Dengue fever

DENGUE AND SMOG | Transport DepartmentDengue fever is a mosquito-borne viral infection that can cause flu-like symptoms and, in severe cases, potentially life-threatening complications. It is caused by the dengue virus, which is transmitted to humans primarily through the bite of infected female Aedes mosquitoes, particularly Aedes aegypti and Aedes albopictus. Dengue fever is common in tropical and subtropical regions of the world, including parts of Southeast Asia, the Pacific Islands, the Caribbean, and Central and South America.

Here are some key points about dengue fever:


The symptoms of dengue fever typically appear 4-10 days after being bitten by an infected mosquito and can include high fever, severe headache, pain behind the eyes, joint and muscle pain, rash, and mild bleeding. In some cases, dengue fever can progress to a more severe form known as dengue hemorrhagic fever or dengue shock syndrome, which can be life-threatening.

Dengue fever presents with a wide range of signs and symptoms that can vary in severity. The disease typically has an incubation period of 4-10 days after being bitten by an infected mosquito. The symptoms of dengue fever can be categorized into three phases: the febrile phase, the critical phase, and the recovery phase. Not all individuals with dengue infection will progress through all three phases, and the severity of symptoms can vary from mild to severe. Here are the common signs and symptoms associated with each phase:

  1. Febrile Phase (Acute Phase):

High Fever: Sudden onset of high fever, often reaching up to 104°F (40°C).

Severe Headache: Intense frontal headache, which is a common feature of dengue fever.

Pain Behind the Eyes: Pain or discomfort, especially when moving the eyes.

Joint and Muscle Pain: Severe joint and muscle pain, often referred to as “breakbone fever.”

Rash: A rash may develop, typically starting a few days after the onset of fever. It can be maculopapular (red and raised) and sometimes itchy.

Fatigue: Extreme fatigue and weakness.

Nausea and Vomiting: Some individuals may experience nausea and vomiting.

Mild Bleeding: Minor bleeding manifestations such as nosebleeds, gum bleeding, or easy bruising can occur.

  1. Critical Phase (Warning Signs):

Around the 3-7 day mark, some patients with dengue fever may progress to a critical phase. Warning signs indicate increased severity and the potential for complications. These signs include:

Persistent Abdominal Pain: Severe abdominal pain may develop, which can be a sign of impending complications like dengue hemorrhagic fever.

Vomiting with Blood: Vomiting blood (hematemesis) or passing blood in the stool (melena) can occur.

Bleeding: Severe bleeding, such as from the nose or gums, petechiae (small red or purple spots on the skin), or hematuria (blood in the urine).

Rapid Breathing: Increased respiratory rate and difficulty breathing.

Cold or Clammy Skin: Skin may become cold, pale, or clammy.

Restlessness: Agitation or restlessness may be observed.

  1. Recovery Phase:

After the critical phase, most patients gradually recover over the next few days to weeks.

The fever subsides, and other symptoms begin to improve.

Convalescence: Patients may experience fatigue and weakness during the recovery phase, which can persist for an extended period.

It’s important to note that not all individuals with dengue fever progress to the critical phase or develop severe symptoms. The majority of cases are mild, and with proper medical care and supportive treatment, the prognosis is usually favorable. However, severe dengue (such as dengue hemorrhagic fever or dengue shock syndrome) can be life-threatening and requires immediate medical attention.

If you or someone you know exhibits the warning signs of dengue fever, it’s crucial to seek medical care promptly to prevent complications and ensure appropriate treatment and monitoring.

Diagnosis: Dengue fever is usually diagnosed through blood tests that detect the presence of the dengue virus or antibodies produced in response to the virus.

Laboratory findings play a significant role in the diagnosis and management of dengue fever. The results of various laboratory tests can help confirm the presence of the dengue virus, assess the severity of the infection, and guide treatment decisions. Here are some of the key laboratory findings associated with dengue fever:

Dengue Serology (Antibody Tests):

IgM Antibodies: In the early stages of the illness (usually within the first week), dengue-specific IgM antibodies can be detected in the patient’s blood. The presence of IgM antibodies suggests a recent dengue infection.

IgG Antibodies: Dengue-specific IgG antibodies may appear later and persist for a more extended period. Elevated IgG levels may indicate a past dengue infection.

Polymerase Chain Reaction (PCR) Test:

Dengue PCR: This test detects the genetic material (RNA) of the dengue virus in a patient’s blood. It is most useful in the early days of infection, even before the appearance of IgM antibodies. PCR can help confirm an acute dengue infection and identify the specific serotype of the virus.

Complete Blood Count (CBC):

Platelet Count: One of the hallmark laboratory findings in dengue fever is a decrease in platelet count (thrombocytopenia). Platelets are essential for blood clotting, and low platelet levels can lead to bleeding tendencies.

Hematocrit (Hct) Levels: An elevated hematocrit (a measure of the proportion of red blood cells in the blood) can indicate hemoconcentration, which is common in dengue fever due to plasma leakage.

Liver Function Tests:

AST (Aspartate Aminotransferase) and ALT (Alanine Aminotransferase): Elevated levels of these liver enzymes are often seen in dengue patients, indicating liver involvement.

Coagulation Profile:

PT (Prothrombin Time) and APTT (Activated Partial Thromboplastin Time): These tests assess the blood’s clotting ability. Prolonged PT and APTT may be seen in severe cases of dengue with bleeding tendencies.

Electrolyte Levels:

Sodium (Na) and Potassium (K): Abnormal electrolyte levels can occur due to fluid imbalances in dengue patients, especially those with severe symptoms.

Creatinine and Urea Levels:

Kidney Function Tests: Elevated creatinine and urea levels may indicate kidney involvement in severe dengue cases.

Other Tests:

NS1 Antigen Test: This test can detect the presence of the dengue virus NS1 antigen in a patient’s blood and is useful for early diagnosis.

Dengue Serotyping: In areas with multiple dengue virus serotypes, it’s important to identify the specific serotype causing the infection as some serotypes are associated with more severe disease.

Laboratory findings in dengue fever can vary depending on the stage of the infection and the severity of the disease. These tests help healthcare providers confirm the diagnosis, assess the patient’s condition, and make decisions regarding treatment and monitoring. It’s important to note that dengue fever is a dynamic disease, and laboratory findings may change over the course of the illness, so repeated testing and close monitoring are often necessary, especially in severe cases.


The best way to prevent dengue fever is to avoid mosquito bites. This can be achieved by using insect repellent, wearing long-sleeved clothing, and staying in air-conditioned or screened-in accommodations. Additionally, efforts to reduce mosquito breeding sites, such as eliminating standing water around homes, are essential for dengue prevention.


As of my last knowledge update in September 2021, there was an approved dengue vaccine called Dengvaxia. However, its use and availability varied by country, and it was primarily recommended for individuals who had previously been infected with dengue. Vaccine availability and recommendations may have evolved since then, so it’s essential to check with local health authorities for the most up-to-date information on dengue vaccines.

It’s important to note that dengue fever can be a serious illness, and early detection and medical care are crucial for managing the disease effectively, especially in severe cases. If you suspect you have dengue fever or are in an area where the disease is prevalent, seek medical attention promptly.


There is no specific antiviral treatment for dengue fever. Management primarily involves relieving the symptoms and providing supportive care, such as staying hydrated and taking pain relievers like acetaminophen. Aspirin and non-steroidal anti-inflammatory drugs (NSAIDs) should be avoided because they can increase the risk of bleeding.

The medical and nursing management of dengue fever involves a combination of supportive care and monitoring to alleviate symptoms, prevent complications, and promote recovery. Here’s a comprehensive overview of the medical and nursing management of dengue fever:

Medical Management:

Diagnosis: Accurate diagnosis through clinical evaluation and laboratory tests (serology or PCR) is essential to confirm dengue fever.

Hospitalization: Depending on the severity of the illness, some patients may require hospitalization. Hospitalization is especially crucial for patients with severe dengue or those at risk of complications.

Fluid Replacement: Adequate hydration is a cornerstone of dengue management. Intravenous (IV) fluids are often administered to maintain fluid and electrolyte balance. Nurses closely monitor patients’ fluid intake and output.

Pain and Fever Management: Analgesics such as acetaminophen are given to relieve pain and reduce fever. Non-steroidal anti-inflammatory drugs (NSAIDs) and aspirin should be avoided, as they can increase the risk of bleeding.

Monitoring: Regular monitoring of vital signs, hematocrit levels, platelet counts, and other relevant parameters is crucial to assess the progression of the disease and the patient’s response to treatment.

Blood Transfusion: In severe cases of dengue with hemorrhagic manifestations, blood transfusion may be necessary to replace lost blood components.

Nursing Management:

Assessment: Nurses conduct a thorough assessment of the patient’s clinical status, including vital signs, hydration level, skin condition, and the presence of bleeding or shock symptoms.

