NECROTIZING FASCIITIS (FLESH EATING BACTERIA)

WHAT IS NECROTIZING FASCIITIS?

Necrotizing fasciitis is an infection caused by bacteria. It can destroy skin, fat, and the tissue covering the muscles within a very short time.

The disease sometimes is called flesh-eating bacteria. When it occurs on the genitals, it is called Fournier gangrene.

Necrotizing fasciitis is very rare but serious. About 1 out of 4 people who get this infection die from it.1 Many people who get necrotizing fasciitis are in good health before they get the infection.

YOUR RISK OF GETTING THIS INFECTION IS HIGHER IF YOU:

Have a weak immune system.

Have chronic health problems such as diabetes, cancer, or liver or kidney disease.

Have cuts in your skin, including surgical wounds.

Recently had chickenpox or other viral infections that cause a rash.

Use steroid medicines, which can lower the body's resistance to infection.

WHAT CAUSES NECROTIZING FASCIITIS?

Necrotizing fasciitis is caused by several kinds of bacteria. Some of these bacteria also cause infections such as strep throat and impetigo. Usually the infections caused by these bacteria are mild. But in rare cases they can cause a more dangerous infection.

You can get necrotizing fasciitis when bacteria enter a wound, such as from an insect bite, a burn, or a cut. You can also get it in:

Wounds that come in contact with ocean water, raw saltwater fish, or raw oysters, including injuries from handling sea animals such as crabs.

An intestinal surgery site, or in tumors or gunshot injuries in the intestines.

A muscle strain or bruise, even if there is no break in the skin.

The bacteria that cause necrotizing fasciitis can be passed from person to person through close contact, such as touching the wound of the infected person. But this rarely happens unless the person who is exposed to the bacteria has an open wound, chickenpox, or an impaired immune system.

WHAT ARE THE SYMPTOMS?

The symptoms often start suddenly after an injury. You may need medical care right away if you have pain that gets better over 24 to 36 hours and then suddenly gets worse. The pain may be much worse than you would expect from the size of the wound or injury. You may also have:

Skin that is red, swollen, and hot to the touch.
A fever and chills.
Nausea and vomiting.
Diarrhea.

The infection may spread rapidly. It quickly can become life-threatening. You may go into shock and have damage to skin, fat, and the tissue covering the muscles. (This damage is called gangrene.) Necrotizing fasciitis can lead to organ failure and death.

DIAGNOSIS?

The doctor will diagnose your infection based on how suddenly your symptoms started and how quickly the infection is spreading. The infected tissue may be tested for bacteria. You also may need X-rays, a CT scan, or an MRI to look for injury to your organs or to find out how much the infection has spread.

TREATMENT

Early treatment of necrotizing fasciitis is critical. The sooner treatment begins, the more likely you will recover from the infection and avoid serious complications, such as limb amputation or death. You may be treated in the intensive care unit (ICU) at the hospital.

Treatment may include:

Surgery that removes infected tissue and fluids to stop the spread of infection. Surgery is almost always needed. Most people need several surgeries to control the infection. Removing limbs (amputation) or organs may be done to save the person's life, depending on how severe the infection is and where it has spread.
Medicines (such as antibiotics). These kill the bacteria causing the infection.
Procedures to treat complications such as shock, breathing problems, and organ failure.
Hyperbaric oxygen therapy.

Necrotizing fasciitis is very rare. Bacteria that cause the disease usually don't cause infection unless they enter the body through a cut or other break in the skin.

If you have been in close contact with someone who has necrotizing fasciitis, your doctor may give you an antibiotic to help reduce your chances of getting the infection. If you notice any symptoms of infection (such as pain, swelling, redness, or fever) after you've been in close contact with someone who has necrotizing fasciitis, see your doctor right away.

To help prevent any kind of infection, wash your hands often. And always keep cuts, scrapes, burns, sores, and bites clean. Good hygiene is a key to be safe.

WHAT IS URETHRITIS?

