AVIAN INFLUENZA AND PREVENTION.

1. Most of us have heard and some must have suffered from influenza/flu which occurs pandemic-wold wide or epidemic with its symptoms with high fever,difficulty in breathing ,head ache ,malaise,nose running,cough,sneezing,etc near about 4 days of its occurrence,The incubation periods is 2 to 4 days,It is due to a virus of 250 groups estimated and human being has no natural immunity for those.Can infect by other group after fortnightly or after a month by other group of organism/virus.It is all known as influenza/flu.Avian flu is deferential from that and through birds.
2.  But Avian influenza/Flu is different from that which causes an organism/virus called H5N1,and normally infected birds including chickens ducks,wild birds,other poultry can infect other birds flu can pose health of people.A case of bird flu directly infected a man N5N1was in Hon gong,China in 1997 then the bird flu has spread the other in countries in Asia,middle east and Europe. Human  infection is still rare,but the virus that causes infection in birds might change and infect humans thus could lead to pandemic,a world wide out break of illness.During an out break of bird flu,people who have contact with infected birds can become sick.May be catch with,bird flu may be possible by eating poultry or eggs that are not properly cooked or that a person contacted with the disease who has it.It can make more people sick and fatal.Antiviral drugs may make the illness less severe may prevent the flu in man ,who were exposed to it,There is no vaccine currently available for it.
3.  Risk of getting flu virus is higher to poultry farmers, travelling country when virus is present,eat a under cooked poultry meat,eggs or blood from infected birds.People who live in the same house with bird flue may also be at higher risk of infection,The flu virus H5N1 lives in the environments for a longer periods of time infection should be spread such by touching surfaces that have the organisms of illness.The birds who were infected with this disease/flu may give the virus in their faces and saliva as long to 8 or 10 days.
4.  Symptoms depend upon the strains of viruses in infected man.The H5N1 virus in infected man causes influenza like symptoms such as cough,diarrhea,breathing trouble,fever.Temperature above 38 C,head ache,malaise,muscles pains,watery nose and sore throat.Tests,x ray chest.blood differential counts,and other tests as per the functioning of heart,liver,kidneys.Treatment differs as per the symptoms out break depend upon the the type of flu and how bad the infection is.The disease can be fatal and the possible  complication are,sudden respiratory failure,jaundice,pneumonia and sepsis.
5.  Prevention.Use protective clothing and wear of special breathing musk,if any one work with mask.If travelling to an area to that H5N1 Out break.avoid going to live birds markets.During this time,does not recommend travel to countries affected H5N1.Avoid uncooked or under cooked meat.Reduce risk of exposure to Avian flu and other food borne diseases.Burial of carcasses flu infected by H5N1 with quick time.Very recently 3-4 days back in Kerala,India in Kuttanadu and Alapuzha ducks were died totally and their blood were examined and found it was due to H5N1,there,fore,all destroyed and buried/burned to prevent infection  to other birds/chickens and human beings.

by pmkutty

EFFECTS OF EXTREME COLD CLIMATE AND PREVENTION OF ITS HAZARDS

1.Winter season started and it will last  up to March 2015, and personal protection and prevention of its hazards to maintain a healthy life is essential. Not only in high altitude, but also those occur in low altitude in the plains of northern India, where effects of cold climate become more complicated due to extreme cold. Cold may exist with very low atmospheric humidity as in Rajasthan or in Punjab or with high humidity and rain fall as in Sikkim and J and K or in NE FA or with low humidity as in the north Indian plains. Height above 3000 meters in the western and 4000 meters in eastern Himalayas represent the same climatic conditions as in the arctic region.Here the temperature in winter ranges between minus 20 C to minus 50 C, there is not much vegetation, the cold is dry cold and is accompanied by severe biting winds with snow particles moving in the air, and deep snow drifts are common. Frost-bite and snow blindness are common dangers.

2.Below that altitude and above the winter snow line at about 2000 meters in western and 2500 in eastern Himalayas, subarctic condition overcome. Melting snow in summer produces watery mud.Winds are cold but less severe because of the protection given by forests and scrub.Atmospheric temperature is normally very low and the region has pleasantly cool summers and the great revers take origin here.Though snow storms are often and frost-bite may occur.Trench foot is more common risk and chilblain is the most common hazard and happens down to the lowest height of this region.

In foothills up to 1000 meters height the climate is humid and warm in summer with high rain in monsoon and with tropical forests and winter seasons are mild.Below the height of winter snow line

the climate is semi-liar to the higher temperature zones with forests,cold is severe in winter but not as more as to produce frost-bite or trench foot,but chilblain is common in susceptible individuals.In western parts,winter rains comes and summers are pleasant.

3.Local effects of severe cold climate are frost-bite,trench foot and chilblains.Frost bite is due to freezing of protoplasm,trench foot is due to the stagnation of circulation and chilblain is due to an allergic type of reaction to cold insusceptible individuals.The area become red and there is irritation specially when the patient is in bed or sitting in front of fire.Frost bite occurs in lower and upper extremities and exposed superficial areas like nose tips and ear lobes.While the tissue temperature goes down below the critical temperature,the the protoplasm in the cells wholly frozen and the cellular frame work gets disrupted and causing negative changes in the affected tissue.Two clinical types are recognized; acute and insidious.Acute frost-bite occurs and develops in extreme cold weather with high wind.Trench foot occurs above the critical tissue temperature in combination with dumpiness due to circulatory stagnation.

4.First aid should be started by removing the individual to a sheltered place soon.Patient must be put in sleeping bag or wrapped in blankets and insulated around between him and ground.The best way of warming the patient is by immersing him in a warm bath,the temperature of which should be 35 C.

