Scarlet Fever – Causes, Symptoms, Diagnosis And Treatment

General

Scarlet fever is an infectious disease common to children under the age of 10. Studies show that boys are more often affected than girls.  Also there appears to be an autumn-winter periodicity.
Scarlet fever is characterized by a sudden onset with fever, altered general state, streptococcal angina  and a characteristic sign a skin rash, followed by skin peeling. Scarlet fever is caused by a toxin released by the beta-hemolytic streptococcus (group A) .

Contamination with scarlet fever is done by respiratory means : coughing, sneezing, laughing, talking, from patients with scarlet fever or healthy carriers of beta-hemolytic streptococcus in the oropharynx.

Sources of infection are represented by:

– persons infected with scarlet fever;
– patients with streptococcal angina, caused by a strain of beta-hemolytic streptococcus which has the ability to release the toxin responsible for the occurrence of scarlet fever;
– patients with mild disease symptoms that may go unnoticed or healthy carriers of the beta-hemolytic streptococcus (group A);

It’s estimated that approximately 20% of the population are carriers of the beta-hemolytic streptococcus in the oropharynx.

Signs and symptoms :

• Onset period

The incubation period ranges from 2 to 6 days. The disease starts suddenly with fever, altered general condition, vomiting and soreness of the throat upon swallowing. The fever can reach values of 39°-40°C and is often preceded by shivers and tachycardia.

In infants and young children the symptoms can be also accompanied by seizures.

The face has a characteristic appearance with paleness around the mouth and congestion of the cheeks, a sign described as “Filatov’s mask” or “slapped face” Changes appear to the tongue as well, following a specific cycle : in the onset period it is covered by a whitish deposit, giving it a specific look described as “porcelain tongue”.

• Status period

After 24-48 hours following the onset, a characteristic rash appears manifesting itself through : scarlet redness, rough papule formations more intense on the internal front side of the limbs and on the front side of the elbow joint where a hemorrhagic line ( Pastia sign).

The lingual cycle consists of daily changes of the to tongue aspect :

– 1st day: a whitish deposit : “porcelain tongue” ;

– 2nd day: peeling in a peak to base direction ;

– 3rd day: the peak is fully peeled while the base  shows white deposits;

– 4th day: fully peeled tongue with the papillae visible : “raspberry tongue”

General signs persist, the fever continues for 2 to 3 days after taking antibiotics. Only in toxic and severe forms we can mention, circulatory changes with tachycardia, hypo tension, collapse, enlargement of the liver,  neuro-psychiatric symptoms (agitation, delirium, convulsions).

• Convalescence period

During the convalescent period tissue regeneration takes place  the tongue appearing  varnished : “varnished tongue.”

Diagnosis

The diagnosis is suspected when the characteristic rash appears alongside fever and angina .

Tests that help confirm suspicion of scarlet fever are:
– laboratory testing for evidence of inflammatory syndrome: leukocytosis,, eosinophilia,  accelerated ESR;
– bacteriological tests : highlighting in cultures the beta-hemolytic streptococcus (mandatory for acceptance of diagnosis);
– serological tests : ASO.

Treatment

Etiological treatment consists in penicillin injections, replaced by a macrolide in case of allergy to penicillin.

Symptomatic treatment consists in antipyretics and vitamin C.

After the infection with scarlet fever a lasting immunity remains , based on antitoxin antibodies.

Da Vinci’s robot benefits

The da Vinci robot is currently the most advanced surgical robot designed to perform  many types of interventions (urologic surgery, gynecological, laparoscopic, etc.). The da Vinci robot consists of four multi-articulated arms which handles various instruments (scalpel, scissors, camera etc.) and a console. Despite its appearance, the da Vinci robot is designed to perform operations with a lot of finesse. Robotic surgery is a minimally invasive surgery (such as laparoscopic surgery), that uses tiny incisions to perform: hysterectomy, prostatectomy, cholecystectomies, Nissen fundoplication etc. Because of small incisions, postoperative recovery time is reduced and the risk of developing complications is also very low.

