Meningococcal disease is a severe illness with high case fatality (5-10%) and frequent sequelae. Meningococcal meningitis is a major cause of morbidity and mortality in the meningitis belt. Meningococcal disease is a major public health challenge in countries of sub-Saharan Africa lying in the meningitis belt. Human infections caused by meningococcal (Neisseria meningitidis) remain a serious health problem, infecting 500,000 to 1.2 million people and killing between 50,000 and 135,000 per year worldwide. The causative agent, Neisseria meningitidis normally lives in a commensal relationship with humans, colonizing the nasopharynx, and is transmitted between healthy persons by close contact. The most common symptoms are a stiff neck, high fever, sensitivity to light, confusion, headaches and vomiting. Low meningitis thresholds improve timely detection of epidemics. The diagnosis of meningococcal meningitis is confirmed by cerebrospinal fluid pleocytosis, Gram stain, polymerase chain reaction, culture of cerebrospinal fluid. Meningococcal disease can be treated with a number of effective antibiotics. It is important that treatment be started as soon as possible. If meningococcal disease is suspected, antibiotics are given right away. Antibiotics effective for this purpose include rifampicin, ciprofloxacin, ceftriaxone or azithromycin. Currently available meningococcal vaccines include polysaccharide vaccines against serogroups A, C, W135 & Y and newer protein polysaccharide conjugate vaccines against serogroup C. This review covers key aspects of the pathogenesis and management of meningococcal disease, as well as the very recent developments in disease epidemiology, outbreaks, and the evolution of meningococcal immunizations.
Syphilis and their Sign and Symptoms, Causes with their Treatment An Overviewijtsrd
Treponema pallidum subsp. pallidum. Clinical appearances partitioned the malady into stages late stages of malady are presently unprecedented compared to the preantibiotic period. T. pallidum has an curiously little genome and needs qualities that encode numerous metabolic capacities and classical harmfulness variables. The life form is amazingly touchy to natural conditions and has not been ceaselessly developed in vitro. In any case, T. pallidum is highly irresistible and survives for decades within the untreated have. Early syphilis injuries result from the hosts safe reaction to the treponemes. Bacterial clearance and determination of early injuries comes about from a deferred extreme touchiness reaction, in spite of the fact that a few living beings elude to cause diligent contamination.One figure contributing to T. pallidums chronicity is the lack of indispensably external film proteins, rendering intaglio living beings for all intents and purposes imperceptible to the resistant framework. Antigenic variety of TprK, a putative surface exposed protein, is likely to contribute to safe avoidance. T. pallidum remains stunningly touchy to penicillin, but macrolide resistance has as of late been distinguished in a number of geographic districts. The advancement of a syphilis immunization, in this way distant tricky, would have a critical positive affect on worldwide wellbeing Sushanta Sarkar | Pankaj Chasta | Kaushal K. Chandrul ""Syphilis and their Sign & Symptoms, Causes with their Treatment: An Overview"" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-3 | Issue-4 , June 2019, URL: https://www.ijtsrd.com/papers/ijtsrd23610.pdf
Paper URL: https://www.ijtsrd.com/other-scientific-research-area/other/23610/syphilis-and-their-sign-and-symptoms-causes-with-their-treatment-an-overview/sushanta-sarkar
Washington Global Health Alliance Discovery Series
Supamit Chinsuttiwat
May 22, 2008
'Response to Avian Influenza and Preparedness for Pandemic Influenza: Thailand's Experience'
emerging and re-emerging vector borne diseasesAnil kumar
this presentation in about emerging and re-emerging vector borne diseases and their spatial spread with reference to time, surveillance, monitoring and management program and other difficulties and suggestions for program
Syphilis and their Sign and Symptoms, Causes with their Treatment An Overviewijtsrd
Treponema pallidum subsp. pallidum. Clinical appearances partitioned the malady into stages late stages of malady are presently unprecedented compared to the preantibiotic period. T. pallidum has an curiously little genome and needs qualities that encode numerous metabolic capacities and classical harmfulness variables. The life form is amazingly touchy to natural conditions and has not been ceaselessly developed in vitro. In any case, T. pallidum is highly irresistible and survives for decades within the untreated have. Early syphilis injuries result from the hosts safe reaction to the treponemes. Bacterial clearance and determination of early injuries comes about from a deferred extreme touchiness reaction, in spite of the fact that a few living beings elude to cause diligent contamination.One figure contributing to T. pallidums chronicity is the lack of indispensably external film proteins, rendering intaglio living beings for all intents and purposes imperceptible to the resistant framework. Antigenic variety of TprK, a putative surface exposed protein, is likely to contribute to safe avoidance. T. pallidum remains stunningly touchy to penicillin, but macrolide resistance has as of late been distinguished in a number of geographic districts. The advancement of a syphilis immunization, in this way distant tricky, would have a critical positive affect on worldwide wellbeing Sushanta Sarkar | Pankaj Chasta | Kaushal K. Chandrul ""Syphilis and their Sign & Symptoms, Causes with their Treatment: An Overview"" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-3 | Issue-4 , June 2019, URL: https://www.ijtsrd.com/papers/ijtsrd23610.pdf
Paper URL: https://www.ijtsrd.com/other-scientific-research-area/other/23610/syphilis-and-their-sign-and-symptoms-causes-with-their-treatment-an-overview/sushanta-sarkar
Washington Global Health Alliance Discovery Series
Supamit Chinsuttiwat
May 22, 2008
'Response to Avian Influenza and Preparedness for Pandemic Influenza: Thailand's Experience'
emerging and re-emerging vector borne diseasesAnil kumar
this presentation in about emerging and re-emerging vector borne diseases and their spatial spread with reference to time, surveillance, monitoring and management program and other difficulties and suggestions for program
Seasonal influenza viruses in tropical regions may occur throughout the year, causing outbreaks and epidemics more regularly in humans. There are four types or large groupings of seasonal influenza viruses; Influenza A, B, C, and D, but only influenza A and B viruses cause clinically important human disease and seasonal epidemics. It can cause mild to severe illnesses and even deaths, particularly in high-risk individuals. Vaccination is the most effective means of preventing influenza and its complications. Among healthy adults, influenza vaccine provides protection, even when circulating viruses may not exactly match the vaccine viruses. In elderly, it reduces severity of disease and incidence of complications and deaths. Vaccination is especially important for people at higher risk of serious influenza complications, and for people who live with, care for, high risk individuals.
