Intensive Talk with Prof Falagas

Summary:
Bacteria develop multiple resistance to antibiotic
By:
1)producing B-lactamase
2)overexpression efflux pump to release extra antibiotic
3)antibiotic modify enzyme
4)ribosomal mutation
Thus appear all superbug such as ESBL, carbapenemase producing klebsiella etc
Pt infected with ESBL +ve had relative risk 1.85 of mortality compared to normal bugs
Treatment of commonest bugs in ICU –Acinetobacter spp.
Recommended to do C+S with MIC
Therapy promptly early
Start therapy right at beginning
Modification therapy as nessasary (de-escalation) early
Tigercycline- a new agt
It evades tetracycline efflux pump and ribosomal protective mechanism
Bacteriostatic
That is limitation no good blood level for therapeutic
Varied response to acinetobacter
Imipenem –launch with 4g/day
Recommend 2g/d as reduce seizure
Not enough as moderate susceptible organism need 1g qid .
Recommended for high MIC acinetobacter to give prolong infusion meropenem 1 g tds as long as 3 hr compared with 30min normally given.
Study proved similar dose with prolong infusion better outcome
Colistin monotherapy
Got 52% isolates for acinetobacter were polymycin only susceptible
The rest need colistin and one other antibiotic (rec add carbapenem)
As highest % of survival
Benault et al. showed Obesity highest rate septic shock
Partly related with leptin def
DM
FOsfamycin-good for Klebsiella spp and pseudomonas spp.
Another talk by gastro
If NDM1 may give fosfamycin + carbapenem.
UGIB
Commonest cause H. pylori followed by NSAID, Antiplatelet
Risk of UGIB-age, multiple co-morbidity and H/O peptic ulcer
If pt got cardiovascular problem, may restart antipltelet after 4-5 days of peptic ulcer

Neurology examination (basic fundamental)

Student, house officer, medical officer hates the most ! neurology system. Coz, no particular song lyrics to sing ! all other system got same chores to sing.-Inspection, palpation, percussion and auscultation.

To me, neurology famous song would be look and proceed + investigator.
The rule no 1- when ask to look at the face, please do look for upper and lower limb grossly also ! This is what i called LOOK thoroughtLY !

Rule no 2-Pretend yourself as a wireman,
rule of thumb - for neuro, first ,level of lesion-brain, cerebellum, brain stem, spinal cord, anterior horn , peripheral nerve or muscle.
After that second question- left or right brain or level of lesion
lAST-cause of the lesion
Then bingo- You are PASSED.

rule no 3- don't panic- apply for all

Rule no 4- common thing come first-apply for ALL physical examination.

Rule no 5- use your rule no2 rule then give the diagnosis with statement like this is a 40 year old (middle-aged) gentleman with left hemiparesis which is due to right cerebral infarct. etc..
Bingo, you are passed then just answer all the question.......to get better marks.


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