The da Vinci robot is designed so as to provide a high-resolution image, which greatly enhances visibility and increases the accuracy with which the maneuvers are performed. Also, the surgeon hand movements are translated into precise surgical movements. Therefore, the da Vinci robot may be used in a series of surgeries that require great care and delicacy: thoracic surgery, gynecological surgery, cardiac surgery.

Da Vinci’s robot

Mount Nittany Physician Group surgeon Dr. Shreya Patel, from Penn State Milton S. Hershey Medical Center, said the da Vinci robot brings a tremendous improvement in terms of patient recovery. She said that it is amazing how quickly  patients operated by robotic surgery recover (they can return home within in 24 hours).

Robotic surgery is an advanced technique, but it does not involve pre-programmed operations and does not replace the   surgeon. When using the da Vinci robot, the surgeon makes incisions himself and controls the movements with the console. It should be noted that the da Vinci robot can not operate on its own and any movement is controlled by the surgeon.

Dr. Gerald Harkins, medical director of the minimally invasive gynecologic surgery schedule at Penn State Hershey Medical Center,who began working with the da Vinci robot in 2010, said that at first they were very selective when it came to operate a patient with the da Vinci system. Since 2010, however, Hershey Medical Center’s Obstetrics and Gynecology Department, the majority of interventions in this department have been conducted with the da Vinci robot.

Harkins believes that one of the biggest advantages of robotic surgery is that it decreases the number of patients that  need invasive surgery (open surgery). “The robot opens the doors for us to work with patients with more complicated illnesses, such as severe endometriosis and cancer,” Harkins explained. “This has resulted in our department performing no open surgeries at all.”

Zollinger-Ellison syndrome Symptoms Diagnosis And Treatment

Zollinger Ellison syndrome (ZES) is a tumor of the endocrine pancreas that secretes gastrin and determines multiple ulcers that do not respond to treatment. SEZ is quite rare, statistics show that the incidence of this disease would be around 3/1000 000 inhabitants but it must be said that the disease may be undiagnosed in many cases. This endocrine tumor is found most often in people aged between 60 and 80 years. In 25% of cases it may be associated with MEN I syndrome, multiple endocrine neoplasia type 1, which is an autosomal dominant syndrome, and involves association of multiple tumors (pituitary tumors, parathyroid, pancreas tumors).

Most tumors are located in the pancreas, others are located in the stomach, duodenum, spleen, liver, lymph nodes, small intestine and ovary. In addition to gastrin, these endocrine tumors may release other hormones, such as insulin, glucagon, somatostatin, but in much smaller amounts. Gastrin is a hormone that acts on parietal cells in the stomach and stimulates them to produce hydrochloric acid. Hydrochloric acid is harmful to gastric mucosa and causes gastric ulcers.

Zollinger Ellison

Symptoms and signs

One of the hallmarks of ZES is the presence of multiple gastric and duodenal ulcers. ZES causes ulcers in almost all patients, but there can also occur other symptoms such as diarrhea, vomiting and weight loss. However it can happen that a patient has diarrhea without having ulcers, which occurs in approximately 30% of patients. Ulcer patients often have complications such as bleeding or perforation,which are medical emergencies. Another sign of the disease is  esophagitis, that is damage to the esophagus from stomach acid.

About half of these endocrine tumors can become malignant and tend to disseminate to the liver. ZES often gives slow-growing tumors but sometimes it may happen that these tumors grow faster and cause early metastasis.