Fluid Administration: Nurses administer IV fluids as prescribed by the physician, ensuring that the rate and type of fluid are appropriate for the patient’s condition.

Monitoring: Frequent monitoring of vital signs, especially blood pressure, pulse rate, and respiratory rate, is essential to detect any deterioration in the patient’s condition promptly.

Pain and Fever Control: Nurses administer pain relievers and antipyretics as ordered by the physician and monitor the patient’s response to these medications.

Emotional Support: Providing emotional support and reassurance to the patient and their family is essential, as dengue fever can be a distressing experience.

Education: Nurses educate patients and their families about the importance of hydration, medication compliance, and the signs and symptoms that require immediate medical attention.

Infection Control: Nurses ensure strict infection control measures to prevent the spread of the virus, particularly in healthcare settings. This includes proper hand hygiene and personal protective equipment (PPE) use.

Patient Education: Patients should be educated about the prevention of mosquito bites and the importance of seeking prompt medical care if their condition worsens.

Discharge Planning: When the patient is stable and ready for discharge, nurses provide instructions for continued care at home, including medication schedules and follow-up appointments.

The medical and nursing management of dengue fever should be tailored to the individual patient’s condition and may vary based on the severity of the illness. Close collaboration between healthcare providers, including physicians, nurses, and other healthcare staff, is crucial to ensure optimal patient care and recovery.

Question and Answers about Monkeypox.

What is monkeypox?

The monkeypox virus causes the disease monkeypox. It is a zoonotic viral illness, which means it may pass from animals to people. It may also transmit from humans to humans and from people to the environment.

What are the symptoms of monkeypox?

Monkeypox can produce a variety of symptoms. While some individuals experience milder symptoms, others may develop more serious illnesses and need hospitalisation. Pregnant women, children, and anyone with impaired immune systems are at a greater risk.

During the 2022 epidemic, the most frequent symptoms of monkeypox were fever, headache, muscular pains, back pain, poor energy, and enlarged lymph nodes, followed or accompanied by the formation of a rash that might last two to three weeks. The rash might appear on the face, palms of hands, soles of feet, groyne, genital, and/or anal areas. It may also be discovered in the mouth, throat, anus, or vagina, as well as on the eyes. The number of sores might vary between one and thousands. Sores on the skin begin flat, then fill with fluids before crusting over, drying up, and falling off, leaving a new layer of skin behind.

There are continuing research to monitor and better understand symptoms during this new epidemic, such as which regions of the body may be impacted and how long symptoms may remain.

Anyone experiencing symptoms of monkeypox or who has had contact with someone who has monkeypox should contact or see a health care practitioner for help.

Symptoms normally resolve on their own or with supportive treatment, such as pain or fever medicine. People are contagious until all lesions have crusted over, scabs have dropped off, and a new layer of skin has developed underneath.

Can people get seriously ill or die from monkeypox?

Most people with monkeypox get better on their own after a few weeks. But for some people, an illness can cause health problems or even death. From what we know about past monkeypox cases, we know that newborn babies, children, and people with weakened immune systems may be more likely to have more severe symptoms or even die from monkeypox.

Monkeypox can lead to complications like secondary skin infections, asthma, confusion, and problems with the eyes. Some newer problems are proctitis, which is painful spots and growth inside the rectum, and pain or trouble peeing. People with monkeypox have died between 1% and 10% of the time in the past. It’s important to remember that death rates can be different in different places because of things like how easy it is to get health care. Because monitoring for monkeypox hasn’t been very good in the past, these numbers may be too high.


Some deaths have been reported in the new countries where the latest outbreak is taking place. This shows how important monkeypox is and how people should keep doing everything they can to protect themselves and others.

How is monkeypox transmitted from person to person?

Close contact with someone who has a monkeypox rash distributes the disease from person to person. Face-to-face contact (such as talking, breathing, or singing close to one another, which can generate droplets or short-range aerosols); skin-to-skin contact (such as touching or vaginal/anal sex); mouth-to-mouth contact (such as kissing); or mouth-to-skin contact (such as oral sex or kissing the skin) are all examples of close contact. The processes of monkeypox transmission via the air are not fully known, and research is being conducted to understand more.

We are still learning how long people with monkeypox are infectious, but they are generally considered infectious until all of their sores have crusted over, the scabs have fallen off and a new layer of skin has formed beneath, and all sores on the eyes and in the body (in the mouth, throat, eyes, vagina, and anus) have healed as well.

When an infected individual touches clothes, bedding, towels, items, devices, or surfaces, the environment might become contaminated with the monkeypox virus. If anybody else touches these goods and has any scrapes or abrasions, or if they accidently contact their eyes, nose, mouth, or other mucous membranes, they may get infected. This is referred to as fomite transmission. Cleaning your hands after contacting potentially infected things may help avoid this form of transfer. Infection may also occur via inhaling skin flakes or viruses from clothes, beds, or towels. Experts are still attempting to figure out if this mechanism of transmission is important in the current epidemic.

The virus may also be transmitted to the foetus during pregnancy, during or after delivery by skin-to-skin contact, or from a parent infected with monkeypox to an infant or kid through intimate contact.

Although asymptomatic infection has been documented, it is unclear if persons who are asymptomatic may transmit the illness or whether the disease can spread via other body fluids. Although a live monkeypox virus has been isolated from sperm, it is unknown if infection may transmit through sperm, vaginal fluids, prenatal fluids, lactation, or blood. More research is being conducted to determine whether or not persons may transmit monkeypox via the sharing of these fluids during and after symptomatic illness.


How is monkeypox transmitted from animals to humans?

Monkeypox can be transmitted to humans through physical contact with an infected animal, such as a non-human primate, terrestrial rodent, antelope, gazelle, or tree squirrel, such as through bites or scratches, or through activities such as hunting, skinning, trapping, cooking, or playing with carcasses. The virus may also be acquired by consuming contaminated animals that have not been completely cooked. Avoiding unprotected contact with wild animals, particularly those that are ill or dead (including their flesh and blood), may lower the chance of contracting monkeypox from them. Any items including animal parts or meat should be fully prepared before consuming in regions where animals spread monkeypox.

Can monkeypox spread from humans to animals?

Monkeypox transmission from people to pets (dogs) is now being explored. Together with our One Health partners, the Food and Agriculture Organisation (FAO) and the World Organisation for Animal Health (WOAH), we are actively watching these developments and considering how to alter our outbreak response and advice if necessary.

Because many animal species are known to be vulnerable to the monkeypox virus, there is the possibility of viral spillover from humans to susceptible animal species in diverse situations, potentially leading to the establishment of new animal reservoirs.

People with monkeypox should avoid close physical contact with animals, including pets (such as cats, dogs, hamsters, gerbils, and so on), livestock, and wildlife.


Who is at risk of catching monkeypox?

People who live with or have close relationships (including sexual contact) with someone infected with monkeypox are the most vulnerable. Anyone who lives with someone who has monkeypox should take precautions to avoid being infected. A person with monkeypox should be evaluated by a health care practitioner to see whether they are healthy enough to be cared for at home and if isolation can be handled safely at home. To protect oneself when caring for monkeypox patients, health staff should practise infection prevention and control methods. Newborn newborns, young children, and persons with underlying immune weaknesses are at a greater risk of developing more severe symptoms, and in rare circumstances, dying from monkeypox. Pregnancy may also raise one’s chances of having a miscarriage or stillbirth.

People who were immunised against smallpox may be immune to monkeypox. Younger individuals, on the other hand, are unlikely to have had smallpox vaccine since the illness was eliminated in most settings worldwide in 1980. People who have received a smallpox vaccination should continue to take steps to protect themselves and others.

What can I do to protect myself and others against monkeypox?

In places where monkeypox is present, avoid unprotected contact with wild animals, particularly those that are ill or dead (including their flesh and blood). Any items containing animal parts or meat should be fully prepared before consumption.

Limit your contact with persons who have suspected or confirmed monkeypox to reduce your chance of contracting it from them. Maintain awareness of monkeypox in your community or social group, and have open dialogues with individuals with whom you have close contact (particularly sexual contact) about any symptoms you or they may be experiencing. Hands should be washed often with soap and water or an alcohol-based hand massage.

Clean and disinfect frequently touched surfaces in locations that might have been contaminated with the virus from an infected person.  The monkeypox virus may be killed with common home disinfectants or bleach solutions.

If you suspect you have monkeypox, get medical attention and isolate yourself from others until you have been assessed and tested. If you have monkeypox, you should separate yourself from people until all of your wounds have crusted over, the scabs have come off and a new layer of skin has grown underneath, and all of your internal sores have healed. This will prevent you from spreading the infection to others. Consult your health care provider about whether you should isolate at home or at a health institution. Use condoms as a precaution when having sexual contact for 12 weeks after you have recovered until more is known regarding transmission via sexual fluids.


