How to treat Cushing's syndrome?

Define Cushing's Syndrome.

Cushing's syndrome is a hormonal condition characterized by high cortisol levels or steroid use. Untreated, it causes physical changes, metabolic issues, and serious health problems. High cortisol levels (hypercortisolism) from long-term steroid use or tumors induce Cushing's syndrome, a dangerous hormonal condition. Rapid weight gain, especially in the face and upper back, along with thin, easily bruised skin, muscle weakness, and purple stretch marks, is common. Surgery or medicine usually cures it. This condition is rare, occurring approximately 2-3 times per million individuals annually.

Causes 

• Endogenous means inside.

• Adrenal glands overproduce cortisol. 

• Cushing's disease (pituitary adenoma) causes excess ACTH production. 

• Rare adrenal tumors or ectopic ACTH-producing tumors. 

• External (exogenous): 

• Long-term use of glucocorticoids (e.g., prednisone) for asthma, arthritis, or autoimmune illnesses.

Other signs: 

• High blood pressure. 

• Muscle weakness and bulk loss. 

• Acne, bruising, and fragile skin. 

• Bone loss (osteoporosis).

Complications 

• Metabolic: Type 2 diabetes, obesity. 

• Cardiovascular: Hypertension, a higher risk of heart disease. 

• Immune: Suppressed immunity leads to frequent infections. 

• Skeletal: Osteoporosis and fractures. 

What are three Cushing's symptoms?

Important Cushing's Syndrome Signs 

• Moon face: Fat redistribution causes a rounder, fuller face. 

• Buffalo hump: A fat pad between the shoulders and upper back. 

• Purple stretch marks (striae): Wide, colourful marks on the abdomen, thighs, or breasts.

Additional Common Symptoms 

• Increased weight in the middle and upper back, with slimmer arms and legs. 

• The skin appears fragile and is prone to easy bruising. 

• The patient exhibits high blood pressure and may be at risk for type 2 diabetes. 

• The patient experiences muscle weakness and bone loss due to osteoporosis. 

Doctors first look for moon face, buffalo hump, and purple stretch marks to suspect Cushing's syndrome.

Cushing's syndrome diagnosis

Hormone and imaging testing establish sustained cortisol excess and its source to diagnose Cushing's syndrome. The 24-hour urine free cortisol, late-night salivary cortisol, and low-dose dexamethasone suppression tests are the best first-line testing.

First Step: Screening Tests

First, doctors screen for abnormal cortisol levels: 

• 24-hour urinary free cortisol (UFC): Tracks daily urine excretion of cortisol. High amounts indicate hypercortisolism. 

• Salivary cortisol levels should be low at night; persistently high levels indicate a lack of normal rhythm. 

• Low-dose dexamethasone suppression test (DST): A synthetic steroid reduces cortisol in healthy individuals but maintains high levels in Cushing's syndrome.

Step 2: Confirmation Testing

Further testing confirms the diagnosis if screening is positive: 

• • Repeat testing is necessary to eliminate false positives, as stress, sadness, and alcohol usage can mimic Cushing's. 
• • Plasma ACTH measurement: This test helps determine if the extra cortisol is caused by too much ACTH from the pit

Third Step: Imaging Studies

Biochemical confirmation is followed by imaging to find the source. MRI of the pituitary gland can detect adenomas (Cushing's disease). 

• Adrenal CT/MRI: Detects adrenal tumors or hyperplasia. 

• Chest/abdominal scans: Check for ectopic ACTH-producing tumors, such as lung cancer.

Important Considerations 

• Repeated and thorough testing is necessary to distinguish pseudo-Cushing's syndrome from persistent drinking, depression, and obesity. 

• To diagnose, biochemical proof and clinical connection are needed, including physical signs (moon face, buffalo hump, purple striae) and abnormal cortisol testing. Early diagnosis is crucial to prevent consequences, including diabetes, hypertension, osteoporosis, and cardiovascular disease.

Which patient is most likely to have Cushing's?

Cushing's disease, which happens when a pituitary adenoma makes too much ACTH, is most often seen in women between 25 and 45 years old who gain weight in their trunk, have a round "moon" face, and purple stretch marks on

Cushing's Disease: Differentiation from Other Types 

• Cushing's disease: pituitary adenoma causes excess ACTH, leading to the adrenal glands overproducing cortisol. 

• Cushing's syndrome can also be caused by adrenal tumors, ectopic ACTH-producing tumors, or long-term steroid use.

The typical Cushing's Disease patient profile 

• The condition is more common in women between the ages of 25 and 45. 

 Symptoms:  Central obesity with thin arms/legs. 

• The condition is characterized by facial redness and a rounded "moon" face. 

• "Buffalo hump" refers to the accumulation of fat between the shoulders. 

• The abdomen and thighs are covered in purple stretch marks. 

• Women's menstrual irregularity. 

• Muscle weakness and weariness. 

Lab Results: 

• The patient's cortisol levels do not respond to dexamethasone. 

• High ACTH levels (pituitary-driven). Pituitary MRI may reveal a tiny adenoma.

An example case

Woman, 30, with:  Rapid weight gain in abdomen and face. 

• Her abdomen has purple stretch marks.

• She also exhibits hypertension and irregular menstrual cycles. 

• She also has elevated levels of cortisol and ACTH.

This profile strongly implies Cushing's illness, not adrenal or ectopic origins.

The video about managing Cushing's syndrome

Treatment for Cushing's

• Adjust medication: Reduce or stop steroid medicines if they are the cause. 

• Surgery: Removal of pituitary or adrenal tumors. 

• Radiation therapy for unremoved pituitary adenomas. 

• Drugs such as ketoconazole and metyrapone, which reduce cortisol production, are also used.

If Cushing's syndrome is caused by steroid medication, the dose is reduced or stopped under medical supervision. If it's caused by a tumor (pituitary, adrenal, or ectopic), surgery is usually the first-line treatment, followed by radiation or cortisol controls.

The main treatment methods

1. Cushing's Syndrome from Medication 

• Cause: Prolonged usage of glucocorticoids (e.g., prednisone, dexamethasone). 

• Prevent adrenal insufficiency by gradually decreasing or discontinuing the medicine under medical supervision. 

• Consider switching to non-steroid drugs as an alternative therapy.

2. Pituitary tumor (Cushing's) 

• First-line: Transsphenoidal surgery for pituitary adenoma removal. 

• For incomplete elimination, use radiation therapy or medicines (e.g., pasireotide, cabergoline) to suppress ACTH production. 

• Temporary control: Ketoconazole, metyrapone, or mitotane can reduce cortisol until permanent treatment is accessible.

3. Adrenal Tumors 

• Treatment: Adrenalectomy, surgical removal of the troubled adrenal gland. 

• Patients post-surgery may require cortisol supplementation till adrenal gland recovery.

4. ACTH-producing ectopic tumors 

• Treatment: Surgically remove the tumor, typically from the lungs or pancreas. 

• If the tumor remains unremoved, medications such as ketoconazole, mitotane, and mifepristone can impede the synthesis of cortisol.

5. Lifestyle and Supportive Measures 

• Diet and exercise: Manage weight gain, diabetes, and hypertension. 

• Ensure bone health with calcium, vitamin D, and bisphosphonates to avoid osteoporosis. 

• Psychological support: Counseling for mood swings and depression.

Risks and Considerations 

• Surgery risks: Pituitary or adrenal surgery may cause transient adrenal insufficiency, necessitating steroid replacement. 

• Medication side effects: Ketoconazole may impact liver function, requiring monitoring. 

• Cushing's illness may reappear following surgery, necessitating long-term monitoring.

What is the life expectancy for individuals with Cushing's syndrome?

The duration of Cushing's syndrome depends on your health and the ease of your treatment. The median survival time after successful therapy was 40 years in one study.

Cushing's Syndrome conclusion

Chronic cortisol exposure causes Cushing's syndrome, a dangerous but curable hormonal condition. Pituitary adenomas (Cushing's disease), adrenal tumors, ectopic ACTH-producing tumors, and long-term steroid use can cause it.

Most people can go into remission and improve their quality of life with early diagnosis and therapy.

Quickest way to fix electrolyte imbalance

An electrolyte imbalance 

When blood levels of key minerals, such as sodium, potassium, calcium, magnesium, or chloride, are too high or too low, nerve signalling, muscular contraction, and fluid balance are disrupted. Mild (fatigue or cramps) to severe (confusion, abnormal heartbeat, or death) can occur.

What are electrolytes?

• Electrolytes are bodily fluid-dissolved charged minerals.
• Sodium, potassium, calcium, magnesium, chloride, bicarbonate, and phosphate are among the most common electrolytes.
• They regulate nerve impulses, muscle contractions, hydration, pH, and heartbeat.

