The facts about trachoma:

Trachoma (a repeated conjunctivitis infection) is found worldwide. Though eradicated in most developed countries, it remains a significant public health problem in parts of the developing world. It is closely linked to poverty.

The facts about trachoma:

• The World Health Organization estimates that trachoma affects about 84 million people
• 8 million of these are visually impaired
• Trachoma is the second most common cause of blindness after cataract.

Where is it found?

Trachoma is found in hot and dusty parts of the world. It is often endemic in rural areas without basic sanitation, where washing hands and faces is difficult. Trachoma spreads rapidly in crowded households or neighbourhoods.

Children and trachoma

Demographically, active trachoma is most prevalent in children, although the scarring doesn't usually become visible until the early 20s. For those who have suffered since childhood, trichiasis normally sets in during their 40s - or even earlier in the worst-affected areas.

Women and trachoma

Women are much more susceptible to trachoma than men because they spend far more time in contact with children, providing childcare.

Prevention

Although trachoma was eliminated from much of the developed world in the last century, this disease persists in many parts of the developing world particularly in communities without adequate access to water and sanitation. In many of these communities, women are three times more likely than men to be blinded by the disease, due to their roles as caretakers in the family.

Without intervention, trachoma keeps families shackled within a cycle of poverty, as the disease and its long-term effects are passed from one generation to the next.

National governments in collaboration with numerous non-profit organizations implement trachoma control programs using the WHO-recommended SAFE strategy, which includes:

Surgery to correct advanced stages of the disease;

Antibiotics to treat active infection, using Zithromax (azithromycin) donated by Pfizer Inc through the International Trachoma Initiative;

Facial cleanliness to reduce disease transmission;

Environmental change to increase access to clean water and improved sanitation.

Surgery: For individuals with trichiasis, a bilamellar tarsal rotation procedure is warranted to direct the lashes away from the globe. Early intervention is beneficial as the rate of recurrence is higher in more advanced disease.

Antibiotic therapy: WHO Guidelines recommend that a region should receive community-based, mass antibiotic treatment when the prevalence of active trachoma among one to nine year-old children is greater than 10 percent.[8] Subsequent annual treatment should be administered for three years, at which time the prevalence should be reassessed. Annual treatment should continue until the prevalence drops below five percent. At lower prevalences, antibiotic treatment should be family-based.

Antibiotic selection: (single oral dose of 20 mg/kg) or topical tetracycline (one percent eye ointment twice a day for six weeks). Azithromycin is preferred because it is used as a single oral dose. Although it is expensive, it is generally used as part of the international donation program organized by Pfizer through the International Trachoma Initiative. Azithromycin can be used in children from the age of six months and in pregnancy.

Facial cleanliness: Children with grossly visible nasal discharge, ocular discharge, or flies on their faces are at least twice as likely to have active trachoma as children with clean faces. Intensive community-based health education programs to promote face-washing can significantly reduce the prevalence of active trachoma, especially intense trachoma  . If somebody is already infected washing one’s face is strongly encouraged, especially a child, in order to prevent re-infection.
Environmental improvement: Modifications in water use, fly control, latrine use, health education and proximity to domesticated animals have all been proposed to reduce transmission of C. trachomatis. These changes pose numerous challenges for implementation. It seems likely that these environmental changes ultimately impact on the transmission of ocular infection by means of lack of facial cleanliness. Particular attention is required for environmental factors that limit clean faces.

Causes of Trachoma

Causes

Trachoma is caused by Chlamydia trachomatis and it is spread by direct contact with eye, nose, and throat secretions from affected individuals, or contact with fomites (inanimate objects), such as towels and/or washcloths, that have had similar contact with these secretions. Flies can also be a route of mechanical transmission. Untreated, repeated trachoma infections result in entropion—a painful form of permanent blindness when the eyelids turn inward, causing the eyelashes to scratch the cornea. Children are the most susceptible to infection due to their tendency to easily get dirty, but the blinding effects or more severe symptoms are often not felt until adulthood.

Blinding endemic trachoma occurs in areas with poor personal and family hygiene. Many factors are indirectly linked to the presence of trachoma including lack of water, absence of latrines or toilets, poverty in general, flies, close proximity to cattle, crowding and so forth. However, the final common pathway seems to be the presence of dirty faces in children that facilitates the frequent exchange of infected ocular discharge from one child’s face to another. Most transmission of trachoma occurs within the family.