Diagnosis

Diagnosis is suspected from clinical signs and confirmed by a number of biological and imaging investigations. Biological investigations show:

-Fasting serum-gastrin- over 100 pg / ml

-Gastric acid level over 30 mEq / l per hour

-Secretin stimulation test over 2 micrograms

Imaging investigations that can be used are:

– Abdominal ultrasound, which can detect the primary tumor in 20% of patients

– Echoendoscopy

-Computed tomography, PET-CT

– Octreotide scintigraphy

Treatment

SEZ benefits of medical and surgical treatment. Medical treatment consists of proton pump inhibitors, which are the treatment of choice in patients with ulcer: omeprazole, pantoprazole. It can also be used H2 receptor inhibitors, such as ranitidine or famotidine. Although these drugs are intended to decrease gastric acid secretion, they are sometimes ineffective. Most effective pharmacological treatment seems to be octreotide.

Surgery aims to remove the tumor which secrete gastrin: pancreatic resection or gastrectomy may help.

Increased risk of suicide among autistic children

Children with autism have a higher risk of suicide than other children, according to a study led by Penn State College of Medicine scientists. Angela Gorman, assistant professor of child psychiatry, said that there are risk factors in these children associated with the idea of suicidal contemplation or suicide attempts than other children. Researchers analyzed several demographic variables (race, age, etc.) to see which risk factors are associated with suicide contemplation or suicide attempt.

This study is the first large-scale study using data from parents to analyze the rate of suicidal ideation and suicide attempts among children with autism. The study included 791 children with autism, 186 typical children and 35 non-autistic  depressed children aged between 1 and 16 years. There were evaluated various demographic, cognitive abilities and IQ.

autistic children

It was found that in autistic children contemplating or attempting suicide risk was 28 times higher than in normal children. However, it should be noted that the risk among these children was three times lower compared with the same risk in depressed non-autistic children. The researchers mentioned that demographic variables in predicting the risk were very significant. It seems that the risk of suicidal contemplation was more important in boys, however gender was not statistically significant for suicide attempts.

It was also found that autistic children whose parents occupy managerial position have a lower risk of suicidal contemplation or attempts than autistic children whose parents occupy other positions (10% versus 16%). It was also discovered that black and Hispanic children were more likely to have suicide contemplation or attempts than white and Asian children. Age over 10 years also involve an increased risk. Gorman said most children that were rated in all 4 categories have contemplated or attempted suicide. Another important finding was that depression and behavioral problems are significant risk factors of suicide ideation.

According to the study, depression was the most important factor in predicting suicide contemplation or attempts among children with autism. This risk is absent among children who were not impulsive and it seems that autistic children who do not have behavioral problems and those who do not fit into any of the four categories are unlikely to have suicide attempts or contemplation. Also, it appears that cognitive ability or IQ does not affect too much the idea of suicide among children with autism. Researchers want now to continue the research and to include more predictors such as previous attempts, negative events, family history of suicide and biological and biochemical variables.

Study finds that new statin has fewer side effects than other cholesterol-lowering drugs

A study led by researchers at the Intermountain Heart Institute at Intermountain Medical Center in Salt Lake City, shows that pivastatin, a new generation of drug that lower cholesterol can be used as an alternative in patients who can not tolerate other statins. It seems that pitavastatin has fewer side effects than other statins and the effects on the cardiovascular system are similar in that it lowers the risk of stroke, heart attack and death in patients with high cholesterol. The study results, presented at the American College of Cardiology’s Annual Scientific Session in San Francisco, are extremely useful because statistics show that up to 15% of patients cannot tolerate statins, which are the current most effective drugs for lowering cholesterol.

Statins

Statins inhibit a key enzyme in the formation of cholesterol, HMG-CoA reductase. By decreasing the amount of cholesterol in the blood,  also lowers LDL, which is the so-called ‘bad cholesterol’, meaning that it participates in cholesterol plaque formation. In addition to lipid-lowering effect, statins also have the effect of modulating the inflammatory response associated with atherogenesis, it stabilizes the endothelial function and cause regression of plaque already formed. Numerous studies have shown that statins are indeed useful for patients with high cholesterol as it decreases the risk of cardiovascular events such as heart attack, stroke and the risk of death. On the other hand statins can have significant side effects such as elevated transaminases, myalgia, muscle cramps, myopathy and others.

