Syphilis is a sexually transmitted disease (STD) caused by an infection with spirochete
bacteria known as Treponema pallidum.
Like other STDs, syphilis can be spread by any type of sexual contact. Syphilis can also be
spread from an infected mother to the fetus during pregnancy or to the baby at the time of
birth.
The signs and symptoms of syphilis vary depending in which of the four stages it presents
(primary, secondary, latent, and tertiary)
Pertussis : Highly contagious respiratory infection caused by Bordetella pertussis
Outbreaks first described in 16th century
Bordetella pertussis isolated in 1906
Estimated >300,000 deaths annually worldwide
Before the availability of pertussis vaccine in the 1940s, public health experts reported more than 200,000 cases of pertussis annually.
Since widespread use of the vaccine began, incidence has decreased more than 75% compared with the pre-vaccine era.
In 2012, the last peak year, CDC reported 48,277 cases of pertussis.
Extremely contagious-attack rate 100%
Immunity is never complete
Protection begins to wane in 3-5 yrs after vaccination
contains about the introduction , causative agents , transmission , clinical features , diagnosis , management and guidelines in Nepal , breaking the chain of transmission
NATIONAL CENTER FOR CASE STUDY TEACHING IN SCIENCEBad Blo.docxvannagoforth
NATIONAL CENTER FOR CASE STUDY TEACHING IN SCIENCE
“Bad Blood” by Fourtner, Fourtner, & Herreid Page 1
by
A.W. Fourtner, C.R. Fourtner and C.F. Herreid
University at Buff alo, State University of New York
Bad Blood:
A Case Study of the Tuskegee Syphilis Project
The Disease
Syphilis is a venereal disease spread during sexual intercourse. It can
also be passed from mother to child during pregnancy. It is caused
by a corkscrew-shaped bacterium called a spirochete, Treponema
pallidum. Th is microscopic organism resides in many organs of
the body but causes sores or ulcers (called chancres) to appear
on the skin of the penis, vagina, mouth, and occasionally in the
rectum, or on the tongue, lips, or breast. During sex the bacteria
leave the sores of one person and enter the moist membranes of
their partner’s penis, vagina, mouth, or rectum.
Once the spirochetes wiggle inside a victim, they begin to multiple
at an amazing rate. (Some bacteria have a doubling rate of 30
minutes. You may want to consider how many bacteria you might
have in 12 hours if one bacterium entered your body doubling
at that rate.) Th e spirochetes then enter the lymph circulation,
which carries them to nearby lymph glands that may swell in
response to the infection.
Th is fi rst stage of the disease (called primary syphilis) lasts only a
few weeks and usually causes hard red sores or ulcers to develop
on the genitals of the victim, who can then pass the disease on
to someone else. During this primary stage, a blood test will not
reveal the disease but the bacteria can be scraped from the sores.
Th e sores soon heal and some people may recover entirely without
treatment.
Secondary syphilis develops two to six weeks after the sores heal. Th en fl u-like symptoms appear with fever,
headache, eye infl ammation, malaise, and joint pain, along with a skin rash and mouth and genital sores.
Th ese symptoms are a clear sign that the spirochetes have traveled throughout the body by way of the lymph
and blood systems, where they now can be readily detected by a blood test (e.g., the Wassermann test). Scalp
hair may drop out to give a “moth-eaten” look to the head. Th is secondary stage ends in a few weeks as the
sores heal.
Signs of the disease may never reappear even though the bacteria continue to live in the person. However, in
about 25% of those originally infected, symptoms will fl are up again in a late or tertiary stage syphilis.
NATIONAL CENTER FOR CASE STUDY TEACHING IN SCIENCE
“Bad Blood” by Fourtner, Fourtner, & Herreid Page 2
Almost any organ can be attacked, such as the cardiovascular system, producing leaking heart valves and
aneurysms—balloon-like bulges in the aorta that may burst, leading to instant death. Gummy or rubbery
tumors fi lled with spirochetes and covered by a dried crust of pus may develop on the skin. Th e bones may
deteriorate as in osteomyelitis or tuberculosis and may produce disfi guring facial mutilations as na ...
Pertussis : Highly contagious respiratory infection caused by Bordetella pertussis
Outbreaks first described in 16th century
Bordetella pertussis isolated in 1906
Estimated >300,000 deaths annually worldwide
Before the availability of pertussis vaccine in the 1940s, public health experts reported more than 200,000 cases of pertussis annually.
Since widespread use of the vaccine began, incidence has decreased more than 75% compared with the pre-vaccine era.
In 2012, the last peak year, CDC reported 48,277 cases of pertussis.
Extremely contagious-attack rate 100%
Immunity is never complete
Protection begins to wane in 3-5 yrs after vaccination
contains about the introduction , causative agents , transmission , clinical features , diagnosis , management and guidelines in Nepal , breaking the chain of transmission
NATIONAL CENTER FOR CASE STUDY TEACHING IN SCIENCEBad Blo.docxvannagoforth
NATIONAL CENTER FOR CASE STUDY TEACHING IN SCIENCE
“Bad Blood” by Fourtner, Fourtner, & Herreid Page 1
by
A.W. Fourtner, C.R. Fourtner and C.F. Herreid
University at Buff alo, State University of New York
Bad Blood:
A Case Study of the Tuskegee Syphilis Project
The Disease
Syphilis is a venereal disease spread during sexual intercourse. It can
also be passed from mother to child during pregnancy. It is caused
by a corkscrew-shaped bacterium called a spirochete, Treponema
pallidum. Th is microscopic organism resides in many organs of
the body but causes sores or ulcers (called chancres) to appear
on the skin of the penis, vagina, mouth, and occasionally in the
rectum, or on the tongue, lips, or breast. During sex the bacteria
leave the sores of one person and enter the moist membranes of
their partner’s penis, vagina, mouth, or rectum.
Once the spirochetes wiggle inside a victim, they begin to multiple
at an amazing rate. (Some bacteria have a doubling rate of 30
minutes. You may want to consider how many bacteria you might
have in 12 hours if one bacterium entered your body doubling
at that rate.) Th e spirochetes then enter the lymph circulation,
which carries them to nearby lymph glands that may swell in
response to the infection.
Th is fi rst stage of the disease (called primary syphilis) lasts only a
few weeks and usually causes hard red sores or ulcers to develop
on the genitals of the victim, who can then pass the disease on
to someone else. During this primary stage, a blood test will not
reveal the disease but the bacteria can be scraped from the sores.
Th e sores soon heal and some people may recover entirely without
treatment.
