Flashcards in Week 201 - International Health Deck (138):
What % of deaths are young people in high income countries?
What % of deaths are young people in low income countries?
No of people living beyond 70 years in high income?
UFM stands for?
Under five mortality
Biggest cause of death in children under 5?
Neonatal causes (37%)
Pneumonia and diarrhoea combined account for what % of deaths in children under 5?
nenatal deaths classified within which time bracket?
Major cause of neonatal deaths?
Prematurity and low birth weight
What is the MMR?
Maternal mortality ratio - NO. deaths /100,000 live births
Critical interventions for maternal mortality prevention
skilled HW (health worker)
tape measure (checking fundal height)
How do you prevent post partum haemorrhage?
Obstructed labour tx?
Partograph, instrumental delivery, LSCS
Prevention of unsafe abortion?
Poor resources lead to what?
Diseases more commonly and inadequately controlled.
Few health staff with limited training and resources have more difficult to solve, Worse outcomes and hugh ecosocial implications.
What is a DALY?
Disability adjusted life year.
How do you equate a DALY?
DALY = YLL +YLD
(YLL = Years of lost life due to premature mortality)
(YLD = years lost to disability due to injury or illness)
When calculating YLL, which life expectancy do we use?
What does wasting mean?
Low weight for height
Stunting is what?
Low weight AND height for age
What are the millenium goals?
eradicate extreme poverty and huger, universal primary education, gender equaliy and empower women, reduce child mortality, improve maternal health, combat hiv/aids malaria and other diseases, ensure environmental sustainability and develop a global partnership for development
Lancet global health collections, who health report, unicef the state of the worlds children, who global health risks
Where could TB present?
Lungs, Node, pericardium, abdomen, renal tract, brain
BCG vaccine was come up with by whom?
Albert Calmette and Camille Guerin in 1906.
Charles Mantoux did what?
Created a screening test for TB (in 1908)
What is a thoracoplasty?
Removed anterior ribs to collapse lung. Very deformed chest wall on one side. Was though to be a treatment for TB.
What type of bacteria is M Tuberculosis?
Obligate aerobe - requires oxygen!
What is the infective dose of TB?
Is tb capable of intracellular survival?
Yes. Due to Acid fast bacillus coating.
What is the most common APC in the lung and how does this cause granulomas?
Macrophages. MHC class 2 --> Helper T cell recruitment --> interferon gamma release causing granulomatous response?
What is the difference between atypical mycobacteria and TB?
Atypical are found in the environment. Not usually pathogenic.
Is atpical mycobacterium infectious?
Does acid fast bacilus ID confirm TB?
NO. Could be atypical.
Symptoms of primary TB are what?
VERY non specific. Fever/sweats, chest pain, cough, fatigue and rash.
What are signs of Primary tB?
Again, non specific. Erythema nodosum (inflammation of fat causgin painful swellings).
What is Brock's Syndrome?
Right middle lobe collapse
secondary to lymphadenopathy
Many nodes around orifice of right middle lobe
Orifice is slit like. Lymphadenopathy causes compression.
What can be associated with TB infection (due to immuno-supression)?
Anti TNF, malignancy, steroids, age, HIV/AIDs, diabetes, chronic renal failure, Chemo, Alcoholism, malnutrition.
Symptoms of POst-Primary TB?
1/3 ID'd when seen about unrelated condition.
Examination findings for TB?
Signs of consolidation/effusion
Investigations for Tuberculosis?
Staining sputum for Acid Fast Bacilli (AFB)
Marker of infectivity (see handout for more info)
Gene probe/PCR --> Isolate specific nucleic acid sequences
Pleural aspiration +/- pleural biopsy
Treatment for TB?
Community if possible. Avoid contact with immunocompromised and those < 4 years.
If MDRTB --> negative pressure room to prevent spread.
Standard trx regime for TB?
@ months 4x drugs, then R + I for 4 months.
90% killed in first two weeks.
TB meningitis 12 months therapy and steroids
Steroids in certain cases
What is a high risk side effect of tB treatment in latent disease?
How do you test for latent disease?
