Treatment Mebendazole is the drug of choice in the UK, being given as a single dose. It should be combined with hygienic measures to break the cycle of autoinfection. All members of the family require treatment. Other ANTHELMINTICS include piperazine and pyrantel.... Medical Dictionary
(e.g. cane sugar), polysaccharides (e.g. starch). Many of the cheaper and most important foods are included in this group, which comprises sugars, starches, celluloses and gums. When one of these foods is digested, it is converted into a simple kind of sugar and absorbed in this form. Excess carbohydrates, not immediately needed by the body, are stored as glycogen in the liver and muscles. In DIABETES MELLITUS, the most marked feature consists of an inability on the part of the tissues to assimilate and utilise the carbohydrate material. Each gram of carbohydrate is capable of furnishing slightly over 4 Calories of energy. (See CALORIE; DIET.)... Medical Dictionary
Measuring the partial pressure of the gas by taking blood for blood gas estimation provides information on the adequacy of breathing. A high partial pressure may indicate impending or actual respiratory failure.... Medical Dictionary
Each year around 50 people in the United Kingdom are reported as dying from carbon monoxide poisoning, and experts have suggested that as many as 25,000 people a year are exposed to its e?ects within the home, but most cases are unrecognised, unreported and untreated, even though victims may su?er from long-term e?ects. This is regrettable, given that Napoleon’s surgeon, Larrey, recognised in the 18th century that soldiers were being poisoned by carbon monoxide when billeted in huts heated by woodburning stoves. In the USA it is estimated that 40,000 people a year attend emergency departments su?ering from carbon monoxide poisoning. So prevention is clearly an important element in dealing with what is sometimes termed the ‘silent killer’. Safer designs of houses and heating systems, as well as wider public education on the dangers of carbon monoxide and its sources, are important.
Clinical e?ects of acute exposure resemble those of atmospheric HYPOXIA. Tissues and organs with high oxygen consumption are a?ected to a great extent. Common e?ects include headaches, weakness, fatigue, ?ushing, nausea, vomiting, irritability, dizziness, drowsiness, disorientation, incoordination, visual disturbances, TACHYCARDIA and HYPERVENTILATION. In severe cases drowsiness may progress rapidly to COMA. There may also be metabolic ACIDOSIS, HYPOKALAEMIA, CONVULSIONS, HYPOTENSION, respiratory depression, ECG changes and cardiovascular collapse. Cerebral OEDEMA is common and will lead to severe brain damage and focal neurological signs. Signi?cant abnormalities on physical examination include impaired short-term memory, abnormal Rhomberg’s test (standing unsupported with eyes closed) and unsteadiness of gait including heel-toe walking. Any one of these signs would classify the episode as severe. Victims’ skin may be coloured pink, though this is very rarely seen even in severe incidents. The venous blood may look ‘arterial’. Patients recovering from acute CO poisoning may su?er neurological sequelae including TREMOR, personality changes, memory impairment, visual loss, inability to concentrate and PARKINSONISM. Chronic low-level exposures may result in nausea, fatigue, headache, confusion, VOMITING, DIARRHOEA, abdominal pain and general malaise. They are often misdiagnosed as in?uenza or food poisoning.
First-aid treatment is to remove the victim from the source of exposure, ensure an e?ective airway and give 100-per-cent oxygen by tight-?tting mask. In hospital, management is largely suppportive, with oxygen administration. A blood sample for COHb level determination should be taken as soon as practicable and, if possible, before oxygen is given. Ideally, oxygen therapy should continue until the COHb level falls below 5 per cent. Patients with any history of unconsciousness, a COHb level greater than 20 per cent on arrival, any neurological signs, any cardiac arrhythmias or anyone who is pregnant should be referred for an expert opinion about possible treatment with hyperbaric oxygen, though this remains a controversial therapy. Hyperbaric oxygen therapy shortens the half-life of COHb, increases plasma oxygen transport and reverses the clinical e?ects resulting from acute exposures. Carbon monoxide is also an environmental poison and a component of cigarette smoke. Normal body COHb levels due to ENDOGENOUS CO production are 0.4 to
0.7 per cent. Non-smokers in urban areas may have level of 1–2 per cent as a result of environmental exposure. Smokers may have a COHb level of 5 to 6 per cent.... Medical Dictionary
See HEART, DISEASES OF.... Medical Dictionary
Although there are numerous possible sources of electrical interference with pacemakers, the overall risks are slight. Potential sources include anti-theft devices, airport weapon detectors, surgical diathermy, ultrasound, and short-wave heat treatment. Nevertheless, many pacemaker patients lead active and ful?lling lives.... Medical Dictionary
Mexican prickly poppy (Argemone mexicana).
