This document discusses the epidemiology of cholera. It begins by describing cholera as an acute diarrheal disease caused by the Vibrio cholerae bacteria. Humans are the only reservoir for the infection. The bacteria spreads through contaminated food and water and direct contact. Clinical features include a sudden onset of watery diarrhea and vomiting. Laboratory diagnosis involves collecting a stool sample and testing for the presence of V. cholerae. Environmental factors like poor sanitation and access to contaminated water sources increase risk of transmission.
Epidemiology of cholera, its history and clinical features are described. The prevention of cholera has also been discussed. Global roadmap for ending cholera by 2030 is also briefly touched upon. This would be useful for medical students.
This ppt is About Rabies epidemiology and treatment .
This is done by using Park book 24th edition of PSM .
This presentation is presented in academics of Master of public health in Christian medical college .
One more Important thing is that that zareb regime (intramuscular ) is not practiced . We try to make this ppt lucid. and the statistics is used in the presentation is upto 27 june 2018
Common forms of plague
Bubonic plague is the most common form of plague. It usually occurs after the bite of an infected flea. The key feature of bubonic plague is a swollen, painful lymph node, usually in the groin, armpit or neck. Other symptoms include fever, chills, headache, and extreme exhaustion. A person usually becomes ill with bubonic plague 1 to 6 days after being infected. If not treated early, the bacteria can spread to other parts of the body and cause septicemic or pneumonic plague.
Epidemiology of cholera, its history and clinical features are described. The prevention of cholera has also been discussed. Global roadmap for ending cholera by 2030 is also briefly touched upon. This would be useful for medical students.
This ppt is About Rabies epidemiology and treatment .
This is done by using Park book 24th edition of PSM .
This presentation is presented in academics of Master of public health in Christian medical college .
One more Important thing is that that zareb regime (intramuscular ) is not practiced . We try to make this ppt lucid. and the statistics is used in the presentation is upto 27 june 2018
Common forms of plague
Bubonic plague is the most common form of plague. It usually occurs after the bite of an infected flea. The key feature of bubonic plague is a swollen, painful lymph node, usually in the groin, armpit or neck. Other symptoms include fever, chills, headache, and extreme exhaustion. A person usually becomes ill with bubonic plague 1 to 6 days after being infected. If not treated early, the bacteria can spread to other parts of the body and cause septicemic or pneumonic plague.
Epidemiology and Control Measures for CholeraAB Rajar
It is an acute diarrheal disease caused by Vibrio Cholera typically characterized by sudden onset of profuse,effortless,watery diarrhea followed by vomiting, rapid dehydration, muscular cramps and suppression of urine.
This ppt contains all the information about the epidemiology of cholera. It is useful for students of the medical field learning Preventive and social medicine, Swasthavritta (Ayurved), and everyone who is interested in knowing about it.
Cholera is a acute diarrhoeal disease caused by Vibrio cholerae.
Majority of infection are mild or asymptomatic.
IV B.PHARM, 8-SEMESTER ,SOCIAL AND PREVENTIVE PHARMACY.
CHOLERA DISESASE
DEFINITION, SYMPTOMS, CAUSES, TREATMENT, PREVENTION.
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
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Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
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
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
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
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.
2. INTRODUCTION
• Is an acute diarrhoeal disease caused by Vibrio
Cholerae.
• Cases range from symptomless to severe infections
• Typical cases are characterized by the sudden onset of
profuse, effortless, watery diarrhoea followed by
vomiting, rapid dehydration, muscular cramps and
suppression of urine.
• Unless there is rapid replacement of fluid and
3. INTRODUCTION
• Cholera transmission is closely linked to
inadequate environmental management.
• Typical at risk areas include peri urban
slums with poor basic infrastructure.
6. AGENT FACTORS
• The agent that causes cholera is named as Vibrio
cholerae.
• Vibrio cholerae are killed within 30 min by heating
at 56 deg C, or with in a few seconds by boiling.
• They remain in ice for 4 – 6 weeks or longer.
• Drying and sunshine will kill them in a few hours.
• They are easily destroyed by coal-tar disinfectants
such as Cresol.
