UNIT 2

MR. RAJESH KAPSE

SOCIAL AND PREVENTIVE PHARMACY
B PHARMACY 4TH YEAR, 8TH SEMESTER

PREVENTIVE MEDICINES
The aim of preventive medicine is the absence of disease, either by preventing the occurrence
of a disease or by halting a disease and averting resulting complications after its onset.
Preventive medicine can be practiced by governmental agencies, primary care physicians and
the individual himself.

Preventive medicine takes a proactive approach to patient care.

Principles of Communicable Diseases Epidemiology

Epidemiology is the study of the distribution and determinants of health-related states and
events in populations, and the application of this study to control health problems
• HOST: Demographic characteristics, Biological characteristics, Socioeconomic
• ENVIRONMENT: Physical environment, Biological environment, Social environment
• AGENTS: Biological agents, Physical agents, Chemical agents, Nutrient agents,
Mechanical agents, Social agents

A communicable disease is an illness due to a specific infectious (biological) agent or its toxic
products capable of being directly or indirectly transmitted from man to man, from animal to
man, from animal to animal, or from the environment (through air, water, food, etc..) to man.

Importance of studying:
1. Changes of the pattern of infectious diseases,
2. Discovery of new infections,
3. the possibility that some chronic diseases have an infective origin

IMPORTANT DEFINITIONS:
Infection is the entry and development or multiplication of an infectious agent in the body of man or
animals. An infection does not always cause illness. There are several levels of infection (Gradients
of infection):
– Colonization (S. aureus in skin and normal nasopharynx)
– Subclinical or in apparent infection (polio)
– Latent infection (virus of herpes simplex)
– Manifest or clinical infection
CONTAMINATION: The presence of an infectious agent on a body surface, on or in clothes,
beddings, toys, surgical instruments or dressings, or other articles or substances including
water and food.
INFESTATION: It is the lodgment, development and reproduction of arthropods on the
surface of the body or in the clothing, e.g. lice, itch mite. This term could be also used to
describe the invasion of the gut by parasitic worms, e.g. ascariasis.

A contagious disease is the one that is transmitted through contact. Examples include
scabies, trachoma, STD and leprosy.

VECTOR OF INFECTION: An insect or any living carrier that transports an infectious agent
from an infected individual or its wastes to a susceptible individual or its food or immediate
surroundings. Both biological and mechanical transmissions are encountered.

HOST: A person or an animal that affords subsistence or lodgment to an infectious agent under
natural conditions. Types include: an obligate host, definitive (primary) host, intermediate host
and a transport host.

RESERVOIR: Any person, animal, arthropod, plant, soil, or substance, or a combination of

these, in which an infectious agent normally lives and multiplies, on which it depends
primarily for survival, and where it reproduces itself in such a manner that it can be
transmitted to a susceptible host. It is the natural habitat of the infectious agent

Incidence of an infectious disease: number of new cases in a given time period

expressed as percent infected per year (cumulative incidence) or number per person time of
observation (incidence density).

Prevalence of an infectious disease: number of cases at a given time expressed as a

percent at a given time. Prevalence is a product of incidence x duration of disease, and is of
little interest if an infectious disease is of short duration (i.e. measles), but may be of interest if
an infectious disease is of long duration (i.e. chronic hepatitis B).

EPIDEMIC: “The unusual occurrence in a community of disease, specific health related

behavior, or other health related events clearly in excess of expected occurrence” (epi=
upon; demos= people) Epidemics can occur upon endemic states too.

ENDEMIC: It refers to the constant presence of a disease or infectious agent within a given
geographic area or population group. It is the usual or expected frequency of disease within a
population. (En = in; demos = people)

The term “hyperendemic” expresses that the disease is constantly present at high incidence
and/or prevalence rate and affects all age groups equally.
The term “holoendemic” expresses a high level of infection beginning early in life and
affecting most of the child population, leading to a state of equilibrium such that the adult
population shows evidence of the disease much less commonly than do the children (e.g.
malaria)

PANDEMIC: An epidemic usually affecting a large proportion of the population, occurring

over a wide geographic area such as a section of a nation, the entire nation, a continent or the
world, e.g. Influenza pandemics.

Exotic diseases are those which are imported into a country in which they do not otherwise
occur, as for example, rabies in the UK.

The word sporadic means “scattered about”. The cases occur irregularly, haphazardly from
time to time, and generally infrequently. The cases are few and separated widely in time and
place that they show no or little connection with each other, nor a recognizable common
source of infection e.g. polio, meningococcal meningitis, tetanus….
However, a sporadic disease could be the starting point of an epidemic when the
conditions are favorable for its spread.

Attack rate: proportion of non-immune exposed individuals who become clinically ill.

Primary (index)/secondary cases: The person who comes into and infects a population
is the primary case. Those who subsequently contract the infection are secondary cases.
Further spread is described as "waves" or "generations".

Nosocomial (hospital acquired) infection is an infection originating in a patient while in a

hospital or another health care facility. It has to be a new disorder unrelated to the patient’s
primary condition. Examples include infection of surgical wounds, hepatitis B and urinary
tract infections.

Opportunistic infections: This is infection by organisms that take the opportunity provided
by a defect in host defense (e.g. immunity) to infect the host and thus cause disease. For
example, opportunistic infections are very common in AIDS. Organisms include Herpes
simplex, cytomegalovirus,
M. tuberculosis….

ERADICATION: Termination of all transmission of infection by the extermination of the

infectious agent through surveillance and containment. Eradication is an absolute process,
an “all or none” phenomenon, restricted to termination of infection from the whole world.

ELIMINATION: The term elimination is sometimes used to describe eradication of a disease

from a large geographic region. Disease which are amenable to elimination in the meantime
are polio, measles and diphtheria.
Reproductive rate of infection: potential for an infectious disease to spread. Influential
factors include the probability of transmission between an infected and a susceptible individual;
frequency of population contact; duration of infection; virulence of the organism and
population immune proportion.

A). Source or Reservoir: The starting point for the occurrence of a communicable disease
is the existence of a reservoir or source of infection.

The source of infection is defined as “the person, animal, object or substance from which an
infectious agent passes or is disseminated to the host (immediate source). The reservoir is “any
person, animal, arthropod, plant, soil, or substance, or a combination of these, in which an
infectious agent normally lives and multiplies, on which it depends primarily for survival, and
where it reproduces itself in such a manner that it can be transmitted to a susceptible host. It is
the natural habitat of the infectious agent.”
1. Human Reservoir,
2. Animal reservoir (Rabies, Plague, Bovine TB), also called Zoonosis
3. Non-living reservoir (Soil- tetanus, anthrax etc.)

CASE: A case is defined as “a person in the population or study group identified as having the
particular disease, health disorder, or condition under investigation”

CARRIERS: It occurs either due to inadequate treatment or immune response, the disease
agent is not completely eliminated, leading to a carrier state.
It is “an infected person or animal that harbors a specific infectious agent in the absence of
discernible (visible) clinical disease and serves as a potential source of infection to others.
Three elements have to occur to form a carrier state:
1. The presence in the body of the disease agent.
2. The absence of recognizable symptoms and signs of disease.
3. The shedding of disease agent in the discharge or
excretions. 4.
B). Mode of transmission:
DIRECT: Direct contact, Droplet infections, contact with soil, and inoculation into skin of
mucosa, transplacental
INDIRECT: Vehicle borne, Vector borne (mechanical, biological), Air borne, Fomite born,
Unclean hands and fingers

C). Susceptible Host:

An infectious agent seeks a susceptible host aiming “successful parasitism”.
Four stages are required for successful parasitism:
1. Portal of entry
 2. Site of election inside the body
3. Portal of exit
4. Survival in external environment

VIRULENCE: is the degree of pathogenicity; the disease evoking power of a micro-organism

in a given host. Numerically expressed as the ratio of the number of cases of overt infection
to the total number infected, as determined by immunoassay, when death is the only
criterion of severity, this is the case fatality rate.

CASE FATALITY RATE FOR INFECTIOUS DISEASES: is the proportion of infected

individuals who die of the infection. This is a function of the severity of the infection and is
heavily influenced by how many mild cases are not diagnosed.

SERIAL INTERVAL: (the gap in time between the onset of the primary and the secondary
cases) the interval between receipt of infection and maximal infectivity of the host (also called
generation time).

INFECTIOUS (COMMUNICABLE) PERIOD: length of time a person can transmit

disease (sheds the infectious agent).

INCUBATION PERIOD: time from exposure to development of disease. In other words, the
time interval between invasion by an infectious agent and the appearance of the first sign or
symptom of the disease in question.

LATENT PERIOD: the period between exposure and the onset of infectiousness (this may
be shorter or longer than the incubation period).

TRANSMISSION PROBABILITY RATION (TPR):

TPR is a measure of risk transmission from infected to susceptible individuals during a
contact. TPR of differing types of contacts, infectious agents, infection routes and strains
can be calculated.

CLASSIFICATIONS OF COMMUNICABLE DISEASES ACCORDING TO NATURE OF THE PATHOGEN

Communicable diseases are classified into nine types according to the nature of the pathogen
(causing agent). They are
1. Viral diseases,
2. Rickettsial diseases,
3. Mycoplasmal diseases,
4. Chlamydial diseases,
5. Bacterial diseases,
6. Spirochaetal diseases,
7. Protozoan diseases,
8. Helminthic diseases and
9. Fungal diseases

1. Viral Diseases:
1. Poliomyelitis or Polio (Infantile Paralysis):
Pathogen: Enter virus (Poliovirus)
Modes of Transmission:
Polio virus usually enters the body via alimentary canal (faecal oral route) where it
multiplies and reaches the nervous system through the blood stream.
Incubation Period: 7 to 14 days
Signs and Symptoms:
It produces inflammation of the nervous system. Stiffness of the neck is an important sign.
Paralysis starts following the weakness of particular skeletal muscles. The attack of
paralysis begins with high fever, headache, chilliness, pain all over the body.
Prevention and Treatment:
There must be provided an adequate arrangement for proper disposal of urine and faeces of
the patient, because they contain polio virus. Overcrowding of children in schools, playgrounds
and cinema halls should be avoided. Polio is preventive. Polio vaccine is safe and effective. The
first polio vaccine was prepared by Jonas Salk (1953). The killed virus is called “Salk Vaccine”
and injected to develop immunity. Jonas Salk is called “father of polio vaccine”.
Sabin et al prepared an oral vaccine known as OPV (Oral Polio Vaccine).

2. Rabies (Hydrophobia):
Pathogen: Rabies virus
Symptoms and Modes of Transmission:
The virus is introduced in the body by the bite of rabid (mad) dogs usually. It can be injected by the bite
of jackals, wolves, cats etc.
Incubation period: 10 days to one year
Signs and Symptoms:
Fear of water is the most important characteristic symptom of this disease. Other symptoms are saliva
from the mouth, severe headache, high fever, alternating periods of excitement and depression,
inability to swallow even fluids due to choked throat. The virus destroys the brain and spinal cord.
Rabies is 100% fatal.
Prevention and Treatment:
There should be compulsory immunisation of dogs and cat population. All ownerless and stray dogs
should be destroyed. Wound of the bitten person should be immediately washed with soap and water.
After this give anti rabies vaccine to the patient. The pet should be watched for 10 days after it has
bitten someone to make sure that it does not have rabies virus.

