Guillain Barre Syndrome (GBS) - Presentation and Diagnosis

What is GBS?

GBS is a post infective demyelinating neuropathy of unknown cause. it usually occurs one to three weeks after an episode of respiratory tract infection, diarrhoea, surgery or vaccination.GBS is a immunologically mediated disease.In most of the cases GBS follow an infection with CMV (Cytomegalovirus), mycoplasma or campylobacter jejuni. 

GBS

Presentation

A patient of GBS usually presents with the complaints of weakness of Lower limbs for few days and difficulty in walking for same duration.Flaccid type of paraplegia is seen in a patient of GBS. 

Important clinical examination findings in GBS

The higher cerebral function of patient of GBS is usually normal. All the cranial nerves are intact. The muscle tone of the Lower limbs of the patient is diminished but the muscle bulk of the patient is normal. The sensory function of the nerves are usually intact.The striking abnormality is seen in a GBS patient when the jerks of the patient are tested. The knee and the ankle jerks are often seen absent but the biceps and triceps jerks are normal.The jerks in the upper limbs may be absent in a patient of GBS in very advanced stage.

Investigations to diagnose GBS

A CSF study may be sufficient to declare GBS. Albuminocytological dissociation is found in the CSF of a GBS patient.(Albumin maybe found very high in the CSF of a GBS patient) But if the lymphocytes count is more than 50/cmm then GBS is unlikely.

Investigations to identify CMV, mycoplasma and campylobacter jejuni can be done.

Nerve condition study can be done and may show slow condition, condition block or demyelinating neuropathy.

Low birth weight and its causes

Low Birth Weight: Babies with birth weight of less than 2500grams irrespective of gestational age may be called as low birth weight.

There are a wide range of causes of low birth weight. Some of them are mentioned below.

LBW

Placental Causes:

a.      Fetal distress

b.     Multiple gestation

c.      Erythroblastosis fetalis

Uterine Causes:

a.      Bicornuate uterus

b.     Incompetent Cervix

Maternal Causes:

a.      Teenage mother

b.     Pre eclampsia

c.      Chronic medical illness

d.     Infections

Other Causes:

a.      Pre mature rupture of membrane (PROM)

b.     Polyhydramnios

c.      Diabetes

d.     Rh incompatibility

More over any factor that causes Intra uterine growth retardation can lead to a low birth weight.

Hepato Renal Syndrome

Hepato Renal Syndrome:

Hepato Renal syndrome is a severe condition usually occurring in chronic liver disease patient. Actually Hepato Renal syndrome occurs at the very end stage of chronic liver disease and the mortality rate of the patients, when hepato renal syndrome developed is very high. In short we can describe hepato renal syndrome as detoriation of the renal function at the late statage of chronic liver disease or fulminant liver failure.

Mechanism of Hepato Renal Syndrome (HRS) development:

The actual mechanism of the development of hepato renal syndrome is not so clear. It is thought that multiple factors play role inn the development of hepato renall syndrome. Constriction of the renal blood veasels is the main of them. Why the constriction of the renal blood vessels occur? The answer is not so clear. It is believed that activation of systemic vaso constrictor agents and the inactivation of the systemic vaso dilator agents are responsible for this. Though the renal blood vessels are constricted, there are no changes are seen in renal parenchyma.

The histological findings of the renal parenchyma appears to be normal where the histological picture of liver shows total loss of normal architecture.
In hepato renal syndrome there is a complete inverse relationship is seen between renal plasma flow and glomerular filtration rate. Though renal plasma flow is decreased, Glomerular filtration rate is still increasing. This is may be due to a very minimal and microscopic damage to glomerular basement membrane.

Painful Blister on lips or herpes labialis.

Infection with type one herpes simplex virus can cause painful blister over you lips. This disease is called herpes labialis. Herpes simplex virus is a very common one. They are of two types. One is type-I another is type-II. Genital herpes usually caused by type-II. Type-I virus usually attack over the west region. But exception may occur.
Painful blister over lips is usually for type-I herpes simplex virus. But keep in mind that this is the commonest but not the only reason.
Patient with herpes labialis develop vescicular rashes over lips and surrounding areas. The rashes first appears in the muco cutanious junction of the lips. Patient usually have low grade fever. Sometimes oral ulceration can be seen ass well. If you dought about SLE, you must take proper history along with serum ANA and serum anti DSDNA test.
Confirmatory Diagnosis :
To confirm herpes labialis proper history and clinical examination is enough. For confirmation PCR and immunoflurocence microscopic study can be done.
Treatment of herpes labialis :
Treatment of herpes labialis is usually easy and the prognosis is very good unless the case is too much complicated. Oral acyclovir can be used for this disease. Proper nutrition must be endured for rapid recovery.

