Arthritis Australia

By X. Grimboll. Sarah Lawrence College.

Acute ligamentous (sprain) lesions and muscular strain are usually self- limiting purchase olmesartan 20mg on line. Causes  Acute ligamentous (sprain) lesions  Muscular strain  Chronic osteoarthritis Other causes include:  Back strain due to poor posture worsened by mechanical factors like overuse 40 mg olmesartan fast delivery, obesity and pregnancy  A protruding or ruptured intervertebral disk  Traumatic ligament rupture or muscle tear  Fracture  Infection (e. Slipping forward of a vertebra upon the one below  Narrowed spinal canal from spinal stenosis 157 | P a g e  Psychogenic pain: The back is a common site of psychogenic pain. Inconsistent historical and physical findings on sequential examination may make one suspicious of this diagnosis  Fibromyalgia rheumatica, connective tissue diseases (give dexamethasone 0. Treatment forChronic low back pain Non−pharmacological Treatment Treat the cause, e. Hyperlipidaemia If hyperlipidaemia is a co-existent risk factor manage according to section 4. V fluids 162 | P a g e Table 2: Treatment of Fluid Overload Using Furosemide Injection Weight Dose Injection Age 10 mg/mL Months/years ≥ 3. Referral  All cases Where adequate laboratory and clinical resources exists, management according to the hospital level guidelines may be instituted 1. General measures  Give oxygen, and nurse in semi-Fowlers position if patient has respiratory distress. V fluids − stop intake of all salt and potassium containing foods and fluids  If not overloaded, dehydrated nor shocked: − no I. V fluids − restrict oral fluid intake to 10 mL/kg/day daily plus visible fluid losses − arrange referral in the meantime  If dehydrated or shocked: − treat immediately as in shock section. Drug treatment Children Fluid overloads (rapid respiration, chest indrawing)  Furosemide, I. Drug treatment The management of glomerular disease depends on the type/cause of the disease and is individualised guided by a specialist according to the biopsy result. Note: Differentiation of upper from lower urinary tract infection in young children is not possible on clinical grounds. Features of urinary tract Infections in children  Signs and symptoms are related to the age of the child and are often nonspecific. If a bag specimen reveals the following, a urine specimen must be collected aseptically for culture and sensitivity:  Positive leukocytes or nitrites on dipsticks in freshly passed urine  Motile bacilli and increased leukocytes or leukocyte casts on urine microscopy Urine dipstix should be performed on a fresh urine specimen. Uncomplicated cystitis Adults: A: Ciprofloxacin (O) 500 mg as single dose Complicated cystitis Adults: A: Ciprofloxacin (O) 500 mg 12 hourly for 7 days For pregnant women and adolescents: A: Amoxicillin/clavulanic acid 500/125 mg(O)12hourly for 7 days 169 | P a g e Children who do not meet criteria for urgent referral:  Amoxicillin/clavulanic acid, oral, 12. A: Ciprofloxacin (O) 500 mg 12 hourly for 7–10 days It is essential to give at least a 7-day course of therapy. Referral Urgent  Acute pyelonephritis with: o vomiting o sepsis o diabetes mellitus  Acute pyelonephritis in: o pregnant women o women beyond reproductive age o men  Children over 3 months who appear ill. Non-urgent  All children for urinary tract investigations after completion of treatment  No response to treatment. Glomerular disease is suggested if proteinuria is present as well as casts on routine microscopy. Clinical features include:  perineal, sacral or suprapubic pain  dysuria and frequency  varying degrees of obstructive symptoms which may lead to urinary retention  sometimes fever  acutely tender prostate on rectal examination The condition may be chronic, bacterial or non-bacterial, the latter usually being assessed when there is failure to respond to antibiotics. For patients presenting with urinary retention, insert a urethral catheter as a temporary measure while patient is transferred to hospital Remove drugs that prevent urinary outflow e. As the axial skeleton is the most common site of metastases, patients may present with back pain or pathological fractures. Referral  All patients with suspected cancer (For more detail refer to the Malignant diseases section) 2. It is important, however, to differentiate between nocturnal enuresis and enuresis during daytime with associated bladder dysfunction. Secondary causes of enuresis include:  diabetes mellitus  urinary tract infection  physical or emotional trauma Note: Clinical evaluation should attempt to exclude the above conditions. General measures  Motivate, counsel and reassure child and parents  Advise against punishment and scolding 173 | P a g e  Spread fluid intake throughout the day  Nappies should never be used as this will lower the child’s self esteem. Referral  Suspected underlying systemic illness or chronic kidney disease  Persistent enuresis in a child 8 years or older  Diurnal enuresis 2. Organic causes include neurogenic, vasculogenic, endocrinological as well as many systemic diseases and medications. General measures  Thorough medical and psychosexual history  Physical examination should rule out gynaecomastia, testicular atrophy or penile abnormalities. Clinical features of obstructing urinary stones may include:  Sudden onset of acute colic, localized to the flank, causing the patient to move constantly. Investigation: Examine the pinna; using an otoscope carefully examine the external auditory canal and the tympanic membrane 175 | P a g e I. Acute suppurative otitis media It is acute purulent exudates in the middle ear cavity with an ear discharge (perforated tympanic membrane) of not more than 12 weeks duration Diagnosis  Discharge of pus from ear  Perforated tympanic membrane Treatment of Acute otitis media & acute suppurative otitis media Acute otitis media should be treated with analgesics, antibiotics and/or paracentesis.

