Lymphangitis is an infection or inflammation of the lymphatic system.

What is Lymphangitis?

Lymphangitis is an infection or inflammation of the lymphatic system. The lymphatic system is a crucial part of the immune system. It is designed to collect fluids from cells and tissues in the body and help them re-enter the bloodstream.

The organs within the lymphatic system, such as the bone marrow, spleen, thymus, lymph nodes, tonsils, and lymphatic vessels, help to create and store lymphocytes, which are white blood cells that play a role in immunity. The system also aids in sending the white blood cells where they need to go in the body to fight off infection.

When an infection infiltrates the lymphatic system, lymphangitis develops and can cause a host of different symptoms.

Pathophysiology of Lymphangitis

The major function of the lymphatic system is to resorb fluid and protein from tissues and extravascular spaces. The absence of a basement membrane beneath lymphatic endothelial cells affords the lymphatic channels a unique permeability, allowing resorption of proteins that are too large to be resorbed by venules.

Lymphatic channels are situated in the deep dermis and subdermal tissues parallel to the veins and have a series of valves to ensure one-way flow. Lymph drains via afferent lymphatics to regional lymph nodes and then by efferent lymphatics to the cisterna chyli and the thoracic duct into the subclavian vein and venous circulation.

Lymphangitis most commonly develops after cutaneous inoculation of microorganisms that invade the lymphatic vessels and spread toward the regional lymph nodes. Organisms may invade lymphatic vessels directly through a skin wound or an abrasion or as a complication of a distal infection.

Causes of Lymphangitis

Lymphangitis is a type of secondary infection, which means it happens because of another infection.

When the infection travels from the original site to the lymph vessels, the vessels become inflamed and infected.

Bacterial infections are the most common cause of lymphangitis. Lymphangitis due to a viral or fungal infection is also possible.

Any injury that allows a virus, bacteria, or fungus to enter the body can cause an infection that leads to lymphangitis. Some possible culprits include:

puncture wounds, such as from stepping on a nail or other sharp object

untreated or severe skin infections, such as cellulitis

insect bites and stings

a wound that requires stitches

infected surgical wounds

sporotrichosis, a fungal skin infection common among gardeners

Risk Factors

Lymphangitis being a manifestation of wide concurrently occurring spectrum of manifestations or pathologies. The risk factors vary from etiology to etiology.

Common risk factors for infectious causes of lymphangits include:

Any trauma to the skin

Chronic skin disorders such as psoriasis or eczema

Diabetes mellitus

Human, animal, or insect bites

Immunocompromised hosts

Lymphedema

Skin and soft-tissue infections

Surgery

Treatment of breast cancer

Venous catheterization

Travel to filaria endemic area

Risk factors for sclerosing lymphangitis include:

  • Vigorous sexual acitvity

Symptoms of Lymphangitis

One of the outstanding symptoms of lymphangitis is red streaks. You will notice reddish stripes extending from the injury site to areas where you have a lot of lymph glands, especially the groin and armpits. They may be common if you have an existing skin infection. Look out for other symptoms of lymphangitis like:

Feeling sick or weak

A wound that’s taking a long time to heal

Fever

Chills

Headache

Loss of appetite

Feelings of fatigue

Swelling near the armpits or groin

If you feel ill following an injury or have a high fever and other symptoms of lymphangitis, you need to see a doctor.

What are the complications of lymphangitis?

Lymphangitis can spread quickly, leading to complications such as:

Cellulitis, a skin infection

Bacteremia, or bacteria in your blood

Sepsis, a body-wide infection that’s life-threatening

Abscess, a painful collection of pus that’s usually accompanied by swelling and inflammation

If bacteria enter your bloodstream, the condition can be life-threatening. Visit your healthcare provider immediately if you experience any of the following:

Increasing pain or redness at the site of the infection

Growing red streaks

Pus or fluid coming from the lymph node

Fever over 101°F (38.3°C) for more than two days

Take antibiotics as prescribed to help prevent complications. Don’t miss a dose, especially in the first few days of treatment.

How Is It Diagnosed?

At first glance, lymphangitis may be confused with thrombophlebitis which is the inflammation of veins along with the formation of blood clots within them as a result. But upon closer examination, it will be noted that the patient displays characteristic red streaks underneath the skin along with enlarged or swollen lymph nodes.

This makes it fairly easy to diagnose lymphangitis. Further procedures can help to illuminate the source of the problem. Your doctor may perform the following tests in order to arrive at a diagnosis:

Physical examination.

Medical history.

Blood culture tests.

Lymphangiography.

Tissue biopsy. This is not always necessary.

Treatment for Lymphangitis

Treatment should begin immediately to keep the condition from spreading. The doctor may recommend the following:

antibiotics, if the cause is bacterial — in the form of oral medication or intravenous antimicrobial therapy, which involves antibiotics given directly into our veins

Pain medication

Anti-inflammatory medication

Surgery to drain any abscesses that may have formed

Surgical debridement, or removal, of a node if it’s causing obstruction

The infected area should be kept at an elevated position to reduce swelling and slow down the infection from spreading. At home, take hot compresses to ease down the pain. Repeat this technique multiple times every day for at least twenty to thirty minutes. The patient can also wet a soft piece of cloth in warm water and keep it in the areas of inflammation. Hot showers can also be taken. It will aid in healing and increase the blood flow. But make sure that the cloth has not soaked water that is too hot as that may lead to further complications.