3. Viral Hepatitis:
Symptoms:
It is commonly called jaundice. Viral hepatitis is the most important form of hepatitis. In early stage the
liver is enlarged and congested. In later stage the liver becomes smaller, yellowish or greenish. The
symptoms in early phase include— fever, anorexia, nausea, vomiting, epigastric discomfort, pains in
muscles and joints. The urine is dark and stool is pale. Splenic enlargement is sometimes present.
Types:
There are 6 types of viral hepatitis. These are Hepatitis A, Hepatitis B, Hepatitis C, Hepatitis D, Hepatitis
E and Hepatitis G. These (except Hepatitis G) are given below in table form. There is no Hepatitis F.

Characteristic Features of Different Types of Hepatitis:

Feature Hepatitis A Hepatitis B Hepatitis C Hepatitis D Hepatitis E

Name of Virus HAV HBV HCV HDV HEV

Nucleic Acid RNA DNA RNA RNA RNA
Transmissi on Faecal oral Parenteral; Parenteral; Parenteral; Faecal oral
Route (Blood, Needle, (Blood) (Blood, Route
Body secretion, Coinfection
Placenta, Sexual with hepatitis
contact) B)
Symptoms Fever, head Similar, to HAV Similar to Severe liver Similar to
ache, gastro but no HBV more damage, high HAV but
intestinal headache. likely to mortality rate pregna nt
disturbanc e, Severeliver become women may
dark urine, damage, chronic have high
jaundice yellowish eyes, mortali ty
light coloured
stools,
Incubation 2-6 weeks 6 weeks- 6 2-22 weeks 6-26 weeks 2-6 weeks
Period Months
Vaccine Hepatitis A Genetically No HBV vaccine is No
virus vaccine Modified vaccine protective
Chronic None Yes Yes Yes No
Hepatitis

4. Chikungunya:
Pathogen:
It is caused by Chikungunya virus. This virus was first isolated from human patients and Aedes aegypti
mosquitoes from Tanzania in 1952. The name ‘Chikungunya’ is derived from the native word for the
disease in which patient lies “doubled up” due to severe joint pains. Epidemics of chikungunya have
occurred in many African countries.

Mode of Transmission: By the bite of Aedes aegypti mosquito. No vaccine is available.

Signs and Symptoms:
Its symptoms include sudden onset of fever, crippling joint pains, lymphadenopathy and conjunctivitis.
Some show haemorrhagic manifestations. The fever is typically biphasic. Chikungunya has been
reported from India.
Incubation Period: Usually 3-6 days
Prevention and Treatment:
Preventive measures include elimination of mosquitoes and their eggs. Paracetamol is given to reduce
fever, analgesic (drug that relieves pain) drugs such as aspirin for the joint pain. Bed rest and adequate
fluid intake are also recommended.

5. Dengue Fever (Break-bone fever):

Pathogen: Dengue fever is caused by mosquito borne flavi-ribo virus.
Mode of Transmission:
The virus of dengue fever is transmitted by the bite of Aedes aegypti (mosquito).
Incubation Period: 3 to 8 days

Types of Dengue Fever:

Two types of dengue fever are common: classical dengue fever and dengue haemorrhagic.

(a) Symptoms of Classical Dengue Fever:

(i) Abrupt onset of high fever
(ii) Severe frontal headache,
(iii) Pain behind the eyes which worsens with eye movement,
(iv) Muscles and joint pains,
(v) Loss of sense of taste and appetite,
(vi) Measles like rash over chest and upper limbs,
(v) Nausea and vomiting.

(b) Symptoms of Dengue Haemorrhagic Fever:

Symptoms similar to classical dengue fever except the following:
(i) Bleeding from the nose, mouth, gums and skin bruising,
(ii) Severe and continuous stomach pains,
(iii) Frequent vomiting with or without blood,
(iv) Pale cold or clammy skin,
(v) Excessive thirst (dry mouth),
(vi) Rapid weak pulse,
(vii) Difficulty in breathing,
(viii) Restlessness and constant crying.
No vaccine for Dengue fever is available.
Prevention and Treatment:
Mosquitoes and their eggs should be eliminated.
No specific therapy is available. Symptomatic care including bed rest, adequate fluid intake and
analgesic medicine is recommended. Do not take aspirin and disprin.

6. Common Cold / Rhinitis:

Pathogen:
It is one of the most infectious human diseases caused by Rhino viruses. The viruses attack the nose
and respiratory passage but not the lungs.
Modes of Transmission:
The viruses are transmitted through inhalation of droplets from infected person or through
contaminated objects (droplet infection).
Incubation Period: 3 to 7 days.
Signs and Symptoms:
The common cold is characterised by nasal congestion, excessive nasal secretion, very sore throat,
cough, headache, etc.
Treatment:
Antihistamines and decongestants are used as drugs to treat common cold. No vaccine is available.

Other Viral Diseases of Humans:

S. No. Disease Pathogen Symptoms Mode of Vaccine,
Spreed and Treatment
Incubation (Drugs)
Period
1 Influenza (Flu) Orthomyxo- Sore throat, Droplet Influenza
virus Headache Infection IP 1- vaccine
fever, 4 days available
Sneezing, Pain
all over the
body, Nasal
2 Small pox (Variola) Variola Virus: High fever, Droplet Vaccine was
It has been Small vesicles Infection discovered by
iradicated last containing Direct contact Edward Jenner
case was clear fluid on IP 12 days in 1798
found in the skin, scars
Somalia, Oct left
1997
3 Chiken pox (Varicella) Varicella Mild fever, Droplet Varicella
zoster virus Rashes, aches, infection, Vaccine
on scar left Direct contact
IP 14-21 days
4 Mumps (Infectious Paramyxo Painful Droplet MMR Vaccine
 Parotiditis) virus swelling of the infection IP
parotid 16-18 days
(salivary
glands on one
or both sides
5 Measles (Rubeola Rubeola Virus Reddish rash Droplet MMR Vaccine
Disease) appears on infection IP 10
neck which days
spreads over
body
6 Rubella (German Rubella Virus Bright red rash Droplet MMR Vaccine
Measles) begins on the infection Virus Pregnant
face, spreads enters woman should
rapidly on Through the not be given
whole body, nasopharynx) vaccine
Rash fainter IP 12-23 days
than measles
arthritis
7 Yellow Fever Flavi virus Sudden High By bite of Vaccine
fever, severe Aedes aeghpti, available
pain in joints, Mosquitoes IP
Chilliness, skin 3-4 Days
becomes
yellow in
colour,
vomiting,
Urine contains
high levels of
albumin
8 SARS- Severe Acute SARS- Corona High fever, Infection from SARS is mostly
Respiratory Syndrome virus chills, the patient’s diagnosed by
headache, secretions PCR
dizziness, sore from the nose (polymerase
throat, mouth and chain reaction)
running rose, throat IP 2- 7 test.
nausea, days.
vomiting,
diarrhea,
trouble in
breathing
9 Swine Influenza (Swine Triple- In humans Infection is Indigenous A
Flu) reassorted flu symptoms are from swine (H1 N1 )
virus A(H1 N1) fever. Cough, (old use of pig) vaccine.
sore throat,
bodyache,
 chills and
fatigue.
10 Genital Herpes Herpis simplex Ulcers over Sexual contact
virus external IP 2-7 days
genitalia and
perianal
region. Fever,
headache,
pain, itching,
vaginal and
urethral
discharge
Diagnosed by
PCR
11 Genital Warts Human Warts (benign Sexual
Papilloma herd, out- intercourse
Virus (HPV) growths with
horny surface
develop over
the skin of
external
genitalia and
perianal area.

2. Rickettsial Diseases:
These are caused by rickettsiae (the obligate intracellular parasites). The Rickettsiae were formerly
considered closely related to viruses. Examples: Rocky Mountain Spotted Fever (RMSF), Rickettsial pox,
trench fever, fever and epidemic typhus fever.
3. Mycoplasmal Diseases:
Mycoplasma are the smallest free living microorganism. They lack a rigid cell wall and hence they are one of
the pleomorphics (having many shapes). They can produce filaments which resemble fungi mycelia hence
their name (mykes- fungus and plasma – formed).
A typical Pneumonia Pathogen:
Mycoplasma pneumonia was discovered by Eaton in 1941.
Transmission:
It is by droplets of nasopharyngeal secretions.
Symptoms:
The disease is characterised by scarcity of respiratory signs on physical examination, low fever, cough,
headache.
Incubation Period:
1 to 3 weeks.
Treatment:
Tetracycline’s are the drugs of choice. Penicillin’s are of no use.

4. Chlamydial Diseases: Chlamydia is also microorganisms that are intracellular parasites. Since the
chlamydiae are obligate intracellular parasites, they were previously thought to be viruses. They are in
between bacteria and viruses. Chlamydiae differ from viruses in having cell wall, both DNA and RNA
and in multiplying by
binary fission. Example: Trachoma

5. Bacterial Diseases:
1. Typhoid (Enteric fever):
Pathogen:
Salmonella typhi.
Modes of Transmission:
Faecal oral route.
Typhoid Mary:
It is a classic case in medicine. Mary Mallon was a cook by profession and was a typhoid carrier. She
continued to spread typhoid for several years through the food she prepared.
Incubation Period:
It is 1-3 weeks.
Signs and Symptoms:
There is high fever but pulse rate is low. The patient feels abdominal pain and passes frequent stools.
Confirmed by Widal Test. Typhoid vaccine is available.
Treatment:
The patient is treated with antibiotics such as Terramycin and Chloromycetin.

2. Pneumonia:
Pathogen: Streptococcus pneumoniae and Haemophilus influenzae. Pneumonia is a serious disease of the
lungs.
Modes of Transmission: The disease spreads by sputum of the patient.
Incubation period: 1-3 days.
Signs and Symptoms: Lymph and mucus collect in the alveoli and bronchioles of the lungs so that the lungs
do not get sufficient air. Therefore, proper exchange of gases does not take place in the alveoli. No vaccine
is available.
Treatment: Use of Penicillin, Streptomycin and Ampicillin.

3. Cholera:
Pathogen:
Vibrio cholera.
Modes of Transmission:
Faecal Oral Route. Robert Koch (1843-1910) discovered cholera. John Snow (1913) was the first to
demonstrate that cholera is transmitted by contaminated water.
Incubation period: It varies from a few hours to 2-3 days.
Signs and Symptoms: The patient starts passing stools frequently, which are white like rice water, and gets
repeated vomiting The disease can be diagnosed by the microscopic examination of the stool or the vomit
when the typical comma-shaped cholera vibrio’s can be seen.
Treatment:
Rapid replacement of fluid and electrolytes is needed by oral rehydration- therapy. You can make your own
oral rehydration solution (ORS) at home by adding one teaspoon of sugar and a pinch of salt to one quarter
of water. Drugs tetracycline and chloramphenicol are used.

