What is Hypersensitivity Pneumonitis?

Hypersensitivity pneumonitis is a condition wherein the alveoli inside the lungs are inflamed because of hypersensitivity reaction. This is also referred as extrinsic allergic alveolitis.

The body’s immune system reacts to the inhaled dust which can consist of molds or fungi, bacteria or any organic matter thus causing the inflammation.

The alveoli are the tiny and fundamental structures inside the lungs. These are grape-like structures where the exchange of oxygenated and unoxygenated gas happens. If the alveoli are irritated, the symptoms such as shortness of breath is experienced about 4 to 6 hours after inhalation of the irritant.

Hypersensitivity Pneumonitis Symptoms

There are 2 categories of hypersensitivity pneumonitis- the acute and chronic types; and the symptoms depend on how long the patient experiences the allergic reactions.

Acute Type

In the acute category, the patient will likely experience the problem within 4 to 6 hours of exposure into the antigen. Then the patient will experience the symptoms like:

• chest tightness
• headache
• dyspnea or difficulty of breathing
• body malaise
• fever and cough.
• Nodules in x-ray — When chest x-ray is taken, doctors will notice some nodules but it will soon disappear a few hours after the exposure.

Chronic Type

In the chronic category, the patient does not experience acute episodes or attack. Instead, there is a subtle onset of symptoms like

• fatigue
• difficulty breathing and
• even weight loss.
• Clubbing of fingers is also noticed.
• Fibrous deposits in alveoli – With the chronic stage; there are fibrous deposits in the alveoli instead of nodules found in the x-ray result.

The condition should be addressed right away so that the hypersensitivity pneumonitis is reversed.

Causes, Riskfactors

There are about 300 possible causes of hypersensitivity pneumonitis and most of the antigens are related to patient’s work. The exposure of the organic materials are mostly due to occupation like

• farming
• cattle workers
• poultry workers
• veterinarians
• those who works in the grain and flour
• textile workers and many  others.

The probable organic matter includes:

• cheese molds
• grains
• shell dusts
• moldy hay
• paprika dusts

Diagnosis

Diagnosing hypersensitivity pneumonitis is diagnosed upon the presentation of the symptoms and with laboratory tests like chest x-ray and blood works.

Sometimes biopsy is taken to ensure that the problem is not cancerous in nature especially in chronic hypersensitivity pneumonitis.

Hypersensitivity Pneumonitis Treatment

Treatment goal is directed towards avoiding exposure to the allergens and taking of corticosteroids.

Avoid allergen exposure

It is important to avoid exposure to the probable cause of pneumonitis especially in the workplace. But if it cannot be completely avoided, wearing of protective gear like masks is also recommended. However, if the diseases are worsen, in some occasions, the need to leave work and transfer home is necessary to avoid complications of the condition.

Corticosteroids

To those relatively healthy individuals and experiences acute hypersensitivity pneumonitis, their allergic reaction will subside after a few hours provided that there is no additional exposure to the allergens. But in order to hasten the recovery period, doctors may suggest taking of corticosteroids. This is only recommended to patients who are taking the drug for a short-term period since corticosteroids can result to weight gain and even diabetes in the future

Antibiotics

Sometimes, antibiotics are also required if infection is involved due to the bacteria present in the allergens. But before prescribing the right antibiotic, diagnosis and proper identification of the bacteria through blood culture is important.

Life style changes & Home remedies

Along with that, there are home remedies and lifestyle changes that go along with hypersensitivity pneumonitis. Oxygen therapy may be done especially if the patient has trouble breathing. Drinking lots of water is also helpful to wash away the allergens and to keep the body hydrated. Adequate rest periods is also necessary to recover faster.

Prenatal Causes of Autism

Pregnancy period is an important time frame because only in that stage, the child’s mental health is determined. Thus autism too in most of the cases develops during the prenatal stage itself.

Some causes of autism during pregnancy (prenatal causes) are

Age

The age of mother and father plays an important role in child birth. Recent studies and researches proved that a woman must give birth to her child within her early 30’s. Similarly, men too must become father before their mid-thirties, since old sperms when fertilized may cause mental illness in the child.

Infections

Viral infections in mother at early stage of pregnancy will become a major cause to autism. Mothers-to-be have to be careful about their health from day 1 of the pregnancy as any disease or infection to them may cause autism, ASD or schizophrenia.

Exposure to chemicals

When pregnant ladies are exposed to certain chemicals like pyrethrin, diazinon etc. their embryo tends to be more prone to autism. Similarly certain antibodies present in mother’s body enters placenta and attacks the embryo’s brain thus causing autism.