Secondary syphilis develops two to six weeks after the sores heal. Th en fl u-like symptoms appear with fever,
headache, eye infl ammation, malaise, and joint pain, along with a skin rash and mouth and genital sores.
Th ese symptoms are a clear sign that the spirochetes have traveled throughout the body by way of the lymph
and blood systems, where they now can be readily detected by a blood test (e.g., the Wassermann test). Scalp
hair may drop out to give a “moth-eaten” look to the head. Th is secondary stage ends in a few weeks as the
sores heal.
Signs of the disease may never reappear even though the bacteria continue to live in the person. However, in
about 25% of those originally infected, symptoms will fl are up again in a late or tertiary stage syphilis.
NATIONAL CENTER FOR CASE STUDY TEACHING IN SCIENCE
“Bad Blood” by Fourtner, Fourtner, & Herreid Page 2
Almost any organ can be attacked, such as the cardiovascular system, producing leaking heart valves and
aneurysms—balloon-like bulges in the aorta that may burst, leading to instant death. Gummy or rubbery
tumors fi lled with spirochetes and covered by a dried crust of pus may develop on the skin. Th e bones may
deteriorate as in osteomyelitis or tuberculosis and may produce disfi guring facial mutilations as na ...
The largest pandemics throughout history and its consequencesFernando Alcoforado
This article aims to present the great pandemics throughout history, pointing out how they originated, pointing out its origins and causes, the characteristic symptoms of the disease, its impact on society with the solutions adopted by medicine for its eradication, as well as the threats of new pandemics in the world such as around plague, measles and influenza, respiratory infections that are transmitted by birds and caused by unknown agents, the so-called “disease X” on the radar of WHO- World Health Organization, the possibility of an unprecedented microbe doing damage and, lastly, multi-resistant bacteria and fungi.
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
Key question:
Could the plague ever re-emerge on a similar level in the twenty-first century?
Due to the potential seriousness of the disease this is a subject worthy of epidemiological consideration and research.
Dr. Richard Chmielewski, DO, FACEP, NMM/OMM lectured on the flu pandemic and the osteopathic approach to treating influenza through various techniques focused on circulation and the lymphatic system.
More information is available at http://falconclinic.com.
Impact of infectious diseases As people know, now the COVID-1.docxcharisellington63520
Impact of infectious diseases
As people know, now the COVID-19 is quite serious and spreading rapidly. And people do not have a curing method about it. COVID-19 causes xxx confirmed diagnosis and xxx death in the whole world. Also, people still don't know where COVID-19 comes from and how we can protect ourselves from being healthy. From COVID-19, people should have profound thinking about why infection diseases cause and how can human avoid virus infection and how can government-run do during the virus outbreak and reconstruction after the outbreak. Historically, there are so many infection diseases in the world, such as SARAS, Ebola, HIV and COVID-19.
Most infectious diseases are caused by microorganisms, such as bacteria, viruses, parasites, or fungi. Diseases can be spread from person to person, directly or indirectly. Zoonotic diseases are infectious diseases of animals that can cause diseases when spread to humans. However, infectious diseases are caused by multiple reasons, mostly infectious is from animals, because some animals they carry the virus in their body, those viruses may not affect themselves, however, when spreading of the virus, the virus will mutate to parasitize humans, and human's body will have an overt reaction to the virus. In this article, it will discuss 4 infectious diseases, SARAS, HIV, Ebola, and COVID-19.
In the first place, whenever someone always have doubts where infectious diseases from, how infectious diseases are formed. 普遍上来说,Infectious diseases usually have a great harm rate, because when an infectious disease breaks out, the doctors usually do not have any preparations, so they can not treat the disease well, or sometimes they can infect the doctor themselves. If people want to protect them in order to avoid disease, the most considerable thing is that they must know least one infectious history, such as how it formed, who is more susceptible to infection, does it have any medical treatment, does it success. SARAS is a typical example about it. Practically, SARS-CoV is the severe acute respiratory syndrome coronavirus, and it is deadly infectious diseases and people are also easily infected. SARS- CoV cause 8096 cases, including 774 deaths, in 37 countries for 8 months. The transmit speed of SRAS is very fast, people who get infection, they always have Fever, cough, difficulty breathing, chest radiographs showing shadows of both lungs, and some patients developed respiratory failure. Unfortunately, the use of antibiotics against bacterial infections has not worked. And SRAS infectious for people is depend on the strength of the personal resistance occurs. From research, SRAS-CoV's occurrence of spreading in wild animals. Because the scientist are aware of SRAS virus related to the spread of wild animals. Following this clue, the scientists first targeted the Guangdong wildlife market, and soon isolated and detected exactly the same virus as the SARS virus in the civet cats on the market..
It is one of three type of hearing loss
Hearing loss due to defect in the sensory apparatus cochlea (sensory)
Or in the pathway of conduction of nerve impulses to the brain (neural)
Neural causes can be
peripheral:8 nerve
Central:auditory pathway or cortex
A hernia happens when an organ or maybe fatty tissue squeezes through a weak
spot in a surrounding muscle or connective tissue called fascia.
Hernias were
once the leading cause of acute intestinal obstruction.
Public alertness of early
repair has markedly reduced the frequency of incarceration of intestine in these
musculofascial defects.
The common sites for these defects, in order of frequency,
are inguinal, umbilical, incisional and femoral. Techniques of repair continue to
evolve but tension-free, mesh repairs are the current standard.
You may have a hernia if you can feel a soft lump in your belly or groin or in a
scar where you had surgery in the past. The lump may go away when you press on
it or lie down. It may be painful, especially when you cough, bend over, or lift
something heavy.
Möbius syndrome: is rare congenital neurological disorder
There are four group: Simple hypoplasia, Primary lesions in CNs, Focal necrosis in brainstem nuclei and Primary myopathy.
Signs and symptoms: Limb abnormalities, Chest-wall abnormalities, Crossed eyes and Difficulty in breathing and/or in swallowing.
It results from a vascular disruption, The use of drugs and a traumatic pregnancy associated with development of Möbius syndrome.
There is no single course of medical treatment for Möbius syndrome.
Psychiatry is the branch of medicine focused on the diagnosis, treatment and prevention of mental, emotional and behavioral disorders
Schizophrenia , psychosis, bipolar disorder are different type of psychiatric disorder
Features of schizophrenia are delusions and hallucinations
Bipolar affective disorder is one of the most common psychiatric illness
elevated mood and pressured speech are clinical features of bipolar disorder
Hearing loss is one of the most frequent sensory deficient in human population. It affects more than 360 million people.
Consequences of hearing impairment include reduced ability to communicate, economic and educational disadvantage, social isolation and stigmatization.
we will talk also about the common types & causes of hearing loss and the possible applicable methods to treat these conditions.
