Best Practice Topic Updates

Assessment of proteinuria

2013-06-18

Average daily urinary protein excretion in adults is 80 mg/day, with normal excretion considered to be <150 mg/day. Albumin represents approximately 15% of the daily urinary protein excretion in healthy people, with other plasma proteins (e.g., immunoglobulins, beta-2-microglobulin) and Tamm-Horsfall protein constituting the remaining 85%. Proteinuria varies in amount and may be transient or persistent.

Assessment of hypotension

2013-06-18

Hypotension can be defined as any BP that is below the normal expected for an individual in a given environment. There is no single numerical cut-off universally accepted as representing hypotension. For example, while <90mmHg may be considered hypotensive for someone with 'normal BP' of 120mmHg, many healthy young adults will have a resting BP at or potentially below this level and will not be considered hypotensive. As a result, it is difficult to estimate the prevalence. Background history and accompanying clinical findings should be considered, bearing in mind that many common illnesses present atypically in older adults, without characteristic symptoms such as pain. Hypotension can be the first sign of a serious acute illness (such as MI, sepsis, or GI haemorrhage). Once acute causes have been excluded, other chronic or recurring causes should then be investigated.

Trachoma

2013-06-18

Trachoma is a keratoconjunctivitis caused by ocular infection with (serovars A, B, Ba, and C). It should not be mistaken for chlamydial conjunctivitis, which is a self-limiting conjunctivitis caused by the sexually transmitted strains of (serotypes D to K). Inflammatory episodes in adults tend to be shorter and less severe than in children. Repeated infections lead to recurrent episodes of chronic inflammation that may progress to scarring of the upper tarsal conjunctiva. The scarring results in distortion of the upper eyelid, and this can cause lashes to abrade the cornea. This is called trachomatous trichiasis and, unless surgically corrected, will rapidly lead to corneal opacity and blindness.

HIV infection

2013-06-18

HIV infection is a pandemic whose impact on societies is without precedent. It is caused by a retrovirus that infects and replicates in human lymphocytes and macrophages, eroding the integrity of the human immune system over a number of years, culminating in immune incompetence and a susceptibility to a series of opportunistic and other infections as well as the development of malignancies.

Overview of meningitis

2013-06-18

Meningitis is usually caused by bacterial, viral, or fungal infection, but may also result from injury, cancer, or drugs (e.g., non-steroidal anti-inflammatory drugs [NSAIDs], trimethoprim/sulphamethoxazole, amoxicillin, or ranitidine). Classic symptoms of meningitis include headache, nausea or vomiting, neck stiffness, and fever. Each subtype also has its characteristic risk factors, signs, and symptoms.

Assessment of urticaria

2013-06-18

Urticaria (also called hives or whealing of the skin) consists of pruritic, pink or pale swellings of the superficial dermis. Most lesions are small, but larger, giant, or annular variants may also be seen. Urticaria can occur in any age group and affects 10% to 25% of the population.

Achalasia

2013-06-18

Achalasia, from the Greek for 'does not relax', is an oesophageal motor disorder of unknown aetiology, characterised by oesophageal aperistalsis and insufficient lower oesophageal sphincter (LOS) relaxation in response to swallowing. This results from loss of inhibitory nitrinergic neurons in the oesophageal myenteric plexus.

Subarachnoid haemorrhage

2013-06-17

Subarachnoid haemorrhage (SAH) is bleeding into the subarachnoid space and is an emergency. The most common cause of non-traumatic SAH is intracranial aneurysm. Aneurysmal SAH causes substantial morbidity and mortality. When a cerebral aneurysm ruptures, blood flows into the subarachnoid space, sometimes seeping into brain parenchyma and/or ventricles. The sudden increase in intracranial pressure, as well as the destructive and toxic effects of blood on brain parenchyma and cerebral vessels, accounts for most complications.

Chronic fatigue syndrome

2013-06-17

Chronic fatigue syndrome (CFS) is characterised by persistent fatigue and other associated symptoms (e.g., musculoskeletal pain, sleep disruption, memory impairments) lasting at least 6 months. The fatigue is not related to other medical conditions, disease processes, or identifiable biological causes. Sleep, rest, and activity restriction do not improve symptoms.

