Respiratory distress syndrome is a complication of SHOCK, systemic SEPSIS and viral respiratory infections. It was ?rst described in 1967, and – despite advances with assisted ventilation
– remains a serious disease with a mortality of more than 50 per cent. The maintenance of adequate circulating blood volume, peripheral PERFUSION, acid-base balance and arterial oxygenation is important, and assisted ventilation should be instituted early.
In newborns the mechanism is diferent, being provoked by an inability of the lungs to manufacture SURFACTANT.... respiratory distress syndrome
The exact trigger is unknown, but it is thought that, whatever the stimulus, chemical mediators produced by cells of the immune system or elsewhere in the body spread and sustain an in?ammatory reaction. Cascade mechanisms with multiple interactions are provoked. CYTOTOXIC substances (which damage or kill cells) such as oxygen-free radicals and PROTEASE damage the alveolar capillary membranes (see ALVEOLUS). Once this happens, protein-rich ?uid leaks into the alveoli and interstitial spaces. SURFACTANT is also lost. This impairs the exchange of oxygen and carbon dioxide in the lungs and gives rise to the clinical and pathological picture of acute respiratory failure.
The typical patient with ARDS has rapidly worsening hypoxaemia (lack of oxygen in the blood), often requiring mechanical ventilation. There are all the signs of respiratory failure (see TACHYPNOEA; TACHYCARDIA; CYANOSIS), although the chest may be clear apart from a few crackles. Radiographs show bilateral, patchy, peripheral shadowing. Blood gases will show a low PaO2 (concentration of oxygen in arterial blood) and usually a high PaCO2 (concentration of carbon dioxide in arterial blood). The lungs are ‘sti?’ – they are less e?ective because of the loss of surfactant and the PULMONARY OEDEMA.
Causes The causes of ARDS may be broadly divided into the following:... acute respiratory distress syndrome (ards)
Diagnosis and treatment Any person with isolated, itching, dry and scaling lesions of the skin with no obvious cause – for example, no history of eczema (see DERMATITIS) – should be suspected of having a fungal infection. Such lesions are usually asymmetrical. Skin scrapings or nail clippings should be sent for laboratory analysis. If the lesions have been treated with topical steroids they may appear untypical. Ultraviolet light ?ltered through glass (Wood’s light) will show up microsporum infections, which produce a green-blue ?uorescence.
Fungal infections used to be treated quite e?ectively with benzoic-acid compound ointment; it has now been superseded by new IMIDAZOLES preparations, such as CLOTRIMAZOLE, MICONAZOLE and terbina?ne creams. The POLYENES, NYSTATIN and AMPHOTERICIN B, are e?ective against yeast infections. If the skin is macerated it can be treated with magenta (Castellani’s) paint or dusting powder to dry it out.
Refractory fungal infection can be treated systematically provided that the diagnosis of the infection has been con?rmed. Terbina?ne, imidazoles and GRISEOFULVIN can all be taken by mouth and are e?ective for yeast infections. (Griseofulvin should not be taken in pregnancy or by people with liver failure or porphyria.) (See also FUNGUS; MICROBIOLOGY.)... fungal and yeast infections
– for example, METHICILLIN-RESISTANT STAPHYLOCOCCUS AUREUS (MRSA). This makes hospital-acquired infections potentially dangerous and sometimes life-threatening, and is one of the developments that is prompting calls for greater care in the prescribing of antibiotics as well as higher standards of cleanliness.... hospital-acquired infection
Symptoms. Irregular bleeding and moderate pain. Women can still have the infection but no symptoms. Damage to the fallopian tubes possible. Sterility may follow neglect.
Treatment. Formula. Echinacea 2; Goldenseal 1; Myrrh half. Mix. Dose: Powders: 250mg (one 00 capsule or one-sixth teaspoon). Liquid extracts: 15-30 drops. Tinctures: 30-60 drops. Thrice daily in water, honey or fruit juice.
Topical. Douche: 10 drops Liquid extract or Tincture Goldenseal in an ounce (30ml) Rosewater or Distilled extract Witch Hazel. If the condition persists for more than a month, add 10 drops Kava Kava. Diet. Dandelion coffee.
On retiring at night. 2-3 Garlic tablets/capsules.
