguishable from each other in any away. However, sufficient evidence on clinical and epidemiological grounds to suggest that two infections are caused by 2 different members of the same family of viruses or different strains of the same virus affecting the liver cells. Virus of the serum hepatitis never find in faeces; but in a more or less close community. Serum hepatitis is spread by using an unsterilized needle for injecting the person after the inoculation of the carrier. Man possess no natural immunity, and incubation period is 25 days with a range of 15 to 50 days.In the case of serum hepatitis 90 days, may be prolonged to 60 to 160 days. Pregnant woman and alcoholics are more vulnerable to high morbidity and high mortality. One attack or childhood exposure to endemic infection confers immunity to certain extent. Virus hepatitis has a world wide distribution and during past years a number of out breaks occurred in India and other countries. Few cases occur throughout the year, but more incidence is in fly breeding seasons.

Prevention and control

A very high standard of environmental sanitation, control of fly breeding and personal hygiene are to be strictly maintained. Protection of water supply and its purification and efficient diary management to avoid unpolluted milk supply and attention to disposal of waste including sewage disposal. Sterilizing needles and syringes every time  when it used for injections.

On occurrence of a case patient should be admitted to hospital for correct diagnosis between infectious or serum hepatitis. So that correct control measures, specially in controlling the constant prevalence of sporadic cases in locally and prevent out breaks. It is not important to isolate the patient. he is kept apart and precautions are taken as for other food and water borne diseases. A case of infectious hepatitis never should be taken to a ward where there are acutely ill patients admitted. Flies should not gain access to stools, urine, sputum,etc.which are to be disinfected. A separate ward or wards are to be set apart in case of a epidemic out break occurs. Current and terminal disinfection should be carried out.

For families immune gamma globulin is good as a preventive measure. Personal hygiene should be maintained at high level. Strict anti fly measures are to be enforced. Attendance should take all precautions as required for the food and water borne diseases. As anything which damages the liver like alcohol should be avoided. Alcohol may increase the disease, it is advisable to with hold them from close contacts. Control food and drink. All source of water supply should be taken to protect, all sources of water from any likely pollution. Water should be taken from sources that are not liable to contaminate with excreta. Even super chlorination is not suppose to kill the virus, unless water is very efficiently clarified and an half hour contact is necessary before supply. Water should be boiled during an out break of jaundice. Strict inspection of sales of ice creams including manufacture and distribution,specially near to educational institutions.

ANIMAL BORNE DISEASES

Definition.

Zoo-noses is the state in which the infections initially affecting animals are transmissible to human beings and also some times the process may be reversed and some infections may pass from man to animals. WHO defines to those infections and diseases which are naturally transmitted between vertebrate animals and man plague, rabies/hydrophobia, anthrax, yellow fever, relapsing fevers, etc, are the some typical examples of such infections originally affecting animals and transmitted to human beings.

Type of reservoirs.

Most of the animal borne diseases start with host-sensitivity and through the stages of achievement of success in parasitism is the genesis of zoo-noses. Parasitism aims at self-preservation and a species propagation by obtaining sustenance from the host. So it attains tolerance and symbiosis to make zoo-nosies progressively more successful. More often the host is partially sensitive. When some vertebrate animal hosts are sensitive to parasites, some other animals are likely to be a tolerant or symbiotic host, so as to permit perpetuation of the parasite in nature. For example dogs are intensely sensitive to rabies virus; the wild Candida like the wolf , jackal or fox, which transmits this infection to dogs also suffer from rabies. The search for more tolerant host which can permit perpetuation of rabies virus in nature, with out themselves succumbing to the infection, has led to the discovery that Vampire bats, etc and some rodent species act as such hosts for rabies virus. Similarly, the urban rodents, who acquire plague infection sylvatic rodents, themselves die of the disease. Tolerant or symbiotic animal hosts are the permanent reservoirs of zoo-noses; the ones either sensitive or only partially resistant are semipermanent reservoirs of zoo-noses; and the ones which are more sensitive are the temporary reservoirs of zoo noses.

Important of the knowledge of animal borne diseases.

When an infection is known to be  animal borne and its temporary or permanent carrier is known, its control in human population becomes easy by either veterinarily controlling it among animals, by destruction of animals themselves, or by interrupting its transmission to the human population. The negative information is also important as it enables us to definitely exclude certain vertebrate from the possibility of being natural reservoirs. The knowledge of animal borne diseases enables us to study the parasite. and reactions and the behavior caused by it in the animal host during the pathogenic process. It is there after, leads us to form a picture of the natural history, remedy and how the disease affect  on the mankind. It also helps in finally diagnosing the otherwise intractable infection. For epidemiological studies, the search for animal borne diseases can be extended infinitely experimental transmission in a laboratory for determining the host range.