• Bleaching powder (6 mg/lit) instantly kills the
organism.
7. AGENT FACTORS
• The vibrios multiply in the small intestinal
lumen and produce an exotoxin
(enterotoxin).
• This toxin produces diarrhoea through
its effect on the adenylate cyclase-cyclic
AMP system of the mucosal cells of the
small intestine
• The endotoxin has no effect on other
tissues except the intestinal epithelial
8. RESERVOIR OF INFECTION
• The human being is the only known reservoir
• The individual may be a case or a carrier
• Cases range from inapparent infections to severe
ones
• Individuals with low immunity (undernourished
children, people with HIV) are at a greater risk of death
if infected.
• It is the mild and asymptomatic cases that play a
significant role in maintaining endemic reservoir
9. RESERVOIR OF INFECTION
• Since carriers excrete fewer vibrios than clinical
cases, carriers best detected by bacteriological
examination of the purged stool induced by
administration of 30-60 g of magnesium sulphate
in 100 ml of water by mouth.
10. Infective Material
• The immediate source of infection are the stools
and vomit of cases and carriers
• Large number of vibrios (107-1010 vibrios /ml of
fluid) are present in watery stools of patients
• An average patient excretes 10- 20 litres of fluid
• Carriers excrete fewer vibrios than cases (102-
105 vibrios / ml stool)
11. INFECTIVE MATERIAL
• The immediate source of infection are the stools
and vomit of cases and carriers
• Large number of vibrios (107-1010 vibrios /ml of
fluid) are present in watery stools of patients
• An average patient excretes 10- 20 litres of fluid
• Carriers excrete fewer vibrios than cases (102-
105 vibrios / ml stool)
12. PERIOD OF COMMUNICABILITY
◦ A case of cholera is infectious for a period of 7-10 days
◦ Convalescent carriers are infectious for 2-3 weeks and
chronic carrier state may last from a month upto 10
years or more
13. CARRIERS
◦ Four types of cholera carriers have been identified
◦ PRECLINICAL or INCUBATORY CARRIERS: The incubatory carriers are potential
patients (since the incubation period of cholera is short ;1-5 days, incubatory carriage
is of short duration)
◦ CONVALESCENT CARRIERS: Patients who have recovered from an attack of
cholera may continue to excrete vibrios during the convalescence period for 2-3
weeks
◦ CONTACT or HEALTH CARRIERS: This is the result f sub clinical infection contracted
through association with a source f infection (in case of an infected environment). The
duration of contact carrier state is usually less than 10 days.
◦ CHRONIC CARRIERS: A chronic carrier state occurs infrequently. The gall bladder is
infected in this state. In such case antibody titre against V. cholerae 01 raises and
remains positive as long as the person harbours the organism
14. HOST FACTORS
• AGE & GENDER: Cholera affects all age and both gender. In
endemic areas attack rate is highest in children
• GASTRIC ACIDITY : Is an effective barrier. The vibrio is destroyed
at an acidity of pH 5 or lower. Condition that affect gastric acidity
may influence individual susceptibility.
• POPULATION MOBILITY: Movement of population (pilgrimage,
marriages, fairs & festivals) results in increased risk of exposure to
infection
• ECONOMIC STATUS: Incidence of cholera tends to be highest in
the lower socio economic groups which could be attributed to poor
hygiene
• IMMUNITY: An attack of cholera is followed by immunity to re
infection, but the duration and degree of immunity are not known.
Vaccination gives only partial immunitybfor3-6 months.
15. ENVIRONMENTAL FACTORS
• Vibrio transmission is highly possible in a community
with poor environmental sanitation.
• The environmental factors of importance include
contaminated water and food
• These comprise certain human habits favouring water
and soil pollution, low standards of personal hygeine,
lack of education and poor quality of life
16. MODES OF TRANSMISSION
◦ Transmission occurs from man to man via fecally contaminated water,
contaminated food and drinks and by direct contact
◦ FAECALLY CONTAMINATED WATER: Uncontrolled water sources such as
wells, ponds, lakes, streams and rivers pose a great threat.
◦ CONTAMINATED FOOD AND DRINKS: Ingestion of contaminated food
and drinks have been associated with the outbreak of cholera. Bottle
feeding could be a significant risk factor for infant.