Then it should be brought up gradually to 40 C in 10 to 15 minutes.Moisture is a  good thermal conductor and its presence in contact with skin interferes with natural insulating action on the skin.Presence of moisture in clothing increases its thermal conductivity.Local blood supply stagnation allows local temperature to be lowered.Physical inactivity increases the risk of cold injuries.Activity decreases the liability to reduce them and is an important prophylaxis against cold injuries.Nutrition plays an important role in resisting cold effects and malnutrition increases a person to cold injuries.Vitamin A and C deficiency also increases healing power of tissues.Fatigue,fear and anxiety are common in cold climate specially at high altitude cause increasing the liability to cold injuries.Local injury or skin infection increases the particular part to cold injuries.Use of tobacco increases the risk of frost bite and alcohol consumption in large quantities increases local cold injuries.

5.Preventive and control measures.The clothing should be in many layers and loose.Wool is the good material.and the outer layer should be wind proof.Boots/shoes socks gloves and head covering should not be tight Snow clothing must be worn and training for its proper use should be given.Damp clothing must be changed soon.In cold weather 2 pairs of socks are worn.Boots should be loose fit,otherwise,inflict injury on feet and toes,if it is so tight;kept soft and water proof,and every person should have an extra pair of dry socks and boots,to change into if his feet get wet.If the person has to work in water or slush,gum boots are of great advantage.Snow boots are used with extreme cold clothing.boots should be used after trying them out with thick woolen socks after walking at least 50 yards and while standing. Socks should not be tight.every person should have 4 pairs of good woolen socks all the time.Regular checking is necessary.Badly torn socks become dangerous,bad one must be changed soon.                                                                                                                                                 

(a)The feet should be inspected before going to bed every night.They must be washed with warm water and dried and applied with little animal or mineral Vaseline before sleeping every night.This helps 'supercooling' and avoid frost-bite.Individuals with ulcers and abrasions should not be exposed to out side in extreme cold weather till it is healed.Foot powder should be used before wearing socks in the morning to reduce dampness and friction with socks.Venous circulatory congestion and stagnation must be avoided,persons should not sit for long periods in enclosed places or upon the railings with feet hanging down and especially over the edges of seats.Too tight clothing also causes venous block.

(b)Shelter from strong wind is necessary.while resting or sleeping.Regular moderate exercise to keep up circulation with out causing any exhaustion or excessive sweating should be taken regularly. Wringing of toes and fingers should be practiced regularly and face muscles should be wrinkled to keep up the circulation.If the tip of nose or ear lobes or cheeks of the one is affected the other persons draw attention and first aid is given.To maintain general heat of the body caloric requirement in the cold is higher,due to higher metabolism.There fore to maintain general heat of the body,the caloric value of food must be taken,hot and adequate appetizing meals to be consumed.Well cooked and nourishing hot foods and drinks increase resistance to cold,promote mental and physical well being and prevent the body against infection,fatigue and dangers of climate extremes.Vitamin C in the form of multivitamin tablets should be taken during extreme cold climate to resist the body from hazards.

(c)Personal cleanliness,dry clothing,ventilated shelter,warm bed and recreational facilities are helpful.At least 2-3 hot baths in a week in snow bound and cold environs are necessary.bathing places should be sheltered from snow fall and wind.Do not use too much soap as it removes the greasy material and decreases insulation and advantage of supercooling phenomenon.Contact with cold metals should be avoided.Metal articles should be covered with adhesive taps.Touching cold metals with bare hands peels off a thin layer of outer skin,especially when the hands  are dump. Alcohol never should be consumed in excess over a short duration.It should be taken at all when likely to be exposed to cold wind,Smoking must be always in moderation or if possible be avoided.Once the cold injury occurs,it should be definitely prohibited.Once a person suffered cold injury due to high altitude effects,must not be exposed to a semi-liar risk again.

(d)First aid and early treatment is aimed at arrest  and prevention of tissue damage.All cold injury cases must be treated as lying cases and transferred to a sheltered place by stretcher in warm surroundings and given extra cloths and blankets,at high altitude oxygen must be given through mask.All tight clothing should be loosened and boots/shoes removed and affected part to be kept at complete rest and the part must be gently and thoroughly cleaned,and wrapped in sterile dressing.Blisters should not be opened.The body should be warmed slowly,but affected limb must be warmed up quickly with warm water at about 42C. The limb must be kept continuously warm for a long time after thawing.Rest,nourishing diet and sleep are necessary to the patient,hot nourishing fluids and meals are helpful in restoring morale and health. Alcohol is contraindicated as it cause heat loss and smoking should be avoided totally.

(e)There is no specific prevention or treatment for chilblain.To improve local circulation such as a hot paraffin wax bath and ultra violet rays are help full.When the skin is intact a paint containing 50% menthol in a compound tincture of benzoin or ointment with 3% of camphor and 0.5% of phenol in linolin paraffin mixture should be rubbed gently into the chilblains every night and morning,after immersing the affected parts in warm water and drying them nicely.Chaffing of cheeks and lips can be prevented by applying lip salve or paraffin jelly.

(f)Effects at high altitude.These are encountered in high altitude aviation and mountaineering.The most frequent and important clinical problems unexpectedly meeting at high altitude are Acute mountain sickness,Acute pulmonary edema,Chronic pulmonary hypertension,coronary and cardiovascular insufficiency and congestive heart disease,manifestations of diabetes mellitus,Psychological effects,etc.Prolonged exposure to hypoxia may produce other minor effects after a long time are Dimness of vision,loosening of teeth,loss of weight,indigestion,anaemia,loose bowels,thyroid deficiency,increase severity of infections,etc may be met in contest.These symptoms normally disappear with in 4 to 5 weeks of move to the plain areas.A high protein diet is necessary in high altitude areas due to subnormal tissue metabolism.The atmosphere being cold,the air has very low atmospheric moisture contents.Much water is so lost from the body through the breath.Lack of interest,irritability,insubordination,and lengthening of reaction time may happen.There is no increased incidence of psychiatric break downs at high altitudes in comparison with plain areas.Lack of concentration and mental impairment may occur on arrival at high altitude as a part of acute mountain sickness for few days which may subside with in few days.If not cured during this period such persons may be brought to sea level and become normal.