Some common animal borne diseases.

WHO has numbered more than 100 diseases constituting animal borne. 40 of them involve dogs and cats and 20 involve rodents of different types. The important examples of zoo-noses generally met with are the rodent borne infections such as plague, relapsing fever, rickettsiases, salmonelloses, worm infections, melloidosis, laptospirosis, rat bite fever, toxoplasmosis, tularaemia, etc.and so on. The primate infections like yellow fever and infective hepatitis and non pulmonary tuberculosis due to drinking of milk of an infected cow, brucellosis, Q fever and taeniasis, canine infections like rabies, leishmanaisis, and echinococcosis.Trypanosomiasis in Africa is also a zoo-noses. Taxoplasmosis is widespread in natural and its disease producing organism is symbiotic with many animal hosts. How man gets this infection is not yet known certainly, but dog is closely associated with man is implicated. Orinithosis is originally a disease of birds, specially in parrots, hawks, kites, etc. Psittacosis is the ornithosis of parrots transmitted to man. The virus of lymphocytic choriomaningitis is spread widely among mice but is transfered to man through a dog or cat due to his proximity to these animals. Anthrax is common farm animals and cattle and its spread to man may be due to the use of wool, hide or meat of infected animals. Some animal borne diseases are transmitted by arthropod vector species is more important means control the transmission of those diseases to human beings.

Prevention and control 

It is to eradicate the disease from human population by controlling natural ranges of animal borne diseases easier and earlier. For e,g.the bovine/intestinal tuberculosis strain was discovered to be the cause of human non-pulmonary tuberculosis infection and a search proved that the natural range for this infection was extremely narrow and almost confined to cows.A wide drive in the U.K. for raising non tuberculosis herds has been very successful that  at present there is no infection among the milking cows and hardly any bovine infection in human beings in that country. Similarly rabies and hydrophobia in many western countries have been almost eradicated by efficient caniculture. The larger the host range the wider should be the spread of infections and more difficult to eradicate. If it is confirmed definitely that there is no animal borne disease exists in respect of a particular human ailment, it leaves us free to concentrate all attention on the measures to control,prevent or eradicate the human reservoir,has happened in the case of malaria.

The general scheme of prevention and control of animal borne diseases may necessary to emphasis on one or more measures written below. We can control arthropod vector, protected the domestic animal from sylvatic disease, protect man from contact with the reservoir, domestic source and arthropod vectors or ectoparasites, protect food of man, water or other relevant articles of use from getting contaminated, destroy sylvatic or domestic sources,cure the domestic reservoir or source to the point of eradication enzootic or epizootic, search for the permanent reservoir in nature and and ruin it, and check the  migration of such reservoir or susceptible animals. Each of these methods has special application in a particular animal borne disease. In addition the international surveiliance is also required to control international transmission of animal borne infections.

PEPTIC ULCER PREVENTION AND CONTROL

INTRODUCTION.

The ulcer in gastric mucosa is called gastric ulcer and that in duodenal mucsa is called duodenal ulcer. Peptic ulcer is benign, circumscribed loss of tissue of the gastric or duodenal mucosal wall by the digestive action of acid gastric juice. A recent increase in its incidence has occurred in years chiefly in the civilised or modernised part of the world, where an increased tempo of life experts stress producing influence on the population. It is, therefore, peptic ulcer is considered to be one of the 'stress diseases'. Peptic ulcer or duodenal ulcer manifests itself by typical syndrome and known as 'peptic syndrome'. The main symptom is the burning, aching, or growing pain in the epigastrium coming on 2 or 3 hours after food, that is when the digestion is in its full swing and the food is ready for passing from stomach to the intestine.This pain is reduced by eating bland food or drinking milk. So it is called hungur pain. Pain is relieved by taking antacids.Diagnosis is confirmed by a gastric juice analysis on a fractional meal test in old days and now a days by radilogical or gastroscopic examinations.

PHYSIOLOGY OF STOMACH.

The main function of stomach is to digest proteins by the pepsin in the presence of 2 percent hydrochloric acid secreted by by the glands in its mucos memberene , up to the stage of polypeptides. It holds the food for four hours and then passes it on the intestine through the pylorus via duodenum. The food in the stomach has an acid reaction, while digesting by alkaline trypsin in intestine going up to the stage of aminoacids, it becomes less and less acidic as it proceeds onwards in the small intestines. The gastric and pyloric mucos memberene is highly resistent to the digestive action of gastric juice which can digest any proteins taken in food. sometimes certain ulcers get heald up rapidly with out causing any symptoms. When certain abnormalities are present in  human system such ulcers persist, get enlarged and produce symptoms. The exact cause is not known. The valnerability of gastric mucosa to ulcerate is due to effects of emotional changes engendered by daily life on gastric secretion, vascularity, and motility. Anxiety, irritability, or hostility, makes the gastric mucosa thickened and hyperaemic rendering the mucosa more valnerable to mechanical injury so that small erosions with bleedings could be produced. Stress and tension  thus can give rise to nervous dyspepsia and other gastric disorders , creating a highly favourable local environment for ulceration.

