Mastitis

Mastitis occurs when bacteria found on skin or saliva enter breast tissue through a milk duct or crack in the skin. Milk ducts are a part of the anatomy of the breast that carry milk to the nipples. All genders have milk ducts and can get mastitis.

Infection also happens when milk backs up due to a blocked milk duct or problematic breastfeeding technique. Bacteria grow in the stagnant milk. These factors increase the risk of a nursing mom developing mastitis:

  • Cracked, sore nipples.
  • Improper latching technique or using only one position to breastfeed.
  • Wearing tight-fitting bras that restrict milk flow.
  • Applying herbs to the breast to facilitate breast milk production.

What are the symptoms of mastitis?

Many people with mastitis develop a wedge-shaped red mark on one breast. (Rarely, mastitis affects both breasts.) The breast may be swollen and feel hot or tender to touch. You may also experience:

How is mastitis diagnosed?

Your healthcare provider will do a physical exam and check your symptoms to make a diagnosis. If you aren’t breastfeeding, you may get a mammogram or other tests to rule out breast cancer or a different breast condition.

How is mastitis managed or treated?

Your healthcare provider may prescribe an oral antibiotic to treat mastitis. The infection should clear up within 10 days but may last as long as three weeks. Mastitis sometimes goes away without medical treatment.

To reduce pain and inflammation, you can:

  • Apply warm, moist compresses to the affected breast every few hours or take a warm shower.
  • Breastfeed every two hours or more often to keep milk flowing through the milk ducts. If needed, use a breast pump to express milk between feedings.
  • Drink plenty of fluids and rest when possible.
  • Massage the area using a gentle circular motion starting at the outside of the affected area and working in toward the nipple.
  • Take over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDS).
  • Wear a supportive bra that doesn’t compress the breast.

What are the complications of mastitis?

If left untreated, a breast infection like mastitis can lead to a breast abscess. This type of abscess typically needs to be surgically drained. If you have an abscess that needs to be drained, your healthcare provider will perform minor surgery or use a small needle to drain the pus. Often, you may need to be admitted to the hospital for IV antibiotics. A breast abscess will not go away with warm compresses.

Prevention

Breastfeeding moms can take these steps to lower their chances of getting mastitis:

  • Air out your nipples after nursing.
  • Don’t wear nursing pads or tight-fitting bras that keep nipples moist.
  • Nurse your baby on one side, allowing the breast to empty, before switching to the other breast.
  • Switch up breastfeeding positions to fully empty all areas of the breast.
  • Use your finger to break your baby’s suction on a nipple if you need to stop a feeding.

When should I call the doctor?

You should call your healthcare provider if you experience:

  • Breast pain.
  • Changes in the way your breasts look or feel.
  • Newly discovered lump.
  • Nipple discharge.
  • Worsening of mastitis symptoms after 24 hours of antibiotics or at-home treatment.

Buruli ulcer

Buruli ulcer  is an infectious disease characterized by the development of painless open wounds. The disease is limited to certain areas of the world, most cases occurring in Sub-Saharan Africa and Australia. The first sign of infection is a small painless nodule or area of swelling, typically on the arms or legs. The nodule grows larger over days to weeks, eventually forming an open ulcer. Deep ulcers can cause scarring of muscles and tendons, resulting in permanent disability.

Causes

Buruli ulcer is caused by skin infection with bacteria called Mycobacterium ulcerans. The mechanism by which M. ulcerans is transmitted from the environment to humans is not known, but may involve the bite of an aquatic insect or the infection of open wounds. Once in the skin, M. ulcerans grows and releases the toxin mycolactone, which blocks the normal function of cells, resulting in tissue death and immune suppression at the site of the ulcer.

The World Health Organization (WHO) recommends treating Buruli ulcer with a combination of the antibiotics rifampicin and clarithromycin. With antibiotic administration and proper wound care, small ulcers typically heal within six months. Deep ulcers and those on sensitive body sites may require surgery to remove dead tissue or repair scarred muscles or joints. Even with proper treatment, Buruli ulcer can take months to heal. Regular cleaning and dressing of wounds aids healing and prevents secondary infections.

Signs and symptoms

The first sign of Buruli ulcer is a painless swollen bump on the arm or leg, often similar in appearance to an insect bite. Sometimes the swollen area instead appears as a patch of firm, raised skin about three centimeters across called a “plaque”; or a more widespread swelling under the skin.

Over the course of a few weeks, the original swollen area expands to form an irregularly shaped patch of raised skin. After about four weeks, the affected skin sloughs off leaving a painless ulcer.Buruli ulcers typically have “undermined edges”, the ulcer being a few centimeters wider underneath the skin than the wound itself

In some people, the ulcer may heal on its own or remain small but linger unhealed for years.[4][5] In others, it continues to grow wider and sometimes deeper, with skin at the margin dying and sloughing off. Large ulcers may extend deep into underlying tissue, causing bone infection and exposing muscle, tendon, and bone to the air. When ulcers extend into muscles and tendons, parts of these tissues can be replaced by scar tissue, immobilizing the body part and resulting in permanent disability. Exposed ulcers can be infected by other bacteria, causing the wound to become red, painful, and foul smelling. Symptoms are typically limited to those caused by the wound; the disease rarely affects other parts of the body.

Buruli ulcers can appear anywhere on the body, but are typically on the limbs. Ulcers are most common on the lower limbs (roughly 62% of ulcers globally) and upper limbs (24%), but can also be found on the trunk (9%), head or neck (3%), or genitals (less than 1%).

The World Health Organization classifies Buruli ulcer into three categories depending on the severity of its symptoms. Category I describes a single small ulcer that is less than 5 centimetres (2.0 inches). Category II describes a larger ulcer, up to 15 centimetres (5.9 in), as well as plaques and broader swollen areas that have not yet opened into ulcers. Category III is for an ulcer larger than 15 centimeters, multiple ulcers, or ulcers that have spread to include particularly sensitive sites such as the eyes, bones, joints, or genitals.

