Doctor, scientist and biomedical engineer Armen Khrlobyan about Dalimed

Botulism is a rare but serious infectious disease caused by the bacterium Clostridium botulinum. The danger comes from the powerful toxin it produces. This poison blocks the function of the nervous system, leads to paralysis, and can be fatal if medical help is not provided in time. There are several main forms of the disease. The most common is the foodborne form, which develops after consuming contaminated food. Wound botulism occurs when bacterial spores enter a wound and multiply. Infant botulism affects children under one year old when spores begin to grow in the intestines. Less frequent variants include intestinal colonization in adults, iatrogenic botulism following medical procedures, and the extremely rare inhalational botulism. Symptoms and Causes The first symptoms are often linked to vision problems: double vision, blurred sight, and dilated pupils. Soon after, droopy eyelids, dry mouth, difficulty swallowing, and slurred speech may appear. As the toxin spreads, muscle weakness develops along with digestive and respiratory difficulties. The most dangerous complication is paralysis of the respiratory muscles. Symptoms depend on the type of botulism: • Foodborne botulism: abdominal pain, nausea, vomiting, bloating, constipation, visual disturbances, and general weakness. • Wound botulism: gradual onset (1–3 weeks), localized weakness near the wound, possible fever, and no early digestive symptoms. The root cause is always the same: multiplication of Clostridium botulinum and release of its toxin. For this to happen, certain conditions are required — low oxygen, insufficient acidity, lack of salt or sugar, improper food storage, or inadequate heat treatment. Homemade canned foods prepared without proper sterilization are a frequent source of infection. Complications The most life-threatening complication of botulism is respiratory failure, which can cause death without mechanical ventilation. Even after successful treatment, patients may suffer from long-lasting weakness and fatigue. Recovery of muscle strength can take weeks or months, sometimes complicated by pneumonia or nervous system disorders. Diagnosis Doctors usually suspect botulism based on clinical symptoms: sudden visual disturbances, difficulty speaking and swallowing, and muscle weakness. Information about recently consumed food or the presence of wounds is also crucial. Laboratory confirmation may include tests of blood, stool, or vomit. To exclude other conditions with similar signs, additional diagnostic methods are often used, such as: • Computed tomography (CT) or magnetic resonance imaging (MRI) • Lumbar puncture • Electromyography Treatment Therapy is focused on quickly neutralizing the toxin and supporting vital functions. Patients older than one year are treated with an antitoxin, which blocks the poison’s further action. In severe cases with respiratory paralysis, artificial ventilation is required. Infants are treated with a specific preparation — botulinum immune globulin (Baby BIG). In wound botulism, treatment also includes surgical cleaning of infected tissue and the use of antibiotics. Prognosis With timely diagnosis and proper treatment, most patients recover. Noticeable improvements usually appear within a few months, but full recovery may take up to a year. Rehabilitation and supportive care are often necessary throughout this period. Prevention Botulism is largely preventable if proper food handling and storage practices are followed, especially when preparing home-canned goods. Key preventive measures include: • Refrigerating food within 2 hours of cooking • Boiling food for at least 10 minutes to destroy toxins • Avoiding swollen or damaged canned goods • Sterilizing homemade preserves in an autoclave at 121°C for at least 30 minutes • Discarding foods with an unusual or foul odor To reduce the risk of wound botulism, wounds should be cleaned promptly, non-sterile needles should never be used, and illicit drug use must be avoided. Injections of botulinum toxin should only be performed by licensed healthcare providers.

