Medical Info: Tetanus

Tetanus is a condition that affects the nervous system and causes painful, uncontrolled muscle spasms. Because of widespread immunization, tetanus is now rare. Another name for tetanus is lockjaw.

What is the infectious agent that causes tetanus?

Tetanus is caused by a toxin (poison) produced by spores of the bacterium Clostridium tetani. Spores are hardy forms of the bacteria that can survive in the environment in an inactive state for a long time.


Where is tetanus found?

Tetanus occurs worldwide. Tetanus spores are found throughout the environment, usually in soil, dust, and animal waste.


How do people get tetanus?

Tetanus spores can enter the body through a wound that is contaminated with soil, dust, or animal waste. Spores can get into the body through even a tiny pinprick or scratch, but they usually enter through deep puncture wounds or cuts, like those made by nails or knives. Tetanus spores can also get into the body when skin is damaged by burns or by injecting contaminated street drugs. Once the spores enter a wound, they produce a powerful nerve poison that spreads through the body and causes painful symptoms.


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What are the signs and symptoms of tetanus?

The first signs of tetanus infection are usually a headache and spasms or cramping of the jaw muscles (lockjaw). As the poison spreads, it progressively attacks more groups of muscles, causing spasms in the neck, arms, legs, and stomach, and sometimes violent convulsions (seizures).


How soon after exposure do symptoms appear?

The time between the contamination of a wound and the first symptoms is usually less than 2 weeks but can range from 2 days to months. In general, the shorter the time between exposure and symptoms, the more severe the disease.


How is tetanus diagnosed?

Tetanus is diagnosed by its symptoms.


Who is at risk for tetanus?

In the United States, tetanus occurs mostly in newborns, children, young adults, and older adults who are either not immunized or not adequately immunized. Injecting drug users are also at risk.


What complications can result from tetanus?

In the United States, 3 of every 10 persons who get tetanus die from it. For those who survive, recovery can be long (1-2 months) and difficult. Muscle spasms usually decrease after about 2 weeks and disappear after another week or two, but the person may be weak and stiff for a long time. Other complications include breathing problems, bone fractures, high blood pressure, abnormal heartbeats, clotting in the blood vessels of the lung, pneumonia, and coma.


What is the treatment for tetanus?

Persons with tetanus usually must spend several weeks in the hospital in intensive care to manage the complications.


How common is tetanus?

Tetanus is a major problem in developing countries where immunization of children is not required or enforced. In the United States, most states require tetanus immunization for entry to school. Cases average between 50 and 100 per year, mostly in under-immunized older adults.


Is tetanus an emerging infectious disease?

No. Cases have been decreasing since the 1940s. However, getting children immunized and guaranteeing that they get the complete series of shots is still a challenge, especially among poor children and in areas of the country where under-immunization is a problem.


How can tetanus be prevented?

The most important way to prevent tetanus is through complete immunization and proper wound care.

1. Prevent tetanus through immunization -- An effective vaccine against tetanus has been available for many years. It is usually given to children combined with diphtheria and pertussis vaccines in a shot called DTP. A child needs five DTP shots, given at specified intervals, for complete protection. Tetanus booster shots are recommended every 10 years.

2. Prevent tetanus through proper care of wounds -- Cleaning all wounds, removing dead tissue, and using antibiotics for contaminated or infected wounds can reduce the likelihood of getting tetanus.

Persons with wounds that are deep or dirty may need a tetanus booster shot if more than 5 years have passed since the last dose. An injection of tetanus immune globulin (TIG) given as soon as possible after a tetanus-prone injury can also help neutralize the poison that has not entered the nervous system.

Medical Info: Frostbite

Frostbite is the freezing of skin and damage to underlying blood vessels upon exposure to extreme cold.

Blood flow halts in frostbitten skin, and the area must be thawed and rewarmed swiftly to prevent tissue death (gangrene) and infection. The ears, nose, hands, and feet are particularly susceptible.
Frostbite is sometimes accompanied by a life-threatening drop in internal body temperature, known as hypothermia, which must be treated first.

Frostbite is not a common problem, but can be a big problem for people who do not regularly experience severe cold weather, as well as for people who do winter camping, high-altitude climbing, hunting, and snowmobiling.
Frostnip, a superficial freezing of the outer layer of the skin - also can occur if you are exposed to cold weather. The skin turns white as blood circulation decreases, then stings, and becomes quite painful.
Frostnip can occur during vigorous outdoor activity and you may not be aware of it until you stop exercising.


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Causes:

Exposure to extremely cold temperatures (32 degrees or below) for prolonged periods of time causes frostbite. The risk becomes greater as the temperature drops and the wind increases.

The risk of frostbite increases with impaired circulation. Those with peripheral vascular disease or diabetes mellitus and those taking beta-blocker drugs are more vulnerable.


Symptoms

Common warning signs include a progressive numbness and a loss of sensitivity to touch. The affected area will also tingle or feel as if it is burning. As the condition worsens, the pain begins to fade or eventually disappear.

The skin also changes color when exposed to extreme cold. It blanches, then may appear red, and finally white-purple if allowed to freeze.

Most people say the affected part of the body feels "wooden," and it may appear to have a wooden texture.
Frostbite can affect any part of the body, but the tip of the nose, ear lobes and rim, fingertips, and toes are the most likely areas.

In mild cases, full recovery can be expected with early treatment. Severe cases of frostbite can result in infection, or gangrene - the death of some body tissue due to the lack of blood supply.


Treatment

When you first notice signs of frostbite, come out of the cold immediately and rewarm the affected area as rapidly as possible.
Do not rub the skin in an effort to get blood flowing back to the area. This causes friction and will destroy the already damaged skin and underlying tissue, as well as increase the risk of infection.