EPIDEMIOLOGICAL FACTORS.

Age-The vulnerable decades of life for peptic ulcers are from 20 t0 50, earlier in females than in males;high incidence is in 30 in females and 40 in males.They are not absent  in earlier ages,may be rare. Sex distribution is almost the same up to the adolscence and then rise in men. At the highest vulnerable age mentioned above, the duodenal ulcers are 10 to 15 times more common and gastric ulcers are 5 times common in males than women. After meno-pause the incidence in women rises. 

Duodenal ulcer is commenest amongst the higher socio-economic class while gastric ulcer is common amongst the low socio-economic class in the western countries. In India duodenal ulcer is commenest amongst poor people. The duodenal ulcer is more common between doctors, engineers, lawyers, clerks, etc. It is more common in western world than in eastern world, which is also showing an increase. gastric ulcer is quite common with out class or sex distinction in south India, and etc. Heridity also a factor in the family. When present in one member they are commonly found in the other members of the identical twins. It is associated with disease and conditions, habits and life situations, personalities, nutrition, drugs, alcohol, smoking, and beverages,etc.

PREVENTION.

As it is now almost certain that the peptic or duodenal ulcer happens in certain types of personalities  the preventive measures should be adopted among such groups or ulcer type of persons, such as, regularity of food habits, avoidance of drinking and smoking, relaxation following acute of mental activity of a high calibre and peridical physical and mental relxations are necessary for vulnerable people in the vulnerable age groups, avoidence of anxiety, worry, exitement, early diagnosis and proper treatment, mainly adequate rest and diet regulations. Avoid hurry, worry and curry.

MILK BORNE DISEASES AND PREVENTION

Introduction.

Comparing the nutritive value of one foodstuff with that of another, milk is the the best fluid secreted by female mammals.It contents almost all nutrients except iron.It can become a carrier of many diseases like tuberculosis ,Brucellosis, septic sore throat, cholera, typhoid, jaundice, poliomyelitis,etc. Milk borne out breaks are common like food poisoning may occur where milk from various source is pooled to provide to large feeding establishments like student hostels or large hotels and restaurants.

The live-stock of milking cattle is initially healthy, free from infections and protected against any of the illness; sick animals are isolated and contacts are separated, to spread if inspection, and ill animals are not milked. Surroundings are maintained at high sanitary standards, milk handlers are healthy, free from and protected against infections and prohibited from handling milk if evidence of diseases are seen;water supply is pure and protected, containers are clean, regularly washed, sterilized  and protected from contamination; and also milk is protected against contamination of flies, dust or other extraneous matters from its production, through processing and bottling up to its delivery to the consumers ; and milk is treated to destroy disease producing organisms and thereafter kept protected.

Preventive measures.

Care of cattle.. The quality of and the quantity of milk depend upon the particular breed. but mainly upon the care that is devoted to the milk cattle. The milk yield is also sensitive to their comfort, feeding, watering, cleanliness. Hence a clean , airy, cool, and sufficient space of cattle shed is of the first importance. Water supply to wash the cattle sheds and the cattle should be available.The arrangements made for washing of the cattle be sufficient. It is healthier to wash the cattle daily with cool water in extreme summer and with warm water in extreme winter. But in any case a wash must be given twice a week at least. Cattle should be groomed and their udders washed and then wiped with a damp cloth every time the the animal is milked. Ample water supply for drinking is necessary. Fodder and other eatable items like cotton seed, oil cake, bran and meal consisting of a crushed mixture of grains must be given to each animal.Meal, cotton seed and fodder stores should be rat proofed. Rat and flea nuisance are as much detrimental to the health and comfort of animals as they are for human beings. Sick animals must be immediately isolated and contacts segregated. Those animals should be inspected by veterinary doctors at least once in a month or often to ensure,if required. Isolation sheds must be available.
Preventive inoculation against common diseases must be ensured. In well developed farms, tuberculin tests followed by segregation, examination, treatment and sacrificing of sick and infected animals according to their stage of disease, is resorted to. So that herds free from tuberculosis have  been raised and the prevalence in a  majorities of firms in countries like Holland, U.S.A, U,K, etc, is nil. Good care of the animal, and affection shown to it increases the milk yield , reduces non-milking days and reducing ailments.

