Academic literature on the topic 'Minimum infective dose'

Guillain-Barré syndrome may present in several ways, although predominant proximal weakness is a common feature of the disease to recognize. The differential diagnosis may be extensive and can include infection, vasculitis, toxin exposure, and malignancy. A lumbar puncture must be done with minimal delay to evaluate for cerebrospinal fluid (CSF) albuminocytological dissociation, however results may be normal early in the course of the disease. EMG/NCS are helpful to support the diagnosis, and early treatment with intravenous immunoglobulin (IVIG) is essential. This chapter discusses the clinic

Many bacterial infections can cause multisystem or metastatic infection, commonly through haematogenous spread, with preferred sites or tropism depending upon specific organism. For example, Staphylococcus aureus is a well-recognized cause of infective endocarditis, joint infection, and vertebral osteomyelitis. Klebsiella pneumoniae can cause endogenous endophthalmitis in association with a pyogenic liver abscess, a syndrome well described in East Asia. Streptococcus pneumoniae typically causes lower respiratory tract infections or bacterial meningitis. The combination of meningitis, pneumonia, and endocarditis is called ‘Austrian syndrome’ and is strongly associated with hyposplenism or alcohol abuse. Other examples of bacteria that disseminate and cause multisystem infection are covered elsewhere. C. albicans or non-albicans species in the blood can metastasize to the eye (causing chorioretinitis or endophthalmitis) or to the heart (causing infective endocarditis). The primary sites of infection are commonly the GI tract or intravascular catheters, and high-risk groups include patients who have recently undergone abdominal surgery, received multiple courses of intravenous antibiotics, and are receiving total parenteral nutrition. Empirical treatment is with either IV liposomal amphotericin or an echinocandin before stepping down to an oral azole, commonly fluconazole at a dose of 400mg od. Because of the risk of metastatic spread, minimum duration is normally two weeks after the first negative blood culture. Cryptococcosis is caused by one of two species: Cryptococcus neoformans or Cryptococcus gattii. Unlike C. neoformans, C. gattii can cause infection in immunocompetent people. The clinical syndrome, Cryptococcosis, is an opportunistic infection for AIDS, but other conditions that predispose to infection are lymphoma, sarcoidosis, liver cirrhosis, and corticosteroids. Following inhalation, cryptococci can disseminate to the cerebrospinal fluid (CSF) and cause meningitis. Occasionally, Cryptococcoma—umbilicated papules on the skin— can occur. Symptoms are often subacute and include fever and dry cough. Following dissemination to the CSF, headache and confusion can occur. Diagnosis is based upon detection of capsular antigen by latex particle agglutination or culture, typically from blood or CSF. For meningitis, treatment consists of three phases. The induction phase is two weeks of IV liposomal amphotericin and flucytosine, followed by consolidation with eight weeks of oral fluconazole 800mg once daily, then finally secondary prophylaxis, 200mg orally once daily.

Minimal-change nephrotic syndrome (MCNS) is an immune-mediated condition, usually of unknown cause. On light microscopy the glomeruli appear normal, and on electron microscopy there is effacement of epithelial cell foot processes over the outer surface of the glomerular basement membrane. MCNS is the cause of about 75% of cases of nephrotic syndrome in children and 17% in adults. Management and prognosis—treatment in adults is with prednisolone at an initial dose of 80 mg/day, then tapering. This leads to complete remission in 90 to 95% of patients, but 50 to 75% of glucocorticoid-responsive adults will have a relapse. Progression to renal failure is not expected and would call the diagnosis of MCNS into question. Focal segmental glomerulosclerosis (FSGS) is not a specific disease entity but a histological lesion, often of unknown aetiology, which is characterized by segmental areas of glomerular sclerosis. It may be (1) primary—either due to genetic mutation, or associated with an unknown circulating protein factor that causes an increase in glomerular permeability; or (2) secondary—the end product of a variety of pathological processes including glomerular hyperfiltration, healed glomerulonephritis, viral (including HIV) infection, or parasitic infection. Management and prognosis—corticosteroid and immunosuppressive therapy should be considered only in patients with primary FSGS and nephrotic syndrome. The steroid regimen is as used for MCNS, but with lesser success. Steroid-resistant cases are treated with ciclosporin (for which there is most published evidence), mycophenolate mofetil, or cyclophosphamide. Prognosis depends on histology and response to treatment.

Travel by air is a safe means of transport, but puts people at various physiological risks and is a potential means of spreading infectious disease. Physiological risks associated with flying include hypoxia, as atmospheric pressure falls with altitude. The minimum cabin pressure in commercial passenger aircraft (565 mm Hg, 75.1 kPa) brings a healthy individual’s arterial P along the plateau of the oxyhaemoglobin dissociation curve until just at the top of the steep part, but does not cause desaturation. By contrast, people with respiratory disease and a low arterial oxygen pressure may desaturate, which can be overcome by administering 30% oxygen, this being equivalent to breathing air at ground level. There is no evidence that the pressurized aircraft cabin itself encourages transmission of disease, and recirculation of cabin air is not a risk factor for contracting symptoms of upper respiratory tract infection.

