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Аналітика публікацій
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01 Ciprofloxacin:
سیپروفلوکساسین:
Maternal use of an ear drop or eye drop that contains ciprofloxacin presents negligible risk for the nursing infant. To substantially diminish the amount of drug that reaches the breastmilk after using eye drops, place pressure over the tear duct by the corner of the eye for 1 minute or more, then remove the excess solution with an absorbent tissue.
Amounts of ciprofloxacin in breastmilk are low. Fluoroquinolones such as ciprofloxacin have traditionally not been used in infants because of concern about adverse effects on the infants' developing joints. However, studies indicate little risk.
The calcium in milk might decrease absorption of the small amounts of fluoroquinolones in milk, but insufficient data exist to prove or disprove this assertion. Use of ciprofloxacin is acceptable in nursing mothers with monitoring of the infant for possible effects on the gastrointestinal flora, such as diarrhea or candidiasis (thrush, diaper rash).
Avoiding breastfeeding for 3 to 4 hours after a dose should decrease the exposure of the infant to ciprofloxacin in breastmilk
LactMed
#ciprofloxacin
#سیپروفلوکساسین
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02 Celiac disease:
Screening programs have detected celiac disease in up to 8 percent of patients with sIgAD , and 1 to 2 percent of all patients with celiac disease have sIgAD . Patients with celiac disease may present with classic symptoms related to malabsorption, including diarrhea, steatorrhea, weight loss, and nutrient or vitamin deficiencies. However, many patients with celiac disease exhibit only minor gastrointestinal complaints, have nongastrointestinal manifestations, or are asymptomatic.
#celiac
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03 HbF and HbA2 in beta-thalassemia :
بتا تالاسمی مینور:
elevated HbF can be measured
together with elevated HbA2 in many carriers of b-thalassemia. The mechanism causing HbF elevation
in carriers of b-thalassemia point mutation defects is the mild but chronic erythropoietic stress, and the amount of HbF depends from the presence or absence
of determinants associated with elevated c genes expression as for instance the common Xmn-I poly-
morphism.
Conversely, the cause of the elevated HbA2 levels in the b-thal carrier is mainly the lower amount of b-chains that changes the b/d ratio in favor of the d.
Then, the number of a chains bound to the b will go down, while the a chain bound to the d chains will
rise from 2.5% in normal conditions to 4% or more when only one b-gene is expressed.
Therefore, in some
mild b-thalassemia defects with only partial reduction in b expression moderately elevated or near normal HbA2 levels are measured . Variations in HbA2 levels may also result from enhanced or reduced d
gene expression in CIS or TRANS and eventually from the relatively longer lifespan of red cells with a better a/cd ratio.
Elevated HbA2 levels are usually not observed in nontransfused homozygous or compound heterozygous b-thalassemia probably because of down regulation on both alleles and dyserythropoietic selection of red cells with elevated HbF expression.
#HbF
#HbA2
#b_thalassemia
#بتا_تالاسمی
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04 Pneumococcal vaccine:
واکسن پنوموکک:
The 23-valent pneumococcal polysaccharide vaccine (PPSV23) is an inactivated vaccine that contains purified capsular polysaccharide antigens of 23 serotypes (1, 2, 3, 4, 5, 6B, 7F, 8, 9N, 9V, 10A, 11A, 12F, 14, 15B, 17F, 18C, 19A, 19F, 20, 22F, 23F, and 33F) . The 23 serotypes were chosen to represent 85 to 90 percent of the serotypes that cause IPD in the United States. PPSV23 does not contain thimerosal .
PPSV23 is licensed for use in people ≥2 years of age. Polysaccharide vaccines are poorly immunogenic in children younger than two years of age .
Randomized trials and systematic reviews have not found administration of PCV to be beneficial in preventing AOM episodes in older children (>2 years) with recurrent AOM . This is primarily because the importance of pneumococcal disease decreases as children with recurrent AOM get older.
We suggest PCV for older children with recurrent AOM who have not received PCV as much to prevent IPD and pneumococcal pneumonia as to prevent AOM because children prone to AOM are at increased risk for IPD and pneumococcal pneumonia.
اپتودیت
#PCV
#PPSV23
#واکسن پنوموکک
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05 خلاصه‌ی مطالعات جدید، اردیبهشت ۱۴۰۳
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06 Auditory Brainstem Response
The auditory brainstem response (ABR) test tells us how the inner ear, called the cochlea, and the brain pathways for hearing are working. You may also hear it called an auditory evoked potential (AEP). The test is used with children or others who cannot complete a typical hearing screening.
#ABR
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07 Cow's milk protein allergy (CMPA):
حساسیت به پروتئین شیر گاو:
Cow's milk protein allergy (CMPA)
is considered as the most common food allergy in early life and may cause anaphylaxis reactions in severe cases. This review summarises recent findings in CMPA studies, especially regarding the main relevant cow's milk substitutes such as hydrolysed and plant-based (soy and rice) formulas in addition to other mammalian milk types (goat, sheep, donkey, mare and camel) to reduce allergy risks for children.
Extensively hydrolysed cow's milk formulas are mainly used as an alternative for children with CMPA, despite their poor palatability.
Goat's and sheep's milk and soy-based formulas are not recommended because of their high cross-reactivity with cow's milk proteins.
On the contrary, equine's and camel's milk proteins are suggested as suitable alternative solutions due to their low sequence identity levels with cow's milk proteins. Nonetheless, further research needs to confirm the usefulness of these milk types as a solution in paediatric CMPA.