To thaw frostbitten skin, immerse the affected part in a bath kept at a constant temperature of 104 to 105 degrees F for an hour or more. This will cause the blood vessels to dilate and circulation to return to the area.
Rapid rewarming is an intensely painful procedure. Take two ibuprofen, aspirin, or acetaminophen to dull the pain.

Do not smoke or chew tobacco. Nicotine constricts the blood vessels, reduces blood flow to chilled areas, and delays the healing process. If you do not have access to warm water, stick the frozen body part under an armpit or between the thighs.
When the skin has thawed and rewarming is complete, cover the damaged skin with bandages and warm clothing. Contact your doctor or go to an emergency room.

If there is any chance of refreezing a thawed body part, do not rewarm it in the first place. Freezing, rewarming and freezing the skin again causes much more tissue damage than being frozen once. As it rethaws, the skin turns red, swelling develops, and the area becomes quite painful. Dark blisters appear on the skin and continue to form over the ensuing week(s) as new skin develops.

Medical Info: Polymyositis

Polymyositis is a disease of muscle featuring inflammation of the muscle fibers. The cause of the disease is not known. It begins when white blood cells, the immune cells of inflammation, spontaneously invade muscles. The muscles affected are mostly those closest to the trunk or torso. This results in weakness which can be severe. It is a chronic illness with periods of increased symptoms, called flares or relapses, and decreased symptoms, known as remissions.

Polymyositis is slightly more common in females. It affects all age groups, although its onset is most common in middle childhood and in the twenties. Polymyositis occurs throughout the world. Polymyositis can be associated with skin rash and is then referred to as "dermatomyositis." It also can affect other areas of the body and is, therefore, a systemic illness. Occasionally, it is associated with cancer, or with other diseases of connective tissue (see systemic lupus erythematosus, scleroderma and rheumatoid arthritis).


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Causes:

To date, no cause of polymyositis has been isolated by scientific researchers. There are indicators of heredity (genetic) susceptibility that can be found in some patients. There is indirect evidence of infection by a virus that has yet to be identified in a form of polymyositis that is particularly resistant to treatment, called inclusion body myositis. This form of polymyositis is diagnosed by the pathologist, a physician specialist who interprets the microscope findings of muscle tissue. The muscle tissue in this form of polymyositis displays clear areas within the muscle cells (called vacuoles) when viewed under the magnification of a microscope.

Aside from diseases with which polymyositis can be associated (as mentioned above), many other diseases and conditions can mimic polymyositis. These include nerve-muscle diseases (such as muscular dystrophies), drug toxins (such as alcohol, cocaine, steroids, colchicine, hydroxychloroquine, and cholesterol lowering drugs), metabolic disorders (where muscle cells are unable to process chemicals normally), hormone disorders (such as abnormal thyroid), calcium, and magnesium conditions), and infectious diseases (such as influenza virus, AIDS, streptococcus and Lyme bacteria, pork tapeworm and schistosomiasis).


Symptoms:

Weakness of muscles is the most common symptom of polymyositis. The muscles involved usually are those that are closest to the trunk of the body. The onset can be gradual or rapid. This results in varying degrees of loss of muscle power and atrophy. The loss of strength can be noticed as difficulty getting up from chairs, climbing stairs or lifting above the shoulders. Trouble with swallowing and weakness lifting the head from the pillow can occur. Occasionally, the muscles ache and are tender to the touch (25% of patients).

Patients can also feel fatigue, a general feeling of discomfort and have weight loss and/or low-grade fever.

With skin involvement (dermatomyositis), the eyes can be surrounded by a violet discoloration with swelling. There can be scaly reddish discoloration over the knuckles, elbows and knees (Gottron's sign). There can also be reddish rash on the face, neck and upper chest. Hard lumps of calcium deposits can develop in the fatty layer of the skin, most commonly in childhood dermatomyositis.

Heart and lung involvement can lead to irregular heart rhythm, heart failure, and shortness of breath.

Because polymyositis can present in combination with other illnesses (see related articles on systemic lupus erythematosus, scleroderma and rheumatoid arthritis), it can also have overlap features with them. These illnesses are discussed elsewhere.

Both polymyositis and dermatomyositis can sometimes be associated with cancers, including lymphoma, breast cancer, lung cancer, ovarian cancer, and colon cancer. The cancer risk is reported to be much greater with dermatomyositis than polymyositis.

Medical Info: Progeria

Progeria is commonly referred to as an "early aging disease." Although whether early aging actually occurs or whether this is a disease with many symptoms that look like aging is debated. It is also known as Hutchinson-Gilford progeria syndrome (HGPS), named after Jonathan Hutchinson, who first described the disease in 1886 and Hastings Gilford (1904), who was the first to refer to the disease as progeria.

It is fortunately an extremely rare disease. Only somewhat more then 100 cases have been reported since it was discovered, and is estimated to affect only 1 to 2 children in 8 million. It is, however, a particularly tragic disease in that it typically strikes children before the age of 10 years, who then usually die before their teens. Patients have some characteristics of aging such as baldness, a pinched nose, delayed tooth formation, stiffness of joints, hip dislocations, cardiovascular problems, arteriosclerosis, wrinkled/aged-looking skin, and a premature cessation of growth (dwarfism). They do not, however, typically show other characteristics of aging such as Alzheimer's disease, and arthritis of the hips in these patients is a result of having been born with dislocated hips, not as an aging process.

