10 MOST INFECTIOUS DISEASES IN WEST AFRICA

West Africa, if one includes the western portion of the Maghreb (Western Sahara, Morocco, Algeria, and Tunisia), occupies an area in excess of 6,140,000 km2, or approximately one-fifth of Africa. Outbreaks of diseases are costly wherever and whenever they occur. However,outbreaks come to an end.
Infectious diseases stemming from health infrastructural deficiencies,
such as poor sanitation and lack of adequate vaccine coverage,
as well as those linked to specific sociocultural factors, such
as airborne and sexually transmitted diseases,are among the leading cause of death in west africa. listed below are a few.

ONCHOCERCIASIS :Onchocerciasis also known as river blindness is the world's third leading infectious cause of blindness. Some 37 Million people are estimated to be infected and over 99% of those affected live in Africa. It is caused by Onchocerca volvulus also know as filirial worm, a nematode that can live for up to fifteen years in the human body. The worms spread throughout the body, and when they die, they cause intense itching and a strong immune system response that can destroy nearby tissue, such as the eye.

skin involvement typically consists of intense itching, swelling, and inflammation. Agrading System has been developed to categorize the degree of skin involvement:Acute Papular dermatitis - scattered pruritic papules; Chronic papular dermatitis -larger papule, resulting in hyperpigmentation; Lichenified dermatitis -hyperpigmented papules and plaques, with edema, lymphadenopathy, pruritusand common secondary bacterial infections; Skin atrophy - loss of elasticity, skin resembles tissue paper, 'lizard skin' appearance; Depigmentation - 'leopard skin'appearance, usually on anterior lower leg.Ocular involvement provides the common name associated with onchocerciasis,river blindness. The microfilariae migrate to the surface of the cornea. Punctatekeratitis occurs in the infected area. This clears up as the inflammation subsides.However, if the infection is chronic, sclerosing keratitis can occur, making theaffected area become opaque. Over time the entire cornea may becomeopaque, thus leading to blindness. There is some evidence to suggest that the effecton the cornea is caused by an immune response to bacteria present in the worms.



2. SYPHILIS is a sexually transmitted disease caused by the Spirochetal bacterium Treponema pallidum. The route of transmission of syphilis is almost always through sexual contact, although there are examples of congenital syphilis via transmission from mother to child in the uterus.The signs and symptoms of syphilis are numerous; before the advent of serological testing, precise diagnosis was very difficult. In fact, the disease was dubbed the"Great Imitator" because it was often confused with other diseases, particularly in its tertiary stage. Most persons with syphilis tend to be unaware of the infection and they can transmit the infection to sexual contacts or in the case of woman to her unborn child. If left untreated, syphilis can cause serious consequences such as stillbirth, prematurity and neonatal deaths. Adverse outcomes of pregnancies are preventable if the infection is detected and treated before mid-second trimester.Congenital syphilis kills more than 1 million babies a year worldwide but preventableif infected mothers are identified and treated appropriately as early as possible.World health Organization estimates that 12 million new cases of syphilis occur every year. In developing countries, 20-35% of women in child bearing age have syphilis.About 60% of pregnant women with syphilis will give birth to a dead baby and another 30% to live baby with congenital syphilis, a condition with mortality of up to70%.
 

HOW TO CLERK A PATIENT..THE GUIDE

A suggested format for clerking patients with all the standard questions you might ever want to ask.  this should be of help to medical students,trainee nurses and other general medical disciplines

Generally clerking is divided into two:
 1.    HISTORY TAKING
 2.    SYSTEMIC REVIEW


We'd begin with history taking


Introduction
Always begin by introducing yourself,develop a rapport.  that the key to a successful history taking
all patients are humans and humans generally are apprehensive when giving out personal information so develop a rapport.


