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Sunday, November 2, 2014

Role of CT Abdomen in Pyrexia of Unknown Origin to Differentiate between Lymphoma and Tuberculosis

Posted by Prahallad Panda on 7:34 PM Comments


Fever of unknown origin (FUO) was defined in 1961 as:
  1. A temperature greater than 38.3°C (101°F) on several occasions,
  2. More than 3 weeks' duration of illness, and
  3. Failure to reach a diagnosis despite 1 week of inpatient investigation.
Now, most of diseases that may cause continuous fever and dilemma in arriving at diagnosis decreased after the advent of various imaging and investigative technologies. 
The most common causes of FUO like tuberculosis, collagen diseases, AIDS and malignancies can be diagnosed by newer serological tests, ultrasonogram, CT, MRI and PET/CT etc..
In spite of all these, there may be occasions, where it may not be possible to differentiate mesenteric lymphadenopathay of lymphoma and tuberculous aetiology without any other associated features.

Intra-Abdominal Lymph Nodes
In multi-detection computerized tomography (MDCT), it has been seen that lymphadenopathy of tuberculous origin mostly affect the LN (Lymph node) adjacent to the intestinal mesenteric boarder, where as in lymphoma more distant LN like para-aortic are involved.
Tuberculosis predominantly involved lesser omental, mesenteric, and upper para-aortic lymph nodes whereas lower para-aortic lymph nodes were involved more often in Hodgkin’s and non-Hodgkin’s lymphoma.
Peripheral enhancement is most commonly seen in tuberculosis, whereas homogeneous enhancement is seen in lymphoma.
The contrast enhancement of tuberculous lymph nodes on contrast-enhanced CT (CECT) have been described as (four patterns) - peripheral rim enhancement, inhomogeneous enhancement, homogeneous enhancement and homogeneous non-enhancement, in that order of frequency.
'Sand-witch' sign, encasing of superior mesenteric vessels and fat (Filling) by the lymph node mass as “Bun” is most commonly seen in lymphoma.
In a study, the mean diameters were 2.95 cm in tuberculous lymphadenopathy, whereas it was 4.10 cm in lymphoma.
Associated findings like thickening of intestine, ascites and peritoneal thickening are more commonly seen in tuberculosis.
In spite of all, a CT/USG guided FNAC or laparoscopic tissue diagnosis is required for the final diagnosis and treatment planning.

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Thursday, October 2, 2014

Importance of Hand Washing & Hygiene in Preventing Infectious Diseases

Posted by Prahallad Panda on 9:01 AM Comments



As India is all set to observe “National Cleanliness Day” to-day i.e. 02.10.2014, on the birth anniversary of “father of Nation”; Mahatma Gandhi; I thought, it will be proper to put this article on Web as a small contribution towards the larger cause.
Do we remember Typhoid Mary? Mary Mallon, better known as Typhoid Mary, a Cook, who got this nick name after spreading Typhoid in about 50 people in New York City in the early 1900s without succumbing to the illness herself. This a bright example of faeco-oral route of transmission of disease.
Various infections are transmitted through hand. Health care persons and those handling food are important vectors. 
In addition, Elementary schoolchildren are important vectors for spreading infectious diseases between themselves and their families.
Infectious agents that children contract in schools can result in infections in up to 50% of household members.
100 trillion microbial symbionts (the human microbiota). Your body is home to 10 times as many microbes as its own cells. The human skin contains microbes that reside either in or on the skin and can be residential or transient. Swab samples from about 200 volunteers' belly buttons contained an astonishing variety of bacteria, nearly 4,000 different strains, many of which are completely new to scientists.
Infectious agents that children contract in schools can result in infections in up to 50% of household members.

The Facts behind the Urgency:

There are many types of germs (viruses, bacteria, parasites, fungi) that cause many types of illnesses– including the common cold or flu, food borne illness, Lyme disease, hantavirus, or plague. 
Enterovirus family of viruses like Coxsackie viruses, poliovirus and hepatitis A virus those live in the human digestive tract can spread from person to person, usually on unwashed hands and surfaces contaminated by faeces, where they can live for several days.
These germs can spread easily from one person to another – and have wide-reaching effects.
About 10 million U.S. adults (ages 18 - 69) were unable to work during 2002 due to health problems.
Salmonella infections (Typhoid etc.) are responsible for an estimated 1.4 million illnesses each year.
Infectious diseases cost the U.S. $120 billion a year. More than 160,000 people in the U.S. die yearly from an infectious disease.
Over 320.000 patients in the UK acquire one or more health care-associated infections during their stay in hospital of which 50.000 result in death, are transmitted via the hands.
The World Health Organization (WHO) recognizes the spread of diarrhoeal diseases as a serious global problem and estimates that each year, there are more than 2.2 million lives lost due to these infections, more than from malaria, HIV/AIDS and measles combined. The majority of these deaths are in children under 5 years of age.
As a consequence, this leads to prolonged patient suffering, longer confinement to bed and elevated treatment costs. In Great Britain, additional hospitalization costs of approximately £930 million (this is equivalent to approx. 1. 2 billion Euros) are calculated to be the result.