Plant Part Used: Leaf, flower, root and stem.Dominican Medicinal Uses: Leaf/whole herb: prepared as a tea for blood-cleansing, cancer, stomach ulcers, delayed menstruation, vaginal infection, menopause symptoms; prepared as a douche for vaginal infection and inflammation; as a multi-herb mixture for ovarian cysts, uterine fibroids and tumors; root: boiled tea for stomach pain.Safety: Entire plant shown to be hepatotoxic due to sanguinarine and alkaloid content, especially concentrated in the seeds; internal use strongly cautioned against.Contraindications: Pregnancy, lactation, children.Laboratory & Preclinical Data: In vitro: antifungal, anti-HIV, anti-tumor, morphine-withdrawal alleviation, uterine stimulant (organic plant extracts).* See entry for Cardo santo in “Part 3: Dominican Medicinal Plant Profiles” of this book for more information, including references.... Medicinal Plants
Carlah, Carlana, Carlee, Carleen, Carleigh, Carlena, Carlene, Carletta, Carlette, Carley, Carli, Carlia, Carlie, Carlina, Carlisa, Carlita, Carlla, Carly, Carlyn, Carlen, Carlin, Carling, Carlea, Carleah... Medical Dictionary
Since April 1993, local social-services departments have been responsible for assessing what help people need from community-care services: these can include home helps, meals on wheels, sheltered housing, etc. Recipients of such services are means-tested and make variable contributions towards the costs. Policies on charging vary from one area to another and there are wide geographical variations in the range of services provided free and the charges levied for others.
People with complex needs may be assigned a case manager to coordinate the care package and ensure that appropriate responses are made to changing circumstances. The success of community care hinges on e?ective coordination of the services of an often large number of providers from the health and social-services sectors. Poor communication between sectors and inadequate coordination of services have been among the most common complaints about the community-care reforms.
Health care for people being cared for in the community remains largely free under the NHS arrangements, although there are regular debates about where the boundaries should be drawn between free health services and means-tested social care. A distinction has been made between necessary nursing care (funded by the state) and normal personal care (the responsibility of the patient), but the dividing line often proves hard to de?ne.
As care has shifted increasingly into the community, previous hospital facilities have become redundant. Vast numbers of beds in long-stay geriatric hospitals and in-patient psychiatric wards have been closed. There is now concern that too few beds remain to provide essential emergency and respite services. In some areas, patients ?t for discharge are kept in hospital because of delay in setting up community services for the elderly, or because of the inability of the local authority to fund appropriate care in a nursing home or at home with community-care support for other patients; the resulting BED-BLOCKING has an adverse e?ect on acutely ill patients needing hospital admission.
Community care, if correctly funded and coordinated, is an excellent way of caring for people with long-term needs, but considerable work is still needed in Britain to ensure that all patients have access to high-quality community care when they need it. Problems in providing such are are not con?ned to the UK.... Medical Dictionary
The new Council for Healthcare Regulatory Excellence will help to promote the interests of patients and to improve co-operation between the existing regulatory bodies – providing, in e?ect, a quality-control mechanism for their activities. The government and relevant professions will nominate individuals for this overarching council. The new council will not have the authority to intervene in the determination by the eight regulatory bodies of individual ?tness-to-practise cases unless these concern complaints about maladministration.... Medical Dictionary
A method of recording the electrical activity of the heart muscles. Electrodes from a recording machine (electrocardiograph) are placed on the skin of the chest wall, arms and legs. The record of the electrical changes is called an ECG (electrocardiogram). The number of electrodes used depends on the complexity of the heart disorder being monitored. The procedure can be done in hospital, doctors’ surgeries and the patient’s home, and should not cause any discomfort.
