If the patient has severe community-acquired pneumonia (Table III), S pneumoniae, Legionella species, aerobic gram-negative bacilli (especially P aeruginosa in the setting of chronic lung disease), and M pneumoniae (Fig. Adapted from Neill AM, Martin IR, Weir R, et al: Community-acquired pneumonia: Aetiology and usefulness of severity criteria on admission. Microbiologic diagnosis of community-acquired pneumonia in the 71% of cases with an etiology documented by sputum culture. Therefore Pneumocystis carinii pneumonia (PCP) must also be included in the clinical differential. Approximately 10% of all AIDS cases manifest in the elderly. Recent reports suggest that more than 50% of community-acquired pneumonia occurs in individuals with impaired host defenses. Based upon this probable spectrum of inciting pathogens the following antibiotic regimens are recommended: a second-generation cephalosporin, or a beta-lactam/beta-lactamase inhibitor, or trimethoprim-sulfamethoxazole, with or without the addition of a macrolide or quinolone antibiotic to cover the so-called atypical pathogens (Table I). S aureus, Moraxella catarrhalis, Legionella species, Mycobacterium tuberculosis, and the endemic fungi must also be considered, especially in compromised hosts. Aerobic gram-negative bacilli including P aeruginosa are increasingly common as a cause of pneumonia in the community. With novel blood sugar monitoring being invented everyday, and the sustained efforts of the pharmaceutical industry offering endless hope in the treatment and cure of diabetes, the take home message which is valid now and forever is: 'Do not to wait to be detected at the hospital'.For older (> 60 years) outpatients, the likely causative organisms are S pneumoniae, respiratory viruses, and Haemophilus influenzae (especially in smokers). It is now believed that the actual death toll related to diabetes in New Zealand could be thrice the official figure, surpassing that caused due to cancer, heart disease and stroke. Surprisingly, out of the 600 people who had died in Christchurch, less than 50% had the condition listed on their death certificate. With health professionals just beginning to understand the far-reaching consequences of diabetes and related complications, the toll related to diabetes is much greater than what is perceived at the moment. 'Patients with diabetes are more likely to have adverse events, more likely to get infections and to require more nursing care,' remarked Dr. 'That's saying if you've got diabetes, your risk of having a heart attack is the same as someone just walking out of the coronary care unit,' says Orr-Walker, a leading physician. It has been established that the risk of heart attack in a diabetic is comparable to the risk of a patient who has had a heart attack previously. Exercise, diet, tablet and insulin therefore continue to be the gold standard. Despite widespread research, there is no guaranteed cure for the disease. The key to effective management of diabetes is therefore early diagnosis/detection and maintenance of blood sugar level at an optimal level to prevent damage to other organs.
In New Zealand alone, more than 70 people lose their eyesight and another 500 have their limbs amputated owing to diabetic complications. With 1 in 5 New Zealanders being obese, this number is only expected to increase in the forth-coming years. The increase in proportion of the aging population, the variation in the ethnic constitution of the country and increase in obesity are responsible for this alarmingly high incidence of type-2 diabetes in New Zealand.
Maori and Pacific Islanders are at particularly increased risk, as they tend to develop the condition 10 years earlier than their counterparts.Ī combination of genetic and environmental factors can be blamed for causing type-2 diabetes. Men above the age of 45 or women above 55 years of age are more likely to develop diabetes. Obesity is an important risk factor for diabetes.
The irony is that nearly 50% of those suffering from diabetes do not even know that they have the disease. Nearly 250, 000 New Zealanders are believed to be afflicted with the deadly disease, and more than 300, 000 are thought to have pre-diabetes.
We're already gasping for breath but if it's hard now it's going to get a lot harder,' says Dr Brandon Orr-Walker, clinical head of the Middlemore Hospital, in response to the looming type-2 diabetes epidemic.
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