Neural Tube Defects

Neural tube defects are birth defects of the brain, spine, or spinal cord. They happen in the first month of pregnancy, often before a woman even knows that she is pregnant. The two most common neural tube defects are spina bifida and anencephaly. In spina bifida, the fetal spinal column doesn't close completely. There is usually nerve damage that causes at least some paralysis of the legs. In anencephaly, most of the brain and skull do not develop. Babies with anencephaly are usually either stillborn or die shortly after birth. Another type of defect, Chiari malformation, causes the brain tissue to extend into the spinal canal.

The exact causes of neural tube defects aren't known. You're at greater risk of having an infant with a neural tube defect if you:

• Have obesity
• Have poorly controlled diabetes
• Take certain antiseizure medicines

Getting enough folic acid, a type of B vitamin, before and during pregnancy prevents most neural tube defects.

Neural tube defects are usually diagnosed before the infant is born, through lab or imaging tests. There is no cure for neural tube defects. The nerve damage and loss of function that are present at birth are usually permanent. However, a variety of treatments can sometimes prevent further damage and help with complications.

NIH: National Institute of Child Health and Human Development

Obesity

What is obesity?

Obesity is a disease that means having too much body fat. It is different from being overweight, which means weighing too much. Both terms mean that your weight is greater than what's considered healthy for your height.

Body Mass Index (BMI) measures how much you weigh compared to how tall you are. An adult who has a BMI of 30 or more is considered to have obesity. Severe obesity is having a BMI of 40 or higher. Obesity increases your risk for many other diseases and health problems, especially if the extra body fat is carried around the waist.

Obesity happens over time from taking in more calories (through food and drinks) than used up from physical activity and daily living. Your body stores the extra calories as fat. The right balance between calories and activity is different for everyone.

There are many different factors that can affect your body weight. Certain medicines or medical conditions may affect your weight. Other factors include your:

• Genetic makeup
• Eating habits
• Sex
• Race or ethnicity
• Physical activity level

To find out if you have obesity, your health care provider may:

• Ask about your health history, which may include reviewing your weight history, weight-loss efforts, and how physically active you are.
• Do a physical exam, which may include checking your height, weight, and vital signs, as well as listening to your heart and lungs.
• Order blood tests or other imaging tests, which may include checking any known health problems, as well as for other weight-related diseases and health conditions.
• Calculate your BMI, to check your risk for certain diseases. The higher your BMI, the higher your risk. BMI does not distinguish between fat, muscle, and bone mass. It may also overestimate body fat in athletes or those with a muscular build, or underestimate body fat in older persons, or others who have lost muscle.
• Check your waist size, since a large waistline, with more body fat around your abdomen (belly) rather than your hips, increases your risk for weight-related health problems.

Having a larger body size can make your heart work harder, put extra pressure on your joints, and may increase your risk for many health conditions, including:

• Type 2 diabetes.
• Heart disease.
• High blood pressure.
• Stroke.
• Metabolic syndrome.
• Osteoarthritis.
• Sleep apnea.
• Pregnancy problems.
• Fertility problems.
• Some cancers.

If you have obesity, losing even 5 to 10% of your weight can delay or prevent some of these diseases. For example, that means losing 10 to 20 pounds if you weigh 200 pounds.

Treatment plans for obesity may depend on your overall weight, other health conditions, and your willingness to participate in a weight-loss plan.

Your provider can tell you what a healthy weight is for you, help you set goals, and give you tips on how to lose weight. They may refer you to other providers that specialize in nutrition or weight loss to help you make realistic goals and provide support.

Possible treatments may include:

• Dietary changes and exercise goals to help you learn how to adopt healthy nutrition, exercise, and lifestyle changes to lose weight safely and keep it off long term.
• Counseling or support groups can give you encouragement and help you understand what's behind weight changes.
• Weight-loss medicines to treat obesity.
• Weight loss procedures or surgery if you have severe obesity or serious obesity-related health problems and have not been able to lose enough weight.

A healthy lifestyle that includes healthy eating patterns and regular physical activity can help you lose weight and lower your chance of developing complications related to obesity.

NIH: National Institute of Diabetes and Digestive and Kidney Diseases

Pituitary Disorders

Your pituitary gland is a pea-sized gland at the base of your brain. The pituitary is the "master control gland" - it makes hormones that affect growth and the functions of other glands in the body.

With pituitary disorders, you often have too much or too little of one of your hormones. Injuries can cause pituitary disorders, but the most common cause is a pituitary tumor.

Pituitary Tumors

Your pituitary gland is a pea-sized gland at the base of your brain. The pituitary is the "master control gland" - it makes hormones that affect growth and the functions of other glands in the body.

Pituitary tumors are common, but often they don't cause health problems. Most people with pituitary tumors never even know they have them. The most common type of pituitary tumor produces hormones and disrupts the balance of hormones in your body. This can cause endocrine diseases such as Cushing's syndrome and hyperthyroidism.

Symptoms of pituitary tumors include:

• Headaches
• Vision problems
• Nausea and vomiting
• Problems caused by the production of too many hormones

Pituitary tumors are usually curable. Treatment is often surgery to remove the tumor. Other options include medicines, radiation therapy, and chemotherapy.