Diagnosis

As Buruli ulcer most commonly occurs in low-resource settings, treatment is often initiated by a clinician based on signs and symptoms alone. Where available, diagnosis may then be confirmed by polymerase chain reaction (PCR) to detect M. ulcerans DNA or microscopy to detect mycobacteria.

Treatment

Buruli ulcer is treated through a combination of antibiotics to kill the bacteria, and wound care or surgery to support the healing of the ulcer. The most widely used antibiotic regimen is once daily oral rifampicin plus twice daily oral clarithromycin, recommended by the World Health Organization. Several other antibiotics are sometimes used in combination with rifampicin, namely ciprofloxacinmoxifloxacinethambutolamikacinazithromycin, and levofloxacin. A 2018 Cochrane review suggested that the many antibiotic combinations being used are effective treatments, but there is insufficient evidence to determine if any combination is the most effective.

Treatment sometimes includes surgery to speed healing by removing necrotic ulcer tissue, grafting healthy skin over the wound, or removing scar tissue that can deform muscles and joints

Prevention of Buruli Ulcer

Buruli ulcer can be prevented by avoiding contact with aquatic environments in endemic areas, although this may not be possible for people living in these areas.The risk of acquiring it can be reduced by wearing long sleeves and pants, using insect repellent, and cleaning and covering any wounds as soon as they are noticed.There is no specific vaccine for preventing Buruli ulcer. The BCG vaccine typically given to children to protect against tuberculosis offers temporary partial protection from Buruli ulcer.


PNEUMONIA

Pneumonia is an infection of the lung tissue caused by various bacterial , viruses or fungi. It happens when an infection causes the air sacs in your lungs (your doctor will call them alveoli) to fill with fluid or pus. That can make it hard for you to breathe in enough oxygen to reach your bloodstream i a lung infection that can range from mild to so severe that you have to go to the hospital.

Anyone can get this lung infection. But infants younger than age 2 and people over age 65 are at higher risk. That’s because their immune systems might not be strong enough to fight it.

Pneumonia types

There are different type of pneumonia, depending on their cause.

  • Bacterial pneumonia: The most common cause is the bacterium Streptococcus pneumoniae (S. pneumoniae), but many different bacteria can cause pneumonia
  • Viral pneumonias; This is cause by syncytia virus (RSV) and influenza types A and B, known as the flu
  • Aspiration pneumonia: This can happen when a person breathes food, liquids, or stomach contents into the lungs. This type is not contagious.
  • Fungal pneumonia: This can results from a condition such as valley fever, caused by the Coccidioides fungus.
  • Hospital-acquired pneumonia: This can occur in patients being treated for other conditions, for example, those attached to a respirator, or breathing machine.

Regardless of the cause, the signs and symptoms will be similar.

Pneumonia symptoms

The first symptoms of pneumonia usually resemble those of a cold or flu. The person then develops a high fever, chills, and cough with sputum.

Common symptoms include:

  • fever
  • cough
  • headache
  • rusty or green phlegm, or sputum, coughed up from lungs
  • fast breathing and shortness of breath
  • shaking chills
  • chest pain that usually worsens when taking a deep breath, known as pleuritic pain
  • fast heartbeat
  • fatigue and weakness
  • nausea and vomiting
  • sweating
  • muscle pain
  • confusion or delirium, especially in older adults

Symptoms can vary depending on other underlying conditions and the type of pneumonia

pnuemonia treatment

Treatment depends on the type and severity of the pneumonia

  • Bacterial types of pneumonia are treated with antibiotics
  • Viral types of pneumonia are usually treated with rest and plenty of fluids. Antiviral medications can be used in influenza.
  • Fungal types of pneumonia are usually treated with antifungal medications.

Doctors commonly prescribe over-the-counter (OTC) medications to help manage the symptoms of pneumonia. These include treatments for reducing fever, reducing aches and pains, and suppressing coughs.

In addition, it is crucial to rest and drink plenty of fluids. Staying hydrated helps to thin out thick phlegm and mucus, making it easier to cough up.

Hospitalization for pneumonia may be required if symptoms are especially bad or if an individual has a weakened immune system or other serious illnesses.

In the hospital, patients are generally treated with intravenous antibiotics and fluids. They may need a supplemental oxygen supply.

Pneumonia complications

Even with treatment, some people with pneumonia, especially those in high-risk groups, may experience complications, including:

  • Bacteria in the bloodstream (bacteremia). Bacteria that enter the bloodstream from your lungs can spread the infection to other organs, potentially causing organ failure.
  • Difficulty breathing. If your pneumonia is severe or you have chronic underlying lung diseases, you may have trouble breathing in enough oxygen. You may need to be hospitalized and use a breathing machine (ventilator) while your lung heals.
  • Fluid accumulation around the lungs (pleural effusion). Pneumonia may cause fluid to build up in the thin space between layers of tissue that line the lungs and chest cavity (pleura). If the fluid becomes infected, you may need to have it drained through a chest tube or removed with surgery.
  • Lung abscess. An abscess occurs if pus forms in a cavity in the lung. An abscess is usually treated with antibiotics. Sometimes, surgery or drainage with a long needle or tube placed into the abscess is needed to remove the pus.

is pneumonia contagious

The germs that cause pneumonia are contagious. This means they can spread from person to person.

Bacterial and viral  pneumonia can spread to others through inhalation of airborne droplets from a sneeze or cough. You can also get these types of pneumonia by coming into contact with surfaces or objects that are contaminated with pneumonia-causing bacteria or viruses.

You can contract fungal pneumonia from the environment. However, it doesn’t spread from person to person.


Gingivitis

An inflammation of the gums surrounding the teeth which affects a significant portion of the population and a common periodontal disease.

This inflammation of the gingiva is classified according to severity. It can range from mild to severe gingivitis and more uncommon but serious necrotizing ulcerative gingivitis.

