Hives are a common allergic reaction that appears in the form of swollen, red bumps or patches on the skin. These usually appear suddenly and cause itchiness. In some cases, it may also sting or burn. Hives can affect any part of the body including the face, ears, tongue, lips and throat. Hives are usually small in size but may grow as large as the size of a dinner plate. In some cases, hives may also join together to form plaques.

Hives are caused as a result of the production of histamines in the body that make plasma leak out of blood vessels in the skin. These histamines are released as a result of an allergic reaction, exposure to chemicals, insect bites, sunlight or adverse reactions to certain medicines. There are four main types of hives:

Acute Urticaria: These hives usually last for less than 6 weeks. They are triggered by insect bites, allergic reactions to food, latex, medicines or by exposure to infections. The most common food items that trigger this type of hives are chocolates, nuts, fish, tomatoes, eggs, soy, wheat and milk. Aspirin and other medicines like ibuprofen, ACE inhibitors and codeine can also trigger these hives.

Chronic Urticaria: Hives that last for longer than 6 weeks fall into the category of chronic urticaria. IT is harder to find what triggers a case of chronic urticaria than it is for acute urticaria. Along with the triggers mentioned above, hormonal disorders, tumours, chronic infections and immune system disorders can also trigger these hives.

Physical Urticaria: Hives caused as a result of physically stimulating skin are called physical urticaria. This includes sudden exposure to heat or cold, sunlight, vibrations, pressure, exercise etc. These hives usually resolve themselves within an hour and only affect the part of the skin that has been stimulated.

Dermatographism: Hives caused by scratching or firmly stroking the skin fall under this fourth category.

Hives can also be genetic in nature. Some people suffer from hereditary angioedema which is a painful swelling under the skin.

Hives caused by an allergic reaction can recur and hence if you suffer from hives you should try and identify the allergen. This can be done by taking an allergen test in a hospital or by changing aspects of your diet and studying the results. Hives are usually treated with antihistamines but in some cases, steroids may also be needed. However, it is usually nothing to worry about.

What Are Hives? What Causes Hives?

Pericardial effusion is the excess fluid between the heart and sac surrounding the heart. The fluid keeps the heart moving in the sac. The excess fluid can cause a problem in the workings of the heart and may lead to death. The space between two layers of sac usually contain 2-3 tablespoons of clear liquid. But pericardial effusion can affect the heart beats and make it weaker.

Causes 

The leading cause of the pericardial effusion is pericarditis. In this condition, the layered sac of the heart is inflamed due to some viral infection. This inflamed sac produces more fluid.

Some of the most common infections that cause pericarditis are: 

  Viral infection 

  Cytomegalovirus 

  Coxsackieviruses 

  Echoviruses 

  HIV 

The other causes of pericarditis and pericardial effusion are: 

  Injury in the heart or the sac 

  Cancer 

  Kidney failure 

  Tuberculosis 

  Lupus 

Symptoms 

Generally, when there is minimal or no inflammation in the sac, there are no symptoms. However, chest pain and short-breathing are the most common symptoms for pericardial effusion. 

The large pericardial effusion in the heart sac can show symptoms like: 

  Shortness of breath 

  Passing out occasionally 

  Fast heart pounding 

  Fatigue 

  Clammy skin 

In some cases, where the condition is not worse, patients may experience: 

  Fever 

  Fatigue 

  Vomiting 

  Muscle aches 

  Viral illness

Diagnosis 

The person experiencing the above-mentioned symptoms should visit a cardiologist for a checkup. The doctor may ask for following tests and checkups for determining the condition: 

  Physical Checkup: In the physical checkup, the doctor listens to the heartbeat of the patient and assess the heart beat rate. He will also ask about the family history and medication records. 

  EKG: With EKG, doctors determine the heart rate with the help of electronic devices. Electrodes are placed on the chest, and heart activity is tested. However, the presence of pericardial effusion is difficult with EKG. 

  Chest X-Ray: X-Ray is an excellent way to detect the presence of pericardial effusion in the patient. The enlarged portion is detected in the image. Once an enlarged sac is detected, doctors order the echocardiogram test. It is an Ultrasound for the heart and gives a clear picture of the patient&#39;s heart condition. Once it is determined that the patient has pericardial effusion, the doctor determines the size of the enlarged sac and quantity of liquid in it. Most of the time, pericardial effusion is small and not severe. But if the size and quantity of the liquid are high, the doctor determines the condition of the heart and the ability to pump the blood. The doctor may also take a sample of the fluid from the sac to determine the exact cause for inflammation. 

