Hives (Urticaria) : Symptom, Cause, Diagnosis, Treatment, And Drug

Hives are a skin reaction that causes red or white itchy welts.Hives may cause a burning or stinging sensation.Hives vary in size from as small as a pen tip to as large as a dinner plate.Hives may last for a few days or less.Acute hives are hives that last less than six weeks.Chronic hives are hives that last more than six weeks.Hives fixed means "not moving."Fixed drug eruption is fixed hives happen when a person takes a certain medicine.Fixed solar urticaria is fixed hives happen when a person gets too much sunlight.Hives can cause trouble breathing or severe chest tightness, tongue or throat swelling, and dizziness.If people have these symptoms , they should visit to doctor to check the bout.Hives can occur within minutes of exposure to the trigger.

Symptoms of Hives

• Slightly raised, pink, or red swelling.
• Welts that occur alone,  in a group, or connect over a large area.
• Skin swelling goes away within 24 hours at one spot but may appear at another spot.
• Itch, sting, and hurt.
• Batches of red or white welts are usually on rge face, trunk, arms, and legs.
• Swelling causes pain or burning, especially inside the throat and around the eyes, cheeks, lips, hands, feet, and genitals.

Causes of Hives

1. The allergic reactions, including 

• Foods : fruits (citrus fruit), shellfish, peanut, egg, milk.
• Medicines
• Pollen
• Animals
• Insect bites or stings
• Allergy shots

2. Stress

3. Bacterial infections or fungi infections

4. Some illnesses, such as lupus, vasculitis, thyroid disease

5. Exposure to sun, heat, cold, or water
6. Pressure on the skin

7. Exercise

8. Scratching the skin

9. Contact with chemicals

Diagnosis

Some tests and procedures are done by dermatologist to diagnose the skin.

• Medical history is about patient's health habit and past illnesses.
• Physical exam is an exam of the body to check general signs of health.
• Allergy Test is a test on the skin.
• Blood Test is a laboratory analysis performed on a blood sample.
• Blood work is to rule out an illness or infection
• A Skin Biopsy is the removal of a small piece of affected skin by viewing under a microscope to check the signs of hives.

Treatment of Hives

The most common treatment of a mild or moderate hives is a non-sedating (does not cause drowsiness) antihistamine.By taking this drug everyday can prevent hives from forming.

Some medicines that are prescribed to treat hives

• Dapsone is a sulfone antimicrobial agent.
• Cortisones are for short-term use only because of side effects with long-term use.

Antihistamine that block the histamine H1 receptor are the first line of therapy.

• First Generation Antihistamines, such as Diphenhydramine (Benadryl), Hydroxyzine (Atarax) block central and peripheral H1 receptors and can be very sedating.
• Second Generation Antihistamines, such as Loratadine (Claritin), Cetirizine (Zyrtec), Desloratadine (Clarinex), Levocetirizine (Xyzal), and Fexofenadine (Allegra).

Several medications are used if Antihistamines alone do not relieve the symptoms of hives :

• Histamine (H-2) Blockers or H-2 Receptor Antagonists may be injected or taken orally.These medications include Ranitidine (Zantac), Nizatidine (Axid), Cimetidine (Tagamet), Famotidine (Pepcid). Their side effects are headache and digestive problems.
• Anti-Inflammatory Medications include Oral Corticosteroids (Prednisone) that can help in lessening swelling, redness, and itching.
• The Tricyclic Antidepressant Doxepin (Zonalon) is to relieve itching.It is used in cream form.The side effect of this drug causes dizziness and drowsiness.
• Leukotriene-Receptor Antagonist include montelukast and Zafirlukast.These drugs are used to treat The patient with CU.

Several medications for treating Chronic Hives :

• The drug Omalizumab (Xolair) is very effective against chronic hives.It is without side effects.
• Oral glucocorticoids are effective to control the symptoms of chronic hives.
• Cyclosporine includes Neoral, Gengraf that relieve the chronic hives.The drugs cause nausea, headache.
• Tacrolimus reduces the immune system response that causes hives.
• Mycophenolate is to improve the signs and symptoms of hives.It is not recommended for pregnant women because it can lead miscarriage.
• Sirolimus is to treat chronic hives.

Drugs for Hives

• Omalizumab
• Dapsone
• Sulfasalazine
• Hydroxychloroquine

Drug combination used in Hives

• Hydroxyzine and Cimetidine

Nasal Polyp : Type, Symptom, Risk Factor, Diagnosis, Treatment, And Drug

Nasal polyps are soft fleshy swellings that grow inside the nose.They are painless and non-cancerous.The colour of nasal polyps may be yellowish, grey or pink.The size of nasal polyps can vary.Polyps usually affect both nostrils.They can block the nose and enlarge gradually.Nasal polyps hang down like teardrops or grapes.They cause chronic inflammation due to asthma, allergies, drug sensitivity, and recurring infection.