Type IV Hypersensitivity reaction
Read at 72 hours
What is an interferon gamma release assay?
Whole blood exposed to antigen specific to MC TB (ESAT6 and CFP10)
Measure interferon gamma release.
Not affected by prior bcg vaccination. Licenced for use post +ve Mantoux.
How would you define latent TB?
Clinically well, but positive skin test/IGRA
What is miliary TB often misidentified by?
Previous chicken pox infection! Gives miliary shadowing.
What is miliary TB?
Disseminated TB. Widespread dissemination of mycobacterium via haematogenous spread. Defined as millet like TB bacilli in the lung. Seen in 1-3% of all TB cases.
What is the importance of IL-32 in TB?
Inter leukin 32 is a molecular marker of a host defense networkin human TB. Induces Vit-D dependant antimicrobial peptides cathelicidin and DEFB4.
If ever you have a px that is unwell and you can't work out why - consider _____.
SEE HANDOUT FOR HELEN DAY TX OF TB
Current drugs used for 1st line tx of TB in the UK?
Rifampicin & Isoniazid
What is rifafter?
Rifampicin, Isoniazid, Pyrasinamide
What is Rifinah?
One of a group of medicines used to treat TB or the lung. Contains isoniazid and Rifampicin.
Other than rifampicin, anti TB drugs are specific to what?
Visual side effects are a consequence of which medications?q
ANTI TB (RIPE)
What should be reviewed during TB treatment?
L + Renal
Effectiveness of regime
Side effects of Izoniazid?
Peripheral neuropathy. Blocks neurotransmitter synthesis (esp GABA)
Interaction beneficial to both microbe and man
Interaction beneficial to microbes, with no hard to man
Interaction beneficial to microbes, harm to man. I.e. Exogenous pathogens.
The organism in or on which the parasite lives and causes harm.
Define Definitive host:
The organism in which the adult or sexually mature stage of the parasite lives.
Define intermediate host:
The organism in which the parasite lives during a period of devlopment only.
A parasitic disease in which an animal is normally the host - but which also infects man.
Lives WITHIN another organism
Lives ON another living organism
Protozoans are _____ ______
Arthropods and helminths are examples of ____ ______
Protozoa belong within the kingdom _____
How do amoebas feed?
Phagocytosis, utilising pseudopodia.
Give two examples of pathogenic flagellates.
Giardia spp. & Trypanosoma brucei.
Give an example of a pathogenic ciliate.
Plasmodium and Crptosporidium are examples of what?q
Which two pathogenic protozoa are the most commonly contracted in the UK?
Cryptosporidiosis and Toxoplasmosis.
Helminth parasites can be divided into three groups. What are these?
What is a vector?
WHO defines as: "organisms that transmit pathogens from infected person or animal to another". The diseases that they transmit are known as vector-borne diseases.
How are microbes transmitted to humans? 7 in list.
Direct to blood
Water & Food borne
Mother to baby
What does "obtunded" mean?
Pale hands in dark skinned patients, sign of anaemia.
What is the difference between a thick and thin blood film?
More blood to look at in thick film, larger sample, but not as much detail as seen in a thin film.
Normal haemoglobin levels in g/dl?
What is the normal (approx) haematocrit?
What is the normal platelet count?
Normal white cell count?
5-15 is the range
How would you identify a malaria parasite on a blood film?
"Ring shaped" (signet ring shaped) intracellular infection.
Symptoms of severe malaria?
Fever - not universal, intermittent,
Abdo pain/D and V
What is found in tonic water that is used to treat acute Exacerbations of malaria?
Which new antimalarial treatment is now overtaking quinine?
Artusate (developed from chinese herbal medicine)
Malaria transmission occurs in how many countries?
How many people in the world are at risk of malaria?
How many people contracted malaria in 2010?
200 million approx
How many people died from malaria in 2010?
How many of malaria deaths occured in under 5's living in sub saharan africa?
Since 2000, Malaria mortality rates have ______ by _____.
Fallen by 20%.
Which malaria species claims most lives?
The female species is more deadly than the male. True or false?
Which malaria treatments are currently in use?