Take Away 

Pericardial Effusion is a condition in which fluid is accumulated between the heart and sac surrounding the heart. Though the problem is not severe, it is advisable to consult a doctor.

Pericarditis / Pericardial Effusion - Know More About It!

Celiac disease is an autoimmune disease caused due to intolerance to the protein called gluten found in common foods like wheat, barley, and rye. The exact reason for the disease is not known, but gluten attacks the small finger-like projections in the intestine called the villi, which help absorb nutrients during the digestion, leading to malnourishment.

Onset of the disease is usually once the child has started on solid foods and can include diarrhea, abdominal discomfort, underweight, skin rashes, anemia, mouth sores, etc.
Diagnosis usually happens with a detailed discussion and checking the level of antibodies against gluten in the blood. In rare cases, an intestinal biopsy may also be required. Once confirmed, the following are ways to manage celiac disease-

Dietary changes: avoiding gluten-containing foods is the first step to treating celiac disease. These are common food substances like wheat and barley. In some cases, the entire family may choose to or need to take this diet, just to provide moral support to the child.
1. Breads, cakes (made from wheat)
2. Creamed or breaded vegetables
3. Processed meats
4. Dry roasted nuts (as agents used in processing could have wheat)
5. Fried chicken
6. Pastas
7. French fries (that are coated in flour)
8. Spreads, soft cheeses, and dips
9. Salad dressings
10. Gravies and sauces (including some tomato and meat sauces)
11. Soup mixes and canned soups
12. Crab or other seafood
13. Malt or malt-flavored drinks (usually made from barley)
14. Modified food starch (modified corn starch is ok; modified wheat starch is not)
15. Nondairy creamer
16. Soy sauce and soy sauce solids (may be fermented with wheat)
17. Wheat-free products (may contain barley or rye flour)
18. Yogurts containing wheat starch
Read the labels of foods to ensure they are free of gluten. Organic/natural food stores and health food stores contain wide range of gluten-free products that can be used with minimal effect on the child's food habits.

Eating out: just because the child has celiac disease, eating out is not ruled out. Carefully choosing what to eat is suggested. Also, letting the chef know is a good idea, as most chefs will prepare something safer for the child.

Cross-contamination: avoid cross-contamination: in schools or in cases where the child could potentially eat from other children's boxes, make sure the child is well informed and ensure he does not eat from other kids' lunch boxes. It is also a good idea to keep the class teacher and a couple of his close friends informed of the child's condition.

Most children are easy to educate and adapt well to the changes required, knowing very well that it is for their own good.

Tips to Deal With Celiac Disease in Children

In some cases, psychological factors rather than physical incapability plays a vital role in causing Erectile Dysfunction (ED). Child abuse or any instance of sexual trauma is considered as one of the root causes of Erectile Dysfunction. Other than this, there are numerous factors like a person s emotional health and well-being can also be a direct reason behind Erectile Dysfunction.

The psychological causes of Erectile Dysfunction are

Pressure: Constant exposure to stress due to work load, difficulties in married life, parenting issues, financial issues can be a major reason behind erectile dysfunction.
Guilt: The pressure of satisfying a new sexual partner may become so overpowering that it may result in poor sexual performance. This may lay seeds of guilt in a person and hamper his emotional health.
Anxiety: If a person erectile droop at any instance, fear may creep in that it can occur again. This situation opens door for  performance anxiety  and may cause erectile dysfunction in the long run.
State of Depression: Even a person who performs normally during sexual intercourse can suffer from erectile dysfunction if he is in depression. Depression poorly hinders a person s emotional health and cause a series of psychological as well as physical problems. The drugs taken during depression may even facilitate erectile dysfunction.
Loss of interest in sex: Reasons behind this can be growing age, disputes with partner, any kind of stress or certain medications.
Loss of Self-confidence: Failure in previous attempts for sexual intercourse, feeling of insufficiency in sex life may lead to loss of self-confidence. This can be one of the deciding factors behind erectile dysfunction.
Remedy 

Occurrence of erectile droop once or twice is quite common among men. There is nothing to be worried about. But if this problem persists, one shall consult a sexologist. Few tips to prevent and cure erectile dysfunction are as follows: 

One needs to open up and discuss such issues with his partner as well as his physician. If the cause of erectile dysfunction is poor emotional health, then he can undergo some therapy. Some stress releasing exercises or meditation can help you gain control over your mind.
One can take some pills like Viagra and prevail over psychological impediments. It helps to boost up one s confidence while performing any sexual act.
Try to remain fit and fine. Exercise daily to shed any extra weight. Avoid drinking and smoking and take a healthy diet. Take adequate sleep (about 7 hours in night) and get your blood pressure and cholesterol levels checked regularly.
All the above tips help in maintaining your physical as well as psychological health. Follow them and get cured of erectile dysfunction.