Define rheumatic fever.
what are the main causes of rheumatic fever.
List the clinical finding of rheumatic fever.
To list and identify the most commonly used laboratory tests to detect the rheumatic fever.
How to treat rheumatic fever .
To list some of the procedures that are used for the prevention of the rheumatic fever .
Can be defined as a dense loss of memory for recent events but with preserved intelligence and personality ,memory can be either totally or partially lost according to the extent of damage that was caused .
Can be defined as a dense loss of memory for recent events but with preserved intelligence and personality ,memory can be either totally or partially lost according to the extent of damage that was caused .
Define rheumatic fever.
what are the main causes of rheumatic fever.
List the clinical finding of rheumatic fever.
To list and identify the most commonly used laboratory tests to detect the rheumatic fever.
How to treat rheumatic fever .
To list some of the procedures that are used for the prevention of the rheumatic fever .
Hepatitis is generally refer to inflammation of liver, it is resulted from infectious causes (such as viral, bacterial and fungal causes ) or noninfectious ( such as alcohol drugs, autoimmune diseases and metabolic diseases) , in this research , I’m going to focus on viral hepatitis because it is the most common cause of acute hepatitis in USA ( 50% of cases ).
The commonness and important viruses that cause viral hepatitis are (A,B,C,D,E) types, approximately 4.4 million Americans are currently living with chronic hepatitis B and C.
The liver continuously filters blood which circulates throughout the body, converting nutrients and drugs absorbed from the digestive tract into ready for using chemicals. The
liver performs many other important functions, such as removing toxins and other chemical waste products from the blood and readying them for excretion. Because all the
blood in the body must pass through it, the liver is unusually accessible to cancer cells traveling in the bloodstream.
We all Know that the most dangerous medical condition in our modern life is cancer!
There are two types of this awful condition, BENIGN and MALIGNANT. The first is safe
and can be removed by many ways without large effects on the patients, but the last
one is very killing and can cause a lot of consequences on the patient, even death.
In my report, I will discuss one of the cancer's types that occur in the human body,
which is "Melanocytes tumors".
I mentioned everything about Melanocytes tumor, starting with signs and symptoms,
and finishing with diagnosis and treatment.
The Melanocytes are found in two areas of the human body, (Eye and skin). It can be
hidden for a lot of time without discovering by patients or doctors, so all people need
to be checked every month or years to be sure that they are safe from this killing
condition.
Also, this condition can be normal without problems and found in all people
approximately, such we called it "Nevus" or "Shama" in Arabic language which is one of
the beauty sings.
ARDS is a widespread acute inflammatory lung injury with various degrees of intensity that occurs in response to a pulmonary or systemic insult and invariably leads to abnormalities in gas exchange (predominantly hypoxemia) and in pulmonary mechanics. It is a prototypical disease of reduced lung compliance that causes acute respiratory failure in both children and adults.
In effect, ARDS impairs the lungs' ability to exchange oxygen and carbon dioxide with the blood across a thin layer of the lungs' microscopic air sacs known as alveoli. The syndrome is associated with a death rate between 20 and 50% .
Stroke is sudden death of brain cells result from deprivation of oxygen ,that caused from
blockage of blood flow or rapture of an essential artery of brain or by cerebral thrombosis that may caused the stroke ,that occurs in varying signs and symptoms from temporary paralysis and loss of speech to the brain damage and death .
Stroke also called brain attack or CVA (Cerebrovascular Accident),it is one of the most risky and critical neurological disorder and also it is the third most common cause of
death in development country(after heart disease and cancers) .it is cause of death in people that younger than 45 years ,that cases account 3000 annually ,stroke also is one of 10
causes of death children and that include 5-10% cases of stroke.
Stroke is clinical syndrome that’s clinical features develops rapidly through minutes because
of a vascular causes
Rubella is a directly transmitted immunizing infection that usually occurs during childhood and is associated with low morbidity and mortality. Infection of women during early pregnancy can lead to spontaneous abortion, fetal death or children born with congenital rubella syndrome (CRS), which is associated with multiple disabilities that can require lifelong care , including hearing impairment, cataracts and congenital heart disease
Hashimoto's thyroiditis (HT) is one of the most common human autoimmune
diseases responsible for numerous morbidity in women. Hashimoto’s disease
is also called Hashimoto’s thyroiditis, chronic lymphocytic thyroiditis, or
autoimmune thyroiditis. Hashimoto’s disease is at least 8 times more common
in women than men. Although the disease may occur in teens or young women,
it more often appears between ages 40 and 60. Your possibility of developing
Hashimoto’s thyroiditis increases if other family members have the disease.
It is an organ-specific T-cell mediated disease that affects the thyroid gland,
and genetics play a contributory role in its complexity. To date, significant
progress has been made in identifying and characterizing those genes involved
in the disease.
The hearing impairment is one of the most frequent sensory deficient in human population.
Consequences of hearing impairment include inability to interpret speech sounds, often producing a reduced ability to communicate, delay in language acquisition, economic and educational disadvantage, social isolation and stigmatization. The function of the ear and the hearing process play an important role in the verbal communication between individuals and make a noticeable impact on individual’s life. So, we decide here to talk about hearing function of the ear from many different points of view. These points of view will include mainly the anatomical, physiological and pathological basis of ear and hearing process. After that, we will talk about the common types and causes of hearing loss and the possible applicable methods to treat these conditions.
Hypopituitarism is defined as a diminished function of the pituitary gland. First described in 1914 by Simmonds, it is
also known as Simmonds’ disease. There are two main reasons for the hypofunction of the pituitary gland: it can
result from pituitary dysfunction per se or from hypothalamic damage. In both cases, the production of pituitary
hormones is diminished. When a single pituitary hormone is affected, this is called isolated pituitary deficiency.
When two or more pituitary hormones are affected, this is referred to as multiple pituitary hormone deficiency.
Panhypopituitarism is a state of reduction of all pituitary hormones.
The multiple aspects of normal pituitary function serve to predict the wide range of clinical manifestations of hypopituitarism which are determined by the severity, extent and duration of the condition.
The discovery of antibiotics existed one of the significant events in medical history and said to have added a decade to the life expectancy of human beings. Antibiotics also known as antibacterial medications that inhibits or slows down
the growth of bacteria. Bacteria are microscopic organisms that cause many types of infection in the human beings.
We have special white blood cells that attack the harmful bacteria and this is the main function of our immune system. In some cases the body can’t defend itself
and needs the help of antibiotics with the immune system to attack the harmful bacteria.
