Allergic Rhinitis - A Brief Discussion

Inroduction: Allergic rhinitis, also known as hay fever, is a type of inflammation in the nose which occurs when the immune system  overreacts to allergens in the air.
Depending on the allergen, the resulting rhinitis and conjunctivitis may be seasonal (hay fever) or year-round (perennial allergic rhinitis). Allergic rhinitis is the most common atopic allergic reaction, affecting over 20 million Americans.

 Causes And Pathophysiology:  Hay fever reflects an immunoglobulin (Ig) E–mediated, type I hypersensitivity response to an environmental antigen (allergen) in a genetically susceptible individual. In most cases, it's induced by wind-borne pollens: in spring, by tree pollens (oak, elm, maple, alder, birch, cottonwood); in summer, by grass pollens (crabgrass, bluegrass, fescue, and ryegrass); and in fall, by weed pollens (ragweed). Occasionally, hay fever is induced by allergy to fungal spores.
With perennial allergic rhinitis, inhaled allergens provoke antigen responses that produce recurring symptoms year-round.
The major perennial allergens and irritants include dust mites, feather pillows, mold, cigarette smoke, upholstery, and animal dander. Seasonal pollen allergy may exacerbate symptoms of perennial rhinitis.

Clinical Features: 
With seasonal allergic rhinitis, the key signs and symptoms are paroxysmal sneezing, profuse watery rhinorrhea, nasal obstruction or congestion, and pruritus of the nose and eyes, usually accompanied by pale, cyanotic, edematous nasal mucosa; red and edematous eyelids and conjunctivae; excessive lacrimation; and headache or sinus pain. Some patients also complain of itching in the throat and malaise.
With perennial allergic rhinitis, conjunctivitis and other extranasal effects are rare, but chronic nasal obstruction is common and often extends to eustachian tube obstruction, particularly in children.

Dysmenorrhea Or Painful Menstruation

Dysmenorrhea, or painful menstruation, is a condition characterized by varying degrees of crampy, lower abdominal pain and other symptoms such as nausea, vomiting, urinary frequency, low back pain, diarrhea, fatigue, thigh pain, nervousness, dizziness, sweating, and headache.

The pain typically begins just after menses and lasts for about 1 to 2 days, but it can also begin 1 to 2 days before the onset of menses and can last up to 4 days into menstruation.

Epidemiology: At least 40% to 60% of adolescent girls suffer some degree of discomfort during menstruation, with about 15% reporting severe symptoms and 14% reporting that they frequently miss school as a result of menstrual symptoms.

Most affected teenage girls have primary dysmenorrhea not associated with pelvic or other pathologic conditions; however, causes of secondary dysmenorrhea always should be considered when the patient is evaluated.

Primary dysmenorrhea: is common menstrual cramps that are recurrent (come back) and are not due to other diseases. Pain usually begins 1 or 2 days before, or when menstrual bleeding starts, and is felt in the lower abdomen, back, or thighs. Pain can range from mild to severe, can typically last 12 to 72 hours. 

Pathophysiology: Increased amounts of prostaglandins E2 and F2 in the endometrium of women with

dysmenorrhea lead to smooth muscle contractions along with other symptoms such as vomiting and diarrhea. This biologic explanation correlates with the clinical observation that women who have anovulatory cycles usually do not have dysmenorrhea. Adolescent girls typically develop dysmenorrhea 1 to 2 years after menarche, correlating with the onset of ovulatory cycles.

Approach To A Patient Presenting With Dysmenorrhea: The assessment of a teenager with dysmenorrhea should include the following:

• Complete menstrual history

• Timing of cramps or pain

• Missed school or other activities

• Ability to participate in social events

• Presence of nausea, vomiting, diarrhea, dizziness, or other symptoms

• Medications used, including doses

• Factors that improve or worsen symptoms

• Family history of dysmenorrhea or endometriosis

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Acne Vulgaris - Brief Discussion

Introduction: Acne vulgaris is a common skin disorder which usually occurs in adolescence. It typically affects the face, neck and upper trunk and is characterised by the obstruction of the pilosebaceous follicle with keratin plugs which results in comedones, inflammation and pustules.