ScienceDirect 2023
#CMPA
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08 Diarrhea Terminology:
اسهال:
Previous classifications have often divided diarrhea into osmotic and secretory, but these
terms can be misleading. Therefore, some new terms are proposed.
Osmotic diarrhea.—The term osmotic diarrhea has been used traditionally to refer to
diarrhea resulting from unabsorbed solutes or nutrients; however, all diarrhea involves
osmotic forces. Therefore, we prefer to use the more precise term, diet-induced diarrhea.
Diet-induced diarrhea is characterized by an elevated stool osmotic gap (>100 mOsm).
Examples include glucose or disaccharide malabsorption.
Secretory diarrhea.—The term secretory diarrhea is also imprecise. The term describes
the underlying pathophysiology of the diarrheas caused by active ion secretion into the intestine, but it does not describe the watery high-salt diarrheas caused by defects in intestinal sodium absorption (eg, as seen in the congenital sodium diarrheas and in some viral infections).
Neither can the term secretory be used to describe all the diarrheas with a low stool osmotic gap (<50 mOsm) (Table 1), because a low stool osmotic gap typically
results from a combination of enhanced anion-driven fluid secretion and loss of Na+-driven fluid absorption. We prefer to use the term electrolyte-transport-related diarrhea. Examples
include congenital chloride or sodium diarrheas.
Mixed diarrhea.—Lastly, diarrhea that is obviously neither secretory nor osmotic, or has
an intermediate stool osmotic gap (50–100 mOsm), has been referred to as “mixed.”
Intermediate values for the stool osmotic gap occur frequently and are generally caused by a
combination of diet-induced diarrhea and electrolyte transport-related diarrhea resulting
from different dietary intakes at the time of testing.
#diarrhea
#اسهال
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09 Anemia:
آنمی:
Anemia is very common in patients with inflammatory disorders. Its prevalence is associated with severity of the underlying disease, and it negatively affects quality of life and cardio-vascular performance of patients. Anemia of inflammation (AI) is caused by disturbances of iron metabolism resulting in iron retention within macrophages, a reduced erythrocyte half-life, and cytokine mediated inhibition of erythropoietin function and erythroid progenitor cell differentiation.
AI is mostly mild to moderate, normochromic and normocytic, and characterized by low circulating iron, but normal and increased levels of the storage protein ferritin and the iron hormone hepcidin. The primary therapeutic approach for AI is treatment of the underlying inflammatory disease which mostly results in normalization of hemoglobin levels over time unless other pathologies such as vitamin deficiencies, true iron deficiency on the basis of bleeding episodes, or renal insufficiency are present.
If the underlying disease and/or anemia are not resolved, iron supplementation therapy and/or treatment with erythropoietin stimulating agents may be considered whereas blood transfusions are an emergency treatment for life-threatening anemia.
New treatments with hepcidin-modifying strategies and stabilizers of hypoxia inducible factors emerge but their therapeutic efficacy for treatment of AI in ill patients needs to be evaluated in clinical trials.
#anemia
#آنمی
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10 urine colors:
علل تغییرات رنگ ادرار:
— Rarely, the urine has other colors, including:
●White urine, which may be due to phosphate crystals, chyluria , or propofol .
●Pink urine, presumably due to uric acid crystals, which may occur following propofol administration .
●Green urine, which may be due to the administration of methylene blue , propofol , amitriptyline, or rarely, from urinary tract infection caused by Pseudomonas aeruginosa .
●Black urine, which may be due to hemoglobinuria , myoglobulinuria, melanuria in the context of metastatic melanoma , or ochronosis. The black urine in ochronosis, which usually results from alkaptonuria (also called "black urine disease"), is caused by the urinary excretion of homogentisic acid. The black color may only be apparent after the urine stands for some time, permitting the oxidation of homogentisic acid.
●Purple urine, which may be due to bacteriuria in patients with urinary catheters , or coadministration of methylene blue and hydroxycobalamin.
اپتودیت
#تغییرات_رنگ_ادرار
#urine_color
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11 تهیه شده توسط :
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12 The normal time of fontanelle closure depends upon the patient's gestational age at birth. The posterior fontanelle usually cannot be palpated after two months of age . The anterior fontanelle generally closes between 10 and 24 months of age . The fontanelles of premature infants tend to close at a later time. Growth of fibrous tissue over the fontanelle precedes closure by several months and may be difficult to distinguish from true closure on physical examination.
In a cross-sectional study, high-resolution computed tomography (CT) scans of the head in young children (0 to 24 months of age) who were born at term were retrospectively reviewed for anterior fontanelle closure and surface area .
The scans were performed for evaluation of clinical findings (eg, trauma, seizure, altered mental status); children with conditions associated with potentially altered anterior fontanelle geometry (eg, hydrocephalus, achondroplasia, craniosynostosis) were excluded.
The proportion with anterior fontanelle closure increased steadily after five months of age:
•5 to 9 months – 3 percent
•10 to 12 months – 21 percent
•13 to 15 months – 35 percent
•16 to 18 months – 60 percent
•19 to 21 months – 84 percent
•22 to 24 months – 89 percent
These findings suggest that there is substantial variability in the timing of closure of the anterior fontanelle and that early or delayed closure may be a normal variant.
Early closure – Early closure of the anterior or posterior fontanelle is not uncommon in an otherwise normal child . However, it should alert the examiner to the possibility of developing microcephaly.
