CDC Treatment Recommendations for Gonorrhea( STD - Tulo )

"Gonorrhea is the second most commonly reported infectious disease in the
US, with about 340,000 cases reported in 2005," John M. Douglas, Jr., MD,
Director of the Division of Sexually Transmitted Diseases Prevention
(DSTD), National Center for HIV/AIDS, Viral Hepatitis, STD [sexually
transmitted disease], and TB Prevention (NCHHSTP), said in a CDC
teleconference. "Like most STDs, gonorrhea is underdiagnosed and
underreported, and we estimate that about twice that number of people were
affected. We've made substantial progress in reducing the burden of
gonorrhea over the years as a result of efforts to prevent, detect and
effectively treat the disease."
Rising rates of gonorrhea resistance to fluoroquinolones were first noted
in Hawaii and California, leading the CDC to recommend in 2000 and in
2002, respectively, that fluoroquinolones not be used to treat gonorrhea
infections in these states. In 2004, rising rates of gonorrhea resistance
to fluoroquinolones in men who have sex with men led the CDC to recommend
against using fluoroquinolones in this group.
"Part of our success in controlling this disease has been our ability to
treat the changing organism itself," Dr. Douglas says. "Gonorrhea has
proven to be quite efficient at navigating around the drugs we use to
combat it, with resistance first to penicillin, then tetracycline, then,
most recently, to fluoroquinolones.... We want a recommended treatment to
cure 95% or more of all gonorrhea infections, [and] we have reached a
level of resistance that threatens our ability to control the disease
across populations."
Data from CDC's Gonococcal Isolate Surveillance Project (GISP) in 26 US
cities showed that in the first half of 2006, 6.7% of gonorrhea cases in
heterosexual men were fluoroquinolone-resistant Neisseria gonorrhoeae
(QRNG), an 11-fold increase from 0.6% in 2001, and well above 5%, the
recognized threshold for changing treatment recommendations.
"As a result of these increases in fluoroquinolone resistance throughout
the country, CDC is no longer recommending that fluoroquinolones be used
to treat gonorrhea anywhere in the U.S.," Dr. Douglas says. "These
recommendations are critical to preserve the progress we've made in
controlling gonorrhea, one of the nation's most common STDs."
The overall proportion of gonorrhea cases that were QRNG increased from
less than 1% in 2001 to 13.3% in the first half of 2006, with dramatic
increases from 2004 to 2006 in Philadelphia (1.2% - 26.6%) and Miami (2.1%
- 15.3%). QRNG also continued to rise among men who have sex with men,
from 1.6% in 2001 to 38% in the first half of 2006.
"We do not have the full data yet from the last half of 2006," Hillard S.
Weinstock, MD, MPH, Medical Epidemiologist, DSTD, NCHHSTP, said in the
teleconference. "However, given the trends we have observed over the last
several years, we expect that the percentage of fluoroquinolone-resistant
cases will go up in the second half of 2006."
Therefore, the CDC no longer recommends fluoroquinolone antibiotics
(ciprofloxacin, ofloxacin, and levofloxacin) for treatment of gonorrhea in
the United States. Because gonorrhea resistance to penicillin, sulfa
drugs, and tetracycline is already widespread, this limits available
options for gonorrhea treatment to drugs in the cephalosporin class. The
United Kingdom preceded the United States by about 3 to 4 years in its
recommendation to switch from fluoroquinolones to cephalosporins in
gonorrhea treatment.
"There is an urgent need for new, effective medicines to treat gonorrhea,"
Kevin Fenton, MD, Director of CDC's National Center for HIV/AIDS, Viral
Hepatitis, STD, and TB Prevention, said in a news release. "We are running
out of options to treat this serious disease. Increased vigilance in
monitoring for resistance to all available drugs is essential."
Although significant resistance to cephalosporins has not been reported
thus far, CDC is collaborating with state and local health departments to
detect emerging cephalosporin resistance. Now that gonorrhea is largely
diagnosed by a convenient DNA test, many laboratories and providers no
longer have the capability of culturing N gonorrhoeae for drug resistance
testing. The CDC is urging health departments to maintain or develop this
capacity and to evaluate any gonorrhea treatment failures for possible
resistance.
"Importantly, with fluoroquinolones no longer recommended, only one class
of drugs remains recommended for treating gonorrhea: the antibiotics known
as cephalosporins," Dr. Douglas says. "Although the cephalosporins offer
several potential options for treating gonorrhea, the lack of additional
classes of antibiotics is a serious concern. There are currently no new
drugs for gonorrhea in the drug development pipeline."
To bolster international monitoring for the emergence of cephalosporin
resistance, CDC is also working with the World Health Organization (WHO)
and with government and industry partners to identify and evaluate new
drug regimens for gonorrhea treatment.
"While we have not seen any evidence of resistance to cephalosporins to
date, emergence of any resistance would be a serious public health
concern," Dr. Douglas said. "CDC will work with government and industry
partners to identify and evaluate promising alternative drug regimens for
treating gonorrhea. Ultimately, reducing the burden of gonorrhea will
require comprehensive and continued action on many fronts, as we work to