If possible, keep the infected area elevated. This helps reduce swelling and slows the spread of infection.

Prevention

Lymphangitis is usually caused by spread from a skin infection. If you have a skin infection, follow your doctor’s treatment plan.

To reduce your risk of getting a skin infection:

  • Keep your skin clean.

Keep your fingernails clipped short and clean.

Apply lotion to dry skin.

Take steps to avoid injury to the skin:

Wear protective gear in sports.

Wear long-sleeved shirts when hiking.

Wear sandals when at the beach, rather than going barefoot.

Be careful around animals. Treat pets with respect to avoid bites.

Do not swim in natural waters if you have cuts or sores.

If a small cut, bite, or other injury occurs:

Clean cuts or scrapes with soap and water.

Apply antibiotic ointment.

Cover with a bandage or dressing.

Do not scratch wounds.

Call your doctor right away if the area becomes red or swollen.

Seek prompt medical care for larger wounds or bites.

If your legs tend to swell, elevate them several times a day.

Russia on Thursday launched weeklong war games involving forces from China.

Russia Starts Serious War Games With China Due to Tensions With U.S.

Russia on Thursday launched weeklong war games involving forces from China and other nations in a show of growing defense cooperation between Moscow and Beijing, as they both face tensions with the United States.

The maneuvers are also intended to demonstrate that Moscow has sufficient military might for massive drills even as its troops are engaged in military action in Ukraine.

The Russian Defense Ministry said that the Vostok 2022 (East 2022) exercise will be held until Sept. 7 at seven firing ranges in Russia’s Far East and the Sea of Japan and involve more than 50,000 troops and over 5,000 weapons units, including 140 aircraft and 60 warships.

Russian General Staff chief, Gen. Valery Gerasimov, will personally oversee the drills involving troops from several ex-Soviet nations, China, India, Laos, Mongolia, Nicaragua and Syria.

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Coma, sometimes also called a persistent vegetative state.

Description

Coma, sometimes also called a persistent vegetative state, is a profound or deep state of unconsciousness. A persistent vegetative state is not brain death. An individual in a state of coma is alive but unable to move or respond to his or her environment. Coma may occur as a complication of an underlying illness, or as a result of injuries, such as head trauma.

Individuals in such a state have lost their thinking abilities and awareness of their surroundings, but retain non-cognitive function and normal sleep patterns. Even though those in a persistent vegetative state lose their higher brain functions, other key functions such as breathing and circulation remain relatively intact.

Spontaneous movements may occur, and the eyes may open in response to external stimuli. Individuals may even occasionally grimace, cry, or laugh. Although individuals in a persistent vegetative state may appear somewhat normal, they do not speak and they are unable to respond to commands.

Types of Coma

Types of coma can include:

Toxic-metabolic encephalopathy

Anoxic brain injury

Persistent vegetative state

Locked-in syndrome

Brain death

Medically induced

Epidemiology

Though coma is a common clinical presentation to the emergency department (ED), the actual frequency of coma at ED presentation is difficult to determine. The number of published studies of patients presenting with coma is surprisingly small. The use of many terms to describe patients with depressed mental states leads to multiple coding options, making retrospective reviews challenging. Within a clinical record, there is often variation in assessments by different providers. Additionally, diagnostic coding frequently reflects the etiology of the altered mental status without specific coding for coma. The fact that a common cause of coma, hypoglycemia, is often treated by emergency medical service providers with resolution prior to emergency department arrival adds to coding confusion.

A more recent single-center study of over 1000 consecutive patients with coma of unknown etiology that excluded traumatic brain injury and cardiac arrest survivors found that patients with coma of unknown etiology comprised 0.4% of all ED patients. The main diagnoses were classified into acute primary brain lesions such as hemorrhage and tumors (39%), primary brain pathologies without acute lesions, largely epilepsy (25%), and pathologies that affected the brain secondarily such as sepsis, intoxications, or metabolic conditions (36%). One-third of subjects had more than one coma-explaining pathology.

What causes coma?

More than 50% of comas are related to head trauma or disturbances in the brain’s circulatory system.

Causes are many and include:

Brain injuries are caused by an accident or violence. Additionally, people can be put into a medically induced coma with medicines. This helps their brain to keep functioning after an injury and saves the patient from feeling extreme pain.

Structural brain disorders e.g. subdural or epidural traumatic hematomas, stroke, venous thrombosis, tumors, acute hydrocephalus, raised intracranial pressure, anoxic brain injury, or brainstem strokes may all cause altered mental status or coma.

Common toxic or metabolic causes include hypoglycemia, hyperglycemia, excessive alcohol intake, medication overdose, and illicit drug use.

Less common metabolic causes include hepatic encephalopathy, hyponatremia, hypernatremia, hypercalcemia, and endocrine abnormalities.

Primary central nervous system infections e.g. meningitis or encephalitis (relatively uncommon)

Seizure.

Symptoms of coma

The person looks like they’re asleep.