Testosterone

If testosterone levels are high in a pregnant female, i.e. if she has more male characteristics then the child is more likely to develop autism.

Diseases of mother during pregnancy

The risk of autism in a child of a diabetic mother is twofold than normal one. When the diabetes is not controlled during pregnancy stages, then the child may have oxidative stress, which in turn leads to autism. Nonetheless, the diabetes itself directly doesn’t cause autism. It’s believed that the thyroid problems in mother may lead to autism, however the hypothesis is yet unproved.

Stress

Stress in any form during pregnancy is a major cause for the mental illness of the child. Any form of physical or mental harassment to the mother would have an adverse effect on the embryo.

Other factors

Some other factors for autism during pregnancy are the intensity of ultra sound scans, mal nutrition, side effects of drugs, smoking and other ill habits, vaccines, etc.

Although the exact cause cannot be determined, the above quoted factors are the basis of autism during pregnancy. It’s a well known fact that autism can’t be completely cured. However with right steps, it can be prevented. Take those right steps now because “Prevention is better than cure”.

What is Hyperprolactinemia?

Hyperprolactinemia is a condition wherein there is a high level of prolactin in the blood. This is an abnormal condition because the normal levels of prolactin in women are at 500mIU/L and 450mIU/L or less in men. The prolactin is an important hormone in women because this aids them in lactation during childbirth. This can be a normal condition especially during pregnancy and breastfeeding. Naturally, the pituitary gland will secrete or produce more prolactin when breastfeeding. But hyperprolactenemia may also be pathologic when there is an injury or disease on the pituitary gland or the hypothalamus.

Hyperprolactinemia Symptoms

Symptoms in women

• This condition affects women more than men and it can lead to amenorrhea or skipping menstruation. Sometimes, the menstrual flow may also be irregular.
• In other cases, even though the woman is not pregnant, she will produce breast milk which should not happen.
• It may also affect the vagina causing it to dry and when there is sexual intercourse, it becomes painful.
• Some women experiences low sex drive or decreased libido and some breast pain.

Even though this problem is common in women, men may also experience hyperprolactinemia.

Symptoms in men

• Some recognizable symptoms would include gynecomastia or sudden enlargement of the breast.
• Their sex drive is also lessened or there is decrease in libido.
• Later on, it can lead to infertility and even
• erectile dysfunction.

Hyperprolactinemia Causes

There are different causes that can lead to hyperprolactinemia. This can be due to the

Physiologic changes

• Physiologic changes such as
• pregnancy
• breastfeeding
• mental stress
• overproduction of prolactin

Underlying Disease

Another probably cause of the problem is due to certain diseases.  A known disease that can lead to hyperprolactinemia is the

• Cushing’s syndrome or acromegaly
• hypothyroidism
• chronic renal failure
• bronchogenic carcinoma.
• Seizure may also be linked with the disease because it alters the normal electrical conduction in the brain.
• Tumors in the pituitary gland may also cause overproduction of prolactin.

Drugs

Drugs may also be the cause of hyperprolactinemia. There are drugs that will block the dopamine secretion. Dopamine is an important chemical in the brain and once it is suppressed, the pituitary gland will secrete more prolactin. Example of drug that causes this condition is the tranquilizers like

• phenothiazines
• haloperidol
• domperidone and others

Hyperprolactinemia Diagnosis, Treatment

After consulting the doctor, the health care team will conduct a series of tests to ensure the right diagnosis of the problem. Checking of the prolactin levels through blood samples will explain the symptoms of the prolactin levels are high. Then the physicians will also check for thyroid tests to see if the problem is due to hypothyroidism. This is one of the most common causes especially if the physician reviews the medications and found no relationship between the drugs taken and the high levels of prolactin.

Imaging studies

Imaging studies like plain x-ray will check for big macro-adenoma, or presence of tumors in the head. Sometimes, MRI and CT scans are also ordered to have a better view of the pituitary gland and its nodule.

Reduction of size of tumour

If tumors are found, the main goal of the treatment is to reduce the size of the tumor. 

Surgery

Surgery may be done but it is risky since the pituitary gland is a small gland and adjacent to it is the hypothalamus.

Radiation Therapy

Other options would include doing radiation therapy to effectively decrease the size of the tumor.

Medications

Medications like dopamine agonists are the drug of choice to treat hyperprolactinemia. There should be enough dopamine in the system so that the pituitary gland will not over secrete prolactin hormones.

The drug is called bromocriptine mesylate. This is drug is taken in order to shrink the prolactonimas and it is proven to be effective in reducing the prolactin level of the patients from 70 to 100%. Another drug is the cabergoline. This drug has the same effects with bromocriptine but the side effects are lesser yet the price is higher.

