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lunes, 29 de julio de 2013
ABCD del Dengue 2011. English version. D d-junking
D, Prevention: “de-junking”, water deposits, insecticides and barriers.
We have already addressed of its origins, how it arrives, how it presents itself and which are the dangers. We are missing the most important issue (hence why the title I suggested in the last installment changed): prevention.
As there is no vaccine against dengue virus, prevention focuses in attacking and eradicating the vector (carrier): the aedes mosquito. Attacking it is done in three manners: preventing bites, attacking the mosquito and breeding.
BARRIERS.
As for barriers we refer to the ways we can stop the mosquito from biting. Although a valuable prevention tool, it might be the less important as if the previous ones are correctly done, the mosquito would not appear. It has to do with avoiding the mosquito from reaching our skin (whether to inoculate the virus or extract it from an already sick person) and we can achieve it mainly in to forms: repellents and mosquito screens or nets. Use of repellents is well known; any presentation is valid and depending on every person’s preference, I will only mention that their use muse be increased during mosquitoes’ feeding schedules: dawn and dusk. Mosquito screens and nets keep the mosquito outside and may be used over beds (nets) or on windows and doors.
INSECTICIDES.
The second prevention aspect, concerns killing the mosquito. While the Health Department watches over and sprays over areas where cases have appeared, we should not expect that all mosquitoes will be killed and the problem eradicated. A large number of mosquitoes live inside homes and other locations where the spray cannot reach, therefore it is important that we take care of our own area and use commercial insecticides at home. Frequency thereof may also be determined by observing or not mosquito, however during this season doing it twice a week cannot hurt. We should not forget that certain spots are great hiding places for mosquitoes during the day such as behind furniture, inside closets and under the beds; in general, dark places.
DE-JUNKING AND WATER DEPOSITS.
The third and most important aspect refers to clearing areas from objects that become potential breeding grounds. Remember that the mosquito requires a small amount of water to place eggs and reproduce; if it finds such spaces in our own yards or homes, no matter how many times we fumigate every so often we will see the mosquito back again. Basically any junk could be used by them, from a lid of a jar or a bottle-cap to a bin o bucket, flower cases, open water tanks, a basin and we have even found then in potato chip bags. It only takes 24 hours of stagnant water to make hatching possible; without question the most important issue. First because is a mosquito does not breed, we stop 15 or more from hatching; second, because no matter how many times we fumigate, the mosquito may find a space to hide and reproduce again.
For large stagnant bodies of water such as puddles, ponds, water tanks, storm drains, wells and sewers we have two options. The first is to use temphos or abate, a substance that prevents mosquitoes from depositing the eggs and larvae settling in. Without going into further details, there are several types and mainly act breaking water’s surface tension, thus are the main option for bodies of water that cannot be covered and do not endanger the environment. The second option is to cover water deposits, starting with water tanks and wells placing sturdy and sealed covers; and, when this is not possible or an inflow/outflow watercourse, a screen cover could be used, depending on the case. For large bodies of water, health authorities must be contacted as they have the cost-free temphos or abate distribution and may carry out a better analysis to find the best solution.
This is it so far with the ABCD of Dengue; I hope the information is useful
jueves, 2 de mayo de 2013
ABCD of Dengue. 2011 ENGLISH VERSION. C. Cases and Clinic
ABCD DENGUE. 2011 ENGLISH VERSION. B: garBage, trash and water containers
First I wish to clarify about a question from the previous publication. An infected person has millions of viral particles in through its bloodstream (viraemia); when a mosquito bites and infected person and absorbs its blood, within the blood DV viral particles are included; thus, when a virus-free Aedes female (reminding you that from this species, only the female bites), she becomes the carrier and a virus transmission vector.
Now, addressing section B, we come into one of the definite issues in this disease’s prevention: water containers. As mentioned before, the virus needs the mosquito in order to spread and, in turn, the mosquito needs the water in order to reproduce. There is an anecdote presented in a course of Dengue where I participated. It explains the importance of this occurrence. In the '50s there was no dengue in the country or in a large portion of Central America. It is said that a cargo ship arriving from Brazilian coasts (where dengue did exist), carried a shipment of used tires and on route called ports in Central America; I don’t know if it ever called Mexico.
It turned out that the tires had wastewater containing mosquito eggs and larvae carrying DV which, when reaching port, infected Central America inhabitants and from there extending to the north, arriving to Mexico, thus reintroducing dengue.