The cow sheds.. Properly constructed cow shed and its cleanliness is one of the main requirements for production of safe milk. The side should be well drained, higher than the surrounding ground , and the approaches to the shed never cross a manure yard. The flour area per cattle head  should be a minimum 6 sq meters.The space allowed per cow should be 18 cubic meters if the cows are allowed to graze, or 24 cubic meters if the cows are not turned out.  The shed must be washed every day and cleaned twice a day. They should be sprayed with insecticide once a week. An isolation shed for sick animal must be provided.

Disposal of manure and sullage..All manure should be removed from the depot. It is a potent source of fly breeding and pollution of milk.All channels carrying liquid manure and sullage should be made of concrete and continued for some distance beyond the shed to a convenient place of disposal out side,like vegetable garden, septic tank with large soak age pits  or broad drainage.

Health and hygiene of workers..There are people working in farm, out side the plant houses, those working inside the plant houses and the administrative staff or disposal of manure,etc. those persons not engaged with milk. All employees except administrative staff should be permanent,and selected after a medical inspection and issued with identity cards. medical examination of such persons be carried out regularly often and strict attention being done to personal cleanliness. They should be free from diarrhea, dysentery, infected fingers or boils, running ears, sore throat,typhoid group of fevers or cough among employees. All workers inside should remove their clothes on arrival for work and keep in a cupboard.They should wash and scrub with nail brush their hands thoroughly with soap and water and put on their working clothes which should be clean and suitable for duties. Milkers should change into their milking suits and overalls and must wear cotton milking caps. Workers handling milk should wear gauze masks. All workers sanitary and washing facilities and should be made to use them by education. When a pail is full it should be covered soon as a protection against flies and dust and removed to the milk room immediately.

Pasteurization..Boiling kills the microorganism in any liquid. It is likely to affect its quality, taste and flavour,if the components of such a liquid are heat-labile, such as are found in milk.Theory of pasteurization is that, rapidly heating a liquid to a degree of temperature lower than the required for boiling it and maintaining it uniformly for a certain period destroys most of the disease producing organisms, reduces the total quantity of the microorganisms and makes all of them less viable with out affecting its inherent qualities or its taste and flavour. It may not sterilize the liquid but make non-infective, retains its nutritive and improves its keeping quality. The important pathogenic organism are destroyed by pasteurization of milk are Bacterium tuberculosis, strep to and staphylococci  and the non-lactose fermenting pathogenic organisms of salmonella-shillelagh group. The rapid cooling of the heated liquid to such a low degree as to destroy the multiplication of any viable residual microorganisms. It is, therefore, a complete process of pasteurization comprises;rapid heating with out boiling, uniformly maintaining that temperature for a definite period, and rapid cooling. Its fat, protein, calcium, phosphorus, and vitamin contents are not affected. The tests for nutritional ingredients, adulteration, bacterial contamination, pasteurization and keeping quality should be carried out before distribution and sales.

PREVENTION AND CONTROL OF HIGH BLOOD PRESSURE

Definition of hypertensin.

Hypertension or high blood pressure means raised arterial blood pressure above normal. It is a symptom and not a disease. It is one of the variety of disorders like kidney failure, lead poisoning, toxaemia of pregnancy, rough of aorta, etc. but in the most of the cases, causes is not known.

Varieties of hypertension.

Hypertension or hypertensive disease when accompanied with clinical manifestations of blood pressure, the condition is said as hypertention or hypertensive disease. Hypertensive heart disease means if the cardiac function is disturbed or myocardiu is involved. If the blood pressure is due to renal disease or any other condition is known as secondary hypertension, or other wise any other condition of blood pressure raises,it known as primary or esential hypertension. Primary hypertensive disease progress soon to heart enlagement and failure and also towards a fatal end, it is called malignant hypertension.It will vary above 180/120 mm of hg and patient should be admitted to hospital for reducing blood pressure to avoid damage of organs like kidney, heart,liver, etc.PAH means pulmonary arterial hypertension.  which can be diagnosed through ecko cardiogram. To find out the gradation of conditions are give below.
1. Ascertain BP at variuos times during day, while resting in bed and when uder treatment with antihypertensive medicines. Find any primary cause like kidney dieases, diabetes, pregnancy or albumen in blood. Finding out any change in heart functions, pulse rate, electro-cardiographic changes, etc. And also ascertain secondary hypertensive complaints such as blood in urine, albumen, and disturbed kidney functions.
2. Hypertension is a socio-medical problem due to its high incidence with hypertensive heart diseases. It is increasing in the world with modern living conditions such as industrailisation, etc, high morbidity and mortality involving disability and economic loss.Next to heart disease and cerebral disease, it has the highest mortality rate.out of over the one fifth of all deaths over the age of 50. Above 30 percentage of population over 50 years of age may be suffering from it. Malignant forms of this disease are less common in eastern than western countries.
3. When hypertension is found out to a specific primary condition, some of the following factors believed to be responsible in the causation of high blood presure,is known as hypertensive risk factor like overweight and obesity,smoking,genetic factors,etc. Salt restriction brings down high blood presure levels,but if an excessive salt intake raises normal blood presure or not and if so whether it is one of the causes of persistant hypertension,is not known.