6.Prevention of effects of high altitude environments. All individuals going to high altitude should be examined.The persons with sound health of cardiovascular and respiratory system should be selected for long residence in high altitude.The ascent should be slow and in stages,like 3000,3700,4300,5000 meters.It is better to avoid alcohol consumption and evening meals should be consumed 2 hours before sleeping.If any one develop with respiratory distress,more cough or fever develops they should be brought down to a height below 1500 meters and treated soon.Gradual acclimatization is the most important preventive measure against sudden effects of high altitude hypoxia. Avoiding trips to higher altitudes if suffering from nose and throat infections.and avoidance of excessive consumption of alcohol and smoking,and adequate consumption of fluids.well cooked food and sufficient rest and,

and also healthy recreation reduce the effects of hypoxia.In order to counteract this increased protein consumption is required.Due to hypoxia the fats can not be well metabolized,there fore,low fat consumption is substituted by high carbohydrate intake meets meets the physiological needs.Fats require more oxygen for its katabolism than the carbohydrates per gram,and per 100 calorie out put.Water drinking must be adequate.This should be had through often drinks.The high altitude foods meets these requirements.

7.First aid and early managements.Complete rest in bed,warmth,and nutritional diets will relieve minor symptoms.Aspirin will relieve most of symptoms including sleeplessness.head ache,cough and irritability.It should not be taken as a preventive measure or more than one .g.(2 tablets) with in 8 hours with  medical advise.It is easier to work during day but sleep may be disturbed or difficult for first few nights..A sleeping tablet may be given under medial advise.persons showing mental irritability,impaired judgement,severe headache vomiting etc,should be removed to a lower shelter at 3000 meters for 3-4 days.Then they can be ascent again to higher shelter.

Individuals suffering from irritable cough and lung edema,pain chest,breathlessness or bruise co-lour in the body,vomiting sensation,severe giddiness etc should be rested soon and given oxygen.They should not be left alone.Arrangements should be made for sudden removal to an altitude below 2000 meters if complaints prevail.Complete bed rest,continuous oxygen and and rapid evacuation to a lower altitude are the 3 initial MUSTS.The congested lungs normally clear with in 6 to 48 hours after removal to a lower altitude.In addition to atmospheric hypoxia it is possible at high altitude to give a rise to psychological voidness,and the appetite becomes poorer,the re activity becomes slower and duller,the ability to grasp the situation becomes blunted and the attitude of mind may assume inclination.This makes a man interpret wrongly and disregard administrative tasks or his health.

pm kutty

INDUSTRIAL HEALTH

Industrial health in relation with the conditions specially to the industrial conditions of the workers can be dealt with the worker,environments,the machinery,the materials used,and method and process of work,,.All buildings,temporary or permanent must be structurally safe and sound to with stand the strain and stress of machinery and single storey construction is the usual rule as it helps flexibility to lay out. It is easier to manage natural ventilation and natural light can be obtained in it by a combination of walls and roof lighting. By care full orientation,direct exposure to the tropical sun can be avoided. protection conducted heat can be achieved by a choice of suitable material. Spreading of  the surface area of walls and ceilings with asbestos reduces the noise of machines and also makes

building fireproof.Work-rooms must be provided with natural and/or artificial lighting.Recently,the fluorescent lamps/tubes in strip lighting is being increasingly used due to their efficiency is high and running costs are law.They give a uniformity of illumination and low heat formation with absent of shadows.But after some time it starts flicker effect,and it is danger,so immediately changed and voltage must be checked and the chock and starter of the tube should be renewed.

Efficient ventilation must be provided in work rooms by natural and artificial means to eliminate stagnation of air,excessive heat or cold and excessive humidity and dryness and objectionable ordours. Clean and fresh air should be supplied to all rooms/enclosed work places at an average rate of not less than 30 to 50 cum per hour per worker or a complete change of air at a rate varying from six per hour for sedentary workers to ten hour for active workers.If a good supply of fresh air could not be maintained by natural ventilation to the centre rooms mechanical ventilation should be provided,All dust,fumes,gases,vapours or mists generated and released during industrial process must be removed at their point of origin.Funnels,flues and vents should be used to extract dangerous fumes vapours,mists and smoke from the immediate vicinity of the workers,All employees should be protected from radiant heat and excessive temperature from heated machines and hot process by the heat insulation of the of the equipment or by suitable protective clothing.Suitable thermal comfort and working comfort should be maintained to all industrial/factory employees to achieve maximum productivity,Seats and work benches should be provided to all workers who can perform their work in sitting posture.Work tables also must be of convenient height with regard to that of the seats.

Sanitary conveniences like toilet rooms,latrines and urinals should be provided in sufficient number as per accommodation.For female workers separate sanitary convenience must be provided as per the strength of female workers.Washing places should be conveniently located.Sufficient washing facilities for maintaining personal cleanliness should be provided in all industrial establishments.For persons whose work  involves contact with any injurious and noxious substances there should be at least one tap for 15 persons.Mixing valves for shower baths,if provided should be a such a type and so installed and adjusted that water can not be supplied at a temperature exceeding 100 degree Fahrenheit.Shower baths and flooring should be thoroughly cleaned at least once in a day and disinfected to prevent fungal infections,All industrial establishments must have suitable and sufficient arrangements for accommodating clothes of workers and drying them,A separate working room should be provided for all employees whose working clothes are exposed to contamination with poisonous materials,infections and irritating or radio active substances.Benches or other suitable seating arrangements are necessary in dressing rooms.