◦ DIRECT CONTACT: In developing countries considerable number of cases
may result from secondary transmission (person to person transmission
through contaminated fingers while carelessly handling human excreta or
vomitus of patients & through contaminated linens and fomites.
18. PATHOGENESIS
• Diarrhoea is the main symptom of cholera
• The pathogen gets through the mucus which overrides the intestinal
epithelium
• This probably secretes mucinase which helps the organism to move
rapidly through the mucus
• Then the vibrio gets attached or adhered to the intestinal epithelial
cells.
• When the vibrio becomes adherent to the mucosa, it produces its
enterotoxin which consists of 2 parts (the light or L toxin and heavy
or H toxin)
19. PATHOGENESIS
• The L toxin combines with substances in the epithelial cell
membrane called gangliosides and this binds the vibrios to the
cell wall. Binding is irreversible.
• The mode of H toxin is not fully clear. However the H toxin
activates the adenyl cyclase in the intestinal epithelial cells.
The activated adenyl cyclase causes a rise in in 3,5 adeosine
monophosphate (cAMP)
• The cAMP provides energy which drives the fluid and ions
into the lumen of intestine.
• This fluid is isotonic and is secreted by all segments of small
intestine. The increase in fluid is the cause of diarrhoea (and
not peristalsis)
20. CLINICAL FEATURES
• The severity of cholera depends on the rapidity and
duration of fluid loss.
• A typical case of cholera shows three stages:
1. Stage of evacuation
2. Stage of collapse
3. Stage of recovery
21. ◦ STAGE OF EVACUATION: The onset is abrupt with profuse, painless, watery
diarrhoea followed by vomiting. The patient may pass as many as 40 stools in a
day. The stools may have rice watery appearance
◦ STAGE OF COLLAPSE: The patient then passes into the stage of collapse
because of dehydration.
◦ The classical signs are sunken eyes, hollow cheeks, scaphoid abdomen, sub
normal temperature, washer man’s hands and feet, absent pulse, unrecordable
blood pressure, loss of skin elasticity, shallow and quick respirations. The output of
urine decreases and may ultimately cease.
◦ The patient becomes restless and complains of intense thirst and cramps in legs
and abdomen. Death may occur at this stage, due to dehydration and acidosis
resulting from diarrhoea.
◦ STAGE OF RECOVERY: If death does not occur then patients begin to show signs
clinical improvement. The blood pressure begins to raise, the temperature returns to
normal and urine secretion is re established. If anuria persists, the patient may die
of renal failure
23. LAB DIAGNOSIS
• COLLECTION OF STOOLS: a fresh specimen of stools should be collected for
laboratory examination. Sample should be collected before the person is treated
with antibiotics. Collection may be made in one of the following ways.
• RUBBER CATHETHER COLLECTION: Soft rubber catheter (No.26-28) sterilized
by boiling should be used. The catheter is introduced (after lubrication with liquid
paraffin) for atleast 4-5 cm into the rectum. The specimen voided may be collected
directly into a transport media (VR medium, alkaline peptone water)
• RECTAL SWAB: Swabs consisting of 15-20 cm long wooden sticks with one end
wrapped with absorbant cotton, sterilized by autoclaving can be also used Rectal
swabs should be dipped with into the holding medium before being introduced into
the rectum.
• If no transport medium is available, a cotton tipped rectal swab should be
soaked in the liquid stool, placed in a sterile plastic bag, tightly sealed and
sent to testing laboratory
24. LAB DIAGNOSIS
• COLLECTION OF STOOLS: a fresh specimen of stools should be collected for
laboratory examination. Sample should be collected before the person is treated
with antibiotics. Collection may be made in one of the following ways.
• RUBBER CATHETHER COLLECTION: Soft rubber catheter (No.26-28) sterilized
by boiling should be used. The catheter is introduced (after lubrication with liquid
paraffin) for atleast 4-5 cm into the rectum. The specimen voided may be collected
directly into a transport media (VR medium, alkaline peptone water)
• RECTAL SWAB: Swabs consisting of 15-20 cm long wooden sticks with one end
wrapped with absorbant cotton, sterilized by autoclaving can be also used Rectal
swabs should be dipped with into the holding medium before being introduced into
the rectum.
