Blepharitis is a very common inflammatory disorder of the edge of the eyelids where the eyelashes are located.

Definition

Blepharitis is a very common inflammatory disorder of the edge of the eyelids where the eyelashes are located. Bacteria, which normally exist on our skin, are drawn to crusts around the base of the eyelashes and produce chemical substances which irritate the eyes resulting in itching, irritation and burning of the eyes. The ducts of special glands, called meibomian glands, which are located in the eyelids just behind the eyelashes, become blocked. These glands are important in helping to prevent the film of tears which covers the very sensitive cornea (the clear window of the eye) from evaporating too rapidly in between blinks, as they produce the mucus layer of the tear film.

It results in:

  • Tear film instability which in turns results in irritation, a foreign body sensation, burning, itching and redness of the eyes (dry eye symptoms)
  • Tearing of the eyes due to an overproduction and overflow of tears as a reflex reaction to eye irritation
  • Red inflamed eyelid margins
  • Cyst formation in the eyelid (chalazion or meibomian cyst – see photograph below)
  • Loss of eyelashes
  • Inturning of the eyelid margins (entropion) resulting in painful rubbing of the eyelashes against the cornea
  • Corneal ulcer (marginal ulcer or marginal keratitis)

Prevalence

It is one of the most common ocular disorders encountered by eye care practitioners. In the United States, blepharitis is estimated to affect more than 180 million people. In a United States survey of ophthalmologists and optometrists, it was estimated that 37% and 47% of the patients presented with certain form of blepharitis in clinical practice, respectively.

Blepharitis

Types of Blepharitis

Anterior blepharitis

Anterior blepharitis is the name given to the condition when the inflammation affects the skin around the base of the eyelashes.

Anterior blepharitis is usually caused by one of two things.

  • Seborrhoeic dermatitis. This complaint causes the skin to become oily or flaky, blocking the Meibomian glands in the eyelid.
  • A reaction to Staphylococcus bacteria, which is usually present but harmless on our skin.

Posterior blepharitis

In patients with posterior blepharitis, the inflammation usually affects the Meibomian glands which are behind the base of the eyelashes. Posterior blepharitis is normally caused by issues with the Meibomian glands, such as when they become blocked by flakes of skin, debris or bacteria. Occasionally, people who suffer from the skin condition known as Rosacea, will also find they are prone to posterior blepharitis.

Mixed blepharitis

Unsurprisingly, mixed blepharitis is a combination of both anterior and posterior types of the condition.

Risk factors

A risk factor is something that increases your chance of getting a disease or condition. Risk factors for blepharitis include:

  • Seborrheic dermatitis
  • Acne rosacea
  • Contact allergies
  • Diabetes
  • Chemical irritants
  • Poor hygiene
  • Cosmetic makeup
  • Advanced age

Causes of Blepharitis

There are a number of possible causes of blepharitis.

They include:

  • An inflammatory reaction to bacteria that normally live on eyelids
  • Seborrheic dermatitis or rosacea
  • Parasites: Demodex eyelash mites
  • Infection with the herpes simplex virus (HSV)

People who have dandruff are more likely to develop blepharitis. Keeping the dandruff under control can help reduce the symptoms.

Another possible cause is dysfunction of the Meibomian glands on the rim of the eyelids. These glands produce an oily substance that prevents the eye’s film of tears from evaporating.

Some doctors believe that blepharitis is a precursor of Meibomian gland dysfunction, rather than the gland dysfunction causing blepharitis.

Blepharitis symptoms

Blepharitis causes varying degrees of discomfort depending on the severity of the case. Common signs and symptoms include:

  • Itchy, flaky eyelid margins
  • Red/blood-shot eyes
  • Foreign body sensation
  • Excessive or frothy tears
  • Crusty or sticky lashes
  • Sensitivity to light
  • Rough, scaly eyelids
  • Excessive blinking

It is a good idea to make an appointment with your optometrist or ophthalmologist as soon you experience any of the above symptoms.

Symptoms of Blepharitis

Complications of Blepharitis

It is unusual for blepharitis to cause serious medical problems. However, blepharitis can lead to the following changes in eye health.

Sty: A sty (sometimes spelled stye) or hordeolum is a bacterial infection in one of the oil glands whose opening is clogged. The result is a painful lump on the edge or inside of the eyelid.

Chalazion: A chalazion or conjunctival granuloma occurs when blockage in one or more of the oil glands causes it/them to become enlarged and scarred. Multiple chalazia can also develop, either on the same eyelid or on different lids.

Chronic pinkeye: Blepharitis can lead to recurrent bouts of pinkeye (conjunctivitis).

Ulceration of the cornea: Constant irritation from inflamed eyelids or misdirected eyelashes may cause a sore (ulcer) to develop on the cornea. It does not affect vision generally, although disturbances of the tear film may intermittently blur vision, causing varying amounts of fluctuating vision during the day.

Diagnosis and test

Blepharitis can be diagnosed through a comprehensive eye examination. Testing, with special emphasis on the eyelids and front surface of the eyeball, may include:

  • Patient history to determine any symptoms the patient is experiencing and any general health problems that may be contributing to the eye problem.
  • External examination of the eye, including lid structure, skin texture and eyelash appearance.
  • Evaluation of the lid margins, base of the eyelashes and meibomian gland openings using bright light and magnification.
  • Evaluation of the quantity and quality of tears to check for any abnormalities.

An optometrist can determine the type of blepharitis based on the appearance of the eyelid margins. The different types and symptoms are as follows:

  • Staphyloccal blepharitis patients frequently exhibit mildly sticking eyelids, thickened lid margins, and missing and misdirected eyelashes.
  • Seborrheic blepharitis patients have greasy flakes or scales around the base of eyelashes and a mild redness of the eyelids.
  • Ulcerative blepharitis patients have matted hard crusts around the eyelashes. Removing the crusts leaves small sores that ooze and bleed. These patients may also experience eyelash loss, distortion of the front edges of the eyelids and chronic tearing. In severe cases, the cornea (the transparent front covering of the eyeball) becomes inflamed.
  • Meibomian blepharitis patients have a blockage of the oil glands in the eyelids, poor quality of tears and redness of the lining of the eyelids.

