Neonatal tetanus

Neonatal tetanus, also known as tetanus neonatorum, occurs in young infants of inadequately immunized mothers. It is a kind of generalized tetanus that is exhibited mainly by prevention of the release of the inhibitory neurotransmitters (i.e., disinhibition) and is initiated by tetanospasmin, an exotoxin created by Clostridium tetani. Contamination of the umbilical cord stump is the main cause. The typical, early manifestations are weakness and lack of ability to suck, continuing within hours to trismus, risus sardonicus, and ultimately generalized tetanic spasm, rigidity, and opisthotonus. Without treatment, neonatal tetanus has a poor outcome with a mortality rate above 90%. Mortality can result from asphyxia due to the spasm and hyper-sympathetic state. The managing goals are to neutralize its toxin, eradicate C. tetani, care for wound, and offer supportive care, such as mechanical ventilation, parenteral nutrition, sedation, neuromuscular blockade, and management of autonomic dysfunction

The role of beta-lactamase-producing-bacteria in mixed infections

Beta-lactamase-producing bacteria (BLPB) can play an important role in polymicrobial infections. They can have a direct pathogenic impact in causing the infection as well as an indirect effect through their ability to produce the enzyme beta-lactamase. BLPB may not only survive penicillin therapy but can also, as was demonstrated in in vitro and in vivo studies, protect other penicillin-susceptible bacteria from penicillin by releasing the free enzyme into their environment. This phenomenon occurs in upper respiratory tract, skin, soft tissue, surgical and other infections. The clinical, in vitro, and in vivo evidence supporting the role of these organisms in the increased failure rate of penicillin in eradication of these infections and the implication of that increased rate on the management of infections is discussed

Cancer of the Throat: A Physician’s Experience as a Patient

The author, a practicing physician, was diagnosed with throat cancer and lost his vocal cords. He endured the side effects of radiation, repeated surgeries, and the effects of prolonged hospitalizations; confronted medical mistakes and discrimination after losing his vocal cords; and struggled to regain his speech and find new meaning and purpose for his life. Facing the hardship and trials of becoming a laryngectomee illustrated to him how dependent and helpless a patient can become. Being unable to speak, eat, and breathe normally, while dealing with a potentially terminal illness, makes the patient very vulnerable, both physically and emotionally. A skillful, competent, error-free, empathetic, and caring approach that recognizes what the patient is experiencing can expedite recovery and well-being and help the patient return to a productive and meaningful life

ANAEROBIC INFECTIONS IN CHILDHOOD

xiii, 359 hlm.; 22 c