Avian influenza is also called as Bird flu. Avian influenza refers to the disease caused by infection with avian (bird) influenza (flu) Type A viruses.

Definition

Avian influenza is also called as Bird flu. Avian influenza refers to the disease caused by infection with avian (bird) influenza (flu) Type A viruses. These viruses occur naturally among wild aquatic birds worldwide and can infect domestic poultry and other bird and animal species. Avian flu viruses do not normally infect humans. However, sporadic human infections with avian flu viruses have occurred.

How Do Humans Get Bird Flu?

People catch bird flu by close contact with birds or bird droppings. Exactly what “close contact” means differs from culture to culture. People don’t catch the virus from eating fully cooked chicken or eggs. There have been a few cases where one infected person caught the bird flu virus from another person but only after close personal contact. So far, there has been no sustained human-to-human spread of H5N1.

As long as the bird flu virus doesn’t change into a human flu virus, it won’t spread far in people. But sometimes after close personal contact a person who gets bird flu does infect another person.

History of avian influenza

In the 1990s, the world’s poultry population grew 76% in developing countries and 23% in developed countries, contributing to the increased prevalence of avian influenza. Before the 1990’s, HPAI caused high mortality in poultry, but infections were sporadic and contained. Outbreaks have become more common due to the high density and frequent movement of flocks from intensive poultry production.

Influenza A/H5N1 was first isolated from a goose in China in 1996. Human infections were first reported in 1997 in Hong Kong. Since 2003, more than 700 human cases of Asian HPAI H5N1 have been reported to the WHO, primarily from 15 countries in Asia, Africa, the Pacific, Europe, and the Middle East, though over 60 countries have been affected

Epidemiology about avian influenza

The first H9N2 low-pathogenicity avian influenza virus (LPAIV) and H5N1 high-pathogenicity avian influenza virus (HPAIV) in Asia were isolated from Guangdong Province, China, in 1994 and 1996, respectively. Currently, H9 and H5 are the most prevalent AIV subtypes and can be found throughout most of the areas in China. Interestingly, the H9N2 and H5N1 AIVs are prevalent in both unvaccinated and vaccinated poultry farms, often causing sporadic outbreaks. Along with the high prevalence of H9 and H5 AIVs in poultry, novel AIVs are also emerging in China.

Causes of avian influenza

Humans can become infected and ill after coming into contact with infected birds.

The following have been linked to human illness:

  • Touching or defeathering infected birds
  • Touching or breathing in feces and other secretions of infected birds
  • Preparing infected poultry for cooking
  • Slaughtering or butchering infected poultry
  • Handling birds for sale
  • Attending markets selling live birds

Signs and symptoms

A person with H5N1 will develop serious symptoms. The incubation period is from 2 to 8 days, and it can take up to 17 days. This is compared with 2 to 3 days for human seasonal flu. Initial symptoms include a high fever, over 38 degrees centigrade, lower respiratory tract symptoms, and, less commonly, upper respiratory tract symptoms.

The following signs and symptoms may occur:

  • a cough, usually dry
  • hoarse voice
  • a high fever, over 38 degrees centigrade
  • a blocked or runny nose
  • aching bones, joints, and muscles
  • bleeding from the nose
  • chest pain
  • cold sweats and chills
  • fatigue
  • headache
  • loss of appetite
  • sleeping difficulties
  • upset stomach, sometimes involving diarrhea
  • bleeding from the gums
  • bloody sputum

Some patients develop pneumonia and breathing difficulties. This occurs around 5 days after the first symptoms appear. The patient’s condition can deteriorate rapidly, resulting in pneumonia, multiple organ failure, and death.

Diagnosis

The test is called influenza A/H5 (Asian lineage) virus real-time RT-PCR primer and probe set. It can offer preliminary results in only four hours. However, the test isn’t widely available. Doctor may also perform the following tests to look for the presence of the virus that causes bird flu:

  • Ascultation (a test that detects abnormal breath sounds)
  • White blood cell differential
  • Nasopharyngeal culture
  • Chest X-ray

Additional tests can be done to assess the functioning of heart, kidneys, and liver.

Treatment and prevention

  • Treatment with antiviral medication such as oseltamivir (Tamiflu) or zanamivir (Relenza) can help reduce the severity of the disease. However, the medication must be taken within 48 hours after symptoms first appear.
  • The virus that causes the human form of the flu can develop resistance to the two most common forms of antiviral medications, amantadine and rimantadine (Flumadine). These medications shouldn’t be used to treat the disease.
  • Unfortunately, H5N1 in humans can be a severe illness requiring hospitalization, isolation, and intensive care.

Avian flu can be prevent from the following actions:

  • Open-air markets
  • Contact with infected birds
  • Undercooked poultry
  • Vaccinations: Stay up-to-date especially with the seasonal flu and pneumococcal vaccines.
  • Isolation: Those who are sick should stay away from public places and avoid contact with people, where possible.
  • Coughing: Cough in to an elbow or a tissue. Carefully disposed of the tissue. If you cough into the hand and then touch some item, another person can pick up the virus from that item.
  • Hand hygiene: Wash hands regularly with warm water and soap before and after using the bathroom, before and after handling food, and after coughing.

Severe combined immunodeficiency (SCID) is the name given to a group of rare.

Description – SCID

Severe combined immunodeficiency (SCID) is the name given to a group of rare, inherited disorders that cause major abnormalities of the immune system. They form part of a larger group of conditions known as primary immunodeficiencies. The immune system abnormalities in SCID lead to greatly increased risks of infection and other complications that are life-threatening. Affected infants become unwell within the first few months of life, and before modern medication and treatments were available, most affected babies did not survive beyond their first year. Today, doctors understand much more about SCID. Treatment is now available that can reduce the risk of serious infection, and in many cases, cure the disorder.

Types of SCID

X-Linked SCID (XSCID)

This is the most frequent type of SCID with approximately 50% of the incidence. Mutation in the interleukin 2 receptor gamma (IL2RG) gene on X-chromosome is the primary cause for XSCID. IL2RG play a crucial role in the development of surface receptors on lymphocytes. These receptors upon activation by cytokines help the cells to mature and multiply. X-linked inherited mutations in IL2RG disrupt its functioning, creating a faulty “common gamma chain subunit”, which is a part of several defective interleukin (IL) receptors.

IL2RG also activates an important signaling molecule, JAK3 on Chromosome 19. Mutations in JAK3 also contribute to defective IL receptors. As a result of these mutations, T-lymphocytes which play a major role in foreign body location and maintaining the natural defense mechanism of the body remain underdeveloped.

Alpha Chain of the IL-7 Receptor deficiency SCID

This is the third most common form of SCID with 11% of the incidence. It is due to the mutation in the gene that encodes the alpha chain of the IL-7 receptor (IL-7Rα). There is a deficiency of T-cells, which further leads to the non-functioning of B-cells.

Janus Kinase 3 deficiency SCID

It results due to the gene mutation that encodes an enzyme, which is present in the lymphocyte named Janus Kinase 3. The patients with this type of SCID are quite similar to X-linked SCID.

CD3 Chains deficiency SCID

Three other forms of SCID results due to genetic mutations leading to deficiency of CD3δ, ε or ζ protein chains.

CD45 deficiency SCID

It is due to mutations in the genes that are responsible for coding CD45 protein, which further is responsible for the correct functioning of T-cells.

Pathophysiology

Genetic mutations in SCID disorders preclude normal production and maturation of T-cell lymphocytes and/or B-cell lymphocyte secretion of antibodies, thus preventing the development of a normal, healthy immune system. Following birth, newborns have high levels of maternal antibodies to provide protection from pathogens until the newborn’s immune system develops over the next few months. Most infants are exposed to pathogens during this period but have some ability to fight infections as their immune system develops. Infants with SCID do not have a functional immune system response to pathogenic antigens and cannot adequately overcome infections. Parents may notice their infant has frequent, severe and long-lasting infections, and often report undergoing diagnostic odysseys until their child is eventually diagnosed with SCID, usually around four to six months later.

Causes of SCID

There are more than 15 recognized kinds of SCID, but the most common type, known as SCID-X1 (for “X-linked severe combined immunodeficiency”), involves a defect in a gene on the X chromosome. Because girls have two X chromosomes while boys have only one, SCID-X1 affects only male children. However, girls can be “carriers” and can pass the disorder on to their own sons later in life.

Different genetic defects cause each form of SCID. But all types of SCID are genetic – meaning they are caused by an error or mutation in the child’s genes.

Even though SCID is a genetic condition, having one child with SCID does not necessarily mean other family members, including siblings, are going to develop the disease. However, it is a good idea to ask your doctor about genetic counseling for you and your other children.

Inheritance Pattern

While all forms of SCID are due to specific gene mutations, some individuals affected with the disorder have the X chromosome-linked form, XSCID. In XSCID, males inherit the X-linked gene mutation from carrier mothers. Females are not affected, although they have a 50 percent chance of being carriers of the gene mutation and may pass this mutation to any future offspring. Several autosomal recessive genetic mutations also may cause SCID.

What are the risk factors for severe combined immunodeficiency?

There are risk factors of age, sex, and ethnicity:

  • Most patients with SCID present by age 3 months.
  • The most common form of SCID (responsible for about 45% of all cases) is X-linked and only presents in males. Other forms, however, can present in males and females equally.
  • Certain ethnic groups – including the Finnish, North Africans, Italians, Navajos, and Apaches – appear to carry a greater risk for specific forms of this condition.

