Ankylosing spondylitis ( AS )

~ Is a form of arthritis.

~ Late diagnosis may result in inflammation which spreads up from the spine and cause the bones in the rib cage to fuse ( jointed together ) resulting in breathing difficulties.

~ In severe cases , the heart and eyes may be affected.

~ Ankylosing ( Greek word ) - fusing together spondylitis - inflammation of the vertebrae.

~ Is a condition when some or all of the bones at the spine fuse or join together.

~ Involve genetic factors ( abnormal gene called HLA - B27 )

~ Three times more common in men.

~ There is inflammation outside the little joint between the spine where the ligament and tendon's are attached to the bone.

~ To heal the body,the spinal bones create new bone matter over the existing bones causing them to become stiff and inflexible.

~ Then stiffen the rib cage,affecting lung and heart function.

~ Main treatment is to relieve pain and stiffness to prevent or delay complications or spinal deformity.

~ Experience early morning stiffness and pain,wear off or reduce in intensity throughout the day with increased mobility or exercise.

~ Feel better after exercising and worse after rest,especially prolonged rest.

Atherosclerosis

~ The narrowing of arteries due to plaque building up causes the space inside the artery to narrow and flow of blood becomes restricted.

~ Cholesterol gets deposited in the arteries and get clogged.

~ The narrowing causes ischaemic heart disease ; lack of blood supply to the heart muscles.

~ Almost half of those heart attacks are found to have normal cholesterol levels.

~ Hardening of arteries is another attributed to inflammation of the arteries.

~ Inflammation of the lining of the arteries is more of the root cause.

~ Inflammation,a protective response of the body against infection and injury,may damage blood vessels if it goes out of control.

~ High cholesterol,high blood pressure,diabetes,smoking and a sedentary life style are the main causes of heart disease.

~ Precursors of inflammation are actually trans-fatty acids,saturated fat,sugar and carbohydrates.

~ Trans-fatty acids are mostly found in hydrogenated oil ( margarine )

~ Important factor in choosing carbohydrates is the Glycaemic Index ( GI ) - an indicator of how fast carbohydrates and sugars in the certain food raise blood sugar levels.

~ High GI ( refined carbohydrates ) - potatoes,table sugar break down in the body rapidly and raise blood sugar levels in a short time.

~ The spike in blood sugar levels generated may cause inflammation as high blood sugar levels,even if transient,favour a process called glycation,which damages and distorts body structures and functions triggering an inflammatory response.

~ Difference between an angina and a heart attack is : - 

( i ) Angina,the heart muscle lacks oxygen but undamaged.

( ii ) Heart attack,the heart muscle dies due to the shortage of oxygen caused by a total occlusion of the coronary artery.

Lymph Node

~ An integral part of the lymphatic system.

~ Forms a very important component of the body's immune system.

~ Lymphatic system is made out of lymph nodes and lymphatic ducts.( spreads throughout the body )

~ Transport lymph ( fluid ) washed the tissues around the cells.

~ Lymph contains a lot of white blood cells ( lymphocytes,which produce antibodies to counter foreign substances ( bacterias & viruses ) that enter the body ),fluid from the intestines(chyle) and some red blood cells.

~ Lymph re-enters our blood vessels through our veins.

~ Lymph nodes are clusters of cells that are surrounded by a capsule.

~ The lymphatic ducts enter and come out of them.

~ Lymph nodes are " clean up " centres in the body where bacteria and viruses are forced to go through ( thus encountering massive numbers of lymphocytes )

~ One of the biggest clusters of lymph nodes is located in the spleen.

~ Most lymph nodes are very small and bean-shaped.

~ They enlarges when there is an underlying disease process going on in the body.

~ They enlarges or swollen in your neck,under your chin,in your armpits,in your groin,( any lymph node throughout the body can be enlarged )

~ Causes a lymph node to swell : -

( i ) Infection : number of white blood cells fight the foreign body invasion multiply.)

( ii ) Inflammation : infiltration with inflammatory cells during an infection.

( iii ) Cancer : Infiltration with cancer cells in a process called metastases. ( cancer cells are " brought " to the node through lymph flowing from the primary cancer )

( iv ) blood cancers : uncontrolled,malignant multiplication of lymphocytes as in lymphoma or leukaemia result in enlarged nodes.

~ Lymph nodes with infection are tender to the touch appear and swell quickly ( 1-2 days) accompanied with signs and symptoms of the infection . ( fever,sore throat,cough,etc) they subside to their normal size when the infection is treated .

Kawasaki's disease

~ Also called Kawasaki's syndrome,described as a " vasculitic syndrome"  - disease of the blood vessels

~ Disease of childhood.

