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Svi odgovori (96467)

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Pitanje #202891Odgovoreno 29. 9. 2022.
Đorđe Jevtović
Đorđe JevtovićSpecijalista infektologije
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Verovatno jeste sindrom iritabilnog kolona, a probiotici su totalno suvišni, nema naučnh dokza da ičemu služe.      candida albicans je normalni stanovnik creva i nije uzročnik bolesti, osim ezofagitisa, kod imunosuprimiranih- DIjeta  koju pominjete nema nikakvog smisla. U prilogu je poglavlje iz udžbenika

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Pitanje #202824Odgovoreno 27. 9. 2022.
Nataša Kaćanski
Nataša KaćanskiSpecijalista pedijatrijske hematologije
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Poštovana,

Krvna slika Vaše bebe je normalna za dob.

Crvena krvna zrnca tj. nivo hemoglobina je uredan.

Kod belih krvnih zrnaca postoji procentualno manji broj limfocita a veći broj monocita, ali to nije od većeg značaja jer je apsolutni broj svih podvrsta belih kr. zrnaca u granicama normale. Ne znam da li je dete možda imalo virusnu inf ili slično.

Trombociti tj krvne pločice su u granicama normale . Boldovane stavke koje su vezane za trombocite su vezane za njihovu veličinu i  koncentraciju, i u slučaju vašeg deteta nisu od značaja.

Srdačan pozdrav,

dr Nataša Kaćanski.

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Pitanje #202826Odgovoreno 27. 9. 2022.
Đorđe Jevtović
Đorđe JevtovićSpecijalista infektologije
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multirezistentni S.aureus, najčešće je intrahospitalna infekcija, u zavisnosti od organa, ili tkiva koje je zahvaćeno, postoji lečenje.Evo u prilogu tekst iz udžbnika

 

 

MRSA isolates have become common, especially in hospitals. MRSA are resistant to all beta-lactam antibiotics, including cephalosporins and carbapenems; however, they may be susceptible to the newest class of MRSA-active cephalosporins (eg, ceftaroline, ceftobiprole [not available in the US]). Hospital-acquired MRSA are also commonly resistant to many other antibiotics, including erythromycin, clindamycin, and fluoroquinolones. In addition, community-associated MRSA (CA-MRSA) has emerged over the past several years in most geographic regions. CA-MRSA tends to be less resistant to multiple drugs than hospital-acquired MRSA. These strains, although resistant to most beta-lactams, are usually susceptible to TMP/SMX and tetracyclines (minocycline, doxycycline) and are often susceptible to clindamycin, but there is the potential for emergence of clindamycin resistance by strains inducibly resistant to erythromycin (laboratories may report these strains as D-test positive). Vancomycin is effective against most MRSA, sometimes with rifampin and an aminoglycoside added for some serious infections (ie, osteomyelitis, prosthetic joint infections, prosthetic valve endocarditis). An alternative drug (daptomycin, linezolid, tedizolid, dalbavancin, oritavancin, telavancin, tigecycline, omadacycline, lefamulin, eravacycline, delafloxacin, quinupristin/dalfopristin, TMP/SMX, possibly ceftaroline) should be considered when treating MRSA strains with a vancomycin minimum inhibitory concentration (MIC) of ≥ 1.5 mcg/mL.

Vancomycin-resistant S. aureus (VRSA; MIC ≥ 16 mcg/mL) and vancomycin-intermediate-susceptible S. aureus (VISA; MIC 4 to 8 mcg/mL) strains have appeared in the US. These organisms require linezolid, tedizolid, quinupristin/dalfopristin, daptomycin, TMP/SMX, delafloxacin, oritavancin, or ceftaroline. Dalbavancin and telavancin are active against VISA but have little activity against VRSA.

Because incidence of MRSA has increased, initial empiric treatment for serious staphylococcal infections (particularly those that occur in a health care setting) should include a drug with reliable activity against MRSA. Thus, appropriate drugs include the following:

  • For proven or suspected bloodstream infections, vancomycin or daptomycin

  • For pneumonia, vancomycin, telavancin, or linezolid (because daptomycin is not reliably active in the lungs)

