Tuesday, 21 April 2015

Crimean-Congo Hemorrhagic Fever


CCHF
Crimean-Congo Hemorrhagic Fever-CCHF –Tick Borne Viral Disease

Crimean-Congo hemorrhagic fever – CCHF is a widespread tick borne viral disease. The pathogenic virus is common in East and West Africa in the family of Bunyaviridae of RNA viruses. The disease was first considered in the Crimea in 1944 and was given the name Crimean hemorrhagic fever and was thereafter recognized in 1969 as the outcome of illness in the Congo which resulted in the prevailing name of the disease. The disease is found in Eastern Europe especially in

the former Soviet Union, all over the Mediterranean, in north-western China, Southern Europe, Central Asia, Africa, the Indian subcontinent and the Middle East. The multitude of the CCHF virus comprise of a wide range of wild and domestic animals like the sheep, cattle and goats and several birds are resistant to infection though ostriches are vulnerable and could show a high occurrence of infection in endemic areas.

Animals tend to get affected by the bite of infected ticks and the virus remains in the bloodstream for around a weeks after the infection enabling the tick animal tick cycle to progress when another tick tends to bite. Though the numbers of tick species have the potential of becoming infected with CCHF virus, ticks of the Hyalomma species are the principal vector

Signs & Symptoms 

The onset of this condition is sudden with early signs and symptoms which include headache, high fever, joint pain, back ache, stomach pain with vomiting. A flushed face, red eyes, red throat, and red spots – petechiae, on the palate are common in this condition.

The symptoms could also include jaundice and in more severe cases it could change in mood as well as sensory perception. Large areas of severe nosebleeds, bruising with uncontrolled bleeding at injection sites can be seen as the illness develops which begins around the fourth day of the illness and lasts for around two weeks.

The virus of this disease is transmitted to human by tick bites or through contact with the infected animal blood or tissues during and immediately after they are slaughtered and most of the cases have taken place in people who are involved in the livestock industry like the agricultural workers, veterinarians and slaughterhouse employees.

Person to person transmission could take place resulting from close contact with the secretion, blood, organs or other body fluids of infected persons. Besides this, hospital acquired infection could also occur due to negligence of sterilization of medical equipment, contamination of medical supplies and reuse of needles.

Diagnosis & Treatment 

The CCHF virus infection can be diagnosed with the help of various laboratory tests namely
  • Antigen detection
  • Enzyme-linked immunosorbent assay – ELISA
  • Serum neutralization
  • Reverse transcriptase polymerase chain reaction – RT-PCR assay
  • Virus isolation by cell culture
Those with fatal disease and patients in the initial stage of their illness do not tend to develop adequate antibody response and hence diagnosis in them is done by virus or RNA detection in their tissue or blood samples.

The tests on these patient samples portray an extreme bio hazard risk and must be done under maximum biological control conditions and if samples are inactive, they could be manipulated in a basic bio safety environment. The supportive care with treatment of symptom is the main approach in managing this condition in people as there is no specific recognized treatment for this condition.

Saturday, 18 April 2015

Sickle Cell Disease


Sickle_Cell
Sickle Cell Disease – Group of Inherited Red Blood Cell Ailment

Sickle cell disease – SCD is considered as a group of inherited red blood cell ailment wherein the red blood cells tend to get hard and sticky and look like a C-shaped farm tool known as a sickle. SCD is a serious disorder wherein the body makes sickle shaped red blood cells in the shape of the sickle while normal red blood cells are disc shaped which look like doughnuts without holes in the centre.

They tend to move with ease in the blood vessels and contain an iron rich protein known as haemoglobin and this protein carries the oxygen from the lungs to the various parts of the body. Sickle cells comprise of abnormal haemoglobin known as sickle haemoglobin which causes the cells to develop a sickle or crescent shape.

In the case of this disorder, the abnormally shaped red blood cells get caught in small blood vessels, blocking the flow of blood and oxygen to organs in the body. These obstructions tend to cause repeated incidents of severe pain, serious infections, organ damage and even stroke.