4. Tuberculosis (ТВ) or Koch’s Disease:

Pathogen: Mycobacterium tuberculosis.
Modes of Transmission: The bacteria damage the tissues and release a toxin named tuberculin which
produces the disease. It affects the lungs, lymph nodes, bones and joints.
Modes of infection includes infection by inhalation of droplets expelled by tubercular patients, infection of
food and drink contaminated with bacteria of tuberculosis, milk from a tubercular cow, etc.
Incubation period: 3-6 weeks (variable).
Signs and Symptoms: Symptoms of pulmonary (lungs) tuberculosis are fever, cough, blood containing
sputum, pain in the chest and loss of weight, excessive fatigue, failure of appetite, slight rise of temperature
in the evening, hoarseness of throat, night sweating and rapid pulse. Diagnosis of ТВ is done by Mantoux
Test
Prevention and Treatment:
BCG vaccine gives protection against tuberculosis. When coughing, he/she should keep the handkerchief
before his/her mouth. Tuberculosis is curable.
Isoniazid, Streptomycin and Rifampicin drugs are used to treat Tuberculosis.
Disease Pathogen Symptoms Mode of Spread Vaccine
and Incubation
Period
1 Diphtheria Corynebacterium Sore throat, Hoarseness, Droplet DPT vaccine
Diagnosis of diphtheria Difficulty in breathing. infection IP 2 to
the disease is 5 days.
done by Schick
test
2 Whooping Bordetella Whooping sound, face Droplet DPT vaccine
cough pertussis becomes red during infection IP 10-
(Pertussis) coughing, convulsions. 16 days
3 Tetanus (Lock Clostridium Spasms of muscles of the Wound DPT vaccine
Jaw) tetani jaw and face, severe pain infection IP 3-25
often fatal. days.
4 Leprosy Mycobacterium Light coloured patches on Through No vaccine is
(Hansen’s leprae skin. Diagnosis is done by prolonged available
Disease) Lepromin skin Test. contact
5 Bacillary Shigella Abdominal pain, Blood & Faecal oral No vaccine
Dysentery dysenteriae mucus in the stools route IP available
(Shigellosis) variable
6 Anthrax Bacillus Anthrax comes from Spores of B Anthrax
anthracus animals to human beings anthracus are vaccine
and is of three types: the source of available
1. Cutaneous Anthrax infection.
2. Pulmonary Anthrax
3. Intestinal Anthrax
7 Bubonic Plague Yersinia pestis High fever, bubo in groin Its bacteria are Antiplague
(Black Deatb) or the armpit, Diagnosis is transmitted vaccine
done by WaySon Stain test from rat flea to available
man
8 Gonorrhea Neisseria In male the disease starts It is STD and is No vaccine is
gonorrhoeae as an acute inflammation spread through available
(named after of urethra, painful sexual contact
Albert Neisser urination and discharge of IP 2-5 days
who isolated it in pus from the penis, in
1897) female the symptoms are
abdominal discomfort,
vaginal discharge,
abnormal uterine
blooding, pelvic
inflammation, sterility
9 Botulism (Food Clostridium Swollen tongue, double Faecal oral No vaccine
Poisoning) botulinum vision, vomiting, diarrhea route IP is available
usually 18 – 36
hours,
10 Chancroid Haemophilus Ulcer appear at the site of Sexual contact
ducrayi infection generally over
external genitalia. It is
painful and bleeds easily
11 Scariet Fever Streptococcus The symptoms are high Infection is Vaccine not
pyrogenes fever, rash on the body through contact available
and tonsillitis and with another
pharyngitis, Tongue is also individual
affected. carrying the
The rash sub-sides after 6 organisms
to 9 days. The Dick test is
done to know the
presence of an immunity
to scarlet fever.

6. Spirochaetal Diseases:
Spirochaetes are flexible, twisted round the long axis microorganisms. The characteristic feature is the
presence of varying numbers of fine fibrils between the cell wall and cytoplasmic membrane. Example:
Syphilis.
Syphilis:
Pathogen:
Treponema palladium
Mode of Transmission:
It is a sexually transmitted disease (STD) which is also known as venereal disease (VD). However, T.
pallidium can be transmitted from an infected mother to the developing foetus across the placenta which is
called congenital syphilis.
Incubation Period: 2 to 3 weeks
Symptoms:
The symptoms of syphilis occur in four stages:
(i) Primary syphilis. A red painless ulcer called a chancre appears at the site of the spirochaete infection. In
males this is usually the penis but in females it is often the vagina or the cervix,
(ii) Secondary syphilis. It includes fever, general enlargement of lymph nodes, a pink skin rash all over the
body and joint pain,
(iii) Latent Syphilis. In this stage there is no sign and symptom of the disease,
(iv) Tertiary syphilis. It is characterized by tumour like masses called gummas. Tertiary syphilis may cause
serious damage to the heart and blood vessels (Cardiovascular syphilis) or bones and skin.
Diagnosis: VDRL test is done to detect the syphilis.
Treatment: Penicillin is still the drug of choice for syphilis (all stages).

7. Protozoan Diseases:

1 Malaria:
Pathogen: Malarial parasite (= Plasmodium). Plasmodium has two hosts:
(a) Female Anopheles Mosquito:
As the sexual phase of the malarial parasite occurs in the mosquito it is considered the definitive (=primary)
host of malarial parasite.
(b) Human beings:
As the asexual phase of the malarial parasite occurs in man, it is considered the intermediate (=secondary)
host. As the female Anopheles mosquitoes feed on blood, only they can serve as vector
hosts (= carrier) of malarial parasites. The parasite does not harm the mosquito.

Historical Aspects: Lancisi (1717) first suspected a relationship between swamp, malaria and mosquito.
Laveran (1880) discovered that malaria is caused by protozoan parasite. In fact he discovered Plasmodium.
He got Nobel Prize in 1907. His topic of discovery was “Role of Protozoans in Causing Disease”.
Golgi (1885) confirmed Laveran’s discovery by observing stages of Plasmodium malariae in human RBCs.
In 1897 Sir Ronald Ross, a doctor who was born at Almora in India and he was in Indian Army, established
that malarial parasite is transmitted by the bite of a female Anopheles mosquito. In 1902, he got Nobel
Prize for this discovery. He worked in India.

Life Cycle of Plasmodium:

Life cycle of Plasmodium requires two hosts for completion, such a two host life cycle is called digenetic.

I. Life Cycle of Plasmodium in Man:

1. Infective stage of Plasmodium is sporozoite. When the mosquito bites another human, sporozoites are
injected with bite.
2. Parasites (sporozoites) reach the liver through blood.
3. The parasite reproduces asexually in liver cells, bursting the cell and releasing into the blood.
4. Parasites enter the red blood cells and reproduce asexually there bursting the red blood cells and causing
cycles of fever and other symptoms. Released parasites infect new red blood cells.
5. Sexual stages (gametocytes) develop in red blood cells.

II. Life Cycle of Plasmodium in Female Anopheles mosquito:

1. Female mosquito takes up gametocytes with blood meal.
2. Fertilisation and development take place in the mosquito’s stomach.
3. The zygote elongates and becomes motile called ookinete.
4. The ookinete moves and bores through the wall of the stomach of female Anopheles
mosquito. The ookinete changes to oocyst on the surface of the stomach.
5. Inside the oocyst, sporozoites are formed which are re
6. leased in the body cavity of the mosquito.
 7. Mature infective stages (sporozoites) move to different organs of the body cavity but many
of them penetrate salivary glands of the mosquito.
8. When the female Anopheles mosquito bites a healthy person, the sporozoites are injected
in his/her blood alongwith saliva.
Human Species of Plasmodium and Types of Malaria:
In human beings, malaria is caused by four species.
1. Plasmodium vivax:
It is most common in India. It is less common in Africa. Its incubation period is about 14
days. It causes Benign Tertian Malaria. Recurrence of fever is after every 48 hours (every
third day). Recurrent attacks of fever are called paroxysms.
2. Plasmodium falciparum:
It is common in certain parts of India. It is the greatest killer of human beings over most
parts of Africa and else where in tropics. Its incubation period is about 12 days. Recurrence
of fever is after every 48 hours (every third day). It causes Malignant (=Aestivo-autumnal or
Pernicious or Cerebral or Tropical) Tertian Malaria.
3. Plasmodium malariae:
It is common in tropical Africa, Burma, Sri Lanka and parts of India. It is less common in
India. This was the species of malarial parasite discovered by Laveran. This is the only
species which can also infect other primates. Its incubation period is 28 days. Recurrence of
fever is after 72 hours (every 4th day). It causes Quartan Malaria.
4. Plasmodium ovale:
This is the rarest of the four species which infect man. It is mostly found in tropical Africa.
It is usually not seen in India. Its incubation period is about 14 days. It causes Mild Tertian
Malaria.

Pigment granules (dots) in the cytoplasm of infected RBCs in four Species of Plasmodium:
Symptoms of Malaria: The patient displays symptoms of malaria fever after a period of 14 days from
infectious bite. Early restlessness, less appetite and slight sleeplessness are followed by muscular pains,
headache and a feeling of chilliness. In response to chills the body temperature starts rising and may reach
106°F at the height of fever. The patient sweats a lot and the temperature steadily goes down to normal, till
the next attack takes place after 48 hours.
Control of Malaria: Malaria is widely spread disease in India. There is separate antimalaria department of
the government. which controls malaria through National Malaria Eradication Programme (NMEP).

(a) Treatment of the patient: Quinine, the oldest drug for malaria, and other drugs are also used for this
purpose. Quinine is extracted from the bark of the cinchona tree which is mostly growing in West
Indies, India, Sri Lanka, Java and Peru. Other anti-malarial drugs are paludrine and Primaquin,
Chloroquinine, Camoquin and Comoprima. Now malaria is also being treated with sulpha drugs such as
 sulphadoxin, dapsone, etc.
(b) Prevention of Infection: Ducks, larvivorous fish like Gambusia, some adult insects like dragon flies,
insectivorous plants such as Utricularia, are the natural enemies of mosquito larvae and pupae as they
feed upon them. These may be introduced in the water containing the larvae and pupae.

P. vivax P. falciparum P. malariae P. ovale

Schuffner’s dots Maurer’s dots Ziemann’s dots Jame’s dots

2. Amoebiasis (= Amoebic Dysentery; Enteritis):

Pathogen: Entamoeba histolytica
Host: It is monogenetic (single host life cycle, i.e., humans).
Discovery: Lamble (1859) discovered Entamoeba histolytica. Losch (1875) discovered its pathogenic nature.
Habitat: The pathogen lives in the large intestine of humans. It is more commonly found in males than
females. Presence of chromatoid bodies is the characteristic of the cysts of Entamoeba hystolytica.
Modes of Transmission:
(i) Faecal oral route,
(ii) Sexual transmission,
(iii) Vectors such as flies, cockroaches, etc.

Incubation Period: 2 to 4 weeks or more.