Urethritis is a condition in which the urethra, or the tube that carries urine from the bladder to outside the body, becomes inflamed and irritated. Semen also passes through the male urethra. Urethritis typically causes pain while urinating and an increased urge to urinate. The primary cause of urethritis is usually infection by bacteria.

Urethritis affects people of all ages. Both males and females can develop the condition. However, females have a greater chance of developing the condition than males.

SYMPTOMS OF URETHRITIS?

Men:

Males with urethritis may experience one or more of the following symptoms:

* a burning sensation while urinating
* itching or burning near the opening of the penis
* the presence of blood in the semen or urine
* discharge from the penis

Women:

Some symptoms of urethritis in women include:

* a more frequent urge to urinate
* discomfort during urination
* pain in the abdominal area
* a high body temperature
* chills
* a more urgent need to urinate
* an abnormal discharge from the vagina

People who have urethritis may also not have any noticeable symptoms. This is especially true for women. In men, symptoms may be silent if the urethritis developed as a result of chlamydia or occasionally trichomoniasis infection.

For this reason, it’s important to undergo testing if you may have been infected with an STI.

WHAT CAUSES URETHRITIS?

Generally, most cases of urethritis are the result of a bacteria or virus. The same bacteria that can cause bladder and kidney infections can also infect the lining of the urethra. Bacteria found naturally in the genital area may also cause urethritis if they enter the urinary tract. According to the Centers for Disease Control (CDC), bacteria associated with urethritis include:

Neisseria gonorrhoeae
Chlamydia trachomatis
Mycoplasma genitalium

Pathogens are the biological agents that cause illness. The same pathogens that cause sexually transmitted infections (STIs) can also cause urethritis. These include the bacteria that cause gonorrhea and chlamydia and the parasite that causes trichomoniasis.

There are also viruses that can lead to the development of urethritis. These include the human papillomavirus (HPV), the herpes simplex virus, and the cytomegalovirus.

DIAGNOSIS

Your doctor will ask you about your symptoms. They’ll likely also examine the genital area to make a diagnosis.

They may order tests to analyze a urine sample or a swab taken from the urethra or vaginal area. If the doctor suspects a specific STI, there will likely be a test.

TREATMENT

Treatment for urethritis typically includes a course of either antibiotics or antiviral medication. Some common treatments for urethritis include:

tetracycline
doxycycline
erythromycin
ofloxacin
If an STI caused the infection, it’s vital that all sexual partners undergo testing and treatment if necessary. This prevents the spread of the STI and reinfection.

COMPLICATIONS ASSOCIATED WITH URETHRITIS?

Medication can often treat urethritis quickly. If the infection goes untreated, however, the effects can be lasting and quite serious. For example, the infection may spread to other parts of the urinary tract, including the ureters, kidneys, and bladder.

In addition, the STIs that frequently cause the condition can damage the reproductive system over time. They can even lead to infertility. For these reasons, you should speak with a doctor as soon as possible if you notice any symptoms of urethritis.

PREVENTION

Many of the bacteria that cause urethritis can pass to another person through sexual contact. Because of this, practicing safe sex is an important preventive measure. The tips below can help reduce your risk:

* Avoid having intercourse with multiple partners.
* Use condoms every time you have sex.
* Get tested regularly.
* Protect others. If you find out you have an STI, inform others who are also at risk of an infection.
* Aside from safer sex practices, there are other ways to promote good urinary tract health. This can lower your risk of urethritis and some other conditions that affect this part of the body. Drink plenty of fluids and make sure to urinate shortly after intercourse.
* Avoid acidic foods. Also, avoid exposure to spermicides, particularly if you already know they irritate your urethra.

GOOD NUTRITION: A KEY ROLE TO HIV/AIDS MANAGEMENT

 Good nutrition plays a key role in the health and wellness of all individuals. It is an essential building block for development and improving global welfare. Eating the right type and amount of food in the right proportion can help prevent, care and slow down the progression of HIV among individuals affected.