Pneumonia

What is pneumonia?

Pneumonia is an infection in one or both of the lungs. It causes the air sacs of the lungs to fill up with fluid or pus. It can range from mild to severe, depending on the type of germ causing the infection, your age, and your overall health.

Bacterial, viral, and fungal infections can cause pneumonia.

Bacteria are the most common cause. Bacterial pneumonia can occur on its own. It can also develop after you've had certain viral infections such as a cold or the flu. Several different types of bacteria can cause pneumonia, including:

• Streptococcus pneumoniae
• Legionella pneumophila; this pneumonia is often called Legionnaires' disease
• Mycoplasma pneumoniae
• Chlamydia pneumoniae
• Haemophilus influenzae

Viruses that infect the respiratory tract may cause pneumonia. Viral pneumonia is often mild and goes away on its own within a few weeks. But sometimes it is serious enough that you need to get treatment in a hospital. If you have viral pneumonia, you are at risk of also getting bacterial pneumonia. The different viruses that can cause pneumonia include:

• Respiratory syncytial virus (RSV)
• Some common cold and flu viruses
• SARS-CoV-2, the virus that causes COVID-19

Fungal pneumonia is more common in people who have chronic health problems or weakened immune systems. Some of the types include:

• Pneumocystis pneumonia (PCP)
• Coccidioidomycosis, which causes valley fever
• Histoplasmosis
• Cryptococcus

Anyone can get pneumonia, but certain factors can increase your risk:

• Age; the risk is higher for children who are age 2 and under and adults age 65 and older
• Exposure to certain chemicals, pollutants, or toxic fumes
• Lifestyle habits, such as smoking, heavy alcohol use, and malnourishment
• Being in a hospital, especially if you are in the ICU. Being sedated and/or on a ventilator raises the risk even more.
• Having a lung disease
• Having a weakened immune system
• Have trouble coughing or swallowing, from a stroke or other condition
• Recently being sick with a cold or the flu

The symptoms of pneumonia can range from mild to severe and include:

• Fever
• Chills
• Cough, usually with phlegm (a slimy substance from deep in your lungs)
• Shortness of breath
• Chest pain when you breathe or cough
• Nausea and/or vomiting
• Diarrhea

The symptoms can vary for different groups. Newborns and infants may not show any signs of the infection. Others may vomit and have a fever and cough. They might seem sick, with no energy, or be restless.

Older adults and people who have serious illnesses or weak immune systems may have fewer and milder symptoms. They may even have a lower than normal temperature. Older adults who have pneumonia sometimes have sudden changes in mental awareness.

Sometimes pneumonia can cause serious complications such as:

• Bacteremia, which happens when the bacteria move into the bloodstream. It is serious and can lead to septic shock.
• Lung abscesses, which are collections of pus in cavities of the lungs
• Pleural disorders, which are conditions that affect the pleura. The pleura is the tissue that covers the outside of the lungs and lines the inside of your chest cavity.
• Kidney failure
• Respiratory failure

Sometimes pneumonia can be hard to diagnose. This is because it can cause some of the same symptoms as a cold or the flu. It may take time for you to realize that you have a more serious condition.

Your health care provider may use many tools to make a diagnosis:

• A medical history, which includes asking about your symptoms
• A physical exam, including listening to your lungs with a stethoscope
• Various tests, such as
  • A chest x-ray
  • Blood tests such as a complete blood count (CBC) to see if your immune system is actively fighting an infection
  • A Blood culture to find out whether you have a bacterial infection that has spread to your bloodstream

If you are in the hospital, have serious symptoms, are older, or have other health problems, you may also have more tests, such as:

• Sputum test, which checks for bacteria in a sample of your sputum (spit) or phlegm (slimy substance from deep in your lungs).
• Chest CT scan to see how much of your lungs is affected. It may also show if you have complications such as lung abscesses or pleural effusions.
• Pleural fluid culture, which checks for bacteria in a fluid sample that was taken from the pleural space
• Pulse oximetry or blood oxygen level test, to check how much oxygen is in your blood
• Bronchoscopy, a procedure used to look inside your lungs' airways

Treatment for pneumonia depends on the type of pneumonia, which germ is causing it, and how severe it is:

• Antibiotics treat bacterial pneumonia and some types of fungal pneumonia. They do not work for viral pneumonia.
• In some cases, your provider may prescribe antiviral medicines for viral pneumonia
• Antifungal medicines treat other types of fungal pneumonia

You may need to be treated in a hospital if your symptoms are severe or if you are at risk for complications. While there, you may get additional treatments. For example, if your blood oxygen level is low, you may receive oxygen therapy.

It may take time to recover from pneumonia. Some people feel better within a week. For other people, it can take a month or more.

Vaccines can help prevent pneumonia caused by pneumococcal bacteria or the flu virus. Having good hygiene, not smoking, and having a healthy lifestyle may also help prevent pneumonia.

NIH: National Heart, Lung, and Blood Institute