Health related information and news from around the world.

PREVENTING INFECTIVE ENDOCARDITIS: RECOMMENDED REGIMENS FOR ANTIBIOTIC PROPHYLAXIS

admin — Thu, 30 Jun 2011 14:29:46 +0000

Choice of AntibioticWhen antibiotic prophylaxis is indicated, practitioners should choose a prophylactic regimen based on several considerations, including the following:• The microbial flora present at the site of the procedure• The spectrum of activity, cost, and ease of administration of the antibiotic• Patient history of allergy or sensitivity to antibiotics Amoxicillin is the preferred antibiotic for endocarditis prophylaxis before most procedures because of its activity against viridans streptococci, favorable side effect profile, low cost, and reasonable bioavailability. When amoxicillin is contraindicated, other oral agents with activity against oral streptococci are reasonable alternatives before oral procedures, including clindamycin, first-generation cephalosporins, or macrolide antibiotics. However, for lower gastrointestinal or genitourinary procedures, vancomycin is recommended because of the perceived need to include coverage for enterococci. In addition, a single dose of an aminoglycoside antibiotic is recommended before lower gastrointestinal or genitourinary procedures in high-risk patients.
Risks of AntibioticsAnaphylaxis is a complication of antibiotic therapy and will occur approximately 4 to10 times per 100,000 patient-doses of prophylactic oral amoxicillin. For intravenous ampicillin courses, the rate of anaphylaxis may approach 15 to 20 per 100,000 patient-doses. Although anaphylaxis is the most commonly considered potential harm of antibiotic prophylaxis for IE, approximately 10 times more patients will experience minor allergic reactions to these antibiotics, predominantly rashes. In addition, use of even single-dose regimens of antibiotics could cause Clostridium difficile colitis, which has significant associated morbidity.The impact of short-course antibiotic prophylaxis for IE on the development of antimicrobial resistance is unknown. Population studies have not consistently shown a correlation between total antibiotic exposure and emergence of antimicrobial resistance. Although it is logical that increasing antibiotic use drives antimicrobial resistance, data to support this hypothesis have been inconsistent.
Practical ConsiderationsIdeally, antibiotics should be administered to ensure peak concentrator of the antibiotic at the initiation of the procedure. Prophylactic oral antibiotics should be taken 1 hour prior to the procedure. In patients who are unable to take oral medicine, or who are prescribed intravenous medications for prophylaxis, the intravenous antibiotic should be administered within 30 minutes of the procedure. Some animal data support a protective role for post-procedure antibiotics administered within 30 minutes of the procedure.Patients who are already taking (or have recently taken) antibiotics for other reasons should be prescribed a different antibiotic for prophylaxis of IE. For example, a patient who has completed a course of amoxicillin for a urinary tract infection within the past week might appropriately be given cephalexin prior to a tooth extraction. This is done with the presumption that the remaining bacterial flora in the patient’s mouth is likely to be those that are resistant to or tolerant of amoxicillin.*50/348/5*

SLEEP PATTERNS: SLEEP DISTURBANCE AND ILLNESS

admin — Sat, 18 Jun 2011 14:24:23 +0000

Our basic circadian cycle of sleeping and waking is built into our systems as a product of our genetic inheritance. The actual rhythm of the cycle is not established until sometime after birth, when the central nervous system is more fully developed. This sleep-wake cycle is the result of a number of processes that must work together in close harmony.With such intricate mechanisms involved, it is perhaps not surprising that so many of us suffer from occasional inability to sleep. In fact, an entire class of sleep disorders, known as disorders of the sleep-wake schedule, all involve misalignment between people’s daily routines and their internal circadian rhythm. Circadian disruption is a likely suspect in those cases where a patient has an erratic sleep schedule or complains of inability to fall asleep. Such people often describe themselves as night owls.Moreover, the sleep-wake cycle itself affects a number of processes, and some researchers believe that it may be connected to the onset and intensity of disorders such as anxiety or depression. For example, studies have linked the abnormal EEG tracings of depressed people to disturbances in the biological rhythms. These rhythms apparently occur earlier than normal in the cycles of depressed patients.*102\226\8*