RELATIONSHIP BETWEEN HIV/AIDS AND NUTRITION

Nutrition and HIV/AIDS are greatly linked. HIV/AIDS can contribute to malnutrition as a result of immune impairment and this worsens the effect of the infection leading to a more rapid progression of the disease. Thus, malnutrition contributes to HIV disease progression. A victim who is malnourished is more at risk as the disease will progress faster to AIDS because of body weakness and the body being unable to fight opportunistic infections.

On the other hand, a well nourished victim, has a stronger immune system for coping with the infection and fighting illness. Improved nutritional status of affected victims helps strengthen the immune system, thereby reducing the incidence of infections, preventing weight loss/lean body mass and delaying the progression of the disease.

HIV/AIDS is one of the crises that have affected human health and threatened social and economic development. As the infection rate increases around the world especially in countries with large rural populations, the pandemic creates a deadly cycle by having a negative impact on food/nutrition security. HIV/AIDS has rural/urban dimensions, affects both poor and rich, though the poor are most severely exposed. It is not gender- neutral, as it affects both sexes leaving women at more risk by affecting them physiologically, economically and culturally.

NUTRITION BENEFITS TO A HIV/AIDS VICTIM

·  Nutrition is an entry point for assisting affected communities to cope with the epidemic particularly as part of an integrated approach to household food insecurity, health and care.

· Nutrition care and support for people living with HIV/AIDS is an important way to reduce human suffering and regenerate societies damaged by the epidemic
Nutrition helps to ease burden of the disease and alleviate the overall negative impact of malnutrition among victims.

· Adequate dietary intake enhances the therapeutic effect of medicines, boosts the immune system (by helping to fight diseases, opportunistic infections and maintain body weight), delays the progression of HIV infection to AIDS and increases longevity.

· Good nutrition makes HIV treatment with the  ARV more effective.

EFFECT OF NUTRITION ON HIV/AIDS

· Good nutrition delays the progression of the disease

· It improves the antiretroviral treatment and makes it works faster

· Reduces viral load: a malnourished victim also suffers micronutrient deficiency which increases the viral load by enabling HIV to replicate faster and this also increases the transmission mode.

EFFECT OF HIV/AIDS ON NUTRITION

HIV on the other hand has its own effect on nutrition. it does this by affecting the nutritional status and by causing

· Reductions in dietary intake

· Increased energy requirements

· Increased nutrient mal-absorption and loss

· Complex metabolic alteration that leads to weight loss and wasting

NUTRITIONAL ASSISTANCE

Considering the strong link between HIV/AIDS and nutrition, nutritional assistance is seen as an important part to the response of people living with this disease. The assistance takes form of

Nutritional assessment: it helps HIV positive victims receive appropriate treatment, care and support even in the poorest settings

Nutritional counselling: victims should be counselled on
Healthy eating

· Achieving a healthy body weight
Managing lipid abnormalities

· Managing dietary complications related to ARV treatment

· Managing symptoms that may affect food intake

· Appropriate use of herbal and/ nutritional supplements

Food security: HIV/AIDS precipitate and exacerbate food and nutrition insecurity especially with individuals with worsening poverty. HIV/AIDS strikes the household’s most productive members first which leads to immediate strain on the family’s ability to work, feed and provide care. Family members without food or income may migrate in search of work, thereby increasing their chances of contracting HIV and bringing it back home. Importance of food security becomes more fundamental as the causes and consequences of HIV/AIDS epidemics become clearer.

RECOMMENDATIONS:

Screening and nutritional status assessment of dietary intake should be included routinely in HIV treatment and care for adults and children.

Government organizations should integrate quality working nutrition assessment and counseling into the health care services for all individuals and this should include provision for therapeutic and supplementary feeding when appropriate along with other type of support.

Government should develop national nutrition strategies to guide the scale-up of nutrition services with the national HIV/AIDS broader health programmes

Facilities equipped to address the household economic and food security issues that are relevant to the well-being and resilience of individuals and families should be provided

By Ihuoma Pearl. 

Bsc, Mph

WHY CYCLING IS GOOD FOR YOUR HEALTH.