Children and infants represents a large part of population in the developing
nations and those groups are usually prone to recurrent attacks of gastrointestinal and respiratory infections of viral origin and usually misuse of antibiotics in these groups have been reported
Oxygen is an essential and fundamental term for life. Cells use oxygen to
produce energy for normal cell activities, Free radicals are normal
consequence of ATP production in the mitochondria. These by-products
are in general reactive oxygen species (ROS) and reactive nitrogen
species (RNS). These two species are referred collectively as ROS/RNS.
The phrases "free radicals" and "reactive oxygen species" (ROS) are
frequently used interchangeably although this is not always correct. The
physiological state of increased steady-state ROS level along with certain
physiological effects has been called oxidative stress. These species play
a dual role. As benefit compounds at low or moderate levels. And as toxic
compounds at high concentrations by generation of oxidative stress .The
delicate balance between their two antagonistic effects is clearly an
important aspect of life [1-5]. Free radicals are, by definition, species
which contain an odd number of electrons. They may be positively
charged, negatively charged, or neutral and all three types are important
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.
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
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
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!
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Title: Sense of Smell
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 primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
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
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
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.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
3. 3
Introduction
Syphilis is a sexually transmitted disease (STD) caused by an infection with spirochete
bacteria known as Treponema pallidum.
Like other STDs, syphilis can be spread by any type of sexual contact. Syphilis can also be
spread from an infected mother to the fetus during pregnancy or to the baby at the time of
birth.
The signs and symptoms of syphilis vary depending in which of the four stages it presents
(primary, secondary, latent, and tertiary). [38]
The primary stage classically presents with a single chancre (a firm, painless, non-itchy
skin ulceration) but there may be multiple sores. [1]
In secondary syphilis a diffuse rash occurs, which frequently involves the palms of the
hands and soles of the feet. [1,2]
There may also be sores in the mouth or vagina. [1]
In latent syphilis, which can last for
years, there are few or no symptoms. [1]
In tertiary syphilis there are gummas (soft non-cancerous growths Syphilis has been
described for centuries. It can cause long-term damage to different organs if not properly
treated).
Figure 1: Chancre on glans and vagina is one of the signs of Syphilis disease.
4. 4
Definition and Transmission Ways
A chronic infectious disease caused by Treponema pallidum, either transmitted by direct
contact, usually in sexual intercourse, or passed from mother to child in utero, and
progressing through three stages characterized respectively by local formation of chancres,
ulcerous skin eruptions, and systemic infection that leads to general paresis. [2]
Syphilis has both acute and chronic forms that produce a wide variety of symptoms
affecting most of the body's organ systems. The range of symptoms makes it easy to
confuse syphilis with less serious diseases and ignore its early signs. Acquired syphilis has
four stages (primary, secondary, latent, and tertiary) and can be spread by sexual contact
during the first three of these four stages.
Syphilis, which is also called lues (from a Latin word meaning plague), has been a major
public health problem since the sixteenth century. The disease was treated with mercury or
other ineffective remedies until World War I, when effective treatments based on arsenic
or bismuth were introduced. These were succeeded by antibiotics after World War II. At
that time, the number of cases in the general population decreased, partly because of
aggressive public health measures. This temporary decrease, combined with the greater
amount of attention given to AIDS in recent years, leads some people to think that syphilis
is no longer a serious problem. In actual fact, the number of cases of syphilis in the United
States has risen since 1980. This increase affects both sexes, all races, all parts of the
nation, and all age groups, including adults over 60. The number of women of
childbearing age with syphilis is the highest that has been recorded since the 1940s. About
25,000 cases of infectious syphilis in adults are reported annually in the United States. It is
estimated, however, that 400,000 people in the United States need treatment for syphilis
every year, and that the annual worldwide total is 50 million persons.
In 1999, the Centers for Disease Control and Prevention (CDC) joined several other
federal agencies in announcing the "National Plan to Eliminate Syphilis in the United
States." Eliminating the disease was defined as the absence of transmission of the disease;
that is, no transmission after 90 days following the report of an imported index case. The
national goals for eliminating syphilis include bringing the annual number of reported
cases in the United States below 1000, and increasing the number of syphilis-free counties
to 90% by 2005. In November 2002, the CDC released figures for 2000–2001, which
indicate that the number of reported cases of primary and secondary syphilis rose slightly.
This rise, however, occurred only among men who have sex with other men. The CDC
also stated that the number of new cases of syphilis has actually declined among women as
well as among non-Hispanic blacks. [3]
The increased incidence of syphilis since the 1970s is associated with drug abuse as well
as changes in sexual behavior. The connections between drug abuse and syphilis include
needle sharing and exchanging sex for drugs. In addition, people using drugs are more
likely to engage in risky sexual practices. As of 2002, the risk of contracting syphilis is
particularly high among those who abuse crack cocaine.
With respect to changing patterns of conduct, a sharp increase in the number of people
having sex with multiple partners makes it more difficult for public health doctors to trace
the contacts of infected persons. Women are not necessarily protected by having sex only
5. 5
with other women; in the past few years, several cases have been reported of female-to-
female transmission of syphilis through oral-genital contact. In addition, the incidence of
syphilis among men who have sex with other men continues to rise. Several studies in
Latin America as well as in the United States reported in late 2002 that unprotected sexual
intercourse is on the increase among gay and bisexual men.
Changing patterns of sexual behavior have led to a striking increase in the number of cases
of syphilis in eastern Europe since the collapse of the Soviet Union; Slovenia reported an
18-fold increase in reported cases of syphilis just between 1993 and 1994. Over half of the
new cases were linked to a source of infection in another European country. [4]
In general, high-risk groups for syphilis in the United States and Canada include:
sexually active teenagers
people infected with another sexually transmitted disease (STD), including AIDS
sexually abused children
women of childbearing age
prostitutes of either sex and their customers
prisoners
persons who abuse drugs or alcohol
The chances of contracting syphilis from an infected person in the early stages of
the disease during unprotected sex are between 30-50%.
Figure 2: The ways of syphilis's transmission
6. 6
History
The first known case of syphilis was documented by Dr. Pintor in 1493 in Rome. He
called it the Morbus Gallicus (The French Disease), and assumed that it had been carried
to Italy by the French Army. When the French began to notice it, they called it mal de
Naples (the sickness of Naples). Emperor Maximilian officially referred to it as malum
franciscum in 1495, but soon it was known by an altogether simpler name: The Pox.