Treatment and medications

Blepharitis cannot be totally cured, but it is possible to make your eyes more comfortable:

Warm compresses- These will help to unblock glands and loosen the crusts on the eyelid so that they are easier to remove. You can buy reusable warming packs which you heat up in the microwave, or you can use a flannel, cotton-wool ball or something similar, which you can soak in hot, but not boiling, water. Place the compress on the edge of your closed eyelids for five minutes, rocking it gently. This will loosen the crusts. Use a use a separate clean compress for each eye.

Lid cleaning- After applying the compress you should clean your lids. Your optometrist will be able to advise you of the different options available.

Lubricants- These are available from your optometrist or pharmacist and can help if your eyes feel gritty and dry.

Antibiotics- If warm compresses and cleaning your eye lids do not work, your doctor or prescribing optometrist may prescribe you antibiotic ointment or tablets. You may need to take these for several weeks or months and the benefits may last for some months after you finish the treatment.

If you have blepharitis, avoid smoky atmospheres and wearing eye makeup, particularly eyeliner and mascara.

Prevention

  • Strict eye hygiene helps prevent blepharitis. Using clean towels and making sure your hands are clean before touching your eyes and eye area are important steps in prevention. If you wear makeup, it is important to thoroughly remove any traces of it before going to bed.
  • In cases of posterior blepharitis where the oil glands are not producing enough oil, nutritional supplements of Omega-3 fatty acids may be recommended by your doctor. Flaxseed oil is a common fatty acid supplement.

Tragedy as Seven person were killed in crackdown on rallies in Sudan’s capital.

According to report, the Organisers of anti-military rallies in Sudan’s capital Khartoum announced an escalation of protests after security forces used gunfire and teargas on Monday to disperse demonstrations against a coup and medics said seven people had been killed.

Security forces fired volleys of tear gas as they blocked thousands of protesters from advancing on Khartoum’s presidential palace, and several injured civilians could be seen bleeding heavily in the street, a Reuters witness said.

They also fired live ammunition and stun grenades, said the Central Committee of Sudanese Doctors, a group of medics aligned with the protest movement, which reported seven deaths.

Medics told Reuters that many others were being treated for injuries at Khartoum hospitals.

The military prepared a massacre for us today, and all we’ve done is ask for civilian rule and democracy, said Mohamed Babaker, a 19-year-old student.

A police spokesman said a statement would be released later. Government sources put the death toll from Monday at three.

Huge crowds have regularly taken to the streets demanding a return to civilian rule since the military coup on Oct. 25 ended a power-sharing arrangement agreed after Islamist autocrat Omar al-Bashir fell during a popular uprising in 2019.

Medics say at least 70 people have died in clashes with security forces since the coup.

http://www.oneworldvisionnews.com

The Federal Government of Nigeria has file new terrorism charge against Mazi Nnamdi Kanu.

According to oneworld news line, it wss learnt that the Federal Government of Nigeria, on Monday, filed new terrorism charges against the leader of the Indigenous People of Biafra, Mazi Nnamdi Kanu.

In the amended process it filed before the Federal High Court sitting in Abuja, the FG increased the counts in the initial charge it preferred against Kanu.

Kanu, who has been in detention since his alleged abduction from Kenya and forceful return to Nigeria, faced a seven-count treasonable felony charge, will now enter his fresh plea to a 15-count amended charge marked FHC/ABJ/CR/383/2015, and signed by the Director of Public Prosecution, DPP, M. B. Abubakar.

The charge was amended barely 24 hours before the scheduled commencement of hearing by trial Justice Binta Nyako.

http://www.oneworldvisionnews.com

The Nigeria police force Katsina command eliminate unidentified number of terrorist in a gun battle.

According to the report made available to oue desk, it was gathered that, a police spokesperson in Katsina, Gambo Isah in a statement released on Monday January 17 released details of the encounter.

Unidentified number of bandits have been shot dead during a gun battle with police in Katsina over the weekend.

The incident happened after the bandits attacked Badole village, in the Kurfi Local Government Area of Katsina state.

Police repelled the bandits killing many in the process. 

The state police spokesperson, Gambo Isah in a statement released on Monday January 17, said the terrorists had swooped on the village early Saturday morning where they, amongst others, rustled an unspecified number of domestic animals.

Operatives of the command and members of the vigilante in the council who were alerted of the incident mobilised and blocked the exit route of the terrorists at Yarrunfar Koza village. This led to a gun battle, and “many terrorists” were killed in the process while all the rustled animals were recovered.

Below is the statement

On January,15,2022, at about 01.20 a.m, bandits in their numbers, attacked Badole village, Kurfi, rustled unspecified number of domestic animals.

The DPO led a combined team of police and vigilante and blocked their exit route at Yarrunfar Koza village, Kurfi Local Government Area.

The team engaged the terrorists in a gun duel, many were neutralized and all the rustled animals were recovered.

http://www.oneworldvisionnews.com

Overactive bladder Syndrome is a health condition that causes a variety of symptoms, many of which can cause feelings of embarrassment.

Definition

Overactive bladder Syndrome is a health condition that causes a variety of symptoms, many of which can cause feelings of embarrassment. Dealing with these symptoms can sometimes cause you to want to isolate yourself or limit your social and work life activities to avoid feeling uncomfortable. The most common symptoms include:

  • The sudden urge to urinate
  • Inability to control urination (urge incontinence)
  • Frequent urination

An overactive bladder also causes nocturia, when you’re woken up by the urge to urinate. A frequent urge to urinate not only leaves you running for the bathroom, but it can also be a true disruption to your everyday life.

Epidemiology

Earlier reports estimated that about one in six adults in the United States and Europe had OAB. The prevalence of OAB increases with age, thus it is expected that OAB will become more common in the future as the average age of people living in the developed world is increasing.

However, a recent Finnish population-based survey suggested that the prevalence had been largely overestimated due to methodological shortcomings regarding age distribution and low participation (in earlier reports). It is suspected, then, that OAB affects approximately half the number of individuals as earlier reported.

The American Urological Association reports studies showing rates as low as 7% to as high as 27% in men and rates as low as 9% to 43% in women. Urge incontinence was reported as higher in women. Older people are more likely to be affected, and the prevalence of symptoms increases with age.

Risk factors of Overactive Bladder Syndrome

  • Older age
  • Increased BMI/metabolic syndrome
  • Diabetes
  • Depression
  • Neurological disorders
  • Pregnancy
  • Vaginal delivery
  • Post-menopause
  • Cystitis and chronic bladder

Causes

There are several factors that may cause Overactive Bladder Syndrome or may make it worse.