To be fit and healthy you need to be physically active. Regular physical activity can help protect you from serious diseases such as obesity, heart disease, cancer, mental illness, diabetes and arthritis. Riding your bicycle regularly is one of the best ways to reduce your risk of health problems associated with a sedentary lifestyle.

Cycling is a healthy, low-impact exercise that can be enjoyed by people of all ages, from young children to older adults. It is also fun, cheap and good for the environment.

Riding to work or the shops is one of the most time-efficient ways to combine regular exercise with your everyday routine. An estimated one billion people ride bicycles every day – for transport, recreation and sport.

CYCLING FOR HEALTH AND FITNESS

It only takes two to four hours a week to achieve a general improvement to your health. Cycling is:

Low impact – it causes less strain and injuries than most other forms of exercise.

A good muscle workout – cycling uses all of the major muscle groups as you pedal.

Easy – unlike some other sports, cycling does not require high levels of physical skill. Most people know how to ride a bike and, once you learn, you don’t forget.

Good for strength and stamina – cycling increases stamina, strength and aerobic fitness.

As intense as you want – cycling can be done at very low intensity to begin with, if recovering from injury or illness, but can be built up to a demanding physical workout.

A fun way to get fit – the adventure and buzz you get from coasting down hills and being outdoors means you are more likely to continue to cycle regularly, compared to other physical activities that keep you indoors or require special times or places.

Time-efficient – as a mode of transport, cycling replaces sedentary (sitting) time spent driving motor vehicles or using trams, trains or buses with healthy exercise.

HEALTH BENEFITS OF REGULAR CYCLING

Cycling is mainly an aerobic activity, which means that your heart, blood vessels and lungs all get a workout. You will breathe deeper, perspire and experience increased body temperature, which will improve your overall fitness level.

THE HEALTH BENEFITS OF REGULAR CYCLING INCLUDE:

* increased cardiovascular fitness
* increased muscle strength and flexibility
* improved joint mobility
* decreased stress levels
* improved posture and coordination
* strengthened bones
* decreased body fat levels
* prevention or management of disease
* reduced anxiety and depression.

Cycling can improve both physical and mental health, and can reduce the chances of experiencing many health problems.
Obesity and weight control

Cycling is a good way to control or reduce weight, as it raises your metabolic rate, builds muscle and burns body fat. If you’re trying to lose weight, cycling must be combined with a healthy eating plan. Cycling is a comfortable form of exercise and you can change the time and intensity – it can be built up slowly and varied to suit you.

Research suggests you should be burning at least 8,400 kilojoules (about 2,000 calories) a week through exercise. Steady cycling burns about 1,200 kilojoules (about 300 calories) per hour.

If you cycle twice a day, the kilojoules burnt soon add up. British research shows that a half-hour bike ride every day will burn nearly five kilograms of fat over a year.

CARDIOVASCULAR DISEASE AND CYCLING

Cardiovascular diseases include stroke, high blood pressure and heart attack. Regular cycling stimulates and improves your heart, lungs and circulation, reducing your risk of cardiovascular diseases.

Cycling strengthens your heart muscles, lowers resting pulse and reduces blood fat levels. Research also shows that people who cycle to work have two to three times less exposure to pollution than car commuters, so their lung function is improved. A Danish study conducted over 14 years with 30,000 people aged 20 to 93 years found that regular cycling protected people from heart disease.

CANCER AND CYCLING

Many researchers have studied the relationship between exercise and cancer, especially colon and breast cancer. Research has shown that if you cycle, the chance of bowel cancer is reduced. Some evidence suggests that regular cycling reduces the risk of breast cancer.

DIABETES AND CYCLING

The rate of type 2 diabetes is increasing and is a serious public health concern. Lack of physical activity is thought to be a major reason why people develop this condition. Large-scale research in Finland found that people who cycled for more than 30 minutes per day had a 40 per cent lower risk of developing diabetes.
Bone injuries, arthritis and cycling

Cycling improves strength, balance and coordination. It may also help to prevent falls and fractures. Riding a bike is an ideal form of exercise if you have osteoarthritis, because it is a low-impact exercise that places little stress on joints.