• If no transport medium is available, a cotton tipped rectal swab should be
soaked in the liquid stool, placed in a sterile plastic bag, tightly sealed and
sent to testing laboratory
25. LAB DIAGNOSIS
• VOMITUS: This is practically never used as the chances of isolating vibrios
are much less and there is no advantage
• WATER: Samples containing 1-3 litres of suspect water should be collected
in sterile bottles (for filter method) Or 9 volumes of sample water added to 1
volume of 10 per cent peptone water and despatched to the lab by quickest
method of transport
• FOOD SAMPLE : Samples of food suspected to be contaminated with
vibrios amounting to 1-3 gms are collected in a transport media and sent to
lab
• TRANSPORTATION: the stool should be transported in sterilized
McCartney bottles 30 ml capacity containing alkaline peptone water or VR
medium
26. • One gram or one ml of faeces in 10 ml of the holding
medium will suffice
• Rectal swabs should have their tops broken off hat caps
of the containers can be replaced.
• DIRECT EXAMINATION: If a microscope with dark field
illumination is available it may be possible to diagnose about
80 percent of cases within few min
• CULTURE METHODS: On arrival at the laboratory the
specimen is well shaken abd about 0.5 to 1 ml material is
inoculated into Peptone Water Tellurite medium for
enrichment.
• GRAM TESTING: Gram negative and curved rods with
characteristic scintillating type of movement in hanging drop
preparations are characteristic of Vibrio cholerae.
28. ◦ The following are guidelines as per WHO to control cholera
• 1. Verification of the diagnosis
• 2. Notification
• 3. Early case finding
• 4. Establishment of treatment centres
• 5. Rehydration therapy
• 6.Adjuncts to therapy
• 7. Epidemiological investigation
• 8. Sanitation measures
• 9. Chemoprophylaxis
• 10. Vaccination
• 11. Health education
29. ◦ Verification & diagnosis: It is important to confirm the outbreak of
cholera . All cases of diarrhoea should be investigated even on
slightest suspicion.
◦ Notification: Cholera is a notifiable disease locally and nationally
(though not internationally). Health workers at all level should be
trained to identify and notify cases immediately to the local health
authority
◦ Early case Finding: An aggressive search for case (mild, moderate,
severe should be made in the community to be able to initiate prompt
treatment. Early detection of cases also permits the detection of
infected household contacts and helps the epidemiologist in
investigating the means of spread for deciding on specific
intervention.
◦ Establishment of treatment centers: In control of cholera no time
should be lost in for providing treatment to patients. Hence treatment
30. ◦ Rehydration therapy: Mortality rated due to cholera can be
effectively brought down by effective rehydration therapy.
Rehydration may be oral or intravenous
◦ Adjuncts to Therapy: Antibiotics should be given as soon as
vomiting stops. The commonly used antibiotics are
flouroquinolones, tetracycline, azithromycin, ampicilline and
trimethioprim slfamethoxazole.
◦ Epidemiological Investigation: Epidemiological studies may be
undertaken to define the extent of outbreak, and identify the
modes of transmission so as to identify specific control measures.
◦ Sanitation Measures: Sanitation measures focusing on water
sanitation, excreta disposal, food sanitation, disinfection should
be put into vigorous interventions.
31. ◦ Chemoprophylaxis: Mass chemoprophylaxis is not advised for
the entire community. Chemoprophylaxis is advised for house
hold contacts.
◦ Tetracycline is the drug of choice for mass chemoprophylaxis. It
has to be given over a 3 day period, in twice daily dose of 500
mg for adults, 125 mg for children aged 4-13 yrs and 50 mg for
children aged 0-3 years.
◦ Vaccination: Two types of vaccination are available :
◦ 1. Dukoral (WC-rBS) – Monovalent, heat killed vaccine. Not
advised for children less than 2 years of age.
◦ 2. Sanchol & mORCVAX- Oral vaccine. Bivalent.
◦ Health Education: The benefit of early reporting and proper
hygiene measures should be taught to the community