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Causes:

Progeria is an autosomal recessive disease, meaning that an individual carrying a mutation in a single gene does not show any symptoms. When two individuals with the mutant gene have a child, that child has a 1 in 4 chance of inheriting two copies of the mutation and therefore having the disease. The mutation that is responsible for the disease is in the gene for lamin A. Lamin A is a fibrous protein involved in the structure of the nuclear membrane. This results in changes in shape of the nucleus and probably in its function. It is not known how this produces the wide range of age-like changes associated with progeria. It is intriguing that mutation of the gene for lamin A is also involved in several other distinct diseases, including muscular dystrophy. Clearly, there is more to be learned about the mechanism of this disease.

Medical Info: Histoplasmosis

Histoplasmosis is an infection that varies in symptoms and seriousness. It usually affects the lungs. When it affects other parts of the body, it is called disseminated histoplasmosis.


Causes
Histoplasmosis is caused by Histoplasma capsulatum, a fungus. The fungus produces spores that can be inhaled when they get into the air. Spores are hardy forms of the fungus that can live in the environment for a long time.


The histoplasmosis fungus is found throughout the world. The fungus grows naturally in soil in some areas of the United States, mostly in the midwestern and southeastern states and along the Ohio and Mississippi River valleys. It thrives in soil that is enriched with bat or bird droppings.

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Histoplasmosis is spread through the air. If soil containing the histoplasmosis fungus is disturbed, the fungus spores get into the air. People can breathe in the spores and get histoplasmosis. The disease is not spread from person to person.


Symptoms:

Most infected persons have no symptoms. When symptoms occur, they vary widely, depending on the form of the disease.

The lung infection can be short-term (acute) and relatively mild, or it can be long-term (chronic) and serious. Symptoms of the acute lung infection are tiredness, fever, chills, chest pains, and a dry cough. The chronic lung infection is like tuberculosis and occurs mostly in persons who already have lung disease. It can progress over months or years and can scar the lungs.

Disseminated histoplasmosis results in a variety of serious symptoms and can involve all body organs. The liver and spleen usually become enlarged, and sores in the mouth or gastrointestinal tract can develop. Disseminated histoplasmosis can be fatal.


Symptoms of acute disease usually appear in 5 to 18 days (usually 10 days) after exposure.

Diagnosis

Diagnosis can be made by laboratory culture or a blood test. A skin test is available but is useful only for outbreak investigations, not for diagnosis.

Anyone can get histoplasmosis. Chronic lung infections are more common in males than in females, and particularly in persons with chronic lung disease. Disseminated histoplasmosis occurs most often in infants, young children, and persons with weakened immune systems, such as those with cancer or HIV infection.

Acute histoplasmosis can keep getting worse or can become chronic. Acute histoplasmosis can also spread from the lungs to other organs and lead to the disseminated form of the disease, especially in persons with weakened immune systems.


Treatment:

Persons with mild disease usually get better on their own. Severe cases of acute histoplasmosis and all cases of chronic and disseminated disease are treated with fungus-killing medicines.


Infection with histoplasmosis is common, but the disease is rare. As many as 80 percent of persons living in U.S. areas where the fungus is common have a positive skin test, meaning they have had the infection in the past. However, most of these people do not have a history of histoplasmosis symptoms.


Yes. Histoplasmosis is on the rise, mainly because of the growing number of persons with weakened immune systems. These include persons with HIV infection, those who have had a bone marrow or organ transplant, and those receiving chemotherapy for cancer.

Prevention:

It is not practical to test or decontaminate all areas that are known to be or might be contaminated with the histoplasmosis fungus, but these steps can reduce the risk of exposure:
Avoid areas where the fungus might be growing, especially areas with accumulations of bird or bat droppings. The fungus often grows around old chicken houses, in caves and other areas where bats live, and around starling and blackbird roosts.
Avoid disturbing accumulations of bat or bird droppings, and minimize exposure to dust in potentially contaminated sites. Before stirring up the soil, spray the area with a mist of water.
When working in high-risk areas, wear disposable clothing and a dust mask that covers the nose and mouth.

Medical Info: Gastroenteritis

Gastroenteritis is an irritation and inflammation of the digestive tract. In the United States, it is second only to the common cold in frequency of occurrence.

Gastroenteritis caused by viruses and bacteria can easily be passed on to others. It is important to wash your hands thoroughly before preparing food. Because the causative organism lives in the gastrointestinal tract, hand washing is also very important after a bowel movement or urination.

There are many causes of gastroenteritis. The most common causes are infecting organisms such as viruses, bacteria or parasites. Food poisoning, allergies, certain medications, stressful situations, and overindulgence of alcohol may play a causal role.

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Symptoms
Symptoms can vary greatly from person to person. Most people experience two or more of the following: nausea, vomiting, diarrhea, abdominal discomfort, headache, low-grade fever (99° F) and muscle aches. Viral gastroenteritis may last several hours to several days, with the average episode lasting 24-48 hours. In contrast, bacterial or parasitic infections can last well over a week and may require medication for treatment. In these cases, laboratory tests are necessary before appropriate antibiotics can be prescribed.

In a normal healthy person, a case of gastroenteritis is no more significant than a common cold. However, prolonged bouts of vomiting and diarrhea can lead to dehydration and disruption of important body chemistry. Chronic diseases such as diabetes mellitus or kidney problems may put you at additional risk for complications from gastroenteritis.

Treatment
Treatment for this problem consists of two important parts: what you can do, and what your health care provider can do.


Stay at home and rest until symptoms subside.

Avoid solid foods.

Take only ice chips until vomiting stops.

