Extrapulmonary TB (Part 2) | Infectious diseases | NCLEX-RN | Khan Academy

Extrapulmonary TB (Part 2) | Infectious diseases | NCLEX-RN | Khan Academy


Charles Prober: This is Charles Prober. Morgan Theis: I’m Morgan Theis. Charles Prober: We’re back
to talk about part 2 of 2 of extrapulmonary disease. The reason we created two
videos on this, again, is because tuberculosis
is such an important world-wide pathogen. In part 2, we’re going
to focus on TB infection involving the bones, involving the gastrointestinal tract, the central nervous system, and infection of the
heart or around the heart, so-called pericarditis. The bones that are most
prominently affected, actually the most common,
is the vertebral column. Morgan Theis: That’s odd. Charles Prober: It is odd because when compared with other
kinds of bone infection, for example, acute
hematogenous osteomyelitis, which is usually caused by a staph aureus, the spinal column is
actually quite uncommon. It occurs, but it’s quite uncommon. Bone infections tend to
occur in weightbearing areas because they take so
much trauma just in daily life; but with staph, those weightbearing joints are usually the hips and
the lower extremeties; not so much the vertebral column. But for TB, the vertebral
column is commonly affected and I’m not exactly sure why. Morgan Theis: I have a question about that because back pain is a
really common complaint. I think it’s like 40%
of primary care doctors’ chief complaints from patients. How would you distinguish
TB in the spinal column, in the vertebral column
which is very scary, from your muscle strain
or something like that? Charles Prober: That’s
a very important point. The physical examination can be helpful because with an infection of the vertebral columns, as you push along the back, along the spinal column, you may encounter an area of exquisite tenderness and pain. That would be more suggestive
of a bone infection and the bone infection
could include tuberculosis. That’s all I’m going to say about TB involving the bones. It can involve other
bones, but remembering the vertebral column is
particularly important. There’s a name that is associated with vertebral TB that I’ll
mention called Pott’s disease. Pott’s disease is simply
tuberculosis of the spinal column. Radiographically what
you see is two adjacent vertebrae that tend to be
eroded with the infection. Pott’s disease. The next form of tuberculosis
that I’ll mention, extrapulmonary tuberculosis, involves the central nervous system. It’s much less common
than these other forms that we’ve already spoken about; estimated to maybe be about 5% of infections. But the problem is, because it involves the central nervous system,
it can be very serious, leading to substantial
long-term consequences, morbidity, and also
potentially leading to death. Though less frequent,
it is very important. The thing about tuberculosis involving the central nervous
system compared to other regular bacteria, like
pneumococcal meningitis or meningococcus, is that tuberculosis tends to be subacute in presentation. The symptoms and signs don’t
come on over a couple of days, they come on over a couple
of weeks or even longer. They sneak up on the patient
in terms of causing disease. At the very beginning,
the symptoms may be really quite nonspecific,
meaning they don’t point to any particular kind of
infection of even site. The patient may have a
couple of weeks of a headache or a little bit of confusion,
some slight mental changes. associated with nonspecific
things like fever, and feeling rundown
and not wanting to eat. sort of those general
symptoms that we’ve also talked about in the
context of TB in the chest. But, if it’s not recognized as a problem sneaking up on the
patient and it continues to progress, the patient
may have a progressive decreased level of consciousness and some patients present
with very advanced disease, coming in in coma. As you might anticipate,
it’s better to recognize this earlier rather than later. There are good data, when
you treat TB involving the central nervous
system, if the infection is treated very early
on with the nonspecific symptoms, the patients
often do quite well; whereas, if it’s not
treated until the patient comes in in coma, the
patients often do very poorly. Morgan Theis: We were
talking about the CNS site. You were talking about meningitis. Is that the main thing that you see or do you see anything else
in the central nervous system? Charles Prober: Meningitis
is the main thing you see. You’ve drawn at the base
of the brain in green the inflammation, and
that’s a well placed drawing because you are correct
that TB often involves the so-called basilar area of the brain. The reason that that
is important is it’s an association that will
make you think more of TB, but also what often happens
is this inflammatory response at the base of the brain entraps the cranial nerves that come
