Wednesday, 2 April 2014

ITP disease treatment diagnose and symptoms in childerns

Idiopathic thrombocytopenic purpura (ITP) is an autoimmune disease affecting platelets. Many people have no symptoms. If symptoms occur they can range from mild bruising to severe bleeding. In children the condition usually goes away in 6-8 weeks, without any treatment. In adults it is usually a lifelong condition. Treatment may or may not be necessary and may include steroids, immunoglobulin and surgery.
Platelets are tiny components of the blood which help blood to clot when we injure ourselves. They are also known as thrombocytes. They are made inside bone, in the bone marrow. They are released into the bloodstream and travel through the body for about seven days, before they are removed by the spleen. The spleen is an organ that lies at the top of the abdomen under the ribs on the left-hand side.

A normal number of platelets is between 150 and 400 x 109 per litre. This is found by a blood test. If you have too many platelets, your blood will clot too easily. If you do not have enough platelets, you may bruise and bleed more easily than usual.
Idiopathic thrombocytopenic purpura (ITP) is an autoimmune disease involving platelets. In autoimmune disorders your body makes an antibody that damages another part of your body. In ITP the antibodies are made against platelets. Once the antibodies have attached to platelets, the platelets do not work so well. They are also removed more quickly by the spleen because they are abnormal.
  • Idiopathic means that there is no known underlying cause found.
  • Thrombocytopenic means not enough platelets.
  • Purpura is a purple-red rash.

ITP occurs in about 5 in 100,000 children. Girls are three times more likely to have it than boys.
  • Most children will not have any symptoms.
  • Those who do develop symptoms have bruising and the rash - purpura. Some have bleeding such as nosebleeds. It usually appears over 1-2 days. The condition often occurs about 2-3 weeks after an infection (often a common viral infection). Occasionally, it follows immunisation. The symptoms disappear over 6-8 weeks in most cases.
  • Very occasionally, it causes severe bleeding which requires emergency treatment.
  • The platelet levels in about 1 in 10 affected children do not ever return to normal, which means that they have developed chronic (persistent) ITP.
So, what seems to happen in children with ITP is that the immune system is triggered to produce antibodies against the platelets by an infecting virus or other germ. In most cases, this is a temporary immune reaction that lasts several weeks only, and then symptoms go. But, in a few cases, the immune system continues to be faulty and the condition becomes long-standing.
ITP is diagnosed by a blood test called a full blood count. This test shows that there are fewer platelets than normal. The laboratory will also have a look at the blood under a microscope.

Sometimes different tests will be needed to make sure that the low number of platelets is not due to another of the potential causes. Rarely, this involves taking a sample of bone marrow.
Most children will not need treatment, even if the number of platelets is very low. The decision to treat is usually based on whether your child has serious bleeding or very pronounced bruising and purpura. If the symptoms are mild, usually there will be no need for treatment. Your child will need to have the full blood count repeated on a few occasions to check that the platelet numbers are stable and that the rest of the blood cell counts are remaining normal. If your child has bleeding and more severe bruising or purpura, treatment may be considered. The aim of treatment is to improve symptoms and increase the number of platelets.

If treatment is needed then the decision on what treatment to use can be difficult. This is because there have not been many studies testing the treatments against each other. The options for treatment include:
  • Prednisolone. This is often the first type of treatment tried. It is a steroid medication and is taken as syrup or tablets. This may be given as a high dose over a short period of time (four days) or as a lower dose for a longer time (two weeks). Prednisolone has been shown to increase the number of platelets quickly in about 3 in 4 children with ITP.
  • Other steroid options. High-dose methylprednisolone or high-dose dexamethasone. These are other types of steroid medicines that have also been shown to be effective in differing degrees. Dexamethasone is not often used in children.
  • Intravenous immunoglobulin (IVIg). This is an injection of a protein into the bloodstream and has been shown to work well in about 8 in 10 children in increasing the number of platelets. It is not usually used as the first option because it involves an injection. It can also cause quite a lot of side-effects and is quite expensive. It may be used as an emergency treatment if your child has severe bleeding or needs surgery.
  • Anti-D immunoglobulin. This is another type of protein that is also effective and causes fewer side-effects than IVIg. It can only be given to children whose blood group is RhD positive.
  • Platelet transfusions. In a life threatening situation your child may be given a transfusion of platelets at the same time as being treated with steroids and IVIg. This only helps to increase the number of platelets for a short time. The transfused platelets are also attacked by the antibody that the body has produced and are destroyed by the spleen.
  • Other medicines. A number of other medicines are being trialled. These are not routinely recommended, as not enough information is known yet about their use and side-effects.
  • Surgery to remove the spleen (splenectomy). This is very rarely done in children with ITP. It is only really considered as an option if your child has life- threatening bleeding or severe chronic disease that is affecting their day-to-day functioning.
In chronic ITP, usually no treatment is needed but your child will need to have regular blood tests and specialist review. If they have an injury or are involved in an accident you will be advised to take them to your local hospital emergency department for review. If the disease is severe, then the treatments outlined above may be considered.