In certain circumstances – for example, where a person has had bouts of chest pain – an exercise ECG may be performed under medical supervision. The patient walks on a treadmill while the ECG is recorded continuously.... Medical Dictionary
The principle of one-to-one, 24-hours-a-day care for seriously ill patients has been widely adopted and developed for the initial treatment of many patients with life-threatening conditions. Thus, severely injured patients – those with serious medical conditions such as coronary thrombosis or who have undergone major surgery, and individuals su?ering from potentially lethal toxic a?ects of poisons – are treated in an INTENSIVE THERAPY UNIT (ITU). Patients whose respiratory or circulatory systems have failed bene?t especially by being intensively treated. Most patients, especially post-operative ones, leave intensive care when their condition has been stabilised, usually after 24 or 48 hours. Some, however, need support for several weeks or even months. Since 1952, intensive medicine has become a valued specialty and a demanding one because of the range of skills needed by the doctors and nurses manning the ITUs.... Medical Dictionary
Because of its possible toxic e?ects – including kidney damage – lithium must only be administered under medical supervision and with monitoring of the blood levels, as the gap between therapeutic and toxic concentrations is narrow. Due to the risk of its damaging the unborn child, it should not be prescribed, unless absolutely necessary, during pregnancy – particularly not in the ?rst three months. Mothers should not take it while breast feeding, as it is excreted in the milk in high concentrations. The drug should not be taken with DIURETICS.... Medical Dictionary
careful control of symptoms, especially PAIN.
psychosocial and spiritual care.
a personalised management plan centred on the patient’s needs and wishes.
care that takes into account the family’s needs and that is carried into the bereavement period.
provision of coordinated services in the home, hospital, day-care centre and other facilities used by the patient. Palliative care should include: managing
chronic cancer pain with planned use of common ANALGESICS including opioids (see SYRINGE DRIVERS); planning ahead to preserve as far as possible the patient’s autonomy and choice as death approaches and the ability to make decisions may decline; and an understanding and use of arti?cial feeding and hydration. Palliative care seeks to improve the satisfaction of both patient and family, to identify their needs and, if possible, to reduce the overall cost because the patient can often be looked after at home or in a HOSPICE instead of in hospital.
A well-publicised question that may arise in the context of palliative care is physician-assisted suicide. This subject is referred to in the entry on ETHICS. A request by a patient for accelerated death may suggest that he or she is depressed – a treatable condition – or that the palliative care is inadequate and needs reviewing and, if possible, improving.... Medical Dictionary
Certain specialties – for example, orthopaedic and reconstructive/cosmetic surgery and mental health – attract more private patients than others, such as paediatrics or medicine for the elderly. The standards of clinical care are generally the same in the two systems, but private patients can see the specialist of their choice at a time convenient to them. Waiting times for consultations and treatment are short and, when in hospital, private patients usually have their own room, telephone, TV, open visiting hours, etc.
A substantial proportion of private medical-care services are those provided for elderly people requiring regular nursing care and some medical supervision. The distinction between residential care and nursing care for the elderly is often blurred, but the government policy of providing means-tested state funding only for people genuinely needing regular nursing care – a system operated by local-authority social-service departments in England and Wales – has necessitated clearer de?nitions of the facilities provided for the elderly by private organisations. The strict criteria for state support (especially in England), the budget-conscious approach of local authorities when negotiating fees with private nursing homes, and the fact that NHS hospital trusts also have to pay for some patients discharged to such homes (to free-up hospital beds for new admissions) have led to intense ?nancial pressures on private facilities for the elderly. This has caused the closure of many homes, which, in turn, is worsening the level of BED-BLOCKING by elderly patients who do not require hospital-intensity nursing but who lack family support in the community and cannot a?ord private care.... Medical Dictionary
Symptoms The period of incubation (i.e. the time elapsing between the reception of infection and the development of symptoms) varies somewhat. In most cases it lasts only two to three days, but in occasional cases the patient may take a week to develop his or her ?rst symptoms. The occurrence of fever is usually short and sharp, with rapid rise of temperature to 40 °C (104 °F), shivering, vomiting, headache, sore throat and marked increase in the rate of the pulse. In young children, CONVULSIONS or DELIRIUM may precede the fever. The rash usually appears within 24 hours of the onset of fever and lasts about a week.
