Preventive and Curative Medicine Overview

L1: Introduction

• Preventive medicine: prevents disease and promotes health, proactive, deals with the whole community
• Curative medicine: treats disease, reactive, deals with individual cases
• Types of health: physical, social, mental, spiritual
• Spectrum of health: ideal (perfect), positive (equilibrium, adjusts to environment), negative (cannot adjust to environment), unapparent disease (appears on tests but no symptoms), apparent disease (symptoms present), death
• Signs of good health: physical health (no disease), social health (positive interactions, fulfilling responsibility), mental health (sensitivity to others, controlling emotions, confidence, peaceful)

L2: General Epidemiology I

• Epidemiology: study of distribution, determinants, and dynamics of health-related states, and its application
• Distribution: factors related to time, place, and person (e.g., year, climatic zone, age, birth order, family size, etc.)
• Determinants: include agent (biological, chemical, physical, and nutritional factors), host (susceptibility), and environmental factors (also ecological triad)

L3: General Epidemiology II

• Importance of carrier: freely moving in community, clinically healthy, large number, long infectivity period
• Types of carriers: incubatory (becomes infective last days of incubation period), convalescent (during healing), contact (polluted environment), healthy (high immunity)
• Classifications of carriers: transient, temporary, permanent (chronic), foci of infection (skin, urinary, gastro-intestinal, respiratory) and portal of exit and etc.

L4: Mode of transmission

• Droplet (airborne) infection: direct or indirect method, e.g., bacterial, viral infections. Predisposing factors e.g., overcrowding, bad ventilation, bad health habits
• Foodborne infection: direct or indirect transmission, e.g., contaminated food through vehicle transmission, etc. Predisposing factors e.g., poor sanitization, lack of supervision
• Contact infection (STDs): organisms or parasites invading the skin or mucous membrane, e.g., tetanus, gas gangrene, syphilis.
• Arthropod-borne infection examples: mechanical transmission (e.g., house flies), biological transmission (e.g., mosquitoes).

L5: Immunity

• Innate immunity: natural barriers (e.g., skin, eyes, respiratory system), inner body defense (e.g., plasma with lysozyme, phagocytosis)
• Acquired immunity: types (passive natural: breast milk, illness, active natural: illness recovery, passive artificial: harvested antibodies, active artificial: vaccines), trans-placental materno-foetal immunity, and colostrum/breast milk containing IgA & lysozymes & macrophages
• Active natural acquired immunity: subclinical, clinical infections (e.g., solid/long-lasting: measles, mumps, chicken pox, and short-lived: influenza).
• Herd immunity: resistance of a group to the spread of infection, occurs when a high percentage of the community is immune, and measures (e.g., frequency of new introductions, mixing of population, duration of infectious periods)

L6: Vaccines & Toxoids

• Types of vaccines: Live (e.g., small pox, attenuated, subunit, recombinant, polysaccharide, conjugate), killed/inactivated (heat/chemical, e.g., pertussis), viral vector (e.g., Covid-19), mixed/combined
• Live attenuated vaccines: potent, only one dose (except polio), not for pregnant, immunodeficient
• Killed or inactivated vaccines: require 2-3 doses/sometimes booster, given intramuscular/subcutaneously.

L7: Seroprophylaxis & Chemoprophylaxis

• Normal human immunoglobulins (NHI): prepared from volunteers plasma, used for prevention if given early, general prevention.
• Specific human immunoglobulins (SHI): prepared from plasma, used to prevent viral diseases.
• Chemoprophylaxis: uses antibiotics, given immediately or before exposure, used in cases that could not be prevented by vaccination.
• Comparing animal vs. human seroprophylaxis
• Indications for chemoprophylaxis: if vaccinations are contraindicated, during epidemics

L8: Prevention of infectious diseases

• Primary prevention: measures taken for healthy individuals to prevent disease occurrence (e.g., community development (income, education, health services), environmental sanitation, health education, immunization, chemoprophylaxis)
• Secondary prevention: focuses on controlling and reducing disease incidence (e.g., isolation of cases, sanitization of cases, disinfection, contact control)

L9: Control measures

• Aims of secondary prevention (control measures): to reduce the incidence of disease, duration, effects, and financial burden
• Isolation of cases: required for quarantinable diseases, including severe endemic diseases such as diphtheria, meningitis, typhoid
• Disinfection of cases: involves treating infective discharges, contaminated articles, etc.

L10: Hospital-acquired infection (nosocomial)

• Nosocomial infections: infections from hospitals, examples include staphylococcus aureus, streptococcus hemolyticus
• General hospital infections: e.g., staphylococcus aureus, streptococcus, other bacteria
• Maternity hospital infections: e.g., staph, aureus, streptococcus

L11: Meningitis

• Causative organism: purulent (septic, e.g., meningococcus, streptococcus), aseptic (e.g., viruses (enteroviruses), and granulomatous (e.g., TB, fungi, syphilis)
• Reservoir: human (often with unique symptoms)
• Mode of transmission: direct droplet infection (direct contact with carriers, etc.), droplet nuclei and articles are less common
• Symptoms/signs: include fever, headache, neck rigidity, and others
• Diagnosis: includes clinical picture, laboratory (blood culture, CSF exam, Nasopharyngeal swab)
• Prevention: includes chemoprophylaxis (e.g., rifampicin) and vaccination (e.g., quadrivalent A-C-Y-W135)
• Complications: may include hydrocephalus, optic neuritis, nerve deafness, ocular nerve palsy, and arthritis

L12,13,14,15,16,17,18: (details will be in future lectures)

• This section has been grouped because details aren't in these notes and will be in subsequent lectures

L19: Diarrheal & Food Poisoning

• Acute watery diarrhea/dysentery: loose/watery stools (≥3 times in 24 hours), with or without blood
• Invasive diarrhea/dysentery: inflammation of the distal small bowel and colonic mucosa caused by bacteria or viruses
• Persistent diarrhea: ≥14 days of loose/watery/bloody stools
• Causes: bacterial (Salmonella, Shigella, E. coli, cholera, campylobacter), viral (rotavirus), fungal (Candida albicans), parasitic (Entamoeba, Giardia), and other causes (e.g., dietary factors, food allergies, etc.)
• Complications: dehydration, electrolyte imbalance, metabolic acidosis, malnutrition, infections
• Diagnosis: clinical assessment (hydration, nutritional, co-morbid conditions) and laboratory tests (stool examination, blood tests).
• Prevention: proper sanitation, safe water supply, adequate nourishment

L20,21,22,23,24: (details will be in future lectures)

L25: Diabetes Mellitus

• Diabetes Mellitus: common group of metabolic disorders
• Definition: fasting blood glucose of 126 mg/dL or more
• Prevalence: estimated at 6% of the world's population and increasing, geographically concentrated
• Epidemiological Features: higher in urban areas and high-income countries, significant morbidity
• Classification: insulin-dependent (Type 1), non-insulin dependent (Type 2)
• Types 1 and 2 etiology and differences

L26: Cancer

• Cancer: malignant tumors/neoplasms, mostly form in epithelial cells, can be caused by many factors
• Types: carcinoma (most common), sarcoma (e.g., bone, soft tissue), leukemia (blood-forming tissue), lymphoma (lymphocytes), brain, spinal cord cancers (gliomas)
• General signs/symptoms: unexplained weight loss, fever, fatigue, pain, skin changes
• Risk factors: tobacco, diet/obesity, infections, radiation, lack of physical activity, genetic predisposition, chronic infections.
• Note: Unequal distribution of cancer, lifestyle differences and chronic infection can affect patterns.