Preventive and control measures of hypertension.

Detection and treatment of early cases is an important measure due to even established hypertension may remain uncompliated for long time. Early,mild and uncomplicated high blood pressure with a view of arresting further progression of the disease and to increase long life under the category of secondary prevention of essential primary hypertension.By the care of certain factors like mode of life, habits, diet and body weight and treatment of antihypertensive medicines and psychotherapy,it is possible to obtain partial or complete cure in such cases towards longer and healthier lives so that the passive attitude based on high blood pressure is incurable. Certain secondary hypertensions are primarily preventable.Corrective surgery  in early childwood for coarctation, early intensive treatment of urinary infections,prevention and early treatment for throat infections in children, quick detection and removal of adrenal tumour, efficient antenatal or prenatal care for detection and treatment of the toxaemia arrest for the development of secondary hypertension. The object of prevention and control of hypertension should be to get rid of, arrest, undo or impede the progress of
the primary and secodary hypertensive disease in its early and late stages with complications. Other measures are the treatment of advanced cases and rehabilitation of the affected persons and health education of public,etc.The preventive approach to hypertension was grasped and professed long back in 1876 Handfield Jones when he said 'If I were bold enough to be a prophet, I should point to the time when the elder folks,instead of waiting till they had a stroke of apoplexy or a touch of paralysis....and then hurriedly summoning a physician to do impossibilities, will seek his advice, asking him to supervise their vital functions, regulate their mode of life and teach them to stay the morbid changes which they know may be silently progressing'

LEPTOSPIROSIS AND PREVENTION.

The disease and identification.

The disease due to leptospirosis is normaly known as Weils disease and also known as spirochaetosis, icterus gravis, etc in various parts of the world. In kerala, in Malayalam it is known as ELIPANI(rat fever) not rat bite fever. It is a sudden febrile animal borne infection charecterised in human beings by fever , icterus, albumen in urine,bleedings , severe headache and pain in the body, skin rashes, enlargement of liver, prostration and passing of bile in urine and faeces and loose motions and abdominal pains and continiues with irregular fever which starts from 4 th day onwards and lasts for a week or upto 10 days after that fever comes down and after 14 the day the healing starts.

Causal organism.

Leprospira icterohaemorrhagiae is the organism. It is a slender, closely wound, very actively motile spirochaeta varying in length from 1m to 4m. The spirals are shallow and regular , each half m in length, thin and acutely bent as a crook. It is found in the blood, urine, ceribrospinal fluid and sputum of the patient. They can be demonstrated by a dark ground illustration by the day in the urine.It can be cultivated on Naguchi's medium or in a mixture of peptone. Besides these types of Europeon strains,there are fifty named strains of Leptospira with varying invasive potentialities.

Source and reservoir of infection.

The natural reservoir of infection are the rats and the field mice. These rodents are tolerent to the spirochaeta and not suffer from the disease. The organism is excreted in their urine  and faeces,The disease also occur in dogs but the sudden source of infection to man is through the soil contaminated with infective excereta, specially urine.

The incubation period and period of infectivity.

The normal incubation period is one week with a range of six to eight days rarely and may go upto 13 days. Route and mode of transmission to man is through microscopic abrasions occured during work in soil,drains.sewers, etc. Bathing in contaminated water has a given rise to outbreaks. It may occur among farmers, sewer workers,miners,fishmongers and other workers during out breaks. Urine of the patient can be infective from the end of first week onwards from 10 to 25 th day, may extend upto 2 months. Rats are infective during their life. Man possess no natural immunity. Aquired immunity is not solid or remains for long time. The disease occure as severe or mild attack depending upon the type of infecting organism.

Geographical prevalence of the disease.

The disease is virulent in warm countries. The disease was early thought to be prevalent in Japan.  It is endemic in Holond, Congo, coastal Germany, Africa, Sudan, Indonenesia, Malayasia and other countries.

PREVENTION AND CONTROL.

Rat control in vulnarable areas like coastal side and sorrounding areas,sewers in towns and urban areas, etc. Protective clothing for workers, in vulnerable trades like sewer workers and divers,etc. Swimming in infected pools should be avoided. Attendants in hospital should wear protective clothing. Disinfection of items used by patient including urine,faeces, etc, and terminal disinfection also carried out. Naguchi prepared a vaccine for giving to persons enggaged in hazardous professions.