~ First described by a Japanese doctor named Tomisaku Kawasaki in 1967.

~ Common in infants aged from 6-12 months.

~ Also occur in children older than 5 years.

~ Most common in boys rather than girls.

~ Researchers suspect something infectious such as viruses or bacterias.

~ It trigger off immune reactivity and the child's own " altered " immune system than turn against his own body to his blood vessels.

~ Having a prolonged fever 39 degrees celsius and unresponsive to antibiotic.

~ Changes in the hands and feet such as swelling,redness or rash and peeling of skin ( desquamation )

~ Not wish to move the hands and feet much,find it difficult to walk. ( happens in 75 % of all cases,2 weeks after the fever's onset )

~ Conjuctivitis of both eyes ( 85% of cases )

~ A rash occurs throughout the body ( 80% of cases ) some occurs in the groin or legs .

~ Enlarged neck lymph nodes.

~ Changes in the lips like swelling,redness or dryness and fissuring.

~ Have a strawberry tongue-(red and the papillae stands clearly out )

~ Fever and rash phase last for 1-2 weeks during this time,heart muscle and the layer surrounding it may be inflamed.

~ After the fever comes another phase until week four,- no appetite,continue to have conjuctivitis,skin changes in the hand and feet are noted.

~ Internal blood vessels(especially the coronary arteries) develop aneurysms-weakening of the vessel walls leading to a bulge.This phase is at the highest risk of death.

~ After the second phase comes the recovery phase the aneurysms are still present the child may have to live with aneurysms for the rest of the life.

~ Aneurysms may come back to haunt him when they rupture during adulthood.

~ The treatment is actually to decrease the severity of the immune reaction.

~ 2% die due to heart attack or heart complications.

Thalassaemia

~ A blood disorder that inherited the day conceived.

~ Caused by charges to the genes that control the production of oxygen-carrying molecules (haemoglobins) in red blood cells.

~ These changes may produce less haemoglobin or haemoglobin that are less efficient in carrying oxygen.

~ Their red blood cells tend to get destroyed faster too.

~ When that happens,they do not have enough haemoglobin or red blood cells ( anaemia ) to carry oxygen around their body.

~ May appear pale and feel fatigued.

~ 2 major types : ( i ) alpha thalassaemia ( ii ) beta thalassaemia,some have delta thalassaemia

~ Patients require regular blood transfusion to have enough healthy red blood cells that can carry enough oxygen to all parts of the body.

~ Signs & symptoms : Fatigue,weakness,shortness of breath,pale appearance and a protruding abdomen.

~ symptoms starts as earlier as at the age of 6 months.

~ Diagnosis is usually made in the first year of life.

~ Poor feeding and poor growth,pale and abdomen is distended due to an enlarged spleen and liver.

~ Diagnosed by a series of blood tests.

~ First blood test evaluates the quality,shape and size of the red blood cells.

~ If not normal,further tests including tests to evaluate the haemoglobin and DNA to diagnose the diseases.

~ Regular transfusions can cause iron to accumulate in the patient's body.

~ Therefore,they need treatment to remove excess iron from their bodies.

~ Can be cured with bone marrow transplantation ( BMT )

