Generalized Anxiety Disorder

Anxiety is a feeling of apprehension that some describe as an exaggerated sensation of impending doom, dread, or uneasiness. Unlike fear—a reaction to danger from a specific external source—anxiety is a reaction to an internal threat, such as an unacceptable impulse or a repressed thought that’s straining to reach a conscious level.
A rational response to a real threat, occasional anxiety is a normal part of life. Overwhelming anxiety, however, can result in generalized anxiety disorder—uncontrollable, unreasonable worry that persists for at least 6 months and narrows perceptions or interferes with normal functioning. Recent evidence indicates that the incidence of generalized anxiety disorder is greater than previously thought and may be even greater than that of depression.

Etiology is thought to involve the y-aminobutyric acid (GABA) A receptor–chloride ion channel complex. Benzodiazepines bind two separate GABA-A receptor sites: Type I has broad anatomic distribution, and type II is concentrated in the hippocampus, striatum, and neocortex. Serotonin (5-hydroxytryptamine [5-HT]) also appears to have a role in anxiety. Theorists share a common premise: Con-flict—whether intrapsychic, sociopersonal, or interpersonal—promotes an anxiety state.
Signs and symptoms
Generalized anxiety disorder can begin at any age but typically has an onset between ages 20 and 40. It’s equally common in men and women. Psychological or physiologic symptoms of anxiety states vary with the degree of anxiety. Mild anxiety mainly causes psychological symptoms, with unusual self-awareness and alertness to the environment. Moderate anxiety leads to selective inattention but with the ability to concentrate on a single task. Severe anxiety causes an inability to concentrate on more than scattered details of a task. A panic state with acute anxiety causes a Continue reading “Generalized Anxiety Disorder”

Neonatal Resuscitation Procedure

Initial Steps
  • Prevent hypothermia—place infant on preheated radiant warmer, dry infant, then rewrap in warm, dry blankets. Polyethylene (food grade) bags may help maintain body temperature of very-low-birthweight infants.
  • Position—place the infant in a supine position with the head slightly extended (“sniffing position”); a small roll placed under the shoulders may be helpful.
  • Airway—if there are copious secretions compromising the airway, suction the mouth first and then the nose using either a suction bulb or 8F or 10F suction catheter; avoid prolonged and deep suctioning. Negative pressure should not exceed 100 mm Hg.
  • Tactile stimulation—if the infant remains apneic after drying, positioning, and suctioning, further tactile stimulation is unlikely to help; brief, gentle back rubbing or flicking the soles of feet, may be tried, but these efforts should not delay onset of positive-pressure ventilation.
Oxygen Administration
Free-flow 100% oxygen (at least 5 L/min) should be provided to any infant who has central cyanosis, pending further intervention(s). If positive-pressure ventilation (PPV) is begun, 100% supplemental oxygen is recommended. To reduce potential harm from excessive tissue oxygenation in preterm infants, the use of an oxygen blender and pulse oximetry is recommended in order to titrate supplemental oxygen delivery, maintaining Continue reading “Neonatal Resuscitation Procedure”

Renal vein thrombosis

Clotting in the renal vein results in renal congestion, engorgement and, possibly, infarction. Renal vein thrombosis may affect both kidneys and may occur in an acute or a chronic form.
Chronic thrombosis usually impairs renal function, causing nephrotic syndrome. Abrupt onset of thrombosis that causes extensive damage may precipitate rapidly fatal renal infarction.
If thrombosis affects both kidneys, the prognosis is poor. However, less-severe thrombosis that affects only one kidney or gradual progression that allows development of collateral circulation may preserve partial renal function.
Renal vein thrombosis results from trauma to the abdomen or back, stricture (scar formation), or a tumor that obstructs the renal vein (usually hypernephroma).
Other causes include thrombophlebitis of the inferior vena cava (may result from abdominal trauma) or blood vessels of the legs, heart failure, and periarteritis. In infants, renal vein thrombosis usually follows diarrhea that causes severe dehydration.
Chronic renal vein thrombosis is a common complication of other glomerulopathic diseases, such as amyloidosis, systemic lupus erythematosus, diabetic nephropathy, and membranoproliferative glomerulonephritis.
Signs and symptoms
Signs and symptoms of renal vein thrombosis vary with the speed of onset.
Rapid onset of venous obstruction produces severe lumbar pain and tenderness in the epigastric Continue reading “Renal vein thrombosis”