Clinical presentations of SCID

Symptoms of SCID usually become apparent within the first year. The following are the most common symptoms of SCID; however, each child may experience symptoms differently. Symptoms may include:

Numerous, serious, and/or life-threatening infections that are not easily treated and do not respond to medications (as they would in children without SCID), including the following:

  • An infection of the lungs.
  • An infection of the brain.
  • An infection in the bloodstream.

Other infections, including the following:

  • Chronic skin infections
  • Yeast infections in the mouth and diaper area
  • Diarrhea
  • Infection of the liver

Diagnosis of SCID

Severe combined immunodeficiency (SCID) is generally suspected in infants younger than one-year-old who suffer from frequent and/or serious infections (especially fungal infections that are resistant to treatment), persistent diarrhea, weight loss, and chronic (ongoing) skin infections. These patients may have an enlarged liver, spleen, and/or lymph nodes, which indicate that the body is fighting off an infection. A series of tests (listed below) are necessary to confirm a diagnosis.

Complete blood count (CBC): A complete blood count (CBC) can be conducted to determine the number of lymphocytes in the blood. Lymphocytes are special cells in the bloodstream that support the immune system and keep a patient healthy. The blood count can also show if other immune cells in the blood are absent or out of balance. During the procedure, a small sample of blood is taken and analyzed under the microscope. Decreased levels of lymphocytes may indicate the presence of SCID.

Blood smear: A blood smear is often used to measure the number of lymphocytes (a kind of white blood cell in the patient’s blood). The white blood cells, which are part of the body’s immune system, help fight against diseases and infections. Healthy patients typically have more than 1,500 lymphocytes per cubic millimeter of blood. Infants who have SCID usually have significantly decreased numbers of white blood cells.

Mitogen stimulation assay: Lymphocyte function can be tested by its reaction to specific stimulation with plant extracts called mitogens. Mitogens are added to a sample of the patient’s blood to stimulate mitosis (cell division) of lymphocytes. This allows the healthcare provider to observe the lymphocytes during mitosis. This test can detect abnormal or dysfunctional lymphocytes that cause SCID.

Immunoglobulin test: An immunoglobulin test measures the levels of antibodies (a glycoprotein that detects and binds to foreign substances that enter the body) in the blood. Patients who have SCID will have extremely low levels of immunoglobulin, especially two types called immunoglobulin A (IgA) and immunoglobulin (IgM). However, soon after birth, immunoglobulin G (IgG) levels may still be high because the newborn still has healthy maternal IgG that it received through the umbilical cord before birth.

X-ray: An X-ray may detect an absent or abnormally small thymus gland, which is associated with SCID. Some T-cells are produced in the thymus gland. If the thymus gland is abnormally small, an insufficient amount of T-cells may be produced causing SCID. An X-ray may also detect inflammation of the lung caused by pulmonary infections like interstitial pneumonitis or pneumonia.

Prenatal testing: Amniocentesis, chorionic villus sampling, or cord blood can be used to diagnose a fetus with SCID. These procedures are most often conducted in patients who have a family history of SCID. Amniocentesis is performed at about 15-18 weeks of gestation. During the procedure, a long, thin needle is inserted into the pregnant woman’s abdominal wall to the uterus. A small amount of fluid is removed from the sac that surrounds the fetus. The fluid is then analyzed for genetic abnormalities. There is a risk of infection or injury to the fetus and a chance of miscarriage.

During chorionic villus sampling (CVS), a small piece of tissue (chorionic villi) is removed from the uterus during early pregnancy to screen the fetus for genetic defects. Depending on where the placenta is located, CVS can be performed through the cervix (Transcervical) or through the abdomen (Transabdominal). The risks of infections or fetal damage are slightly higher than the risks of amniocentesis. Fetal loss occurs about two percent of the time.

During a cord blood test, a sample of blood is taken from the umbilical cord at the time of birth. The sample is then analyzed in a laboratory to determine whether the newborn has genetic abnormalities that indicate SCID.

Treatment and Medications that can cure SCID.

Isolation

Your baby may need to stay away from young children. This makes it less likely they will catch an illness from another child.

Immunoglobulin Replacement Therapy

Babies with SCID should be placed on immunoglobulin replacement therapy if they are more than three months of age or have already had infections. Regular immunoglobulin replacement therapy can replace missing antibodies that help your baby fight infections.

Bone Marrow Transplant

The most effective treatment for SCID is a bone marrow transplant. Bone marrow makes cells for fighting infections and illnesses. In a bone marrow transplant, bone marrow cells from a person with a working immune system are given to a person with SCID, whose bone marrow cannot make cells to fight infections and illnesses.

Gene therapy

Gene therapy involves inserting genes into an individual’s cells and tissues to treat a hereditary (passed down from parents to children) disease. Several gene therapy clinical trials based on gene transfer to hematopoietic cells (blood-forming cells in the bone marrow) have been performed. However, further research is necessary before gene therapy can be recommended.

Integrative Therapies

Blessed thistle: Laboratory studies report that the herb blessed thistle and chemicals in blessed thistles, such as cnicin and polyacetylene, have activity against several types of bacteria and no effects on other types. Avoid if allergic to blessed thistle, mugwort, bitter weed, blanket flower, chrysanthemum, coltsfoot, daisy, dandelion, dwarf sunflower, goldenrod, marigold, prairie sage, ragweed, Echinacea, or any plants of the Asteraceae or Compositae families. Avoid in patients with a history of bleeding diseases or gastroesophageal reflux disease (GERD), or if taking drugs for blood disorders, stroke, stomach diseases, or to control stomach acid. Avoid if pregnant or breastfeeding. Stop use two weeks before surgery/dental/diagnostic procedures with bleeding risk and do not use immediately after these procedures.

Bladderwrack: Laboratory study suggests the antifungal and antibacterial activity of bladderwrack. However, there are no reliable human studies to support its use as an antibacterial or antifungal agent.

Avoid if allergic or hypersensitive to Fucus vesiculosus and iodine. Avoid with a history of thyroid disease, bleeding, acne, kidney disease, blood clots, nerve disorders, high blood pressure, stroke, or diabetes. Avoid if pregnant or breastfeeding.

Cranberry: Study results of cranberry as an antibacterial in other conditions show conflicting results. Further research is needed before a conclusion can be drawn.

Avoid if allergic to cranberries, blueberries or other plants of the Vaccinium genus. Sweetened cranberry juice can affect blood sugar levels. Use cautiously with a history of kidney stones. Avoid more than the amount usually found in foods if pregnant or breastfeeding.

Iodine: Iodine is commonly applied to the skin’s surface to clean wounds, sterilize the skin before surgical/invasive procedures, or sterilize the place for catheters before they are put in to collect urine. Betadine solution (topical disinfectant), for example, contains povidone-iodine. Other topical disinfectants include alcohol and antibiotics; iodine is sometimes used in combination with these. Commercially prepared iodine products are recommended in order to assure appropriate concentrations (strengths).

Probiotics: An increasing number of studies support the use of probiotics as a supplement to antibiotic therapy. Probiotic supplementation during treatment of antibiotics may reduce the side effects of antibiotics in the digestive tract. This includes reducing the growth of Clostridium difficile bacteria, which can lead to colitis, a common complication of antibiotics, especially in the elderly. Some probiotics may also help prevent the development of antibiotic resistance. In acutely ill children, synbiotics (nutritional supplements containing probiotics and prebiotics) have been linked to greater weight gain and fewer bacterial illnesses after antibiotics are ended. The evidence consistently supports supplementation of antibiotics.

Medications for Severe combined immunodeficiency (SCID)

Antibiotics: Antibiotics, such as erythromycin (ERYC©), azithromycin (Zithromax©), and clarithromycin (Biaxin© Filmtab, Biaxin© Granules, Biaxin© XL Filmtab, or Biaxin© XL Pac), are used to treat bacterial infections that are often associated with SCID.

Antifungals: Antifungals, such as trimethoprim and sulfamethoxazole (Bactrim© or Septra©), pentamidine (NebuPent©, Pentam©, Pentacarinat©), amphotericin B (Abelcet©), fluconazole (Diflucan©), ketoconazole (Nizoral©), nystatin (Mycostatin©), and atovaquone (Mepron©), are used to treat fungal infections that are commonly associated with SCID.

Antivirals: Antivirals, such as ganciclovir (Cytovene©), foscarnet (Foscavir©) and acyclovir (Zovirax©), are used to treat viral infections that are often associated with SCID.

SCID – Prognosis

Without treatment SCID usually results in severe infection and death in children by age of 2. When performed from an HLA-identical sibling, and in the first few months of life, HSCT can result in a greater than 90% long-term survival rate.

Emphysema is a lung condition that causes shortness of breath.

What is emphysema?

Emphysema is a lung condition that causes shortness of breath. In people with this condition, the air sacs in the lungs (alveoli) are damaged. Over time, the inner walls of the air sacs weaken and rupture creating larger air spaces instead of many small ones. This reduces the surface area of the lungs and, in turn, the amount of oxygen that reaches your bloodstream.