off the base of the brain and patients often present
with craniopathies, abnormalities in their cranial nerves. So that should be a tip-off to consider tuberculosis more likely. The other important
element of it involving the base of the brain
is that the infection interferes with the flow of spinal fluid, so it blocks the flow of spinal fluid and these patients may develop increased spinal fluid in the
ventricles or hydrocephalus. That’s another tip-off that the infection might be involving tuberculosis. When you are evaluating
a patient with suspected TB meningitis, or any
meningitis for that matter, a spinal tap is usually
part of the workup, after you’ve assured
yourself that it’s safe. With tuberculosis, the typical results of the spinal tap is there
are white cells present. The white cells are often
lymphocytes in their nature and they number often
in the range of several hundred to maybe a couple of thousand. Also, the protein concentration in the spinal fluid tends
to be quite increased and progressively so; so it can go 100, 200 or several hundred. The glucose tends to be
a little bit depressed but not as severely so as
acute bacterial meningitis caused by pneumococcus. The glucose, instead of being zero like it can be with pneumococcus, may be in the 20 to 30 range. You may see, when a stain
is done for tuberculosis, some of those little red characters under the specially stained CSF, but that only occurs about 1/3 of the time that you can actually see them, even
with the special stains, microscopically, so you
culture them like for other forms of TB and the culture is positive about 80% of the time. There’s also a PCR test
available for tuberculosis that especially the
developing world is used to augment our ability to diagnose it. That’s tuberculous meningitis. We’re not talking much
about treatment here, but one thing that I
will throw in is the role of steroids in tuberculous meningitis. More often than not,
clinicians do use steroids for this form of TB infection, although it’s not without some controversy about whether they should be used. A couple of final things about extrapulmonary sites
and then we’ll wrap up. The gastrointestinal
tract, the gut, can be involved with tuberculosis
as well, but it’s really quite uncommon, maybe 3% or so, and quite nonspecific like most other forms of tuberculosis. The infection for reasons
that aren’t clear to me often involves the terminal
ileum and the cecum, so down there around the appendiceal area with often a lot of
lymph node involvement. One can have obstruction. If the infection is not
recognized and treated, it can erode through the
gastrointestinal tract, so perforation, and
you can get peritonitis and air in the peritoneal cavity. The whole myriad of symptoms that occurs in other parts of the
body can also involve the gastrointestinal tract. Morgan Theis: How do you actually get it into the gastrointestinal tract? Can you ever eat stuff that has TB in it, or are you getting it
throughout your own body? Charles Prober: Actually both. You can actually ingest,
or eat, certain kinds of TB bugs, microbacteria bovus, which is what it sounds like, microbacteria and it comes from cows, can contaminate cow milk. If you ingest unpasteurized cow milk, then that can occur and that’s one way you can get TB involving
the gastrointestinal tract. The other is that if you have pulmonary disease with tuberculosis and you cough up the TB bacilli, you can then swallow them and that can cause the gut
to be infected as well. Another form of tuberculosis,
again in the uncommon variety, but continue
to emphasize the great imitator characteristics
of this infection, tuberculosis can cause
infection around the heart, so TB pericarditis. This can be either from direct extension of lymph nodes around the heart that often are involved when you
have pulmonary disease, or it also can spread
directly through the blood. It seems to be a more
common type of infection in the elderly, whose immune system is not as robust as the youth,
or in patients who have compromised immunity for other reasons, for example patients infected with human immunodeficiency virus. Involvement of the heart is not good. Mortality is very high,
estimated to be almost 50%. The infection, because it has a vigorous inflammatory response associated with it, can cause so-called
constrictive percarditis, so the pericardium
actually squeezes the heart so the heart can’t contract effectively and one dies of heart
failure as a result of that. Those are the key elements with regards to extrapulmonary tuberculosis. There are other organs
that can be involved that are very, very uncommon, the adrenals and so forth, but the
main sites of involvement, lymph nodes very high
on the list, and then less likely the other ones
that we’ve spoken about. Morgan Theis: Another
great reason to treat this as soon as you can
so you don’t get all of these extensive complications. Charles Prober: Exactly.

