Autism or Autism Spectrum Disorder refers to a wide range of symptoms characterized by challenges with social skills, repetitive behaviors, speech and nonverbal communication. Autism spectrum disorder affects children of all races and nationalities.

SYMPTOMS
Children with autism spectrum disorder usually show some signs of delayed development before age 2 years. Some show signs in early infancy, such as reduced eye contact, lack of response to their name or indifference to caregivers. Others may develop normally for the first few months or years of life, but then suddenly become withdrawn or aggressive or lose language skills they’ve already acquired.
Each child with autism spectrum disorder is likely to have a unique pattern of behavior and level of severity — from low functioning to high functioning.

Social communication and interaction
• Fails to respond to his or her name or appears not to hear you at times.
• Resists cuddling and holding, and seems to prefer playing alone, retreating into his or her own world.
• Has poor eye contact and lacks facial expression.
• Doesn’t speak or has delayed speech, or loses previous ability to say words or sentences
• Can’t start a conversation or keep one going, or only starts one to make requests or label items.
• Repeats words or phrases verbatim, but doesn’t understand how to use them.
• Doesn’t appear to understand simple questions or directions.
• Doesn’t express emotions or feelings and appears unaware of others’ feelings.
• Doesn’t point at or bring objects to share interest.
• Doesn’t respond with a smile or happy expression by 6 months
• Doesn’t mimic sounds or facial expressions by 9 months
• Doesn’t babble or coo by 12 months
• Doesn’t gesture — such as point or wave — by 14 months
• Doesn’t say single words by 16 months
• Doesn’t play “make-believe” or pretend by 18 months
• Doesn’t say two-word phrases by 24 months
• Loses language skills or social skills at any age

Causes/Risk factors
There is no known cause for autism spectrum disorder, but a number of factors have been implicated in increasing the risk of developing this condition. These include:
• Genetics. Several different genes appear to be involved in autism spectrum disorder. For some children, autism spectrum disorder can be associated with a genetic disorder, such as Rett syndrome or fragile X syndrome. For other children, genetic changes (mutations) may increase the risk of autism spectrum disorder. Still other genes may affect brain development or the way that brain cells communicate, or they may determine the severity of symptoms. Some genetic mutations seem to be inherited, while others occur spontaneously.

• Environmental factors. Researchers are currently exploring whether factors such as viral infections, medications or complications during pregnancy, or air pollutants play a role in triggering autism spectrum disorder.
• Your child’s sex. Boys are about four times more likely to develop autism spectrum disorder than girls are.
• Family history. Families who have one child with autism spectrum disorder have an increased risk of having another child with the disorder. It’s also not uncommon for parents or relatives of a child with autism spectrum disorder to have minor problems with social or communication skills themselves or to engage in certain behaviors typical of the disorder.

• Other disorders. Children with certain medical conditions have a higher than normal risk of autism spectrum disorder or autism-like symptoms.
• Present structured social and communication interactions to your child and score the performance
• Use the criteria in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association
• Include other specialists in determining a diagnosis
• Recommend genetic testing to identify whether your child has a genetic disorder such as Rett syndrome or fragile X syndrome

 

Treatment
There is no cure for autism spectrum disorder and treatment is often multidisciplinary.
The main aim of treatment is to maximize the child’s ability to function by reducing the symptoms and supporting development and learning. Intensive and early intervention can make a big difference in the lives of these children.
Treatment options may include:

• Behavior and communication therapies. Many programs address the range of social, language and behavioral difficulties associated with autism spectrum disorder. Some programs focus on reducing problem behaviors and teaching new skills. Other programs focus on teaching children how to act in social situations or communicate better with others.
• Educational therapies. Children with autism spectrum disorder often respond well to highly structured educational programs. Successful programs typically include a team of specialists and a variety of activities to improve social skills, communication and behavior. Preschool children who receive intensive, individualized behavioral interventions often show good progress.
• Inappropriately approaches a social interaction by being passive, aggressive or disruptive
• Has difficulty recognizing nonverbal cues, such as interpreting other people’s facial expressions, body postures or tone of voice.

 

Patterns of Behaviour
• Performs repetitive movements, such as rocking, spinning or hand flapping
• Performs activities that could cause self-harm, such as biting or head-banging
• Develops specific routines or rituals and becomes disturbed at the slightest change
• Has problems with coordination or has odd movement patterns, such as clumsiness or walking on toes, and has odd, stiff or exaggerated body language
• Is fascinated by details of an object, such as the spinning wheels of a toy car, but doesn’t understand the overall purpose or function of the object
• Is unusually sensitive to light, sound or touch, yet may be indifferent to pain or temperature
• Doesn’t engage in imitative or make-believe play
• Fixates on an object or activity with abnormal intensity or focus
• Has specific food preferences, such as eating only a few foods, or refusing foods with a certain texture.

 

When to see a doctor
If you are concerned about your child’s development or you suspect that your child may have autism spectrum disorder, discuss your concerns with your doctor. The symptoms associated with the disorder can also be linked with other developmental disorders.