  • Urinary tract infections may inflame and irritate the lining of the bladder, which can make it more sensitive and prone to being overactive.
  • Caffeinated and carbonated drinks and some citrus and spicy foods may cause irritation of the bladder.
  • Certain neurological conditions including Multiple Sclerosis may disrupt normal bladder function.
  • Sometimes the bladder may fail to empty completely. If there is an obstruction or if there is a prolapse blocking the flow of urine, this can lead to an overactive bladder as there is not enough storage space available.
  • Certain medications may disrupt bladder activity.
  • Bladder abnormalities such as tumors or bladder stones.
  • Sometimes there is no known cause for Overactive Bladder Syndrome.

Symptoms of Overactive Bladder Syndrome

The symptoms include:

The frequency of urination: A person will urinate more than eight times a day.

Nocturia: A person cannot sleep through the night without waking up to urinate, usually one to two times.

Urinary urgency: A person will experience a sudden and uncontrollable urge to urinate.

Urge incontinence: A person will leak urine when they experience the urge to urinate.

A person with an overactive bladder may often feel like they can’t completely empty their bladder. They may use the restroom and then feel like they need to go again a very short time after.

Complications

Any type of incontinence can affect your overall quality of life. If your overactive bladder symptoms cause a major disruption to your life, you might also have:

  • Emotional distress or depression
  • Anxiety
  • Sleep disturbances and interrupted sleep cycles
  • Issues with sexuality

Diagnosis and test

Medical History

Your health care provider will ask you a number of questions to understand your medical history. This should include information about the symptoms you are having, how long you have had them, and how they are changing your life.

Physical Exam

Your health care provider will examine you to look for something that may be causing your symptoms. In women, the physical exam will likely include your abdomen, the organs in your pelvis, and your rectum. In men, a physical exam will include your abdomen, prostate, and rectum.

Bladder Diary

You may be asked to keep a bladder diary, where you will note how often you go to the bathroom and any time you leak urine. This will help your health care provider learn more about your day-to-day symptoms.

Other Tests

Urine culture: Your health care provider may ask you to leave a sample of your urine to test for infection or blood.

Bladder scan: This type of ultrasound shows how much urine is still in the bladder after you go to the bathroom.

Cystoscopy:  During this test, the doctor inserts a narrow tube with a tiny lens into the bladder. This can be used to rule out other causes of your symptoms.

Urodynamic testing: These tests check to see how well your lower urinary tract stores and releases urine.

Symptom Questionnaire: Many doctors use a written quiz to ask questions about your bladder problems and what causes you the most bother.

Treatment  of Overactive Bladder Syndrome

Kegel or pelvic floor retraining exercises: These exercises teach you how to strengthen the muscles of the pelvic floor. By contracting the muscles that support the bladder, you strengthen and tighten the bladder outlet. These exercises need to be done on a regular basis and as discussed with your health professional in order for them to be successful.

Bladder training or bladder drill: By gradually increasing the time between each visit to the bathroom you may be able to train your bladder so that the urge to urinate does not occur as often. Your doctor will provide education on this technique and how to schedule your bathroom visits. While you are doing this, your doctor may ask you to reduce your fluid intake. Always discuss any change of fluid intake with your doctor.

Surgery: Those who don’t experience relief from OAB with medications or other treatments may benefit from surgery. Surgery may be aimed at reducing the nerve stimulation that causes the involuntary contractions of the bladder, increasing the size of the bladder, or creating a different pathway for urine to be drained.

Medications for OAB include

Antimuscarinic (antispasmodic) medications: These medications reduce the number of involuntary bladder contractions by preventing spasm of the detrusor muscle that causes them, and increase bladder capacity. In general, these medications can reduce leakage of urine caused by OAB by 60% to 75%. Examples of antimuscarinic medications include:

  • Darifenacin
  • Oxybutynin
  • Solifenacin
  • Tolterodine
  • Trospium

The most common side effects of antimuscarinic medications are dry mouth, dry eyes, increased pressure inside the eye, and constipation. Be sure to tell your doctor about all of the medications you are taking and all of your medical conditions, as there are some people who should not take antimuscarinic medications. These side effects can be minimized by starting with a low dose of medication and gradually increasing the dose.

Prevention of Overactive Bladder Syndrome

OAB prevention and managing options include:

  • Staying hydrated but not overhydrated
  • losing weight
  • treating chronic constipation through medication or diet
  • pelvic floor muscle exercises, including Kegels
  • treating urinary and bladder infections
  • quitting smoking to reduce coughing
  • regular exercise

Many foods and drinks worsen OAB symptoms. Making a few dietary changes will often reduce symptoms greatly.

Caffeine, alcohol, and salty foods can act as a diuretic, increasing urine output and trips to the bathroom.

Interstitial cystitis or bladder pain syndrome (IC/BPS), the lining of the bladder is constantly irritated, causing pain during urination and urinary frequency.

Definition

Interstitial cystitis or bladder pain syndrome (IC/BPS), the lining of the bladder is constantly irritated, causing pain during urination and urinary frequency. It is not certain why individuals have IC/BPS, but it is thought to be due to chronic inflammation of the bladder, possibly from defects in the inside wall of the bladder. It may also be partly an autoimmune disorder, in which the body makes substances that attack the lining of the bladder.

History of Interstitial Cystitis

  • Philadelphia surgeon Joseph Parrish published the earliest record of interstitial cystitis in 1836 describing three cases of severe lower urinary tract symptoms without the presence of a bladder stone.
  • The term “interstitial cystitis” was coined by Dr. Alexander Skene in 1887 to describe the disease. In 2002, the United States amended the Social Security Act to include interstitial cystitis as a disability.
  • The first guideline for diagnosis and treatment of interstitial cystitis is released by a Japanese research team in 2009.
  • The American Urological Association released the first American clinical practice guideline for diagnosing and treating IC/BPS in 2011.

Epidemiology

Current studies estimate that 2.7% to 6.5% of women in the United States have symptoms consistent with a diagnosis of interstitial cystitis/bladder pain syndrome (IC/BPS). PBS/IC is more common in women, with a female/male ratio that ranges from 5:1 to 10:1 and the Median age at diagnosis is 42 to 46 yr old whereas men are diagnosed at a younger age. According to DelveInsight, the number of Incident Probable IC cases in 7 major markets is expected to reach 1,97,086 cases in 2023. The report is built using data and information sourced from proprietary databases, primary and secondary research and in-house Forecast model analysis by Publisher team of industry experts.