maintain and expand effective programs to prevent and control this disease
across the nation."
Most cases of gonorrhea in women are asymptomatic and untreated. However,
failure to treat gonorrhea aggressively and early may result in pelvic
inflammatory disease with associated infertility, chronic pelvic pain,
and/or ectopic pregnancy. In men, rare complications of untreated
gonorrhea may include epididymitis, rarely associated with infertility.
Even when asymptomatic, inflammation of the male genitourinary tract
associated with gonorrhea may increase susceptibility to HIV infection.
Rarely, untreated gonorrhea may be associated with serious sequelae such
as infectious arthritis, meningitis or endocarditis.
Updated recommended treatment regimens for gonorrhea infection are as
follows:
For uncomplicated gonococcal infections of the cervix, urethra, and
rectum, recommended treatments are 125 mg of ceftriaxone in a single
intramuscular (IM) dose or 400 mg of cefixime (not available in the United
States) in a single oral dose, plus treatment of Chlamydia if chlamydial
infection is not ruled out. Although 400-mg tablets of cefixime are not
available in the United States, and it is only available in a suspension
formulation, Dr. Douglas said that the CDC has approached the Food and
Drug Administration regarding this, and they are hopeful that oral tablets
will soon be an option in the United States.
"While we only have this single class of recommended antibiotics, the
cephalosporins, and the vigilance we've talked about today is a key public
health priority, we've been using this class of drugs for the treatment of
gonorrhea since the early 1980s, and fortunately, so far, there has not
been any documentation of emergence of resistance," Dr. Douglas says. "I
don't want to present an injectable antibiotic as an insurmountable
obstacle, because we used it for years with penicillin; it's more of a
bump in the road in terms of how providers will be caring for patients
with gonorrhea."
Alternative regimens for uncomplicated gonococcal infections of the
cervix, urethra, and rectum are 2 g of spectinomycin (not available in the
United States) in a single IM dose or cephalosporin single-dose regimens
(ceftizoxime, 500 mg IM; or cefoxitin, 2 g IM, administered with
probenecid, 1 g orally; or cefotaxime, 500 mg IM).
For uncomplicated gonococcal infections of the pharynx, recommended
regimens are 125 mg of ceftriaxone in a single IM dose, plus treatment of
Chlamydia if chlamydial infection is not ruled out. There are currently no
recommended alternatives for pharyngeal infection.
For disseminated gonococcal infection, pelvic inflammatory disease,
epididymitis, and treatment of gonorrheal infections in patients with
documented severe allergic reactions to penicillins or cephalosporins,
updated treatment regimens are available at
http://www.cdc.gov/std/treatment.
A limitation of findings from GISP, which is conducted in publicly funded
clinics and includes only male urethral isolates, is that they might not
be representative of the entire US population infected with gonorrhea.
"We've looking hard for resistance for the duration of the GISP project,
and we've never seen gonorrhea that we would consider to be resistant to
cephalosporins," Dr. Douglas said. "Based on global surveillance, we have
not documented any strains resistant to cephalosporins at all. That's
comforting, of course, but because of the genetic versatility of the
organism, it's not something we feel completely complacent about.
Although test of cure is not recommended routinely for uncomplicated
gonorrhea treated with recommended or alternative regimens, persons with
persistent symptoms of gonococcal infection or whose symptoms recur
shortly after treatment with a recommended or alternative regimen should
be reevaluated by culture for N gonorrhoeae. Positive isolates should be
tested for antimicrobial susceptibility, and clinicians and laboratories
should report treatment failures or resistant gonococcal isolates to the
CDC at the telephone number: 1-404-639-8373, through state and local
public health authorities.
"In [other] Gram-negative bacteria, very highly resistant strains even to
these third generation cephalosporin antibiotics have occurred," Dr.
Douglas concluded. "It's just very hard to know if that could happen [for
N gonorrheae], and when it could happen, but it's certainly not
implausible. Can it happen? Absolutely."
Morbid Mortal Wkly Rep. 2007;56:332-336.
http://www.cdc.gov/std/treatment
http://www.cdc.gov/std/gonorrhea/arg/
Clinical Context
In the United States, gonorrhea is the second most frequently reported
notifiable disease, with 339,593 cases documented in 2005. Although
fluoroquinolones (ciprofloxacin, ofloxacin, or levofloxacin) are highly
effective, readily available, and convenient as single-dose oral therapy
and have been used since 1993 for gonorrhea treatment, prevalence of
fluoroquinolone resistance in N gonorrhoeae has been increasing and is now
widespread.
Beginning in 2000, fluoroquinolones were no longer recommended for
treatment of gonorrhea acquired in Asia or the Pacific Islands (including
Hawaii); in 2002, this recommendation was extended to California; and in
2004, CDC recommended that fluoroquinolones not be used in the United
States to treat gonorrhea in men who have sex with men. This Morbidity and
Mortality Weekly Report article summarizes findings from the GISP and
updates CDC's Sexually Transmitted Diseases Treatment Guidelines, 2006
regarding the treatment of N gonorrhoeae infections.