The Major Types of Nasal Polyp :

• Antrochoanal Polyps arise from the maxillary sinuses.They are single and unilateral.Antrochoanal polyps are common found in children.
• Ethmoidal Polyps originates from the ethmoidal sinuses.They are bilateral.Ethmoidal polyps are usually found in adults.

The Symptoms of Nasal Polyps

• A runny nose
• Nasal congestion
• Persistent stuffiness
• The sensation of something continually runs down the back of the throat or the postnasal drip
• Loss of smell and taste
• Headache
• Pain in the upper teeth
• Snoring
• A sense of pressure  over the forehead and face
• Itching around the eyes
• The blockage of the drainage channel of the sinuses into the nose.
• Common cold

Risk Factors of Nasal Polyps

• Asthma is a respiratory condition marked by spasms in the bronchi of the lungs, causing difficulty in breathing.
• Drug like aspirin.
• Cystic Fibrosis results in the production and secretion of abnormally thick, sticky fluids, including thick mucus from nasal and sinus membranes.
• Allergic fungal sinusitis.
• Churg-Strauss syndrome causes the inflammation of blood vessels.

Diagnosis of Nasal Polyps

Some tests and procedures are done to diagnose the nose.

• Physical exam is an exam of the body to check general signs of health.
• A General Practitioner (GP) is a medical doctor who treats illnesses and provides preventive care and health education to patients.It can examine the lower part of the nostrils.It might be able to see a large polyp.
• An Ear ,Nose and Throat (ENT) surgeon is to examine the nose.
• Nasendoscopy is a procedure that passes a small flexible telescope with a camera on an endoscope into the nose.
• Computed Tomography (CT) scan is a procedure that makes a series of detailed pictures of areas inside the body, taken from different angles.
• Magnetic Resonance Imaging (MRI) is a procedure that uses a magnet, radio, wave, and computer to make a series of detailed pictures of areas inside the body.
• Allergy test is a test on the skin.
• Test for Cystic Fibrosis is a noninvasive sweat test , which determines whether the child's perspiration is saltier than the most people'sweat.

Treatment of Nasal Polyps

1. Medicines might be topical, such as drops, sprays or tablets.

• Steroid nasal drops include Betamethasone (Betnesol drops or Vistamethasone drops) dan Fluticasone (Flixonase Nasule).They are used for at least 4 or 6 weeks.
• Steroid nose sprays are to prevent further polyps from developing.They can be used regularly or long-term.Steroid nasal sprays include Mometasone (Nasonex), Beclometasone (Beconase), Fluticasone (Flixonase or Nasofan), Triamcinolone (Nasacort), and Budesonide (Rhinocort Aqua).
• Steroid tablets, such as prednisolone that can reduce the inflammation in the nose.It is prescribed for a week.

2. Salt water (saline) nasal douches are a cheap and safe treatments.

3. Allergen Immunotherapy (Desensitisation) is used in allergic people with allergic rhinitis and polyps.

4. Surgery is done if polyps are large and the steroid drops and tablets cannot work.

• Polypectomy is to remove the polyps with a surgical instrument.It can be done through the nostrils, either with local anaesthetic (awake) or under general anaesthetic.
• Endoscopic Sinus Surgery is done with general anaesthetic.It can be done where the polyps are very large and numerous, or where the polyps are seriously blocking the sinuses.

Drugs for Nasal Polyps

Steroid Nasal Drops

• Betamethasone (Betnesol drops or Vistamethasone drops) 
• Fluticasone (Flixonase Nasule)

Steroid Nose Sprays

• Mometasone (Nasonex)
• Fluticasone (Flixonase or Nasofan)
• Budesonide (Rhinocort Aqua).
• Beclometasone (Beconase)
• Triamcinolone (Nasacort)
• Flunisolide
• Ciclesonide (Omnaris, Zetonna)

Steroid Tablet

• Prednisolone

Prevention

• Practicing the good hygiene by washing hands to protect against bacterial and viral infections.
• Using a humidifier if the air of the home tends to be dry.
• Managing Asthma and allergies.
• Avoid the breathing of airbone substances, such as dust, tobacco smoke, chemical fumes.
• Using a nasal lavage to rinse the nasal passages.