These episodes are known as sickle cell crisis or vaso-occlusive crisis and they could last from a few minutes to several months though on an average most of them could last for five to seven days.

Abnormal Blood Cells – Shorter Lifespan 

The abnormal blood cells also tend to have a shorter lifespan and cannot be replaced as quickly as the normal blood cells which lead to shortage of red blood cells called anaemia. Sickle cell anaemia is due to mutation in the gene which instructs the body to develop haemoglobin and this gene is inherited.

To obtain sickle cell anaemia, the person has to inherit the defective gene from both the parents. If the gene is inherited from one of the parent, the sickle cell strait – SCT and it is likely that the blood will have some sickle cells and they will be able to produce normal haemoglobin without any symptoms.

However, they could be carrier of sickle cell anaemia and could pass the abnormal gene to their children. If two individuals with the sickle cell trait tend to have a child, there could be a possibility of one in four chance that the child could be born with sickle cell anaemia.

Those who inherit one sickle cell gene and one normal gene have sickle cell trait – SCT and people with SCT frequently do not have any of the symptoms of sickle cell disease – SCD

Symptoms 

Sickle cell anaemia is diagnosed with a simple blood test wherein the blood is checked for defective haemoglobin. A small portion of defective haemoglobin can indicate if the person has the sickle cell trait but not sickle cell anaemia and a high level can indicate sickle cell anaemia.

To reduce the risk of sickle cell crisis, one should cultivate a simple lifestyle of consuming plenty of fluids.At times, a person suffering from sickle cell anaemia continues to experience pain inspite of taking precautions for which medication is recommended to get relieve.

Due to the risk of potentially life threatening complications, it is essential to check out for any symptoms or signs where the health of a person suffering from this condition could suddenly get worse which include a high temperature of 38C or above, breathing difficulties or severe pain that cannot be controlled even with medication that are available over the counter.

Thursday, 16 April 2015

Ganglion Cyst


Ganglion Cyst
Image credit:faoj.org
Ganglion Cysts – Lump like Fluid Filled Swelling

Ganglion cysts is a very common lump like a fluid filled swelling which tends to develop near a joint or a tendon and can vary in size from a pea to the size of a golf ball. The most common areas are the top of the wrist, palm side of the wrist, base of the finger on the palm side and the top of the end joint of the finger.

 It often appears like a water balloon on a stalk which is filled with clear fluid or gel known as synovial fluid which surrounds the joints and tendons in order to lubricate and cushion them during movement and is generally harmless though they can at times be painful especially if it is located next to a nerve. If they are not painful or cause any discomfort, it could be left untreated and may disappear without any treatment though it could take a number of years.

The formation of ganglions is not clear though it could be related to age or injury to the joint or tendon and occurs when the synovial fluid surrounding the joint or tendon leaks out and collects under the skin.

Cysts not Cancerous 

The cysts may change in size, are not cancerous and will not spread to other parts of the body. Diagnosis depends on the location of the cysts and its appearance which is usually oval or round and could be soft or very firm.

The cysts which are at the base of the finger on the palm area are very firm, the size of a pea which are tender to applied pressure while gripping and light tends to pass through these lumps which can help in the diagnosis. Cysts at the far joint of the finger often have an arthritic bone shoot linked with them and the overlapping skin could be thin with lengthwise groove in the fingernail beyond the cyst.

Treatment is often recommended only if the cyst may cause pain or it may affect the range of movement in a joint and the two main options of treatment for ganglion cysts comprises of draining of fluid out of the cyst with a needle and syringe known as aspiration in medical term or cutting the cyst out through surgery. Aspiration is a simple process and recurrence of the cyst is very common.

Treatment – Surgical/Non-Surgical

Treatment could also be non-surgical and in several cases, the cysts can be observed if they are not painful since they tend to disappear within a period of time. If they tend to be painful, limits activity, several other options are available like the use of splints and anti-inflammatory medication may be prescribed to relieve the pain linked with activities.