Unsuspected Source of infection: Germs are hiding everywhere
  • “The bulk of germs are hiding where you least suspect – playground equipment, the phone receiver, ATMS and elevator buttons.” 229,000 germs per square inch on frequently used faucet handles. 
  •  21,000 germs per square inch on work desks about 400 times more than the average toilet seat. 
  •  More germs at the kitchen sink than at the toilet. 
  •  1,500 on each square centimetre of hands.
 High on the worst list:
  • Work desk, Kitchen sink, Dishcloth, sponge 
  •  Garbage can, Refrigerator, Telephone receiver, Cell Phones 
  •  Bathroom doorknob, Keyboards, Escalator handrails 
  •  Shopping cart handles, Picnic tables, Pens, pencils and crayons 
  •  Remote controls, Light switches, Bathroom cups 
  •  The soap suspends the dirt and soils. 
  •  Many pets, such as dogs, cats, reptiles, rodents, and birds, carry germs that can be spread from animals to people.



Nosocomial infections:

Nosocomial infections, also called “hospital-acquired infections”, are the infections acquired during hospital care which are not present or incubating at admission. Infections occurring more than 48 hours after admission are usually considered nosocomial.
When you cough or sneeze, you send tiny germ-filled droplets into the air. Colds and flu usually spread that way. You contaminate your hand from these acts and handling patients and their body fluids. You transmit and contact disease to yourselves.

Hand Hygiene:
Washing your hands correctly is the best way to stop the spread of infections.  Eighty percent of common infections are spread by hands. Washing your hands at least five times a day has been shown to significantly decrease the frequency of colds, influenza (the “flu”) and other infections.

Good Hand washing Really Works!

The US Centers for Disease Control (CDC) confirms, “Handwashing is the single most important means of preventing the spread of infection.”
A Wirthlin study of 305 Detroit students washed four times a day resulting in 24% fewer colds and 51% less stomach upsets.
A Minnesota daycare provider reported that teachers helped the kids wash their hands every morning when they arrived and the staff disinfected all areas parents may have touched. Result was 50% fewer illnesses at those daycares. 

  • Covering your mouth and nose when you sneeze or cough. Sneeze or cough into your elbow, not your hands.
  • Cleaning your hands often - always before you eat or prepare food, and after you use the bathroom or change a diaper
  • Avoiding touching your eyes, nose or mouth
Hand washing is one of the most effective and most overlooked ways to stop disease. Soap and water work well to kill germs. Wash for at least 20 seconds and rub your hands briskly.

When:
  • After going to the toilet or changing diapers 
  •  After coughing or sneezing 
  •  After getting visible soil on hands 
  •  After handling raw meat/poultry or unwashed fruits and veggies 
  •  After playing with pets 
  •  After smoking, eating or drinking 
  •  After touching sores, lacerations or infected areas 
  •  After playing/working outside 
  •  After playing in water more than one person has used 
  •  After touching any animals
  • After handling shared objects like telephone, Key Board, Door Knob
  • After helping someone with a runny nose
  • Before and after caring for someone who is sick
  • Before performing first aid or applying a band-aid
  • When arriving at work or school
  • Before and after eating or feeding someone else
  • Before preparing food 
  •  Before handling foods 
  •  Before eating 
  •  Before giving medications 
  •  Before putting contacts in eyes 
  •  Before playing in water more than one person is using 
  •  Before touching ready-to-eat foods/snacks
  • Household or garden chemicals, or anything that could be contaminated — such as a cleaning cloth or soiled shoes
How to Wash Your Hands Correctly



·        Wet your hands with clean, running water (warm or cold), turn off the tap, and apply soap.
·         Lather your hands by rubbing them together with the soap. Be sure to lather the backs of your hands, between your fingers, and under your nails.
·          Scrub your hands for at least 20 seconds. Need a timer? Hum the "Happy Birthday" song from beginning to end twice.
·          Rinse your hands well under clean, running water.
·                                                                                                                 Dry your hands using a clean
                                                                                                              towel

 A word of Caution:
  • In public restrooms, consider using a paper towel to flush the toilet and open the door because toilet and door handles harbor germs. Throw the towel away after you leave. 
  • Keep in mind that antibacterial soap is not more effective at killing germs than is regular soap. Using antibacterial soap may even lead to the development of bacteria that are resistant to the product's antimicrobial agents — making it harder to kill these germs in the future. 
  •  Alcohol-based hand sanitizers can quickly reduce the number of microbes on hands in some situations, but sanitizers do not eliminate all types of germs. 
  • Although alcohol-based hand sanitizers can inactivate many types of microbes very effectively when used correctly, people may not use a large enough volume of the sanitizers or may wipe it off before it has dried. Furthermore, soap and water are more effective than hand sanitizers at removing or inactivating certain kinds of germs, like Cryptosporidium, norovirus, and Clostridium difficile. 
  • Alcohol-based hand rubs may be less effective against C. difficile; using soap and running water is recommended if there is an outbreak of C. difficile infection.
SEPARATE:

Don’t cross-contaminate one food with another:

Cross-contamination occurs when bacteria spread from a food to a surface . . . from a surface to another food . . . or from one food to another. 

You’re helping to prevent cross-contamination when you:

  • Separate raw meat, poultry, seafood and eggs from other foods in your grocery cart, grocery bags, and in your refrigerator.  Be sure to use the plastic bags available in the meat and produce sections of the supermarket. 
  • Use one cutting board for fresh produce and a different one for raw meat, poultry and seafood. 
  • Never place cooked food on a plate that previously held raw meat, poultry, seafood, or eggs.  
  • Don’t allow juices from meat, seafood, poultry, or eggs to drip on other foods in the refrigerator.  Use containers to keep these foods from touching other foods. 
  • Never re-use marinades that were used on raw food, unless you bring them to a boil first.
Take Home Message:





It is always better to prevent disease than to treat. Hand washing is proven, but least used means to prevent and control infectious diseases.
Let us spread the information to remain healthy, wealthy and wise.
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