  • Inflammation is a complex system by which bacteria-fighting cells of the body are recruited to an area of bacterial infection. Inflammation plays a major role in gingivitis. It is this inflammation of the gums that accounts for most of the symptoms of gingivitis.
  • Bacteria can cause inflammation of the gums. Although bacteria are normally found in our bodies and provide protective effects most of the time, bacteria can be harmful. The mouth is an ideal place for bacteria to live. The warm, moist environment and constant food supply are everything bacteria need to thrive. If not for a healthy immune system, bacteria in the mouth would rapidly reproduce out of control, overwhelming the body’s defense system.
  • An infection begins when the body’s immune system is overwhelmed. The gum disease of gingivitis is an infection that occurs when bacteria invade soft tissues and bone adjacent to teeth. The severity of this infection varies from mild to severe and can be an indication of a life-threatening systemic disease.

What Are Gingivitis Symptoms and Signs?

  • The presence of dental plaque, a sticky substance on the teeth, will inevitably cause gingivitis.
  • Swelling, redness, pain, and bleeding of the gums are signs of gingivitis. Swelling of the gums is referred to as gingival hyperplasia.
  • Receding gums are a sign of gingivitis that may be advancing into periodontal disease
  • Loose teeth or tooth loss in the presence of gum inflammation is a sign of gingivitis and periodontal disease.
  • Halitosis (bad breath ) , in which the breath begins to take on a foul odor, may be present in more severe forms of gingivitis.

How Do You Treat Gingivitis?

For simple gingivitis, work with a dentist. A concerted effort involving good home denta hygiene, including regular and correct brushing and flossing, and regular dental visits should be all that is required to treat and prevent gingivitis. Gingivitis can usually be managed at home with good dental hygiene.

If gingivitis continues despite the effort to prevent it, contact a doctor to investigate the possibility of an underlying illness. If there are other conditions that seem to be coinciding with the signs and symptoms of gingivitis, seek medical attention. For example, chronic gingivitis and periodontitis are felt by medical scientists to be risk factors for the development of rheumatoid arthritis.

One complication of gingivitis may be the presence of ulcers on the gums — if rampant, this could be a sign of acute necrotizing ulcerative gingivitis and will require medical diagnosis and treatment.


Cholera

Cholera is a serious bacterial disease that usually causes severe diarrhea and dehydration. The disease is typically spread through contaminated water.

In severe cases, immediate treatment is necessary because death can occur within hours. This can happen even if you were healthy before you caught it.

Modern sewage and water treatment have effectively eliminated cholera in most countries. It’s still a problem in countries in Asia, Latin America, Africa, and the Middle East.

Countries affected by war, poverty, and natural disasters have the greatest risk for a cholera outbreak. That’s because these conditions tend to force people to live in crowded areas without proper sanitation.

Causes of cholera

Cholera is caused by bacteria called Vibrio cholerae. The disease’s deadly effects are the result of a strong toxin known as CTX that is produced by these bacteria in your small intestine.

CTX interferes with the normal flow of sodium and chloride when it binds to your intestinal walls. When the bacteria attaches to the small intestine’s walls, your body begins to secrete large amounts of water that lead to diarrhea and the rapid loss of fluids and salts.

Contaminated water supplies are the primary source of cholera infection. Uncooked fruits, vegetables, and other foods can also contain the bacteria that cause cholera.

Cholera is not usually passed from person to person through casual contact.

Are you at risk?

Anyone can become sick with cholera, but a few factors may increase your risk. These risk factors also increase the likelihood that you’ll have a severe case. These include:

  • unclean conditions (such as poor sanitation and contaminated water)
  • low levels of stomach acid (cholera bacteria cannot live in highly acidic environments)
  • sick household members
  • type O blood (it’s not clear why this is true, but more people with this blood type seem to be at risk for cholera)
  • eating raw shellfish (if the shellfish live in dirty waters where the cholera bacteria live, there is greater chance of becoming ill)

Symptoms of cholera

The majority of people exposed to cholera never become ill. In most cases, you may never know you’ve been exposed.

Once you’re infected, you’ll continue to shed cholera bacteria in your stools for 7 to 14 days. Cholera usually causes mild to moderate diarrhea, like other illnesses.

One in 10 people who are infected will develop typical symptoms within 2 to 3 days after infection.

Common symptoms of cholera include:

The dehydration caused by cholera is usually severe and can cause tiredness, moodiness, sunken eyes, dry mouth, shriveled skin, extreme thirst, reduced urine outputirregular heartbeat, and low blood pressure.

Dehydration may lead to loss of minerals in your blood. This can lead to an electrolyte imbalance. The first sign of an electrolyte imbalance is severe muscle cramps. An electrolyte imbalance can eventually lead to shock.

Children usually have the same cholera symptoms as adults. Children may also experience the following:

  • severe drowsiness
  • fever
  • convulsions
  • coma

Cholera rarely occurs in first world nations. If you follow proper food safety practices, even in affected areas, the risk of infection is minor. Still, cholera continues to occur worldwide. If you develop severe diarrhea after visiting an area with a high rate of cholera, you should see a doctor.

Diagnosing and treating cholera

If you have symptoms of cholera, you should contact your doctor. A doctor can confirm that you have cholera by identifying bacteria in a stool sample.

Common methods for treating cholera include:

These treatments add to the liquid in the body and rehydrate it. They also help reduce the length of time you have diarrhea.

Cholera complications

Cholera can be fatal. In severe cases, rapid loss of fluids and electrolytes can cause death in as little as 2 or 3 hours. Even in typical cases, if cholera is left untreated, people can die of dehydration and shock in as little as 18 hours.

Shock and severe diarrhea are the most serious complications of cholera. However, other problems may occur, such as:

Preventing cholera infection

If you’re traveling to an area where cholera is common, your chances of catching the disease are still low if you:

  • wash your hands
  • drink only bottled or boiled water
  • avoid raw food and shellfish
  • avoid dairy foods
  • eat raw fruits and vegetables that you can peel yourself

Kawasaki disease

Overview

Kawasaki disease causes swelling (inflammation) in the walls of medium-sized arteries throughout the body. It primarily affects children. The inflammation tends to affect the coronary arteries, which supply blood to the heart muscle.

