Henoch-Schonlein purpura (HSP) is a disease involving inflammation of small bloodvessels. It most commonly occurs in children. The inflammationcauses blood vessels in the skin, intestines, kidneys, and joints to start leaking. The main symptom is a rash with numerous small bruises, which have a raised appearance, over the legs or buttocks.

Although HSP can affect people at any age, most cases occur in children between the ages of 2 and 11. It is more common in boys than girls. Adults with HSP are more likely to have more severe disease compared to children.

HSP usually ends after four to six weeks — sometimes with recurrence of symptoms over this period, but with no long-term consequences. If organs such as the kidneys and intestines are affected, treatment is often needed and it is important to have regular follow-up to prevent serious complications.

The exact cause of HSP is not known. The body’s immune system is believed to play a role in targeting the blood vessels involved. An abnormal immune response to an infection may be a factor in many cases. Approximately two-thirds of the cases of HSP occur days after symptoms of an upper respiratory tract infection develop.

Some cases of HSP have been linked to vaccinations for typhoid, cholera, yellow fever, measles, or hepatitis B; foods, drugs, chemicals, and insect bites. Some experts also say that HSP is associated with the colder weather of fall and winter.

The classic symptoms of HSP are rash, joint pain and swelling, abdominal pain, and/or related kidney disease, including blood in urine. Before these symptoms begin, patients may have two to three weeks of fever, headache, and muscular aches and pains. Rarely, other organs, such as the brain, heart, or lungs, may be affected.

Here are some key details about the symptoms of HSP:

Rash. The rash usually appears in all patients with HSP. The initial appearance may resemble hives, with small red spots or bumps on the lower legs, buttocks, knees, and elbows. But these change to appear more like bruises. The rash usually affects both sides of the body equally and does not turn pale on pressing.

Arthritis. Joint inflammation, involving pain and swelling, occurs in approximately three-quarters of cases, particularly affecting the knees and ankles. It usually lasts only a few days and does not cause any long-term, chronic joint problems.

Abdominal pain. In more than half of people with HSP, inflammation of the gastrointestinal tract may cause pain or cramping; it may also lead to loss of appetite, vomiting, diarrhea, and occasionally blood in the stool.

In some cases, patients may have abdominal pain before the rash appears. In rare cases, an abnormal folding of the bowel (intussusception) may cause a bowel blockage, which may require surgery to fix.

Kidney impairment. HSP can cause kidney problems, indicated by such signs as protein or blood in the urine. This is usually only discovered on urine testing, since it does not generally cause any discomfort.

In most patients, the kidney impairment is mild and goes away without any long-term damage. It’s important to monitor the kidney problems closely and make sure they clear up, since about 5% of patients may develop progressive kidney disease. About 1% may go on to develop total kidney failure.

The diagnosis of HSP may be clear when the typical rash, arthritis, and abdominal pain are present. A doctor may order some tests to rule out other diagnoses, confirm the diagnosis, and assess its severity.

Occasionally, when the diagnosis is uncertain, particularly if the only symptom is the classic rash, your doctor may perform biopsies of the skin or kidney. Urine and blood tests will likely be done to detect signs of kidney involvement and may need to be repeated during follow-up to monitor any changes in kidney function.

Although there is no specific treatment for HSP, you can use over-the-counter pain medicines, such as acetaminophen or nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and naproxen for joint pain. In some cases, corticosteroid medication may be used.

The rash and joint pain will usually go away after four to six weeks without causing any permanent damage. Bouts of the rash may recur in approximately one-third of cases, but they are usually milder, do not involve joint and abdominal symptoms, and they clear up on their own.

Fecal incontinence is the inability to control bowel movements. It’s a common problem, especially among older adults.

Accidental bowel leakage is usually not a serious medical problem. But it can seriously interfere with daily life. People with bowel incontinence may avoid social activities for fear of embarrassment.

Many effective treatments can help people with bowel incontinence. These include:

• medicine
• surgery
• minimally invasive procedures

Talking to your doctor is the first step toward freedom from bowel incontinence.