Carbon monoxide or carbonous oxide is a gas that appears to be colorless and odorless. It is also tasteless and non-irritant to people when inhaled but it can be poisonous and life threatening. This is usually difficult to detect because it can be mixed with the air and people can just inhale it. In chemistry, carbon monoxide is a result of the incomplete combustion. This is due to the fact that there is not enough oxygen so it will not be able to oxidize into carbon dioxide.

Carbon monoxide can be found in the combustion of cars, stoves, heating systems and gas range. Because it is odorless and colorless, it is considered as the “silent killer” and according to the Center for Disease Control, an estimate of about 15,000 emergency cases found in the hospitals and about 500 of these died. Home appliances are the usual sources of carbon monoxide. This can be found in: propane heaters, cigarette smoke, and spray paints, saws which use gasoline as a source of power, boat with engine, gas water heaters, and others.

Signs & Symptoms

Carbon monoxide poisoning does not happen then are there right away. There are two types of poisoning from carbon dioxide – the acute and chronic poisoning.

Acute Phase

With the acute phase, the person will experience headache and body malaise. This can be mistaken as a simple problem but increase in exposure can lead to more conclusive symptoms like

1. hallucinations
2. unsteady gait or imbalance when standing
3. seizure
4. dizziness
5. hypotension or low blood pressure
6. unconsciousness which can lead to cardiac arrest.

Chronic Phase

For chronic symptoms, the patient is exposed to carbon monoxide but these are low level carbon monoxide. However later on, the person will

1. feel lightheadedness
2. confusion
3. nausea and vomiting
4. depression
5. memory loss and sometimes
6. permanent neurological problems.

In the long run, it can also lead to cardiac problems resulting to heart failure and even cardiac arrests.

Mechanism

Oxygen is the only gas that should combine with the hemoglobin and transport these to all parts of the body. But if carbon monoxide pairs with oxygen in the hemoglobin, it will result to formation of carboxyhemoglobin (COHb). When this is formed, it will no longer be transported to the other parts of the body.

Effects

The effects of the poisoning can lead to permanent or temporary damage on the vital organs like the brain and heart. But this depends on the exposure of the person to the poisonous gas.

The possible effects of carbon monoxide poisoning can be broken down into this:

1. 10% of COHb will no produce symptoms immediately. Even the heavy smokers, carbon monoxide only consists of about 9%.
2. 15% of COHb can produce mild headache while
3. 25% can lead to nausea and vomiting and headache but it can be quickly recovered if there is oxygen or even a breath of fresh air
4. 30% of COHB will intensify the first few symptoms. But in pregnant women, elderly and even infants, it can lead to permanent damage of the vital organs
5. 45% COHb content can lead to lusciousness
6. 50% + can lead to death.

Diagnosis

Assessment of patients

Diagnosing the problem can be difficult especially if the patient is brought unconscious on the emergency room. So the health care team needs to gather important details such as work, lifestyle and prior activity before bringing them to the hospital.

Luckily, there are some gadgets that measure the level of carbon monoxide in the body such as the CO-oximeter. This is like a pulse oximeter only that it measures the level of carbon monoxide or carbon dioxide in the body. A breathing carbon monoxide gadget can also be used to detect the CO level.

Treatment

The treatment of carbon monoxide poisoning can be tricky.

Oxygenation

The first step is to provide a high dose of oxygenation via the oxygen tank with the use of a face mask. This will show improvement of the breathing pattern of the patient when bought to the hospital. However, if the patient is bought unconsciously, they may have cardiac arrest so a CPR on site may be done.

Treating Underlying sickness

If there are further involvement of vital organs like the heart and the brain, then the patient needs hospitalization to treat the underlying sickness. If the patient has metabolic or respiratory acidosis, then the patient may be given a bolus of sodium bicarbonate. This will help increase the oxygen in the tissues thus improving the breathing pattern of the patient. And before sending the patient home, their carbon monoxide level should be checked first to avoid complications.

What is Restless Leg Syndrome?

This condition is a problem of the leg wherein there is an uncomfortable feeling such as pain the leg area whenever the patient is at rest such as sitting down or even lying in bed. This is a neurological disorder affecting the legs but sometimes, other parts of the body are also affected like the torso or trunk, and the arms.

The RLS is also called as the Willis-Ekbom disease where the patient will associate the discomfort as something that can’t be scratched or a tickle that cannot be stopped. More than that, the restless leg syndrome is intensified when the person is at rest like reading a book, studying and even during sleep.