Emerging and Re-emerging Infectious DiseasesFarooq Khan
Overview of literature around the following emerging and re-emerging infectious diseases relevant to Canadian Emergency Physicians in terms of their epidemiology, recognition, and treatment:
- Community-acquired MRSA
- Non-vaccine serotype Pneumococcus
- Fusobacterium Necrophorum
The whole world is suffering from the corona virus, a global pandemic, which has captured world attention to the immune system. As the world scrambles to find a cure for Covid-19, health experts have suggested boosting the body’s immunity. Immune system defense against bacteria, virus and other organisms may help minimize the effects and hasten the recovery from the disease. Covid-19 still has a troublingly high mortality rate. A person with a strong immune system and good body health should be able to recover from severe acute respiratory syndrome corona virus 2 (SARS-CoV-2) infections without any complications because the immune system produced antibodies. Immunity will be “our savior” against the virus. The idea is that if you don’t have a potent weapon to combat the enemy, a strong and effective shield is the best bet to protect yourself. There are still millions of people in the world at risk due to old age, weak immune system and pre-existing medical issue. Turmeric plays a major role to boost the immune system and a potent immunomodulatory agent that can help the population to prevent the covid-19 infection. Based on these facts A Natural immunomodulatory agent CURCUMET CAPSULES has been Developed by R&D Centre, Lactonova Nutripharm (P) Ltd, HYDERABAD. The present paper Reviews the Role of CURCUMET CAPSULES, A Natural immunomodulatory agent helps to prevent covid-19 infection.
ABSTRACT- Human immunodeficiency virus (HIV) is a major contributor to the global burden of the disease, opportunistic infections, and tumors follow. HIV also directly attacks the immune system and affects certain body’s system (like Central Nervous System, Respiratory and Cardiovascular Systems, Digestive System etc). HIV transmission is complex and depends on the number of behavioral and biological co-factors. The hallmark of HIV infection is the progressive depletion of CD4 helper T cells because of reduced production and increased destruction. Although the typical HIV infected patient shows a sustained CD4 cell increase, a remarkable number of subjects never achieve normal ranges of CD4. HIV infection is also characterized by a marked increase in immune activation, which includes both the adaptive and innate immune systems and abnormalities in coagulation. Extraordinary efforts in the fields of clinical, pharmacology, and biology care have contributed to progressively turn HIV infection from an unavoidably fatal condition into a chronic manageable disease, at least in the countries where HIV infected people have full access to the potent anti-retroviral (ARV) drug combinations that permit a marked and sustained control of viral replication. Although their pathogenesis is still under discussed, they are likely to originate from immune dysfunction associated with HIV infection and chronic inflammation. The last consideration regards the dis-homogenous pattern of HIV disease worldwide. Key-words- Human immunodeficiency virus (HIV), simian immunodeficiency viruses (SIV), Antiretroviral (ARV) therapy, Acquired immunodeficiency syndrome (AIDS), Cell mediated immunity (CMI), Anti-retroviral agents
Presentation made by Zsuzsanna Jakab, WHO Regional Director for Europe, at the meeting "Health in Action reforming the Greek National Health System to Improve Citizens’ Health", on 5 March 2014, Athens, Greece.
Human Coronaviruses (HCoV) exhibit positive single stranded RNA genome with enveloped nucleocapsid. Coronavirus belongs to the family Coronaviridae, originated from avian and mammalian species causes upper respiratory tract infection in humans by novel HCoVs viruses named as HCoV-HKU1, HCoV-NL63 but predominant species is Middle East respiratory syndrome (MERS-CoV) across the world. HCoV-HKU1 sp. is associated with chronic pulmonary disease, while HCoV-NL63 causes upper and lower respiratory tract disease in both children and adults, but most recent one was MERS-CoV, which caused acute pneumonia and occasional renal failure. The novel coronavirus SARS-CoV-2 is a new strain that causes the Coronavirus Disease 2019 (COVID-19) as named by the World Health Organization. According to the recent world statistics report about the COVID-19 cases approx. 101,500 confirmed cases and 3,500 death cases appeared. And mostly, a case of infection with CoV was identified in Wuhan, China. Structurally viral genome constitutes of 2/3rd of replicase gene encoding ORFs regions and rest of the 1/3rd region of genome form the structural proteins. The aim of the study was to understand the viral genetic systems in order to facilitate the genetic manipulation of the viral genome and to know the fundamental mechanism during the viral replication, facilitating the development of antidotes against the virus.