It was called this because of the noticeable effects the disease had on the skin of the
afflicted, leaving lesions and decaying soft tissues that were sometimes mistaken for
leprosy. The name syphilis comes from a Greek legend about a peasant Apollo had
punished with poor health and lesions all over his body: the peasant’s name was Syphilus,
and he could only be cured (rather chillingly) by Mercury. [5]
It is generally believed that Columbus had brought the disease back with him from the
Americas. It existed in the Americas before Columbus arrived, and the timing certainly
was convenient. Some Renaissance thinkers suspected it had something to do with
astrology (see right and above left), while others thought it was derived from leprosy.
Francis Bacon believed that it was a result of cannibalism. [5]
The oldest artistic representation of syphilis is considered one on a Peruvian jug dating
back to VIth
century, depicting a mother suffering from syphilis holding a child in her
arms; the mother shows a saddle nose and superior incisive teeth with notches on their free
margins. The piece belongs to a collection of jugs also encompassing two jugs illustrating
leprosy and leishmaniasis. [6]
Albrecht Dürer, a German artist, depicts in woodcuts, for the first time in Europe, in 1496,
the image of a mercenary whose skin bears sores of multiple chancres (Fig. 3). Next to the
image lays written a text by physician Theodorus Ulsenius warning on the new disease,
also describing its signs and symptoms, mentioning that the illness is not curable and
establishing a direct link between the epidemic and the grand astrological conjuction in
1484 [6,7]
Figure 3: A mercenary whose skin presents multiple chancres, woodcut
by Albrecht Dürer, 1496 –published in a Romanian book in 1933
7. 7
From the very beginning numerous theories on the origin of syphilis existed, most of
which linking initially syphilis and leprosy together. According to several fables of the
early XVI th century, syphilis was the result of a sexual relation between a Spanish
prostitute and a leper. The prostitute also infected the soldiers of Charles VIII. Paracelsus
(1493-1541) considered that syphilis was the result of a sexual intercourse between a
prostitute suffering from gonorrhea and a French leper. In compliance to other theories of
the time, the disease might have been the outcome of the relationship of a prostitute having
a uterine abscess with a leper or the result of poisoning the wine with blood coming from a
leper [8]
.
Sexual transmitted diseases were seen as a single disease for many centuries. The
differentiation between gonorrhea, cancroids and syphilis as distinct maladies was
achieved no earlier than XIXth century. In the beginning of XVIIIth century there were
several doctors who treated syphilis and gonorrhea as separate entities. However, in 1767
John Hunter a famous physician of venereal diseases at that time (1728-1793) conducted
an experiment consisting of an inoculation of the urethral secretion of a gonorrhea patient
in the prepuce of a healthy patient, the last developing syphilis shortly afterwards.
Consequently, his experiment proved that syphilis resulted from gonorrhea. What Hunter
has missed out was that the patient from whom the urethral secretion was taken had both
syphilis and gonorrhea. However, his experiment, widely acknowledged in his époque,
delayed the differential diagnosis of the two diseases with a few decades [9,10]
.
In 1831 Ricord has designed a larger study on syphilis and gonorrhoea and succeeded to
show that the last occurs only after contact with gonorrohea patients, whilst the former –
only after contact with syphilis patients [9]
.
It was not earlier than 1905 that Schaudinn (1871-1906) and Hoffman (1868 – 1959) have
discovered the etiologic agent of syphilis, whom they have named Spirochaeta pallida, on
various syhilis lesions, proving its existence in both fresh and Giemsa coloured specimens.
It was them who changed the name of the bacterium subsequently to Treponema pallidum
[9,11,12]
.
In 1906 Landsteiner introduced the use of the dark-field microscopy method for the
detection of the spirochete of syphilis. In 1910 the German bacteriologist August
Wasserman (1866-1925) came with the first serologic test for syphilis and in 1949 Nelson
and Mayer have conceived Treponema pallidum immobilization test (TPI), the first
specific test for T. pallidum [11,13]
. Their discoveries had a very important role in detecting
the disease in patients who were suspected of syphilis, as well as in other healthy
individuals, and in monitoring syphilis response to treatment.
Syphilis treatments along the history
Initially, the treatment of syphilis included less efficient methods that were accompanied
by pain and multiple adverse reactions [11]
. Taking into consideration that the disease was
associated with the discovery of the American continent, numerous treatments included
plants brought from the New World, such as the guaiac tree (lat. Guaiacum Officinale),
8. 8
known also as sasafras or willow (Salix), which led to the widest recognition at the time
(Fig. 4). These plants acted as purgative agents, lead to sudoration, diarrhea and the
increase in urinary debt and were believed to be “blood cleansers” [9]
. One of the main
supporters of the guaiac tree utilisation in the treatment of syphilis, and in the same time
an ardupus opponent of mercury treatment, was Ulrich von Hutten (1488-1523), a former
priest who described in a detail the manifestations of the disease as well the simptoms of
mercury intoxication, based on his own experience as a sufferrer from the disease [14,15]
.
From the guaiac tree a decoction was made, the resulted potion was boiled and the patient
was assumed to consume the mixture daily for 30 days. Before drinking the potion, the
patient was covered in blankets in order to induce perspiration, and a mild purgative was
also administered [14]
.
German scientist Paul Ehrlich (1854-1915) received Nobel Prize in Physiology and
Medicine in 1908 for his discovery of arsphenamine (Salvarsan). The scientist discovered
the compound that acted like an antibiotic by accident, while working on finding a cure for
Trypanosoma brucei. Ehrlich’s desire was to discover a “magical bullet”- a drug able to
specifically bind to a bacterium and kill it, without affecting human cells. Salvarsan was
also denominated as “Compound 606”, as it was discovered after 606 failed experiments
(Fig. 5) [9]
. The safer novel drug that superseded the more toxic and less water-soluble
salvarsan as a treatment for syphilis was Neosalvarsan, also an arsenic compound. Both
Salvarsand and Neosalvarsan were replaced in the treatment of syphilis by Penicillin, after
1940.
Figure 4: Guaiacum officinale (guaiac tree), used widely for the
treatment of syphilis
Figure 5: The laboratory in which famous 606 compound was
invented
9. 9
Etiology
The cause of syphilis is infection with the spirochete T pallidum.T pallidum is solely a
human pathogen and does not naturally occur in other species. T pallidum has, however,
been cloned in Escherichia coli and has been used experimentally in rabbits.
Transmission of T pallidum occurs via penetration of the spirochetes through mucosal
membranes and abrasions on epithelial surfaces. It is primarily spread through sexual
contact but can be spread by exposure to blood products and transferred in utero. T
pallidum is a labile organism that cannot survive drying or exposure to disinfectants; thus,
fomite transmission (eg, from toilet seats) is virtually impossible.
