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아토피 피부염은 소아의 10∼30%에서 발병될 만큼 흔한 질환이다.
아토피 피부염은 가려움증 치료만 계속하면 '가려움→긁음→감염'의 악순환이 계속된다.
따라서 정확한 원인을 찾아 꾸준히 치료하고 이와 더불어 세심한 관리를 병행해야 한다.
목욕 후 제대로 된 보습을 하지 않으면 피부가 더 건조해지고 아토피 피부염이 더 심해진다.
그렇다고 목욕을 게을리하면 피부가 지저분해져서 가려워 긁게 되고 피부염이 낫지 않고
오래가게 된다. 목욕은 미지근한 물을 채워 10∼15분이내에 간단한 샤워를 해 주는것이 좋다.
때밀이 타월을 사용하지 말고 중성·약산성 비누를 사용해야 한다. 목욕이 끝나면 3분 이내에
면수건으로 가볍게 톡톡 눌러주면서 물기를 없앤 다음 로션이나 크림을 얇게 발라주는것이 좋다.
 

▲ 외출시 자외선 주의

아토피 피부염의 발병과 악화에는 환경적인 요인이 크게 작용한다. 특히 자외선은 365일 주의해
야 할 경계 대상
이다. 자외선에 노출될 경우 아토피 피부염 환자들은 발열감이나 가려움·발진·
짓무름 등의 증세가 나타나기 쉽다. 따라서 외출할 때 직사광선을 피하고 자외선 차단제를 반드시 발
라야 한다. 또한 자외선 차단 기능이 있는 선글라스나 챙이 있는 일반 모자를 쓰는 것이 좋다.


▲ 일상생활 주의사항

잠잘 때는 가급적 면으로 만든 잠옷을 입는다. 침구도 면제품을 사용하는 것이 좋으며 항상 깨끗하게
유지해야 한다. 너무 꽉 끼는 옷과 털옷을 피하면 옷에 의한 피부의 자극을 줄일 수 있다.
털이 많은 옷이나 먼지가 많은 니트류는 좋지 않다. 적당한 실내 온도는 섭씨 20∼26도,
습도 40∼60%. 가습기 등을 이용해 실내 습도를 적절히 유지해 주고 물이나 과일주스 등으로
에 수분을 충분히 공급해 준다.






Posted
Filed under Wellbaby/Vaccination

신종플루와 타미플루에 대해서 쓴 기사입니다.

http://media.daum.net/society/others/view.html?cateid=1067&newsid=20091105094221193&p=akn

아무 원칙도 없이 그냥 타미 플루에 달라고 하시는 분들 때문에 아주 많은 어려움을  격고 있습니다. 그냥 콧물과 기침만 있어도 타미플루를 처방하라는 지침으로만 신문에 기사가 나면서 왜 처방을 하지 않는지에 대해서 문의하고 심지어는 항의하시는 분들도 계시거던요...

의사가 아무 책임을 지지 않을려고 하면 그냥 무조건 처방하면 되지만 귀찮치도 않고 나중에 내성이 생기거나 말거나 신경쓰지 않고 그냥 주면 되지만 그것이 과연 환자에게 이득이 되는 것이지 모르겠습니다.

증상의 경중도를 진찰해 보고 거기에 맞게 주기도 하는 것이 가장 합리적이고 이성적인 판단이라고 생각이 듭니다. 나중에 마구 처방되어 지고 마구 먹고 난후에 생길 수있는 합병증이나 내성 또는 변종 바이러스의 출현이 범 국가적인 재난이 될 수도 있는 것인데 이러한 것에 대한 논의나 대책은 없이 아주 편안한 재고 물량 소진을 위해서 정부가 이러한 정책을 펴는 것은 비 이성적인 것으로 생각이 됩니다. 고위험군이 아닌 이상 그러한 처방은 국민 전체에게 더 해가 될 가능성이 있으니까요

또한  조금 더 합리적이고 편한 방법이 겨울 방학 땡겨서 하기를 하면 이러한 학생들의 공동체감염을 막을 수 있는 데 말입니다.

아무튼 큰 걱정입니다. 하루에 12만명분의 타미플루가 처방되고 있다고 합니다. 이러한 것이 우리나라의 앞으로의 재난에 큰 장해가 되지 않기를 간절히 기원해 봅니다.