Cycling does not specifically help osteoporosis (bone-thinning disease) because it is not a weight-bearing exercise.
Mental illness and cycling

Mental health conditions such as depression, stress and anxiety can be reduced by regular bike riding. This is due to the effects of the exercise itself and because of the enjoyment that riding a bike can bring.

Pick up a form of exercise and keep fit, but if you usually have a tight schedule, make cycling that keeping fit means. It's economy friendly and requires no unique qualities.

HIDDEN HUNGER

Hidden hunger is a type of malnutrition which is also known as micronutrient deficiency.
It is a major public health problem found in most developing countries.
It is called hidden hunger because it does not elicit the hunger in the affected individual,
thereby making the individual to look alright but suffering extremely negative impact on
health and well being. It affects infants, children, adults, adolescents and expectant
mothers. Children may turn out stunted and most times suffer frequent illness
1 out of 3 people suffer from hidden hunger mostly from developing countries thereby
exposing them to higher risk to infections, birth defects and impaired development.
Sufferers of this type of malnutrition consume diets that are micronutrient deficient. They
habitually consume large amounts of staple foods crops, high in calories (e.g. cassava,
maize, wheat and rice) but lack sufficient micronutrients.
Affected victims are often too poor to understand or afford balanced /nutritious diet.

CAUSES:

Common cause of hidden hunger is poor diet. Diets based mostly on stable crops such
as maize, wheat, rice and cassava that provides large amount of energy but relatively
lack essential vitamins and minerals, (vit A, zinc, iron and iodine) always result in hidden
hunger. Impaired absorption due to infections or parasites can also lead to hidden
hunger

EFFECT OF HIDDEN HUNGER

Hidden hunger leads to mental impairment, poor health, and low productivity which
affect children by preventing them from achieving the full development needed in their
physical, intellectual and social potential.
It has adverse effect on the society at large by posing devastating threats to health,
education, economic growth especially in developing countries.

KEY MICRONUTRIENT DEFICIENCIES AND THEIR EFFECTS

IODINE DEFICIENCY: it affects 780 million people worldwide. The clearest symptom is a
swelling of the thyroid gland called goiter. But the most serious impact is on the brain,
which cannot develop properly without iodine. It is associated with severe mental
retardation and physical stunting in infants.

VITAMIN A DEFICIENCY: vitamin A deficiency weakens the immune systems of a large
proportion of under-fives in poor countries, thereby increasing their vulnerability to
disease. A deficiency in vit A increases the risk of dying from diarrhea, measles and
malaria, affects pregnant women, and also a leading cause of child blindness across
developing countries.

ZINC DEFICIENCY: contributes to growth failure and weakened immunity in young
children. It is linked to a higher risk of diarrhea and pneumonia, stunting and frequent
infections

IRON DEFICIENCY: this is the most prevalent form of malnutrition worldwide, affecting
millions of people. Iron forms the molecules that carry oxygen in the blood, so
symptoms of a deficiency include tiredness and lethargy. Lack of iron in large segments
of the population severely damages a country's productivity. Iron deficiency also
impedes cognitive development and low energy, affecting 40-60 percent of children
aged 6-24 months in developing countries. It also leads to anemia, low birth weight, high
maternal mortality and premature births.

SOLUTIONS TO ERADICATING HIDDEN HUNGER

Dietary diversity:

Dietary diversity should be encouraged and practiced as it ensures a healthy diet that
contains a balanced and adequate combination of macronutrients, micronutrients and
other food-based substances like dietary fiber.

Food fortification:

Food fortification adds trace amount of micronutrients to staple foods during processing
and also helps in achieving recommended levels of micronutrients.

Biofortification:

This involves breeding foods crops, using conventional or transgenic method to
increase their micronutrients content. It can provide steady and safe source of certain
micronutrients for people not reached by other interventions as it targets mostly rural
areas

Vitamin A supplementation:

This improves child survival by reducing high risk of child mortality and also reduces
incidence of diarrhea.