Sunday, 19 May 2013

about chakwal

Chakwal (Urdu: چکوال‎), (Punjabi: چکوال) is the capital of Chakwal District, Punjab, Pakistan. It is located 90 km south-east of the federal capital, Islamabad[1] and is named after Chaudhry Chaku Khan,[2] chief of the Mair Minhas tribe from Jammu, who founded it in 1525 CE during the era of the Mughal Emperor, Zaheerudun Babur. It remained a small but central town of the Dhan Chaurasi Taluka for many centuries. In 1881, during the British era, it was declared the Tehsil Headquarters. It was finally upgraded to district status in 1985. The area of Chakwal city is about 10 square kilometres.
Chakwal is located in the Dhanni region of the Potohar in northern Punjab, Pakistan. The Potohar Plateau (Urdu: سطح مُرتفع پوٹھوہار), (also spelled Pothohar or Potwar) was the home of the ancient Soan valley civilization, which is evidenced by the discovery of fossils, tools, coins, and remains of ancient archaeological sites. The Indus Valley civilization flourished in this region between the 23rd and 18th centuries BC. Some of the earliest Stone Age artefacts in the world have been found on the plateau, dating from 500,000 to 100,000 years ago. The crude stone recovered from the terraces of the Soan testify to human endeavour in this part of the world from the inter-glacial period.[3]
The Stone Age people produced their equipment in a sufficiently homogeneous way to justify grouping the inhabitants of this area into one. Around 3000 BC, small village communities developed in the Pothohar area.[4]
For much of its early history, Dhanni was an uninhabited part of the Jammu state of the Dogra Rajputs, and Khokhar Rajputs, held as a hunting ground for the Rajas of Jammu.[5]
Chaudhary Sidhar settled villages named after his sons Chaku, Murid and Karhan and as Chaku Khan became the chief, he decided to settle in Chakwal, the village named after him and make it the center of administration of the Taluka. Kassar chiefs founded the villages of Bal-Kassar and Dhudial.[6]
Awans,Waince, Mair Minhas, Khokhar Rajputs,Bhatti Rajputs, Mughal Kassar and Kahut Quriesh were probably the Seven landowning tribes that were originally settled in this tehsil by the Mughal Emperor Zaheerudin Babur. The main concentration of the Mair-Minhas and Rajputs was in the center (Haveli-Chakwal), North-East (Badshahan), West (Rupwal) and South West (Thirchak-Mahal). The Kassar in the northern part of the tehsil, the area called 'Babial' and 'Chaupeda' and the Kahuts in 'Kahutani' in the South East.[citation needed]
These tribes, particularly the Mair-Minhas Chaudharials of Chakwal, rose to further prominence during the short rule of Sher Shah Suri who handed them control over the adjoining territories, as far as Swan River in Potohar and the Pind Dadan Khan plains in the South.[citation needed]
After the Mughal ruler, King Humayun, returned to India with the help of the Persians, he handed over Potohar, including Dhanni, to the Gakhars, who had helped him escape from India during Sher Shah's revolt and reign. The Gakhars moved the capital of the taluka from Chakwal to a neighbouring town, Bhon, and stationed their Kardars there.[citation needed]
The Mair-Minhas and Mughal Kassar tribes again rose to power after King Aurangzeb's death. They had supported his son Moazzam Shah in his quest for power and, in return, he re-appointed the Mair-Minhas chief Gadabeg Khan as the Taluqdar and Chaudhary of the entire 'Dhan Chaurasi', whereas the rule of the Kassar Chaudharys was confirmed in Babial and Chaupeda 'illaqa'.[citation needed]
Their rule over Dhanni continued during the Sikh era; Chaudhry Ghulam Mehdi had invited Sardar Mahan Singh to this side of Jhelum River. It was during that era that the Dhanni breed of horses became popular; even Maharaja Ranjeet Singh's personal horses were kept in the stables of the 'Chakwal Chaudhrials'. In 1801 Ranjit Singh visited the Dhanni, which had been in a very disturbed state, subduded it without resistance,and returned to Lahore with 400 fine horses.[7] Maharaja Ranjeet Singh was very kind to Chaudharials of Chakwal due to their obedient services.[citation needed]During the Independence War of 1857 Chaudharials of Chakwal strengthened the hand of the British Raj by escorting the treasury from Chakwal to Rawalpindi and got the khilats and Jagirs.[8]
Awans remain the most prominent and dominant tribe of the Chakwal keeping their holds in the central and westward areas of Salt Ranges and adjoining areas on both sides of the ranges since their arrival in the region with Sultan Mehmood Ghaznavi and Qutab shah during the series of Ghaznavid attacks on India. They also hold their domination in many but scattered villages of Chakwal. (e.g. Bhaun, Sarkal Kassar, jand, mohra awan etc.) Shamsuddin of Bhaun struggled a lot to get recognition of Awans in the area as Hindus were known superior and local inhabitants of Chakwal area.
Chakwal's non-Muslim minorities departed during partition of the subcontinent in 1947 but the city is still in their heart and mind and had never forgotten it.[9] In April 2009 a terrorist attack on the mosque killed more than 30 people.