Can I get monkeypox from touching things and surfaces in public?

Previous monkeypox outbreaks have shown that getting monkeypox after contacting infected materials is possible. If an infected person touches an object, surface, or fabric, it might get contaminated with the monkeypox virus. In some settings, the virus has been discovered to live on various surfaces for some time. However, in this epidemic, researchers are currently investigating whether humans may get monkeypox through contacting surfaces and objects.  Currently, practically all instances are connected to close contact, such as touching or intercourse.

To destroy the monkeypox virus, clean objects and surfaces with soap and water, basic home disinfectants, or a bleach product.

What should I do if I have signs of monkeypox or have been around someone who has it?

If you have had close contact with someone who has monkeypox or have been in an area that may have been contaminated with the virus, keep a watchful eye out for signs and symptoms for 21 days following your last exposure. Limit your close contact with other people as much as possible, and let your contacts know if it is unavoidable that you have been exposed to monkeypox.

If you suspect you have monkeypox, contact your healthcare professional for guidance, testing, and medical treatment. Isolate yourself from people as much as possible until you get your test results. Hands should be cleaned on a regular basis.

If you test positive for monkeypox, your doctor will tell you whether you should isolate at home or in a hospital, as well as what kind of treatment you need.

If I have monkeypox, what should I do to protect other people from getting infected?

If you have monkeypox, your doctor will tell you whether you should be treated in a hospital or at home. This will depend on the severity of your symptoms, whether you have risk factors that put you at risk for more severe symptoms, and if you can reduce your chances of infecting everyone you live with.

You should not go out if it is recommended that you isolate at home. Protect those with whom you live as much as possible by:

  • Inviting friends and relatives to assist you by providing items you need
  • Isolating yourself in a different room
  • Having a separate loo or washing after each use
  • Using soap and water and a home disinfectant, clean and disinfect regularly touched surfaces.
  • Avoid cleaning or vacuuming (this may dislodge virus particles and infect others).
  • Before sharing, use separate utensils, items, and devices, or thoroughly clean with soap and water/disinfectant.
  • There will be no sharing of towels, beds, or clothing.
  • Doing your own laundry (carefully lifting bedding, shirts, and towels without shaking them, placing them in a plastic bag before transporting them to the washing machine, and washing them in hot water > 60 degrees)
  • Ventilation may be improved by opening windows.
  • Encourage everyone in the family to wash their hands with soap and water or an alcohol-based hand sanitizer on a frequent basis.


If you can’t avoid being in the same room as someone else or having close contact with another person while isolating yourself at home, try to decrease their danger by:

  • Avoiding physical contact
  • Hands should be washed often with soap and water or an alcohol-based hand sanitizer.
  • Covering your rash with clothes or bandages (until you can isolate again – your rash heals quickest when left alone)
  • Leaving windows open around the house
  • Ensure that you and everyone else in the room are wearing properly fitted medical masks.
  • Keeping at least one metre apart from others
  • If you are unable to wash your own laundry and require someone to assist you, they should wear a well-fitting medical mask, disposable gloves, and follow the laundry procedures specified above.

Is there a vaccine against monkeypox?

Yes. There are three vaccinations available to protect against monkeypox. Despite the fact that supplies are now limited, get vaccinated if provided since they provide a vital degree of protection against the illness. After being vaccinated, continue to take precautions to avoid catching and spreading monkeypox; this is because immunity takes several weeks to develop after vaccination, and we don’t yet know how well the vaccines protect you or prevent you from infecting others, as efficacy data in this outbreak setting is needed.

Vaccination is recommended in several nations for those who are at risk. Many years of study have resulted in the creation of improved and safer vaccinations for smallpox, which may also be effective for monkeypox. Two of them (MVA-BN and LC16) have been licenced for monkeypox prophylaxis. Only those who are at risk (for example, someone who has had intimate contact with someone who has monkeypox) should be vaccinated. At this time, mass immunisation is not advised.

While the smallpox vaccination has previously been found to be protective against monkeypox, current evidence on the efficacy of newer smallpox/monkeypox vaccines in the prevention of monkeypox in clinical practise and in field settings is sparse. The study of the usage of monkeypox vaccinations wherever they are used will allow for the quick collection of more information on the efficiency of these vaccines in various circumstances.

How should someone take care of themselves if they have monkeypox? What care do they need?

The care someone need will be determined by their symptoms and their risk of developing a more serious condition. People who have monkeypox should listen to their doctor’s recommendations.  Symptoms often last two to three weeks and resolve on their own or with supportive treatment, such as pain or fever medication (such as analgesics and antipyretics).

It is critical for anybody suffering with monkeypox to remain hydrated, eat properly, and get enough sleep. People who are self-isolating should take care of their mental health by doing things they find relaxing and enjoyable, staying connected to loved ones through technology, exercising if they feel well enough and can do so while isolating, and seeking mental health support if necessary.

People suffering from monkeypox should avoid scratching their skin and take care of their rash by washing their hands before and after touching sores and keeping their skin dry and uncovered (unless they are forced to share a room with someone else, in which case they should cover it with clothing or a bandage until they can isolate again). The rash may be cleaned with sterile water or an antiseptic. Saltwater rinses may aid with mouth sores, while warm baths with baking soda and Epsom salts can help with body sores. If necessary, paracetamol may be given to assist control the discomfort produced by sores. A health expert should be consulted if greater pain medication is required.

Many years of study on smallpox therapies have resulted in the discovery of medications that may also be beneficial for treating monkeypox.  The European Medicines Agency authorised tecovirimat, an antiviral intended to treat smallpox, for the treatment of monkeypox in exceptional circumstances in January 2022. There has been little experience with these therapies in the setting of a monkeypox epidemic. As a result, their usage is often accompanied by enrollment in a clinical trial or extended access protocol, as well as the gathering of data that will increase understanding on how to effectively utilise them in the future.

Where in the world is there currently a risk of monkeypox?

A multi-country monkeypox epidemic is presently happening throughout Europe, the Americas, Africa, the Western Pacific, Eastern Mediterranean nations, and South East Asia, where the virus has not before been identified. More cases than usual have been documented in 2022 in previously reported areas of Africa, including Nigeria, the Democratic Republic of the Congo, and the Central African Republic. WHO is collaborating with all impacted countries to improve monitoring and give guidelines on how to contain the outbreak and care for patients.

Monkeypox has been documented in various African nations prior to the pandemic. Cameroon, Central African Republic, Republic of the Congo, Côte d’Ivoire, Democratic Republic of the Congo, Gabon, Liberia, Nigeria, and Sierra Leone are among them. Some of these nations experienced just a few instances, while others had continuous or recurring epidemics. Travel from Nigeria has been related to a few instances in other countries. The current epidemic, which is hitting many nations at the same time, is unlike earlier outbreaks.

Is there a risk of this becoming the next pandemic?

Monkeypox is not as infectious as other viruses because it needs intimate contact (e.g., face-to-face, skin-to-skin, mouth-to-skin, or mouth-to-mouth), a contaminated environment, or an infected animal to spread. We have a window of opportunity to stem the spread of this epidemic by collaborating closely with communities and groups at greater risk. It is critical that everyone work together immediately to limit the spread by understanding their risk and taking measures to reduce it. In July, the Director General of WHO declared the monkeypox epidemic a public health emergency of worldwide concern and issued Temporary Recommendations to assist nations in combating and controlling the outbreak.

To prevent future spread, WHO is reacting to this epidemic as a top priority. WHO is focused on learning more about how the virus is spreading during this epidemic and preventing additional individuals from being sick. Raising awareness about this new condition will aid in the prevention of future spread.

What do we know about monkeypox and sex?

Monkeypox may be transmitted by any kind of intimate contact, including kissing, touching, oral and penetrative vaginal or anal intercourse with an infected person.  People who have sex with several or new partners are more vulnerable. Although the monkeypox virus has been discovered in sperm, it is still unknown if monkeypox may be transmitted by sperm or vaginal secretions.

If you are having sex, check yourself for symptoms on a frequent basis and advise your partners to do the same. Anyone who develops new or unusual rashes or sores should avoid having sex or other close contact with other people until they have been tested for sexually transmitted diseases (STIs) and monkeypox. Remember that the rash may appear in regions that are difficult to view within the body, such as the mouth, throat, genitals, vagina, and anus/anal area.

Consider decreasing your number of sexual partners to lower your chance of monkeypox. You could wait a while before having sex with new people, or you could stop having sex until the outbreak is under control or until you can get vaccinated (and even then, it’s best to limit your number of partners because no vaccine provides 100% protection and you could still pass the virus on to others). Keep in mind that immunisations take many weeks to work.