THE WAY FORWARD

There should be actions aimed at improving monitory and public education about the
importance of consuming iodized salts and these activities should be focused mainly on
infants, children, adolescents and pregnant women.
Dietary diversity should be promoted by involving in food-based strategies like home
gardening, food preparation and storage/preservation method and educating people on
better infant and young child feeding practices
Easy access to consumers in the rural areas should be provided as to reduce the gap in
accessing fortified foods among rural and urban consumers
There should be actions to educate, improve and monitor biofortification as it can help
to close the micronutrient deficiency gap.
Vitamin A supplements should be provided an targeted at the vulnerable populations
like pregnant women and under 5 children.
Social protection that gives poor people access to nutritious foods and shields them
from price spike should be provided.

By Ihuoma Pearl
BS.c, MPH.

WHAT YOU NEED TO KNOW ABOUT DOWN SYNDROME

WHAT IS DOWN SYNDROME?

Down syndrome is a condition in which a person has an extra chromosome. Chromosomes are small “packages” of genes in the body. They determine how a baby’s body forms during pregnancy and how the baby’s body functions as it grows in the womb and after birth. Typically, a baby is born with 46 chromosomes. Babies with Down syndrome have an extra copy of one of these chromosomes, chromosome 21. A medical term for having an extra copy of a chromosome is ‘trisomy.’ Down syndrome is also referred to as Trisomy 21. This extra copy changes how the baby’s body and brain develop, which can cause both mental and physical challenges for the baby.

Even though people with Down syndrome might act and look similar, each person has different abilities. People with Down syndrome usually have an IQ (a measure of intelligence) in the mildly-to-moderately low range and are slower to speak than other children.

SOME COMMON PHYSICAL FEATURES OF DOWN SYNDROME INCLUDE:

A flattened face, especially the bridge of the nose
Almond-shaped eyes that slant up
A short neck
Small ears
A tongue that tends to stick out of the mouth
Tiny white spots on the iris (colored part) of the eye
Small hands and feet
A single line across the palm of the hand (palmar crease)
Small pinky fingers that sometimes curve toward the thumb
Poor muscle tone or loose joints
Shorter in height as children and adults

TYPES OF DOWN SYNDROME

There are three types of Down syndrome. People often can’t tell the difference between each type without looking at the chromosomes because the physical features and behaviors are similar.

TRISOMY 21: About 95% of people with Down syndrome have Trisomy 21. With this type of Down syndrome, each cell in the body has 3 separate copies of chromosome 21 instead of the usual 2 copies.

TRANSLOCATION DOWN SYNDROME: This type accounts for a small percentage of people with Down syndrome (about 3%). This occurs when an extra part or a whole extra chromosome 21 is present, but it is attached or “trans-located” to a different chromosome rather than being a separate chromosome 21.

MOSAIC DOWN SYNDROME: This type affects about 2% of the people with Down syndrome. Mosaic means mixture or combination. For children with mosaic Down syndrome, some of their cells have 3 copies of chromosome 21, but other cells have the typical two copies of chromosome 21. Children with mosaic Down syndrome may have the same features as other children with Down syndrome. However, they may have fewer features of the condition due to the presence of some (or many) cells with a typical number of chromosomes.
Other Problems

Many people with Down syndrome have the common facial features and no other major birth defects. However, some people with Down syndrome might have one or more major birth defects or other medical problems. Some of the more common health problems among children with Down syndrome are listed below.

Hearing loss (up to 75% of people with Down syndrome may be affected)
Obstructive sleep apnea, which is a condition where the person’s breathing temporarily stops while asleep (between 50 -75%)

Ear infections (between 50 -70%)
Eye diseases (up to 60%), like cataracts and eye issues requiring glasses
Heart defects present at birth (50%)
Other less common health problems among people with Down syndrome include:

Intestinal blockage at birth requiring surgery
Hip dislocation
Thyroid disease
Anemia (red blood cells can’t carry enough oxygen to the body) and iron deficiency (anemia where the red blood cells don’t have enough iron)
Leukemia in infancy or early childhood
Hirschsprung disease
Health care providers routinely monitor children with Down syndrome for these conditions. If they are diagnosed, treatment is offered.