As soon as you are able, take small amounts (about 1 oz. every 15 minutes by the clock) of clear liquids such as tea, ginger ale or broth. If vomiting recurs, wait 1-2 hours before trying clear liquids again. Once you are retaining fluids without difficulty, try to increase the amount you take each hour, gradually (or decrease the amount of time between sips).

After 24 hours without nausea, vomiting or diarrhea, or if hungry and not vomiting, you should try dry toast, saltines, or white rice, with jelly or honey for energy.

Progress to soft, mildly flavored foods that are low in fiber until you are back to good health. You may wish to use the "BRAT" diet as a guide: Bananas - Rice (white) - Applesauce - Tea and Toast.

Many people can temporarily lose the ability to digest milk sugar for 1-2 weeks after an episode of gastroenteritis. Avoid milk products, oils and spices until you are feeling better - and resume them gradually, as tolerated.

See suggested diets.

What Can Your Health Care Provider Do?

If appropriate, your health care provider will prescribe medication. If your nausea and diarrhea are relatively mild, your provider will probably advise you to continue the self-help measures recommended (above). If vomiting is severe, an anti-emetic drug may be prescribed in suppository form, or given to you by injection. Persistent diarrhea is sometimes treated with other medications such as narcotic-type drugs, which harden your bowel movements, or antispasmodic drugs that slow down bowel activity. Any such treatment is usually stopped as soon as the bowels begin to function normally. Analysis of bowel movements may be necessary if diarrhea is prolonged. Such testing can identify more severe causes of this illness so that specific therapy may be targeted to the cause.

Prevention
If your gastroenteritis is caused by a virus, it probably cannot be prevented.

If food poisoning is the cause of the symptoms, it is important in the future to avoid foods that have been incorrectly prepared or have not been properly refrigerated. Bacteria often grow in poultry products, foods made with eggs, or cream products. Do not leave foods like potato salad, chicken salad, cream puffs, or chicken un-refrigerated, especially in warmer weather.

Gastroenteritis caused by emotional upsets may be preventable to some degree by making a conscious effort to reduce stress in your life. Balancing the demands of work and school with opportunities for leisure time with family and friends may modify the effects stress has on your well-being. Regular physical exercise allows an outlet for tension and may help build up your immune system. Stress-related diarrhea is often caused by the involuntary nervous system reacting to stressors that may not be consciously perceived.

Vomiting and diarrhea caused by overindulgence in alcohol is largely preventable by exerting self-control and limiting the number of drinks you consume.

Medical Info: Kernicterus

Kernicterus is a rare neurological disorder characterized by excessive levels of bilirubin in the blood (hyperbilirubinemia) during infancy. Bilirubin is an orange-yellow bile pigment that is a byproduct of the natural breakdown of hemoglobin in red blood cells (hemolysis). Toxic levels of bilirubin may accumulate in the brain, potentially resulting in a variety of symptoms and physical findings.

These symptoms may include lack of energy (lethargy), poor feeding habits, fever, and vomiting. Affected infants may also experience the absence of certain reflexes (e.g., Moro reflex, etc.); mild to severe muscle spasms including those in which the head and heels are bent backward and the body bows forward (opisthotonus); and/or uncontrolled involuntary muscle movements (spasticity). In some cases, infants with kernicterus may develop life-threatening complications.

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Pathophysiology:
Bilirubin staining can be noted on autopsy of fresh specimens in the regions of the basal ganglia, hippocampus, substantia nigra, and brainstem nuclei. Such staining can occur in the absence of severe hyperbilirubinemia; in this situation, factors influencing permeability of the blood-brain barrier (eg, acidosis, infection) and the amount of unbound (versus albumin-bound) bilirubin may play a role.

Characteristic patterns of neuronal necrosis leading to the clinical findings consistent with chronic bilirubin encephalopathy are also essential in the pathophysiology of this entity. Bilirubin staining of the brain without accompanying neuronal necrosis can be observed in babies who did not demonstrate clinical signs of bilirubin encephalopathy but who succumbed from other causes. This staining is thought to be a secondary phenomenon, dissimilar from the staining associated with kernicterus.

Medical Info: Acne vulgaris

Acne vulgaris is a common skin disorder affecting at least 85 percent of adolescents and young adults. This disorder is often dismissed by the medical community and general population as a superficial affliction associated with growing up, however scientific evidence has illustrated that the effects of this condition are far more than skin deep. This brief review of relevant scientific literature discusses the potential effect of acne beyond its dermatological manifestations. These include effects on psychiatric health, psychological well-being, and quality of life.

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Common acne is the most prevalent skin disorder seen by dermatologists, about one in six visits to dermatologists are for acne. Most of these cases are AV (common acne). Acne vulgaris usually develops after onset of puberty, and thus affects teenagers disproportionately. Various forms of acne, however, can affect people of all ages, from infants to the elderly. Acne can cause disfigurement and permanent scarring, thus having an adverse effect on psychological development. Embarrassment, social phobia and depression are linked to acne.

Severe acne, manifested clinically by nodules and cysts, affects more men than women in the 18–28 age group (35% vs. 23%). More women than men are affected from ages 29–49 years. Milder forms of acne occur mostly in women.

In addition to poor diet or poor hygiene, factors beyond a person's control have significant impact.
Age, heredity, stress, hormonal changes and onset of puberty can trigger the changes leading to an outbreak.

The treatment of acne vulgaris in a culture which craves a quick fix has been, predictably, with medication. Because these medications are expensive and not altogether safe, no treatment regime should be undertaken without weighing all the factors. Willingness to leave off junk food, psychological impact, commitment to therapy, and cost of treatment should all be considered. The best sort of doctor to see for treatment which will result in long term improvement of both the acne condition and health in general are those who practice holistic medicine. The entire patient must be looked at and dealt with if a satisfactory outcome is to be expected. The use of dietary supplements should not be overlooked and is best addressed in partnership with a doctor who practices nutritional medicine.