Brent Muhlestein, MD, cardiologist at the Heart Institute at Intermountain Intermountain Medical Center, and lead researcher for the study, said the study shows that pivastatin is a more tolerable statin that patients can take and can be equally effective in lowering cholesterol.

The researchers conducted the study on 40 patients who previously tried two other statins that were not well tolerated. At baseline patients were tested to see the level of LDL in the blood then they followed treatment with pivastatin ( 2 mg) per day. Those who could not bear the treatment without side effects were finally tested to see if LDL decreased. It was showed that 68% of study participants were able to tolerate pivastatin, and the patients who could best tolerate the drug was those that had no history of diabetes or heart disease. Also it was demonstrated that pivastatin decreased cholesterol on average by 34%. “If patients are having a hard time taking older statins, they should try this newer option. We believe the side effects of this drug differ from other statins because pitavastatin is water-soluble and metabolizes differently, “said Muhlestein.

People with insomnia have an increased risk of heart failure

According to a study published in the European Heart Journal, individuals who suffer from insomnia have a higher risk of developing heart failure. It should be noted that the study is the largest of its kind and was conducted on 54,279 people who were followed for 11 years. It seems that those who have 3 symptoms of insomnia have a three times higher risk of developing heart failure than those without sleep problems.

Dr Lars Laugsand, a postdoctoral fellow in the Department of Public Health, Norwegian University of Science and Technology, Trondheim, Norway, said that the three symptoms related to insomnia are trouble in falling asleep, difficulties in maintaining sleep and not feeling refresh in the morning. It seems that those who have all three symptoms have a significantly increased risk of heart failure.

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Dr. Laugsand wanted to mention that even though there was discovered this connection between insomnia and heart failure, this does not necessarily mean that the relationship is causal. He says it is not know if heart failure is caused by insomnia, but if it so, insomnia is a treatable condition. Those who have trouble sleeping may use various strategies such as psycho-behavioral or psychological therapies or simply reconsider sleep hygiene. In addition, investigation of sleep problems can provide useful information in preventing heart failure. However, to see if insomnia is indeed a cause of heart failure, further studies are needed to confirm this. Dr. Laugsand said that there may be a biological cause for insomnia as stress activates mechanisms that affect heart function.

Insomina

Researchers recruited both men and women (aged between 20-89 years) between 1995 – 1997, without heart failure, which were followed for 11 years, that is by 2008. Of the 54,279 participants, there were found 1412 cases of heart failure during the study. At enrollment, participants completed questionnaires regarding their sleep during the night: if they sleep well, if they have trouble staying asleep or if they feel tired in the morning.

After analyzing the survey results, the researchers concluded that those who had trouble sleeping more than once a week had a higher risk of heart failure compared with those who had no symptoms at all. It seems that as the frequency of these symptoms is higher, the risk of heart failure was even greater. “However, the risk among those with all the three insomnia symptoms simultaneously was particularly high even after adjustment for established cardiovascular risk factors and psychological distress”, Dr. Laugsand said.

Weight loss reverses heart damage in young mice

An experimental study conducted by researchers at Johns Hopkins shows that weight loss and diet may reverse cardiac function but only in the young mice. Published in Journal of Cardiovascular Translational Research, the study highlights the benefits of weight loss on the cardiovascular system. It seems that heart function recovery depends very much of the duration of obesity. This fact points out that it is important that the healthy lifestyle be adopted early in life in order to prevent cardiovascular disease. AlGhatrif Majd, MD, the first author of the study and assistant professor of medicine at  the Johns Hopkins University School of Medicine, said: “Our research indicates that the longer mice are obese, the greater the risk that their heart damage is irreversible”. The study draws the attention that obese individuals should take very seriously into account losing weight as soon as possible.