Kawasaki disease is sometimes called mucocutaneous lymph node syndrome because it also affects glands that swell during an infection (lymph nodes), skin, and the mucous membranes inside the mouth, nose and throat.

Symptoms

Kawasaki disease signs and symptoms usually appear in three phases.

1st phase

Signs and symptoms of the first phase may include:

  • A fever that is often is higher than 102.2 F (39 C) and lasts more than three days
  • Extremely red eyes without a thick discharge
  • A rash on the main part of the body and in the genital area
  • Red, dry, cracked lips and an extremely red, swollen tongue
  • Swollen, red skin on the palms of the hands and the soles of the feet
  • Swollen lymph nodes in the neck and perhaps elsewhere
  • Irritability

2nd phase

In the second phase of the disease, your child may develop:

  • Peeling of the skin on the hands and feet, especially the tips of the fingers and toes, often in large sheets
  • Joint pain
  • Diarrhea
  • Vomiting
  • Abdominal pain

3rd phase

In the third phase of the disease, signs and symptoms slowly go away unless complications develop. It may be as long as eight weeks before energy levels seem normal again.

When to see a doctor

If your child has a fever that lasts more than three days, contact your child’s doctor. Also, see your child’s doctor if your child has a fever along with four or more of the following signs and symptoms:

  • Redness in both eyes
  • A very red, swollen tongue
  • Redness of the palms or soles
  • Skin peeling
  • A rash
  • Swollen lymph nodes

Treating Kawasaki disease within 10 days of when it began may greatly reduce the chances of lasting damage.

Causes

No one knows what causes Kawasaki disease, but scientists don’t believe the disease is contagious from person to person. A number of theories link the disease to bacteria, viruses or other environmental factors, but none has been proved. Certain genes may make your child more likely to get Kawasaki disease.

Risk factors

Three things are known to increase your child’s risk of developing Kawasaki disease.

  • Age. Children under 5 years old are most at risk of Kawasaki disease.
  • Sex. Boys are slightly more likely than girls are to develop Kawasaki disease.
  • Ethnicity. Children of Asian or Pacific Island descent, such as Japanese or Korean, have higher rates of Kawasaki disease.

Complications

Kawasaki disease is a leading cause of acquired heart disease in children. However, with effective treatment, only a few children have lasting damage.

Heart complications include:

  • Inflammation of blood vessels, usually the coronary arteries, that supply blood to the heart
  • Inflammation of the heart muscle
  • Heart valve problems

Any of these complications can damage your child’s heart. Inflammation of the coronary arteries can lead to weakening and bulging of the artery wall (aneurysm). Aneurysms increase the risk of blood clots, which could lead to a heart attack or cause life-threatening internal bleeding.

For a very small percentage of children who develop coronary artery problems, Kawasaki disease can cause death, even with treatment

Diagnosis

  • Blood tests. Blood tests help rule out other diseases and check your child’s blood cell count. A high white blood cell count and the presence of anemia and inflammation are signs of Kawasaki disease.Testing for a substance called B-type natriuretic peptide (BNP) that’s released when the heart is under stress may be helpful in diagnosing Kawasaki disease. However, more research is needed to confirm this finding.
  • Electrocardiogram. Electrodes are attached to the skin to measure the electrical impulses of your child’s heartbeat. Kawasaki disease can cause heart rhythm problems.
  • Echocardiogram. This test uses ultrasound images to show how well the heart is working and can help identify problems with the coronary arteries.

Treatment

Treatment for Kawasaki disease may include:

  • Gamma globulin. Infusion of an immune protein (gamma globulin) through a vein (intravenously) can lower the risk of coronary artery problems.
  • Aspirin. High doses of aspirin may help treat inflammation. Aspirin can also decrease pain and joint inflammation, as well as reduce the fever.Kawasaki treatment is a rare exception to the rule that says aspirin shouldn’t be given to children. Aspirin has been linked to Reye’s syndrome, a rare but potentially life-threatening condition, in children recovering from chickenpox or flu. Children should be given aspirin only under the supervision of a doctor.

Because of the risk of serious complications, initial treatment for Kawasaki disease usually is given in a hospital.

After the initial treatment

Once the fever goes down, your child may need to take low-dose aspirin for at least six weeks and longer if he or she develops a coronary artery aneurysm. Aspirin helps prevent clotting.

However, if your child develops flu or chickenpox during treatment, he or she may need to stop taking aspirin. Taking aspirin has been linked to Reye’s syndrome, a rare but potentially life-threatening condition that can affect the blood, liver and brain of children and teenagers after a viral infection.

With treatment, your child may start to improve soon after the first gamma globulin treatment. Without treatment, Kawasaki disease lasts an average of 12 days. However, heart complications may be longer lasting.

Monitoring heart problems

If your child has any signs of heart problems, the doctor may recommend follow-up tests to check your child’s heart health at regular intervals, often at six to eight weeks after the illness began, and then again after six months.

If heart problems continue, you may be referred to a doctor who specializes in treating heart disease in children (pediatric cardiologist). Treatment for heart complications related to Kawasaki disease depends on what type of heart condition is present. If a coronary artery aneurysm ruptures, treatment may include anticoagulant drugs, stent placement, or bypass surgery.


Leukemia

Overview

Leukemia is cancer of the body’s blood-forming tissues, including the bone marrow and the lymphatic system.

Some forms of leukemia are more common in children. Other forms of leukemia occur mostly in adults.

Leukemia usually involves the white blood cells. Your white blood cells are potent infection fighters — they normally grow and divide in an orderly way, as your body needs them. But in people with leukemia, the bone marrow produces an excessive amount of abnormal white blood cells, which don’t function properly.