Types of Interstitial Cystitis

Currently, there are two recognized subtypes of IC: non-ulcerative and ulcerative.

Non-ulcerative: 90% of IC patients have the non-ulcerative form of IC. Non-ulcerative IC presents with pinpoint hemorrhages, also known as glomerulations, in the bladder wall. However, these are not specific for IC and any inflammation of the bladder can give that appearance.

Ulcerative: 5 to 10% of IC patients have the ulcerative form of IC. These patients usually have Hunner’s ulcers or patches, which are red, bleeding areas on the bladder wall.

Risk factors

Certain risk factors are believed to lead to the development of Interstitial Cystitis. These include:

  • Damage to the bladder from a previous surgery
  • A distending bladder, which may occur when one regularly refrains from emptying the bladder
  • Spinal cord damage
  • Inflammation or sensitivity of the pelvic nerves
  • Bacterial infection of the bladder
  • Debilitated pelvic floor muscles due to old age. This results in improper functioning of the urinary bladder
  • Autoimmune disorders such as systemic lupus erythematosus (SLE)

The above-mentioned risk factors are not direct causes, but they can cause irritation to the bladder, which can lead to the onset of Interstitial Cystitis.

Causes of Interstitial Cystitis

The cause of interstitial cystitis is unclear, but some theories suggest that it may be a result of:

  • A defect in the bladder
  • An autoimmune condition where the body’s immune system attacks the bladder
  • A substance in the urine that damages the bladder

Some researchers believe that interstitial cystitis may be caused by infection, allergies or that it may be a hereditary condition.

Symptoms

Symptoms of IC include the following:

  • Abdominal or pelvic discomfort
  • Pain, pressure, and/or discomfort coming from the bladder
  • Having to urinate frequently
  • Passing only a small amount of urine
  • The pressure in the abdomen and/or pelvis
  • In men, discomfort in the penis and/or scrotum
  • Lower abdominal pain that gets worse as the bladder fills
  • Pain during sexual intercourse

Cystoscopic finding in an interstitial cystitis patient

Complications of Interstitial Cystitis

Interstitial cystitis can result in a number of complications, including:

Reduced bladder capacity: Interstitial cystitis can cause stiffening of the bladder wall, which allows your bladder to hold less urine.

Lower quality of life: Frequent urination and pain may interfere with social activities, work and other activities of daily life.

Sexual intimacy problems: Frequent urination and pain may strain your personal relationships, and sexual intimacy may suffer.

Emotional troubles: The chronic pain and interrupted sleep associated with interstitial cystitis may cause emotional stress and can lead to depression.

Diagnosis and test

There is no single test that diagnoses IC, rather it is often a process of ruling other conditions or infections, such as urinary tract infections, an overactive bladder, bladder stones, bladder cancer, a sexually transmitted infection, endometriosis (in women), and BPH (in men).

The tests or procedures that may be performed to diagnose IC (i.e. rule out the above) include:

Urinary culture samples to test for infection in the urine

Cystoscopy – a procedure where a thin tube with a camera is inserted into the urethra to view the bladder

Bladder hydrodistension – where the bladder is stretched with a sterile fluid using a cystoscope

Biopsy – where a small piece of the bladder is cut out using a cystoscope for further analysis.

Treatment and medications

There is no single known effective treatment. It may take some time to find the right combination of treatments for you.

Medication options include

Pain medications: These may be used for a short time to help ease discomfort.

Antispasmodic medications: These may help relax the bladder muscles. This may decrease the need to urinate.

Nonsteroidal anti-inflammatory drugs (NSAIDs): These may help reduce inflammation and ease pain.

Antihistamines: These may help reduce inflammation and ease pain.

Antidepressants: In low doses, these may block pain and help ease symptoms.

Pentosan polysulfate sodium (Elmiron) and similar medications: These can restore the bladder lining.

Bladder instillation: In some cases, medication may be flushed directly into the bladder using a catheter.

Other treatments may include

Biofeedback: Biofeedback uses sensors placed on your abdomen to allow you to see signals given off by your bladder muscles. This may help you control your bladder muscles and reduce symptoms.

Electrical stimulation: Electrical signals may help block nerve sensations to and from the bladder. This may improve blood flow and strengthen pelvic muscles. This is sometimes called TENS.

Surgery: For severe cases, surgery may be recommended.

Prevention of Interstitial Cystitis

Interstitial Cystitis may not be preventable; however, the symptom severity may be reduced with certain lifestyle changes:

  • Worsening symptoms of Interstitial Cystitis may be prevented through a diet that limits or eliminates alcohol, chocolate, caffeine, tomatoes, spices, and citrus foods
  • Quitting smoking can also help prevent the worsening of symptoms; moreover, smoking can also lead to bladder cancer

Ehlers Danlos syndrome (EDS) is a disease that weakens the connective tissues of your body.

Overview – Ehlers Danlos Syndrome

Ehlers Danlos syndrome (EDS) is a disease that weakens the connective tissues of your body. These are things like tendons and ligaments that hold parts of your body together. EDS can make your joints loose and your skin thin and easily bruised. It also can weaken blood vessels and organs.

It is an inherited condition that affects the connective tissues in the body. Connective tissue is responsible for supporting and structuring the skin, blood vessels, bones, and organs. It’s made up of cells, fibrous material, and a protein called collagen. A group of genetic disorders causes Ehlers-Danlos syndrome, which results in a defect in collagen production.

Types of Ehlers Danlos Syndrome

There are several types of EDS. They can range from mild to life-threatening. Recently, 13 major types of Ehlers-Danlos syndrome have been subtyped. These include:

  • Classic
  • Classic-like
  • Cardiac-valvular
  • Vascular
  • Hypermobile
  • Arthrochalasia
  • Dermatosparaxis
  • Kyphoscoliotic
  • Brittle cornea
  • Spondylodysplastic
  • Musculocontractural
  • Myopathic
  • Periodontal

Pathophysiology of EDS

Ehlers-Danlos syndrome (EDS) is a heterogeneous group of inherited connective tissue disorders characterized by joint hypermobility, cutaneous fragility, and hyperextensibility. The collagen defect has been identified in at least six of the many types of Ehlers-Danlos syndrome. The vascular form sometimes referred to as type IV, is characterized by a decreased amount of type III collagen. It is autosomal dominant and caused by mutations in the COL3A1 gene that result in increased fragility of connective tissue with arterial, intestinal, and uterine ruptures and premature death. Types V and VI are characterized by deficiencies in hydroxylase and lysyl oxidase, an important posttranslational modifying enzyme in collagen biosynthesis. Type VII has an amino-terminal procollagen peptidase deficiency. Type IX has abnormal copper metabolism. Type X has nonfunctioning plasma fibronectin.

