Heritable variants, such sickle cell anaemia or thalassemia, are caused by genetic changes that impact the composition or synthesis of haemoglobin. Conversely, exposure to chemicals, drugs, infections, and autoimmune diseases can all cause acquired hemolytic anaemias.

Tiredness, jaundice (yellowing of your skin and eyes), and a larger spleen are common signs of hemolytic anaemia. Blood tests are used in diagnosis to evaluate

Challenges in Diagnosing Hemolytic Anaemia: Hemolytic anaemia diagnosis requires a complete evaluation that includes a full health history, a physical examination, blood testing, and occasionally extra specialised diagnostics. It might be difficult to distinguish between various forms of hemolytic anaemia, necessitating the knowledge of healthcare providers.

Treatment Plans: The root cause of hemolytic anaemia determines how to treat it. Sometimes it’s enough to address the underlying cause—for example, by treating a condition that is autoimmune or offering supportive care. More serious cases, however, can call for treatments like bone marrow transplants in certain genetic disorders or transfusions of blood.

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We breathe air in and out through the nose and mouth. The air is warm and bedewed along the way. The air passes through our larynx, which contains the oral cords that allow us to talk. Air also passes into through the upper airways, including the trachea (windpipe) and bronchi to reach our lungs. The filling of the respiratory tract makes mucus to trap foreign patches. In our lungs, air sits in small air sacs called alveoli, which are right next to blood vessels.

Oxygen from the air we breathe in peregrination from our alveoli into our bloodstream. The carbon dioxide travels the other way, from our bloodstream into our alveoli. We also breathe the carbon dioxide out. What are the symptoms of respiratory conditions? Symptoms of problems with the airways and lungs may include a watery or blocked nose, sore throat breathlessness heaving cough casket pain, coughing up mucus or numbness, or blood CHECK YOUR SYMPTOMS — Use the Symptom Checker and find out if you need to seek medical help.

To keep your respiratory system (and especially your lungs) avoid dangerous environmental factors similar as bank, dust and chemicals eat a healthy diet, maintain a healthy weight have an active life. Try to exercise down from busy roads with lots of air pollution. To reduce your trouble of getting or spreading respiratory infections wash your hands regularly stay home when you’re bad cover your mouth and nose when coughing or sneezing Consider having the flu vaccine each time and keep up to date with your COVID- 19 vaccinations. Also, consider other vaccinations similar as whooping cough and pneumonia.

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A cauterization device, known as a Cautery Machine, is a heated metal tool applied by physicians to generate heat, halt blood vessel bleeding, and serve other treatment purposes. Modern cauterization primarily employs electrocautery and chemical cautery.

Electrocautery utilizes heat conduction from an electrically heated metal probe to destroy tissue or cut through soft tissue, effectively stopping bleeding from small vessels. This process, also referred to as thermal cautery, involves passing direct or alternating current through a resistant metal wire electrode to generate heat, which is then applied to living tissue for hemostasis or controlled tissue destruction. Electrocautery finds applications in various surgical fields, including dermatology, ophthalmology, otolaryngology, plastic surgery, and urology.

Chemical cauterization employs reactions to destroy tissue, commonly used for removing skin lesions like warts or necrotized tissue and achieving hemostasis. While agents like silver nitrate, trichloroacetic acid, and cantharidin are utilized, caution is exercised due to the potential of chemicals leaching into unintended areas. Laser and electrical methods are often preferred.

Cauterization procedures are generally not painful, as prior medications are administered to numb the targeted area. Following cauterization, wounds typically heal within two to three weeks, leaving a flat, round scar that gradually fades to blend with the surrounding skin.

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The two main components of inflammatory reaction are vascular reaction and cellular reaction. These reactions are mediated by chemical factors that are produced by plasma proteins or cells.

Inflammation of the organs are

Gastritis-Inflammation of stomach.

Colitis-inflammation of colon

Hepatitis -Inflammation of liver

The five signs of inflammations are Redness, Swelling, Heat, Pain and Loss of function.