Secondary peritonitis arises from a perforated viscus and is usually polymicrobial. Empiric antimicrobial therapy should include agents active against aerobic Gram-negative bacilli and anaerobes, but not necessarily enterococci. There are a variety of potential treatment regimens but the choice will depend on whether community-acquired or healthcare-associated, local antimicrobial resistance patterns, and the severity of the illness. Controversy exists as to whether β‎-lactam/β‎-lactamase inhibitors can be used for infections involving extended-spectrum β‎-lactamase-producing bacteria as some argue in favour of this if the minimum inhibitory concentrations are low. The duration of treatment is variable but less than 5 days is probably adequate for uncomplicated cases, especially if there is adequate source control, and the patient does not require admission to a critical care unit. Up to a half of all patients undergoing an emergency laparotomy for a perforated viscus will develop a surgical site infection.

Hybrid Mita (Suzuki) method is a newly developed technique of scoliosis surgery. This concept consists of three components: rib mobilization, rod rotation maneuver and hook rotation maneuver, which does not require intra-operative CT scan with lower risk of screw malposition. The aim of this study is to evaluate the efficacies of this method for correction in scoliosis. : This is a retrospective observational study, consist of eighty-nine idiopathic scoliosis patients who underwent this method between 2009 and 2016 with minimum 2-years follow-up. The curve pattern, Cobb angle, hump height and angle, peri-operative events and complications were analyzed. The mean pre- and post-operative Cobb angle was 50.9° and 10.1°, respectively. The average correction rate was 80.5%. Hump height was reduced from 20.2 mm to 9.8 mm and hump angle reduced from 13.1° to 6.1° in average. The correction loss at the final follow-up was 0.3° in average. There were two local superficial infection cases, but there was no instrumentation failure such as malposition or dislodgement, or pseudarthrosis. This novel method is promising to provide excellent clinical correction to idiopathic scoliosis, which is no less than all pedicle screw constructs. The technique of the skillful utilization of hooks in spinal surgery should not perish from the stage.

Concussion rarely causes recurrent seizures. A patient with a brief seizure that occurs within the first 30 minutes of concussion does not need to be treated with antiepileptics or have driving restrictions. However, a seizure occurring later than 30 minutes after the injury, a seizure that lasts more than one minute, or a seizure after concussion in a patient with a previous seizure disorder requires a different approach. Consider hospital observation, brain MRI, EEG, laboratory studies, assessment for infection, and a screen for drug and alchohol use or withdrawal. If seizures need to be treated, often the best approach includes mood stabilizing medications with minimal cognitively impairing side effects. An oxcarbazepine (Trileptal) bridge during lamotrigine (Lamictal) titration is a reasonable choice. Carbamazepine generic is a good option when cost is an issue.

Concussion rarely causes recurrent seizures. A patient with a brief seizure that occurs within the first 30 minutes of concussion does not need to be treated with antiepileptics or have driving restrictions. However, a seizure occurring later than 30 minutes after the injury, a seizure that lasts more than 1 minute, or a seizure after concussion in a patient with a previous seizure disorder requires a different approach. Consider hospital observation, brain magnetic resonance imaging (MRI), electroencephalogram (EEG), laboratory studies, assessment for infection, and a screen for drug and alcohol use or withdrawal. If seizures need to be treated, the best approach often includes mood stabilizing medications with minimal cognitively impairing side effects. An oxcarbazepine (Trileptal) bridge during lamotrigine (Lamictal) titration is a reasonable choice. Carbamazepine generic is a good option when cost is an issue. Levetiracetam (Keppra) often causes mood dysregulation in concussion patients.

Intraosseous access can be used to rapidly deliver fluids and medications when venous access is not feasible. The intraosseous space does not collapse (as can occur with large veins), making the intraosseous route particularly useful in a patient in whom venous access cannot be obtained readily by peripheral or central routes. In fact, the most recent American Heart Association/American Academy of Pediatrics guidelines for Pediatric Advanced Life Support state that in an emergency situation, “intraosseous (IO) access can be quickly established with minimal complications by providers with varied levels of training. Limit the time spent attempting to establish peripheral venous access in a critically ill or injured child.” Contraindications include underlying bone disease, infection at the site, or recent IO access in the same bone. Severe complications, including loss of bone or limb, have been reported; neonates are at higher risk for these complications. There are several options for devices for obtaining intraosseous access.

Abstract The recent global pandemic is an unprecedented event and took the world by storm. The Movement Control Order (MCO) issued by Malaysia's government to halt the spread of the deadly infection has changed the landscape of work via a flexible working arrangement. The Wells Real Time Centre (WRTC) is not an exception and is also subjected to the change. WRTC is an in-house proactive monitoring hub, built to handle massive real-time drilling data, to support and guide wells delivery effectiveness and excellence. The functionality of the WRTC system and applications are embedded in the wells

Cell adhesion plays a pivotal role in diverse biological processes, including inflammation, tumor metastasis, arteriosclerosis, and thrombosis. Changes in cell adhesion can be the defining event in a wide range of diseases, including cancer, atherosclerosis, osteoporosis, and arthritis. Cells are exposed constantly to hemodynamic/hydrodynamic forces and the balance between the dispersive hydrodynamic forces and the adhesive forces generated by the interactions of membrane-bound receptors and their ligands determines cell adhesion. Therefore to develop novel tissue engineering based approaches