What is Middle East Respiratory Syndrome (MERS)

Common conditions

Passengers wearing masks to prevent contracting Middle East Respiratory Syndrome (MERS) walk past a thermal imaging camera (unseen) at Incheon International Airport in Incheon, South Korea, June 2, 2015. REUTERS/Kim Hong-Ji

What is MERS?

The Middle East respiratory syndrome is a viral life-threatening infection caused by the coronavirus (MERS-CoV).

Signs and Symptoms of MERS

Although uncommon, these symptoms may be present:

  • Fever
  • Cough
  • Breathlessness

More serious symptoms:

  • Chills
  • Diahorrea
  • Nausea/vomiting
  • Coughing out blood

Complications of MERS

  • Pneumonia
  • Kidney failure
  • worsening of pre – existing diseases like diabetes, cancer, heart problems etc.

Source of MERS-CoV 

The exact source is unknown. However, camels and bats are suspected to be the main host of origin for these viruses. Camels are reported to be able to carry these viruses but it cannot be explained how many of the humans got infected without having any direct contact with camels. Bats can also carry and they often feed on fruit that’s harvested by people, so that is another possible route.

What does the virus do to the human body?

One of the most important cells of the human immune system is the macrophages. These macrophages help to eliminate any infections.

MERS-CoV can establish a productive infection in the macrophages. This induces a release of pro-inflammatory cytokines leading to:

  • Severe inflammation
  • Tissue damage

These manifest clinically as severe pneumonia and respiratory failure. The cells of the lungs are infected the most by MERS-CoV.

Severe acute respiratory syndrome (SARS) and MERS

Both SARS and MERS are relatives and have come from the Coronaviruses. They are a large family of viruses that can cause a range of illnesses in humans, from the common cold to the Severe Acute Respiratory illnesses (SARS). Viruses in this family also cause a number of animal diseases. Compared to SARS, MERS-CoV appears to be more severe and have been reported to be the cause of death to more people (40% versus 10%), more quickly and especially more severe in those with pre-existing medical conditions.

MERS is a global threat

Since the discovery of MERS in 2012, it is considered a pandemic threat to the Gulf region. However, MERS-CoV has now reached about 23 countries affecting thousands of people. 

Although MERS have been reported in US, UK, France, Germany and other countries, strict measures have been taken to stop the spread and since then there has been a decline in the numbers infected.

2015 updates on the Countries with travel-associated MERS cases: Algeria, Austria, China, Egypt, France, Germany, Greece, Italy, Malaysia, Netherlands, Philippines, Republic of Korea, Tunisia, Turkey, United Kingdom (UK), and United States of America (USA) 

However, people in South Korea are still facing the problems of MERS and about 2,300-plus people are quarantined and 1,800 schools closed in South Korea due to the fast spreading of this virus.  

Possible reasons why South Korea has more MERS cases

  • As per reports, the first patient who contracted MERS from a travel visit to the middle east when returned to Korea was left undiagnosed for a week. In that time period, many health professionals and other people who came in contact got infected.
  • There was not enough infection control taken. Bad ventilated hospital rooms may have aided the spread of the virus.
  • South Korea has also been quick to report MERS cases to the World Health Organization as compared to other countries.
  • The worst possibility that the virus may have mutated and become more infectious. Although further research needs to be done to know the exact cause as of now the World Health Organization (WHO) reports, “”There is no evidence to suggest sustained human-to-human transmission in communities and no evidence of airborne transmission. However, MERS-CoV is a relatively new disease and information gaps are considerable.”

The Ministry of Health (MOH) in Singapore continues to closely monitor the recent progress on research regarding MERS-CoV infections. As of now, no cases of MERS-CoV have been detected in Singapore. Nonetheless, given today’s globalised travel patterns. Awareness and strict precautionary measures should be undertaken.

Who is at risk of being infected?

  • Travelers: People who have come in close contact with infected people while travelling to high-risk countries.
  • Consumption of Camel products.
  • Compromised immune system: People who have lung, heart or other conditions or diseases have lower immunity and are more susceptible to the viral infection.
  • Contact with infected person such as health care professionals in hospitals. Also, people who take care of animals like bats and camels may be at increased risk. 