If non-surgical treatment does not provide relief or if the cyst recurs, surgical alternative are available and the surgery involves the removal of the cyst along with a part of the joint capsule or tendon sheath. With regards to wrist ganglion cysts, traditional open and arthroscopic techniques tend to provide good results and surgical treatment is often successful though they cysts may reappear.

Both the techniques can be performed under either local or general anaesthetic depending on the area of the ganglion and which anaesthetic one would prefer and what is recommended by the surgeon.

Monday, 13 April 2015

Sleepwalking


Sleepwalking
Sleepwalking – Deep Stage/Lighter Stage/Awake Stage

Sleep walking is a type of a disorder which causes a person to get up and walk while they are asleep and usually tends to take place when the person is going from the deep stage of sleep to a lighter stage or in the awake stage. It occurs during a period of deep sleep which is at its height during the early part of the night and takes place within the first few hours on falling asleep.

Sleepwalking could start at any age though it is more common in children and most of them tend to grow out of in due course by the time they reach puberty but it could persist in adult life. The person who tends to sleepwalk is unable to respond during that time and also does not seem to remember the incident and in some cases may tend to talk without making much sense.

When a person sleepwalks, they could walk quietly around the place or they could run or make attempts to escape. Some may just sit up in bed and look around while the others getting out of bed may walk about, open cupboards, get dress or eat. In certain extreme cases, they are also known to walkout of the house carrying complex activities like driving a car.

Usually the sleepwalker’s eyes remain open with a glassy look as they move around the place and when quietened, they may slow down to respond or may not respond at all. Often, they are capable of manoeuvring around the object.

Unable to Recall Incident of Sleepwalking

Whenever they are put back in their bed without waking them from their sleep, they usually are unable to recall the incident. Sleepwalking could be the cause of it running in the family, or some of the factors that could trigger the disorder are: deprived sleep, stress, getting drunk, chaotic sleep schedule, habit of taking drugs like sedative-hypnotic which enables relaxation or sleep, stimulants and other antihistamines.

If the victim has a blood relative who sleepwalks, then they are ten times more likely to have the disorder than someone with no sleepwalker in the family. Some medical condition which have been linked to sleepwalking comprises of fever, heartburn, heart rhythm problems, night-time asthma, night-time seizures, restless leg syndrome, obstructive sleep apnea, together with psychiatric disorders like post-traumatic stress disorder, panic attacks or dissociative states like multiple personality disorder.

To prevent these triggers some steps could be taken like getting enough sleep and engaging in activities which could be helpful in reducing the stress

Refrain from Shouting & Startling 

The most important thing to be done when a person is sleepwalking is to ensure that they are safe and one should refrain from shouting or startling them or waking them up. They should be gently guided back to bed and if they are undisturbed they tend to fall back to sleep.

Sometimes in the case of children gently waking them fully when they are coming out of the incident before letting them to go back to sleep helps in the prevention of another event taking place from the same deep sleep cycle.

There is no treatment for this disorder but sufficient sleep together with a regular and relaxed routine prior to bedtime could be beneficial to the person with Sleepwalking disorder.

Thursday, 9 April 2015

Pericarditis


Pericarditis
Pericarditis – Swelling of the Pericardium around the Heart

Pericardium is a thin, double layered fluid filled sac which covers the exterior surface of the heart and shields the heart from any type of infection or malignancy. Besides this, it also prevents the heart from expanding too much whenever the blood volume increases thus enabling the functioning of the heart in an efficient manner.

Pericarditis is the swelling of the pericardium surrounding the heart where the main symptom is chest pain which could be sudden, sharp with stabbing pain behind the breastbone or something like a dull ache. The pain tends to get worse on lying down or breathing in and improves in a sitting position.

Pericarditis is not a serious condition and can be treated as an outpatient treatment without the need to be hospitalized. It is said to be an inflammation of the pericardium which develops suddenly and could last for several months.