intestinal infection | Symptoms of intestinal infection

intestinal infection | Symptoms of intestinal infection


Symptoms of intestinal infection. Symptoms of intestinal infection, also called
gastroenteritis can arise from 30 minutes to 3 days after consumption of food contaminated
by viruses, fungi or bacteria. These symptoms vary according to the type
of micro-organism causing, the severity of the infection, the age and health status of
the infected person, and may include: Abdominal pain and cramps;
Diarrhea, with blood in stool; Vomiting;
Headache; Loss of appetite;
Fever. It is important to remember that the symptoms
of intestinal infection are more serious and worrisome in children and the elderly, as
they have a greater tendency to become dehydrated and to lose weight. What to Eat in Intestinal Infection. During the treatment of intestinal infection,
it is important to drink plenty of water to replenish fluids lost through diarrhea and
vomiting, and to consume easily digestible foods such as white rice, pasta, low-season
white meats, boiled and shelled fruits, teas with sugar, remembering to avoid caffeinated
teas like green tea, black and mate. In snacks, it is advisable to eat dry biscuits
without filling, white bread with fruit jelly, natural yoghurts and white cheeses such as
ricotta because they are low in fat and easily digested. What to avoid in food. While diarrhea lasts, one should avoid consuming
vegetables and fruits in shell, even in soups or cooked salads, as they are rich in fiber
that will increase intestinal transit and favor diarrhea. You should also avoid foods high in fat, such
as red meat, butter, whole milk, yellow cheese, bacon, sausage, sausage and processed foods,
as excess fat also facilitates intestinal transit and makes digestion difficult. In addition, foods that increase the formation
of gas, such as cabbage, egg, beans, corn, peas and sugar-rich desserts, should be avoided
as they favor diarrhea and increase abdominal pain. How to avoid dehydration. To avoid dehydration, it is important to consume
at least 2 liters of fluids a day, and you can also use homemade whey, following the
recipe: 1 tablespoon of sugar;
1 teaspoon of salt; 1 liter of filtered or boiled water. You should leave the homemade whey in a separate
bottle for the patient to drink throughout the day for as long as symptoms persist. This
serum is also indicated for children, pregnant women and the elderly. When to seek medical advice. The doctor should be sought when symptoms
of infection have not improved after 2 days for children and 3 for adults, or in cases
of blood in the stool. In addition, infants younger than 3 months
should be taken to the doctor as soon as they experience vomiting and diarrhea, while children
older than 3 years should see their pediatrician if symptoms last longer than 12 hours. Risk Factors for Intestinal Infection. People with weak immune systems, such as patients
with AIDS or in treatment for cancer, children, pregnant women and the elderly have a greater
chance of having intestinal infection because they have the weakest immune system. In addition, people who have gastritis or
heartburn or who use drugs to control stomach acidity, such as Omeprazole, have a higher
risk of having intestinal infection because the acidity of the stomach is reduced, making
it difficult to fight viruses and bacteria. How to prevent. To prevent intestinal infections, it is important
to take personal and food hygiene care, such as: Wash hands thoroughly after using the bathroom
or touching pets; Wash hands thoroughly before and after picking
on any food; Avoid consumption of meat and eggs poorly
cooked; Consume filtered or boiled water. As long as symptoms of food infection are
present, it is important to avoid preparing food for others to prevent them from getting
sick as well. In addition, one should avoid consuming the foods that most cause intestinal
infection, like sushi and eggs poorly.

MSc Infection, Immunity and Human Disease | Postgraduate Degrees at the University of Leeds

MSc Infection, Immunity and Human Disease | Postgraduate Degrees at the University of Leeds


[MUSIC PLAYING] Working in virology is
important because of the impact it has on say the health
of others around the world. What draws them to the
course is an interest in infection and the
way in which disease works in the human body and
how we can counteract that. [MUSIC PLAYING] On this degree course,
we have students from a wide variety
of backgrounds, and they come from both
the UK and overseas. They were all from
scientific backgrounds. It was quite nice to
have a perspective from a different university. And you can really
learn from each other. The infection immunity
course is a specific set of modules of classes basically
that they can give you, that cover subjects on infection
and immunity and human disease. We start off in
the first semester by looking at the source of
diseases caused by bacteria, by viruses, by parasites. And we also consider the
immune systems and how your body fights infection. And then in the
second semester, we try and look more at
how we diagnose disease and how we treat disease. Get to write things
on cancer biology, different infectious diseases,
malaria, things like that. And then in the last part of the
course, the bit which is still compulsory, but you
have some choices, when you do a research project. And obviously, then
you would select a project working with
one of the research labs within this faculty. So there will be projects
which you have interest in. And also, the projects
are also quite good in terms they have a
broad range of techniques and principles. Even just being like three
weeks into the project, you can already
tell that there’s a huge amount of direction that
you can apply to it that you can’t with just a bachelors. So that’s been a
really positive thing. The most important thing that’s
changed over the last say, 10, 15 years, is the
amount of information that we have available
and the speed in which we can generate
that information about biological systems. People talk about big data. It’s true, it’s
just mind boggling the amount of information
that’s out there. And learning how to deal with
that is part of the process. You can tell that you’re
there to learn what’s going on in the research world,
what’s actually happening, instead of just sort of
following a curriculum. I give some lectures on
viruses, for example, like hepatitis C virus,
which is one of the viruses that my lab research
on, and I’ll bring into those
lectures information from what the guys in the
lab are doing at the moment. And then, of course, when they
do their research project, they come into a lab, they’re
working with the postdocs, with the PhD
students, and they’re doing a piece of
original research, which we hope will lead to
publications or increased knowledge about the field. So research-led teaching
is implicit in the whole of the process. [MUSIC PLAYING] It’s a very good
sense to prepare you for say working within science. And the skill set
that you develop could be also
applied to jobs which aren’t in science, as well. It’s a springboard to the
rest of your career basically. And I think that’s how
a lot of people see it, and that’s definitely
what it was for me. We’re trying to tailor this, not
only to the ability of students to work in research, but
also to go into industry and to be competitive
for those industry jobs. Leeds has a very active
research community with fantastic facilities. We have new kit, which is
arriving all the time, which is state of the art. And we are, in fact,
envied by a lot of other universities in
the UK for the facilities we have for biological sciences. Every day is different. You go do your own
experiments and you try to do
hypothesis-driven research to study towards a bigger goal. The sense of
independence that I’ve been able to develop while
I’m working in the lab has been really,
really valuable. And that’s something
that I think will come across in research
that I do in the future. And it prepares you
for the next level. And I believe that
doing research could hopefully help
make a difference.