In Ehlers-Danlos syndrome types I and II, the classic variety, identifying the molecular structure in most individuals who are affected is difficult. Causative mutations may involve the COL5A1, COL5A2, and tenascin-X genes and are implied to be in the COL1A2 gene. Nonetheless, in most families with autosomal dominant Ehlers-Danlos syndrome, the disease appears to be linked to loci that contain the COL5A1 or COL5A2 genes. Although half of the mutations that cause Ehlers-Danlos syndrome types I and II are likely to affect the COL5A1 gene, a significant portion of the mutations result in low levels of mRNA from the mutant allele as a consequence of nonsense-mediated mRNA decay.

What causes Ehlers Danlos Syndrome?

Ehlers-Danlos syndromes (EDS) are genetic disorders that can be caused by mutations in several different genes, including COL5A1, COL5A2, COL1A1, COL3A1, TNXB, PLOD1, COL1A2, FKBP14, and ADAMTS2. However, the underlying genetic cause is unknown in some families.

Mutations in these genes usually change the structure, production, and/or processing of collagen, or proteins that interact with collagen. Collagen provides structure and strength to connective tissues throughout the body. A defect in collagen can weaken connective tissues in the skin, bones, blood vessels, and organs, resulting in the signs and symptoms of EDS.

How EDS is inherited?

The two main ways Ehlers-Danlos syndrome is inherited are:

  • Autosomal dominant inheritance (hypermobile, classical and vascular Ehlers-Danlos syndrome) – the faulty gene that causes Ehlers-Danlos syndrome is passed on by one parent and there’s a 50% risk of each of their children developing the condition
  • Autosomal recessive inheritance (kyphoscoliotic Ehlers-Danlos syndrome) – the faulty gene is inherited from both parents and there’s a 25% risk of each of their children developing the condition

A person with Ehlers-Danlos syndrome can only pass on the same type of Ehlers-Danlos syndrome to their children. For example, the children of someone with hypermobile Ehlers-Danlos syndrome can’t inherit vascular Ehlers-Danlos syndrome.

Signs, Symptoms, and Complications of EDS

Classical (cEDS)

cEDS (formerly EDSI and EDSII) is associated with the primary problems described above, skin hyperextensibility, joint laxity, and fragile blood vessels. Scars are very thin, discolored, and stretch with time. Such paper-like (papyraceous) scarring occurs especially over prominent bony pressure points such as the knees, elbows, shins and forehead.

Classical-like (clEDS)

clEDS is similar in clinical course to cEDS. Genetic causes of cEDS and clEDS differ.

Cardiac-valvular type (cvEDS)

cvEDS is a rare subtype of EDS wherein patients may have minor signs of EDS with severe defects to their aorta, requiring surgical interventions.

Vascular type (vEDS)

vEDS (formerly EDSIV), can be identified at birth with noticeable clubfoot deformities and dislocation of the hips. In childhood, inguinal hernia (partial slip of intestine beyond the abdominal wall) and pneumothorax (collection of air between the lung and chest wall, impairing proper lung inflation) are commonly experienced and are indicative of this syndrome.

Hypermobility type (hEDS)

hEDS (formerly EDSIII) comes with a defined set of complications to be managed but is generally a less severe form of the syndrome. For example, aortic root dilation is usually minimal and does not significantly increase the risk for dissections. The major complications to patients with hEDS are musculoskeletal in nature. Frequent joint dislocation and degenerative joint disease are common and associated with a baseline chronic pain, which affects both physical and psychological well being.

Arthrochalasia type (aEDS)

aEDS (formerly EDSVII, A and B) is associated with the lifelong risk for the dislocation of multiple major joints concurrently. This condition makes achieving mobility significantly challenging.

Dermatosparaxis type (dEDS)

Patient with dEDS (formerly EDSVIIC) tends to show a set of common body features. These include short stature and finger length, loose skin of the face, with comparatively full eyelids, blue-tinged whites of the eye (sclera), skin folds in the upper eyelids (epicanthal folds), downward slanting outer corners of the eyes (palpebral fissures) and a small jaw (micrognathia). A major complication of dEDS is herniation, the improper displacement of an organ through the tissues holding it in a proper position.

Kyphoscoliotic type (kEDS)

kEDS is accompanied by scleral fragility, increasing the risk for rupture of the white globe of the eye. Microcornea, near-sightedness (myopia), glaucoma and detachment of the nerve-rich membrane in the back of the eye (retina) are common and can result in vision loss. Patients experiencing floaters, flashes or sudden curtains falling across their visual field should seek immediate medical attention.

Brittle cornea syndrome (BCS)

BCS is a variant of EDS that also involves the eyes. People with variant risk ruptures to the cornea following minor injuries with scarring, degeneration of the cornea (keratoconus), and protrusion of the cornea (keratoglobus). Patients may have blue sclera.

Spondylodysplastic type (spEDS)

spEDS, previously spondylocheirodysplastic type, describes an EDS variant with skeletal dysmorphology. It primarily involves the spine and the hands. Clinical presentation can include stunted growth, short stature, protuberant eyes with bluish sclera, wrinkled skin of the palms, atrophy of muscles at the base of the thumb (thenar muscles), and tapering fingers.

Musculocontractural type (mcEDS)

mcEDS is characterized by progressive multisystem complications. This subtype is especially associated with developmental delay and muscular weakness plus hypotonia. Patients often have facial and cranial structural defects, congenital contractures of the fingers, severe kyphoscoliosis, muscular hypotonia, club foot deformity, and ocular problems.

Myopathic type (mEDS)

mEDS is characterized by muscle hypotonia evident at birth with muscles that do not function properly (myopathy). Scoliosis and sensorineural hearing impairment may accompany this condition.

Periodontal type (pEDS)

pEDS type (formerly EDS VII) has findings that include disease of the tissues surrounding and supporting the teeth (periodontal disease), potentially resulting in premature tooth loss.