Disclaimer : Medicines and the cure for gonococal urethritis or Tulo may differ from person to person and it is always advisable to consult a physician whenever possible.

5 Steps to Lower Blood Pressure

Every day, millions of Americans quietly battle a silent killer. High blood pressure is an elevation in the force of blood pushing against the walls of the arteries. It affects one out of every three Americans, according to the American Heart Association (AHA). High blood pressure is considered a major risk factor for heart attack, heart failure and stroke. Untreated high blood pressure can cause the heart to eventually overwork itself to the point at which serious damage can occur. High blood pressure can also cause injury to other areas served by delicate arteries that are damaged by the increased pressure. These include the brain, the eyes (retinopathy) and/or the kidneys (nephropathy). In most cases, there is no cure for high blood pressure. Medication can control high blood pressure, but there are several lifestyle changes you can make to keep your blood pressure lower. What You Can Do There are several things you can do to lower your blood pressure. The top five are:
1)Eat a healthful diet.
Studies have shown that people on the American Heart Association's Dietary Approaches to Stop Hypertension diet, or "DASH" diet, for only eight weeks experienced a significant reduction in blood pressure. The DASH diet emphasizes fruits, vegetables, whole grains and low-fat dairy while limiting saturated fat and red meat.
Excessive sodium intake also has been linked to an increased risk of high blood pressure. Limiting salt intake to 2,000 milligrams per day may help keep blood pressure low. A diet of 1,500 milligrams or less salt is especially effective at controlling blood pressure, according to the National Institutes of Health. Sodium is found in many foods, so keep an eye on the ingredients list to help rein in your sodium intake. In addition, avoid adding table salt to foods.
2)Avoid smoking and excessive drinking.
The nicotine found in tobacco products constricts blood vessels, causing your hear to beat faster and raising blood pressure for a period of time. Smoking also damages blood vessel walls and hardens the arteries, which both increase the risk of high blood pressure.
Alcohol consumption has a significant impact on blood pressure in some people. Limit alcohol use to one drink per day for women and two drinks per day for men. One drink is defined as one 6-ounce glass of wine per day, one 12-ounce beer or one 1-ounce shot of distilled spirits.
3)Get regular exercise.
Exercising three to four times per week helps regulate high blood pressure, keeping in mind that the regularity of the exercise is more important than the intensity of the workout. Individuals should consult their physician before starting an exercise program.
To be effective, the exercise must be aerobic, meaning it must move large muscle groups and cause you to both breathe more deeply and to push your heart to work harder to pump blood. However, your activity level does not need to be especially intense. For example, studies have shown that tai chi (an ancient Chinese workout involving slow, relaxing movements) may lower blood pressure almost as well as moderately intense aerobics.
4)Lose weight.
Shedding pounds, especially in the abdominal area, can immediately lower blood pressure and help reduce the size of the heart. A loss of just 10 pounds can make a significant difference. In many people, a simple combination of weight loss and salt restriction eliminates the need for taking blood-pressure medication.
5)Try to relax.
Emotional factors may play important roles in the development of high blood pressure. Studies have linked numerous activities to reducing blood pressure. These include cognitive-behavioral therapy, transcendental meditation, active religious faith and participation in activities related to a faith community. Other research has linked owning a pet with lower overall blood pressure. Relaxation techniques typically work best when they are employed at least once a day.