Key Electrolyte Imbalance Signs

1. Muscle cramps or weakness

• Cramps and weakness can result from low potassium, calcium, or magnesium levels.
• Usually, these symptoms occur after intense perspiration, vomiting, or the use of certain medicines.

2. Fatigue and poor energy

• Insufficient sodium and potassium deplete cellular energy and hydration.
• Even after resting, patients may feel fatigued.

3. Heart rhythm irregularities

• Heart rhythm requires potassium, calcium, and magnesium.
• Palpitations and severe arrhythmias can result from high or low levels.

4. Confusion, dizziness, or disorientation

• Sodium imbalance—especially hyponatremia—affects brain function.
• Severe cases may cause unconsciousness or seizures.

Other Possible Signs

• Headaches
• Nausea, vomiting
• Extremity tingling/numbness
• In severe circumstances, seizures

What causes electrolyte deficiency most often?

Main Electrolyte Deficiency Causes

1. Fluid Loss (Most Common)

• Sweating: Exercise, heat, and fever can deplete salt and potassium.
• Vomiting and diarrhea rapidly deplete electrolytes, particularly sodium, potassium, and chloride.
• Diuretics and uncontrolled diabetes increase electrolyte excretion.

2. Poor Intake

• A poor diet or prolonged fasting might lower electrolytes.
• Alcoholism and eating disorders may contribute.

3. Health Issues

• Kidney disease can cause dysregulation of sodium, potassium, and magnesium.
• Endocrine disorders: Thyroid and adrenal issues can affect electrolytes.
• Chronic diseases: Heart failure, liver disease, and cancer therapy can alter electrolytes.

4. Medications

• Diuretics: Used for hypertension and heart failure, they increase salt and potassium loss.
• Chemotherapy and corticosteroids affect electrolyte metabolism.

Also, read https://colonydiner.com/blog/nutrition/treat-electrolyte-imbalance/.

Tips for Prevention

• Water and electrolytes are essential in hot regions.
• Balanced diet: Eat bananas, oranges, veggies, dairy, and nuts for electrolytes.
• Regular blood tests help track electrolyte levels with diuretics and other long-term treatments.
• After illness/exercise, ORS or sports drinks can restore balance.

Dangers of Electrolyte Imbalance

1. Heart Risks

• Abnormal potassium, calcium, or magnesium levels cause arrhythmias.
• Cardiovascular arrest can result from a severe imbalance.

2. Neurological Risks

• Sodium imbalance causes confusion, dizziness, convulsions, or coma.
• Brain swelling or shrinking (hyponatremia) can kill.

3. Organ and Muscle Risks

• Low potassium or calcium causes muscle weakness, spasms, or paralysis.
• Critically abnormal magnesium or potassium levels cause respiratory failure.

4. Systemic Risks

• Fluid loss, shock, and dehydration.
• Continuing abnormalities might cause kidney failure.

The Riskiest Time

• Vomiting, diarrhea, and heatstroke cause rapid fluid loss.
• These conditions include kidney disease, heart failure, and diabetes.
• Diuretics and chemotherapy can cause side effects.
• Children and elderly people are particularly susceptible to dehydration.

The Bottom Line

• Fluids and nutrition can fix mild imbalances, such as after exercise.
• Urgent IV fluids, medicines, or hospitalization are needed for severe imbalances.
• Ignoring confusion, abnormal heartbeat, or seizures can be fatal.

The Electrolytes Effect on Dry Mouth

Function of Electrolytes

• Sodium and potassium regulate bodily fluids. Low levels dehydrate, reducing saliva.
• Calcium and magnesium support neuron, muscular, and salivary gland function.
• Chloride and bicarbonate: Balance pH, indirectly affecting oral moisture.

Mechanism

• Electrolyte shortage causes dehydration, diminished salivation, and dry mouth (xerostomia).
• Rarely, electrolyte excess can affect fluid balance, but deficit is more common.

Common Electrolyte-Linked Dry Mouth Causes

• Hot weather causes profuse sweating.
• Food poisoning or diseases can cause vomiting or diarrhea.
• Diuretics, or fluid/electrolyte-losing drugs.
• Insufficient electrolytes or hydration can occur during illness or exertion.

Warning Signs of Dry Mouth

• Dry mouth/sticky saliva
• Trouble swallowing or speaking
• Broken lips or sores
• Reduced saliva cleansing causes bad breath.

Electrolyte imbalance signs

• Common electrolyte imbalance symptoms
• All-around symptoms
• Muscle spasms or weakness
• Low energy, fatigue
• Headaches
• Nausea, vomiting
• Unsteadiness
• Neurosymptoms
• Confused or lost
• Trouble concentrating
• In severe circumstances, seizures
• CVD symptoms
• Heartbeat irregularities
• Chest discomfort/palpitations
• High or low blood pressure
• GI Symptoms
• Appetite loss
• Discomfort or diarrhea

Electrolyte Imbalance Risks

Major electrolyte imbalance risk factors

1. Fluid loss/dehydration

• Hot weather, fever, intense exertion, heavy perspiration.
• Infection-related vomiting or diarrhea.
• Diabetes or diuretics cause excessive urination.
• This condition accelerates the depletion of sodium and potassium.

2. Kidney Diseases

• Electrolytes are balanced by the kidneys.
• CKD or acute injury reduces sodium, potassium, and magnesium regulation.
• Dialysis patients are vulnerable.

3. Medications

• Diuretics (for hypertension/heart failure) cause sodium and potassium loss.
• Drugs such as chemotherapy, corticosteroids, and antibiotics can affect electrolyte metabolism.
• Laxative misuse causes persistent depletion.

4. Endocrine/Metabolic Issues

• Uncontrolled diabetes causes frequent urination and fluid changes.
• Sodium/potassium imbalance is a problem in adrenal illnesses, including Addison's disease and Cushing's syndrome.
• Thyroid illness may contribute.

5. Chronic Illness

• Heart failure causes fluid retention and sodium imbalance.
• Liver disease alters fluid distribution.
• Cancer therapies can cause electrolyte imbalances.

6. Age, lifestyle factors

• Reduced renal function, polypharmacy in seniors.
• Abuse of alcohol: malnutrition and dehydration.
• Low mineral uptake via food or fasting.

High-risk groups

• Seniors are at high risk due to their frequent use of drugs and the decline in their renal function.
• Hot environment athletes risk hyponatremia from perspiration.
• Hospitalized patients require IV fluids and medications and are at risk for serious illness.
• Children with diarrhoea often experience dehydration and sodium loss.

Diagnosis

• Blood test for electrolytes includes sodium, potassium, calcium, chloride, and bicarbonate.
• Urine testing can help to assess kidney function and electrolyte excretion.

Home electrolyte imbalance treatment

If moderate and unrelated, an electrolyte imbalance can be treated at home. Hydration and vital minerals, including salt, potassium, calcium, and magnesium, are key.

Home Treatments for Mild Electrolyte Imbalance

1. Rehydrate well

• Stay hydrated throughout the day.
• For vomiting, diarrhea, or profuse perspiration, use oral rehydration solutions (ORS) or electrolyte beverages.
• Coconut water has potassium and sodium naturally.

2. Eat Electrolytic Foods

• Sodium: soups, broths, light salts.
• Potassium: spinach, sweet potatoes, bananas, oranges.
• Calcium sources include dairy, fortified plant milks, and leafy greens.
• Magnesium can also be found in seeds, nuts, whole grains, and legumes.

3. Maintain Hydration

• Drinking too much water with no electrolytes can dilute sodium and cause hyponatremia.
• When exercising or sweating, switch between water and electrolyte-rich fluids.

4. Reduce depleting substances

• Reduce fluid-loss-causing alcohol and caffeine.
• Use laxatives and diuretics sparingly unless prescribed.

5. Rest and Recovery

• Allow your body to recover after illness.
• Soft foods and water replace electrolytes without digestive stress.

The video explains how to overcome electrolyte imbalance.

Medical attention is needed if: When Home Care Is Insufficient

• Constant diarrhoea or vomiting. 
• Cramps or severe muscular weakness
• Confusion, dizziness, fainting
• Chest discomfort or irregular heartbeat
• Seizures
• These may indicate a significant imbalance requiring IV fluids or medical attention.

Curing Electrolyte Imbalance: 

• Medical Treatment for Moderate to Severe Imbalance
• IV fluids quickly replenish hydration and electrolytes.
• Medications: Oral or IV potassium supplements for hypokalemia.
• Injections of calcium or magnesium are administered when the levels are critically low.
• Dialysis or diuretics are used to treat hyperkalemia or hypernatremia.
• Prevent recurrence by treating kidney disease, diabetes, heart failure, or hormonal abnormalities.

Conclusion 

Electrolyte imbalances can result in everything from fatigue and muscle cramps to seizures, arrhythmias, and cardiac arrest. Electrolytes are essential for fluid balance, neuron signaling, muscular contraction, and heart rhythm. Electrolyte imbalance is deadly if neglected but treatable with prompt detection, hydration, and medical attention.

