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By: Simon G. Stacey

  • Consultant Anaesthetist & Intensivist, Bart's Heart Centre, Bart's and The London NHS Trust, London, UK

Specific bacterial infections Meningococcal infection Meningococcal infection is a disease that strikes fear intobothparentsanddoctors geriatric women's health issues order 70mg alendronate with visa,asitcankillpreviously healthy children within hours (Case History 14 women's healthy eating tips discount 35 mg alendronate. Without surgical intervention and debridement of necrotic tissue menopause 11hsd1 cheap alendronate 70mg visa, the infection will continue to women's health center kirksville mo alendronate 70 mg low price spread. In hospital, he required immediate resuscitation and transfertoapaediatricintensivecareunitformulti organfailure(Fig. Optimal outcome requires immediate recognition, prompt resuscitation and antibiotics. Pneumococcal infections Streptococcus pneumoniae is often carried in the nasopharynx of healthy children. Invasive disease, which carries a high burden of mor bidityandmortality,mainlyoccursinyounginfantsas theirimmunesystemrespondspoorlytoencapsulated pathogenssuchaspneumococcus. Impetigo this is a localised, highly contagious, staphylococcal and/or streptococcal skin infection, most common in infantsandyoungchildren. Lesions are usually on the face, neck and hands and begin as erythematous macules which may become vesicular/pustular or even bullous. Rupture Staphylococcal and group A streptococcal infections Staphylococcalandstreptococcalinfectionsareusually causedbydirectinvasionoftheorganisms. Theymay also cause disease by releasing toxins which act as 1 Infection and immunity 249 2 14 Infection and immunity Figure 14. Summary Staphylococcal and streptococcal infections · Symptomsarecausedbydirectinvasionof bacteriaorbyreleaseoftoxins · Impetigoishighlycontagious · Periorbitalcellulitisshouldbetreated aggressivelytopreventspreadtotheorbitor brain · Scaldedskinsyndromeisrarebutserious. Boils these are infections of hair follicles or sweat glands, usuallycausedbyStaphylococcus aureus. Recurrent boils are usually from persistent nasal car riage in the child or family acting as a reservoir for reinfection. Periorbital cellulitis Inperiorbitalcellulitisthereisfeverwitherythema,ten derness and oedema of the eyelid. Periorbitalcel lulitis should be treated promptly with intravenous antibioticstopreventposteriorspreadoftheinfection tobecomeanorbitalcellulitis. Theinfectiousperiodcharacteristicallybeginsaday or two before the rash appears and, for purposes of nursery/school exclusion, is generally considered to lastuntiltherashhasresolvedorthelesionshavedried up. Fordetailsaboutincubationandexclusionperiods, see the Health Protection Agency website The hallmark of the herpesviruses is that, after primary infection, latency is established and there is longterm persistence of the virus within the host, usuallyinadormantstate. Therearevesicularlesionsonthelips,gumsand anteriorsurfacesofthetongueandhardpalate,which often progress to extensive, painful ulceration with bleeding(Fig. There are a number of rare but serious complica tionsthatcanoccurinpreviouslyhealthychildren: is very miserable. Herpetic whitlows­Thesearepainful,erythematous, oedematous white pustules on the site of broken skinonthefingers. Watch for the child with chickenpox whose fever initially settles, but then recurs a few days later ­ it is likely to be due to secondary bacterial infection. Immunocompromised children should be treated with intravenous aciclovir initially. It occurs most commonly in the thoracic region, although any dermatome can be affected. Shingles in child hood is more common in those who had primary infectioninthefirstyearoflife. Otherfeaturesinclude: · petechiaeonthesoftpalate · splenomegaly(50%),hepatomegaly(10%) · amaculopapularrash(5%) · jaundice. Diagnosisissupportedby: · atypicallymphocytes(numerouslargeTcellsseen onbloodfilm) · apositiveMonospottest(thepresenceofheterophile antibodies,i. Indevelopedcountries,abouthalfofthe adult population show serological evidence of past infection. The virus has a particular tropism for B lymphocytes and epithelial cells of the pharynx. Manychildrenhave a febrile illness without rash, and many have a sub clinicalinfection. Rarely, they may cause aseptic meningitis, encephalitis, hepatitis, or an infectious mononucleosislikesyndrome. Following replication in the pharynx and gut, the virus spreads to infect other organs.