Medical Info: Rubella

Rubella (German measles) is a mild childhood illness that poses a serious threat to the fetus (unborn baby), if the mother contracts the illness during pregnancy. More than 20,000 babies were born with defects during an outbreak of rubella in 1964-65. The same outbreak also resulted in at least 10,000 miscarriages and stillbirths.

Fortunately, major outbreaks of rubella no longer occur in the United States. Since 1969, when a vaccine for rubella became available, children have been routinely vaccinated, helping to prevent the spread of the illness to susceptible pregnant women. Most women of childbearing age are immune to rubella because they either were vaccinated or had the illness during childhood. Because of widespread use of the vaccine, birth defects caused by rubella have become rare.

However, since small outbreaks of rubella continue to occur, the potential for susceptible pregnant women to become infected continues to exist. As many as 2 in 10 women of childbearing age are susceptible to rubella. Women can protect their future children from the effects of rubella by getting tested for immunity prior to pregnancy and being vaccinated if they are not immune.

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Risks:
About 25 percent of babies whose mothers contract rubella during the first trimester of pregnancy are born with one or more birth defects which, together, are referred to as congenital rubella syndrome. These birth defects include eye defects (resulting in vision loss or blindness), hearing loss, heart defects, mental retardation and, less frequently, movement disorders.

Many children with congenital rubella syndrome are slow in learning to walk and in doing simple tasks, although some eventually catch up and do well.

The infection frequently causes miscarriage and stillbirth. The risk of congenital rubella syndrome is highest (up to 90 percent) when infection occurs in the first 11 weeks of pregnancy. Birth defects rarely result when maternal rubella occurs after 20 weeks of pregnancy.

Some infected babies have health problems that aren’t lasting. They may be born with low birthweight (less than 5-1/2 pounds), or have feeding problems, diarrhea, pneumonia, meningitis (inflammation around the brain) or anemia. Red-purple spots may show up on their faces and bodies because of temporary blood abnormalities that can result in a tendency to bleed easily. The liver and spleen may be enlarged.

Some infected babies appear normal at birth and during infancy. However, all babies whose mothers had rubella during pregnancy should be monitored carefully because problems with vision, hearing, learning and behavior may first become noticeable during childhood. Children with congenital rubella syndrome also are at increased risk of diabetes, which may develop during childhood or adulthood.

Prevention:
The March of Dimes recommends that all women be tested for immunity to rubella before they become pregnant, and that they consider being vaccinated at that time if they are not immune. A nonimmune woman can be vaccinated with the rubella vaccine alone or with a combination vaccine such as measles-mumps-rubella (MMR), so that her future children will be protected from the congenital rubella syndrome.

Women who missed being tested prior to pregnancy are routinely tested during an early prenatal visit. If a pregnant woman is not immune, she should avoid anyone who has this illness. There is no effective treatment for rubella during pregnancy, nor is there an effective way to prevent rubella in a susceptible woman who is exposed to the illness. Pregnant women who are not immune also should consider being vaccinated after delivery, so that they will be immune during any future pregnancies. A woman who is breastfeeding her baby can safely be vaccinated.

The rubella and MMR vaccines are not recommended during pregnancy, and a woman should wait 28 days after vaccination before she attempts to conceive.

Medical Info: Cystinuria

Cystinuria is an autosomal recessive defect in reabsorptive transport of cystine and the dibasic amino acids ornithine, arginine, and lysine from the luminal fluid of the renal proximal tubule and small intestine. The only phenotypic manifestation of cystinuria is cystine urolithiasis, which often recurs throughout a patient's lifetime. Surgical intervention is necessary, but the cornerstones of treatment are dietary and medical prevention of recurrent stone formation.

In 1810, Wollaston first described a different type of urinary calculi from the urinary bladder and coined the term "cystic oxide." Berzelius recognized that the compound was not an oxide, and he named it "cystine" because the material originated from the bladder. In 1908, Sir Archibald Garrod identified cystinuria as one of the original "inborn errors of metabolism." Yeh et al and Dent and Rose showed abnormal excretion of the dibasic amino acids lysine, arginine, and ornithine in persons with cystinuria. In 1955, Harris et al reported the complex autosomal recessive pattern of inheritance of cystinuria. In 1961, Milne et al demonstrated reduced intestinal absorption of dibasic amino acids in persons with cystinuria.

In 1954, while studying skin sensitivity to penicillin and its derivatives, Tabachnick et al noted that one of the degradation products of penicillin, penicillamine, reacted with cystine to form a mixed disulfide: penicillamine cysteine. In 1963, Crawhall et al first used penicillamine to manage cystinuric patients.

In recent years, understanding of the genetic and molecular components of cystinuria has advanced. In 1993, Lee et al cloned a human cDNA (rBAT [renal basic amino acid transporter]) in chromosome 2 encoding a transport protein for cystine and dibasic amino acids. In 1997, Bisceglia et al identified type III cystinuria on band 19q13.1.

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Treatment:
Management algorithm
Overall, for a cystinuric patient without a stone, first-line therapy in the majority of cases is a conservative approach, including large-volume fluid intake (urine output >2.5 L/d), regular urine pH monitoring (urine pH of 7.5 and <8.0), dietary restrictions, and urinary alkalization with potassium citrate.

If this standard therapy fails to achieve the urinary cystine concentration of 300 mg/L, then medical therapy with D-penicillamine, alpha-MPG, or captopril must be added.

