慢郎中的住院門診大楼(只看性病+已診斷為艾滋病患者)

peying84

原帖由 范逍遥 于 15-8-2008 05:35 PM 发表




孺子可教
錢途無量

大爸，答案真的是酱吗？

peying84

原帖由 范逍遥 于 15-8-2008 10:46 PM 发表


不是
答案不是這樣
也不是大爸，請叫我靚仔

靓仔
还是大爸好听些
大爸，是不是因为到现在都没有正式的方法，要如何去perform therapeutic drug monitoring for once dailing dosing。
因为aminoglycoside是narrow therapeutic index的，毕竟会造成nephrotoxicity，虽然很多clinical trial说less nephrotoxicity effect for once daily dosing.
还是因为ethical 的问题，很少人做这个trial？

如果不是，是什么答案呢？
钓鱼都钓很多天了，可是还是钓不到

[ 本帖最后由 peying84 于 16-8-2008 12:11 AM 编辑 ]

xiangqichess

请教一下. intravesical bcg 在 bladder transitional cell carcinoma as a immunotherapy. 能不能帮忙解释指点一下?

慢郎中

原帖由 xiangqichess 于 19-8-2008 09:16 AM 发表
请教一下. intravesical bcg 在 bladder transitional cell carcinoma as a immunotherapy. 能不能帮忙解释指点一下?

This treatment is performed in an outpatient setting generally and involves the insertion of a catheter and the administration of BCG directly in to the bladder.

To administer the BCG vaccine, the bladder must be completely empty, therefore patients are recommended to restrict fluid intake for 8-12 hours and have no fluid for 4 hours before the treatment.

The BCG vaccine in combination with saline is infused through the catheter into the bladder in combination with a vaccine through the skin. The BCG solution must remain in direct contact with the bladder for two hours.

When emptying the bladder, you must avoid direct skin contact both during and after urinating, as the solution may cause skin irritation or a rash.

The bladder must be completely emptied, with men being advised to sit while urinating to avoid splashing.

Afterwards the genital area as well as the hands must be thoroughly cleansed and washed. As this treatment uses live bacteria, the possibility of contamination means the toilet must be neutralized.

This can be done by pouring two cups (or a pint) of neat bleach into the toilet and letting it stand for 15-20 minutes before flushing. The bladder should be thoroughly flushed after the treatment by increasing fluid intake.

Immunotherapies work by creating a reaction within the body's immune system that works to restore or boost the body's natural immune defence.

How exactly immunotherapies work to destroy cancer and reduce the possibility of recurrence is relatively unknown apart from the known response from the body's immune system.

Intravesical BCG immunotherapy is used for high grade tumours, often in patients with multiple or recurrent tumours.

Treatment with intravesical BCG has shown to delay progression to the muscles or/and metastatic disease, preserve the bladder and decrease the possibility of death from bladder cancer.

maileng

少年人, 现在讲话要斯文点,不要那么冲
他是找钟浪漫先生贝.

sotsotgirl

原帖由 范逍遥 于 9-8-2008 09:45 PM 发表


如果 trough 高，要如何調整？
如果  peak 高，要如何調整？(其實臨床上如果用 daily dosing 我個人不認為需要做 peak level)

本人刚过了tdm的clerkship就来插嘴一下。。。
基本上aminoglycoside的trough量出来是0.多的，所以机器都会量不到，所以医院都会用post 1 和 post 6 而没有用pre value了。。。

此蛛不同彼蛛

原帖由 ShyCao 于 9-8-2008 06:44 PM 发表



这个有点难度
请问nsaids如何 reduce the seizure threshold?

答了你的问题先
AMH找不到的去MIMS找

可惜MIMS不给我copy and paste

大意是NSAIDS会INHIBIT BINDING OF GABA to its receptor (which quinolones will do the same too, synergistic effect)

你在澳洲哪里啊？

blue_yee

Once daily administration of aminoglycosides in patients without pre-existing renal impairment is as effective as multiple daily dosing, has a lower risk of nephrotoxicity, and no greater risk of ototoxicity. Given the additional convenience and reduced cost, once daily dosing should be the preferred mode of administration.

http://www.bmj.com/cgi/content/abstract/312/7027/338

peying84

原帖由 范逍遥 于 9-8-2008 09:42 PM 发表


那么在 bacterial endocarditis
能不能夠用 daily dosing？

答案要自己找出來
大媽叫你自己去學習釣魚

大妈，是不是once-daily dosing of gentamicin is recommended to cover the possibility of gram-
negative sepsis for the empirical treatment of endocarditis. however, only limited clinical data are available on the once daily dosing of aminoglycoside, therefore, multiple dosing is recommended until adequate data are reported.

对吗？

原帖由 青菜 于 11-8-2008 07:59 PM 发表


啊是aminoglycoside啊。
TDM的都忘了呢。。。
endocarditis通常会和别的antibiotic一起用，dose不需要那么高，所以不用once daily dosing.
目前的literature应该就是这样吧。。

原帖由 范逍遥 于 14-8-2008 06:06 PM 发表


可是為什么沒有人要大量的去做 clinical trials 呢？

对了，大妈，这个答案是什么？

blue_yee

献丑了。

Gentamicin is used in combination with other antibiotics for the treatment of bacterial endocarditis. Serum-gentamicin concentration should be determined twice each week (more often in renal impairment). Streptomycin may be used as an alternative in gentamicin-resistant enterococcal endocarditis.