The Ministry of Health’s campaign "Patio limpio" (clean patio) promotes the removal of cans, buckets, junk and any garbage container to prevent the potential of stagnant water. For this individual work, we only need to go outside, walk around checking and identifying where water accumulates on the house roof. We must get rid of waste, protect or keep buckets and canisters turned over; cisterns, water tanks or other fastened deposits should be covered and/or sealed. In waterloggings, ponds and other deposits which given their nature cannot be covered, temephos or abate (a substance that breaks the surface tension of water and prevents mosquitoes from standing on the surface to deposit its egg) must be used.
No matter how much we try to eradicate potential mosquito "nests" with the abovementioned measures, mosquitoes always appear. I do not have the official figures, but consider the 10 kms (6.2 miles) the mosquito may travel; and probably a few more depending on the wind speed. Hence, if there are no mosquitoes or dengue around us, the source could be a colony or a distant bog. In that case we must take precautions against the mosquito. Some of these measures are spraying (fumigation) our homes and surroundings (further below we will discuss spraying as a health campaign), use repellents even more at dawn and dusk (females’ feeding hours), place window screens and bed or hammock (pavilions) nets.
That's it for the B; wait for the next installment of C: Cases and dengue clinic.
viernes, 19 de abril de 2013
ABCDs of Dengue. English version of 2011 with 2013 remarks.
Remembering, re-editing and reloading. It’s been two years since our last outbreak of dengue in Cozumel; exactly on april 2011 I remember having the first case of hemorraghic dengue at San Miguel Clinic and, after discussing it with some colleagues we concurred: that was a “dengue year”.
We tried to warn patients and authorities, the answer came three months later, once rain season started overtly, patients were filling hospitals and a very late attempt for prevention was just getting started.
I posted the following at blogtorchey.blogspot.com on its spanish version on june 2011, by that time, little had been made and misleading information was a current language on the streets. In an effort to avoid our past experience and after a very assertive sugestion and precious help from the Cozumel4you team, here it is: the ABCDs for dengue. I decided not to edit pieces of the article that tell how was our scenario at that moment, the reason for this is explained within the first paragraph: we forget and lower the guard quite fast. Whenever necessary or possible, I will add 2013 remarks and information which will be properly pointed out.
JUNE 2011
Though behind schedule, they arrived. After a very dry May in Cozumel, the rainy season came on mid June and a couple of heavy rains were enough for dengue season to formally begin; after five days, the reckoning was evident: five cases of dengue, four of them hemorrhagic. This is no alarm, however though it turns-up every year, we seem to forget about it; thus one of the reasons for writing about dengue. A second reason arises from remarks in hallways, in meetings and on the table, which, on the one hand suggest amnesia or ignorance about its monitoring and prevention or, otherwise, amongst colleagues, concern about its scope this season. In the following installments I will explain the ABCs and, if I may, the D of dengue.
A. Aedes aegypti. This is the main name of the mosquito that transmits dengue. You may soon find a picture in the blog where you may observe its white and black legs, one of its main features. While it transmits the dengue, it does not originate the disease. Dengue is a diseased produced by the dengue virus (DV), described as having four subtypes which cause, to our knowledge, the same type of disease. The only variable we have observed is that when a person who has previously had dengue caused by one of the viruses (say, DV type 1), when infected with a different type (for instance, DV type 4), that person is more susceptible to hemorrhagic dengue: We will speak of it later.
In general, viruses are microscopic organisms usually formed of primary chains of genetic material that do not have a cellular structure of their own. I do not intend to give a class on biology, but only want to emphasize these are microorganisms that depend on a host (in this case, the mosquito and the human being) in order to reproduce and fulfill their life cycle. On the particular case of DV, this is an ongoing cycle from man to mosquito and vice versa. Outside one of its hosts, the virus is very fragile.
We could summarize the virus’ life cycle as follows: from an infected man. The man has the virus circulating in the blood, the mosquito bites and draws the virus from the ingested blood. The virus reproduces and multiplies inside the mosquito; copies of the virus are placed in the “eggs” of future mosquito larvae. Thus, the mosquito lays the eggs (which contain genetic material of the virus) in a water container. The egg hatches and in just a few days, the larval stage begins within the water container. The larva settles on the surface of the water forming a cocoon, from where it emerges as a developed mosquito. We need to remember that this mosquito holds the genetic contents of the virus from the moment it was deposited in the form of an egg and once in the mosquito stage, the material rests in its “salivary” glands. When a human is bitten, this mosquito “saliva” slips anticoagulant and antihistamine into the skin, thus the infected mosquito transmits the virus.