Introduction to Renal tubular acidosis

A syndrome of persistent dehydration, hyperchloremia, hypokalemia, metabolic acidosis, and nephrocalcinosis, renal tubular acidosis (RTA) results from the kidneys’ inability to conserve bicarbonate. This disorder occurs as distal RTA (type I, or classic RTA) or proximal RTA (type II). The prognosis is usually good but depends on the severity of renal damage that precedes treatment.
Metabolic acidosis usually results from renal excretion of bicarbonate. However, metabolic acidosis associated with RTA results from a defect in the kidneys’ normal tubular acidification of urine.
Distal RTA
Type I RTA results from an inability of the distal tubule to secrete hydrogen ions against established gradients across the tubular membrane. This results in decreased excretion of titratable acids and ammonium, increased loss of potassium and bicarbonate in the urine, and systemic acidosis.
Prolonged acidosis causes mobilization of calcium from bone and eventually hypercalciuria, predisposing the patient to the formation of renal calculi.
Distal RTA may be classified as primary or secondary:
  • Primary distal RTA may occur sporadically or through a hereditary defect and is most prevalent in females, older children, adolescents, and young adults.
  • Secondary distal RTA has been linked to many renal and systemic conditions, such as starvation, malnutrition, hepatic cirrhosis, and several genetically transmitted disorders.
Proximal RTA
Type II RTA results from defective reabsorption of bicarbonate in the proximal tubule. This causes bicarbonate to flood the distal tubule, which normally secretes hydrogen ions, and leads to impaired formation of titratable acids and ammonium for excretion. Ultimately, metabolic Continue reading “Introduction to Renal tubular acidosis”

Obsessive-compulsive disorder

Obsessive thoughts and compulsive behaviors represent recurring efforts to control overwhelming anxiety, guilt, or unacceptable impulses that persistently enter the consciousness.
The word obsession refers to a recurrent idea, thought, impulse, or image that is intrusive and inappropriate and causes marked anxiety or distress.
A compulsion is a ritualistic, repetitive, and involuntary defensive behavior. Performing a compulsive behavior reduces the patient’s anxiety and increases the probability that the behavior will recur. Compulsions are commonly associated with obsessions.
Patients with obsessive-compulsive disorder are prone to abuse psychoactive substances, such as alcohol and anxiolytics, in an attempt to relieve their anxiety. In addition, other anxiety disorders and major depression commonly coexist with obsessive-compulsive disorder.
Obsessive-compulsive disorder is typically a chronic condition with remissions and flare-ups. Mild forms of the disorder are relatively common in the population at large.

The cause of obsessive-compulsive disorder is unknown. Some studies suggest the possibility of brain lesions, but the most useful research and clinical studies base an explanation on psychological theories. Several studies show brain abnormalities, such as decreased caudal size and decreased white matter, but results are inconsistent and remain under investigation. In addition, major depression, organic brain syndrome, and schizophrenia may contribute to the onset of obsessive-compulsive disorder.
Signs and symptoms
The psychiatric history of a patient with this disorder may reveal the presence of obsessive thoughts, words, or mental images that persistently and involuntarily invade the consciousness.
Some common obsessions include thoughts of violence (such as stabbing, shooting, maiming, or Continue reading “Obsessive-compulsive disorder”

Brief Summary of Conjunctivitis

Hyperemia of the conjunctiva from infection, allergy, or chemical reactions characterizes conjunctivitis. Bacterial and viral conjunctivitis are highly contagious but are also self-limiting after 2 weeks. Chronic conjunctivitis may result in degenerative changes to the eyelids. In the Western hemisphere, conjunctivitis is probably the most common eye disorder.
The most common causative organisms are the following:
  • bacterial: Staphylococcus aureus, Streptococcus pneumoniae, Neisseria gonorrhoeae, Neisseria meningitidis
  • chlamydial: Chlamydia trachomatis (inclusion conjunctivitis)
  • viral: adenovirus types 3, 7, and 8; herpes simplex virus type 1.
Other causes include allergic reactions to pollen, grass, topical medications, air pollutants, and smoke; occupational irritants (acids and alkalies); rickettsial diseases (Rocky Mountain spotted fever); parasitic diseases caused by Phthirus pubis and Schistosoma haematobium; and, rarely, fungal infections.
Vernal conjunctivitis (also called seasonal or warm-weather conjunctivitis) results from allergy to an unidentified allergen. This form of conjunctivitis is bilateral; it usually begins before puberty and persists for about 10 years. Sometimes it’s associated with other signs and symptoms of Continue reading “Brief Summary of Conjunctivitis”

Chronic constipation

Also known as lazy colon, colonic stasis, colonic inertia, and atonic constipation, chronic constipation may lead to fecal impaction if left untreated. It’s common in elderly and disabled people because of their inactivity and is commonly relieved with diet and exercise. Left untreated, it can result in hemorrhoids, fissures and megacolon.

