CEREBRAL ABSCESS

According to the World Health Organization , waterborne diseases account for an estimated 3.6% of the total DALY (disability- adjusted life year) global burden of disease , and cause about 1.5 million human deaths annually. The World Health Organization estimates that 58% of that burden, or 842,000 deaths per year, is attributable to a lack of safe drinking water supply, sanitation and hygiene (summarized as WASH ). [1] Overview The term waterborne disease is reserved largely for infections that predominantly are transmitted through contact with or consumption of infected water. Trivially, many infections may be transmitted by microbes or parasites that accidentally, possibly as a result of exceptional circumstances, have entered the water, but the fact that there might be an occasional freak infection need not mean that it is useful to categorise the resulting disease as "waterborne". Nor is it common practice to refer to diseases such as malaria as "waterborne" just because mosquitoes have aquatic phases in their life cycles, or because treating the water they inhabit happens to be an effective strategy in control of the mosquitoes that are the vectors . Microorganisms causing diseases that characteristically are waterborne prominently include protozoa and bacteria , many of which are intestinal parasites , or invade the tissues or circulatory system through walls of the digestive tract. Various other waterborne diseases are caused by viruses . (In spite of philosophical difficulties associated with defining viruses as " organisms ", it is practical and convenient to regard them as microorganisms in this connection.) Yet other important classes of water- borne diseases are caused by metazoan parasites. Typical examples include certain Nematoda , that is to say "roundworms". As an example of water-borne Nematode infections, one important waterborne nematodal disease is Dracunculiasis . It is acquired by swallowing water in which certain copepoda occur that act as vectors for the Nematoda. Anyone swallowing a copepod that happens to be infected with Nematode larvae in the genus Dracunculus , becomes liable to infection. The larvae cause guinea worm disease . [2] Another class of waterbornemetazoan pathogens are certain members of the Schistosomatidae , a family of blood flukes . They usually infect victims that make skin contact with the water. [2] Blood flukes are pathogens that cause Schistosomiasis of various forms, more or less seriously affecting hundreds of millions of people worldwide. [3] Long before modern studies had established the germ theory of disease , or any advanced understanding of the nature of water as a vehicle for transmitting disease, traditional beliefs had cautioned against the consumption of water, rather favouring processed beverages such as beer , wine and tea . For example, in the camel caravans that crossed Central Asia along the Silk Road , the explorer Owen Lattimore noted, "The reason we drank so much tea was because of the bad water. Water alone, unboiled, is never drunk. There is a superstition that it causes blisters on the feet." [4] Socioeconomic impact Waterborne diseases can have a significant impact on the economy, locally as well as internationally. People who are infected by a waterborne disease are usually confronted with related costs and not seldom with a huge financial burden. This is especially the case in less developed countries. The financial losses are mostly caused by e.g. costs for medical treatment and medication, costs for transport, special food, and by the loss of manpower. Many families must even sell their land to pay for treatment in a proper hospital. On average, a family spends about 10% of the monthly households income per person infected. [5] Infections by type of pathogen Protozoan Disease and Transmission Microbial Agent Sources of Agent in Water Supply General Symptoms Amoebiasis (hand-to-mouth) Protozoan ( Entamoeba histolytica ) (Cyst-like appearance) Sewage , non- treated drinking water , flies in water supply, saliva transfer (if the other person has the disease) Abdominal discomfort, fatigue , weight loss, diarrhea , bloating , fever Cryptosporidiosis (oral) Protozoan ( Cryptosporidium parvum ) Collects on water filters and membranes that cannot be disinfected , animal manure , seasonalrunoff of water. Flu-like symptoms , watery diarrhea, loss of appetite, substantial loss of weight, bloating , increased gas, nausea Cyclosporiasis Protozoan parasite ( Cyclospora cayetanensis ) Sewage , non- treated drinking water cramps , nausea, vomiting , muscle aches, fever, and fatigue Giardiasis (fecal- oral) (hand-to- mouth) Protozoan ( Giardia lamblia ) Most common intestinal parasite Untreated water, poor disinfection, pipe breaks, leaks, groundwater contamination, campgrounds where humans and wildlife use same source of water. Beavers and muskrats createponds that act as reservoirsfor Giardia. Diarrhea, abdominal discomfort, bloating , and flatulence Microsporidiosis Protozoan phylum ( Microsporidia ), but closely related to fungi Encephalitozoon intestinalis has been detected in groundwater , the origin of drinking water [6] Diarrhea and wasting in