Measles is a highly contagious viral disease that causes fever, cough, and a characteristic skin rash. The infection is transmitted by airborne droplets and can lead to severe complications, including pneumonia and inflammation of the brain. Furthermore, having had measles weakens the immune system, making a person more susceptible to other infections. Before mass vaccination, measles claimed millions of lives annually worldwide. The disease is also called ordinary measles, 10-day measles, or rubeola. It should be distinguished from rubella (German measles)—which is a completely different infection. Symptoms of Measles Signs of the disease develop gradually. First, a high temperature, cough, runny nose, and red eyes appear. After 2–3 days, characteristic white spots on a background of red dots—the so-called Koplik's spots—appear in the oral cavity. Then, a rash appears, typically on the 3rd–5th day of the illness. Key symptoms: • high temperature; • dry, "barking" cough; • red or inflamed eyes; • runny nose; • weakness, fatigue; • white spots with a red border in the mouth; • extensive skin rash; • sore throat and muscle aches; • headache; • sometimes—digestive disorders (vomiting, diarrhea, abdominal pain). The rash usually begins on the face, then spreads down the body: neck, chest, back, arms, legs. In light-skinned people, it looks red; in dark-skinned people, it may be purple or less noticeable. The spots can merge, but itching rarely occurs. Causes and Transmission Routes The causative agent of the disease is the measles virus (Morbillivirus). It spreads through the air when an infected person coughs, sneezes, talks, or breathes. Virus particles can remain in the air and on surfaces for up to two hours after the infected person leaves. Infection can occur: • by being close to a sick person; • through shaking hands, kissing, sharing food or drinks; • through objects and surfaces contaminated with viral particles; • from mother to child during pregnancy, childbirth, or breastfeeding. Measles is one of the most contagious diseases: if one sick person and 10 unvaccinated people are in a room, 9 of them will become infected. The risk of transmission remains from the onset of the first symptoms, for 4 days before the rash appears and for another 4 days after. Risk Factors Severe progression and complications are more likely to develop in: • children younger than 5 years and adults older than 20 years;• pregnant women; • people with a weakened immune system. Measles Complications The consequences of the infection can range from mild to life-threatening: • otitis (ear infection); • dehydration due to severe diarrhea; • bronchitis, laryngitis; • pneumonia; • vision loss; • encephalitis (brain swelling); • subacute sclerosing panencephalitis (SSPE) — a rare but fatal infection of the nervous system that occurs years later; • measles inclusion body encephalitis (MIBE), more common in people with immunodeficiency; • death. Infection during pregnancy increases the risk of premature birth and low birth weight for the child. Diagnosis A doctor may suspect measles based on the appearance of the rash and the patient's complaints. To confirm the diagnosis, the following are used: • blood test; • nose or throat swab; • urine test. Treatment There is no specific cure for measles. The illness lasts about 10–14 days if complications do not arise. In a hospital setting, patients may be prescribed Vitamin A, which reduces the likelihood of severe consequences. However, it should not be taken without medical supervision: an overdose is dangerous for the liver and other organs. To ease symptoms at home, it is recommended to: • drink plenty of fluids; • get bed rest; • take antipyretics and pain relievers (Paracetamol, Ibuprofen); • gargle with a saline solution. Seek immediate medical attention if there is: • difficulty breathing; • chest pain; • sensitivity to light; • severe headache or neck stiffness; • confusion; • severe vomiting or diarrhea. Prognosis Measles can cause a severe course: approximately 2 out of 5 people who become ill require hospitalization. Even after recovery, a person remains more vulnerable to other infections. Dangerous complications can develop months or even years after the illness. Prevention The best way to protect yourself is vaccination. Vaccinations are given in childhood, but they can also be administered to adults if necessary. Illness after vaccination is extremely rare, especially if both doses are administered. One dose provides less protection.

Viruses are the smallest infectious agents that can affect humans, animals, plants, and also bacteria and fungi. Each virus has its "own host" and can only infect specific cells. The main characteristic of viruses is that they are not fully-fledged living organisms. They don't have a cellular structure or their own mechanisms for reproduction. Instead, a virus penetrates the body's cells and uses their "machinery" to create new copies. Structurally, a virus consists of genetic material (DNA or RNA) surrounded by a protein coat called a capsid. Some viruses have an additional outer envelope called a "supercapsid". How Do Viruses Enter the Body? Infections are most often transmitted through mucous membranes—the nose, mouth, eyes, genital organs, and anus. Infection can also occur through damaged skin or insect bites (mosquitoes, ticks). How Do Viruses Work? Once in the body, a virus attaches to a cell and penetrates it. The subsequent path can vary: • Lytic cycle — the virus immediately begins to actively multiply, destroying the cell. • Lysogenic cycle — the virus "falls asleep" inside the cell, integrating into its genetic code. Under certain conditions (stress, weakened immunity), it activates and begins to spread. Main Types of Viruses There are a huge number of viruses, among which the most well-known are: • Influenza (Influenza A and B) — causes seasonal epidemics. • Herpesviruses (Herpesviridae) — cause herpes, chickenpox, and shingles. • Coronaviruses — including SARS-CoV-2 (COVID-19). • Human Papillomavirus (HPV) — causes warts and can be linked to oncological diseases. • Enteroviruses — including poliomyelitis and hand, foot, and mouth disease. • Flaviviruses — transmitted by mosquitoes (dengue, yellow fever, Zika virus). • Hepatitis A, B, C — affect the liver and can lead to chronic diseases. • HIV and retroviruses — integrate into human DNA, causing severe chronic illnesses. Diseases Caused by Viruses Clinical manifestations depend on the specific pathogen. Viral infections can be asymptomatic but can also cause severe diseases: • colds and flu • COVID-19 • measles, chickenpox • hepatitis • HIV/AIDS • papillomavirus infections • herpes • poliomyelitis • rabies Living or Non-living? Scientists still debate whether to consider viruses as living organisms. On one hand, they don't have a metabolism and cannot exist without a host. On the other hand, they are capable of reproduction and change (evolution). Therefore, viruses occupy a "grey zone" between living and non-living. Why Is It Important to See a Doctor? Many viral infections are mild and resolve on their own. However, a number of diseases can have serious consequences: chronic liver damage, oncological processes, and complications to the respiratory system and immunity. Only a doctor can make an accurate diagnosis and prescribe treatment or prevention (for example, vaccination).

