Archive for June, 2011

posted by admin on Jun 28

EpidemiologyImpetigo is a common superficial skin infection that is usually caused by S. aureus, but it can also be caused by group A beta-hemolytic streptococci or a combination of the two. Bullous impetigo is usually caused by a toxigenic staphylococcus strain that causes epidermal cleavage. Impetigo is more commonly seen in children, especially those between 2 and 5 years of age. The rash usually occurs on intact skin, but streptococci require traumatized skin to cause infection. Two to 5% of impetigo cases are complicated by post-streptococcal glomerulonephritis, but clusters with rates as high as 15% have been reported.
Signs and SymptomsImpetigo typically occurs around the nose and mouth or on the limbs. It begins as a vesicle (<5 mm) or cloudy pustule that spontaneously ruptures to expose a well-demarcated, red, weeping, shallow erosion. In bullous impetigo, vesicles progress to form bullae (>5 mm) before eroding. A characteristic honey-colored crust accumulates on the lesions. The infections spread both radially and by autoinoculation to form satellite lesions. Lesions are typically asymptomatic, but some patients may report mild pruritis. Regional adenopathy is common, but systemic symptoms are unusual. Without treatment, lesions can persist for months.
DiagnosisThe diagnosis is based on clinical assessment. In recurrent or resistant cases, Gram stain and culture of the lesions should be performed. The differential diagnosis of impetigo includes varicella (chickenpox), herpes simplex virus, candidiasis, atopic or contact dermatitis, scabies, and guttate psoriasis. Impetigo can also arise secondarily from these lesions.
TreatmentTreatment should provide coverage for both S. aureus and streptococci. Topical treatment with mupirocin 2% ointment/cream (Bactroban) works well for isolated lesions. It should be applied three times daily for 7 to 14 days or until the infection is clear. Oral antibiotics are favored by many experts, especially when impetigo is extensive. Options for systemic treatment include cloxacillin, dicloxacillin, clindamycin, amoxicillin-clavulonate, azithromycin, clarithromycin, first- and second-generation cephalosporins, and second-generation fluoroquinolones. Patients should be warned to use contact precautions until lesions begin to heal.
Recurrent ImpetigoRecurrent impetigo has been linked to carriage of S. aureus, especially in the nares. Mupirocin ointment applied to the nares twice daily for 5 days can reduce nasal carriage and infection. The 5-day treatment can be repeated monthly in difficult cases.
Ecthyma (Ulcerative Impetigo)Ecthyma can be considered an ulcerative variation of impetigo. It is caused by streptococci and begins as vesicles or bullae, typically on the legs. These lesions progress to a deeper erosion and have a thick crust that is sometimes gray. Ecthyma arises in minor wounds that are neglected. It should be treated with systemic antibiotics to minimize scarring.*110/348/5*

posted by admin on Jun 18

Feeling your baby’s first movements must be one of life’s most wonderful experiences, knowing that first little flutter is the sign that your baby is growing inside you. As the weeks go by the movements will get stronger and your partner will be able to experience this wonderful feeling with you. This should also make you feel more at ease, knowing that your baby is doing well and is active. By the seventh month you might see a foot shape or a little hand or bottom imprinted in your stomach.At the end of the pregnancy before the baby’s head engages, the baby will be very active, moving around from side to side. Once it has engaged, however, you will notice that the movements are much less. This is because the head is now engaged in the pelvis and is unable to move around much.Any appreciable change in fetal activity, whether increased or decreased, may be a cause for concern and the woman should notify her medical practitioner immediately. Generally women should note 10 movements in a 12 hour period. If you don’t notice any movements then contact your practitioner or the midwife.*4/199/5*

posted by admin on Jun 7

ADHD can play a very detrimental role in a child’s ability to make and keep friends. And as ADHD children grow older, the situation becomes even more complicated.All very young children are impulsive and active, so in nursery school there is less reflection regarding others who behave differently. But in elementary school, children begin to observe and compare each other. The normal child is better able to delay gratification, to delay impulse, to sit and listen, and to model his behavior according to group norms. But in a child with ADHD, those abilities are impaired on many different levels. They may be more hyperactive than the other children and unable to delay their response to stimuli. This may mean talking too much, not completing classroom assignments, and running around rather than sitting still.In addition, ADHD children of school age are not as well equipped to make interpersonal judgments. They don’t understand what’s transpiring emotionally in others or how to read the expressions in other people’s faces. Consequently, they have to work much harder than normal youngsters to evaluate what’s going on socially and to find their own place in it. This can be a serious struggle because they already have so many other problems. They can’t concentrate, they’re easily distracted, and nothing they do seems right. It’s a tremendous uphill battle for many of these children.By the first grade, children start to observe and make comments about each other. They notice right away that an ADHD child’s behavior is different, and they react to him. They may not want to play with him, for example, or they may call him names, which only compounds the situation by lowering his self-esteem even further.We know that ADHD children have a great amount of trouble tolerating uncomfortable internal emotions because, as infants, they didn’t have the learning experiences that teach them how to cope. They don’t know how to find significant people within the environment to help them cope either. Consequently, the only thing they can do is react in the same way as the screaming infant does. They may throw screaming tantrums, be overtly aggressive, pick fights, and even lose control of their urine or bowels.This was a problem of Peter’s. His severe encopresis recurred at times of stress even as he grew older and advanced through grade school, causing him enormous humiliation among his peers. This was an older child’s version of the uncontrolled bodily outbursts he had as an infant.Once school-age children develop the most telling symptoms of ADHD, they may become social pariahs. Classmates refuse to play with them and often tease them unmercifully because of their strange behavior. Not surprisingly, this can severely hamper any possibility of academic success, which is already difficult for the ADHD child.*23\173\2*