Epilepsy

Epilepsy is a chronic neurological disorder that causes unprovoked, recurrent seizures. A seizure is usually defined as a sudden alteration of behavior due to a temporary change in the electrical functioning of the brain. Anyone can develop epilepsy, but it’s more common in young children and older adults. It occurs slightly more in males than in females. There are two main types of seizures. Generalized seizures affect the whole brain and Focal (partial) seizures, affect just one part of the brain.

Causes

The causes of epilepsy are divided into the following categories: structural, genetic, infectious, metabolic, immune and unknown. Examples include:

• Certain genetic syndrome
• Stroke due to lack of oxygen to the brain (leading epilepsy cause in over age 35)
• Very high fever
• Head trauma
• Brain tumor or cyst
• Very low blood sugar
• Dementia or Alzheimer’s disease
• Brain infections such as meningitis, encephalitis or neurocysticercosis
• Congenital abnormalities or genetic conditions with associated brain malformations
• Alcohol withdrawal

Types of seizure:

Seizures are the main symptom of epilepsy. Symptoms differ from person to person and according to the type of seizure.

Focal (partial) seizures

It doesn’t involve loss of consciousness. Symptoms include; alterations to sense of taste, smell, sight, hearing, or touch, dizziness, tingling and twitching of limbs

Generalized seizures

Generalized seizures involve the whole brain. There are six types:

Absence seizures,

which used to be called “petit mal seizures,” cause a blank stare. This type of seizure may also cause repetitive movements like lip smacking or blinking. There’s also usually a short loss of awareness.

Tonic seizures cause muscle stiffness.

Atonic seizures lead to loss of muscle control and can make you fall down suddenly.

Clonic seizures are characterized by repeated, jerky muscle movements of the face, neck, and arms.

Myoclonic seizures cause spontaneous quick twitching of the arms and legs.

Tonic-clonic seizures used to be called “grand mal seizures.” Symptoms include; stiffening of the body, shaking, loss of bladder or bowel control, biting of the tongue and loss of consciousness.

Facts and statistics about epilepsy

Worldwide, around 60 million people have epilepsy, making it one of the most common neurological diseases globally. Nearly 80% of people with epilepsy live in low- and middle-income countries. As many as link 500 genes may relate to epilepsy in some way. For most people, the risk of developing epilepsy before age 20 is about 1 percent. Having a parent with genetically linked epilepsy raises that risk to 2 to 5 percent. For people over age 35, a leading cause of epilepsy is stroke. Between 15 to 30 percent of children with intellectual disabilities have epilepsy. Between 30 and 70 percent of people who have epilepsy also have depression, anxiety, or both. Between 60 and 70 percent of people with epilepsy respond satisfactorily to the first anti-epilepsy drug they try. About 50 percent can stop taking medications after two to five years without a seizure. One-third of people with epilepsy have uncontrollable seizures because they haven’t found a treatment that works. More than half of people with epilepsy who don’t respond to medication improve with a ketogenic diet. Three quarters of people with epilepsy living in low-income countries do not get the treatment they need. References: Healthline.com , Who.int/news

Hypertension

Hypertesion is a primary risk factor for cardiovascular disease, including stroke, heart attack, heart failure, aortic aneurysm and kidney disease. Keeping blood pressure under control is vital for preserving health and reducing the risk of these dangerous conditions.

As a general guide:

• high blood pressure is considered to be 140/90mmHg or higher (or 150/90mmHg or higher if you're over the age of 80)
• ideal blood pressure is usually considered to be between 90/60mmHg and 120/80mmHg

Causes:

The cause of hypertension is often not known. In many cases, it is the result of an underlying condition.
Primary hypertension can result from multiple factors, including:

• blood plasma volume
• hormone activity in people who manage blood volume and pressure using medication
• environmental factors, such as stress and lack of exercise

Secondary hypertension has specific causes and is a complication of another health problem.
Chronic kidney disease (CKD) is a common cause of high blood pressure, as the kidneys no longer filter out fluid. This excess fluid leads to hypertension.
Conditions that can lead to hypertension include:

• Diabetes, due to kidney problems and nerve damage
• Kidney disease
• Pheochromocytoma, a rare cancer of an adrenal gland
• Cushing syndrome that corticosteroid drugs can cause
• Congenital adrenal hyperplasia, a disorder of the cortisol-secreting adrenal glands
• Hyperthyroidism, or an overactive thyroid gland
• Hyperparathyroidism, which affects calcium and phosphorous levels
• Pregnancy
• Sleep apnea
• Obesity

Risk factors

High blood pressure has many risk factors, including:

• Ages (above 65y)
• Race (African heritage, often developing at an earlier age than it does in whites)
• Family history
• Being overweight or obese
• Not being physically active
• Not being physically active
• Not being physically active
• Too much salt (sodium) in your diet
• Too little potassium in your diet
• Drinking too much alcohol
• Stress
• Certain chronic conditions, such as kidney disease, diabetes and sleep apnea
• Pregnancy

Lifestyle changes to reduce blood pressure

These lifestyle changes can help prevent and lower high blood pressure:

• reduce the amount of salt you eat and have a generally healthy diet
• cut back on alcohol 
• lose weight if you're overweight
• exercise regularly
• cut down on caffeine
• stop smoking

Some people with high blood pressure may also need to take 1 or more medicines to stop their blood pressure getting too high.
Test your blood pressure

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Arrhythmia

Cardiac arrhythmia refers to a group of conditions that cause the heart to beat irregular, too slowly, or too quickly.
There are several categories of arrhythmia, including:

• bradycardia, or a slow heartbeat
• tachycardia, or a fast heartbeat
• irregular heartbeat, also known as a flutter or fibrillation
• early heartbeat, or a premature contraction

Some people may hear doctors use the word “dysrhythmia” when referring to their irregular heartbeat. The words arrhythmia and dysrhythmia mean the same, but the word arrhythmia is more prevalent.

Types

There are several types of arrhythmia, as described here:

Atrial fibrillation

This is the irregular beating of the atrial chambers, and nearly always involves tachycardia. Atrial fibrillation (A-fib) is common and mainly develops in adults over 65 years of age.
Instead of producing a single, strong contraction, the chamber fibrillates, or quivers, often producing a rapid heartbeat.

Atrial flutter

While fibrillation causes many random and different quivers in the atrium, atrial flutter is usually from one area in the atrium that is not conducting properly. This produces a consistent pattern in the abnormal heart conduction.
Some people may experience both flutter and fibrillation. Atrial flutter can be a serious condition and usually leads to fibrillation without treatment.

Supraventricular tachycardia

The condition known as supraventricular tachycardia (SVT) refers to a rapid but rhythmically regular heartbeat. An individual can experience a burst of accelerated heartbeats that can last from a few seconds to a few hours. Doctors classify atrial fibrillation and flutter under SVTs.

Ventricular tachycardia

This condition refers to abnormal electrical impulses that start in the ventricles and cause an abnormally fast heartbeat. This often happens if the heart has a scar from a previous heart attack.

Ventricular fibrillation

This is an irregular heart rhythm consisting of rapid, uncoordinated, and fluttering contractions of the ventricles. The ventricles do not pump blood but quiver instead
Ventricular fibrillation can be life threatening and usually has links to heart disease. A heart attack often triggers it.

Long QT syndrome

This syndrome refers to a heart rhythm disorder that sometimes causes rapid, uncoordinated heartbeats. This can result in fainting, which may be life threatening.
It can also occur due to genetic susceptibility or taking certain medications.

Causes

Any interruption to the electrical impulses that stimulate heart contractions may result in arrhythmia. Several factors can cause the heart to work incorrectly, including:

• alcohol abuse
• diabetes
• substance use disorder
• drinking too much coffee
• heart disease, such as congestive heart failure
• high blood pressure
• hyperthyroidism, or an overactive thyroid gland
• stress
• scarring of the heart, often due to a heart attack
• smoking
• certain dietary and herbal supplements
• some medications
• structural changes in the heart

A person with good heart health will hardly ever experience long-term arrhythmia unless they have an external trigger, such as a substance use disorder or an electric shock.

However, an underlying heart problem can mean that electrical impulses do not travel through the heart correctly. This increases the risk of arrhythmia.

Risk factors

The following may increase a person’s risk of arrhythmia:

• being 65 years of age or older
• inherited genetic anomalies
• underlying heart problems
• hypothyroidism or hyperthyroidism
• some prescription medications and over-the-counter drugs
• hypertension
• obesity
• uncontrolled diabetes
• obstructive sleep apnea
• electrolyte imbalances
• heavy and regular alcohol consumption
• too much caffeine
• illegal drugs

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Bacterial infections

Pneumonia

Pneumonia is among the leading causes of morbidity and mortality worldwide. Although Streptococcus pneumoniae is the most likely cause in most cases, the variety of potential pathogens can make choosing a management strategy a complex endeavor.

• Hospital-acquired pneumonia (HAP) or nosocomial pneumonia refers to any pneumonia contracted by a patient in a hospital at least 48–72 hours after being admitted. It is the most common cause of death among nosocomial infections and is the primary cause of death in intensive care units. The majority of cases related to various rod shaped gram-negative organisms (52%) and Staphylococcus aureus (19%), usually of the MRSA type, and also Pseudomonas aeruginosa, and Enterobacter.
• Risk factors including; active cigarette smoking, alcohol abuse, underlying disease and severity, malnutrition, anemia, history of nosocomial infection during the same admission, pharmacologic immunosuppression (corticosteroids and chemotherapy), previous antibiotic therapy, antacid use (antiH2 and proton pump inhibitor), nebulization, invasive techniques (endotracheal intubation, tracheotomy, nasogastric tube), surgery, hospital admission in the previous month, previous ICU admission, and interval from admission to presentation of pneumonia
• Community-acquired pneumonia (CAP) refers to pneumonia contracted by a person outside of the healthcare system. CAP is common, affecting people of all ages, and its symptoms occur as a result of oxygen-absorbing areas of the lung (alveoli) filling with fluid. This inhibits lung function, causing dyspnea, fever, chest pains and cough.
• Risk factors including; age >65 years, smoking, alcoholism, immunosuppressive conditions, and conditions such as COPD, cardiovascular disease, cerebrovascular disease, chronic liver or renal disease, diabetes mellitus and dementia.