Parenteral treatment should continue until patient is well enough to swallow cheap 40 mg olmesartan fast delivery, and for at least 24 hours even if the patient is well enough to swallow before 24hours order olmesartan 40 mg visa. Reconstituting ParenteralArtesunate Artesunate is dispensed as a powder of artesunic acid in vials of 30mg, 60mg or 120mg and usually in packs containing sodium bicarbonate solution and normal saline. Check the brand available at your facility and follow the general instructions provided below. Step 2 Step 2 Step 2 Gently Shake for 2–3 Gently Shake for 2–3 Gently Shake for 2–3 minutes to ensure minutes to ensure minutes to ensure dissolution dissolution dissolution into a clear solution. Withdraw the required amount required amount required amount of the solution of the solution and of the solution and and inject slowly inject slowly at a inject slowly at a rate at a rate of 3-4ml rate of 3-4ml per of 3-4ml per minute. It should always be given by slow rate-controlled infusion, never by bolus intravenous injection. The dose is Quinine Hydrochloride salt at 10mg per kg body weight (maximum dose 600mg) 8 hourly in 5-10ml/kg of dextrose saline or in 5% dextrose over 4-8 hours. Use the appropriate Quinine dilution for adults or children, as described above in Section 4. Cinchonism is mild when Quinine is used in the recommended doses and subsides spontaneously when administration of the drug ends. The most serious frequent nd adverse drug reaction for injectable Quinine is hypoglycaemia, particularly in the 2 rd and 3 trimesters of pregnancy. In most other respects, however, the treatment of severe/complicated malaria in pregnancy shall be the same as the treatment of severe/complicated malaria for the general population. Supportive care may include the following: Ÿ Blood Transfusion for severe anaemia. Exclude other treatable causes of coma (such as hyperglycaemia, and bacterial meningitis). If injectable glucose is not available, give glucose solutions through nasogastric tube (glucose powder or sugar water). If the child is not able to breastfeed but is able to swallow: Give expressed breast milk, or if not available, consider giving sugar water. If the child is not able to swallow, give 50ml of expressed breast milk or sugar solution must be given by nasogastric tube. Note: The routine administration of bolus fluid infusion for resuscitation is contraindicated. For life- threatening hypoxaemia, consider intubation with mechanical ventilation. Severe Anaemia: Diagnosed in patients with Hb <5g/dl, or packed cell volume <15%; and/or in anaemic patient with signs of heart failure (dyspnoea, enlarged liver, gallop rhythm). Transfuse with 10ml per kg body weight packed cells or 20ml per kg of whole blood as appropriate. Acute Renal Failure: Exclude dehydration, maintain strict fluid balance, monitor fluid input and urine output (urine output: 25-30ml/hour). Avoid drugs that increase the risk of gastro-intestinal bleeding: Ÿ Corticosteroids. Vital Signs: blood pressure, body temperature, pulse, respiratory rate four (4) hourly. While patient is hospitalised, it is recommended to repeat at least six (6) hourly. Check for neurological sequelae (deficit): Assess patient for possible neurological sequelae (deficit) of the disease or the treatment. This is important in children, since it is likely that 10% of them may develop neurological sequelae after they recover from cerebral malaria. Perform follow-up laboratory tests on the 7 and 14 days: Ÿ Thick and thin blood films Ÿ Haematocrit Ÿ Haemoglobin c) ForAdults and Children Recovering from SevereAnaemia: Ÿ Give iron and folic acid for two months with regular follow-up Ÿ If child has sickle cell disease, give folic acid only, unless laboratory findings indicate the need for iron supplementation. It is delivered through trained community members living as close as possible to where the children under-five years live. Home Management of malaria allows for coverage of the health services for malaria to extend beyond the reach of health facilities. Supportive care should also be provided, including tepid sponging and administration of paracetamol. The following treatment guidelines apply: Ÿ For dosing regimens of Artesunate-Amodiaquine and Paracetamol, refer to Sections 3. The following categories of patients should not be managed at home, but referred urgently to the nearest community health officer or health center for further evaluation and treatment. In summary, the following guidelines apply: Ÿ (a) Patients requiring immediate referral must not be managed at hom e Ÿ Children below 3 months of age. Target areas for implementation is the Sahel sub-region where: Ÿ malaria transmission is highly seasonal and the majority of clinical malaria cases occur during a short period of about four months Ÿ the clinical attack rate of malaria is greater than 0. Women are four times as likely to get sick from malaria if they are pregnant, and twice as likely to die from the disease. Malaria in pregnancy is associated with the following serious complications: Ÿ MaternalAnemia, Ÿ SpontaneousAbortion, Ÿ Pre-term Birth, Ÿ Severe/Complicated Malaria, Ÿ Pre-maturity, Ÿ Low Birth Weight.