No amount of sensory stimulation can wake them up.

They may be breathing unusually.

They may be holding their body in an unusual posture.

Their pupils may be affected in a number of different ways. For example, one pupil is larger than the other or both pupils are constricted.

Risk factors

A hemorrhagic or ischemic stroke

A severe head injury

Seizures

Brain tumor

Brain infections

Hypoxia for a long time

Metabolic abnormalities, such as diabetic hyperosmolar coma, hypoglycemia

Toxins, including poisons, alcohol and other drugs (barbiturates, sedatives, amphetamines,cocaine)

Liver failure or kidney failure

Complications of Coma

The possible complicationsTrusted Source of a coma relate to the following:

Incompetence to respond to body stimuli, causing incontinence of the bladder and bowel

Inability to move, which may result in bedsores, or pressure ulcers

Failure to handle respiratory secretions, meaning pneumonia could develop

Doctors pay close attention to a person’s condition to prevent any secondary brain injury. This may require respiratory and cardiovascular support.

Caring for and monitoring a person in a coma

Doctors assess a person’s level of consciousness using a tool called the Glasgow Coma Scale. This level is monitored constantly for signs of improvement or deterioration. The Glasgow Coma Scale assesses three things:

Eye opening – a score of one means no eye opening, and four means opens eyes spontaneously

Verbal response to a command â€“ a score of one means no response, and five means alert and talking

Voluntary movements in response to a command – a score of one means no response, and six means obeys commands

Most people in a coma will have a total score of eight or less. A lower score means someone may have experienced more severe brain damage and could be less likely to recover.

In the short term, a person in a coma will normally be looked after in an intensive care unit (ICU). Treatment involves ensuring their condition is stable and their body functions, such as breathing and blood pressure, are supported while the underlying cause is treated.

In the longer term, healthcare staff will give supportive treatment on a hospital ward. This can involve providing nutrition, trying to prevent infections, moving the person regularly so they don’t develop bedsores, and gently exercising their joints to stop them becoming tight.

Diagnosis

Because people in a coma can’t express themselves, doctors must rely on physical clues and information provided by families and friends. Be prepared to provide information about the affected person, including:

Events leading up to the coma, such as vomiting or headaches

Details about how the affected person lost consciousness, including whether it occurred suddenly or over time

Noticeable signs or symptoms before losing consciousness

The affected person’s medical history, including other conditions he or she may have had in the past, such as a stroke or transient ischemic attacks

Recent changes in the affected person’s health or behavior

The affected person’s drug use, including prescription and over-the-counter medications as well as unapproved medications and illicit recreational drugs

Physical exam

The exam is likely to include:

Checking the affected person’s movements and reflexes, response to painful stimuli, and pupil size

Observing breathing patterns to help diagnose the cause of the coma

Checking the skin for signs of bruises due to trauma

Speaking loudly or pressing on the angle of the jaw or nail bed while watching for signs of arousal, such as vocal noises, eyes opening, or movement

Testing reflexive eye movements to help determine the cause of the coma and the location of brain damage

Squirting cold or warm into the affected person’s ear canals and observing eye reactions

Laboratory tests

Blood samples will be taken to check for:

Complete blood count

Electrolytes, glucose, thyroid, kidney, and liver function

Carbon monoxide poisoning

Drug or alcohol overdose

A spinal tap (lumbar puncture) can check for signs of infections in the nervous system. During a spinal tap, a doctor or specialist inserts a needle into the spinal canal and collects a small amount of fluid for analysis.

Brain scans

Imaging tests help doctors pinpoint areas of brain injury. Tests might include:

CT scan: This uses a series of X-rays to create a detailed image of the brain. A CT scan can show a brain hemorrhage, tumors, strokes and other conditions. This test is often used to diagnose and determine the cause of a coma.

MRI: This uses powerful radio waves and magnets to create a detailed view of the brain. An MRI can detect brain tissue damaged by an ischemic stroke, brain hemorrhages and other conditions. MRI scans are particularly useful for examining the brainstem and deep brain structures.

Electroencephalography (EEG): This measures the electrical activity inside the brain through small electrodes attached to the scalp. Doctors send a low electrical current through the electrodes, which record the brain’s electrical impulses. This test can determine if seizures might be the cause of a coma.

Brain scan of a coma patient

Treatment

Treatment starts with reducing further damage to the brain. Physicians must clear the patient’s airways so he or she is able to breathe. In some cases, the person will have to be put on a mechanical ventilator (breathing machine).

Specific treatment will depend on the cause of the coma. For example, if the coma was caused by head trauma, efforts will be made to stop any bleeding or swelling in the brain. If the coma was caused by a disease, physicians will try to reverse it by treating the underlying condition. If poisoning caused the coma, physicians may give medications to counteract the depressive effects of the substance that caused the coma.

Once the person is treated appropriately for the immediate cause of coma, treatment will focus on supportive care. This usually includes making sure the person does not suffocate, making sure the person’s muscles and ligaments stay flexible, providing adequate nutrition, and taking precautions to help prevent infections, such as pneumonia. Because a person in a coma cannot move on his or her own, it’s important that his or her body be rotated periodically to prevent bedsores.

