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Kawasaki Disease
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Kawasaki Disease
Description. Kawasaki disease (mucocutaneous lymph node syndrome) is a children's illness characterized by fever, rash, swelling of the hands and feet, irritation and redness of the whites of the eyes, swollen lymph glands in the neck, and irritation and inflammation of the mouth, lips and throat. These immediate effects of Kawasaki disease are rarely serious: however, long-term heart complications result in some cases and can be seen as early as two weeks after onset of the disease.
Named after Dr. Tomisaku Kawasaki, a Japanese pediatrician, the disease has probably been in existence for a long time, but was not recognized as a separate entity until 1967. The incidence is higher in Japan than in any other country. In the United States it is more frequent among children of Asian-American background, but can occur in any racial or ethnic group. The disease is not common, and its incidence in the United States has not been determined. In recent years, it has tended to occur in localized outbreaks, most often in the late winter or spring, but is seen year-round. Kawasaki disease almost always affects children; most patients are under 5 years old, and the average age is about 2 years. Boys develop the illness almost twice as often as girls.
The heart may be affected in as many as one of five children who develop Kawasaki disease. Damage sometimes occurs to the blood vessels that supply the heart muscle (the coronary arteries) and to the heart muscle itself. A weakening of a coronary artery can result in an enlargement or swelling of the blood vessel wall (an aneurism). Infants less than 1 year old are usually the most seriously ill and are at greatest risk for heart involvement.
The acute phase of Kawasaki disease commonly lasts 10 to 14 days or more. Most children recover fully. The likelihood of developing coronary artery disease later in life is not known, and remains the subject of medical investigation.
Cause. The cause of Kawasaki disease is unknown. It does not appear to be hereditary or contagious. Because the illness frequently occurs in outbreaks, an infectious agent (such as a virus) is likely the cause. It is very rare for more than one child in a family to develop Kawasaki disease.
Signs and Symptoms. Fever and irritability are often the first indications of the disease. Fever ranged from moderate (101 to 103 F) to high (above 104 F). The lymph glands in the neck may become swollen. A rash usually appears on the back, chest, and abdomen early in the illness; in infants it may develop in the groin. In some cases, the rash may spread to the face. The rash appears as poorly defined spots of various sizes, often bright red. Fever continues to rise and fall, sometimes for as long as 3 weeks.Bloodshot eyes (conjunctivitis) may develop, and the eyes can become sensitive to light.
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The child's tongue may be coated, slightly swollen, and resemble the surface of a strawberry, sometimes referred to as "strawberry tongue". The lips may become red, dry, and cracked; the inside of the mouth may turn darker red than usual.
The palms of the hands and soles of the feet often become red, and hands and feet may swell. Occasionally, a stiff neck will develop. Abdominal pain and diarrhea occur in some children.
When the fever subsides, the rash and swollen lymph glands usually disappear. The skin around the toenails and fingernails often peels painlessly, usually during the second or third week of illness. The skin on the hands or feet may peel in large pieces.
The knees, hips, and ankles may become swollen and painful. Occasionally, joint pain and swelling persist after other symptoms have disappeared, but permanent joint damage does not occur. Lines or ridges on fingernails and toenails, formed during the illness, may be seen for weeks or months.
Diagnosis. The diagnosis of Kawasaki disease cannot be made by a single laboratory test or combination of tests. Physicians make the diagnosis after carefully examining a child, observing signs and symptoms, and eliminating the possibility of other diseases that are similar. Blood tests are used to detect mild anemia, an elevated white blood cell count, and an elevated sedimentation rate, indicating inflammation. A sharp increase in the number of platelets, a major clotting element in blood, may also be found.
Urine tests may reveal the presence of protein (albumin) and white blood cells. An irregular heartbeat and evidence of heart muscle involvement can be detected by electrocardiogram (ECG). An echo-cardiogram (or echo) is used to look for possible damage to the heart or to the coronary arteries that supply blood to the heart muscle. Other blood tests or diagnostic studies may be requested by the physician.
Complications. The possibility of heart and coronary artery involvement makes Kawasaki disease unpredictable, but these problems usually are not serious and disappear with time. However, on occasion aneurisms of coronary or other arteries of the body can occur, and some may require medical or surgical treatment. Very rarely, complications may include heart attacks, which can be fatal.
Treatment. Kawasaki disease is frequently treated in the hospital, with a stay from a few days to a few weeks. Some children may receive care at home without hospitalization.