When you exhale, the damaged alveoli don’t work properly and old air becomes trapped, leaving no room for fresh, oxygen-rich air to enter. Most people with emphysema also have chronic bronchitis. Chronic bronchitis is inflammation of the tubes that carry air to your lungs (bronchial tubes), which leads to a persistent cough. Emphysema and chronic bronchitis are two conditions that make up chronic obstructive pulmonary disease (COPD). Smoking is the leading cause of COPD. Treatment may slow the progression of COPD, but it can’t reverse the damage.

Types of Emphysema

Emphysema is a type of COPD, and there are different types of emphysema, depending on which part of the lungs it affects.

These are:

  • paraseptal emphysema
  • centrilobular emphysema, which affects mainly the upper lobes and is most common in people who smoke
  • panlobular emphysema, which affects both the paraseptal and centrilobular areas of the lungs

During diagnosis, a CT scan can show which type of emphysema is present. The type does not affect the outlook and treatment.

Pathophysiology

Emphysema is a pathologic diagnosis defined by permanent enlargement of airspaces distal to the terminal bronchioles. This leads to a dramatic decline in the alveolar surface area available for gas exchange. Furthermore, loss of alveoli leads to airflow limitation by 2 mechanisms. First, loss of the alveolar walls results in a decrease in elastic recoil, which leads to airflow limitation. Second, loss of the alveolar supporting structure leads to airway narrowing, which further limits airflow.

It has 3 morphologic patterns:

  • Centriacinar
  • Panacinar
  • Distal acinar, or paraseptal

Centriacinar emphysema is characterized by focal destruction limited to the respiratory bronchioles and the central portions of the acini. This form of emphysema is associated with cigarette smoking and is typically most severe in the upper lobes.

Panacinar emphysema involves the entire alveolus distal to the terminal bronchiole. The panacinar type is typically most severe in the lower lung zones and generally develops in patients with homozygous alpha1-antitrypsin (AAT) deficiency.

Distal acinar emphysema, or paraseptal emphysema, is the least common form and involves distal airway structures, alveolar ducts, and sacs. This form of emphysema is localized to fibrous septa or to the pleura and leads to formation of bullae (as seen in the images below). The apical bullae may cause pneumothorax. Paraseptal emphysema is not associated with airflow obstruction.

The gradual destruction of alveolar septae (shown in the image below) and of the pulmonary capillary bed in emphysema leads to a decreased ability to oxygenate blood. The body compensates with lowered cardiac output and hyperventilation. This V/Q mismatch results in relatively limited blood flow through a fairly well oxygenated lung with normal blood gases and pressures in the lung, in contrast to the situation in chronic bronchitis. Because of low cardiac output, the rest of the body also suffers from tissue hypoxia and pulmonary cachexia. Eventually, these patients develop muscle wasting and weight loss and are identified as “pink puffers.”

Causes

  • The main cause is exposure to airborne irritants, which include tobacco smoke, marijuana smoke, air pollutants, and manufacturing smoke.
  • Very rarely, emphysema is caused by heredity, wherein a person has a shortage of a protein that guards the elastic structure in the lungs, known as alpha-1 antitrypsin deficiency.
  • Close relatives of people with emphysema are more likely to develop the disease themselves. This is probably because the tissue sensitivity or response to smoke and other irritants may be inherited. The role of genetics in the development of emphysema, however, remains unclear.
  • Abnormal airway reactivity, such as bronchial asthma, has been shown to be a risk factor for the development of emphysema.

Who is at risk for emphysema?

The risk factors include

  • This the main risk factor. Up to 75 percent of people who have emphysema smoke or used to smoke.
  • Long-term exposure to other lung irritants, such as secondhand smoke, air pollution, and chemical fumes and dusts from the environment or workplace.
  • Most people who have emphysema are at least 40 years old when their symptoms begin.
  • This includes alpha-1 antitrypsin deficiency, which is a genetic condition. Also, smokers who get emphysema are more likely to get it if they have a family history of COPD.

Symptoms of emphysema

The symptoms include:

  • Breathlessness with exertion, and eventually breathlessness most of the time in advanced disease
  • Susceptibility to chest infections
  • Cough with phlegm production
  • Fatigue
  • Barrel-shaped chest (from expansion of the ribcage in order to accommodate enlarged lungs)
  • Cyanosis (a blue tinge to the skin) due to lack of oxygen.

Complications of Emphysema

People who have emphysema are also more likely to develop:

Collapsed lung (pneumothorax). A collapsed lung can be life-threatening in people who have severe emphysema, because the function of their lungs is already so compromised. This is uncommon but serious when it occurs.

Heart problems. Emphysema can increase the pressure in the arteries that connect the heart and lungs. This can cause a condition called cor pulmonale, in which a section of the heart expands and weakens.

Large holes in the lungs (bullae). Some people with emphysema develop empty spaces in the lungs called bullae. They can be as large as half the lung. In addition to reducing the amount of space available for the lung to expand, giant bullae can increase your risk of pneumothorax.

How do doctors diagnose Emphysema?

Your chest feels tight, you’re out of breath much of the time, and you have a cough that won’t go away. Do you have emphysema? You can’t go on symptoms alone. See your doctor. They’ll do the following tests to find out for sure:

Medical History

Your doctor will talk to you about your health and any recent changes you might have noticed. If you have emphysema, you’ll probably have had shortness of breath, often over a period of months or years. You may also experience wheezing. You might have a cough that won’t go away, too.

Physical Exam

Your doctor will check your weight and blood pressure. They’ll listen to your heartbeat and keep an eye out for anything that seems strange or unusual.

If you have advanced emphysema, your doctor may notice that you have any of the following:

  • You have a “barrel chest” caused by larger-than-normal lungs.
  • You’re wheezing, having a hard time getting air out of your lungs.
  • Your fingertips are rounded. Doctors call this “clubbing.”
  • You purse your lips when you breathe, like you’re blowing a kiss.
  • The oxygen levels in your blood are low (hypoxemia).
  • The carbon dioxide levels in your blood are high (hypercarbia), because emphysema makes it hard to exhale properly.
  • Your lips have a blue tinge (cyanosis), another sign of low oxygen in your blood.
  • Malnutrition causes muscles to slowly waste away in advanced emphysema.

Pulmonary Function Tests (PFTs)

For this exam, you may sit inside an enclosed booth and breathe into a tube. This will allow your doctor to measure:

  • How much air your lungs can hold
  • How fast you can blow air out of your lungs
  • How much air stays trapped in your lungs after you exhale
  • Whether you’re able to breathe better after using medicines you inhale, such as albuterol

If you have normal lungs, you’ll likely be able to empty most of the air from them in 1 second. If you have emphysema, it’ll probably take longer.

Chest X-ray and CT scan

If you have advanced emphysema, your lungs will appear to be much larger than they should be. In early stages of the disease, your chest X-ray may look normal. Your doctor can’t diagnose emphysema with an X-ray alone.

A CT scan of your chest will show if the air sacs (alveoli) in your lungs have been destroyed. These make it hard for you to breathe out like normal.

Arterial blood gas

This test measures the amount of oxygen and carbon dioxide in blood from an artery. It is a test often used as emphysema worsens. It is especially helpful in determining if a patient needs extra oxygen.

Pulse oximetry

This test is also known as an oxygen saturation test. Pulse oximetry is used to measure the oxygen content of the blood. This is done by attaching the monitor to a person’s finger, forehead, or earlobe.

Electrocardiogram (ECG)

ECGs check heart function and are used to rule out heart disease as a cause of shortness of breath.

How is emphysema treated?

There is no cure for emphysema. Treatment aims to reduce symptoms and slow the progression of the disease with medications, therapies, or surgeries.

If you are a smoker, the first step in treating this condition is to quit smoking, either with medications or cold turkey.

Medications

Bronchodilator Medications

Inhaled as aerosol sprays or taken orally, bronchodilator medications may help to relieve symptoms of emphysema by relaxing and opening the air passages in the lungs.

Steroids

Inhaled as an aerosol spray, steroids can help relieve symptoms of emphysema associated with asthma and bronchitis. Over time, however, inhaled steroids can cause side effects, such as weakened bones, high blood pressure, diabetes and cataracts. It is important to discuss these side effects with your doctor before using steroids.

Antibiotics

Antibiotics may be used to help fight respiratory infections common in people with emphysema, such as acute bronchitis, pneumonia and the flu.

Vaccines

Patients with emphysema should receive a flu shot annually and pneumonia shot every five to seven years to prevent infections.

Oxygen Therapy

As a patient’s disease progresses, they may find it increasingly difficult to breathe on their own and may require supplemental oxygen. Oxygen comes in various forms and may be delivered with different devices, including those you can use at home.

Surgery or Lung Transplant

Lung transplantation may be an option for some patients with emphysema. For others, lung volume reduction surgery, during which small wedges of damaged lung tissue are removed, may be recommended.

Protein Therapy

Patients with emphysema caused by an alpha-1 antitrypsin (AAT) deficiency may be given infusions of AAT to help slow the progression of lung damage.

Pulmonary Rehabilitation

An important part of emphysema treatment is pulmonary rehabilitation, which includes education, nutrition counseling, learning special breathing techniques, help with quitting smoking and starting an exercise regimen. Because people with it are often physically limited, they may avoid any kind of physical activity. However, regular physical activity can actually improve a patient’s health and wellbeing.

