Download Accidents, Blindness, Rheumatic Fever

Rheumatic Fever,
Stroke and Accidents
Dr. Pracheth R.
Rheumatic Fever
• Introduction
• Problem Statement
• Epidemiological factors
• Diagnosis
• Prevention
Introduction
• Febrile disease-connective tissue heart, joints
• Initiated by throat infection: Group A Beta
Haemolytic Streptococci
• Crippling disease
• Premature death
Problem Statement
• World: Developing countries
• India: 1 million cases
• Streptococcal : 1-3%
Agent factors
• Agent: preceded by sore throat;
Group A: M type 5
• Carriers: high
Host and environmental
• Age: childhood, adolescence
• Initial attack young: valvular lesions
• Sex: Equal, prognosis bad: females
• Socio-economic status
• High risk : slums, closed community, children-5
to 15 years
Clinical features
• Fever
• Polyarthritis: large joints-ankle, knee, elbow,
wrist
• Carditis: pericardium, myocardium, valves
• Tachycardia, murmurs, enlarged heart, heart
failure
• Nodules: small, painless, non-tender
• Brain: abnormal, jerky, purposeless movement
• Skin: rash
Major manifestations
• Carditis
• Polyarthritis
• Chorea
• Erythema marginatum
• Subcutaneous nodules
Minor manifestations
• Clinical: fever, polyarthralgia
• Elevated ESR, leukocyte count
Supporting evidence (45 days)
• ECG: prolonged PR interval
• Elevated ASO antibody
• Positive throat culture
• Rapid antigen test: Group A streptococci
Definitions
• Primary RF: two major or one major and two
minor + Group A streptococcal infection
• Established rheumatic heart disease: two minor
+ Group A streptococcal infection
Primary prevention
• Identify streptococcal infection: treat penicillin
• Not feasible
• Concentrate: high risk-school children
• Swab not there: directly treat
• 1.2 million benzyl penicillin: adults
• 600,000 units: children
• Single injection
• Oral penicillin: 10 days
Secondary prevention
• More practical
• Identify those having RF
• One IM injection: Benzathine Benzyl Penicillin at
interval of 3 weeks
• At least 5 years/18 years of age-later
• Carditis: 10 years/25 years- longer
• Severe valvular disease: life-long treatment
• One problem: patient compliance
Non-medical measures
• Improve living conditions
• Socio-economic conditions
Evaluation
• Survey school children
• Find out prevalence
Stroke
• Definitions
• Problem statement
• Epidemiology
• Control
Definition
• Rapidly developed clinical signs of focal
disturbance, neurological functions
• More than 24 hours
• No apparent cause other than vascular
Problem statement
• 6.1 million worldwide deaths,10.8% of all deaths
• Highest risk of death: first few weeks
• Survive: disability
• India: comparatively less
• Younger adults
• Rheumatic Heart Disease
• Ischaemic Stroke
• CNS infections: bacterial, TB meningitis
• 1.54 cases/1,000
Risk factors
• Hypertension: cerebral thrombosis,
haemorrhage
• Other factors:
Cardiac abnormalities: left ventricular
hypertrophy, cardiac dilation
Diabetes, dyslipidemia
Obesity
Smoking
OCPs.
Transient Ischaemic Attack
• Focal, reversible, neurological deficit
• Sudden onset
• Less than 24 hours
• Tend to recur
• Warning sign of stroke
Host factors
• Age: Rises with age
India: 1/5th below 40 years
• Gender: Males>females
• Personal history: CVD/diabetes
Control
• Tissue Plasminogen Activator IV
• Address risk factors
• NPCDCS
Accidents
• Definition
• Problem statement
• Epidemiology
• Prevention
• Domestic accidents
Definition
• Unexpected, unplanned occurrence-injury
• WHO: unpremeditated event: recognizable
damage
Problem Statement
• World:
4th leading cause
• India:
Mechanization, awareness, poor implementation-
safety
Road Traffic Accidents
• 1.3 million deaths-world, higher: young age
• Half: vulnerable road users
• 90% deaths: low, middle income countries
• India:
 4.4 lakh accidents, 22.4% : two wheelers
Human factors
• Age, sex, education
• Medical conditions
• Fatigue
• Psychosocial:
Lack experience, risk taking, impulsiveness
Defective judgement, delay : decision,
aggressiveness
• Lack of body protection
Helmets, safety belts
Environmental factors
• Road:
Defective, narrow roads
Defective lay-out: cross-roads
Poor lighting, lack of familiarity
• Vehicle:
Excessive speed, old vehicles, large number,
overloaded
• Bad weather
• Mixed traffic ( slow, fast moving, pedestrians,
animals)
Human
Environmental
Prevention
• Data collection:
Basic reporting system
Studies: risk factors, circumstances, chain of events
Police: investigate
Without: implementation not effective
• Safety education
Prevention
• Promote safety measures:
Seat belts, helmets
Leather boots: protect lower legs
Children: front seat ?