Symptoms

Leukemia symptoms vary, depending on the type of leukemia. Common leukemia signs and symptoms include:

  • Fever or chills
  • Persistent fatigue, weakness
  • Frequent or severe infections
  • Losing weight without trying
  • Swollen lymph nodes, enlarged liver or spleen
  • Easy bleeding or bruising
  • Recurrent nosebleeds
  • Tiny red spots in your skin (petechiae)
  • Excessive sweating, especially at night
  • Bone pain or tenderness

How leukemia is classified

Doctors classify leukemia based on its speed of progression and the type of cells involved.

The first type of classification is by how fast the leukemia progresses:

  • Acute leukemia. In acute leukemia, the abnormal blood cells are immature blood cells (blasts). They can’t carry out their normal functions, and they multiply rapidly, so the disease worsens quickly. Acute leukemia requires aggressive, timely treatment.
  • Chronic leukemia. There are many types of chronic leukemias. Some produce too many cells and some cause too few cells to be produced. Chronic leukemia involves more-mature blood cells. These blood cells replicate or accumulate more slowly and can function normally for a period of time. Some forms of chronic leukemia initially produce no early symptoms and can go unnoticed or undiagnosed for years.

The second type of classification is by type of white blood cell affected:

  • Lymphocytic leukemia. This type of leukemia affects the lymphoid cells (lymphocytes), which form lymphoid or lymphatic tissue. Lymphatic tissue makes up your immune system.
  • Myelogenous (my-uh-LOHJ-uh-nus) leukemia. This type of leukemia affects the myeloid cells. Myeloid cells give rise to red blood cells, white blood cells and platelet-producing cells.

Types of leukemia

The major types of leukemia are:

  • Acute lymphocytic leukemia (ALL). This is the most common type of leukemia in young children. ALL can also occur in adults.
  • Acute myelogenous leukemia (AML). AML is a common type of leukemia. It occurs in children and adults. AML is the most common type of acute leukemia in adults.
  • Chronic lymphocytic leukemia. the most common chronic adult leukemia, you may feel well for years without needing treatment.
  • Chronic myelogenous leukemia . This type of leukemia mainly affects adults. A person with CML may have few or no symptoms for months or years before entering a phase in which the leukemia cells grow more quickly.
  • Other types. Other, rarer types of leukemia exist, including hairy cell leukemia, myelodysplastic syndromes and myeloproliferative disorders.

Risk factors

Factors that may increase your risk of developing some types of leukemia include:

  • Previous cancer treatment. People who’ve had certain types of chemotherapy and radiation therapy for other cancers have an increased risk of developing certain types of leukemia.
  • Genetic disorders. Genetic abnormalities seem to play a role in the development of leukemia. Certain genetic disorders, such as Down syndrome, are associated with an increased risk of leukemia.
  • Exposure to certain chemicals. Exposure to certain chemicals, such as benzene — which is found in gasoline and is used by the chemical industry — is linked to an increased risk of some kinds of leukemia.
  • Smoking. Smoking cigarettes increases the risk of acute myelogenous leukemia.
  • Family history of leukemia. If members of your family have been diagnosed with leukemia, your risk of the disease may be increased.

Diagnosis

  • Physical exam. Your doctor will look for physical signs of leukemia, such as pale skin from anemia, swelling of your lymph nodes, and enlargement of your liver and spleen.
  • Blood tests. By looking at a sample of your blood, your doctor can determine if you have abnormal levels of red or white blood cells or platelets — which may suggest leukemia. A blood test may also show the presence of leukemia cells, though not all types of leukemia cause the leukemia cells to circulate in the blood. Sometimes the leukemia cells stay in the bone marrow.
  • Bone marrow test. Your doctor may recommend a procedure to remove a sample of bone marrow from your hipbone. The bone marrow is removed using a long, thin needle. The sample is sent to a laboratory to look for leukemia cells. Specialized tests of your leukemia cells may reveal certain characteristics that are used to determine your treatment options.

Treatment

Treatment for your leukemia depends on many factors. Your doctor determines your leukemia treatment options based on your age and overall health, the type of leukemia you have, and whether it has spread to other parts of your body, including the central nervous system.

Common treatments used to fight leukemia include:

  • Chemotherapy. Chemotherapy is the major form of treatment for leukemia. This drug treatment uses chemicals to kill leukemia cells.Depending on the type of leukemia you have, you may receive a single drug or a combination of drugs. These drugs may come in a pill form, or they may be injected directly into a vein.
  • Targeted therapy. Targeted drug treatments focus on specific abnormalities present within cancer cells. By blocking these abnormalities, targeted drug treatments can cause cancer cells to die. Your leukemia cells will be tested to see if targeted therapy may be helpful for you.
  • Radiation therapy. Radiation therapy uses X-rays or other high-energy beams to damage leukemia cells and stop their growth. During radiation therapy, you lie on a table while a large machine moves around you, directing the radiation to precise points on your body.You may receive radiation in one specific area of your body where there is a collection of leukemia cells, or you may receive radiation over your whole body. Radiation therapy may be used to prepare for a bone marrow transplant.
  • Bone marrow transplant. A bone marrow transplant, also called a stem cell transplant, helps reestablish healthy stem cells by replacing unhealthy bone marrow with leukemia-free stem cells that will regenerate healthy bone marrow.Prior to a bone marrow transplant, you receive very high doses of chemotherapy or radiation therapy to destroy your leukemia-producing bone marrow. Then you receive an infusion of blood-forming stem cells that help rebuild your bone marrow.You may receive stem cells from a donor or you may be able to use your own stem cells.
  • Immunotherapy. Immunotherapy uses your immune system to fight cancer. Your body’s disease-fighting immune system may not attack your cancer because the cancer cells produce proteins that help them hide from the immune system cells. Immunotherapy works by interfering with that process.
  • Engineering immune cells to fight leukemia. A specialized treatment called chimeric antigen receptor (CAR)-T cell therapy takes your body’s germ-fighting T cells, engineers them to fight cancer and infuses them back into your body. CAR-T cell therapy might be an option for certain types of leukemia.
  • Clinical trials. Clinical trials are experiments to test new cancer treatments and new ways of using existing treatments. While clinical trials give you or your child a chance to try the latest cancer treatment, treatment benefits and risks may be uncertain. Discuss the benefits and risks of clinical trials with your doctor.

