Isotretinoin therapy has furthermore proven effective against genital warts in experimental use, but is rarely used for this indication as there are more effective treatments. Isotretinoin may represent an efficacious and safe alternative systemic form of therapy for recalcitrant condylomata acuminata (RCA) of the cervix. In most countries this therapy is currently unapproved and only used if other therapies failed. Prescribing restrictions
Isotretinoin is a teratogen; there is about a 20–35% risk for congenital defects in infants exposed to the drug in utero, and about 30–60% of children exposed to isotretinoin prenatally have been reported to show neurocognitive impairment. Because of this, there are strict controls on prescribing isotretinoin to women who may become pregnant and women who become pregnant while taking isotretinoin are strongly advised to terminate their pregnancies.In most countries, isotretinoin can only be prescribed by dermatologists or specialist physicians; some countries also allow limited prescription by general practitioners and family doctors. In the United Kingdom and Australia, isotretinoin may be prescribed only by or under the supervision of a consultant dermatologist. Because severe cystic acne has the potential to cause permanent scarring over a short period, restrictions on its more immediate availability have proved contentious. In New Zealand, isotretinoin can be prescribed by any doctor but subsidised only when prescribed by a vocationally-registered general practitioner, dermatologist or nurse practitioner.In the United States, since March 2006 the dispensing of isotretinoin is run through a website called iPLEDGE.
Bronchopneumonia is a subtype of pneumonia. It is the acute inflammation of the bronchi, accompanied by inflamed patches in the nearby lobules of the lungs.It is often contrasted with lobar pneumonia; but, in clinical practice, the types are difficult to apply, as the patterns usually overlap. Bronchopneumonia (lobular) often leads to lobar pneumonia as the infection progresses. The same organism may cause one type of pneumonia in one patient, and another in a different patient. Causes
Bronchopneumonia is usually a bacterial pneumonia rather than being caused by viral disease.It is more commonly a hospital-acquired pneumonia than a community-acquired pneumonia, in contrast to lobar pneumonia.Bronchopneumonia is less likely than lobar pneumonia to be associated with Streptococcus pneumoniae. Rather, the bronchopneumonia pattern has been associated mainly with the following: Staphylococcus aureus, Klebsiella, E. coli and Pseudomonas. Pathology
Bronchopneumonia may sometimes be diagnosed after death, during autopsy. On gross pathology there are typically multiple foci of consolidation present in the basal lobes of the human lung, often bilateral. These lesions are 2–4 cm in diameter, grey-yellow, dry, often centered on a bronchiole, poorly delimited, and with the tendency to confluence, especially in children. Light microscopy typically shows neutrophils in bronchi, bronchioles and adjacent alveolar spaces. Treatment
Compared to pneumonia in general, the association between the bronchopneumonia pattern and hospital-acquired pneumonia warrants greater consideration of multiple drug resistance in the choice of antibiotics. See also
Lobar pneumonia


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