immunocompromised individuals. Bacterial Disease and Transmission Microbial Agent Sources of Agent in Water Supply General Symptoms Botulism Clostridium botulinum Bacteria can enter an open wound from contaminated water sources. Can enter the gastrointestinal tract through consumption of contaminated drinking water or (more commonly) food Dry mouth, blurred and/or double vision , difficulty swallowing, muscle weakness, difficulty breathing, slurred speech, vomiting and sometimes diarrhea . Death is usually caused by respiratory failure . Campylobacteriosis Most commonly caused by Campylobacter jejuni Drinking water contaminated with feces Produces dysentery like symptoms along with a high fever . Usually lasts 2–10 days. Cholera Spread by the bacterium Vibrio cholerae Drinking water contaminated with the bacterium In severe forms it is known to be one of the most rapidly fatal illnesses known. Symptoms include very watery diarrhea, nausea , cramps , nosebleed , rapid pulse , vomiting, and hypovolemic shock (in severe cases), at which point death can occur in 12–18 hours. E. coli Infection Certain strains of Escherichia coli (commonly E. coli ) Water contaminated with the bacteria Mostly diarrhea. Can cause death in immunocompromised individuals, the very young, and the elderly due to dehydration from prolonged illness. M. marinum infection Mycobacterium marinum Naturally occurs in water, most cases from exposure in swimming poolsor more frequently aquariums ; rare infection since it mostly infects immunocompromised individuals Symptoms include lesions typically located on the elbows, knees, and feet (from swimming pools ) or lesions on the hands ( aquariums ). Lesions may be painless or painful. Dysentery Caused by a number of species in the genera Shigella and Salmonella with the most common being Shigella dysenteriae Water contaminated with the bacterium Frequent passage of feces with blood and/ or mucus and in some cases vomiting of blood. Legionellosis(two distinct forms: Legionnaires' disease and Pontiac fever) Caused by bacteria belonging to genus Legionella (90% of cases caused by Legionella pneumophila ) Legionella is a very common organism that reproduces to high numbers in warm water; [7] but only causes severe disease when aerosolized. [8] Pontiac fever produces milder symptoms resembling acute influenza without pneumonia . Legionnaires' disease has severe symptoms such as fever , chills , pneumonia (with cough that sometimes produces sputum ), ataxia , anorexia , muscle aches, malaiseand occasionally diarrhea and vomiting Leptospirosis Caused by bacterium of genus Leptospira Water contaminated by the animal urine carrying the bacteria Begins with flu-like symptoms then resolves. The second phase then occurs involving meningitis , liver damage (causes jaundice ), and renal failure Otitis Externa (swimmer's ear) Caused by a number of bacterial and fungal species. Swimming in water contaminated by the responsible pathogens Ear canal swells, causing pain and tenderness to the touch Salmonellosis Caused by many bacteria of genus Salmonella Drinking water contaminated with the bacteria. More common as a food borne illness . Symptoms include diarrhea , fever , vomiting, and abdominal cramps Typhoid fever Salmonella typhi Ingestion of water contaminated with feces of an infected person Characterized by sustained fever up to 40 °C (104 °F), profusesweating ; diarrhea may occur. Symptoms progress to delirium , and the spleen and liver enlarge if untreated. In this case it can last up to four weeks and cause death. Some people with typhoid fever develop a rash called "rose spots", small red spots on the abdomen and chest. Vibrio Illness Vibrio vulnificus , Vibrio alginolyticus , and Vibrio parahaemolyticus Can enter wounds from contaminated water. Also acquired by drinking contaminated water or eating undercooked oysters . Symptoms include abdominal tenderness, agitation, bloody stools, chills, confusion, difficulty paying attention (attention deficit), delirium, fluctuating mood, hallucination, nosebleeds, severe fatigue, slow, sluggish, lethargic feeling, weakness. [9][10] Viral Disease and Transmission Viral Agent Sources of Agent in Water Supply General Symptoms SARS(Severe Acute Respiratory Syndrome) Coronavirus Manifests itself in improperly treated water Symptoms include fever , myalgia , lethargy , gastrointestinal symptoms , cough , and sore throat Hepatitis A Hepatitis A virus (HAV) Can manifest itself in water (and food) Symptoms are only acute (no chronic stage to the virus) and include Fatigue , fever, abdominal pain, nausea, diarrhea, weight loss, itching, jaundice and depression . Poliomyelitis (Polio) Poliovirus Enters water through the feces of infected individuals 90-95% of patients show no symptoms, 4-8% have minor symptoms (comparatively) with delirium , headache , fever , and occasional seizures , and spastic paralysis , 1% have symptoms of non- paralytic aseptic meningitis . The rest have serious symptoms resulting in paralysisor death Polyomavirus infection Two of Polyomavirus : JC virus and BK virus Very widespread, can manifest itself in water, ~80% of the population has antibodies to Polyomavirus BK virus produces a mild respiratory infection and can infect the kidneys of immunosuppressed transplantpatients. JC virus infects the respiratory system , kidneys or can cause progressive multifocal leukoencephalopathy in the brain (which is fatal). [6][11] Algal Disease and Transmission Microbial Agent Sources of Agent in Water Supply General Symptoms Desmodesmus infection desmodesmus