What causes wound infection?

What causes wound infection?


What causes wound infection. The cause of surgical wound infections are generally bacteria rather than other bugs such as viruses The skin is the first barrier of defence against infection if during or after surgery harmful bacteria get into the wound or if normal bacteria get mixed up with unhealthy or damaged tissue the wound can become infected. Sometimes there may be some gaping of the wound incision and this increases the risk of infection. Your body will respond to bacteria in a similar way as it helps itself to heal with inflammation. Red and white blood cells will be brought to the area to fight off infection so if you notice new or spreading heat redness pain or swelling around the area where the surgeon cut your skin the wound may be showing signs of infection. These signs would usually occur after a number of days or even weeks after your surgery. Other signs of infection include pus which is a thick green, yellow or brown liquid coming from the wound. It is very important to watch out for these signs and symptoms as well as for high temperature or fever in the months after your operation. Please contact your GP or hospital immediately if you think your wound might be infected. Treating an infection early stops it from becoming worse or lasting longer than it should. If your doctor suspects you have an infection take the antibiotics as advised. If you don’t take antibiotics at the right time or complete the course of antibiotics there is a risk that the bacteria will become stronger and harder to treat.

Drug-resistant TB | Infectious diseases | NCLEX-RN | Khan Academy

Drug-resistant TB | Infectious diseases | NCLEX-RN | Khan Academy


Charles: This is Charles Prober. Morgan: And Morgan Theis. Charles: And for this video, we’re going to talk about
resistance among TB infections, so resistance, drug resistance, a very important topic because
it dramatically affects how we treat different patients. The timeline and the patient
that Morgan has drawn is going to help us
describe different scenarios about how to treat patients
who have different kinds of TB in terms of the resistance pattern. This little person we’ve
diagnosed as having a TB infection based upon their clinical presentation
and some of the laboratory tests we did, which we talked about in another video. And when the patient starts their therapy, especially if they’re in a
developing world, where the
Xpert RIF test is available – that’s that molecular test that
we described in another video that identifies that TB is present, it’s on a molecular assay, and that that particular TB
is resistant to rifampin. If that’s the case, then that’s going to immediately
modify how we treat this patient with their TB infection. But let’s assume that the
expert test is negative. Morgan: OK. Charles: And we have a TB
infection that we’ve diagnosed. We take cultures of the sputum, and we know that those cultures are
going to come back in 4 weeks or 6 weeks. It takes a bit of time. Those cultures are also
going to be tested. The bacteria are going to be tested for sensitivity to the
antituberculose agents, but we’re not going to have that
information out for about 6 weeks, because that’s how long
it takes the TB to grow. Morgan: OK, so here’s
my little culture plate that’s trying to grow out that sputum. Charles: Perfect. While we’re waiting for the
culture results and sensitivity
testing to come back, we need to start therapy
for this TB infection. The standard therapy is using
all of the first-line drugs that you’ve listed in
the top right-hand corner that we referred to before as RIPE: the rifampin, isoniazid,
pyrazinamide, and ethambutol. Morgan: OK. Charles: The rifampin
and isoniazid, or INH, are used for a full 6 months if this
turns out to be a sensitive TB bug. They’re both used for 6 months. The pyrazinamide and ethambutol
are used for the first 2 months of that 6-month interval. That’s the standard therapy. Now let’s consider we’ve got the
culture results that have come back from that sputum, and we’re
6 weeks into this treatment, and we discover from those culture
results that the organism, the TB, is resistant to one of our TB agents. The most common resistance
would be to INH, but they can be resistant to any
of the different first-line drugs. If the organism turns out
to be resistant to INH, we will stop the INH because