Signs of autism spectrum disorder often appear early in development when there are obvious delays in language skills and social interactions. Your doctor may recommend developmental tests to identify if your child has delays in cognitive, language and social skills, if your child:

Examples include fragile X syndrome, an inherited disorder that causes intellectual problems; tuberous sclerosis, a condition in which benign tumors develop in the brain; and Rett syndrome, a genetic condition occurring almost exclusively in girls, which causes slowing of head growth, intellectual disability and loss of purposeful hand use.

• Extremely preterm babies. Babies born before 26 weeks of gestation may have a greater risk of autism spectrum disorder.
• Parents’ ages. There may be a connection between children born to older parents and autism spectrum disorder, but more research is necessary to establish this link.

Complications
Problems with social interactions, communication and behavior can lead to:
• Problems in school and with successful learning
• Employment problems
• Inability to live independently
• Social isolation
• Stress within the family
• Victimization and being bullied

Prevention
There is no way to prevent autism spectrum disorder, but treatment options are available. Early diagnosis and intervention is most helpful and can improve behavior, skills and language development. However, intervention is helpful at any age. Though children usually don’t outgrow autism spectrum disorder symptoms, they may learn to function well.

Diagnosis
There isn’t a specific medical test to determine the disorder since autism spectrum disorder varies widely in symptoms and severity. Therefore, making a diagnosis may be difficult. The specialist may:
• Observe your child and ask how your child’s social interactions, communication skills and behavior have developed and changed over time
• Give your child tests covering hearing, speech, language, developmental level, and social and behavioral issues.

• Family therapies. Parents and other family members can learn how to play and interact with their children in ways that promote social interaction skills, manage problem behaviors, and teach daily living skills and communication.
• Other therapies. Depending on your child’s needs, speech therapy to improve communication skills, occupational therapy to teach activities of daily living, and physical therapy to improve movement and balance may be beneficial. A psychologist can recommend ways to address problem behavior.
• Medications. No medication can improve the core signs of autism spectrum disorder, but specific medications can help control symptoms.

WORLD CANCER DAY 2019

The theme for 2019 is “I am and I will” – all about your story and your commitment. Whoever you are, you have the power to reduce the impact of cancer for yourself, the people you love and for the world. It’s time to make a personal commitment.

CANCER

• • Generic term for a large group of diseases that can affect any part of the body. Other terms used are malignant tumours and neoplasm.
  • One defining feature of cancer is the rapid creation of abnormal cells that grow beyond their usual boundaries, which can then invade adjoining parts of the body and spread to other organs. This process is referred to as METASTASIS. Metastases are the major cause of death from cancer.
  • It is a leading cause of death worldwide and accounting for 7.6 million deaths

The main types of Cancer are: lung, stomach, liver, colorectal and breast.
About 70% of all cancer deaths occurred in low and middle income countries

WHAT CAUSES CANCER?
Cancers arise from one single cell and the transformation from a normal cell into a tumour cell is a multistage process. These changes are the result of the interaction between a person’s genetic factors and three categories of external agents which are:
1. Physical Agents: ultraviolet and ionizing radiation.
2. Chemical Agents: asbestos, components of tobacco smoke.
3. Biological Agents: infections from certain viruses, bacteria and parasites.
Age is another fundamental factor for development of cancer.

RISK FACTOR FOR CANCERS
Tobacco use, alcohol use, unhealthy diet and chronic infections from Hepatitis B (HBV), Hepatitis C (HCV) and some types of Human Papilloma Virus (HPV).

HOW CAN THE BURDEN OF CANCER BE REDUCED?
Cancer can be reduced by a) Prevention b) Early detection c) Management of patients with cancer.

a) Prevention (30-40% of cancer can be prevented)

• • Increase avoidance of risk factors
  • Vaccinate against human papilloma virus implicated in cancer of the cervix and Hepatitis B virus (HBV)
  •  Control occupational hazards.
  • Reduce exposure to sunlight.

b) Early detection (30% can be cured through early diagnosis and treatment)
Deaths from cancer can be reduced if cases are detected and treated early. There are two components of early
detection

i. Early Diagnosis
The awareness of early signs and symptoms in order to facilitate diagnosis and treatment before diseases become advanced.
ii. Screening
Systematic application of screening test in the population. It aims to identify individuals with abnormalities suggestive of a specific cancer and refer them promptly for diagnosis and treatment.
For example – Mammogram for Cancer of the breast, PAP Smear for Cancer of the Cervix

c) Management of a patient with cancer
It is the series of interventions including surgery, radiotherapy, chemotherapy and psychosocial support that is aimed at cutting the disease or considerably prolonging life while improving the patient’s quality of life.

 

WHAT IS DIABETES MELLITUS?