1.         Introduce myself
2.     Tell patient what U want to do
3.     Ask patient if it is alright
4.     Ask patient if they are comfortable



Preliminaries

After the rapport development and the introduction, its important you get the bio-data of the patient next.
follow either of the two format

1.         Full name
2.     Age
3.     Occupation
4.     Marital Status
5.     Patient's Address & Telephone
6.     Next of Kin's Address & Telephone
7.     GP's name & area
8.     Hospital consultant

or break it down into acronyms NASOMATI
 N      NAME
 A      AGE
 S      SEX
 O      OCCUPATION
 M      MARITAL STATUS
 A      ADDRESS
 T      TRIBE/RELIGION( DEPENDING ON YOUR LOCATION)
 I      INFORMANT...(its necessary to point out the person who answered the questions if twas the patient or the relation)


Presenting Complaint  (PC)
        ask the patient what brought him to the hospital...and categorize complain chronologically in descending order of date the complain started
        its important that you put this in the patient own word.

History of Presenting Complaint  (HPC)
1.         Could you take me through everything leading up to you coming to hospital.
2.     Symptoms most symptom can be exhausted under the acronym (SOCRATEIS)
    Site
    Onset  (Sudden  /  Gradual)
    Character
        (Aching,  Burning,  Stabbing,  Throbbing)
        (Crushing,  Constricting,  Distending)
        (Constant  or  Colicky)
        (Deep  or  Superficial)
        (Sharp  or  Dull)
    Radiation
    Alleviating factors
    Time
    Exacerbating Factors
    Intensity  /  Severity
    Associated features
    Preceding events
    Ever had it before?
    Getting better  /  worse





Past Medical History  (PMH)
1.         Have you had any other problems requiring treatment or hospitalisation before?
2.     IS THE PATIENT CURRENTLY ON TREATMENT FOR ANY CONDITION
3.     Ask about :-

    Rheumatic Fever
    Diabetes
    Jaundice      Epilepsy 
    Tuberculosis 
    Hypertension  
    Asthma   
    Myocardial Infarction   
    Heart Disease      Stroke
    Chronic Bronchitis
    Kidney Disease
    Venereal Disease
    Tropical Diseases
    Operations )
    Anaesthetic Problems (Anaes)
    Immunizations (Imun)
    Childhood Infections
        (Measles, Mumps, Chicken Pox, German Measles)
        (Diphtheria, Whooping Cough, Scarlet Fever)
    Allergies  /  Drug Reactions
    Anything else which I haven't mentioned or we haven't covered?


NEXT IS THE SOCIAL/FAMILY HISTORY
     Ask about the family background of the patient,marital status, marital setting if  married (monogamous/polygamous) number of children etc
    Also ask about
    Smoking
    Drinking
    Drugs
    Allergies to either food and drugs




Review of Systems  (ROS)

General
1.         Weight Loss  /  Gain
2.     Appetite  /  Diet
3.     Thirst
4.     Energy  /  Fatigue
5.     Lumps
6.     Fevers
7.     Itches
8.     Sleep
9.     Night Sweats

Respiratory
1.         Cough
2.     Sputum
3.     Haemoptysis
4.     Dyspnoea
5.     Wheeze
6.     Chest Pain
7.     Tachypnoea

Cardiovascular
1.         Exertional dyspnoea
2.     Paroxysmal Nocturnal Dyspnoea
3.     Orthopnoea
4.     Chest Pain
5.     Palpitations
6.     Ankle oedema
7.     Intermittent Claudication
8.     Headaches
9.     Rheumatic Fever  /  Chorea
10.     Pedal edema
Gastrointestinal

Upper Alimentary Tract :
1.         Abdominal Pain
2.     Appetite
3.     Vomiting  /  Nausea
4.     Vomit  /  Haematemesis
5.     Belching  /  Flatulence
6.     Water Brash
7.     Heartburn
8.     Indigestion
9.     Swallowing  /  Dysphagia
10.     Haemotypsis