ｐｏｌｉｏ

～　ｃａｕｓｅｄ　ｂｙ　ｔｈｅ　ｐｏｌｉｏ　ｖｉｒｕｓ　．
～　ｓｐｒｅａｄ　ｔｈｒｏｕｇｈ　ｃｏｎｔａｍｉｎａｔｅｄ　ｆｏｏｄ　，　ｗａｔｅｒ　，　ｔｈｒｏｕｇｈ　ｃｌｏｓｅ　ｃｏｎｔａｃｔ　．
～　ｉｔ　ｃａｕｓｅｄ　ｐａｒａｌｙｓｉｓ　ａｎｄ　ｄｅａｔｈ　．
～　ｔｈｅ　ｐｏｌｉｏ　ｖａｃｃｉｎｅ　ｉｓ　ａ　　ｌｉｖｅ　ａｔｔｅｎｕａｔｅｄ　ｖｉｒｕｓ　，　ｗｈｉｃｈ　ｍｅａｎｓ　ｉｔ　ｃｏｎｓｉｓｔｓ　ｏｆ　ｗｅａｋｅｎｅｄ　ｐｏｌｉｏ　ｖｉｒｕｓ　ｓｔｒａｉｎｓ　．
～　ｍｏｓｔ　ｏｆ　ｔｈｅ　ｔｉｍｅ　，　ｔｈｅ　ｃｈｉｌｄ　ｇｅｔｓ　ｉｎｆｅｃｔｅｄ　ｗｉｔｈｏｕｔ　ｓｙｍｐｔｏｍｓ（ｂｅｆｏｒｅ　１９５０ｓ　，ｎｅｖｅｒ　ｂｅｅｎ　ｖａｃｃｉｎａｔｅｄ．）
～　ｔｈｅ　ｐｏｌｉｏｖｉｒｕｓ　ｉｓ　ｔｒａｎｓｍｉｔｔｅｄ　ｔｈｒｏｕｇｈ　ｔｈｅ　ｏｒａｌ　ｒｏｕｔｅ　．
～　ｉｔ　ｒｅｐｌｉｃａｔｅｓ　ｉｎ　ｔｈｅ　ｎａｓｏｐｈａｒｙｎｘ　ａｎｄ　ｇａｓｔｒｏｉｎｔｅｓｔｉｎａｌ　ｔｒａｃｔ　，　ｔｈｅｎ　ｉｎｖａｄｅｓ　ｔｈｅ　ｂｌｏｏｄ　ｓｔｒｅａｍ　．
～　ｆｒｏｍ　ｔｈｅ　ｂｌｏｏｄ　，　ｉｔ　ｅｎｔｅｒｓ　ｔｈｅ　ｎｅｒｖｅｓ　，　ｌａｒｇｅｌｙ　，ｔｈｅ　ｍｏｔｏｒ　ｎｅｕｒｏｎｓ　ｉｎ　ｔｈｅ　ｓｐｉｎａｌ　ｃｏｒｄ　．
～　ｍｏｔｏｒ　ｎｅｕｒｏｎｓ　ａｒｅ　ｔｈｅ　ｏｎｅｓ　ｒｅｓｐｏｎｓｉｂｌｅ　ｆｏｒ　ｔｒａｎｓｍｉｔｔｉｎｇ　ｔｈｅ　ｂｒａｉｎ　ｍｅｓｓａｇｅｓ　ｆｏｒ　ｍｏｖｅｍｅｎｔｓ　ｉｎ　ｔｈｅ　ｌｉｍｂｓ　．
～　ｗｉｔｈ　ｔｈｅ　ｍｏｔｏｒ　ｎｅｕｒｏｎｓ　ｄｅｓｔｒｏｙｅｄ　，　ｔｈｅ　ｎｅｒｖｅ　ｉｍｐｕｌｓｅｓ　ｃａｎｎｏｔ　ｂｅ　ｒｅｌａｙｅｄ　ａｎｄ　ｇｅｔ　ｆｌａｃｃｉｄ　ｐａｒａｌｙｓｉｓ　．
～　ａｆｔｅｒ　ａ　ｆｅｗ　ｗｅｅｋｓ　ｏｆ　ｐｏｌｉｏ　ｐａｒａｌｙｓｉｓ　，　ｂｅｇｉｎ　ｔｏ　ｎｏｔｉｃｅ　ｍｕｓｃｌｅｓ　ｄｅｃｒｅａｓｉｎｇ　ｉｎ　ｓｉｚｅ　ａｎｄ　ｂｕｌｋ　（　ｃａｌｌｅｄ　ａｔｒｏｐｈｙ　）
～　ｍａｙ　ｒｅｃｏｖｅｒ　ｃｏｍｐｌｅｔｅｌｙ　，　ｏｒ　ｐａｒｔｉaｌｌｙ　ａｎｄ　ｓｏｍｅ　ｎｅｖｅｒ　ｒｅｃｏｖｅｒ　ａｔ　ａｌｌ　．
～　ｐｏｓｔ　ｐｏｌｉｏ　ｓｙｎｄｒｏｍｅ　ｔｙｐｉｃａｌｌｙ　ｄｅｖｅｌｏｐｓ　３０　－　４０　ｙｅａｒｓ　ａｆｔｅｒ　ｔｈｅ　ｉｎｉｔｉａｌ　ｐｏｌｉｏ　ｉｎｆｅｃｔｉｏｎ　．　（　ｈａｄ　ａ　ｈｉｓｔｏｒｙ　ｏｆ　ｐｏｌｉｏ　ｉｎ　ｔｈｅ　ｐａｓｔ　）
～　ｔｅｎｄ　ｔｏ　ｐｒｏｇｒｅｓｓ　ｓｌｏｗｌｙ　，　ｓｔａｂｉｌｉｓｉｎｇ　ｆｒｏｍ　ｔｉｍｅ　ｔｏ　ｔｉｍｅ　．
～　ｌｏｏｋ　ｏｕｔ　ｆｏｒ　：－