The most common cause of bowel incontinence is damage to the muscles around the anus (anal sphincters). Vaginal childbirth can damage the anal sphincters or their nerves. That’s why women are affected by accidental bowel leakage about twice as often as men.

Anal surgery can also damage the anal sphincters or nerves, leading to bowel incontinence.

There are many other potential causes of bowel incontinence, including:

• Diarrhea (often due to an infection or irritable bowel syndrome)
• Impacted stool (due to severe constipation, often in older adults)
• Inflammatory bowel disease (Crohn’s disease or ulcerative colitis)
• Nerve damage (due to diabetes, spinal cord injury, multiple sclerosis, or other conditions)
• Radiation damage to the rectum (such as after treatment for prostate cancer)
• Cognitive (thinking) impairment (such as after a stroke or advanced Alzheimer’s disease)

More than one cause for bowel incontinence is frequently present. It’s also not unusual for bowel incontinence to occur without a clear cause.

Discussing bowel incontinence may be embarrassing, but it can provide clues for a doctor to help make the diagnosis. During a physical examination, a doctor may check the strength of the anal sphincter muscle using a gloved finger inserted into the rectum.

Stool testing. If diarrhea is present, stool testing may identify an infection or other cause.

Endoscopy. A tube with a camera on its tip is inserted into the anus. This identifies any potential problems in the anal canal or colon. A short, rigid tube (anoscopy) or a longer, flexible tube (sigmoidoscopy or colonoscopy) may be used.

What Is Wernicke–Korsakoff Syndrome?

Risk Factors for WKS;

Causes of WKS:

Dementia causes problems with thinking, memory, and reasoning. It happens when the parts of the brain used for learning, memory, decision making, and language are damaged or diseased.

Also called major neurocognitive disorder, it’s not a disease itself. Instead, it’s a group of symptoms caused by other conditions.

Alzheimer’s disease is the most common cause of dementia. Between 60% to 80% of people with dementia have Alzheimer’s. But there are as many as 50 other causes of dementia.

The symptoms of dementia may improve with treatment. But many of the diseases that cause dementia aren’t curable.

The most common causes of dementia include:

• Degenerative neurological diseases. These include Alzheimer’s disease, Parkinson’s disease, Huntington’s disease, and some types of multiple sclerosis. These diseases get worse over time.
• Vascular disorders. These are disorders that affect the blood circulation in your brain.
• Traumatic brain injuries caused by car accidents, falls, concussions, etc.
• Infections of the central nervous system. These include meningitis, HIV, and Creutzfeldt-Jakob disease.
• Long-time alcohol or drug use
• Certain types of hydrocephalus, a buildup of fluid in the brain

Dementia can be split into two groups based on which part of the brain is affected.

• Cortical dementias happen because of problems in the cerebral cortex, the outer layer of the brain. They play a critical role in memory and language. People with these types of dementia usually have severe memory loss and can’t remember words or understand language. Alzheimer’s and Creutzfeldt-Jakob disease are two forms of cortical dementia.
• Subcortical dementias happen because of problems in the parts of the brain beneath the cortex. People with subcortical dementias tend to show changes in their speed of thinking and ability to start activities. Usually, people with subcortical dementia don’t have forgetfulness and language problems. Parkinson’s disease, Huntington’s disease, and HIV can cause these types of dementia.

Some types of dementia affect both parts of the brain.

To treat dementia, doctors will treat whatever is causing it. About 20% of the causes of dementia are reversible.

Causes of dementia that may be reversible include:

• Alcohol or drug abuse
• Tumors
• Subdural hematomas, blood clots beneath the outer covering of the brain
• Normal-pressure hydrocephalus, a buildup of fluid in the brain
• Metabolic disorders such as a vitamin B12 deficiency
• Low levels of thyroid hormones, called hypothyroidism
• Low blood sugar, called hypoglycemia
• HIV-associated neurocognitive disorders (HAND)

These forms of dementia are partially manageable, but they aren’t reversible and get worse over time:

• Alzheimer’s disease
• Vascular dementia
• Dementia from Parkinson’s disease and similar disorders
• Dementia with Lewy bodies
• Frontotemporal dementia (Pick’s disease)
• Creutzfeldt-Jakob disease

Usually, dementia goes through these stages. But it may vary depending on the area of the brain that is affected.