Main On TV iVillage

New Guidelines Issued for Food Allergies

New Guidelines Issued for Food Allergies News Author: Laurie Barclay, MD

In children of parents with asthma, the rate of observed food allergy may be 4 times higher than in the general population. IgE-mediated food reactions may occur as a result of gastrointestinal sensitization, respiratory tract sensitization, or sensitization through the epidermis. Immune responses include acute IgE-mediated, local inhalational, systemic, and cell-mediated reactions (eg, atopic dermatitis and celiac disease). Sensitivity to most food allergens, such as milk, wheat, and egg, tend to remit in late childhood. Sensitivity to peanut, tree nuts (walnuts, cashew, Brazil nut, pistachio), and seafood are likely to continue throughout life. Allergies to fruits and vegetables tend to develop later in life as a consequence of shared homologous proteins with airborne allergens (eg, pollen). Anaphylaxis after exposure to foods reflects reactions of respiratory, dermatologic, cardiovascular, and other organ systems. In children, anaphylaxis occurs most commonly after ingestion of peanuts, other legumes, tree nuts, fish, shellfish, milk, and eggs. Diagnosis requires a detailed history of exposures and targeted physical examination. Initial evaluation may include skin prick or puncture tests. Commercial food extracts with stable proteins (eg, peanut, milk, egg, tree nuts, fish, shellfish) are reliable to detect IgE antibodies in most patients. Extracts from foods with more labile proteins (eg, many fruits and vegetables) are less reliable for diagnosis. Intradermal skin tests are not recommended as they are dangerous. A positive skin test has a positive predictive value (PPV) of less than 50% (ie, not specific) but a negative skin test has a negative predictive value (NPV) of more than 95% (ie, highly sensitive) and can reliably rule out IgE-mediated food allergy. Double-blind, placebo-controlled food challenge is most likely to provide a high PPV in conjunction with a careful history. In vitro serum tests are useful in patients with a history of life-threatening reaction, with medical conditions, a nonreactive histamine control, and in pregnant women. If a patient has a history of anaphylactic reaction with a positive test for IgE specific antibodies, no further evaluation is usually required. Provocation-neutralization is considered disproved as a diagnostic method. Hair analysis, food-specific IgG, cytotoxic tests, and immune complex assays are considered experimental or unproven. Adverse reactions to food additives (such as tartrazine) are rare.
Monosodium glutamate is a rare cause of angioedema, urticaria, or bronchospasm in patients with asthma. Sulfites produce bronchospasm in 5% of the population with asthma. Food allergy prevention strategies include breast-feeding, maternal dietary restriction during breast-feeding, late introduction of solids and allergenic foods, and the use of hypoallergenic infant formulas although effectiveness of the strategies has not been established. Avoidance of allergens is the key management strategy. Because elimination diets may lead to malnutrition or other serious adverse effects (eg, personality change), every effort should be made to ensure that the dietary needs of the patient are met and that the patient and/or caregiver(s) are fully educated in dietary management measures to prevent inadvertent exposure to known or suspected allergens. Injectable epinephrine should be given to patients or caregivers of patients with a history of IgE-mediated systemic reactions. Delay in epinephrine administration is the most common cause of fatalities, with peanuts and tree nuts accounting for most fatal and near-fatal reactions.

Contraceptive for Nursing Mothers

I’m a 24 mother, nursing my 9 month old daughter and I’m afraid of getting pregnant, Dok, Is there a contraceptive pill that I can take?

Yes, you may take Lynestrenol( Exluton Tab) 1 tablet daily at the same time of the day without interruption for 28 consecutive days.May be taken with or without food.