If you’re having sex, have open, nonjudgmental talks with your partner or partners and exchange contact information so you may notify each other if you develop symptoms, even if you don’t intend to see each other again.

Wearing a condom will not completely prevent you from monkeypox, but it will minimise your risk or level of exposure and will also protect you and others from a variety of other STIs. People with monkeypox are recommended to wear condoms for 12 weeks following recovery until more is known about virus levels and possible infectivity in sperm during this time.

The virus spreads not just via sexual intercourse, but also through any sort of intimate contact with an infected person. Persons living in the same home are more vulnerable. Anyone experiencing signs of monkeypox should seek medical attention right once.

Are men who have sex with men at higher risk of catching monkeypox?

The danger of monkeypox is not confined to sexually active persons or men who have sex with males. Anyone in close touch with someone suffering from symptoms is at danger. However, the majority of the cases reported in the current epidemic have been detected in males who have intercourse with men.  Given that the virus is now spreading from person to person in these social networks, males who have sex with men may be more vulnerable to infection if they have intercourse or other intimate contact with someone who is contagious. People who have several or new sexual partners are the most vulnerable right now.

Monkeypox cases have been detected in sexual health clinics. One reason we’re getting more reports of monkeypox cases among communities of guys who have sex with males is that this demographic group is more health-conscious. Monkeypox rashes may mimic those of sexually transmitted illnesses such as herpes and syphilis, which may explain why these cases are being reported to sexual health clinics. We may find additional examples in the larger community as we learn more. Monkeypox has been discovered in some mothers and children.

Raising awareness among homosexual, bisexual, and other men who have sex with men is critical to protecting those most vulnerable. If you have intercourse with other males, be aware of your risk and take precautions to protect yourself and others. Anyone experiencing symptoms suggestive of monkeypox should seek medical attention promptly to be diagnosed and treated.

What is WHO’s response to stigma and discrimination related to monkeypox?

We’ve witnessed prejudice and messages stigmatising specific categories of individuals in the aftermath of the monkeypox epidemic. We want to make it quite clear that this is not acceptable. This epidemic response should be carried out in accordance with long-standing ideals of human rights, inclusivity, and the dignity of all persons and communities.

Anyone who comes into close personal contact with someone who has monkeypox, regardless of who they are, what they do, who they have sex with, or any other circumstance, is at danger. It is wrong to stigmatise somebody because of a sickness or condition. Stigma is simply going to make things worse and prevent us from stopping this pandemic as soon as possible. We must all work together to support anybody who has been infected or who is assisting in the care of those who are ill. We understand how to halt the spread of this illness and how we can all safeguard ourselves and others. Stigma and prejudice are never acceptable, and they are more so in the context of this epidemic. We’re in this together.

Is my risk of becoming infected, developing serious symptoms or dying from monkeypox higher if I am living with HIV?

Anyone who comes into touch with someone who has monkeypox is at danger of getting it.

HIV may impair your immune system if left untreated. There is some evidence that being immunocompromised may raise your chances of being infected and developing severe disease or dying from monkeypox if you are exposed. More evidence, however, is required to properly comprehend this.

People with preexisting immunological weaknesses may be more vulnerable to monkeypox. People living with HIV who are aware of their status, have access to, and utilise, medication, may achieve viral suppression. This implies that their immune systems are less susceptible to other illnesses than they would be if they were not receiving therapy. Many persons with monkeypox in the present epidemic also had HIV, but there have been very few severe instances of monkeypox, most likely because their HIV infection was well-controlled in the majority of cases. Studies are being conducted to have a better understanding of these issues.

People who have multiple sexual partners, including those living with HIV, are encouraged to take precautions to reduce their risk of exposure to monkeypox by avoiding close contact with anyone who has symptoms and avoiding high-risk situations where multiple contacts may occur, even with people who are unaware they have monkeypox. Having fewer sexual partners may lessen your risk.


Can children get monkeypox?

Children may get monkeypox if they come into touch with someone who is ill.  According to data from previously impacted nations, children are more susceptible to serious sickness than adolescents and adults.  There have been a few cases of monkeypox among youngsters in the current epidemic. Some children have been exposed to the virus at home via close contact with parents, carers, or other family members. Other children are teens who have had sexual relations with someone infected with monkeypox.

What should I do if a child in my care has symptoms that could be monkeypox?

At first glance, the monkeypox rash resembles other common children diseases such as chickenpox and other viral infections. Consult a healthcare practitioner if a kid you are caring for exhibits signs of monkeypox. They will assist them in getting tested and receiving the necessary treatment.

Children may be more vulnerable to severe monkeypox than adults. They should be constantly watched until they have healed in case they need further treatment. A health professional in charge of the kid may recommend that they be cared for at a health institution. In this case, a healthy parent or carer who is at low risk of monkeypox will be permitted to isolate with them.

What are the risks of monkeypox during pregnancy?

More study is required to better understand the hazards of monkeypox during pregnancy, as well as how the virus may be transmitted to the foetus in the womb, the baby during or after delivery, or during nursing. According to available evidence, acquiring monkeypox during pregnancy may be harmful to the foetus.

Avoid close contact with somebody who has monkeypox if you are pregnant. Anyone who comes into touch with an infected person, regardless of age, may get monkeypox.

Contact your healthcare practitioner if you believe you have been exposed to or are experiencing symptoms of monkeypox. They will assist you in getting tested and receiving the necessary treatment.


Can I continue to breastfeed if I have been diagnosed with monkeypox?

If you have confirmed or suspected monkeypox and are nursing, get guidance from your healthcare professional. They will analyse the danger of spreading monkeypox as well as the risk of depriving your child of nursing. If you can continue to breastfeed and have close contact, they will advise you on how to limit the risk by taking precautions such as covering your sores and wearing a mask to reduce the danger of viral transmission. The danger of infection must be carefully evaluated against the possible damage and suffering caused by discontinuing nursing and close parental-child interaction. It is unknown if the monkeypox virus may be passed from parent to kid via breastfeeding; additional research is needed in this area.

Why is this disease called ‘monkeypox’?

The illness is known as monkeypox because it was discovered in 1958 in study colonies of monkeys. It was only in 1970 that it was discovered in humans. Experts are being consulted on whether the illness should be renamed.

Can the monkeypox virus be spread through a blood transfusion?

You should never give blood if you are sick. If you have a blood donation appointment, examine your health and monitor any signs of monkeypox, and postpone if you don’t feel well.

When individuals may donate blood, severe processes are in place. The potential donor is questioned about their present state of health and any symptoms they are experiencing. This is done to limit the possibility of someone with an infectious illness donating blood.

There have been no cases of monkeypox being transmitted via blood transfusions.

Does past exposure to chickenpox provide any protection against monkeypox?

A separate virus (the varicella virus) causes chickenpox. Past chickenpox exposure does not protect against monkeypox (produced by the monkeypox virus, an orthopoxvirus).

Is there a test to check whether I have had monkeypox in the past?

There are tests available to determine if you have antibodies to orthopoxviruses (the viral family to which monkeypox belongs). These tests may assist determine if you had previously been immunised against smallpox or monkeypox or exposed to an orthopoxvirus. However, the tests cannot tell you if you were exposed to a vaccination, the monkeypox virus, or another orthopoxvirus in the past. As a result, antibody tests are seldom utilised to screen for prior monkeypox exposure or to diagnose a suspected new disease.

I’ve had monkeypox in the past. Can I catch it again?

Our knowledge of how long immunity lasts after monkeypox infection is still limited. We don’t know if a past monkeypox infection provides protection against subsequent infections, and if so, for how long. There have been rare reports of second infections. Even if you have previously had monkeypox, you should take every precaution to prevent being infected again.

If you have had monkeypox in the past and someone in your home now has it, you may protect others by being the designated carer, since you are more likely to be immune than others. You should, however, take all care to prevent being infected.

Are people who are immunosuppressed at higher risk of developing severe mpox?

Immunocompromised patients, notably those with untreated HIV and advanced HIV illness, seem to be at a greater risk of getting severe mpox and dying. Larger, more extensive lesions (particularly in the mouth, eyes, and genitals), secondary bacterial infections of the skin or blood, and lung infections are all symptoms of severe mpox. The statistics reveal that persons with significant immunosuppression (CD4 count fewer than 200 cells/mm3) had the worst symptoms.

People living with HIV who achieve viral suppression by antiretroviral therapy have no increased risk of severe mpox. In the event of infection, effective HIV therapy lowers the likelihood of developing severe mpox symptoms. People who are sexually active and do not know their HIV status should be tested for HIV if it is accessible. HIV-positive people who are receiving effective treatment have the same life expectancy as HIV-negative people. More information may be obtained from your health care provider.