Since the cause of Kawasaki disease is unknown, no specific medication is available. Aspirin is often used to reduce fever, rash, joint inflammation, and pain, and to prevent formation of blood clots. Recent studies from Japan arid the United States suggest that another medication, intravenous gamma globulin, may decrease the risk of developing heart disease when given early in the illness. A major goal of treatment both in the hospital and at home is to make a child as comfortable as possible while the illness runs its course.
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If tests reveal an aneurysm or other heart or blood vessel abnormality, repeated echocardiograms or other tests may be necessary for several years following recovery from Kawasaki disease. Almost all children return to completely normal activity after the acute phase of the illness.
Prevention. There is no known prevention for Kawasaki disease. Approximately one child in a hundred may develop the disease a second time. Parents should know that nothing they could have done would have prevented the disease.
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KD (Kawasaki Disease)
Kawasaki disease is an 1... vasculitis of infants and children that results in coronary artery 2... in 15% to 25% of those
affected. 3... of KD with aspirin plus high 4... doses of y-globulin, instituted within the first 10 days of 5... reduces cardiovascular sequelae, 6... it is highly desirable to identify patients with KD early in the 7... of their illness. In the absence of a definitive laboratory test result, the diagnosis of KD is dependent on the 8... of clinical features that may be mimicked by other disease processes. Indeed, the differentiation of KD from other 9... and immunologic diseases constitutes a major challenge for the practitioner. The purpose of our study was 10... those diseases that most closely mimic KD in the United States and 11... the details of the history, 12... examination, and laboratory investigation that influenced 13... clinicians to exclude the diagnosis of KD. We also used this 14... to compare certain epidemiologic 15... of KD patients and of those patients referred for evaluation of possible KD in whom 16... diagnoses were established.
1. assessment 2. lesions 3. alternative 4. features
5. treatment 6. course 7. infectious 8. to examine
9. opportunity 10. experienced 11. acute 12. to determine
13. physical 14. illness 15. thus 16. intravenous.
All About Aspirin
Modern medicine is devoting considerable time and money to the primary prevention of coronary artery disease before it becomes a problem. But when primary prevention" fails, the next logical step is secondary prevention of recurrent heart attacks and death. For some people who fall into this category... enter aspirin.
Aspirin or acetylsalicylic acid is one of the safest and least expensive medications available today. An early form of the drug, which was extracted from the bark of a willow tree, was first prescribed by the ancient Greek physician Hippocrates some 2300 years ago.
Over the years aspirin has probably been used more widely than any other medication for such problems as headaches, fever, and menstrual discomfort. Recently the United States Food and Drug Administration approved yet another use: Aspirin is now indicated for preventive treatment in some patients with cardiovascular disease. Aspirin in the dosages prescribed by your doctor may be effective in preventing heart attacks and stroke.
Heart attacks are usually the result of impeded blood flow through the vessels that carry blood to the heart. One possible cause of this impeded flow is a blood clot created by the buildup of platelets tiny blood components that play an important role during blood clotting.
As a rule, blood clot formation is a desirable condition. The formation of blood clots at the site of a wound is a normal and necessary response to injury. If your blood did not clot, you would bleed to death following the infliction of even a small wound. However, blood clotting within the circulating bloodstream a process that is promoted by platelet aggregation or clumping is undesirable. Such platelet activity can lead to the formation of those blood cells that are responsible for strokes, heart attacks, and other potentially fatal circulatory problems.
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Why aspirin for heart attacks? The rationale for administering aspirin" to patients who are at high risk for heart attack is that some patients with CAD have greater-than-normal platelet activity. This increased platelet activity may result in an increase in the formation of blood clots in the circulation and. thus increase blockage in the blood vessels.
How does aspirin do it? In 1971, Dr. John R. Vanean English scientist who received the Nobel Prize for Medicine for this work found that aspirin interferes with the production of certain pro-staglandins, chemicals that occur naturally in the body and that are involved in platelet clumping. This, in turn, inhibits the accumulation
of platelets within a blood vessel and reduces the platelets' tendency to adhere to the vessel walls. In patients with a tendency toward platelet aggregation, aspirin may prove life saving.
But remember the general indications for aspirin that you will find listed on your aspirin bottle do not include prevention of cardiovascular disease. Taking aspirin for heart disease should be done only on the advice of your physician.
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All about RSV: A guide for parents.
Questions:
1. What is RSV?
2. When does RSV occur?
3. What are the symptoms of RSV?
4. Can RSV be serious?
5. How do I know if my child hasNa serious RSV infection?
6. When should I call the doctor?
7. If my child should get an RSV, how is it treated?
8. Where does RSV come from, and how can I prevent my
child from being infected?