Mode of Infection: The cyst passes unaltered through the stomach. The cyst wall is resistant to the action
of the gastric juice but is digested by the action of trypsin in the intestine. Thus active parasites are
liberated from the cyst into the intestine where it starts normal life. E. histolytica eats red blood
corpuscles. Tetranucleate
cyst is infective stage.
E. histolytica is dimorphic, i.e., occurs in two forms larger harmful magna form and smaller harmless minuta
form.
Diagnosis:
Presence of Charcot-Leyden crystals made up of protein, normally found in the cytoplasm of
eosinophil’s. Presence of chromatid bodies is the characteristic of E. histolytic.
Incubation Period:
It varies in humans but is generally 4 or 5 days.
Symptoms:
In amoebic dysentry (amoebiasis) the patient passes blood alongwith the faeces and feels pain in the
abdomen.
Prevention and Treatment:
Symptomatic treatment includes the use of Metronidazole and Tinidazole.

3.Giardiasis (= Diarrhoea):
It is caused by a zooflagellate protozoan named Giardia intestinalis. Giardia was discoverd by Leeuwenhoek
in his own stools in 1681. It is the first human parasitic protozoan known. It lives in the upper parts
(duodenum and jejunum) of human small intestine. It absorbs nourishment from the food passing through
intestine, grow and multiply through binary fission.
The large number of parasites interferes with digestion and absorption of food. This causes epigastric pain,
abdominal discomfort, diarrhoea, headache and sometimes fever. The diseases caused by Giardia are
popularly known as giardiasis or diarrhoea (watery and frequent stools).

4. Trypanosonaiasis:
It includes African Trypanosomiasis and American Trypanosomiasis.
(i) African Trypanosomiasis (African Sleeping Sickness):
Its pathogens are transmitted by bite of tse tse fly (Glossima palpalis and G. morsitans). The
pathogens are found in blood but later enter the cerebrospinal fluid and migrate to the brain. The
patient becomes lethargic and uncounscious.
Because of it the disease is called sleeping sickness. African Trypanosomiais is of two types (a)
Gambian Trypanosomasis (West African Sleeping Sickness) caused by Trypanosoma gambiense and
(b) Rhodesian Trypanosomiasis (East African Sleeping Sickness) caused by Trypanosoma
Rhodesiense.
(ii) American Trypanosomiasis (American Sleeping Sickness or Chagas Disease):
Chagas disease occurs rarely in the United States and Mexico but is more common in South America
particularly Brazil. Its pathogen is Trypanosoma cruzi which is transmitted by “kissing bugs”
(triatomids).
The bugs pass the infectious parasites in the faeces. The infectious parasites enter the host through
damaged skin or mucous membrane. The parasite is found in blood. The patient becomes lethargic. In
Chagas disease other symptoms are fever, cardiac dilation, digestive tract damage, enlargement of
spleen, etc.

5. Leishmaniasis or Kala-azar (Dum-Dum Fever):

It is caused by Leishmania donovani. The parasite is transmitted by Phlebotomus argentipes (sandfly). Its
symptoms are continuous fever, anaemia, enlargement of liver, spleen, etc.
6. Trichomoniasis (Vaginitis, Leucorrhoea):
It is caused by Trichomonas vaginalis. It lives in the vagina of women. The symptoms of this diseases are
burning sensation, itching and frothy discharge. In males the parasite produces irritation in urethra. Its
transmission is through sexual act.
7. Balantidiasis (= Balantidium Dysentery): It is caused by Balantidium coli. This parasite lives in the
human large intestine (colon). It feeds on human red blood corpuscles, tissue fragments, undigested food
and bacteria. It also undergoes cyst formation. Cysts are passed out in the host’s faeces. Infection occurs
by ingesting cysts with food and water.
Balantidium coli invades mucous membrane of the colon by secreting an enzyme hyaluronidase. The
parasite causes ulcers in the human colon and diarrhoea but may also lead to severe dysentery. Ciliary
dysentery can be prevented by protecting food articles from dust and flies that carry cysts of Balantidium
coli.
8. Helminthic Diseases: These diseases are caused by flat worms and round worms.
Platyhelminths (Flatworms) and Nematodes (Round worms) constitute the Helminths.
(a) Diseases Caused by Flat Worms:

Disease Pathog en Site of Infectio Mode of Secondar y Effect

n Infectio n Host
Fasciolopsiasis Fasciolopsis Small Intestine Metace rcariae Segmenti na or Intestinal
buski – The of man on water plants Planorbis inflammation,
Intestinal (snails) ulcer, diarrhea
Fluke
Schistos omiasis Schisto soma Portal and Cercariae in Bulinus or Urinogenitalschi
haemat obium mesent eric water penetra Melania(snails) stosomiasis
(Blood fluke) veins of man te the skin
when come in
contact
Taeniasi s Taenia solium Small Intestine By eating ill Pig Taeniasis(intesti
(Pork of man cooked measly naldisorders)
tapeworm) pork
Taeniasi s Taenia saginat a Small Intestine By eating ill Cattle Intestinal
(Beef cooked of man cooked beef disorders &
tapeworm) anaemia
Cysticer cosisIt Cystice rcus Ingesti on of Ingestio n of Man In the eye
is more (larva of eggs or eggs of tapewo cysticercus can
dangerous tapeworm) onchos rm or they cause blindness
than taeniasis pheres reach reach lower & in the brain it
the stomach part of digestiv can cause
from intestine e tract and epilepsy
by antiperi develop into
stalsis of cysticer ci &
intestine reach the eyes
where onchos and brain
pheres (larvae)
develo p into
cysticer ci
(larvae) . From
stomach
cysticerci reach
the eyes and
brain
Hydatid Echinoc occus In the intestin By playing with Man, sheep, The parasite
Disease granulo sus e of dogs, pet dogs. goat, pig and liberates toxins
(Dog tapeworm cats, foxes cat which have
or Hydatid and man harmful effect
worm) on the body &
brain of the
host
Diseases Caused by Nematodes (Round Worms):
1. Ascariasis:
Pathogen:
It is caused by Ascaris lumbricoides.
Host and Infection:
Ascaris is an endoparasite of the small intestine of human beings. It is more common in the children,
because the latter are generally in the habit of eating soil and clay, which may be infected by the eggs of
Ascaris. Second stage juvenile— also called embryonated egg, is infective stage. There is no secondary host
in the life cycle of this parasite.
Route of the Parasite / Juveniles and Moulds Fertilized eggs —> Out with host faeces —> First stage
juvenile in egg— also called Rhabditiform larva (First mould) —> 2nd stage juvenile— also called
embryonated egg (infective juvenile in egg) —> Embryonated egg swallowed by man with food —> 2nd
stage juvenile becomes free in human intestine —> 2nd stage juvenile bores through intestinal wall into
blood capillaries —> Heart -> 3rd stage juvenile in lung alveoli (2nd mould) —> 4th stage juvenile in lung
alveoli (3rd mould) —> Bronchioles (4th stage juvenile) —> Bronchi —>Trachea —> Pharynx —> Intestine
(4th mould) —» Young worms.
Symptoms:
Since a large number of adult Ascaris worms normally infest a single host, they obstruct the intestinal
passage and thereby cause abdominal discomforts, like colic pains. The patient may also
suffer from indigestion, diarrohea and vomiting.
Treatment and Prevention:
The disease can best be treated by administering antihelminthic drugs such as oil of chenopodium,
Alcopar, Bendex, Dewormis, Zental, etc. Mebendazole is the drug of choice. The parents should see to it
that their children do not take to the habit of eating soil.
2. Filariasis (Elephantiasis):
Pathogen:
Filariasis is caused by a number of worms. But in India only two types of worms are responsible and are
called Wuchereria bancrofti and W. malayi.
Transmission:
The infestation is transmitted by female Culex mosquitoes from one individual to the others. The worms
live in the lymphatic system.
Symptoms:
This disease is characterised by the swelling of the legs and scrotum. The disease is, therefore, commonly
known as elephantiasis due to its resemblance to a leg of an elephant.
Treatment:
Albendazole with Diethylcarbamazine (DEC- hetrazan) is the commonly used drug.
(b) Other Diseases Caused by Round Worms:
Disease Pathogen Site of Infection Mode of Infecti Effect
on
Ancylosto miasis Ancylostomaduodenale( Small Intestine Larvae bore Itching and
Hookworm) throug h the skin Inflamm ation of
of feet skin, anaemia,
mental & physical
deficienc y
Enterobia sis Enterobius vermicularis Caecum & Colon By swallo wing Anal itching,
(Oxyurias is) (Pin worm) appendix eggs with appendicitis,
food nervous trouble
Trichinell osis Trichinellaspiralis Encysted By eating half Muscular pain,
(Trichina worm) larvae in cooked infecte d pneumonia
striated pork
muscles,
adults in
intestine
Dracuncu liasis Dracunculus medinesis Subcutaneou Taking infecte d Ulcers, diarrhoe
(Guinea worm) stissue Cyclops with a, asthma,
water giddiness
Trichurias is Trichuristrichiura(Whipw Caecum and By taking eggs Abdomin al pain,
orm) appendix with anaemia, bloody
food stools
Loiasis(Ey e Loa Loa (Eye worm) Subcutaneou s By bite of infecte Conjunct ivitis
worm disease) tissue of eyes d deerfly
(Chrysops)

9. Fungal Diseases:
These are caused by fungi. Fungi had been discovered as causative agents of human diseases earlier than
bacteria. Study of fungal diseases in humans is called Medical Mycology.
The fungal diseases of man are either mycoses (caused by infection of fungi) or toxicoses (caused by toxic
fungal metabolites). The term myco refers to a fungus and osis or iosis means condition.
Ringworm or Tinea:
A long time ago people believed that worms lived in the scaly ring, hence the name the ringworm or tinea.

Pathogen:
Fungi belonging to genera Trichophyton, Epidermophyton and Microsporum are responsible for ringworm
or tinea in man.
Mode of Infection:
The infection is generally acquired from soil or by using towels, clothes or even the comb of infected
persons.
Effects of three Genera:
Effects of three genera Trichophyton, Epidermophyton and Microsporum are given below.
(i) Trichophyton:
Trichophytons infect skin, hair and nails. T. rubrum is the most common species infecting man.
(ii) Epidermophyton:
It attacks the skin and nails but not the hair, e.g., E. floccsum.
(iii) Microsporum:
It infects the hair and skin but usually not the nails, e.g., M. canis.
Treatment:
Griseofulvin (orally) and Miconazole (topically).
Some Types of Tinea or Ringworm (According to the Affected Parts):
(i) Tinea pedis (athletes’foot) is ringworm of the foot. Drug Tolnaftate is used to cure the athlete’s foot,
(ii) Tinea capitis- ringworm of the scalp,
(iii) Tinea cruris— involvement of the groin and perineum,
(iv) Tinea barbae- involvement of the bearded areas of the face and neck.

