Rabies is a vaccine-preventable infectious viral disease that usually lead to fatal outcome following onset of clinical symptoms. It is caused by rabies virus from animals; in which up to 99% of cases were origi- nated from domestic dogs. It transmitted to human after in con- tact with specific bodily excretions and tissues from infected animals; commonly via saliva (through bites or scratches). However, when the body excretions dries out or is exposed to sunlight, the virus become noninfectious. Initial symptoms of rabies are characterized by fever with pain and un- usual tingling, pricking or burning sensation (paresthesia) at the wound site. Upon spread of virus, infected person may developed either one of the two form of the disease; furious rabies or paralytic rabies. RABIES Prepared by: Miss Fatin Nabila HOSPITAL LABUAN NOVEMBER 2017 PHARMACY BULLETIN I NSIDE THIS ISSUE : R ABIES 1-2 HEMORRHOIDS 3 PREECLAMPSIA 4 DIABETES MYTHS 5 DEPRESSION 6 B ELL ’ S PALSY 7 COLD SORE 7 Did you know? Rabies virus does not transmitted through contact such as petting or handling FURIOUS RABIES Sign and symptoms such as hyperactivity, excitable behav- ior, hydrophobia (fear of water) and sometimes aerophobia (fear of drafts or fresh air).Cardio- respiratory arrest is major cause of death. PARALYTIC RABIES Symptoms include gradual pa- ralysis of muscle beginning at the site of bite or scratch, which slowly develops into coma and eventually death. This form of rabies is often not reported due to misdiagnosis. Dog bites victims were vaccinated 6 Dog bites cases reported 6 Incubation Weeks But also may vary from 1 week to 1 year SYMPTOMS A Publication of Drug Information Service (DIS) Pharmacy, Labuan Hospital Advisor Pn Ashrafinah Ahmad Editor Sanggeri M.Veloo Any comment, query, recommendation kindly contact DIS Pharmacy 087-596888 Ext: 4185 419 Death Among 6 cases of rabies re- ported in Sarawak 1-3 678 5
Transcript
Rabies is a vaccine-preventable infectious viral disease that usually
lead to fatal outcome following onset of clinical symptoms. It is caused
by rabies virus from animals; in which up to 99% of cases were origi-
nated from domestic dogs. It
transmitted to human after in con-
tact with specific bodily excretions
and tissues from infected animals;
commonly via saliva (through
bites or scratches). However,
when the body excretions dries
out or is exposed to sunlight, the
virus become noninfectious.
Initial symptoms of rabies are characterized by fever with pain and un-
usual tingling, pricking or burning sensation (paresthesia) at the wound
site. Upon spread of virus, infected person may developed either one
of the two form of the disease; furious rabies or paralytic rabies.
RABIES Prepared by: Miss Fatin Nabila
HOSPITAL LABUAN NOVEMBER 2017
PHARMACY BULLETIN
INSIDE THIS ISSUE :
RABIES 1-2
HEMORRHOIDS 3
PREECLAMPSIA 4
D IABETES MYTHS 5
DEPRESSION 6
BELL ’S PALSY 7
COLD SORE 7
Did you know?
Rabies virus does not
transmitted through contact
such as petting or handling
FURIOUS RABIES
Sign and symptoms such as
hyperactivity, excitable behav-
ior, hydrophobia (fear of water)
and sometimes aerophobia (fear
of drafts or fresh air).Cardio-
respiratory arrest is major cause
of death.
PARALYTIC RABIES
Symptoms include gradual pa-
ralysis of muscle beginning at
the site of bite or scratch, which
slowly develops into coma and
eventually death. This form of
rabies is often not reported due
to misdiagnosis.
Dog bites victims were vaccinated 6
Dog bites cases reported 6
Incubation Weeks But also may vary from 1 week to 1
year
SYMPTOMS
A Publication of Drug Information
Service (DIS) Pharmacy, Labuan
Hospital
Advisor
Pn Ashrafinah Ahmad
Editor
Sanggeri M.Veloo
Any comment, query, recommendation kindly
contact DIS Pharmacy 087-596888 Ext: 4185
419
Death Among 6 cases of rabies re-ported in Sarawak
1-3
678
5
Immediate treatment
After victim from a rabies outbreak area was
bitten/scratched/in contact with saliva on broken
skin; extensive washing and local treatment of the
wound must be done as soon as possible. The
wound must be thoroughly flushed and washed
with soap and water, detergent, povidone iodine or
other substances that kill the rabies virus for a mini-
mum of 15 minutes.
