Cytomegalovirus Infections

Cytomegalovirus (CMV) is a virus found around the world. It is related to the viruses that cause chickenpox and infectious mononucleosis (mono). Between 50% and 80% of adults in the United States have had a CMV infection by age 40. Once CMV is in a person's body, it stays there for life.

CMV is spread through close contact with body fluids. Most people with CMV don't get sick and don't know that they've been infected. But infection with the virus can be serious in babies and people with weak immune systems. If a woman gets CMV when she is pregnant, she can pass it on to her baby. Usually the babies do not have health problems. But some babies can develop lifelong disabilities.

A blood test can tell whether a person has ever been infected with CMV. Most people with CMV don't need treatment. If you have a weakened immune system, your doctor may prescribe antiviral medicine. Good hygiene, including proper hand washing, may help prevent infections.

Centers for Disease Control and Prevention

Delirium

What is delirium?

Delirium is a mental state in which you are confused, disoriented, and not able to think or remember clearly. It usually starts suddenly. It is often temporary and treatable.

There are three types of delirium:

• Hypoactive, when you are not active and seem sleepy, tired, or depressed
• Hyperactive, when you are restless or agitated
• Mixed, when you change back and forth between being hypoactive and hyperactive

There are many different problems that can cause delirium. Some of the more common causes include:

• Advanced cancer.
• Alcohol or drugs, either from intoxication or withdrawal. This includes a serious type of alcohol withdrawal syndrome called delirium tremens. It usually happens to people who stop drinking after years of alcohol use disorder (AUD).
• Dehydration and electrolyte imbalances.
• Dementia.
• Hospitalization, especially in intensive care.
• Infections, such as urinary tract infections, pneumonia, and the flu.
• Medicines. This could be a side effect of a medicine, such as sedatives or opioids. Or it could be from withdrawal after stopping a medicine.
• Metabolic disorders.
• Organ failure, such as kidney or liver failure.
• Poisoning.
• Serious illnesses.
• Severe pain.
• Sleep deprivation.
• Surgeries, including reactions to anesthesia.

Certain factors put you at risk for delirium, including:

• Being in a hospital or nursing home
• Having dementia
• Having a serious illness or more than one illness
• Having an infection
• Older age
• Having surgery
• Taking medicines that affect the mind or behavior
• Taking high doses of pain medicines, such as opioids

The symptoms of delirium usually start suddenly, over a few hours or a few days. They often come and go. The most common symptoms include:

• Changes in alertness (usually more alert in the morning, less at night)
• Changing levels of consciousness
• Confusion
• Disorganized thinking, talking in a way that doesn't make sense
• Disrupted sleep patterns, sleepiness
• Emotional changes: anger, agitation, depression, irritability, overexcitement
• Hallucinations and delusions
• Memory problems, especially with short-term memory
• Trouble concentrating

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

• A medical history, which includes asking about your symptoms
• Physical and neurological exams
• Mental status testing, which checks for problems with your thinking and alertness
• Lab and diagnostic imaging tests

Delirium and dementia have similar symptoms, so it can be hard to tell them apart. You can also have both at the same time. The differences between them are that:

• Delirium starts suddenly and can cause hallucinations. It is mainly a problem with attention and staying alert. The symptoms may get better or worse and can last for hours or weeks.
• Dementia develops slowly and does not cause hallucinations. It usually starts with memory loss. The symptoms don't change often, like they can with delirium. Dementia almost never gets better.

Treatment of delirium focuses on the causes and symptoms of delirium. The first step is to identify the cause. Often, treating the cause will lead to a full recovery. The recovery may take some time - weeks or sometimes even months. In the meantime, there may be treatments to manage the symptoms, such as:

• Controlling the environment, which includes making sure that the room is quiet and well-lit, having clocks or calendars in view, and having family members around
• Medicines, including those that control aggression or agitation and pain relievers if there is pain
• If needed, making sure that the person has a hearing aid, glasses, or other devices for communication

Treating the conditions that can cause delirium may reduce the risk of getting it. Hospitals can help lower the risk of delirium by avoiding sedatives and making sure that hospital rooms are kept quiet, calm, and well-lit. It can also help to have family members around and to have the same staff members treat the person each day (if possible).

Developmental Disabilities

What are developmental disabilities?

Developmental disabilities are conditions that are usually present at birth. They can affect a child's growth and development. These conditions can cause physical, learning, language, or behavior issues. They can include:

• Learning disabilities. These conditions affect the ability to learn.
• Autism spectrum disorder (ASD). This is a disorder that affects behavior, communication, and social skills.
• Cerebral palsy (CP). This is a condition that affects movement, coordination, and balance.
• Physical disabilities. These could include blindness or deafness.
• Conditions that can affect both physical and mental abilities. This could include Down syndrome.

These conditions can cause lifelong challenges in learning. Completing daily tasks may be difficult. Early treatment may help your child learn important skills and make the most of their strengths.

Developmental disabilities are often present at birth. They can occur due to various reasons. These can include:

• Genetic or chromosome abnormalities. These cause conditions such as Down syndrome, Fragile-X-Syndrome, and Rett syndrome.
• Use of substances while pregnant. For example, drinking alcohol when pregnant can cause fetal alcohol spectrum disorders.
• Certain infections during pregnancy.
• Preterm birth or low birth weight.