EBOLA VIRUS
Ebola virus disease (EVD) is a deadly disease with occasional outbreaks that occur
primarily on the African continent. EVD most commonly affects people and nonhuman
primates (such as monkeys, gorillas, and chimpanzees). It is caused by an infection with a
group of viruses within the genus Ebolavirus:

• Ebola virus (species Zaire ebolavirus)

• Sudan virus (species Sudan ebolavirus)
• Taï Forest virus (species Taï Forest ebolavirus, formerly Côte d’Ivoire ebolavirus)
• Bundibugyo virus (species Bundibugyo ebolavirus)
• Reston virus (species Reston ebolavirus)
• Bombali virus (species Bombali ebolavirus)

The virus spreads through direct contact (such as through broken skin or mucous
membranes in the eyes, nose, or mouth) with:
• Blood or body fluids (urine, saliva, sweat, feces, vomit, breast milk, amniotic fluid, and
semen) of a person who is sick with or has died from Ebola virus disease (EVD).
• Objects (such as clothes, bedding, needles, and medical equipment) contaminated
 with body fluids from a person who is sick with or has died from EVD.
• Infected fruit bats or nonhuman primates (such as apes and monkeys).
• Semen from a man who recovered from EVD (through oral, vaginal, or anal sex). The
virus can remain in certain body fluids (including semen) of a patient who has recovered
from EVD, even if they no longer have symptoms of severe illness. There is no evidence
that Ebola can be spread through sex or other contact with vaginal fluids from a woman
who has had Ebola.
SYMPTOMS
Primary signs and symptoms of Ebola often include some or several of the following:
• Fever
• Aches and pains, such as severe headache, muscle and joint pain, and abdominal (stomach) pain
• Weakness and fatigue
• Gastrointestinal symptoms including diarrhea and vomiting
• Abdominal (stomach) pain
• Unexplained hemorrhaging, bleeding or bruising
Other symptoms may include red eyes, skin rash, and hiccups (late stage).

PREVENTION
When living in or traveling to a region where Ebola virus is potentially present, there are a
number of ways to protect yourself and prevent the spread of EVD.
• Avoid contact with blood and body fluids (such as urine, feces, saliva, sweat, vomit,
breast milk, amniotic fluid, semen, and vaginal fluids) of people who are sick.
• Avoid contact with semen from a man who has recovered from EVD, until testing shows
that the virus is gone from his semen.
• Avoid contact with items that may have come in contact with an infected person’s blood
or body fluids (such as clothes, bedding, needles, and medical equipment).
• Avoid funeral or burial practices that involve touching the body of someone who died
from EVD or suspect EVD.
• Avoid contact with bats, forest antelopes, and nonhuman primates (such as monkeys
and chimpanzees) blood, fluids, or raw meat prepared from these or unknown animals
(bushmeat).
This vaccine is given as a single dose vaccine and has been found to be safe and protective
against Zaire ebolavirus, which has caused the largest and most deadly Ebola outbreaks to
date.
DIAGNOSIS
Polymerase chain reaction (PCR) is one of the most commonly used diagnostic methods
because of its ability to detect low levels of Ebola virus. PCR methods can detect the presence
of a few virus particles in small amounts of blood, but the ability to detect the virus increases
as the amount of virus increases during an active infection

TREATMENT
The first drug approved in October 2020, Inmazeb™external icon, is a combination of three
monoclonal antibodies. The second drug, Ebanga™external icon, is a single monoclonal
antibody and was approved in December 2020 SUPPORTIVE CARE
• Providing fluids and electrolytes (body salts) orally or through infusion into
the vein (intravenously).
• Using medication to support blood pressure, reduce vomiting and diarrhea, and to
manage fever and pain.
• Treating other infections, if they occur.

ACUTE RESPIRATORY INFECTIONS

Acute respiratory infection is a serious infection that prevents normal breathing function. It
usually begins as a viral infection in the nose, trachea (windpipe), or lungs. If the infection is not
treated, it can spread to the entire respiratory system. Acute respiratory infection prevents the
body from getting oxygen and can result in death. Person suffering from this condition needs
medical assistance immediately. Also, acute respiratory infections are infectious, which means
they can spread from one person to another. The disease is quite widespread. It is particularly
dangerous for children, older adults, and people with immune system disorders. According to

The early symptoms of acute respiratory infection usually appear in the nose and upper lungs. Other

the World Health Organization (WHO), acute respiratory infections kill an estimated 2.6 million
children annually every year worldwide. Symptoms of Acute Respiratory Infection
symptoms include:
• congestion, either in the nasal sinuses or lungs
• runny nose • cough
• sore throat
• body aches
• fatigue
If the disease advances, there may be high fever and chills. Other serious symptoms are
• difficulty breathing
• dizziness
• low blood oxygen level
• loss of consciousness
Causes of Acute Respiratory Infection
Although some causes of the condition are unknown, a few have been identified. They are as follows.

• Adenoviruses
Adenoviruses are a class of microorganisms that can cause acute respiratory
infection. Adenoviruses consist of more than 50 different types of viruses known to
cause the common cold, bronchitis, and pneumonia.
• Pneumococcus
Pneumococcus is a type of bacterium that causes meningitis. However, it can also
trigger certain respiratory illnesses like pneumonia.
 • Rhinoviruses
Rhinoviruses are the source of the common cold, which in most cases is
uncomplicated. However, in the very young, elderly, and people with a weak
immune system, a cold can advance to acute respiratory infection.
Diagnosis of Acute Respiratory Infection
In a respiratory exam, the doctor focuses on the patient’s breathing. Breath sounds in the lungs are
checked for fluid and inflammation. The doctor may peer into the nose and check the throat. If
diagnosed early, over-the-counter medications can help alleviate symptoms while the virus
runs its course. However, if the infection is advanced, an X-ray or CT scan (computer
tomography) may be needed to check the condition of the lungs. Lung function tests have
shown to be useful as diagnostic tools and for prognosis purposes. Pulse oximetry, also
known as pulse ox, may be used to check how much oxygen gets into the lungs. A physician
may also need a sputum (material coughed up from the lungs) sample to check for the type

of virus causing the disease. Who is at Risk for Acute Respiratory Infection?
While it is almost impossible to avoid viruses and bacteria, certain risk factors increase the
likelihood of developing acute respiratory infection. The immune systems of children and the
elderly are more prone to be affected by viruses. Children are especially at risk because of their
constant contact with other kids who could be virus carriers. Children often do not wash their
hands regularly, rub their eyes, and put their fingers in their mouths, resulting in the spread of
viruses.
People with heart diseases or other lung problems are more likely to contract an acute
respiratory infection. Anyone whose immune system might be weakened by another
disease is at risk. Smokers also are at high risk and have more trouble recovering from it.

Potential Complications of Acute Respiratory Infection?

Complications of acute respiratory infection are extremely serious and can result in permanent
damage and even death. They include:
• respiratory arrest
• respiratory failure
• congestive heart failure
Prevention of Acute Respiratory Infection
Most causes of an acute respiratory infection are not treatable. Therefore, prevention is the
best
method to ward off harmful respiratory infections. Practice good hygiene by doing the
following:
• Wash hands frequently, especially after having been in a public place.
• Always sneeze into one's arm of the shirt or in a tissue. Although this may not
ease one's symptoms, it will prevent the spreading of infectious diseases.
• Avoid touching one's face, especially eyes and mouth, to prevent introducing germs
into one's system.

HYPERTENSION:
High blood pressure (hypertension) is a common condition in which the long-term force of
the blood against your artery walls is high enough that it may eventually cause health
problems, such as heart disease.
Blood pressure is determined both by the amount of blood your heart pumps and the amount
of resistance to blood flow in your arteries. The more blood your heart pumps and the
narrower your arteries, the higher your blood pressure. A blood pressure reading is given in
millimeters of mercury (mm Hg). It has two numbers.
• Top number (systolic pressure). The first, or upper, number measures the pressure
in your arteries when your heart beats.
• Bottom number (diastolic pressure). The second, or lower, number measures the
pressure in your arteries between beats.
SYMPTOMS
Most people with high blood pressure have no signs or symptoms, even if blood pressure
readings reach dangerously high levels.
A few people with high blood pressure may have headaches, shortness of breath or
nosebleeds, Blood pressure generally should be checked in both arms to determine if there's
a difference. It's important to use an appropriate-sized arm cuff.
CAUSES
There are two types of high blood pressure.
Primary (essential) hypertension
For most adults, there's no identifiable cause of high blood pressure. This type of high blood
pressure, called primary (essential) hypertension, tends to develop gradually over many
years.
Secondary hypertension
Some people have high blood pressure caused by an underlying condition. This type of high
blood pressure, called secondary hypertension, tends to appear suddenly and cause higher
blood pressure than does primary hypertension. Various conditions and medications can
lead to secondary hypertension, including:
• Obstructive sleep apnea
• Kidney disease
• Adrenal gland tumors
• Thyroid problems
• Certain defects you're born with (congenital) in blood vessels
• Certain medications, such as birth control pills, cold remedies,
decongestants, over- thecounter pain relievers and some prescription drugs
• Illegal drugs, such as cocaine and amphetamines

RISK FACTORS

High blood pressure has many risk factors, including:

• Age. The risk of high blood pressure increases as you age. Until about age 64, high
blood pressure is more common in men. Women are more likely to develop high
 blood pressure after age 65.
• Race. High blood pressure is particularly common among people of African
heritage, often developing at an earlier age than it does in whites. Serious
complications, such as stroke, heart attack and kidney failure, also are more
common in people of African heritage.
• Family history. High blood pressure tends to run in families.
• Being overweight or obese. The more you weigh, the more blood you need to
supply oxygen and nutrients to your tissues. As the amount of blood blow
through your blood vessels increases, so does the pressure on your artery
walls.
• Not being physically active. People who are inactive tend to have higher heart
rates. The higher your heart rate, the harder your heart must work with each
contraction and the stronger the force on your arteries. Lack of physical activity
also increases the risk of being overweight.
• Using tobacco. Not only does smoking or chewing tobacco immediately raise
your blood pressure temporarily, but the chemicals in tobacco can damage the
lining of your artery walls. This can cause your arteries to narrow and increase
your risk of heart disease. Secondhand smoke also can increase your heart
disease risk.
• Too much salt (sodium) in your diet. Too much sodium in your diet can cause
your body to retain fluid, which increases blood pressure.
• Too little potassium in your diet. Potassium helps balance the amount of sodium
in your cells. A proper balance of potassium is critical for good heart health. If
you don't get enough potassium in your diet, or you lose too much potassium
due to dehydration or other health conditions, sodium can build up in your
blood.
• Drinking too much alcohol. Over time, heavy drinking can damage your heart.
Having more than one drink a day for women and more than two drinks a day for
men may affect your blood pressure.
If you drink alcohol, do so in moderation. For healthy adults, that means up to one
drink a day for women and two drinks a day for men. One drink equals 12 ounces
of beer, 5 ounces of wine or 1.5 ounces of 80-proof liquor.
• Stress. High levels of stress can lead to a temporary increase in blood
pressure. Stressrelated habits such as eating more, using tobacco or drinking
alcohol can lead to further increases in blood pressure.
• Certain chronic conditions. Certain chronic conditions also may increase your risk
of high blood pressure, including kidney disease, diabetes and sleep apnea.
Sometimes pregnancy contributes to high blood pressure as well.
COMPLICATIONS
The excessive pressure on your artery walls caused by high blood pressure can damage your
blood vessels as well as your organs. The higher your blood pressure and the longer it goes
uncontrolled, the greater the damage.
Uncontrolled high blood pressure can lead to complications including:
• Heart attack or stroke. High blood pressure can cause hardening and thickening
 of the arteries (atherosclerosis), which can lead to a heart attack, stroke or other
complications.
• Aneurysm. Increased blood pressure can cause your blood vessels to weaken
and bulge, forming an aneurysm. If an aneurysm ruptures, it can be life-
threatening.
• Heart failure. To pump blood against the higher pressure in your vessels, the heart
has to work harder. This causes the walls of the heart's pumping chamber to
thicken (left ventricular hypertrophy). Eventually, the thickened muscle may have
a hard time pumping enough blood to meet your body's needs, which can lead to
heart failure.
• Weakened and narrowed blood vessels in your kidneys. This can prevent these
organs from functioning normally.
• Thickened, narrowed or torn blood vessels in the eyes. This can result in vision loss.
• Metabolic syndrome. This syndrome is a group of disorders of your body's
metabolism, including increased waist size, high triglycerides, decreased high-
density lipoprotein (HDL) cholesterol (the "good" cholesterol), high blood
pressure and high insulin levels. These conditions make you more likely to develop
diabetes, heart disease and stroke.
• Trouble with memory or understanding. Uncontrolled high blood pressure may
also affect your ability to think, remember and learn. Trouble with memory or
understanding concepts is more common in people with high blood pressure.
• Dementia. Narrowed or blocked arteries can limit blood flow to the brain,
leading to a certain type of dementia (vascular dementia). A stroke that
interrupts blood flow to the brain also can cause vascular dementia.