Pregnancy is a special time in a woman's life when a future baby develops in her uterus. Conception most often happens after sexual intercourse, but it can also occur with the help of assisted reproductive technologies (ART). You can tell if you're pregnant using home tests or a blood test. Some of the earliest signs include a missed period, nausea, and fatigue. Most pregnancies end with the birth of a child, either naturally or by cesarean section. However, outcomes like miscarriage, abortion, or stillbirth are also possible. How Conception Happens Pregnancy begins when an egg and a sperm meet: • Ovulation: Once per cycle, an ovary releases an egg that waits in the fallopian tube for a sperm for 12–24 hours. • Fertilization: Millions of sperm race toward the egg, but only one fuses with it. • Embryo Development: The fertilized egg (zygote) begins to divide, becoming a blastocyst. • Implantation: About three days later, the blastocyst reaches the uterus and attaches to its wall. From this point, the placenta starts to form, and the embryo develops into a fetus. During this period, the woman's body produces special hormones that stop menstruation and support the baby's development. Assisted Reproductive Technologies (ART) If natural conception is difficult, a doctor can help: • IUI (Intrauterine Insemination): Sperm are injected directly into the uterus during ovulation. • IVF (In Vitro Fertilization): An egg is fertilized by sperm in a lab, and the resulting embryo is placed in the uterus. How Long Pregnancy Lasts On average, a pregnancy lasts 40 weeks or 280 days. However, the duration is counted from the first day of the last menstrual period, not from the moment of conception. So, when a woman discovers she's pregnant (about two weeks after ovulation), she is already considered to be around 4 weeks along. How to Calculate the Due Date The simplest way is: • Write down the date of your last menstrual period. • Add 7 days. • Count back 3 months. • Add 1 year. Keep in mind that only about 5% of women give birth exactly on their estimated due date. An ultrasound can determine the due date more accurately. Gestational Age Gestational age is the length of a pregnancy, measured in weeks and days from the last menstrual period, not the actual date of conception. For example, 22 weeks and 3 days of pregnancy. Trimesters of Pregnancy Pregnancy is divided into three stages, each lasting about 13 weeks. • First Trimester (0–13 weeks): This is the most crucial stage when all of the fetus's organs are formed. Symptoms might include fatigue, nausea, breast tenderness, changes in appetite, constipation, and mood swings. Doctors recommend prenatal vitamins and avoiding alcohol, tobacco, drugs, and certain foods. • Second Trimester (14–28 weeks): Nausea usually lessens and well-being improves. New changes can occur, such as weight gain, muscle aches, darkening of the areolas, the appearance of a pregnancy line, and the baby's first movements. • Third Trimester (29–40 weeks): This is the final stage where the fetus actively grows and gains weight. A woman may experience shortness of breath, back pain, frequent urination, and difficulty sleeping. The first signs of labor, such as contractions and the passing of the mucus plug, may also appear. Full-Term and Preterm Pregnancies • Term pregnancy: 39–40 weeks. • Early-term: 37–38 weeks. • Late-term: 41 weeks. • Post-term pregnancy: After 42 weeks. Why Is Prenatal Care Needed? Regular visits to the doctor allow for monitoring the health of both the mother and the child. At appointments, the doctor will measure your blood pressure and weight, check lab results, listen to the fetal heartbeat, perform an ultrasound, and give you recommendations on diet and lifestyle. Here is a typical visit schedule: • Until week 28: once a month. • 28–36 weeks: every 2 weeks. • After week 36: weekly. How Much Weight Should You Gain? The normal amount is individual, but it is most often 11–16 kg throughout the entire pregnancy.Dalimed Medical Center Cares for You Pregnancy is an important and responsible stage that requires professional support. At Dalimed Medical Center, you will receive comprehensive care, from your first tests and ultrasounds to preparation for childbirth. Our experienced specialists will help you get through all the stages of pregnancy calmly, ensuring the health of both the future mother and the baby.