Other causes of early closure of the anterior fontanelle include :
•Craniosynostosis
•Hyperthyroidism
•Hypophosphatasia
•Hyperparathyroidism
The approach to the child with early closure of the anterior fontanelle depends upon associated clinical findings. As examples:
•Ridging at the suture lines suggests craniosynostosis
•Decreased head circumference (or decreasing percentile) indicated microcephaly
●Delayed closure – The most common causes of delayed closure of the anterior fontanelle include :
•Normal variation
•Congenital hypothyroidism
•Primary megalencephaly
•Increased intracranial pressure
•Down syndrome
•Rickets
اپتودیت
#fontanelle
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13 The normal time of fontanelle closure depends upon the patient's gestational age at birth. The posterior fontanelle usually cannot be palpated after two months of age . The anterior fontanelle generally closes between 10 and 24 months of age . The fontanelles of premature infants tend to close at a later time. Growth of fibrous tissue over the fontanelle precedes closure by several months and may be difficult to distinguish from true closure on physical examination.
In a cross-sectional study, high-resolution computed tomography (CT) scans of the head in young children (0 to 24 months of age) who were born at term were retrospectively reviewed for anterior fontanelle closure and surface area .
The scans were performed for evaluation of clinical findings (eg, trauma, seizure, altered mental status); children with conditions associated with potentially altered anterior fontanelle geometry (eg, hydrocephalus, achondroplasia, craniosynostosis) were excluded.
The proportion with anterior fontanelle closure increased steadily after five months of age:
•5 to 9 months – 3 percent
•10 to 12 months – 21 percent
•13 to 15 months – 35 percent
•16 to 18 months – 60 percent
•19 to 21 months – 84 percent
•22 to 24 months – 89 percent
These findings suggest that there is substantial variability in the timing of closure of the anterior fontanelle and that early or delayed closure may be a normal variant.
اپتودیت
#fontanelle
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14 Cyclic neutropenia:
is a rare syndrome in which the neutrophil count oscillates approximately every three weeks, paralleled by fever, skin and oral ulcerations, and/or cervical adenopathy; affected individuals are generally healthy between episodes.
●Cyclic neutropenia is associated with pathogenic variants (ie, mutation) of ELANE, the gene that encodes neutrophil elastase, but the mechanism by which they cause a cyclic pattern of neutropenia is incompletely understood.
●The hallmark of the clinical presentation is a predictable pattern of recurrent neutropenia with associated symptoms that typically include recurrent fever, inflammation of skin and oropharynx, and cervical lymphadenopathy. The periodicity of findings is approximately three weeks, and affected individuals are generally well between episodes. Individuals usually present within the first year of life, and symptoms generally improve in adulthood.
●The history should evaluate fever, skin and oropharyngeal inflammation, cervical adenopathy, and other infectious or inflammatory findings; explore a pattern of periodicity; and determine if there are affected family members. Physical examination should include examination of the gingiva, oral mucosa, and perianal region.
●Serial complete blood counts (CBC) with differential (eg, twice or thrice per week for eight weeks) are needed to document the severity and periodicity of neutropenia. Molecular testing will identify pathogenic variants of ELANE. Bone marrow examination is not required to establish the diagnosis.
●Cyclic neutropenia should be suspected in an infant, child, or adult in whom recurrent fever, oral ulcers, and/or lymphadenopathy parallel neutropenia at intervals of approximately three weeks.
The diagnosis is established by identification of a heterozygous pathogenic variant of ELANE in an appropriate clinical setting (eg, periodic fever, mucosal ulceration, lymphadenopathy with an approximately three-week periodicity) and documented absolute neutrophil count (ANC) <200/microL.
#neutropenia
#cyclic
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15 راجع به مشخصات تب در PFAPA:
Fever begins abruptly, often accompanied by chills. Prodromal symptoms of malaise, irritability or mood change, sore throat, or aphthous ulcers may occur during the preceding day. Temperatures range from 38.5 to 41ºC for two to seven days and then abruptly fall to normal. Episodes rarely last for more than seven days. Thus, prolonged fever episodes should prompt consideration of other diagnoses. In most cohorts, episodes last an average of 4 to 4.5 days .
Fever episodes typically occur every two to eight weeks; the average reported in most cohorts is approximately four weeks . Often, the start of the next episode can be predicted because of the regularity of episode timing. In other patients, the interval between episodes is approximately the same, but episodes do not occur with such perfect regularity as to allow for precise prediction of the next start date. Highly irregular episode timing should prompt evaluation for alternate diagnoses. Between febrile episodes, children with PFAPA are healthy and have normal growth and development.
اپتودیت
#PFAPA
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16 difference between DHEA and DHEA-S:
The difference in structure of the two molecules is the presence of a sulfate group – DHEA-S is the sulfated form of DHEA. Approximately 98% of circulating DHEA in the bloodstream is the sulfated form (DHEA-S). DHEA-S binds more strongly to albumin, its carrier protein, than DHEA, thus contributing to the slower metabolic clearance from circulation . In addition to the longer biological half-life, DHEA-S does not exhibit a strong diurnal rhythm as seen with cortisol and DHEA, nor does it vary from day to day . Additionally, the levels of DHEA-S run in parallel to those of DHEA, and correlate very closely with clinical symptoms of androgen deficiency and excess.
Consequently, DHEA-S represents a more stable index of adrenocortical activity and stress accumulated over time, whereas DHEA may better reflect the response to acute stressors. So when we measure DHEA-S, we gain an understanding of the body’s systemic biological reservoir of DHEA. All of the above reasons make DHEA-S the ideal molecular testing candidate.
