This document summarizes various classes of antibiotics including their mechanisms of action, coverage, side effects, and special considerations. It discusses cell wall synthesis inhibitors like beta-lactams (penicillins, cephalosporins, carbapenems) and vancomycin. It also covers other classes that inhibit protein synthesis like aminoglycosides, tetracyclines, macrolides, and chloramphenicol. Nucleic acid synthesis inhibitors discussed include sulfonamides and fluoroquininolones. Each antibiotic is described in terms of its indication, dosing considerations, resistance issues, and adverse drug reactions.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
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TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
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MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
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Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Ocular injury ppt Upendra pal optometrist upums saifai etawah
Antibiotics notes.docx
1. Antibiotics
- cell wall synthesis (Betalactam) inhibitors and polypeptide (Vancomycin)
Betalactam antibiotics- penicillin, cephalosporins, Monobactams, Carbapenems
Beta lactam antibiotics
Penicillin
Types MOA Coverage Side effects/ Special Topics
Natural Betalactam Penicillin
Pen G (Benzyl penicillin)
- IV; Poorly absorbed from GIT
- IM (Benzathine)- given for
compliance measure due to depot
effect
Pen V (Phenoxymethyl
Penicillin)
- Oral (V- Vunganga)
- acid stable
Interfere transpeptidation and
cross linking of peptidoglycan
chains
Gram +
No Gram (-) coverage except
Neiserria meningitidis,
Treponema and Leptospira
A little of anaerobes except
Bacteroides (not to be given
in intra-abdominal infection)
Penicillinase enzyme- mostly produced by Staph. Aureus
- break the beta-lactam ring
Anti staphylococcal Penicillins
Methicillin
MSSA Interstitial Nephritis (reason why it
was phased out)
MRSA- cause by mutation mec- A gene/
cassette
2. - Change the PBP to PBP 2A causing the
B-Lactam loss its affinity.
- DOC: Community-acquired
(Clindamycin)
Hospital-aquired (Vancomycin
Nafcillin MSSA Reversible aggranulocytosis
Hepatoxicity
Isoxazoyl Penicillin
- Oxacillin, Cloxacillin, Dicloxacillin
Best treatment for staphylococcal
infection
Like IMPETIGO
Aminopenicillin
Ampicillin- parenterally; poor
GI absorption; Frequently
combined with aminoglycoside
(Amikacin or gentamicin)
because of synergism
Amoxicillin- better GI
absorption
Gram +
Gram -
Little of anaerobes except
Bacteroides fragilis
Antipseudomonal Penicillins
Carboxypenicillins
- Carbenicillin, Ticarcillin
Ureidopenicillin
- Piperacillin (Most potent)
- Azlocillin
-Mezlocillin
Pseudomonas Aeroginosa
Beta-lactamase Inhibitors
- Clavulanic acid
co-administered with beta-lactam
antimicrobials to prevent
Gram +
Gram -
3. - sulbactam
- tazobactam
antimicrobial resistance by
inhibiting serine beta-lactamases,
which are enzymes that inactivate
the beta-lactam ring, which is a
common chemical structure to all
beta-lactam antimicrobials
Anaerobes including
Bacteroides fragilis
Cephalosporins
Generation Drugs Coverage
First Generation -CEPH including
Cefalexin (formerly cephalexin)
Cefazoline
Cefadoxil
Gram + plus PEK
P- Proteus
E- E.coli
K- Klebsiella
Second generation -CEF followed by a VOWEL
Including, META PRO
*CefPROzil
*CefMETAzol
And LORAcarbef
Gram +
HEN- Haemophilus influenzae, Enterobacter, Neiserria
PEK
Anaerobes
Third Generation -CEF Plus Consonant including
PERA, TAXes and FIXers
*CefoPERAzone
*CefoTAXime
*CeFIXime
And Moxalactam
Gram -
HEN
PEK
Plus SSS- Serratia, Salmonella, Shiegella
Pseudomonas- Ceftazidime, Cefoperazone only
Fourth Generation Cefipime
Cefpirone
3rd Gen coverage + Pseudomonas
Fifth Generation The Bothers ROLI and TOBI 4th Generation Plus MRSA
4. CeftaROLIne
CefTOBIprol
Monobactams
Astreonam- only IV
Same coverage with Ceftazidime (3rd gen coverage + pseudomonas)
S/e: No- cross sensitivity
ADR: Transaminitis-> Drug induced hepatitis (Increase AST, ALT)
Carbapenems- sulfur atom in the
Thiazolidine ring was replaced by
CARBON atom
COVERAGE
- Gram +, gram -, Anaerobes, Pseudomonas aeroginosa (except ERTAPENEM)
-ALL are epileptogenic but IMEPENEM is more pronounced.