Vaccination
There are 3 risk categories to differentiate man-
agement required post- exposure (illustrated in Ta-
ble 1) in which risk category II and III must receive
vaccine rabies whereas rabies immunoglobulin
(RIG) is given for risk category III only. Doses of
vaccine given depends on whether patient is previ-
ously unvaccinated (4 doses), previously vacci-
nated (2 doses) and is immunocompromised (5
doses).
Rabies is a vaccine-preventable disease. Hence vaccination of pets (dogs) and avoid contact with wild dogs is
the key for preventing rabies in people. Other than that, good personal hygiene such as frequent hand washing
with soap and water after in contact with dog may prevent spread of rabies. Owner must also get their dog
treated at the veterinary if the dog become unwell or aggressive. Also, it is encouraged to report to the local
authority if wild dogs are spotted in your neighborhood. Lastly, education on awareness of rabies prevention to
the community will also greatly help in preventing spread of rabies.
References
1. Centers for Disease Control and Prevention (CDC). Rabies. April 22,2011 2. World Health Organization (WHO). Rabies. March 2017 3. Disease Control Division, Ministry of Health Malaysia. Interim Guideline for Human Rabies Prevention & Control in Malaysia 4. Berita Harian Online. 1 Julai 2017. 3 Kes jangkitan Rabies semakin tenat, M.N. Parzi 5. Berita Harian Online. 24 Julai 2017. Rabies: Mangsa kelima meninggal dunia, R.A. Khalik 6. Berita Harian Online. 22 Julai 2017. Jumlah digigit anjing meningkat, tiada kes baharu rabies, M.R. Kawi
PAGE 2 PHARMACY BULLETIN
RABIES - Continues
Post– Exposure Prophylaxis
Prevention
What is HAEMORRHOID? Haemorrhoids had been used to refer to normal structure of anorectum which is universally pre-sent. It has rich blood sup-ply, highly sensitive and high tendency to prolapse. Main function of this tissue is to prevent leakage of faeces from the anus.
Haemorrhoid is one of the common conditions diagnosed in clinical practice. However, many patients feel embarrassed to seek treatment from hospital.
Haemorrhoids Prepared by: Miss Nur Izza
“Haemorrhoids,
piles.. What
should I do?”
PAGE 3 PHARMACY BULLETIN
Prevent constipation
Increase FIBRE intake (20-35g daily)
Increase FLUID intake (at least 8 glasses per day) Do regular EXERCISE AVOID laxatives that cause diarrhea and worsen haem-
orrhoids Avoid of STRAINING and PROLONGED toilet sit-
ting
Relieving pain
WARM BATHS (2-3x/day) to help to sooth pain and
itchiness Ice packs to reduce swelling
Surgical intervention
When haemorrhoid persistently bothersome For 3rd and 4th degree hemorrhoids
Medications
Drugs Dosage regimen
DAFLON (Diosmin
450mg/Hesperidin
50mg Prolong vasoconstrictor
effect Admin with food as it
can cause gastric
discomfort
Acute attack
2 tabs TDS x 4/7 2 tabs BD x 3/7 Short term treatment
Chronic
1 tab BD
ANUCARE supposito-
ries (Benzyl benzoate 33mg/
Balsam peru 50mg/
Zinc oxide) Reduce irritation and
inflammation
Insert 1 supp at morning and
night and after bowel move-
ment
Do not use longer than 7days Not recommended use in
defecation. It is advisable to seek treatment in early
stage, as it will be fast and painless recovery.
MEASURES can be taken to avoid haemorrhoids and
reducing symptoms:-
Image courtesy from WebMD Corporation
They are categorized into internal and external haemorrhoid (see above image). It be-came haemorrhoidal disease or “penyakit bua-sir” when it becomes enlarged, inflamed or pro-lapsed. The symptoms are bleeding while defe-cating, swelling, itchiness, mucous discharge and pain sensation. In some cases, haemor-rhoids prolapse and bulge outside the anal sphincter. It usually goes back inside by itself or can be pushed gently back into place.