Congestive Heart Failure

What is congestive heart failure?

Heart failure describes the inability or failure of the heart to meet the needs of organs and tissues for oxygen and nutrients. This decrease in cardiac output, the amount of blood that the heart pumps, is not adequate to circulate the blood returning to the heart from the body and lungs, causing the fluid (mainly water) to leak from capillary blood vessels. This leads to symptoms that may include shortness of breath, weakness, and swelling.

Understanding blood flow in the heart and body

The right side of the heart pumps blood to the lungs while the left side pumps blood to the rest of the body. Blood from the body enters the right atrium through the vena cava. It then flows into the right ventricle where it is pumped to the lungs through the pulmonary artery, which carries deoxygenated blood to the lungs. In the lungs, oxygen is loaded onto red blood cells and returns to the left atrium of the heart via the pulmonary veins. Blood then flows into the left ventricle where it is pumped to the organs and tissues of the body. Oxygen is downloaded from red blood cells into the various organs while carbon dioxide, a waste product of metabolism, is added to be removed in the lungs. Blood then returns to the right atrium to start the cycle again. The pulmonary veins are unusual in that they carry oxygenated blood, while the pulmonary artery carries deoxygenated blood. This is a reversal of duties versus the roles of veins and arteries in the rest of the body.

Understanding blood flow in the heart and body.

Left heart failure occurs when the left ventricle cannot pump blood to the body and fluid backs up and leaks into the lungs causing shortness of breath. Right heart failure occurs when the right ventricle cannot adequately pump blood to the lungs. Blood and fluid may back up in the veins that deliver blood to the heart. This can cause fluid to leak into tissues and organs.

Understanding blood flow in the heart and body.

Left heart failure occurs when the left ventricle cannot pump blood to the body and fluid backs up and leaks into the lungs causing shortness of breath. Right heart failure occurs when the right ventricle cannot adequately pump blood to the lungs. Blood and fluid may back up in the veins that deliver blood to the heart. This can cause fluid to leak into tissues and organs.

It is important to know that both sides of the heart may fail to function adequately at the same time and this is called biventricular heart failure. This often occurs since the most common cause of right heart failure is left heart failure.

What are the signs and symptoms of congestive heart failure?

Shortness of breath

The hallmark and most common symptom of left heart failure is shortness of breath and may occur.

  1. While at rest
  2. With activity or exertion
  3. While lying flat (orthopnea)
  4. While awakening the person from sleep (paroxysmal nocturnal dyspnea); or
  5. Due to fluid (water, mainly) accumulation in the lungs or the inability of the heart to be efficient enough to pump blood to the organs of the body when called upon in times of exertion or stress.

Right heart failure, left heart failure, or both

Chest Pain

  1. Chest pain or angina may be associated, especially if the underlying cause of the failure is coronary heart disease.
  1. People with right heart failure leak fluid into the tissue and organs that deliver blood to the right heart through the vena cava.
  2. Backpressure in capillary blood vessels causes them to leak water into space between cells and commonly the fluid can be found in the lowest parts of the body.
  3. Gravity causes fluid to accumulate in the feet and ankles but as more fluid accumulates, it may creep up to involve all of the lower legs.
  4. Fluid can also accumulate within the liver causing it to swell (hepatomegaly) and within the abdominal cavity (ascites).
  5. Ascites and hepatomegaly may make the patient feel bloated, nauseated, and have abdominal pain with the feeling of distension.
  6. Depending upon their underlying illness and the clinical situation, patients may have symptoms of right heart failure, left heart failure, or both.

What causes congestive heart failure?

Many disease processes can impair the pumping efficiency of the heart to cause congestive heart failure. In the United States,. The most common causes of congestive heart failure are:

  • Coronary artery disease
  • High blood pressure (hypertension)
  • Longstanding alcohol abuse
  • Disorders of the disorders of the heart valves
  • Unknown (idiopathic) causes, such as after recovery from myocarditis

Less common causes of congestive heart failure include:

  • Viral infections of the stiffening of the heart muscle
  • Thyroid disorders
  • Heart rhythm abnormalities

In people with congestive heart failure with underlying heart disease, taking certain medications could lead to the development or worsening of the lung disease. Moreover, drugs that can cause sodium retention or affect the power of the heart muscle. Examples of such medications are the commonly used nonsteroidal anti-inflammatory drugs (NSAIDs), which include ibuprofen (Motrin and others) and naproxen (Aleve and others) as well as certain steroids, some medication for type 2 diabetes, for example, rosiglitazone (Avandia) or pioglitazone (Actos), and some calcium channel blockers (CCBs).


Paralysis

What is paralysis?

Paralysis is a loss of strength in and control over a muscle or group of muscles in a part of the body. Most of the time, this is not due to a problem with the muscles themselves. It is more likely due to a problem somewhere along the chain of nerve cells that runs from the body part to your brain and back again. These nerve cells deliver the signals for your muscles to move.

There are many types and degrees of paralysis. The condition can be:

  • Partial, when you still have some control of your muscles (sometimes called paresis).
  • Complete, when you can’t move your muscles at all.
  • Permanent, when muscle control never comes back.
  • Temporary, when some or all muscle control returns.
  • Flaccid, when the muscles get flabby and shrink.
  • Spastic, when the muscles are tight and hard and jerk around oddly (spasm).

Paralysis can occur in any part of the body and is either localized, when it affects only one part of the body, or generalized, when it affects a wider area of the body.

Localized paralysis often affects areas such as the face, hands, feet, or vocal cords.