On seeing and touching it, the membrane surrounding the heart tends to get swollen and seems red like the skin around a cut which gets inflamed. At times the excess fluid develops in the area between the pericardial layers causing pericardial effusion or build-up of excess fluid around the heart.

Symptoms of Pericarditis

The symptoms of chest pain connected with pericarditis are – sharp and stabbing pain, caused by the heart which rubs against the pericardium, which could increase with swallowing, coughing or deep breathing or lying flat, gets relieve on sitting up and leaning forward, or may feel the need to bend over or hold the cheat in order to breathe with ease.

Other symptoms would include, dry cough, anxiety or fatigue, pain in the back, left shoulder or neck and difficulty in breathing while lying down. In some cases, there could be swelling of the feet, ankles or legs and these symptoms could be of constrictive pericarditis which is a serious form of pericarditis.

In these cases, the patient’s pericardium tends to get harden and/or thickens thus preventing the heart muscles from expanding thereby affecting the efficient function of the heart. Due to the constrictive process, the heart could be compressed causing the blood to back up into the lungs, abdomen as well as the legs thus resulting in the swelling.

Various Causes of Pericarditis

Men in the age group of 20 to 50 could suffer from pericarditis though it could also occur in women. There are various causes of pericarditis thoughit could at times be a complication of viral infection, usually a gastrointestinal virus or rare cases of flu virus or AIDS.

 It could also be due to bacterial infection, fungal infection or parasitic infection. Some cases of certain autoimmune diseases like rheumatoid arthritis lupus and scleroderma could also cause pericarditis while other additional causes could include injury to the chest like a car accident – traumatic pericarditis, and other health problems like kidney failure, tumours, and genetic disease as Familial Mediterranean Fever (FMF).

Other rare cases could be medication which could suppress the immune system. It is said the risk of pericarditis is much greater after a heart attack or after a heart surgery, radiation therapy or a percutaneous treatment like cardiac catheterization or RFA – radio-frequency ablation.

Acute pericarditis is treated with medication to reduce swelling though antibiotics could be used if suffering from bacterial infection. Chronic pericarditis is treated based on the underlying causes.

Tuesday, 7 April 2015

Prader-Willi Syndrome


Prader-Willi Syndrome
Prader-Willi Syndrome – An Unusual Genetic Condition

Prader-Willi syndrome – PWS is an unusual genetic condition which affects several parts of the body. Prader-Willi syndrome is the outcome of the loss of genes in a certain region of chromosome 15 and a person generally inherits one copy of this chromosome from each parent.

Some of the genes are turned on or are active only on the inherited copy from the father or the paternal copy and this parent specific gene activation is caused by genomic imprinting, It occurs when the region of the paternal chromosome 15 comprisingof these kind of genes is absent. Research is on in identifying genes on chromosome 15 which are responsible for Prader-Willi syndrome.

 It is believed that a deletion of the OCA2 gene on chromosome 15 could be associated with unusually fair skin and light coloured hair in some cases. The protein which is produced from this gene determines the colouring or the pigmentation of the skin, eyes and hair. Researchers have not yet connected completely any other genes with specific symptoms and signs of this condition.

Several cases of this condition take place when a section of the paternal chromosome 15 is missing in each cell while in other cases, the person with two copies of chromosome 15 inherited from their mother, the maternal copies, instead of one copy from each parent. This is known as maternal uniparental disomy.

Weak Muscle Tone/Poor Growth/Delayed Development/Feeding Difficulties 

In seldom cases, Prader-Willi syndrome could be caused by chromosomal rearrangement known as translocation or by mutation or other deficiency which could abnormally turn off or inactivates genes on the paternal chromosome 15 and each of these genes could cause loss of gene function in serious region of chromosome 15.

In infancy, this ailment is characterized by weak muscle tone, poor growth, feeding difficulties together with delayed development. In the initial stage of childhood, some may develop an insatiable appetite which could result in chronic overeating and obesity while those with obesity could develop type 2 diabetes mellitus which is the common type of diabetes.

