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Description:

Acute lymphoblastic leukaemia is a type of blood cancer that affects white blood cells. Cancer starts in the bone marrow, the spongy tissue inside the bones where blood cells are produced
It is a cancer of the lymphoid line of blood cells characterized by the development of large numbers of immature lymphocytes. Symptoms may include feeling tired, pale skin color, fever, easy bleeding or bruising, enlarged lymph nodes, or bone pain. As an acute leukemia, ALL progresses rapidly and is typically fatal within weeks or months if left untreated.

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The underlying mechanism involves multiple genetic mutations that results in rapid cell division. The excessive immature lymphocytes in the bone marrow interfere with the production of new red blood cells, white blood cells, and platelets. Diagnosis is typically based on blood tests and bone marrow examination.

ALL affected about 876,000 people globally in 2015 and resulted in about 111,000 deaths. It occurs most commonly in children, particularly those between the ages of two and five. In the United States it is the most common cause of cancer and death from cancer among children. ALL is notable for being the first disseminated cancer to be cured. Survival for children increased from under 10% in the 1960s to 90% in 2015. Survival rates remain lower for babies (50%) and adults (35%).

Symptoms:
Initial symptoms can be nonspecific, particularly in children. Over 50% of children with leukemia had one or more of five features: a liver one can feel (64%), a spleen one can feel (61%), pale complexion (54%), fever (53%), and bruising (52%). Additionally, recurrent infections, feeling tired, arm or leg pain, and enlarged lymph nodes can be prominent features. The B symptoms, such as fever, night sweats, and weight loss, are often present as well.

Central nervous system (CNS) symptoms such as cranial neuropathies due to meningeal infiltration are identified in less than 10% of adults and less than 5% of children, particularly mature B-cell ALL (Burkitt leukemia) at presentation.

Signs and symptoms of acute lymphocytic leukemia may include:

*Bleeding from the gums
*Bone pain
*Fever
*Frequent infections
*Frequent or severe nosebleeds
*Lumps caused by swollen lymph nodes in and around the neck, armpits, abdomen or groin
*Pale skin
*Shortness of breath
*Weakness, fatigue or a general decrease in energy

Causes:
In most cases, the cause is unknown. Genetic risk factors may include Down syndrome, Li–Fraumeni syndrome, or neurofibromatosis type 1. Environmental risk factors may include significant radiation exposure or prior chemotherapy. Evidence regarding electromagnetic fields or pesticides is unclear. Some hypothesize that an abnormal immune response to a common infection may be a trigger.

The cancerous cell in ALL is the lymphoblast. Normal lymphoblasts develop into mature, infection-fighting B-cells or T-cells, also called lymphocytes. Signals in the body control the number of lymphocytes so neither too few nor too many are made. In ALL, both the normal development of some lymphocytes and the control over the number of lymphoid cells become defective.

ALL emerges when a single lymphoblast gains many mutations to genes that affect blood cell development and proliferation. In childhood ALL, this process begins at conception with the inheritance of some of these genes. These genes, in turn, increase the risk that more mutations will occur in developing lymphoid cells. Certain genetic syndromes, like Down Syndrome, have the same effect. Environmental risk factors are also needed to help create enough genetic mutations to cause disease. Evidence for the role of the environment is seen in childhood ALL among twins, where only 10–15% of both genetically identical twins get ALL. Since they have the same genes, different environmental exposures explain why one twin gets ALL and the other does not.

Infant ALL is a rare variant that occurs in babies less than one year old. KMT2A (formerly MLL) gene rearrangements are most common and occur in the embryo or fetus before birth. These rearrangements result in increased expression of blood cell development genes by promoting gene transcription and through epigenetic changes. In contrast to childhood ALL, environmental factors are not thought to play a significant role. Aside from the KMT2A rearrangement, only one extra mutation is typically found. Environmental exposures are not needed to help create more mutations.

Risk factors:
Factors that may increase the risk of acute lymphocytic leukemia include:

1.Previous cancer treatment. Children and adults who’ve had certain types of chemotherapy and radiation therapy for other kinds of cancer may have an increased risk of developing acute lymphocytic leukemia.

2. Toomuch exposure to radiation. People exposed to very high levels of radiation, such as survivors of a nuclear reactor accident, have an increased risk of developing acute lymphocytic leukemia.

3.Genetic disorders. Certain genetic disorders, such as Down syndrome, are associated with an increased risk of acute lymphocytic leukemia.

Diagnosis:
The doctor may ask for the following tests:

*Blood tests. Blood tests may reveal too many or too few white blood cells, not enough red blood cells, and not enough platelets. A blood test may also show the presence of blast cells — immature cells normally found in the bone marrow.