DIABETES MELLITUS

Diabetes happens when your body isn't able to take up sugar (glucose) into its cells and use it
for energy. This results in a buildup of extra sugar in your bloodstream.
Poorly controlled diabetes can lead to serious consequences, causing damage to a wide
range of your body's organs and tissues – including your heart, kidneys, eyes and nerves.
The process of digestion includes breaking down the food you eat into various different
nutrient sources. When you eat carbohydrates (for example, bread, rice, pasta), your body
breaks this down into sugar (glucose). When glucose is in your bloodstream, it needs help – a
"key" – to get into its final destination where it's used, which is inside your body's cells (cells
make up your body's tissues and organs). This help or "key" is insulin.
Insulin is a hormone made by pancreas; an organ located behind your stomach. Your pancreas
releases insulin into your bloodstream. Insulin acts as the “key” that unlocks the cell wall
“door,” which allows glucose to enter your body’s cells. Glucose provides the “fuel” or energy
to tissues and organs need to properly function. If you have diabetes:
• Your pancreas doesn’t make any insulin or enough insulin. Or
• Your pancreas makes insulin but your body’s cells don’t respond to it and can’t use it as it
 normally should.
If glucose can’t get into your body’s cells, it stays in your bloodstream and your blood glucose level
rises.

The types of diabetes are:

• Type 1 diabetes: This type is an autoimmune disease, meaning your body attacks itself.
In this case, the insulin-producing cells in your pancreas are destroyed. Up to 10% of
people who have diabetes have type 1. It’s usually diagnosed in children and young
adults (but can develop at any age). It was once better known as “juvenile” diabetes.
People with type 1 diabetes need to take insulin every day. This is why it is also called
insulin-dependent diabetes. (IDDM)
• Type 2 diabetes: With this type, your body either doesn’t make enough insulin or your body’s
cells don’t respond normally to the insulin. This is the most common type of diabetes.
Up to 95% of people with diabetes have type 2. It usually occurs in middle-aged and
older people. Other common names for type 2 include adult-onset diabetes and insulin-
resistant diabetes. Or (NIDDM)
• Prediabetes: This type is the stage before type 2 diabetes. Your blood glucose levels
are higher than normal but not high enough to be officially diagnosed with type 2
diabetes.
• Gestational diabetes: This type develops in some women during their pregnancy.
Gestational diabetes usually goes away after pregnancy, however, if you have
gestational diabetes, you're at higher risk of developing type 2 diabetes later on in life.
• Diabetes insipidus is a distinct rare condition that causes your kidneys to
produce a large amount of urine.
• Risk factors for type 1 diabetes include:
o Having a family history (parent or sibling) of type 1 diabetes. o Injury to the
pancreas (such as by infection, tumor, surgery or accident). o Presence of
autoantibodies (antibodies that mistakenly attack your own body’s tissues or
organs).
o Physical stress (such as surgery or illness).
o Exposure to illnesses caused by viruses.
• Risk factors for prediabetes and type 2 diabetes include:
o Family history (parent or sibling) of prediabetes or type 2 diabetes.
o Being overweight. o Having high blood pressure.
o Having low HDL cholesterol (the “good” cholesterol) and high triglyceride level. o
Being physically inactive. o Being age 45 or older. o Having
gestational diabetes or giving birth to a baby weighing more than 9 pounds. o
Having polycystic ovary syndrome. o Having a history of heart disease or
stroke.
o Being a smoker.
• Risk factors for gestational diabetes include:
o Family history (parent or sibling) of prediabetes or type 2 diabetes. o
 Being overweight before your pregnancy.
o Being over 25 years of age.
Symptoms of diabetes include:
• Increased thirst (Polydipsia)
• Increased Appetite (Polyphagia) • Weak, tired feeling
• Blurred vision.
• Numbness or tingling in the hands or feet.
• Slow-healing sores or cuts.
• Unplanned weight loss.
• Frequent urination (Polyurea) • Frequent unexplained infections.
• Dry mouth.
Other symptoms
In women: Dry and itchy skin, and frequent yeast infections or urinary tract
infections. In men: Decreased sex drive, erectile dysfunction, decreased muscle
strength.

COMPLICATIONS INCLUDE:
• Cardiovascular issues including coronary artery disease, chest pain, heart attack,
stroke, high blood pressure, high cholesterol, atherosclerosis (narrowing of the
arteries).
• Nerve damage (neuropathy) that causes numbing and tingling that starts at toes or
fingers then spreads.
• Kidney damage (nephropathy) that can lead to kidney failure or the need for
dialysis or transplant.
• Eye damage (retinopathy) that can lead to blindness; cataracts, glaucoma.
• Foot damage including nerve damage, poor blood flow and poor healing of cuts and sores.
• Skin infections.
• Erectile dysfunction.
• Hearing loss.
• Depression.
• Dementia.
• Dental problems.
• Complications of gestational diabetes:
• In the mother: Preeclampsia (high blood pressure, excess protein in urine, leg/feet
swelling), risk of gestational diabetes during future pregnancies and risk of diabetes later
in life.
• In the newborn: Higher-than-normal birth weight, low blood sugar (hypoglycemia),
higher risk of developing type 2 diabetes over time and death shortly after birth.

DIAGNOSIS

• Fasting plasma glucose test: This test is best done in the morning after an eight
hour fast (nothing to eat or drink except sips of water).
 • Random plasma glucose test: This test can be done any time without the need to fast.
• A1c test: This test, also called HbA1C or glycated hemoglobin test, provides your
average blood glucose level over the past two to three months. This test measures the
amount of glucose attached to hemoglobin, the protein in your red blood cells that
carries oxygen.
• Oral glucose tolerance test: In this test, blood glucose level is first measured after an
overnight fast. Then you drink a sugary drink. Your blood glucose level is then checked
at hours one, two and three.
Normal Prediabetes Diabetes
Type of test (mg/dL) (mg/dL) (mg/dL)

Less than 100

Fasting glucose test 100-125 126 or higher

Less than 140

Random (anytime) glucose test 140-199 200 or higher

Less than 5.7%

A1c test 5.7 - 6.4% 6.5% or higher

Oral glucose tolerance test Less than 140 140-199 200 or higher
MANAGEMENT:
Diabetes affects your whole body. To best manage diabetes, you’ll need to take steps to keep your risk
factors under control and within the normal range, including:

• Keep your blood glucose levels as near to normal as possible by following a diet
plan, taking prescribed medication and increasing your activity level.
• Maintain your blood cholesterol (HDL and LDL levels) and triglyceride levels as near
the normal ranges as possible.
• Control your blood pressure. Your blood pressure should not be over 140/90 mmHg.

You hold the keys to managing your diabetes by:

• Planning what you eat and following a healthy meal plan. Follow a Mediterranean
diet (vegetables, whole grains, beans, fruits, healthy fats, low sugar) or Dash diet.
These diets are high in nutrition and fiber and low in fats and calories. See a
registered dietitian for help understanding nutrition and meal planning.
• Exercising regularly. Try to exercise at least 30 minutes most days of the week. Walk,
swim or find some activity you enjoy.
• Losing weight if you are overweight. Work with your healthcare team to develop a
weight-loss plan.
 • Taking medication and insulin, if prescribed, and closely following recommendations on
how and when to take it.
• Monitoring your blood glucose and blood pressure levels at home.
• Keeping your appointments with your healthcare providers and having
laboratory tests completed as ordered by your doctor.
• Quitting smoking (if you smoke).

You have a lot of control – on a day-to-day basis – in managing your diabetes!

HYPOGLYCAEMIA
Having a blood glucose level that is lower than the normal range (usually below 70 mg/dL)
is called hypoglycemia. This is a sign that your body gives out that you need sugar.
Symptoms you might experience if you have hypoglycemia include:
• Weakness or shaking.
• Moist skin, sweating.
• Fast heartbeat.
• Dizziness.
• Sudden hunger.
• Confusion.
• Pale skin.
• Numbness in mouth or tongue.
• Irritability, nervousness.
• Unsteadiness.
• Nightmares, bad dreams, restless sleep.
• Blurred vision.
• Headaches, seizures.
You might pass out if your hypoglycemia is not
managed. What happens if my blood glucose level is
high?
HYPERGLYCAEMIA
If you have too much glucose in your blood, you have a condition called hyperglycemia.
Hyperglycemia is defined as:
• A blood glucose level greater than 125 mg/dL while in the fasting state (nothing to eat
or drink for at least eight hours) or
• A blood glucose level greater than 180 mg/dL one to two hours after eating.
MECHANISM
Oral medications and insulin work in one of these ways to treat your diabetes:
• Stimulates your pancreas to make and release more insulin.
• Slows down the release of glucose from your liver (extra glucose is stored in your liver).
• Blocks the breakdown of carbohydrates in your stomach or intestines so that your
tissues are more sensitive to (better react to) insulin.
• Helps rid your body of glucose through increased
urination. Diabetes medication drug classes include:
• Sulfonylureas: These drugs lower blood glucose by causing the pancreas to release
 more insulin. Examples include glimepiride , glipizide and glyburide
• Glinides (also called meglitinides): These drugs lower blood glucose by getting the
pancreas to release more insulin. Examples include repaglinide and nateglinide
• Biguanides: These drugs reduce how much glucose the liver produces. It also
improves how insulin works in the body, and slows down the conversion of
carbohydrates into sugar. Metformin
• Alpha-glucosidase inhibitors: These drugs lower blood glucose by delaying the
breakdown of carbohydrates and reducing glucose absorption in the small intestine.
An example is acarbose
• Thiazolidinediones: These drugs improve the way insulin works in the body by allowing
more glucose to enter into muscles, fat and the liver. Examples include pioglitazone
and rosiglitazone
• GLP-1 analogs (also called incretin mimetics or glucagon-like peptide-1 receptor
agonists): These drugs increase the release of insulin, reduce glucose release from the
liver after meals and delay food emptying from the stomach. Examples include
exenatide , liraglutide, albiglutide , semaglutide and dulaglutide .
• DPP-4 inhibitors (also called dipeptidyl peptidase-4 inhibitors): These drugs help your
pancreas release more insulin after meals. They also lower the amount of glucose
released by the liver. Examples include alogliptin, sitagliptin, saxagliptin and linagliptin .
• SGLT2 inhibitors (also called sodium-glucose cotransporter 2 inhibitors): These drugs
work on your kidneys to remove glucose in your body through your urine. Examples
include canagliflozin
, dapagliflozin and empagliflozin .
• Bile acid sequestrants: These drugs lower cholesterol and blood sugar levels. Examples
include colestipol, cholestyramine and colesevelam.
• Dopamine agonist: This medication lowers the amount of glucose released by the
liver. An example is bromocriptine . insulin types.
• Rapid-acting insulins: These insulins are taken 15 minutes before meals, they peak
(when it best lowers blood glucose) at one hour and work for another two to four
hours. Examples include insulin glulisine, insulin lispro and insulin aspart .
• Short-acting insulins: These insulins take about 30 minutes to reach your
bloodstream, reach their peak effects in two to three hours and last for three to six
hours. An example is insulin regular (Humulin R®).
• Intermediate-acting insulins: These insulins reach your bloodstream in two to four
hours, peak in four to 12 hours and work for up to 18 hours. An example in NPH.
• Long-acting insulins: These insulins work to keep your blood sugar stable all day.
Usually, these insulins last for about 18 hours. Examples include insulin glargine,
Lantus®, insulin detemir ®) and insulin degludec.
There are insulins that are a combination of different insulins. There are also insulins that are
combined with a GLP-1 receptor agonist medication (e.g. Xultophy®, Soliqua®).