Hospital-acquired Acinetobacter baumannii  treatment

What does "Acinetobacter baumannii" mean?

Acinetobacter baumannii is a highly drug-resistant bacterium that mostly causes illnesses people get in hospitals, like pneumonia, bloodstream infections, urinary tract infections, and wound infections. The type of cell is a Gram-negative, opportunistic pathogen. It lives in dirt, water, hospital surfaces, ventilators, and catheters. People who are very sick, on ventilators or tubes, or who have open wounds are at a higher risk. Colonisation vs. infection: Some people may carry the bacteria without any signs (colonisation), but it can cause serious infections in weak people.

Acinetobacter Baumannii

Most Common Infections

• Get pneumonia in the hospital, especially if you use a respirator.
• Sepsis is an illness of the bloodstream.
• Urinary tract diseases (catheter-related).
• Sores and wounds that need care.
• Meningitis, endocarditis, and diseases of the bones and soft tissues happen less often.

Why is it a Major Concern?

• Multidrug resistance (MDR): Many strains are not responding to carbapenems, cephalosporins, or aminoglycosides, which means there aren't many treatment options.
• Persistence: Can live on hospital surfaces for a long time, which makes breakouts hard to control.
• High death rate: invasive infections like sepsis or pneumonia can kill more than 40–60% of severely ill patients.

Diagnosis:

• Samples for diagnosis: Blood, urine, mucus from the lungs, and wound swabs.
• Tests include Gram stain, culture, biochemical identification, and antibiotic sensitivity testing.

How does Acinetobacter spread?

The main transmission routes

• The most common method is through the hands of healthcare workers. Bacteria can spread from one patient to another if proper hand hygiene is not maintained. 
• Surfaces like bed rails, doorknobs, ventilators, catheters, and medical tools can hold the bacteria for a long time in a hospital setting that is contaminated.
• Infected medical tools include ventilators, urinary catheters, and intravenous lines.
• Person-to-person contact is less common, but it can happen in healthcare situations where there isn't enough infection control.
• The genus Acinetobacter can be found in dirt and water, but A. baumannii infections rarely happen outside of hospitals.

Who is at risk? 

Individuals in the ICU who are on ventilators or tubes are susceptible to infection.

• Individuals with burns or open wounds are also at risk.
• Individuals with weaker immune systems, such as those suffering from cancer, transplants, or diabetes, are also at risk.
• Those on broad-spectrum antibiotics, which harm healthy bacteria and facilitate the growth of resistant bacteria, are also at risk.

What's wrong with the transmission

• A. baumannii can live on dry surfaces for weeks at a time.
• Resistance: Multiple drugs cannot easily kill many strains, making the management of breakouts challenging.
• Colonisation vs. infection: People may carry the germs around without getting sick, but they can later give them a very bad illness.

Is Acinetobacter baumannii serious?

• Multidrug resistance (MDR): Many types resist carbapenems, cephalosporins, and aminoglycosides, leaving few treatment options.
• High death rate: Between 40 and 60% of severely ill patients who get invasive infections like ventilator-associated pneumonia or sepsis die.
• Persistence in hospitals: It can live for a long time on surfaces, medical equipment, and even skin, which makes it hard to control breakouts.
• Opportunistic: Healthy people don't get infected very often, but people with weak immune systems, open cuts, or medical devices like catheters or ventilators are more likely to get sick.

Types of Infections

• Pneumonia (especially when linked to a respirator).
• Sepsis is an illness of the bloodstream.
• Urinary tract diseases (catheter-related).
• Sores and wounds that need care.
• Meningitis, brain tumors, and endocarditis are less common but very dangerous.

What Causes Risk

• The risk factors include placement in the ICU or prolonged hospital stays.
• These risks may include mechanical breathing or the use of catheters that remain in the body for extended periods.
• When you have cancer, a donation, or diabetes, your immune system weakens.
• You should seek medical advice before using broad-spectrum antibiotics, as they target resistant strains.

Problems with Treatment

• There aren't many choices. Colistin, tigecycline, and some newer mixtures of β-lactam and β-lactamase inhibitors are used, but resistance is growing.
• Combination therapy: To get better results, doctors sometimes use more than one drug at the same time.
• Experimental methods: Antimicrobial peptides and phage treatment are being looked into.

Where did the Acinetobacter baumannii come from?

• In hospitals, the germs can live for a long time on surfaces, bed rails, ventilators, catheters, and other medical gear.
• Direct contact: It can be passed from healthcare workers' or patients' dirty hands to other people.
• They can be found in dirt, water, and sometimes food, but infections that happen outside of hospitals are not common.
• Colonization: Some people carry the bacteria on their skin or in their lungs without showing any symptoms. If their immune system is weak, the bacteria can later cause an infection.

Also read https://www.sciencedirect.com/science/article/abs/pii/S2173572722002375

How do people get sick with it?

• Patients who use breathing machines are more likely to develop ventilator-associated pneumonia.
• Intravenous lines and devices are frequently the source of bloodstream infections.
• Infections of the urinary tract: Especially in people who have urinary tubes that stay in their bodies.
• Infections in wounds: Burns, surgery wounds, and trauma sites can get infections.

What Causes Risk

• Long stays in the hospital or ICU can increase the risk of infection.
• Long stays in the hospital or ICU may involve mechanical ventilation or the use of gadgets inside the body.
• Cancer, transplants, diabetes, and other serious illnesses can weaken the immune system.
• Before using broad-spectrum antibiotics, it is important to select resistant strains.

Prevention

• Safety First 
• Healthcare workers and guests must wash their hands very well.
• Cleaning and disinfecting hospital surfaces and tools. 
• Staff members should wear safety measures such as gloves and gowns during contact. 
• Use antibiotics wisely to reduce resistance.

Can you get rid of Acinetobacter?

Acinetobacter baumannii infections can be cured, but many strains are resistant to many drugs.

How It's Possible to Get Better

Targeted antibiotics: To find out which drugs work against a certain strain, doctors use culture and susceptibility testing.

Open options:

• It is often used for types that are resistant to more than one drug.
• Tigecycline—it can help with serious infections sometimes.
• Combinations with sulbactam can be helpful in some situations.
• There are new drugs on the market, such as cefiderocol or β-lactam/β-lactamase inhibitor combos.
• Combining two or more antibiotics improves their effectiveness. This is called combination treatment.
• Supportive care: It is essential to remove infectious devices like catheters and ventilators, treat sepsis, and keep the patient stable.

Problems

• Multidrug resistance (MDR): Common medicines are ineffective in killing many strains.
• How dangerous last-resort drugs are: Colistin, for example, can hurt nerves and kidneys.
• High death rate: Even with care, severe infections like ventilator-associated pneumonia or bloodstream infections can still kill.

Treatment for Acinetobacter baumannii

The video on the treatment of Acinetobacter baumannii

• Standard Ways of Treating
• Testing for culture and sensitivity is the most important part of treatment. Doctors compare the bacteria to medicines that are already on the market to find ones that work.
• Agents that are often used:
• Colistin, also known as polymyxin E, is often used to treat strains that are immune to multiple drugs, but it can be harmful to nerves and kidneys.
• Tigecycline: It can sometimes help with diseases that are hard to treat.
• Sulbactam-containing regimens: These are useful when the strain is still vulnerable.
• If the strain is still sensitive, carbapenems like imipenem and meropenem should only be used.

Fresh and new choices

• Cefiderocol is a new siderophore cephalosporin that appears to be effective against carbapenem-resistant A. baumannii bacteria.
• β-lactam/β-lactamase inhibitor mixtures, like sulbactam-durlobactam, are being tested in humans right now.
• Antimicrobial peptides and phage treatment are two experimental methods being looked at to treat infections that are resistant to other drugs.

Having trouble with treatment

• Multidrug resistance (MDR): Common medicines cannot kill many strains.
• Toxicity of last-resort drugs: Colistin works, but it can have severe side effects.
• High death rates: Even with care, severe infections like ventilator-associated pneumonia or bloodstream infections can kill.

Helpful and Safeguarding Steps

• Device care includes removing or replacing infected catheters, ventilators, or IV lines.
• Supportive care includes treating sepsis, giving the patient air and fluids, and keeping them stable.
• Strict virus control: hospitals clean their environments, wash their hands, and put people in isolation.
• The careful use of antibiotics to slow the growth of resistance is called antibiotic stewardship.

Conclusion

Acinetobacter baumannii is a dangerous hospital-acquired pathogen that is a big problem all over the world because it can live on surfaces, spread in healthcare settings, and not be killed by many antibiotics.