A sufficient supply of cool and safe drinking water should be provided for in a readily available place in all work places.Closed electric water coolers are ideal and most hygienic.Proper care must be taken to prevent contamination in water tanks and other containers.if water cooler is not provided.Section 18 of factory act says a minimum scale of drinking water per day per worker.House-keeping implies general cleanliness and orderliness of the plants,the tools and the products.Cleaning and working must be done during none-working hours.For any technical reason,cleaning must be done during working hours.Wet mopping of floors after sweeping or vacuum cleaners are to be used as a routine method.Wet work process should be done in dusty industries and effective drainage has to be maintained.False floors,platforms,mats or other dry standing places with suitable foot wear for use must be provided. While at work on an oily or greasy working places floor constitutes the commonest slipping hazard.House-keeping means keep the working places neat and clean.Due to improper house-keeping is a another cause of accidents.Many a punctured wound is a result of stepping on the screws,nails and other sharp objects carelessly thrown on floors.Infestation of rodents,vermin and insects should be eliminated by control measures.Protective fencing around factory/industry should be installed to avoid hot pieces of iron coming out from the furnaces before cooling.

Accidental injury due to machinery is the most important industrial hazard.It is due to various causes,like bad house keeping,faulty and unguarded machines and carelessness,etc.Most of the accidents are preventable by the close collaboration of safety officer,engineer,welfare officer,chemist and hygienist and medical officer.There fore,workers must be educated and trained in various industrial processes and handling of various different types of machines.The materials handled and industry uses and makes wide range of materials/substances which are known or suspected to cause toxic effects in the employees working with them.Industrial toxicology deals itself with the study of various substances used in industry either as media for processing some materials or as raw materials or the finished product.Things used solids,liquids and gases-may produce dusts,fumes,gases and rays.which may be inhaled,swallowed,absorbed by skin or attack the skin and cause harmful effects like occupational hazards and diseases.Where ever practicable the use of offending substance should be prohibited.failing that,a harmless materiel should be substituted for the harmful one.For example,use of yellow phosphorus has been prohibited in match factory under international law;sand-blasting may be substituted by shot blasting.Gasoline derivatives may be used in place of benzol as solvents.

Total enclosure of plant.personal contact with harmful materials such as dusts,fibres,fumes,gases mists or vapours into the air of the work room would be prevented.Elimination of the dangerous products by suction hoods properly connected to efficient exhaust systems where an air tight apparatus can not be used.Where practicable the materials should be used in a moist or wet state to prevent the evolution of dust,for example.lead.Health education is the most important safety factor.The atmosphere of work rooms should be tested periodically to ensure that the concentration of toxic or irritating dusts,gases,fumes mists,etc are with in normal and safe limits.Disinfection of articles infected with bacteria should be carried out.Wearing of personal protective clothing and equipment such as respirators/breathing apparatus and also skin must be protected by use of protective creams.prohibition of taking or preparing meals and smoking in work rooms. Separate meals rooms should be provided in the case of lead and radio-active processes.Prohibition of the employment of persons in particular industries,for example,women and young persons below 15 years in lead processes.Occurrence of certain diseases like lead poisoning,phosphorus poisoning,Mercury poisoning,manganese poisoning,Arsenic poisoning,Anthrax,silicosis,Toxic anaemia and toxic jaundice due to poisonous materials,etc.should be notified.

Common occupational hazards are acute poisoning by benzol inhalation of very high concentrations of benzene vapours,may result in unconsciousness and respiratory failure.Due to chronic poisoning

degenerative changes are observed in kidneys and heart.Red blood cells are decreased and anaemia may develop.The ventilation of the of the rooms of workman should be improved by mechanical exhaust ventilation is one of the preventive measures.Carbon monoxide poisoning is an acute poisoning with a sudden on set of unconsciousness and rapidly developing bluish co-lour and death.

It is formed from incomplete combustion of materials containing carbon.It is coming from various industries like gasworks,foundries coke-ovens,blast furnaces and in automobile garages.The chemical

causes asphyxia/suffocation,if the exposure continues the victim become unconsciousness,resulting in death from respiratory failure.Chronic poisoning shows all these symptoms coming on gradually and then continuing for longer periods.Head ache,breathlessness,physical and mental weakness  are the common symptoms.Carbon monoxide poisoning can be prevented by prevention of its production

in combustion,then give attention to all possible leakage in the exhaust system and ensuring good ventilation and finally by observing the rules of personal protection.A competent person must be made responsible for all circuit.

First aid and early treatment must be given to all poisoning cases immediately.The first object is to restore normal breathing and the to eliminate shock.The victim must be removed into  fresh air on a stretcher and should not be made to walk even though he is conscious.The oxygen carbon dioxide mixture should be given.if the breathing has stopped or is shallow artificial respiration should be continued till normal respiration returns.Complete bed rest and warmth are necessary,and give hot tea with plenty of sugar.Watch the patient for long time in all cases because of the tendency to relapse. If the breathing again become shallow,give artificial respiration and administration of 95% oxygen and 5% carbon dioxide mixture should be given.Chronic ulceration,cutting oil dermatitis,caustic acids and alkalies,cyanide poisoning,lead poisoning,metal fume fever,mercury fulminate,nitroglycerin,nitrous fumes,physical hazards,welding hazards,silicosis,etc are the some common industrial hazards.

The worker is the most important component of the industrial set up.The workers remain in an optimal state of mental,physical and social health and it is necessary for industrial productivity.