Prognosis

Comas can last from days to weeks while some severe cases have lasted several years. Recovery depends, to a considerable extent, on the original cause of the coma and on the severity of any brain damage. Some patients (e.g. patients in a diabetic coma) will make a complete recovery while others, particularly those who have suffered head trauma, may have some physical, intellectual, or psychological impairment that will require further treatment. They may need physiotherapy, occupational therapy, psychological assessment, and support during a period of rehabilitation and may need care for the rest of their lives.

The chances of someone recovering from a coma largely depend on the severity and cause of their brain injury, their age, and how long they’ve been in a coma. It’s impossible to accurately predict whether the person will eventually recover, how long the coma will last, and whether they’ll have any long-term problems.

Patients can gradually come out of the coma, some progress to a vegetative state (aka unresponsive wakefulness syndrome), and others die. Some patients who have entered a vegetative state go on to regain a degree of awareness (see Minimally Conscious State). The likelihood of significant functional improvement for coma patients diminishes over time.

Prevention of Coma

The risk of this problem may be lowered by taking steps to avoid head injury, such as:

Wearing a seatbelt in motor vehicles

Using safe, age-based sports methods for children

Wearing a helmet when:

Playing a contact sport like football, soccer, or hockey

Riding a bike or motorcycle

Using skates, scooters, and skateboards

Catching, batting, or running bases in baseball or softball

Riding a horse

Skiing or snowboarding

Dactylitis is the clinical name for when your fingers and toes are swollen.

What Is Dactylitis Psoriatic Arthritis?

Dactylitis is the clinical name for when your fingers and toes are swollen, tender, warm, and inflamed due to a psoriatic arthritis (PsA) flare-up or an associated condition. The name comes from the Greek word for finger (“dactylos”).

With dactylitis, your fingers can become so swollen that they look like sausages, which is why this condition and characteristic symptom is sometimes referred to as “sausage fingers” or “sausage digits.” Swelling in the toes can make it difficult to get around.

What are the causes and risk factors of dactylitis?

Dactylitis is a feature of the conditions listed below.

Infection        

Blistering distal dactylitis    

Superficial infection of the anterior fat pad of the distal portion of the finger(s)

Most often occurs in children.

Most commonly caused by group A beta-haemolytic streptococcus but also may be due to Staphylococcus aureus.

Tuberculous dactylitis         

A rare manifestation of extra-pulmonary tuberculosis

A variant of tuberculous osteomyelitis affecting the short tubular bones of the hands and feet.

Radiological findings show a central, lytic, cystic, and expansive lesion known as spina ventosa.

Syphilitic dactylitis   

A manifestation of congenital syphilis.

Similar features as tuberculous dactylitis but involvement is bilateral and symmetrical.

Spondyloarthritis     

It is a common feature in all forms of spondyloarthropathy, including psoriatic arthritis, reactive arthritis and ankylosing spondylitis.

Dactylitis occurs in about one-third of patients with psoriatic arthritis, with the feet being most affected.

Dactylitis is a marker of disease severity in psoriatic arthritis.

Gout               

  • Dactylitis can be found in up to 5% of people with gout, arthritis due to deposition of urate crystals.

Sarcoidosis    

Occurs in about 0.2% of patients with sarcoidosis, and often associated with lupus pernio (large bluish-red and dusky purple infiltrated nodules and plaque-like lesions on nose, cheeks, ears, fingers and toes).

Bone and soft tissue involvement of the fingers classically presents as bilateral, fusiform or sausage-shaped swellings.

Sickle-cell dactylitis

Also known as hand-foot syndrome

Occurs in patients with sickle-cell anaemia, most frequently for the first time within the first four years of life

In many cases, dactylitis is the first sign of the presence of the blood disorder and often leads to the diagnosis of sickle-cell disease.

Sickle-cell dactylitis is often mistaken for other diseases, especially acute osteomyelitis, cellulitis, leukaemia, and rheumatic fever.

Importantly, dactylitis is not considered a typical feature of rheumatoid arthritis or osteoarthritis.

Signs and Symptoms of Dactylitis

Dactylitis in PsA, a chronic, inflammatory disease of the joints that can also cause a skin disorder called psoriasis, often occurs asymmetrically, meaning on just one side of the body. It involves the feet more than the hands, and it affects multiple digits (fingers or toes) at the same time.

It is common in 16%–49% of people who experience psoriatic arthritis. It can be the first sign of the illness, and it may also be the only symptom for several months or years before other symptoms of PsA develop.

Symptoms in affected fingers or toes include:

Inflammation

Swelling

Redness

Stretched or shiny appearance to the skin

Pain

Warmth

Dactylitis complications

For people with PsA, dactylitis is a marker of the disease’s severity. Finger and toe joints with dactylitis may have significantly more damage than joints without it.

It may indicate other health risks as well.

The risk of a future cardiovascular event such as a heart attack or stroke increases by 20% for each finger or toe with dactylitis, according to a 2016 study of adults with PsA.

How dactylitis is diagnosed?

Dactylitis has many underlying causes. A doctor may order many different tests before making a diagnosis.