Treat patients with stone disease according to the location of the stone. The expertise of a urologist and a radiologist is important for decision-making processes, and stone site and size also influence further management (see Image 7).

Hydration

The average homozygous cystinuric patient excretes 600-1400 mg of cystine per day. The solubility of cystine at a pH of 7.0 is 250-300 mg/L. Therefore, one of the oldest and most effective cystine stone–prevention techniques is hyperdiuresis to decrease urinary cystine concentration. Early studies by Dent et al in the 1960s showed that hydration alone could prevent stone recurrence in up to a third of patients. This finding has been corroborated by more recent studies.

The goals of hydration therapy are urine volumes in excess of 3 L/d. This goal may require ingesting 4-4.5 L of water per day. Patients should drink 240 mL of water every hour during the day and 480 mL before retiring and at least once during the night.

Alkalizing beverages, such as mineral water, rich in bicarbonate and low in sodium (1500 mg HCO3/L, maximum 500 mg sodium/L), and citrus juices are preferred.

Patients should monitor the specific gravity of their urine using Nitrazine dipsticks, with a goal of achieving a value less than 1.010.
Alkalinization

Alkaline urine can prevent the precipitation of cystine calculi and can even aid in dissolution. Urine pH must be more than 7.5 for stone dissolution to occur.

Paradoxically, urine pH of more than 7.5 can cause a predisposition to the formation of calcium phosphate calculi, so urine must be monitored with dipsticks to maintain a pH of 7.0-7.5 for stone prevention.

Currently, Nitrazine paper and standard pH dipsticks have no clear color differentiations in the range of 6.0-7.5 pH. UriDynamics, a small company in Indianapolis, Ind, has developed a new test strip called StoneGuard II. This strip includes an additional color block at a pH of 7.5. The colors produced are yellow-orange (pH 5.0), yellow-green (pH 6.0), green-yellow (pH 6.5), light green (pH 7.0), green with blue cast (pH 7.5), and greenish blue (pH 8.0). No interference from common medications, nutritional supplements, or blood has been observed. It also has a pad to measure specific gravity over a range of 1.000-1.030.

Sodium bicarbonate was used in the past but is no longer recommended as a first-line agent. The sodium ion may actually increase the amount of cystine excreted.

Potassium citrate is the first-line alkalinizing drug. The typical adult dose is 60-80 mEq/d divided into 3-4 doses (15-20 mL/d), titrating the dose as needed to maintain a urine pH within the target range of 7.0-7.5.

Acetazolamide inhibits the brush-border carbonic anhydrase of the proximal convoluted tubule, thereby increasing urinary bicarbonate excretion. Acetazolamide is not widely used as a first-line drug and is of questionable efficacy.

With any alkalinization therapy, monitoring of urinary pH is essential.

Medical Info: Actinomycosis

Actinomycosis is an infection caused by a bacterium called Actinomyces israelii (A. israelii).

Actinomycosis (also known as Rivalta disease, big jaw, clams, lumpy jaw or wooden tongue) is an infection, commonly of the face and neck, that produces abscesses (collections of pus) and open-draining sinuses (tracts in the skin).

Actinomycosis is caused by a bacterium called Actinomyces israelii (A. israelii). It occurs normally in the mouth and tonsils. This bacterium may cause infection when it is introduced into the soft tissues by trauma, surgery or another infection. Once in the tissues, it may form an abscess that develops into a hard red to reddish purple lump. When the abscess breaks through the skin, it forms pus-discharging lesions.

Medical info:

There are at least five (5) types of actinomycosis:

Cervicofacial actinomycosis occurs in the mouth, neck and head region. The bacterium enters through the periodontium (the tissues surrounding and supporting the teeth), soft tissue wounds or salivary gland ducts. It is believed that infection may arise after a tooth extraction, from tooth decay or abscess, as a part of periodontal disease, from a nonpenetrating jaw trauma, poor dental hygiene, or mucosal injuries.

Cervicofacial actinomycosis develops slowly. The area becomes hard, the overlying skin becomes reddish and swelling appears in the mouth and neck. Abscesses develop within and eventually drain to the surface where sulfur granules (yellowish gray masses), masses of filamentous (long, threadlike structure) organisms, may be found in the pus.

Thoracic actinomycosis involves the lungs and mediastinum (region between the two lungs). The disease begins with fever, cough, and sputum production. The patient becomes weak, loses weight and may have night sweats and shortness of breath. Multiple sinuses may extend through the chest wall, to the heart, or into the abdominal cavity. Ribs may be involved. Occasionally, cervicofacial and thoracic disease may result in nervous system complications - most commonly brain abscesses or meningitis.

Abdominal actinomycosis are mostly preceded by surgery such as laparotomy for acute appendicitis, perforated ulcer, or gallbladder inflammation. Infection usually begins in the gastrointestinal tract and spreads to the abdominal wall. Spiking fever and chills, intestinal colic, vomiting, and weight loss, a palpable (can be felt) mass and an external sinus are evident in this type of actinomycosis. This type of actinomycosis may be mistaken for Crohn's disease, malignancy, tuberculosis, Amebiasis (an infection of the intestine or liver), or chronic appendicitis.

Pelvic actinomycosis affects the women's pelvic area and may cause lower abdominal pain, fever, and bleeding between menstrual periods. This form of the infection has been associated with the use of IUDs (intra-uterine devices) that do not contain copper.

Generalized actinomycosis may involve the skin, brain, liver and urogenital system.

Diagnosis
Actinomycosis may be hard to diagnose at onset. There are lab tests that may isolate actinomyces in pus or tissue specimens.