Severe mpox instances in certain countries underscore the critical need to expand equitable access to mpox vaccinations and medicines, as well as HIV prevention, testing, and treatment. Most impacted groups will be left without the tools they need to preserve their sexual health and well-being if this does not happen.

If you have mpox symptoms or believe you may have been exposed, contact your health care provider to get tested for mpox and obtain the information you need to lower your risk of developing more severe symptoms.

Monkeypox (Mpox)

Key facts

  • Mpox, also called “monkeypox,” is a disease caused by a virus called the monkeypox virus, which is a species of the genus Orthopoxvirus. There are two different clades: clade I and clade II.
  • Common symptoms of Monkeypox include a skin rash or mucosal lesions that can last 2–4 weeks, along with fever, headache, muscle aches, back pain, low energy, and swollen lymph nodes.
  • Monkeypox can be passed to humans through direct contact with an infected person, contaminated materials, or infected animals.
  • PCR tests of skin lesions can be used to prove Monkeypox in the lab.
  • Supportive care is used to treat mumps. Some vaccines and treatments for smallpox that have been cleared for use in some countries can also be used for Monkeypox.
  • In 2022–2023, a type called clade IIb spread Monkeypox all over the world.
  • You can avoid getting Monkeypox by staying away from people who have it. Vaccinations can help keep people who are at risk from getting sick.


Mpox, also called “monkeypox,” is a condition spread by the monkeypox virus. It may cause you a fever, a painful rash, and swollen lymph nodes. The majority of people get better, but some get very sick.

Anyone can get Monkeypox. It spreads through touch with people who have it:

  • Individuals, through touch, kissing, or sex;
  • Animals, when shooting, skinning, or cooking them;
  • Materials, such as dirty sheets, clothes, or needles;
  • Pregnant individuals, who may pass the virus on to their developing child.

If you have Monkeypox:

  • Tell anyone you’ve been close to recently
  • Stay at home until all the scabs fall off and a new layer of skin forms
  • Cover the sores and wear a mask when you’re around other people.
  • Don’t touch anyone.

The monkeypox virus, also known as MPXV, is what causes Monkeypox, which used to be called monkeypox. MPXV is an enveloped double-stranded DNA virus of the Orthopoxvirus genus in the Poxviridae family. Other viruses in this family include variola, cowpox, vaccinia, and others. Clades I and II are the two groups of genes that make up the virus.

The monkeypox virus was first found in 1958 in monkeys kept for study in Denmark. In 1970, a nine-month-old boy in the Democratic Republic of the Congo (DRC) was the first person to be diagnosed with monkeypox. Mumps can be passed from person to person and sometimes from animals to people. After smallpox was wiped out in 1980 and vaccinations against it were stopped everywhere, Monkeypox slowly spread through central, east, and west Africa. In 2022 and 2023, there was a worldwide spread. No one knows where the virus comes from in nature, but small animals like squirrels and monkeys can get it.


Person-to-person transmission of Monkeypox can happen through direct contact with infected skin or other lesions, like those in the mouth or genitals. This includes

  • face-to-face contact (talking or breathing),
  • skin-to-skin contact (touching or vaginal/anal sex),
  • mouth-to-mouth contact (kissing), and
  • mouth-to-skin contact (oral sex or kissing the skin).
  • breathing drops or short-range fumes from close touch for a long time

The virus then gets into the body through broken skin, mucous areas (like the mouth, throat, eyes, genitalia, and urethra), or the breathing system. Mumps can spread to other people in the same house and to people who have sex. People who have more than one sexual partner are more likely to get sick.

People can get Monkeypox from animals when they bite or scratch them, or when they hunt, skin, trap, cook, play with dead animals, or eat them. We don’t know everything about how viruses spread through animal groups, and more research is being done.

People can get Monkeypox from infected items like clothes or sheets, from sharps injuries in health care, or in public places like tattoo parlours.

Signs and symptoms

Monkeypox causes signs and symptoms that usually start within a week, but can start anywhere from 1 to 21 days after contact. Symptoms usually last between two and four weeks, but someone with a weak immune system may have them for longer.

Common symptoms of Monkeypox are:

  • rash
  • fever
  • sore throat
  • headache
  • muscle aches
  • back pain
  • low energy
  • swollen lymph nodes.

For some people, the first sign of Monkeypox is a rash. For others, the first sign may be something else.

The rash starts out as a flat sore that turns into a blister filled with fluid. The blister may itch or hurt. As the rash gets better, the sores dry out, harden, and fall off.

Some people have one or two skin blemishes, while others have hundreds or even thousands. These can appear anywhere on the body such as the:

  • palms of hands and soles of feet
  • face, mouth and throat
  • groin and genital areas
  • anus.

Some people also have painful swelling of their rectum, or they have pain and trouble going to the toilet.

People with monkeypox are contagious and can give the disease to others until all the sores have healed and a new layer of skin has grown.

People with weak immune systems, children, and pregnant women are more likely to get sick from monkeypox.

Most of the time, heat, aches in the muscles, and a sore throat are the first signs of monkeypox. The rash of monkeypox starts on the face and moves to the rest of the body, including the palms and soles of the feet and hands. It happens in stages over 2 to 4 weeks: macules, papules, vesicles, and pustules. Lesions have a depression in the middle before they crust over. Then, the scabs fall off. Monkeypox often causes lymphadenopathy, which means that the lymph nodes swell up. Some people can be sick but not show any signs of illness.

In the setting of the worldwide spread of monkeypox that started in 2022 and was mostly caused by the Clade IIb virus, some people get sick in different ways. A rash can show up before or at the same time as other symptoms in just over half of cases, and it doesn’t always spread all over the body. The first spot can be in or around the mouth, in the groyne, or in the anus.

When someone has monkeypox, they can get very sick. For example, germs can get into the skin and cause sores or major damage to the skin. Other complications include pneumonia, an infection of the cornea that causes blindness, pain or trouble swallowing, vomiting and diarrhoea that cause severe dehydration or malnutrition, sepsis, inflammation of the brain (encephalitis), heart (myocarditis), rectum (proctitis), genital organs (balanitis), or urinary passages (urethritis), or death. Monkeypox is more likely to cause major illness or death in people whose immune systems are weak because of medicine or a medical condition. People whose HIV is not well controlled or handled are more likely to get very sick.


Monkeypox can be hard to spot because it looks like other illnesses and diseases. It is important to tell the difference between monkeypox and chickenpox, measles, bacterial skin infections, lice, herpes, syphilis, and other sexually transmitted diseases, as well as allergies caused by medications. Someone with monkeypox might also have an illness that can be spread sexually, like herpes. On the other hand, a child who might have monkeypox could also have chickenpox. Because of these things, testing is important so that people can get care as soon as possible and the disease doesn’t spread further.

The best lab test for Monkeypox is polymerase chain reaction (PCR), which looks for virus DNA. The best diagnostic samples come from the rash itself—skin, fluid, or crusts—and are taken by swabbing it hard. If there are no skin sores, tests can be done with swabs from the oropharynx, the anus, or the pelvic area. It is not a good idea to test blood. Methods for finding antibodies may not be useful because they can’t tell the difference between different orthopoxviruses.

Treatment and vaccination

The goal of treating monkeypox is to get rid of the rash, ease the pain, and keep other problems from happening. It’s important to get care early and in a helpful way to help handle symptoms and keep problems from getting worse.

Getting a vaccine against monkeypox can help keep you from getting sick. The vaccine should be given within 4 days of coming into touch with someone who has monkeypox, or within 14 days if there are no signs.

People who are at a high risk of getting Monkeypox should get vaccine, especially when there is an outbreak. This includes:

  • health workers at risk of exposure
  • men who have sex with men
  • people with multiple sex partners
  • sex workers.

People who have monkeypox should be cared for away from other people.

Tecovirimat and other antivirals that were made to treat smallpox have been used to treat monkeypox, and more research is being done. There is more information about monkeypox vaccinations and how to treat cases.

Self-care and prevention

Most people get better in 2–4 weeks after getting monkeypox. Things you can do to ease the symptoms and keep from spreading the illness:


  • If you can, stay home and in your own room.
  • Wash your hands often with soap and water or hand sanitizer, especially before or after touching sores.
  • Wear a mask and cover sores when you’re around other people until your rash heals.
  • Keep skin dry and covered (unless you’re in a room with someone else);
  • Don’t touch things in shared spaces and clean them often;
  • Rinse mouth sores with saltwater;
  • Soothe body sores with sitz baths, warm baths with baking soda or Epsom salts;
  • Take painkillers like paracetamol (acetaminophen) or ibuprofen.

Do not

  • pop blisters or scratch sores, which can slow healing, spread the rash to other parts of the body, and cause sores to get sick; or
  • shave areas with sores until scabs have healed and new skin is showing (this can spread the rash to other parts of the body).