1) No impairment: Someone at this stage will show no symptoms, but tests may reveal a problem.

2) Very mild decline: You may notice slight changes in behavior, but your loved one will still be independent.

3) Mild decline: You’ll notice more changes in his thinking and reasoning. He may have trouble making plans, and he may repeat himself a lot. He may also have a hard time remembering recent events.

4) Moderate decline: He’ll have more problems with making plans and remembering recent events. He may have a hard time with traveling and handling money.

5) Moderately severe decline: He may not remember his phone number or his grandchildren’s names.He may be confused about the time of day or day of the week. At this point, he will need assistance with some basic day-to-day functions, such as picking out clothes to wear.

6) Severe decline: He’ll begin to forget the name of his spouse. He’ll need help going to the restroom and eating. You may also see changes in his personality and emotions.

7) Very severe decline: He can no longer speak this thoughts. He can’t walk and will spend most of his time in bed.

About 5% to 8% of adults over age 65 have some form of dementia. This percentage doubles every 5 years after 65. As many as half of people in their 80s have some dementia.

Patellofemoral arthritis is where there is degeneration and inflammation of the bone and cartilage at the patella (kneecap). It causes stiffness and pain at the front of the knee (anterior knee pain) and makes activities such as kneeling, climbing stairs, walking on slopes and getting up from sitting difficult and painful. It may develop gradually over time as part of aging or following an injury such as a fall or recurrent dislocations.

Here we will look at the different aspects of patellofemoral arthritis including what is going on in the joint, the common causes and symptoms, how it is diagnosed and the various treatment options, both surgical and non-surgical.

In patellofemoral arthritis, the cartilage on the back of the patella and in the trochlear groove become worn and inflamed. The cartilage thins and frays and if the wear and tear is severe it can expose the underlying bone. In an attempt to protect itself, the body may lay down extra layers of bone, known as bone spurs. The smooth surface is gradually lost leading to bone rubbing on bone. This can be painful and may limit movement.

In the picture here you can see changes that develop in patellofemoral arthritis. The LEFT image shows a normal knee – note the space between the kneecap and the femur. The MIDDLE image shows the loss of joint space due to arthritis. The RIGHT image highlights the bone spurs that form.

Patellofemoral arthritis may develop for a number of reasons:

1) Wear and Tear: Cartilage gradually thins as part of the normal aging process. Degenerative patellofemoral arthritis (known as osteoarthritis) usually affects those over the age of 65. Factors that increase the risk of developing arthritis include obesity, hip angle (which in turn affects knee position), gender (more prevalent in females), genetics and abnormal foot mechanics

2) Kneecap Injuries: Injuries to the kneecap such as fractures or dislocations can damage the cartilage on the patella which can lead to arthritis. Visit the kneecap injury section to find out more

3) Dysplasia: This is when the patella doesn’t sit properly in the trochlear groove, due to either the trochlear or the patellar being a slightly unusual shape, or tightness/laxity in the soft tissues affecting the angle that the patella sits at. As a result, when the knee moves there is excess stress, friction and/or pressure on the bones which can lead to patellofemoral arthritis

4) Medical Conditions: Certain medical conditions such as Gout or Paget’s disease increase the risk of developing patellofemoral arthritis.

The most common symptom of patellofemoral arthritis is anterior knee pain – pain at the front of the knee. The pain tends to be worse with activities that place pressure through the kneecap such as going up and down stairs, kneeling, squatting and getting up from a chair/bed.

Some people also experience crepitus, where they feel, or sometimes even hear, a cracking, grinding or popping sensation, when they move their knee. In severe cases when there is bone rubbing on bone, people may experience stiffness or the kneecap may get momentarily stuck, known as pseudolocking.