According to the studies, women have higher tendencies of developing the problem than men. And the symptoms develop gradually peaking when the person is about 50 years old, the symptoms become worse at nighttime causing the, to have an abnormal sleeping pattern.

Picture view to show restless leg syndrome

Symptoms & Signs

With RLS, the problem is diagnosed 10 to 20 years after because at a younger age, the pain is generic and it is not worse. But during middle adulthood, more signs and symptoms are experienced like:

1. Unpleasant sensations wherein patients would describe it as either: cramping, creeping, tense, pulling, uncomfortable, itchy, burning, gnawing, aching, tingling and others
2. The pain escalades when the patient is resting or about to rest
3. Then it worsens during nighttime
4. The pain will be relieved if certain movements are done like jogging, walking, pacing, or whatever movements that offers relief
5. Twitching of the legs during night time
6. Disturbed sleeping pattern

Apart from that, by 2003, the NIH or National Institutes of Health made concise criteria on how to diagnose the problem with the symptoms presented like:

1. Activity improvement where patients will find relief if they keep on moving
2. Having the urge to move the limbs without sensation or with sensation
3. It gets worse while at rest
4. Worsening at night disrupting the circadian rhyth

Causes & Risk factors

There are 2 kinds of restless leg syndrome: the primary and secondary restless leg syndrome. In primary RLS, the cause is idiopathic or unknown. In secondary RLS however, there are underlying medical problems that causes the RLS

1. Lack of iron or iron deficiency is said to be a cause of RLS. Iron is linked with the problem or at some point, it worsens the RLS
2. Peripheral neuropathy. With this problem, the nerves in the arms and legs are damaged causing the lack of oxygen supply in the area then results to painful sensation, numbness and tingling sensation.
3. Abnormalities in the neurotransmitters like dopamine are also likely to cause restless leg syndrome. These neurotransmitters help in regulating the muscle contraction or movements.
4. Medications may also worsen the RLS like antiemtic drugs, antipsychotic drugs, anticonvulsants, anti-depressants, and even sudden withdrawal of benzodiazepines.

Treatment

As soon as restless leg syndrome is diagnosed, it is important to know the cause of the problem and address it right away. There are medications that can be taken in order to avoid worsening the problems like:

A. Opioids

These are narcotics which should be given at a small dose since it can be addicting. Opioids are analgesics of higher dose that helps relieve the uncomfortable feeling. Some opioids include codeine, oxycodone, etc.

B. Parkinson’s disease medications

The Parkinson’s disease medications are given in patients with RLS because it reduces their extra movements. Parkinson’s disease drugs such as carbidopa and levodopa increases the level of dopamine, one of the neurotransmitters in the brain that also causes the restless leg syndrome. Most of the time, the drug taken by patients with RLS are a combination of carbidopa and levodopa and patients are expected to feel mild side effects like nausea and fatigue.

C. Sleeping pills and muscle relaxants

These are prescribed since RLS has the tendency to disrupt the circarian rhythm which dictates the sleeping pattern of an individual. These drugs include clonazepam, eszopiclone, ramelteon, etc.

D. Epileptic drugs

Sometimes, drugs for epilepsy like gabapentin are prescribed to reduce abnormal twitching for patients with restless leg syndrome.

Home Remedies

Aside from the medications prescribed by the doctor, there are home remedies that need to be done in order to give relief from RLS. These include:

1. Massage and warm bath are suggested in order to relax the muscles especially the legs. Aside from massage, there are also other relaxation methods like doing yoga, meditation especially at night before going to bed.
2. Pain relievers are also suggested like NSAIDS to address simple discomforts and relieve muscle twitching sensations
3. Having warm, clean and good sleep hygiene may promote sleep at night. As much as possible, it is important to have a cool and quite place and a comfortable bed to relax and entice sleep. Having a warm shower is also suggested to have good nights sleep.
4. Application of warm and cold packs in alternate is helpful to reduce sensation of the limbs.
5. Vices should be cut like drinking alcohol and smoking. These aggravate the symptoms of RLS especially when there is peripheral neuropathy.
6. Cutting on caffeine or caffeinated drinks may reduce the restlessness felt by the patient.

What is Metatarsalgia?

Metatarsalgia (also known as stone bruise, painful foot or ball-of-foot pain) is a medical term used for the inflammation and pain affecting the metatarsal part of the foot. It includes the joints and bones as well as the nerves therein.

