WORLD MALARIA DAY 2024

World Malaria day 2024,  April 25 th.

Accelerate the fight against Malaria for a more equitable world… is the theme of world malaria day 2024.

Know about Malaria, organism, vector  ,symptoms, complications, treatment and prevention.

HOW DOES IT SPREAD

Malaria is transmitted by  female Anopheles mosquito when it takes bloodmeal from  a human infected with  malaria and causative parasite is plasmodium species like falciparum, vivax, ovale, malariae. Falciparum species  are responsible for malarial deaths. Vivax and falciparum species are seen in India.

Mosquito breeds in water tanks, pits, overhead tanks,edge of streams, wells, brackish water, pools, ponds, marshy areas.

When an infected female Anopheles mosquito bites a human, the parasite ( sporozoite form )enters the human blood stream from the mosquito’s salivary gland. It reaches the liver through the blood, where it undergoes  amplification process, then released into blood stream which will invade and multiply inside RBC. Symptoms appear as a result of invasion and destruction of RBC and by host  response.

Malaria endemic countries are Africa,  Asia. Certain countries have eliminated Malaria. It affects both urban and rural areas, multifactorial like inappropriate water storage and disposal, population migration from endemic to nonendemic areas and vive versa.

WHAT ARE THE SYMPTOMS 

 Both adults and children are affected. Endemic area they present with  severe anaemia and cerebral malaria.

Common symptoms are high  fever, which spikes regularly daily, 2 days or 3 days, chills ,rigor, headache , fatigue, loss of appetite, jaundice. Falciparum malaria can  affect brain leading to coma or cerebral malaria ,anaemia, renal failure,lung issues or respiratory distress, hypoglycemia, bleeding from nose, gums, GIT ,seizures, hypovolemia . Classic intermittent fever is usually not seen in children.

ENT manifestations are bleeding from the nose, headache,dizziness, ringing sensation in the ear,hearing loss. 

 WHAT ARE THE COMPLICATIONS ?

It can cause multi-organ  failure. Coma, convulsions, shock, breathing problems or respiratory distress, spontaneous bleeding.

Malaria can undergo relapse also.

HOW TO DIAGNOSE ?

Diagnosis is   history, by peripheral blood smear examination for malarial parasite. Rapid test for antibody, PCR .

TREATMENT 

Treatment by  antimalarial drugs, oral and injections, supportive measures.

Complicated or severe cases by falciparum requires requires immediate attention, hospital admission .

Oral medicine for uncomplicated malaria.

How to prevent Malaria

Use bed nets treated with insecticide especially in endemic areas, kill the vector mosquito ,  find and eliminate the breeding places  ,early or rapid diagnosis and management of the infection, chemo prevention or prophylaxis.

Avoid exposure to mosquito, use insect repellent, use fully covered clothes ,use bednets.

Chemoprophylaxis  should be taken, if travelling to endemic area, pregnant women to be warned about the risks if travelling. Consult a doctor for prophylaxis  before travelling as antimalarial drug resistance also is a problem.Those taking medicines should be advised regarding the side effects  of the medicine and  should inform the doctor if any adverse effects happen.

EARLY CASE DETECTION, PROMPT TREATMENT AND VECTOR CONTROL   PREVENTS SPREAD OF MALARIA.

VOICE AND SOME PROBLEMS WE COME ACROSS

April 16th is celebrated as WORLD VOICE DAY, in order to highlight the importance of voice in our daily lives. 2024 theme is   Resonate Educate Celebrate .Voice is produced by the vibration of vocal cords, as the expired air passes through it. Voice is unique. 

WHAT ARE THE  CAUSES THAT LEADS TO PROBLEMS WITH  THE VOICE  ? 

Structural abnormalities due to any inflammation ( upper respiratory infections,allergies,acid reflux), lesions, neurology or muscular problems can lead on to hoarse or weak voice along with pain or discomfort in the throat. 

Problems can arise due to overuse or abuse of the vocal cords as in professional voice users like teachers or singers ( vocal cord nodules)  and  shifting from high pitch to low pitch as in mimicry . There will be early tiring  of the voice. 

Other problems are due to restricted activity of the vocal cords . 

WHAT ARE THE  SYMPTOMS AND SIGNS ? 

Abnormal vocal cord vibration leads to DYSPHONIA ( impairment of voice) absence of vocal cord vibration results in APHONIA. Vocal cord nodule ( teacher's or singer's nodule) , vocal cord polyp, cyst,  inflammation  due to chronic laryngitis, keratosis, granuloma, papilloma, cancers, cleft , neurological problems  causing vocal cord paralysis ,these are some of the conditions affecting vocal cords. 

WHAT CAN BE DONE? 

Examination of the ENT areas, Endoscopy , Stroboscopy , Radiological evaluation and Biopsy  . 

Treatment depends upon the diagnosis. Voice rest, vocal hygiene, voice therapy, vocal exercises ,laryngeal massages are some of the measures.. Medical management ( for upper respiratory infections, allergic and acid reflux) and in some cases phonosurgery. 

WHAT IS VOCAL HYGIENE ? 