Cholangiocarcinoma

2013-06-17

Cholangiocarcinomas are cancers arising from the bile duct epithelium. These can be divided depending on their location in the biliary tree: intrahepatic or extrahepatic (perihilar and distal). Perihilar tumours involving the bifurcation of the ducts are also known as Klatskin's tumours. More than 95% are adenocarcinomas. Most are of the infiltrating nodular or diffusely infiltrating type. Purely nodular or papillary are less frequent subtypes.

SARS

2013-06-17

Severe acute respiratory syndrome (SARS) is a viral pneumonia that rapidly progresses to respiratory failure. It is an emerging, potentially fatal infectious disease. A novel coronavirus (SARS-CoV), which is not closely related to any of the previously characterised coronaviruses, has been identified as the pathogen responsible for the disease. This syndrome is associated with signs and symptoms of acute lower respiratory tract illness and radiological evidence of consolidation following close contact with an infected person.

Assessment of polyneuropathy

2013-06-14

Polyneuropathy is a generalised disease of the peripheral nerves. Estimates on the prevalence in the general population range from 2% to 7%.

Osteomyelitis

2013-06-14

Osteomyelitis is an infection of the bone that presents a variety of challenges to the physician. The severity of the disease is staged depending on the infection's aetiology, pathogenesis, extent of bone involvement, and duration, and host factors particular to the individual patient. Osteomyelitis may be either haematogenous or caused by a contiguous spread of infection. is the most common organism isolated.

Assessment of pericardial effusion

2013-06-14

Pericardial effusion is a frequent finding that occurs due to primary pericardial disease or in relation to a myriad of systemic disease processes. The significance of effusions lies in their relationship to an underlying disease state and in their potential to affect a patient's haemodynamics.

Insect bites and stings

2013-06-14

The term 'insect' refers to a distinct taxonomic class. However, it is used generically throughout this monograph to represent a multitude of bugs, including arachnids. Encounters with insects or arachnids can result in bites or stings.

Molluscum contagiosum

2013-06-12

This condition is caused by the molluscum contagiosum virus, a ubiquitous poxvirus that escapes immune destruction for months to years. Lesions are cutaneous (less commonly mucosal). They appear as pearl-like, smooth papules, which are umbilicated. The histological equivalent of epidermal collections of molluscum bodies is referred to as Henderson-Patterson bodies; virally infected keratinocytes with a central orifice. Lesions are generally caused via skin-to-skin or fomite contact in children and by sexual transmission in adults.

Assessment of traumatic brain injury, acute

2013-06-12

Head injury is defined as any trauma to the head, with or without injury to the brain. The head injury can be described as minimal, minor, moderate, or severe, based on symptoms after the injury. Patients with minimal head injury are those with trauma to the head and no loss of consciousness, a normal GCS, and no symptoms of head injury. Minor head injury patients have a Glasgow Coma Scale (GCS) score of 13 to 15 after head injury.

Acute sinusitis

2013-06-12

Acute sinusitis (also commonly known as acute rhinosinusitis) is a symptomatic inflammation of the mucosal lining of the nasal cavity and paranasal sinuses, where clinical symptoms have been present for 4 weeks or less. It can be caused by either a viral or a bacterial infection.

Histoplasmosis

2013-06-12

Histoplasmosis is an infectious disease caused by the fungus . It is not communicable from person to person but is acquired from inhalational exposure to infectious spores found in soil contaminated with bird or bat droppings. African histoplasmosis is a different clinical entity and will not be discussed here.

Poliovirus infection

2013-06-12

Poliomyelitis is contracted through transmission of poliovirus, an enterovirus, usually through gastrointestinal-oral transmission. The condition may manifest as the minor illness, which is usually gastrointestinal, or as the major illness, characterised by acute flaccid paralysis (AFP). Ninety-five percent of poliovirus infections are asymptomatic. The classic clinical syndrome of poliomyelitis involves asymmetrical paralysis of the affected limb (usually the lower extremities). There is no specific treatment, making vaccination and global eradication a major priority for the World Health Organization (WHO).