hmm..i hate it..very toxic!!..a lot of things to do..hai..i don't even enjoy those things..
thanks God!!!..this summer class will end so soon..
Friday, May 7, 2010
How Can I Differentiate Viral Conjunctivitis From Bacterial Conjunctivitis?
How Can I Differentiate Viral Conjunctivitis From Bacterial Conjunctivitis?
Conjunctivitis is a common entity in young children and, while the list of potential etiologies is large, viruses, most commonly adenovirus, cause the majority of cases. Viral infections spread rapidly in daycares and schools from eye to hand to eye and, for that reason, many schools have adapted rigid exclusion policies that are not evidence-based.
Classic "pink eye," or, more appropriately, acute follicular conjunctivitis caused by adenovirus, is distinguished by bilateral watery discharge and erythema, often in the presence of a viral upper respiratory infection; a palpable preauricular node commonly occurs, sometimes on the more severely affected side. This is the most common conjunctivitis seen in school-aged children.
Bacterial conjunctivitis is less common, though the true incidence is unknown. For children outside of the neonatal age group but younger than 6 years, it is most commonly caused by Haemophilus influenzae (nontypeable) and Streptococcus pneumoniae. It is associated with purulent discharge and a lesser degree of erythema.
A recent study of adults in The Netherlands sought to determine those signs and symptoms that were most predictive of a bacterial etiology for conjunctivitis. The investigators determined that awakening with one or both eyes glued shut was the single strongest predictor of a bacterial infection, with an odds ratio of 2.96 (one eye) to 14.99 (both eyes). Negative predictors included itching and a prior history of conjunctivitis. The exception to this rule is the less common epidemic keratoconjunctivitis (EKC), an adenoviral infection, which causes redness, swelling, and sticky discharge from the eyes that may cause the lids to stick together. EKC is accompanied by a foreign body sensation and photophobia and may lead to chronic, painful, epithelial opacities of the cornea that can cause visual impairment.
Conjunctivitis caused by adenoviruses or enteroviruses is self-limiting and requires no therapy other than careful hand washing to minimize spread to others. Artificial tears, topical antihistamines, and cool compresses may provide symptomatic relief. Bacterial conjunctivitis is typically treated with one of a variety of prescription ocular antibiotics. The AAO guidelines state that this infection, too, may be self-limiting and not require antibiotics, though they caution that this practice is only approved for adults.
The difficulty lies in identifying the child, often younger than 5 years old, who develops bacterial conjunctivitis as a secondary complication of a primary viral infection. For this reason, many providers opt to treat all children who present with a clinical picture consistent with conjunctivitis. Treatment with topical antibiotics shortens the course of infection and may allow a child to return to school earlier. However, a recent British study of over 300 children found that treatment with chloramphenicol or placebo resulted in virtually identical clinical cure rates and argued that most children with conjunctivitis do not require treatment.
A prospective study conducted in Kentucky from 1997 to 1998 found that almost 70% of H influenzae isolates collected from 250 children with suspected conjunctivitis demonstrated beta-lactamase production Additionally, a study of postcataract surgery patients treated with fluoroquinolone found resistance rates of 4% to 50%. However, these patients had been treated, on average, for 4 weeks, a period of time much longer than is typical in conjunctivitis.
Conjunctivitis is a common entity in young children and, while the list of potential etiologies is large, viruses, most commonly adenovirus, cause the majority of cases. Viral infections spread rapidly in daycares and schools from eye to hand to eye and, for that reason, many schools have adapted rigid exclusion policies that are not evidence-based.
Classic "pink eye," or, more appropriately, acute follicular conjunctivitis caused by adenovirus, is distinguished by bilateral watery discharge and erythema, often in the presence of a viral upper respiratory infection; a palpable preauricular node commonly occurs, sometimes on the more severely affected side. This is the most common conjunctivitis seen in school-aged children.
Bacterial conjunctivitis is less common, though the true incidence is unknown. For children outside of the neonatal age group but younger than 6 years, it is most commonly caused by Haemophilus influenzae (nontypeable) and Streptococcus pneumoniae. It is associated with purulent discharge and a lesser degree of erythema.
A recent study of adults in The Netherlands sought to determine those signs and symptoms that were most predictive of a bacterial etiology for conjunctivitis. The investigators determined that awakening with one or both eyes glued shut was the single strongest predictor of a bacterial infection, with an odds ratio of 2.96 (one eye) to 14.99 (both eyes). Negative predictors included itching and a prior history of conjunctivitis. The exception to this rule is the less common epidemic keratoconjunctivitis (EKC), an adenoviral infection, which causes redness, swelling, and sticky discharge from the eyes that may cause the lids to stick together. EKC is accompanied by a foreign body sensation and photophobia and may lead to chronic, painful, epithelial opacities of the cornea that can cause visual impairment.
Conjunctivitis caused by adenoviruses or enteroviruses is self-limiting and requires no therapy other than careful hand washing to minimize spread to others. Artificial tears, topical antihistamines, and cool compresses may provide symptomatic relief. Bacterial conjunctivitis is typically treated with one of a variety of prescription ocular antibiotics. The AAO guidelines state that this infection, too, may be self-limiting and not require antibiotics, though they caution that this practice is only approved for adults.
The difficulty lies in identifying the child, often younger than 5 years old, who develops bacterial conjunctivitis as a secondary complication of a primary viral infection. For this reason, many providers opt to treat all children who present with a clinical picture consistent with conjunctivitis. Treatment with topical antibiotics shortens the course of infection and may allow a child to return to school earlier. However, a recent British study of over 300 children found that treatment with chloramphenicol or placebo resulted in virtually identical clinical cure rates and argued that most children with conjunctivitis do not require treatment.
A prospective study conducted in Kentucky from 1997 to 1998 found that almost 70% of H influenzae isolates collected from 250 children with suspected conjunctivitis demonstrated beta-lactamase production Additionally, a study of postcataract surgery patients treated with fluoroquinolone found resistance rates of 4% to 50%. However, these patients had been treated, on average, for 4 weeks, a period of time much longer than is typical in conjunctivitis.
Thursday, May 6, 2010
World's Oldest Person Dies
The world's oldest person died Sunday, a week before her 115th birthday.
Kama Chinen, who was born May 10, 1895, died at her care facility on the Japanese island of Okinawa, the Associated Press reported.
She became the world's oldest person last September after the death of 115-year-old Gertrude Baines of California.
A French woman, 114-year-old Eugenie Blanchard, is now the oldest living person, according to the Gerontology Research Group. She was born on Feb. 16, 1896, the AP reported.
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