J Postgrad Med
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Renal involvement is common in leptospirosis. Bacterial invasion, inflammatory process, haemodynamic alterations and direct toxicity of bacterial products are thought to be responsible for the development of nephropathy. Pathologically, all renal structures are involved. ⋯ ARF with major organ failure has unfavorable outcome. Plasmapheresis and continuous venovenous hemofiltration improve hemodynamics and are beneficial for the patients with acute renal failure and multiorgan involvement. Recovery of renal function is usually complete in most patients.
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Infectious diseases account for a third of all the deaths in the developing world. Achievements in understanding the basic microbiology, pathogenesis, host defenses and expanded epidemiology of infectious diseases have resulted in better management and reduced mortality. ⋯ Better understanding of melioidosis is essential, as it is life-threatening and if untreated, patients can succumb to it. Our sources include a literature review, information from international consensus meetings on melioidosis and ongoing discussions within the medical and scientific community.
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Complex regional pain syndrome (CRPS) is a challenging neuropathic pain state, quite difficult to comprehend and treat. Its pathophysiological mechanisms are unclear and its treatment is difficult. ⋯ The primary goals of managing patients with this syndrome are to: 1) perform a comprehensive diagnostic evaluation, 2) be prompt and aggressive in treatment interventions, 3) assess and reassess the patient's clinical and psychological status, 4) be consistently supportive, and 5) strive for the maximal amount of pain relief and functional improvement. This article reviews the different aspects of CRPS including definition, classification, epidemiology and natural history, clinical presentation, pathophysiology and management.
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Opioid dependence is a major health problem and a cause of increasing concern to physicians and other health professionals worldwide. A crucial first step in intervention is detoxification. ⋯ This review delves into the theoretical and methodological aspects related to ultra-rapid opioid detoxification (opioid detoxification procedure using opioid antagonists, performed under general anaesthesia or heavy sedation) and discusses the status of the same in light of the available evidence regarding its applicability, safety and effectiveness. Although useful in some respects (especially in completion rates for detoxification and subsequent induction onto naltrexone maintenance), the justification of this procedure lies in (a) the resolution of the ethical conflicts surrounding the procedure and (b) conduction of methodologically sound long-term studies to demonstrate greater efficacy over routine/standard detoxification procedures beyond the short-term detoxification period.