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17 Normal IGF-1 values in children younger than three years may be very low and, in some cases, may be below the lower limit of detection of the assay. As a result, the normal range overlaps with that for GHD. Newer assays using mass spectrometry may resolve this issue.
●Inadequate nutrition lowers IGF-1 concentrations despite normal or even elevated levels of GH.
●Serum IGF-1 levels may be low in conditions other than GHD, such as GH insensitivity, hypothyroidism , diabetes , renal failure , and cancer .
#IGF
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18 Children with severe, long-standing primary hypothyroidism occasionally present with precocious puberty. In females, findings include early breast development, galactorrhea, and recurrent vaginal bleeding, while affected males present with premature testicular enlargement . Historically, this has been referred to as the "overlap" or Van Wyk-Grumbach syndrome . The signs of pubertal development regress with thyroxine therapy.
A proposed mechanism is cross-reactivity and stimulation of the FSH receptor by high serum thyrotropin (thyroid-stimulating hormone [TSH]) concentrations, given that both TSH and FSH share a common alpha subunit .
#Thyroid
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19 Tooth, Odontogenic Infection, Ludwig's Angina
Clinical Setting:
Tooth infections result from dental caries (cavities) and periodontal disease (gingivitis and periodontitis). Collectively, as they arise from the teeth, such infections are referred to as odontogenic.
Periapical tooth infections can extend and cause a variety of infectious complications:
Ludwig's angina is a complication of an infected tooth and/or periodontal infection:
Rapidly progressive bilateral infection of the submandibular space leading to posterior displacement of the tongue with a choking (angina) sensation.Usually occurs in adults with infection of the mandibular teeth.Can occur after fracture of mandible or piercings of the frenulum or tongue.
Other complications include: odontogenic sinusitis, cervical necrotizing fasciitis, cavernous sinus thrombosis, brain abscess Noma (also known as Cancrum oris) is a Variant in the malnourished manifest as severe necrotizing gingivitis .
Most of the infections are polymicrobic; in general strict or facultative anaerobic bacteria predominate .
Ludwig's Angina: Surgical drainage and removal of necrotic tissue are essential!
Risk of airway compromise is increased 10x in the absence of surgical drainage.
Etiologies:
Polymicrobial:
Viridans group streptococci.
Oral anaerobes:
Peptostreptococci, Fusobacteria, Prevotella and Actinomyces.
Streptococcus pyogenes.
In immunocompromised patients, worry about Staph. aureus and aerobic gram-negative bacteria.
Primary Regimens:
Severe infection:
Protect the airway.
Immunocompetent: patient: Penicillin G 3 mU IV q6h + Metronidazole 500 mg IV q6h; add Vancomycin if gram-positive cocci in clusters on gram stain.
Immunocompromised patient:
Vancomycin 1 gm IV q12h + Piperacillin-tazobactam 4.5 gm IV q6h.
Surgical debridement if abscess seen on CT scan or MRI.
Alternative Regimens:
Less severe infections:(Amoxicillin-clavulanate 875/125 mg po bid or 2000/125 mg bid) q12h.
Severe infections immunocompetent or immunocompromised:
Piperacillin-tazobactam 3.375 gm IV q6h or Meropenem 1 gm IV q8h.
Penicillin allergy:
Clindamycin 600 mg IV q6-8h
Sanford Guide
#odontogenic
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20 A Cochrane review of 23 studies (3938 participants) investigated giving probiotics containing either one or a combination of the following: Bacillus spp., Bifidobacterium spp., Clostridium butyricum, Lactobacilli spp., Lactococcus spp., Leuconostoc cremoris, Saccharomyces spp., or Streptococcus sp.
Results from 22/23 trials that reported on the incidence of antibiotic-associated diarrhea show a significant benefit from probiotics compared to active, placebo, or no treatment control (8% in the probiotic group compared to 19% in the control group). None of the 16 trials (n = 2455) that reported on side events documented any serious side events attributable to probiotics with the most common ones being rash, nausea, gas, flatulence, abdominal bloating, abdominal pain, vomiting, increased phlegm, chest pain, constipation, taste disturbance, and low appetite. The author’s concluded that there was a protective effect of probiotics for preventing antibiotic-associated diarrhea. The relative risk was 0.46 (95% CI 0.35 to 0.61) and the NNT was 10.
The authors considered Lactobacillus rhamnosus or Saccharomyces boulardii at 5 to 40 billion colony forming units/day to be the most appropriate choice. They also commented that although no serious adverse events were observed among the otherwise healthy children in these trials, serious adverse events have been observed in severely debilitated or immuno-compromised children with underlying risk factors (eg, central venous catheter use), and advised that probiotics should be avoided in pediatric populations at risk for adverse events until further research has been conducted.
Drugs.com
#probiotics
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21 💥سایمد درماتولوژی(SciMed Dermatology)💥
⭐️اولین نرم افزار آموزشی در پوست ، مو و زیبایی⭐️
ویژه پزشکان
⭐️کاملا رایگان برای همه همکاران پزشک
شامل:
📚ژورنال های درماتولوژی
📚ژورنال های پوست, مو و زیبایی
📚ژورنال های جراحی های زیبایی
📺ویدیو های آموزشی پروسیجر های زیبایی
📌اخبار پزشکی در پوست، مو و زیبایی
📕کتب کمیاب طب درماتولوژی و روش های زیبایی در پزشکی جهت ارتقا دانش پزشکی و مهارت در علم :
Medical cosmetics
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جهت جلوگیری از سواستفاده توسط افراد غیر پزشک، دسترسی فقط با احراز هویت ممکن خواهد بود.
