RESUMEN
In 2004 a large focus of Plasmodium knowlesi malaria was reported in the human population in Sarawak, Malaysian Borneo. Plasmodium knowlesi, a parasite of the South-East Asian macaques (Macaca fascicularis and Macaca nemestrina), had entered the human population. Plasmodium knowlesi is transmitted by the leucosphyrus group of Anopheline mosquitoes and transmission is largely zoonotic and restricted to the jungle setting. Humans entering jungle transmission sites are at risk. Since 2004, human cases of P. knowlesi have been continuously reported in local communities and in travellers returning from South East Asia. Plasmodium knowlesi is the most common type of indigenous malaria reported in Malaysia. Infections are most often uncomplicated but at least 10% of patients report with severe malaria and 1-2% of cases have a fatal outcome. Parasitaemia is positively associated with the clinical and laboratory markers of severe malaria. The current literature on P. knowlesi, including epidemiology, natural hosts and vectors, pathogenesis, clinical descriptions, treatment and diagnosis, is reviewed. There are many gaps in our understanding of this disease that are highlighted here with suggestions for further research to inform pre-emptive control measures that would be required to prevent a full emergence of this parasite into the human population.
Asunto(s)
Malaria/epidemiología , Malaria/parasitología , Plasmodium knowlesi/aislamiento & purificación , Zoonosis/epidemiología , Zoonosis/parasitología , Animales , Anopheles/parasitología , Antimaláricos/uso terapéutico , Asia Sudoriental/epidemiología , Reservorios de Enfermedades , Humanos , Insectos Vectores , Macaca/parasitología , Malaria/diagnóstico , Malaria/transmisión , Resultado del Tratamiento , Zoonosis/diagnóstico , Zoonosis/transmisiónRESUMEN
With increasing frequency, ambulatory patients maintained on multiple medications are seeking dental care. Because new medications are approved for use each year and new interactions and side effects are regularly exposed for existing medications, it is important to keep current in this area. With the availability of regularly updated computer programs to help analyze accurate patient medication lists, the treatment of the polymedication patient has become much easier. The close, careful attention to patient medications should help prevent medical problems as well as reveal much about the patient's ability to withstand dental procedures.
Asunto(s)
Cuidado Dental para Ancianos/métodos , Atención Dental para Enfermos Crónicos/métodos , Interacciones Farmacológicas , Efectos Colaterales y Reacciones Adversas Relacionados con Medicamentos , Anciano , Servicios de Información sobre Medicamentos , Prescripciones de Medicamentos , Utilización de Medicamentos , Humanos , Anamnesis/métodos , Enfermedades de la Boca/inducido químicamente , Medicamentos sin Prescripción , Negativa del Paciente al TratamientoRESUMEN
Mania is a rare complication of prescribed drug use in elderly persons. The drugs most likely to produce mania include corticosteroids and dopamine agonists. It is uncertain if antidepressants cause mania or only increase the propensity for latent bipolar mania to be expressed. Drug-induced mania may promote poor judgment, risk-taking behaviours and medical noncompliance. The majority of episodes of drug-induced mania are short-lived and respond to discontinuation of the drug. Antipsychotic agents may hasten resolution of this psychiatric syndrome. Lithium may prevent corticosteroid-induced mania, but the role of lithium in the treatment of other drug-induced manic episodes has not been studied adequately.
Asunto(s)
Envejecimiento/psicología , Trastorno Bipolar/inducido químicamente , Anciano , Trastorno Bipolar/diagnóstico , Trastorno Bipolar/psicología , HumanosRESUMEN
Over 10% of medically ill elderly persons have concurrent major depression, and medical illness is the most influential stressor contributing to depression in old age. The contribution of prescribed medications to depression in the medically ill is poorly understood. Most information on drug-induced depression is derived from case reports; 43 classes of medications have been implicated, including reserpine, beta-blockers, levodopa, corticosteroids, and antipsychotics. However, large rigorously performed studies of some drugs, particularly antihypertensives, suggest that drug-induced depression is uncommon and idiosyncratic. There is no evidence that age is an independent risk factor for drug-induced depression. However, elderly persons are the largest consumers of prescribed drugs, and the burden of drug-induced depression is carried by the old. Because of the frequency of atypical presentations of mental disorders in the elderly, drug-induced depression is often misdiagnosed. Nevertheless, basic principles of geriatric medicine offer useful guidance to clinicians in evaluating the complex interrelationships between prescribed medications and depression. We recommend an approach that includes regular inquiry into the common symptoms of mood disorders, vigilance in assessing the contribution of drugs in their development, but scepticism in assessing a depressive episode as caused only by medication.
Asunto(s)
Trastorno Depresivo/inducido químicamente , Anciano , Trastorno Depresivo/psicología , Femenino , Humanos , MasculinoRESUMEN
Increasingly, patients with complicated medical problems are coming to dental offices for treatment. These patients report using a variety of medications to control one or more chronic conditions. Many of these medications produce changes in the mouth because of toxic overdoses, side effects, allergic reactions, or as a consequence of the primary action of the drug. These effects include: xerostomia, gingival hyperplasia, candidiasis, mucositis, stomatopyrosis, gingival bleeding, petechia, salivary gland problems, intrinsic stain, cheilitis, erythema multiforme, lichen planus, ulcerations, taste changes, tardive dyskinesias, and soft tissue pigmentation. This article discusses presentations and causes of oral changes secondary to systemic drug use.