Table

MRSA isolates have become common, especially in hospitals. MRSA are resistant to all beta-lactam antibiotics, including cephalosporins and carbapenems; however, they may be susceptible to the newest class of MRSA-active cephalosporins (eg, ceftaroline, ceftobiprole [not available in the US]). Hospital-acquired MRSA are also commonly resistant to many other antibiotics, including erythromycin, clindamycin, and fluoroquinolones. In addition, community-associated MRSA (CA-MRSA) has emerged over the past several years in most geographic regions. CA-MRSA tends to be less resistant to multiple drugs than hospital-acquired MRSA. These strains, although resistant to most beta-lactams, are usually susceptible to TMP/SMX and tetracyclines (minocycline, doxycycline) and are often susceptible to clindamycin, but there is the potential for emergence of clindamycin resistance by strains inducibly resistant to erythromycin (laboratories may report these strains as D-test positive). Vancomycin is effective against most MRSA, sometimes with rifampin and an aminoglycoside added for some serious infections (ie, osteomyelitis, prosthetic joint infections, prosthetic valve endocarditis). An alternative drug (daptomycin, linezolid, tedizolid, dalbavancin, oritavancin, telavancin, tigecycline, omadacycline, lefamulin, eravacycline, delafloxacin, quinupristin/dalfopristin, TMP/SMX, possibly ceftaroline) should be considered when treating MRSA strains with a vancomycin minimum inhibitory concentration (MIC) of ≥ 1.5 mcg/mL.

Vancomycin-resistant S. aureus (VRSA; MIC ≥ 16 mcg/mL) and vancomycin-intermediate-susceptible S. aureus (VISA; MIC 4 to 8 mcg/mL) strains have appeared in the US. These organisms require linezolid, tedizolid, quinupristin/dalfopristin, daptomycin, TMP/SMX, delafloxacin, oritavancin, or ceftaroline. Dalbavancin and telavancin are active against VISA but have little activity against VRSA.

Because incidence of MRSA has increased, initial empiric treatment for serious staphylococcal infections (particularly those that occur in a health care setting) should include a drug with reliable activity against MRSA. Thus, appropriate drugs include the following:

  • For proven or suspected bloodstream infections, vancomycin or daptomycin

  • For pneumonia, vancomycin, telavancin, or linezolid (because daptomycin is not reliably active in the lungs)

Table

MRSA isolates have become common, especially in hospitals. MRSA are resistant to all beta-lactam antibiotics, including cephalosporins and carbapenems; however, they may be susceptible to the newest class of MRSA-active cephalosporins (eg, ceftaroline, ceftobiprole [not available in the US]). Hospital-acquired MRSA are also commonly resistant to many other antibiotics, including erythromycin, clindamycin, and fluoroquinolones. In addition, community-associated MRSA (CA-MRSA) has emerged over the past several years in most geographic regions. CA-MRSA tends to be less resistant to multiple drugs than hospital-acquired MRSA. These strains, although resistant to most beta-lactams, are usually susceptible to TMP/SMX and tetracyclines (minocycline, doxycycline) and are often susceptible to clindamycin, but there is the potential for emergence of clindamycin resistance by strains inducibly resistant to erythromycin (laboratories may report these strains as D-test positive). Vancomycin is effective against most MRSA, sometimes with rifampin and an aminoglycoside added for some serious infections (ie, osteomyelitis, prosthetic joint infections, prosthetic valve endocarditis). An alternative drug (daptomycin, linezolid, tedizolid, dalbavancin, oritavancin, telavancin, tigecycline, omadacycline, lefamulin, eravacycline, delafloxacin, quinupristin/dalfopristin, TMP/SMX, possibly ceftaroline) should be considered when treating MRSA strains with a vancomycin minimum inhibitory concentration (MIC) of ≥ 1.5 mcg/mL.

Vancomycin-resistant S. aureus (VRSA; MIC ≥ 16 mcg/mL) and vancomycin-intermediate-susceptible S. aureus (VISA; MIC 4 to 8 mcg/mL) strains have appeared in the US. These organisms require linezolid, tedizolid, quinupristin/dalfopristin, daptomycin, TMP/SMX, delafloxacin, oritavancin, or ceftaroline. Dalbavancin and telavancin are active against VISA but have little activity against VRSA.

Because incidence of MRSA has increased, initial empiric treatment for serious staphylococcal infections (particularly those that occur in a health care setting) should include a drug with reliable activity against MRSA. Thus, appropriate drugs include the following:

  • For proven or suspected bloodstream infections, vancomycin or daptomycin

  • For pneumonia, vancomycin, telavancin, or linezolid (because daptomycin is not reliably active in the lungs)

 

 

 

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Pitanje #202763Odgovoreno 27. 9. 2022.
Bojan Pejaković
Bojan PejakovićSpecijalista maksiofacijalne hirurgije
Zakažite

najverovatnije je prosireni kapilar, ne deluje nista opasno. Javite se na pregled kod hirurga kada budete mogli

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Pitanje #202798Odgovoreno 27. 9. 2022.
Dušanka Milošević
Dušanka MiloševićSpecijalista otorinolaringologije
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Moze ali samo ako je pedijatar ili pumnolog to savetovao. Ne na svoju ruku.

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