Lower Abdominal Tract :1.         Diarrhoea
2.     Constipation
3.     Stools  (Steatorrhoea, Blood, Slime, Consistency, Colour, Flushing)
4.     Pain
5.     Frequency  /  Bowel Habit
6.     Tenesmus  /  Urgency

Liver & Gallbladder :
1.         Jaundice
2.     Colour of Urine and Faeces
3.     Itching Skin
4.     Pain

Genito-Urinary System

Urinary :
1.         Loin Pain  /  Dysuria
2.     Oedema
3.     Incontinence
4.     Haematuria
5.     Nocturia
6.     Frequency
7.     Polyuria  /  Oliguria
8.     Hesitancy
9.     Terminal Dribbling

Genital :
1.         Vaginal  /  Urethral Discharge
2.     Menses  (Frequency, Regularity, Heavy or Light, Duration, Pain)
3.     Perineal Pain  /  Swelling  /  Ulceration
4.     Pregnancies  (Gravida  /  Para)
5.     Menarche  /  Menopause
6.     Infertility
7.     Sex Life  /  Dyspareunia

Neurological
1.         Sight
2.     Hearing
3.     Taste
4.     Touch
5.     Smell
6.     Epilepsy  /  Seizures
7.     Faints  /  Blackouts
8.     Headaches
9.     Injuries
10.     Parasthesia  /  Sensation
11.     Motor Weakness  /  Muscle Twitches
12.     Nausea  /  Vomiting
13.     Paralysis  /  Stroke
14.     Balance  /  Coordination
15.     Speech
16.     Higher Mental Function
17.     Psychiatric Symptoms
(Anxiety, Phobias, Obsessive Thoughts, Compulsive Acts)
(Depression, Mania, Psychoses)

Musculo-Skeletal
1.         Pain
2.     Stiffness
3.     Swelling of Joints
4.     Functioning of Joints  /  Mobility

Skin
1.         Rashes
2.     Itching
3.     Smell
4.     Drugs
5.     Hobbies  /  Occupation
6.     Personal Hygiene
7.     Allergies

systemic reviews comes next..

MEDICAL BOOKS guide to a successful erotic massage massage tips that can help improve the massage experience of an erotic evening: Massage Tips1. The person being massaged should be as comfortable and relaxed as possible - You can dim the lights, put on soft music, and silence any other distractions such as telephones in order to make the relaxation process easier. 2. Use essential oils – when you use essential oils it limits the pulling of skin and hairs when you are giving a massage and makes for a better massage experience. Be sure to start by putting the oil in your hands and rubbing them together to warm up the oil, otherwise it might be too cold for the person being massaged. 3. Try lighting candles – many people find candle light relaxing, so this might help make the experience more pleasant. 4. Keep the room at a comfortable temperature – You don’t want the person getting a massage to be too cold or too hot. Make sure that the room is kept at a comfortable temperature, and that you keep warm towels over any part of the patient that isn’t being worked on. 5. Start with the back – The massage experience tends to be best when you start by massaging up and down a patient’s back. Have the person start out lying comfortably on their stomach on a massage table or other comfortable surface, with pillows to prop up any body parts as needed. 6. Vary your massage strokes – Start out with up and down strokes on the back, then move on to a circular motion, using larger circles near the top of the back and smaller circles near the bottom of the back and the hips. This is usually found to be very relaxing for people getting a massage. 7. Vary the pressure and speed of your massage – During the massage you should change the speed and the pressure that you are applying from time to time. Sometimes use a gentler touch and sometimes use a more firm touch. 8. Keep the relaxation going – after a massage, the patient should try to remain relaxed and take deep breaths. You don’t want to rush them off the table and out the door as this would minimize the benefits of the massage. 9. Provide water – drinking plenty of water after the massage will help to increase the benefits and help remove the toxins from the body that were released during the massage. 10. Suggest a bath – another way to continue the relaxation process is to take a nice bath after getting a massage. Suggest this to your clients.s telephones in order to make the relaxation process easy.. get the guide to make it all easy freee