HEALTH CARE

PREVENTION IS BETTER THAN CURE.

Personal hygiene: Regular bowel habits are important for maintaining good health. It is cultivated by regularity in its act. A daily bath is essential to maintain a healthy skin and to avoid communicable skin diseases. Using of too much soap is not good always. Hair should be washed regularly and should be kept short to avoid dirt accumulating in it. Nails accumulate dirt and pathogenic organisms and introduces them dirt to food if hands are not washed properly and in the skin also if one happens to scratch it. They should be kept short. Eyes,ears,nose and throat should be cleaned before before brushing the teeth. Cold and hot baths respectively cool down the body in summer and warm it in winter. Teeth should be brushed after every meal,but at least after the last meal of the day. A proper brush should be used for cleaning the teeth. Eyes should not be rubbed always or wiped with dirty hands. A clean handkerchief should be used for wiping the eyes and another for cleaning the nose,and while sneezing or coughing. Fingers should not be used for cleaning nose and ears. It is a dirty habit and may damage the ear drum or nasal mucosa. The nose should not be blown too much violently as it results in driving the mucous discharge up the Eustachian tube and may rupture the ear drum. Communal shaving by a barber may cause sycosis or tenia infection or other skin diseases. Spitting indiscriminately or coughing,sneezing with out use of handkerchief are bad habits which help to spread the respiratory infection,and such habits should be discouraged. Tobacco or betel chewing in public places must be prohibited and the habit of spitting can be curbed.

FOOD HABIT.

The habit of eating food at fixed times,from healthy sources where it is well and hygienically cooked,preserved,protected and served. It should be eaten in a sanitary surroundings with out fly or dust nuisance or bad odours. It should be served by hygienic food handlers in a hygienic manner. Personal hygiene before and after eating is very important. Hands and mouth must be washed before and after eating. Teeth should always be cleaned with a brush or finger while washing the mouth after eating. The habit of using  a toothpick is not good as it harms teeth and gums. Eating between should be avoided by persons of advancing age. Over consumption of oils, vanaspathi or pure ghee is not beneficial as it usually believed.When people get into good food habits detest eating in unhygienic places and unwholesome food.

WATER HYGIENE.

Water should be consumed from an authorized or a known safe source in adequate quantity. Laziness in adhering to this habit may  cause infections of gastrointestinal disease,specially during rainy season and extreme summer while journeys by train or road. Arrangements should be made to facilitate these habits by the persons themselves while traveling. Pure cool drinking water should be carried to maintain fitness and to prevent effects of heat during long journey.

EXERCISE.

The human body requires regular exertion. lack of exercise leads to obesity, muscular laxity, low vital capacity, low katabolism, low cardiac tolerance and low threshold for physical and emotional stress. Physical activity is a stimulus to the growth of children and adolescence and promotes mental relaxation in adults. It produces and enhances resistance against heart diseases,respiratory infections, prevents obesity and mental and physical well beings. Exercise should, but, not to be so excessive as to cause extreme fatigue, as like all other stimuli, it becomes a stress producing factor if it is excessive. It should be enough to produce pleasant fatigue demanding relaxation. Relaxation and sleep are necessary for recovery of the body from fatigue by vanishing biochemical products and psychological effects of physical and mental exertion. Sleep should be sound with out any artificial aids. A sound sleep is necessary from ill health, good feeding and sufficient physical and mental exercises,comfortable thermal environments and also freedom from pests like bed bugs, mosquitoes,rats and so on ; comfortable garments, bed, and bed linen and freedom from noise. Men get used to sleeping with open windows and uncovered faces. During winter and rainy season adequate clothes and blankets must be put for warmth while sleeping.

RECREATION.

Healthy out door and indoor games, recreational outings, visit to places of historical and cultural interests, hobbies like music, photography or handicraft , and  other re-creative pastime engagements for using leisure in healthy habits produces a healthy attitude of life,those prevent temptation to indulge unhealthy activities, aimless loitering,quarrelsome behavior and provides relaxation with out dullness or drowsiness. Ethical,religious,moral teaching keeps the mind of people geared to healthy thought and action.

DRINKING AND SMOKING.

It is not necessary in any form for nutrition. The higher regular consumption may lead to diseases of liver, stomach, kidneys,heart and nervous system causing alcoholic cirrhosis, stomach ulcers, psychic ailments and cancers of mouth, throat, food pipe and stomach. Regular consumption leads to compulsive drinking and further on to addiction and later confirmed 'alcoholism' its classical stage which is harmful to the body and mind. Alcoholism is a disease needing psychological treatment. Chronic alcoholism may lea to obesity and its effects. Heavy smoking is another unhealthy habit. Tobacco is not essential for a healthy or happy life. Excessive smoking started in early life causes addiction and increased incidence of lung cancer and higher incidence heart diseases. It also causes peptic ulceration, gastric cancer and tremors. Withdrawal symptoms or denial of smoking to a person used to it are similar to withdrawal of any other material of addiction like irritability, lack of concentration, restlessness,etc.