Erectile Dysfunction - Psychological Causes + Remedies

The intervertebral discs are made-up of two concentric layers, the inner gel-like Nucleus Pulposus and the outer fibrous Annulus fibrosus. As a result of advancing age, the nucleus loses fluid, volume and resiliency and the entire disc structure becomes more susceptible to trauma and compression. This condition is called as degeneration of the disc. The disc then is highly vulnerable to tears and as these occur, the inner nucleus pulposus protrudes through the fibrous layer, producing a bulge in the intervertebral disc. This condition is named as herniated disc. This can then cause compression to the spinal cord or the emerging nerve roots and lead to associated problems of Sciatica radiating pain from back to legs in the distribution of the nerve. Other symptoms could be a weakness, tingling or numbness in the areas corresponding to the affected nerve. Sometimes bladder compromise is also present, which is made evident for urine retention and this need to be taken care as an emergency.
Excessive weight, bad postures, undue movements, improper weight lifting and other kinds of traumas may weaken the intervertebral discs. When this occurs the pulpous nucleus will bulge against the annulus, or even be squeezed through it (extruded disc).

The first steps to deal with a herniated or prolapsed lumbar disc are conservative. These include rest, analgesic and anti-inflammatory medication and in some cases physical therapy. At this point, it is convenient to have some plain X-rays done, in search of some indirect evidence of the disc problem, as well as of degenerative changes on the spine.

If in a few days these measures have failed, the diagnosis has to be confirmed by means of examinations that give better detail over the troubled area, as the MRI, CT which will show the disc, the space behind it and in the first case, the nerves. In some instances, the EMG (electromyography) is also of great value, as this will show the functionality of the nerves and muscles.

Once the diagnosis has been confirmed, one of the best alternatives existing today is the Ozone Discolysis as the results obtained are excellent and practically has no complications. This novel treatment avoids the use of surgery in 80% of those who needed it. In most patients left with painkillers as the only treatment, the symptoms eventually disappear, only that this could take weeks to months. Ozone speeds up these developments, see the same result in a few weeks. The problem has to be seen and approached integrally and frequently the combination of therapies has to be used, most frequently physiotherapy. Also, it has to be known that those who had a herniated disc have 10 times more chances of having another herniation than the rest of the population.

If despite the ozone therapy the symptoms persist, Drill Discectomy/ Laser Discectomy are good alternatives before open surgery (Discectomy) which has to be contemplated in those true emergencies, as mentioned above, this is possibly the first choice.

Once the conservative treatment fails:

Early aggressive treatment plan of pain has to be implemented to prevent peripherally induced CNS changes that may intensify or prolong pain making it a complex pain syndrome. Only 5% of total LBP patients would need surgery & 20% of discal rupture or herniation would need surgery. Nonoperative treatment is sufficient in most of the patients, although patient selection is important even then.

Depending upon the diagnosis one can perform & combine properly selected percutaneous fluoroscopic guided procedures with time spacing depending upon pt`s pathology & response to treatment.

Using precision diagnostic & therapeutic blocks in chronic LBP, isolated facet joint pain in 40%, discogenic pain in 25% (95% in L4-5&L5S1), segmental dural or nerve root pain in 14% & sacroiliac joint pain in 15% of the patients. This article describes successful interventions of these common causes of LBP after conservative treatment has failed.

LESI: Lumbar Epidural Steroid Injection

Indicated in   Acute radicular pain due to irritation or inflammation.

Symptomatic herniated disc with failed conservative therapy
Acute exacerbation of discogenic pain or pain of spinal stenosis
Neoplastic infiltration of roots
Epidural fibrosis
Chronic LBP with acute radicular symptoms
Epidural- lumbar injection
ESI Treatment Plan

Compared to interlaminar approach better results are found with a transforaminal approach where drugs (steroid+ LA/saline +/- hyalase) are injected into anterior epidural space & neural foramen area where herniated disc or offending nociceptors are located. Whereas in interlaminar approach most of drug is deposited in posterior epidural space.Drugs are injected total 6-10 ml at lumbar, 3-6 ml at cervical & 20+ ml, if caudal approach is selected. Lumbar ESI is performed close to the level of radiculopathy, often using paramedian approach to target the lateral aspect of the epidural space on involved side. Cervical epidural is performed at C7-T1 level.