To achieve this it is the main and prime importance to fit the skill of worker to the job and job his skill.Hence medical point of view,a pre-placement of medical examination must be carried out taking into the consideration the hazards which the factory life will impose on the employee.It should not mean,however,the factory job does not require highest physical standard of health.A disabled person can be accepted how much really he can do his job safely.For example,a totally full blind ex-soldiers

have been employed in an optical factory and it has been found that their out put has been more than

that of a normal man.The work through the sense of touch which they have developed in themselves to an extraordinary degree of proficiency and also some times, blindness in their case has actually helped greater concentration on work by excluding visual distraction.After selection and placement it is the duty of the management to provide sufficient safeguards to protect him from accidents,toxic and other industrial hazards.It is then essential to train him in work methods and self protection from all possible occupational hazards.Working clothes should protect him from or minimize the effects of hazards to which the wearer may be exposed and improve working efficiency and physical comfort.

Protection of head,eye and ear protection,hand and arm protection,foot and leg protection and respiratory protection with proper apparatus are essential during the process of work carried out by employees.Occupational psychology enables the study of psychological fitness for employment and investigation into the causes of psychological beak-down due to strain and stress in some industry occupations.This also include certain aptitude investigations/tests for different kind of work and into the causes of industrial fatigue.There are many psychological factors involved in industrial morbidity

by which work may be dull,monotonous,repetitive or other wise unsuited of some persons of certain

character or temperament.All persons must undergo a medical check up before entering industrial

employment for the first time or with in 15 days of employment.Medical services should collaborate

closely with technical services of industrial establishments to ensue as perfect selection of workers and also the skill of workers.Periodical medical examination should complete and thorough including special investigations.

Industry not only presents hazards to workers but also creates hazards and annoying conditions to the residents in the vicinity or in the township.Air pollution by smoke and poisonous gases and dusts are common in residential areas near to factory/industry.and water pollution due to industrial effluents.and also noise produced by machinery during work processes.disturbing calm of residential areas.Use or consumption of final hazardous products produced by industry.In recent years air pollution by smoke and poisonous gases,dusts and fumes has become an important public health problem.Most cokes,coals and heavier oils contains sulphur compounds when burnt,most of them emitted as sulphur dioxide and other chemicals such as gasoline produces carbon monoxide and Irritating hydrocarbon as Ole-fin.Other organic compounds found in polluted air in big cities are cresol,phenol,xylene,soot and tar compounds.Dust is a special hazard from cement manufacturing

industries and radio-active wastes from atomic reactors.

Ill effects are air polluted with sulfuric acid and sulfuric dioxide can cause respiratory distress and

acute respiratory irritation.This may show finally the persons suffering from respiratory/cardiac diseases and allergic disorders of the respiratory tract.to the aged ,and premature infants.Eye disorder

also may be increased in smoky atmosphere.Unpleasant or-dour may cause gastric troubles and vomiting sensations/anorexia.Silicosis occur due to pollution with dusts in lungs.The disposal of waste water from factories is another public health problem.Untreated liquid wastes are lead into a stream which makes the water unpotable,destroys fish and renters it unfit for bathing and recreational

facilities.Live stock and diary cattle may get poisoned by drinking contaminated with industrial wastes like insecticides and mineral oil trade or even unpleasant flavour to milk.Anthrax is known is to be transmitted by using the polluted water in slaughter houses.Waste water from ammunition and chemical factories remove waste products like arsenic cyanide,which are toxic to plant,animal and human life.Some effluents from industries are discharge to sewer with out correct treatment make the final treatment of sewage unsatisfactory.Trade wastes from gas works give an offensive tastes and smell to the water.The indiscriminate discharge of waste waters on land may cause water logging and

infertility and destruction of standing crops.It may produce foul smell and make the place ugly for any other purposes.

Control measures are effective legal provisions for control of waste water and soil pollution.A technical organization to assess nature of water pollution is necessary,and legislative procedures for control of smoke nuisance and rigid enforcement of these provisions.Standard for the sulphur content of coal and smoke in the air must be laid down.An administrative body to enforce legal provisions with representatives from the state health department and factory inspectorate and public health engineering should be established.Proper siting of residential areas and industrial areas by sound town planning is important to decrease the hazards of air pollution.Smoke nuisance from railway locomotives,ships and also from the industry can be eliminated by a change over to diesel or electric power.The active cooperation of industrialists who must recognize their responsibility in this matter

plays a vital roll in the control of air and water pollution.The education of the legislators,industrialists and workmen is important  to make them appreciate the problem and their respective roll in cut down the hazards to minimum.

pm kutty

PREVENTION AND CONTROL OF DENGUE FEVER

Dengue is a sudden specific fever of about seven days duration,and characterized by pains in all over the body.a rash and a raise in temperature,by the cause of a specific filterable virus.Man is the reservoir of infection.The Aedes mosquito which has acquired infection from a case is the immediate source of infection.

The virus multiplies in the stomach of the female mosquito of Aedes and its transmission occurs to man through its bite about 10 days after taking a blood meal from a case of dengue during its infective period.The most Important vector species in India is Aedes aegypti which bites man in day and night.The incubation period is normally 4 to 7 days and can limit from two to fifteen days.

A case is infective to mosquitoes during the first 3 days of the illness,and the mosquito remains infective for the whole of its life period of 3-4 weeks after it becomes infective. Man possess no natural immunity,but an attack confers considerable immunity.Second or third attack may occur occasionally,but they are much milder than the first attack. In an endemic area local people enjoy

almost complete immunity.The new comers from non-infected areas are particularly susceptible and among them the disease occur with suddenness affecting large numbers.