Mosquito nets (treated)
Indoor spraying with insecticides
Artemisinin is found from _____ and ha been in use for ____
More than 2000 years
Whats normal Albumin?
Albumin reflects the synthetic function of which organ?
Causes of low albumin (hypoalbuminemia)?
GI - IBS, Lymphoma, side effects, Infections i.e TB.
Lymphocyte nucleus is equivocal in size to ____
Normal red blood cells
Central opacity is ___ in anaemic rbc's
What can give microcytic anaemia?
Serum ferretin reflects ______.
Total body iron.
Transferrin is a (not great) marker of what?
Ferritin is an _______. this means it goes ___ when you have an infection.
Acute phase protein.
Iron deficiency is due to:
What pH does iron Absorbtion best occur at?
What supp. causes reduced iron absorbtion?
What does sickle cell and thalassemia have in common?
Inherited disruption of haemoglobin synthesis. Genetic ineritance?
Desferrioxamine is an iron chelating compound - how is it administered?
12 hr sub cut infusion
Lifespan of an average red cell?
Red cell turnover is how many per second?
Sickls cell is due to a __________ _______ mutation, causing conformational change
Point mutation to beta chain only.
Thalassemias are ____ ____.
Abnormalities of either alpha or beta chains. May be point mutation, shift or other.
In Thalassaemia, blood film shows rbc's of ______.
Different sizes and shapes - v varied.
Haemoglobin c, d, and e are point mutations of which chain?
How do you equate Hb concentration from packed cell volume?
PCV/3 = Hb
Haemoglobin F is upregulated by which drug?
Define Cultural Competency
The provision of services and care that are respectful of and responsive to the values health beliefs, practices and cultural and linguistic of diverse patients, families and communities. IT may require an adaptation of skills or approach to meet different patients needs (McKimm)
A Shared origins or social background. Shared culture and traditions (Gill), Ethnicity is but one element of culture, but within one ethnic group many cultures may exist (Schouten, B C MEeuwesen L)
Refers to integrated patterns of human behaviour that include the language, thoughts, communications, actions, customs, beliefs, values, and institutions of racial origin.
Cultural competence req's the recognition of the culture of the ___ and the ____
Profession and the institution.
What is the mini-ethnography approach, and by whom was it proposed?
Kleinman and benson, 2006
1.) Ethnic identity
2.) What is at stake? What does being ill mean to them?
3.)The illness narrative
4.) Pyschosocial stresses
5.) Influence of culture on clinical relationship
6.) Has the approach worked in that case?
What is human trafficking?
Human trafficking is the ____ criminal industry in the world.
Global market for slavery is estimated at ________.
32 billion dollars per year.
How would you identify someone being sexually exploited?
Is a child
Is closely guarded by a controlling person
Lacks control over schedule
A person who suffers from epilepsy may qualify for a group 1 driving livence is he or she has been free from Any epileptic attack for ___.
A person who suffers an epileptic attack whilst asleep must refrain driving for __ from the date of the attack., unless they have had an attack whilst asleep more than ____ years ago and have not had any awake attacks since that attack.
A person may qualify for a group 1 driving licence provided he or she has estblished, over a course of ____ a history or patten of attacks that have only ever occurred ___ ____.
If a seizure occurs as a result of a physician directed change or a reduction of anti epileptic medication, licence is revoked for _______.
Factors causing TB reactivation?
Age, malignancy, , DRUGs, CRF, DM,
Investigations for suspected TB?
Staining sputum for AFB (does not distinguish)
Auromine rhodamine staining - more sensitive than Ziehl Nielson
Liquid culture 3-15 days
Traditional culture - takes 4-6 weeks.
Px with splenomegaly, lethargy, PCV 23%, and nucleated cells/target cells on blood film. What do you suspect?
Adolescent boy with chronic leg ulcers, jaundice and bony prominence. Blood film shows target cell, nucleated, sickle cell. What do you expect electrophoresis to show, list 2 common complications and list two management options.
S-homogynous sickle cell
Dactylitis & Infections
Analgesia, Oxygen, Dehydration, Infection Tx