Friends today I am discussing about a very common problem occurs in change of weather known as tonsillitis. What is tonsillitis? Tonsils are the two lymph nodes located on each side of the back of your throat. They function as a defense mechanism. They help prevent your body from infection. When the tonsils become infected, the condition is called tonsillitis. Tonsillitis can occur at any age and is a common childhood infection. It is most often diagnosed in children from preschool age through their midteens. Symptoms include a sore throat, swollen tonsils, and fever. This condition is contagious and can be caused by a variety of common viruses and bacteria, such as Streptococcal bacteria, which causes strep throat. Tonsillitis caused by strep throat can lead to serious complications if left untreated. Tonsillitis is easily diagnosed. Symptoms usually go away within 7 to 10 days. Find a internist or a pediatrician or an ENT near you. Causes of tonsillitis Tonsils are your first line of defense against illness. They produce white blood cells to help your body fight infection. The tonsils combat bacteria and viruses that enter your body through your mouth. However, tonsils are also vulnerable to infection from these invaders. Tonsillitis can be caused by a virus, such as the common cold, or by a bacterial infection, such as strep throat. According to the American Academy of Family Physicians (AAFP), an estimated 15 to 30 percent of tonsillitis cases are due to bacteria. Most often it's strep bacteria. Viruses are the most common cause of tonsillitis. The Epstein-Barr virus can cause tonsillitis, which can also cause mononucleosis. Children come into close contact with others at school and play, exposing them to a variety of viruses and bacteria. This makes them particularly vulnerable to the germs that cause tonsillitis. Symptoms of tonsillitis There are several types of tonsillitis, and there are many possible symptoms that include: a very sore throat difficulty swallowing or painful swallowing a scratchy-sounding voice bad breath fever chills earaches stomachaches headaches a stiff neck jaw and neck tenderness due to swollen lymph nodes tonsils that appear red and swollen tonsils that have white or yellow spots In very young children, you may also notice increased irritability, poor appetite, or excessive drooling. There are two types of tonsillitis: recurrent tonsillitis: multiple episodes of acute tonsillitis a year chronic tonsillitis: episodes last longer than acute tonsillitis in addition to other symptoms that include: chronic sore throat bad breath, or halitosis tender lymph nodes in the neck When to see a doctor In rare cases, tonsillitis can cause the throat to swell so much that it causes trouble breathing. If this happens, seek immediate medical attention. See a doctor if you experience the following symptoms: fever that’s higher than 103˚F (39.5°C) muscle weakness neck stiffness sore throat that doesn’t go away after two days While some tonsillitis episodes go away on their own, some may require other treatments. How tonsillitis is diagnosed Diagnosis is based on a physical examination of your throat. Your doctor may also take a throat culture by gently swabbing the back of your throat. The culture will be sent to a laboratory to identify the cause of your throat infection. Treatment for tonsillitis A mild case of tonsillitis does not necessarily require treatment, especially if a virus, such as a cold, causes it. Treatments for more severe cases of tonsillitis may include antibiotics or a tonsillectomy. Antibiotics will be prescribed to fight a bacterial infection. It’s important you complete the full course of antibiotics. Your doctor may want you to schedule a follow-up visit to ensure that the medication was effective. Surgery to remove the tonsils is called a tonsillectomy. This was once a very common procedure. However, tonsillectomies today are only recommended for people who experience chronic or recurrent tonsillitis. Surgery is also recommend to treat tonsillitis that doesn’t respond to other treatment, or tonsillitis that causes complications. If a person becomes dehydrated due to tonsillitis, they may need intravenous fluids. Pain medicines to relieve the sore throat can also help while the throat is healing. Home care tips to ease a sore throat drink plenty of fluids get lots of rest gargle with warm salt water several times a day use throat lozenges use a humidifier to moisten the air in your home avoid smoke Also, you may want to use over-the-counter (OTC) pain medications, such as acetaminophen and ibuprofen. Always check with your doctor before giving medications to children. Tonsillitis complications People who experience chronic tonsillitis may start to experience obstructive sleep apnea. This happens when the airway swells and prevents