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Andreea Pintilie

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What is Gilbert Syndrome?

Gilbert syndrome is a condition characterized by the existence of high levels of bilirubin in the blood.People with Gilbert’s syndrome present a liver enzyme deficiency,which is responsible for the  bilirubin metabolism.Bilirubin results from hemoglobin – the protein contented in erythrocytes,that gives them the main function of oxygen transport.Hemoglobin is composed of a fraction called heme,and a protein called globin fraction. After the death of erythrocytes, it is released into the blood stream and broken down into heme and globin.The globin fraction is stored in the body to be reused later. The heme fraction will be transformed into a lipid-soluble yellow pigment called free bilirubin (unconjugated, indirect).Free bilirubin is transported to the liver, where it is metabolized by a liver enzyme(glucuroniltransferaza) and it is transformed into conjugated bilirubin – which is soluble in water.In this form, bilirubin is easily included in the bile,which is a fluid produced by the liver cells. The bile plays an important role in digestion,because it is released into the intestine.There under the action of bacteria it is converted into a variety of pigmentation compounds , mainly urobilirogen.Then it is discharged from the body through faeces and urine.

Causes

Gilbert syndrome is a hereditary condition, which means that  it is caused by an abnormal  gene passed from generation to generation within a family.Gene involved in Gilbert’s syndrome is associated with liver enzyme(glucuroniltransferaza) which plays an important role in the metabolism of unconjugated bilirubin (free) in the liver. Genetic mutation leads to the limitation of hepatic enzyme synthesis, which contributs to the increase of unconjugated bilirubin in the body.Gilbert syndrome is a condition present at birth (congenital).

Symptoms

Although the symptoms are rarely obvious, the disease can cause an increase of unconjugated bilirubin levels which is sufficient to cause the appearance of a weak jaundice.  Jaundice is characterized by yellowing of the skin and cornea.  In Gilbert syndrome,predominantly appear yellowing of the eyes.Coloration may become more pronounced in stress condition, infections(especially viral), or if the patient is malnourished or dehydrated. Also, menstruation can be an important factor of increased bilirubin levels, and consequently the  jaundice will be more intense.Although jaundice is the only clinical symptom recognized, many people with Gilbert’s syndrome reported a number of common events that assigns disease.

The most common symptoms are:

  • fatigue;
  • decreased appetite;
  • nausea or dizziness;
  • abdominal pain;
  • Irritable bowel syndrome;
  • disturbance of concentration;
  • dark urine.
Diagnosis
Gilbert syndrome is most often found accidentally in a blood test done for other health problems.
Although present at birth,the syndrome is usually not diagnosed  until puberty or even later, when the synthesis of bilirubin increases.Blood tests used in diagnosis of Gilbert syndrome include blood counts and liver function tests.
The liver function tests  determine the ability of  liver to metabolize and convert the bilirubin into bile. Bilirubin value is considered a significant marker of liver activity.
The increased levels of  unconjugated bilirubin ,in the blood can indicate the presence of the syndrome. However, the level of bilirubin in Gilbert’s syndrome may fluctuate and they may be within the normal range for a certain period of time, so the test must be repeated.
A value of unconjugated bilirubin more than 17 umol / L  is considered abnormal.
Treatment
Gilbert syndrome usually causes mild symptoms, and require no treatment. Jaundice associated with the syndrome is less obvious and disappears with no medical intervention.
People affected  does not require medical monitoring, but is necessary to  consult a doctor if you notice that the  jaundice or other symptoms are more intensified.

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Erythrodermia

Erythrodermia is also known as Exfoliative Dermatitis or Red Man Syndrome. It is an inflammatory skin disease with erythema and scaling, which affects the entire skin surface. It is characterized by keratodermie which is especially on hand and sole , dermatophatic lymphadenopathy and increased serum of Ig E.