OCCURRENCE

Down syndrome remains the most common chromosomal condition diagnosed in the United States. Each year, about 6,000 babies born in the United States have Down syndrome. This means that Down syndrome occurs in about 1 out of every 700 babies.1

CAUSES AND RISK FACTORS

The extra chromosome 21 leads to the physical features and developmental challenges that can occur among people with Down syndrome. Researchers know that Down syndrome is caused by an extra chromosome, but no one knows for sure why Down syndrome occurs or how many different factors play a role.

One factor that increases the risk for having a baby with Down syndrome is the mother’s age. Women who are 35 years or older when they become pregnant are more likely to have a pregnancy affected by Down syndrome than women who become pregnant at a younger age. However, the majority of babies with Down syndrome are born to mothers less than 35 years old, because there are many more births among younger women.6,7 

DIAGNOSIS

There are two basic types of tests available to detect Down syndrome during pregnancy. Screening tests are one type and diagnostic tests are another type. A screening test can tell a woman and her healthcare provider whether her pregnancy has a lower or higher chance of having Down syndrome. So screening tests help decide whether a diagnostic test might be needed. Screening tests do not provide an absolute diagnosis, but they are safer for the mother and the baby. Diagnostic tests can typically detect whether or not a baby will have Down syndrome, but they can be more risky for the mother and baby. Neither screening nor diagnostic tests can predict the full impact of Down syndrome on a baby; no one can predict this.

SCREENING TESTS

Screening tests often include a combination of a blood test, which measures the amount of various substances in the mother’s blood (e.g., MS-AFP, Triple Screen, Quad-screen), and an ultrasound, which creates a picture of the baby. During an ultrasound, one of the things the technician looks at is the fluid behind the baby’s neck. Extra fluid in this region could indicate a genetic problem. These screening tests can help determine the baby’s risk of Down syndrome. Rarely, screening tests can give an abnormal result even when there is nothing wrong with the baby. Sometimes, the test results are normal and yet they miss a problem that does exist.

A new test available since 2010 for certain chromosome problems, including Down syndrome, screens the mother’s blood to detect small pieces of the developing baby’s DNA that are circulating in the mother’s blood. This test is recommended for women who are more likely to have a pregnancy affected by Down syndrome. The test is typically completed during the first trimester (first 3 months of pregnancy) and it is becoming more widely available.

DIAGNOSTIC TESTS

Diagnostic tests are usually performed after a positive screening test in order to confirm a Down syndrome diagnosis. Types of diagnostic tests include:

Chorionic Villus sSampling (CVS)—examines material from the placenta
Amniocentesis—examines the amniotic fluid (the fluid from the sac surrounding the baby)
Percutaneous Umbilical Blood Sampling (PUBS)—examines blood from the umbilical cord
These tests look for changes in the chromosomes that would indicate a Down syndrome diagnosis.

TREATMENTS

Down syndrome is a lifelong condition. Services early in life will often help babies and children with Down syndrome to improve their physical and intellectual abilities. Most of these services focus on helping children with Down syndrome develop to their full potential. These services include speech, occupational, and physical therapy, and they are typically offered through early intervention programs in each state. Children with Down syndrome may also need extra help or attention in school, although many children are included in regular classes.

WHAT YOU NEED TO KNOW ABOUT LASSA FEVER.

Lassa fever is a severe and often fatal hemorrhagic illness caused by Lassa virus. Since its original discovery in 1969 in the village of Lassa in Borno State, Nigeria, there have been countless outbreaks of various magnitude and severity across West Africa. Estimates of annual incidences of Lassa fever across this region reach as high as 300,000 infections and 5,000 deaths. However due to scarce resources to diagnose the illness as well as inadequate surveillance, many cases remain unaccounted.