How does MERS-CoV spread? 

The virus can spread between people in close contact. It can spread through the air as the infected person sneezes and releases viral droplet in the air which could spread across to other individuals in close contact. 

The average incubation period has been reported to be 5 days but there are cases that occurred up to 14 days after exposure. Incubation period refers to the amount of time when a person is first exposed to the virus and when the symptoms starts to occur.

How is MERS diagnosed?

There are two main ways to determine if an infection is with MERS-CoV.

  •  Polymerase chain reaction (PCR) analysis: PCR tests are done with respiratory samples and can quickly indicate if a person has an active infection with MERS-CoV.
  • Serology testing: blood samples designed to look for antibodies to MERS-CoV that would indicate a person had previously been infected with the virus hence developed an immune response.

Other tests

  • X-ray to determine the extent of the damage: All patients with MERS have an abnormal chest X-ray. Pneumonia is commonly seen as shown in Fig 1.  The black portion shows the normal air-filled spaces in the lungs and the white portion on the left lung is called infiltrates (filling of air spaces with infectious fluid) that identifies the presence of pneumonia infection. 
image016 (1)

Fig 1: Pneumonia in the Right lung

How to prevent and treat MERS?

There is no known vaccine for MERS and no known medications that have been proved to be effective for the treatment of coronavirus infections. Clinical research is still working on establishing an effective treatment.

Infection prevention and control measures: Especially in healthcare settings, this is important to prevent the possible spread of MERS-CoV.

Early identification of people with MERS-CoV is difficult as like other respiratory infections, the early symptoms of MERS-CoV are non-specific. Therefore, standard precautions should be taken with all patients, regardless of diagnosis.

General precautionary measures

  • When in contact with a person with any symptoms of acute respiratory infection, contact precautions and eye protection should be taken. As the infection is airborne, it can spread through the mucosal lining of the eyes and nose. 
  • Even touching contaminated objects or surfaces and then touching the eyes, nose, or mouth can lead to the spread of the infection. 
  • General hygiene measures – regular hand washing before and after touching animals and avoiding contact with sick animals.
  • Food hygiene practices should be observed. People should avoid camel food products.

Until research reveals more about MERS-CoV, people with diabetes, renal failure, chronic lung disease and people with compromised immunity are considered to be at high risk from MERS‐CoV infection. Therefore, these people should avoid close contact with animals, particularly camels when visiting farms, markets or barn areas where the virus is known to be potentially circulating.

Varicose and Spider Veins – What are they and How to avoid them.

anatomy, Common conditions, Exercise, Health

main pic veins

What are Varicose and Spider veins?

Varicose veins are abnormal, dilated blood vessels (veins) caused by a weakening in the vessel wall. They may appear as swollen, twisted clusters of blue or purple veins.

Varicose veins are sometimes surrounded by thin, red capillaries also known as spider veins.

(group of tiny blood vessels located close to the surface of the skin, also called telangiectasias) – Refer Fig 1.

varicose veins
Fig 1: Varicose vs Spider veins

Role of veins and formation of abnormal veins

Veins carry blood back to the heart and have one-way valves that prevent the blood from back-flowing. The calf muscles act as a pump by which the blood is pumped back from the legs towards the heart as shown in Fig 2.

Deep Leg Veins

Fig 2: Normal blood flow through Veins, Calf muscle pump

If those valves of the veins become weak from extended periods of increased pressure and swelling, the blood can back up and collect within the veins. This causes the vein walls to weaken and bulge with blood, causing the veins to appear swollen and twisted as shown in Fig 3.

deformed valves

Fig 3: Normal vs Abnormal blood flow

Who can get it and where does it happen?

Varicose veins and spider veins can occur both in men and women. However, women are known to be affected more than men due to their hormonal predisposition and changes during pregnancy that affect the veins. 

These abnormal veins can develop anywhere, but most often appear on the legs and in the pelvic area because as compared with other veins in the body. This is because, lower limb veins work harder to carry blood back to the heart with forces from the body weight and gravity acting at the same time. This pressure can be stronger than the one-way valves in the veins.