Treatment
Treatment for actinomycosis is long term, generally with up to one month of intravenous penicillin G, followed by weeks to months of penicillin taken by mouth. Additionally, surgical excision and drainage of abscesses may be necessary.

Medical Info: Diabetes Insipidus

Diabetes insipidus is a disorder in which the kidney is insensitive to a hormone, called anti-diuretic hormone (ADH) or in which there is not sufficient quantity of this hormone available. The result is excessive drinking and urination, or polydipsia and polyuria. This is one cause of changes in urinary habits that leads to problems with urination inside the house in dogs in which "housebreaking" seemed to be satisfactory prior to the disease onset.

ADH is secreted by the body when it has a need to conserve water. It makes the kidneys work harder to conserve water, which makes the urine more concentrated. When the dog can not respond to this hormone or doesn't make enough of it, the dog can not concentrate its urine. This can lead to serious problems, including death, if the dog does not have access to large quantities of water. On the other hand, it may not cause any significant problem if there is always plenty of water available. This problem can occur for a number of reasons and for no reason at all. Examples of predisposing causes are kidney failure, hyperadrenocorticism, liver disease, pyometra and others. These things affect the kidney's ability to respond. Head trauma or brain cancer can affect the body's ability to produce ADH.

This condition is treated using desmopressin acetate (DDAVP), which is a replacement for the anti-diuretic hormone. It can be administered intra-nasally or on the conjunctiva (the inside lining of the eyes). It is pretty effective. Unfortunately, it is also somewhat expensive. Some dogs benefit from therapy with other medications, including chlorpropamide and chlorothiazide diuretics.


Medical info:
The prognosis for this condition varies with the underlying cause. Dogs that have diabetes insipidus due to trauma often recover in a short time and the same is true after successful treatment of pyometra. The prognosis is good for spontaneous occurrences of diabetes insipidus as well. When it occurs for other reasons the prognosis is usually less favorable.

Medical Info: Priapism

Priapism is a persistent, usually painful, erection that lasts for more than four hours and occurs without sexual stimulation. The condition develops when blood in the penis becomes trapped and unable to drain. If the condition is not treated immediately, it can lead to scarring and permanent erectile dysfunction.

It can occur in all age groups, including newborns. However, it usually affects men between the ages of 5 to 10 years and 20 to 50 years.

There are two categories of priapism: low-flow and high-flow.

Low flow: This type of priapism is the result of blood being trapped in the erection chambers. It often occurs without a known cause in men who are otherwise healthy, but also affects men with sickle-cell disease, leukemia (cancer of the blood) or malaria.
High flow: High flow priapism is more rare than low-flow and usually less painful. It is the result of a ruptured artery from an injury to the penis or the perineum (area between the scrotum and anus), which prevents blood in the penis from circulating normally.
What causes priapism?

Sickle cell anemia: Some adult cases of priapism are the result of sickle-cell disease and approximately 42% of all adults with sickle-cell will eventually develop priapism.
Medications: A common cause of priapism is the use and/or misuse of medications. Drug-related priapism includes drugs such as Desyrel used to treat depression or Thorazine, used to treat certain mental illnesses. For people who have erectile dysfunction, injection therapy medications to treat the condition may also cause priapism.
Other causes of priapism include:

Trauma to the spinal cord or to the genital area
Black widow spider bites
Carbon monoxide poisoning
Illicit drug use, such as marijuana and cocaine
In rare cases, priapism may be related to cancers that can affect the penis and prevent the outflow of blood.

Medical info:

How is priapism diagnosed?
If you experience priapism, it is important that you seek medical care immediately. Tell your doctor:

The length of time you have had the erection
How long your erection usually lasts
Any medication or drugs, legal or illegal, which you have used. Be honest with your doctor, illegal drug use is particularly relevant since both marijuana and cocaine have been linked to priapism.
Whether or not priapism followed trauma to that area of the body.
Your doctor will review your medical history and perform a thorough physical examination to determine the cause of priapism. This will include checking the rectum and the abdomen for evidence of unusual growths or abnormalities that may indicate the presence of cancer.

After the physical exam is complete, the doctor will take a blood-gas measurement of the blood from the penis. During this test, a small needle is placed in the penis, some of the blood is drawn and then it is sent to a lab for analysis. This provides a clue as to how long the condition has been present and how much damage has occurred.

How is priapism treated?
The goal of all treatment is to make the erection go away and preserve future erectile function. If a person receives treatment within four to six hours, the erection can almost always be reduced with medication. If the erection has lasted less than four hours, decongestant medications, which may act to decease blood flow to the penis, may be very helpful. Other treatment options include:

Ice packs: Ice applied to the penis and perineum may reduce swelling.
Surgical ligation: Used in cases where an artery has been ruptured, the doctor will ligate (tie off) the artery that is causing the priapism in order to restore normal blood flow.
Intracavernous injection: Used for low-flow priapism, during this treatment drugs known as alpha-agonists are injected into the penis that cause the veins to narrow reducing blood flow to the penis causing the swelling to subside.
Surgical shunt: Also used for low-flow priapism, a shunt is a passageway that is surgically inserted into the penis to divert the blood flow and allow circulation to return to normal.
Aspiration: After numbing the penis, doctors will insert a needle and drain blood from the penis to reduce pressure and swelling.
If you suspect that you are experiencing priapism, you should not attempt to treat it yourself. Instead seek emergency as soon as possible.

What is the outlook for people with priapism?
As long as treatment is prompt, the outlook for most people is very good. However, the longer medical attention is delayed, the greater the risk of permanent erectile dysfunction.