Advanced age, having comorbidities, and vitamin D deficiency are three most important reasons for increased vulnerability to COVID-19 and also worsen complications and increase the risk of death. Despite the vast amount of information available and lessons learned, many countries are still not fully utilizing these to manage secondary peaks of COVID-19 infection. Factors associated with worse COVID-19 prognosis include, older age, ethnicity, male sex, having comorbidities, obesity, diabetes, hypertension, and smoking; all these are associate with vitamin D deficiency. COVID-19 symptomatology varies from mostly asymptomatic, to, up to 2% fatality.
Emerging and reemerging infectious diseasesarijitkundu88
Various emerging and reemerging diseases. Factors contributing to the emergence of infectious diseases. Antibiotic resistance. The global response to control them. Laboratories network in surveillance.
Seasonal influenza viruses in tropical regions may occur throughout the year, causing outbreaks and epidemics more regularly in humans. There are four types or large groupings of seasonal influenza viruses; Influenza A, B, C, and D, but only influenza A and B viruses cause clinically important human disease and seasonal epidemics. It can cause mild to severe illnesses and even deaths, particularly in high-risk individuals. Vaccination is the most effective means of preventing influenza and its complications. Among healthy adults, influenza vaccine provides protection, even when circulating viruses may not exactly match the vaccine viruses. In elderly, it reduces severity of disease and incidence of complications and deaths. Vaccination is especially important for people at higher risk of serious influenza complications, and for people who live with, care for, high risk individuals.
Emerging and Re-emerging Infectious DiseasesFarooq Khan
Overview of literature around the following emerging and re-emerging infectious diseases relevant to Canadian Emergency Physicians in terms of their epidemiology, recognition, and treatment:
- Community-acquired MRSA
- Non-vaccine serotype Pneumococcus
- Fusobacterium Necrophorum
The whole world is suffering from the corona virus, a global pandemic, which has captured world attention to the immune system. As the world scrambles to find a cure for Covid-19, health experts have suggested boosting the body’s immunity. Immune system defense against bacteria, virus and other organisms may help minimize the effects and hasten the recovery from the disease. Covid-19 still has a troublingly high mortality rate. A person with a strong immune system and good body health should be able to recover from severe acute respiratory syndrome corona virus 2 (SARS-CoV-2) infections without any complications because the immune system produced antibodies. Immunity will be “our savior” against the virus. The idea is that if you don’t have a potent weapon to combat the enemy, a strong and effective shield is the best bet to protect yourself. There are still millions of people in the world at risk due to old age, weak immune system and pre-existing medical issue. Turmeric plays a major role to boost the immune system and a potent immunomodulatory agent that can help the population to prevent the covid-19 infection. Based on these facts A Natural immunomodulatory agent CURCUMET CAPSULES has been Developed by R&D Centre, Lactonova Nutripharm (P) Ltd, HYDERABAD. The present paper Reviews the Role of CURCUMET CAPSULES, A Natural immunomodulatory agent helps to prevent covid-19 infection.
ABSTRACT- Human immunodeficiency virus (HIV) is a major contributor to the global burden of the disease, opportunistic infections, and tumors follow. HIV also directly attacks the immune system and affects certain body’s system (like Central Nervous System, Respiratory and Cardiovascular Systems, Digestive System etc). HIV transmission is complex and depends on the number of behavioral and biological co-factors. The hallmark of HIV infection is the progressive depletion of CD4 helper T cells because of reduced production and increased destruction. Although the typical HIV infected patient shows a sustained CD4 cell increase, a remarkable number of subjects never achieve normal ranges of CD4. HIV infection is also characterized by a marked increase in immune activation, which includes both the adaptive and innate immune systems and abnormalities in coagulation. Extraordinary efforts in the fields of clinical, pharmacology, and biology care have contributed to progressively turn HIV infection from an unavoidably fatal condition into a chronic manageable disease, at least in the countries where HIV infected people have full access to the potent anti-retroviral (ARV) drug combinations that permit a marked and sustained control of viral replication. Although their pathogenesis is still under discussed, they are likely to originate from immune dysfunction associated with HIV infection and chronic inflammation. The last consideration regards the dis-homogenous pattern of HIV disease worldwide. Key-words- Human immunodeficiency virus (HIV), simian immunodeficiency viruses (SIV), Antiretroviral (ARV) therapy, Acquired immunodeficiency syndrome (AIDS), Cell mediated immunity (CMI), Anti-retroviral agents
Presentation made by Zsuzsanna Jakab, WHO Regional Director for Europe, at the meeting "Health in Action reforming the Greek National Health System to Improve Citizens’ Health", on 5 March 2014, Athens, Greece.