it won’t do much good, and we’ll either just continue the
three drugs for a longer period of time or we may add a fluoroquinolone. If the TB turns out to
be resistant to rifampin based upon that sensitivity testing, we’ll stop the rifampin and may
continue the other three drugs and maybe even add
something like streptomycin. Morgan: So the idea here is that if whatever drug this particular
TB organism is resistant to, you’re going to stop using it, and you’re going to continue
with the other ones. You may consider adding a secondary drug, and you might consider a longer treatment. Charles: All correct, yes. Charles: So if the bugs are resistant, the TB is resistant to
both INH and rifampin, the term that is used for
that resistance is MDR, which stands for multiple
drug-resistant TB. These are becoming increasingly
important around the world. It turns out that the countries
that have the most MDR isolates are five countries in the world, and those include China, India, Pakistan,
the Russian Federation countries, and South Africa. That’s only five countries, and they have the
largest amount of MDR-TB. The final type of resistant TB
that I would like to mention is called XDR-TB, which stands
for extreme drug resistant. XDR-TB is less common than
MDR-TB but more serious because it’s harder to treat because they’re resistant
to multiple drugs that are either first-line anti-TB drugs or second-line, which you’ve also put in
the right-hand corner of this picture. They’re more difficult to treat, and in fact, the mortality rate
for this XDR-TB is much higher. But let’s assume that we
do the sensitivity testing when the sputum comes back
positive at 6 weeks or so and they turn out to be sensitive, and we’re continuing on with
just a standard RIPE therapy. But then as we’re checking
the sputum cultures, as we want to do on a regular basis, when you get out to 3 months, it turns out the sputum
culture is still positive. It should not be still positive. You should have a negative sputum
culture by about 2 months or so, or even earlier. Morgan: Right, because
you’ve been treating the TB. Charles: Exactly. Morgan: OK. Charles: So if it’s still positive, there is one or two possibilities. One is the TB has developed resistance to one of the anti-tuberculose agents, in which case, you’ll
have to modify therapy. And you’ll know it’s resistant
because you tested sensitivity again. The other possibility is
it’s just a slow responder, that the patient continues
to have positive sputums even though the bugs are sensitive, are killed by the antibiotics
you’re using, and it’s just slow. Under either circumstance, therapy, you’ll have to
anticipate modifying therapy. If it’s resistant, you’ll change
the anti-tuberculose agents and treat the patient longer. If it’s sensitive, you’ll just anticipate treating the
patient longer than the standard 6 months. Then the final scenario
that I would like to mention is all goes well for
the 6 months of therapy. The patient’s chest X-ray gets better. They look well, and you believe you have
cured the infection. Morgan: OK, so here at 6 months … Charles: All is good. Morgan: … my patient is happy. Charles: Exactly. Morgan: And cured, supposedly. Charles: But the scenario
that I’ll now describe is several months or even years later, that happy patient becomes sad again because the patient has a
relapse of the infection. The signs and symptoms of TB reappear. Now, that may be because the
patient’s initial infection was never completely eradicated
and it just came back, or it may be that the patient acquired
a new TB infection from somebody else, so it’s a completely
different TB infection, so it’s not really relapse in that case. It’s re-infection, but nonetheless,
the symptoms have relapsed. Morgan: So how could
you tell the difference? If a patient who was treated
for their original TB then years later presented with TB again, how could you tell if it was a
relapse of their original bug or a new infection with a new bug? Charles: That’s a great question, and the only way you’d be
able to tell the difference is if you had both TB bugs in your
laboratory available to retest, and you can do molecular
testing on the two bugs and see if their DNA is
the same or different. If the DNA is the same,
then it’s a relapse because it’s the same bug. If the DNA is different,
then it’s a reinfection. Morgan: Oh, great. So you really can figure that out. Charles: Exactly.