*Bone marrow test. During bone marrow aspiration and biopsy, a needle is used to remove a sample of bone marrow from the hipbone or breastbone. The sample is sent to a lab for testing to look for leukemia cells.

Doctors in the lab will classify blood cells into specific types based on their size, shape, and other genetic or molecular features. They also look for certain changes in the cancer cells and determine whether the leukemia cells began from B lymphocytes or T lymphocytes. This information helps your doctor develop a treatment plan.

*Imaging tests. Imaging tests such as an X-ray, a computerized tomography (CT) scan or an ultrasound scan may help determine whether cancer has spread to the brain and spinal cord or other parts of the body.

*Spinal fluid test. A lumbar puncture test, also called a spinal tap, may be used to collect a sample of spinal fluid — the fluid that surrounds the brain and spinal cord. The sample is tested to see whether cancer cells have spread to the spinal fluid.

Treatment:

In general, treatment for acute lymphocytic leukemia falls into separate phases:

Induction therapy. The purpose of the first phase of treatment is to kill most of the leukemia cells in the blood and bone marrow and to restore normal blood cell production.
Consolidation therapy. Also called post-remission therapy, this phase of treatment is aimed at destroying any remaining leukemia in the body.
Maintenance therapy. The third phase of treatment prevents leukemia cells from regrowing. The treatments used in this stage are usually given at much lower doses over a long period of time, often years.

Preventive treatment to the spinal cord. During each phase of therapy, people with acute lymphocytic leukemia may receive additional treatment to kill leukemia cells located in the central nervous system. In this type of treatment, chemotherapy drugs are often injected directly into the fluid that covers the spinal cord.
Depending on your situation, the phases of treatment for acute lymphocytic leukemia can span two to three years.

Treatments may include:

*Chemotherapy. Chemotherapy, which uses drugs to kill cancer cells, is typically used as an induction therapy for children and adults with acute lymphocytic leukemia. Chemotherapy drugs can also be used in the consolidation and maintenance phases.

*Targeted therapy. Targeted drug treatments focus on specific abnormalities present within cancer cells. By blocking these abnormalities, targeted drug treatments can cause cancer cells to die. Your leukemia cells will be tested to see if targeted therapy may be helpful for you. Targeted therapy can be used alone or in combination with chemotherapy for induction therapy, consolidation therapy or maintenance therapy.

*Radiation therapy. Radiation therapy uses high-powered beams, such as X-rays or protons, to kill cancer cells. If the cancer cells have spread to the central nervous system, your doctor may recommend radiation therapy.

*Bone marrow transplant. A bone marrow transplant, also known as a stem cell transplant, may be used as consolidation therapy or for treating relapse if it occurs. This procedure allows someone with leukemia to reestablish healthy bone marrow by replacing leukemic bone marrow with leukemia-free marrow from a healthy person.

A bone marrow transplant begins with high doses of chemotherapy or radiation to destroy any leukemia-producing bone marrow. The marrow is then replaced by bone marrow from a compatible donor (allogeneic transplant).

*Engineering immune cells to fight leukemia. A specialized treatment called chimeric antigen receptor (CAR)-T cell therapy takes your body’s germ-fighting T cells, engineers them to fight cancer and infuses them back into your body.

CAR-T cell therapy might be an option for children and young adults. It might be used for consolidation therapy or for treating relapse.

Clinical trials. Clinical trials are experiments to test new cancer treatments and new ways of using existing treatments. While clinical trials give you or your child a chance to try the latest cancer treatment, the benefits and risks of the treatment may be uncertain. Discuss the benefits and risks of clinical trials with your doctor.
Treatment for older adults:
Older adults, such as those older than 65, tend to experience more complications from treatments. And older adults generally have a worse prognosis than children who are treated for acute lymphocytic leukemia.

Some people may choose to forgo treatment for the cancer, instead focusing on treatments that improve their symptoms and help them make the most of the time they have remaining.

Prognosis:
Prior to the development of chemotherapy regimens and hematopoietic stem cell transplant, children were surviving a median length of 3 months, largely due to either infection or bleeding. Since the advent of chemotherapy, the prognosis for childhood leukemia has improved greatly and children with ALL are estimated to have a 95% probability of achieving a successful remission after 4 weeks of initiating treatment. People in pediatric care with ALL in developed countries have a greater than 80% five-year survival rate. It is estimated that 60–80% of adults undergoing induction chemotherapy achieve complete remission after 4 weeks, and those over the age of 70 have a cure rate of 5%

However, there are differing prognoses for ALL among individuals depending on a variety of factors:

*Gender: Females tend to fare better than males.

