“Anyone can get monkeypox. In Africa, most cases are among children under 15 years old. Outside of Africa, the disease appears to be more common in men who have sex with men, but there are numerous cases in people who don’t fall into that category.

Monkeypox is usually a self-limited disease with symptoms lasting from two weeks to four weeks. Most people with monkeypox get better on their own without treatment. Following diagnosis, your healthcare provider will monitor your condition and try to relieve your symptoms, prevent dehydration and give you antibiotics to treat secondary bacterial infections if they develop.

There’s currently not an approved antiviral treatment for monkeypox. Antiviral drugs may help, but they haven’t been studied as a treatment for monkeypox. Several investigational antivirals with activity against monkeypox are available, but only as part of a research study.”

Cleveland Clinic (https://my.clevelandclinic.org/health/diseases/22371-monkeypox)

“The Schnitzler syndrome is a rare and underdiagnosed entity which is considered today as being a paradigm of an acquired/late onset auto-inflammatory disease. It associates a chronic urticarial skin rash, corresponding from the clinico-pathological viewpoint to a neutrophilic urticarial dermatosis, a monoclonal IgM component and at least 2 of the following signs: fever, joint and/or bone pain, enlarged lymph nodes, spleen and/or liver, increased ESR, increased neutrophil count, abnormal bone imaging findings. It is a chronic disease with only one known case of spontaneous remission. Except of the severe alteration of quality of life related mainly to the rash, fever and pain, complications include severe inflammatory anemia and AA amyloidosis. About 20% of patients will develop a lymphoproliferative disorder, mainly Waldenström disease and lymphoma, a percentage close to other patients with IgM MGUS. It was exceedingly difficult to treat patients with this syndrome until the IL-1 receptor antagonist anakinra became available. ”

National Library of Medicine-NIH  (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3018454/)

Schnitzler syndrome is considered to be a rare disorder characterized by a monoclonal IgM protein and chronic urticaria that is associated with considerable morbidity. We hypothesized that the syndrome may be under-recognized and patients may be deprived of highly effective therapy in the form of anakinra (an interleukin-1 receptor antagonist=inhibits interleukin 1).  This treatment controls the condition but does not cure it. Around 15% of people develop complications, but the condition generally does not shorten life

Schnitzler is a rare disease characterised by onset around middle age of chronic hives (urticaria) and periodic fever, bone pain and joint pain (sometimes with joint inflammation), weight loss, malaise, fatigue, swollen lymph glands and enlarged spleen and liver.

How its Diagnosed:

–Blood tests show a high concentration of specific gamma-globulins (monoclonal gammopathy) of the IgM type. It almost always has light chains of the κ-type. A variant in which IgG is raised has been described, which appears to be one-tenth as common.

–CBC, this could show signs of inflammation are often present: these include an increased white blood cell count (leukocytosis) and a raised erythrocyte sedimentation rate=we would see this in what we call a simple Complete Blood Count(CBC) and C-reactive protein blood test.

-There can be anemia of chronic disease showing low red blood count again in a simple CBC.

-Bone abnormalities can be seen on radiological imaging (often increased density or osteosclerosis)

-Biopsy

-What we call the Lipsker criteria require hives, the presence of monoclonal IgM, and at least 2 of the following: fever, joint pain or arthritis, bone pain, swollen lymph nodes, enlarged spleen or liver, elevated erythrocyte sedimentation rate, high levels of white blood cells, and findings of problems in bone imaging.

-What we call the Strasbourg criteria, the person must have hives and the presence of monoclonal IgM or IgG. Schnitzler’s is diagnosed if the person has IgM and two of the following, or IgG and three of the following: recurrent fevers, abnormalities in bone imaging, with or without bone pain, findings of neutrophil infiltration in a skin biopsy, high levels of white blood cells or C-reactive protein.

Other conditions which can cause periodic fevers, paraproteins or chronic hives that should be ruled out, include (and are not limited to) autoimmune or autoinflammatory disorders such as adult-onset Still’s disease, angioedema, hematological disorders such as lymphoma or monoclonal gammopathy of undetermined significance (MGUS), other causes of hives, cryoglobulinemia, mastocytosis, chronic neonatal onset multisystem inflammatory disease or Muckle–Wells syndrome.

Treatment:

As of 2017 no drug was approved to treat Schnitzlers. Drugs that inhibit interleukin 1 activity have been the preferred treatment since they emerged in 2005; since 2012 a consensus guideline has recommended treatment with anakinra. Immunosuppressant drugs such as corticosteroids, cyclooxygenase inhibitors, interferon alpha may be effective.

“Antimicrobial resistance (AMR) is a threat to humans, animals, plants and the environment. It affects us all. This is why this year’s theme calls for collaboration across sectors to preserve the efficacy of these critical medicines. Fighting AMR is a truly global endeavour and must be addressed through a One Health approach.

To curb it effectively, all sectors must join forces and encourage the prudent use of antimicrobials, as well as preventive measures. Strengthening infection prevention and control in health care facilities, farms and food industry premises, ensuring access to vaccines, clean water, sanitation and hygiene, implementing best practices in food and agriculture production, and guaranteeing the sound management of waste and wastewater from key sectors are critical to reducing the need for antimicrobials and minimizing the emergence and transmission of AMR.”