Obese

Lili Barouch, MD, the senior author of the study and a cardiologist and assistant professor of medicine at the Johns Hopkins University School of Medicine, said that it is not known whether the same principle applies to people and that would be significant, but is to note that early weight loss is beneficial. It would be interesting to see if the same thing happens in humans.

Obesity is one of the most important health problems worldwide with an increasing incidence. WHO estimated in 2008 that about 10% of the world population suffers from obesity, and the highest rates are registered in the U.S., Australia and Canada. According to the Center for Disease Control and Prevention, at present over 35% of Americans suffer from obesity.

Obesity is an aggravating factor for a many of medical conditions: heart attack, stroke, diabetes, cancer etc. Several studies have shown that weight loss can reverse some of the harmful effects of obesity on the cardiovascular system, but it was not clear whether patient age or the number of years of obesity influences this. Therefore, researchers conducted a study on two groups of obese rats: a group of young mice and one of old mice. All mice were genetically engineered to be born without leptin, a hormone that plays a role in producing satiety. Absence of leptin leads to obesity because mice have no feeling of fullness. All mice had the same weight and they all lost the same amount of weight. It was found that diastolic function in young mice returned to normal. However, in old mice diastolic function remained unchanged.

Ultrasound at birth predicts autism risk

Recent studies led by researchers at Michigan State University show that cerebral ultrasound can predict the risk of new-born to develop autism. It seems that low-birth weight babies with a specific brain abnormality have an increased risk of developing autism. Autism is a developmental disorder  which is characterized by a behavioural and social impairment, observed in the first three years of life. Children with autism do not interact with others, have repetitive behaviors, strange gestures and weird reactions to certain stimuli. Mental retardation may be present but some have an IQ above average.

It is not clear what causes autism, but there are several assumptions in this regard. Some believe that this disorder is due to an imbalance between neurotransmitters in the brain (serotonin and dopamine) or due to a lack of neuronal migration during embryogenesis. Others believe that autism occurs because of stress experienced by the mother during pregnancy or due to exposure to certain toxic. However, multiple causes may contribute together to the development of this disorder.

Ultrasound

Lead author Tammy Movsas, clinical assistant professor of Pediatrics at MSU and medical director of the Midland County Department of Public Health, said that there has been much controversy regarding the causes of autism. It is unclear whether the disease is triggered by postnatal vaccination or by environmental factors or if it already exists at birth. Now, recent studies have shown that some low-birth weight babies have enlarged ventricles  and that this increases 7 times the risk of developing autism. “What this study shows us is that an ultrasound scan within the first few days of life may already be able to detect brain abnormalities that indicate a higher risk of developing autism,” Movsas said.

In the study 1105 cases were evaluated  with the use of cranial ultrasound after birth. The same patients were screened for autism after 16 years and 21 years and it was found that 14 of them developed autism. Movsas said the study shows that ultrasound done in the first few days after birth to identify brain abnormalities may indicate risk of autism. Ventricles are cavities in the brain where cerebrospinal fluid is formed; enlarged ventricles damage the white matter in the brain. Co-author Nigel Paneth, MSU epidemiologist, said the study provides an important key to understanding brain abnormalities in autism. However, he added that more studies must be done to elucidate the mechanisms by which loss of white matter leads to autism.

Findings about omega 6 fats

An article recently published in the British Medical Journal launches a challenging hypothesis, namely that omega-6 fatty acids are not as beneficial to health, on the contrary it seems that they are harmful to people with heart problems. Findings of study derived from an earlier study published in 1978 which aimed an association between diet and cardiovascular disease. This new research points out that consumption of omega-6 fatty acids leads to an increased risk of death among individuals who had suffered from heart attack. The study conclusion is contrary to popular belief because it has long been thought that omega 6 and omega 3 fatty acids have multiple benefits on health.