SIDE-EFFECTS AND SPECIAL PRECAUTIONS
(a)
During the first few months of treatment irregular loss of blood may occur. Experience has shown that this is almost certainly a temporary problem. If it should occur, tablet taking should not be interrupted. If the irregular bleeding is severe or prolonged, the doctor should be consulted.
(b)
Occasionally menstruation fails to occur. If the tablets have been taken as directed, this will almost certainly not mean that the patient is pregnant. Tablet-taking should not be interrupted. If the bleeding is more than one month late, the patient must consult her doctor in order to rule out the possibility of pregnancy. She may of course consult her doctor earlier, if wanted.
(c)
Nausea, headache and breast tenderness may also be experienced during the initial months of treatment, but these are only temporary symptoms.
(d)
During the use of oral contraceptives the body mass may increase. Experience has shown that the body mass stabilizes after some time and, in most cases, can be easily controlled by diet.
(e)
Symptoms such as sudden and severe headache, pain in the chest, visual disturbances, and a swollen arm or leg require medical examination.
(f)
By regular medical control it is possible to detect thromboembolic processes (thrombophlebitis; cerebrovascular disorders, pulmonary embolism and retinal thrombosis) in an earlier stage. The use of the preparation should be stopped immediately in these cases.

Studies in England and in the United States have shown that women using oral contraceptives run a greater risk of thrombosis than non-users. As to how far this applies also to Exluton, which contains no oestrogenic substance, is not known. For the time being, it seems advisable to observe the same caution when using this preparation.
(g)
If jaundice should occur during the use of the product, administration should be discontinued immediately.
(h)
Since the glucose tolerance may diminish during the use of oral contraceptives, diabetic patients should be kept under strict control.
(i)
Because fluid retention may sometimes be possible during the use of the product, conditions which might be influenced by this factor, such as cardiac or renal dysfunction, epilepsy, migraine and asthma, require careful observation.
(j)
Caution should be observed in young women whose cycles are not yet established.
(k)
Since oral contraceptives may cause an increase of blood pressure in predisposed women, this should be checked regularly. In case of serious hypertension, further administration of the preparation should be withheld.
(l)
In case no withdrawal bleeding occurs it is advisable to rule out pregnancy. Important in this respect is, of course the question of whether tablets have been forgotten. If no bleeding has occurred in two consecutive cycles pregnancy should be ruled out anyway.
(m)
It is advisable to perform periodic physical examination once every 3 months during the first year of treatment and once every 6 months thereafter. These examinations should include special reference to duration of the cycle, body mass, blood pressure, breasts, pelvic organs, legs and skin

Allergic Rhinitis

CC., 42 year old, female, married, visited the clinic for frequent sneezing usually in the morning occurring for more than a month, with associated watery nasal congestion clearing after a few hours, occasional itchy eyes with no fever and body pain. Patient claims symptoms started when they moved in a new apartment.
After careful history and thorough physical examination, patient was advised on appropriate environmental measures and was given :

Cetirizine 20mg tab daily
Momethasone Aqueous Nasal Spray 2 sprays in each nostril once daily


Characteristic physical appearance of patients with allergy

Eyes
Patients may have injected conjunctiva; increased lacrimation; and
long, silky eyelashes.
Dennie-Morgan lines (creases in the lower eyelid skin) and allergic
Shiners (dark discoloration below the lower eyelids) caused by venous
stasis may be present.

Nose
A transverse nasal crease may be present because of the patient's
repeated lifting of the nasal tip to relieve itching and open the
nasal airway.
The turbinates are frequently hypertrophic and covered with a boggy
pale or bluish mucosa.
Nasal secretions can range from clear and profuse to stringy and
mucoid.
The presence of polyps does not necessarily indicate that the affected
individual has allergic rhinitis.

Face
Patients with allergic rhinitis frequently grimace and twitch their
face, in general, and nose, in particular, because of itchy mucus
membranes.
Chronic mouth breathing secondary to nasal congestion can result in
the typical adenoid facies.

Environmental controls and Avoidance of Allergens

Individuals who have seasonal allergies should avoid outdoor activities
when allergens are in the air. Home, rooms and workplace
should be kept as clean as possible since
house dust mites thrive in warm, humid conditions, and the antigen is
found in their feces. Control measures include removing reservoirs
like carpets, stuffed toys and heavy drapes.

How do I perform CPR ?

Dok , I saw someone who almost drowned in the beach yesterday, how do i perform CPR ?