Acinetobacter baumannii infections are curable, but they are difficult to treat due to their resistance to many drugs. Prevention is just as important as treatment. One way to do this is to keep hospitals clean and use antibiotics wisely.

Peripartum Cardiomyopathy Safety Considerations

What Is Peripartum Cardiomyopathy (PPCM)?

Peripartum Cardiomyopathy (PPCM) is a rare but deadly form of heart failure that develops in women without cardiac disease in the last month of pregnancy or the first five months following delivery. It can't pump blood well when the heart muscle weakens and enlarges

Key PPCM Features

Cardiomyopathy is specific to pregnancy and postpartum. Cardiomyopathy is typically diagnosed in the final month of pregnancy or five months postpartum. Systolic dysfunction (low ejection fraction, typically <45%) is caused by enlarged heart chambers and muscle weakness. PPCM affects 1 in 2,000 newborns worldwide.

Symptoms

• Normal pregnancy changes can mask symptoms, making diagnosis difficult:
• Shortness of breath (particularly when lying down)
• Reduced exercise tolerance and fatigue
• Leg, ankle, or foot swelling
• Heart palpitations or fast beat
• Cough or chest pain persists

Possible Risks

• Conditions that enhance PPCM risk:
• Pre-eclampsia, gestational hypertension
• Twin or triple pregnancies
• Mother's advanced age
• Nutritional inadequacies (some places lack selenium)
• Genotype
• Black women have a higher incidence.

Core insights

• Approximately 70% of women recover within one year of diagnosis.
• Complications include heart failure, arrhythmias, and thrombosis, as well as mechanical support or transplantation in difficult situations.
• Unresolved PPCM increases the likelihood of recurrence and worsened cardiac function in future pregnancies.

Major Postpartum Cardiomyopathy Causes

 "No single reason explains all cases, although numerous crucial systems are involved."

1. Vascular and Hormonal Stress

• Cleaved prolactin from breastfeeding can harm cardiac muscle cells and blood arteries.
• Increased free radicals during pregnancy might cause this damaging cleavage.
• Endothelial dysfunction: The blood vessel linings deteriorate, reducing blood flow and injuring the heart muscle.

2. Immune/inflammatory factors

• Autoimmune response: A woman's immune system may change during pregnancy, causing cardiac inflammation.
• Inflammation of the cardiac muscle can result from viral infections or immunological activation.

3. DNA susceptibility

• Some women with PPCM have dilated cardiomyopathy gene mutations.
• Risk of cardiomyopathy increases with family history, suggesting genetics.

4. During pregnancy, hemodynamic stress

• Pregnancy causes a ~50% increase in blood volume and cardiac output.
• This higher workload can reveal cardiac muscle weakening in sensitive women.

5. Nutrition and Environment

• In some places, PPCM is linked to selenium and iron deficits.
• Geographic variation: Higher frequency in Africa and South Asia reflects environmental or nutritional factors.

Four cardiomyopathy symptoms?

Key Cardiomyopathy Signs

These four symptoms commonly imply cardiomyopathy:

1. Dyspnea (Shortness of Breath)

• Dyspnea occurs either during rest or during exercise.
• Usually, the condition deteriorates when lying down.
• Poor cardiac pumping causes lung fluid accumulation.

2. Fatigue and Weakness

• Even after resting, exhausted.
• Low exercise tolerance.
• This is often caused by inadequate blood flow to the muscles and organs.

3. Edema (swelling)

• Edema typically occurs in the ankles, feet, legs, or abdomen.
• This condition is typically brought on by fluid retention related to heart failure.

4. Heartbeat irregularities (arrhythmias/palpitations)

• The symptoms may include fluttering, hammering, or skipping beats.
• Extreme cases may cause dizziness or fainting.

Other Possible Signs

• Chest pain or pressure may occur, especially during physical exertion.
• Abnormal rhythms cause dizziness or syncope.
• Fluid overflow can cause neck vein distension.
• The exam revealed heart murmurs.

Why These Signs Matter

• Early detection is critical because many of these symptoms match typical pregnancy/postpartum changes or other disorders.
• Cardiomyopathy worsens over time if neglected.
• Potential complications: Severe arrhythmias, cardiac failure, and thrombosis.

What tests prove cardiomyopathy?

Key Cardiomyopathy Tests

1. Echocardiogram

• Most critical test: Ultrasound cardiac imaging.
• Displays chamber size, wall thickness, EF, and valve function.
• This test confirms the presence of restricted, hypertrophic, or dilated cardiomyopathy.

2. ECG/EKG

• Heart activity is recorded.
• The ECG/EKG checks for arrhythmias, conduction abnormalities, and hypertrophy.
• An initial test is usually requested when symptoms occur.

3. Chest X-ray

• This test reveals signs of cardiac hypertrophy and lung fluid accumulation.
• It aids in differentiating between cardiomyopathy and lung disease.

4. Blood Tests

• BNP: High in heart failure.
• Thyroid, renal, liver, and iron tests are conducted to exclude any secondary causes.

5. MRI cardiac

• An MRI cardiac scan provides detailed information about the cardiac muscle and scarring.
• This scan aids in distinguishing between myocarditis and cardiomyopathy.

6. Pharmacologic or Exercise Stress Test

• Assesses cardiac response to exercise.
• This test checks for ischemia or exercise-induced arrhythmias.

7. Catheterisation (Angiography)

• This procedure is utilised when there is a suspicion of coronary artery disease.
• This procedure is used to monitor coronary blood flow and intracardiac pressure.

What organs does cardiomyopathy affect?

Any cardiac muscle condition is a cardiomyopathy. In cardiomyopathy, the heart cannot pump blood well. Sometimes the heartbeat is disrupted.

Which patient is more susceptible to cardiomyopathy?

• Some cardiomyopathy risk factors are unchangeable:
• A family history of heart failure, cardiomyopathy, or sudden cardiac arrest increases susceptibility.
• Personal heart attack history.
• The individual has a history of chronic cocaine or alcohol use.
• Pregnancy.
• The death of a loved one is stressful.

Prevention of cardiomyopathy:

• Lifestyle precautions
• Nutrition Balanced
• Enjoy fruits, veggies, healthy grains, and lean proteins.
• Saturated, trans, and added sugars and salt should be limited.
• Maintain micronutrient intake (iron, selenium, and magnesium).
• Regular exercise
• Strive for 150 minutes of moderate exercise every week (walking, cycling, swimming).
• If you have cardiac problems, avoid strenuous exercise.
• Manage Weight
• Maintain a healthy weight to prevent cardiac strain.
• Cardiomyopathy can result from obesity-related hypertension and diabetes.

Medication Warnings

• Manage Hypertension, Diabetes
• Uncontrolled diabetes and high blood pressure destroy the heart muscle.
• Regular monitoring and drug compliance are essential.
• Check Cholesterol.
• Cardiomyopathy worsens with high cholesterol and coronary artery disease.
• Regular Checkups
• If you have a family history of cardiomyopathy, an ECG may be recommended.
• Treatment and lifestyle changes are possible with early detection.

Stay away from harmful substances

• Stop smoking: Tobacco damages blood arteries and increases heart disease.
• Limit Alcohol: Alcohol weakens the heart muscle (alcoholic cardiomyopathy).
• Stop using illegal drugs: Cocaine and amphetamines damage the heart.

Risk Awareness

• Family history: Cardiomyopathy is best treated with genetic counseling and early screening.
• Peripartum cardiomyopathy (PPCM) should be examined, especially in women with hypertension or numerous pregnancies.
• Viral myocarditis and autoimmune disorders can lead to cardiomyopathy; therefore, it is important to seek medical attention if you experience unexplained fevers or chest pain.

Its treatment?

The video about the Story of Survival and Recovery

Cardiomyopathy is treated with drugs, lifestyle changes, and, in difficult situations, surgery or medical devices. We aim to improve heart function, alleviate symptoms, and prevent heart failure and arrhythmias.

1. Medications

• Beta-blockers: Lower heart rate and boost pumping.
• ACE/ARB inhibitors lower blood pressure and cardiac strain.
• Diuretics reduce edema and dyspnea by removing excess fluid.
• Anticoagulants: Used to prevent blood clots in patients with significant cardiac hypertrophy or arrhythmia.
• Control irregular heartbeats with antiarrhythmics.
• ARNIs: Newer heart failure medications that improve outcomes.

2. Lifestyle changes

• A low-salt, heart-healthy diet that includes fruits, vegetables, and lean proteins is recommended.
• Avoid overexertion and exercise moderately.
• Stop drinking and smoking: They destroy the heart muscle.
• Weight control: Reduces heart strain.
• Reduce cardiovascular stress using yoga, meditation, or counseling.

3. Medical Gear

• ICD: Corrects harmful arrhythmias to prevent abrupt cardiac death.
• A pacemaker regulates slow or irregular heartbeats.
• CRT coordinates contractions in heart failure and conduction abnormality patients.