 Those with this condition tend to have mild to moderate intellectual impairment as well as learning disabilities. They may also have behavioural problems including temper tantrums, compulsive behaviour and stubbornness. Several may also have sleep abnormalities. Besides these, other symptoms could also include distinctive facial features, short stature with small hands and feet.

Some may tend to have fair skin and light coloured hair and the affected person; both males as well as females may tend to have underdeveloped genitals. Puberty tends to be delayed or incomplete and most of them are unable to have children.

Manage Over-eating Habits and Behavioural Problems 

Though there is no cure for this condition, the person can be treated to manage the symptoms together with associated problems. For parents, it could mean dealing with their child’s over-eating habits and other behavioural problems.

Getting your child to maintain a healthy balanced diet could help in maintaining normal weight and can be one of the most important help in caring for a child suffering from Prader-Willi syndrome which could be quite a challenging task.

If a child with this condition tends to follow a strict diet and control their weight they can live a normal and healthy quality of life though due to their behavioural problems and learning issues, it could be likely that they would be unable to live an independent life.

Saturday, 4 April 2015

Chronic Fatigue Syndrome -CFS


Chronic_Pain
Credit: Georgetown University Medical Center
Chronic fatigue syndrome – CFS is a complicated disorder which causes persistent fatigue or exhaustion and affects the daily lifestyle of the person. The exhaustion or fatigue may worsen with physical or mental activity and does not go away inspite of a good sleep or rest.

CFS is also known as ME - myalgic encephalomyelitis where myalgia means muscle pain and encephalomyelitis means inflammation of the brain and the spinal cord and both the terms are commonly used. CFS seems to be a serious condition which could cause long term illness and disability though several people especially children and young people tend to improve over a period of time.

The cause of this disorder is not known though there are several theories which range from viral infection to psychological stress while some are of the belief that chronic fatigue syndrome could be triggered due to a combination of factors. Since there is not a single test to confirm the diagnosis of this condition a variety of medical test may be needed to rule out other health issue with similar symptoms and the treatment is based on the symptom relief.

Signs & Symptoms 

CFS has eight signs and symptoms together with central symptoms which are related to its name. They include -
  • Fatigue
  • Lack of memory or concentration
  • Sore Throat
  • Unexplained muscle pain
  • Enlarged lymph nodes in the neck or armpits
  • Pain which moves from one joint to another without redness or swelling
  • Sleep which is not refreshing
  • Extreme exhaustion for more than 24 hours after mental or physical exercise
  • Headache of a new kind, pattern or severity
NICE – Specific Guidelines for Diagnosis & Management of CFS

Some individuals are more prone to the condition due to their genes and the condition is often common in some families. National Institute for Health and Care Excellence – NICE has issued specific guidelines for the diagnosis and management of CFS. According to them the diagnosis of CFS is considered.if one meets specific criteria with regards to exhaustion or fatigue, for instance, which cannot be explained by other conditions and other symptoms like sleeping problem or thinking and concentration. The diagnosis is then confirmed only when these symptoms occur for several months. There is no cure for this disorder though treatment could reduce the symptoms and the treatment plan may differ from individual to individual since each person may respond differently to the treatment.

Treatment for CFS

Some of the treatment includes –
  • Cognitive behavioural therapy - CBT
  • Structured exercise programme known as graded exercise therapy
  • Medication to control pain, sleeping problem and nausea
These treatments help to improve the condition in several cases though some are not restored to complete recovery. There could also be instances where the symptoms would get better or even worse. Some of the factors which could increase the risk of CFS comprise of:

  • Age wherein it could occur at any age and is mostly commonly within the age group of 40s and 50s
  • Gender – Women are more prone to this ailment than men though it could be more likely that women tend to report their symptoms to the physician.
  • Stress also contributes to the development of chronic fatigue syndrome.