Archive for December, 2010

PULMONARY TUBERCULOSIS: TREATMENT FAILURE

Author: admin Post Date: December 29 2010
Patient noncompliance and the development of drug resistance are the two most common reasons for failure of an appropriate tuberculosis regimen. If a patient continues to have positive results of mycobacterial smears or cultures at 3 months, an investigation into the cause of the treatment failure should be undertaken. It is often very difficult to evaluate patient compliance, and if a patient is self-administering medications, a switch to directly observed therapy should be made. To evaluate for drug resistance, repeat cultures with drug susceptibilities should be undertaken. If the possibility of drug resistance is suspected, adding two or more agents (to which the organism is likely to be susceptible) is recommended. A single drug should never be added to a failing regimen. If second-line agents are required, three or more drugs should be added to the treatment regimen.
Inappropriate initial regimens, inadequate dosing, and adding a single drug to a failing regimen have all been associated with treatment failure, the development of drug resistance, and poor patient outcomes. This has been shown to occur more frequently when the patient is treated by a private physician, who typically has less experience in treating tuberculosis, then by public clinics that are more experienced in the management of tuberculosis.
*64/348/5*

PULMONARY TUBERCULOSIS: TREATMENT FAILUREPatient noncompliance and the development of drug resistance are the two most common reasons for failure of an appropriate tuberculosis regimen. If a patient continues to have positive results of mycobacterial smears or cultures at 3 months, an investigation into the cause of the treatment failure should be undertaken. It is often very difficult to evaluate patient compliance, and if a patient is self-administering medications, a switch to directly observed therapy should be made. To evaluate for drug resistance, repeat cultures with drug susceptibilities should be undertaken. If the possibility of drug resistance is suspected, adding two or more agents (to which the organism is likely to be susceptible) is recommended. A single drug should never be added to a failing regimen. If second-line agents are required, three or more drugs should be added to the treatment regimen.Inappropriate initial regimens, inadequate dosing, and adding a single drug to a failing regimen have all been associated with treatment failure, the development of drug resistance, and poor patient outcomes. This has been shown to occur more frequently when the patient is treated by a private physician, who typically has less experience in treating tuberculosis, then by public clinics that are more experienced in the management of tuberculosis.*64/348/5*

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BDD BEHAVIOURS – DOCTOR SHOPPING: THE NEVER-ENDING QUEST

Author: admin Post Date: December 20 2010
I got a call one morning from a psychiatrist in Boston who needed some advice about a patient. “He’s seeing all the ophthalmologists in Boston,” he told me. “He thinks his eyes look cross-eyed, and he can’t be reassured that they’re not. He’s seeing doctor after doctor. They all tell him he looks fine, but he won’t stop doctor shopping. He wants to get his eyes fixed.”
This story isn’t unusual. Many people with BDD seek nonpsychiatric treatment, often dermatologic or surgical. They see dermatologists for slight or nonexistent hair loss or skin problems, requesting various types of treatment. They see surgeons to have their lips thickened, jaws widened, ears pinned, or breasts enlarged. They see endocrinologists for supposedly excessive or insufficient body hair, dentists for braces, orthopedic surgeons for a supposedly crooked spine, podiatrists for “bent” toes, and urologists for penis enlargement. They may see doctor after doctor, trying to find one who will provide the desired treatment. Others visit nonprofessionals, seeking electrolysis, a hairpiece, or hair-growth tonics. There’s no limit to the types of treatment requested.
“Seeing doctors is an obsession for me,” Victoria told me. “I’m looking for something from them. I want to keep some until I find out the answer. I’ve seen all types—general practitioners, orthopedists, and podiatrists. I’m trying to find someone who can tell me why my feet are so misshapen. They all tell me that nothing’s wrong with my feet. One doctor said my problem was that I had an obsession with body image. I agree that I have a body image problem because I’m so obsessed, but I also need to find out what’s wrong with my feet.”
Doctors are seen for various reasons: to diagnose a perceived appearance problem, do testing to determine the cause of the perceived problem, obtain reassurance that it looks okay, or give treatment. They may be asked to provide
treatment after treatment, or to redo a disappointing procedure done by themselves or another physician. ‘
Jennifer had seen at least 15 different dermatologists. She visited each of them repeatedly, asking them over and over if her skin looked okay. “I saw some of them several times a week,” she said. “I couldn’t be reassured that my skin was fine. I wouldn’t go away. I asked and asked them about my skin, and I begged and begged them for treatment. A lot of them refused to see me anymore.”
*107\204\8*