Trachoma

Trachoma (Ancient Greek: "rough eye") is an infectious eye disease, and the leading cause of the world's infectious blindness. Globally, 84 million people suffer from active infection and nearly 8 million people are visually impaired as a result of this disease. Globally this disease results in considerable disability.

Signs and symptoms

The bacterium has an incubation period of 5 to 12 days, after which the affected individual experiences symptoms of conjunctivitis, or irritation similar to "pink eye." Blinding endemic trachoma results from multiple episodes of reinfection that maintains the intense inflammation in the conjunctiva. Without reinfection, the inflammation will gradually subside.

The conjunctival inflammation is called “active trachoma” and usually is seen in children, especially pre school children. It is characterized by white lumps in the undersurface of the upper eye lid (conjunctival follicles or lymphoid germinal centres) and by non-specific inflammation and thickening often associated with papillae. Follicles may also appear at the junction of the cornea and the sclera (limbal follicles). Active trachoma will often be irritating and have a watery discharge. Bacterial secondary infection may occur and cause a purulent discharge.

The later structural changes of trachoma are referred to as “cicatricial trachoma”. These include scarring in the eye lid (tarsal conjunctiva) that leads to distortion of the eye lid with buckling of the lid (tarsus) so the lashes rub on the eye (trichiasis). These lashes will lead to corneal opacities and scarring and then to blindness. Linear scar present in the Sulcus subtarsalis is called Arlt's line(named after Carl Ferdinand von Arlt). In addition, blood vessels and scar tissue can invade the upper cornea (pannus). Resolved limbal follicles may leave small gaps in pannus (Herbert’s Pits).

Further symptoms include:

Eye discharge

Swollen eyelids

Trichiasis (turned-in eyelashes)

Swelling of lymph nodes in front of the ears

Corneal scarring

Further ear, nose and throat complications.

The major complication or the most important one is corneal ulcer occuring due to rubbing by concentrations, or trichiasis with superimposed bacterial infection.

 

Paracetamol comes as:

Paracetamol comes as:

tablets, caplets (torpedo-shaped tablets that may be easier to swallow) or capsules for swallowing a powder or tablet to dissolve in water, or a liquid/syrup forma suppository, for inserting into the rectum (back passage)You can buy paracetamol from pharmacies in packs of 32 tablets. You don't need a prescription.

For safety reasons, you can't buy more than 100 tablets at any one time from a pharmacy. In other shops, such as supermarkets or convenience stores, the packs contain a maximum of 16 tablets. It's crucial that you don't take more paracetamol than the dose recommended on the packet.

Over-the-counter painkillers - ones you buy without a prescription - are only meant to be taken occasionally. If you have to take painkillers for more than three days you should ask your GP or pharmacist about what to take and what else might help. Taking painkillers too often or for too long may make headaches worse.

It's always best to get advice from your GP if you need daily pain relief. Many GPs advise using paracetamol for problems such as painful joints.

Always read the patient information leaflet that comes with your medicine.

Avoiding accidental overdose

Paracetamol comes as tablets, but it is also contained in several other over-the-counter cold and flu remedies, such as powders that you make up into flavoured hot drinks (eg Lemsip). Make sure you count the paracetamol in all the medicines you have taken.

Children and paracetamol

The dose for a child depends on their age and weight and is clearly given on the medicine's container. On a doctor or nurse's advice, you can give paracetamol to young babies after they have had vaccinations, but otherwise it's not recommended for babies under three months old. Syrups containing paracetamol (eg Calpol) can be easier for younger children to take. The children's version of paracetamol syrup contains 120mg of paracetamol per 5ml (teaspoon). Sugar-free versions are available.

Special care

Check with your doctor or pharmacist before taking paracetamol if: you know that your kidneys or liver are not working properly you are a very heavy drinker (both paracetamol and alcohol can harm the liver)you are malnourished

If you're pregnant

As with any drug, it's always wise to discuss your situation with your pharmacist or doctor. However, in general, paracetamol is not known to be harmful in pregnancy.

If you're breastfeeding

Very little paracetamol gets into breast milk so experts say that it's usually safe for nursing mothers to take it.

Side-effects

When taken at the recommended dose, side-effects of paracetamol are rare. Skin rashes, blood disorders and a swollen pancreas have occasionally happened in people taking the drug on a regular basis for a long time.

One advantage of paracetamol over aspirin and similar drugs (eg ibuprofen and diclofenac) is that it won't upset your stomach or cause it to bleed.