If there is no laboratory diagnosis to confirm the presence of amoebae discount olmesartan 40mg fast delivery, first line treatment is for shigellosis olmesartan 10mg with visa. Prevention – Breastfeeding reduces infant morbidity and mortality from diarrhoea and the severity of diarrhoea episodes. Shigella dysenteriae type 1 (Sd1) is the only strain that causes large scale epidemics. Clinical features Bloody diarrhoea with or without fever, abdominal pain and tenesmus, which is often intense. Patients with at least one of the following criteria have an increased risk of death: – Signs of serious illness: • fever > 38. After confirming the causal agent, antimicrobial susceptibility should be monitored monthly by culture and sensitivity tests. Organise home visits for daily monitoring (clinically and for compliance); hospitalise if the patient develops signs of serious illness. Shigellosis is an extremely contagious disease (the ingestion of 10 bacteria is infective). Note: over the past few years, Sd1 epidemics of smaller scale and with lower case fatality rates (less than 1%) have been observed. Transmission is faecal-oral, by ingestion of amoebic cysts from food or water contaminated with faeces. Usually, ingested cysts release non-pathogenic amoebae and 90% of carriers are asymptomatic. In 10% of infected patients, pathogenic amoebae penetrate the mucous of the colon: this is the intestinal amoebiasis (amoebic dysentery). The clinical picture is similar to that of shigellosis, which is the principal cause of dysentery. Occasionally, the pathogenic amoebae migrate via the blood stream and form peripheral abscesses. Clinical features – Amoebic dysentery • diarrhoea containing red blood and mucus • abdominal pain, tenesmus • no fever or moderate fever • possibly signs of dehydration – Amoebic liver abscess • painful hepatomegaly; mild jaundice may be present • anorexia, weight loss, nausea, vomiting • intermittent fever, sweating, chills; change in overall condition Laboratory – Amoebic dysentery: identification of mobile trophozoites (E. Treatment – First instance, encourage the patient to avoid alcohol and tobacco use. Gastric and duodenal ulcers in adults Clinical features Burning epigastric pain or epigastric cramps between meals, that wake the patient at night. They are most characteristic when they occur as episodes of a few days and when accompanied by nausea and even vomiting. Gastrointestinal bleeding Passing of black stool (maelena) and/or vomiting blood (haematemesis). Gastric lavage with cold water is not essential, but may help evaluate persistence of bleeding. If a diagnosis of ulcer is probable, and the patient has frequent attacks requiring repeated treatment with antiulcer drugs or, in cases of complicated ulcers (perforation or gastrointestinal bleeding) treatment to eradicate H. Dyspepsia is most commonly functional, linked with stress and not linked to the quantity of gastric acid (antiacids and antiulcer drugs are ineffective). Treatment If the symptoms persist, short term symptomatic treatment may be considered. Note: consider and treat possible intestinal parasites (taeniasis, ascariasis, ancylostomiasis, giardiasis, amoebiasis). Prolonged or painful stomatitis may contribute to dehydration or may cause loss of appetite with denutrition, particularly in children. In infants, examine routinely the mouth in the event of breast refusal or difficulties in sucking. In all cases: – Maintain adequate hydration and feeding; offer foods that will not irritate the mucosa (soft, non-acidic). Use a nasogastric tube for a few days if pain is preventing the patient from eating. Oral and oropharyngeal candidiasis Infection due to Candida albicans, common in infants, immunocompromised or diabetic patients. Other risk factors include treatment with oral antibiotics or high-dose inhaled corticosteroids. Clinical features White patches on the tongue, inside the cheeks, that may spread to the pharynx. Show the mother how to treat since, in most cases, candidiasis will be treated at home. Primary infection typically occurs in children aged 6 months-5 years and may cause acute gingivostomatitis, sometimes severe. After primary infection, the virus remains in the body and causes in some individuals periodic recurrences which are usually benign (herpes labialis). Local lesions are usually associated with general malaise, regional lymphadenopathy and fever. Both forms of herpes are contagious: do not touch lesions (or wash hands afterwards); avoid oral contact.