*Ethnicity: Caucasians are more likely to develop acute leukemia than African-Americans, Asians, or Hispanics. However, they also tend to have a better prognosis than non-Caucasians.

*Age at diagnosis: children 1–10 years of age are most likely to develop ALL and to be cured of it. Cases in older people are more likely to result from chromosomal abnormalities (e.g., the Philadelphia chromosome) that make treatment more difficult and prognoses poorer. Older people are also likely to have co-morbid medical conditions that make it even more difficult to tolerate ALL treatment.

*White blood cell count at diagnosis of greater than 30,000 (B-ALL) or 100,000 (T-ALL) is associated with worse outcomes

*Cancer spreading into the Central nervous system (brain or spinal cord) has worse outcomes.

*Morphological, immunological, and genetic subtypes
Person’s response to initial treatment and longer length of time required (greater than 4 weeks) to reach complete remission

*Early relapse of ALL

*Minimal residual disease

*Genetic disorders, such as Down syndrome, and other chromosomal abnormalities (aneuploidy and translocations)

Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose.

Resources:
https://en.wikipedia.org/wiki/Acute_lymphoblastic_leukemia
https://www.mayoclinic.org/diseases-conditions/acute-lymphocytic-leukemia/symptoms-causes/syc-20369077

Common Name: BPPV

Description:
Benign paroxysmal positional vertigo (BPPV) is one of the most common causes of vertigo — the sudden sensation that some one spinning or that the inside of head is spinning.

BPPV causes brief episodes of mild to intense dizziness. It is usually triggered by specific changes in one’s head position. This might occur when he or she tips head up or down, when lie down, or when turn over or sit up in bed.

Although BPPV can be bothersome, it’s rarely serious except when it increases the chance of falls. One can receive effective treatment for BPPV during a doctor’s office visit.

BPPV can affect people of all ages but is most common in people over the age of 60.
Most patients can be effectively treated with physical therapy. In rare cases, the symptoms can last for years.

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Symtoms:
People with BPPV can experience a spinning sensation — vertigo — any time there is a change in the position of the head.

The symptoms can be very distressing. People can fall out of bed or lose their balance when they get up from bed and try to walk. If they tilt their head back or forward while walking, they may even fall, risking injury. Vertigo can cause the person to feel quite ill with nausea and vomiting tendensis.

While the hallmark of BPPV is vertigo associated with changes in head position, many people with BPPV also feel a mild degree of unsteadiness in between their recurrent attacks of positional vertigo.

The onset of BPPV may be abrupt and frightening. People may think they are seriously ill; for example, they may fear they are having a stroke. A doctor’s diagnosis of BPPV can be reassuring, especially when people understand that help is available to relieve their symptoms.

Without treatment, the usual course of the illness is lessening of symptoms over a period of days to weeks, and sometimes there is spontaneous resolution of the condition. In rare cases, the person’s symptoms can last for years.

In many people, especially older adults, there is no specific event that causes BPPV to occur, but there are some things that may bring on an attack:

*Mild to severe head trauma

*Keeping the head in the same position for a long time, such as in the dentist chair, at the beauty salon or during strict bed rest

*Bike riding on rough trails

*High intensity aerobics

*Other inner ear disease (ischemic, inflammatory, infectious)

Causes:
BPPV occurs when tiny calcium crystals called otoconia come loose from their normal location on the utricle, a sensory organ in the inner ear.

If the crystals become detached, they can flow freely in the fluid-filled spaces of the inner ear, including the semicircular canals (SCC) that sense the rotation of the head. Otoconia will occasionally drift into one of the SCCs, usually the posterior SCC given its orientation relative to gravity at the lowest part of the inner ear.

The otoconia will not cause a problem when located in an SCC until the person’s head changes position, such as when looking up or down, going from lying to seated or lying to seated in bed, or when rolling over in bed. The otoconia move to the lowest part of the canal, which causes the fluid to flow within the SCC, stimulating the balance (eighth cranial) nerve and causing vertigo and jumping eyes (nystagmus).

Risk factors:
Benign paroxysmal positional vertigo occurs most often in people age 60 and older, but can occur at any age. BPPV is also more common in women than in men. A head injury or any other disorder of the balance organs of your ear may make you more susceptible to BPPV.

Complications:
Although BPPV is uncomfortable, it rarely causes complications. The dizziness of BPPV can make a person unsteady, which may put him or her at greater risk of falling.