Human Coronaviruses (HCoV) exhibit positive single stranded RNA genome with enveloped nucleocapsid. Coronavirus belongs to the family Coronaviridae, originated from avian and mammalian species causes upper respiratory tract infection in humans by novel HCoVs viruses named as HCoV-HKU1, HCoV-NL63 but predominant species is Middle East respiratory syndrome (MERS-CoV) across the world. HCoV-HKU1 sp. is associated with chronic pulmonary disease, while HCoV-NL63 causes upper and lower respiratory tract disease in both children and adults, but most recent one was MERS-CoV, which caused acute pneumonia and occasional renal failure. The novel coronavirus SARS-CoV-2 is a new strain that causes the Coronavirus Disease 2019 (COVID-19) as named by the World Health Organization. According to the recent world statistics report about the COVID-19 cases approx. 101,500 confirmed cases and 3,500 death cases appeared. And mostly, a case of infection with CoV was identified in Wuhan, China. Structurally viral genome constitutes of 2/3rd of replicase gene encoding ORFs regions and rest of the 1/3rd region of genome form the structural proteins. The aim of the study was to understand the viral genetic systems in order to facilitate the genetic manipulation of the viral genome and to know the fundamental mechanism during the viral replication, facilitating the development of antidotes against the virus.
Advanced age, having comorbidities, and vitamin D deficiency are three most important reasons for increased vulnerability to COVID-19 and also worsen complications and increase the risk of death. Despite the vast amount of information available and lessons learned, many countries are still not fully utilizing these to manage secondary peaks of COVID-19 infection. Factors associated with worse COVID-19 prognosis include, older age, ethnicity, male sex, having comorbidities, obesity, diabetes, hypertension, and smoking; all these are associate with vitamin D deficiency. COVID-19 symptomatology varies from mostly asymptomatic, to, up to 2% fatality.
Emerging and reemerging infectious diseasesarijitkundu88
Various emerging and reemerging diseases. Factors contributing to the emergence of infectious diseases. Antibiotic resistance. The global response to control them. Laboratories network in surveillance.
4. post traumatic stress disorder (ptsd) an overviewSuresh Rewar
Post-traumatic stress disorder (PTSD) is a complex mental disorder with psychological and emotional components, caused by exposure to single or repeated extreme traumatic events found in war, terrorist attacks, natural or man-caused disasters, and by violent personal assaults and accidents. In recent years, armed conflicts in the Middle East have resulted in high rates of exposure to traumatic events. Despite the increasing demand of mental health care provision, ongoing violence limits conventional approaches of mental health care provision. Internet-based interventions for posttraumatic stress disorder (PTSD) have proved feasible and effective in Western countries, but their applicability and efficacy in war and conflict regions remains unknown. Despite clinical studies and improved understanding of the mechanisms of cellular damage, prevention and treatment strategies for patients with PTSD remain unsatisfactory. Posttraumatic stress disorder is a prevalent mental health problem associated with substantial psychiatric morbidity. To develop an improved plan for treating and impeding progression of PTSD, it is important to identify underlying biochemical
changes that may play key role in the initiation and progression of these disorders.
Several new viral respiratory tract infectious diseases with epidemic potential that threaten global health security have emerged in the past 15 years. A severe viral illness caused by a newly discovered coronavirus was first reported in the 2003. In 2003, WHO issued a worldwide alert for an unknown emerging illness, later named severe
acute respiratory syndrome (SARS). The disease caused by a novel coronavirus (SARS-CoV) rapidly spread worldwide, Coronaviruses are enveloped viruses with plus-stranded RNA genomes of 26-32 kb, the
largest contiguous RNA genomes in nature. Symptoms of SARS include: high fever, cough pneumonia, breathing difficulties headache, chills, muscle aches and sore throat. According to the World Health Organization (WHO), From November 2002 to July 2003 a total of 8098 patients, in 25 countries, were affected by the atypical pneumonia which resulted in 774 deaths globally. The severe acute respiratory syndrome (SARS) is a febrile respiratory illness
primarily transmitted by respiratory droplets or close personal contact. There are several laboratory tests used to detect SARS-CoV and other causes of respiratory illness. Many methods used in the treatment of viral infections have been only partially effective. For example, the standard treatment in HCV (with ribavirin and interferon-alpha) is effective in 50% of cases.
5. swine flu influenza viruses a (h1 n1)Suresh Rewar
Flu viruses have mainly affected humans, birds and pigs worldwide. Influenza A viruses is highly infectious respiratory pathogens that can infect many species. The swine flu H1N1 reassorted subtype caused the first global pandemic in last 40 years, resulting in substantial illness, hospitalizations of millions of peoples and thousands of deaths throughout the world. There is no direct evidence that the reassortment events culminating in the 1918, 1957 or 1968 pandemic influenza viruses originated from pigs. Genetic reassortment among avian, human and/or swine influenza virus gene segments has occurred in pigs and some novel reassortant swine viruses have been transmitted to humans. The WHO declared the H1N1 pandemic on June 11, 2009, after more than 70 countries reported 30000 cases of H1N1 infection. Pandemic (H1N1) influenza most commonly causes a self-limited illness; however, significant morbidity and mortality were reported in the young, the obese and in pregnant women. The CDC recommends real time PCR as the method of choice for diagnosing H1N1. The U.S. Centers for Disease Control and Prevention recommends the use of Oseltamivir
(Tamiflu) or Zanamivir (Relenza) for the treatment. The drugs of choice for treatment and prophylaxis of pandemic (H1N1) influenza are the neuraminidase inhibitors, Oseltamivir and Zanamivir. In this review, a brief overview on swine flu is presented highlighting the characteristics of the causative virus, the disease and its public health consequences, advances made in its diagnosis, vaccine and control to be adapted in the wake of an outbreak.