Cardiopulmonary resuscitation (CPR) is a lifesaving technique useful in many emergencies, including heart attack or near drowning, in which someone's breathing or heartbeat has stopped. CPR involves a combination of chest compression and mouth-to-mouth rescue breathing that keeps oxygenated blood flowing to the brain and other vital organs until more definitive medical treatment can restore a normal heart rhythm. When the heart stops, the absence of oxygenated blood can cause irreparable brain damage in only a few minutes. Death will occur within eight to 10 minutes. Time is critical when you're helping an unconscious person who isn't breathing. To learn CPR properly, take an accredited first-aid training course, including CPR and how to use an automatic external defibrillator (AED). Before you beginAssess the situation before starting CPR: Is the person conscious or unconscious? If the person appears unconscious, tap or shake his or her shoulder and ask loudly, "Are you OK?" If the person doesn't respond and two people are available, one should call 911 or the local emergency number and one should begin CPR. If you are alone and have immediate access to a telephone, call 911 before beginning CPR — unless you think the person has become unresponsive because of suffocation (such as from drowning). In this special case, begin CPR for one minute and then call 911. If an AED is immediately available, deliver one shock if advised by the device, then begin CPR. Remember the ABCs Think ABC — Airway, Breathing and Circulation — to remember the steps explained below. Move quickly through Airway and Breathing to begin chest compressions. AIRWAY: Clear the airway Put the person on his or her back on a firm surface. Kneel next to the person's neck and shoulders. Open the person's airway using the head-tilt, chin-lift maneuver. Put your palm on the person's forehead and gently tilt the head back. Then with the other hand, gently lift the chin forward to open the airway. Check for normal breathing, taking no more than five or 10 seconds: Look for chest motion, listen for breath sounds, and feel for the person's breath on your cheek and ear. Gasping is not considered to be normal breathing. If the person isn't breathing normally and you are trained in CPR, begin mouth-to-mouth breathing. If you believe the person is unconscious from a heart attack and you haven't been trained in emergency procedures, skip mouth-to-mouth rescue breathing and proceed directly to chest compression. BREATHING: Breathe for the personRescue breathing can be mouth-to-mouth breathing or mouth-to-nose breathing if the mouth is seriously injured or can't be opened. With the airway open (using the head-tilt, chin-lift maneuver) pinch the nostrils shut for mouth-to-mouth breathing and cover the person's mouth with yours, making a seal. Prepare to give two rescue breaths. Give the first rescue breath — lasting one second — and watch to see if the chest rises. If it does rise, give the second breath. If the chest doesn't rise, repeat the head-tilt, chin-lift maneuver and then give the second breath. Begin chest compressions to restore circulation. CIRCULATION: Restore blood circulation with chest compressions Place the heel of one hand over the center of the person's chest, between the nipples. Place your other hand on top of the first hand. Keep your elbows straight and position your shoulders directly above your hands. Use your upper body weight (not just your arms) as you push straight down on (compress) the chest 2 inches (approximately 5 centimeters). Push hard and push fast — give two compressions per second, or about 120 compressions per minute. After 30 compressions, tilt the head back and lift the chin up to open the airway. Prepare to give two rescue breaths. Pinch the nose shut and breathe into the mouth for one second. If the chest rises, give a second rescue breath. If the chest doesn't rise, repeat the head-tilt, chin-lift maneuver and then give the second rescue breath. That's one cycle. If someone else is available, ask that person to give two breaths after you do 30 compressions. If the person has not begun moving after five cycles (about two minutes) and an automatic external defibrillator (AED) is available, apply it and follow the prompts. The American Heart Association recommends administering one shock, then resuming CPR — starting with chest compressions — for two more minutes before administering a second shock. If you're not trained to use an AED, a 911 operator may be able to guide you in its use. Trained staff at many public places are also able to provide and use an AED. Use pediatric pads, if available, for children ages 1 to 8. Do not use an AED for infants younger than age 1. If an AED isn't available, go to No. 5 below. Continue CPR until there are signs of movement or until emergency medical personnel take over. To perform CPR on a child: The procedure for giving CPR to a child age 1 through 8 is essentially the same as that for an adult. The differences are as follows: If you're alone, perform five cycles of compressions and breaths on the child — this should take about two minutes — before calling 911 or your local emergency number or using an AED. Use only one hand to perform heart compressions. Breathe more gently. Use the same compression-breath rate as is used for adults: 30 compressions followed by two breaths. This is one cycle. Following the two breaths, immediately begin the next cycle of compressions and breaths. After five cycles (about two minutes) of CPR, if there is no response and an AED is available, apply it and follow the prompts. Use pediatric pads if available. If pediatric pads aren't available, use adult pads. Continue until the child moves or help arrives. To perform CPR on a baby: Most cardiac arrests in infants occur from lack of oxygen, such as from drowning or choking. If you know the infant has an airway obstruction, perform first aid for choking. If you don't know why the infant isn't breathing, perform CPR. To begin, assess the situation. Stroke the baby and watch for a response, such as movement, but don't shake the child. If there's no response, follow the ABC procedures below and time the call for help as follows: If you're the only rescuer and CPR is needed, do CPR for two minutes — about five cycles — before calling 911 or your local emergency number. If another person is available, have that person call for help immediately while you attend to the baby. AIRWAY: Clear the airway Place the baby on his or her back on a firm, flat surface, such as a table. The floor or ground also will do. Gently tip the head back by lifting the chin with one hand and pushing down on the forehead with the other hand. In no more than 10 seconds, put your ear near the baby's mouth and check for breathing: Look for chest motion, listen for breath sounds, and feel for breath on your cheek and ear. If the infant isn't breathing, begin mouth-to-mouth breathing immediately. BREATHING: Breathe for the infant Cover the baby's mouth and nose with your mouth. Prepare to give two rescue breaths. Use the strength of your cheeks to deliver gentle puffs of air (instead of deep breaths from your lungs) to slowly breathe into the baby's mouth one time, taking one second for the breath. Watch to see if the baby's chest rises. If it does, give a second rescue breath. If the chest does not rise, repeat the head-tilt, chin-lift maneuver and then give the second breath. If the chest still doesn't rise, examine the mouth to make sure no foreign material is inside. If the object is seen, sweep it out with your finger. If the airway seems blocked, perform first aid for a choking infant. Begin chest compressions to restore circulation. CIRCULATION: Restore blood circulation Imagine a horizontal line drawn between the baby's nipples. Place two fingers of one hand just below this line, in the center of the chest. Gently compress the chest to about one-third to one-half the depth of the chest. Count aloud as you pump in a fairly rapid rhythm. You should pump at a rate of about 100 to 120 pumps a minute. Give two breaths after every 30 chest compressions. Perform CPR for about two minutes before calling for help unless someone else can make the call while you attend to the baby. Continue CPR until you see signs of life or until a professional relieves you.