طراحی توسط :
👨⚕️دکتر سید امیدرضا علی احمدی(MD)
📱dr.ahmadi.omid
📲لینک های دانلود اندروید:
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https://myket.ir/app/com.scimed.app
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App.scimedpro.com
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امیدوارم برای همکاران مفید واقع گردد.
ارادتمند:
دکتر امیدرضا علی احمدی
ن.پ: ۱۰۹۳۶۰
شماره همراه: 09126584472
تماس فقط در واتس اپ
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22 نکاتی درباره‌ی سرعت جریان در تزریق خون
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23 مروری بر الگوریتم تشخیصی آمبولی ریه
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24 Abbreviations:
AAP, American Academy of Pediatrics;
ACOG, American College of
Obstetricians and Gynecologists; ADH, antidiuretic hormone;
AFB, acid-fast bacilli;
AHA, American Heart Association; ALT, alanine transaminase;
AmB, amphotericin B;
amox/clav, amoxicillin/clavulanate; AOM, acute otitis media;
ARF, acute rheumatic fever;
AST, aspartate transaminase; AUC:MIC, area under the curve (the mathemati- cally calculated area below the serum concentration-versus-time curve) to minimum
inhibitory concentration;
BAL, bronchoalveolar lavage;
bid, twice daily;
BL, beta- lactamase;
CA-MRSA, community-associated methicillin-resistantStaphylococcus aureus;
cap, capsule;
CDC, Centers for Disease Control and Prevention;
cephalo- sporin-R,cephalosporin-resistant;
CF, cystic fibrosis;
CMV, cytomegalovirus;
CNS, central nervous system;
CRP, C-reactive protein;
CSD, cat-scratch disease;
CSF, cere- brospinal fluid;
CT, computed tomography;
DAT, diphtheria antitoxin;
div, divided;
DOT, directly observed therapy;
EBV, Epstein-Barr virus;
ESBL, extended-spectrum beta-lactamase;
ESR, erythrocyte sedimentation rate; ETEC, enterotoxin-producing
Escherichia coli;
FDA, US Food and Drug Administration;
GC, Neisseria gonorrhoeae;
gentamicin-S,gentamicin-susceptibe;
GI, gastrointestinal;
HACEK, Haemophilus
aphrophilus, Aggregatibacter (formerly Actinobacillus) actinomycetemcomitans, Car-
diobacterium hominis, Eikenella corrodens, Kingella species;
HSV, herpes simplex virus;
HUS, hemolytic uremic syndrome; I&D, incision and drainage;
ID, infectious disease;
IDSA, Infectious Diseases Society of America;
IM, intramuscular;
INH, isonia- zid; IV, intravenous;
IVIG, intravenous immune globulin; KPC, Klebsiella pneumoniae
carbapenemase;
L-AmB, liposomal amphotericin B; LFT, liver function test;
LP, lumbar puncture;
max, maximum;
MDR, multidrug resistant;
MIS-C, multisystem inflamma-
tory syndrome in children;
MRI, magnetic resonance imaging; MRSA, methicillin- resistant S aureus;
MRSE, methicillin-resistant Staphylococcus epidermidis;
MSM, men who have sex with men; MSSA, methicillin-susceptible S aureus;
MSSE, methicillin- sensitive S epidermidis;
ophth, ophthalmic;
PCR, polymerase chain reaction; PCV13,
Prevnar 13-valent pneumococcal conjugate vaccine;
pen-R, penicillin-resistant;
pen-S, penicillin-susceptible;
PIDS, Pediatric Infectious Diseases Society;
PIMS-TS, pediatric
inflammatory multisystem syndrome temporally associated with SARS-CoV-2;
pip/ tazo, piperacillin/tazobactam; PMA, postmenstrual age;
PO, orally;
PPD, purified protein derivative; PZA, pyrazinamide;
q, every; qd, once daily; qid, 4 times daily;
qod, every other day;
RIVUR, Randomized Intervention for Children with Vesicoureteral
Reflux;
RSV, respiratory syncytial virus; RT-PCR, real-time polymerase chain reaction;
soln, solution; SPAG-2, small particle aerosol generator-2;
spp, species;
staph, staphy- lococcal;
STEC, Shiga toxin–producing E coli; STI, sexually transmitted infection;
strep, streptococcal;
tab, tablet; TB, tuberculosis;
Td, tetanus, diphtheria;
Tdap, tetanus, diphtheria, acellular pertussis;
tid, 3 times daily;
TIG, tetanus immune globulin;
tol/ taz, ceftolozane/tazobactam; TMP/SMX, trimethoprim/sulfamethoxazole;
ULN, upper limit of normal;
UTI, urinary tract infection;
VDRL, Venereal Disease Research Labo- ratories;
WBC, white blood cell.
#abbreviations
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25 Urine casts are cylindrical, cigar-shaped structures produced by the kidney and present in the urine in certain disease conditions.
All casts are composed of a mucoprotein known as Tamm-Horsfall protein which is secreted by the distal loop of Henle, the distal tubule and the collecting ducts at a fairly constant rate. A significant number of urinary casts usually indicates the presence of renal disease.