Epidemiology: affects around 80-90% of teenagers, 60% of whom seek medical advice. Acne may also persist beyond adolescence;

Etiology And Pathophysiology : is multifactorial

• Follicular epidermal hyperproliferation resulting in the formation of a keratin plug.
• This in turn causes obstruction of the pilosebaceous follicle. 
• Activity of sebaceous glands may be controlled by androgen, although levels are often normal in patients with acne
• Colonisation by the anaerobic bacterium Propionibacterium acnes
• Inflammation

Clinical Features: Acne is a disease of the pilosebaceous unit. 

Several different types of acne lesions are usually seen in each patient

Comedones are due to a dilated sebaceous follicle

• if the top is closed a whitehead is seen
• if the top opens a blackhead forms

Inflammatory lesions form when the follicle bursts releasing irritants

• papules
• pustules

An excessive inflammatory response may result in:

• nodules
• cysts

This sequence of events can ultimately cause scarring

• icepick scars
• hypertrophic scars

In contrast, drug nduced acne is often monomorphic (e.g. pustules are characteristically seen in steroid use)

Acne fulminans is very severe acne associated with systemic upset (e.g. fever). Hospital admission is often required and the condition usually responds to oral steroids.

Classification Of Acne Based On Severity Of Symptoms: Acne may be classified into:

1. Mild: open and closed comedones with or without sparse inflammatory lesions

2. Moderate acne: widespread noninflammatory lesions and numerous papules and pustules

3.Severe acne: extensive inflammatory lesions, which may include nodules, pitting, and scarring.

Management: A simple management scheme often used in the treatment of acne is as follows:

• single topical therapy (topical retinoids, benzyl peroxide)
• topical combination therapy (topical antibiotic, benzoyl peroxide, topical retinoid)
• oral antibiotics: e.g. Oxytetracycline, doxycycline. Improvement may not be seen for 34 months. Minocycline is now considered less appropriate due to the possibility of irreversible pigmentation. Gram negative folliculitis may occur as a complication of longterm antibiotic use high dose - oral trimethoprim is effective if this occurs
• oral isotretinoin: only under specialist supervision
• There is no role for dietary modification in patients with acne.

You may find the following article interesting and useful as well:

http://studymedicalphotos.blogspot.com/2016/02/a-case-of-acne-vugaris-in-adolescent-boy.html

A Brief Introduction To Sexually Transmitted Diseases

Introduction And Definitions: Sexually transmitted infections (STIs) are the infections that are passed from one person to another through unprotected sex or genital contact.

Sexually transmitted infections refers to the mode of transmission of infection and the the reproductive tract infection refers to the site where the infection occurs. All Reproductive tract infections cannot be sexually transmitted infections.

The causes of Sexually transmitted Diseases (STDs) are bacteria, parasites, yeast, and viruses. There are more than 20 types of STDs, some of which include:

• Gonorrhoea
• Chylamydia
• Syphilis
• Trichomoniasis
• Chancroid
• Genital herpes
• Genital warts caused by HPV

Incidence: The incidence of STD's is increasing by 10% every year where safe sex practices are being ignored. 448 million new cases of curable STD's occur annually through out the world in persons aged 15 to 49 years.

Risk Factors

• Age less than 25 years
• Young age at first sex
• Non barrier contraception method
• New, multiple or symptomatic sexual partners

Women At More Risk: Most STDs affect both men and women, but in many cases the health problems they cause can be more severe for women. If a pregnant woman has an STD, it can cause serious health problems for the baby.

Women are physiologically more vulnerable than men. If they are asymptomatic they might not seek proper medical care and later it may lead to serious complications. Use of traditional vaginal medications and douching may also increase the risk for acquiring the STD's in women. With the exception of HIV all STD's have more threatening consequences in women than in men. In women it usually leads to infertility, ectopic pregnancy and cervical cancer.

Discussion on Some Common STDS: 

1. Chlamydia: is one of the most common STI and is easily passed on during sex. Most people don't experience any symptoms, so they are unaware they're infected.