OBESITY.

An excessive deposit of fat in the body with an increase in body weight  more than 10 percent above normal for the age,sex,height,etc. Fat in the body is deposited in the fat depots such as over the abdominal wall, buttocks,thighs and over the shoulders and the back. In addition to this deposition extra fat in intestinal tissues in the body, bone marrow, around the heart, spleen and liver and kidneys and also higher lipids circulating in the blood. Obesity is associated with serious disease processes. Premature death rate is more amongst obese persons. It is one of the major factor of heat diseases. Obesity increases the rate amongst diabetes 4 times who get cardiovascular diseases about 1.5 times. The most important and most universal cause for obesity is over eating and lack of exercise. Obesity decreases exercise tolerance. The only 2 ways of preventing it are regular exercises and a restricted dietary specially the fat producing items like ghee, oil, sugar. Active preventive measures against diseases and change in mode of life becomes necessary under certain conditions. Care of family and school children's' health care is a link between the maternity and child health care and the general community health care.

Mosquito control and prevention of Filariasis .

 Amongst the numerous species of blood sucking arthropods that hurt man and other warm blooded animals,mosquito is most eminent. Mosquitoes have a world wide distribution, being seen in tropics, in the temperature regions and also in the cold circles like arctic areas. They have been found breeding in deep mines,underground tunnels and have been found at altitudes as four thousand meters above sea level. There are about 2400 species of mosquitoes in the world, out of which only 10 species of medical importance. In India only the Anopheles,Cu lex,Aides and Monsoonal are the vectors causing malaria, dengue,filariasis, yellow fever and certain encephalitis.

MOSQUITOES: We, human being have different blood groups. No matter whatever the blood group, mosquitoes like to feast on human blood and mosquitoes do not have any blood groups of their own. In fact they do not have any blood at all. They have body fluids only,but it is not blood, it is called hemolymph, and different from human blood. It does not have RB C in it.This absence makes a huge difference, because RB C determine the blood group of human beings. In other words, those possess neither blood nor have any blood group.The females of all medically important mosquitoes are blood suckers as they require a blood meal for the development of eggs.

MOSQUITO CONTROL: ANTI-ADULT MEASURES.

Personal protection against their bites helps these measures in the control of disease. Anti-adult and anti-larval measures are 2 most important mosquito control measures. Space spraying of insecticides can be used against adult mosquitoes for controlling the transmission of malaria or to reduce density of adult mosquito population.The object is to destroy infected vector mosquitoes during the incubation period of the parasites by spraying 0.1 percent pyre thrum extract.Aerosols are also used as spare insecticides under emergency conditions.

PERSONAL PROTECTION AGAINST BITES.

Use of mosquito net is the most effective personal protective measure. Protective clothing and screening of the houses and hospital wards also can be practiced from mosquito bite.

ANTI LARVAL MEASURES.

Prevention of breeding places ,destruction of larvae, in breeding places by oiling, praying of BHC on water acts as a contact and oral poison to mosquito larvae.A weekly dose of 70 mg per sq.mtr is sufficient to keep the water free from larvae.A 5 percent watery solution applied at the scale of 3 liters per acre will ensure this dose.In this dosage it is not harmful to fish, cattle or crop. Fish of Gambusia affinis are useful in dealing with larvae in wells, gardens tanks,  ornamental tanks, fountains and small permanent pools. It can multiply in artificial tanks. It flourishes under different climatic conditions and equally thrives in deep and shallow waters and changes in the salinity of water dose not effect its survival. If used large fish in fire fighting tanks they may block the engine hose or nozzle. It is, there fore, in fire fighting tanks observance a dry day and use of BHC or DDT as larvicide is the only method of larval control.

FILARIASIS.

It is a mosquito borne worm infection of lymphatic and connective tissues of man by round worms of the family Filarioidae. Sudden clinical signs and symptoms are caused by enlargement of lymphatic glands and inflammation of tissues and organs swelling of testes and genital parts and non genital elephantiasis due to blockage of lymphatics. Diagnosis is confirmed by microscopic examination of a night blood smear. The disease filariasis in man is due to Wuchereria Bancroft and Brugia malayi. there are many other tissue filariae parasites to animals, but they have not been seen parasitising man. The adult worm is 5 to 8 cm long,female are longer than the male. Male and female live together coiled or knotted in lymphatic glands, lymphatic ducts and connective tissues. It may live for long periods ,even up to 12 years. The embryo or  microfilaria is about is about 280m and lives for a 15 days if not picked up by the mosquito vector.They are regular active in midnight and appear in the peripheral blood stream.  Mosquito,  Culex fatigans is the main vector of filaria in India.Incubation period in man is about 9 months to 2 years or may be longer;normally a period of one year is required for symptoms of lymphatic blockage to make their visibility; after introduction of larva in man. The incubation period in mosquito is 10 to 14 days. Man possess no natural immunity.