The most common factors of haemor-
rhoids are caused by chronic constipation.
Chronic constipation leads to prolonged sitting
and vigorous straining. Besides that, other fac-
tors like prolonged coughing, aging process,
internal sphincter abnormalities also can cause
piles. Pregnant women may have this condition
due to enlarged uterus and hormonal changes.
References:
1.http://emedicine.medscape.com/artile/775407-overview 2.http://www.myhealth.gov.my/en/hemorrhoids/ 3.MIMS Malaysia 4.MOH Drug Formulary
1. http://americanpregnancy.org/pregnancy-complications/preeclampsia/ 2. https://www.preeclampsia.org/PreAM 3. University of Exeter. "Aspirin reduces risk of pre-eclampsia in pregnant
women: Extensive study offers 'definitive proof' of improved outcomes in high-risk pregnancies." 28 June 2017.
4. World Health Organization. WHO Recommendations for Prevention and Treat-ment of Pre-Eclampsia and Eclampsia. World Health Organization; 2011.
How do I know if I have preeclampsia?
At each prenatal checkup your healthcare provider will check your blood pressure, urine levels, and may order blood tests which may show if you have preeclampsia. Your physician may also perform other tests that include: checking kidney and blood-clotting func-tions; ultrasound scan to check your baby’s growth; and Doppler scan to measure the efficiency of blood flow to the placenta.
How does preeclampsia affect my baby?
Preeclampsia can prevent the placenta from getting enough blood. If the placenta doesn’t get enough blood, your baby gets less oxy-gen and food. This can result in low birth weight. Most women still can deliver a healthy baby if preeclampsia is detected early and treated with regular prenatal care
Signs and Symptoms
1. Elevated blood pressure (gestational hypertension) 2. Swelling of the eyes, face and hands 3. Difficulty breathing, gasping, or panting 4. Changes in vision – spots, light flashes, or loss of vision 5. Nausea after mid pregnancy 6. Weight gain of more than 5 pounds(2.26kg) in a week 7. Headache that will not go away even with medication
Findings so far
1. Administering low-dose aspirin (150 mg) led to a 62% reduction in the rate of pre-term preeclampsia, resulting in delivery before 37 weeks.
3
2. Based on WHO “Recommendations for Prevention and Treatment of Preeclampsia and Eclampsia”, the use of low-dose aspirin (75 mg/day) was recommended for women deemed high-risk and initiation early during preg-nancy (<20 weeks and as early as 12 weeks).
4
Facts and Figures
Affects 5-8 percent of all pregnan-cies
A leading course of maternal and infant mortality with nearly 76,000
maternal and 500,000 infant deaths each year world wide
Occurs during pregnancy (after week 20) and affects the mother
and baby
Preeclampsia doubles a women’s risk for developing heart disease or having a stroke over the next 5-15
years
Who is at risk?
1. A first time mother 2. Previous experience with
gestational hypertension or preeclampsia
3. Women whose sisters and mothers had pree-clampsia
4. Women carrying multiple babies
5. Women younger than 20 years and older than age 40
6. Women who had high blood pressure or kidney disease prior to preg-nancy
What you can do
1. Attend all of your prena-tal appointments
2. Talk to your healthcare provider before or early in your pregnancy about your risk for preeclamp-sia
3. Monitor your blood pres-sure and weight regu-larly, and contact your healthcare provider im-mediately if either be-comes unexpectedly high
4. Know your family history, especially pregnancy, high blood pressure and heart failure
5. Eat right, exercise regu-
How can preeclampsia affect the mother?
If preeclampsia is not treated quickly and properly, it can lead to serious complications for the mother such as liver or renal failure and future cardiovascular issues.It may also lead to the following life-threatening conditions:
Eclampsia– This is a severe form of preeclampsia that leads to seizures in the mother.
HELLP Syndrome (hemolysis, elevated liver enzymes, and low platelet count)
Separating Myths from the Facts about Diabetes Prepared by: Jason Lee Kung Yin
PAGE 5 PHARMACY BULLETIN
Knowing the facts about diabetes is important when it comes to managing the condition. There is so much
information out there, but it is not all true. It is often difficult to know what is right and what is not. The following
information is to help distinguished the myths from the facts about diabetes.