4. Surgery Choices

• Septal myectomy: Removes thickened heart muscle for hypertrophic cardiomyopathy.
• In end-stage cardiomyopathy, a heart transplant is considered when other therapies fail.
• LVAD: A mechanical pump that sustains heart function in difficult situations.

5. Monitoring, Follow-up

• Regular echocardiograms monitor heart function.
• Blood tests (BNP, electrolytes) are performed to track the progression of heart failure.
• Holter arrhythmia monitoring.
• Family history-related genetic counseling.

Conclusion

Cardiomyopathy is a dangerous but treatable condition that impairs the heart's ability to pump blood. Genetics, pregnancy-related stress (peripartum cardiomyopathy), lifestyle, or secondary medical disorders might cause it. Cardiomyopathy is not always preventable, although prompt medical attention and follow-up significantly improve results. Understanding signs, causes, and treatments empowers patients and caregivers to improve heart health.

Vestibular Neuritis rehabilitation with a physical therapist

Vestibular Neuritis (Vestibulopathy)—Info:

Vestibular neuritis is caused by inflammation of the vestibular nerve, leading to sudden, severe vertigo, dizziness, balance problems, nausea, and vomiting. Viruses are usually to blame for this condition, which affects the brain's spatial orientation nerve.

Exactly What Is Vestibular Neuritis?

Vestibular neuritis is an inflammation of the vestibular branch of the vestibulocochlear nerve (cranial nerve VIII), which sends balance signals from the inner ear to the brain. Balance and spatial orientation signals are disrupted, creating vertigo and instability. Labyrinthitis affects both balance and hearing, whereas vestibular neuritis only affects balance.

Symptoms

• Instant, acute vertigo lasting hours to days
• Dizziness and unsteadiness
• Disrupted balance signals cause nausea and vomiting.
• Involuntarily moving eyes
• Contrary to labyrinthitis, there is no loss of hearing.

Causes

• Most triggers are viral diseases such as colds, flu, and herpes.
• Rarely, bacterial infections or autoimmune reactions may cause it.
• Inflammation of the vestibular nerve disrupts brain signalling.

Diagnosis

• Clinical evaluation: Neurological and balance testing.
• Rule out stroke, Ménière's disease, or multiple sclerosis.
• Imaging (MRI/CT): Used to rule out CNS causes.

Treatment

The video about vestibular therapy

• Manage symptoms with short-term usage of vestibular suppressants.
• Anti-nausea drugs
• Corticosteroids: Reduce nerve inflammation for some.
• Brain retraining and balance exercises are a vestibular rehabilitation treatment (VRT).
• Most patients recover within a few weeks, though mild imbalances can last months.

Important Info

• An acute episode of vestibular neuritis can be severely debilitating but not fatal.
• Rest, rehabilitation, and time typically fix it.
• Hearing is preserved, unlike labyrinthitis.
• Early medical evaluation helps rule out stroke.

Vestibular neuritis—brain damage?

Vestibular neuritis is not a brain injury. It is an inner ear condition caused by vestibular nerve inflammation that impairs brain-sent balancing signals. Though severe and disabling, vertigo and dizziness do not damage the brain.

Important Difference

• The difference lies in the inflammation of the inner ear vestibular nerve.
• Damage to brain tissue can occur due to stroke, trauma, or neurodegenerative illness.
• Difference: Vestibular neuritis affects brain signal input, not brain tissue.

Causes of Symptom Confusion

• The vestibular nerve links the brainstem and inner ear.
• During inflammation, the brain misinterprets balance information due to incorrect or decreased impulses.
• This produces vertigo, imbalance, nausea, and nystagmus, which resemble neurological issues.
• Unlike stroke or brain injury, hearing and brain tissue frequently survive.

Recovery, Outlook

• Extreme vertigo can persist for hours to days.
• Most people recover within weeks as the brain adapts (central compensation).
• Long-term: Some have a lasting imbalance but no brain damage.
• Treatment options include anti-nausea and vestibular suppressants, steroids, and vestibular rehabilitation.

Important info

• Vestibular neuritis is inner ear nerve irritation, not brain injury.
• Though strong, symptoms are usually transient.
• Vertigo can overlap with neurological problems; thus, medical evaluation is necessary to rule out stroke or other brain conditions.
• Most patients recover totally with proper care.

Recovery from vestibular neuritis

Depending on severity and individual conditions, vestibular neuritis might take 4–6 weeks to 2–3 months to fully recover. Most people recover within a few weeks. Patients may have months-long imbalances.

Typical Recovery Time

First few days: Acute phase

• The acute phase is characterised by sudden, acute vertigo, nausea, vomiting, and instability.
• This stage has the most severe symptoms.

Subacute phase (1–4 weeks): Vertigo progressively improves.

• When moving fast or in visually complex situations, patients may feel shaky.
• During the recovery phase (4–8 weeks), many patients achieve a near-normal balance.
• Central compensation helps the brain use signals from the unaffected ear.
• Extended recuperation (2-3 months) may cause minor dizziness or imbalance in certain individuals.
• Stress, fatigue, and illness can increase symptoms.

Recovery Factors

• Age: Recovery may be slower for seniors.
• Nerve irritation severity: Severe instances slow healing.
• Early treatment: Corticosteroids and VRT enhance recovery.
• Lifestyle: Exercise and balancing activities speed brain adaptation.

Managing Recovery

• Vestibular suppressants and anti-nausea medications are used for acute symptoms.
• Balance and dizziness exercises are part of vestibular rehabilitation therapy (VRT).
• Walking and other gentle activities speed up compensation.
• Avoid overrest: Bed rest slows healing.

Key points

• Most recover in 4–8 weeks, although full recovery may take 3 months.
• Some imbalances last for months.
• Faster and more complete healing requires vestibular rehabilitation.
• A medical assessment is necessary to rule out stroke and other potential causes of vertigo.

Exercises for VN

Vestibular rehabilitation treatment (VRT) involves vestibular neuritis exercises that retrain your brain to respond to balance signals and reduce dizziness. Gaze stabilisation, balance training, and habituation exercises are most effective when performed daily for 20–30 minutes.

Main Exercise Types

1. VOR Training: Gaze Stabilisation

• Improve head-moving eye control.
• Sit or stand and gaze on a stationary object (such as a wall letter).
• Raise or lower your head while keeping your eyes fixed.
• Start slowly, then accelerate as tolerated.
• Benefit: Reduces head-movement blurring and dizziness.

2. Balance Exercises

• Increase stability and postural control.
• Stand with feet together, then one foot.
• Walk straight, heel-to-toe.
• Experiment with head-turning while walking.
• Keep yourself safe by performing near a wall or with assistance.

3. Practice Habituation

• Repeating symptom-causing movements reduces dizziness.
• Sit, rapidly lie down, and sit up (perform multiple times).
• Sit or stand with your head turned.
• Bend forward to grab something, then stand.
• Expect little dizziness to help the brain adapt.

4. Functions

• Daily walks: Even small ones improve balance.
• Walk with your head turned left/right.
• Walking while counting or carrying an object tests coordination.

The frequency and duration

• The frequency and duration should be two to three 20–30-minute sessions per day.
• Progress: Start with simple movements, then add speed and complexity.
• Recovery requires consistency: daily practice.

Safety Tips

• Mild dizziness is normal during adaptation.
• Don't overdo it: Exercise should challenge but not fatigue.
• Environment: Start in a safe place with someone nearby.
• For stability during standing activities, wear flat shoes or go barefoot.

Whom should I see for vestibular neuritis?

Vestibular neuritis specialists differ based on the stage of symptoms and the need for diagnosis or rehabilitation.

Consult Specialists

ENT Specialist (Otolaryngologist): Initial contact.

• Examines inner ear problems, ruling out labyrinthitis, Ménière's, and infections.
• The ENT specialist prescribes anti-nausea, vestibular suppressants, and corticosteroids.

Neurologist

• Consult a neurologist for severe or abnormal symptoms or to rule out stroke/neurological reasons.
• After conducting thorough neurological evaluations, the neurologist may order MRI/CT scans.

Audiologist: 

• The audiologist evaluates the function of hearing and balance.
• Labyrinthitis (hearing loss) may overlap, making this important.

Balance-specialised physical therapist:

• A balance-specialised physical therapist assists patients with vestibular rehabilitation.
• The treatment plan encompasses techniques such as gaze stabilization, balancing, and habituation exercises.
• This is crucial for promoting long-term healing and reducing symptoms of dizziness.

When to Get Help Now

• For sudden vertigo, weakness, slurred speech, double vision, or severe headache, seek emergency examination to rule out stroke.
• For persistent vomiting or inability to walk safely, seek medical attention immediately.