Most varicose veins are seen on the surface of the skin as the superficial veins get swollen with blood collected in it that get raised on the surface and at times above the surface of the skin.  

Signs and Symptoms

Some may not have any symptoms but may be concerned about the appearance of the veins. Symptoms usually worsen after prolonged standing or sitting as the blood pools or collects in the veins of the lower limbs. 


Fig 4: Swelling, Skin changes and Ulcers due to varicose veins

If symptoms occur, they may include:

  • Tiredness, burning, throbbing, tingling or heaviness in the legs
  • Itching around the vein
  • Swollen legs (Refer Fig 4)
  • Muscle cramps, soreness or aching in the legs
  • Brown discoloration of the skin, especially around the ankles (Refer Fig 4)
  • Leg ulcers (Refer fig 4)
  • Rarely varicose veins can form a painful blood clot, referred to as superficial thrombophlebitis (inflammation of a vein).

Risk factors and causes of abnormal veins

Varicose veins are related to increased pressure in the leg veins or defective valves in the veins.

They can happen due to reasons:

  • Idiopathic: The exact cause of this problem is unknown.
  • Heredity: A family history of varicose veins can put a person at risk of developing abnormal veins.
  • Advancing age: With aging veins can lose elasticity causing them to stretch. The valves in your veins may become weak, allowing blood that should be moving toward your heart to back-flow.
  • Prolonged standing or sitting.
  • Being overweight puts extra pressure on your veins, which means damage to the valves, making them more prone to swell.
  • Pregnancy: Pregnancy increases the volume of blood in your body but decreases the flow of blood from your legs to your pelvis. This circulatory change is designed to support the growing foetus but it can produce an unfortunate side effect — enlarged veins in your legs.
  • Hormonal influences during pregnancy, postmenopausal hormonal replacement therapy and use of birth control pills can cause excessive swelling in the lower limbs that hampers blood flow through veins. 
  • Wearing tight clothes can put pressure on the veins which can cause abnormal blood flow.
  • Injury to the veins due to trauma or accidents.
  • Other health conditions that cause increased pressure in the abdomen including liver disease, fluid in the abdomen, previous groin surgery or heart failure.

How is Varicose and Spider veins diagnosed?

A physical examination of the body especially the legs while the person is standing is done. A Doppler ultrasound scan can also check the blood flow in the veins near the skin’s surface and the deep veins. 

When to seek medical care?

  • Walking or standing becomes painful.
  • Soreness develops on or near a varicose vein
  • Your feet or ankles swell up very frequently.

If immediate care is not taken, symptoms may worsen. Complications may develop if there is an underlying disease in the deep veins or in the perforating veins which connect the deep and superficial veins.

  • Chronic venous insufficiency: Untreated venous problems may progress to a chronic condition of abnormal blood flow through the veins.
  • Venous stasis ulcers that result when the enlarged vein does not provide enough drainage of fluid from the skin. As a result, an ulcer (open sore) may form.
  • Fungal and bacterial infections may occur as the result of skin problems caused by the fluid buildup (edema) in the leg. These infections also increase the risk of tissue infection (cellulitis).
  • Thrombophlebitis: Inflammation of the vein due to blood clot formation.
  • Venous hemorrhage: Bleeding through the veins due to micro-tears and ruptures.

How to prevent varicose veins and its complications?

Lifestyle modifications:

  • Losing weight if you are overweight
  • Exercising regularly (especially walking)
  • Avoiding prolonged periods of sitting or standing
  • Avoid wearing tight-fitting undergarments and clothing that constricts the waist, groin or legs.
  • Avoid crossing your legs while seated.
  • Elevating your legs while sitting and sleeping will help.
  • When you need to stand for long periods, take frequent breaks – sit down and elevate your feet.
  • Do ankle pump exercises as shown in Fig 5.

ankle pumps

If you still develop varicose or spider veins, it is best to seek medical attention to know more in details on exercises and lifestyle changes that can be personalized to your needs.  