BDD BEHAVIOURS – DOCTOR SHOPPING: THE NEVER-ENDING QUESTI got a call one morning from a psychiatrist in Boston who needed some advice about a patient. “He’s seeing all the ophthalmologists in Boston,” he told me. “He thinks his eyes look cross-eyed, and he can’t be reassured that they’re not. He’s seeing doctor after doctor. They all tell him he looks fine, but he won’t stop doctor shopping. He wants to get his eyes fixed.”This story isn’t unusual. Many people with BDD seek nonpsychiatric treatment, often dermatologic or surgical. They see dermatologists for slight or nonexistent hair loss or skin problems, requesting various types of treatment. They see surgeons to have their lips thickened, jaws widened, ears pinned, or breasts enlarged. They see endocrinologists for supposedly excessive or insufficient body hair, dentists for braces, orthopedic surgeons for a supposedly crooked spine, podiatrists for “bent” toes, and urologists for penis enlargement. They may see doctor after doctor, trying to find one who will provide the desired treatment. Others visit nonprofessionals, seeking electrolysis, a hairpiece, or hair-growth tonics. There’s no limit to the types of treatment requested.”Seeing doctors is an obsession for me,” Victoria told me. “I’m looking for something from them. I want to keep some until I find out the answer. I’ve seen all types—general practitioners, orthopedists, and podiatrists. I’m trying to find someone who can tell me why my feet are so misshapen. They all tell me that nothing’s wrong with my feet. One doctor said my problem was that I had an obsession with body image. I agree that I have a body image problem because I’m so obsessed, but I also need to find out what’s wrong with my feet.”Doctors are seen for various reasons: to diagnose a perceived appearance problem, do testing to determine the cause of the perceived problem, obtain reassurance that it looks okay, or give treatment. They may be asked to providetreatment after treatment, or to redo a disappointing procedure done by themselves or another physician. ‘Jennifer had seen at least 15 different dermatologists. She visited each of them repeatedly, asking them over and over if her skin looked okay. “I saw some of them several times a week,” she said. “I couldn’t be reassured that my skin was fine. I wouldn’t go away. I asked and asked them about my skin, and I begged and begged them for treatment. A lot of them refused to see me anymore.”*107\204\8*

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ASTHMA IN CHILDREN: THE INHALED ALLERGENS – OUTDOOR ALLERGENS -FUNGI ALLERGY

Author: admin Post Date: December 13 2010
Next to pollens, spores of different fungi present in the air are the most common cause of allergy.
During the rainy season, a green or white fibrous growth often appears on bread left unused for a few days; this also happens on shoes left unused. These fibrous growths, which appear in humid weather, are known as moulds or fungi. Fungi are simple plants, very small in size. They have no chlorophyll. They generally reproduce by means of spores.
Most fungi perform a useful function in nature. They act as scavengers, converting live and dead material into basic chemicals, which in turn nurture new life. Antibiotics, like penicillin and streptomycin are made from them. Alcohol, wine, cheese and certain bakery products are made by using fungi.
Controlling Indoor Fungi
Avoid basements for storage of food.
Walls should be plastered and painted so that they do not absorb any moisture and remain dry.
All rooms and spaces inside the house should have effective ventilation.
Potted plants should not be kept indoors.
28\260\8*

ASTHMA IN CHILDREN: THE INHALED ALLERGENS – OUTDOOR ALLERGENS -FUNGI ALLERGYNext to pollens, spores of different fungi present in the air are the most common cause of allergy.During the rainy season, a green or white fibrous growth often appears on bread left unused for a few days; this also happens on shoes left unused. These fibrous growths, which appear in humid weather, are known as moulds or fungi. Fungi are simple plants, very small in size. They have no chlorophyll. They generally reproduce by means of spores.Most fungi perform a useful function in nature. They act as scavengers, converting live and dead material into basic chemicals, which in turn nurture new life. Antibiotics, like penicillin and streptomycin are made from them. Alcohol, wine, cheese and certain bakery products are made by using fungi.Controlling Indoor FungiAvoid basements for storage of food.Walls should be plastered and painted so that they do not absorb any moisture and remain dry.All rooms and spaces inside the house should have effective ventilation.Potted plants should not be kept indoors.28\260\8*

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