Dengue has a wide distribution in tropical and sub-tropical areas and mainly in coastal region and and the deltas of great rivers.it is a disease of towns rather than of the villages of the country,In the tropics the disease is always onset of the monsoon rise.In the sub-tropics the incidence occur in summer and autumn.In India Dengue occurs in the eastern side of the country mainly north east and less in south east.It is also occurs in epidemic form in north-west India.In Bengal the highest disease occurs in August and September and also it may occur in epidemics.In Kerala also endemic cases occur during rainy season.

Though the disease is with no mortality,it is important as it may affect a number of people when occurring in epidemic form.

Prevention and control of the disease.

The only preventive measure of dengue is the control of the vector mosquito i.e .Aedes aegypti. This

mosquito has limited power of infiltration so that its breeding places to be eliminated from human habitations and places of working areas.This is effective in controlling dengue in epidemic areas.Use of repellents and protective clothing and mosquito nets come under personal protective measures.The use of insecticides are very important during epidemics. The patient should be treated under a mosquito net during day and night,as the vector Aedes aegypti mosquito is active in day and night.For attendants and contacts no action is essential.

pm kutty

PREVENTION AND CONTROL OF RABIES/HYDROPHOBIA

Rabies is an acute,almost fatal infectious disease of animals mainly in canidae  tribe from which man is secondarily infected.After 15 days of incubation period the infected dog shows symptoms in one of the two forms i.e dump or paralytic form and furious form.Furious canine rabies causes maximum cases of the diseases in man.Stray dogs and pet dogs are the intermediate host of the disease to human beings and animals like cow,be-fellow,cat,sheep,etc.When the disease occur in man it is known as Hydrophobia, means fear of water.In man the disease is characterized by sudden onset with headache malaise and nervous symptoms of depression progressing to paralysis with spasms of muscles on attempt to drink,followed by delirium and convulsion and resulting to death from respiratory failure with in two days to a week.The difficulty to drink water is in patients only in human beings,and does not occur in dogs or other animals.

The organism causing this disease is a neurotropic filterable virus.The strain recovered from the stray rabid dog has been named as"the street virus".It is found normally in the hippocampus of the rabid dogs/animals brain and that of man dying of hydrophobia.Virus is present in the saliva one week before symptoms appear.The street virus loses its virulence and retains the antigenic properties when passaged a hundred times through the rabbit.This is used for preparation of antirabic vaccine and is named as"Virus fixe"

The temporary reservoir of infection is found in the canidae. Some of the members of these families harbour the virus with out suffering from the disease or death,and also excrete it in saliva at intervals

for long time.The Indian mongoose and the American Vampire bats are also found to harbor the virus.Some wild rodents also have been suspected of playing an intermediary role in the transmission of infection from animal to animal with in these tribes of canidae families and non-canidae families to the wild canidae tribe,with out themselves suffering from the disease.Therefore,these animals serve as permanent reservoir of infection in nature,migrating from this reservoir occur in wild canidae like,jackals,foxes,wolves and wild dogs in whom reservoir is found.Transmission of virus then occur

from wild canidae to domestic stray dogs,when meeting them on the out sides of town,near butcheries

and refuse disposal yards.In rural areas the wild canidae can meet the  domestic stray dogs with in the areas of the villages.Domestic stray dogs thereafter transmit to pet dogs.

The canines suffer and die of the disease with in 10 days after the symptoms appear.For man the source of infection is from the rabid ,domestic,street,or pet dogs or cats.In rural areas wild dogs,foxes,jackals or wolves may attack human beings,during epizootics among st domestic dogs and cats.Infection is transmitted through bites coming out blood or licks on broken skin surface by the rabid dog.Infection doesnot occur with out some injury of epidermis or mucosa. Virus deposited at the site lastly reaches the central nervous system and the route and its travel up to brain is doubtful but the blood stream do not play a part;perineural lymphatics of the secondary nerves may be the route of travel.The average incubation period developing hydrophobia in man is 3 to 8 weeks,may vary from 10 to 90 or longer up to 6 months as per location of the bite and wound from head.The nearer the dog-bite to brain the shorter is the incubation period.In animals incubation period

is about 2 weeks.

The saliva of a rabid dog or fox is ineffective for a week to ten days,before symptoms appear,till death of the dog.but some times occurs only a time before the starting first symptoms of rabies appear. All warm blooded animals and mammals are susceptible.Man possess no natural immunity against the disease.Rabies has a distribution all over the wold.It was absent long time in some countries like New Zeal and, Australia,Hawaii and some pacific islands,and some other countries  like U.K, Scandinavia were strict anti-rabies vigilance is observed.In Asia and Africa the disease is very common.In India more than 7000 cases of hydrophobia occur in every year.

Preventive measures against hydrophobia;Immediate first aid treatment of dog bite  should  be given on the spot.All bites from dogs and other animals should be regarded as dangerous and first aid treatment should be carried out immediately.

The wound should be suddenly cleaned and washed thoroughly with soap and water to reach the depths of pockets of the wounds with the help of a forcible jet of water and application of tincture

of iodine or 70 % of ethyl alcohol should be carried out with swab so as to reach the depths of wound.

In emergency 20 percent soap solution can be used for this purpose.Local application of 5 ml hyper immune antirabic serum around and underneath wound is an added helpful first aid if possible.Tetanus toxoid 0.5 ml given to all pre immunized persons.Antibiotic treatment may be needed to treat badly lacerated cases and subsequent infection.Normally sutures do not apply for 3 days.

A full course of antirabic vaccination is the only specific procedure which  prevents hydrophobia.The

principle is to make an active immunity by giving daily injection by the modified inactivated rabies virus during the incubation period.Vaccination must be started and completed very early after the rabid dog bite.