CANCER:
Cancer is a broad term. It describes the disease that results when cellular changes cause the
uncontrolled growth and division of cells.
Some types of cancer cause rapid cell growth, while others cause cells to grow and divide at
a slower rate.
Certain forms of cancer result in visible growths called tumors, while others, such as leukemia,
do not. Most of the body’s cells have specific functions and fixed lifespans. While it may sound
like a bad thing, cell death is part of a natural and beneficial phenomenon called apoptosis.
A cell receives instructions to die so that the body can replace it with a newer cell that
functions better. Cancerous cells lack the components that instruct them to stop dividing and
to die.
As a result, they build up in the body, using oxygen and nutrients that would usually nourish
other cells. Cancerous cells can form tumors, impair the immune system and cause other
changes that prevent the body from functioning regularly.
Cancerous cells may appear in one area, then spread via the lymph nodes. These are clusters of
immune cells located throughout the body.

There are many causes of cancer, and some are

preventable. In addition to smoking, risk factors for
cancer include:
• heavy alcohol consumption
• excess body weight
• physical inactivity
• poor nutrition

Below are examples of approaches to cancer treatment:

• Chemotherapy aims to kill cancerous cells with medications that target rapidly dividing
cells. The drugs can also help shrink tumors, but the side effects can be severe.
• Hormone therapy involves taking medications that change how certain hormones work
or interfere with the body’s ability to produce them. When hormones play a significant
role, as with prostate and breast cancers, this is a common approach.
• Immunotherapy uses medications and other treatments to boost the immune
system and encourage it to fight cancerous cells. Two examples of these
treatments are checkpoint inhibitors and adoptive cell transfer.
• Precision medicine, or personalized medicine, is a newer, developing approach. It
involves using genetic testing to determine the best treatments for a person’s particular
presentation of cancer. Researchers have yet to show that it can effectively treat all
types of cancer, however.
• Radiation therapy uses high-dose radiation to kill cancerous cells. Also, a
doctor may recommend using radiation to shrink a tumor before surgery or
reduce tumor-related symptoms.
• Stem cell transplant can be especially beneficial for people with blood-related cancers,
such as leukemia or lymphoma. It involves removing cells, such as red or white blood
cells, that chemotherapy or radiation has destroyed. Lab technicians then strengthen
the cells and put them back into the body.
• Surgery is often a part of a treatment plan when a person has a cancerous
 tumor. Also, a surgeon may remove lymph nodes to reduce or prevent the
disease’s spread.
• Targeted therapies perform functions within cancerous cells to prevent them from
multiplying. They can also boost the immune system. Two examples of these therapies
are small-molecule drugs and monoclonal antibodies.

Types of cancer:
• bladder
• colon and rectal
• endometrial
• kidney
• leukemia
• liver
• melanoma
• non-Hodgkin’s lymphoma
• pancreatic
• thyroid
Cancer development and cell division
Doctors classify cancer by:
• its location in the body
• the tissues that it forms in
For example, sarcomas develop in bones or soft tissues, while carcinomas form in cells
that cover internal or external surfaces in the body. Basal cell carcinomas develop in the
skin, while adenocarcinomas can form in the breast.
When cancerous cells spread to other parts of the body, the medical term for this is
metastasis. A person can also have more than one type of cancer at a time.

SYMPTOMS
Signs and symptoms caused by cancer will vary depending on what part of the body is
affected. Some general signs and symptoms associated with, but not specific to, cancer,
include:
• Fatigue
• Lump or area of thickening that can be felt under the skin
• Weight changes, including unintended loss or gain
• Skin changes, such as yellowing, darkening or redness of the skin, sores that won't
heal, or changes to existing moles
• Changes in bowel or bladder habits
• Persistent cough or trouble breathing
• Difficulty swallowing
• Hoarseness
• Persistent indigestion or discomfort after eating
• Persistent, unexplained muscle or joint pain
• Persistent, unexplained fevers or night sweats
• Unexplained bleeding or bruising
DRUG ADDICTION AND DRUG SUBSTANCES ABUSE:
Psychosocial Pharmacy: Drugs of misuse and abuse – psychotropic and narcotics,
and other pharmaceuticals and chemicals, tobacco and tobacco products, alcohol.

Social & psychosocial impact of these, role of pharmacist in reducing, preventing the menace

Complimentary therapy is quite useful in chronic ailments. There are many psychosocial needs
that motivate the patients. The most common factors involved are increased anxiety, need for
additional information, maintenance of hope, a sense of control, negative experiences with
conventional medicines, and perceived value of complimentary therapy. Pharmacists are at the
right position to identify and address some of the psychosocial issues either directly or through
clinical psychologists or counsellors.

The intervention will involve:

• A medication review to support appropriate prescribing by an experienced
specialist pharmacist.
• A behaviour change element based on education and training of care staff to
support them in managing challenging behaviour without medication.

Psychotropic and Narcotics:

Narcotic Drugs and Psychotropic Substances have several medical and scientific uses. However,
they can be and are also abused and trafficked. India’s commitment to prevention of drug abuse
and trafficking predates the coming into force of the three conventions. The Narcotic Drugs and
Psychotropic Substances (NDPS) Act, 1985 was framed taking into account India’s obligations
under the three UN drug Conventions as well as Article 47 of the Constitution. This Act
prohibits, except for medical or scientific purposes, the manufacture, production, trade, use,
etc. of narcotic drugs and psychotropic substances.

Substance abuse refers to excessive use of a drug in a way that is detrimental to self, society, or
both, and includes both physical dependence and psychologic dependence. Physical
dependence caused by prolonged use of a drug refers to an altered physiologic state in which
withdrawal symptoms develop when the drug is discontinued. Psychologic dependence refers
to a state of intense need to continue taking a drug in the absence of physical dependence.
Alcohol is a drug that can cause both physical and psychologic dependence.

Following classes of substances have potential of abuse:

• Opioids: heroin, morphine, meperidine
• Hypnotics and sedatives: barbiturates, diazepam (Valium), chlordiazepoxide
hydrochloride (Librium), methaqualone (Quaalude), Clonazepam (Rivotril),
Lorazepam (Larpose)
• Stimulants: amphetamine, cocaine
• Hallucinogens: lysergic acid diethylamide (LSD), phencyclidine (PCP), mescaline
• Volatile hydrocarbons: gasoline, paint thinner
• Cannabinoids: marijuana, hashish
 • Alcohol
Adolescents and young adults
• Abuse of prescription drugs is highest among young adults aged 18 to 25,
• Prescription and OTC drugs are among the most commonly abused drugs after
alcohol, marijuana, and tobacco.
• Youth who abuse prescription medications are also more likely to report use of other
drugs.
• Multiple studies have revealed associations between prescription drug abuse and higher
rates of cigarette smoking; heavy episodic drinking; and marijuana, cocaine, and other
illicit drug use among adolescents, young adults, and college students in the United
States.
Older adults
• Older patients are more likely to be prescribed long-term and multiple prescriptions,
• Cognitive decline leads to improper use of medications.
• Using remaining medication to save money.
• Using OTC medicines and dietary supplements

Patients in need of narcotics, for example, may feign kidney stone pain in an effort to obtain an
injection of an opioid. The physician should be alert to observable evidence of use of abusable
substances including the following: needle-track marks on the arms and legs or areas of fatty
necrosis from subcutaneous injections in opiate addicts; redness of the eyes and tachycardia in
marijuana users; excitement, tachycardia, increased blood pressure, and paranoid thinking in
amphetamine users; and sensory distortion such as illusions and hallucinations in patients on
psychedelic drugs. Reliable laboratory procedures for detection of opiates, amphetamines,
barbiturates, cocaine, phencyclidine, and alcohol are now widely available. At times, a small
dose of a narcotic antagonist such as naloxone is given as a diagnostic test in order to
precipitate an abstinence syndrome that will be confirmatory of narcotic addiction.

Tobacco Products:
Every year, more than 8 million people die from tobacco use. Most tobacco-related deaths
occur in low- and middle-income countries, Tobacco can also be deadly for non-smokers.
Second-hand tobacco smoke contributes to heart disease, cancer, and other diseases, causing
an additional 1.2 million deaths annually. Tobacco contains nicotine, the ingredient that can
lead to addiction. Smoking, taking snuff, chewing tobacco and any other form of tobacco
consumption is called ‘abuse of tobacco’.

Poor social resources and low self-esteem have been implicated in the development of teenage
drug abuse. The unique or independent effects of cigarettes and hard drug use (while
controlling for General Drug Use) had a wide range of negative effects on health, psychosomatic
symptoms, emotional distress, and interpersonal relationships. Specific use of cannabis
increased health and family problems. Alcohol use, which was not reflected in General Drug
Use, had no specific negative effects, but it reduced loneliness in romantic relationships, self-
derogation, and family problems.

Tobacco cessation:
Recent evidence suggests that pharmacists' advice to quit smoking can produce significant
increases in quit rates among smokers. Therefore, even when a patient's condition is unrelated
to tobacco use, giving up smoking will improve the health of all smokers, and the health of their
families will be improved by eliminating second hand smoke in the household. There is a wealth
of literature on nicotine pharmacology, tobacco use, and smoking cessation.