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This causes decreased sodium and water reabsorption resulting in loss of sodium and water through urine menopause bleeding symptoms generic 70 mg alendronate otc. Reabsorption of sodium decreases the osmolarity of tubular fluid to ucsf women's health center mt zion alendronate 35 mg generic a greater extent women's health questions pregnancy symptoms order alendronate 35mg. Metabolic activities in the body produce large quantity of acids (with lot of hydrogen ions) menstrual cramps 9 weeks pregnant alendronate 70 mg, which threaten to push the body towards acidosis. About 4,380 mEq of H+ appear every day in the renal tubule by means of filtration and secretion. Carbon dioxide formed in the tubular cells or derived from tubular fluid combines with water to form carbonic acid in the presence of carbonic anhydrase. This enzyme is available in large quantities in the epithelial cells of the renal tubules. H+ is secreted into the lumen of proximal convoluted tubule, distal convoluted tubule and collecting duct. Distal convoluted tubule and collecting duct have a special type of cells called intercalated cells (I cells) that are involved in handling hydrogen and bicarbonate ions. The sodiumhydrogen antiport pump present in the tubular cells Chapter 54 t Acidification of Urine and Role of Kidney in Acid-base Balance 331 is responsible for the exchange of Na+ and H+. This type of sodium-hydrogen counter transport occurs predominantly in distal convoluted tubule (Table 54. About 80% of it is reabsorbed in proximal convoluted tubule, 15% in Henle loop and 5% in distal convoluted tubule and collecting duct. Carbonic acid dissociates into carbon dioxide and water in the presence of carbonic anhydrase. Simultaneously Na+ is reabsorbed from the renal tubule under the influence of aldosterone. Now, the H+ is secreted into the tubular lumen from the cell in exchange for Na+. Thus, for every hydrogen ion secreted into lumen of tubule, one bicarbonate ion is reabsorbed from the tubule. Simultaneously, Na+ is reabsorbed from renal tubule under the influence of aldosterone. The H+, which is added to urine in the form of sodium dihydrogen, makes the urine acidic. It happens mainly in distal tubule and collecting duct because of the presence of large quantity of sodium hydrogen phosphate in these segments. In the tubular epithelial cells, ammonia is formed when the amino acid glutamine is converted into glutamic acid in the presence of the enzyme glutaminase. Ammonia is also formed by the deamination of some of the amino acids such as glycine and alanine. Thus, H+ is added to urine in the form of ammonium compounds resulting in acidification of urine. This process takes place mostly in the proximal convoluted tubule because glutamine is converted into ammonia in the cells of this segment. If stored for some time, the odor becomes stronger due to bacterial decomposition. Volume Increase in urine volume indicates increase in protein catabolism and renal disorders such as chronic renal failure, diabetes insipidus and glycosuria. Abnormal coloration of urine is due to several causes such as jaundice, hema turia, hemoglobinuria, medications, excess urobilino gen, ingestion of beetroot or color added to food. Physiological conditions causing turbidity of urine are precipitation of crystals, presence of mucus or vaginal discharge. Pathological conditions causing turbidity are presence of blood cells, bacteria or yeast. SpecificGravity Specific gravity of urine is the measure of dissolved solutes (particles) in urine. It is low in diabetes insipidus and high in diabetes mellitus, acute renal failure and excess medications. Red Blood Cells Presence of red blood cells in urine indicates glomerular disease such as glomerulonephritis. The number increases in acute glomerulonephritis, infection of urinary tract, vagina or cervix. Presence of many epithelial cells suggests nephrotic syndrome and tubular necrosis.

