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By W. Marlo. Philander Smith College. 2018.

This infection is diagnosed by isolating enterococci from Proteus organisms are normally found in the intestinal tract and in blood cultures discount 5mg aygestin visa menstruation calculator menstrual cycle. They most often cause urinary tract and wound ampicillin and gentamicin buy generic aygestin 5 mg on-line breast cancer grade 0, enterococcal endocarditis may be fatal. Infection usually occurs with antibiotic therapy, which de- Gram-Negative Bacteria creases drug-sensitive bacteria and allows drug-resistant bacteria Bacteroides to proliferate. Bacteroides are anaerobic bacteria normally found in the digestive, respiratory, and genital tracts. They are the most common bacte- Pseudomonas ria in the colon, where they greatly outnumber Escherichia coli. They are found in the stools of some healthy people and pelvic abscesses (eg, after surgery or trauma that allows fecal con- possibly 50% of hospital patients. Because of its resistance to many antibiotics, it can cause se- Escherichia coli vere infections in people receiving antibiotic therapy for burns, E. Infection is more likely to occur in hosts who synthesizing vitamins and by competitively discouraging growth are very young or very old or who have impaired immune systems. They also cause pneu- trauma or procedures involving the brain or spinal cord, and con- monia and sepsis in immunocompromised hosts and meningitis and tamination of respiratory ventilators. In healthy people, the normal gram- fections are especially difficult to treat because the organism is re- positive organisms of oral cavities attach to material that coats the sistant to many of the antibiotics used to treat other gram-negative surface of oral mucosa and prevents transient E. Debilitated or severely ill people produce an en- Serratia zyme that destroys the material that allows gram-positive flora to S. They cause serious nosocomial infections of the uri- enteric bacteria) to compete successfully with the normal gram- nary tract, respiratory tract, skin, burn wounds, and bloodstream. Then, droplets of the oral They also may cause hospital epidemics and produce drug-resistant flora are aspirated into the respiratory tract, where impaired protec- strains. High-risk patients include newborns, the debilitated, and the tive mechanisms allow survival of the aspirated organisms. The organisms cause gastroenteritis, typhoid bloodstream of people with severe illnesses and conditions such as fever, septicemia, and a severe, sometimes fatal type of food poi- neutropenia, the host is unable to mount adequate defenses and sep- soning. Humans become infected through ingestion of contaminated organisms causing nosocomial septic shock and meningitis. Infection by food usually strain, called O157:H7, causes hemorrhagic colitis, a disease char- results from ingestion of contaminated meat or by hands transfer- acterized by severe abdominal cramps, copious bloody diarrhea, ring organisms from an infected source. In the United States, and hemolytic-uremic syndrome (hemolytic anemia, thrombo- undercooked poultry and eggs are common sources. Hemolytic-uremic syndrome Salmonella enterocolitis is a common cause of food-borne out- occurs most often in children. Diarrhea usually begins several hours intestinal tract of animals, especially cattle, and several epidemics after ingesting contaminated food and may continue for several have been associated with ingestion of undercooked ground beef. Other sources include contaminated water and milk and person-to- Shigella person spread. Because it cannot survive in nature, the presence of Shigella species cause gastrointestinal problems ranging from E. Humans, who seem to Klebsiella be the only natural hosts, become infected after ingestion of con- Klebsiella organisms, which are normal bowel flora, may infect the taminated food or water. Effects of shigellosis are attributed to the respiratory tract, urinary tract, bloodstream, burn wounds, and loss of fluids, electrolytes, and nutrients and to the ulceration that meninges, most often as opportunistic infections in debilitated per- occurs in the colon wall. In pneumococcal penicillin use because the organisms produced beta-lactamase en- infections resistant to penicillins and cephalosporins, vancomycin, zymes (penicillinases) that destroyed penicillin. To decrease one of five drugs developed to resist the action of beta-lactamase spread of resistant S. MRSA have an • Pneumococcal vaccination for people older than 2 years of additional PBP called 2a or 2′. Methicillin cannot bind effectively age with increased risk of pneumococcal infection, and for to the PBPs and inhibit bacteria cell wall synthesis except with very all people older than 65 years of age. Consequently, minimum inhibitory con- Vancomycin-Resistant Enterococci centrations (MICs) of methicillin increased to high levels that were Enterococci have intrinsic and acquired resistance to many anti- difficult to achieve. For example, penicillins and cephalosporins inhibit The term MRSA is commonly used but misleading because rather than kill the organisms at achievable concentrations, and the organisms are widely resistant to penicillins (including all of aminoglycosides are ineffective if used alone. As a result, standard the antistaphylococcal penicillins, not just methicillin) and treatment of an enterococcal infection outside of the urinary tract has cephalosporins. Many strains of MRSA are also resistant to eryth- involved a combination of ampicillin and gentamicin or strepto- romycin, clindamycin, tetracycline, and the aminoglycosides.

