Smileband health topics

Introduction to magnesium 

Magnesium, an abundant mineral in the body, is naturally present in many foods, added to other food products, available as a dietary supplement, and present in some medicines (such as antacids and laxatives). Magnesium is a cofactor in more than 300 enzyme systems that regulate diverse biochemical reactions in the body, including protein synthesis, muscle and nerve function, blood glucose control, and blood pressure regulation Magnesium is required for energy production, oxidative phosphorylation, and glycolysis. It contributes to the structural development of bone and is required for the synthesis of DNA, RNA, and the antioxidant glutathione. Magnesium also plays a role in the active transport of calcium and potassium ions across cell membranes, a process that is important to nerve impulse conduction, muscle contraction, and normal heart rhythm 

An adult body contains approximately 25 g magnesium, with 50% to 60% present in the bones and most of the rest in soft tissues, Less than 1% of total magnesium is in blood serum, and these levels are kept under tight control. Normal serum magnesium concentrations range between 0.75 and 0.95 millimoles (mmol)/L,  Hypomagnesemia is defined as a serum magnesium level less than 0.75 mmol/L [ Magnesium homeostasis is largely controlled by the kidney, which typically excretes about 120 mg magnesium into the urine each day,  Urinary excretion is reduced when magnesium status is low .

Assessing magnesium status is difficult because most magnesium is inside cells or in bone, The most commonly used and readily available method for assessing magnesium status is measurement of serum magnesium concentration, even though serum levels have little correlation with total body magnesium levels or concentrations in specific tissues, Other methods for assessing magnesium status include measuring magnesium concentrations in erythrocytes, saliva, and urine; measuring ionized magnesium concentrations in blood, plasma, or serum; and conducting a magnesium-loading (or “tolerance”) test. No single method is considered satisfactory, Some experts, but not others consider the tolerance test (in which urinary magnesium is measured after parenteral infusion of a dose of magnesium) to be the best method to assess magnesium status in adults. To comprehensively evaluate magnesium status, both laboratory tests and a clinical assessment might be required. 

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Plague is caused by the bacteria Yersinia pestis, and circulates among rabbits and rodent populations. Symptoms can include:

• fever
• headache
• weakness
• pain or swelling of the groin, armpit or neck.

Plague infections in people can occur in three forms: bubonic, septicemic, or pneumonic, depending on route of exposure. Bubonic plague or septicemic plague often results from flea bites or contact with infected animal fluids or tissues. People with bubonic plague can develop swollen, tender lymph nodes called “buboes”. Septicemic plague is more severe, and causes bleeding into the skin and other tissues. Skin and tissue necrosis can also occur, especially on the fingers, toes, and nose. Pneumonic plague often results when a person breathes in infectious droplets. People can experience shortness of breath, chest pain, cough, pneumonia, and respiratory failure.

 

In Arizona, plague is found in most areas of Arizona above 4,500 feet elevation and activity occurs in prairie dog, ground squirrel, and rat populations.

 

Arizona 5 year median: 0 cases

 

Transmission

Plague is spread by the bite of infected fleas. Plague can also be spread through direct contact with blood or tissues of infected rodents, rabbits, or other animals. It is possible for pneumonic plague to be spread from person to person (e.g. coughing). Isolation Precautions

Standard and droplet precautions are recommended in healthcare settings. 

Prevention for Patients
Prevention methods include:

• Avoid contact with sick or dead animals, especially rodents and rabbits.
• Stay away from rodent burrows.
• Reduce rodent habitats around home and work environments.
• Remove brush, rock piles, firewood, and possible food sources.
• Do not feed wildlife, including rodents.
• Wear insect repellant to keep fleas away when hiking or working in areas where plague might be active.
• Always wear protective equipment, including gloves and mask, when handling wildlife in the field (e.g. skinning and cleaning game).
• Keep fleas off pets by using flea prevention for cats and dogs.