Lifestyle changes

  • Quitting smoking if you are a smoker. This is the most important step you can take to treat this condition.
  • Avoiding secondhand smoke and places where you might breathe in other lung irritants
  • Ask your health care provider for an eating plan that will meet your nutritional needs. Also ask about how much physical activity you can do. Physical activity can strengthen the muscles that help you breathe and improve your overall wellness.

Prevention of Emphysema

To prevent emphysema:

  • If you smoke, talk to your doctor about how to quit
  • Avoid exposure to secondhand smoke
  • Avoid exposure to air pollution or irritants
  • Wear protective gear if you are around irritants or toxins on the job

Hemolytic uremic syndrome, or HUS, is a kidney condition that happens when red blood cells are destroyed.

What is hemolytic uremic syndrome?

Hemolytic uremic syndrome, or HUS, is a kidney condition that happens when red blood cells are destroyed and block the kidneys’ filtering system. Red blood cells contain hemoglobin an iron-rich protein that gives blood its red color and carries oxygen from the lungs to all parts of the body.

When the kidneys and glomeruli – the tiny units within the kidneys where blood is filtered – become clogged with the damaged red blood cells, they are unable to do their jobs. If the kidneys stop functioning, a child can develop acute kidney injury – the sudden and temporary loss of kidney function. Hemolytic uremic syndrome is the most common cause of acute kidney injury in children.

Pathophysiology

Hemolytic-uremic syndrome, like thrombotic thrombocytopenic purpura (TTP), involves nonimmunologic platelet destruction. Endothelial damage is common. Loose strands of platelets and fibrin are deposited in multiple small vessels and damage passing platelets and red blood cells (RBCs), causing significant thrombocytopenia and anemia (microangiopathic hemolytic anemia). Platelets are also consumed within multiple small thrombi, contributing to the thrombocytopenia.

Multiple organs develop bland platelet–von Willebrand factor (VWF) thrombi localized primarily to arteriocapillary junctions, described as thrombotic microangiopathy. The brain, heart, and kidneys are particularly likely to be affected. The microthrombi do not include RBCs or fibrin (unlike thrombi in disseminated intravascular coagulation) and do not manifest the vessel wall granulocytic infiltration characteristic of vasculitis. Large-vessel thrombi are uncommon.

What causes hemolytic uremic syndrome?

While the cause of HUS has not been established with certainty, researchers believe that an abnormal inflammatory reaction is stimulated in the blood stream causing platelets (the parts of the blood that form clots) to sludge in small blood vessels and form blood clots where they are not supposed to. This uses up the platelets and causes a shortage of them in the rest of the body. This abnormal reaction may be caused by a yet unidentified chemical that is produced in blood plasma (the fluid or non-cellular part of the bloodstream).

The triggering events for HUS are varied and include:

  • Enterohemorrhagic Coli is a type of bacteria that causes bloody diarrhea. E. coli is a very common type of bacteria in the body, and it is only the OH157:H7 type that causes the problem. It can be found in undercooked meat and other foods; and is one of the causes of food recalls and restaurant-related food poisoning outbreaks. This accounts for almost 90% of HUS in children. The 2011 outbreak of HUS in Germany was due to a different type of Shigela toxin-producing E. coli called 0104:H4.
  • Pregnancy and the early postpartum (after delivery) time period and the use of birth control pills are the more common associations with HUS.
  • Pneumonia caused by the Streptococcus pneumoniae bacteria is another possible precipitating factor. HUS is rare complication of this common infection. Most often, this pneumonia is treated with antibiotics as an outpatient. However, it is the cause of 40% of atypical HUS.
  • Medications may be also associated with HUS, including some chemotherapy and immunosuppression drugs, birth control pills, ticlopidine (Ticlid, an anti-platelet drug) and quinine (Quinerva, Quinite) an anti-platelet drug.
  • AIDS may be associated with HUS.

Risk factors

  • Ingestion of contaminated food or water
  • Known community outbreak of toxicogenic E coli
  • Exposure to infected individuals in institutional settings
  • Genetic predisposition (atypical HUS)
  • Bone marrow transplant
  • Exposure to cyclosporine, some chemotherapy agents, targeted cancer agents, and quinine
  • Pregnancy- or postpartum-related

Symptoms

STEC-HUS often begins with vomiting and diarrhea, which may be bloody. Within a week, the person may become weak and irritable. People with this condition may urinate less than normal. Urine output may almost stop.

Red blood cell destruction leads to symptoms of anemia.

Early symptoms:

  • Blood in the stools
  • Irritability
  • Fever
  • Lethargy
  • Vomiting and diarrhea
  • Weakness

Later symptoms:

  • Bruising
  • Decreased consciousness
  • Low urine output
  • No urine output
  • Pallor
  • Seizures — rare
  • Skin rash that looks like fine red spots (petechiae)

Complications

HUS can cause life-threatening complications, including:

  • Kidney failure, which can be sudden (acute) or develop over time (chronic)
  • High blood pressure
  • Stroke or seizures
  • Coma
  • Clotting problems, which can lead to bleeding
  • Heart problems
  • Digestive tract problems, such as problems with the intestines, gallbladder or pancreas

How is hemolytic uremic syndrome in children diagnosed?

A health care provider diagnoses hemolytic uremic syndrome with

  • A medical and family history
  • A physical exam
  • Urine tests
  • A blood test
  • A stool test
  • Kidney biopsy

Medical and Family History

Taking a medical and family history is one of the first things a health care provider may do to help diagnose hemolytic uremic syndrome.

Physical Exam

A physical exam may help diagnose hemolytic uremic syndrome. During a physical exam, a health care provider most often

  • Examines a child’s body
  • Taps on specific areas of the child’s body

Urine Tests

A health care provider may order the following urine tests to help determine if a child has kidney damage from hemolytic uremic syndrome.

  • Dipstick test for albumin. A dipstick test performed on a urine sample can detect the presence of albumin in the urine, which could mean kidney damage. The child or caretaker collects a urine sample in a special container in a health care provider’s office or a commercial facility. For the test, a nurse or technician places a strip of chemically treated paper, called a dipstick, into the child’s urine sample. Patches on the dipstick change color when albumin is present in the urine.
  • Urine albumin-to-creatinine ratio. A health care provider uses this measurement to estimate the amount of albumin passed into the urine over a 24-hour period. The child provides a urine sample during an appointment with the health care provider. Creatinine is a waste product that is filtered in the kidneys and passed in the urine. A high urine albumin-to-creatinine ratio indicates that the kidneys are leaking large amounts of albumin into the urine.

Blood Test

A blood test involves drawing blood at a health care provider’s office or a commercial facility and sending the sample to a lab for analysis. A health care provider will test the blood sample to

  • Estimate how much blood the kidneys filter each minute, called the estimated glomerular filtration rate, or eGFR. The test results help the health care provider determine the amount of kidney damage from hemolytic uremic syndrome.
  • Check red blood cell and platelet levels.
  • Check for liver and kidney function.
  • Assess protein levels in the blood.

Stool Test

A stool test is the analysis of a sample of stool. The health care provider will give the child’s parent or caretaker a container for catching and storing the stool. The parent or caretaker returns the sample to the health care provider or a commercial facility that will send the sample to a lab for analysis. Stool tests can show the presence of E. coli O157:H7.

Kidney Biopsy

Biopsy is a procedure that involves taking a small piece of kidney tissue for examination with a microscope. A health care provider performs the biopsy in an outpatient center or a hospital. The health care provider will give the child light sedation and local anesthetic; however, in some cases, the child will require general anesthesia. A pathologist—a doctor who specializes in diagnosing diseases—examines the tissue in a lab. The pathologist looks for signs of kidney disease and infection. The test can help diagnose hemolytic uremic syndrome.

How is hemolytic uremic syndrome treated in a child?

There is no treatment to stop HUS. But treatment can be done to help support your child during the illness. Your child may need close monitoring in an intensive care unit (ICU). Treatments in ICU may include:

  • IV (intravenous) fluids and electrolytes. This is done to treat dehydration.
  • Blood transfusions. Your child may need a blood transfusion to treat a medium to severe case of low red blood cell count (anemia).
  • Your child may need IV nutrition if he or she has severe digestive problems.
  • Dialysis to help failing kidneys. During dialysis, a machine is used to filter waste products from the blood. Dialysis is only needed in the most severe cases of HUS. It is usually temporary. But people with severe kidney damage could need it long-term.
  • Your child may need medicine to treat high blood pressure.

How can hemolytic uremic syndrome be prevented?

Following this list of simple tasks may help prevent hemolytic uremic syndrome due to E. coli O157:H7:

  • Avoid unclean swimming areas.
  • Avoid unpasteurized milk, juice, and cider.
  • Clean kitchen utensils and food surfaces often.
  • Cook meat to an internal temperature of at least 160°F/70°C.
  • Defrost meat in the microwave or refrigerator.
  • Keep children out of pools if they have had diarrhea.
  • Separate raw foods from cooked items.
  • Wash hands before eating.
  • Wash hands after using the restroom and after changing diapers.
  • Wash hands after petting farm animals.

The term Viral Hemorrhagic Fever (VHF) refers to a group of serious illnesses caused by particular viruses.