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Thus contemporary women's health issues for today and the future 4th edition best alendronate 35 mg, hypersecretion of glucocorticoids causes edema minstrel krampus voice purchase alendronate 35 mg visa, hypertension breast cancer kd shoes purchase 70mg alendronate with mastercard, hypokalemia and muscular weakness pregnancy ring test discount alendronate 35mg with amex. Glucocorticoids decrease the blood calcium by inhibiting its absorption from intestine and increasing the excretion through urine. On Bone Glucocorticoids stimulate the bone resorption (osteoclastic activity) and inhibit bone formation and mineralization (osteoblastic activity). On Central Nervous System Glucocorticoids are essential for normal functioning of nervous system. Insufficiency of these hormones causes personality changes like irritability and lack of concentration. Permissive Action of Glucocorticoids Permissive action of glucocorticoids refers to execution of actions of some hormones only in the presence of glucocorticoids. The increase in glucocorticoid level is very essential for survival during stress conditions, as it offers high resistance to the body against stress. Immediate release and transport of amino acids from tissues to liver cells for the synthesis of new proteins and other substances, which are essential to withstand the stress ii. Release of fatty acids from cells for the production of more energy during stress iii. Enhancement of vascular response to catecholamines and fatty acid-mobilizing action of catecholamines, which are necessary to withstand the stress iv. Anti-inflammatory Effects Inflammation is defined as a localized protective response induced by injury or destruction of tissues. When the tissue is injured by mechanical or chemical factors, some substances are released from the affected area. On Blood Cells Glucocorticoids decrease the number of circulating eosinophils by increasing the destruction of eosinophils in reticuloendothelial cells. On Vascular Response Presence of glucocorticoids is essential for the constrictor action of adrenaline and noradrenaline. In adrenal insufficiency, the blood vessels fail to respond 432 Section 6 t Endocrinology i. Chemical substances such as histamine, serotonin, leukotrienes, prostaglandins and bradykinin, which are released from damaged tissue cause vasodilatation and erythema (rushing of blood) in the affected area ii. From blood, many leukocytes, particularly neutrophils and monocytes infiltrate the affected area. Vasodilator substances released in the affected area increase the permeability of capillary membrane, resulting in oozing out of fluid from blood into interstitial space iv. Coagulation occurs in the interstitial fluid because of fibrinogen and other proteins, which are leaked out from blood v. Finally, edema occurs in that area which may be non-pitting type because of hard clot formation. Even if inflammation has already started, the glucocorticoids cause an early resolution of inflammation and rapid healing. Inhibiting the release of chemical substances from damaged tissues and thereby preventing vasodilatation and erythema in the affected area ii. Decreasing the permeability of capillaries and preventing loss of fluid from plasma into the affected tissue iv. Suppressing T cells and other leukocytes, so that there is reduction in the reactions of tissues which enhance the inflammatory process. Anti-allergic Actions Corticosteroids prevent various reactions in allergic conditions as in the case of inflammation. Immunosuppressive Effects Glucocorticoids suppress the immune system of the body by decreasing the number of circulating T lymphocytes. It is done by suppressing proliferation of T cells and the lymphoid tissues (lymph nodes and thymus). Thus, hypersecretion or excess use of glucocorticoids decreases the immune reactions against all foreign bodies entering the body. Immunological reactions, which are common during organ transplantation, may cause rejection of the transplanted tissues. Glucocorticoids are used to suppress the immunological reactions because of their immunosuppressive action.

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References:

  • http://www.imedpub.com/articles/stem-cell-basics-classification-andapplications.pdf
  • https://www.abta.org/wp-content/uploads/2018/03/oligodendrioma-oligo.pdf
  • https://www.nebraskamed.com/sites/default/files/documents/for-providers/asp/viraldiagnostictests_revised.pdf