To prevent Monkeypox from spreading to other people, those who have it should stay at home or, if necessary, in the hospital for as long as they are contagious (from the start of symptoms until sores have healed and scabs fall off). Covering the sores and wearing a medical mask when around other people may help stop the disease from spreading. Using a condom when you have sex will lower your chance of getting monkeypox, but it won’t stop the virus from spreading through skin-to-skin or mouth-to-skin contact.

Source: WHO

Sun causes wrinkles, dark circles and fine lines on the face: How to prevent skin aging?

A long time ago, the lyrics of an Indian film song caught my ears, which went something like this: ‘Dhoop mein nikla na karo roop ki rani, gora rang kala na pad jaye’.

Despite having no attachment to these lyrics, even fair-skinned people like me must have at least learned in this age of childhood ignorance that exposure to strong sunlight damages our skin’s natural color.

The glory of the memory of this song comes to an end. In the year 2023, spring spread its pleasant colors in most parts of Pakistan, but from the beginning of April, it started to feel as if the sun has come to our senses this time.

On the one hand, when everyone outside seems to seek shade from time to time to avoid the heat of the sun, many people, including me, are experimenting with possible ways to protect themselves from this skin-burning sun.

However, while the sun has many benefits, it also has some disadvantages, especially with regard to skin problems.

According to experts, while the gentle rays of the sun in the morning are said to be helpful for obtaining vitamin D, the sun from 11 am to 3 pm is at its peak, and during this time, going out without any protective measures is harmful to the skin. Can be quite harmful.

So, with the changing of the season, what should be done to protect the skin to avoid the harmful effects of the hot sun, which can give glow (shine and freshness) to our skin in every season, including the heat, to know different skin specialists (specialists in diseases) Soon) we spoke to.

Sunblock is as important in winter as it is in summer. ‘

Dr. Maria Syed, Skin Specialist (Dermatologist) at Shifa International Hospital Islamabad, was the first to tell that whether the weather is cloudy or sunny, UV (ultraviolet rays) from the sun are harmful to our skin. Sun block must be applied for protection.

However, the most immediate sun damage depends on your skin tone. The effects of sun damage on the skin are long-lasting and ‘ageing’ occurs with the appearance of wrinkles, fine lines and wrinkles.

According to Dr Maria, ‘darker or tanned complexions are protected from immediate sun damage, while fair-toned sun damage is more immediate and more severe, with skin tanning first. So first of all the color on it gets a little bad and starts getting tanned. According to Dr. Maria, ‘If we talk about our skin, applying sun protection is very important to avoid the effects of aging.’

Before proceeding, let me remind you that there are three types of UV (ultraviolet rays) in sunlight.۔

  • UVA (UVA) is based on many of the ultraviolet rays that reach the Earth’s surface. Due to its ability to penetrate the skin, it is responsible for 80% of skin aging, from wrinkles to facial blemishes.
  • UVB can damage the DNA in our skin, leading to sunburn and eventually cancer.
  • UVC is very effective at destroying genetic material, but ozone in the atmosphere filters it before it reaches Earth and penetrates our delicate skin.

In this regard, Dr. Maria said that UVA affects the upper skin of the skin, it will tan the skin and create shadows, while UVB radiation also affects the inner layer of the skin and goes to the dermis and destroys collagen. Affects and ages.

Dr. Armila Javed is a skin specialist as well as a cosmetologist. She also recommends regular use of sunblock to avoid the harmful effects of the sun.

The use of sun block is very important to protect the skin. Especially in areas where the sun’s rays are very strong and you spend most of your time outside, the use of sunblock becomes very important.

The use of sunblock protects from the rays of the sun that can cause skin cancer. Apart from this, sunblock also protects against ultraviolet rays, which cause dark spots, wrinkles and dark spots on the skin. These rays of the sun aggravate eczema in many people and bring out various problems including skin inflammation in some.

“Lotion for dry skin and gel and cream sunblock for oily skin”

  • To avoid the harmful rays of the sun, experts are calling the use of sun block necessary, but it is also important to understand how to apply it.
  • Not only this, but the different SPFs written on the sunblock also confuse the general public as to which subblock is suitable for them.
  • According to Dr Maria, SPF stands for Sun Protecting Factor and applying sunblock once in the morning and once in the afternoon can provide good protection.
  • According to Dr. Maria
  • For people who have any serious skin disease, their SPF will be recommended by their doctor, but for those who do not have any skin disease and want to avoid sun rays, SPF 30 to 50. Enough is enough.
  • Those with dry skin should apply sunblock available in the form of a lotion, otherwise the sunblock available in the form of a cream will stick to their skin and look ugly.
  • Some sunblocks are labeled as sebum control, so they are meant for oily or oily skin. Mainly it also controls oil and acne.
  • Both cream and gel sun block can be applied for combination or normal skin.
  • For better protection, reapply sunblock every two to three hours to provide good protection.۔

Avoid sun stress by using an umbrella, hat or p-cap and sunglasses

  • We have known and understood the use of sun block and its benefits, but despite this, many people are not able to apply sun block habitually.
  • It should be remembered that the sun does not harm our skin in one day, but when the skin is affected by the sun from childhood, the problem of aging or pigmentation starts appearing in youth.
  • For such people, experts say that while taking care of our health, we have to change our lifestyle to avoid the harmful effects of the sun.
  • According to Dr. Urmila:
  • ‘Avoid going out unnecessarily when the sun is hot.’
  • Cover yourself with a cotton or muslin cloth when going out. If you have taken a dupatta, cover your face with it or shade it.
  • “Using an umbrella is an easy way to minimize the negative or harmful effects of the sun.”
  • Children or young people who ride a bicycle or bike should wear a cap while in the sun. Even in the case of a helmet, the face is protected from the sun, but if you apply sunblock before that, you can get additional protection.
  • “Pedestrians should also wear a hat or p-cap as it can provide shade.”
  • Those mothers who go to pick up or drop their children from school should not only take an umbrella themselves, but also make the children accustomed to take an umbrella from childhood. ‘

Dr. Maria also shared some tips to avoid harmful effects of sun. According to them

  • “Wearing sunglasses while in the sun helps prevent the stress of the sun, including tightening of the skin around the forehead and around the eyes.”
    Always wear gloves while driving and apply shades on the glasses to protect yourself from the sun and its effects.
    Those who are unable to apply sunblock should at least apply a moisturizer to provide some sun protection. The more raw the skin, the more direct the sun’s rays will affect us۔

Dr. Maria says, “When the sun rays don’t reach us directly, we don’t feel so tired on our skin.”

Aloe vera gel is better for skin but not a substitute for sunblock.

Among the remedies available for many skin problems, aloe vera gel is considered an elixir. And it has been used since ancient times to protect skin and hair. However, can it be a substitute for sunblock? In response to this question, Dr. Maria said that aloe vera gel is not a substitute for sun block.

Elvera gel keeps the skin healthy, but this gel cannot act as a sunblock. It is better to apply aloe vera directly from the plant than its gel formula which is available in the market.

Dr. Urmila says that aloe vera contains natural ingredients that are good for skin and hair alike. According to him, its gel is also helpful in reducing the harmful effects of the harmful rays of the sun, but instead of taking the gel directly from the plant, the commonly available gel in the market is easier to use.

According to Dr. Urmila

  • Aloe vera has a soothing effect on the skin and its gel works well as a conditioner and helps retain moisture.
  • Aloe Vera is neither acidic nor alkaline in nature, so it has an effect on the skin that is equally effective for both children and adults and is completely harmless.
  • Aloe vera gel can be used in all seasons, summer and winter.
  • Aloe Vera gel deeply moisturizes the skin and also helps in reducing the harmful effects of the sun’s harmful rays.

How much and how much sunblock to apply before going out in the sun?

Regarding the application of sun block, some people complain that after applying sun block, a gray or white layer appears on the face, which looks ugly. In the same way, people are afraid of the sunblock being washed off the skin during the heat, so some are afraid of washing their face or washing it off.

Dr. Urmila says that some people cannot tolerate sunblock in the form of creams or lotions, or they do not like the smell, so there are alternatives to sunblock for them.

Some people don’t like a gray or white layer of sunblock or find it a difficult task to apply nblock, in which case we recommend subblocks in powder form that are applied to the skin like face powder. Gets excited. ‘

According to Dr Urmila, oral sun protection tablets or supplements also work to protect the skin in the same way that we get the benefits of sun block cream, lotion or gel.

There are chemicals or supplements that protect against the sun’s rays, we call them oral sun protection tablets or sunblock. They are made from chemicals or plant-derived ingredients that, after eating, provide the same protection to your skin that sunblock in the form of lotions or creams.