When you visit a doctor, make sure you have a list of:

your symptoms

medications

key medical and personal information

You may also want to check whether anyone in your family has had similar issues. This information can help your doctor make a proper diagnosis.

PsA can often go undetected. Inflammation caused by PsA can be misdiagnosed as another type of arthritis such as RA, osteoarthritis, or gout.

Inflammation caused by arthritis can cause serious damage to your body. Improperly treated arthritis can lead to permanent joint deformity and loss of function.

Testing may include:

looking for swollen joints, fingernail irregularities, and tender feet

imaging tests, such as X-rays, MRI, or a musculoskeletal ultrasound (MSK), which provides pictures of your joints, ligaments, and tendons

laboratory tests such as a joint fluid test to rule out gout or a blood test to rule out RA

In 2020, researchers created a new ultrasound scoring system called Dactylitis Global Sonographic to help determine the severity of dactylitis in the hands of people with PsA and to better assess the response to treatment.

With this system, which is primarily used in clinical trials, people are given a score from 0 to 25 for each hand. The score is calculated by adding the scores for each lesion of every affected finger, based on the results of an MSK.

Treatment for Dactylitis (Sausage Fingers)

Everybody gets swollen fingers or toes sometimes. When your fingers or toes are so puffy that they look like sausages — and they hurt, too — you need to see your doctor. You could have a type of inflammation called dactylitis, or sausage digits. It can damage your fingers if you don’t get the right treatment.

It is common in certain types of inflammatory arthritis, including psoriatic arthritis and ankylosing spondylitis. It’s considered a hallmark of psoriatic arthritis. It can also show how severe a case of psoriatic arthritis will be. Fingers and toes usually don’t swell like this when you have rheumatoid arthritis or osteoarthritis.

Unless you have psoriatic arthritis or a high risk for inflammatory arthritis, your swollen fingers or toes probably have a different cause. Salty food, extra weight, and certain medications can make your fingers swell. So don’t assume the worst if you can’t get your ring off. But do pay attention to your swelling. Dactylitis usually won’t go away on its own.

Nonsteroidal Anti-inflammatory Drugs (NSAIDs)

The first drug your doctor recommends for dactylitis will probably be a nonsteroidal anti-inflammatory drug, or NSAID. These medications ease swelling and pain.

Some, like ibuprofen (Advil, Midol, Motrin) and naproxen (Aleve), are available over the counter. Others are prescription-only. Here are a few of many examples:

Meloxicam (Mobic)

Nabumetone (Relafen)

Sulindac (Clinoril)

While NSAIDs can ease some symptoms, they often don’t do enough to address the problem. You may need stronger medications.

Cortisone Shots

Cortisone shots (injections of corticosteroids) typically come after NSAIDs. They send powerful medicine directly into affected joints to relieve pain and swelling. Your doctor may use ultrasound or a type of X-ray called fluoroscopy to guide the needle.

Like all drugs, these shots can have side effects. They include:

Cartilage or nerve damage

Death or thinning of nearby bone

Joint infection

Tendon problems

Because of the potential side effects, you shouldn’t get cortisone shots often. If your dactylitis doesn’t go away, you may need something stronger still.

Disease-Modifying Antirheumatic Drugs (DMARDs)

Some doctors prescribe disease-modifying antirheumatic drugs for dactylitis. These drugs target the underlying disease to slow or stop joint damage. They may also ease some symptoms.

DMARDs used for dactylitis include:

Cyclosporine

Leflunomide

Methotrexate

Sulfasalazine

DMARDs are powerful drugs used for many types of inflammatory arthritis. But even they may not be enough to tame the inflammation in your fingers and toes.

Biologics

If your fingers or toes remain swollen despite attempts at treatment (the doctor will call this resistant dactylitis), it may be time to try a biologic drug. These medications also target the underlying disease. They could be your best option to control dactylitis when nothing else works. You can take them with or without DMARDs. You get biologics as shots or in a vein (IV).

Older biologic drugs are known as tumor necrosis factor-alpha (TNF-alpha) inhibitors. A recent review of the medical literature showed these medications, as well as newer biologics, significantly improved dactylitis. This gives you and your doctor several drug options to discuss. In this review, the three biologic drugs that showed the most promise for dactylitis were:

Certolizumab pegol (Cimzia)

Infliximab (Remicade)

Ustekinumab (Stelara)

Your doctor might also try:

Ixekizumab (Taltz)

Secukinumab (Cosentyx)

Are there Natural Remedies?

You may be tempted to reduce the swelling in your fingers and toes with natural or home remedies. It would be wise to check with your doctor first. Dactylitis may be a hallmark of psoriatic arthritis, but it also happens in other diseases, including:

Tuberculosis

Syphilis

Gout

Sarcoidosis, but this is rare

You’ll want to know exactly what’s wrong so you can make the best decision about treatment.

Cold therapy is usually a safe home remedy for warm, painful, swollen fingers. An ice pack, a bag of frozen vegetables, even a bowl of cold water can temporarily reduce these symptoms.

Outlook

With prompt treatment, the outlook for dactylitis tends to be good. The pain and swelling typically go away following treatment of the underlying condition. In the case of sickle cell-related dactylitis, the swelling usually goes away on its own.

