The Ezetimibe
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The Ezetimibe/Simvastatin Single Pill in the Management of Hypercholesterolaemia
Akira Yik-Tian Wu, MBBS (Monash), FRACP, FAMS
oduction
Therapy with 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitors or statins has been shown to be effective in lowering low-density lipoprotein cholesterol (LDL-C) levels, which are linked to cardiovascular morbidity and mortality. Previous pivotal trials with simvastatin have demonstrated that reductions in LDL-C resulted in a decrease in acute coronary events and improved survival.1,2 However, a significant number of patients still fail to achieve LDL-C goals.3 There is evidence to suggest that greater reductions in LDL-C can further protect patients from cardiovascular events.2,4 The strategy of increasing the doses of statins is effective but is complicated by an increase in the incidence of adverse reactions.5 To limit toxicity and maintain anti-atherosclerotic benefits, one approach is to combine a moderate dose of a statin and another lipid-lowering drug, such as ezetimibe. This review will focus on simvastatin and ezetimibe in a single pill.
Systemic infections
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Systemic infections
Australian spotted fevers (tick typhus: Rickettsia australis, R. honei), scrub typhus (Orientia tsutsugamushi)
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1 |
doxycycline (child >8 years: 2 mg/kg up to) 100 mg orally, 12-hourly for 7 to 10 days |
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OR |
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2 |
chloramphenicol (child: 12.5 mg/kg up to) 500 mg orally or IV, 6-hourly for 7 to 10 days. |
In severe disease or children less than 8 years old, consultation with an infectious diseases physician or clinical microbiologist is recommended.
Streptococcal and Enterococcal Infections
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Streptococcal and Enterococcal Infections
Michael R. Wessels
Many varieties of streptococci are found as part of the normal human flora colonizing the respiratory, gastrointestinal, and genitourinary tracts. Several species are important causes of human disease. Group A Streptococcus, or S. pyogenes, is responsible for streptococcal pharyngitis, one of the most common bacterial infections of school-age children, and for the postinfectious syndromes of acute rheumatic fever and poststreptococcal glomerulonephritis. Group B Streptococcus, or S. agalactiae, is the leading cause of bacterial sepsis and meningitis in newborns and a major cause of endometritis and fever in parturient women. Enterococci are important causes of urinary tract infection, nosocomial bacteremia, and endocarditis. Viridans streptococci are the most common cause of bacterial endocarditis.
Sweating disorders
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Sweating disorders
Hyperhidrosis
Hyperhidrosis or excess sweating most commonly affects the palms, soles and axilla and is usually idiopathic, prolonged and symmetrical. It is exacerbated by stress but is relatively independent of temperature and occurs in both warm and cold climates, although it is usually more severe with warmth. Onset is most common in childhood or around puberty, and it may spontaneously improve after the age of 25. It is estimated that 1% of the population is affected, and there may be a positive family history.
Staphylococcal Infections
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Staphylococcal Infections
Franklin D. Lowy
Staphylococcus aureus, the most virulent of the many staphylococcal species, has demonstrated its versatility by remaining a major cause of morbidity and mortality despite the availability of numerous effective antistaphylococcal antibiotics. S. aureus is a pluripotent pathogen, causing disease through both toxin-mediated and non-toxin-mediated mechanisms. This organism is responsible for both nosocomial and community-based infections that range from relatively minor skin and soft tissue infections to life-threatening systemic infections.
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