It is a chronic condition (it lasts a lifetime) associated with abnormally high levels of sugar (glucose) in the blood.
It occurs either when the pancreas does not produce enough insulin or when the body cannot effectively use the insulin it produces. Insulin is a hormone that regulates blood sugar.
Hyperglycaemia, or raised blood sugar is a common effect of uncontrolled diabetes and over time leads to serious damage to many of the body’s system especially the nerves and blood vessels

WHAT ARE THE DIFFERENT TYPES OF DIABETES?
There are 2 major types called Type 1 & Type 2.
Type 1 is characterized by deficient insulin production and requires daily administration of insulin.
Symptoms include excessive excretion of urine, thirst, constant hunger, weight loss, vision changes and fatigue. These symptoms may occur suddenly.

Type 2 comprises 90% of people with diabetes resulting from the body’s ineffective use of insulin and is largely due to excess body weight and physical inactivity.
Symptoms may be similar to those of Type 1, but are often less marked as a result; the disease may be diagnosed several years after onset.

Other types are:
• Gestational diabetes which is hyperglycaemia with onset or first recognition during pregnancy.
• Secondary diabetes – refers to elevated blood sugar levels from another medical condition, certain medications such as prednisone and drugs used in treatment of HIV infection.

WHAT ARE THE RISK FACTORS?
• Anyone can develop diabetes but it is common in:
• Overweight/Obese people
• People who are physically inactive

• Blacks, Indians and Hispanics
• Older persons
• People with a family history of diabetes.

HOW CAN THE BURDEN OF DIABETES BE REDUCED OR AVOIDED?
Simple lifestyle measures have been shown to be effective in preventing or delaying the onset of Type 2 diabetes. To help prevent Type 2 diabetes and its complication, people should:

• Achieve and maintain healthy body weight
• Be physically active – at least 30minutes of regular, moderate – intensity activity daily.
• Eat a healthy diet of between three and five servings of fruits and vegetables a day and reduce sugar and saturated fats intake.
• Avoid tobacco use.

MANAGEMENT & TREATMENT OF DIABETES MELLITES
Early diagnosis can be done through relatively inexpensive blood testing.
Diabetes cannot be cured and treatment involves lowering blood glucose with diet, exercise and use of appropriate medications (insulin, oral medications).
Other interventions that are both cost saving and feasible include:

• Blood pressure control
• Foot care
• Screening for retinopathy (which causes blindness)
• Blood lipid control (to regulate cholesterol level)
• Screening for early signs of diabetes – related kidney disease.

Monkey pox is an infectious disease caused by monkeypox virus. The disease was first identified in laboratory monkeys, hence its name, but in its natural state it seems to infect rodents.

It is a rare disease, that occurs primarily in remote parts of Central and West Africa, near tropical rainforests, Human Monkeypox was first identified in humans in 1970 in the Democratic Republic of Congo (ZAIRE).

 

Monkeypox is a viral Zoonosis (a virus transmitted to humans from animals).

 

TRANSMISSION

Infection of index cases results from direct contact with the blood, bodily fluids, cutaneous or mucosal lesions of infected animals – infected monkeys, giant rats and squirrels.  Eating inadequately cooked meat of infected animals is a possible risk factor. It can also occur via an animal bite.

Secondary or human to human transmission can result from close contact with infected respiratory tract. Secretions, skin lesions of an infected person or objects contaminated by patient fluids or lesion materials.

 

SIGN AND SYMPTOMS

The incubation period (interval from infection to onset of symptoms) is usually from 6 to 16 days but can range from 5 to 21 days.

The infection can be divided into 2 periods.

1. The invasion period (0 – 5 days) characterized by fever, intense headache, swelling of the lymph rode, back pain, muscle ache and lack of energy.
2. The skin eruption period (within 1-3 days after appearance of fever) where the various stages of rash appears.

 

The face (95% of cases) and palms of hands and soles of the feet (75%) are most affected.

 

Monkeypox is usually a self-limited disease! Severe cases occur more commonly among children and are related to the extent of virus exposure, patient health status and severity of complications.

 

DIAGNOSIS

Monkeypox has symptoms in human similar to those seen in the past in small pox patients although less severe. Smallpox was eradicated in 1980.

 

It can only be diagnosed definitively in the laboratory where the virus can be identified by a number of different tests.

 

TREATMENT AND VACCINE

There is no specific treatment or vaccines available for monkeypox infection.

Vaccination against smallpox has been proven to be 85% effective in preventing monkeypox in the past but the vaccine is no longer available after it was discontinued following global smallpox eradication. Nevertheless prior smallpox vaccination will likely result in a milder disease course, Cidofovir, an antiviral drug is suggested for patients with severe, life-threatening symptoms.

 

PREVENTION

1. Reducing the risk of infection in people

• During human monkey outbreaks, close contact with other patients is the most significant risk factor, therefore close physical contact with monkeypox infected people should be avoided. Gloves and protective equipment should be worn when taking care of ill people.
• Regular hand washing should be carried out after caring or visiting sick people.
• Cooking all animal products before eating.
• Protective clothing and gloves should be worn while handling animals during slaughtering procedures.

 

1. Controlling infection in healthcare settings

• Implementation of standard infection control in hospitals.

 

1. Preventing monkeypox expansion through restrictions on animal trade.

Restrictions or banning the movement of small African mammals and monkeys may be effective in slowing the expansion of the virus