UN environment programme (https://www.unep.org/events/unep-event/world-antimicrobial-awareness-week-2022)

In the lead-up to World Antibiotic Awareness Week, the Food and Agriculture Organization of the United Nations (FAO), the World Health Organization (WHO) and the World Organisation for Animal Health (OIE) are together calling for responsible use of antibiotics in humans and animals to reduce the emergence of antibiotic resistance.

Antibiotic resistance is rising to dangerously high levels in all parts of the world and threatening our ability to treat common infectious diseases. Infections affecting people – including pneumonia, tuberculosis, blood poisoning and gonorrhoea – and animals alike are becoming harder, and sometimes impossible, to treat as antibiotics become less effective.

Antibiotics are often overprescribed by physicians and veterinarians and overused by the public. Where they can be bought for human or animal use without a prescription, the emergence and spread of resistance is made worse. Examples of misuse include taking antibiotics for viral infections like colds and flu, and using them as animal growth promoters on farms or in aquaculture.

To tackle these problems, WHO, FAO and OIE are leveraging their expertise and working together in a ‘One Health’ approach to promote best practices to reduce the emergence and spread of antibiotic-resistant microbes in both humans and animals.

“Antibiotic resistance is a global crisis that we cannot ignore,” says Dr Tedros Adhanom Ghebreyesus, Director-General of WHO. “If we don’t tackle this threat with strong, coordinated action, antimicrobial resistance will take us back to a time when people feared common infections and risked their lives from minor surgery.”

“The overuse of antimicrobials blunts their effectiveness, and we must reduce their misuse in food systems,” says José Graziano da Silva, Director-General of FAO. “Antimicrobial veterinary medicines are a crucial tool for animal health and welfare and safe food production, but they are by no means the only tool.”

“Like in human health, veterinary medicine has tremendously progressed thanks to antibiotics. Preserving their efficacy and availability through their responsible use associated with good husbandry and prevention practices, is therefore essential to preserve animal health and welfare,” highlights Dr Monique Eloit, Director-General of OIE.

“Do not weigh yourself the day after Thanksgiving. The extra sodium and carbs may cause your weight to temporarily jump up 3 pounds. Wait at least 3 days.  If you end up eating a lot more than you planned, don’t beat yourself up. Tell yourself it was one day and get back on track the next day.  If you are in someone’s home for the weekend and are surrounded by leftovers, focus on the healthier ones like turkey and veggies.  If you are really tempted, allow yourself one “treat” a day for the rest of the weekend. Maybe a dessert one day or a portion of stuffing and gravy.  If you are home for the holiday, make sure you plan activities for the day after Thanksgiving as well as the weekend. This will get you out of the house and away from the leftovers.”

Martha  McKittrick – a RN, registered dietitian,  and a certified diabetes educator.  (http://marthamckittricknutrition.com)

Wishing all a Happy Thanksgiving!

“While the holiday season is certainly merry and sentimental, these festive months carry the added risk of holiday weight gain. If you’re looking for ways to cut down on the calories this Thanksgiving, take note of these 10 ways to watch your waistline.
1. Choose Healthy Thanksgiving Dishes
2. Watch Your Alcohol Intake
3. Don’t Forget About Exercising
4. Make Only One Thanksgiving Dessert
5. Eat Before the Main Event-If you can’t trust yourself and your appetite around a table full of delicious Thanksgiving delicacies, aim to eat an hour or so before the main meal. Eating before Thanksgiving will help you to not pile your plate with too much food as you’ll already been pretty full.
6. Be Social-Aside from being a prerequisite on special family occasions, socializing will help you stay away from the chips, dip and celebratory snacks. Mix and mingle around the room or the table and you’ll find you’ve forgotten all about the temptation to eat the unhealthy snacks on offer.
7. Get Out of the House-Why not troop the whole family out of the house after the big meal? This can be a great adventure if there’s kids involved.
8. Less is More
9. Use a Smaller Plate
10. Avoid the Leftovers”

FITDAY (https://www.fitday.com/fitness-articles/nutrition/10-tips-to-have-a-healthier-thanksgiving.html)

“Boiled shrimp with lemon or cocktail sauce is a healthier pick than fried hors d’oeuvres. Try having a pot of a roasted vegetable soup, such as carrot or butternut squash, on offer for guests to enjoy. Other healthful starters include stuffed mushrooms, raw veggies with hummus, and seasonal fruit.

Thanksgiving is a great time to serve family recipes like Grandma’s pumpkin pie or your dad’s dinner rolls. Our advice: Don’t mess with your favorite holiday dishes. But do try swapping or adding ingredients to less sacred one.

• Skip the cream. Use Greek yogurt or whole milk instead in mashed potatoes, creamy soups, and creamed onion or spinach recipes.

• Reduce the sugar. Cut it back by 10 to 25 percent in baking recipes. You’ll barely taste the difference.

• Add some fiber. Replace 25 to 50 percent of the all-purpose flour called for in recipes with whole-wheat flour. Or try half all-purpose, half white whole-wheat flour, a lighter, milder version of the whole grain. If your recipe calls for breadcrumbs or panko, opt for whole wheat.

• Upgrade the stuffing. Replace half the white bread with whole wheat, use low-sodium chicken broth, and add extra vegetables, such as carrots, mushrooms, and peppers.

• Be sodium savvy. Using the flavors of the season—thyme, sage, rosemary, cinnamon, nutmeg, cloves—will cut the need for salt.”

CR  Consumer Reports  (https://www.consumerreports.org/healthy-eating/ways-to-eat-smarter-at-thanksgiving-dinner-a2912481484/)