Acute inflammation: It is a rapid response to an injurious agent that helps to deliver mediators or host defence. i. e plasma proteins and leucocytes to the site injury. They are divided as vascular and cellular events in acute inflammation.

A variety of stimuli are responsible for acute inflammation. They are

Infection – bacterial, viral, fungi and microbial toxins.

Trauma. 

Physical and chemical agents such as burns, frost bite and environmental chemicals.

Foreign bodies.

Hypersensitivity.

Vascular changes: The blood stream carries antibodies and leucocytes which play an important role in the defence of host. The blood vessels undergo a series of changes in inflammation which help the plasma proteins cells to move out of the vessel and to the site of injury.

The first changes occur after injury is vasodilation (dilation of blood vessels). The result in increased blood flow causes heat and redness. Followed by increased permeability, as a result outpouring of protein rich fluid into the extravascular tissue. The loss of fluid leads to blood vessels being packed with RBCs which slows the blood flow. As a result leucocytes accumulate along the endothelial vessels. Later migrate to the site of injury.

Increased vascular permeability: In acute inflammation the Protein rich fluid leaks through the vessel and escapes in to extravascular space where they collect and this is called oedema.

Cellular events in the lumen or margination

Transmigration 

Migration to the intestinal tissue known as chemotaxis. In which neutrophil monocytes and few lymphocytes responds to the chemotactic stimuli which are bacterial products or endogenous which reach the site of injury. Here they phagocyte the offending agent .

Phagocytosis: The two cells that are capable of phagocytosis are the neutrophils and monocytes.

Three steps involved in phagocytosis are recognition and attachment.

Engulfment

Killing and degradation.

 Chemical mediators of inflammation:

Cellular mediators which are divided into two parts 

1. Performed mediators. These are mediators already present within the cell granules. include Histamine It is distributed in tissue, sources comes from mast cells. also present in basophil and platelets. They are responsible for dilation of arterioles and increased permeability of the venules.
   
2. Serotonin  It’s action similar to histamine It is found in platelets.

Lysosomal enzymes:  are present within the lysosomes of neutrophils and macrophages.

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There are several types of glomerulonephritis, including acute glomerulonephritis, chronic glomerulonephritis, and rapidly progressive glomerulonephritis. The condition can be caused by various factors such as infections (particularly bacterial or viral infections), autoimmune disorders, genetic predisposition, and certain medications.

The most common symptoms of glomerulonephritis include blood in the urine (hematuria), foamy urine due to excess protein leakage (proteinuria), swelling in the face, hands, and feet (edema), high blood pressure, and decreased urine output. However, the severity of symptoms can vary depending on the underlying cause and individual factors.

Diagnosis of glomerulonephritis typically involves a combination of medical history evaluation, physical examination, laboratory tests (such as urine analysis, blood tests, and kidney function tests), and imaging studies (like ultrasound or kidney biopsy) to determine the extent of kidney damage and identify the underlying cause.

Treatment for glomerulonephritis aims to reduce inflammation, manage symptoms, and prevent further kidney damage. The specific approach may vary depending on the type and severity of the condition. In cases of acute glomerulonephritis, treatment often focuses on addressing the underlying infection or autoimmune disorder, along with measures to control blood pressure and reduce fluid retention. Chronic glomerulonephritis may require long-term management, including medications to control blood pressure, reduce protein leakage, and slow down the progression of kidney damage.

In some cases, glomerulonephritis may progress to end-stage renal disease (ESRD), where the kidneys are no longer able to function adequately. When this occurs, treatment options may include dialysis or kidney transplantation to sustain normal kidney function.

Prevention of glomerulonephritis involves practicing good hygiene, especially during infections, managing chronic conditions such as diabetes and high blood pressure, avoiding exposure to toxins and chemicals, and seeking prompt medical attention for any persistent urinary symptoms or signs of kidney problems.

In conclusion, glomerulonephritis is a condition characterized by inflammation of the glomeruli in the kidneys, leading to impaired kidney function. Prompt diagnosis and appropriate treatment are crucial to manage symptoms, slow down the progression of kidney damage, and prevent complications. If you suspect you may have glomerulonephritis or are experiencing any concerning symptoms, it is important to consult a healthcare professional for an accurate diagnosis and appropriate management.

