WHO issues Fresh Alert for Gonorrhea

June 7, 2012 By Anisha Francis, DC Chennai

Deccan Chronicle

The World Health Organisation on Wednesday issued a fresh alert on a drug resistant type of gonorrhoea, a common sexually transmitted disease, warning that a strain resistant to the very last line of antibiotic treatment had been found.

Doctors in Chennai, however, report that they have been receiving “superbug” gonorrhoea cases since the early 2000s, thanks to overzealous cephalosporin antibiotics prescriptions.

Gonorrhoea is a bacterial infection and initial symptoms include penile discharge and burning sensation in men, while 50 per cent of women do not have any significant symptoms.

Dr Manjula Lusti-Narsimhan of the WHO’s department of reproductive and sexual health announced that the organisation was drawing up a global action plan to combat the superbug, which could pose a public health challenge.

“Gonorrhoea used to be an easily manageable disease, but difficult-to-treat strains have now emerged. This is mainly because of the irrational use of antibiotics like Cephalexin by both patients and physicians.

General practitioners prescribe this drug for so many different ailments — diarrhoea, sore throat, respiratory and urinary infections — that the gonorrhoea bacteria has developed resistance,” explained Dr N. Kumarasamy, Chief Medical Officer at Y.R.G. Care here, which specialises in HIV and other STIs.

“If not treated, gonorrhoea can cause the urethra to constrict in both men and women. Infertility and pelvic inflammatory disease can also occur.

The infection can cause severe vision problems in infants born to infected mothers, as they can contract the bug as they pass through the birth canal,” he added.

At the Government General Hospital’s STI clinic, most patients with gonorrhoea are young, in the 20- 35 age group, said counsellor Mr Wilson.

“It is not sex workers or homosexual men from the ‘high risk groups’ who come here with gonorrhoea; they are well aware of how to protect themselves from STDs. It is the uninformed general public, mostly young men and often married couples who come for treatment,” he said.

Many patients, meanwhile, admit that they first try over-the-counter antibiotics “prescribed” by salesmen at the medical shop and visit the venerologist only when the symptoms get worse.

Vascular Reactivity in Pre-Diabetes Improves With Regular Aerobic Exercise

Vascular Reactivity in Pre-Diabetes Improves With Regular Aerobic Exercise

By Fran Lowry


NEW YORK (Reuters Health) Jun 01 - People with pre-diabetes who engage in regular aerobic exercise improve their vascular reactivity to nearly normal levels, even if they do not lose weight, researchers said in Philadelphia last weekend at the American Association of Clinical Endocrinologists 21st Annual Meeting and Clinical Congress.


"Doctors should tell their patients with pre-diabetes to do moderate exercise," lead author Dr. Sabyasachi Sen, from Bay State Medical Center and Tufts University School of Medicine in Boston told Reuters Health.


"The patients in this study did what the American Diabetes Association recommends, 150 minutes of aerobic exercise a week at 70% of their maximum heart rate, and showed improvement in several of their lipid fractions and their vascular reactivity," he said.


There is a lack of data on endothelial function in pre-diabetes, although there is a fair amount in the literature confirming endothelial cell dysfunction and poor vascular reactivity in diabetics.


In a randomized crossover trial, Dr. Sen and his team studied 20 exercise-na�ve subjects with pre-diabetes aged 45 to 65, with body mass index ranging from 25 to 34.9.


Ten subjects did 150 minutes per week of aerobic exercise for six weeks, and 10 did no exercise. After a four-week washout period, the groups switched. The investigators studied endothelial function in both groups with flow mediated dilatation (FMD) of the brachial artery. They also looked at endothelial, bio-inflammatory markers and blood pressure, fasting lipids, insulin, and glucose.


The mean FMD in the no-exercise phase was 5.7%. After exercise, the FMD improved to 11.2%.


No weight loss was noted, but there were statistically significant reductions in leptin, interleukin-6, high sensitivity-C reactive protein (hs-CRP), tumor necrosis factor (TNF), fasting triglyceride, low-density lipoprotein, and ApoB levels with exercise, Dr. Sen said.


In addition, insulin sensitivity as measured by homeostatic model assessment (HOMA) and Apo-A1 improved after exercise. However, fasting glucose levels, HbA1c, and high density lipoprotein (HDL) cholesterol levels did not change.