Urinary casts are formed only in the distal convoluted tubule (DCT) or the collecting duct. The proximal convoluted tubule (PCT) and loop of Henle are not locations for cast formation. Casts are the result of solidification of material (protein) in the lumen of the kidney tubules.
Once formed, these casts of the tubule are eliminated via the urine and may be seen in the urine sediment. They may contain RBCs, WBCs, renal epithelial cells, fat globules, bacteria, and degenerated forms of any of these structures, which are seen as granules.
Aggregates of plasma proteins, including fibrinogen, immune complexes, and globulins, may also be seen as granules within a cast.
#cast
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26 Complications of HZO have been documented in the eye and central nervous system. Some studies suggest that up to 50% of untreated patients with HZO will go on to develop ocular complications. These commonly include corneal involvement , often in the form of neurotrophic keratitis. Intraocular pressure (IOP) should be measured during treatment because of the risk of IOP spikes, which may be related to the ocular disease or to steroid use. Complications can extend to the posterior segment, resulting in ocular apex syndrome, optic neuritis, and acute retinal necrosis.
Notably, HZO has been associated with central nervous system pathology, including cerebral stroke.Within one year of a patient’s initial episode, those with HZO have a risk of stroke 4.3 times higher than that of all HZ patients (whose risk is 1.3 times that of؟ controls). It is believed that the virus can cause vascular inflammation and occlusion, as the trigeminal nerve fibers extend along the middle, anterior, and inferior cerebellar arteries. Currently, no data have shown that treatment of HZO reduces the risk of stroke.
Although rare, additional neurologic sequelae have been documented, including cerebellar ataxia and meningoencephalitis.
AMERICAN ACADEMY OF OPHTHALMOLOGY
#zoster
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27 Herpes Zoster Ophthalmicus - American Academy of Ophthalmology
https://www.aao.org/eyenet/article/herpes-zoster-ophthalmicus-pearls#zoster
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28 امرپ فارسی، اردیبهشت ۱۴۰۳
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29 The Effect of Helicobacter pylori on the Presentation and
Clinical Course of Coronavirus Disease 2019 Infection
2021 ESPGHAN
#covid19
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30 .
EXTENDED-SPECTRUM BETA-LACTAMASES
Not long after cefotaxime came into clinical use in Europe, strains of Klebsiella pneumoniae were discovered in Germany with transferable resistance to the oxyimino-cephalosporins (eg, cefotaxime, ceftazidime, and ceftriaxone) . The enzyme responsible was related to SHV and was named SHV-2.
TEM-related extended-spectrum beta-lactamases (ESBLs) were discovered in France in 1984 and in the United States in 1988.
The ESBL family is heterogeneous. SHV and TEM-type ESBLs arose by amino acid substitutions that allowed narrower-spectrum enzymes to attack the new oxyimino-beta-lactams. Others, notably members of the CTX-M family, represent plasmid acquisition of broad-spectrum beta-lactamases originally determined by chromosomal genes.
ESBLs vary in activity against different oxyimino-beta-lactam substrates but cannot attack the cephamycins (cefoxitin, cefotetan and cefmetazole) and the carbapenems (imipenem, meropenem, and ertapenem). They are also generally susceptible to beta-lactamase inhibitors, such as clavulanate, sulbactam, and tazobactam, which consequently can be combined with a beta-lactam substrate to test for the presence of this resistance mechanism.
ESBLs have been found exclusively in gram-negative organisms, primarily in Klebsiella pneumoniae, Klebsiella oxytoca, and Escherichia coli but also in Acinetobacter, Burkholderia, Citrobacter, Enterobacter, Morganella, Proteus, Pseudomonas, Salmonella, Serratia, and Shigella spp.
Infection due to ESBL-producing E. coli has become widespread in hospitals around the world. Community-associated infection due to ESBL has also been recognized as an important clinical problem in the United States and Europe. In addition, a substantial portion of community-onset infection due to ESBL-producing E. coli has been observed among patients with no discernible health care-associated risk factors.
#ESBL
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31 Headache:
The mnemonic SNNOOP10 is a reminder of the danger signs ("red flags") for the presence of serious underlying disorders that can cause acute or subacute headache :
●Systemic symptoms including fever
●Neoplasm history
●Neurologic deficit (including decreased consciousness)
●Onset is sudden or abrupt
●Older age (onset after age 50 years)
●Pattern change or recent onset of new headache
●Positional headache
●Precipitated by sneezing, coughing, or exercise
●Papilledema
●Progressive headache and atypical presentations
●Pregnancy or puerperium
●Painful eye with autonomic features
●Post-traumatic onset of headache
●Pathology of the immune system or immunosuppressive therapy
●Painkiller overuse (includes analgesics, ergot, triptans)
Any of these findings should prompt further investigation, including brain imaging with magnetic resonance imaging (MRI) or computed tomography (CT).
#headache
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32 Beta-lactam antibiotics
inhibit the growth of sensitive bacteria by inactivating enzymes located in the bacterial cell membrane, which are involved in the third stage of cell wall synthesis. It is during this stage that linear strands of peptidoglycan are cross-linked into a fishnet-like polymer that surrounds the bacterial cell and confers osmotic stability in the hypertonic milieu of the infected patient. Beta-lactams inhibit not just a single enzyme involved in cell wall synthesis, but a family of related enzymes (four to eight in different bacteria), each involved in different aspects of cell wall synthesis. These enzymes can be detected by their covalent binding of radioactively-labeled penicillin (or other beta-lactams) and hence have been called penicillin binding proteins (PBPs).