Public Health Actions
Environmental partners should be notified to determine source of exposure and potential animal die-off. 

Public health will conduct an epidemiological investigation on a case or suspect case. 

Public health will follow-up with pneumonic plague contacts for seven days after last exposure to the case. 

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Lyme disease is a tick-borne disease caused by the spirochete bacterium Borrelia burgdorferi. The majority of cases in the United States come from endemic states in the Midwest and East coast areas. Lyme disease is not endemic to Arizona due to the absence of the species of tick that spreads the bacteria. Asking travel history is very important to assessing risk for Lyme disease.

 

Symptoms tend to be nonspecific and may include: fever, fatigue, chills, headache, muscle and joint aches, and swollen lymph nodes. A red, expanding rash called erythema migrans occurs at the site of the tick bite in approximately 70-80% of cases. Typically, rashes present as the hallmark “bull’s-eye” pattern.

 

Arizona 5 year median: 13 cases

 

Transmission
Lyme disease is spread through the bite of an infected Ixodes tick.

Incubation period from the initial bite to the appearance of erythema migrans lesions ranges from 1 to 32 days.

Lab Tests & Specimen Info

Test*	Specimen
Western Blot	Serum
PCR	CSF,  Synovial Fluid, Whole Blood
IgG/IgM  Serology	Serum
Culture	Blood,  Skin Biopsy

  Isolation Precautions

Standard precautions are recommended in healthcare settings. 

Prevention for Patients
Avoid exposure to tick habitats:

• Avoid areas with overgrown grasses or brush.
• Wear long pants, long-sleeved shirts and socks when outdoors.
• Apply insect repellents to skin and clothing.
• Check body for ticks after being outdoors.

Public Health Actions
Public health will conduct an epidemiological investigation on a case or suspect case. 

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Epiphany celebrations were in full swing around the world as people came out in their droves to mark the Christian festival. There were events held to mark the day all over the globe, with traditional celebrations in Europe, Africa and the Middle East.

The most striking tradition was in the village of Vale de Salgueiro in Portugal, which allows children as young as five to smoke cigarettes during Epiphany celebrations. Children, like those pictured, smoke cigarettes in the village in northern Portugal, during the traditional celebration.

The village's Epiphany event, called Kings' Feast, feature the tradition which causes an outcry and draws strong criticism from outsiders. 

However, locals say that practice is a centuries-old tradition, although nobody is sure what it symbolises or why parents buy the packs of cigarettes for their children and encourage them to take part.

The annual 'king' is responsible for organizing the village's Epiphany celebrations, with this year's King a man called Alexandre Taveira. The legal age to purchase tobacco in Portugal is 18, but nothing prohibits parents from giving children cigarettes, and Portuguese authorities do not intervene to stop the practice.

Guilhermina Mateus, a 35-year-old coffee shop owner, cites custom as the reason why she gives her daughter cigarettes.

Ms Mateus said: 'I don't see any harm in that because they don't really smoke, they inhale and immediately exhale.'

Locals, both adults and children, can be seen smoking and dancing during celebrations in the village. 

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Campylobacteriosis is caused by bacteria of the genus Campylobacter. It is one of the most common causes of “traveler’s diarrhea.” Many infections are asymptomatic. If illness occurs, it generally lasts 7-10 days.

 

Diarrhea associated with Campylobacteriosis may be watery or sticky and can contain blood (usually occult) and fecal leukocytes (white cells).

 

In Arizona, Campylobacteriosis is one of the highest reported enteric disease with case numbers ranging from 800 to 1,400 per year.

 

Arizona 5 year median: 940 cases

 

Transmission

Transmission occurs through ingestion of the organisms in raw poultry and pork, contaminated food and water, unpasteurized dairy, juices, and ciders; from contact with infected pets, farm animals or infected infants.

Person-to-person transmission, which occurs by hand-to-mouth transfer of feces, appears to be uncommon.