Causes
Erythroderma may occur as a response to drug therapy, systemic disease or the entity may be unknown. Over 40% of cases involve existing skin disease. About 10% of cases are drug reactions. 40% are caused by systemic diseases. The rests are idiopathic. This disease occurs due to other diseases such as lupus erythematosus, atopic dermatitis, contact dermatitis, pemphigus, psoriasis, sarcoidosis, stasis dermatitis,etc. Over 60 drugs have been implicated in the erythroderma etiology.These drugs are: penicillins, sulfonamides, carbamazepine, phenytoin, gold, allopurinol, captopril.Carbamazepine can cause a  pseudolimfomatos syndrom, allopurinol may be accompanied by hepatitis, gastrointestinal bleeding and nephropathy.
Pathogenesis and symptoms
Normal epidermis has a fast turnover of epithelial cells. Cell division occurs in the basal layer. As the cells migrate to the periphery they become keratinized. This process requires 10-12 days. Cells remain in the corneum layer for another 14 days before they exfoliate.
In erythrodermia  in the basal layer,the mitotic rate increases and decreases during the transition, so many cells are lost from the surface. The responsible mechanism is unknown.Erythrodermia affecting people over 40 years but the disease can occur in those with atopic or seborrheic dermatitis. Patients who suffering from this disorder have generalized erythema and scaling occurs after 2-6 days. If the condition persists for several weeks,the patient can observe the fall hair or tendency of stiffness and thickening of the nail.Another consequence of the disease is the pigmentary changes that occur only in severe cases. Potential systemic manifestations include fever, chills, hypothermia, reactive adenopathy, peripheral edema, hypoalbuminemia and heart failure.
Treatment
Patients with erythrodermia should be hospitalized,especially those who have  fever, hypotension and toxic shock,because this disease can be treated.This means, more specifically, balancing electrolyte and conducting laboratory studies of the protective and enabling the prevention of bacterial infection and fungal infections.

During treatment will also consider topical maintaining hydration and the patient will be protected from possible hypothermia.They have to keep their skin hydrated, avoid scratching  and precipitating factors.In these disease the most important thing and the first step in erythrodermia treatment  is to treat the underlying disease,otherwise erythrodermia will resist to therapy. Also, the patient needs a high-protein diet with additional folic acid. To relieve symptoms, the patient can make a warm bath, apply emollient creams and wet dressings with triamcinolone. For secondary infection is administered antihistamines,which are also useful for reducing itching.

Prognosis
With regard to disease,the prognosis is related to underlying disease. Evolution is marked by multiple exacerbation and  is required corticosteroid therapyThe fact is that  erythroderma rapidly evolving when the patient has a drug allergy, lymphoma, leukemia, scalded skin syndrome or contact allergens. The mean duration of disease is about 5 years with a median of 10 months. In erythrodermia disease, mortality occurs in approximately 20-40% of cases.

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Folliculitis

Folliculitis is an infection of the hair root. Each hair grows from a hair follicle, which is found in the middle layer of skin that is called the dermis.Hair follicle can be invaded by germs, and consequently here will appear an inflammation of the hair root. Folliculitis can appear on any part of the body covered with hair, but most often it occurs in the face, scalp and areas that come in close contact with the clothing,like hips and groin regions.

Causes

Folliculitis can be caused by fungus, bacteria, or may be non-bacterial.Bacterium that can cause folliculitis is Staphylococcus aureus.Superficial Staphylococcus folliculitis is common, occurs in people of all ages, and generally occurs on the face, scalp, torso, thighs or buttocks.

Folliculitis caused by the fungus is more common and more difficult in people with weaker immune system.Folliculitis development is favored by skin lesions or damage of hair follicles.

For example,hair removal,clothes that irritate the skin,sweat ,oil and make-up can cause damage of hair follicles,which can cause folliculitis.Fungus that can cause folliculitis are:
¢Trichophyton – because hair removal razor
¢Pityrosporum -is manifest on the shoulders and back, especially in adolescents
¢Candida -is manifest on the scalp and soft areas such as breasts or buttocks,especially in obese people. Non-infectious folliculitis is caused by oil or grease in contact with skin.