Different PBPs appear to serve different functions for the bacterial cell. As an example, PBP2 in Escherichia coli is important in maintaining the rod-like shape of the bacillus, while PBP3 is involved in septation during cell division . Different beta-lactam antibiotics may preferentially bind to and inhibit certain PBPs more than others. Thus, different agents may produce characteristic effects on bacterial morphology and have different efficacies in inhibiting bacterial growth or killing the organism.
Beta-lactam antibiotics are generally bactericidal against organisms that they inhibit. The mechanism of bacterial cell killing is an indirect consequence of the inhibition of bacterial cell wall synthesis. Enzymes that mediate autolysis of peptidoglycan are normally present in the bacterial cell wall but are strictly regulated to allow breakdown of the peptidoglycan only at growing points. Beta-lactam inhibition of cell wall synthesis leads to activation of the autolytic system through a two component system, VncR/S, which initiates a cell death program .
Certain bacteria are deficient in these autolytic enzymes or have mutations in the regulatory genes; these strains show the phenomenon of "tolerance" to beta-lactam antibiotics, that is, their growth is inhibited by the antibiotic but the bacteria are not killed.
#Betalactam
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33 Long COVID: major findings,
mechanisms and recommendations.
Nature.com 2023
#covid19
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34 🔵دفترچه سوالات پنجاه و يكمين دوره آزمون پذيرش تخصصى پزشكى سال ۱۴۰۳
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35 https://www.drugs.com/drug-interactions/bismuth-subsalicylate-metronidazole-tetracycline-with-famotidine-392-0-1066-0.html
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Repost from N/a
Ciprofloxacin:
سیپروفلوکساسین:
Maternal use of an ear drop or eye drop that contains ciprofloxacin presents negligible risk for the nursing infant. To substantially diminish the amount of drug that reaches the breastmilk after using eye drops, place pressure over the tear duct by the corner of the eye for 1 minute or more, then remove the excess solution with an absorbent tissue.
Amounts of ciprofloxacin in breastmilk are low. Fluoroquinolones such as ciprofloxacin have traditionally not been used in infants because of concern about adverse effects on the infants' developing joints. However, studies indicate little risk.
The calcium in milk might decrease absorption of the small amounts of fluoroquinolones in milk, but insufficient data exist to prove or disprove this assertion. Use of ciprofloxacin is acceptable in nursing mothers with monitoring of the infant for possible effects on the gastrointestinal flora, such as diarrhea or candidiasis (thrush, diaper rash).
Avoiding breastfeeding for 3 to 4 hours after a dose should decrease the exposure of the infant to ciprofloxacin in breastmilk
LactMed
#ciprofloxacin
#سیپروفلوکساسین
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Celiac disease:
Screening programs have detected celiac disease in up to 8 percent of patients with sIgAD , and 1 to 2 percent of all patients with celiac disease have sIgAD . Patients with celiac disease may present with classic symptoms related to malabsorption, including diarrhea, steatorrhea, weight loss, and nutrient or vitamin deficiencies. However, many patients with celiac disease exhibit only minor gastrointestinal complaints, have nongastrointestinal manifestations, or are asymptomatic.
#celiac
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HbF and HbA2 in beta-thalassemia :
بتا تالاسمی مینور:
elevated HbF can be measured
together with elevated HbA2 in many carriers of b-thalassemia. The mechanism causing HbF elevation
in carriers of b-thalassemia point mutation defects is the mild but chronic erythropoietic stress, and the amount of HbF depends from the presence or absence
of determinants associated with elevated c genes expression as for instance the common Xmn-I poly-
morphism.
Conversely, the cause of the elevated HbA2 levels in the b-thal carrier is mainly the lower amount of b-chains that changes the b/d ratio in favor of the d.
Then, the number of a chains bound to the b will go down, while the a chain bound to the d chains will
rise from 2.5% in normal conditions to 4% or more when only one b-gene is expressed.
Therefore, in some
mild b-thalassemia defects with only partial reduction in b expression moderately elevated or near normal HbA2 levels are measured . Variations in HbA2 levels may also result from enhanced or reduced d
gene expression in CIS or TRANS and eventually from the relatively longer lifespan of red cells with a better a/cd ratio.
Elevated HbA2 levels are usually not observed in nontransfused homozygous or compound heterozygous b-thalassemia probably because of down regulation on both alleles and dyserythropoietic selection of red cells with elevated HbF expression.
#HbF
#HbA2
#b_thalassemia
#بتا_تالاسمی
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Pneumococcal vaccine:
واکسن پنوموکک:
The 23-valent pneumococcal polysaccharide vaccine (PPSV23) is an inactivated vaccine that contains purified capsular polysaccharide antigens of 23 serotypes (1, 2, 3, 4, 5, 6B, 7F, 8, 9N, 9V, 10A, 11A, 12F, 14, 15B, 17F, 18C, 19A, 19F, 20, 22F, 23F, and 33F) . The 23 serotypes were chosen to represent 85 to 90 percent of the serotypes that cause IPD in the United States. PPSV23 does not contain thimerosal .
PPSV23 is licensed for use in people ≥2 years of age. Polysaccharide vaccines are poorly immunogenic in children younger than two years of age .
Randomized trials and systematic reviews have not found administration of PCV to be beneficial in preventing AOM episodes in older children (>2 years) with recurrent AOM . This is primarily because the importance of pneumococcal disease decreases as children with recurrent AOM get older.