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The four Operation Theatre zones are:

1. Unrestricted zone.
2. Semi-exclusion zone or semi-sterile area
3. Restricted or sterile area.
4. Disposal zone

Unrestricted Zone

• This is an area where hospital staff, Surgeons, Operation Theatre technicians, patients and nurses can present in their normal clothing or attire.

Semi-exclusion zone or protected zone or semi-sterile area

• Surgical team enters this area after donning of PPE kit i.e. changing from normal attire into hospital uniform, head cover, foot cover, surgical gown etc.

Restricted/Sterile Area or Aseptic Area:

• Surgical procedures are performed in this area. Only surgeons, Operation Theatre technicians and Nursing staff are permitted in this zone. Unnecessary movement is restricted to keep the zone infection free.

Fumigation of the Operation theatre helps to maintain this zone as a sterile area. 

Disposal Zone: Doffing of PPE kit, handling of used surgical instruments and biomedical waste disposal takes place in this area. The articles which require sterilization will be sent to the CSSD department.

Subareas like the preoperative area and anesthesia room are also there. In the preoperative area, the patient enters prior to surgery to the surgery where his medical records are checked. Cannulation and catheterization are also performed in the preoperative area. In the anesthesia room, the patient is administered anesthesia under strict monitoring of the vital signs.

The Benefits of dividing Operation Theatre into zones are:

• To Minimize the risk of nosocomial infections

 • To Minimize unnecessary movement of staff and patients to prevent contamination

• To Increase the efficiency of the operations theatre team

• To Minimize the risk of  operating room hazards

 • All the articles and equipments are placed in the appropriate zones to ensure a smooth workflow within Operation Theatre.

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Prevalence of Needle Stick Injury

Needle stick injuries are a significant problem in the healthcare industry. According to the Centers for Disease Control and Prevention (CDC), about 600,000 to 800,000 needle stick injuries occur each year in the United States alone. Nurses, physicians, and other healthcare workers who perform invasive procedures are at the highest risk for needle stick injuries.

Causes of Needle Stick Injury

There are several reasons why needle stick injuries occur in the healthcare industry. One common cause is the lack of proper training on the safe handling of needles and other sharp objects. Many healthcare workers are not trained to use proper techniques to prevent needle stick injuries, such as using safety devices on needles or properly disposing of used needles.

Another cause of needle stick injuries is the improper disposal of used needles. Used needles should be immediately disposed of in a sharps container, but sometimes they are improperly disposed of in regular trash bins, which can lead to accidental needle stick injuries.

Finally, healthcare workers may be at risk for needle stick injuries due to the unpredictable nature of their work. Patients may move suddenly, causing a needle or other sharp object to puncture the skin of the healthcare worker.

Complications of Needle Stick Injury

Needle stick injuries can result in serious health complications, particularly if the needle was contaminated with infectious material. Infectious diseases such as hepatitis B, hepatitis C, and HIV can be transmitted through needle stick injuries.

Immediate medical attention should be sought if a needle stick injury occurs, particularly if the needle is contaminated with infectious material. Testing for infectious diseases should be done to determine if any disease has been transmitted through the injury. If a needle stick injury occurs, thoroughly rinse the injured site with running water & gently clean it with soap & water.

Preventing Needle Stick Injury

There are several steps that healthcare workers can take to prevent needle stick injuries. First, proper training on the safe handling of needles and other sharp objects should be provided to all healthcare workers. This training should include the proper use of safety devices on hands and the proper disposal of used needles.

Second, healthcare workers should always wear personal protective equipment (PPE), such as gloves, when handling needles or other sharp objects. This can help prevent accidental punctures.

Finally, healthcare workers should be aware of the risks associated with their work and take appropriate precautions. For example, healthcare workers should be aware of the unpredictable nature of their work and take steps to avoid accidental punctures, such as positioning themselves in a way that minimizes the risk of accidental punctures.