Blisters in HSV-I

Hallucination

Hallucination is nothing but sensory perception which occurs in the absence of external stimuli. As for example we can call the followings;

Types of Anemia

Anemia

Anemia may be defined as qualitative or quantitative deficiency of hemoglobin in the blood for the age and sex of the individual. The Normal Hemoglobin level in an adult male is 14 to 18 mg/dl and 12 to 16 for female. When the hemoglobin concentration is below of this level then the person can be called anemic theoretically. Normally the hemoglobin concentration in female body is less than a male body. This is due to the activity of estrogen hormone.

Nail change in Anemia

Classification of Anemia

Morphological classification:

Microcytic hypo chromic anemia:

Causes:

1.       Iron deficiency anemia

2.       Thalassaemia

3.       Sideroblastic anemia

4.       Anemia in chronic disease.

Normocytic normochromic anemia:

Causes:

1.       Aplastic anemia

Causes of Iron Deficiency Anemia

Iron Deficiency Anemia

This is a condition when the loss of iron or the physiological demand for iron is more than the intake or absorption. In Iron deficiency anemia, the red blood cells become small and hypo chromatic. The major causes of Iron deficiency anemia are the followings:

Iron Deficiency Anemia

Blood loss:

1.       Gastriris

2.       Peptic Ulceration

3.       Gastric malignancy

4.       Carcinoma colon

5.       Inflammatory bowel disease

6.       Diverticulitis

7.       Polyps

8.       Hook worm infestation

9.       Schistosomiasis

10.   Chronic use of NSAIDs or Aspirin

Common Causes of Anemia in Bangladesh

Anemia

Bangladesh is a poor country. Most of the people here are deprived of basic needs of life. The number of doctors and the health care centers are insufficient. They cannot take nutritious food for their illiteracy and poverty. For these reasons most of the people in Bangladesh are anemic. More over the chronic disease such as Tuberculosis, SLE, Peptic Ulcer Disease, hook worm infestation are very common. These diseases also play a vital role in the development of anemia. A short example can give you a clear idea about the hematological condition of Bangladeshi people. In Bangladesh a lady with a hemoglobin level of 10mg/dl is considered as free from anemia, where the normal international level is 12 to 16 mg/dl.

Indications of Bone Marrow Transplantation

Indications of Bone Marrow Transplantation

Allogeneic bone marrow transplantation is the last line of treatment in some systemic and some Hematological diseases. The indications of allogeneic bone marrow transplantation are the following;

General indications for allogeneic bone marrow

Bone Marrow Transplantation

transplantation:

1.       Neoplastic disorders affecting the totipotent or pluripotent cell component (Such as Leukemia )

2.       Those with a failure of haematopoiesis

3.       A major inherited defect in blood cell production

4.       Inborn errors of metabolism with missing enzymes or cell lines.

Hematological indications for allogeneic bone marrow transplantation:

1.       AML high risk CR1 and CR2

2.       Adult ALL CR1 and CR2

What is Hydatid cyst? Investigations and treatment.

Hydatid cyst

Hydatid cyst is a very common cystic disease of liver, in the people of the subcontinent. This disease is most common among the people of India, Bangladesh, Nepal and Myanmar. This is a parasitic disease. And the causative organism is Echinococcus granulosus.

Hydatid cyst

Structure of Hydatid cyst:

The cyst is composed of three layers. They are;

1.       An outer layer derived from the host.

2.       An intermediate laminated layer.

3.       An inner germinal layer.

Feature of the cyst:

1.       They can be single or multiple.

2.       Chronic cysts become calcified.

3.       The cyst may be asymptomatic but may present with abdominal pain or mass.

4.       Rupture or secondary infection of the cyst can occur and a communication with the intrahepatic biliary tree can then result with associated biliary obstruction.

Causes of Dry Tap

Dry Tap

Bone marrow study is an essential investigation to diagnose the blood disease mainly. But this investigation can help to diagnose many other systemic and neurological diseases. To do the bone marrow study first of all the aspiration of the bone marrow is required from the medulary cavity of the bone. In most of the cases wide bore needle is used for this aspiration. But in complicated cases another method named trephine can be used as well. Dry tap is one of the complicated cases where the trephine method is required.