Oral sunblock also prevents skin damage by reducing the absorption of ultraviolet radiation, preventing collagen fiber breakdown, pigmentation, and even DNA damage. which may lead to cancer. ‘

According to Dr. Urmila, the effect of oral sunblock or supplement is also more and for more protection, additional protection can be given by applying sunblock on top.

According to them, sunblock should be applied at least one hour before going out in the sun.

We usually apply a small amount of sunblock. A teaspoonful should be applied as a layer for the face and neck as soon as we get protection. After two hours, its effectiveness starts to decrease, even if the mouth is not washed.

According to him, oral sunblock is very useful for people with many types of skin problems. Also, they are very important for those who are allergic to the sun.

Courtesy BBC URDU (

Why does our hair turn gray with age?

American scientists claim that they have discovered the reason why hair turns gray with age.

These scientists have claimed that when the cells that keep the hair black lose their ability to mature, the hair begins to turn white.

If these cells mature, they turn into melanocytes, which maintain the hair’s natural color. A team of researchers from New York University has done this research on mice. Mice have the same type of hair cells.

The research scientists claim that it will help start the process of re-darkening gray hair. According to the British Association of Dermatologists (BAD), the study of melanocytes will help find treatments for certain types of cancer and other health conditions.

How does hair turn white?

We grow old and lose hair. It is a normal process of our life which continues throughout our life. Hair grows from hair glands in the skin, where the cells that keep the hair dark are located.

These cells are formed and destroyed regularly. These cells are formed from stem cells.

Scientists at New York University believe that when the process of making these cells from stem cells stops for any reason, people’s hair starts to turn white.

New York University’s Langwan Health team has studied the formation and development of these cells with the help of special scanning and lab techniques. When hair ages and begins to fall out, hair continues to grow. But later the cells of the melanocytes start to slow down.

The stem cells stabilize in place but the melanocytes do not improve. Due to this, the process of color formation stops and the hair starts turning white.

Can white hair turn black again?

“Our study helps us understand how melanocyte stem cells work to keep hair dark,” Dr. Si Sun, a PhD scholar at New York University Langone Health and leader of the research team, told Nature Journal.

This is not the first time that scientists have hoped to turn white hair back to black. However, malnutrition is also considered to be one of the causes of premature graying of hair.

On the other hand, some other researchers believe that stress also causes graying of hair. According to these experts, the graying of hair can be stopped for some time by removing stress.

On the other hand, according to some researchers, there are genetic reasons for gray hair.

Some people start to dye their hair white or gray prematurely. According to Glamor magazine, the silver hair trend is very popular among young women, besides the shiny and pearly color oyster gray has also become quite popular on Instagram.

Hair stylist Luke Hirschson recently told British Vogue, ‘There was a time when people didn’t want to have gray hair, but we don’t associate gray hair with being ‘old’ anymore, a lot of people do.’

After the lockdown, many people have turned gray hair as the business of hair dyeing has ended and many people are happy with this change.

Usually, people try to remove a hair when it turns gray. According to experts, it is not possible to stop other hairs coming from the same cells from turning white.

Damage to the hair follicles also stops the growth of new hair, in which case the hair begins to recede or become bald.

How big is the hair coloring business?

Dr Leila Asfour of the British Association of Dermatologists told the BBC that hair coloring is big business. He further said, ‘By 2030, the global hair color market will reach 33.7 billion dollars. There is clearly a demand in the market for hair color.

“This research gives a clear indication, from a layman’s point of view, that we are one step closer to turning white hair black again, while from a medical point of view, other hair-related issues are becoming more common,” he said. The complications are better understood.

“It will also help us understand the nature of the disease, for example, melanoma or serious skin cancer,” he said.

This research may be helpful in understanding the disease of ‘hair loss’

According to Dr Leela, it may also help to understand a medical condition known as ‘baldness’. In this condition, the body’s own immune system attacks the hair itself and due to this, the hair falls out. Sometimes these patients have white spots.

According to Dr Leela, ‘this research may provide more information about vitiligo, the appearance of white patches on any part of the skin. To maintain the natural color of the skin, scientists can try transplanting hair follicles into the affected area. However, more research is needed on this.

Dr. Yusser Al Naimi, from the British Hair and Nail Society, said that scalp health becomes important as we age for good hair growth.

“Recent research in mice has increased our understanding of hair follicles and the cells that keep hair black,” he added. More information is being gained about the potential of stem cell therapy for hair loss and other conditions.

In such a scenario, the new research could pave the way for future treatments for patients with pigment-producing cell disorders.

Courtesy BBC/URDU

Acute and Chronic Metabolic Alkalosis (Base bicarbonate excess)

Definition: metabolic alkalosis is a clinical disturbance characterized by a high pH (decrease H+ concentration) and a high plasma bicarbonate concentration

It can be produced by a gain of bicarbonate or a loss of H+ (khanna and khurtzman 2001) Probably the most common cause of metabolic alkalosis is vomiting or gastric function with loss of hydrogen and chloride ions

This order also occurs in pyloric stenosis, in which only gastric fluid is lost Gastric fluid has an acid pH (usually 1-3)

Therefore loss of highly acidic fluid increase the alkalinity of body fluids Other loss of K+ such as diuretic therapy that promotes excretion of K+ (furosemide)

Hypokalemia produces alkalosis In two ways

  1. The kidney conservative potassium
  2. Cellular K+ moves out of the cell into ECF

Chronic metabolic alkalosis can occur with long term diuretic therapy, villous adenoma, external drainage of gastric fluids, cystic fibrosis and chronic ingestion of milk and calcium carbonate

Clinical Manifestation

  • Primary symptoms related to decreased calcium ionization such as tingling of the finger and toes, dizziness, and hypertonic muscles Serum Ca+ level decreased in alkalosis as more Ca+ combines with serum proteins
  • Respirations are depressed as compensatory action by the lungs
  • Arterial tachycardia may occur As pH increases above 7.6 and hypokalemia develops Ventricular disturbance may occur
  • Decreased motility and paralytic ileus may also occur Symptoms of chronic metabolic alkalosis are same as for acute metabolic alkalosis
  • ABG’s – pH greater than 7.45 and serum bicarbonate concentration greater than 20mEq/L Serum electrolytes – decreased Ca+ + K+


  • Treatment aimed at reversing the underlying disorder
  • Sufficient chloride must be supplied for kidney to absorb sodium with chloride Restoring normal fluids by Na+Cl fluids
  • To maintain alkalosis Administer K+CL
  • Histamine – 2 – receptor antagonists (cimitidine)
  • Management of chronic metabolic alkalosis is aimed to correct underlying acid- base disorder

Metabolic Acidosis

Definition: metabolic acidosis is a clinical disturbance characterized by a low pH (increased H+ concentration) and a low plasma bicarbonate concentration

  • It can be produced by a gain of hydrogen ion or a loss of bicarbonate (Swenson, 2001)
  • It can be divided clinically into two forms according to values of serum anion gap
  • High anion gap acidosis
  • Normal anion gap acidosis
  • Anion gap = Na+ + K+ – (Cl + HCO3)
  • Anion gap = Na+ – (Cl + HCO3)
  • Potassium is often omitted from the equation because of its low level in the plasma
  • The normal value for an anion gap is 8 to 12mEq/L (8 – 12 mmol/L) without K+ in the equation
  • Normal anion gap acidosis results from the direct loss of bicarbonate as in diarrhea, lower intestinal fistulas, use of divertics
  • High anion gap acidosis results from excessive accumulation of fixed acid
  • If it increased to 30mEq/L (30mmol/L) or more than a high anion gap metabolic acidosis is present regardless of what the pH and the HCO3 are
  • High ion gap occurs in ketoacidosis, lactic acidosis

Clinical Manifestation

  • Signs and symptoms of metabolic acidosis vary with the severity of the acidosis may include Headache
  • Confusion Drowsiness
  • Increased respiratory rate and depth Nausea and vomiting
  • Peripheral vasodilatation
  • And decreased cardiac output occurs when the pH falls below 7 On Examination physical findings
  • Low BP
  • Cold and Clammy skin Shock (Swenson 2001)


  • ABG’s – expected blood gas changes, low bicarbonate level less than 22mEq/L and low pH less than 7.35
  • Serum electrolytes Hyperkalemia ECG


  • Treatment is directed at correcting the metabolic defects (Swenson 2001) Decrease source of chloride
  • Administer bi carbonate if pH level is less 7.1 Serum K+ level monitored closely Hypokalemia is corrected
  • In chronic metabolic acidosis low serum Ca+ are treated Hemodialysis or peritoneal dialysis

Respiratory Acidosis, and Respiratory Alkalosis (carbonic acid deficit)

Respiratory Acidosis

Definition: respiratory acidosis is a clinical disorder in which the pH is less than 7.35 and the Pco2 is greater than 42mmHg