Chronic constipation usually results from some deficiency in the three elements necessary for normal bowel activity: dietary bulk, fluid intake, and exercise. Other possible causes can include habitual disregard of the impulse to defecate, emotional conflicts, overuse of laxatives, or prolonged dependence on enemas, which dull rectal sensitivity to the presence of stool. Certain medications (tranquilizers, anticholinergics, opioids, antacids) can cause it, and patients with certain disorders (Parkinson’s disease, multiple sclerosis, hypothyroidism, scleroderma, lupus erythematosus) are more prone to develop it.

Signs and symptoms
The patient typically strains to produce dry, hard stool accompanied by mild abdominal discomfort. Straining can aggravate other rectal conditions such as hemorrhoids.
A patient history of dry, hard stool and infrequent bowel movements suggests chronic Continue reading “Chronic constipation”

Reye’s syndrome in Children

An acute childhood illness, Reye’s syndrome causes fatty infiltration of the liver with concurrent hyperammonemia, encephalopathy, and increased intracranial pressure (ICP). In addition, fatty infiltration of the kidneys, brain, and myocardium may occur.
Reye’s syndrome affects children. It’s most common in patients ages 4 to 12, with a peak incidence at age 6.
The prognosis depends on the severity of central nervous system depression. Previously, mortality was as high as 90%. Today, ICP monitoring and, consequently, early treatment of increased ICP, along with other treatment measures, have cut mortality to about 20%. Death is usually a result of cerebral edema or respiratory arrest. Comatose patients who survive may have residual brain damage.
Incidence of Reye’s syndrome usually rises during influenza outbreaks and is linked to aspirin use. It almost always follows within 1 to 3 days of an acute viral infection, such as an upper respiratory tract infection, type B influenza, or varicella (chickenpox).
With Reye’s syndrome, damaged hepatic mitochondria disrupt the urea cycle, which normally changes ammonia to urea for its excretion from the body. This results in hyperammonemia, hypoglycemia, and an increase in serum short-chain fatty acids, leading to encephalopathy. Continue reading “Reye’s syndrome in Children”

Introduction to Kaposi’s sarcoma

Kaposi’s sarcoma, a cancer of the lymphatic cell wall, affects tissues under the skin or mucous membranes that line the mouth, nose, and anus. In recent years, the incidence of Kaposi’s sarcoma has risen dramatically along with the incidence of human immunodeficiency virus (HIV) infection. It’s now the most common HIV-related cancer.
Kaposi’s sarcoma causes structural and functional damage. It progresses aggressively, involving the lymph nodes, the viscera and, possibly, GI structures.
The exact cause of Kaposi’s sarcoma is unknown, but the disease may be related to immunosuppression. Genetic or hereditary predisposition is also suspected.

Signs and symptoms
The initial sign of Kaposi’s sarcoma is one or more obvious lesions in various shapes, sizes, and colors (ranging from red-brown to dark purple) that appear most commonly on the skin, buccal mucosa, hard and soft palates, lips, gums, tongue, tonsils, conjunctivae, and sclerae.
With advanced disease, the lesions may join, becoming one large plaque. Untreated lesions may appear as large, ulcerative masses.
Other signs and symptoms include:

What is Lyme disease

A multisystemic disorder, Lyme disease is caused by the spirochete Borrelia burgdorferi, which is carried by the minute tick Ixodes dammini or another tick in the Ixodidae family. It typically begins in summer, with the classic skin lesion called erythema chronicum migrans (ECM). Weeks or months later, cardiac or neurologic abnormalities sometimes develop, possibly followed by arthritis.
Lyme disease occurs primarily in areas of the United States inhabited by the deer tick, such as:
  • in the northeast, from Massachusetts to Maryland
  • in the midwest, in Wisconsin and Minnesota
  • in the west, in California and Oregon.
Although Lyme disease is endemic to these areas, cases have been reported in 43 states and 20 other countries, including Germany, Switzerland, France, and Australia.
Lyme disease occurs when a tick injects spirochete-laden saliva into the bloodstream or deposits fecal matter on the skin. After incubating for 3 to 32 days, the spirochetes migrate out to the skin, causing ECM. Then they disseminate to other skin sites or organs by the bloodstream or lymph system.
The spirochetes’ life cycle isn’t completely clear: They may survive for years in the joints or they may trigger an inflammatory response in the host and then die.

Signs and symptoms
Typically, Lyme disease has three stages. Continue reading “What is Lyme disease”