Diagnosis and Test for Ehlers Danlos Syndrome

A diagnosis of the Ehlers-Danlos syndromes (EDS) is typically based on the presence of characteristic signs and symptoms. Depending on the subtype suspected, some of the following tests may be ordered to support the diagnosis:

  • Collagen typing, performed on a skin biopsy, may aid in the diagnosis of vascular type, arthrochalasia type, and dermatosparaxis type. People with EDS often have abnormalities of certain types of collagen.
  • Genetic testing is available for many subtypes of EDS; however, it is not an option for most families with the hypermobility type.
  • Imaging studies such as CT scan, MRI, ultrasound, and angiography may be useful in identifying certain features of the condition.
  • Urine tests to detect deficiencies in certain enzymes that are important for collagen formation may be helpful in diagnosing the kyphoscoliosis type.

Is there any treatment for Ehlers Danlos Syndrome?

There is no cure for Ehlers-Danlos syndrome, but treatment can help you manage your symptoms and prevent further complications.

Medications

Your doctor may prescribe drugs to help you control:

Pain. Over-the-counter pain relievers — such as acetaminophen (Tylenol, others) ibuprofen (Advil, Motrin IB, others) and naproxen sodium (Aleve) — are the mainstay of treatment. Stronger medications are only prescribed for acute injuries.

Blood pressure. Because blood vessels are more fragile in some types of Ehlers-Danlos syndrome, your doctor may want to reduce the stress on the vessels by keeping your blood pressure low.

Physical therapy

Joints with weak connective tissue are more likely to dislocate. Exercises to strengthen the muscles and stabilize joints are the primary treatment for Ehlers-Danlos syndrome. Your physical therapist might also recommend specific braces to help prevent joint dislocations.

Surgical and other procedures

Surgery may be recommended to repair joints damaged by repeated dislocations. However, your skin and the connective tissue of the affected joint may not heal properly after the surgery.

Surgery may be necessary to repair ruptured blood vessels or organs in people with Ehlers-Danlos syndrome, vascular type.

Precautions & Prevention of Ehlers-Danlos Syndrome

Genetic counseling can help you understand the inheritance pattern of the type of EDS that affects you and the risks it poses for your children.

Here are a few guidelines you can do to reduce your risk:

  • Avoid contact sports, weightlifting, and other activities
  • Use protective gear
  • Use mild soaps and sunscreen
  • Use assistive devices to help decrease stress on your joints

Rubella is commonly known as German measles or 3-day measles is an infection that mostly affects the skin and lymph nodes.

Overview – Rubella

Rubella is commonly known as German measles or 3-day measles is an infection that mostly affects the skin and lymph nodes. It is caused by the rubella virus (not the same virus that causes measles).

German measles spreads when people breathe in virus-infected fluid, such as the droplets sprayed into the air when a person with german measles sneezes or coughs, or share food or drink with someone who’s infected. It also can pass through a pregnant woman’s bloodstream to infect her unborn child.

It’s a generally mild disease in children; the primary medical danger of german measles is the infection of pregnant women because it can cause congenital rubella syndrome in developing babies.

Before a vaccine against german measles became available in 1969, german measles epidemics happened every 6-9 years, usually among kids 5 to 9 years old, along with many cases of congenital rubella. Thanks to immunization, there are far fewer cases of rubella and congenital rubella.

Most german measles infections today appear in young, non-immunized adults rather than in kids. In fact, experts estimate that 10% of young adults are currently susceptible to german measles, which could pose a danger to any children they might have someday.

Pathophysiology of Rubella

Postnatal rubella

The usual portal of entry of the rubella virus is the respiratory epithelium of the nasopharynx. The virus is transmitted via the aerosolized particles from the respiratory tract secretions of infected individuals. The virus attaches to and invades the respiratory epithelium. It then spreads hematogenously (primary viremia) to regional and distant lymphatics and replicates in the reticuloendothelial system. This is followed by a secondary viremia that occurs 6-20 days after infection. During this viremic phase, the rubella virus can be recovered from different body sites including lymph nodes, urine, cerebrospinal fluid (CSF), conjunctival sac, breast milk, synovial fluid, and lungs. Viremia peaks just before the onset of rash and disappear shortly thereafter. An infected person begins to shed the virus from the nasopharynx 3-8 days after exposure for 6-14 days after onset of the rash.

Congenital rubella syndrome

Fetal infection occurs transplacentally during the maternal viremic phase, but the mechanisms by which the rubella virus causes fetal damage are poorly understood. The fetal defects observed in congenital rubella syndrome are likely secondary to vasculitis resulting in tissue necrosis without inflammation. Another possible mechanism is direct viral damage to infected cells. Studies have demonstrated that cells infected with german measles in the early fetal period have reduced mitotic activity. This may be the result of chromosomal breakage or due to the production of a protein that inhibits mitosis. Regardless of the mechanism, any injury affecting the fetus in the first trimester (during the phase of organogenesis) results in congenital organ defects.

Causes of Rubella

German measles is caused by a virus that is spread through the air or by close contact.

A person with german measles may spread the disease to others from 1 week before the rash begins, until 1 to 2 weeks after the rash disappears.

Because the measles-mumps-rubella (MMR) vaccine is given to most children, german measles is much less common now. Almost everyone who receives the vaccine has immunity to German measles. Immunity means that your body has built a defense against the rubella virus.

In some adults, the vaccine may wear off. This means they are not fully protected. Women who may become pregnant and other adults may receive a booster shot.

Children and adults who were never vaccinated against german measles may still get this infection.

Who is at risk for German measles?

Most cases of German measles occur in people who live in countries that don’t offer routine immunization against german measles.

The rubella vaccine is usually given to children when they’re between 12 and 15 months old, and then again when they’re between ages 4 and 6. This means that infants and young toddlers who haven’t yet received all vaccines have a greater risk of getting German measles.

To avoid complications during pregnancy, many women who become pregnant are given a blood test to confirm immunity to German measles. It’s important to contact your doctor immediately if you’ve never received the vaccine and think you might have been exposed to German measles.

Symptoms of Rubella

Rubella means “little red” and the disease features a red rash, “rubella” is Latin for “little red.”

Symptoms normally appear 14 to 21 days after infection.

The rash often starts on the face and moves to the trunk and limbs. After 3 to 5 days, it fades and disappears. It can be itchy.