Infective Endocarditis

Infective endocarditis is an infection of the inner surface of the heart, usually the valves. Symptoms may include fever, small areas of bleeding into the skin, heart murmur, feeling tired, and low red blood cell count. This condition is usually caused by bacteria entering the bloodstream and infecting the heart. Bacteria may originate in the mouth, skin, intestines, respiratory system and urinary tract. When this condition is caused by bacteria, it’s also known as bacterial endocarditis. In rare cases, it can also be caused by fungi or other microorganisms.
Risk factors including; artificial heart valves, congenital heart disease, heart valve disease, hypertrophic cardiomyopathy, a history of endocarditis, history of illegal drug use, mitral valve prolapse and valve regurgitation (leaking), after procedures that allow bacteria access to the bloodstream, such as; dental procedures involving the gums, insertion of catheters or needles, procedures to treat infections.

Complicated skin & soft tissue infections

Complicated skin and soft tissue infections (cSSTIs) represent the severe form of infectious disease that involves deeper soft tissues. S aureus and streptococci are the predominant organisms responsible for most SSTIs. Involvement of methicillin-resistant Staphylococcus aureus (MRSA) further complicates cSSTI with increased hospitalization, health care costs, and overall mortality. Infections may present either as cutaneous abscesses with a collection of pus surrounded by an area of erythema and swelling or as diffuse, spreading infections, as in cellulitis or erysipelas.

Bone and joint infections

Bone and joint infections include septic arthritis, prosthetic joint infections, osteomyelitis, spinal infections (discitis, vertebral osteomyelitis and epidural abscess) and diabetic foot osteomyelitis. Many types of bacteria can cause bone and joint infections, including Staphylococcus aureus, also called staph, Enterobacter, and Streptococcus.
Septic arthritis is the inflammation of a joint due to a bacterial or fungal infection. The condition occurs when a penetrating injury, such as a puncture wound, occurs near or above a joint, allowing bacteria to directly enter the joint. Bacteria can also spread through the bloodstream to a joint from a recent infection or after surgery. The knee and hip are the most commonly affected joints in adults, whereas the hip is the most common site of infection in infants. Septic arthritis can quickly cause severe damage to the cartilage and bone within a joint. 
Prosthetic joint infections (PJIs) represent one of the most disastrous complications in prosthetic surgery, requiring long hospitalization, prolonged antimicrobial treatment and repeated surgical interventions.
Osteomyelitis is inflammation of the bone caused by an infecting organism. Although bone is normally resistant to bacterial colonization, events such as trauma, surgery, the presence of foreign bodies, or the placement of prostheses may disrupt bony integrity and lead to the onset of bone infection. can also result from hematogenous spread after bacteremia. In most cases, a bacteria called Staphylococcus aureus, a type of staph bacteria, causes osteomyelitis. Certain chronic conditions like diabetes may increase your risk for osteomyelitis.
Spinal infections are most commonly either haematogenous or postsurgical. Haematogenous infections are most commonly due to S aureus. Streptococcus spp, aerobic Gram-negative bacilli and M tuberculosis should also be considered as should Brucella spp in endemic areas and fungi in immunocompromised patients.
Diabetic foot infections usually occur following skin ulceration in patients with neuropathy and/or vascular insufficiency. Infections can go on to cause adjacent osteomyelitis. In severe infections this can rapidly become limb and life threatening. 

Urinary tract infections

Complicated urinary tract infections (UTIs) occur in the setting of a urinary tract that has metabolic, functional, or structural abnormalities. Complicated UTIs may involve both lower and upper tracts. They include cystitis (infection of the bladder/lower urinary tract) and pyelonephritis (infection of the kidney/upper urinary tract). Risk factors include female anatomy, increasing age, diabetes, obesity, and frequent intercourse (although UTI is not defined as a sexually transmitted infection).

Peritonitis

Peritonitis is inflammation of the peritoneum, the thin layer of tissue covering the inside of your abdomen and most of its organs. The inflammation is usually the result of a fungal or bacterial infection. This can be caused by an abdominal injury, an underlying medical condition, or a treatment device, such as a dialysis catheter or feeding tube. Symptoms will vary depending on the underlying cause of your infection. Common symptoms of peritonitis include:

• tenderness in your abdomen
• pain in your abdomen that gets more intense with motion or touch
• abdominal bloating or distention
• nausea and vomiting
• diarrhea
• constipation or the inability to pass gas
• minimal urine output
• anorexia, or loss of appetite
• excessive thirst
• fatigue
• fever and chills

Clostridium difficile infection-associated diarrhea & colitis

Clostridium difficile–associated diarrhea (CDAD) has been recognized with increased frequency as a cause of nosocomial illness. The clinical presentation varies from asymptomatic colonization to mild diarrhea to severe debilitating disease, with high fever, severe abdominal pain, paralytic ileus, colonic dilation (or megacolon), or even perforation.