Lassa virus is a member of the Arenaviridae virus family. Humans contract the virus primarily through contact with the contaminated excreta of Mastomys natalensis rodents (commonly known as the Multimammate rat), which is the natural reservoir for the virus. Little is known regarding the transmission of the virus from the rodent reservoir to the human host, although there is compelling evidence that Arenaviruses are stable and infectious by the aerosol route in nonhuman primates. The rodents live in houses with humans and deposit excreta on floors, tables, beds and food. Consequently the virus is transmitted to humans through cuts and scratches, or inhaled via dust particles in the air. In some regions Mastomys rodents are also consumed as food.

Secondary transmission of the virus between humans occurs through direct contact with infected blood or bodily secretions. This occurs mainly between individuals caring for sick patients although anyone who comes into close contact with a person carrying the virus is at risk of infection. Nosocomial transmission (transmission that occurs as a result of treatment in a hospital) and outbreaks in healthcare facilities in endemic areas represent a significant burden on the healthcare system.

In the early stages, Lassa fever is often misdiagnosed as influenza, typhoid or malaria, and as a result many patients fail to receive appropriate medical treatment. Making a correct diagnosis of Lassa fever is made difficult by the wide spectrum of clinical effects that manifest, ranging from asymptomatic to multi-organ system failure and death. The onset of the illness is typically indolent, with no specific symptoms that would distinguish it from other febrile illnesses. Early signs include fever, headache and general malaise, followed by a sore throat, nausea, vomiting, abdominal pain and diarrhea in some cases. After 4 to 7 days, many patients will start to feel better, but a small minority will proceed to display symptoms such as edema, hypertension, bleeding and shock. Death from Lassa fever most commonly occurs 10 to 14 days after symptom onset.

Because of its high case fatality rate, ability to spread easily by human-to-human contact, and potential for aerosol release, Lassa virus is classified as a Biosafety Level 4 (BSL4) and NIAID Biodefense category A agent. The potential use of Lassa virus as a biological weapon directed against civilian or military targets necessitates the development of counter-threat measures, such as diagnostic assays, vaccines and therapeutics. Moreover, the impact of the disease in endemic regions of West Africa is immense, and therefore means to diagnose, treat and prevent this viral hemorrhagic fever will provide a significant public health benefit.

No vaccine for Lassa fever is currently available for use in humans, and the only available drug, ribavirin, is only effective if administered early in infection (within the first 6 days after disease onset). One of the hallmarks of Lassa virus infection is the apparent absence of functional antibodies during acute infection. A fundamental understanding of the mechanisms of antibody-mediated neutralization of Lassa virus may have significant implications for the generation of antibody-based therapeutics or epitope-targeted vaccines.

GEOGRAPHIC DISTRIBUTION

Lassa fever is endemic to West Africa. Confirmed incidences have been recorded in Sierra Leone, Liberia, Guinea, Nigeria and Mali. However, concerns exist that there may be Lassa(-like) viruses in other countries such as Central African Republic, Ghana, Mali, Ivory Coast, Togo, Benin and Cameroon. Furthermore, Mastomys rodents are distributed across the African continent, indicating a strong possibility for the spread of the disease they carry.

PREVENTION

Primary transmission of the Lassa virus from its host to humans can be prevented by avoiding contact with Mastomys rodents, especially in the geographic regions where outbreaks occur. Putting food away in rodent-proof containers and keeping the home clean help to discourage rodents from entering homes. Using these rodents as a food source is not recommended. Trapping in and around homes can help reduce rodent populations; however, the wide distribution of Mastomys in Africa makes complete control of this rodent reservoir impractical.

When caring for patients with Lassa fever, further transmission of the disease through person-to-person contact or nosocomial routes can be avoided by taking preventive precautions against contact with patient secretions (called VHF isolation precautions or barrier nursing methods). Such precautions include wearing protective clothing, such as masks, gloves, gowns, and goggles; using infection control measures, such as complete equipment sterilization; and isolating infected patients from contact with unprotected persons until the disease has run its course.

Further, educating people in high-risk areas about ways to decrease rodent populations in their homes will aid in the control and prevention of Lassa fever. Other challenges include developing more rapid diagnostic tests and increasing the availability of the only known drug treatment, ribavirin. Research is presently under way to develop a vaccine for Lassa fever.