This is All for the time being. I hope you find it helpful. Wait for the next installment: B – GarBage, trash and water containers
miércoles, 13 de marzo de 2013
MANEJOS CASEROS DE GRIPAS Y CATARROS
- Control de fiebre con baños cada toma de medicamento o cada vez que se observe temperatura de 38ºC o superior.
- Baño por 20 minutos o más en agua tibia.
- Aplicar paños de agua tibia a fría en abdomen, ingles y axilas.
- Paracetamol se puede dar cada 4, 6 u 8 horas.
- La fiebre regresa cuando el cuerpo agota el medicamento que se dio, por lo que se debe de repetir la dosis.
- Abundantes líquidos: el cuerpo gasta más líquido en moco y fiebre, se tiene que reponer para seguir protegiendo nariz y garganta con moco suficiente.
- Frutas con abundante vitamina C: naranja, mandarina, limón, guayaba.
- No use de antibióticos (ampicilina, penicilina, trimetoprim, etc…) SOLO debe ser indicado por médicos. NO SE AUTORRECETE.
- La mayoría de las infecciones de garganta y gripa son por virus los cuales no se afectan por antibióticos y las molestias pueden durar 5 a 7 días a pesar de tratamiento
- Después de una infección por virus puede atacar una por bacteria y entonces requerir antibiótico. La realización de gárgaras de isodine una o dos veces al día por 3 días puede ayudar a desarrollar la infección bacteriana pero no siempre se recomienda.
- Datos de alarma (acudir a urgencias).
- Dificultad para respirar
- Pecho que sube y baja rápido, se hunde en costillas.
- Nariz que aletea.
- Respiración rápida y poco profunda.
- Los ANTIGRIPALES solo disminuyen los síntomas y molestias, el cuadro seguirá aún si se ingieren. Solo se toman para poder desempeñar las actividades diarias; se sugiere que mejor se eviten si se puede reposar en casa.
- CUIDADO ESPECIAL: Hay muchos antigripales que contienen cafeína y pueden dificultar el sueño, elevar la presión arterial en hipertensos o causar taquicardia si no se esta acostumbrado a la cafeína.
- ANTIGRIPALES DE DIA: sustancias como loratadina o cetirizina ayudan a la descongestión con poca somnolencia.
- ANTIGRIPALES DE NOCHE: sustancias como clorfenamina o difenhidramina que tienen efecto sedante y por lo tanto inducen sueño y nos ayudan a tener una mejor noche.
- Manejo de tos y jarabes: lo mejor es iniciar e intentar los remedios caseros y luego acudir al jarabe. Finalmente la tos es una defensa del cuerpo que nos permite expulsar flemas.
- En caso de frío: dormir con sabana sobre nariz y boca, por la noche y madrugada tapar boca y nariz, tomar bebidas calientes y evitar las frías. Se puede usar cubrebocas.
- El caldo de pollo (típico remedio de abuelita) ha demostrado tener propiedades antiinflamatorias y promover la inmunidad y recuperación en este tipo de enfermedades.
- En general hay dos tipos de jarabes para la tos, los que quitan el reflejo de toser (benzonatato, dextrometorfano) y los que promueven la secreción y fluidificación del moco (ambroxol); en lo personal prefiero los segundos que permiten que se expulse la flema. Los que inhiben el reflejo de la tos los reservo para los casos en los cuales la tos lleva mas de 5 días o agota al paciente ya que el uso temprano de estos productos no nos permite expulsar las flemas adecuadamente y éstas se pueden infectar.
- El famoso Vick Vaporrub y otros eucaliptos ayudan a descongestionar, su uso se limita a la aplicación sobre el pecho, espalda y, si se tolera y no quema, por abajo de la nariz. No se debe usar para golpes, introducir en la nariz u otras prácticas inusuales e inadecuadas comúnmente observadas en ciertas regiones.
jueves, 5 de enero de 2012
TEMPORADA DE FRIO, PREVENCION DE INFLUENZA
Les dejo la información textual difundida por la Dirección General de Promoción de la Salud durante la epidemia de Influenza en 2009. Estas medidas son comunes para la prevención de cualquier catarro, gripa o influenza estacional de tal suerte que en esta temporada de fríos es imprescindible realizarlas para evitar dichas enfermedades. Yo sigo pendiente, ustedes sigan previniéndose.
Si bien se ha avanzado en el control de la enfermedad de la influenza A(H1N1), aún seguimos en alerta y no debemos bajar la guardia, es nuestro deber seguir reforzando las medidas preventivas, realizar llamados a la acción y continuar informados sobre todo aquello concerniente al nuevo virus de la influenza A(H1N1).