We suggest PCV for older children with recurrent AOM who have not received PCV as much to prevent IPD and pneumococcal pneumonia as to prevent AOM because children prone to AOM are at increased risk for IPD and pneumococcal pneumonia.
اپتودیت
#PCV
#PPSV23
#واکسن پنوموکک
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Auditory Brainstem Response
The auditory brainstem response (ABR) test tells us how the inner ear, called the cochlea, and the brain pathways for hearing are working. You may also hear it called an auditory evoked potential (AEP). The test is used with children or others who cannot complete a typical hearing screening.
#ABR
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Cow's milk protein allergy (CMPA):
حساسیت به پروتئین شیر گاو:
Cow's milk protein allergy (CMPA)
is considered as the most common food allergy in early life and may cause anaphylaxis reactions in severe cases. This review summarises recent findings in CMPA studies, especially regarding the main relevant cow's milk substitutes such as hydrolysed and plant-based (soy and rice) formulas in addition to other mammalian milk types (goat, sheep, donkey, mare and camel) to reduce allergy risks for children.
Extensively hydrolysed cow's milk formulas are mainly used as an alternative for children with CMPA, despite their poor palatability.
Goat's and sheep's milk and soy-based formulas are not recommended because of their high cross-reactivity with cow's milk proteins.
On the contrary, equine's and camel's milk proteins are suggested as suitable alternative solutions due to their low sequence identity levels with cow's milk proteins. Nonetheless, further research needs to confirm the usefulness of these milk types as a solution in paediatric CMPA.
ScienceDirect 2023
#CMPA
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Diarrhea Terminology:
اسهال:
Previous classifications have often divided diarrhea into osmotic and secretory, but these
terms can be misleading. Therefore, some new terms are proposed.
Osmotic diarrhea.—The term osmotic diarrhea has been used traditionally to refer to
diarrhea resulting from unabsorbed solutes or nutrients; however, all diarrhea involves
osmotic forces. Therefore, we prefer to use the more precise term, diet-induced diarrhea.
Diet-induced diarrhea is characterized by an elevated stool osmotic gap (>100 mOsm).
Examples include glucose or disaccharide malabsorption.
Secretory diarrhea.—The term secretory diarrhea is also imprecise. The term describes
the underlying pathophysiology of the diarrheas caused by active ion secretion into the intestine, but it does not describe the watery high-salt diarrheas caused by defects in intestinal sodium absorption (eg, as seen in the congenital sodium diarrheas and in some viral infections).
Neither can the term secretory be used to describe all the diarrheas with a low stool osmotic gap (<50 mOsm) (Table 1), because a low stool osmotic gap typically
results from a combination of enhanced anion-driven fluid secretion and loss of Na+-driven fluid absorption. We prefer to use the term electrolyte-transport-related diarrhea. Examples
include congenital chloride or sodium diarrheas.
Mixed diarrhea.—Lastly, diarrhea that is obviously neither secretory nor osmotic, or has
an intermediate stool osmotic gap (50–100 mOsm), has been referred to as “mixed.”
Intermediate values for the stool osmotic gap occur frequently and are generally caused by a
combination of diet-induced diarrhea and electrolyte transport-related diarrhea resulting
from different dietary intakes at the time of testing.
#diarrhea
#اسهال
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Anemia:
آنمی:
Anemia is very common in patients with inflammatory disorders. Its prevalence is associated with severity of the underlying disease, and it negatively affects quality of life and cardio-vascular performance of patients. Anemia of inflammation (AI) is caused by disturbances of iron metabolism resulting in iron retention within macrophages, a reduced erythrocyte half-life, and cytokine mediated inhibition of erythropoietin function and erythroid progenitor cell differentiation.
AI is mostly mild to moderate, normochromic and normocytic, and characterized by low circulating iron, but normal and increased levels of the storage protein ferritin and the iron hormone hepcidin. The primary therapeutic approach for AI is treatment of the underlying inflammatory disease which mostly results in normalization of hemoglobin levels over time unless other pathologies such as vitamin deficiencies, true iron deficiency on the basis of bleeding episodes, or renal insufficiency are present.
If the underlying disease and/or anemia are not resolved, iron supplementation therapy and/or treatment with erythropoietin stimulating agents may be considered whereas blood transfusions are an emergency treatment for life-threatening anemia.
New treatments with hepcidin-modifying strategies and stabilizers of hypoxia inducible factors emerge but their therapeutic efficacy for treatment of AI in ill patients needs to be evaluated in clinical trials.
#anemia
#آنمی
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urine colors:
علل تغییرات رنگ ادرار:
— Rarely, the urine has other colors, including:
●White urine, which may be due to phosphate crystals, chyluria , or propofol .
●Pink urine, presumably due to uric acid crystals, which may occur following propofol administration .
●Green urine, which may be due to the administration of methylene blue , propofol , amitriptyline, or rarely, from urinary tract infection caused by Pseudomonas aeruginosa .
●Black urine, which may be due to hemoglobinuria , myoglobulinuria, melanuria in the context of metastatic melanoma , or ochronosis. The black urine in ochronosis, which usually results from alkaptonuria (also called "black urine disease"), is caused by the urinary excretion of homogentisic acid. The black color may only be apparent after the urine stands for some time, permitting the oxidation of homogentisic acid.
●Purple urine, which may be due to bacteriuria in patients with urinary catheters , or coadministration of methylene blue and hydroxycobalamin.
اپتودیت
#تغییرات_رنگ_ادرار
#urine_color
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