Unprotected sex is the major risk factor for the acquisition of syphilis, especially among
men who have sex with men (MSM), who accounted for 83.7% of all syphilis cases in the
United States. [16]
There are two causes for syphilis disease which are:
Bacteriology
Treponema pallidum subspecies pallidum is a spiral-shaped, Gram-negative, highly
mobile bacterium. [17]
Three other human diseases are caused by related Treponema
pallidum subspecies, including yaws (subspecies pertenue), pinta (subspecies carateum)
and bejel (subspecies endemicum). Unlike subtype pallidum, they do not cause
neurological disease. Humans are the only known natural reservoir for subspecies
pallidum. It is unable to survive more than a few days without a host. This is due to its
small genome (1.14 Mbp) failing to encode the metabolic pathways necessary to make
most of its macronutrients. It has a slow doubling time of greater than 30 hours. [17]
Transmission
Syphilis is transmitted primarily by sexual contact or during pregnancy from a mother to
her fetus; the spirochete is able to pass through intact mucous membranes or compromised
skin. [18]
It is thus transmissible by kissing near a lesion, as well as oral, vaginal, and anal
sex. Approximately 30% to 60% of those exposed to primary or secondary syphilis will
get the disease. Its infectivity is exemplified by the fact that an individual inoculated with
only 57 organisms has a 50% chance of being infected. [17]
Most (60%) of new cases in the
United States occur in men who have sex with men. Syphilis can be transmitted by blood
products, but the risk is low due to blood testing in many countries. The risk of
transmission from sharing needles appears limited.
It is not generally possible to contract syphilis through toilet seats, daily activities, hot
tubs, or sharing eating utensils or clothing. This is mainly because the bacteria die very
quickly outside of the body, making transmission by objects extremely difficult. [19]
10. 10
Signs and symptoms
The first symptoms of syphilis can take 10 days to 3 weeks to appear after infection. The
most common symptom is a painless sore that appears where the virus was transmitted -
normally on the penis, vagina or anus. Your lymph glands (in the neck, groin or armpit)
may also swell. [38]
The sore will disappear in 2-6 weeks. However, if the infection itself is not treated, it will
move to the second stage.
You can't diagnose syphilis by looking at pictures because symptoms vary from person to
person. If you think you have syphilis, see your doctor or healthcare worker as soon as
possible. [20]
Symptoms of secondary syphilis begin a few weeks after the disappearance of the sore and
include:
a non-itchy skin rash
small skin growths on the vulva (in women) and around the anus (in both men and
women)
flu-like symptoms such as tiredness, headaches, joint pains and fever
swollen lymph glands
weight loss
hair loss.
These symptoms may disappear within a few weeks, or come and go over a period of
months.
Without treatment, syphilis becomes 'latent' whereby you do not experience any symptoms
even though you remain infected. This stage can happen for years, even decades and there
is a danger of moving onto the most dangerous stage - tertiary syphilis. [21]
A third of people who are not treated for syphilis develop serious symptoms at this stage
including: Fig (6): A maculopapular rash is pre- sent on the palm
stroke
dementia
loss of co-ordination
numbness
paralysis
blindness
deafness
heart disease
skin rashes.
At this stage, syphilis can also cause death.
This is why it is important to see a healthcare professional and get tested and treated in the
early stages of syphilis. [21]
11. 11
Diagnosis
Patient history and physical diagnosis
The diagnosis of syphilis is often delayed because of the variety of early symptoms, the
varying length of the incubation period, and the possibility of not noticing the initial
chancre. Patients do not always connect their symptoms with recent sexual contact. They
may go to a dermatologist when they develop the skin rash of secondary syphilis rather
than to their primary care doctor. Women may be diagnosed in the course of a
gynecological checkup. Because of the long-term risks of untreated syphilis, certain
groups of people are now routinely screened for the disease: [39]
pregnant women
sexual contacts or partners of patients diagnosed with syphilis
children born to mothers with syphilis
patients with HIV infection
persons applying for marriage licenses
When the doctor takes the patient's history, he or she will ask about recent sexual contacts
in order to determine whether the patient falls into a high-risk group. Other symptoms,
such as skin rashes or swollen lymph nodes, will be noted with respect to the dates of the
patient's sexual contacts. Definite diagnosis, however, depends on the results of laboratory
blood tests. [22]
Blood tests
There are several types of blood tests for syphilis presently used in the United States.
Some are used in follow-up monitoring of patients as well as diagnosis.
NONTREPONEMAL ANTIGEN TESTS. Nontreponemal antigen tests are used as
screeners. They measure the presence of reagin, which is an antibody formed in reaction to
syphilis. In the venereal disease research laboratory (VDRL) test, a sample of the patient's
blood is mixed with cardiolipin and cholesterol. If the mixture forms clumps or masses of
matter, the test is considered reactive or positive. The serum sample can be diluted several
times to determine the concentration of reagin in the patient's blood.
The rapid plasma reagin (RPR) test works on the same principle as the VDRL. It is
available as a kit. The patient's serum is mixed with cardiolipin on a plastic-coated card
that can be examined with the naked eye.
Nontreponemal antigen tests require a doctor's interpretation and sometimes further
testing. They can yield both false-negative and false-positive results. False-positive results
can be caused by other infectious diseases, including mononucleosis, malaria, leprosy,
rheumatoid arthritis, and lupus. HIV patients have a particularly high rate (4%, compared
to 0.8% of HIV-negative patients) of false-positive results on reagin tests. False-negatives
can occur when patients are tested too soon after exposure to syphilis; it takes about 14-21
days after infection for the blood to become reactive.
TREPONEMAL ANTIBODY TESTS. Treponemal antibody tests are used to rule out
false-positive results on reagin tests. They measure the presence of antibodies that are
specific for T. pallidum. The most commonly used tests are the microhemagglutination-T.
pallidum (MHA-TP) and the fluorescent treponemal antibody absorption (FTA-ABS)
12. 12
tests. In the FTA-ABS, the patient's blood serum is mixed with a preparation that prevents
interference from antibodies to other treponemal infections. The test serum is added to a
slide containing T. pallidum. In a positive reaction, syphilitic antibodies in the blood coat
the spirochetes on the slide. The slide is then stained with fluorescein, which causes the
coated spirochetes to fluoresce when the slide is viewed under ultraviolet (UV) light. In
the MHA-TP test, red blood cells from sheep are coated with T. pallidum antigen. The
cells will clump if the patient's blood contains antibodies for syphilis.
Treponemal antibody tests are more expensive and more difficult to perform than
nontreponemal tests. They are therefore used to confirm the diagnosis of syphilis rather
than to screen large groups of people. These tests are, however, very specific and very
sensitive; false-positive results are relatively unusual.
