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Croup

Croup

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Published by Jowena Lou Burguite

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Published by: Jowena Lou Burguite on Jan 23, 2012
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09/06/2013

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Croup
(or 
laryngotracheobronchitis
)is a respiratory condition that is usually triggered by an acute viral infection of the upper airway. The infection leads to swelling insidethe throat, which interferes with normal breathing and produces the classical symptoms of a "barking" cough,stridor, and hoarseness. Itmay produce mild, moderate, or severe symptoms, which often worsen at night. It is often treated with a single dose of oral steroids;occasionally epinephrine is used in more severe cases. Hospitalization is rarely required.Croup is diagnosed on clinical grounds, once potentially more severe causes of symptoms have been excluded (i.e. epiglottitis or an airway foreign body). Further investigations²such as blood tests, X-rays, and cultures²are usually not needed. It is a relativelycommon condition that affects about 15% of children at some point, most commonly between 6 months and 5±6 years of age. It isalmost never seen in teenagers or adults.Signs and symptomsCroup is characterized by a "barking" cough, stridor, hoarseness, anddifficult breathing which usually worsens at night.
[1]
The "barking"cough is often described as resembling the call of a seal or sea lion.
[2]
The stridor is worsened by agitation or crying, and if it can beheard at rest, it may indicate critical narrowing of the airways. As croup worsens, stridor may decrease considerably.
[1]
 Other symptoms include fever, coryza (symptoms typical of thecommon cold), and chest wall indrawing.
[1][3]
Drooling or a very sickappearance indicate other medical conditions.
[3]
 [edit]CausesCroup is usually deemed to be due to a viral infection.
[1][4]
Others use the term more broadly, to include acute laryngotracheitis,spasmodic croup, laryngeal diphtheria, bacterial tracheitis, laryngotracheobronchitis, and laryngotracheobronchopneumonitis. The firsttwo conditions involve a viral infection and are generally milder with respect to symptomatology; the last four are due to bacterialinfection and are usually of greater severity.
[2]
 [edit]
Viral
Viral croup/acute laryngotracheitis is caused by parainfluenza virus, primarily types 1 and 2, in 75% of cases.
[5]
Other viral etiologiesincludeinfluenza A and B, measles, adenovirus and respiratory syncytial virus (RSV).
[2]
Spasmodic croup is caused by the same groupof viruses as acute laryngotracheitis, but lacks the usual signs of infection (such as fever, sore throat, and increased white blood cellcount).
[2]
Treatment, and response to treatment, are also similar.
[5]
 [edit]
Bacterial
Bacterial croup may be divided into laryngeal diphtheria, bacterial tracheitis, laryngotracheobronchitis, andlaryngotracheobronchopneumonitis.
[2]
Laryngeal diphtheria is due to Corynebacterium diphtheriae while bacterial tracheitis,laryngotracheobronchitis, and laryngotracheobronchopneumonitis are usually due to a primary viral infection with secondary bacterialgrowth. The most common bacteria implicated are Staphylococcus aureus, Streptococcus pneumoniae, Hemophilus influenzae,and Moraxella catarrhalis.
[2]
 
Steroids
Corticosteroids, such as dexamethasone and budesonide, have been shown to improve outcomes in children with all severities of croup.
[7]
Significant relief is obtained as early as six hours after administration.
[7]
While effective when given orally, parenterally, or byinhalation, the oral route is preferred.
[4]
A single dose is usually all that is required, and is generally considered to be quitesafe.
[4]
Dexamethasone at doses of 0.15, 0.3 and 0.6 mg/kg appear to be all equally effective.
[8]
 [edit]
Epinephrine
Moderate to severe croup may be improved temporarily with nebulized epinephrine.
[4]
While epinephrine typically produces a reductionin croup severity within 10±30 minutes, the benefits last for only about 2 hours.
[1][4]
If the condition remains improved for 2±4 hours after treatment and no other complications arise, the child is typically discharged from the hospital.
[1][4
 
 
 
Celiac disease
is a chronic digestive disorder in which damage to the lining of the small intestine leads to the malabsorption of minerals and nutrients.
 
y
 
The destruction of the inner lining of the small intestine in celiac disease is caused by an immunological (allergic) reaction to gluten.
y
 
Gluten is a family of proteins present in wheat, barley, rye, and sometimes oats.
y
 
Individuals with celiac disease may developdiarrhea, steatorrhea, weight loss, flatulence, iron deficiency anemia, abnormalbleeding, or weakened bones. However, many adults with celiac disease may have either no symptoms or only vague abdominaldiscomfort such as bloating, abdominal distension, and excess gas.
y
 
Children with celiac disease may have stunted growth, and if untreated, childhood celiac disease can result in short stature as anadult.
y
 
Small intestinal biopsy is considered the most accurate test for celiac disease.
y
 
Blood tests can be performed to diagnose celiac disease; these include endomysial antibodies, anti-tissue transglutaminaseantibodies, and anti-gliadin antibodies.
y
 
There is no cure for celiac disease. The treatment of celiac disease is agluten free diet.
y
 
In most individuals, a gluten free diet will result in improvement in symptoms within weeks. Many individuals report symptomimprovement within 48 hours.
y
 
In children with celiac disease, successful treatment with a gluten free diet can lead to the resumption in growth (with rapid catch upin height).
y
 