Myth: Type 2 diabetes is a mild form of diabetes Fact: There is no such thing as mild diabetes. All diabetes is serious and, if not properly controlled, can
lead to serious complications
Myth - Diabetes can be prevented Fact - Not all types of diabetes can be prevented. Type 1 is an autoimmune condition, it cannot be pre-
vented and there is no cure. The cause of type 1 diabetes is still unknown. Myth: People who are overweight eventually get diabetes. Fact: Being overweight is just one risk factor for developing diabetes. There are other factors, such as
family history, race or ethnicity, and age. By knowing all of the risk factors, you may better understand your overall risk and what you can do to improve your health.
Myth: Diabetes is contagious. Fact: No. You can’t catch diabetes from someone else like a cold or the flu. But it’s important to know that
type 2 diabetes can run in families. Myth - You only get type 1 diabetes when you’re young Fact - The onset of type 1 diabetes occurs most frequently in people under 30 years, however new re-
search suggests almost half of all people who develop the condition are diagnosed over the age of 30. Myth - You only get type 2 diabetes when you’re old Fact - Type 2 diabetes usually develops in adults over the age of 45 years but is increasingly occurring in
younger age groups including children, adolescents and young adults. Myth - Only people with type 1 diabetes need insulin Fact - Type 2 diabetes is a progressive condition. 50 percent of people with type 2 diabetes will need in-
sulin after 6-10 years of being diagnosed with diabetes because the pancreas produces less insulin over time. Taking medication when required can result in fewer complications in the long-term and is part of managing type 2 diabetes. People with type 1 diabetes depend on insulin replacements every day of their lives. They must test their blood glucose levels several times throughout the day.
Myth: Alcohol is off-limits. Fact: Moderate drinking -- meaning no more than one drink a day for women and two for men is safe for
most people with diabetes. Some medications, like insulin or those that help increase insulin levels can make you prone to hypoglycemia (low blood sugar). Alcohol may make that worse. Also, your body digests alcohol differently from sugar, and the effects aren't always felt right away. But it's a good idea to talk it over with your doctor first.
Myth: "Diabetes-friendly" and "sugar-free" foods are good for you. Truth: Sugar-free foods often contain plenty of calories and even carbs, so always check nutrition labels
closely. You'll also want to scan ingredients lists for sweeteners such as sorbitol, mannitol, and xylitol, which may upset your stomach. In general, it's best to limit all processed foods. Instead, fill up on a variety of fruits and vegetables, lean beef, poultry, fish, and low-fat dairy products.
Myth: Fruit is good for you, so it is okay to eat as much as you want. Fact: It is true that fruit is a healthy food. Fruit is full of fiber, vitamins, and minerals. But because fruits
contain carbohydrates, which are broken down into sugars by your body, it is important that you eat only as much fruit as stated in your mean plan.
Depression (major de-pressive disorder or clinical depression) is a common but serious mood disorder. It causes severe symptoms that affect how you feel, think, and handle daily activities, such as sleep-ing, eating, or working. To be diagnosed with depression, the symp-toms must be present for at least two weeks.
Seasonal affective dis-order is characterized by the onset of depression during the winter months, when there is less natural sunlight. This depression generally lifts during spring and summer. Win-ter depression, typically accompanied by social withdrawal, increased sleep, and weight gain, predictably returns every year in seasonal affective disorder.
SOME FORMS OF DEPRESSION ARE SLIGHTLY DIFFERENT, OR THEY MAY DEVELOP UNDER UNIQUE CIRCUMSTANCES
Persistent depressive disorder (also called dysthymia) is a depressed mood that lasts for at least two years. A person diagnosed with persistent depressive disorder may have episodes of major depression along with periods of less severe symptoms, but symptoms must last for two years to be considered persistent
depressive disorder.