a person from sleeping well. It’s also possible the infection will worsen and spread to other areas of the body. This is known as tonsillar cellulitis. The infection can also cause a person to develop a buildup of pus behind the tonsils, which is known as peritonsillar abscess. This can require drainage and more surgery. If a person doesn’t take a full course of antibiotics or the antibiotics don’t kill off the bacteria, it’s possible a person could develop complications. These include rheumatic fever and poststreptococcal glomerulonephritis. Preventing tonsillitis Tonsillitis is highly contagious. To decrease your risk of getting tonsillitis, stay away from people who have active infections. Wash your hands often, especially after coming into contact with someone who has a sore throat, or is coughing or sneezing. If you have tonsillitis, try to stay away from others until you are no longer contagious. Outlook for tonsillitis Swollen tonsils may cause difficulty breathing, which can lead to disturbed sleep. Tonsillitis left untreated can result in the infection spreading to the area behind the tonsils or to the surrounding tissue. Symptoms of tonsillitis caused by a bacterial infection usually improve a few days after you begin taking antibiotics. Strep throat is considered contagious until you have been taking antibiotics for a 24-hour period. Strep Throat Strep throat is a bacterial infection that causes inflammation and pain in the throat. This common condition is caused by group A Streptococcus… Diphtheria Diphtheria is a bacterial infection that affects the throat and nose. Get the facts on causes, symptoms, treatment, and prevention. What’s the Difference Between Tonsillitis and Strep Throat? Tonsillitis can be caused by various viruses or bacteria. Strep throat is only caused by group A Streptococcus bacteria. Tonsillectomy A tonsillectomy is a surgical procedure to remove the tonsils, which are located in the back of your throat. Sometimes they can become infected. Here there are some common homeopathic medicines given for tonsillitis Belladonna – belladonna is the most common and hugely prescribed homeopathic medicines for tonsillitis. Belladonna has the best anti inflammatory action and thus helps a lot to relief the symptoms both in acute and chronic condition. The key symptoms by which belladonna is prescribes are – pain in throat at the time of wallowing, red congested and swelling of tonsils, mild to moderate fever associates with tonsillitis, headache and malaise also present. The tonsils are been affected by taking any cold things like chilled drink or ice cream or cold drink or exposing to cold air etc. The throat pain is slightly relieved after taking any sort of warm drink. If all those symptoms are prominently found in a tonsillitis patient then belladonna is the suitable medicine for that person. Mercurius Solubis- Here is another best hoemopathy medicine for tonsillitis. The key symptoms to prescribe tonsillitis are – pain in throat, congestion of tonsils and unable to drink or eat anything. There is more salivation from mouth. The pain is worse in the night time in compare to day time. There is swelling of tonsils and also swelling of other lymph nodes in neck and sub mandibular regions. There is mild to moderate fever and the person feels thirsty though there is more salivation. If the above symptoms are prominent in any tonsillitis patient this medicine is most suitable medicine for that person Phytolacca- it is also one of the important homeopathic medicine for tonsillitis. The tonsils are dark red or bluish red in colour. There is much pain at the root of tongue, soft palate. The tonsils are swollen. There is a sensation of a lump in throat. While taking any food the throat feels rough, narrow, and hot. The Tonsils are swollen, especially of right side. There is a sharp shooting pain into ears on swallowing anything. There is much pain when swallow anything hot. The pain of phytolacca is burning type of pain. The person cannot swallow anything even water. Hepar Sulphur- Hepar Sulphur is one of the best Homeopathic medicines for tonsillitis. The tendency to suppuration is most marked, and has been a strong guiding symptom in tonsillitis. When swallowing, sensations as if a plug and of a splinter like sensation in throat. There is quinsy with suppuration of tonsils. When swallowing there is stitching type of pain in throat extending to the ear. There is mild to moderate fever and chilliness is feeling during the tonsillitis affection. The person is very chill and cannot tolerate any cold air or cold water. Calcarea Carb –It is a medicine for chronic tonsillitis problem.The person is bulky, obese, gaining weight easily. He is though fatty but very weak in stamina. Exhausted or tired on slightest physical activity. He/she sweats a lot on slightest physical exertion. He is very susceptible to catch cold. the tonsils are large, swelled and get acutely affected on slightest exposure to cold. The throat appearance itself is not always sufficient to prescribe on, but the complaints in the throat are those that come on in persons taking cold so frequently. On every cold he will have cough, tonsil affection, appetite