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Filed under Illbaby/감기

Antiviral use and the risk of drug

resistance

Pandemic (H1N1) 2009 briefing note 12

25 SEPTEMBER 2009 | GENEVA -- Growing international experience in the treatment of pandemic H1N1 virus infections underscores the importance of early treatment with the antiviral drugs, oseltamivir or zanamivir. Early treatment is especially important for patients who are at increased risk of developing complications, those who present with severe illness or those with worsening signs and symptoms.[1]

The experience of clinicians, including those who have treated severe cases of pandemic influenza, and national authorities suggests that prompt administration of these drugs following symptom onset reduces the risk of complications and can also improve clinical outcome in patients with severe disease.

This experience further underscores the need to protect the effectiveness of these drugs by minimizing the occurrence and impact of drug resistance.

High-risk situations for development of drug resistance

WHO encourages clinicians to be alert to two situations that carry a high risk for the emergence of viruses resistant to oseltamivir.

The risk of resistance is considered higher in patients with severely compromised or suppressed immune systems who have prolonged illness, have received oseltamivir treatment (especially for an extended duration), but still have evidence of persistent viral replication.

The risk of resistance is also considered higher in people who receive oseltamivir for so-called “post-exposure prophylaxis” following exposure to another person with influenza, and who then develop illness despite taking oseltamivir.

In both of these clinical situations, health care staff should respond with a high level of suspicion that oseltamivir resistance has developed. Laboratory investigation should be undertaken to determine whether resistant virus is present and appropriate infection control measures should be implemented or re-enforced to prevent spread of the resistant virus.

When a drug-resistant virus is detected, WHO further recommends that an epidemiological investigation be undertaken to determine whether onward transmission of the resistant virus has occurred. In addition, community surveillance for oseltamivir-resistant pandemic H1N1 virus strains should be enhanced.

In general, WHO does not recommend the use of antiviral drugs for prophylactic purposes. For people who have had exposure to an infected person and are at a higher risk of developing severe or complicated illness, an alternative option is close monitoring for symptoms, followed by prompt early antiviral treatment should symptoms develop.

WHO has also recommended against the use of a particular antiviral where the virus is known or highly likely to be resistant to it. For this reason, zanamivir is the treatment of choice for patients who become ill while on oseltamivir prophylaxis.

Oseltamivir-resistant viruses

Systematic surveillance conducted by the Global Influenza Surveillance Network, supported by WHO Collaborating Centres and other laboratories, continues to detect sporadic incidents of H1N1 pandemic viruses that show resistance to oseltamivir. To date, 28 resistant viruses have been detected and characterized worldwide.[2]

All of these viruses show the same H275Y mutation that confers resistance to the antiviral oseltamivir, but not to the antiviral zanamivir. Zanamivir remains a treatment option in symptomatic patients with severe or deteriorating illness due to oseltamivir-resistant virus.

Twelve of these drug-resistant viruses were associated with the use of oseltamivir for post-exposure prophylaxis. Six were associated with the use of oseltamivir treatment in patients with severe immunosuppression. Four were isolated from samples from patients receiving oseltamivir treatment.

A further two were isolated from patients who were not taking oseltamivir for either treatment or prophylaxis. Characterization of the remaining viruses is under way.

These numbers are comparatively small at present. Worldwide, more than 10,000 clinical specimens (samples and isolates) of the pandemic H1N1 virus have been tested and found to be sensitive to oseltamivir.

Current conclusions

These data support several conclusions. Cases of oseltamivir-resistant viruses continue to be sporadic and infrequent, with no evidence that oseltamivir-resistant pandemic H1N1 viruses are circulating within communities or worldwide.

To date, person-to-person transmission of these oseltamivir resistant viruses has not been conclusively demonstrated. In some situations, however, local transmission may have occurred, but without any further onward or ongoing transmission.

Except for immunocompromised patients, those infected with an oseltamivir-resistant pandemic H1N1 virus have experienced typical uncomplicated influenza symptoms. No evidence suggests that oseltamivir-resistant viruses are causing a different or more severe form of illness.

The occurrence of oseltamivir-resistant viruses is expected and is consistent with observations from early clinical trials. As use of antiviral drugs continues to grow, further reports of drug-resistance viruses are certain to occur. WHO and its network of collaborating laboratories are closely monitoring the situation and will issue information and advice on a regular basis as indicated.