INVESTIGATIONAL BLOOD TESTS. Currently, ELISA, Western blot, and PCR testing
are being studied as additional diagnostic tests, particularly for congenital syphilis and
neurosyphilis. [23]
Other laboratory tests
MICROSCOPE STUDIES. The diagnosis of syphilis can also be confirmed by identifying
spirochetes in samples of tissue or lymphatic fluid. Fresh samples can be made into slides
and studied under darkfield illumination. A newer method involves preparing slides from
dried fluid smears and staining them with fluorescein for viewing under UV light. This
method is replacing darkfield examination because the slides can be mailed to professional
laboratories.
SPINAL FLUID TESTS. Testing of cerebrospinal fluid (CSF) is an important part of
patient monitoring as well as a diagnostic test. The VDRL and FTA-ABS tests can be
performed on CSF as well as on blood. An abnormally high white cell count and elevated
protein levels in the CSF, together with positive VDRL results, suggest a possible
diagnosis of neurosyphilis. CSF testing is not used for routine screening. It is used most
frequently for infants with congenital syphilis, HIV-positive patients, and patients of any
age who are not responding to penicillin treatment. [24]
Figure 7
13. 13
Table 1: Presentations and features of the phases of syphilis [25]
Stage Features
Primary syphilis (10-
90 days afterinitial in
fection)
Skin: papule develops at site of initial infection; undergoes
ulceration to form apainless, firm chancre
Lymphatics: painless regional lymphadenopathy
Duration: lesion heals spontaneously in 2-3 weeks
Comment: cervical and rectal lesions may go unnoticed
Secondary syphilis (4
-
10 weeks afterappea
rance of primary lesi
on)
Constitutional illness: fever, sore throat, malaise and arthral
gia; inflammation of manyorgans, e.g. hepatitis, nephritis, a
rthritis
Skin: generalized papular, non-
itchy rash involving plantar and palmar skin, butexcluding t
he face; condylomata lata; oral and genital snail track ulcers
Lymphatics: generalized lymphadenopathy
Duration: signs subside in 3-
12 weeks, but 20% of cases show recurrent symptomsover 1
-2 years
Tertiary syphilis (3-
30 years aftersecond
ary stage has passed)
Widely varying signs and symptoms
Skin: granulomatous and ulcerating lesions (gumma) often
developing at sites oftrauma
Bone: gumma-
like lesions develop in any bone causing local pain and path
ologicalfracture
Viscera: gumma-
like lesions of the gastrointestinal tract, especially in the liv
er, withresultant dysfunction
Cardiovascular: aortitis and aortic aneurysm
Neurosyphilis: aseptic meningitis, tabes dorsalis, general pa
ralysis of the insane;Argyll Robertson pupils
Congenital syphilis Early signs show at age 2-6 weeks, and include:
Skin: chronic catarrhal inflammation of mucous membranes
Failure to thrive
Late signs show at 2+ years and include:
Skin eruptions
Corneal keratitis (corneal deposits)
Tooth deformity: peg (Hutchinson) incisors, multicusped (m
ulberry) molars
Collapse of nasal cartilage (saddle nose)
Bone deformity
Neurosyphilis
14. 14
Treatment
Approach Considerations
Key principles for the treatment of syphilis include the following: [26]
Penicillin is the drug of choice to treat syphilis.
Doxycycline is the best alternative for treating early and late latent syphilis. Syphilis
associated with HIV infection does not require any enhanced antimicrobial therapy.
In the treatment of late syphilis by weekly injections, missing a dose of penicillin for a
period of 10-14 days does not require restarting the entire course of injections.
The exception to this is in the case of pregnant women in whom there is no latitude for
missing a dose of penicillin.
There is evidence that an interval of 7-9 days between doses may produce better results.
CSF testing to detect neurosyphilis is strongly recommended in patients with tertiary
syphilis or with neurological signs or symptoms consistent with neurosyphilis and in
patients without symptoms whose serologic titers do not decline appropriately after being
treated with recommended therapy.
Reinfection rates among MSM are high, so frequent serological testing in this group is
recommended.
CDC recommends the use of the RPR-based screening algorithm. When there is a low
epidemiologic risk or clinical probability of syphilis, the positive predictive value of an
isolated unconfirmed reactive treponemal chemoluminescence test or enzyme
immunoassay is low.
Antibiotic Therapy
Penicillin
Penicillin was established as an effective treatment for syphilis before the widespread use
of randomized clinical trials. [26] The treatment guidelines published by the CDC (see
current CDC recommendations) are based largely on uncontrolled trials and expert
opinion. Guidelines are based on staging, with later stages requiring longer courses of
treatment due to the slower rate of bacterial replication. [27]
Penicillin remains the mainstay of treatment and the standard by which other modes of
therapy are judged. [28] The 2015 CDC STD treatment guidelines support the use of
penicillin as the preferred drug for treating all stages of syphilis. [19] Penicillin is the only
recommended therapy for neurosyphilis, congenital syphilis, or syphilis during pregnancy.
Rarely, T pallidum has been found to persist following adequate penicillin therapy;
however, there is no indication that the organism has acquired resistance to penicillin.
The following regimens are recommended for penicillin treatment:
Primary or secondary syphilis - Benzathine penicillin G 2.4 million units
intramuscularly (IM) in a single dose
Early latent syphilis - Benzathine penicillin G 2.4 million units IM in a single dose
Late latent syphilis or latent syphilis of unknown duration - Benzathine penicillin G 7.2
million units total, administered as 3 doses of 2.4 million units IM each at 1-week
intervals
15. 15
Pregnancy - Treatment appropriate to the stage of syphilis is recommended.
Clinicians should be aware that only benzathine penicillin product (Bicillin L-A) should be
used, not benzathine-procaine penicillin (Bicillin C-R). In addition, oral penicillin is never
appropriate for the treatment of syphilis.
If the patient arrives late for subsequent doses, clinical experience suggests that an interval
of 10-14 days between doses of benzathine penicillin for latent syphilis might be
acceptable before restarting the sequence of injections; however, according to
pharmacokinetics/pharmacodynamics, an interval of 7-9 days between doses is more
optimal. [29, 30, 31]
In pregnancy, missed doses are not acceptable. Pregnant patients must
repeat the full course of therapy. [28]
In patients with a history of penicillin allergy, desensitization may be necessary in cases of
pregnancy, neurosyphilis, congenital syphilis, or tertiary syphilis.