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They are usually not effective for bed-wetting unless daytime lack of control is also present order 5mg aygestin with mastercard women's health equity act. Hence the symptoms indicating its clinical use are enuresis more than one time a night and symptoms of urgency order aygestin 5mg fast delivery women's health issues research topics, frequency, and/or incontinence of urine. For this reason, this drug has been shown to be helpful in children with urge syndrome/dysfunctional voiding or neurogenic bladder. In some cases, this medication is used in combination with DDAVP to control enuresis. In the past, uncontrolled studies report that these types of medications are beneficial. However, there is only one controlled trial that has attempted to establish this benefit. This blinded study failed to show a substantial difference between the anti- cholinergic agent and placebo. Commonly reported side effects of these drugs include dry mouth, drowsiness, constipation, dizzi- ness, facial flushing, irritability, blurred vision, occasional tremu- lousness, and even heat exhaustion during hot months. While the Western medical treatments described above have their limitations and drawbacks, any of them can be combined with a judicious use of TCM. In particular, parent and patient coun- seling, behavior modification, and guided imagery work well in tandem with Chinese medicine and I routinely use or recommend these in my practice. The three main viscera which control water fluids in the body are the three main Chinese medical viscera involved in enuresis— the lungs, spleen, and kidneys. The lungs are the upper source of water which downbear and diffuse water fluids through the water passageways of the three burners. It is the descension and free flow of the lung qi which transports water fluids to the lower burner for excretion by the kidneys and bladder. The spleen gov- erns the movement and transformation of the water fluids. In par- ticular, it is the spleen which sends the clear part of water fluids taken in by the stomach up to the lungs for distribution around the body. If the spleen qi fails to upbear these fluids, they tend to pour downward to the lower burner where they overflow from the bladder. If, for any reason, one or more of these viscera become vacuous and insufficient or their function is inhibited by the presence of evil qi, their control of water fluids may be impaired and enuresis may result. Further, if water fluids collect and transform into dampness, these damp evils may seep downward to become depressed in the lower burner where they inhibit the free flow of the yang qi. If the yang qi, which is inher- ently warm, also becomes depressed and dampness unites with this depressed yang qi, it will give rise to damp heat. Because the liver channel surrounds the genitourinary tract, liver channel damp heat may be the result, and this may also cause enuresis. In Chinese medicine, children are considered both physically and physiologically immature. Chao Yuan-fang, in his book Zhu Bing Yuan Hou Lun (Treatise on the Origins & Symptoms of Various Diseases) stated, The five viscera and six bowels are made but 40 Treating Pediatric Bed-wetting with Acupuncture & Chinese Medicine not complete,. This is why babies and young children tend to present so many signs and symptoms of dampness, phlegm, and turbidity, i. In particular, the spleen is not fortified or mature until around six years of age, and the kidneys do not become exuberant until puberty. In addition, it is said in Chinese medicine that, The spleen is the root of phlegm engenderment; the lungs are [merely] the place where phlegm is stored. It is the inherent immatu- rity of the lungs, spleen, and kidneys which make enuresis mostly a pediatric complaint. However, anything that damages and causes detriment to these three viscus can also cause formerly mature organs to become vacuous and insufficient. Things which can damage the lungs include excessive grief and sorrow and the chronic presence of evil qi, including wind evils, phlegm, and dampness. Signs and symptoms of lung qi vacuity include spontaneous perspiration, a weak voice, rapid breathing, and easy contraction of wind evils. Things which can damage the spleen include foods which engen- der excessive fluids, such as sweets, dairy products, and exces- sive oils and fat, and uncooked, chilled foods, as well as exces- sive fatigue, excessive worry and anxiety, excessive use of antibi- otics, chronic respiratory and/or digestive diseases, and insuffi- cient physical exercise. Signs and symptoms of spleen qi vacuity include fatigue, lack of strength, somnolence, lack of warmth in the hands and feet, torpid intake, loose stools, a fat tongue with teeth-marks on its edges, and a fine, forceless pulse.

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