Without exercising, pre-diabetic patients had vascular reactivity levels as poor as those in patients with overt diabetes, Dr. Sen said.


"Knowing that exercise significantly improves vascular reactivity for pre-diabetic patients is substantial," he said. "The pre-diabetic stage is a therapeutic window when aerobic exercise can make significant improvement in vascular reactivity and bring it back towards normalcy, before these patients progress to overt diabetes. It may be too late in the overt diabetes stage to make significant impact in vascular reactivity with exercise alone."

Image from TopNewsHealth

Drowning

Drowning

Posted by Sara Fazio • May 31st, 2012

NOW@NEJM

In many areas of the world, drowning is a leading cause of death, especially among young children. The latest review in our Current Concepts series describes the pathophysiology of drowning and summarizes the principles of resuscitation, prehospital treatment, and intensive care.

According to the World Health Organization, 0.7% of all deaths worldwide — or more than 500,000 deaths each year — are due to unintentional drowning. Since all cases of fatal drowning are not classified as such according to the codes of the International Classification of Disease, this number underestimates the real figures, even for high-income countries, and does not include drownings that occur as a result of floods, tsunamis, and boating accidents.

Clinical Pearls

• What are the risk factors for drowning?

Key risk factors for drowning are male sex, age of less than 14 years, alcohol use, low income, poor education, rural residency, ethnic group, aquatic exposure, risky behavior, and lack of supervision. For people with epilepsy, the risk of drowning is 15 to 19 times as high as the risk for those who do not have epilepsy. Drowning is a leading cause of death worldwide among boys 5 to 14 years of age. In the United States, drowning is the second leading cause of injury-related death among children 1 to 4 years of age, with a death rate of 3 per 100,000.

• What is the pathophysiology of drowning?

If the individual is rescued alive, the clinical picture is determined predominantly by the amount of water that has been aspirated and its effects. The combined effects of fluids in the lungs, loss of surfactant, and increased permeability of the alveolar-capillary membrane (alveolitis) result in decreased lung compliance, increased right-to-left shunting in the lungs, atelectasis, and bronchospasm. If the individual is not rescued, aspiration of water continues, and hypoxemia quickly leads to loss of consciousness and apnea. The sequence of cardiac rhythm deterioration is usually tachycardia followed by bradycardia, pulseless electrical activity, and, finally, asystole. The whole drowning process, from submersion to cardiac arrest, usually occurs in seconds to a few minutes.

Morning Report Questions

Q: What are the key elements of rescue and resuscitation?

A: Attempts at chest compression are futile as long as the rescuer and drowning person are in deep water, so assessment for a pulse does not serve any purpose. Drowning persons with only respiratory arrest usually respond after a few rescue breaths. If there is no response, the person should be assumed to be in cardiac arrest and be taken as quickly as possible to dry land, where effective CPR can be initiated. The European Resuscitation Council recommends five initial rescue breaths instead of two because the initial ventilations can be more difficult to achieve, since water in the airways can interfere with effective alveolar expansion. Once on land, the person who has drowned should be placed in a supine position, with the trunk and head at the same level, and the standard checks for responsiveness and breathing should be carried out. If the person is unconscious but breathing, the recovery position (lateral decubitus) should be used. If the person is not breathing, rescue ventilation is essential.

Q: What are the important aspects of emergency department care for a drowning victim?

A: Once the airway has been secured, oxygenation has been optimized, the circulation has been stabilized, and a gastric tube has been inserted, thermal insulation of the patient should be instituted. This is followed by physical examination, chest radiography, and measurement of arterial blood gases. Metabolic acidosis occurs in the majority of patients and should be corrected by increasing minute ventilation. Routine use of sodium bicarbonate is not recommended. The recorded history of events surrounding the drowning incident should include information on the rescue and resuscitation activities and any current or previous illness. Drowning is sometimes precipitated by an injury or medical condition (e.g., trauma, seizure, or cardiac arrhythmia) and such conditions affect treatment decisions. If the person remains unresponsive without an obvious cause, a toxicologic investigation and computed tomography of the head and neck should be considered. Measurements of electrolytes, blood urea nitrogen, creatinine, and hematocrit are rarely helpful; abnormalities are unusual.