Life style changes and dietary modifications, voice rest, adequate hydration,  to quit smoking and alcohol,  to consume less spicy food, to cut down tea and coffee ,  to have food 3 hours before sleep. 

VOICE IS A PRECIOUS GIFT, DON'T ABUSE OR OVER USE IT. ANY CHANGE IN VOICE WHICH IS LASTING FOR  MORE THAN 3 WEEKS NEEDS ATTENTION. 

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Throat pain causes and infection

Throat  pain is a very distressing symptom especially when you are not able to eat or drink or swallow  saliva. The cause for throat pain can be various like infection, inflammation, ulcers inside the mouth or any lesions.

Infective causes are  viral, bacterial and fungal .Viral pharyngitis  usually accompanied by cold or coryza symptoms, body pain, chills, fever ( always need not be in this order).Those with long standing  tonsillitis issue may come with flare up of tonsillitis or membrane  over the tonsils. Viral pharyngitis need to be treated symptomatically.

Bacterial pharyngitis and tonsillitis usually caused by gram positive cocci  like streptococcus. Antibiotics are needed to control bacterial tonsillitis to prevent abscess formation ( collection of pus).

Fungal Infection  seen more in those with low immunity like Diabetes or those on immunosuppressive medication. 

Other causes are allergic reaction to food or drinks, it can cause  pain , itchy throat, swelling of pharynx especially uvula .

Chronic conditions like acid reflux or Sinusitis with post nasal discharge leads to throat pain which will be of long standing duration.

 Preventive measures 

Viral and bacterial Infection usually spread through nasal or oral route. Those with illness should wear mask while going out . Avoid overcrowded areas as it leads to rapid spread of upper respiratory Infections.

Eat healthy food,  adequate hydration ,maintain oral hygiene.

TREATMENT 

Depends on the findings, comorbidities . Analgesics to relieve the pain, gargling with salt water and betadine. Drink warm fluids. Antibiotics only if symptoms point towards bacterial infection. Don't self medicate, visit a nearby doctor.

Red flag signs 

Any choking sensation or breathing difficulties change in voice ( like hot potato voice) high fever with chills need immediate hospital visit.

If mouth ulcers or blister like lesions are the causes for throat pain, topical  cream   should be added according to the findings.

Eat healthy, adequate hydration, take rest, avoid travelling if you are sick .

Oral health day

 World Oral health day is  on 20 th March .Theme this year (2024 )is "A HAPPY MOUTH   is ......a HAPPY BODY".

Mouth  extends from the lips and cheeks and it's divided into oral cavity and oropharynx. Infections from the mouth can spread to involve nose, ear, jaw joint and throat. Salivary gland ducts open into the mouth, hence infection can spread on to the salivary glands.Tissue spaces  associated with the mouth hasten the spread of infection.

Dental infection 

Carries teeth  or tooth decay is the  common cause of infection and if untreated dental  abscess can spread rapidly to adjacent areas, if patient is having uncontrolled Diabetes  or any low immunity. conditions. Lower dental abscess spread to spaces below the jaw and upper  dental Infection into maxillary sinus area ( cheek ).Gum infection,ulcer, swelling it can be due to local pathology or secondary to  certain medications and systemic disease manifestations.

Oral mucosa  ( lining the cheek, palate, floor  of the mouth) can present with ulcer, swelling, redness , fungal infection .Premalignant and malignant lesions to be kept in mind. Any nonhealing ulcer needs to be examined . Certain immunological conditions affect oral cavity and oropharynx like Lichen planus.

Dehydration, obstruction to salivary duct leads to stone formation. Multivitamin deficiency  has oral manifestations like cheilitis, glossitis, stomatitis.

Smoking and smokeless tobacco  as in paan  with betel leaves, arecanut, lime leads to mucositis, submucous fibrosis,cancer.

Oral health is  necessary to prevent various infections. Maintain oral hygiene by brushing teeth, rinsing mouth after eating, drink adequate water to prevent dehydration  and other problems.Those with Diabetes Mellitus  and other immunodeficiency diseases need to take special care, any carries teeth needs to be examined by a dentist. Various systemic conditions have oral manifestations,needs to be evaluated.

MAINTAIN ORAL HEALTH  TO IMPROVE QUALITY OF LIFE .

SMOKING AND IT'S HARMFUL EFFECTS

Smoking can affect  the body thereby our health in various ways. It depends on the duration, number of cigarettes  and associated comorbidities which smoking can contribute or  worsen.

Every year March second Wednesday  is considered as NO SMOKING DAY. Smoking can lead on  Cardiovascular diseases, lung diseases or can aggravate existing lung conditions and can  cause Cancer.

SMOKING  AND IT'S  MANIFESTATIONS IN ENT 

Tobacco contains certain substances which are carcinogens like polycyclic aromatic hydrocarbons and nitrosamines. Use of  unfiltered cigarette, pipe will increase the carcinogenic effect ,:along with alcohol intake synergistic effect occurs as alcohol increases absorption of carcinogens contained in the tobacco. Duration of smoking, amount of cigarettes daily increase the carcinogenic effect.