Failure to aspirate any material in the bone marrow aspiration needle is referred as dry tap.

Acute pancreatitis can bringa muti systemic complication

Acute pancreatitis

Pancreas 

Acute pancreatitis can be defined as an acute inflammation of the tissue of the pancreas. The most common causes of acute pancreatitis are, stone in the common bile duct and excessive alcohol intake. In most of the cases the patient presents with a severe upper abdominal pain which radiates to the back. Skin color change in the flank of the abdomen can also be seen. The mortality rate in severe attack of acute pancreatitis is very high. And the risk of long term complication or other disabilities are very high as well.

Some Common Complications of Acute Pancreatitis:

Systemic complications:

1.       Systemic inflammatory response syndrome (SIRS)

2.       Hypoxia

Complication of BCG vaccine

Complication of BCG vaccine

Complication of BCG vaccine

BCG vaccine is used to prevent tuberculosis related to meningitis as well as disseminated TB in humankind. Although severe cases of complication of BCG vaccine are rare, there are selected cases where acute reactions have been observed.  These cases include a situation where a test was carried out on a patient with erythematous (7-mm) nodule at 4cm – distance from the vaccination site. During this test, histopathologically, a reaction (necrotizing granulomatous) pattern was observed in the dermis.

Causative organism of tuberculosis and its structure

Causative organism of tuberculosis and its structure

Mycobacterium

Common and lethal in most cases, tuberculosis (TB) is an infectious disease associated with various types of mycobacteria, normally the mycobactrium tuberculosis. It mostly affects the lungs but can spread to other parts of the body. As an airborne disease, it is easily spread through the air especially so when TB victims sneeze, cough or emit respiratory fluids to the air. Most of the TB infections are asymptomatic and latent but it is

Second-line anti tubercular drugs

Second-line anti tubercular drugs

These types of drugs are mostly used as an alternative to the tuberculosis therapy. In most cases, second-line anti-tubercular drugs are preserved for TB victims with special conditions. This is especially when; a patient exhibits resistance to the first-line tubercular drugs (therapy) or cases of MDR-TB (multidrug-resistance) occurring.

Drugs used to treat TB

Drugs used to treat TB

There are various ways by which TB can be managed. This includes a number of drugs given at different stages of various conditions.

First-line anti-tubercular drugs

Diseases caused by herpes virus

Diseases caused by herpes virus

Diseases caused by herpes virus

There are various diseases caused by herpes virus. Genital herpes and sores around the mouth are some of the health conditions one may experience once infected with one type of the herpes virus. Facial sores may also occur in individuals victimized by the herpes virus.

In certain cases, another type 3 three of the virus has been associated with chickenpox as well as shingles in adults. This occurs as a result of the varicella zosta virus. Mononucleosis condition, a highly contagious infection of the herpes virus, is characterized by coughing, sneezing and

Types of herpes virus

Types of herpes virus

There are 8 different types of herpes virus known to affect human beings and they are popularly known by numbers from HHV1 to 8.

Types of herpes virus

HHV 1

This is also referred to as herpes simplex virus 1 or HSV1. This is one of the types of herpes virus that can spread to the genital area resulting to genital herpes. This is mainly through genital contact (oral). HHV 1 is highly contagious and can spread through broken skin or mucous membranes when one comes into direct contact with an infected person. This can also spread through sharing of things like utensils, towels from people with active lesions and razors

Structures of herpes virus

Structures of herpes virus

Structures of herpes virus

According to researches, all animal herpes viruses have similar properties. The herpes virus has a double-stranded, DNA genome (linear) which is found within a cage called caspid, an icosahedral protein cage. It is wrapped in a lipid bilayer commonly known as envelope. By means of tegument, the enveloped is attached to the caspid. 

Differential diagnosis of white vaginal discharge

Differential diagnosis of white vaginal discharge

white vaginal discharge

Differential diagnosis is the determination of which one of the several diseases with similar symptoms is causing the patient’s condition. Vaginal discharge serves an important role in distinguishing abnormalities in the female reproductive system. Fluids that are produced by the glands in the vagina and cervix help to prevent infection by making it easy for the excretion of dead cells and bacteria.

The color and odor of the vaginal discharge depends on