Health Tips on Fever Management

You may lower fever by applying sponge bath ("punas") using tap water place in a container for about 5-10 minutes(to be at room temperature). Do not use alcohol ,ice , cold bath to cool the skin since these may make the situation worse by causing shivering or chills that may increase the core body temperature.

Health Tips on Fever Medications

Give only Paracetamol for fever especially if you are not sure of the cause or origin of the high body temperature since it may be due to Dengue Fever. Never give NSAIDs which includes Aspirin, Ibuprofen(Dolan etc..), Mefenamic Acid(Ponstan,Dolfenal etc..) Naproxen (Flanax etc.) because NSAIDs inhibit blood clotting which may worsen bleeding in Dengue Hemorrhagic Fever.

Epididymitis, Testicle Infection

A 24 year old male, single, sexually active, complained of pain in the right testicle with associated low grade fever of 1 day duration. He said that it was painful when touched with a heavy sensation in the testicle area he also noted that the right is slightly larger than the left testicle.

There is no past medical history of mumps, urinary tract infection and denies previous sexually transmitted disease. Patient have no history of trauma to the groin , and is not engaged in biking or other physical athletic activity.

The patient was diagnosed with Epididymitis and was given Azythromycin 1 gram as single dose and Cefuroxime 200mg Cap, 2 capsules as single dose. Bed rest was also advised as well as elevation and applying ice pack to the affected area.

Epididymitis is a condition wherein there is inflamation of the epididymis or the tube that connects the testicle with the vas deferens. Pathophysiology usually involves ascending infection via vas deferens from prostatic urethra. It usually starts with a low grade fever with associated chills and a feeling of heaviness in the testicular area. Patient usually complains of sensitivity to pressure in the area. Other symptoms may include a mass or lump in the testicle, pain during urination and also ejaculation, blood in the semen, scrotal swelling and urethral discharge.

Physical examination may reveal a red, tender mass on the affected side of the scrotum. Usually there is pain and tenderness in a small area of the testicle where the epididymis is attached. Enlarged lymph nodes in the groin is usually noted. Digital rectal exam may show enlarged and tender prostate.

The most common infectious causes are Escherichia coli, Neisseria gonorrhoea, Chlamydia trachomatis.

General risk includes prolonged sitting, strenuous exercise like biking or motorcycle riding, and also sexual activity.

Laboratory test that may be performed includes urinalysis and if necessary urine culture, complete blood count, doppler ultrasound and STD testing.

image from A.D.A.M

Impetigo, Mamaso or Talipaso

A 2 year old girl was brought to the clinic for rashes in the cheeks and forehead of 3 days duration, initially like small pinheads,"butlig", then after a day rapidly converted to vesicular rashes, "nagtutubig". It was noted that a playmate suffers from a similar condition.

On physical examination , the lesion erodes with a honey colored crust and slightly wet. Patient was occasionally scratching the lesion but nevertheless was afebrile.

The patient was diagnosed with Impetigo, locally known as Mamaso or Talipaso and was given an oral Antibiotic Cefalexin susp , every 8 hours(3xday) for 10 days . Mupirocin cream was also prescribed to be applied 3x day . Advised was given regarding improvement of personal hygiene and avoidance of crowded places.

Impetigo or Mamaso or Talipaso

Impetigo is the most common skin infection in children and is caused by Streptococcal and Staphylococcal bacteria. Preschool children are most often affected and is highly contagious.The intact skin is an effective barrier that that keeps bacteria from entering and growing in the body, but if there is a break in the skin , like that from scratching, bacteria may then enter and grow there causing inflamation and infection. Break in the skin may come from insect bite, human bites,animal bites and other trauma to the skin. It spreads across body with scratching and found easily in daycares and school. It is advisable not to share towels, clothing and other personal care articles with other members of the family and also encourage thorough washing of hands after touching the lesions.

Predisposing factors and conditions may include hot and humid weather, malnutrition, poor hygiene , over crowded living conditions, minor skin trauma like abrasions and skin conditions like Atopic Dermatitis.

The lesion or sores of impetigo usually heal slowly but seldom leave a scar. The cure rate is very good but the condition always recurs in young children thus emphasis is on hygiene and prevention.

 Bullous Impetigo

image from impetigopictures.org

photos and images compiled from Google.com