Generally there is no danger of infection through unbroken skin,but the virus may have been present in the saliva of the dog up to 10 days before the onset of the symptoms,the patient has to decide for himself whether there is any possibility of the dog having licked on the broken skin during that period.The medical attendant should not be expected to decide this for him.If the patient is with considerable doubt in such cases antirabic treatment is generally given to be on the safe side.

In some cases, antirabic treatment is not necessary.1.Drinking of milk from rabid animals.2.If the biting animal remains healthy and alive for a minimum period of 10 days after the bite.3.A bite through clothes with out tearing, when the skin not broken,even though the bruise co lour may be present.4.Handling of clothes or materials contaminated by the rabid animal or a patient of hydrophobia.5.Handling of animals bitten by rabid animals provided the skin of the individual is free from cuts,abrasions open injuries.6.Attendance on a case of hydrophobia,unless bitten by him.

Complication of antirabic treatment;Anaphylactic reaction may happen in sensitive persons.Non specific reaction may also occur, like,moderate local pain,redness and swelling,etc.mainly in obese patients.For these complaints local fomentation may apply.High fever,malaise,headache,pain and stiffness in neck and back or limbs may appear after 4th day due to allergic manifestations which is rare complication to antirabic vaccine treatment.In India the reported cases were one in fifteen thousand persons under vaccine treatment.This occurs between 9th and 15th day of treatment

more in males than in females.and among adults than in children.

Prevention and control of rabies in animals; It consists of mainly controlling the stray dog population,protection of pet dogs and cats and prevention of importation of disease from out side,if the country is already disease free, and personal protection against dog bite.Destroy or plan the growth of number of stray dogs in the country specially owner less dogs.All pet dogs to be registered

and use of metal badges on the collar,to identify from them stray dogs and owner less dogs.For promoting registration the local authorities should give free pre-exposure antirabic immunization and free treatment for other canine diseases.Ingress of wild canidae in habitations and their mixing with domestic dogs can be controlled making the slaughter houses,rubbish disposal yards,poultry farms and such other places attracting dogs,animal food and disposal of all such waste by burning.To  promote caniculture, publicity campaign should be carried out,registration of pet dogs,their protection and destruction stray dogs.Education regarding the dangers of rabies,rabid dog bites and important of early vaccine treatment must be carried out.During an epizootic,restrain the movements of all dogs and  observe them at least for 3 months.Dogs that have been bitten by rabid dog should be destroyed preferably.Dogs in contact with ,but not known to have been bitten by a rabid dog to be kept and given antirabic vaccine treatment and be observed for 6 months.Self protection from dog bites,as the bites are through clothes and likely to transmit disease,trousers and full sleeve shirts are more protective than other type of Indian clothing.Disinfect all places where a rabid animal has been confined and the carcase of a rabid animal must be buried with quick lime or cresol solution.Health laws of some countries do not permit any dog to import from any country.Some countries permit them to import after quarantining period of six months.Some countries with and others with out taking compulsory immunization as per their law permits.

Particulars of all dog bites and cases of hydrophobia to be warned all concerned regarding the presence of epizootic or endozootic in the area,and also report should be given to higher medical

authorities.All valuable animals should be given regular vaccination in endozootic areas.The mortality is 100 percent and no curative treatment is not available,patients should be admitted hospital and observed in a quiet room shaded light and all the forms disturbance must be avoided.Attendants must wear gloves,gown goggles.In case he comes to expose the risk of infection

by the bite of patient or contact with his saliva on broken skin,he must take correct course of treatment.Bedding and clothing used by patients or contacted by rabid dogs should be soaked in 5%

cresol solution or exposed to formalin mixed with potassium permanganate fumes for one day,then washed and dried in the sun for 24 hours.There being no other points presently with me,this has come

to an end.

pm kutty

FOOD POISONING AND ITS PREVENTION AND CONTROL

Consumption of unwholesome food or drinks leads to food poisoning.In its broad sense includes the ill effects produced by the ingestion of food contaminated by bacteria or in many other ways such as addition by a criminal intent or accidentally of poisons like lead,arsenic or by through eating mistakenly of poisonous items such as certain mushrooms or fishes or by adulteration of food with poisonous articles like Argemone mexicana in mustard or gingelly oil producing epidemic dropsy in man and also some virulent seeds mixed with food item seeds and adulterated for profit and regular

ingestion of such foods may cause diseases like Parkinson and crippling paralysis etc. Gastro-enteritis