Treatment by a general medical practitioner or hospital specialist. ... chlamydial infection
Tinctures. Formula. Echinacea 3; Goldenseal 1; Myrrh quarter. One teaspoon in water every 2 hours (acute) thrice daily (chronic). ... coxsackie infection
A study carried out at Moorfields Eye Hospital, London, has shown that those who use extended-wear soft contact lenses are more likely to develop microbial keratitis than users of other lenses.
Treatment. Internal: Powders, Tinctures or Liquid Extracts. Combine Echinacea 2; Blue Flag 1; Goldenseal 1. Doses: Powders: 500mg (one-third teaspoon or two 00 capsules). Liquid Extracts 30-60 drops.
Tinctures: 1-2 teaspoons. In water, or honey.
Comfrey. To promote epithelial regeneration. Potential benefit far outweighs possible risk.
Evening Primrose capsules.
Topical. Alternatives. (1) Goldenseal Eye Lotion: 1 part Goldenseal root macerated in 40 parts distilled extract of Witch Hazel 2-3 days. Strain. 5-10 drops in eyebath half filled with warm water; douche. Wipe eyelids. (2) Aloe Vera juice or gel. (3) Moisten Chamomile teabag with warm water and fix over eye for styes, etc. (4) Bathe with Periwinkle minor tea: 2 teaspoons to cup boiling water allowed to cool and strain. (5) Elderflower water. The above to relieve pain, redness and gritty sensation. (6) Evening Primrose lotion. (7) Raw carrot compress to ripen stye. Nasturtium seed compress.
Supplements. Daily. Vitamin A 7500iu, Vitamin B2 10mg, Vitamin C 3g, Vitamin E 400iu, Zinc 15mg. Referral to consultant ophthalmologist. ... eyes – infection
whose immune system is impaired.
In most patients with AIDS, death is due to opportunistic infections, especially pneumocystis pneumonia.
Many fungal infections, such as candidiasis, and some viral infections, such as herpes simplex, are opportunistic infections.
Treatment is with appropriate antimicrobial drugs.... opportunistic infection
Treatment is with ventilation and oxygen for the underlying cause.... respiratory failure
Most urinary tract stones are composed of calcium oxalate or other salts crystallized from the urine. These may be associated with a diet rich in oxalic acid (found in leafy vegetables and coffee); high levels of calcium in the blood as a result of hyperparathyroidism; or chronic dehydration. Other types of stone are associated with gout and some cancers. An infective stone is usually a result of chronic urinary tract infection.
In developing countries, bladder stones usually occur as a result of dietary deficiencies. In developed countries, they are usually caused by an obstruction to urine flow from the bladder and/or a longstanding urinary tract infection.
The most common symptom of a stone in the kidney or ureter is renal colic (a severe pain in the loin) that may cause nausea and vomiting. There may be haematuria (blood in the urine). A bladder stone is usually indicated by difficulty in passing urine. The site of the stone can usually be confirmed by intravenous or retrograde urography.
Renal colic is treated with bed rest and an opioid analgesic (painkiller).
With an adequate fluid intake, small stones are usually passed in the urine without problems.
The first line of treatment for larger stones is lithotripsy, which uses ultrasonic or shock waves to disintegrate the stones.
Alternatively, cytoscopy can be used to crush and remove stones in the bladder and lower ureter.
In some cases, surgery may be needed.... calculus, urinary tract
Practising safer sex can help prevent STIs.... sexually transmitted infections
Different types of staphylococci are responsible for a variety of disorders, including skin infections such as pustules, boils, and abscesses, and a rash in newborn babies (see necrolysis, toxic epidermal); pneumonia; toxic shock syndrome in menstruating women; urinary tract infection; food poisoning; and, if the bacteria enter the circulation, septic shock, infectious arthritis, osteomyelitis, or bacterial endocarditis.... staphylococcal infections
The first, CHLAMYDIA TRACHOMATIS, has a number of strains. In men, it is a major cause of nongonococcal urethritis, which may cause a discharge from the penis. In women, the infection is usually symptomless, but it can lead to salpingitis. A baby born to a woman with chlamydial infection may acquire an acute eye condition called neonatal ophthalmia. In parts of Africa and Asia, certain strains of CHLAMYDIA TRACHOMATIS cause trachoma, a serious eye disease.