EPILEPSY AND ITS SPECIAL FORMS/EPILEPSY SYNDROMES: INFANTILE SPASMS

admin — Mon, 06 Jun 2011 14:14:23 +0000

Infantile spasms are a special form of epilepsy of infancy readily recognized clinically, but initially mistaken for colic. In a typical infantile spasm, the child will suddenly flex his head or his body at the waist. The arms come up in a startle-like reaction, the knees are drawn up, and the child may let out a short cry. This spasm lasts just a second or two, then the child relaxes, but the spasm quickly recurs in the same form. These spasms continue in a series of five to fifty or more before the series stops. The child may have many series per day.Since the mother often thinks that the cry and the flexion represent cramps or pain, her description may sound to the physician as if the child has colic, but colic does not occur in a series of episodes.Infantile spasms is the only type of epilepsy where seizures occur in series.The series of infantile spasms is most likely to occur when the child is drowsy, either waking from a nap or going to sleep. A parent might notice them particularly when the child has been placed in a high-chair for a meal.Less frequently, the spasms may be extensor, with the head thrown back and the body briefly stiffening while the legs are extended; or the spasm may be unilateral, with one arm coming up, the head turned to that side and the leg on the same side extended. These brief atypical spells also occur in series.Infantile spasms rarely start before two months of age, and most commonly between four and eight months. Spells that occur in series in this age group are usually infantile spasms or one of its variants. Even untreated, this form of epilepsy gradually disappears during the second to the fourth year of life. However, the child is usually severely handicapped otherwise. Shortly after the spasms begin, these children seem to stop making developmental progress and often lose skills they had previously acquired. A child who had started to sit may stop sitting, may even lose the ability to roll over, may stop babbling, and may function like a much younger child. Because of this deterioration, children with infantile spasms are often thought to have an underlying degeneration of the brain. Only 10 to 2o percent of children with infantile spasms will have normal mental function; the vast majority will have moderate to severe mental retardation. This is the only seizure type where one can predict such a poor outlook (prognosis). The poor prognosis is in part a consequence of the underlying brain pathology, but also may in some way be a result of the effects of this chaotic electrical activity in the brain. Some people think that the earlier the treatment of these seizures is initiated, the better the outlook. But even infants whose spasms are brought under control with treatment often develop another special form of epilepsy called the Lennox-Gastaut syndrome.*93\208\8*

BACH FLOWER REMEDIES: ELM REMEDY – PROFESSOR GUPTA’S CASE

admin — Sun, 22 May 2011 14:09:49 +0000

Professor Gupta was a very able and hardworking person, much revered in his profession of his capacity to work.But he lost his self-confidence during examination days. For sometime he just sat quietly feeling tired and helpless. On one side lay a heap of examination papers to be marked. On the other side lay the proof copy of his book for correction. The same evening he had to deliver a lecture in the University. On the cot in the next room lay his ailing wife who had to be accompanied to the doctor the same evening.”How on earth can I do all the above works today”? The thought made Mr. Gupta very sad.Fortunately Mr. Gupta had Elm remedy in his stock. He took a dose of Elm remedy which restored his self-confidence immediately.Mr. Chaudhri was a capable administrator as the principal of a public school. He had been a very good sportsman in his college-days, a respected art critic, an author of several books and had made his mark in many diverse fields.With his many-faceted activities, he was always busy here and there and everywhere, and had very little time to have any rest.Incessant work, the great responsibilities, no respite sometimes left him totally exhausted, physically and mentally. At such moments he felt himself inadequate to perform the various jobs that lay before him. He knew full well that he would overcome that feeling after sometime, but he could not afford to feel frustrated for anytime. His doctor friend had given him a phial full of ELM-saturated globules which he took and immediately got over his feeling of inadequacy.*95\308\8*