Conclusion

An inner ear illness called vestibular neuritis causes sudden vertigo, dizziness, and balance issues due to vestibular nerve irritation. Disrupted inner ear balancing signals are the issue, not brain damage. Some people may have an imbalance for months after 4–8 weeks of recovery. Gaze stabilisation, balance training, and habituation techniques can speed up recovery and help the brain adapt. Medical evaluation is needed to rule out stroke; most patients recover with careful care.

How to get rid of dermatillomania?

Dermatillomania—Overview

Dermatillomania, also known as excoriation disorder or skinpicking disorder, is characterized by compulsive picking at one's skin, which causes tissue damage, infections, and scarring. It belongs to the OCD spectrum. Psychotic Dermatillomania (Excoriation Disorder) causes bodily injury. DSM-5 classifies it as Obsessive–Compulsive and Related Disorders.

Symptoms

• Excessive picking of the skin, scabs, acne, or perceived flaws.
• Sores, bleeding, scars, infections.
• Distress: guilt, humiliation, anxiety, or low quality of life.

Causes

• Multifactorial causes: Genetic predisposition.
• Mental issues such as OCD, stress, and anxiety also play a significant role.
• Environmental factors such as boredom, stress, and sensory cravings also play a significant role.

Impact

• Physical health risks: infections, delayed wound healing, permanent scars.
• This can lead to heightened feelings of anxiety, despair, and social isolation.

Options for Management and Treatment

• CBT: Especially Habit Reversal Training (HRT), which helps people identify triggers and replace picking with better habits.
• In difficult situations, SSRIs and other psychiatric drugs may be administered.
• Lifestyle tips: Trim nails.
• Consider using stress balls or fidgets.
• Bandaging afflicted areas.
• Relaxation and mindfulness.

Risks and Factors

• Delayed diagnosis: Embarrassment causes many to hide symptoms, exacerbating damage.
• It frequently co-occurs with OCD, anxiety, and depression.
• Need for expert help: Self-management typically requires psychiatric or psychological support.

What therapist treats dermatillomania?

Skin-picking disorder, dermatillomania, is best treated by clinical psychologists or psychiatrists who specialize in OCD and similar disorders. CBT, particularly HRT, is the best method. Dermatologists may treat skin damage, although psychologists and psychiatrists are usually the main therapists.

Therapist Types: Those who treat dermatomania

1. Clinical psychologists

• CBT and HRT psychotherapy are recommended.
• Help patients recognise triggers, learn coping skills, and adopt better picking habits.
• Relapse prevention and long-term behaviour change.

2. Psychiatrists

• Medical mental health specialists.
• Recognise excoriation disorder, administer SSRIs and N-acetylcysteine, and coordinate care.
• They are recommended for treating severe depression, anxiety, and OCD.

3. Dermatologists

• Treat skin-picking injuries, infections, and scars.
• Give wound care, topical therapies, and cosmetic recommendations.
• Best for: Skin care and psychotherapy.

4. Specialised BFRB Therapists

• BFRB therapists treat trichotillomania and dermatillomania.
• Focus: Customized CBT, mindfulness, and acceptance therapies.
• Ideal for: Specialised patients.

Important Considerations

• Psychologists, psychiatrists, and dermatologists work best together for therapy, medicine, and skin health.
• Early intervention reduces scarring and psychological anguish.
• Online therapy: BetterHelp and PsychologyHelp match patients with dermatillomania-trained therapists.

How prevalent is dermatillomania?

Dermatillomania (excoriation condition) affects 1.4%–5.4% of the population, more than many realize. Shame and embarrassment lead individuals to conceal their symptoms, resulting in underdiagnosis of the condition.

Epidemiology and prevalence

• 1.4%–5.4% of individuals develop dermatillomania, according to studies.
• Gender differences: Women are more affected, although men are too.
• It usually starts in youth or early adulthood, around the time acne or skin changes are widespread.
• Underreporting: Many cases are overlooked because people perceive it as a “bad habit” rather than a mental illness.

Why It's Missed

• Patients may avoid care owing to stigma and guilt regarding visible scars or wounds.
• Overlap with other disorders: OCD, anxiety, sadness, and body dysmorphic disorder sometimes disguise its presence.
• Mental illness is sometimes misdiagnosed as dermatological.

Co-occurrence with other conditions

• OCD is compulsive.
• Body-centered repetitive behaviors (BFRBs) include trichotillomania.
• Depression and anxiety: High comorbidity increases disease burden.

Can dermatillomania be cured?

Dermatillomania (excoriation disorder) is a chronic mental illness whose "cure" is rarely mentioned. Instead, professionals discuss management, treatment, and rehabilitation. With the correct therapy, medicine, and lifestyle changes, many patients improve and even go into remission.

Treatment Prospects

Why “cure” is challenging

• Dermatillomania, like OCD and trichotillomania, is a body-focused repetitive activity.
• Symptoms fluctuate with stress, surroundings, and mood.
• Relapses are possible; therapy can greatly reduce severity and frequency.

Treatments Based on Evidence

1. Psychotherapy

• CBT helps discover triggers and change mental habits.
• Habit Reversal Training (HRT): Addresses impulses and promotes healthy habits.
• ACT decreases compulsive plucking and builds discomfort tolerance.

2. Drug

• Some SSRIs lessen compulsive cravings.
• Some research has demonstrated that N-acetylcysteine (NAC) reduces BFRB symptoms.
• Medication is generally used with therapy.

3. Dermacare

• Wounds, scars, and infections become less embarrassing and painful when treated.
• Bandages and barrier creams minimize picking.

4. Manage Yourself

• Keep nails short.
• Use stress balls or fidget toys.
• Practice mindfulness and reduce stress.
• Cover sensitive areas with clothing or bandages.

Test for skin picking

To better understand your symptoms, take a free online self-assessment exam for dermatillomania (skin-picking disorder). These tests are screening tools and do not replace a professional diagnosis.

Recommended Online Skin-Picking Disorder Tests

1. SkinPick.com Dermatillomania Test

• The test utilizes a validated scale-based questionnaire, such as the Skin Picking Scale-Revised and Milwaukee Inventory.
• The test identifies the symptoms and severity of excoriation disorder.
• Review your 7-day behavior.
• Available from SkinPick.com

2. Online Dermatillomania Quiz

• Complete clinical self-assessment.
• Skin-picking frequency, intensity, and effects are assessed.
• This information should only serve as a guide.
• It is not a substitute for seeking medical advice.
• Online Dermatillomania Test Toolkit

3. Dermatillomania OCD Screening MantraCare

• The survey is simple and provides immediate results.
• Screens for compulsive skin-picking and its effects on daily life.
• Connects therapists if needed.
• MantraCare OCD Dermatillomania Test

These tests measure

• The MantraCare OCD Dermatillomania Test measures the frequency of picking (never, rarely, sometimes, often, or always).
• The tests distinguish between minor scratches and the level of harm caused by wounds or scars.
• Ineffective attempts to stop.
• The condition can cause distress, embarrassment, and disruption to daily life.

Vital Considerations

• Autotests aren't diagnostic. It is important to determine whether your symptoms are indicative of dermatillomania.
• Professional assessment is crucial. A psychologist or psychiatrist can diagnose and treat.
• Early intervention is important. Assistance can prevent scarring, infections, and emotional distress.

Dermatillomania therapy

The video is about tips to avoid skin picking.

Skin-picking condition can be treated with psychotherapy, medicine, and dermatology. The most successful treatment is Cognitive Behavioral Therapy (CBT) with Habit Reversal Training (HRT), often combined with SSRIs or N-acetylcysteine, wound care, and lifestyle changes.

Main Treatment Methods

1. First-line psychotherapy

• CBT helps patients discover triggers and change cognitive patterns.
• Habit Reversal Training (HRT): Addresses impulses and promotes healthy habits.
• ACT decreases compulsive plucking and builds discomfort tolerance.
• Body-focused repetitive behaviours such as trichotillomania and dermatillomania necessitate specialized BFRB treatment.

2. Adjunctive medication

• Reduce anxiety and obsessive cravings with SSRIs.
• N-acetylcysteine (NAC), an amino acid supplement, reduces compulsive picking in studies.
• Sometimes antipsychotics or glutamatergic medications are used in resistant patients.
• 3. Dermacare
• Initial treatment: wound care, antiseptics, and infection surveillance.
• Permanent skin repair: Hydroquinone for pigmentation, silicone for scars.
• Prevention: Bandages, barrier creams, and safety gear.

Risks and Factors

• Stress might trigger relapse; therapy helps maintain remission.
• Side effects of SSRIs include nausea, sleep disturbances, and sexual dysfunction.
• Patients delay therapy owing to embarrassment; education and support groups lessen isolation.
• Mental illness is often misdiagnosed as dermatological.

Also, read https://www.medicoverhospitals.in/diseases/skin-picking-disorder/.