Definition

The term Viral Hemorrhagic Fever (VHF) refers to a group of serious illnesses caused by particular viruses. There are four VHFs that are of major concern from an Infection Control Perspective as they can be transmitted directly from humans to humans, and are a hazard for staff handling blood samples. These are:

  • Lassa fever
  • Congo-Crimean HF
  • Ebola
  • Marburg
  • Dengue
  • Yellow Fever

If one of these VHFs is suspected seek immediate advice from the on-call consultant infectious diseases physician and consultant medical microbiologist.

Other VHFs include

  • Chikungunya HF
  • Haemorrhagic fever with renal syndrome (Hantaan)
  • Kyasanur Forest disease
  • Omsk HF
  • Rift Valley disease

These are less of a concern from an Infection Control perspective. Standard isolation precautions and good laboratory practice are sufficient (wearing gloves for taking and handling blood samples and avoidance of sharps injuries).

Pathophysiology

The primary defect in patients with viral hemorrhagic fever (VHF) is that of increased vascular permeability. Hemorrhagic fever viruses have an affinity for the vascular system, leading initially to signs such as flushing, conjunctival injection, and petechial hemorrhages, usually associated with fever and myalgias. Later, frank mucous membrane hemorrhage may occur, with accompanying hypotension, shock, and circulatory collapse. The relative severity of the clinical presentation may vary depending on the virus in question, amount, and route of exposure.

In acute disease, patients are extremely viremic, and messenger ribonucleic acid (mRNA) evidence of multiple cytokine activation exists. In vitro studies reveal these cytokines lead to shock and increased vascular permeability, the basic pathophysiologic processes most often seen in viral hemorrhagic fever infection. Another prominent pathologic feature is pronounced macrophage involvement. Inadequate or delayed immune response to these novel viral antigens may lead to rapid development of overwhelming viremia. Extensive infection and necrosis of affected organs also are described. Hemorrhagic complications are multifactorial and are related to hepatic damage, consumptive coagulopathy, and primary marrow injury to megakaryocytes. Aerosol transmission of some viral hemorrhagic fever infections is reported among nonhuman primates and likely is a mode of transmission in patients with severe infection.

Multisystem organ failure affecting the hematopoietic, neurologic, and pulmonary systems often accompanies the vascular involvement. Hepatic involvement varies with the infecting organism and is at times seen with Ebola, Marburg, RVF, CCHF, and yellow fever. Renal failure with oliguria is a prominent feature of HFRS seen in Hantavirus infection and may be seen in other VHFs as intravascular volume depletion becomes more pronounced. Bleeding complications are particularly prominent with Ebola, Marburg, CCHF, and the South American arenaviruses.

Although the pathophysiology of dengue infection is complex and incompletely understood, severe dengue infection can be differentiated from milder forms by the presence of increased vascular permeability. The greatest risk factor for severe dengue infection is secondary infection with a dengue serotype different from the initial dengue infection. This increased vascular permeability is thought to be secondary to widespread T-cell activation and apoptosis and is also thought to be related to a process known as antibody-dependent enhancement, best described as the balance between neutralizing versus enhancing antibodies after an initial dengue infection, which can contribute to the severity of secondary dengue infection.

What causes viral hemorrhagic fevers?

These illnesses are caused by viruses from 4 groups:

  • Arenaviruses: Jupin, Machupo, and Lassa fever virus
  • Filoviruses: Marburg virus and Ebola virus
  • Bunyaviruses: Crimean-Congo hemorrhagic fever (CCHF) and rift valley fever (RVF)
  • Flaviviruses: Dengue and yellow fever

These viruses infect insects or rodents. You can become infected from exposure to the body, body fluids, or the droppings of an infected rodent or through an insect bite, usually from a mosquito or tick. Some of the viruses also spread from person to person. Viruses can also be spread if you crush an infected tick.

How are hemorrhagic fever viruses transmitted?

Viruses causing hemorrhagic fever are initially transmitted to humans when the activities of infected reservoir hosts or vectors and humans overlap. The viruses carried in rodent reservoirs are transmitted when humans have contact with urine, fecal matter, saliva, or other body excretions from infected rodents. The viruses associated with arthropod vectors are spread most often when the vector mosquito or tick bites a human, or when a human crushes a tick. However, some of these vectors may spread virus to animals, livestock, for example. Humans then become infected when they care for or slaughter the animals.

Some viruses that cause hemorrhagic fever can spread from one person to another, once an initial person has become infected. Ebola, Marburg, Lassa and Crimean-Congo hemorrhagic fever viruses are examples. This type of secondary transmission of the virus can occur directly, through close contact with infected people or their body fluids. It can also occur indirectly, through contact with objects contaminated with infected body fluids. For example, contaminated syringes and needles have played an important role in spreading infection in outbreaks of Ebola hemorrhagic fever and Lassa fever.

What are the risk factors for viral hemorrhagic fevers (VHFs)?

People at higher risk for VHFs include those who:

  • Have direct contact with natural hosts of VHF viruses including mosquitoes, ticks or rodents
  • Have close contact with infected people
  • Travel to developing countries

Symptoms of viral hemorrhagic fever

Signs and symptoms of viral hemorrhagic fevers vary by disease. In general, initial signs and symptoms may include:

  • High fever
  • Fatigue
  • Dizziness
  • Muscle, bone or joint aches
  • Weakness

Symptoms can become life-threatening

Severe cases of some types of viral hemorrhagic fevers may cause bleeding, but people rarely die of blood loss. Bleeding may occur:

  • Under the skin
  • In internal organs
  • From the mouth, eyes or ears

Other signs and symptoms of severe infections can include:

  • Septic shock
  • Nervous system malfunctions
  • Coma
  • Delirium
  • Kidney failure
  • Respiratory failure
  • Liver failure

Complications of viral hemorrhagic fever

The viral hemorrhagic fever can progress rapidly and can result in numerous complications. Also, in some cases, untreated viral hemorrhagic fever can be fatal. Some of the common complications resulting from VHF include:

  • Hepatitis
  • Transverse myelitis
  • Uveitis
  • Miscarriage
  • Arthritis
  • Neurological problems
  • Renal insufficiency

Apart from the above complications, viral hemorrhagic fever can cause damage to organs, such as heart, lung, spleen, liver, and kidneys.

Diagnosis and Test

Most of the times, it is difficult to diagnose viral hemorrhagic fever at early stages. The initial signs and symptoms of VHF, such as high fever, fatigue, and muscle aches can be due to other illnesses.

To diagnose the condition, the doctor performs a routine physical examination and review the medical history. The doctor will ask to describe the symptoms, and places visited recently to identify the possible sources of infection. The doctor would recommend the following tests to diagnose viral hemorrhagic fever.

Blood tests: A sample of the blood is collected and tested to determine the causative organism. As viral hemorrhagic fevers are highly contagious, these tests are performed under strict precautionary measures.

Treatment of Viral Hemorrhagic Fever:

There is no cure or specific treatment for viral hemorrhagic fevers. However, the doctor will prescribe antiviral medications, such as ribavirin to prevent the risk of further complications.

Antiviral drug: While no specific treatment exists for most viral hemorrhagic fevers, the antiviral drug ribavirin (Rebetol, Virazole, others) may help shorten the course of some infections and prevent complications in some cases.

Supportive care is essential. To prevent dehydration, you may need fluids to help maintain your balance of electrolytes — minerals that are critical to nerve and muscle function.

Isolate the patient: Viral Hemorrhagic Fever (VHF) isolation guidelines dictate that all VHF patients should be cared for using strict contact precautions; including hand hygiene, double gloves, gowns, shoe and leg coverings, and faceshield or goggles. Lassa, CCHF, Ebola, and Marburg viruses may be particularly prone to nosocomial (hospital-based) spread. Airborne precautions should be utilized including, at a minimum, a fit-tested, HEPA filter-equipped respirator (such as an N-95 mask), a battery-powered, air-purifying respirator, or a positive pressure supplied air respirator to be worn by personnel coming within 1,8 meter (six feet) of a VHF patient. Multiple patients should be cohorted (sequestered) to a separate building or a ward with an isolated air-handling system. Environmental decontamination is typically accomplished with hypochlorite (e.g. bleach) or phenolic disinfectants.

Home-care

  • Add a tea spoon of turmeric in a cup of warm milk and consume it once in a day. Turmeric helps to treat gastrointestinal upset and arthritic pain caused by viral infection.
  • The polyphenols in green tea have several antiviral properties, which help to boost the immune system response.
  • Ginger helps to fasten the recovery and ease the respiratory and gastrointestinal problems that resulted from viral infection.
  • Soak a soft cloth or sponge in cold water and compress it on the forehead to reduce moderate to high-grade fever caused by viral infection.
  • Drink plenty of fluidsto maintain the balance of electrolytes and prevent dehydration.

Can viral hemorrhagic fever diseases be prevented?

No vaccines are available to prevent these diseases. Two exceptions are for yellow fever and Argentine hemorrhagic fever. As a result, the focus is on staying away from the rodents or insects that carry the virus.

For rodents:

  • Control the number of rodents
  • Prevent them from entering or living in homes or workplace
  • Learn how to safely clean up nests and droppings

For viruses spread by ticks or mosquitoes, prevention focuses on:

  • Control mosquitoes and ticks in your environment
  • Use insect repellent, proper clothing, bed nets, window screens, and other insect barriers to avoid being bitten

If you are traveling to an area where there is risk for viral hemorrhagic fevers:

  • Wear long sleeves and long pants treated with permethrin
  • Use insect repellent
  • Use bed nets in areas where outbreaks are occurring
  • Avoid contact with livestock or rodents in areas where outbreaks are occurring

Syringomyelia is the disorder in which a cyst or cavity forms within the spinal cord.