Penile Discharge "Tulo"

A 24 year old, male, married, OFW, visited the clinic for a light yellow discharge coming out of his penis for the past 3 days, staining his underwear, he also complains of pain during urination. He admitted having sexual intercourse with a prostitute about 5 days before symptoms appeared. He is scheduled to depart for the Middle East in 3 days.
After physical examination and confirming the creamy penile discharge, with no laboratory test and no possibility of follow up, I gave the following meds.
1) Doxycycline 100mg tab. 2 tablets initially then 1 tablet every 12 hours(2xday) for 10 days plus
2) Cefixime 200mg Tab , 1 tab every 12 hours for 5 days

Gonococcal urethritis (check my latest blog on GC Urethritis,"Tulo" here -http://wazzupdok.blogspot.com/2010/12/tulo-or-gonococcal-urethritis.html

Gonorrhoea is caused by the bactterium Neisseria gonorrhoeae that grow and multiply in the reproductive tract of women(cervix ,uterus, fallopian tubes) and men (urethra). The bacteria can also multiply in eyes, mouth, throat and anus.

Incubation period usually takes two to five days from infection to symptoms and without treatment,the symptoms of urethritis (inflammation of the urethra) and purulent (pus-containing) discharge peak within two weeks.

Most notable symptom is the penile discharge which occurs in 95 per cent of men and is purulent in 75 per cent, white or cloudy in 10 per cent and clear in 5 per cent. Recent urination can make the discharge appear less purulent. When the infection begins to resolve, the discharge changes from purulent to mucoid (mucus-like).

Transmission of the disease is usually by sexual intercourse, including oral sex and without treatment, the infection can continue for many months.

Complications can occur and spread up the urethra to the epididymis (sperm-storing tube connected to the testicles) but is rare and infertility can be a rare late complication. Anal infection is common especially, but not only, when the infection is transmitted by anal intercourse. Bloodstream infection occurs in less than 1 per cent of patients, causing arthritis of the knees, wrists and hands plus fever, chills and skin lesions, usually papules or pustules (red or pus-containing raised spots or bumps) on the hands or feet.

Reminder: Article was written as a physician's personal experience and should be viewed for information and guide only, and was not intended to replace actual consultation with a medical practitioner.

Photos and Images compiled fromGoogle.com