Lab Tests & Specimen Info

Test*	Specimen
Culture	Stool
Immunoassay EIA	Stool

 Isolation Precautions

Enteric precautions followed for the duration of acute symptoms.

Prevention for Patients
Prevention methods include:

• Cooking all poultry thoroughly (make sure it reaches an internal temperature of 165 degrees F)
• Wash your hands with soap before preparing food
• Wash hands with soap after handling raw foods of animal origins
• Prevent cross-contamination in the kitchen by using separate cutting boards for foods of animal origin and another for other foods
• Do not drink unpasteurized milk or untreated surface water
• Wash hands with soap after contact with pet feces

Public Health Actions
Symptomatic indivdiuals and symptomatic household contacts should be excluded from food handling, care of patients in hospitals, and care of people in custodial care and child care centers until no longer symptomatic or until treatment has been maintained for at least 24 hours.

Children with diarrhea may not attend daycare or school until symptoms have resolved or until treatment has been maintained for at least 24 hours. 

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The Chinese have quietly taken control of a £5 billion, Lonfon based company that stores vast amounts of highly sensitive data, sparking fears for Britain’s national security.  Politicians and experts last night called for the security services to investigate the £100 million share swoop over the New Year that gave Chinese investors majority control over Global Switch, Europe’s largest data centre operator.

The Australian government has already said it will to move files from its Department of Defence out of a Global Switch site in Sydney, due to concerns that Communist officials in Beijing could access military secrets.

But security expert Professor Anthony Glees accused the UK Government of ‘failing to take this threat as seriously as it should’, adding that Ministers were ‘so obsessed’ with attracting foreign investment that they risked ‘throwing national security to the four winds’. Conservative MP Nigel Evans also questioned the deal. ‘If other countries like Australia have had deep concerns, then why is it we don’t?’ he said.

A group of Chinese investors operating as a consortium called Elegant Jubilee increased its stake to 51 per cent in the company in discreet dealings between Christmas and the New Year. The power-grab went almost unnoticed because most people were on holiday.

The Chinese have been investing heavily in UK infrastructure over the past few years, including Hinkley Point nuclear power station and National Grid gas pipelines.

Elegant Jubilee was put together by Li Qiang, the founder of Chinese data centre firm Daily-Tech, and is led by Jiangsu Sha Steel Group, China’s largest private steel-maker.

They say they are independent investors with no links to the Chinese state.

Smileband general news

A former Bristol police officer who became a victim of pervert doctor Reg Bunting has spoken of what she believes was a “cover up” in the force. 

The woman was subjected to the force doctor fondling her breasts in what should have been a routine medical examination.

The former officer said when she told her colleagues what had happened she was pressurised not to say anything by those senior to her.

A report into the doctor’s behaviour while at Avon and Somerset police has revealed how he inappropriately touched staff and recruits during routine medical examinations. Various complaints were made by officers and recruits over the years – but no action was taken until after the doctor had died.

One of his victims said the doctor had the power of careers in his hands and abused that. “I thought it was a bit weird and I went to him for an unrelated issue,” she said.

“Looking back now it makes me feel sick.

“Even I may not have seen it at the time, but I was sexually abused by this man who had a lot of power.

“I am completely embarrassed and ashamed of what happened, but I did say something at the time. “I mentioned what had happened to a colleague and I was later told by others in the force to keep quiet if I wanted to keep my job.

“They knew about this for a very long time and it was all swept under the carpet for years.

“We were all told to never leave people alone with him in the detention centre, but he must have had connections and friends high up in the force because no one ever did anything.

“It makes me just so angry and upset when I raised it and was basically told to shut up.

“No one took it seriously – no one listened.

Smileband health topics

Vancomycin-resistant Enterococci are bacteria that are resistant to an antibiotic that is usually used to treat enterococci. Enterococci are found normally in the human intestine and female genital tract as well as the environment. Most VRE infections occur in hospital settings.