Treatment for patellofemoral arthritis usually starts with conservation i.e. non-operative, methods. In most cases, surgery is not required. Non-surgical treatments for patellofemoral arthritis include:

1) Rest and Activity Modification

Avoid activities that aggravate symptoms as much as possible whilst still getting on with daily life. Use the hand rail when going up and downstairs, when sitting down or standing up take your weight through your good leg and if necessary use a stick or crutches when walking.

2) Medication

Non-steroidal anti-inflammatory medication (NSAIDs) such as ibuprofen or Advil may be prescribed to help reduce pain and inflammation.

3) Exercises

Strengthening and stretching exercises help to improve the strength, stability and flexibility of the knee which can help to reduce the pressure on the kneecap and thus reduce pain – they are one of the most effective treatments for patellofemoral arthritis. A physical therapist will be able to give you a rehab programme to follow specific to your needs. Exercises that place pressure on the kneecap, such as squatting, should be avoided. Swimming is a good option as it strengthens the muscles without placing weight through the joint, or opt for cycling over running. Visit the knee exercises section for a whole range of exercises that can help.

4) Heat/Ice

Many people find that using either ice or heat helps to reduce pain and inflammation from patellofemoral arthritis. Ice has the added benefit that it helps to reduce inflammation – visit the ice wraps section to find out more.

5) Weight Loss

Losing weight can make a difference, but is only appropriate if you are overweight. This will help to reduce the pressure going through the kneecap. Talk to your doctor or a dietician before starting on a weight loss programme to ensure it is suitable for you.

6) Corticosteroid Injections:

Corticosteroid injections can help to reduce patellofemoral arthritis pain and inflammation. However, they only help to treat the symptoms of arthritis, not the underlying cause so should be used alongside other treatment methods such as exercises or else the pain is likely to return. Find out more in the knee injectionssection

7) Knee Braces and Taping

Wearing a knee brace or taping the patella can help to support the knee and change the position of the kneecap. Visit the knee braces section to find the right brace for you.

8) Supplements

Glucosamine and chondroitin are popular supplements for reducing knee arthritis pain.

If moderate to severe symptoms of patellofemoral arthritis persist for more than 3-6 months of non-operative treatment, surgery may be advised. There are a few different options depending on the severity of the arthritis, which parts of the joint are affected and the age of the patient.

1) Chondroplasty

Suitable for mild to moderate patellofemoral arthritis. A chondroplasty is carried out arthroscopically (keyhole surgery). Small incisions are made around the kneecap through which thin surgical instruments and a small camera are inserted. Worn and frayed cartilage is trimmed and bone spurs smoothed out which both help to reduce friction in the joint.

2) Tibial Tuberosity Transfer

This involves shifting the position of the tibial tuberosity – a small bony lump on the tibia (shin bone) where the kneecap attaches via the patella tendon. With this type of surgery, the tibial tuberosity is removed, repositioned and then reattached with anchors or screws. This makes subtle changes to the position of the knee cap improving the tracking of the patella, allowing it to glide more smoothly in the trochlear groove therefore resulting in less stress and friction on the arthritic parts of the patella. Tibial tuberosity transfer tends to be done in cases where patellofemoral arthritis affects only a portion of the kneecap, seeking to offload the arthritic parts.

3) Realignment Surgery

Patella realignment surgery is done when tightness or laxity in the soft tissues means the patella doesn’t sit correctly in the trochlear groove which places excess pressure and friction on certain parts of the bone. With realignment surgery, the soft tissues around the kneecap are tightened or released to change the position of the patella in the trochlear groove. Examples of realignment surgery include lateral patellar retinaculum release, to release tight structures on the outer side of the kneecap, and reattachment or reconstruction of the medial patellofemoral ligament on the inner side of the knee.

4) Cartilage Grafting

With cartilage grafting, the damaged cartilage is replaced with healthy cartilage either from another part of the knee or from a tissue bank. If cartilage is being taken from the person’s own knee, two operations are required. The first is to harvest the cartilage from a non-weight-bearing part of the knee, which is then sent to a laboratory where cells are cultured for 3-6 weeks to increase the number of cartilage cells. In the second operation, the new cartilage cells are transplanted back into the affected parts of the patellofemoral joint. Cartilage grafting is usually done in younger patients in an attempt to delay the need for joint replacement.