Palliative/terminal care:
Prognostication of life expectancy is of the utmost importance to patients, families, and health
care professionals, particularly in the setting of advanced disease. Palliative and supportive
care differ in philosophy from curative strategies in focusing primarily on the consequences of
a disease rather than its cause or specific cure. The approach therefore complements
oncological or antiretroviral treatments; it doesn’t substitute or replace them. The old view was
that palliative care apply only to those who are dying, but in reality, palliative care is often
needed from the time of diagnosis. Cost effectiveness of palliative care outweighs attempts at
disease cure, in terms of quality of life for the individual and family. The palliative care services
have acquired an increasing role in incurable diseases apart from cancer and further task is to
ensure better care to those at risk of complicated grief. Palliative care cannot remove the
impact of a tragedy, but it can ensure that the patient’s voice is heard and the need are
addressed.

Role of Pharmacist:

Pharmaceutical care is defined as: "the direct, responsible provision of medication-related care
for the purpose of achieving definite outcomes that improve a patient's quality of life. To fulfil
these goals, pharmacists must acquire a complete drug history for all patients under their care.
It is considered routine practice to ask patients about prescription and over-the-counter
medications, and in recent years, the importance of herbal product use has become apparent.
However, it is doubtful that pharmacists routinely ask about nicotine or alcohol use and more
unlikely that they question patients about illicit drug use. Cigarette use is associated with and
exacerbates cardiovascular and pulmonary dysfunction. Nicotine is a vasopressor and cardiac
stimulant, and smoke is an obvious pulmonary irritant. Thus, in the short run, any patient
receiving prescription medication for any cardiovascular or pulmonary condition should be
screened for tobacco use. Smokers need unambiguous information about the association
between their tobacco use and their medical problem. However, asking about tobacco use
should not be limited to patients with these medical conditions. Asking about alcohol use and
screening for dependence can provide vital data for optimizing pharmacotherapy outcomes.
All patients are be asked about tobacco use at every visit. An opening question such as "How do
you use alcohol?" is non-threatening and unlikely to be regarded as being intrusive. After
ascertaining tobacco use and alcohol use, a natural follow-up question is "Do you take any other
kinds of drugs?".
Pharmacists can play an important role in educating parents and teens about the dangers of
drug abuse. It is crucial for parents and teens to have open lines of communication to prevent
this dangerous epidemic.

Ultimately, pharmacist professionals are responsible for:

• To acquire basic knowledge on drug abuse and dependence
• Clinical and toxicological analyses
• To advise & guide as health agent
• To counsel on psychological issues of drug dependence and drug abuse
• Pharmacists as the first line of defense in recognizing prescription drug abuse (As
dispenser, understanding instructions, by being watchful for prescription
falsifications or alterations).
• Developing hotlines to alert other pharmacies in the region when a fraudulent
prescription is detected.
• Prescription drug monitoring programs (PDMPs), which require physicians and
pharmacists to integrate in identifying authenticity.
• Behavioral treatments, such as individual counseling, group or family counseling,
contingency management, and cognitive behavioral therapies, also can help patients
improve their personal relationships and their ability to function at work and in the
community
• Some addictions, such as opioid addiction, can be treated with medications.
These pharmacological treatments counter the effects of the drug on the brain
and behavior,
• Although a behavioral or pharmacological approach alone may be sufficient for
treating some patients, research shows that a combined approach may be best.
• Pharmacists can review profile of the patients who are chronically taking controlled substances
• One of the ways that pharmacist can prevent substance abuse is via counseling.
Individualized drug counseling focuses directly on reducing or stopping the addict's
illicit drug use. It also addresses related areas of impaired functioning such as
employment status, illegal activity, family and social relations.
• Pharmacists should emphasize that medication alone is insufficient for the long-term
successful treatment of substance dependence
• Pharmacists should tell patients that their active participation in a comprehensive
pharmacotherapy program of recovery is expected of them. Thus, in addition to
abstinence from their drug of choice, patients should make adjustments in their lives
that promote abstinence and reduce their exposure to situations associated with their
drug abuse.
• Pharmacists can prevent drug abuse by identifying forged prescriptions and taking
appropriate steps to correct it.
• The dispensing pharmacist must maintain constant vigilance against forged or altered
prescriptions. Pharmacists should be aware of the various kinds of fraudulent
prescriptions which may be presented for dispensing. Legitimate prescription pads are
 stolen from physicians' offices and some patients, in an effort to obtain additional
amounts of legitimately prescribed drugs, alter the physician's prescription.
• There are other characteristics that make a prescription forged. They include:
Prescription looks too good, prescription appears to be photocopied, directions written
in full with no abbreviations, prescription does not comply with the acceptable
standard abbreviations or appear to be textbook presentations, and prescription
written in different color inks or written in different handwriting. Proper controls
against fraudulent prescriptions can best be accomplished by following common sense,
sound professional practice, and using proper dispensing procedures and controls. It is
a challenge for pharmacists to be vigilant in trying to prevent drug abuse.
• Pharmacists can play an active role in treating and preventing substance abuse by
making appropriate recommendations to the prescriber when appropriate.
• Pharmacists can participate in substance abuse education and prevention programs
• Pharmacists can play a major role in reducing the negative effects that substance
abuse has on society, health systems and the pharmacy profession.
 Multiple Choice Questions
1. Which of the following is a set of bacterial diseases?
a. Malaria, polio, mumps b. Plague, leprosy, diphtheria
c. Mumps, cholera, typhold d. measles Tuberculosis Tetanus
Answer: Mumps, cholera, typhold
2. Vibrio Cholerae is a motile bacterium, which belong to the group of -
a Lophotrichous b. Peritrichous c. Monotrichous d. Amphitrichous
Answer: Monotrichous
3. What is the standard treatment of Cholera?
a ORS replacement therapy
b. Tetracycline antibiotics
c. Trimethoprim sulfamethoxazole
d. Diuretic drugs?
Answer: Trimethoprim sulfamethoxazole
4. What is the full frame of SARS?
a. Severe acute respiratory syndrome
b. Severe acute Respiratory symptoms
c. Severe actual respiratory symptoms
d. Serious acute respiratory syndrome
Answer: Severe acute respiratory syndrome
5. What is the biggest risk factor for the infection with Ebola?
a. working in a category IV laboratory b. Nursing a patient at home
c. Attending of funeral of a victim outside d. Attending large gatherings
Answer: Nursing a patient at home
6. Ebola virus disease is a type of.
a. viral hemorrhagic fever b. Avian Influenza
c. plague d. viral respiratory illness
Answer: viral hemorrhagic fever
7. Incubation period of Ebola virus is...
a. within an hour b. 2 to 21 days c. within 48 hours d. 2 to 7 days
Answer: 2 to 21 days
8. Which of the following indicates hypertensive crisis?
a blood pressure of 140/99 mmhg b. BP of 160/100 mmhg
c. BP of 150/99 mmhg d. BP of 180/120 mmhg
Answer: BP of 180/120 mmhg
9. What are the top three modifiable risk factors for developing cancer?
a. Tobacco use, excess body weight, alcohol Intake
b. Tobacco use, cancer-causing pathogens, physical inactivity
c. Tobacco use Sun/UV exposure, alcoholic use
d Tobacco use. Sun/UV exposure, excess body weight
Answer: Tobacco use, excess body weight, alcohol Intake
10. Changing or modifying certain behaviors can reduce your risk for developing cancer, which of the
following lifestyle modification can reduce your risk of cancer
a. Stay Physically Active
b. limit consumption of red meat and processed food
c. limit alcohol consumption
d. all of the above
Answer: all of the above
11. Which of the following drop functions as a CNS depressant?
a. amphetamine b. caffeine c. oplum d. cocaine
Answer: oplum
12. compulsory drinking is also called....
a. Dipsomania b. Pyromania c. Trichotillomania d. Dyslexia
Answer: Dipsomania
13. Substance abuse is……
a taking of a drug or alcohol in damaging quantities or in quantities other than prescribed
b. typified by continued use of alcohol or other drugs in spite of negative consequences
c characterized by repeated compulsive seeking or use of a substance despite adverse social psychological
and/or physical consequences
d use of any drug
Answer: typified by continued use of alcohol or other drugs in spite of negative consequences
14. Filarial larvae can be collected from man's
a. peripheral blood at midnight b. smears of spleen
c. smears of intestinal contents d. biopsy of liver
Answer: peripheral blood at midnight
15. This does not accurately describe lymphatic filariasis
a. Vector is the mollusk b. chyluria is the most common manifestation
c. Manly affects the lower limb d. Caused by woms wuchererubancrofti
Answer: Vector is the mollusc
16. Which of the following coronavirus is has goes to thousands of deaths around the world as an emergent
virus?
a. MERS b. SARS c. OC43 d. HKU1
Answer: SARS
17. Chikungunya is primarily spread by…..
a bacteria b. viruses c protozoa d mollusk
Answer: viruses
18 Chikungunya has spread widely from Asia and Africa into the Caribbean in recent years. This has been
mainly facilitated by
a. mutation in the virus allowing the replication in the mosquito aedesalbopictus
b. Air travel
c. climate change
d. poor mosquito control and absence of the DTT
Answer: mutation in the virus allowing the replication in the mosquito aedesalbopictus
19. Mosquito responsible for malaria transmission...
a. Aedesegypti b. Aedesalbopictus c. Anopheles d. Haemagogus
Answer: Anopheles
20. Trophozoites, scizonts and gamatocytes of all the malarial parasites are seen in the peripheral blood
smear except;
a. P.falciparum b. P.malariae c. P.Ovale d. P.vivax
Answer: P.falciparum

21. Which of the following can repel mosquitoes...

a. banana b. chili c. citronella d. garlic
Answer: citronella
22. At what age should you have your first screening for high blood pressure...
a 16 b. 18 c. 30 d. 50
Answer: 50
23. What is the most common symptom of high blood pressure?
a. racing heartbeat b. fatigue
c. high body temperature d. It has no symptoms that you notice
Answer: It has no symptoms that you notice
24. This measure does not help to prevent diabetes complications
a. controlling blood lipids and blood pressure
b. controlling blood glucose
c. prompt detection of diabetic eye and kidney
d. eliminating all carbohydrates from the diet
Answer: eliminating all carbohydrates from the diet
25. Gestational diabetes is diagnosed by:
a. Glucose tolerance test b. fasting and postprandial blood sugar
c. random blood sugar d. 24 hours blood glucose profile
Answer: Glucose tolerance test
26. Vibrio Cholera is a motel bacterium Which belong to the group of
a Lophotrichous b. Peritrichous
c. Monotrichous d. Amphitrichous
Answer: Monotrichous
27. What is /are the Primary goals of oral replacement therapy?
a. replace lost water and electrolytes c. slow down the heart rate
b. kill vibrio Cholerae d. prevent transmission of the vibrio cholerae
Answer: replace lost water and electrolytes
28. Which makes SARS even more difficult to diagnose?
a. asymptomatic nature b. symptoms same as common cold and flu
c. Mistake in lab tests d. all of the above
Answer: all of the above
29. Which Laboratory test is the criteria standard for diagnosis of viral community-acquired pneumonia in
adults?
a viral culture b. Rapid RSV test
c. Rapid antigen testing d. nasal swab test
Answer: nasal swab test
30. Risk factors for Hospital acquired pneumonia include all of the following except
a. presence of COPD b. obesity
c. duration of surgery d. age older than 60 years.
Answer: obesity