lost. The calcarea carb child is very lazy and lethargic in nature. he takes cold from every, draft, from very exposure, and from damp weather. There are little red patches in the throat, this extends to the roof of the mouth, a sore tongue, and a constant dry, choking feeling in the pharynx, covering the tonsils. The throat is very painful on swallowing. Baryta Carb – it is one of the 1st grade medicine for chronic tonsillitis. The tonsils are inflamed, swelled and very painful in acute condition. After the acute attack passed on the tonsils looks larger than with the last cold. The child is weak, not fatty like calcarea carb. Physically and also mentally he is week. He/she has a tendency to catch cold very easily. But the most important symptom is whenever he catch cold first it attack to the tonsil or throat. So it is written in allens materia medica that every cold settles in the throat. The person sweats more from the feet. Every cold change inflames the tonsils, and in children they very soon enlarge. Children with enlarged tonsils, and with enlarged glands in other places, somewhat weak intellectually, slow to learn.The throat is very painful on swallowing.On every cold change of the weather, and on every exposure to the cold, he gets rattling respiration.

HOMEOPATHIC MEDICINES FOR MEASELS. #Aconite. [Acon] Aconite is one of the first remedies for measles; that is, while the case is presumed to be one of measles, and a hard croupy cough are present. Ferrum phosphoricum in many respects is similar to Aconite, and will take its place where restlessness and anxiety are wanting. It is somewhat questionable whether Aconite will ever be strictly indicated in any disease depending on a poisoned or infected condition of the blood, since in its pathogenesis it does not show any evidence of such condition; however, it may be indicated in the catarrhal irritation, sneezing , etc., before the case can be fully determined to be measles. In catarrhal conditions Aconite ceases to be of use after exudation has taken place, and so in measles; it would cease to be of use after it modified the fever, and the eruption appears and the disease is diagnosed as measles. Ferrum phosphoricum will perhaps be the better remedy if there be chest involvement together with the catarrhal symptoms. #Gelsemium. [Gels] Gelsemium is, on the whole, a more usefulremedy in commencing measles than Aconite ; that is, it is oftener indicated; there is much chilliness, the fever is a prominent symptoms, the child is dumpish, apathetic, does not want to be disturbed ; there is watery coryza which excoriates the upper lip and nose, and there is harsh, barking, croupy cough, with chest soreness and hoarseness. Gelsemium, too, has an action on the skin and may be continued with benefit afterthe eruption has appeared; there is an itching and redness of the skin, and a decidely measly eruption produced by it. It has some aching in the limbs, and may be compared with Dulcamara, but seldombe mistaken for that remedy. Gelsemiumhas more coryza, Dulcamara more aching.Both may be useful in an undeveloped eruption ; Gelsemium when there is pain at the base of the brain , high fever and passive brain symptoms ; Dulcamara when occurring from damp, cool air, rainyweather or sudden changes. Belladonna may be indicated in measles when sore throat is present and the cerebral excitement indicating that remedy, together with moisture and heat; but it corresponds more closely to scarlet fever .#Euphrasia. [Euph] When the catarrhal symptoms greatly predominate Euphrasia may be used. Acrid tears stream out of the eyes, with a red and swollen conjunctiva. The cough is dry and very hoarse, and there is an intense throbbing headache which is relieved on the appearance of the eruption. The excoriating discharge fromthe eyes will distinguish from Allium cepa. The photophobia of Euphrasia is worse in artificial light , and a brightnessof the eyes despite the catarrhal condition is characteristic. #Pulsatilla. A little later in the disease Pulsatilla symptoms may make their appearance. The fever has subsided or entirely disappeared. There is coryza and profuselachrymation. The cough is still dry at night, but loosens a little in the daytime. The child sits up to cough. There is much predisposition to earache and sometimes sickness at the stomach. Where there is catarrh of the digestive canal and diarrhea Pulsatilla will be found useful. The eyes agglutinate and the discharge is purulent. Kali bichromicum is so similarto Pulsatilla in many respects that it maybe mentioned here, as the two remedies seem to differ in intensity only. Kali bichromicum has pustules developing on the cornea. The throat is swollen and there is catarrhal deafness. It produces an eruption which closely resembles measles. It comes in very well after Pulsatilla when the patient develops more intense symptoms. Measles associated with ear symptoms and swollen glands especially call for Kali bichromicum, and it is one of our best remedies for laryngeal affections, with a hoarse, dry,croupy cough. Dr. Jousset recommends Viola odorata for the cough.Sulphur is a great measles remedy. It is useful where the skin is dusky and the