However, many causes of dactylitis are incurable chronic conditions. These conditions may require ongoing treatment and management. If treatment stops working, dactylitis can reoccur.

People with psoriatic arthritis may have multiple dactylitis flare-ups as the condition progresses. Careful management and monitoring can reduce the severity of dactylitis and may prevent it from returning.

Because many of the conditions that cause dactylitis are serious, it is vital that a person contacts a doctor as soon as possible for swollen fingers.

(CHD) involves heart defects that reduce the amount of oxygen delivered to the rest of your body.

What is Cyanotic heart disease?

Cyanotic heart disease (CHD) involves heart defects that reduce the amount of oxygen delivered to the rest of your body. It’s sometimes called critical congenital heart disease. When a baby is born with CCHD, their skin has a bluish tint, called cyanosis.

CHD is often treatable if detected early. It can encompass abnormalities in the rhythm of the heart, as well as a wide array of structural heart problems.

These problems can range from mild (never requiring cardiac surgery), to severe (requiring multiple different stages of open heart surgeries). CHD can involve abnormal or absent chambers, holes in the heart, abnormal connections in the heart, and abnormalities in the function or squeeze of the heart. Most congenital heart conditions affect patients from childhood through adulthood.

Some babies affected with CHD can look and act healthy at first, but within hours or days after birth they can have serious complications. Pulse oximetry newborn screening is a non-invasive test that measures how much oxygen is in the blood and can help to identify babies that may be affected with CHD before they leave the newborn nursery. If detected early, infants affected with CHD can often be treated and lead longer, healthier lives.

Etiology

The etiology of CHD is still largely unknown. Many cases of CHD are multifactorial and result from a combination of genetic predisposition and environmental risk factors. CHD is usually isolated and sporadic, but it can also be associated with genetic syndromes. Approximately 15% to 20% of infants with CHD are related to known chromosomal abnormalities, most of these are aneuploidies (trisomy 21, 13, and 18 and Turner syndrome). Potential environmental risk factors include maternal illnesses, including diabetes and phenylketonuria, maternal exposure to toxins or drugs and viral infections during pregnancy.

Types of Cyanotic heart disease

There are three different types of cyanotic heart disease:

Left heart obstructive lesions

These congenital heart defects reduce blood flow between your heart and the rest of your body (systemic blood flow). Specific conditions include:

Hypoplastic left heart syndrome: Hypoplastic left heart syndrome (HLHS) involves underdeveloped structures in the left side of your heart. The left side of your heart is too small to pump enough blood to the rest of your body.

Interrupted aortic arch: In interrupted aortic arch, your aorta is incomplete.

Right heart obstructive lesions

These congenital heart defects reduce blood flow between your heart and lungs (pulmonary flow). Specific conditions include:

Pulmonary atresia: The pulmonary valve is like a door between the right side of your heart and lungs. With pulmonary atresia (PA), the pulmonary valve doesn’t develop correctly or is blocked.

Tricuspid atresia: The tricuspid valve is between the two chambers (atrium and ventricle) on the right side of your heart. In tricuspid atresia, the valve is not formed correctly. A piece of solid tissue blocks blood flow from the right atrium to the right ventricle.

Tetralogy of Fallot: Tetralogy of Fallot (TOF) is the most common CCHD. It involves four heart defects.

Mixing lesions

The third type of CCHD is called mixing lesions. These heart defects cause your body to mix pulmonary and systemic blood flow. Specific conditions include:

Transposition of the great arteries: In this condition, the two main arteries that leave your heart (the main pulmonary artery and the aorta) are reversed. This defect is your second most common CCHD.

Total anomalous pulmonary venous return (TAPVR): In a baby with TAPVR, oxygen-rich blood doesn’t go from their lungs to the left side of their heart, where it should. Instead, the blood goes to the right side of their heart.

Truncus arteriosus: In truncus arteriosus, you have only one main artery to carry blood to your body and your lungs, instead of two separate arteries.

Risk factors

In many cases, an infant will be born with this disease in association with a genetic factor. An infant is more at risk for CCHD when there’s a family history of congenital heart diseases.

Certain genetic syndromes can be accompanied by defects that cause CCHD. These include:

Down syndrome

Turner syndrome

Marfan’s syndrome

Noonan syndrome

In some instances, outside factors can cause this disease. If a pregnant woman is exposed to toxic chemicals or certain drugs, her infant may have a higher risk of developing heart defects.

Infections during pregnancy are also a factor. Poorly controlled gestational diabetes can also lead to a higher risk of the infant developing CCHD.

Causes of Cyanotic heart disease

Cyanotic heart diseases may be caused by:

Chemical exposure

Genetic and chromosomal syndromes, such as Down syndrome, trisomy 13, Turner syndrome, Marfan syndrome, and Noonan syndrome

Infections (such as rubella) during pregnancy

Poorly controlled blood sugar levels in women who have diabetes during pregnancy

Medications prescribed by your doctor or bought on your own and used during pregnancy

Street drugs used during pregnancy

Symptoms

Signs of a condition are things someone else can see or know about you, like you have a rash or you’re coughing. Some CHDs have no signs, so you may not know that your baby has a CHD until he’s older.