It may be either:

  • Acute respiratory acidosis
  • Chronic respiratory acidosis

Respiratory acidosis is always due to inadequate excretion of Co2 with inadequate ventilation, resulting in elevated plasma Co2 levels and thus elevated carbonic acid (H2CO3) levels (Epstein and singh 2001)

Acute respiratory acidosis occurs in emergency situations such as acute pulmonary edema, aspiration of foreign object, atelectasis, pneumothorax, over dose of sedatives, sleep apnea syndrome

Reparatory acidosis can also occur in disease that impair respiratory muscles such as: muscular dystrophy, myasthenia gravis and gullian-ballian syndrome

Clinical manifestation

  • Clinical manifestations in acute and chronic respiratory acidosis vary sudden hypercapnia (PaCO2) can cause increased pulse rate
  • Increased respiratory rate
  • Increased blood pressure
  • Mental cloudiness
  • Feeling of fullness in the head
  • An elevated PaCO2
  • Cerebrovascular vasodilatation
  • Increased cerebral blood flow particularly when it is higher than 60mmHg
  • Ventricular fibrillation may be the first sign of respiratory acidosis
  • If respiratory acidosis is severe, intra cranial pressure may increase, resulting in palpation and dilated conjuctival blood vessels
  • Chronic respiratory acidosis occurs with pulmonary disease such as:
  • Chronic emphysema and bronchitis, obstructive sleep apnea and obesity
  • Cyanosis, ICP, tachypnea, COPD

Assessment and Diagnostic Findings

  • Arterial blood gas (ABG’s) evaluation reveals a pH less than 7.35 a PaCO2 greater than 42mmHg and variation in the bicarbonate level
  • Depending on the duration and cause of the acidosis in acute respiratory acidosis
  • ECG

Medical management

  • Treatment is directed at improving ventilation
  • Pharmacological agents are used as indicated e.g bronchodilators, to relieve spasm Antibiotics for infection
  • Thrombolytics or anti coagulants are used for pulmonary emboli Adequate hydration
  • Mechanical ventilation use appropriately may improve pulmonary ventilation

Respiratory Alkalosis (carbonic acid deficit)

 Definition: respiratory alkalosis is a clinical condition in which the arterial pH is greater than 7.45 and the PaCO2 is less than 38mmHg

  • As like respiratory acidosis acute and chronic condition can occur
  • Respiratory alkalosis is always due to hyperventilation which cause excessive blowing off of CO2 and hence a decrease in the plasma carbonic acid concentration
  • Causes can include”
  • Extreme anxiety
  • Hypoxemia
  • Inappropriate ventilator setting
  • Chronic respiratory alkalosis results from chronic hypocapnia and decreased serum bicarbonate levels
  • Chronic liver insufficiency
  • Cerebral tumors are predisposing factors

Clinical Manifestation

  • Light headedness – due to vasoconstriction and decreased cerebral blood flow
  • Inability to concentrate
  • Numbness
  • Tingling due to decreased calcium
  • Tinnitus and at time loss of consciousness
  • Tachycardia
  • Arterial dysthermias


  • ABG’s assist in the diagnosis of respiratory alkalosis
  • In acute state pH is elevated above normal as result of low PaCO2 and normal bicarbonate level
  • Serum electrolytes analysis decreased Ca+ level
  • Patient with chronic respiratory alkalosis are usually asymptomatic

Medical Management

  • Treatment depends on the underlying cause of respiratory alkalosis
  • If the cause is anxiety – the patient instructed to breath slowly to allow CO2 to accumulate
  • A sedative may be required to relieve hyperventilation in vary anxious patients
  • To correct underlying problem

Fluid Volume Excess (Hypervolemia)


  • Fluid volume excess (FVE) refers to an isotonic expansion of ECF (Extra cellular fluid) caused by the abnormal retention of water and sodium in approximately the same proportions in which they normally exist in the ECF
  • It is always secondary to an increase in the total body sodium content which lead an increase to total body water, due to there is isotonic retention of body substances the serum sodium concentration remains essentially normal


  • FVE may be related to simple fluid overload or diminished functions of the homeostatic mechanisms responsible for regulating fluid balance

Contributing factors include

  • Heart failure
  • Renal failure
  • Cirrhosis of liver
  • Other contributing factors are
  • Consumption of excessive amount of table or other sodium salts
  • Administration of excessive sodium containing fluid to patient with impaired regulatory mechanisms (Beck – 2000)

Clinical Manifestation

  • Clinical manifestation of FVE start from expansion of the extra cellular fluid (ECF) and include
  • Edema
  • Distended Neck Veins
  • And Crackles (abnormal lung sound) Other manifestations include
  • Tachycardia
  • Increased blood pressure
  • Increased pulse pressure
  • Increased central venous pressure
  • Increased Wt
  • Increased urine output
  • Shortness of breath (SOB) and wheezing


  • Laboratory data useful in diagnosing FVE include BUN and hematocrit level
  • In both FVE both of these values may be decreased because of plasma dilution
  • Other causes include low protein intake and anemia
  • In chronic renal failure both serum osmolality and sodium level are decreased due to excessive retention of water
  • x- ray chest reveal pulmonary congestion
  • LFT
  • RFT

Medical Management

  • Treat the cause
  • If the fluid excess is related to excessive administration of sodium containing fluids, discontinuing the infusion may be all that is needed
  • Symptomatic treatment consist of diuretics and restriction fluids and sodium
  • Hemodialysis
  • Nutritional therapy – restrict sodium in diet
  • Pure water may be used

Nursing Management

  • To asses for FVE
  • The nurse measure intake and output at regular intervals to identify excessive fluid retention
  • Daily Wt of patient
  • To assess breath sounds at regular intervals
  • The nurse monitors degree of edema in most depending parts of body as feet, ankles, sacral region bed ridden patient
  • The degree of pitting edema is assessed
  • Preventing FVE
  • Detecting and controlling FVE
  • Teaching, patients about edema

Fluid Volume Disturbance

Fluid Volume Deficit (Hypovolemia)

 Definition:fluid volume deficit (FVD) occurs when loss of extracellular fluid volume exceeds the intake of fluid

It occurs when water and electrolyte are lost in the same proportion as they exist in normal fluids Fluid volume deficit (hypovolemia) should not be confused with the term dehydration, which refers to loss of water alone with increased serum sodium level, FVD may occur alone or in combination with other imbalances


FVD results from loss of body fluids and occurs more rapidly when coupled with decreased fluid intake

FVD can develop from inadequate intake alone if the decreased intake is prolonged

Causes of FVD include abnormal fluid losses such as resulting from vomiting, diarrhea, G.I suctioning and sweating and decreased intake as in Nausea or irritability to gain access to fluids (Beck – 2000) Additional risk factors diabetes inspidius, adrenal insufficiency, osmotic dieresis hemorrhage and coma

Clinical Manifestation 

Fluid volume deficit can develop rapidly and can be

  • Mild
  • Moderate
  • Or severe depending on the degree of fluid loss

Important characteristics of FVD include

  • Acute wt loss
  • Decreased skin turgor
  • Oliguria
  • Concentrated urine
  • Postural hypotension
  • A weak, rapid heart rate
  • Flattened neck veins
  • Increased temperature
  • Decreased central venous pressure
  • Cool
  • Clamming skin related to peripheral vasoconstriction
  • Thirst
  • Anorexia
  • Nausea
  • Muscles weakness
  • Cramps


  • BUN (blood urine nitrogen) related to serum cretinine concentration (a ratio greater than 20:1)
  • Health history
  • Physical examination
  • Serum electrolytes changes serum K, Na (hypokalemia, hyponatermia or hypernatermia, hyperkalemia)
  • Urine specific gravity increased

Medical Management 

  • Planning of correction of fluid loss for patient with fluid volume deficit (FVD)
  • The health care provider consider the usual maintenance requirements of the patient and other factors (such as fever) that can influence fluid needs
  • When deficit is not severe the oral route is preferred
  • In acute and severe losses the I/V route is required isotonic electrolyte solutions e.g lactated Ringer’s or 0.9% N/S are frequently used to treat hypotension pts with FVD
  • Maintain and assess I/O (intake and output chart)
  • Wt: , vital signs, central venous pressure, level of consciousness (LOC), breath sounds, skin color
  • The rate of fluid administration is based on severity of loss of and patient hemodynamic response

Nursing Management 

  • To assess for fluid volume deficit
  • Nurse monitors and measures fluid intake and output at least every 8 hours and sometime hourly
  • Vital signs closely monitored
  • Nurse should observe for weak pulse and postural hypotension
  • Skin and tongue turgor is monitored on regular basis
  • Preventing FVD – as diarrhea
  • Correcting FVD – if patient is unable to take fluid the orally the nurse should give fluid parental I/V