Learning issue in INFECTION 12/19

1.The adult-onset diabetes is called?

-->Latent autoimmune diabetes of adult(LADA)

also named:

LADA may be diagnosed using any of the following terms:

• latent autoimmune diabetes of adulthood
• late-onset autoimmune diabetes of adulthood
• latent autoimmune diabetes of aging
• slow onset type 1 diabetes, or
• type 1.5 (type one-and-a-half) diabetes

小重點* estimated that 20% of persons diagnosed as having non-obesity-related type 2 diabetes may actually have LADA.

 *Islet cell, insulin, and GAD antibodies testing should be performed on all adults who are not obese that appear to present with type 2 diabetes

那如何診斷?

----->1. C-peptide test(type 1->low to moderate/type 2 ->high)

       2. Glutamic acid decarboxylase autoantibodies

       3.Islet cell antibodies tests

2.P24 test for HIV Diagnosis

-->p24

     *core protein of the HIV virus particle->capsid of HIV

     *the level of p24 is indicator of HIV progression

     *In the early stage of HIV infection,the P24 antigen appears before the existence of antobody to HIV

3.What is ESBL mean?

ESBL=extended-spectrum beta-lactamases

水解酶，存於部分格蘭氏陰性菌中，可以對beta-lactam產生抗藥，故可以對抗

>Penicilin系列

>Cephalosporin系列

>Cefotaxime/ceftriaxone/ceftazidime/aztreonam

但不能破壞

>cephamycin:cefmentazone/cefoxitin/moxalactam/carbapene(imipenem,meropenem)

另一方面，可以利用beta-lactamase對抗:clavulanic acid,sulbactam,tazobactam

>從up to date 查到的治療方式:

• carbapenem (imipenem, meropenem, doripenem, and ertapenem). 
• We use meropenem or imipenem for most ESBL infections.
•  Ertapenem is an acceptable option in the absence of resistance or severe sepsis and can be particularly useful in the outpatient setting. 
• Cefepime may be effective against ESBL-producing organisms that test susceptible if administered in high doses (ie, 2 g every eight hours). 
• Use of other cephalosporins and piperacillin-tazobactam has been associated with treatment failures. 
• There is little clinical evidence for cephamycin use, which has been associated with development of resistance. 
• Resistance to aminoglycosides and fluoroquinolones is also common in these organisms.

      

Read More

Forrest classification in GI bleeding

Forrester classification


註:Cardiac index (CI) is a vasodynamic parameter that relates the cardiac output (CO) to body surface area (BSA),thus relating heart performance to the size of the individual. The unit of measurement is litres per minute per square metre (l/min/m2).


The index is usually calculated using the following formula:

where
CI=Cardiac index
BSA=Body surface area
SV=Stroke volume
HR=Heart rate
CO=Cardiac output
Clinical significance

The normal range of cardiac index in rest is 2.6 - 4.2 L/min per square meter.
It is frequently measured and used in intensive care medicine, and cardiac intensive care. It is a useful marker of how well the heart is functioning as a pump by directly correlating the volume of blood pumped by the heart with an individual's body surface area.
If the CI falls below 1.8 L/min/m², the patient may be in cardiogenic shock.
-------------------------------------------------------------------------------------------------------

Forrest classification

Forrest classification is a classification of upper gastrointestinal hemorrhage used for purposes of comparison and in selecting patients for endoscopic treatment

Acute hemorrhage

Forrest I a (Spurting hemorrhage)  O

Forrest I b (Oozing hemorrhage)   O

Signs of recent hemorrhage

Forrest II a (Visible vessel)  

Forrest II b (Adherent clot)

Forrest II c (Hematin on ulcer base)

Lesions without active bleeding

Forrest III (Lesions without signs of recent hemorrhage or fibrin-covered ulcer base)[2]

Read More