Smallpox : Type, Symptom, Transmission, Diagnosis, And Treatment

Smallpox is an infectious disease caused by variola major virus and variola minor virus.Variola is a large brick-shaped virus measuring approximately 302 to 350 nanometers by 244 to 270 nm, with a single linear double stranded DNA genome 186 kilobase pairs (kbp) in size and containing a hairpin loop at each end.Four orthopoxviruses cause infection in human, including variola, vaccinia, cowpox, and monkeypox.Variola minor causes a milder form of disease.Variola major causes a more serious disease.The disease is known as pox or red plague in English.Contagion from smallpox begins in small blood vessels of the skin, in the mouth and throat before disemminating.The symptoms of smallpox firstly appear twelve to fourteen days after infecting.During seven to seventeen days in incubation period, smallpox cannot infect others.Someone looks and feels healthy at that time.A few days later a rash appears on the face and spreads to hands, forearms, and later on the trunk.Within a day or two days of appearance the rash develops into abscesses that are filled fluid and pus.The abscesses break open and scab over.The scabs begin to form eight to nine days later and eventually fall off, leaving deep, pitted scars.Someone still remain contagious until the scabs fall off.

The symptoms of Smallpox

• High fever
• Headache
• Chills
• Vomiting
• Nausea
• Malaise
• Influenza
• Abdominal pain
• Muscle pain
• Severe back pain
• Severe fatigue
• Prostration

Types of Smallpox caused by Variola major virus :

• Ordinary Smallpox generally produces a discrete rash, in which the pustules stand out on the skin separately.
• Modified Smallpox occurs mostly in previously vaccinated people.The skin lesions tend to be fewer and evolve more quickly.
• Malignant Smallpox remains soft and flat throughout the entire illness.The lesions of malignant smallpox does not develop into pustules or pus filled bumps on the skin.
• Hemorrhagic Smallpox causes organs to leak blood into the mucous membranes and skin.

Transmission of Smallpox

• Inhalation of airbone variola virus, usually droplets expressed from the oral, nasal, or pharxngealmucosa of an infected person.
• Prolonged face-to-face contact with an infected within a distance of 1.8 meters.
• Direct contact with infected bodily fluid or contaminated objects, such as clothing, blanket, bedding.
• The virus can be transmitted throughout the course of illness, but is most frequent during the first week of the rash, when most of the skin lesions are intact.

Diagnosis of Smallpox

Some laboratory tests are done to diagnose smallpox

• An Electron Microscopy is a microscope that uses a beam accelerated electrons as a source of illumination.The electron microscopy is used to investigate the ultrastructure of a wide range of biological and inorganic specimens, including microorganisms, cells, and biopsy samples.
• Restriction  Fragment Length Polymorphism (RFLP) is a technique that exploits variation in homologous DNA sequences.
• Polymerase Chain Reaction (PCR) is a technique in molecular genetics that permits the analysis of any short sequence of DNA or RNA even in samples containing only minute quantities of DNA or RNA.It is used to reproduce selected sections of DNA or RNA for analysis.
• Enzyme Linked Immunosorbent Assay (ELISA) is a test to measure a wide variety of tests of body fluids.
• Serologic Tests are blood test that look for antibodies in the blood.

Treatment of Smallpox

• Smallpox vaccination within three days of exposure will prevent or significantly lessen the severity of smallpox symptoms in the vast majority people.Vaccination four to seven days after exposure can protect from disease or modify the severity of disease.
• No drugs are currently approved to treat smallpox.
• Cidofovir is the antiviral drug that is useful as a therapeutic agent.

Fever (Pyrexia) : Type, Symptom, Cause, Temperature, Diagnosis, Treatment, And Drug

Fever (Pyrexia) is a condition that has a temperature above the normal range due to an increase in the body's temperature set-point.Normal body temperatures vary depending on many factors, including age, sex, time of day, ambient temperature, and activity level.Harrison's textbook of internal medicine defines a fever as a morning oral temperature of over 37.2 C (over 98.9 F) or an afternoon oral temperature of over 37.7 C (over 99.9 F) while the normal daily temperature variation typically 0.5 C (0.9 F).Hyperpyrexia is a fever with an extreme elevation of body temperature greater than or equal to 41.5 C (106.7 F)

Children with a high temperature can develop a febrile seizure.It is known as a Febrile convulsion.It may cause ear infection, gastroenteritis, and cold.Fabrile seizure occurs in the age of children between six months to six years old.It affects commonly boys than girls.The children with febrile seizure do not need the treatment.The temperature can be controlled by Acetaminophen (Paracetamol), sponging and sodium valproate or clonazepam (anticonvulsant).