rash does not come out, or is purplish when it does appear. #Arsenicum. In measles which do not run a favourable course, in malignant type or black or haemorrhagic measles we have two or three important remedies. The first of these is Arsenicum. There will be sinking of strength, diarrhea,delirium, restlessness and debility, petechiae and general typhoid symptoms. The stools areparticularly offensive and exhausting. Arsenicum may save the patient in these conditions. Dr. Gaudy, of Brussels, considers Arsenicum almost specific in measles. He says that its action is little short a marvelous. It is prophylactic and curative, and one of the best remedies to remove all sequelae of the disease. It corresponds to the insidious phenomena of severe epidemics of measles. Crotalusmay also be indicated in the form known as black measles. Also Baptisia, with its foetor and prostration, may prove useful. Lachesis is the fourth remedy for these conditions. The individual symptom of each remedy will differentiate them, but all four should be studied carefully in these low conditions of measles. #Stramonium. When the eruption does not come out properly, or when it disappears suddenly and grave symptoms appear, there are a few remedies which play a most important role. Stramonium is one of these. In a case calling for it you will find these symptoms: non-appearance ofthe rash; the child is hot, restless, and onfalling asleep cries out as if frightened ;there are convulsive movements and the face is red. Cuprum is indicated in convulsion due to recession of the eruption. It has the same terror on awakening, but its symptoms are move violent than those of Stramonium and the face instead of being red is more apt to be bluish. Zincum has the same awakening from sleep as if terrified, butwith Zincum there is much weakness, the child seems too weak to develop the eruption. Bryonia is useful when chest symptoms appear upon a retardation or arecession of the eruption. Too slow development of the eruption with chest symptoms calls for it. Antimonium tartaricum is another remedy for retarded or repelled eruption. There will be great difficulty in breathing, rattlingof mucus, bluish or purplish face, drowsiness and twitching.

ALL YOU NEED TO KNOW ABOUT SWINE FLU: Editor: Dr.Shashank Kumar Srivastav MICU/ICCU Incharge, Care Hospitals, Hyderabad, Former President Indian Medicos Association. Email: dr.shashankksrivastava@gmail.com INTRODUCTION The classical swine flu virus an influenza type A (H1N1) virus was first isolated from a pig in 1930. Swine flu viruses cause high level of illness, but low death rates in pigs. Like all influenza viruses, swine flu viruses change constantly. Pigs can also be infected by avian influenza and human influenza viruses. When influenza viruses from different species infect pigs, the viruses can reassort (i.e. swap genes) and new viruses that are a mix of swine, human and/or avian influenza viruses can emerge. Suspect Case: A suspect case is defined as an individual with fever (temperature 100.4°F/ 38°C) and one or more of the following manifestations- cough, sore throat, or shortness of breath. Probable Case: A probable case is defined as an individual with an influenza test that is positive for influenza A, but is unsubtypable by reagents used to detect seasonal influenza virus infection or an individual who died of an unexplained acute respiratory illness. Confirmed Case: A confirmed case is defined as an individual who is confirmed in the laboratory with PCR or virus culture for pandemic influenza virus 2009. TRANSMISSION The SO-IAV has efficiently transmitted between humans since its first detection in April 2009. So far it has spread in the Northern hemisphere outside of the flu season and in the Southern hemisphere during its flu season. It has caused mild disease, and that is in accordance with absence of the pathogenicity marker PB1- F2. As seasonal influenza A (H1N1) viruses are also circulating in humans since 1977, mild disease could also be due to partial immunity in the population. It will now be critical to watch how the virus behaves as it comes back to the Northern hemisphere in the next wave with the approaching flu season. All previously characterized pandemics have been due to viruses generated by antigenic shift involving the HA gene of avian lineage – H1 for 1918 virus, H2 for 1957 virus and H3 for 1968 virus. Though still of the H1 serotype, the HA of SO-IAV is different from the H1 HAs of seasonal influenza viruses; the inclusion of a porcine H1 in human influenza A viruses has been considered an antigenic pseudo- shift. Although SOIAV is of zoonotic origin, it’s HA may not be sufficiently divergent to call it a true antigenic shift5. Compared to viruses that caused previous pandemics, SO-IAV is at present not sufficiently virulent. But, it is already transmitting like a pandemic virus and is undergoing adaptive mutations. Whether it will remain mild or develop into a highly pathogenic fully pandemic virus remains to be seen. PREVENTION * There currently is no vaccine to protect humans against the H1N1 flu virus. The following tips will help you prevent flu infections such as the common flu and the H1N1 flu. 