Gentamicin is the aminoglycoside of choice in the UK and is used widely for the treatment of serious infections. It has a broad spectrum but is inactive against anaerobes and has poor activity against haemolytic streptococci and pneumococci. When used for the ‘blind’ therapy of undiagnosed serious infections it is usually given in conjunction with a penicillin or metronidazole (or both). Gentamicin is used together with another antibiotic for the treatment of endocarditis.

Loading and maintenance doses of gentamicin may be calculated on the basis of the patient’s weight and renal function (e.g. using a nomogram); adjustments are then made according to serum-gentamicin concentrations. High doses are occasionally indicated for serious infections, especially in the neonate, in the patient with cystic fibrosis, or in the immunocompromised patient. Whenever possible treatment should not exceed 7 days.

Cardiovascular system
Endocarditis: initial ‘blind’ therapy
- Flucloxacillin (or benzylpenicillin if symptoms less severe) + gentamicin
- Substitute flucloxacillin (or benzylpenicillin) with vancomycin + rifampicin if cardiac prostheses present, or if penicillin-allergic, or if meticillin-resistant Staphylococcus aureus suspected

Endocarditis caused by staphylococci
- Flucloxacillin (or vancomycin + rifampicin if penicillin-allergic or if meticillin-resistant Staphylococcus aureus)
-Treat for at least 4 weeks; treat prosthetic valve endocarditis for at least 6 weeks and if using flucloxacillin add rifampicin for at least 2 weeks

Endocarditis caused by streptococci (e.g. viridans streptococci)
-Benzylpenicillin (or vancomycin) if penicillin- allergic or highly penicillin-resistant) + gentamicin
-Treat endocarditis caused by fully sensitive streptococci with benzylpenicillin or vancomycin alone for 4 weeks or (if no cardiac or embolic complications) with benzylpenicillin + gentamicin for 2 weeks. Treat more resistant organisms for 4–6 weeks (stopping gentamicin after 2 weeks for organisms moderately sensitive to penicillin); if aminoglycoside cannot be used and if streptococci moderately sensitive to penicillin, treat with benzylpenicillin alone for 4 weeks. Treat prosthetic valve endocarditis for at least 6 weeks (stopping gentamicin after 2 weeks if organisms fully sensitive to penicillin)

Endocarditis caused by enterococci (e.g. Enterococcus faecalis)
- Amoxicillin (or vancomycin) if penicillin-allergic or penicillin-resistant) + gentamicin
- Treat for at least 4 weeks (at least 6 weeks for prosthetic valve endocarditis); if gentamicin-resistant, substitute gentamicin with streptomycin

Endocarditis caused by haemophilus, actinobacillus, cardiobacterium, eikenella, and kingella species (‘HACEK’ organisms)
-Amoxicillin (or ceftriaxone if amoxicillin-resistant) + low-dose gentamicin
- Treat for 4 weeks (6 weeks for prosthetic valve endocarditis); stop gentamicin after 2 weeks

Taken from BNF 56th ed

就叫我蓝鲸吧！

y no ppl reply here anymore...
is very useful information..

i face some problems on respi system..
can any senior clarify me what is the difference between chronic asthma and acute ashtma? i mean the defination..

second question, what is teh diff between chronic COPD and acute COPD...
when we say CHRONIC obtructive pulmonary disease, doesnt it mean that is chronic? how come stil acute?

i read pharmacotherapy handbook.. still doesnot help me much in understanding...

penryn

好可惜，被荒废了
范大妈， 慢郎中不在了吗？

慢郎中

睡了一下，回來了。看著7，8年前的自己寫的文字，有點陌生了；
基本上，我患了怪病，倒地不起，昏睡了一陣子，自己覺得才躺下幾分鐘，醒來摸索了一下才發現人事全非，原來自己已經昏迷了那么久，看看鏡中的自己，都不認識了，過往的銳氣、殺氣，好像都不見了。
唉，試試看重開此樓，
有認識的，先進來聊一下，好讓我喚回一些記憶和過往的功力～～～

Only^Two

慢郎中 发表于 10-7-2015 11:16 PM
睡了一下，回來了。看著7，8年前的自己寫的文字，有點陌生了；
基本上，我患了怪病，倒地不起，昏睡了一陣 ...

慢大夫的归来是这板块今年最大的喜事！ 宴请三百桌。

慢郎中

Only^Two 发表于 11-7-2015 10:47 AM
慢大夫的归来是这板块今年最大的喜事！ 宴请三百桌。

謝謝謝謝，閣下名字讓我想了300秒還是想不到我們是什么時候交手過，啊，沒關系啦，

來者是客，歡迎光臨大樓。

Hope2000

可以解释下herpes type 1吗？谢谢

tmm123

Hope2000 发表于 8-8-2015 09:48 PM
可以解释下herpes type 1吗？谢谢

去google一下，一大堆資料。

Hope2000

tmm123 发表于 9-8-2015 03:34 PM
去google一下，一大堆資料。

是的，的确很多资料。。。
可是想请教这里的专业医生们，
1) herpes 1是属于性病还是皮肤病？
2) 真的大部分人都有感染这病毒吗？
3) 感染了需要注意什么呢？感觉没有什么症状？

谢谢您们

jinreung

慢郎中 发表于 10-7-2015 11:16 PM
睡了一下，回來了。看著7，8年前的自己寫的文字，有點陌生了；
基本上，我患了怪病，倒地不起，昏睡了一陣 ...

大人這幾年是不是看港劇太多了，情節怎麼那麼似曾相似？

yice

多年不回来， 翻回旧贴，看到慢大夫的回帖。。。。再看回现在的帖子， 也变得有点意兴阑珊。。。。

不过，还是大力欢迎慢大夫。。。