 

VRE can cause infections in the urinary tract, bloodstream or in wounds associated with catheters or surgical procedures. These infections can lead to more severe issues such as bacteremia.

 

Transmission

Transmission occurs from person to person. Individuals who have had contact with someone with VRE or with a contaminated object and then have contact with another individual can pass the VRE.

Lab Tests & Specimen Info

Test*	Specimen
Culture	Specimen from any site
Susceptibility testing	Isolate

 Isolation Precautions

Standard and contact precautions are recommended in healthcare settings. 

Prevention for Patients

• Maintain good hand and body hygiene. Wash hands often, and clean body regularly, especially after exercise.
• Keep cuts, scrapes, and wounds clean and covered until healed.
• Avoid sharing personal items such as towels and razors.
• Seek care early if there are signs of infection.

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Typhoid fever is a life-threatening illness caused by the bacterium Salmonella typhi. Salmonella typhi lives only in humans. Persons with typhoid fever carry the bacteria in their bloodstream and intestinal tract. A small number of persons, called carriers, recover from typhoid fever but continue to carry the bacteria. Both ill persons and carriers shed S. typhi in their feces (stool).

Often characterized by:

• insidious onset of sustained fever
• headache
• malaise
• anorexia
• relative bradycardia
• constipation or diarrhea
• nonproductive cough

However, many mild and atypical infections occur.

In Arizona, there is a range of 5 to 15 cases of typhoid fever reported every year. In 2015, all cases had international travel or travel outside of Arizona.

Arizona 5 year median: 7 cases

Transmission

Transmission occurs when an individual consumes water or food that has been contaminated. Transmission through sexual contact, particularly among men who have sex with men, has been rarely documented. Isolation Precautions

Standard precautions are recommended in healthcare settings. 

Prevention for Patients

• If traveling to a country where typhoid is common, consider getting vaccinated against typhoid.
• Avoid eating undercooked or raw meats and seafood and drinking unfiltered or untreated water.

Public Health Actions
Public health will conduct case investigation to determine the source, identify contacts, and transmission setting. 

Cases or contacts should be excluded from working as a food handler, caring for children in or attending a child care establishment, or caring for patients or residents in a healthcare institution. 

Public health will facilitate forwarding specimens to the Arizona State Public Health Laboratory. 

Smileband health topics

Gonorrhea is caused by the bacterium Neisseria gonorrhoeae. It is the second most commonly reported infectious disease in Arizona and the United States.

 

Over the last five years, counts and rates of reported gonococcal infections have significantly increased in the state of Arizona. The number of reported infections increased 133.5% from 3,249 in 2010 to 7,585 in 2014.

 

Transmission

Gonorrhea is transmitted through sexual contact with the penis, vagina, mouth, or anus of an infected partner. Ejaculation does not have to occur for gonorrhea to be transmitted or acquired. Gonorrhea can also be spread perinatally from mother to baby during childbirth.

Lab Tests & Specimen Info

Test*	Specimen
PCR	Genital Swab, Urine
IgG/IgM Serology	Serum, Whole Blood
Culture	Genital Swab, Urine
Gram Stain	Genital Swab

 Isolation Precautions

Infected individuals should be advised to refrain from sexual activity for at least 7 days after being fully treated. 

Standard precautions are recommended in healthcare settings.

Prevention for Patients
There are several ways to prevent sexually transmitted infection:

• Condoms
• Monogamous relationships
• Abstinence

Expedited partner therapy (EPT) is an available option in Arizona in order to treat partners.

Pregnant females should be screened during  Public Health Actions

Public health monitors gonorrhea case counts and trends statewide.  Due to the high morbidity in Arizona, case investigations may only occur in more severe cases (I.e. co-infection or reinfection).

Public Health in Arizona has developed a plan for addressing the possibility of gonorrhea antimicrobial resistance.  Public health recommends following the CDC recommended treatment guidelines to avoid further antimicrobial resistance development.