Other symptoms include:

  • A stuffy or runny nose
  • Headache
  • A mild fever
  • Red, inflamed eyes
  • Nerve inflammation
  • Enlarged and tender lymph nodes
  • Aching joints

Though the infection can happen at any age, german measles rarely affects young infants or people over 40 years. A person who is infected with German measles at an older age will normally have more severe symptoms.

Complications

Up to 70% of women who get german measles may experience arthritis; this is rare in children and men. In rare cases, german measles can cause serious problems, including brain infections and bleeding problems.

The most serious complication from german measles infection is the harm it can cause a pregnant woman’s developing baby. If an unvaccinated pregnant woman gets infected with the rubella virus she can have a miscarriage, or her baby can die just after birth. Also, she can pass the virus to her developing baby who can develop serious birth defects such as:

  • Heart problems,
  • Loss of hearing and eyesight,
  • Intellectual disability, and
  • Liver or spleen damage.

Serious birth defects are more common if a woman is infected early in her pregnancy, especially in the first trimester. These severe birth defects are known as congenital rubella syndrome (CRS).

Complications are rare with german measles in healthy infants.  Complications can include:

  • Arthralgia or arthritis in adults
  • Thrombocytopenic purpura
  • Otitis media

Diagnosis and Test?

If a woman is pregnant and she may have come into contact with german measles, she should see a doctor at once.

It is best to call the doctor’s office first, as they may wish to schedule an appointment at a time when there is the least chance of passing the virus on.

If there are no symptoms, a diagnosis is made by testing a saliva or blood sample. If IgM antibodies are present, this may indicate a new german measles infection.

If IgG antibodies are present, they indicate that a german measles infection has either been present in the past or the individual has already been vaccinated.

If neither antibody is present, the individual does not carry the virus and has never been immunized.

Treatment

No treatment will shorten the course of rubella infection, and symptoms are often so mild that treatment usually isn’t necessary. However, doctors often recommend isolation from others — especially pregnant women — during the infectious period.

If you contract German measles while you’re pregnant, discuss the risks to your baby with your doctor. If you wish to continue your pregnancy, you may be given antibodies called hyperimmune globulin that can fight off the infection. This can reduce your symptoms, but doesn’t eliminate the possibility of your baby developing congenital rubella syndrome.

Support of an infant born with congenital rubella syndrome varies depending on the extent of the infant’s problems. Children with multiple complications may require early treatment from a team of specialists.

Lifestyle and home remedies

In rare instances when a child or adult is infected with German measles, simple self-care measures are required:

  • Rest in bed as necessary.
  • Take acetaminophen (Tylenol, others) to relieve discomfort from fever and aches.
  • Tell friends, family, and co-workers — especially pregnant women — about your diagnosis if they may have been exposed to the disease.
  • Avoid people who have conditions that cause deficient or suppressed immune systems.
  • Tell your child’s school or child care provider that your child has German measles.

Prevention

  • Exclude people with german measles from childcare, preschool, school, and work until fully recovered or for at least 4 days after the onset of the rash.
  • Rubella is best prevented by the measles, mumps and
  • Rubella (MMR) combination vaccine or the measles, mumps, German measles, and varicella (MMRV) combination vaccine. Most people who have two doses of a rubella-containing vaccine will be protected against German measles infection.
  • Vaccination after exposure will not prevent infection.
  • All health care and childcare staff (men and women) should be assessed for immunity to German measles and if not immune, should be immunized.
  • Anyone with suspected german measles should consult a doctor both to check that the diagnosis is correct and so that contacts (in particular, pregnant women) can be advised. A contact is any person who has been close enough to an infected person to be at risk of having acquired the infection from that person.

Pregnant women

In addition to the above prevention points, all pregnant women:

  • Should be tested for immunity to German measles prior to, or during early pregnancy. If found not to be immune, MMR vaccination is given after delivery of the baby but before discharge from the maternity unit. Rubella vaccine should not be given to a woman known to be pregnant and pregnancy should be avoided for one month after vaccination.
  • With suspected german measles or exposure to german measles should seek specialist obstetric advice, regardless of a history of german measles or rubella vaccination. german measles re-infection, often without symptoms, can occur in individuals who have had previous infection or vaccination, although fetal damage is very rare in these cases.

The vaccine to prevent german measles

Getting vaccinated is the best way to prevent german measles. And when enough people get vaccinated against German measles, the entire community is less likely to get it. So when you and your family get vaccinated, you help keep yourselves and your community healthy.

There are 2 vaccines that can prevent german measles:

  • The MMR vaccine protects children and adults from German measles and mumps
  • The MMRV vaccine protects children from german measles, measles, mumps, and chickenpox

Who needs to get the rubella vaccine?

All children need to get the vaccine — and some adults may need it, too.

Children: Children ages 1 through 6 years need to get the rubella vaccine as part of their routine vaccine schedule.

Children need 2 doses of the vaccine at the following ages:

  • 12 through 15 months for the first dose
  • 4 through 6 years for the second dose (or sooner as long as it’s 28 days after the first dose)

Children ages 1 through 12 years can get the MMRV vaccine, which is a combination vaccine. The MMRV vaccine protects against measles, mumps, rubella, and chickenpox. Your child’s doctor can recommend the vaccine that’s right for your child.

Adults: Adults may need to get the rubella vaccine if they didn’t get it as a child. In general, everyone age 18 and older born after 1956 who has not had rubella needs at least 1 dose of the rubella vaccine.

What are the side effects of the rubella vaccine?

Side effects are usually mild and go away in a few days. They may include:

  • Fever
  • Mild rash
  • Swollen glands in the cheeks or neck

Less common side effects of the vaccine include:

  • Pain or stiffness in the joints, usually in women (up to 1 person out of 4)
  • Seizures (sudden, unusual movements or behavior) from having a high fever (about 1 out of every 3,000 doses)
  • Temporary (short-term) low platelet count (about 1 out of every 30,000 doses)

Like any medicine, there’s a very small chance that the german measles vaccine could cause a serious reaction.

Paronychia is an infection of the skin around a fingernail or toenail.

Definition

Paronychia is an infection of the skin around a fingernail or toenail. The infected area can become swollen, red, and painful, and a pus-filled blister (abscess) may form. Most of the time, paronychia is not serious and can be treated at home. In rare cases, the infection can spread to the rest of the finger or toe and lead to a deeper infection that may require a doctor’s help. It’s unlikely that your child will get paronychia in a toe (unless he or she has an ingrown toenail). But fingernail paronychia is one of the most common hand infections.