Kebudayaan Megalitikum bukanlah suatu zaman yang berkembang tersendiri, melainkan suatu hasil budaya yang timbul pada zaman Neolitikum dan berkembang pesat pada zaman logam. Setiap bangunan yang diciptakan oleh masyarakat tentu memiliki fungsi.
Meningococcal carriage in the African meningitis belt and the impact of MenAfriVac: an overview of the MenAfriCar project
http://www.meningitis.org/conference2015
Rising Enemy fungal in middle east clinical patho.pdfEmad Zarief Kamel
Treating patients with confirmed fungal disease with effective antifungal agents is crucial to reduce morbidity and mortality.
Several investigations described a significant link between early reliable diagnosis and treatment of IFIs and improved outcomes of patients at risk
Statistical analysis on household factors influencing annual episodes of malariacimran15
Malaria is responsible for about 66 per cent of all clinic visits in Nigeria. It accounts for 25% of under-5 mortality, 30% childhood mortality and 11% maternal mortality. At least 50% of the population will have at least one episode of malaria annually. Moreover, environment dictates the incidence and prevalence of diseases all over the world and if timely action is not taken, it may lead to diseases. Three (3) out of six (6) major towns in Ido local government area are considered and accumulated one hundred and ninety one (191) individuals as respondents using haphazard non probability sampling technique for selection. The obtained data through questionnaire was presented on frequency table and charts while inferential statistics were analysed using dummy variables in regression. It was revealed that majority of the respondents suffered from one or more incidences of malaria in a year, where female had the higher percentage of the incidence and there was high incidence of malaria among the adult ages 30years and above. The qualitative predictor variable in regression analysis revealed significant relationship between annual episode of malaria and number of members of household, toilet type, absent ceiling, building type, disposable site and source of domestic water. The ANOVA, F – test was significant for all predicted factors. Conclusively, in the view of the discovery, it was therefore recommended that people need awareness on densely populated area / household are more prone to experience more episodes of malaria incidence than sparsely populated one, encouragement on utilization of closed domestic water system instead of open system to avoid reservoir for mosquito, enlightenment on type toilet used and avoid absence ceiling to prevent being a breeding site for mosquitoes, government to stage more campaign against malaria especially for adult not for children under 5year alone and create a task force officer/ sanitary inspectors to checkmate sanitation of our environment to avoid unkempt toilet habit which serves as breeding site for mosquitoes.
This study evaluated the prevalence of malaria parasite among pregnant and non pregnant women attending Federal Medical Centre (FMC) Owerri Imo State Nigeria within the age range of 21-50 years. The molecular identification and speciation of the malaria parasites were carried out using different diagnostic techniques. The blood samples were analyzed using microscopy, Rapid Diagnostic Test (RDT) and Polymerase Chain Reaction (PCR). Results using the microscopy for pregnant women was 181(90.5%) and for non pregnant women, it was 185(92.5%) within the age range of under 21, 41 and above. The result of RDT for pregnant women was 58(32.0%) and for non pregnant women were 46(24.9%). However, the age group of pregnant women that had the highest occurrence of malaria using microscopy was (21-25yrs) with 100% of persons tested positive and (41-45yrs) with 78.8% had the lowest occurrence. For non pregnant women, the age group that had the highest occurrence of malaria parasite was (31-35yrs) with 95.3%of persons reporting tested reporting positive while, (21-25yrs) with 84.6% had the lowest occurrence. Polymerase Chain Reaction (PCR) was used for the speciation of the parasites and the result revealed that Plasmodium falciparum in pregnant women within the ages of 46-50yrs had the highest (96.0%) prevalent followed by Plasmodium vivax for women within the ages of 21-25yrs had the highest (13.6%) occurrence, Plasmodium malariae for women within the ages 21-25yrs and had the highest (9.4%) occurrence. In this study, Polymerase Chain Reaction was very sensitive, takes more large samples at a time and specific for both P. falciparum and non falciparum Plasmodium infections and has many diagnostic advantages over microscopy. Out of 400 venous blood samples collected from both pregnant and non-pregnant women, 27 blood samples had mixed malaria parasite infections. Therefore, following this study, it will be recommended that we urge the pharmaceutical companies to improve on the manufacturing of broad-spectrum antimalarial drugs to cover all species of Plasmodium as it’s done with antimicrobials not only concentrating on the drugs for the treatment of P. falciparum alone.
Bacteria Isolated From the Cerebrio-Spinal Fluid (Csf) of Suspected Cases of ...iosrjce
IOSR Journal of Nursing and health Science is ambitious to disseminate information and experience in education, practice and investigation between medicine, nursing and all the sciences involved in health care. Nursing & Health Sciences focuses on the international exchange of knowledge in nursing and health sciences. The journal publishes peer-reviewed papers on original research, education and clinical practice.
By encouraging scholars from around the world to share their knowledge and expertise, the journal aims to provide the reader with a deeper understanding of the lived experience of nursing and health sciences and the opportunity to enrich their own area of practice. The journal publishes original papers, reviews, special and general articles, case management etc.