Medical Info: Furunculosis

Furunculosis is a condition causing deep sores of the skin, also known as boils. Furuncles are painful, deep bacterial infections of hair follicles. The usual cause is infection, usually from Staphy-lococcus bacteria, that begins in the hair follicle and penetrates into deeper skin layers. Furunculosis is very uncommon in young children, but it occurs more frequency after puberty. Transmission from individual to individual can occur if contact is made with drainage of pus from a furuncle. The furuncle begins as a deep, tender, firm, red papule which enlarges rapidly into a tender, deep-seated nodule that remains painful. With appropriate treatment, the infection can be eradicated.

Medical info:

Living With Your Diagnosis
Pain becomes more intense as the furuncle enlarges. Furuncles can appear suddenly and are usually 1/2 to 1 inch in diameter; some are larger. The furuncle either remains deep and reabsorbs or it will rupture through to the surface of the skin. The point of rupture heals with scarring. Without treatment, the infection may enter the bloodstream and spread to other body parts.

Treatment
Warm moist compresses provide comfort and encourage localization and pointing of the abscess; apply three or four times daily for 20 minutes each time. Your physician may incise and drain the furuncle when the skin over the furuncle becomes thin and the mass underneath is soft. Without treatment, the furuncle will heal in 10-20 days. With treatment, furuncles will heal in less time and symptoms will be less severe. A potential complication of treatment is that the pus that drains when the furuncle opens spontaneously may contaminate nearby skin, causing new furuncles.

The DOs
1) Do take prescribed antibiotics.
2) Do decrease activity until the infection heals. Avoid sweating and contact sports while furuncles are present.
3) Do keep the skin clean.

The DON'Ts
1) Dont use nonprescription antibiotic creams or ointments on the furuncles surface because they are ineffective.
2) Dont share towels, washcloths, or clothing with other household members.

When to Call Your Doctor
1) If fever occurs or symptoms do not improve in 3 or 4 days, despite treatment.
2) If new furuncles appear or furuncles develop in other family members.

Medical Info: Urticaria

Urticaria is a raised itchy and painful skin rash sometimes called a “nettle rash” or hives. There are two distinct types of urticaria:

Acute urticaria is often caused by an allergy to food or medication and can last between several hours and six weeks.

Chronic urticaria is diagnosed if the rash persists for six weeks or longer, the underlying cause is then usually not due to food allergies.

Medical info:

Causes

Acute Urticaria

The most likely cause of Acute Urticaria is an allergy due to exposure to pets, horses, latex rubber, food such as shellfish, nuts, egg and dairy products or bee and wasp stings. Allergies to medication such as antibiotics (penicillin, tetracycline, sulphonamides and cephalosporins), blood pressure pills (ACE inhibitors and diuretics), codeine and aspirin containing pain killers can cause acute urticaria. Sometimes viral infections such as glandular fever and hepatitis B, or bacteria (helicobacter, streptococci), fungal and parasitic infections can trigger urticaria. Allergic reactions to blood products, transfusions, xray contrast and vaccines have also been implicated. Papular urticaria is the medical term for “itchy bumps” or grouped urticarial lesions seen mainly in children and which follow insect bites from midges, fleas and mosquitoes.

Chronic Urticaria

The cause of Chronic Urticaria is much more difficult to identify. The role of true food allergy is hardly ever a significant trigger but food additives such as salicylate, sodium benzoate, colourings and nitrites may play a role. We often end up diagnosing Chronic Idiopathic Urticaria. This condition (which can persist for many years) is due to the production of “auto-antibodies” which in turn attack specific Mast Cells in our skin and tissues causing an enormous release of histamine. Why we suddenly switch-on production of these aggressive antibodies to our own skin cells is a complete enigma. Our bodies may continue producing these auto-antibodies for a number of years leading to a great deal of distress and discomfort for the urticaria sufferer. Unfortunately over 50% of Chronic Urticaria cases are due to production of these “auto-antibodies” to the IgE and its receptor on Mast Cells found in the skin.



Chronic parasitic infections and ACE inhibitor blood pressure pills may play a role in both acute and chronic urticaria. Stress is known to aggravate urticaria and stress reduction measures are very important in treating chronic urticaria.



Chronic urticaria can also be triggered by physical factors such as exposure to environmental heat (prickly heat), intense cold, sunlight, vibration or pressure on the skin (from tight clothing). Very rarely some people react to bath water, this is called “Aquagenic” Urticaria. Exercising after eating certain foods such as wheat, celery and shellfish might provoke delayed urticaria. Many people have very sensitive skin and any friction or rubbing will cause raised red lines to develop. This is called Dermatographism and indicates just how easily they can release histamine in their own skin. A good test for cold urticaria is to hold a block of ice against the skin for 5 minutes and see if an urticaria weal develops after the ice is removed.



Underlying thyroid diseases and autoimmune diseases such as Systemic Lupus and Rheumatoid Arthritis can provoke Chronic Urticaria or even Urticarial Vasculitis (a variant in which the lesions tend not to fluctuate but lead to skin discolouration). Urticarial Vasculitis may be associated with a fever, bone pains and joint swelling (Schnitzler’s Syndrome).



Occasionally an inherited deficiency of the C1 Esterase Inhibitor Enzyme leads to a non-itchy form of urticaria called Hereditary or Familial Angioedema. This condition affects mainly females in a family, is associated with sudden swelling of the face and neck which is not itchy but tends to be painful. These lesions usually last for 2 to 3 days and do not respond to antihistamine medication. Sufferers characteristically have low levels of the Complement C4 in their bloodstream and respond to medication called Danazol or Tranexamic acid which prevents attacks.