Head and neck cancers like oral cavity and oropharynx  , Larynx, hypopharynx  majority of the patients give history of smoking and alcohol intake.

Chewing tobacco or smokeless tobacco  lead on to cancers of  oral cavity and oropharynx. Paan mixed with  lime ,where lime lowers the pH thereby increasing the release of alkaloids from tobacco and  arecanut  making more prone to cancer . It can lead on to fibrosis, oral submucous fibrosis where patient will have difficulty in opening the mouth due to  fibrous bands.

Smoking can worsen laryngitis,cause polypoid chan ges in the larynx. Bronchitis and exacerbation of asthma have been observed.

Ear infections and hearing loss

Smoking is a risk factor for ear Infections like middle ear Infections especially in children due to parental smoking. Age related hearing loss and noise induced hearing loss aggravated by smoking. its also related to tinnitus ( sound in the ear ). Smoking  causes Ventilating or Eustachian tube dysfunction and causes  increased mucus build up in the middle ear.

Nose and paranasal sinuses

Smoking  affects the inner lining of nose and PNS, decrease the number of cilia , change the viscosity thereby alter the mucociliary  pathway,  causing mucus build up. It can lead on to Rhinitis due to the irritating effect, worsening  of occupational rhinitis or prolongation of rhinosinusitis. Tobacco smoke will irritate the nerves related to smell resulting in decrease in smell sensation, which will reverse once smoking is stopped.

Certain lesions like polyp,  inverted papilloma  has history of active or passive smoking.

To summarise smoking leads to various diseases, interfere with the quality of life. Stopping smoking will improve mucociliary function. Active and passive smoking  is a health hazard, parents should be careful if they have small kids and avoid smoking in front of them or try to quit the habit.

DEAF AWARENESS WEEK

September last week is celebrated as DEAF AWARENESS WEEK internationally. 

Aim is to create awareness among  hearing impaired people and others, their  human rights, needs  and to support  and rehabilitate them. 

Deafness or hearing impairment can be from birth (congenital)  due to genetic defects or in utero infection (TORCH  infection  or other infection among pregnant women ). 

Acquired causes can be due to infection be it viral  like measles, mumps , rubella or bacterial infection like pnuemoccal or other bacteria resulting in severe ear infection or meningitis. Other causes are trauma to the ear by physical impact, NIHL( noise induced hearing loss), barotrauma. Cardiovascular diseases can also result in hearing impairment. 

WHAT CAN BE DONE ? 

Genetic counselling, educate  pregnant women of various infections and proper care. Early identification of the problem by screening during neonatal  period and later at school (audiological tests)  and vaccination . 

Can give Hearing aid, or Cochlear implant  according to the pathology, so speech and language development will not be affected. Ear infections should be treated promptly. AWARENESS regarding ear safety measures among factory workers, or over use of earphones, listening to loud sound , prolonged use of ototoxic medication should be done. 

REHABILITATION

Hearing impaired people  should be  supported emotionally and economically . Have patience while talking to them, repeat the sentence again, have eye contact as they depend on lip reading. Learn sign language and make sure they understand, can also write or draw. Support them  by promoting their business, art or any enterprises started by them. Bring them back to mainstream. Motivate them to carry on with their lives and educate them regarding their human rights. 

Let's make this Deaf awareness  week   fruitful by helping those who need our hand and support them. 

NECK SWELLINGS... WHAT ARE THEY ?

Some times patients come with a neck swelling and most often  they are noncancerous but some times cancerous. 

Among the swellings there are solid and cystic type. Can occur in children and adults  and if the duration of the swelling is short, detailed  evaluation and investigation has to be done. It may present any where in the neck, upper, middle, lower or side of the neck. Sometimes it could be  a lymph node draining a cancerous site. 

Here am focussing on a  cystic swelling in front of the neck which is related to the thyroid gland and is known as THYROGLOSSAL CYST or thyroglossal duct cyst. 

WHAT IS THYROGLOSSAL CYST  ? 

This cystic swelling is due to a congenital (from birth) abnormality. Normally  thyroid gland develops from a part of the tongue called foramen caecum and it comes down as a duct to lie in front of the neck before birth. This duct involutes in utero, but when it fails to involute, the duct remains in the neck. Cyst can develop anywhere along the path of the tract. 

HOW DOES IT LOOK LIKE ? 

Though it is present from birth, swelling appears during late childhood or adulthood. Site usually is in the midline but some times seen on the side of the neck.  The characteristic feature of the swelling is that, it moves up on swallowing and protrusion of the tongue. 

WHAT ARE THE COMPLICATIONS ? 

Cyst can get infected and present as a discharging fistula ( opening on the skin)  ,

if it is cut or drainage of the pus is done. Rarely cancer can develop from the cyst. 

Sometimes the cyst may be the only functioning thyroid tissue and it's removal can cause hypothyroidism. So always one has to look for normal thyroid gland, which can be examined clinically and  by ultrasound. 

HOW IS IT TREATED  ? 

If the cyst gets repeated infection and size gets bigger, the cyst along with the tract has to be removed to prevent recurrence. 

This is in short about thyroglossal duct cyst. 

PHOTO published with patient's consent.