- Imepenem is degraded by dehydropeptidase enzyme at renal tubule thus added with CILASTIN (prolongs
Imepenem effects)
-tx for ESBL infection
- Doripenem- best coverage for pseudomonas
Polypeptide antibiotics
Vancomycin
Others: Televancin, teicoplanin
MOA: inhibits cell wall synthesis by binding to D-ala-ala- terminus thereby inhibiting transglycosylation furthering subsequent transpeptidydation 0r
cross-linking
* Vancomycin DOC for hospital-acquired MRSA and PSEUDOMEMBRANOUS Colitis (ORAL)
In PH we used METRONIDAZOLE for Pseudomembranous colitis
ADR:
* REDMAN or RED neck syndrome- erythematous rash; This is INFUSION RElated
- SLOW the infusion
- Hydrate the patient
- give Antihistamines- Cetirizine->Diphenhydramine->Steroids
*Nephrotoxic
- Vancomycin trough level must be requested, the lowest possible dose to have its effects.
5. POLYMIXINS
- cell membrane inhibitors
-cationic detergents
-never a drug of choice
-last line
- not as a monotherapy (combined with betalactam and aminoglycoside
Polymixin B Topical
B- Bilat JOKE!!!! BALAT
Polymixin E
Colistin
Parenteral
PROTEIN SYNTHESIS INHIBITORS
- targets translation; ALL Protein SYNTHESIS Inhibitors are Bacteriostatics except AMINOGLYCOSIDES
REMEMBER: Buy AT 30 SELL CC at 50
30 S- Aminoglycosides, Tetracyclins
BLOCKS 30S->blocks formation of initiation complex-> blocks translation-> mRNA misreading
Aminoglycosides
- MYCIN- from Streptomyces
*Neomycin
*Tobramycin
*Streptomycin
- MICIN- from Microminispora
*Gentamicin
*AMikacin
- BACTERICIDAL
- Polar- No oral absorption
- ALL must be given PARENTERALLY to achieve adequate serum levels except NEOMYCIN (topical or oral)
- synergistic with BETA-LACTAM, do not combine in 1 contaniner (Beta lactam first then aminoglycoside)
-ADR: NEPHROTOXICITY, VESTIBULOTOXICITY, OTOTOXICITY (only in high frequency sounds)
OTOTOXIC- Neomycin> Amikacin> Kanamycin (sino ang inuoto? aNAK)
VESTIBULOTOXIC- Streptomycin, Gentamicin
NEPHROTOXIC- Neomycin, Tpbramycin, Gentamicin
- Tobramycin- most toxic
-COVERAGE:
* Gram + except strep pneumoniae
6. * Gram -
* Pseudomonas
* No coverage for atypical and anaerobes
Tetracyclines- bacteriostatic
Short acting
* Tetracycline
* Chlortetracyclines
* Oxytetracycline
Intermediate
* Demeclocycline
*Methacycline
Long-acting- DoMino
*Doxicycline
*Minocycline
Pharmacokinetics
Absorption impaired by food
(except doxycycline,
minocycline), antacids, dairy
products, and divalent cations
(Ca2+, Mg2+, Fe2+),
or Al3+ due to COMPLEX
FORMATION/ CHEILATION
*Separate atleast 2 hours for
gastric emptying
· High protein-binding
· Widely distributed to tissues
except CSF
· Excellent intracellular
penetration
· Excreted in bile and urine
except Doxycycline
(bile only not renally
excreted)
· Can pass the placenta,
excreted in milk