SKIN IN CHILDHOOD: MORE ABOUT SUNBURN

admin — Wed, 18 May 2011 14:03:53 +0000

Sunburn is caused predominantly by ultraviolet В light and therefore can be totally prevented. It is more likely to occur in the summer months when the ultraviolet В rays are strongest, especially between 10.00 a.m. and 3.00 p.m. Sunburn can also occur in winter, especially when the sun reflects off surfaces such as snow and water. It is quite possible to get sun-burnt on cloudy days, as cloudy weather will only ever block out about twenty per cent of ultraviolet rays.
Preventing sunburn To prevent sunburn in children, they should remain indoors between 10.00 a.m. and 3.00 p.m., especially in summer. Hopefully, schools will eventually adopt this policy in relation to playtimes and scheduling sports activities. Outdoors, physical shade should be used as much as possible to protect the skin. This includes wearing wide-brimmed hats and clothing which covers the arms and legs, and using umbrellas and trees for shade.When playing outdoors in summer, children should wear a factor 15 sunscreen on all exposed parts of the body. Factor 15 sunscreens protect the skin very well from sunburn, particularly if they are re-applied every one to two hours. They should also be re-applied after swimming or any activity which has induced sweating as they tend to ‘wash off. On very sensitive areas such as the nose and ears stronger sunscreens are needed. These include zinc cream as well as Clinique Continuous Coverage and other thick make-ups. These products are superior to all sunscreens. Although fluorescent zinc creams have become very popular, they are a nightmare to remove from clothing, bathrooms and walls. It may be best to avoid these deceptively appealing preparations and opt for the more standard creams instead.
Treating sunburnOnce sunburn has occurred, the skin is damaged and the consequences will probably become evident in the long term. Any treatment will only provide symptomatic relief. Cold, wet compresses of diluted vinegar (one part vinegar to ten parts water), baking soda or any other cooling preparation will make the skin feel more comfortable, and taking one or two aspirin will help decrease pain and inflammation. Topical anesthetic and antihistamine creams should not be used as they can produce severe allergic reactions. If a child has severe sunburn, he or she should be taken to a doctor as cortisone creams are very effective.
*11/150/5*

WOMEN’S PROBLEMS: DILATATION AND CURETTAGE (D AND C)

admin — Thu, 05 May 2011 12:58:26 +0000

Many other operations are commonly carried out on the female pelvis. Some are for diagnostic purposes. Others are strictly for therapeutic reasons; and still others are for both diagnosis and therapy. This is carried out under a general anaesthetic. A manual pelvic examination is performed, with the patient fully relaxed. Much detail can be picked up, as the various pelvic organs are easily Celt with no muscular resistance from the patient. Diagnostically it can yield important results. Then the cervical canal is dilated to allow the passage of a curette, a metal instrument with a spoon-shaped far end. With this the endometrial lining of the wall can be scraped clean. Abnormal linings, polyps and small growths may be removed in total or in part. The scrapings (as they are called) are then examined by a pathologist, from whose findings the nature of the endometrium and the presence of disease (cancer being the most important) may be diagnosed. It is a popular and important examination. Hospitalisation usually lasts 1 to 2 days.*124\45\4*

THE EMOTIONAL EATER-THE MIND/BODY SPLIT

admin — Thu, 28 Apr 2011 12:54:10 +0000

In developing the Beverly Hills Diet, both for myself and my clients, I have never lost sight of the power of emotions. I know that our hearts are inextricably locked into our eating, that any lifelong diet, by definition, must include not only the mind and the stomach, but our hearts as well.Those of us who love to eat (“eaters”) fall into a special category: almost all of us, at one time or another have been classified as sensitive. And it’s always said in hushed tones as if sensitivity is a bad thing, something to be ashamed of. Sensitivity is feeling. It’s being alive. Eaters are feelers. For us, our need to eat, comes not from a physical hunger but from an emotional hunger.It’s our hearts that need the nourishment, our souls that need to be fed.We swallow our disappointments, we swallow our hurt, we swallow our anger, we swallow our pride. We eaters, we feelers, will all too often swallow our feelings because publicly and even privately it’s the most acceptable way of dealing with them.We eat when we’re excited. We eat when we’re sad, when we have too much to do or not enough to do. We eat when we want to escape reality or when we want to connect back to it. When a nightmare wakes us in the middle of the night, food brings reality back into focus.Eating helps us preserve our sanity. When our pain is intense, eating soothes us—or so we think. It doesn’t. It creates a pain all its own. It only prolongs the misery. But we blot this out, obsessed only with the very real, transitory pleasure it affords us.*56\251\8*