La mejor manera de prevenir la influenza A(H1N1), es realizando las siguientes medidas de higiene básicas:
Lavarse las manos frecuentemente con agua y jabón (al llegar de la calle, periódicamente durante el día, después de tocar áreas de uso común, después de ir al baño y antes de comer).
Cubrirse la nariz y boca con un pañuelo desechable o con el ángulo interno del codo al toser o estornudar.
Si es necesario escupir, hacerlo en un pañuelo desechable, tirarlo a la basura y lavarse las manos. Nunca escupir en el suelo.
Lavar frecuentemente (higiene del vestido) corbatas, sacos, bufandas, abrigos, etc., de preferencia después de cada uso.
Mantener la higiene adecuada de los entornos (casas, oficinas, centros de reunión), ventilarlos y permitir la entrada del sol.
Limpiar superficies y objetos de uso común.
Quedarse en casa cuando se tienen padecimientos respiratorios y acudir al médico si se presenta alguno de los síntomas (fiebre mayor a 38° C, dolor de cabeza, dolor de garganta, escurrimiento nasal, etc.).
Para mayor información visite: www.promocion.salud.gob.mx
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CONSULTORÍA MÉDICA INTEGRAL.
lunes, 12 de diciembre de 2011
MOCOS, GRIPAS Y CATARROS
En su gran mayoría se trata de infecciones virales que suelen complicarse con una infección bacteriana (aunque a veces la bacteriana sea la inicial). Al ser virales, no importa el medicamento, médico o enfermo, la enfermedad durará un tiempo determinado por las defensas de este último que puede oscilar entre los 3 y los 10 días. Los medicamentos en este caso solo contrarrestan los síntomas y nos permiten sentirnos mejor en lo que el cuerpo resuelve el cuadro y aunque nada es mejor que el reposo y las medidas generales para resolverlos, en la gran mayoría de ocasiones nos es difícil detenernos un par de días para hacerlo.
Normalmente los catarros aparecen en tiempos fríos y prácticamente todas las molestias derivan de esto. El frío reseca el recubrimiento de la nariz y garganta lo que produce irritación lo que se manifiesta con tos, aunado a la presencia de virus, el cuerpo responde generando moco para protegerse; la primera medida es garantizar la presencia de ese recubrimiento con mucho líquido de preferencia al tiempo o tibio (el líquido frío aumenta la irritación y con ello la tos), cuando falta líquido el moco se vuelve espeso y la mucosa se seca más aumentando la tos y propiciando la infección de ese moco con bacterias. Los antigripales (clorfenamina, difenhidramina, loratadina, etcétera) solo disminuyen los síntomas, no curan la enfermedad como tal. Nos ayudan a seguir con nuestras actividades aliviándonos la congestión nasal y el moqueo; sin embargo he observado que al cortar el moco se reseca más la mucosa de nariz y garganta y muchas veces los cuadros suelen durar más tiempo.
En un artículo anexo encontrarás el manejo general de fiebres e infecciones de vías respiratorias superiores. En niños o cuando hemos estado muchos días congestionados es bueno hacer lavados nasales con sterimar (o, por si no quieres gastar, con un vaso chico de agua purificada con una cucharada de sal y media de bicarbonato introduciendo la mezcla con jeringa) ya que permite fluidificar el moco y evita que se acumule en los senos paranasales; en un niño pequeño al no poder “sonarlo” esto se realiza con perilla. El seguir éstas medidas en ocasiones nos salva del uso de antibióticos sin embargo hay ocasiones en que son necesarios. Aunque suelo reservar el uso de los mismos tras haber hecho un chequeo médico hay datos que se observan más (pero no siempre) en las infecciones por bacterias y que hace necesario su uso:
El cambio de una tos seca o de moco transparente a una con flema verde espesa después de unos días de catarro y mocos con más malestar general y dolor de garganta.
El inicio de la enfermedad con dolor de garganta, con dolor o sensación de “ganglios” en el cuello así como dolor al tragar.
En los niños el dolor de garganta se suele traducir en pocos deseos de comer sólidos prefiriendo los líquidos, vómitos con flema y escurrimiento de baba en los más pequeños (lactantes).
Consulta el artículo “Manejo Caseros” para checar las medidas generales para el tratamiento de estas enfermedades y recuerda que estas medidas y manejos son simplemente recomendaciones, no sustituyen al médico o la consulta