Signs of heart defects include:

A heart murmur. This is a blowing, whooshing or rasping sound heard during a heartbeat. It’s caused by rough blood flow through the heart valves or near the heart. Your baby’s provider may hear a murmur when she checks your baby’s heartbeat using a stethoscope.

A pounding heart

A weak pulse

Gray or blue color of the skin, lips or fingernails

Sleepiness while feeding or being very sleepy at other times

Swollen belly or legs or puffiness around the eyes

Trouble breathing or fast breathing. Breathing problems while feeding can lead to slow weight gain.

Cyanotic heart disease complications

Complications of cyanotic heart disease include:

Abnormal heart rhythms and sudden death

Long-term (chronic) high blood pressure in the blood vessels of the lung

Heart failure

Infection in the heart

Stroke

Death

Diagnosis and test

Your child’s doctor may suspect cyanotic heart disease after listening to your child’s heart and lungs with a stethoscope, or by noticing their blue appearance. Your child may then be referred to the hospital for further tests to confirm the diagnosis and determine the underlying cause.

Common tests include:

Chest X-ray

EKG

Holter and event monitors

ECHO

Cardiac catheterization

Exercise test

Treatment and medications

The treatment of cyanotic heart disease is based on the severity of the defects in the infant or child:

Catheter: It involves inserting a catheter into an artery or a vein by making a small puncture in the skin. In this procedure there is no need to open the chest and operate directly on the heart, thus recovery is easier and faster. It is the preferred method of treatment in cases of simple heart defects such as pulmonary valve stenosis.

Open-heart Surgery: It is used in cases, which cannot be treated using a catheter to close holes in the heart or to repair/replace heart valves or widen the openings to heart valves.

In severe cases, surgery or a combination of catheter and surgical procedures might be needed to correct the physical defects.

Heart Transplant: This is needed in babies who have multiple heart defects which are complex in nature. In this case, the baby’s heart is replaced with a donor heart from a deceased child.

Medications: Drugs are prescribed based on the nature of the heart defect and the degree of symptoms exhibited. Some of the medications used are ‘diuretics’ to eliminate extra fluids from the body and make breathing easier, anti-arrhythmic drugs to regulate abnormal heart rhythms and increase the strength at which the heart pumps the blood.

Prevention of Cyanotic heart disease

Women who are pregnant should get good prenatal care.

Avoid using alcohol and drugs during pregnancy.

Tell your doctor that you are pregnant before taking any prescribed medicines.

Get a blood test early in the pregnancy to see if you are immune to rubella. If you are not immune, you must avoid any exposure to rubella and should get immunized right after delivery.

Pregnant women with diabetes should try to get good control over their blood sugar level.

Some inherited factors may play a role in congenital heart disease. Many family members may be affected. If you are planning to get pregnant, talk to your provider about screening for genetic diseases.

Terrorist ambush Army convoy kill six and abduct others in Katsina state.

According to Homepage news channel, two personnel of the Nigerian army have been killed following an ambush on a military convoy by gunmen suspected to be terrorists in Katsina State.

Also, an officer was declared missing in action and feared abducted by the terrorists.

The deceased soldiers and others were ambushed on Wednesday evening along Shimfida Gurbi Road, Jibia Local Government Area of the state.

Four civilians were also killed during the attack.

Homepage news channel learnt that the military convoy was escorting residents of Shimfida community to Jibia town.

Also, an officer was declared missing in action and feared abducted by the terrorists.

An Armoured Personnel Carrier ran over IEDs planted by the terrorists, killing two soldiers and four civilians, a source said.

Some bandits were also killed while others sustained life-threatening injuries.

Katsina, despite being the home state of President Muhammadu Buhari, has witnessed sporadic attacks by bandits and kidnappers that have claimed the lives of many.

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FG reply Governor Samuel Ortom, challenge Him over claim.

The Presidency has challenged the Benue State Governor, Samuel Ortom, to either make public the top security personnel who told him he got instruction from President Muhammadu Buhari not to move against killer Fulani herdsmen or keep shut permanently.

Senior Special Assistant to the President on Media and Publicity, Garba Shehu, threw this challenge yesterday in response to a recent interview granted by the governor where he raised the allegation.

Shehu wrote: “In a recent interview, the Governor of Benue State, Samuel Ortom, claimed that high ranking security personnel had informed him personally that President Buhari had ordered security forces not to move against the Fulani herdsmen responsible for recent violence.

These ridiculous claims arepatentlyuntrue. If heisas brave as he claims to be, let him name names. Let him name the military person-nel who told him this story or forever shut up.

It is disappointing that Ortom, who in the same interview describes himself as a child of God who believes in being lawful and respects the Nigerian constitution, felt the need to spread such a divisive lie.

In a period of heightened insecurity, our politicians should be working to bring us closer together, not risking further violence by dishonestly seeking to further divide us along ethnic or religious lines.

Fortunately, the cheap, dog whistle politics behind Ortom’s falsehood are plain for all to see.

He is not the first opportunistic politician who has attempted to sow discord amongst his country’s people in the run-up to an election; sadly, he will not be the last.