 * Wash your hands often with soap and water, especially before eating and after sneezing or coughing. 
 * You can also use an alcohol gel product available over the counter, which is also effective in protecting against flu. 
 * When you cough or sneeze, cover your mouth and nose with your elbow or sleeve. Or use a tissue and be sure to throw away the tissue after use. Wash your hands after you sneeze or cough. 
 * Try to avoid close contact with sick people. Avoid touching your eyes, nose, or mouth. Germs spread this way. Try to stay in good general health. Get plenty of sleep, be physically active, manage your stress, drink plenty of fluids, and eat nutritious food. 
CLINICAL MANISFESTATIONS 
Signs 
Swine flu, or H1N1, is a type A influenza virus that can infect humans. It is similar to the seasonal influenza virus, but can be more severe in people who may be at high risk because of a preexisting condition. According to the Centers for Disease Control, risk factors include chronic medical conditions such as diabetes, heart disease, and asthma. 
Aches and Fevers 
Swine flu is severe body aches, this can include muscle weakness and difficulty standing up or walking. Headaches in combination with body aches are also quite common. 
Upper-Respiratory Symptoms 
A common element of swine flu is upper-respiratory symptoms. These can be similar to a cold, except more severe. A runny or stuffy nose combined with head congestion is typically present. Itchy or watery eyes may also be a symptom. 
Weakness 
Feelings of general malaise or weakness are common with swine flu, as is overall discomfort. Many people infected with the virus are tired and too weak to complete most normal day-to-day activities, and may sleep longer and more often than usual. Staying home and getting plenty of rest is the best way to fully recover from swine flu. 
Gastrointestinal 
In some cases of swine flu, people experience gastrointestinal effects. These can range from stomachaches and cramping to nausea and vomiting, and diarrhea. Swine flu may be confused with food poisoning because of the symptoms of stomach pain and upset. 
Warning Signs 
Other signs to watch for may indicate that swine flu is developing into a secondary medical condition that can be serious or life- threatening. Because swine flu involves the respiratory tract, there is a risk for developing pneumonia, respiratory failure, and bronchitis. 
According to the Centers for Disease Control and Prevention (CDC), in humans the symptoms of the 2009 "swine flu" H1N1 virus are similar to those of influenza and of influenza-like illness in general. Symptoms include fever, cough, sore throat, body aches, headache, chills and fatigue. 
 * DIAGNOSIS 
The first cases of swine flu were diagnosed in the US in San Diego in mid-April. The discovery was serendipitous, the result of out of season. US-Mexican border surveillance and use of a new diagnostic test at the Naval Health Research Center. When the new test protocol showed infection with influenza A with undeterminable subtype, follow-up testing showed it to be an previously unknown swine flu virus. Detection of a second, apparently unlinked swine flu infection in San Diego got the outbreak (now pandemic) investigation rolling. That was just a month ago, but it established the initial diagnostic pattern that was the tail end of the flu season, but seasonal influenza was still present in the community and for the first weeks of the outbreak CDC's lab in Atlanta was the only place that had the reagents to confirm an infection was from swine flu and not seasonal flu or another virus altogether. So a make-shift case definition was set-up to take this into account. If a person with an influenza-like illness (which required sudden onset, fever and respiratory symptoms) had a rapid flu test positive for influenza (or influenza A if the test could differentiate), a nose or throat swab was sent to the state lab. As a result of preparedness activities envisioning a possible pandemic with bird flu, CDC had been training state labs to make the differentiation between the two seasonal flu subtypes, H1N1 and H3N2, and bird flu, H5N1, so the capability to do seasonal sub typing already existed outside of CDC. But neither the reagents nor the proficiency for the new swine virus did. Therefore all specimens that were positive with a rapid test at the point of visit, and so were putative influenza A, were first subtyped at the state lab level. If they could not be sub typed, they were sent on to CDC for confirmation as swine flu. CDC later determined that virtually all unsubtypable influenza A specimens turned out to be swine flu. TREATMENT The main symptoms of Swine Flu are a cough, sore throat, runny nose and fever. Usually there's more muscle pain, headache, fever and chills than seen with the common cold. If you think your child has Swine Flu, here's what you can do to make him feel better: Prescribing pattern for swine flu: 1. For a stuffy or blocked nose, use saline (or warm-water) nose drops followed by nose blowing or suctioning. 