A Key Note

• Although treatable, dermatillomania is rarely “curable.”
• A psychologist for treatment, a psychiatrist for medicine, and a dermatologist for skin care get the best results.
• Early intervention reduces scarring and psychological anguish.

Conclusion

Dermatillomania, or excoriation disorder, is a mental illness that causes excessive skin-picking and physical and emotional suffering. Though commonly mistaken for a "bad habit," it is part of the body-focused repetitive behaviours (BFRBs) continuum, strongly connected to OCD and trichotillomania. Dermatillomania is serious, curable, and common. Early detection, destigmatization, and multidisciplinary care are crucial for rehabilitation. Patients should know they have support and effective treatment.

Actinic keratosis is most effectively treated

Actinic keratosis—Overview

Actinic keratosis (AK), also called solar keratosis, is a precancerous skin condition caused by prolonged sun exposure. Untreated, rough, scaly patches on sun-exposed areas such as the face, head, ears, lips, forearms, and hands can develop into squamous cell carcinoma. The patches may appear pink, crimson, brown, or flesh-colored. Due to sun exposure, it usually develops in individuals over 40. AK is not contagious.

Actinic keratosis face, head

Possible Risks

• Possible risks include outdoor work, tanning beds, and chronic sun exposure.
• Light hair, eyes, and skin minimise melanin protection.
• Over 40.
• HIV and organ transplant recipients are immunosuppressed.

Location: 

• This condition is more common in sunny climates, such as in South Indian states like Tamil Nadu, where UV exposure is intense.

Possible Issues

• If left untreated, 5–10% of AKs develop Squamous Cell Carcinoma (SCC)
• Cosmetic issues: Face/scalp patches might impact appearance.
• Field cancerization: Multiple AKs imply broad solar exposure.

Diagnosis

• Clinical exam: Dermatologists examine patients visually and tactilely.
• If the lesion suggests invasive cancer, biopsy.

Ways to prevent

• For sun protection, use broad-spectrum sunscreen (SPF ≥30), protective clothes, and helmets.
• Stay away from tanning beds.
• Patients with AK who are at high risk or have multiple cases should have regular skin checks.
• Early treatment can prevent skin cancer.

What causes actinic keratosis?

Main Actinic Keratosis Causes

Long-term UV exposure

• Sunlight: The main reason. UV radiation damages keratinocyte DNA through the skin.
• Tanning beds and lights emit UV.

Long-term damage

• The cumulative effects of daily outdoor activities mount up over decades.
• Years of exposure cause lesions, not one sunburn.

Increased Susceptibility Risks

• Fair skin, light hair, and light eyes have less melanin.
• Over-40s are the most common.
• They typically reside in bright or high-UV areas such as South India and Australia.
• Job: Outdoor workers (farmers, builders, fishers).
• Chronic immunosuppression: Organ transplant recipients or immunosuppressive medication users.
• UV exposure causes DNA mutations in skin cells.
• Damaged epidermal cells provide rough, scaly areas.
• Untreated lesions can become squamous cell cancer.

Can actinic keratosis become cancerous?

• AK is a precancerous lesion that, in some cases, can progress to cancer.

Cancer Progression Risk

• AKs can lead to Squamous Cell Carcinoma (SCC), a prevalent skin disease.
• Studies predict that 5–10% of untreated AKs may develop SCC.
• Multiple AKs (field cancerization), lip lesions (actinic cheilitis), or immunosuppression (transplant patients) increase risk.

BCC/Melanoma:

• Although AKs don't cause these malignancies, their existence indicates significant UV damage, which raises skin cancer risk.

Malignant Transformation Warning Signs

• A thicker, sensitive, or painful lesion is a warning sign of malignant transformation.
• Rapid expansion or ulceration.
• Unhealing bleeding or crusting.
• The condition is compared to the firmness of the adjacent skin.

Monitoring & Prevention

• Early AK therapy greatly decreases cancer risk.
• If you have several lesions, see a dermatologist regularly.
• Protection from the sun (SPF ≥30, hats, clothing) is the best strategy to avoid new AKs and lower progression risk.

Also, read https://dermnetnz.org/topics/actinic-keratosis.

Who is most at risk for actinic keratosis?

High-risk Actinic Keratosis groups

1. Genetics, Skin Type

• Fair complexion, light hair, and light eyes result in reduced UV protection due to melanin.
• Skin cancer risk increases with family history and genetic predisposition.

2. Age

• Risk increases with accumulated sun exposure for individuals over 40.
• AKs are rare in youngsters but widespread in middle-aged and elderly individuals.

3. Solar exposure

• Outdoor workers such as farmers, builders, fishers, and athletes are susceptible to solar exposure.
• Solar exposure also affects people who live in bright climates or near the equator, such as in South India or Australia.
• People may have a history of sunburn or exposure to tanning beds.

4. Immune State

• Individuals who are on immunosuppressants following an organ transplant are a prime example.
• HIV-positive or immunocompromised people.
• Reduced immune surveillance lets aberrant cells proliferate unrestrained.

5. Other Risks

• Men are more harmed owing to outdoor work and less sunscreen application.
• Bald or thinning hair: Increases UV exposure.
• Unprotected sunbathing, gardening, sports, and leisure activities increase UV exposure.

Common Actinic Keratosis Symptoms • Texture:

The affected areas may be rough, dry, or scaly, exhibiting a harsh texture. • These regions may exhibit a crusty texture or feature a prominent bulge resembling horns. • Color: red, pink, tan, brown, silvery, or skin-colored. • The color can manifest as discoloured patches or blend in with the surrounding skin. • Size: • The size can vary from a small spot to a diameter of 1 inch (2.5 cm). • Shape and Surface: • Flat or slightly elevated. • Over time, the surface may harden and develop a wart-like appearance. • Location: • Chronic sun exposure areas: face, scalp, ears, lips, neck, shoulders, forearms, and backs of hands. • Progress: • Lesions develop gradually over months to years. • Progressing squamous cell carcinoma may cause thickening, tenderness, or bleeding.

Warning Signs of Medical Concern · 

• The tumour may grow quickly or undergo a rapid size shift. • Pain, soreness, or itching. • Ongoing bleeding or ulceration. • The skin appears firmer in comparison to the surrounding skin.

Is the actinic keratosis resolved?

Untreated actinic keratosis (AK) often persists, recurs, or worsens.

• Natural Actinic Keratosis Course
• Persistence: AK lesions typically stay on the skin without treatment.
• Spontaneous Regression: AKs may temporarily fade or disappear when sun exposure is minimised.
• The sun damage keeps them from disappearing, so they regularly return.
• Untreated AKs can progress to squamous cell carcinoma (SCC) at a rate of 5-10%.
• No one can anticipate which lesions will become malignant.

Reasons to Treat

• Dermatologists proactively treat precancerous AKs.
• Removing them minimises SCC risk and enhances attractiveness.
• Cold therapy, topical creams (5-FU, imiquimod, and diclofenac), photodynamic therapy, and laser therapy are used.

Long-term care and prevention

• Provide consistent sun protection (SPF ≥30, caps, clothes).
• Check skin for new lesions regularly.
• Lifestyle changes: Stop using tanning beds and limit noon sun.

How to treat toddler keratosis?

• Bathe warmly, not hotly. Use a gentle, soap-free body and face wash. Apply a light moisturizer multiple times a day.

Treating actinic keratosis

The Main Treatments

1. Freezing therapy

• Liquid nitrogen is used to freeze and destroy abnormal cells.
• Ideal for: Few lesions.
• Quick, effective, and low-downtime.
• Cons: Possible redness, blistering, or hypopigmentation.
• Recurrence: 24% within 12 months if sun exposure continues.

2. Topically applied drugs

• 5-Fluorouracil (5-FU) cream destroys aberrant cells.
• Imiquimod: Boosts the immune system attack on damaged cells.
• Diclofenac gel: Milder, slower anti-inflammatory.
• Ingenol mebutate: Fast but rarely used.
• Best for: Multiple lesions or “field cancerization” (widespread UV damage).
• Cons: Treatment may cause redness, inflammation, and peeling.

3. Photodynamic Therapy

• A light-activated medication is applied to skin and exposed to specific light.
• This treatment is specifically designed for larger areas that have multiple AKs.
• Pros: Cosmetically effective, cures visible and unseen lesions.
• Cons: Clinic visits, transient pain/redness.

4. Surgery Choices

• Curettage and electrocautery: Lesion removal.
• Abnormal cells vaporise under laser therapy.
• This treatment is particularly effective for thick, resistant lesions.

5. Self-Care, Prevention

• Use sunscreen (SPF ≥30) daily on exposed skin.
• Protective gear, caps, and sunglasses.
• Avoid tanning beds and the noon sun.
• Regular dermatology exams should be conducted at least annually following therapy.