Sri Lanka faced an unpredicted outbreak of dengue fever. It is a tropical country with two monsoon seasons. With each monsoon brings in two peaks of dengue fever making it an endemic disease in Sri Lanka.
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
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Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
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2. Suresh et al,2015
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INTRODUCTION
Meningococcal disease is a severe illness with high case fatality (5-10%) and frequent
sequelae (10-20%) that require lifelong medical attention. (1) Meningococcal meningitis is a
major cause of morbidity and mortality in the meningitis belt of sub-Saharan Africa where it
occurs in epidemics every 8-12 years. (2) Meningococcal meningitis is a bacterial form of
meningitis, a serious infection of the meninges that affects the brain and spinal cord. It can
cause severe brain damage and is fatal in 50% of cases if untreated. (3) Human infections
caused by meningococcal (Neisseria meningitidis) remain a serious health problem, infecting
500,000 to 1.2 million people and killing between 50,000 and 135,000 per year worldwide.(4)
Meningococcal disease is a relatively new disease that was first observed in 1805 in Europe,
1806 in North America, and 1905 in Africa. (5) From 1 January to 12 May 2015, Niger’s
Ministry of Public Health notified WHO of 6179 suspected cases of meningococcal
meningitis, including 423 deaths. This is a rapidly growing outbreak with some
unprecedented features. (6) Meningococcal disease, also referred to as cerebrospinal
meningitis is a contagious bacterial disease caused by the meningococcus (Neisseria
meningitidis). It is spread by person to person contact through respiratory droplets of infected
people. (7) There are 3 main clinical forms of the disease: the meningeal syndrome, the
septic form and pneumonia. (8) The onset of symptoms is sudden and death can follow within
hours. In as many as 10-15% of survivors, there are persistent neurological defects, including
hearing loss, speech disorders, loss of limbs, mental retardation and paralysis. (9)
Meningococcal meningitis and septicemia tends to be more common during winter and early
spring. (3) Most cases occur below age 5 years and particularly during the first year of life.
There is also a smaller peak at age 14-19 years. However, about one third of the cases of
meningococcal disease occur in adults. (10) There has been a shift in the age groups affected
by invasive meningococcal disease with an increase among the elderly due to serogroup Y
and a decrease in adolescents due to serogroup C. (5) The extended meningitis belt of sub-
Saharan Africa, stretching from Senegal in the west to Ethiopia in the east (26 countries), has
the highest rates of the disease. (11) This experiences epidemics during the hot, dry, and
windy months from December through April. Because of a lack of affordable conjugate
vaccines, African countries in the meningitis belt have adopted a strategy of reactive
immunization. (12) As of January 2015, over 217 million persons have received
meningococcal A conjugate vaccine in 15 countries of the African belt. (13) Between 1
January and 25 April 2015, the Ministry of Public Health of Niger notified WHO of 1543
suspected cases of meningococcal disease, including 147 deaths. (14)
EPIDEMILOGY
Many countries suffer from endemic meningococcal disease at an annual attack rate of
around 1 to 3 per 100,000 of the population. Some of these countries, mostly in the
developing world, suffer from repeated epidemics of meningococcal disease. (15, 16) In
temperate regions the number of cases increases in winter and spring. (3) Serogroups B and C
together account for a large majority of cases in Europe and the Americas. Several local
outbreaks due to Neisseria meningitidis serogroup C have been reported in Canada and the
United States (1992-93) and in Spain (1995-97). (17) Major African epidemics are associated
with Neisseria meningitidis serogroup A, (18) which is usually the cause of meningococcal
disease in Asia. (19) N. meningitidis serogroup A and C outbreaks are occasionally reported
to the World Health Organization (WHO) Regional Office in Asia, or to national
authorities.(20) Between 1988 and 1997, 704,000 cases and more than 100,000 deaths were
reported in Africa, some 20,000 occurring in 1996, the largest epidemic year ever recorded.