5) Patellofemoral Replacement

With this type of partial knee replacement, the worn and damaged parts of the patellofemoral joint are removed and the surfaces re-lined with prosthetic implants.  The trochlear groove is lined with a thin metal plate, and a plastic “button” is attached to the back of the patella – both components are fixed on using bone cement. Patellofemoral replacement is only suitable if the arthritis is confined to the patellofemoral joint – if other parts of the knee are also affected, a total knee replacement is needed. Patellofemoral replacement surgery tends to be most suitable for younger patients and has the advantage of being less invasive than a total knee replacement. People often report the knee feels more “normal” afterwards, most likely due to the fact that the knee ligaments are all preserved.

6) Patellectomy

With a total or partial patellectomy, part or all of the patella is removed. It is only considered when there are no other options as whilst it may reduce pain, it inhibits the function of the quadriceps resulting in ongoing weakness.

Spinal muscular atrophy type 2 (SMA II) is an inherited condition that affects the muscles. It is characterized primarily by progressive muscle weakness that develops in children between ages 6 and 12 months. Affected children can sit without support; however, they cannot stand or walk unaided. Other signs and symptoms may include a tremor of the fingers, breathing issues, feeding difficulties and skeletal abnormalities (such as scoliosis and hip dislocation). SMA II is caused by mutations in the SMN1 gene and is inherited in an autosomal recessive manner. Treatment is based on the symptoms in each person.

Symptoms:

The signs and symptoms of spinal muscular atrophy type 2 (SMA II) typically become apparent between 6 and 12 months of age. Poor muscle tone may be noticed at birth or within the first few months of life. Affected children may initially slowly gain some motor milestones. However, the highest motor milestone attained is generally the ability to sit independently, and this milestone is often lost by the mid-teens. People with SMA II are not able to stand or walk unaided. Other signs and symptoms may include a tremor of the fingers, breathing issues, feeding difficulties and skeletal abnormalities (such as scoliosis and hip dislocation).

Causes:

Spinal muscular atrophy type 2 (SMA II) is caused by changes (mutations) in the SMN1 gene. Extra copies of the SMN2 gene affect how severe the condition is. These genes encode a protein that is important for the normal functioning of certain nerve cells (called motor neurons) which help control muscle movements. Mutations in the SMN1 gene lead to reduced levels of this protein and the death of motor neurons. This in turn causes the characteristic signs and symptoms associated with SMA II.

The protein made by additional copies of SMN2 can compensate for some of the protein lost due to mutations in SMN1. Affected people who have extra copies of SMN2 may, therefore, have milder symptoms and develop the condition later in life.

Diagnosis:

A diagnosis of spinal muscular atrophy (SMA) is first suspected based on the presence of characteristic signs and symptoms. Identifying mutations in the SMN1 gene confirms the diagnosis.^[1]

Classifying the type of SMA is based on the age of onset and the maximum function attained. Classisfying SMA as type 2 is based on:

• onset of muscle weakness usually after age six months; ability to sit independently achieved when placed in a sitting position
• finger trembling – almost invariably present
• low muscle tone (flaccidity)
• absence of tendon reflexes in approximately 70% of individuals
• average intellectual skills during the formative years and above average by adolescence

The treatment of spinal muscular atrophy type 2 (SMA II) is based on the symptoms present. Physical therapy, occupational therapy and assistive devices (walkers, wheelchairs, etc) are generally recommended to help encourage maximum mobility and independence. These interventions may also prevent or delay scoliosis and abnormal contractions of the muscles and tendons. Some children with SMA II may have difficulty eating enough calories to maintain a normal weight. In these cases, nutritional counseling and/or a feeding tube may become necessary. Breathing problems are also common in people affected by SMA II and may require the use of BiPAP machines or other methods of respiratory support. Some affected children may require surgery to treat scoliosis or severe cases of hip dislocation.

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