Definition

Syringomyelia is the disorder in which a cyst or cavity forms within the spinal cord. This cyst, called a syrinx, can expand and elongate over time, destroying the spinal cord. The damage may result in pain, paralysis, weakness and stiffness in the back, shoulders, and extremities. Syringomyelia may also cause a loss of the ability to feel extremes of hot or cold, especially in the hands. The disorder generally leads to a cape-like loss of pain and temperature sensation along the back and arms.

A syrinx can develop at any time, but it is most commonly diagnosed in young adults. In some individuals, the syrinx does not cause any symptoms and does not progress; in others the syrinx causes neurological symptoms and continues to progress. As a syrinx grows, the nerve fibers inside the spinal cord are compressed and stretched and a wide variety of symptoms can occur, depending upon the size and location of the syrinx. As it stretches it may damage the gray matter in the spinal cord and cause pain, loss of sensation, and loss of muscle bulk.  Damage to the white matter causes stiffness and poor muscle control. Left untreated, a syrinx may eventually lead to paralysis.

Epidemiology

Estimated prevalence of the disease is about 8.4 cases per 100,000 people and occurs more frequently in men than in women. The disease usually appears in the third or fourth decade of life, with a mean age of onset of 30 years. Rarely, syringomyelia may develop in childhood or late adulthood.

Types of Syringomyelia

The brain and spinal cord (central nervous system) are surrounded by a clear fluid known as cerebrospinal fluid. Some of the functions of cerebrospinal fluid include nourishing and cushioning the central nervous system.

The three broad categories of syringomyelia include:

Congenital brain defects – Such as Arnold-Chiari malformation. The bottom part of the brain (cerebellum) lies in the upper part of the neck, instead of within the skull. This obstructs the flow of cerebrospinal fluid. It may be associated with hydrocephalus.

Injury to the spinal cord – Including trauma, tumours and infections (such as meningitis, HIV), and where there is severe cord compression.

Idiopathic syringomyelia – The cause is unknown.

Syringomyelia risk factors

Syringomyelia can be caused by another medical condition such as a tethered spinal cord, a Chiari malformation, or a spinal cord tumor.

Syringomyelia can also be caused by damage to a previously healthy spinal cord. This damage can be caused by trauma, meningitis (an infection in the spinal cord membranes), arachnoiditis (inflammation and scarring of the spinal cord membranes), hemorrhage (bleeding), or other problems.

Causes of Syringomyelia

It’s unclear how and why syringomyelia happens. When it develops, cerebrospinal fluid- the fluid that surrounds, cushions and protects your brain and spinal cord- collects within the spinal cord itself, forming a fluid-filled cyst (syrinx).

Several conditions and diseases can lead to syringomyelia, including:

  • Chiari malformation, a condition in which brain tissue protrudes into your spinal canal
  • Meningitis, an inflammation of the membranes surrounding your brain and spinal cord
  • Spinal cord tumor, which can interfere with the normal circulation of cerebrospinal fluid
  • Conditions present at birth, such as a tethered spinal cord, a condition caused when tissue attached to your spinal cord limits its movement
  • Spinal cord injury, which can cause symptoms months or years later

Syringomyelia symptoms

The symptoms of syringomyelia are very variable, and often progress slowly over years. Classic findings include:

  • Scoliosis
  • Sensory loss in a “cape” distribution (over the tops of the shoulders); loss of pain and temperature sensation without loss of touch and position sense
  • Neck pain and pain in the back of the head
  • Pain in legs and arms, and hands and feet
  • Hand and arm weakness and loss of muscle function
  • High muscle tone in the arms and legs (spasticity)
  • Sleep apnea

Syringomyelia is diagnosed with MRI. Small syrinxes or hydromyelia in the spinal cord can be a normal finding.

Complications of Syringomyelia

In some people, syringomyelia can progress and lead to serious complications. Others have no symptoms.

Possible complications as a syrinx enlarges or if it damages nerves within your spinal cord include:

  • An abnormal curve of your spine (scoliosis)
  • Chronic pain as a result of spinal cord damage to the spinal cord
  • Motor difficulties, such as weakness and stiffness in your leg muscles that can affect your walking
  • Paralysis

Diagnosis and test

Magnetic Resonance Imaging (MRI) is currently the diagnostic test of choice for syringomyelia.

Myelography Enhanced Computed Tomography (CT-myelography). A significant improvement over plain CT, as it is able to show swelling and fixation of the cord and localized CSF flow obstruction.

Virtual Endocopy (VE) by Computer Tomography allows non-invasive exploration of the spinal canal in all directions and can provide information regarding the extent of stenosis, which plain CT cannot provide. Ultrasonography is useful in localizing syrinxes, determining the safest place to open the dura, and facilitating optimal shunt placement during surgery.

Intraoperative Somatosensory Evoked Potentials have limited value in assessing for syringomyelia, however may be used during surgery to prevent neurological damage.

Treatment and medications

Treatment for syringomyelia depends on the severity and progression of symptoms.

Monitoring

Syringomyelia that doesn’t show symptoms is usually not treated but the person should be carefully monitored by a neurologist or neurosurgeon as symptoms can worsen over time.  A physician may recommend not treating the condition in individuals of advanced age or in cases where there is no progression of symptoms.  Individuals with syringomyelia should avoid activities that involve straining (e.g., lifting heavy objects, jumping) since these actions can trigger symptoms.  People with an associated Chiari malformation are especially apt to experience headache with straining.

Surgery

If syringomyelia is causing signs and symptoms that interfere with your life, or if signs and symptoms rapidly worsen, your doctor will likely recommend surgery.

The goal of surgery is to remove the pressure the syrinx places on your spinal cord and to restore the normal flow of cerebrospinal fluid. This can help improve your symptoms and nervous system function. The type of surgery you’ll need depends on the cause of syringomyelia.

To reduce pressure on your brain and spinal cord, surgery options include:

Treating Chiari malformation: If syringomyelia is caused by Chiari malformation, surgery might involve removing a small section of bone at the back of your skull. This surgery can reduce pressure on your brain and spinal cord, restore the normal flow of cerebrospinal fluid, and might improve or resolve syringomyelia.

Draining the syrinx: Your doctor will surgically insert a drainage system, called a shunt. It consists of a flexible tube that keeps fluid from the syrinx flowing in the desired direction. One end of the tubing is placed in the syrinx, and the other is placed in another area of your body such as your abdomen.

Removing the obstruction: If something within your spinal cord, such as a tumor or a bony growth, is hindering the flow of cerebrospinal fluid, surgically removing the obstruction might restore the flow and allow fluid to drain from the syrinx.

Correcting the abnormality: If a spinal abnormality is hindering the flow of cerebrospinal fluid, surgery to correct it, such as releasing a tethered spinal cord, might restore fluid flow and allow the syrinx to drain.

Surgery doesn’t always restore the flow of cerebrospinal fluid, and the syrinx might remain, despite efforts to drain the fluid from it.

Syringomyelia prevention

There is no known way to prevent this condition, other than avoiding injuries to the spinal cord. Getting treated right away slows the disorder from getting worse.

History of Ota Benga an African man.

Ota Benga.

Ota Benga was an African man from Mbuti, Congo. He was taken from his village in Congo to the United States of America. During Ota Benga’s stay in the United States of America, he was featured in some exhibits where he was put in a cage for people to watch.

Around 1904 and 1906, Ota Benga was featured in two separate exhibitions in the United States of America.

The first exhibition was a Purchase Exposition that took place in St. Louis, Missouri. The second place that Ota Benga featured was at a human zoo exhibit that took place at the Bronx Zoo.

Ota Benga was among those Africans who were victims of the slave trade that later ravaged most parts of Africa.

After Ota Benga arrived in America, he was featured at the Bronx Zoo where he was exhibited alongside some monkeys. During such an exhibit, Ota Benga was locked inside a cage, and people came into the zoo to take a look at him.

Another thing to note from the life of Ota Benga during his stay in America was that each time he was locked in a cage with an Ape, he was given a bow and an arrow to enable him to protect himself from the monkeys.

There were records of incidents whereby Ota Benga used the bow and arrow to shoot at people who laughed at him during the exhibit.

Although not so much is known about the personal life of Ota Benga before he was taken to America, some pictures he took at the St. Louis World’s Fair suggest that he was a young man in 1904 and he might have arrived in the United States of America as a very young boy.

Ota Benga continued to live in Virginia, the United States of America until his death on March 20th, 1916. Ota Benga had two children before his death.

It is important to note that Ota Benga did not die in the dehumanizing state he suffered during those exhibits in the United States of America.

A lot of groups spoke against the way he was being treated and around the end of 1906, Ota Benga was released and he stayed in an Orphan Asylum in Brooklyn.

Although Ota Benga spent the rest of his life in America, he tried to return to Africa but he was unsuccessful because of the First World War.

Ota Benga later learned how to speak English and he even secured a job in a Tobacco company but all the stress he had to go through during his time in America is believed to be one of the reasons why he later became depressed and finally committed suicide in his early 30s.

http://www.oneworldvisionnews.com

Nasopharyngeal cancer is a type of head and neck cancer.