Brief Summary

Precancerous actinic keratosis demands active treatment. The most common first-line treatment is cryotherapy, whereas topical creams and photodynamic therapy treat extensive lesions. Sun protection is crucial to preventing recurrence.

Conclusion

Long-term sun exposure causes actinic keratosis (AK), a common precancerous skin disease. Sun-exposed areas develop rough, scaly patches that indicate skin injury. AKs can develop squamous cell carcinoma, so early identification and treatment are crucial.

Prevent, treat, and control actinic keratosis. Consistent sun protection and early medical care work best. AKs are a symptom of cumulative sun exposure, so patients may protect their skin and lower cancer risk.

Kaposi sarcoma cancer treatment guidelines

Kaposi's Sarcoma—Overview:

Kaposi's Sarcoma (KS), a rare malignancy caused by Human Herpesvirus 8 (HHV-8), usually appears as purple, red, or brown skin lesions but can also infect the lungs and gastrointestinal tract. Kaposi's Sarcoma is a type of cancer that affects the lining of blood and lymph vessels. It is strongly connected to reduced immunity, notably in HIV/AIDS and immunosuppressive therapy patients. HIV/AIDS (KS). Patients are often prescribed immunosuppressants following an organ transplant. Elderly males from the Mediterranean/Eastern Europe typically have HIV/AIDS (KS), while sub-Saharan Africans have endemic KS.

Kaposi sarcoma

Symptoms

• Skin lesions: Painless purple, red, or brown spots, plaques, or nodules.
• Mucosal lesions may appear on the mouth, nose, or anus.
• Internal Involvement: Lung or digestive system lesions can cause respiratory problems, bloody coughs, and GI bleeding.

What causes Kaposi sarcoma?

Kaposi sarcoma (KS) is caused by infection with the Human Herpesvirus 8 (HHV-8, also known as KSHV), but not everyone infected with HHV-8 develops KS. The virus needs cofactors like immune suppression to transform cells into cancerous ones, affecting the skin, lymph nodes, and internal organs.

What are the four Kaposi sarcoma types?

• Four forms of Kaposi's Sarcoma (KS) are associated with various populations and risk factors:
• Traditional KS: Slow, skin-focused older males.
• Aggressive African KS can affect children.
• Epidemic KS: HIV/AIDS-related, widespread, and expanding.
• Often reversible, immunosuppressive therapy causes KS.

How does Kaposi sarcoma spread?

Kaposi's Sarcoma (KS) spreads differently depending on the type and the patient's immunological condition. A breakdown:

Key spread factors

• Low immunity (HIV/AIDS, immunosuppressive therapy) promotes spread.
• Effective HIV antiretroviral therapy (ART) can stop or reverse KS development.
• Internal organ involvement indicates a more aggressive illness; skin-only KS is slower.
• Compared to younger, immunocompromised patients, older classic KS patients progress more slowly.

Classic KS: Slow, indolent.

• AIDS-related KS: Rapid, life-threatening.
• Adjustments to immunosuppressive therapy cause KS.
• Kaposi's Sarcoma can range from indolent (developing over years) to aggressive (expanding within months), with HIV-related KS spreading fastest.

Also, read https://emedicine.medscape.com/article/279734-treatment?form=fpf.

Can Kaposi sarcoma be prevented?

Kaposi's Sarcoma (KS) is connected to Human Herpesvirus 8 (HHV-8); however, the best prevention methods focus on immune system health, specifically HIV control and immunosuppressive medication use.

Important Prevention Methods

1) HIV/AIDS Management

• The most effective strategy to avoid epidemic (AIDS-related) KS is consistent ART use. ART improves immunity and greatly reduces KS risk.
• HIV testing and early treatment: Early HIV detection and ART reduce KS risk.

2. Immunosuppression reduction

• If KS develops, transplant doctors may alter or reduce immunosuppressive medicines.
• Use immunosuppressive drugs under physician supervision to avoid unnecessary long-term use.

3. General Immune Health

• Healthy lifestyle: Balanced food, exercise, sleep, and stress management boost immunity.
• Avoiding co-infections like tuberculosis and hepatitis reduces immune strain.

4. Know HHV-8

• Transmission: Saliva, sexual contact, and potentially blood spread HHV-8.
• Safe practices: Protecting sexual activity and not sharing toothbrushes or razors can reduce risk.
• Geographic risk: HHV-8 is more prevalent in sub-Saharan Africa and the Mediterranean; awareness is crucial.

Controllable Risks

• Untreated HIV infection represents the highest risk for KS.
• Long-term immunosuppression increases risk.
• Weakened immunity from poor health or co-infections promotes KS development.

Who has the highest sarcoma risk?

Certain genetic disorders, past radiation therapy, chemical exposure, chronic lymphedema, and weakened immune systems increase sarcoma risk. Sarcoma risk is not highly connected to diet or smoking.

Major Sarcoma Risk Groups

1. Genes and heredity

• TP53 mutations cause Li-Fraumeni syndrome.
• Familial retinoblastoma (RB1 mutations)
• Type 1 neurofibromatosis
• Werner syndrome (early ageing)
• These disorders enhance bone and soft tissue sarcoma risk.

2. Radiation/chemotherapy history

• Radiation for other malignancies can increase sarcoma risk years later.
• Secondary sarcomas are linked to alkylating chemotherapy medications.

3. Chemical Encounters

• Vinyl chloride, dioxins, arsenic, and pesticides increase sarcoma risk.
• In chemical industries, occupational exposure is a risk.

4. Chronic Lymphedema

• Chronic limb swelling following breast cancer surgery or radiation can lead to lymphangiosarcoma, a rare sarcoma subtype.

5. Immunosuppression

• Individuals who are taking immunosuppressants following an organ transplant are also at risk.
• HIV/AIDS patients, particularly those suffering from Kaposi's Sarcoma, also face this risk.

Disconnected Groups

• Lifestyle factors such as smoking, eating, and exercising do not increase the risk of developing sarcoma.
• Sarcoma is not caused by trauma, but tumors may appear after an injury.

Practical Tip

• People with genetic cancer syndromes, radiation/chemo, chemical exposure, chronic lymphedema, or immunological suppression are most at risk.
• General population: Sarcoma is infrequent and usually risk-free.

How is sarcoma diagnosed?

Stepwise clinical evaluation, imaging, and biopsy are needed to diagnose sarcoma. Sarcomas are rare and can look like benign masses; thorough diagnosis is necessary.

Common Diagnostic Steps

1 Clinical Exam

• Patients describe lumps, swelling, discomfort, or inexplicable symptoms.
• Physical exam: Doctors evaluate mass size, position, depth, and growth rate.
• Rapidly developing, deep-seated, or painful masses are suspicious.

2. Imaging Studies

• MRI is the preferred method for diagnosing soft tissue sarcomas, as it provides information on the size, depth, and proximity to adjacent tissues.
• CT scan: Used for lung metastases and bone sarcomas.
• Ewing's and osteosarcomas benefit from X-rays.
• PET Scan: Used to assess spread or therapy response.

3. Biopsy (final diagnosis)

• Core needle biopsy: Preferred; minimally invasive but delivers pathologic tissue.
• If needle biopsy fails, incisional biopsy is used.
• Excisional biopsy: For tiny, readily removed lesions.
• Pathology: Cell morphology and markers confirm sarcoma.

4. Laboratory/Molecular Tests

• Immunohistochemistry classifies sarcoma subtypes using particular proteins.
• Genetic testing: Finds Ewing's sarcoma's EWS-FLI1 chromosomal translocation.
• Although not diagnostic, blood testing can assist measure health before therapy.

5. Staging

• Upon diagnosis, clinicians stage sarcoma using:
• Tumor depth and size
• Spread to lymph nodes or distant organs (lungs)
• Depends on how aggressive the cells are histologically

Treatment Choices

The video about causes and treatment for Kaposi sarcoma

• Antiretroviral Therapy (ART): First-line HIV-related KS treatment; immune function recovery decreases lesions.
• Local treatments: Surgery, cryotherapy, or radiation for lesions.
• Systemic therapy: Liposomal doxorubicin, interferon-alpha, or immunotherapy for disease dissemination.
• Manage bleeding and respiratory issues with supportive care.

The prognosis varies depending on the immunological status and the severity of the disease.

• ART helps HIV-related KS; relapse is probable.
• Classic KS: Slow-growing and controllable.
• Endemic KS: Aggressive, especially in kids.

Conclusion

Sarcomas are rare, diverse malignancies that affect connective tissues such as bone, muscle, fat, and blood vessels. Kaposi's Sarcoma (KS) is distinct since it is caused by HHV-8 and is connected to immunological suppression.

Kaposi's Sarcoma demonstrates the importance of the immune system in cancer development. Stimulating immunity by HIV therapy, medical management, or a healthy lifestyle is key to prevention and control. Early detection and customized therapy improve outcomes.