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Between 1998 and 2002, African countries within the meningitis belt reported more than
224,000 new cases of meningococcal disease. (17) In Africa, major epidemics have been
occurring over the past 100 years. (5) Most of them have been attributed to serogroup A and
occurred in the African "meningitis belt”, a large area that spans sub Saharan Africa from
Senegal in the west to Ethiopia in the east. (21, 22) In 1996 to 1997, the largest epidemic in
history swept across the belt, causing over 250 000 cases, an estimated 25 000 deaths, and
disability in 50 000 people. Large epidemics recur in the meningitis belt on a regular
basis.(23) In Togo, the 1997 meningitis epidemic spread rapidly. Overall annual incidence
was 652 cases/ 100000 inhabitants. (24) 48 198 cases reported in 174 districts in Benin,
Burkina Faso, the Gambia, Ghana, Mali, Niger, and Togo. These cases were 80.3% of those
reported from Africa to WHO during the 1997 epidemic period. (25) Serogroup X
meningococcus outbreak in Kenya, An age- and location-matched case-control study for risk
factors was done. From December 2005 to April 2006, 82 suspect cases of meningitis were
reported. (26) During the 2006–2007 epidemic season, 53 438 suspected cases and 3816
deaths were reported to WHO from 15 African countries. (27) In 2012, an outbreak of
Neisseria meningitidis serogroup W135 occurred in The Gambia. The attack rate was highest
among young children. During Feb. 1 to June 25, 2012, a total of 469 suspected cases were
identified, and 114 were confirmed to be serogroup W135. Most (67%) suspected case
patients were <5 years of age, and 56% of cases occurred in male patients. The overall case
fatality rate was 8%. (28) In Nigeria, all of the 856 and 333 clinically suspected meningitis
cases were treated in 2013 and 2014, respectively. Overall attack (AR) and case fatality
(CFR) rates were 673/100,000 population and 6.8% in 2013, and 165/100,000 and 10.5% in
2014. (29) Limited data available on the epidemiology of meningococcal infection in India
reveal a low background incidence of disease. There are occasional large epidemics mostly
distributed in the drier Northern states. (30) During the 2014 epidemic season, 19 African
countries implementing enhanced surveillance reported 11 908 suspected cases including
1146 deaths. (31) From 1 January to 12 May 2015, Niger’s Ministry of Public Health notified
WHO of 6179 suspected cases of meningococcal meningitis, including 423 deaths. This is a
rapidly growing outbreak with some unprecedented features. (32)
ETIOLOGY
Several different bacteria can cause meningitis. Neisseria meningitides is the one with the
potential to cause large epidemics. (31) Twelve serogroups of Neisseria meningitidis have
been identified, Six of which (A, B, C, W135, X and Y) can cause epidemics. (32, 33)
Geographic distribution and epidemic capabilities differ according to the serogroup.(34)
Neisseria meningitidis was first identified as the causative agent of bacterial meningitis by
Weichselbaum in 1887. (35) Meningococcal serogroups A, B, C and Y cause the majority of
cases of invasive disease in the US and throughout the world, with epidemics usually caused
by serogroups A and C. (36) Serogroup W causes a small portion of disease, and serogroup A
causes disease in developing countries and the meningitis belt of sub-Saharan Africa.(37)
Meningococcal disease is caused by the bacterium Neisseria meningitidis, also called
meningococcus. About 10% of people have this type of bacteria in the back of their nose and
throat with no signs or symptoms of disease, called being 'a carrier'. But sometimes Neisseria
meningitidis bacteria can invade the body causing certain illnesses, which are known as
meningococcal disease. (15)
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PATHOGENSIS & TRANSMISSION
The first step in the pathogenesis of meningococcal disease is attachment of the organism
through surface pili to non-ciliated columnar epithelial cells of the nasopharynx.(38)
Meningococci can pass through the epithelial cells and enter the blood stream, where they
occasionally survive and multiply intravascularly. Progression to severe meningococcal
disease can occur very rapidly. (39) This pathogen may also translocate across the blood-
meningeal barrier to infect the meninges and cause meningitis. In the blood, meningococci
produce a strong inflammatory response with activation of the complement and coagulation
cascades. (40, 41) Bacteria are transmitted from person to person through droplets of
respiratory or throat secretions. (42)
RISK FACTORS
Certain groups of people are at increased risk for meningococcal disease. For some of these
groups, there are recommended vaccines that prevent two of the three major serogroups
("strains") of Neisseria meningitidis bacteria. (43) Vaccination is the best way to protect
against meningococcal disease. Some risk factors includes,
Age
Meningococcal disease is more commonly diagnosed among infants, adolescents and young
adults. (44) A vaccine is available and recommended for all 11 through 18 year olds. A
vaccine is also available for infants and children 6 weeks through 10 years of age, but it is
only routinely recommended for those with certain medical conditions or who are traveling to
specific countries. (45, 46)
Community setting
Infectious diseases tend to spread quickly wherever large groups of people gather together.
As a result, first-year college students living in residence halls are at slightly increased risk
compared with other persons of the same age. A vaccine is available and recommended for
all first-year college students living in a residence hall. However, any college student can
receive the vaccine to decrease their chances of getting meningococcal disease. (2, 44)
Certain medical conditions
There are certain diseases, medications and surgical procedures that put people at increased
risk of meningococcal disease, such as not having a spleen. A vaccine is available and
recommended for those with these conditions. Learn more about those with certain medical
conditions being at risk. (47)
Travel
Travelers to the meningitis belt in sub-Saharan Africa may be at risk for meningococcal
disease, particularly during the dry season. (2)
SIGNS & SYMPTOMS
A common outcome of meningococcal infection is meningitis. When caused by Neisseria
meningitides bacteria it is known as meningococcal meningitis. When someone has
meningococcal meningitis, the protective membranes covering their brain and spinal cord,
known as the meninges, become infected and swell. (48) The most common symptoms are a
stiff neck, high fever, sensitivity to light, confusion, headaches and vomiting. (4, 45) The
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symptoms of meningococcal meningitis can appear quickly or over several days. Typically
they develop within 3-7 days after exposure. (49) In newborns and infants, the classic
symptoms of fever, headache, and neck stiffness may be absent or difficult to notice. The
infant may appear to be slow or inactive, irritable, vomiting or feeding poorly. In young
children, doctors may also look at the child’s reflexes, which can also be a sign of
meningitis.(50) Meningococcal meningitis is very serious and can be fatal. In fatal cases,
deaths can occur in as little as a few hours. In non-fatal cases, permanent disabilities can
include hearing loss and brain damage. (51)
DIAGNOSIS
The diagnosis of meningococcal meningitis is confirmed by cerebrospinal fluid pleocytosis,
Gram stain, polymerase chain reaction, culture of cerebrospinal fluid, or cultures of blood or
skin lesions. (4, 45) Early diagnosis and treatment are very important. (25) If meningococcal
disease is suspected, samples of blood or cerebrospinal fluid are collected and sent to the
laboratory for testing. (42) It is important to know if it is meningococcal disease because the
severity of illness and the treatment will change depending on the cause. In the case of
meningococcal disease, antibiotics can help prevent severe illness and reduce the chances a
close contact will also develop disease. (15) If Neisseria meningitidis bacteria are present,
they can be grown (cultured). Growing the bacteria in the laboratory is important for
confirming the presence of bacteria, identifying the specific type of bacteria that is causing
the infection, and deciding which antibiotic will work best. Other tests can sometimes detect
and identify the bacteria if the cultures do not. (52) Methods based on rapid polymerase chain
reaction (PCR) can complement standard laboratory procedures as they are less affected by
prior antibiotic therapy and these methods are being used increasingly. (53, 54) Evaluate
dipstick rapid diagnostic tests (RDTs) for meningococcal meningitis in basic health
facilities.(55) Diagnosis of bacterial meningitis is based on identification of the pathogen in
the cerebrospinal fluid (CSF), obtained by lumbar puncture, using a combination of
macroscopic, microscopic and culture or PCR techniques. (56) For a macroscopic
examination, samples are checked for clarity, cloudiness and the presence of blood.