PREVENTION AND CONTROL.

The important measures for prevention and control of infestation in the community are mosquito control at all stages of their life cycle,personal protection from mosquito bites, and personal protection has a value during night, dusk, dawn, but vector species may bite during day time also.

Endemic simple goitre and its prevention and control

Introduction

It is an expansion of a simple thyroid gland with out toxic display is called simple endemic goitre or in other words,a morbid enlargement of the thyroid gland.A normal thyroid gland takes up a space of about 5 cm square across the front of the wind pipe( trachea) rings below the cricoid cartilage.It is a few mm in thickness at its central part. Normally the gland is not visible nor palpable. It becomes palpable only when it is enlarged 5 times all round. So goitre can not be diagnosed before the gland is 5 times expanded.It regulates body growth, metabolic rate, the development of brain, sexual development at adolescence, maintain normal pregnancy and milk lactation. These are carried by its internal secretions(hormone) called thyroxine. This gland has a chemical attraction for iodine. Iodine is necessary for the reduction of thyroxine.

Prevelance(Epidemiological distribution)

Local inhabitants in the foot hills of Himalayas up to the height of 6000 to 7000 ft,suffer from endemic goitre. Simple goitre becomes endemic if the soil in an area is lack of iodine and hence results in low iodine content in water and vegetables and products grown there upon. Such goitre areas are found in Swiss, french,Austrian and Italian Alps and rocky mountains in United states and also found in Himalayan regions.The distribution of endemicity in these areas is, however belonging to focus, sometimes the goitre pockets adjourns the non goitre areas, separated by only a water shed or supply of salt.

Causes of the simple goitre

Simple goitre develops if enough iodine is not made available to the thyroid gland or if the demand increases as in puberty for growing tissues or if the thyroid can not utilise the available iodine. Thyroid may go deficient of iodine if it is deficient in food, water, milk if it is not properly absorbed. It may less in food and water if it is less in soil or bacterial pollution of water or cyanates in vegetables. The deficiency in hill areas may also be low consumption of common salt due to non availability or low bodily requirement due to the cold atmosphere. In mountainous areas the soil is also poor in sodium or potassium salts. If the soil is salt free due to ancient deposition of ice on it which has left silt-free salt dry, for example, in North America, St.Lawrence and lake city area and Oregon.

Stages of goitre.

Simple goitre starts in childhood due to lack of iodine and fully develops by the age of 30 years after that it becomes nodule or swelling.The cells increases in size and numbers in the attempt to produce enough thyroxine out of diminished iodine contents,when it is enlarged more than about 5 times.It is palpable and called first stage. according to expansion it has 4 stages and further enlargement of swelling becomes irregular and nodular,then terned as nodular goitre,and this stage may be reached after 30 years of age.hence there are 2 groups,first group is called non nodular and second is called nodular stage.

Effects of goitre

Simple goitre may not cause any ill effects,but has a potential of becoming nodular and then its big size it may cause disturbances in breathing due to pressure on the nerve.When it may become a toxic goitre and rise to the signs and symptoms of Graves disease.Congenital or infancy defects are more common in goitrogenic tracts. Nodular goitre may turn to malignancy in advanced ages.

Causes of iodine deficiency in regional areas

Genetic character of the local population, deficient iodine in vegetable products due to presence of cyanates, bacteriological pollution of water supplies causing iodine deviation,high magnesium and calcium hardness of water and lack of iodine in the soil and tracts.

Prevention,control and remedy

Administration of a minute quantity of iodine from childhood prevents goitre in endemic areas. Iodized salt supply to population in goitrogenous areas prevents endemic goitre from developing the community. It is proposed by mixing and and then grinding common salt with 0.02 percent of potassium iodide or 0.002 percent of iodate. It is noted that even proprtions of lower than this will prevent endemic goitre. Eltraxin(sodium levo-thyroxine)is used with results for rapid reduction of enlarged goitre. Uncomplicated cases may be treated with Eltroxin with out admission to hospitals,but those cases showing toxicity or other complications should be admitted to hospitals.All treatments should be given under the supervision of registered medical practitioners. Monthly or periodical check up for the detection of the early goitre in endemic areas also be carried out as preventive and control measures.

PM Kutty