Infection
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Eighteen studies on Selective Decontamination of the Digestive Tract (SDD) have been published up to now. A statistically significant reduction of infection rate was found in fourteen out of the fifteen controlled studies. Although all the studies were designed to evaluate infection-related morbidity as the end point, ten centres have reported fatality rates. ⋯ The Paris trial suggests a major impact of the SDD maneuver on the ICU ecology. Emergence of resistance to the SDD agents among gram-positive cocci has been described, although the clinical impact of this antibiotic side effect has not been reported so far. There are three indications for SDD, as follows: (i) trauma patients; (ii) liver transplant recipients and (iii) outbreaks of multi-resistant organisms.
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Chest physiotherapy is a treatment program that attempts to compensate for impaired mucociliary clearance. By removing mucopurulent secretions, it reduces airway obstruction and its consequences, such as atelectasis and hyperinflation; furthermore, physiotherapy can decrease the rate of proteolytic tissue damage by removing infected secretions. Conventional physiotherapy (clapping, vibration and compression, together with postural drainage and assisted coughing) is the most efficient physiotherapy for sick infants and young children. ⋯ Autogenic drainage, a special breathing technique, aims at avoiding airway compression by reducing positive expiratory transthoracic pressure. PEP-mask-physiotherapy achieves the same goal by expiring against an external airflow obstruction. Last but not least, physical exercise can clear the lungs of some CF patients and thus offers an attractive adjunct to physiotherapy.
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Reactivation of chronic, latent infection of Toxoplasma gondii has been observed previously in transplant patients and malignancies treated with immunosuppressive drugs. Recently it has emerged as the most common recognized central nervous system infection in acquired immunodeficiency syndrome (AIDS) patients, seen in 6-20% of all AIDS cases. It produces diffuse encephalopathy or space-occupying and necrotic lesions. Contrary to classical toxoplasmosis, the serological diagnosis is unreliable and the therapeutical response in most cases is poor.