A paracetamol overdose is particularly dangerous because the liver damage may not be obvious for four to six days after the drug has been taken. Even if someone who has taken a paracetamol overdose seems fine and doesn't have any symptoms, it's essential that they are taken to hospital urgently. An overdose of paracetamol can be fatal.

Interactions with other medicines

Check with your doctor or pharmacist before you take any other medicines or herbal remedies at the same time as paracetamol.

You may need to adjust your usual dose of anticoagulants (eg warfarin) if you take paracetamol regularly. Check with your anticoagulation clinic. Otherwise there are no serious interactions between paracetamol and other drugs

Paracetamol

Published by Bupa's health information team, March 2007.

This factsheet is for people who would like information about paracetamol and how to use it safely.

Paracetamol (known as acetaminophen in the USA) is a painkiller that lowers a high temperature. Provided that you take the correct dose at the right intervals, paracetamol is relatively safe. An overdose is dangerous.

Why would I take it?How does paracetamol work?How to take paracetamolAvoiding accidental overdoseChildren and paracetamolSpecial careSide-effectsInteractions with other medicinesParacetamol productsFurther informationQuestions and answersSourcesWhy would I take it?

Paracetamol can be taken to relieve a variety of common aches and pains including headache, muscle and joint pain, backache and period pains.

Paracetamol brings down a high temperature caused by a cold or flu. It can be given to children after they have had vaccinations to prevent a high temperature after immunisation. It's often included in cough, cold and flu remedies, which you can buy in pharmacies and shops (see Paracetamol products).

How does paracetamol work?

No one is sure how paracetamol works. It probably acts by blocking the way in which pain signals are processed in the brain. It doesn't have the anti-inflammatory action of NSAIDs (non-steroidal anti-inflammatory drugs) such as aspirin. You can't get addicted to paracetamol.

How to take paracetamol

The recommended dose for adults is 500mg to 1000mg - that's usually one or two tablets (depending on tablet size) - every four to six hours with a maximum of 4000mg (usually eight tablets, but make sure you check the size of your tablets) in 24 hours.

However, just twice this dose can be dangerous and you should never exceed the recommended dose. Keep all medicines out of the reach of children.

Paracetamol uses

Adults

The recommended dosage of paracetamol in adults is two 500mg tablets (i.e. 1gm paracetamol) every four to six hours, not exceeding eight tablets (4gms) in any 24 hour period (1). This dosage may be continued for several days. If pain relief is required for a longer period it should be with the supervision of a doctor.

Children

Children's dosages vary with the age of the child and the type of product, therefore the instructions on the pack should always be followed.

In general, children's dosages are based on a single dose of 10mg paracetamol per kilogram bodyweight, which can be repeated 4-6 hourly, not exceeding four doses per 24 hours.

On a doctor's recommendation only, paracetamol may be given to a 2 month old child following immunisation as a single dose of 60mg (i.e. 2.5mL paracetamol liquid (oral suspension) at a strength 120mg per 5 mL).

For children under 3 months, on a doctor's advice only, the dosage is 10mg paracetamol per kilogram body weight (5mg/kg if jaundiced).

For a child 3 months to 1 year of age a dose of between 60mg and 120mg (i.e. 2.5mL to 5mL of paracetamol liquid (oral suspension) at a strength of 120mg/5mL) may be repeated every 4-6 hours to a maximum of 4 doses in 24 hours.

For a child 1 to 5 years of age 120mg to 250mg (i.e. 5mL to 10mL of paracetamol liquid (oral suspension) at a strength of 120mg/5mL) may be repeated every 4-6 hours to a maximum of 4 doses in 24 hours.

For a child 6 to 12 years of age 250mg to 500 mg (i.e. 5mL to 10mL paracetamol liquid (oral suspension) at a strength of 250mg/5mL) may be repeated every 4-6 hours to a maximum of 4 doses in 24 hours.

These dosages have been found to be effective, well tolerated and safe (2) in OTC usage and there are no circumstances in which they should be exceeded. If this dosage is not proving effective, then a pharmacist or doctor should be consulted for further advice.

Prescription Use

In general the recommended dosages shown above should be followed. If, in a hospital setting, a higher dosage is considered desirable it is the responsibility of the prescribing physician. As there is no clear threshold at which toxicity may occur in an individual patient, it has been recommended that where a higher dosage is prescribed for an extended period, liver function should be monitored (2).

References:

1 British National Formulary, Vol. 40; September 2000

2 OICPC Therapeutic Highlights; Progress in Palliative Care (2000); 8 (4); 198-202.