According to the 2015 CDC STD guidelines, no treatment regimens for syphilis have been
shown to be more effective in preventing neurosyphilis in patients who are HIV positive
than the syphilis regimens recommended for patients who are HIV negative. Careful
monitoring after therapy is required, as patients with HIV infection are at higher risk for
reinfection and have a slower serologic response than patients without HIV infection. [32]
Alternatives to penicillin
As stated in the 2015 CDC guidelines, several therapies exist that might be effective in
nonpregnant, penicillin-allergic patients with primary or secondary syphilis. [32]
Surgical Care
Surgical care is reserved for treating the complications of tertiary syphilis (eg, aortic valve
replacement).
Table 2
16. 16
Epidemiology and Prognosis
In 2012, about 0.5% of adults were infected with syphilis, with 6 million new cases. In
1999 it is believed to have infected 12 million additional people, with greater than 90% of
cases in the developing world. It affects between 700,000 and 1.6 million pregnancies a
year, resulting in spontaneous abortions, stillbirths, and congenital syphilis. During 2010,
it caused about 113,000 deaths, down from 202,000 in 1990. In sub-Saharan Africa,
syphilis contributes to approximately 20% of perinatal deaths. Rates are proportionally
higher among intravenous drug users, those who are infected with HIV, and men who have
sex with men. In the United States, rates of syphilis as of 2007 were six times greater in
men than women; they were nearly equal in 1997. African Americans accounted for
almost half of all cases in 2010. As of 2014, syphilis infections continue to increase in the
United States. [33]
Syphilis was very common in Europe during the 18th and 19th centuries. Flaubert found it
universal among nineteenth-century Egyptian prostitutes. In the developed world during
the early 20th century, infections declined rapidly with the widespread use of antibiotics,
until the 1980s and 1990s. Since 2000, rates of syphilis have been increasing in the USA,
Canada, the UK, Australia and Europe, primarily among men who have sex with men.
Rates of syphilis among American women have remained stable during this time, while
rates among UK women have increased, but at a rate less than that of men. Increased rates
among heterosexuals have occurred in China and Russia since the 1990s. This has been
attributed to unsafe sexual practices, such as sexual promiscuity, prostitution, and
decreasing use of barrier protection. [33]
Untreated, it has a mortality rate of 8% to 58%, with a greater death rate in males. The
symptoms of syphilis have become less severe over the 19th and 20th centuries, in part
due to widespread availability of effective treatment, and partly due to virulence of the
spirochaete. With early treatment, few complications result. Syphilis increases the risk of
HIV transmission by two to five times, and coinfection is common (30–60% in some
urban centers). In 2015, Cuba became the first country in the world to eradicate mother to
child transmission of syphilis.
Figure 8
17. 17
Prevention
Syphilis is an infectious disease but it is preventable to a large extent. The best and the
most certain method of prevention of this infection is to avoid sexual contact or only to
maintain sexual contact with one faithful partner who has been tested and is not infected.
Some of the tips to prevent transmission of syphilis include the safe sex measures. [34]
Safer sex
Safer sex measures include:
Having sex with a single faithful, tested and non-infected partner. Sexual penetration or
ejaculation does not need to take place for syphilis to spread. Condoms can be used to
reduce the risk of catching syphilis, but cannot prevent it altogether. Some risk remains via
exposure to the mouth (those having oral sex) or via anus (those having anal intercourse).
It is important to use a condom during vaginal, oral and anal sex. Other forms of barriers
like use of a dental dam (square of plastic) when having oral sex or when the mouth of an
uninfected individual makes contact with partner's vagina or anus. This also prevents
transmission of sexually transmitted infection (STI). Sex toys that have been used by
another individual (possibly infected) should not be shared. For people who wish to use
them can wash them after each use and use a fresh condom over them. [35]
Syphilis and injection drug users
Syphilis can also spread by sharing injection drug users. Injection drug users should avoid
sharing needles. They can opt for needle-exchange programmes that are offered by many
pharmacies and local authorities. In these used needles can be exchanged for new
disposable clean ones. [36]
Treatment of sexual partner
Transmission needs to be prevented by routine testing and, if positive, treatment of sexual
partners of infected individuals.
The infected individuals are counselled regarding prevention of spread to their sexual
partners. Individuals sexually exposed to a person with primary, secondary, or early latent
syphilis within 90 days preceding the diagnosis should be assumed to be infected.
All sexual partners of the infected person in the recent past need to be identified, notified
and rapidly referred for medical
evaluation and treatment. Long-
term sex partners of patients
with late syphilis should be
evaluated clinically and
serologically and treated
appropriately. All patients with
syphilis should be tested for
HIV. Patient and partner
education is important. [37]
Figure 9
18. 18
Summary
Treponema pallidum infection in men not only provoked a disease that represented a threat
to humans for many centuries, but it also had a tumultuous history. From examining it, one
could learn how easy was to place stigma not only on individuals affected by the disease,
but on entire nations, as countries were blamed along the history for the spread of the
disease. Throughout the centuries, syphilis has affected individuals of various origins,
from monarchs, painters and philosophers to low income people, mainly due to
promiscuity. Various treatments to cure the disease were tried along the centuries;
nowadays, penicillin and prevention programs control the disease.
Syphilis is difficult to diagnose clinically early in its presentation. Confirmation is either
via blood tests or direct visual inspection using microscopy. Blood tests are more
commonly used, as they are easier to perform. Diagnostic tests are unable to distinguish
between the stages of the disease.
Congenital syphilis is that which is transmitted during pregnancy or during birth. Two-
thirds of syphilitic infants are born without symptoms. Common symptoms that develop
over the first couple of years of life include enlargement of the liver and spleen (70%),
rash (70%), fever (40%), neurosyphilis (20%), and lung inflammation (20%). If untreated,
late congenital syphilis may occur in 40%, including saddle nose deformation,
Higoumenakis sign, saber shin, or Clutton's joints among others. Infection during
pregnancy is also associated with miscarriage.
The signs and symptoms of syphilis vary depending in which of the four stages it presents
(primary, secondary, latent, and tertiary). The primary stage classically presents with a
single chancre (a firm, painless, non-itchy skin ulceration) but there may be multiple sores.
In secondary syphilis a diffuse rash occurs, which frequently involves the palms of the
hands and soles of the feet. There may also be sores in the mouth or vagina. In latent
syphilis, which can last for years, there are few or no symptoms. In tertiary syphilis there
are gummas (soft non-cancerous growths), neurological, or heart symptoms. Syphilis has
been known as "the great imitator" as it may cause symptoms similar to many other
diseases.
Syphilis can be cured with the right antibiotics. However, treatment will not undo any
damage that the infection has already caused.
19. 19
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