Door locks, proper vehicle design
• Alcohol: 50-80mg/100 ml.
Prevention
• Primary care:
Emergency care: accident site, transport, hospital
Accident Services Organization
Trauma care hospitals
• Eliminate causative factors:
Improve roads, speed limits, provision of fire guards,
marking danger points
Prevention
• Law enforcement:
 Driving tests, medical fitness, enforce speed limits, seat
belt, helmets, check blood alcohol conc, road side breath
test, periodic re-examination - over 55
• Rehabilitation services:
• Accident research:
Accidentology
Drowning
• Respiratory impairment from submersion/ immersion of
•
•
•
•
liquid
306,000 people died: drowning
Numbers exclude floods, boating, water transport
mishaps
3rd leading cause of unintentional injury
India : 43% of world’s drowning deaths
Risk factors
• Age: under 5 years
• Gender: males> females
• Access to water: fishing
• Others: infants unsupervised, unsafe/overcrowded
transport, alcohol use, unfamiliar with local water risks
Prevention
• Engineering methods to remove hazard
• Legislation to enforce prevention
• Education: individuals, communities
• Laws, regulations: safety checks transport, alcohol
Burns
• Definition: Injury to skin/ organic tissue: caused by heat,
radiation, electricity, friction or contact with chemicals
• Problem: Majority: low, middle income countries,
• Half: South East Asia
Risk factors
• Gender: females
• Age: children
• Socio-economic: low, middle income
• Other: occupations-exposure to fire, poverty,
overcrowding, medical conditions: epilepsy, alcohol,
smoking, inadequate safety measures for LPG
Prevention
• Address hazards for specific burn injuries, education:
vulnerable populations, train: first aid
• First aid: Do’s
Remove clothes, irrigate burns
Use cool running water: reduce temperature of burns
Roll on ground, blanket
Wrap in clean cloth/ sheet
Don’t’s
• Don’t start before ensure your safety
• Don’t apply: paste, oil, haldi
• No ice
• Not open blisters
• Not apply any matter directly to wound
• Avoid prolonged cooling with water.
Falls
• 424,000 fatal falls: every year. 2nd leading cause –
unintentional injuries after road traffic
• Over 80%: low, middle income countries
• Risk factors:
Occupations at elevated heights
Alcohol/substance use
Socio-economic factors
Underlying medical conditions: neurological/cardiac
Unsafe environment
Prevention
• Screen living environment: risk of falls
• Address clinical factors
• Environmental modification of homes
• Assistive devices: physical impairments
• Muscle strengthening/ balance training
• Education
Poisoning
• 252,000 deaths
• India: 28,012 deaths
• Accidental ingestion of kerosene
Snake bite
• Neglected issue
• Outcome: depends on species , area of body bitten,
amount of venom injected, health condition of victim
• Neurotoxic: respiratory paralysis
• Cytolytic: tissue destruction by digestion, haemorrhage
due to heamolysis
First aid
• National Snake Bite Protocol, 2007
Reassure
Immobilize like fractured limb
Remove clothes : constrict bitten limbs
Do not incise / manipulate bitten site
Transport to medical facility
Antivenom: IV, works by binding and neutralizing venom
enzymes
Questions
• Epidemiology and prevention of accidents (6 marks)
• Domestic accidents (3 marks)
• Prevention of rheumatic fever (3 marks)
• Stroke in young (3 marks)
• Risk factors for stroke (3 marks)
Summary
THANKS 