Nail Structure and Function

The nail is a complex unit composed of five major modified cutaneous structures: the nail matrix, nail plate, nail bed, cuticle (eponychium), and nail folds. The cuticle is an outgrowth of the proximal fold and is situated between the skin of the digit and the nail plate, fusing these structures together. This configuration provides a waterproof seal from external irritants, allergens, and pathogens.

Types of Paronychia

There are primarily two types of paronychia which may develop around the finger or toenails. These are classified by the time duration that the skin infection lasts.

Acute Paronychia: The skin infection develops fast and lasts for a few days in acute paronychia. This kind of paronychia is seen following skin breaks during a manicure, or when infection sets into an ingrown toenail. It is usually bacterial in nature, often caused by straphylococcus aureus bacteria. However, germs from the cold sore virus like herpes simplex or yeast such as Candida may also cause the condition.

Chronic Paronychia: The infection develops slowly and may last for many weeks. In such cases, a mix of multiple pathogens causes the infection. A combination of yeast like candida, virus like herpes simplex, and bacteria like Staphylococcus aureus may be found. This condition is commonly found in people who have to work with their hands constantly being exposed to water, chemicals and detergents. It has a tendency to reoccur even after being treated and cured.

The third variety of paronychia is a subungual abscess, which occurs in the same location as a subungual hematoma and presents with pain and entrapped pus that is visible between the nail plate and the nail bed

Risk factors of Paronychia

  • Acute: direct or indirect trauma to cuticle or nail fold, manicured/sculptured nails, nail biting, thumb sucking, manipulating a hangnail
  • Chronic: frequent immersion of hands in water with excoriation of the lateral nail fold (e.g., chefs, bartenders, housekeepers, swimmers, dishwashers, nurses)
  • Predisposing conditions such as diabetes mellitus (DM) and immunosuppression
  • Medications such as EGFR inhibitors, systemic retinoids, chemotherapy and antiretroviral agents

Causes of Paronychia

The infection occurs when the skin around the nail becomes damaged, allowing germs to enter.

Bacteria or fungi can cause paronychia, and common culprits are Staphylococcus aureus and Streptococcus pyogenes bacteria.

Common causes of skin damage around the nail include:

  • Biting or chewing the nails
  • Clipping the nails too short
  • Manicures
  • Excessive exposure of the hands to moisture, including frequently sucking the finger
  • Ingrown nails

Paronychia Symptoms

If your child has paronychia, it’s usually easy to recognize. Look for:

  • An area of red, swollen skin around a nail that’s painful, warm, and tender to the touch
  • A pus-filled blister

A pus-filled blister

Bacterial paronychia:

  • Usually appears very suddenly

Fungal paronychia:

  • Can take longer to notice and causes less obvious symptoms
  • Can be a chronic condition (last for a long time)

Chronic paronychia can cause changes in the affected nail. It might turn a different color or look as though it is detached or abnormally shaped.

In rare cases, if the paronychia is especially severe and goes untreated, the infection can spread beyond the area of the nail.

Complications

Systemic implications and complications are rare but may include:

  • Abscess formation
  • Permanent deformation of the nail plate
  • Systemic fever/chills
  • Development of red streaks along the skin
  • Development of cellulitis or erysipelas
  • Joint pain
  • General ill feeling
  • Flu-like symptoms
  • Osteomyelitis
  • Flexor tenosynovitis

Diagnosis and test

Paronychia is a clinical diagnosis, often supported by laboratory evidence of infection.

  • Gram stain microscopy may reveal bacteria
  • Potassium hydroxide microscopy may reveal fungi
  • Bacterial culture
  • Viral swabs
  • Tzanck smears
  • Nail clippings for culture (mycology).

Treatment and medications

  • Paronychia is typically treated with antibiotics, although milder acute cases can often resolve on their own without treatment. The antibiotics most commonly used to treat paronychia are Bactrim (TMP/SMX) and a cephalosporin named Keflex (cephalexin).
  • If an anaerobic bacterium is suspected, Evoclin (clindamycin) or Augmentin (amoxicillin-clavulanate) may be given with Bactrim. Bactrim is especially effective against drug-resistant bacteria, including methicillin-resistant Staphylococcus aureus.
  • In severe cases, a physician can elevate the hardened bit of skin bordering the nail itself (eponychium) so that pus can be drained. Alternatively, the doctor can directly slice into the fluctuant portion of the infection; this procedure is no different from draining an abscess or boil.
  • Because paronychia are pretty superficial, anesthesia is unnecessary to drain most infections of pus. In fact, anesthetizing the area will likely result in added pain with little benefit.
  • Sometimes paronychia can extend under part of the nail. In these cases, either part or all the nail needs to be removed. A paronychia that is left untreated can sometimes surround the entire nail margin and result in a “floating” nail.
  • After a paronychia is drained of pus, there is usually no need for antibiotics. However, if the paronychia is accompanied by localized cellulitis or skin infection, then antibiotics are needed to treat the skin infection.

Surgical treatment of acute paronychia

Paronychia home care

Follow these guidelines when caring for yourself at home:

Clean and soak the toe or finger. Do this 2 times a day for the first 3 days. To do so:

  • Soak your foot or hand in a tub of warm water for 5 minutes. Or hold your toe or finger under a faucet of warm running water for 5 minutes.
  • Clean any crust away with soap and water using a cotton swab.
  • Put antibiotic ointment on the infected area.

Change the dressing daily or any time it gets dirty.

If you were given antibiotics, take them as directed until they are all gone.

If your infection is on a toe, wear comfortable shoes with a lot of toe room. You can also wear open-toed sandals while your toe heals.

You may use over-the-counter medicine (acetaminophen or ibuprofen) to help with pain, unless another medicine was prescribed. If you have chronic liver or kidney disease, talk with your healthcare provider before using these medicines. Also talk with your provider if you’ve had a stomach ulcer or gastrointestinal bleeding.

Prevention

To help reduce your chances of paronychia:

  • Keep your hands and feet clean and dry. Use a moisturizer after hand washing.
  • Wear rubber gloves if you often come in contact with water or chemicals.
  • Avoid biting or picking your nails.
  • Practice proper hygiene. Do not share bathroom supplies.
  • Avoid cutting, pulling, or tearing your cuticles.
  • Avoid artificial nails, vigorous manicures, or treatments that remove the cuticles.