Syphilis

Syphilis

Management of sexual contacts

contact partners from the past 3 months if the patient has primary syphilis, and over a longer period if they have secondary syphilis (eg 6 months) or latent syphilis (eg 12 months).

Perform serological testing of sexual contacts and then presumptively treat them with:

benzathine benzylpenicillin 2.4 million units intramuscularly [Note 2], as a single dose.

Investigations for syphilis

Diagnosis of active syphilis is confirmed with both:

• a positive nontreponemal test result (such as rapid plasma reagin [RPR] test)
• a positive treponemal test result (such as treponemal enzyme immunoassay [EIA], T. pallidum particle agglutination test [TPPA] or T. pallidum haemagglutination assay [TPHA]).

Neither test alone is adequate for diagnosis.

Early syphilis

For treatment of early syphilis, use:

1	benzathine benzylpenicillin 2.4 million units intramuscularly [Note 1], as a single dose

Late latent syphilis

Late latent syphilis is defined as latent (asymptomatic) syphilis of longer than 2 years’ duration, or of unknown duration. Seek expert advice about the need for and interpretation of lumbar puncture. This is particularly important for patients who have previously been treated for syphilis or for patients with HIV infection. If neurosyphilis is confirmed, treat as for tertiary syphilis.

For treatment of late latent syphilis, use:

1	benzathine benzylpenicillin 2.4 million units intramuscularly [Note 3], once weekly for 3 weeks

10991

10991

A medical service to which an item in this table (other than this item or item 10990) applies if:
(a) the service is an unreferred service; and
(b) the service is provided to a person who is under the age of 16 or is a Commonwealth concession card holder: and
(c) the person is not an admitted patient of a hospital: and
(d) the service is bulk-billed in respect of the fees for:
     (i) this item and
     (ii) the other item in this table applying to the service; and
(e) the service is provided at, or from, a practice location in a regional, rural or remote area.

 Fee: $23.05 Benefit: 85% = $19.60

seizures are electrically induced in anesthetized patients for therapeutic effect

Electroconvulsive therapy (ECT), formerly known as electroshock, is a psychiatric treatment in which seizures are electrically induced in anesthetized patients for therapeutic effect. Its mode of action is unknown.[1] Today, ECT is most often recommended for use as a treatment for severe depression that has not responded to other treatment, and is also used in the treatment of mania and catatonia.[2] It was first introduced in 1938 by Italian neuropsychiatrists Ugo Cerletti and Lucio Bini, and gained widespread use as a form of treatment in the 1940s and 1950s.[

Mechanism of action

The aim of ECT is to induce a therapeutic clonic seizure (a seizure where the person loses consciousness and has convulsions) lasting for at least 15 seconds. Although a large amount of research has been carried out, the exact mechanism of action of ECT remains elusive. ECT doctors claim it may "jumpstart the brain", helping boost neurotransmission, while others like Peter Breggin,[citation needed] claim it causes the "euphoric" effects similar to the effects found in "closed head injury" or people with fresh traumatic brain injury.

VASCULAR, or multi-infarct, dementia

VASCULAR, or multi-infarct, dementia is caused by the accumula-tion of small (lacunar) or large infarctions, often in conjunction with deep white-matter ischaemia. These changes are best seen on MRI using T2-weighted sequences (figure 5)

cholinesterase inhibitors for anti dementia

Acetylcholine is the neuro-transmitter most involved in creating new memories. As dementia progresses, acetyl-choline levels fall steeply. This decline is corrected by cholinesterase inhibitors, which boost the levels of available acetylcholine.

Three cholinesterase inhibitors are approved for treatment of Alzheimer's dis-ease: donepezil (Aricept), galantamine (Reminyl) and rivastigmine (Exelon). Mar-keting claims aside, there is little to distinguish between them in terms of efficacy.

Starting on half the rec-ommended dose reduces side effects (nausea, loose bowel motions, leg cramps and vivid dreams), which often settle within weeks. Gas-trointestinal symptoms are also mitigated by the use of Exelon patches. Cholinesterase inhibitors can aggravate peptic ulcer, asthma and bradycardia. The last of these is a particu-lar concern in patients taking beta blockers, which may need to be stopped. They also prolong the action of succinylcholine and other muscle-paralysing agents. Treatment must therefore be stopped briefly a day before surgery requir-ing the use of such agen

Heart sound splitting

Splitting.
Splitting of the first heart sound is usually not detectable clinically; however, when it occurs it is
most often due to the cardiac conduction abnormality known as complete right bundle branch block.

Increased normal splitting (wider on inspiration) of the second heart sound occurs when there is
any delay in right ventricular emptying, as in right bundle branch block (delayed right ventricular
depolarisation), pulmonary stenosis (delayed right ventricular ejection), ventricular septal defect
(increased right ventricular volume load), and mitral regurgitation (because of earlier aortic valve
closure, due to more rapid left ventricular emptying).
In the case of fixed splitting of the second heart sound, there is no respiratory variation (as is
normal) and splitting tends to be wide. This is caused by an atrial septal defect where equalisation
of volume loads between the two atria occurs through the defect. This results in the atria acting as a
common chamber.
In the case of reversed splitting P2 occurs first and splitting occurs in expiration. This can be due to
delayed left ventricular depolarisation (left bundle branch block), delayed left ventricular emptying
(severe aortic stenosis, coarctation of the aorta) or increased left ventricular volume load (large
patent ductus arteriosus). However, in the last-mentioned, the loud machinery murmur means that
the second heart sound is usually not heard.

Alzheimer's disease diagnostic criteria

Alzheimer's disease diagnostic criteria



• Memory impairment and one or more of:

— aphasia

— apraxia

— agnosia

— disturbance in executive functioning (ie, planning,

organising, sequencing, abstracting).

• These cognitive changes are sufficient to cause significant

impairment in social or occupational functioning and

represent a significant decline from a previous level of

functioning.

• These changes are not due solely to delirium or other

neurological conditions (eg, cerebrovascular disease) or

systemic conditions (eg, neurosyphilis).

• The course is characterised by gradual onset and continuing

decline.