What is called Nasoharyngeal Cancer?

Nasopharyngeal cancer is a type of head and neck cancer. It is sometimes called nasopharyngeal carcinoma or NPC. It is a disease of the nasopharynx, which is the air passage between the nose and the throat and lungs. It is located behind the nasal cavity and above the soft palate of the mouth. An opening on either side of the nasopharynx, called the Eustachian tube, leads into the middle ear on each side (see Medical Illustrations).

The nasopharynx contains several types of tissue. Each tissue type contains several types of cells and different cancers can develop from each kind of cell. For example, many types of NPC contain white blood cells, called lymphocytes. Therefore, the cancer is named after these lymphocytes and called lymphoepithelioma. The type of cell involved and other factors are important because they determine the seriousness of the cancer and the type of treatment needed.

 Types of Nasopharyngeal Tumors

Several types of tumors can develop in the nasopharynx. Some of these tumors are benign (not cancer), but others are malignant (cancer). It’s important to talk with your doctor about what type of tumor you might have.

Nasopharyngeal carcinoma (NPC)

Most nasopharyngeal cancers are nasopharyngeal carcinoma (NPC). It is by far the most common cancer in the nasopharynx. Carcinoma is cancer that starts in the cells that line the internal and external surfaces of the body (called epithelial cells).

There are 3 types of NPC. They all start from epithelial cells that line the nasopharynx, but the cells of each type look different under a microscope:

  • Non-keratinizing undifferentiated carcinoma (this is the most common type of NPC in the US.)
  • Non-keratinizing differentiated carcinoma
  • Keratinizing squamous cell carcinoma

The treatment is the same for all types of NPC. The non-keratinizing types tend to respond better to treatment, but the stage of the cancer – how far it has grown and spread – is often more important than the type in predicting a person’s outlook (prognosis).

Many NPCs also contain lots of immune system cells, especially white blood cells called lymphocytes. The term lymphoepithelioma is sometimes used to describe an undifferentiated NPC with many lymphocytes among the cancer cells. The presence of these cells does not usually affect the choice of treatment options. But they may help researchers develop new treatments, because they may be a clue to how the body attempts to fight the tumor.

Other cancers in the nasopharynx

Other types of cancers can also be found in the nasopharynx:

  • Lymphomas can sometimes start in the nasopharynx. They are cancers of immune system cells called lymphocytes, which are found throughout the body, including in the nasopharynx. See Non-Hodgkin Lymphoma to learn more.
  • Adenocarcinoma and adenoid cystic carcinoma are cancers that can start in the minor salivary glands in the nasopharynx. But these cancers are more commonly found in the nose (nasal cavity) or mouth (oral cavity). See Oral Cavity and Oropharyngeal Cancer, Nasal Cavity and Paranasal Sinuses Cancer, or Salivary Gland Cancer for more about these cancers.

Benign nasopharyngeal tumors

Benign nasopharyngeal tumors are fairly rare and tend to develop in children and young adults. These tumors do not spread to other parts of the body and are usually not life-threatening. They include tumors or malformations of the vascular (blood-carrying) system, such as angiofibromas and hemangiomas, and benign tumors of minor salivary glands within the nasopharynx.

Benign nasopharyngeal tumors don’t always need treatment. When they do, the treatment is not the same as for nasopharyngeal cancer. If you have a benign tumor, talk to your doctor about what to expect.

Pathophysiology

The detection of the Epstein-Barr virus (EBV) nuclear antigen and viral DNA in nasopharyngeal carcinoma has revealed that EBV can infect epithelial cells and is associated with their malignant transformation. Copies of the EBV genome have been found in cells of preinvasive lesions, suggesting that it is directly related to the process of transformation.

What causes Nasopharyngeal Cancer?

Experts aren’t exactly sure what causes nasopharyngeal cancer. However, certain risk factors can increase your chance of developing the disease, including:

  • Epstein-Barr virus (EBV). This is the same virus that causes mononucleosis. EBV is common in people diagnosed with nasopharyngeal cancer. Even though the link between the two conditions is widely known, not all people who’ve had EBV will develop nasopharyngeal cancer.
  • Salt-cured foods. People who eat diets rich in salt-cured meat and fish have a higher chance of developing nasopharyngeal cancer.
  • Alcohol and tobacco use. Heavy smoking or drinking can increase your risk of nasopharyngeal cancer.
  • Age. Though nasopharyngeal cancer can occur at any age, it’s most commonly diagnosed in people between the ages of 30 and 50.
  • Race. Nasopharyngeal cancer is more common in people living in Southeast Asia, southern China and northern Africa. People who have immigrated to the United States from Asia also have a higher risk compared to American-born Asians.
  • Sex. Men are about three times more likely than women to develop nasopharyngeal cancer.
  • Family history. If you have a family member with nasopharyngeal cancer, you are more likely to develop the condition.

Risk factors

You are more likely to get this type of cancer if you:

  • Are male
  • Eat a diet rich in salt-cured fish and meats
  • Have a family history of nasopharyngeal cancer
  • Have certain genes linked to cancer development
  • Have come in contact with EBV

Some, but not all, studies have found a higher risk of nasopharyngeal cancer in people who:

  • Smoke
  • Drink a lot of alcohol
  • Work around wood dust or a chemical called formaldehyde

Symptoms of Nasopharyngeal Cancer

It’s often difficult to recognize nasopharyngeal cancer because the symptoms are similar to other, less serious conditions.

Also, many people with nasopharyngeal cancer don’t have any symptoms until the cancer reaches an advanced stage.

Symptoms of nasopharyngeal cancer can include:

  • A lump in the neck that doesn’t go away after 3 weeks
  • Hearing loss (usually only in 1 ear)
  • Tinnitus (hearing sounds that come from inside the body rather than from an outside source)
  • A blocked or stuffy nose (usually only blocked on 1 side)
  • Nosebleeds
  • Headaches
  • Double vision
  • Numbness in the bottom part of your face
  • Swallowing problems
  • A hoarse voice
  • Unintentional weight loss

See a GP if you have any of these symptoms, particularly if they haven’t improved after 3 weeks.

It’s very unlikely they’ll be caused by nasopharyngeal cancer, but it’s best to get them checked out.

Complications

Nasopharyngeal carcinoma complications can include:

  • Cancer that grows to invade nearby structures. Advanced nasopharyngeal carcinoma can cause complications if it grows large enough to invade nearby structures, such as the throat, bones and brain.
  • Cancer that spreads to other areas of the body. Nasopharyngeal carcinoma frequently spreads (metastasizes) beyond the nasopharynx.

Most people with nasopharyngeal carcinoma have regional metastases. That means cancer cells from the initial tumor have migrated to nearby areas, such as lymph nodes in the neck.

Cancer cells that spread to other areas of the body (distant metastases) most commonly travel to the bones, lungs and liver.

Diagnosis

The doctor will examine your mouth, throat, ears and will use a small lighted mirror to examine your nasopharynx. The doctor will pass a thin flexible tube with a light at the end (flexible endoscope) into the nostril to look at the back of the nose. A local anesthetic spray might be used to numb your nose and throat. You will be instructed not to eat or drink anything for an hour afterwards, or until your throat is no longer numb.

If a tumor is suspected, the doctor will take a biopsy and a pathologist will examine the tissue under a microscope.

Pathologists classify nasopharyngeal cancer by the type of cell. There are three types:

  • Keratinizing squamous cell carcinoma
  • Non-keratinizing squamous cell carcinoma
  • Undifferentiated or poorly differentiated carcinoma

The doctor also may order other tests, such as:

Physical examination and blood tests. During a physical examination, the doctor feels for any lumps on the neck, lips, gums, and cheeks. The doctor will look for any abnormalities in the nose, mouth, throat, and tongue, often using a light and/or mirror to get a clearer view. A blood test to check for antibodies against the EBV virus may be done at the same time.

Endoscopy. An endoscopy allows the doctor to see inside the body with a thin, lighted, flexible tube called an endoscope. The person may be sedated as the tube is inserted through the mouth or nose to examine the head and neck areas. Sedation is giving medication to become more relaxed, calm, or sleepy. When an endoscopy is done to look into the nasopharynx, it is called a nasopharyngoscopy.

Biopsy. A biopsy is the removal of a small amount of tissue for examination under a microscope. Other tests can suggest that cancer is present, but only a biopsy can make a definite diagnosis.

Neurological tests. During these examinations, the doctor tests a person’s nerve function, especially the sense of touch in their face and the motor function of certain nerves in the head and neck area.

Hearing test. The doctor may perform a hearing test if it seems that fluid could be in the middle ear.

Imaging studies to determine if the tumor has invaded nearby tissue or other organs in the body

  • Orthopantomography (Panorex) is a panoramic X-ray of the upper and lower jaw. It shows a view from ear to ear and it helps determine if a tumor has grown into the jaw bone.
  • CT scan. A special type of x-ray that makes a series of detailed pictures, with different angles, of areas inside the mouth and neck. A computer is linked to the x-ray machine. A dye may be injected into a vein or swallowed in a pill to help highlight the organs or tissues on the x-ray. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.
  • MRI (magnetic resonance imaging). A machine that uses a magnet, radio waves, and a computer to make detailed pictures of areas inside the mouth and neck. This procedure is also called nuclear magnetic resonance imaging (NMRI).
  • PET scan. During a positron emission tomography scan (PET), a small amount of radioactive glucose (sugar) is injected into a vein. The scanner makes computerized pictures of the areas inside the body. Cancer cells absorb more radioactive glucose than normal cells, so the tumor is highlighted on the pictures.