_______________________

[1] Briefing Note on recommendations for use of antivirals
[2] Weekly updates on cases of oseltamivir resistant pandemic H1N1 virus


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Recommended use of antivirals

Pandemic (H1N1) 2009 briefing note 8


21 AUGUST 2009 | GENEVA -- WHO is today issuing guidelines for the use of antivirals in the management of patients infected with the H1N1 pandemic virus.
The guidelines represent the consensus reached by an international panel of experts who reviewed all available studies on the safety and effectiveness of these drugs. Emphasis was placed on the use of oseltamivir and zanamivir to prevent severe illness and deaths, reduce the need for hospitalization, and reduce the duration of hospital stays.
The pandemic virus is currently susceptible to both of these drugs (known as neuraminidase inhibitors), but resistant to a second class of antivirals (the M2 inhibitors).
Worldwide, most patients infected with the pandemic virus continue to experience typical influenza symptoms and fully recover within a week, even without any form of medical treatment. Healthy patients with uncomplicated illness need not be treated with antivirals.
On an individual patient basis, initial treatment decisions should be based on clinical assessment and knowledge about the presence of the virus in the community.
In areas where the virus is circulating widely in the community, clinicians seeing patients with influenza-like illness should assume that the pandemic virus is the cause. Treatment decisions should not wait for laboratory confirmation of H1N1 infection.
This recommendation is supported by reports, from all outbreak sites, that the H1N1 virus rapidly becomes the dominant strain.

Treat serious cases immediately

Evidence reviewed by the panel indicates that oseltamivir, when properly prescribed, can significantly reduce the risk of pneumonia (a leading cause of death for both pandemic and seasonal influenza) and the need for hospitalization.
For patients who initially present with severe illness or whose condition begins to deteriorate, WHO recommends treatment with oseltamivir as soon as possible. Studies show that early treatment, preferably within 48 hours after symptom onset, is strongly associated with better clinical outcome. For patients with severe or deteriorating illness, treatment should be provided even if started later. Where oseltamivir is unavailable or cannot be used for any reason, zanamivir may be given.
This recommendation applies to all patient groups, including pregnant women, and all age groups, including young children and infants.
For patients with underlying medical conditions that increase the risk of more severe disease, WHO recommends treatment with either oseltamivir or zanamivir. These patients should also receive treatment as soon as possible after symptom onset, without waiting for the results of laboratory tests.
As pregnant women are included among groups at increased risk, WHO recommends that pregnant women receive antiviral treatment as soon as possible after symptom onset.
At the same time, the presence of underlying medical conditions will not reliably predict all or even most cases of severe illness. Worldwide, around 40% of severe cases are now occurring in previously healthy children and adults, usually under the age of 50 years.
Some of these patients experience a sudden and very rapid deterioration in their clinical condition, usually on day 5 or 6 following the onset of symptoms.
Clinical deterioration is characterized by primary viral pneumonia, which destroys the lung tissue and does not respond to antibiotics, and the failure of multiple organs, including the heart, kidneys, and liver. These patients require management in intensive care units using therapies in addition to antivirals.
Clinicians, patients, and those providing home-based care need to be alert to warning signals that indicate progression to a more severe form of illness, and take urgent action, which should include treatment with oseltamivir.
In cases of severe or deteriorating illness, clinicians may consider using higher doses of oseltamivir, and for a longer duration, than is normally prescribed.

Antiviral use in children

Following the recent publication of two clinical reviews, [1,2] some questions have been raised about the advisability of administering antivirals to children.
The two clinical reviews used data that were considered by WHO and its expert panel when developing the current guidelines and are fully reflected in the recommendations.
WHO recommends prompt antiviral treatment for children with severe or deteriorating illness, and those at risk of more severe or complicated illness. This recommendation includes all children under the age of five years, as this age group is at increased risk of more severe illness.
Otherwise healthy children, older than 5 years, need not be given antiviral treatment unless their illness persists or worsens.

Danger signs in all patients

Clinicians, patients, and those providing home-based care need to be alert to danger signs that can signal progression to more severe disease. As progression can be very rapid, medical attention should be sought when any of the following danger signs appear in a person with confirmed or suspected H1N1 infection:
  • shortness of breath, either during physical activity or while resting
  • difficulty in breathing
  • turning blue
  • bloody or coloured sputum
  • chest pain
  • altered mental status
  • high fever that persists beyond 3 days
  • low blood pressure.
In children, danger signs include fast or difficult breathing, lack of alertness, difficulty in waking up, and little or no desire to play.
________________________________
[1] Neuraminidase inhibitors for treatment and prophylaxis of influenza in children: systematic review and meta-analysis of randomised controlled trials. Shun-Shin M, Thompson M, Heneghan C et al. BMJ 2009;339:b3172; doi:10.1136/bmj.b3172
[2] Prescription of anti-influenza drugs for healthy adults: a systemic review and meta-analysis. Burch J, Stock C et al. Lancet Infect Dis 2009; doi:10.1016/S1473-3099(09)70199-9

 
http://www.who.int/csr/disease/swineflu/notes/h1n1_use_antivirals_20090820/en/index.html
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