Coverage:
Gram +
Gram -
Atypical organism (leigionella, chlamydia, leptospira, vibrio, borelia- DOC
Anaerobes
(-) coverage for Pseudomonas aeroginosa
BROADEST spectrum
TIGECYCLINE- COVERS everything except 3PM
3P- Pseudomonas, proteus, providencia
L- Morganella
ADR: Straining TET (Teeth)
Enamel hypoplasia
Bone deformity/ growth retardation
Avoid in children <8 years old
50 S SUBunits- SELL CC at 50
Streptogramins
Erythromycin and other macrolides
7. Lincosamides
Linzezolides- Chloramphenicol, Clindamycin
Macrolides
-thromycin
RACE
Roxitromycin
Azithromycin- only macrolide using
concentration dependent reaction
Clarithromycin
Erythromycin
Coverage:
Gram +
Gram -
Atypical
NO COVERAGE for Pseudomonas and Anaerobes
SUBSTITUTE for PENICILLIN allergies
ADR: Erythromycin- GI disturbances, motilin release
Lincosamide
* Lincomycin
- sulfur containing antibiotics
- notorious in causing Steven Johnson Syndrome
*Clindamycin Coverage
- Gram positive
- Community acquired MRSA
- Anaerobes
* above respiratory diaphragm except brain: CLINDAMYCIN
* below the respiratory diaphragm including the brain: METRONIDAZOLE
ADR: most commonly cause Pseudomembranous colitis ( due to prolong and/0r multiple antibiotics)
Tx: Oral Vancomycin, or metronidazole
8. Chloramphenicol - second line drugs due to BONE MARROW SUPPRESSION/ myelosuppresion-> Aplastic ANEMIA
- ADR: GRAY BABY SYNDROME- baby appears cyanotic (dose= <50mg/kg/day)
Due to impaired glucorinidation reaction due to lack of UDP- glucoronosyl transferase in infant.
-in INFANT drug metabolism is only via SULFATION
NUCLEIC ACID SYNTHESIS Inhibitors
- TMP- Sulfamethoxazole or Co- Trimoxazole
Co-timoxazole Mechanism of action
Dihydropteroate synthase Dihydrofolate reductase
(Sulfonamide acts here) (TMP acts here)
PABA--------------------------> Dihydrpfolic acid----------------------------> Tetrahydrofolic acid--------> Purine----> DNA
DRUG of CHOICE for:
Stenotrophomonas maltophilia
Burkholderia cepacian
Pneumocystis jeroveci pneumonia
Toxoplasma gondii
OTHER diseases: ONLY as SECOND LINE
ADR:
*Bleeding and KIDNEY OBSTRUCTION (Crystalluria)
* CRYSTALLURIA: Acidic Urine, High Urinary Concentration, Low Solubility
* Agranulocytosis
*hemolytic anemia: C/I in G6PD deficiency
*Kernecterus
*STEVEN JOHNSON SYNDROME
9. - Interfere in TOPOISOMERASE II and IV----> increase supercoiling-----> bacterial DNA will be fragile-----> DNA Damage
- TOPOISOMERASE- relieve Supercoiling
- BACTERICIDAL
-Coverage: Gram positive, gram negative, ATYPICAL, anaerobe (only in MOXIfloxacin), Pseudomonas aeroginosa (ONLY CIPROFLOXACIN and LEVOFLOXACIN)
- Respiratory fluoroquinolones: MOXIfloxacin, LEVOfloxacin, GATIfloxacin
- ADR: HYPERGLYCEMIA (except GATIFLOXACIN but causes HYPOglycemia), Arthropathy, QT-prolongation