There are two types of Febrile seizure

1. Simple Febrile Seizure is the seizure that lasts no longer than fifteen minutes and does not occur again during a 24-hour period.In most cases it happens less than five minutes.The symptoms of simple febrile seizure include the stiff body and arm, twitched leg, vomiting, urinating, defecating, and the loss of conciousness but the eyes open.
2. Complex Febrile Seizure is the seizure that lasts longer, comes back more often and affects the part of body.

Types of Fever

• Continuous fever is a body temperature greater than 37.7 C (100 F) that continues to persist for twenty four hours or more.
• Remitten fever is a fever pattern in which temperature varies during each 24-hour period but never reaches normal.
• Intermitten fever is an attack of fever, with recurring paroxysms of elevated temperature separated by intervals during which the temperature is normal.It can be divided into three types.Quotidian fever is a fever with a periodicity of 24 hours and it is typical of Plasmodium falciparum.Tertian fever is a fever with a periodicity of 48 hours and it is typical of Plasmodium vivax.Quartan fever is a fever with periodicity of 72 hours and it is typical of Plasmodium malariae.
• Undulant fever is a fever that is typically undulant rising and falling like a wave.It is an infectious disease due to the bacteria Brucella that characteristically causes rising and falling fevers, sweat, malaise, weakness, anorexia, headache, muscle pain, and back pain.
• Relapsing fever is a vector-borne disease caused by infection with certain bacteria in genus Borrelia, which are transmitted through the bites of lice or soft-bodied ticks (genus Ornithodoros).

The Symptoms of Fever

• Feeling cold
• Sweating
• Shivering
• Dehydration
• Headache
• Muscle pain
• Loss of appetite
• General weakness
• Lethargy
• Sleepiness
• Depression
• Inability to concentrating

High fever between 39.4 C (103 F) and 41.1 C (106 F) can cause

• Hallucination
• Confusion
• Extreme Irritability
• Convulsion
• Delirium

Causes of Fever

• Viral, bacterial, and parasitic infections , such as malaria, urinary tract infection, meningitis
• Medications, such as antibiotics
• Rheumatoid arthritis
• Over-exposure of the skin to sunlight
• Silicosis
• Heat stroke
• Alcohol withdrawal
• Amphetamine abuse
• Some immunizations, such as tetanus, diphtheria, acellular pertussis or pneumococcal vaccine

Temperatures of Fever

• Temperature in the anus (rectum/rectal) is at or over 37.5 - 38.3 C (99.5 - 100.9 F).
• Temperature in the mouth (oral) is at or over 37.7 C (99.9 F).
• Temperature under the arm (Axillary) is at or over 37.2 C  (99.0 F).

The Normal Temperatures in Healthy Adult Men and Women

• Temperature in the anus (rectum/rectal) is at 34.4 - 37.8 C (93.9 - 100.0 F).
• Temperature in the mouth (oral) is at 33.2 - 38.2 C  (91.8 - 100.8 F).
• Temperature under the arm (Axillary) is at 35.5 -  37.0 C (95.9 - 98.6 F).
• Temperature in the ear drum (tympanic membrane) is at 35.4 - 37.8 C (95.7 - 100.0 F).

Temperatures of Fever in Infants

• A new born is at less than 36.1 C (97.0 F).
• Younger than Age 3 months in the anus (rectal) is at  or over 38.0 C (100.4 F).
• Between Age 3 to 6 months is at or over 38.9 C (102 F).
• Between Age 6 to 24 months is at or over 38.9 C (102 F).

Diagnosis of Fever

Some tests are done to diagnose fever depending on the signs and symptoms of fever.The temperature of the patient is taken.

• Blood Test is a laboratory analysis performed on a blood sample that is usually extracted  from a vein in the arm using a needle or via fingerprick.It is used to determine physiological and biochemical states, such as disease, mineral contents, pharmaceutical drug effectiveness and organ function.
• Urine Test is to check  different components of urine, a waste product made by the kidneys.
• X-Ray is to create pictures of the inside of the body.

Treatment  and Drugs for Fever

1.  Sponging or bathing feverish children with tepid water.
2. The use of a fan or air conditioning may reduce temperature and increase comfort.Aggressive cooling is needed If the temperature reaches the extremely high level of hyperpyrexia.
3. Keeping adequately hydrated

Drugs for Fever :

• Antipyretics such as Ibuprofen (Advil, Motrin IB) and Acetaminophen are used for children.Ibuprofen and acetaminophen are to reduce fever.Ibuprofen is more effective than acetaminophen (paracetamol).The consumption of Acetaminophen (Tylenol) in high doses or long-term use can cause kidney or liver damage.
• Aspirin is used for adults.