The original study was conducted on 500 men aged 30-59 years who had heart disease. Of these, half consumed linoleic acid from safflower oil (unsaturated fat) and half remained with the same type of diet. Researchers found that the first had a higher risk of mortality than the last.

Fatty Acids

As consumption of linoleic acid in the American diet has tripled in the last decades, researchers believe that there is a link between the increased incidence of cardiovascular disease and this type of diet. However they noted that more studies should be done to confirm this: “it would be a jump to say that this is what caused the rise in cardiovascular disease. Yet this is the conclusion we keep going back to,” Daisy Zamora, a nutrition epidemiologist with the University of North Carolina’s Gillings School of Health in Chapel Hill, said.

It should be noted that omega 3 and omega 6 are essential fatty acids, meaning the body cannot synthesize and they must be taken from the diet. Numerous studies have shown that these fatty acids have cardiovascular protective effects because they reduce “bad cholesterol”, that is LDL cholesterol, and reduce the risk of atherosclerosis.

Elisabetta Politi, nutrition director at the Duke Diet and Fitness Center, explained that omega-6 fats are found in all kinds of vegetable oils such as safflower, sunflower and corn oil, and are widely used in food industry as they are available and inexpensive. These are unsaturated fats and have been widely recommended in recent decades to replace saturated fats found in animal products.

Daisy Zamora, a nutrition epidemiologist with the University of North Carolina’s Gillings School of Health in Chapel Hill, said that what they found did not comply with the dietary advice given to patients in the last 50 years. She added that the study results should  make people reconsider their choice regarding the food they consume daily. However she said that these results are not sufficient to make people to stop eating all foods containing omega-6 fatty acids.

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Genetic Risks of Behçet’s disease

Researchers at the University of Michigan in collaboration with an international team of scientists have made new discoveries about Behcet’s disease, or Silk Road disease, a rare autoimmune disorder characterized by mucosal ulceration and visual loss. The study, which was published in the journal Nature Genetics, highlights genetic risk factors involved in the onset of this disease. Lead author Amr Sawalha, MD, associate professor of internal medicine in the Division of Rheumatology at the UM Medical School, said Behcet’s disease is associated with many complications and because the disease pathogenesis is not clearly understood, treatment is limited. Dr. Sawalha says in the study were found many genetic factors associated with Behcet’s disease and they hope that these findings will help them discover a more effective treatment of disorder.

Behcet’s Disease

Behcet’s disease can affect all ethnic groups but is most common in East Asia, Turkey, and the Mediterranean and Middle Eastern countries. Behcet’s disease is a vasculitis that is an inflammation of the blood vessels throughout the body and this leads to damage practically to any organ: the skin, eyes, digestive system, brain, joints etc. There are affectted the skin, the eye, the gastrointestinal system, the pulmonary system, the musculoskeletal system, the nervous system and the heart. Behcet’s disease patients have painful  mucocutaneous ulcers that can be located both oral and genital. Eye disease refers to different types of uveitis (anterior uveitis, posterior uveitis, etc.) that usually occurs early in the disease and can lead to vision loss due to optic nerve atrophy.

Other symptoms are abdominal pain, diarrhea, nausea, vomiting, pain, hemoptysis, etc.. Because of damage to cerebral blood vessels, symptoms like headaches, confusion, seizures may appear. Treatment is similar to other autoimmune diseases as it is based on corticosteroids and immunosuppressants ( azathioprine, ciclosporin), interferon, anti-TNF therapy etc.

So far studies have shown that in this disease is involved a specific form of a gene on chromosome 6 in the HLA region. The study of the University of Michigan researchers shows that there are at least four independent genetic risk within the HLA region involved in Behcet disease. This finding contradicts the previous research showing that a major genetic risk factor is represented by one form of the gene HLA-B, called HLA-B *51. Sawalha explained that HLA region plays an important role in many diseases. He added that this region is also one of the most complex regions of the genome and is therefore difficult to analyze.