• ｍｕｓｃｌｅｓ　ａｎｄ　ｊｏｉｎｔ　ｗｅａｋｎｅｓｓ　ａｎｄ　ｐａｉｎ　ｔｈａｔ　ｐｒｏｇｒｅｓｓｅｓ　ｇｒａｄｕａｌｌｙ．
• ｔｉｒｅｄｎｅｓｓ　ａｎｄ　ｐｒｏｆｏｕｎｄ　ｆａｔｉｇｕｅ　ｗｉｔｈ　ｊｕｓｔ　ｍｉｎｉｍａｌ　ａｃｔｉｖｉｔｙ　．
• ｍｕｓｃｌｅｓ　ｓｔａｒｔｉｎｇ　ｔｏ　ａｔｒｏｐｈｙ　．
• ｂｒｅａｔｈｉｎｇ　ａｎｄ　ｓｗａｌｌｏｗｉｎｇ　ｐｒｏｂｌｅｍ　．
• ｉｎａｂｉｌｉｔｙ　ｔｏ　ｔｏｌｅｒａｔｅ　ｃｏｌｄ　ｔｅｍｐｅｒａｔｕｒｅｓ　．　

～　ｉｔ　ｉｓ　ｂｅｌｉｅｖｅｄ　ｔｈａｔ　ｔｈｅ　ｉｎｉｔｉａｌ　ｐｏｌｉｏ　ｉｎｆｅｃｔｉｏｎ　ｄｅｓｔｒｏｙｓ　ｔｈｅ　ｍｏｔｏｒ　ｎｅｕｒｏｎｓ　ａｎｄ　ｂｅｎｄ　ｔｈｅｍ　ｏｕｔ　ｏｆ　ｓｈａｐｅ　．
～　ｔｈｅｎ　ｔｏ　ｃｏｍｐｅｎｓａｔｅ　ｆｏｒ　ｔｈｅ neuron shortage , the remaining motor neurons become enlarged and sprout new fibres .
~ this stresses the remaining neurons and over the years , they deteriorate too .
~ then begin to lose their corresponding action .
~ the more severe the initial polio infection , the higher the chance of getting post - polio syndrome .
~ the later the develop polio ( teenager or adult ) the higher the risk also .
~ the better recovery after polio , the higher chance of this syndrome too .
~ because it seems that a greater recovery paces more stress on the remaining motor as neurons .
~ exercise too much also higher the chance of this syndrome because exercise confers stress .
~ polio is a virus , none of the antivirals are effective .

Shingles

~ shingles in a skin rash caused by the virus that also causes chicken pox .
~ also called herpes zoster .
~ the virus is called varicella zoster .
~it belongs to herpes group .
~ shingles usually occurs years after getting chickenpox .
~ once you have had chickenpox , you are immune to get chickenpox again .
~ but the varicella virus may still remain in the body's nervous system - in particular , the nerves .
~ when the body's immune system is suppressed the virus can then be reactivated and cause shingles .
~and once you have suffered from shingles , you are more likely to get it again . ( recurrence )
~ commonly occur in people above age 60 .
~ shingles is contagious . it spread it to another person who has not had chickenpox . they catch chickenpox instead , and not shingles .
~ chickenpox - the rash appears over the body .
~ shingles - rash appear only in one patch of the skin .
~ before rash appears , you may feel a burning pain on a patch of the skin and it may become very sensitive .( go on for several days or up to a week ) during this time , you are actually not sure what you are getting .
~ then small blisters on a red patch begin to appear .
~ new blisters come up . ( 3 - 5 days )
~ the patch of skin involved is the patch serviced by a particular nerve , the same nerve that hosts the varicella virus that has lain dormant all these years in the body .
~ shingles is likely to affect the nerves of the body that service the patches / bands of skin on your trunk or back .
~ these bands are called dermatomes , so the blisters will only appear on the dermatome .
~ usually only one dermatome is involved .
~ like chickenpox , the blisters itch , pop , ooze out liquid , and then crust over as healing begin .
~ this whole process may last up to 4 weeks .
~ there is one variant of shingles where pain is present , but the blisters never appear .
~ usually no complications ( depend on where the shingles is affecting you )
~ when scratch too much and bleed , blisters can get infected with bacteria , then you can have cellulitis .
~ if shingles affect your face , particularly in the region of your forehead and nose , ( a dermatome serviced by fifth cranial nerve ) , eye can be affected .
~ antiviral medication for shingles ( Acyclovir ) should be taken early . ( within three days of the first appearance of the rash .)