2. For throat pain, Tylenol or ibuprofen is very helpful. Children over 6 years old can also suck on hard candy. Children over 1 year old can sip warm chicken broth or other warm liquids. 3. For coughs, try to soothe the throat. For children over age 6, give cough drops. If your child is over 1 year of age, give honey. The dosage would be 1/2 to 1 teaspoon as needed. Never give honey to babies. If honey is not available, you can use corn syrup. 4. Flu can cause body aches that include leg pain, back pain, chest pain and headache. Give ibuprofen to make these sore muscles feel better. 5. For diet, mainly encourage your child to drink adequate fluids to prevent dehydration. This will also thin out the nasal secretions and loosen the phlegm in the lungs. 6. Tamiflu is an antiviral medicine that may be useful for some children. Finally: Your job is to keep your child comfortable. Determine your child's main symptoms and treat them. Antiviral Drugs for Influenza Oseltamivir: The neuraminidase inhibitor oseltamivir formulated as capsules or oral suspension (Tamiflu®) is FDA-approved for the treatment of uncomplicated acute influenza in patients 1 year and older who have been symptomatic for no more than 2 days. Zanamivir: The neuraminidase inhibitor zanamivir formulated for oral inhalation (Relenza®) is FDA-approved for the treatment of influenza in patients 7 years of age and older who, similar to approved uses for oseltamivir, have uncomplicated illness and have been symptomatic for no more than 2 days. Peramivir: A third neuraminidase inhibitor peramivir formulated for intravenous (IV) administration is an investigational product currently being evaluated in clinical trials. Children: Children younger than 2 years of age are at higher risk for influenza-related complications and have a higher rate of hospitalization compared to older children. Children aged 2 to 4 years are more likely to require hospitalization or urgent medical evaluation for influenza compared with older children and adults, although the risk is much lower than for children younger than 2 years old. Adults aged 65 years and older: Even though persons aged 65 years and older are less likely to become ill with 2009 H1N1 influenza compared to younger persons, when they do acquire influenza, they are at higher risk for severe influenza-related complications. Pregnant women: Pregnancy increases the risk of complications, hospitalization, and severe disease. One study estimated the risk of hospitalization for 2009 H1N1 to be four times higher for pregnant women than for the general population hile oseltamivir and zanamivir are "Pregnancy Category C" medications.

Seizure disorder- Hypoxic Ischemic Encephalopathy and Colpocephaly *Chief Complaints* A 18 yr old female attended Mopd with 1 episode of Generalized Convulsion 1 days back. There was associated tongue bite,frothing of mouth , post ictal confusion and Urine incontinence. No associated fever,headache, nausea or vomiting, Dizziness,slurring of speech,Neck rigidity,limb weakness, chest pain or palpitation,Diaphoresis. She had similar episodes of convulsion in past since childhood but stopped medicine after 2 yrs . No reports available. No H/O HTN/DM/Thyroid disorder or substance abuse. On multiple questioning pt father answered regarding her birth history. She was born at home by local dai and it was prolong labour. Normal Menstrual cycle. General and Systemic Examination normal except pt has low height for her age. No Mental retardation with Normal MMSE score. Routine Ix along CT Brain was advised. Next day pt attended Mopd with reports showing- Raised ALP ( due to growing age ) Rest blood reports normal. CT Brain- Asymmetrical enlargement of occipital horn of left lateral ventricle suggestive of colpocephaly. Subtle reduced density of the cerebrum relative to cerebellum may suggest mild/early diffuse edema. Next MRI Brain and EEG was advised . Tests were done and reports show - MRI Brain- FEATURES OF LEFT PERITRIAGONAL WHITE MATTER VOLUME LOSS WITH COLPOCEPHALY - PATTERN OF THE LESION IS SUGGESTIVE OF OLD MILD H.I.E. EEG - AN ABNORMAL EEG SHOWING GENERALIZED SLOW AND SHARP WAVE ACTIVITY. Pt started on Anti convulsant and put under follow up.