The Nigerian people will see him for what he is: an opportunist flaunting his wares as the country prepares to elect its next president; a man fond of posing in military fatigue who expects the country to believe Nigeria’s top security personnel would share high-level confidential information with him.

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Belarus president Lukashenko criticize people who label Russia and Belarus aggressors.

Belarusian President Alexander Lukashenko has warned that a battle with Ukraine could erupt soon, claiming that tensions are escalating between the country’s armed forces and civilian leadership.

At a virtual seminar for all Belarusian school and university students, Lukashenko stated on Thursday that “Ukraine is being split” and that a “war between the president and the military is developing.

According to Belarus’s president, the Ukrainian army is the only force in the country capable of pounding the table and saying: let’s speak or Ukraine will be wiped off the face of the planet.

According to Lukashenko, the country’s military, which has firsthand knowledge of what is occurring on the frontlines, “sees that it’s hopeless.

Meanwhile, he warned that the neighboring country’s dispute might escalate into the most horrific clash involving the deployment of weapons of mass destruction.

He also asserted that Russia cannot be defeated there, adding that Minsk is strongly behind its partner, Moscow.

Lukashenko went on to criticize people who label Russia and Belarus aggressors.

He claimed that Moscow’s military intervention was preemptive in character, assisting in averting an impending Ukrainian missile assault on Belarus’ southern areas, including against Russian personnel that had not yet been removed from the nation following military training.

He also claimed that the Russian military destroyed Ukraine’s missile units half an hour before President Vladimir Putin declared the beginning of Moscow’s attack in late February.

Lukashenko said that the West, particularly the US, was behind the preparations for the planned attack on Belarus and that those countries would continue to do everything to bring Russia to its knees.

And Russia cannot kneel, He stated.

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Governor Samuel Ortom alleges that FG order prohibiting security agents from apprehending and arraigning killer herders and bandits.

BENUE State governor Samuel Ortom has alleged that armed Fulani herdsmen cannot be brought to book for violent attacks on agrarian communities across the country because of a Federal Government order prohibiting security agents from apprehending and arraigning them.

In an interview with The ICIR, the governor said those being referred to as bandits are members of Miyetti Allah.

Ortom also alleged that all Miyetti Allah does is claim responsibility for attacks and collect huge sums of money from the government. He claimed that the Federal Government is protecting them.

I have spoken to some security men who told me the Federal Government gave them directive that they do not have to move against these Fulani men.

That is why I keep saying that the Federal Government’s action and inaction clearly show that they are complicit in the criminality that is going on in Nigeria. They call them bandit because they do not want people to call them Fulani herdsmen.

Remember what the Sultan of Sokoto said some time ago: anywhere you arrest ten bandits, most of them are Fulanis.

That is a Fulani man himself, and that is why when I am talking, I try to differentiate it by saying that those people who are coming against us here because we have lived with Fulani before.

These are from Mali, Niger, Senegal, and other parts of the world who had chosen to relocate here and take over. We have not sent any Fulani man away from Benue State. Some are still here, and some are even in my government. 

These people called Miyetti Allah have no job other than collecting huge sums of money from the government. The Federal Government is protecting them, which is why they have been talking in the manner they do because even when they do, nothing will happen to them.

Even when we do, nothing has taken place. Nobody has called them to question why you are doing this and taking responsibility for attacks.

The governor also reacted to Miyetti Allah’s claim that he has neglected his responsibilities and become an errand boy for Rivers State governor Nyesom Wike.

I am the governor of Benue State, and I am not lacking in any area of my responsibility.

Despite all the challenges I have we have been able to provide basic infrastructure. Go round despite all the challenges I have, we have been able to provide basic infrastructure, go around Makurdi.

You will see the road, the urban renewal we have done, and the road construction we have taken key responsibility for. 

Go to the teaching hospitals to see our work; go to lands and surveys, see what we are doing; go to the Ministry of Housing and see what we are doing. We have provided roads in Zone A, Zone B and Zone C. We have provided clinics, and everything is functional.

We have been able to establish primary health care, some of the states, up till today they have not been able to do that, and it is functional. We have been able to provide facilities that serve the people. We are not lacking in any area in sports.

My relationship with Wike pains them. You know your true friend when you are in distress. When the same Miyetti Allah came with their people and attacked and killed our people, Wike came here with stakeholders from Rivers State.

I was not close to Wike before. We disagreed on a number of things. I looked at it and said this is somebody that can be a friend, and we are working together. Nobody will stop me from being friends with Governor Wike.

We speak to ourselves frankly. He is not happy with what is happening in the country today, and nobody is happy about this, so we are on the same page.

Birds of the same feather flock together. He has spoken to condemn this administration and what Miyetti Allah is doing. He followed us in Benue and established the law prohibiting open grazing in Rivers State.

They are annoyed because I have taken the lead in guiding people. I know that some states are already asking me about the process of establishing the Community Volunteers Guard, which they will adopt. Very soon, you will see it.

If the Federal Government had listened to us, because you see the security men are doing their best, but they lack capacity, manpower, equipment, training and funding, they do not have it.

We have been talking about restructuring and trying to have state police for a long time.

The Federal Government does not want it. They want to control the security at the centre so they will do what they want.

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