HIV INFECTION AND ITS EFFECTS ON INTERPERSONAL RELATIONS: HELPLESSNESS, DEPENDENCY, AND CONTROL-CONTROL AND THE CAREGIVER

admin — Wed, 20 Apr 2011 12:22:01 +0000

For caregivers, problems with control are different. Caregivers need to balance several things at once. They need to deal with their own sense of helplessness, to allow the people they’re caring for to maintain a sense of control, and to care for them, all at the same time. Maintaining this balance is tricky and confusing. “My son is so much in control and I always push that,” June said. “But it backfires. When he really needs help, like with getting meals when he’s sick, he doesn’t ask. Sometimes I help him anyway. I also wish I could help him with the emotional things too, by just sitting and talking. But I’m afraid of smothering him. I just don’t know where the line is.” On the whole, caregivers should probably try to let the people they care for determine where the line is. The problems and feelings that people with HIV infection face can be resolved only by them. In fact, for people with HIV infection, being told solutions to problems they know are insoluble, or whose solutions only they can find, is annoying and intrusive. The best help caregivers can give is listening. Caregivers find it hard just to listen; they feel passive and helpless. Nevertheless listening, as Dean said, “really helps.” Listening means being quiet, not interrupting, not judging, not giving advice, not trying to fix what’s wrong. It means paying sympathetic attention, drawing the person out. Try saying, “I’m interested in that if you want to tell me.” Or, “That sounds hard. How are you handling it?” If the person is crying, don’t interrupt or make him or her stop. If you want to know why he or she is crying, wait until the crying is over to ask. Let the person cry it out—some things deserve tears. Listening also means picking up cues: perhaps the person does not want to talk, or wants to talk but is afraid of being a burden, or does not want help, or wants help but does not want to ask. The cues will help the caregiver decide how to act. Sometimes giving this much control to someone else annoys the caregiver. Caregivers occasionally feel as though they are looking after a demanding and self-centered child. They feel manipulated and demeaned, as though they are being servants. Sometimes, the people they are caring for want things that seem unreasonable: to go on a long trip, to spend money a certain way. Lisa’s husband inherited some money from his uncle and wanted to spend it all on a pickup truck. Lisa thought he was rapidly getting too sick to get much use out of a truck, but after she gave him the reasons against it, she thought, “Why shouldn’t he have what he wants? It was his uncle and it’s his money. He needs to control what’s left of his life.” Like Lisa, caregivers need to remember that people with HIV infection are in positions of dependency and need to feel as effective and competent and in control as possible. Likewise, people who are being cared for need to remember they are placing unusual demands on the caregiver. They need to share control whenever they can. A caregiver could say, “I know how much you dislike feeling helpless, but I’m feeling bossed around. I’d like to decide what to fix for supper tonight.” The person being cared for could say, “I wouldn’t like taking orders either, and I appreciate your fixing supper. Whatever you make, could you make it spicy?”
*86\191\2*