Complications The most common and serious of these is glomerulonephritis (see under KIDNEYS, DISEASES OF), which may arise during any period in the course of the fever, but particularly when DESQUAMATION occurs. Occasionally the patient develops chronic glomerulonephritis. Another complication is infection of the middle ear (otitis media – see under EAR, DISEASES OF). Other disorders a?ecting the heart and lungs occasionally arise in connection with scarlet fever, the chief of these being ENDOCARDITIS, which may lay the foundation of valvular disease of the heart later in life. ARTHRITIS may produce swelling and pain in the smaller rather than in the larger joints; this complication usually occurs in the second week of illness. Scarlet fever, which is now a mild disease in most patients, should be treated with PENICILLIN.... Medical Dictionary
External injuries to the skin such as the sting of a nettle (‘nettle-rash’) or an insect bite cause histamine release from MAST CELLS in the skin directly. Certain drugs, especially MORPHINE, CODEINE and ASPIRIN, can have the same e?ect. In other cases, histamine release is caused by an allergic mechanism, mediated by ANTIBODIES of the immunoglobulin E (IgE) class – see IMMUNOGLOBULINS. Thus many foods, food additives and drugs (such as PENICILLIN) can cause urticaria. Massive release of histamine may a?ect mucous membranes – namely the tongue or throat – and can cause HYPOTENSION and anaphylactic shock (see ANAPHYLAXIS) which can occasionally be fatal.
Physical factors can cause urticaria. Heat, exercise and emotional stress may induce a singular pattern with small pinhead weals, but widespread ?ares of ERYTHEMA, activated via the AUTONOMIC NERVOUS SYSTEM (CHOLINERGIC urticaria) may also occur.
Rarely, exposure to cold may have a smiilar e?ect (‘cold urticaria’) and anaphylactic shock following a dive into cold water in winter is occasionally fatal. The diagnosis of cold urticaria can be con?rmed by applying a block of ice to the arm which quickly induces a local weal.
Transient urticaria due to rubbing or even stroking the skin is common in young adults (DERMOGRAPHISM or factitious urticaria). More prolonged deep pressure induces delayed urticaria in other subjects. IgE-mediated urticaria is part of the atopic spectrum (see ATOPY, and SKIN, DISEASES OF – Dermatitis and eczema). Allergy to peanuts is particularly dangerous in young atopic subjects. Notwithstanding the many known causes, chronic urticaria of unknown cause is common and may have an autoimmune basis (see AUTOIMMUNE DISORDERS).
Treatment Causative factors must be removed. Topical therapy is ine?ective except for the use of calamine lotion, which reduces itching by cooling the skin. Oral ANTIHISTAMINES are the mainstay of treatment and are remarkably safe. Rarely, injection of ADRENALINE is needed as emergency treatment of massive urticaria, especially if the tongue and throat are involved, following by a short course of the oral steroid, prednisolone.
Angio-oedema is a variant of urticaria where massive OEDEMA involves subcutaneous tissues rather than the skin. It may have many causes but bee and wasp stings in sensitised subjects are particularly dangerous. There is also a rare hereditary form of angio-oedema. Acute airway obstruction due to submucosal oedema of the tongue or larynx is best treated with immediate intramuscular adrenaline and antihistamine. Rarely, TRACHEOSTOMY may be life-saving. Patients who have had two or more episodes can be taught self-injection with a preloaded adrenaline syringe.... Medical Dictionary