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Kawasaki Disease

Kawasaki Disease or Kawasaki Syndrome typically affects children under 5 years. It is noticed more among children of Japanese and Korean origin. The rash may be worse in the groin. There is fall and rise of temperature. Symptoms of Kawasaki Disease include high fever accompanied by redness in both eyes or redness in the palms and soles. The lymph nodes in the neck may be enlarged. The fingers and toes may develop swelling and discoloration. The mouth and lips usually get severely chapped. There is a rash on the chest and stomach. The rash may be worse in the groin. There is fall and rise of temperature.


It is essential that Kawasaki disease be diagnosed and treated at an early stage to avoid complications with the heart. It can lead to an inflammation of the blood vessels of the heart (vasculitis). There can also be subsequent swelling of the heart muscles, coronary arteries and valves. Kawasaki disease goes through phases. In the initial phase, there is high fever and rashes begin to appear. Mild conjunctivitis is observed. The mouth mucous membranes are inflamed and appear bright red. In the second phase, the child experiences peeling skin on the hands and feet. There may be vomiting and diarrhea. Joint pain and swelling is noticed in the knees, hips and ankles.


Other conditions that have similar symptoms are scarlet fever, Steven Johnson syndrome and Toxic shock syndrome. Urine and blood tests are conducted to diagnose Kawasaki syndrome. Intravenous doses of gamma globulin are given to a child suffering from Kawasaki disease to boost the body's resistance to infection. Aspirin is given to relieve some of the symptoms and prevent blood clots and heart disease.

Convulsions

Seizures or convulsions are associated with the electrical activity of the brain. They have an impact on major systems of the body and can be fatal if not treated. Seizures are classified predominantly based upon their site of occurrence and the affected organ or system.

Types of Convulsions

General or clonic seizures: In most cases, generalized seizures are also called as tonic-clonic seizures as they involve the entire body. In common parlance, it also referred as epileptic attacks. Patients experience changes in sensations such touch, taste, smell and vision. Hallucinations or auras are also experienced as they begin to influence the emotional balance of a person.

Focal or Partial seizures: These types of seizures are cause because of disturbed electrical activity in the brain which is localized to one part of the brain. It acts on the temporal region of the brain leading loss of memory and balance in extreme conditions.

Petit mal Seizures: These are temporary and their effects are usually limited to 20 seconds. They generate temporary muscle spasms which happen because of electrical imbalances in the brain.

Epilepsy: This type of seizure is closely related to general seizures. The factors associated with the onset of epilepsy may include preexisting conditions such as ischemic heart disease, Alzheimer disease, meningitis and encephalitis.

Fever induced convulsions: These types of seizures predominantly occur in children, infants and toddlers. The initial phase of these convulsions is very intense as they cause much discomfort to the child. They usually subside within a few hours. Most of the fever induced convulsions are caused by viruses and ear infections.

Clinical manifestations

Most convulsions or seizures are characterized by classical muscle spasm symptoms which includes rigorous shaking and frothing with prolonged effects like unconsciousness (blackout). Since the predominant reason associated with convulsions are related to the electrophysiology of the brain, neurological symptoms such as confusion, hallucination, dementia, drooling, lack of bladder control and sudden loss of balance may also be noticed.

Convulsions also have effects on the emotions of a person as many people complain of unprecedented symptoms such as sudden aggression, depression, mood swings, panic, extreme laughter and joy for a temporary period of time. Warning signs often appear before any form of seizure such as dizziness, sensitivity to light, vertigo and nausea.

Seizures can also occur as a result of withdrawal from use of drugs such as barbiturates, valium or benzodiazepines. Drug abuse and alcohol abuse along with preexisting health complications such as end-stage renal disease, renal failure and congenital heart disease can indicate high percentage of seizure onset. Seizures also occur in conditions such as Steven Johnson syndrome, a disease occurring in children. In addition to these clinical manifestations, seizures can occur because of severe brain injury, shock or even during athletic events as result of extreme adrenaline levels in the blood.

Diagnosis and Treatment

Epileptics are diagnosed with a meticulous examination of their history. Various biochemical tests such as sodium levels, SGOT, SGPT and blood glucose levels are analyzed. Electro encephalogram is done to understand the electrophysiology of the brain. In some cases, neurologists recommend MRI and CT scans to understand the presence of any abnormalities or to identify any kind of trauma caused in the brain or the spinal cord.

In most cases seizures are treated with antidepressants as the predominant cause of any form of seizure is depression. Anti epileptic drugs such as sodium channel blockers and GABA transaminase inhibitors are recommended.


Balanitis

Balanitis is a common inflammatory condition in men caused due to infections, trauma and poor personal hygiene. The inflammation is caused on the head of the penis also called as the glans penis. The region of glans penis along with the foreskin becomes inflamed. This condition is rare among men who are circumcised. Many underlying infections induce the onset of balanitis. One of the most common causes of balanitis is poor personal hygiene. In this case a layer of creamy substance called smegma is formed under the foreskin causing balanitis. Men who are circumcised rarely suffer this condition.


Phemosis is a condition in which the foreskin cannot be retracted. This condition predominantly happens in boys at the age of four. The urine collecting under the foreskin along with debris may lead to balanitis.

Candidiasis is one of the major causes of balanitis. In most cases candida associated balanitis is caused because of trauma and it also referred as circinate balanitis.

Many other infectious organisms like Streptococcus.Sp, Staphylococcus aureus (Steven Johnson's syndrome) cause balanitis. Most of these organisms cause infections in uncircumcised persons who do not clean the glans penis region on a regular basis. Balanitis is also sexually transmitted. Men are generally advised to clean their genital areas after intercourse, to prevent balanitis. Balanitis is also caused because of certain soaps or disinfectants used in washing the glans region. In some cases, use of spermicides and lubricants present in the condoms can induce balanitis.


Balanitis Symptoms

Balanitis symptoms begin with the appearance of rash on the glans region. In some cases these rashes progress into more predominant sores leading to discharge with odor. In these cases the region behind the glans penis is also affected. Other associated symptoms of balanitis include joint pains, malaise and soreness of the mouth. The classic clinical presentation of balanitis includes the presence of ulcerated glans tissue, edema, leukoplakia, exudation and also crusting. Untreated balanitis is often associated with the development of meatal stenosis and also malignancy leading to painful discharge and localized lymphadenopathy.


Risk Factors for Balanitis: The risk factors associated with the occurrence of balanitis includes diabetes and trauma. In case of diabetics who are uncircumcised, the urine droplet accumulation leads to serious infections along with balanitis. In some cases balanitis risk factor is also reported among sexual partners affected by vaginitis. The other factors include obesity, chemicals and reaction to certain group of drugs.


Treatment of Balanitis

Balanitis treatment is often associated with personal hygiene. Men who are uncircumcised and are prone to frequent episodes of balanitis are advised to wash and dry the glans penis region every day and especially after intercourse to prevent infections which may lead to balanitis. Diabetics are advised to keep a regular check on their sugar levels especially pertaining to urine sugar levels to prevent the onset of balanitis.

Antibiotics and steroidal creams are generally prescribed for this infection. In some cases ibuprofen and acetaminophen are given to relieve the pain. In case of recurrent balanitis, removal of foreskin (Circumcision) is suggested. Patients undergoing treatment are advised to abstain from sexual activity until the treatment is completed to prevent relapse.

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Bibliography / Reference

Collection of Pages - Last revised Date: November 22, 2019