Stages of Nasopharyngeal cancer

Nasopharyngeal cancer staging is determined by several factors, including the size and location of the tumor and how far the cancer cells have spread. Here’s a general outline of the nasopharyngeal cancer stages:

  • Stage 0: Cancer only affects the top layer of cells inside the nasopharynx.
  • Stage 1: The tumor has grown into nearby structures, such as the back of the throat or the nasal cavity.
  • Stage 2: At this stage, cancer has spread to one or more lymph nodes on one side of the neck.
  • Stage 3: Cancer has spread to lymph nodes on both sides of the neck.
  • Stage 4: The tumor has spread to the skull, eye, cranial nerves, salivary glands or lower part of the throat. At stage 4, nasopharyngeal cancer may also spread to distant parts of the body.

Nasopharyngeal Cancer Treatment

If you are diagnosed with nasopharyngeal cancer, you will need regular follow-ups with your medical team before, during, and after treatment.

Your treatment will depend on many things, including:

  • Location of the tumor
  • Stage of the tumor
  • Your overall health

Treatment may include:

Radiation Therapy. Radiation therapy uses X-rays to kill cancer cells and stop them from growing. It is usually part of the standard treatment for early stage nasopharyngeal cancer.

One type called IMRT delivers high-dose radiation directly to the tumor while minimizing damage to nearby healthy tissue. It may cause fewer side effects or complications than conventional radiation treatment to the nasopharynx, which can lead to:

  • Dry mouth
  • Inflammation of the lining of your mouth and throat
  • Blindness
  • Brain stem injury
  • Death of healthy tissue
  • Tooth decay

Chemotherapy. Chemotherapy uses drugs to kill cancer cells. By itself, it is not usually helpful for treating nasopharyngeal cancer. But it may help you live longer when combined with radiotherapy or biological drugs.

Surgery. Surgery to remove the tumor is not often performed because of the tumor’s location near nerves and blood vessels. It may cause permanent damage to the eye and other nearby structures.

Not all people with nasopharyngeal cancer can have surgery. Your doctor will consider the location and stage of your tumor when discussing your treatment options.

Biologic drugs. Biologic drugs affect how your body’s immune system fights disease. They include monoclonal antibodies such as cetuximab (Erbitux), pembrolizumab (Keytruda), and nivolumab (Opdivo). Biologics work differently than chemotherapy drugs and may be used more often in cases of advanced or recurrent cancer.

Palliative therapy. The goal of palliative treatment is to control symptoms related to cancer and cancer treatment and make you as comfortable as possible.

Clinical trials. If treatment does not work, consider joining a clinical trial. Researchers are always testing new ways to treat cancer, and they need your help. Ask your doctor or nurse if there are any clinical trials on nasopharyngeal cancer in your area.

Prevention of Nasopharyngeal Cancer

Different factors cause different types of cancer. Researchers continue to look into what factors cause NPC, including ways to prevent it. Although there is no proven way to completely prevent NPC, you may be able to lower your risk. Talk with your health care team for more information about your personal risk of cancer.

Although some of the risk factors of NPC cannot be controlled, such as ancestry, several can be avoided by making lifestyle changes. Stopping the use of all tobacco products is the most important thing a person can do to reduce their risk of NPC, even for people who have used tobacco products for many years.

All the freely movable joints of the body have a lubricating lining called the synovial membrane.

What is Irritable Hip?

All the freely movable joints of the body have a lubricating lining called the synovial membrane. Irritable hip occurs when the membrane becomes inflamed for a short period of time (otherwise known as ‘transient synovitis’). The inflammation causes pain. The synovial membrane produces more than its usual thin film of lubricating fluid when it is inflamed and this can result in more pain in the joint. Irritable hip occurs in children (usually aged between 3 and 10 years) and is more common in boys than girls.

Risk factors and causes of Irritable Hip?

Irritable Hip (also known as Transient Synovitis and Toxic Synovitis) is a common cause of hip pain and limping in children. Doctors don’t know its exact cause, but some kids develop it after having a viral infection (such as a cold or diarrhea). Because of this, some doctors think that toxic synovitis is caused by substances made by the body’s immune system to fight the infection.

Toxic synovitis can happen at any age, but is most common in kids between 3 and 8 years old. It’s also more common in boys.

Sometimes toxic synovitis can be confused with septic arthritis, or infectious arthritis, a more serious condition caused by a bacterial infection that invades the joints and can cause long-term joint damage. Doctors can rule out septic arthritis or other conditions through a physical exam and diagnostic tests.

What are the symptoms of Irritable Hip in children?

Your children may start to walk with a limp, or experience trouble walking, standing or crawling. You should take your child to a consultant if they:

  • Develop a fever or is otherwise unwell
  • Develop an obvious swelling or redness on any part of the hip or leg
  • Have increasing or persistent pain that is not relieved by ibuprofen or paracetamol
  • Are in pain when they are at rest
  • Are not starting to improve within three days or has not recovered fully in two weeks

What are the complications associated with Irritable Hip?

Although this condition is rarely serious, you should call your child’s doctor if:

  • The fever or pain becomes worse even after taking anti-inflammatory medication
  • The joint pain lasts longer than three weeks or comes back after your child stops taking medication
  • The anti-inflammatory medication doesn’t start working within a few days

In these cases, your child’s doctor might need to prescribe a different medication or perform additional tests to check for other causes of hip pain.

How is Irritable Hip diagnosed?

Ruling out other conditions

Irritable Hip can be difficult to diagnose. Other conditions that are much more serious can also cause hip pain. Since these conditions require prompt medical treatment, your child’s doctor must first test for them before making a toxic synovitis diagnosis. These include the following:

  • Septic arthritis, a bacterial or fungal infection that results in joint inflammation and can lead to permanent joint damage if left untreated
  • Legg-Calve-Perthes disease, a condition marked by insufficient blood flow to the hip joint, which leads to the collapse of the joint as the bone dies
  • Lyme disease, a bacterial infection caused by tick bites that can result in long-term joint problems if left untreated
  • Slipped capital femoral epiphysis (SCFE), which occurs when the ball of the hip joint and the thighbone (femur) separate, leading to a joint disorder called osteoarthritis later in life

Diagnosing Irritable Hip

Your child’s doctor will perform a physical exam to find out which movements are causing pain. This involves moving your child’s hips, knees, and other joints.

Your doctor might order an ultrasound of your child’s hip to check for fluid in the joint, which is a sign of inflammation.

Blood tests can show how severe the swelling is. Your child’s doctor might also check for other causes of hip pain, such as Lyme disease. They might remove a fluid sample and send it to a lab for testing. This is usually done when the swelling or fever is serious and septic arthritis hasn’t been ruled out.

Your child’s doctor might take X-rays to rule out Legg-Calve-Perthes disease or SCFE.

What is the treatment for irritable hip?

Most children with irritable hip can be treated at home using a combination of painkillers and bed rest.

Painkillers: The non-steroidal anti-inflammatory drug (NSAID) called ibuprofen is the painkiller that’s usually recommended to treat hip pain. Ibuprofen should help to relieve pain, reduce inflammation and speed up your child’s recovery. Aspirin is not given to children who are under 16 years old because it can trigger a serious condition called Reye’s syndrome, which can cause brain and liver damage. Massaging the affected hip and applying heat may also help to reduce the child’s hip pain.

Bed rest: Bed rest is recommended until the symptoms of pain resolve, which usually takes around 7 to 10 days.

Hospital admission: The child may be admitted to hospital if diagnosis is uncertain or painkillers and bed rest haven’t eased the pain. Further tests may be given to rule out an infection inside the hip joint (septic arthritis).

These tests may include:

  • Magnetic resonance imaging (MRI) scan to build-up an image of the inside of the joint
  • Removing a sample of fluid from the affected joint and checking it for infection
  • Septic arthritis can be treated by taking antibiotics and by draining the infected fluid out of the joint.

Recovery

It usually takes a fortnight to recover from irritable hip, although your doctor may recommend that the child does not play sport or take part in any strenuous activities for at least another two weeks following treatment. This is to reduce the chance of irritable hip returning. Swimming is a good way to strengthen the joint and get it moving again.

Care at home

Irritable hip is a mild condition that will get better on its own. Complete rest is usually all that is needed. It should start to improve in about three days and be better in two weeks.

Non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, are helpful for irritable hip as they relieve the pain as well as reducing inflammation. Give the ibuprofen according to packet directions regularly for 48 hours. Paracetamol may also help with reducing the pain. Never give aspirin to children under the age of 12. See our fact sheet Pain relief for children.

Antibiotics are not given as the condition is not caused by a bacterial infection.

While your child is recovering:

  • It is important to encourage your child to rest at home. They will naturally sit, crawl, walk or lie in the most comfortable position.
  • Allow your child to gradually go back to their usual activities as they improve, but they should not play sport or undertake any strenuous activities until they are completely better.

How can it be prevented?

Usually toxic synovitis is not preventable, except by avoiding the viral infections that can trigger it.