Lamotrigine is associated with an increased risk for developing a serious and potentially life threatening rash called Stevens-Johnson syndrome buy 20 mg olmesartan mastercard. Stevens- Johnson syndrome is a potentially life-threatening allergic reaction that can occur when taking antiseizure medication purchase olmesartan 10mg overnight delivery. In addition, lamotrigine is often combined with valproex sodium or valproic acid (Depakote®, Depakene®)—a combination that increases the risk for developing Stevens-Johnson syndrome. See page 32 for an expanded description of the symptoms of Stevens-Johnson syndrome. Stud- ies are not conclusive as to whether these medications will help to prevent future episodes of bipolar disorder. A recent study among children and adolescents aged 10 to 17 showed that this medication was effective in controlling the acute manic symptoms of bipolar disorder children and adolescents. A recent study among children and adolescents aged 10 to 17 years old showed that this drug was effective in controlling the acute symptoms of mania and mixed mania. This medica- tion was indicated in 2003 for the treatment of the depressive episodes of bipolar I disorder in adults. For example, in addition to being approved for children and adolescents aged 10 to 17 with bipolar mania or mixed mania, aripiprazole, risperidone, and olanzapine have been approved for treatment of schizophrenia in adolescents aged 13 to 17. Also, risperidone and apripiprazole are approved to treat the aggression and irritability associated with autistic disorder in children and adolescents aged 6 to 17. It appears that children and adolescents are more sensitive to the side effects of medications used for bipolar disorder than are adults. Caution also should be taken when giving a child or adolescent other medication while he or she is taking an atypical antipsychotic. Antihy- pertensive medications (such as Aldomet®, Procardia®, Vasotec®, and Lasix®) can cause a sudden drop in blood pressure. Over-the-counter cold and allergy medications may cause an increase in the sedative effects of atypical antipsy- chotic medication. In addition, caffeine and cigarettes can reduce the effective- ness of atypical antipsychotics. Ask your child’s doctor about potential drug interactions before taking any prescribed or over-the-counter medications. Mild to Moderate Side Effects Mild to moderate side effects common among atypical antipsychotics include: • Akathisia (restlessness) • Dizziness or fainting spell due to decrease in blood pressure when standing up (orthostasis) • Increased appetite • Weight gain • Tiredness • Drowsiness • Nausea • Heartburn • Night tremors • Decreased sexual interest Rapid weight gain is a well-recognized side effect from most atypical antipsy- chotics medications. If your child has gained weight while taking an atypical antipsychotic, consult with your child’s doctor and a dietician to create a plan that helps manage weight gain. More information about medication weight gain can be found on page 50 of this guide. In addition, many atypical antipsychotics medications increase the risk for seizures, especially at high doses. Patients with epilepsy should be closely monitored while taking these medications. It consists of marked muscle stiff- ness, high fever, racing heart beat, fainting spells, and a general sense of feeling very ill. This syndrome is more likely to occur when high doses of antipsychotic medication are prescribed, or when the dose is in- creased rapidly. If your child or adolescent is taking an atypical or typical antipsychotic and is active in sports or plays outside on very hot days, make sure he or she drinks plenty of liquids. Metabolic Syndrome Metabolic syndrome is a collection of risk factors that increase the likelihood of a person developing cardiovascular disease and/or diabetes. Many who take atypical antipsychotics have problems with metabolism, including weight gain, high blood sugar (causing diabetes), and high blood fat (lipids) are potential side effects that pose serious health risks. Children and adolescents are particu- larly sensitive to weight gain associated with atypical antipsychotics. Atypical antipsychotics differ in their short- and long-term effects on weight gain. Some research suggests that most of the weight gain occurs within the frst 6 months of taking an atypical antipsychotic. The information contained in this guide is not intended as, and is not a substitute for, professional medical ParentsMedGuide. Some common typical antipsychotics include haloperidol (Haldol®), chlorpromazine (Thorazine®), perphenazine (Trilafon®), and molindone (Moban®). These medications have been shown effective in adults for treatment of bipolar mania as well as bipolar psychosis. While some children and adoles- cents are still prescribed typical antipsychotics, most child and adolescents psychiatrists prefer to use atypical antipsychotics. Typical antipsychotics are associated with high rates of side effects, such as muscle stiffness, and tremor, restlessness of the legs (akathisia), involuntary muscle movements [tardive dyskinesia], and high levels of prolactin (a hor- mone that affects sexual development and function).