Run safe, run right.

Exercise, Lifestyle

Runners Knee

No matter what body type you are or the level of activity you do, a good run does wonders. Most of us run for fitness, fun, stress relief or even for a living.

Even the world’s fastest runner, Usain Bolt, will not deny the fact that running is a high impact aerobic exercise and many injuries could be associated with it. Simply put, it is not uncommon for some to experience some sort of aches and pains in your knee after running.

One of the most common knee injury affecting people is “Runner’s Knee”. Though this condition is associated with running, even normal people who engage in knee workouts could be affected by it.

Runner’s Knee- the Mystery behind it

“Runner’s knee” is a term used to describe pain and inflammation in the front of the knee due to several factors. It is mostly believed to be a fault in the biomechanics of your body during the running process.

Runners Knee-osteopathy

Biomechanics of running

Biomechanics is the study of the structure and function of body systems when forces are applied.

In simple words, when you run, the foot impact creates a force that transfers upwards to your knees. The force meant to propel you forward is about 2 to 3 times your body weight. To prevent this force from directly impacting your knees, correct posture and placement of your foot is required. Together with coordinated contraction of your leg muscles to balance out these forces.

good run

Injury and pain are believed to occur if there is:

  • Muscular imbalances, tightness and stiffness around the knee.
  • Malalignment of your joints affecting the correct heel placement. For example, poor posture or runners with flat or high-arch feet.
  • Over- activity and weakness in the leg muscles.

How to run safely?

Experts researching on Cheetahs are amazed at their genetics and want to pass along few tips that you could implement.

Cheetah so fast

Tips for humans

Get Good Shoes

Many shoe manufacturers have realized the importance of shoes for performance and have responded by giving us a range of options.

Important things you want to look for:

  • Light weight shoes for swift movements
  • Correct fit – snug and supportive
  • Good arch support

Always Warm-up and Cool-down

Warm-up exercises will prepare the circulatory and respiratory system for the upcoming workout. It also improves the flexibility of your muscles whether it’s just walking or running. On the other hand, cool down exercises help you to gradually lower your heart rate and blood pressure as well as restore the flexibility of your muscles. By skipping them may cause muscle aches and pains after the run.

Maintain the flexibility in your joints, tendons, ligaments and muscles

You want to avoid any restrictions on your movement while running. Improve the range of motion of all the joints and reduce the risk of any muscle strains.

Correct your posture

Poor posture creates imbalances in your muscles and restricts the circulation of blood to them. Over time, it may reduce the oxygen supply which may affect overall health. Therefore, posture is one of the things we try to correct as much as possible.

Prevent Over-striding and Under-striding

Normally you should land with your feet right under you. Over- striding is increasing your stride length over your normal capacity while under-striding is the exact opposite. This happens when you are not bending your knees enough maybe due to tightness in your muscles, joint stiffness and/or poor circulation in your legs.

Watch your Strides- Cadence

Moving with long steps while you run is great! But you may want to consider the number of strides to be maintained about 85-90 per minute with each leg. You could use a digital metronome to record and regulate your strides.

Listen to your body

It will truly help you recognize any restrictions, tightness, faults in your posture that need fixing.

Enrich your brain

You will be amazed how your body adapts to what your brain knows. You can control your body movements and speed just by learning the correct body postures and foot placements.

Maintain good upper and lower body coordination

Muscles work together to cause a movement and running involves co-ordination of your upper and lower limb muscle groups. Any fault in this co-ordination will impose great stress and cause muscle imbalances.

Breathe well

Running being a high impact aerobic exercise requires a great amount of oxygen supply to your muscles to produce energy.

Simple Exercise:

“Diaphragmatic Breathing or Belly breathing”- Breathe deep from your belly, see your stomach rise out as your diaphragm contracts. Practice this technique at rest or while running, it will surely help!


Every person is unique and we need to look at what our body requires. Whether it is tight muscles or faulty posture, you need to fix it before its too late. A safe run is what you want without worrying about injuries, you may want to consider meeting the experts to get a detailed assessment of your body before starting any physical activity.