Microscopy includes white blood cell (WBC) count and Gram stain. Intracellular Gram-
negative diplococci on Gram stain indicate the presence of meningococci, but this technique
cannot confirm the serogroup(s) involved. In addition, PCR is often performed to enhance
confirmatory results. (57)
TREATMENT
Meningococcal disease can be treated with a number of effective antibiotics. It is important
that treatment be started as soon as possible. If meningococcal disease is suspected,
antibiotics are given right away. Antibiotics effective for this purpose include rifampicin,
ciprofloxacin, ceftriaxone or azithromycin. (58) Once the diagnosis is confirmed, (59)
treatment can be changed to intravenous penicillin G. Alternatively, ceftriaxone may be used
for the entire duration of therapy owing to ease of dosing and reports of decreased
susceptibility to penicillin in several countries. (60, 61) A single dose of long-acting
chloramphenicol or ceftriaxone is used for the treatment of epidemic meningococcal
meningitis in sub-Saharan Africa. (62)
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VACCINATION
There is a vaccine for the bacteria that cause meningococcal disease. However, available
vaccines do not cover all serogroups (“strains”) of Neisseria meningitidis bacteria. Like with
any vaccine, meningococcal vaccines are not 100% effective. This means that even if you
have been vaccinated, there is still a chance you can develop a meningococcal
infection.(63,64,65) MenAfriVac, a safe, immunogenic and affordable conjugate vaccine was
developed especially to eliminate NmA epidemics in the meningitis belt. (7) The PsA-TT
vaccine elicited a stronger response to group A antibody than the PsACWY vaccine.(66)
Currently available meningococcal vaccines include polysaccharide vaccines against
serogroups A, C, W135 & Y and newer protein polysaccharide conjugate vaccines against
serogroup C. (1, 67) Several types of vaccine are available: polysaccharide vaccines-available
in either bivalent (groups A and C), trivalent (groups A, C and W135), or tetravalent (groups
A, C, W135 and Y) forms; and conjugate vaccines against group A and group C and
tetravalent vaccines against groups A, C, W135 and Y. (68, 69) The 4CMenB vaccine,
invented through the process of reverse vaccinology, and studied extensively for its
immunogenicity and safety in infants, adolescents and adults, holds the potential to help
decrease further the global burden of IMD (invasive meningococcal disease). (70)
Meningococcal vaccines routinely used in the United States protect against most types of
meningococcal disease, but they do not prevent all cases. There are two kinds of vaccines
against Neisseria meningitides bacteria available in the United States: meningococcal
polysaccharide vaccine (Menomune®) and meningococcal conjugate vaccine (Menactra®,
Menveo® and MenHibrix®). (71, 72)
CONCLUSION
Meningococcal meningitis is a major cause of morbidity and mortality in the meningitis belt
of sub-Saharan Africa where it occurs in epidemics every 8-12 years. Meningococcal disease
is spread by person to person contact through respiratory droplets of infected people.
Meningococcal meningitis and septicemia tends to be more common during winter and early
spring. Most cases occur below age 5 years and particularly during the first year of life. In
newborns and infants, the classic symptoms of fever, headache, and neck stiffness may be
absent or difficult to notice. Several different bacteria can cause meningitis. Neisseria
meningitides is the one with the potential to cause large epidemics. Diagnosis of bacterial
meningitis is based on identification of the pathogen in the cerebrospinal fluid (CSF),
obtained by lumbar puncture, using a combination of macroscopic, microscopic and culture
or PCR techniques. Early diagnosis and treatment are very important. Meningococcal disease
can be treated with a number of effective antibiotics. Vaccination is the best way to protect
against meningococcal disease.
ACKNOWLEDGEMENT
The authors reported no conflict of interest. The authors alone are responsible for the content
and writing of the paper and no funding has been received on this work. Ethical Approval
was not required.
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