Generalized paralysis is broken down based on how much of the body is paralyzed:

  • Monoplegia affects one limb only, such as one arm or one leg.
  • Hemiplegia affects one side of the body, such as the leg and arm of the same side of the body.
  • Diplegia affects the same area on both sides of the body, such as both arms or both sides of the face.
  • Paraplegia affects both legs and sometimes parts of the trunk.
  • Quadriplegia affects both arms and both legs and sometimes the entire area from the neck down. The function of the heart, lungs, and other organs might also be affected.

What causes paralysis?

Muscle movement is controlled by trigger signals relayed from the brain. When any part of the relay system — such as the brain, spinal cord, nerves, or junction between the nerve and the muscle — is damaged, the signals to move do not make it through to the muscles and paralysis results. There are many ways the relay system can be damaged.

A person can be born with paralysis due to a birth defect such as spina bifida, which occurs when the brain, spinal cord, and/or the covering that protects them do not form the right way. In most cases, people get paralysis as the result of an accident or a medical condition that affects the way muscles and nerves function. The most common causes of paralysis include:

  • Stroke
  • Spinal cord injury
  • Head injury
  • Multiple sclerosis

Some other causes include:

  • Cerebral palsy
  • Guillain-Barré syndrome
  • Peripheral neuropathy
  • Toxins/poisons
  • ALS (Lou Gehrig’s disease

What are the symptoms of paralysis?

Symptoms of paralysis may vary based on the cause, but are often easy to spot. A person born paralyzed due to a birth defect, or paralyzed suddenly due to a stroke or spinal cord injury, will be partially or totally unable to move the affected body parts. At the same time, the person may experience muscle stiffness and decreased feeling in the affected body parts.

A person who becomes paralyzed due to a medical condition might lose muscle control and feeling slowly. The person might feel tingling or numbing sensations or muscle cramps before losing control of his or her muscles.

What other problems can occur with paralysis?

Because paralysis can happen to any muscle or group of muscles, many body functions can be affected. Some of the problems that can occur along with paralysis include:

  • Problems with blood flow, breathing, and heart rate
  • Changes in the normal function of organs, glands, and other tissues
  • Changes to muscles, joints, and bones
  • Skin injuries and pressure sores
  • Blood clots in the legs
  • Loss of urine and bowel control
  • Sexual problems
  • Problems speaking or swallowing
  • Behavior and mood changes

How does the doctor diagnose paralysis?

Diagnosing paralysis is often easy to do because the main symptom — loss of muscle control in a body area — is obvious. An important part of the diagnosis is to determine the cause of the paralysis. This can be relatively straightforward if the paralysis occurs after an event such as a stroke or spinal cord injury. Sometimes, the doctor might want to learn more about the injury that’s causing the paralysis, the degree of the paralysis, and/or the state of the nerves involved. To do that, the doctor might use one or more of these tests:

  • X-ray: This test uses small amounts of radiation to produce detailed images of the dense structures inside the body, such as the bones.
  • CT scan: CT uses computers to combine many X-ray images into cross-sectional views of the inside of the body.
  • MRI: MRI uses a large magnet, radio waves, and a computer to create clear images of the body.
  • Myelography: This test uses a contrast dye that is injected into the spinal canal to make the nerves show up very clearly on an X-ray, CT scan, or MRI.
  • Electromyography (EMG): This test is used to measure the electrical activity in the muscles and nerves.
  • Spinal tap: A long needle is injected into the spine to collect spinal fluid.

How is paralysis treated?

Currently, there is no cure for paralysis itself. In certain cases, some or all muscle control and feeling returns on its own or after treatment of the cause for the paralysis. For example, spontaneous recovery often occurs in cases of Bell’s palsy, a temporary paralysis of the face. It might also occur to some extent with treatment after a stroke. Sometimes, treatment is important to prevent further worsening of paralysis, for example in multiple sclerosis.

Rehabilitation is often recommended to address problems that can occur as a consequence of the paralysis, to enable the paralyzed person to live as independently as possible and to provide the person with a high quality of life. Some of the rehabilitation treatments used for people with paralysis include:

  • Physical therapy uses treatments such as heat, massage, and exercise to stimulate nerves and muscles.
  • Occupational therapy concentrates on ways to perform activities of daily living.
  • Mobility aids include manual and electric wheelchairs and scooters.
  • Supportive devices include braces, canes, and walkers.
  • Assistive technology such as voice-activated computers, lighting systems, and telephones.
  • Adaptive equipment such as special eating utensils and controls for driving a car.

What is the outlook for people with paralysis?

The evolution of paralysis depends on the cause, but in most cases the paralysis cannot be fully reversed. Paralysis, especially sudden paralysis, leads to many emotions.

For this reason, depression is common in people with paralysis. Help is available to cope with this difficult life transition. Having paralysis often requires making major changes to your way of life. People with some types of paralysis, such as monoplegia, hemiplegia, and paraplegia, can usually lead independent and active lives with the help of mobility aids and supportive and adaptive devices. While people with quadriplegia need lifelong care and support from others, they can still live happy and fulfilling lives.

It is important for people with paralysis to keep a healthy lifestyle. This includes remaining as physically active as possible, and exercising on a regular basis. Exercises can be adapted to take into account the limitations related to paralysis.

When should I call my healthcare provider?

Call your healthcare provider if you experience any numbing or tingling feelings in your muscles, or if you suddenly cannot move a muscle or body part.

Also, call 9-1-1 right away if you have any of the signs of a stroke. A stroke is a medical emergency and effective treatments are available, but they must be started within a few hours after stroke symptoms begin.

The American Stroke Association uses the word F.A.S.T. as a guide to identify a stroke and call 9-1-1:

  • F: Face drooping
  • A: Arm weakness
  • S: Speech difficulty
  • T: Time to call 9-1-1

These other symptoms, all of which come on suddenly, may appear separately or in combination with F.A.S.T. signs:

  • Sudden confusion, trouble speaking or understanding speech.
  • Sudden numbness of face, arm, or leg, usually on one side of the body.
  • Sudden trouble with vision in one of both eyes.
  • Sudden trouble walking, dizziness, loss of balance or coordination.
  • Sudden onset of headache with no known cause.