A second species of chlamydiae, CHLAMYDIA PSITTACI, mainly affects birds but can occasionally spread to people who have contact with pigeons, parrots, parakeets, or poultry, causing a type of pneumonia called psittacosis.
Treatment for chlamydial infections is with antibiotic drugs.... chlamydial infections
Immunization is available against certain food- and water-borne infections such as typhoid fever.... food-borne infection
A particular type, haemolytic streptococci, can cause tonsillitis, strep throat, scarlet fever, otitis media, pneumonia, erysipelas, and wound infections.
Another type is often responsible for urinary tract infection, and another can cause bacterial endocarditis if it enters the bloodstream.... streptococcal infections
Fungal infections are therefore more common and serious in people taking long-term antibiotic drugs (which destroy the bacterial competition) and in those whose immune systems are suppressed by immunosuppressant drugs, corticosteroid drugs, or by a disorder such as AIDS. Such serious fungal infections are described as opportunistic infections. Some fungal infections are more common in people with diabetes mellitus.
Fungal infections can be classified into superficial (affecting skin, hair, nails, inside of the mouth, and genital organs); subcutaneous (beneath the skin); and deep (affecting internal organs).
The main superficial infections are tinea (including ringworm and athlete’s foot) and candidiasis (thrush), both of which are common. Subcutaneous infections, which are rare, include sporotrichosis and mycetoma. Deep infections are uncommon but can be serious and include aspergillosis, histoplasmosis, cryptococcosis, and blastomycosis. The fungal spores enter the body by inhalation.
Treatment of fungal infections is with antifungal drugs, either used topically on the infected area or given by mouth for generalized infections.... fungal infections
Infections acquired during birth are almost always the result of microorganisms in the mother’s vaginal secretions or uterine fluid. Premature rupture of the membranes is associated with increased risk of infection, particularly streptococcal. Conditions that can be acquired during delivery include herpes, chlamydial infections, and gonorrhoea.
Treatment of the baby depends on the type of infection. Some birth defects caused by infection (such as certain types of heart defect) can be treated; others (such as congenital deafness) are usually not treatable.... infection, congenital
In both sexes, causes of urinary tract infections include stones (see calculus, urinary tract), bladder tumours, congenital abnormalities of the urinary tract, or defective bladder emptying as a result of spina bifida or a spinal injury. The risks of developing a urinary tract infection can be reduced by strict personal hygiene, drinking lots of fluids, and regularly emptying the bladder.
Urethritis can lead to the formation of a urethral stricture. Cystitis usually only causes complications if the infection spreads to the kidneys. Pyelonephritis, if it is left untreated, can lead to permanent kidney damage, septicaemia, and septic shock.
The infection is diagnosed by the examination of a urine culture. Further investigations using urography or ultrasound scanning may be necessary. Most infections of the urinary tract are treated with antibiotic drugs.... urinary tract infection
Swimming in polluted water should be avoided because, if swallowed, there is a risk of contracting disease. In addition, a form of leptospirosis is caused by contact with water contaminated by rat’s urine. In tropical countries, there is also a risk of contracting schistosomiasis (bilharzia), which is a serious disease caused by a fluke that can burrow through the swimmer’s skin.... water-borne infection
respiratory distress syndrome (RDS; hyaline membrane disease) the condition of a newborn infant in which the lungs are imperfectly expanded. Initial inflation and normal expansion of the lungs requires the presence of a substance (*surfactant) that reduces the surface tension of the air sacs (alveoli) and prevents collapse of the small airways. Without surfactant the airways collapse, leading to inefficient and ‘stiff’ lungs. The condition is most common and serious among preterm infants, in whom surfactant may be deficient. It lasts 5–10 days, with worsening on days 2–3. Breathing is rapid, laboured, and shallow, and microscopic examinations of lung tissue in fatal cases has revealed the presence of *hyalin material in the collapsed air sacs. The condition is treated by careful nursing, intravenous fluids, and oxygen, with or without positive-pressure ventilation (see noninvasive ventilation). Early surfactant replacement therapy has been shown to reduce the severity of RDS and when given prophylactically it has been demonstrated to improve clinical outcome. See also adult respiratory distress syndrome.... respiratory distress
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