Failure to respond to a gluten free diet can be due to several reasons; the most common reason is failure to adhere to a strict glutenfree diet.
phenylketonuria
P
henylketonuria (commonly known as
PKU
) is an inherited disorder that increases the levels of a substance called phenylalanine in theblood.
P
henylalanine is a building block of proteins (an amino acid) that is obtained through the diet. It is found in all proteins and insome artificial sweeteners. If 
PKU
is not treated, phenylalanine can build up to harmful levels in the body, causing intellectual disabilityand other serious health problems.
What are the symptoms of PKU?
The signs and symptoms of 
PKU
vary from mild to severe.The most severe form of this disorder is known as classic
PKU
.
y
 
Infants with classic
PKU
appear normal until they are a few months old.
y
 
Without treatment with a special low-phenylalanine diet, these children develop permanent intellectual disability.
y
 
Seizures, delayed development, behavioral problems, and psychiatricdisorders are also common.
y
 
U
ntreated individuals may have a musty or mouse-like odor as a side effect of excess phenylalanine in the body.
y
 
Children with classic
PKU
tend to have lighter skin and hair than unaffected family members and are also likely to have skindisorders such as eczema.
What genes are related to phenylketonuria?
Mutations in the
P
 AH gene cause phenylketonuria.The
P
 AH gene provides instructions for making an enzyme called phenylalanine hydroxylase. This enzyme converts the amino acidphenylalanine to other important compounds in the body. If gene mutations reduce the activity of phenylalanine hydroxylase,phenylalanine from the diet is not processed effectively. As a result, this amino acid can build up to toxic levels in the blood and other tissues. Because nerve cells in the brain are particularly sensitive to phenylalanine levels, excessive amounts of this substance cancause brain damage.Classic
PKU
, the most severe form of the disorder, occurs when phenylalanine hydroxylase activity is severely reduced or absent.
P
eople with untreated classic
PKU
have levels of phenylalanine high enough to cause severe brain damage and other serious medicalproblems. Mutations in the
P
 AH gene that allow the enzyme to retain some activity result in milder versions of this condition, such asvariant
PKU
or non-
PKU
hyperphenylalaninemia.
 
Changes in other genes may influence the severity of 
PKU
, but little is known about these additional genetic factors.
 The main phenylketonuria treatment is a strict diet with very limited intake of phenylalanine, which is mostly found in foodscontaining protein.
Which foods to avoid
 Because the amount of phenylalanine adults can safely eat is so low, it's crucial they avoid all high-protein foods, including:
y
 
Milk Eggs Cheese Nuts Soybeans Beans Chicken Steak and other beef products
P
ork Fish Chocolate candy
P
eas Beer Children and adults should also avoid foods, including many diet sodas, and medications made with aspartame (NutraSweet, Equal). Aspartame, found in many artificial sweeteners, releases phenylalanine when digested.
 Recently,
sapropterin
has been approved by the
U
S Food and Drug Administration (FDA) as a treatment for 
PKU
. It seems tobe effective in a subset of patients.
ScoliosisScoliosis
(from Ancient Greek:  skolios "crooked")
[1]
is a medical condition in which a person's spine is curved from side to side. Although it is a complex three-dimensional deformity, on an X-ray, viewed from the rear, the spine of an individual with scoliosis maylook more like an "S" or a "C" than a straight line. Scoliosis is typically classified as either congenital (caused by vertebral anomaliespresent at birth), idiopathic (cause unknown, subclassified as infantile, juvenile, adolescent, or adult, according to when onsetoccurred), or neuromuscular (having developed as a secondary symptom of another condition, such as spina bifida, cerebralpalsy,spinal muscular atrophy, or physical trauma).Signs and symptoms
P
atients having reached skeletal maturity are less likely to have a worsening case. Some severe cases of scoliosis can lead todiminishing lung capacity, putting pressure on the heart, and restricting physical activities.The signs of scoliosis can include:
 
U
neven musculature on one side of the spine
 
 A rib prominence and/or a prominent shoulder blade, caused by rotation of the ribcage in thoracic scoliosis
 
U
neven hips/leg lengths
 
Slow nerve action (in some cases)CauseIt has been estimated that approximately 65% of scoliosis cases are idiopathic, approximately 15% are congenital and approximately10% are secondary to a neuromuscular disease.
[4]
 Idiopathic scoliosis is a condition which lasts a lifetime, but it does not increase the risk of mortality.
[5]
 In adolescent idiopathic scoliosis, there is no clear causal agent and it is generally believed to be multifactorial, although genetics arebelieved to play a role.
[6]
Various causes have been implicated, but none of them have consensus among scientists as the cause of scoliosis, though the role of genetic factors in the development of this condition is widely accepted.
[7]
Still, at least one gene,notably CHD7, has been associated with the idiopathic form of scoliosis.
[8][7]
 In some cases, scoliosis exists at birth due to a congenital vertebral anomaly. Another cause in the past was when the father had ether in his blood stream when the baby was conceived. This would happen if the man was a busy anaesthetist using ether daily in hosptaloperating rooms. It no longer happens because ether is not used for anaesthetic any more.
[9]
Scoliosis often presents itself, or worsens, during the adolescence growth spurt and is more often diagnosed in females versus males.

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