Diagnosis:
The doctor may do a series of tests to determine the cause of your dizziness. During a physical exam, the doctor will likely look for:

*Signs and symptoms of dizziness that are prompted by eye or head movements and then decrease in less than one minute

*Dizziness with specific eye movements that occur when you lie on your back with your head turned to one side and tipped slightly over the edge of the examination bed

*Involuntary movements of the person’s eyes from side to side

*Inability to control the eye movements

If the doctor can’t find the cause of your signs and symptoms, he or she may order additional testing, such as:

*Electronystagmography (ENG) or videonystagmography (VNG). The purpose of these tests is to detect abnormal eye movement. ENG (which uses electrodes) or VNG (which uses small cameras) can help determine if dizziness is due to inner ear disease by measuring involuntary eye movements while your head is placed in different positions or your balance organs are stimulated with water or air.

*Magnetic resonance imaging (MRI). This test uses a magnetic field and radio waves to create cross-sectional images of your head and body. Your doctor can use these images to identify and diagnose a range of conditions. MRI may be performed to rule out other possible causes of vertigo.

Treatments:
Benign paroxysmal positional vertigo may go away on its own within a few weeks or months. But, to help relieve BPPV sooner, the doctor, audiologist or physical therapist may treat the person with a series of movements known as the canalith repositioning procedure.

Canalith repositioning:

This can be performed in doctor’s office, the canalith repositioning procedure consists of several simple and slow maneuvers for positioning your head. The goal is to move particles from the fluid-filled semicircular canals of inner ear into a tiny baglike open area (vestibule) that houses one of the otolith organs in the ear, where these particles don’t cause trouble and are more easily resorbed.

Each position is held for about 30 seconds after any symptoms or abnormal eye movements stop. This procedure usually works after one or two treatments.

The doctor will likely teach the person how to perform the procedure on oneself so that he or she can do it at home if needed.

Surgical alternative:
In rare situations when the canalith repositioning procedure doesn’t work, the doctor may recommend a surgical procedure. In this procedure, a bone plug is used to block the portion of the inner ear that’s causing dizziness. The plug prevents the semicircular canal in the ear from being able to respond to particle movements or head movements in general. The success rate for canal plugging surgery is about 90%.

But the sergical option is needed in very very rare cases.

Medication:
The use of medication in treating vestibular disorders depends on whether the vestibular system dysfunction is in an initial or acute phase (lasting up to 5 days) or chronic phase (ongoing). Pharmacological treatments may be used to control symptoms, accelerate central compensation, and diminish psychological comorbidity.

AYURVEDIC TREATMENT: Some effective herbs tried in vertigo: Ginger Coriander Lemongrass – helps to treat nausea and dizziness, effective in vertigo. Herbal tea prepared with lemongrass is highly effective. It will relieve the symptoms within few minutes of onset. Cayenne – contains a chemical called capsaicin which helps enhance blood flow in your brain.

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Exercises:
The home Epley maneuver is a type of exercise help that helps to treat the symptoms of benign paroxysmal positional vertigo (BPPV).One can do this exercise at home. BPPV is caused by a problem in your inner ear.

Semont Maneuver:
*Sit on the edge of your bed. Turn your head 45 degrees to the right.

*Quickly lie down on your left side. Stay there for 30 seconds.

*Quickly move to lie down on the opposite end of your bed. …

*Return slowly to sitting and wait a few minutes.

*Reverse these moves for the right ear.

Yoga therapy :
There are several types of yoga poses, or asanas: meditative, cultural, and therapeutic poses.

Meditation helps to calm the mind and reduce anxiety. Because stress is a trigger for many vestibular patients, reducing stress can also help to minimize symptoms like dizziness and vertigo. Controlled breathing, or pranayama, is a tool that can help you control your energy level, reduce stress, increase your endurance and reduce your anxiety.

Cultural asanas are so named because they play a central role in forming a comprehensive physical culture of exercise and general well-being. Cultural asanas are sub-divided into physical asanas and relaxative asanas. Physical asanas greatly assist in rendering the body healthy, while relaxative asanas work on the Chitta (the understated aspect of consciousness) level, eliminating physical and mental tension.

Certain therapeutic poses can be helpful for different ailments, like imbalance, dizziness, diabetes, arthritis, or back pain. Yoga can be considered “therapeutic” when poses are adjusted to fit the unique needs of the practitioner. Some yoga classes are designed for special groups with unique needs, such as people with balance issues.

Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose.

Help taken from:
https://www.hopkinsmedicine.org/health/conditions-and-diseases/benign-paroxysmal-positional-vertigo-bppv

https://www.mayoclinic.org/diseases-conditions/vertigo/symptoms-causes/syc-20370055#:~:text=Benign%20paroxysmal%20positional%20vertigo%20(BPPV)%20is%20one%20of%20the%20most,changes%20in%20your%20head’s%20position.