TB epidemiology | Infectious diseases | NCLEX-RN | Khan Academy

TB epidemiology | Infectious diseases | NCLEX-RN | Khan Academy


Voiceover: Back in 2011, I’m
going to write it down here. Our worlds population
was about 6.9 billion. That’s a pretty large number and sometimes when I’m thinking of big numbers they
all kind of melt into each other. I thought it would be helpful to just
write it out so you could see it. 6.9 billion people and that’s
what I try to represent here with this little black circles,
that’s my best attempt. It’s showing all the people on the planet and you just have to take my word for
it that it’s roughly representative. What I wanted to point
out is that the WHO, the World Health Organization, has
said that about one in three people living on our planet, so you
just divide this number by three. One in three people has
latent TB infection., so this is an enormous number of people. When you read that you
might not think about it but that’s actually 2.3 billion
people with latent TB infection. Remember when I say latent TB infection, what I mean is that the bacteria is
either dormant inside of someone’s lungs or it’s dead but it’s really
hard to tell the difference so we always kind of hedge
on the side of being cautious and we treat them as if they have
dormant bacteria in their lungs. Some of us might even see the term LTBI. Now keep your eye on the map and
what I’m going to do is show you what that would actually look like. So if I actually erased
two-thirds of the people this is what you basically
have left, something like this. This people are the ones that we can
imagine then have latent TB infection. Still a lot of people right? The WHO found that in 2011. There are also about nine million
individuals that had active disease. This is actually people that are
coughing and having chest pain, maybe having bloody sputum, all sorts of signs and
symptoms of active disease. That’s a huge number of people and we know that a lot of those
folks have active disease, they’re actually coming from
this pool of latent TB infection. Now about 10% of these folks
that have latent TB infection will actually go on to get active disease and you can break that down further and say well 5% will be in
the first couple of years after they get the latent TB infection. Another 5% will be over a lifetime,
will be in there lifetime. You can split it up so you can
see that most of that risk, that 10% risk is coming in
the first couple of years. In general if you think about 10%
of that enormous number, 2.3 billion that’s a lot of sick folks, right? Let me actually draw in here what
10% of these people would look like just so you get a visual idea. Maybe this person in Brazil will be
sick, maybe another person out here. Perhaps this person over here,
maybe someone in America. Maybe someone in Mexico. We’ve got five, maybe a Canadian, get six. We got six people over there. Maybe seven, eight,
couple in India nine, ten. A couple of folks in
China 11, 12, 13, 14, 15, I mean it’s a lot of folks, right? 17, 18, maybe a Nigerian, maybe
an Ethiopian, something like this. Let me just make sure I did
the math right really quick. A couple more, let’s just
do one here and one there. This is 10%, that’s what
10% visually looks like, so you get a sense for how many
people are actually going to get sick and have active disease. We know that there are a
couple of other groups of folks that are also going to get active disease. Some would be the folks
that had primary infection because you can get primary
infection then immediately have what we call primary
progressive disease. Or you might have
secondary infection, right? You might have latent TB infection then you get another
person coughing on you and we call that secondary infection. These are the different ways
that you might get to be part of that nine million
who have active disease but I want to point out
that this is a huge pool. This is a large number of people
and so many, many, many people are going to contribute to that
nine million with active disease. Now you might be thinking, “Wait
a second the math doesn’t add up.” Because if you just take
10% of this enormous number that’s actually way more
than nine million people so how does that make sense? Just remember this is a risk in a lifetime or in a couple of years and
this is actually looking
at how many people are sick with active disease in one given year. To extend a little bit further, just
want to make a little bit of space. Those folks are going to go on to actually some of them are
going to go on to die. You’re going to have, in 2011 we had
about 1.4 million people that died. Ultimately that’s really
what we’re trying to avoid. We’re trying to avoid people dying of TB and we want to avoid people
getting active disease because it’s a horrible illness, and so you can see why there’s
such pressure to try to find people that have latent TB infection
and really intervene before they actually go on to get sick. The final thing I want to show
you is actually another picture, I think you’ll find this interesting. This is actually 22 countries
where 80% of the disease is. Go on take a look at this map
we’ve got 22 countries in total. This account for 80% of the cases of TB, so this together account for 80%. The majority of the disease in the
world is coming from this places, so TB cases. It’s actually quite interesting,
you can take a look at this and say okay, you can see that
you’ve got some African countries, you’ve got countries in
Asia, and you’ve got Russia, and you’ve got Brazil out here. These countries combined
make up the majority of where people are sick with TB.

When Should a Dog’s Anal Glands Be Expressed and Can An Infection Develop If Left Untreated?

When Should a Dog’s Anal Glands Be Expressed and Can An Infection Develop If Left Untreated?