Metatarsalgia Symptoms, Signs

Metatarsalgia may be acute, recurrent or chronic. It is also referred to as a symptom and it may conclude another disease therefore, careful examination of the foot must be done. A person may suspect having metatarsalgia when there is:

• Pain felt on the toes (metatarsal area) described as burning, sharp, aching, increasing, localized or extremewhen standing, walking or moving around, alleviated when on bare foot on hard surface and lessened when immobilized.
• Tingling sensation and/or numbness in the toes.
• Swelling.
• May have visible skin lesions and callous formation in the toes especially underneath the second, third and fourth toe.

Image source – Patient.co.uk

Metatarsalgia Causes, Risk Factors

• Stress due to intense exercise such as running wherein the weight of one’s body is transferred to the toes
• Foot injury/fracture
• Faulty distribution of weight on the toes
• Bunion or toe-joint arthritis and gout
• Poor blood supply to the feet due to poor fitting or high-heeled shoes, as well as having diabetes or edema
• Being overweight. Upon standing, the feet become the shock absorber and carry the weight of the body.
• Foot structure or deformities/ flat feet
• Overuse of the toes as to those of the runners and athletes who always undergo strenuous physical activity
• Older people havethinner foot pads therefore have greater pressure on their toes and may cause metatarsalgia
• Morton’s neuroma (Morton’s metatarsalgia) is a benign growth of fibrous tissue that leads to the thickening of the nerves of the toes and contributes to metatarsal stress. This nerve damage has no certain cause, and is common to women who wear high-heeled and constricting shoes. In Morton’s neuroma, sharp, shooting, intermittent pain can be felt when the person wears shoes and relieved immediately when shoes are removed and the foot is manipulated. Localized tenderness over the site of the neuroma can be assessed.

Diagnostic Tests

• Foot X-ray
• MRI
• Ultrasound
• Electromyography

Treatment

A. Simple measures

Sample measures to lessen pain at the front of the foot

• Remove shoes and massage the painful toes gently several times a day.
• Rest and elevate your feet.
• Apply ice packs wrapped in thin sheet of cloth to the painful area for 20 minutes as needed
• Compress by putting pressure bandage on the area.
• Wear nice fitting shoes and socks. Avoid walking barefooted.
• Keep a normal weight.

B. Medications for metatarsalgia

• Non-steroidal Anti-inflammatory Drugs (i.e. Ibuprofen, Diclofenac Sodium)
• Astringents
• Emollients
• Ointments
• Corticosteroid injection
• Anaesthetics
• Sclerosant injections

C. Orthotics or footpads

Footpads duly fitted and prescribed by a podiatrist or physician

• Rigid
• Semi-rigid

D. Shock absorbing insoles

Shock absorbing insoles to cushion the toes

• Cork
• Rubber
• Plastic
• Gel-like substance

E. Exercises for Matatarsalgia

• Calf muscle stretch, done as if you are pushing the wall. Put your hands on the wall, one foot in front of the other, and the back heel on the floor and knee straight. Do this for 30-60 seconds, twice a day.
• Ankle extension and flexion is done while sitting in a chair, with your painful foot over your other knee. For the ankle extension, hold the ankle and pull the toes of your painful foot towards you. For the ankle flexion, hold the ankle and pull the toes towards your lower leg. Do this for 10 seconds, in 3 sets of 8 repetitions per day, 10 seconds of rest on between.
• Achilles Tendon Stretch is done while sitting on a chair, with your legs straight infront of you. Grasp your toes and pull it towards your knees. Hold this for 10 seconds and relax. Do 3 sets of 10 per day.
• Plantar flexion and dorsiflexion is done with your legs extended while sitting in a chair. Curl your toes as tightly as you can, relax, then, point the toes towards your knee. Hold for 10 seconds and relax. Repeat 10 times.

F. Metatarsalgia shoes

Metatarsalgia shoes must  have:

• Soft and comfortable soles;
• Cushioned and well-fitted arch;
• Enough space for the forefoot to relax;
• Ability to help feet absorb shock;
• Proper materials for individual needs

Surgery

Surgery is not so often necessary but it could be done to realign, reshape or modify metatarsal bones. In Morton’s neuroma, there are two surgical options. One is tocut the metatarsal ligament to give space for the nerve known as nerve decompression, and the other is to remove the nerve on the affected area known as nerve resection.

A small incision will be made either on the top or on the sole of the foot, in between the painful toes.

The operation is mostly done in an out-patient basis, depending on the severity of the condition. The patient may or may not be put in cast, and may or may not be allowed to walk. It may take up to 3 months or more to recover, but, might still have limitations on foot activities.

So with the other surgeries, there are risks involve which includes infection, delayed healing of the surgical incision, broken pins, delayed bone-healing and nerve injury that can cause damage in the circulation and altered sensation of the toes.