SNRB- Selective Nerve Root Block 

Fluoroscopically performed it is a good diagnostic & therapeutic procedure for radiculopathy pain if

There is minimal or no radiological finding.
Multilevel imaging abnormalities
Equivocal neurological examination finding or discrepancy between clinical & radiological signs
Postop patient with unexplainable or recurrent pain
Combined canal & lateral recess stenosis.
To find out the pathological dermatome for more invasive procedures, if needed
Intradiscal Procedures 

Provocative Discography - Coupled with CT

A diagnostic procedure & prognostic indicator for surgical outcome is necessary for the evaluation of patients with suspected discogenic pain, its ability to reproduce pain(even with normal radiological finding), to determine type of disc herniation /tear, finding surgical options & in assessing previously operated spines.

Percutaneous Disc Decompression (PDD)

After diagnosing the level of painful offending disc various percutaneous intradiscal procedures can be employed

Ozone Discolysis: Ozone Discectomy a revolutionary least invasive safe & effective alternative to spine surgery is the treatment of choice for prolapsed disc (PIVD) done under local anaesthesia in a daycare setting. This procedure is ideally suited for cervical & lumbar disc herniation with radiculopathy. The total cost of the procedure is much less than that of surgical discectomy. All these facts have made this procedure very popular at European countries. It is also gaining popularity in our country due to high success rate, less invasiveness, fewer chances of recurrences, remarkably fewer side effects meaning high safety profile, short hospital stay, no postoperative discomfort or morbidity and low cost.

Dekompressor: A mechanical percutaneous nucleosome cuts & drills out the disc material somewhat like morcirator debulking the disc reducing nerve compression.

Epidural Adhenolysis or Percutaneous Decompressive Neuroplasty for Epidural Fibrosis or Adhesions in Failed Back Surgery Syndrome (FBSS)

A catheter is inserted in epidural space via caudal/ interlaminar/ transforaminal approach. After epidurography testing volumetric irrigation with normal saline/ L.A./ hyalase/ steroids/ hypertonic saline in different combinations is then performed along with mechanical adenolysis with spring loaded or stellated catheters or under direct vision with epiduroscope.

Procedures That Can Help Treat Slip Disc & Sciatica!

Personality refers to the enduring and habitual patterns of behaviour, cognition, emotion, motivation and ways of relating to others. In simpler terms, it's the persona we have for the world to see and interact with. If these patterns or ways of relating with others become nonadaptive or pathological, a personality disorder develops.

Borderline Personality Disorder (BPD) is such a disorder of personality that causes mood swings, self-esteem issues, impulsive behavior and recurrent self-harm behaviour. It is very difficult to lead a normal life with these varied psychological issues.

The symptoms begin to appear from early childhood but they take a serious form only when one reaches adulthood. Issues with behavior and emotion are difficult to treat, people suffering from this illness should be willing to spend a lot of time and be dedicated towards his/her recovery. Through treatments and therapies, they do make significant improvements over time.

Causes

The exact cause of borderline personality disorder is not known but various reasons have been hypothesised as possible aetiology. Neuro-chemical disturbance in the brain, genetic vulnerability, some kind of childhood trauma like abandonment, death, neglect and/ or sexual abuse are probable causes of the disease. Prolonged and chronic stress/ anxiety may also lead to triggering of BPD symptomatology in vulnerable individuals later in life.

Symptoms

Prolonged dysthymia/ sadness
Feeling lonely/ misfit
Emotional dysregulation or Frequent mood swings
Significant interpersonal issues
Self-Injurious behaviour like making cuts in skin, burning, pricking etc

These symptoms are warning signs of borderline personality disorder and should be paid attention to:

Abandonment issue - People suffering from BPD have serious abandonment issues. They have an intense fear that they would be left alone and often act out to restrict their love ones from leaving. Sometimes their strategy is to not get too close to protect themselves from being left alone, so they appear aloof.
Disturbed self-image - People have self-esteem issues, they sometimes love or hate themselves or see themselves as evil. They have unclear goals, views, beliefs and often end up changing their friends, lovers, jobs, sexual identity frequently.
Dysfunctional relationships - It is very difficult to maintain a normal relationship for people with personality disorder. They tend to have quick short-lived relationships and get put off very easily which leads to a lot of heartbreak.
Suicidal tendencies and frequent self-harm behaviour like cutting skin using blades/ sharp objects are common.

Drugs and alcohol abuse, eating disorders and sexual promiscuity are other forms of self-destructive behaviour commonly encountered in this population. Extreme aggression, delusions, transitional Psychotic states are other possible symptoms of BPD.

Love and support from family and friends are crucial for patients suffering from this disease. Prolonged counseling sessions, therapies and the effort to break away from the chronic gloomy thoughts will definitely lead one to a better life.

All about Borderline Personality Disorder

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