I’m Dr. Clayton Greenway with healthcareforpets.com and we’re answering questions this morning that came into the website. Here’s a good one, it comes from Paul. What are the signs? [Dr. Clayton Greenway: Is that you Paul?] Yeah okay that’s my partner. What are the signs and symptoms that my dog needs its anal glands expressed and can my dog develop an infection if they aren’t expressed? [Dr. Clayton Greenway: You know don’t we get enough questions?] Okay Paul wants to know about anal glands. Anal glands are wonderful things. They are two sacks that sit beside the anus and they fill with this really stinky stuff that basically when a poop comes out a nice firm put poop puts pressure on these glands and it causes them to express and this stuff gets on the, the poop and it really is for marking and so what happens is when they have anal gland problems you can have leaking of the anal glands and things like that and it really smells in the house. In fact, if the anal glands don’t express they can become firm, the material inside gets insipissated, it dries out, the anal glands become irritated and inflamed and the dog can be quite painful. The thing we usually see with dogs is they put their bum on the ground and they rub it along. Some of them will look back there and sometimes anal glands that are impacted like this and won’t express, they will become infected and an abscess will form and a drainage hole will open up beside the anal gland outside of the regular tube that this stuff is supposed to come out so it can be very painful. Basically what can happen is to treat this, you go to your veterinarian some groomers do it, some groomers express anal glands well some of them not as well but veterinarians and their staff sometimes cannot express them as well either but usually what you do is put a glove on and you have to put your finger in there and express the anal gland. Some groomers will do it from the outside so they may not fully express it and by doing it this way you can tell if an anal gland is fully empty. So you express them and basically what happens is you release the material. If the anal gland is inflamed, sometimes it produces more material rather rapidly so I always tell people, you might see the symptoms come back in about two or three days in that case come back in for another expression. I always say that because some people will see it come back in about two or three days and they’ll think, we must not event we emptied them fully but in fact if they’re inflamed they can sometimes fill up rather rapidly and usually after that second expression, then they’re fine and anal glands are interesting I mean if you have soft stools you will have anal gland problems, but the other thing is, is there’s lots of other things that are suspected as contributing to anal problems like allergies or vaccination or other diseases but we don’t really know any rhyme or reason. I had a cat that I had for a number of years was an older cat and basically it had an anal gland problem once but never again. Some dogs I see, I’ve had to express their anal glands once a month for six months and then never again after that. So sometimes we don’t really understand the rhyme or reason. If you’re starting to have problems beyond that and the expressions don’t work, there are actual surgeries you can do. There’s an anal sacculectomy, where you can have your veterinarian perform a surgery to remove those anal glands. In 13 years I have never had to do that and I’ll tell you why. The thing that I do is I will actually sedate the dog, I will find a little catheter and I’ll insert it into the tube of each anal gland and I’lll flush them out really thoroughly and I’ll pack the anal gland full of a medicine that’s an antibiotic and anti-yeast and inflammatory. It’s actually very common ear medication and skin medication but I actually put it in the anal gland. It’s not really used for that but it’s something that I’ve done and it’s never caused a problem, it’s really settled the anal glands down and it’s avoided the surgery for me every single time. In some cases you might have to get to that surgery, so this is the way you deal with it Paul and hopefully there’s no ongoing problems and if there are you can come and ask me again but I appreciate the question coming in and for everyone out there keep those questions coming to healthcareforpets.com where we’re dedicated to your pet’s health.

MSc Microbiology and Infection – Youseuf Suliman

MSc Microbiology and Infection – Youseuf Suliman


My name’s Youseuf Suliman and I’m doing
Microbiology and Infection at the University of Birmingham. So what’s special about Microbiology and Infection?
Well the Institute of Microbiology and Infection is right here in Birmingham, and you get to
walk around the people who are world leading researchers within that field, and you really
get that sense of these aren’t just your lecturers or professors, these are your colleagues that
hopefully you’ll be with this venture in science for the rest of your career. So it’s a mix between seminars and lectures.
We have about eight to ten lectures a week ranging from different modules in host pathogen
interactions or some core concepts, and we have a mix between those some practical activities.
We do have some group work now and then involving presentations or lab work. Favourite thing about being a postgrad? Compared
to undergrad I’d say it’s – you’re not really looking – you’re lecturers aren’t
teaching you as if you’re kids anymore. They really see you as your peers and you’re really
almost on the same level as them. Obviously on understanding you’re nowhere near, but
they really try and bring you up to that level of the forefront. For the postgrad it’s got a really big postgraduate
community, and I love the redbrick campus – it’s got a real sense of lasting and
knowledge that’s really gone throughout the ages. You feel like you can may be adopt
some of that hopefully. So the main difference in postgrad and undergrad
is you kind of finish your undergrad feeling as if you know everything, and as soon as
you step into the Masters you realise you don’t really know anything. The level of
detail you’re taught here is such exponentially different from undergrad, and you’re really
pushing the boundaries between like current knowledge. After I graduate, hopefully, if I get some
funding, to be a PhD would be nice and the life of a perpetual student. There’s a great postgraduate community. We
have a specialist room called the Masters room, so you really get to talk in amongst
your postgraduate colleagues and pupils, not just within your disciplines. You really get
to throw ideas with each other and get like a broader sense of the field of the biosciences. Top tip? Definitely make sure you have a passion
for it. Don’t do it if you don’t really know what you’re doing. Try and really get
a grasp of where you want to go and what you enjoy, and just pursue it and completely immerse
yourself when you’re here as well.