9. Can my child get RSV again?
10. Will RSV weaken my child's lungs and make him more susceptible to pneumonia in the future? Texts:
1. Although a child can get a second RSV infection, it is very
likely that the symptoms will be much milder than the first time.
2. In the great majority of cases RSV infection is self-limiting
and requires no specific therapy. If your child has a fever, your
pediatrician may prescribe some medication to control it. If he or
she develops an ear infection associated with RSV, antibiotics may
be prescribed. Most children exhibiting the respiratory symptoms
commonly associated with RSV {such as a stuffy nose and cough)
require no treatment.
If, however, your child has more severe symptoms of RSV infection and needs hospitalization, then specific antiviral treatment with ribavitin may be administered Whether your physician decides to use this drug which is administered in a mist form will depend on the severity of the illness, any associated diseases or conditions, and several other factors.
3. A child who develops signs of more stressful breathing,
deeper and more frequent coughing, and who generally acts sicker
by appearing tired, less playful, and less interested in food may have developed a more serious RSV infection. But only your doctor can tell for sure.
4. Most children recover completely and will handle their next
respiratory infection with no more'difficulty than the average child.
A few children, however, appear to be more susceptible to
subsequent respiratory problems. Susceptibility may relate, however,
to some other underlying medical condition or allergy.
5. RSV causes nasal stuffiness and discharge, cough, and
sometimes ear infections. It is usually self-limiting and does not
require hospitalization or specific treatment even in the majority
of those who also have lower respiratory tract involvement. These
children may have a low-grade fever for several days, respiratory
symptoms that may last for 1 to 2 weeks, and a cough that
sometimes persists beyond 2 weeks.
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6. Children and adults of all ages can become infected. The
infection-in older children and adults may be very mild, usually causing
cold-like symptoms. A person becomes infected by coming in close
contact with another infected person or with the secretions from an
infected person. An infant usually acquires the infection from close
contact with an older family member who may not be aware that
he or she is ill or who may have only mild, cold-like symptoms.
As noted earlier, RSV occurs throughout the year, but because it occurs in wide scale, sudden outbreaks, and is so prevalent in the winter months, it is not feasible or advisable to attempt to prevent the normal child's exposure to RSV infection. When a family member is infected, extra precautions may be taken by washing hands often and preventing the spread of infectious secretions on tissues and objects.
7. RSV occurs throughout the year and is most prevalent during
the winter months.
8. RSV stands for respiratory syncytial virus, the most frequent
cause of serious respiratory tract infections in "infants and children
younger than 4 years of age. This is such a common virus that
virtually all children have been infected by RSV by the age of 3.
In most young children it results in a mild respiratory infection
that is not distinguishable from a cold.
9. As in any case of illness, you should call your pediatrician
whenever you are worried about your child. He or she can best
decide with you whether the symptoms and behaviour you describe
suggest that your baby should be seen.. In general, pediatricians
prefer to examine ill infants in person, as severity may be impossible
to determine over the phone.
Certainly, if the respiratory syptoms appear to interfere with your baby's ability to sleep or drink, or if the baby appears to
have difficult or rapid breathing, you should call your pediatrician. If your child is younger than 1 year of age and has an underlying disease such as heart disease or lung disease or was premature, with lung disease developing after birth, you should let your physician know whenever the baby develops a respiratory infection.
10. Yes. An infant or young child who is experiencing his or
her first RSV infection may develop a severe infection in the lower
respiratory tract that is best managed in the hospital. Approximately
80,000 children are hospitalized with these infections each year.
Most commonly, the ones requiring hospitalization are newborns
and infants and those who have another complicating or underlying
condition, such as congenital heart or lung disease.
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" ". "", 1991 ., ! 119, 2, . 183-186.
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,
:
) :
(has occurred, were considered, died, should be instituted, was given, led, acquired, etc).
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)
e.g. The infection control program (p. 184).
r) "No" .
e.g. No secondary cases of measles occurred in hospital personnel.
) :
1. Of the 37 patients, six were not thought to have measles.
2. Measles exposure was considered to have occurred in patients
and personnel....
3. If the exposure was assessed to have been between 72
hours and days....
4. Therefore a total of 107 susceptible hospitalized patients
are known to have been exposed to measles during 1988.
5. Transmission of measles virus in medical settings appears
to be an important factor in ongoing outbreaks.
6. Hospital personnel born before 1957 are generally considered
to be immune to measles....
III. . , .
To expose 6. to vaccinate
To infect 7. to respirate