The way a developmental disability is diagnosed depends on the condition. Screening tests or a physical exam may be done to check for a medical problem. Other tests and questionnaires may help find out if your child has a developmental disability. These may include:

• Screening tests that are done during pregnancy or for newborns
• Developmental and behavioral screening tests or questionnaires to check if your child is developing on schedule
• Observing your child's behavior and how they interact with other people
• Testing your child's intellectual and school performance
• Asking about your family history

If your child has a developmental disability, these are usually lifelong conditions. Often, there is no cure, but treatment can help the symptoms. Treatments can include:

• Physical, speech, and occupational therapy
• Special teaching methods
• Psychological counseling
• To keep track of how your child grows and changes over time

NIH: National Institute of Child Health and Human Development

Diabetes Type 2

What is type 2 diabetes?

Type 2 diabetes is a disease in which your blood glucose, or blood sugar, levels are too high. Glucose is your main source of energy. It comes from the foods you eat. A hormone called insulin helps the glucose get into your cells to give them energy. If you have diabetes, your body doesn't make enough insulin or doesn't use insulin well. The glucose then stays in your blood and not enough goes into your cells.

Over time, having too much glucose in your blood can cause health problems. But you can take steps to manage your diabetes and try to prevent these health problems.

Type 2 diabetes may be caused by a combination of factors:

• Being overweight or having obesity
• Not being physically active
• Genetics and family history

Type 2 diabetes usually starts with insulin resistance. This is a condition in which your cells don't respond normally to insulin. As a result, your body needs more insulin to help the glucose enter your cells. At first, your body makes more insulin to try to get cells to respond. But over time, your body can't make enough insulin, and your blood glucose levels rise.

You are at higher risk of developing type 2 diabetes if you:

• Are over age 45. Children, teenagers, and younger adults can get type 2 diabetes, but it is more common in middle-aged and older people.
• Have prediabetes, which means that your blood glucose is high for you but not high enough to be called diabetes
• Had diabetes in pregnancy or gave birth to a baby weighing 9 pounds or more.
• Have a family history of diabetes
• Are overweight or have obesity
• Are Black or African American, Hispanic/Latino, American Indian, Asian American, or Pacific Islander
• Are not physically active
• Have other conditions such as high blood pressure, heart disease, stroke, polycystic ovary syndrome (PCOS), or depression
• Have low HDL (good) cholesterol and high triglycerides
• Have acanthosis nigricans - dark, thick, and velvety skin around your neck or armpits

Many people with type 2 diabetes have no symptoms at all. If you do have them, the symptoms develop slowly over several years. They might be so mild that you do not notice them. The symptoms can include:

• Increased thirst and urination
• Increased hunger
• Feeling tired
• Blurred vision
• Numbness or tingling in the feet or hands
• Sores that do not heal
• Unexplained weight loss

Your provider will use blood tests to diagnose type 2 diabetes. The blood tests include:

• A1C test, which measures your average blood glucose level over the past 3 months.
• Fasting plasma glucose (FPG) test, which measures your current blood glucose level. You need to fast (not eat or drink anything except water) for at least 8 hours before the test.
• Random plasma glucose (RPG) test, which measures your current blood glucose level. This test is used when you have diabetes symptoms and the provider does not want to wait for you to fast before having the test.

Treatment for type 2 diabetes involves managing your blood glucose levels. Many people are able to do this by living a healthy lifestyle. Some people may also need to take medicine:

• A healthy lifestyle includes following a healthy eating plan and getting regular physical activity. You need to learn how to balance what you eat and drink with physical activity and diabetes medicine, if you take any.
• Medicines for diabetes include oral medicines, insulin, and other injectable medicines. Over time, some people will need to take more than one type of medicine to control their diabetes.
• You will need to check your blood glucose regularly. Your provider will tell you how often you need to do it.
• It's also important to keep your blood pressure and cholesterol levels close to the targets your provider sets for you. Make sure to get your screening tests regularly.

You can take steps to help prevent or delay type 2 diabetes by losing weight if you are overweight, eating fewer calories, and being more physically active. If you have a condition which raises your risk for type 2 diabetes, managing that condition may lower your risk of getting type 2 diabetes.

NIH: National Institute of Diabetes and Digestive and Kidney Diseases

Diabetic Nerve Problems

If you have diabetes, your blood glucose, or blood sugar, levels are too high. Over time, this can damage the covering on your nerves or the blood vessels that bring oxygen to your nerves. Damaged nerves may stop sending messages, or may send messages slowly or at the wrong times.

This damage is called diabetic neuropathy. Over half of people with diabetes get it. Symptoms may include:

• Numbness in your hands, legs, or feet
• Shooting pains, burning, or tingling
• Nausea, vomiting, constipation, or diarrhea
• Problems with sexual function
• Urinary problems
• Dizziness when you change positions quickly

Your doctor will diagnose diabetic neuropathy with a physical exam and nerve tests. Controlling your blood sugar can help prevent nerve problems, or keep them from getting worse. Treatment may include pain relief and other medicines.

NIH: National Institute of Diabetes and Digestive and Kidney Diseases