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.