Case 18- SAP 2 Flashcards
The major causes of mortality and morbidity in the developed world
Heart disease, Stroke, COPD, Dementia, Diabetes and Road injuries
The major causes of mortality in the morbidity in the developing world
LRTIs, Diarrhoeal diseases, IHD, HIV/AIDs, Malaria, TB, Birth complications.
Major determinants of mortality in different areas of the world- air pollution
Causes more mortality than HIV/AIDS and malaria combined, cooking fires in developing countries.
Major determinants of mortality in different areas of the world- Cancer
Australia has high rates of melanoma due to sun exposure, Japan has high rates of stomach cancer linked to high salt diets, Sub Saharan Africa has high rates of cervical cancer due to lack of HPV vaccination.
Major determinants of mortality in different areas of the world- life expectancy
UK has higher life expectancy, making cancer, dementia, IHD more common. Central African Republic has lowest life expectancy, most common causes of death are CV disease, TB, diarrhoea, HIV, more children under 5 die in developing countries to due poor neonatal care and complications, alongside diarrhoea, malaria.
The other major determinants of mortality in different regions of the world
Lower socioeconomic status - life expectancy is directly linked to how wealthy a country is, less money to go into healthcare spending.
Basic infrastructure - access to clean water, sanitation and electricity.
Education
Different health beliefs
Organisations whuch help improve global health
- World Health Organisation
- UnAIDS
- Centres for Disease Control and Prevention
- Bill & Melinda Gates foundation
- Unicef
- International Red Cross
Sustainable development goals
Seventeen goals adopted by the U.N. in 2015 to reduce disparities between developed and developing countries by 2030 Response put in place by international communities to address global inequalities: - No poverty - No hunger - Good health and well-being - Gender/education equality - Clean water and sanitation - Economic growth - Climate action
Health inequalities
Differences in health status and the distribution of health resources between different population groups, arising from the social conditions in which people are born, grow, live, work and age.
Key indicators for health inequality
- Death before the child’s 5th birthday
- Maternal mortality
- Tuberculosis rates
- Rates of premature deaths due to non-communicable diseases, medication is often too expensive
- Life expectancy
- The inequalities within countries
What is included under global health
1) Measurement of health and disease
2) Determinants of health and inequality
3) Culture and health
4) Demographic and epidemiological transitions
5) Key risk factors for health conditions
6) Health systems
How to measure the health of a country
1) Measuring birth and death rates
2) Measuring disease rates
3) Quantity of life (life expectancy)
4) Disability adjusted life year (DALY)
5) Quality adjusted life year (QALY)
Global health- social and health factors
Lower socioeconomic status - life expectancy is directly linked to how wealthy a country is, less money to go into healthcare spending.
Basic infrastructure - access to clean water, sanitation and electricity.
Education
Different health beliefs
Sex
What factors increase the emergence of new zoonotic diseases
1) Commercial air travel
2) Global trade
3) Urbanisation
4) Living in close proximity to animals
5) Unchecked population growth
6) Climate change
Coronaviruses
1) They are enveloped ssRNA viruses
2) HCoV-NL63 and HCoV-HKU1, cause seasonal and usually mild respiratory tract infections associated with symptoms of the ‘common cold’
3) Pathogenesis, incubation period 3 days, malaise, nasal discharge, No fever, cough/ sore throat rare
Alpha, beta, gamma and delta coronavirus
Alpha and beta infect humans and other mammals. Gamma infects birds. Delta infects birds and some other mammals but not humans
Presentation of coronavirus
- Common= Cough, fever, myalgia, headache, dyspnoea
- Less common= Sore throat, diarrhoea, nausea/vomiting, loss of smell or taste, rhinorrhoea, abdominal pain
- Complications= severe viral pneumonia, acute respiratory distress syndrome, PE/DVT (give anticoagulants to those with severe infection), multi-organ failure
Transmission of coronavirus
Picking up fomites from infected areas and then touching mucus membranes, you then contract the infection. Also through respiratory droplets and aerosols.
Prevention of coronavirus
Good hygiene, Cloth face mask, PPE, isolation of infected people, screening upon admission, Social distancing
Diagnosis of coronavirus
- Nasopharyngeal swabs - RT-PCR on the sample
- Lateral flow test
- Around 24 hours to get results back
- FBC shows lymphopenia
- Chest Xray may show infiltration/ground-glass opacities
- New continuous cough, temperature >37.8, loss/change in sense of smell or taste
Treatment of coronavirus
- Oxygen
- Ventilatory support - supine position improves oxygenation
- Antibiotics for secondary bacterial infection
- Remdesivir - antiviral reduces duration of disease
- Defamethasone - steroid which improves survival of those in intensive care
Risk factors for severe illness and mortality in COVID-19
- Age
- CVD
- Diabetes, hypertension
- BAME ethnicity
- Chronic lung disease
- CKD
- Obesity
- Smoking
- Cancer
Pathogenesis of coronavirus
- SARS-CoV-2 has spike proteins on its surface which have receptor binding domains
- These can bind to ACE2 receptors which are highly expressed on type II alveolar cells and cells of GI tract, heart and kidney
- Virus can fuse with host cell and viral RNA enters
- Cell machinery is hijacked to replicate viral RNA and translate it into proteins
- Viral proteins are made and a new viral particle is assembled and they exit cell and infect other cells
- Also displays PAMPs which are targeted directly by the immune system and cause inflammatory cytokine release
- Some people get cytokine storm - severe inflammatory cascade
- Cause inflammation in lung - acute respiratory distress syndrome and multi-organ dysfunction
The 3 coronaviruses which cause severe pathogenic disease:
1) MERS
2) SARs
3) SARs- CoV-2 (Covid-19)
Origins of pathogenic Covid
1) Bats or animals may be the natural host
2) Sometimes there is no direct origin which suggests a recombination event
3) Tend to have had animal exposure before developing the disease
Covid-19 severity
The illness is variable in severity from asymptomatic (15-20%), to mild upper respiratory tract infection in some people to severe pneumonia in others.
COVID- 19 when to admit to hospital
1) Have either clinical or radiological evidence of pneumonia or
2) Acute respiratory distress syndrome or
3) Influenza-like illness (fever ≥37.8°C and at least one acute onset of : persistent cough [with or without sputum], hoarseness, nasal discharge or congestion, shortness of breath, sore throat, wheezing, sneezing).
Types of COVID-19
1) Acute COVID-19is defined as signs and symptoms of infection for up to the first 4 weeks.
2) Ongoing symptomatic COVID-19is defined as signs and symptoms of infection from 4–12 weeks.
3) Post-COVID-19 syndromeis defined as signs and symptoms of infection consistent with COVID-19 lasting longer than 12 weeks.
4) Long COVIDis defined as signs and symptoms persisting after the first 4 weeks, so encompasses both ongoing symptomatic and post-COVID-19 syndrome
Vaccines approved by the WHO for Covid-19
1) Pfizer- BioNTech
2) Oxford- AstraZeneca
3) SinopharmBIBP
4) CoronaVac
5) Moderna
6) Janssen
7) Covaxin
Antibody treatment for COVID-19
Regeneron, two monoclonal antibodies= Casirivimab, Imdevimab