Folliculitis

Folliculitis

Symptoms

Early symptoms include redness ,surrounding in one or more root hairs , accompanied by pain and itching. Later,red areas and inflamed bumps turn into blisters which containing pus and gives a burning sensation. They break at some point and from them flows the blood and pus.

Some pustules,that develop in deeper follicles,are larger and more painful. They can turn into boils and can be accompanied by fever and impaired general condition.
There can exist a type of folliculitis that occurs after a hot bath,which is especially localized on the chest, arms and legs,but that type of folliculitis will disappear after a week.

Treatment

Proper treatment depends on the etiology of infection.

¢For bacterial folliculitis you can use antibiotic ointments or antiseptic substances. If folliculitis is more severe is necessary to administer antibiotic pills.
¢For fungal folliculitis you need antifungal drugs ,such as fluconazole.
¢If folliculitis is located on the scalp, dermatologist can prescribe a shampoo which containing selenium sulfide or propylene glycol.
¢ If folliculitis does not respond to antibiotic treatment or it appear very often, you can turn to laser treatment, which consists in the destruction of hair follicles with a laser.

Measures you can take home are:

¢ Use an antibacterial soap;

¢ Use a shampoo based on selenium;

¢ Apply warm compresses to the affected area;

Prevention

For prevention of this disease is recommended by maintaining a good body hygiene,daily showers with warm water and plenty of soap and shampoo;you must to avoid using towel with other persons,you have to wear loose clothing,and you can also use creams or lotions after hair removal.

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Andreea Pintilie

Introduction to nausea and vomiting

Nausea and vomiting are symptoms of an underlying disease and not a specific  illness. Nausea is the sensation that the stomach wants to empty itself, while  vomiting (emesis) or throwing up, is the act of forcible emptying of the  stomach

Vomiting is a violent act in which the stomach has to overcome the pressures  that are normally in place to keep food and secretions within the stomach.

  1. The  stomach almost turns itself inside out – f
  2. orcing itself into the lower portion  of the esophagus
  3. (the tube that connects the mouth to the stomach) during a  vom
  4. iting episode.

vomtingWhat causes nausea or vomiting?

There are numerous causes of nausea and vomiting. These symptoms may be due  to the following:

  • acute gastritis
  • central causes (signals from the brain)
  • association with other illnesses remote from the stomach
  • medications and medical treatments
  • mechanical obstruction of the bowel

Acute gastritis

Acute gastritis (gastro=stomach + it is= inflammation) is often caused by an  offending agent which irritates the lining of the stomach. Examples of these  include:

  • Infections: Infections are often the cause, whether it is a common virus or an  infection that is contracted from travel. There may be associated crampy upper abdominal pain, fever ,and chills may be present. Common viral infections  include noroviruses and rotavirus. Parasitic infections often are associated  with diarrhea but may also have a component of nausea and vomiting. Infection by  bacteria in the Helicobacter family (like H. Pylori) can also be the infectious  agent.
  • Stomach flu: Stomach flu is a non-specific term used to describe vomiting and diarrhea  associated with a viral infection. It should not be confused with influenza,  whose symptoms include fever, chills, cough, and myalgias (muscle pain).
  • Food poisoning: Food poisoning may cause significant vomiting and usually is caused by a  bacterial toxin. Symptoms begin within a couple of hours of eating contaminated or  poorly prepared food and may last for 1-2 days. Sources of food poisoning  include Salmonella, Campylobacter, Shigella, E. coli, Listeria, or Clostridium  botulinum (botulism).
  • Other stomach irritants: alcohol, smoking, and non steroidal  anti-inflammatory medications such as aspirin and ibuprofen may irritate the  stomach lining.
  • Peptic ulcer disease:Peptic ulcer disease can range from mild irritation of the stomach lining  to the formation of a defect in the protective lining of the stomach called an  ulcer.
  • Gastroesophageal reflux disease (GERD, reflux esophagitis): Nausea or  vomiting is also associated with irritation of the lining of the esophagus