Conclusion

Needle stick injuries are a significant occupational hazard in the healthcare industry. Healthcare workers who work with needles and other sharp objects are at the highest risk for needle stick injuries. These injuries can result in serious health complications, including the transmission of infectious diseases such as hepatitis B, hepatitis C, and HIV.

Preventing needle stick injuries requires proper training on safely handling needles and other sharp objects, using personal protective equipment (PPE), and awareness of the risks associated with the work. By taking these steps, healthcare workers can reduce their risk of needle stick injuries and protect their health and well-being.

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Urinary tract infections (UTIs) are a common type of bacterial infection that can affect any part of the urinary tract, including the bladder, ureters, kidneys, and urethra. While both men and women can develop UTIs, women are more susceptible to this type of infection due to their shorter urethras.

Symptoms

Symptoms of UTIs can include painful urination, frequent urination, cloudy or strong-smelling urine, abdominal pain, fever, and chills. In severe cases, UTIs can lead to kidney damage or sepsis, a life- threatening infection that can spread throughout the body.

Pathogenesis

UTIs are caused by the invasion of pathogenic bacteria into the urinary tract. The most common causative agents of UTIs are Gram-negative bacteria, particularly Escherichia coli (E. coli), which is responsible for up to 80% of UTIs. Other Gram-negative bacteria that can cause UTIs include Klebsiella pneumoniae, Proteus mirabilis, and Pseudomonas aeruginosa.

Gram-positive bacteria such as Enterococcus faecalis and Staphylococcus saprophyticus can also cause UTIs, although they are less common. Fungal UTIs can also occur, particularly in individuals with weakened immune systems or those who have undergone certain medical procedures. UTIs can occur when bacteria enter the urinary tract through the urethra and travel upwards towards the bladder or kidneys.

Risk factors

Risk factors for UTIs include a history of UTIs, sexual activity, the use of certain types of birth control (such as diaphragms), menopause, urinary tract abnormalities, and weakened immune systems.

Treatment

Treatment for UTIs typically involves a course of antibiotics, although the specific type of antibiotic used may vary depending on the causative agent and the severity of the infection. In addition to antibiotics, individuals with UTIs are often advised to drink plenty of water and avoid irritants such as caffeine and alcohol, which can exacerbate symptoms.

Prevention

Prevention of UTIs can involve practicing good hygiene, such as wiping from front to back after using the bathroom, urinating after sexual activity, and staying hydrated. Some individuals may also benefit from taking prophylactic antibiotics or using cranberry products, although the efficacy of these measures is not clear-cut.

Conclusion

In conclusion, UTIs are a common type of bacterial infection that can affect any part of the urinary tract. While Gram-negative bacteria, particularly E. coli, are the most common causative agents, other types of bacteria and fungi can also cause UTIs. Treatment typically involves a course of antibiotics, and prevention strategies include practicing good hygiene and staying hydrated.

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For decades, formaldehyde fumigation has been the most reliable technique for sterilising areas which are required to be microbiologically clean. 

Method- Electric Boiler Fumigation Technique 

For Each 1000 cubic feet, 500 ml of formaldehyde (40% solution) is added in 1000 ml of purified water (if not available use tap water) in an electric boiler. After the boiler is switched on one should move outside the Operation theatre and shut the door.  The boiler should be turned off without entering the room after 45 minutes (the exact time will depend on the volume in the heating device and how well it heats the space). 

Precaution

Formaldehyde is irritating to the eyes and nose and has been identified as a potential carcinogen, thus it is important to take the necessary precautions by wearing a cap, mask, foot cover. Hence, personal protective equipment (PPE) must be given to the fumigator. It is necessary to put a warning sign stating that a fumigation is taking place on the front door of the Operation theatre.

Benefits of Fumigation 

• It helps to eradicate all stages of Pathogen’s life cycle.
• It is time-saving method.
• It can reach the areas where other chemicals cannot. 
• It leaves less residue on the articles present in fumigation zone.

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Malaria is caused by Plasmodium group of parasites. It is spread through infected mosquitoes. 