High blood pressure (hypertension)

High blood pressure (hypertension) is a common condition in which the long-term force of the blood against your artery walls is high enough that it may eventually cause health problems, such as heart disease.

Blood pressure is determined both by the amount of blood your heart pumps and the amount of resistance to blood flow in your arteries. The more blood your heart pumps and the narrower your arteries, the higher your blood pressure. A blood pressure reading is given in millimeters of mercury (mm Hg). It has two numbers.

You can have high blood pressure for years without any symptoms. Uncontrolled high blood pressure increases your risk of serious health problems, including heart attack and stroke. Fortunately, high blood pressure can be easily detected. And once you know you have high blood pressure, you can work with your doctor to control it.

You can have high blood pressure for years without any symptoms. Uncontrolled high blood pressure increases your risk of serious health problems, including heart attack and stroke. Fortunately, high blood pressure can be easily detected. And once you know you have high blood pressure, you can work with your doctor to control it.

Causes

There are two types of high blood pressure.

Primary (essential) hypertension

For most adults, there’s no identifiable cause of high blood pressure. This type of high blood pressure, called primary (essential) hypertension, tends to develop gradually over many years.

Secondary hypertension

Some people have high blood pressure caused by an underlying condition. This type of high blood pressure, called secondary hypertension, tends to appear suddenly and cause higher blood pressure than does primary hypertension. Various conditions and medications can lead to secondary hypertension, including:

  • Obstructive sleep apnea
  • Kidney disease
  • Adrenal gland tumors
  • Thyroid problems
  • Certain defects you’re born with (congenital) in blood vessels
  • Certain medications, such as birth control pills, cold remedies, decongestants, over-the-counter pain relievers and some prescription drugs
  • Illegal drugs, such as cocaine and amphetamines

Risk factors

High blood pressure has many risk factors, including:

  • Age. The risk of high blood pressure increases as you age. Until about age 64, high blood pressure is more common in men. Women are more likely to develop high blood pressure after age 65.
  • Race. High blood pressure is particularly common among people of African heritage, often developing at an earlier age than it does in whites. Serious complications, such as stroke, heart attack and kidney failure, also are more common in people of African heritage.
  • Family history. High blood pressure tends to run in families.
  • Being overweight or obese. The more you weigh, the more blood you need to supply oxygen and nutrients to your tissues. As the amount of blood blow through your blood vessels increases, so does the pressure on your artery walls.
  • Not being physically active. People who are inactive tend to have higher heart rates. The higher your heart rate, the harder your heart must work with each contraction and the stronger the force on your arteries. Lack of physical activity also increases the risk of being overweight.
  • Using tobacco. Not only does smoking or chewing tobacco immediately raise your blood pressure temporarily, but the chemicals in tobacco can damage the lining of your artery walls. This can cause your arteries to narrow and increase your risk of heart disease. Secondhand smoke also can increase your heart disease risk.
  • Too much salt (sodium) in your diet. Too much sodium in your diet can cause your body to retain fluid, which increases blood pressure.
  • Too little potassium in your diet. Potassium helps balance the amount of sodium in your cells. A proper balance of potassium is critical for good heart health. If you don’t get enough potassium in your diet, or you lose too much potassium due to dehydration or other health conditions, sodium can build up in your blood.
  • Drinking too much alcohol. Over time, heavy drinking can damage your heart. Having more than one drink a day for women and more than two drinks a day for men may affect your blood pressure.If you drink alcohol, do so in moderation. For healthy adults, that means up to one drink a day for women and two drinks a day for men. One drink equals 12 ounces of beer, 5 ounces of wine or 1.5 ounces of 80-proof liquor.
  • Stress. High levels of stress can lead to a temporary increase in blood pressure. Stress-related habits such as eating more, using tobacco or drinking alcohol can lead to further increases in blood pressure.
  • Certain chronic conditions. Certain chronic conditions also may increase your risk of high blood pressure, including kidney disease, diabetes and sleep apnea.

Sometimes pregnancy contributes to high blood pressure as well.

Although high blood pressure is most common in adults, children may be at risk, too. For some children, high blood pressure is caused by problems with the kidneys or heart. But for a growing number of kids, poor lifestyle habits — such as an unhealthy diet and lack of exercise — contribute to high blood pressure.

Complications

The excessive pressure on your artery walls caused by high blood pressure can damage your blood vessels as well as your organs. The higher your blood pressure and the longer it goes uncontrolled, the greater the damage.

Uncontrolled high blood pressure can lead to complications including:

  • Heart attack or stroke. High blood pressure can cause hardening and thickening of the arteries (atherosclerosis), which can lead to a heart attack, stroke or other complications.
  • Aneurysm. Increased blood pressure can cause your blood vessels to weaken and bulge, forming an aneurysm. If an aneurysm ruptures, it can be life-threatening.
  • Heart failure. To pump blood against the higher pressure in your vessels, the heart has to work harder. This causes the walls of the heart’s pumping chamber to thicken (left ventricular hypertrophy). Eventually, the thickened muscle may have a hard time pumping enough blood to meet your body’s needs, which can lead to heart failure.
  • Weakened and narrowed blood vessels in your kidneys. This can prevent these organs from functioning normally.
  • Thickened, narrowed or torn blood vessels in the eyes. This can result in vision loss.
  • Metabolic syndrome. This syndrome is a group of disorders of your body’s metabolism, including increased waist size, high triglycerides, decreased high-density lipoprotein (HDL) cholesterol (the “good” cholesterol), high blood pressure and high insulin levels. These conditions make you more likely to develop diabetes, heart disease and stroke.
  • Trouble with memory or understanding. Uncontrolled high blood pressure may also affect your ability to think, remember and learn. Trouble with memory or understanding concepts is more common in people with high blood pressure.
  • Dementia. Narrowed or blocked arteries can limit blood flow to the brain, leading to a certain type of dementia (vascular dementia). A stroke that interrupts blood flow to the brain also can cause vascular dementia.