NATURAL HISTORY OF TYPE 1 DIABETES: EFFECT OF INTENSIVE MANAGEMENT – PREGNANCY

admin — Thu, 14 Apr 2011 12:13:33 +0000

Before the DCCT, it had been conclusively demonstrated that intensive glycemic management before and during pregnancy markedly improved fetal mortality and morbidity. Accordingly, whenever a patient was actively pursuing pregnancy during the trial (or when pregnancy was diagnosed), she was immediately placed on intensive management, whether initially randomized into the conventional or intensive management group.A total of 180 women in the DCCT completed 270 pregnancies, with 191 total live births. HbA1c values differed at conception (intensive, 7.4%; conventional, 8.1%), but were similar in both groups during pregnancy (6.6%). There were no significant differences in outcome between the women with conventional treatment who initiated intensive therapy before conception and those who began it after conception. Intensive therapy was associated with rates of spontaneous abortion and congenital malformations similar to those in the nondiabetic population. Thus, the DCCT findings supported recommendations that intensive management should be initiated in all women with type 1 diabetes who are planning pregnancy or who are pregnant.The DCCT afforded an opportunity to explore the effect of pregnancy in type 1 diabetes on progression of retinopathy and albuminuria. Furthermore, the effect of prior randomization into the conventional or intensive treatment group was assessed. In accord with other studies, there was a transient increase in the risk of progression of retinopathy during pregnancy in the DCCT. In the intensive group, there was a 1.63-fold greater risk of worsening of retinopathy from before to during pregnancy compared with nonpregnant women. This risk was 2.48-fold greater in the conventional group compared with nonpregnant women. The odds ratio peaked during the second trimester and persisted as long as 12 months after pregnancy. Small changes in albumin excretion rates were within the normal range in most subjects. It is significant, however, that the long-term risk of progression of retinopathy and albumin excretion, as assessed at the end of the DCCT, was not affected by pregnancy.In view of the transient increase in the risk of retinopathy progression during pregnancy in type 1 diabetes, increased ophthalmologic surveillance is indicated.*32\357\8*

ISD AND THE MIND: REMOTE CAUSES OF ISD

admin — Mon, 28 Mar 2011 09:01:17 +0000

Compared to immediate concerns, which you may be able to recognize and connect to your sexual problems, remote causes of ISD are even more difficult to identify. Indeed, they tend to operate subconsciously and may involve influences from the past. In other instances, you will recognize the issue but fail to understand the source of the problem, believing that you could not possibly be inhibiting your desire because of events or feelings you are sure you “got over” years ago. This was certainly the case for:
• Janet, who truly loved and fully trusted Tim but was terrified by the thought of having sex with him
• Wendy, who lost all sexual desire six months before her husband’s death and has yet to get it back, even though she is now in love with a man whom she once considered extremely sexy and desirable
• Maggie, who wants to have sex so that she can please and hold on to her husband, but feels anxious, out of control, and turned off every time she thinks about sex
• Larry, who was given a clean bill of health two years after having a heart attack, but is still unable to feel any interest in sex
Like many of the other ISD sufferers and desire discrepancy couples who appear in this book, they are living proof that ISD is, more often than not, a case of mind over matter. While they want to enjoy sexual desire, they rarely or never do. Indeed, when they should be “all systems go,” they unconsciously go on red alert status instead, shutting down the circuits that receive and transmit sexual messages. Because this process often takes place without their conscious awareness, they don’t know what’s happening, or why it’s happening, or that anything is happening at all.
For instance, Larry, the heart attack victim, was initially convinced that his body had undergone a drastic chemical change that had robbed him of his sex drive. But there was no physical reason for Larry’s global loss of desire. In fact, although he vehemently denied it at first, tucked in the back of Larry’s mind was the idea that having sex would set off another heart attack, this time a fatal one. Strongly related to his current fear are his unresolved feelings about his father’s death, which occurred when Larry was seven. Rather than admit to his fear of dying during sex or take the risk of disproving it, Larry, without knowing he was doing it, protected himself by not feeling sexual desire.
Of course, when ISD patients come to us for treatment, we attempt to identify the immediate and/or remote causes of their condition, and try to determine if there might be a physical cause. If there doesn’t seem to be any immediate cause or if it doesn’t respond to short-term sex therapy, we explore deeper, more complicated psychological issues, many of which we will discuss in the remainder of this chapter. In treating patients who mistrust a partner who is, in reality, loving and giving, or those who experience unprovoked anger, extreme anxiety, or total numbness in sexual situations, we look for and often find underlying fears—like Larry’s—that are the cause of their ISD.
*93\261\8*