The mosquito bite introduces the parasites from its saliva into a person’s blood.

Then the parasites slowly travel to the liver where they mature and reproduce. Species of Plasmodium can infect to the Red Blood Cells.

        Plasmodium group of parasites are:

• Plasmodium falciparum
• Plasmodium vivax
• Plasmodium ovale
• Plasmodium malariae.

        Most of the death by Malaria are caused by Plasmodium falciparum. Other group of malarial Parasites (Plasmodium vivax, Plasmodium ovale and plasmodium malariae) generally cause a milder effect than falciparum.

       Malaria is usually diagnosed by laboratory examination of blood films, and with antigen based rapid diagnostic test.

       Methods that use the PCR (polymerase chain reaction) detect the parasite’s DNA have been developed, but are not widely used due to their cost and complexity.

        Treatment

       The recommended treatment for malaria is a combination of antimalarial medications. The types of drugs and period of treatment may vary depending on type of malarial parasite.

        Chloroquine phosphate.

        Artemisinin-based combination therapies. 

        Quinine sulphate with doxycycline. 

        Prevention 

        Preventing mosquito bites with mosquito nets.

        Insect repellents.

        Spraying insecticides.

        Draining standing water.

        Several medications are available to prevent malaria for travelers in areas where the disease is common. 

        In 2020, there is one vaccine which has been shown to reduce the risk of malaria by about 40% in children. Efforts to develop more effective vaccines are ongoing.

Life cycle of Malarial Parasite

Infected Anopheles mosquito introduced sporozoites. These parasite follow the bloodstream to the liver where they invade hepatocytes. Then they grow and divide in the liver. It takes 2-10 days. Each infected hepatocyte harboring 30,000 – 40,000 parasites.

Then hepatocytes break down and releasing form (Plasmodium- merozoites) into the blood stream. These merozoites invade red blood cells. Then they started replicating. It takes 2 to3 days. 

The infected red blood cell lyses, and the new merozoites infect new red blood cells. This cycle continuously increased the number of parasites in an infected patient.

During the cycle, a small number of parasites do not replicate.  They develop into male and female Gametocytes.

These gametocytes develop in the Bone marrow, then return to the blood circulation. Then they are taken by the bite of another mosquito. 

Once inside a mosquito, the gametocytes undergo sexual reproduction and form daughter sporozoites that migrate to the mosquito’s salivary glands. Then infects a new host by the mosquito bites.

Diagnosis:

Malaria diagnosis is typically suspected based on symptoms and travel history, then confirmed with a blood test. 

In areas where malaria is common, the World Health Organization (WHO) recommends clinicians suspect malaria in any person who reports having fevers, or who has a current temperature above 37.5 °C without any other obvious cause.

Malaria should similarly be suspected in children with signs of anaemia, pale palms.

Malaria is usually confirmed by the microscopic examination of blood films or by antigen-based rapid diagnostic tests (RDT). Microscopy – Examining stained blood smear with microscope for malaria diagnosis. 

In places where microscopy is unavailable, malaria is diagnosed by rapid antigen tests (RDT) that detect parasite.

RDTs are targeting the parasite proteins histidine rich protein (HRP2, detects P. falciparum only) lactate dehydrogenase or aldolase. The HRP2 test is widely used in Africa, where Plasmodium falciparum predominates.

Classification:

Malaria is classified into either “severe” or “uncomplicated” by the (WHO). It is considered severe when any of the following criteria are present, otherwise it is considered uncomplicated. 

• Decreased consciousness
• Weakness such that the person is unable to walk.
• Inability to feed.
• Two or more convulsions.
• Low Blood pressure (less than 70 mm Hg in adults and 50 mmHg in children).
• Breathing Problems. 
• Shock. 
• Kidney Failure or haemoglobin in the urine.
• Bleeding problems, or haemoglobin less than 5.0 g/dL. 
• Blood glucose level less than 40 mg/dL.

Cerebral malaria is defined as a severe Plasmodium falciparum-malaria presenting with neurological symptoms. 

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