PAGE 6 PHARMACY BULLETIN
Perinatal depression is much more serious than the “baby blues” (relatively mild depressive and anxiety symptoms that typically clear within two weeks after delivery) that many women experience after giving birth. Women with perinatal depression experience full-blown major depression during pregnancy or after deliv-ery (postpartum depres-sion). The feelings of extreme sadness, anxi-ety, and exhaustion that accompany perinatal depression may make it difficult for these new mothers to complete daily care activities for themselves and/or for their babies.
Psychotic depres-sion occurs when a per-son has severe depres-sion plus some form of psychosis, such as hav-ing disturbing false fixed beliefs (delusions) or hearing or seeing upset-ting things that others cannot hear or see (hallucinations). The psy-chotic symptoms typi-cally have a depressive “theme,” such as delu-sions of guilt, poverty, or
Bipolar disorder is dif-ferent from depression, but it is included in this list is because someone with bipolar disorder ex-periences episodes of extremely low moods that meet the criteria for major depression (called “bipolar depression”). But a person with bipolar disorder also experi-ences extreme high – euphoric or irritable – moods called “mania” or a less severe form called “hypomania.”
Beyond Treatment: Things You Can Do 1.Try to be active and exercise. 2.Set realistic goals for yourself. 3.Try to spend time with other people and con-fide in a trusted friend or relative. 4.Try not to isolate your-self, and let others help you. 5.Expect your mood to improve gradually, not immediately. 6.Postpone important decisions, such as get-ting married or divorced, or changing jobs until you feel better. 6.Continue to educate yourself about depres-sion.
Antidepressants are medicines that treat depression. They may help improve the way your brain uses cer-tain chemicals that control mood or stress. You may need to try several different antidepressant medicines before finding the one that improves your symptoms and has manageable side effects. A medication that has helped you or a close family member in the past will often be considered
Antidepressants take time usually 2 to 4 weeks to work, and often, symptoms such as sleep, appetite, and concentration problems improve before mood lifts, so it is important to give medication a chance before reach-ing a conclusion about its effectiveness. If you begin taking antidepressants, do not stop taking them without the help of a doctor. Stopping them abruptly can cause withdrawal symptoms.
Bell’s palsy is a condition in which the muscles on one side of your face become weak or paralyzed. It af-fects only one side of the face at a time, causing it to droop or become stiff on
that side.It’s caused by some kind of trauma to the seventh cranial nerve. This is also called the “facial nerve.” Bell’s palsy can happen to anyone. But it seems to occur more often in people who have diabetes or are re-
covering from viral infec-tions.Most of the time, symptoms are only tempo-rary. What Causes It? Most doctors believe that it’s due to damage to the facial nerve, which causes swelling. This nerve passes through a narrow, bony area within the skull. When the nerve swells even a little bit, it pushes against the skull's hard surface. This affects how well the nerve works.
BELL’S PALSY PREPARED BY: SHARIZA SULAIMAN
WHAT ARE THE SYMPTOMS OF BELL’S PALSY?
You might also notice the following things before the onset of Bell’s palsy
You’re unable to close
your eyelid or blink Your eye waters more or less than usual
Drooling
Difficulty chewing
Decreased sense of
taste
Your facial mus-
cles twitch
Pain or numbness be-
hind your ear
Facial weakness and drooping typically reach their peak within a day or two. Most people start to feel better within a couple of weeks. They usually recover completely within 3 months. Some people who develop Bell's palsy have a longer recovery period. In rare cases, they may have some permanent symp-toms.
The symptoms of Bell’s palsy tend to come on all of a sudden. You may go to bed one night feeling fine. But when you look in the mirror the next morning, you see that part of your face seems to be drooping. Some people feel pain behind their ear 1-2 days before they notice any weakness.
BELL’S PALSY CAN HAPPEN TO ANYONE. BUT IT
SEEMS TO OCCUR MORE OFTEN IN
PEOPLE WHO HAVE DIABETES
OR THOSE RECOVERING FROM VIRAL INFECTIONS
PAGE 7 PHARMACY BULLETIN
WHAT ARE THE TREAT-
MENTS FOR BELL'S PALSY? There aren’t any that can stop it. If the symptoms suspected to be triggered by the herpes virus (herpes simplex 1) or by shingles (herpes zos-ter), antiviral medication like acyclovir might be prescribed. Corticoster-oids such as predniso-lone may also be given in a short course to de-crease swelling of facial nerve.