Paronychia Fingernail Abscess Infection Treatment | Auburn Medical Group

Paronychia Fingernail Abscess Infection Treatment | Auburn Medical Group


You’re not really feeling good right now?
No, not really, one of the most painful things I’ve ever experienced Believe me it is throbbing and stinging And I haven’t slept for the last four nights
It’s a real hindrance to daily activities You know? You notice something
like a hangnail You know? And then that day it just started
getting worse. You have something called a paronychia. Somehow some bacteria got
under the space between the skin and the nail and they got into the skin there
and you have an abscess with pus and when there’s pus it needs to be drained.
All right, so this is where we put on gloves and betadine up the entire hand Ok and then I’m going to numb up this
back nerve here… Just a little sting…Just a little sting. Not too bad. You feel the medicine going in? No… No… Don’t feel anything now So I get the nerve where it goes through
on this one What I do is I try to go in right about
where the edge of the nail is. And so I look down the finger and see… You’re lining it up where it should be. Yeah and that gets us just right at the
side of the bone and to get it on the other side I don’t turn your hand around
because that would hurt to get stuck on the palm side of the finger I’m instead going to use a longer needle
to go in right where we did before Anything? Yeah Okay I’m going to be putting the medicine in as
I go down and I’m going deeper this time..You are? To hit the nerve down on the bottom
side Oh! You hit a nerve there…Sorry. Let’s give it a lot
of medicine and then we’re going to do the same thing over here Yeah we number it up from the back. You
feeling it?… Yeah Sorry It does sting as it goes in and this is
how it’s done I actually just did a literature search
on the computer and found that in February of 2016 an article was published in
a surgical rehabilitation journal that showed that in a series of cases that
they did, they found that if they use antibiotics, they had no better outcome
except in one single case and that one single case they said it wasn’t adequately
drained, so drainage is the treatment not antibiotics with all their side effects
and resistant organisms. Is it still hurting?…Not now Does it feel better than when we started? I’ll
push more gently. So I’m kind of milking it over from this side… That’s just dead white blood cells attacking that…and bacteria Does it hurt when I do this? No, not yet…Ok so if we look at it from the top,
all that yellow color that was there is disappearing Does it hurt to push down here?…No, not there…Up here?… Not too much Now I’m going to open that up more…
You’re really going to come up with that. Boy! What do you do for fun? I go fishing Fuller Lake, Sugar Pine… closer I’ve
been catching them trout over at uh Chana high school pond
over there Oh yeah at the regional park… Yeah, they
stocked it for the kids fishing Oh and they’re still in there?… Oh yeah, they
put three thousand pounds in there It’s just a small pond. Have you been there
lately? Oh it’s all tapped out now…Oh it is?…
I got, I loaded my freezer up You did? And they spiced it up with
some big ones, some three pounders. I caught two of those Oh you did? Yeah and then the regular, you know, pan-fry side. At
this point we’re not getting any more pus out, just a little bit of blood We’ll just put a dressing on it and have you
keep that on, but just letting this drain and then heal as the incision heals as
it normally would over the following days What about showers and washing your hands and getting them wet? I want you to keep it covered and
keep stuff from getting in it for, until we see it on Monday Alright, let’s see… Better already? Yep… Okay
good Thanks for joining us, we’re glad that
you joined us for this drainage of Max’s paronychia. If you like videos like this,
make sure you’re subscribed and tell friends who enjoy watching videos like
this Hopefully…Here it is… Yeah hopefully Max won’t
have to be in the next one. Until next time this is Max and myself, Dr. Mark Vaughan,
telling you to stay in good health