caused by bacterial pollution of food or drinks also normally known as food poisoning.There are three types,namely,infection type,toxin type and botulism type due to toxin produced by bacterial contamination in food and it is deferential from other types.The prominent symptom of botulism type poison affects on the nervous system.The early symptom is loss of visual accommodation and gradually muscles of the body gets weaker.In infection type,due to living bacteria present in food, man gets fever,vomiting and diarrhea and watery motions.Dehydration is more in these cases. .Incubation period is with in hours to one day and decease is about 5 days.In the Toxin type is due to multiplication of bacteria in food,severe loose motions and vomiting with dehydration occurs.incubation period is 4 hours to 24 hours.
Causative organisms  for bacterial food poisoning by salmonella organisms which is commonly in ice creams and suffer diarrhea,dysentery,etc.Reservoir of infection is salmonella organisms, are natural commensals of rodents,pigs.poultry,cattle,ducks eggs and also some healthy human carriers.The source of infection commonly comes to a healthy person by man handling the food from its production to consumer.Rat droppings and fowl faeces may also come as source of infection.A Cow or sheep with mastitis may act as source of infection of milk. Auto-infection of meat during slaughtering and processing may occur.
Route of infection normally is the tinned and preserved food stuffs,generally of animal origin or milk or fruits. Infective bacteria/virus/fungi are derived from animals slaughtered or are transferred from the handler of milk,meat,or fruits from its source,through processing to the consumer.A milk man may infect milk from his infected finger or ear or nose or skin boils or contaminated hands.Pollution may occur while processing,and flies may also transfer infection.
All those who have been infected do not suffer from the syndrome,excretion of bacteria of salmonella type is common among chronic cases of loose motions{diarrhea}.Carrier ship may exist.Any person carrying salmonella and staphylococci may possess an indefinite period of infectivity. Man possess
no natural immunity against salmonellosis and toxins of other organisms.An infection does not confer long standing immunity.Children suffer more from complaints and cases of fatality is also more among children than adults.
Out breaks of food poisoning is mostly in close community catering organisations like students hostels,old peoples homes and messes,but some times in hotels and marriage auditoriums,rarely such out breaks occur in house old cooking,and mostly on festive occasions when large gatherings of the meal,and also out breaks are common when the temperature is high.
Prevention of out breaks and their control:Meat and meat products coming from slaughter houses should not contaminate by any type of pollution by organisms and a care full control from the slaughter of the animal to the final preparation for consumption is necessary and should include a thorough system of meat inspection.Animals also are to be inspected before slaughtering.Strict supervision of of made-up food and milk should be boiled and all care must be taken against further contamination.
Individuals suffering from septic fingers,throat,eye lids or skin lesions should not be employed as cooks or food handlers.Persons having history of  suffering from enteric fever or food poisoning also should not be employed as food handlers as they may be the carriers of typhoid,paratyphoid etc.Everything is to be done to prevent access of rats,mice or other animals to food stored for human consumption.For maintenance of high standard of sanitation and freedom from fly nuisance strict supervision is necessary,and personal hygiene and inspection for the presence of any intestinal,skin or nasal infection among food handlers are important. A large number of organisms are required to produce clinical symptoms of food poisoning.These can be only ha-pend when their multiplication occurs in the prepared dish stored for some time at normal temperature.It is,therefore,necessary that made up food in which raw eggs have been used must be kept in a proper
ice box or refrigerator.
For controlling of an out break of food poisoning the only and most important precaution is to prohibit consumption of any articles of food which are suspected of forming a part of the suspected food articles.Subsequently specific precautions are to be taken to ensure recurrence are made after exact circumstance is known on investigation and also improving hygiene and sanitation to a good standard.
 pm kutty

PREVENTION AND CONTROL OF MALARIA

It is an insect borne communicable disease,caused by Sporozo parasites belonged to genus plasmodium,characterized by intermittent fever.chills.cold,shivering,enlargement of spleen and a tendency to relapse.Temperature may shoot up to 39-40 centigrade,make patient shivering and finally wet stage with sweating brings down temperature.It may occur daily,alternative days or 36-48 hours.Each lasts 10-15 hours and rarely up to 24 hours or longer. Diagnosis is confirmed by microscopic examination of blood smear,There are 2 types of malaria commonly depend upon severity of paroxysms of the species of plasmodium i.e. benign Tirtian fever and malignant Tirtian fever.Relapses are more common in benign malaria and is not common in malignant tertian..The parasite has to under go 2 cycles that is,namely sexual cycle in mosquito and asexual cycle in man by the bite of infected female Anopheles mosquito.
2.Incubation period is period in human being is 14 days and in mosquito is 10-14 days.Man has no immunity against malaria.There are 3 recognized malaria zones,those are the tropical zone between
the cancer and Capricorn,has almost universal endemic malarial area.The malaria season is long in areas near equator it may last throughout the year.In India malaria transmission season is from July to November with its peak in September.A secondary infection occurs in April-May relapsed and delayed primary attacks by malaria.In southern India the season varies according rainy season.In hill areas the disease occurs from February to June,meanwhile in plain areas malaria occurs in autumn or in early of spring corresponding the starting of monsoon.In Assam malaria
 is high just arrival of monsoon from March to June with a peak in May and June.
3.Anti malaria measures;There are three broad Groups of antimalarial measures aimed at breaking the "man-mosquito-man" cycle of transmission.namely,personal protection against mosquito bite,chemo prophylaxis and chemotherapy.
Individual protection against mosquito bite obtained by the use of net,application of repellents to exposed skin parts when not under net,and protection by proper use of clothing from dusk to dawn.Of all these measures,the use of mosquito net is the most useful single measure.Screening of homes and public buildings had been tried in so many places in south east Asia,but it is not practicable or economical.
Chemo prophylaxis is a supplementary measure under high risk situations,but it is not a substitute for other control measures.It reduces clinical attacks by suppressing the malarial parasite,sporozites induced per infected mosquito bite.Theoretically it is possible to control malaria in a country by giving radical treatment with ideal and specific drugs,but this can be achieved rarely in practice. Chemotherapy reduces the parasite count in community and it is an ideal and valuable aid in control programmes.
Health education among public regarding transmission of disease from mosquito to man and important of personal protective measures.to prevent mosquito breeding,residual insecticide spray and etc.
Space spray is carried out once in week in a highly malarious area to be occupied for purposes of industrial .defense and engineering projects at short notice.to control quickly an epidemic or as a remedial measure in the locality where local transmission is detected.
Malaria control in India in its first phase till 1934 larval control was the main method used.Few achievements were gained due engineering methods and larvicidal oils were used.They were slow,expensive and laborious.
An ideal anti-malaria drug for use in mass control program-me should be a prophylactic drug against all species of sporozites of malaria i.e.it should not allow to develop further,it should be a radical curative i.e it should destroy all types malaria parasite and should possess very low toxicity and should be available readily at a low cost.The drugs at present available have various limitations.
Mass chemotherapy may also be used after withdrawal from or passing through a hyper endemic. area.
pm kutty