Podcasts about Gentamicin

Jeff Walter, DPT, NCS, returns to Neuro Navigators to share even more clinical practice tips for clinicians who are both new and experienced with vestibular rehab. Host JJ Mowder-Tinney and Jeff dive into the vestibular management hidden gems that could be the strategies to transform your clinical practice. From alternative benign paroxysmal positional vertigo (BPPV) assessment techniques to under-recognized treatments for Meniere's disease to emerging treatments for vestibular-related imbalance and falls, you'll walk away with practical tools you can apply immediately. Whether you are a physical or occupational therapy practitioner, this episode is for you. Don't miss this engaging discussion filled with actionable takeaways to enhance your confidence in treating dizziness and balance disorders.Learning ObjectivesAnalyze the evidence regarding optimal management of vestibular disordersApply evidence-based, practical strategies to actionably address the efficient evaluation and treatment of vestibular-related dizzinessSolve patient case scenarios involving frequent falls and disabling vertigo to support participation in instrumental activities of daily living (IADLs), such as community mobility and home managementTimestamps(00:00:00) Welcome(00:00:15) Welcome back, guest Jeff Walter, DPT, NCS(00:00:55) Jeff's background and work at Geisinger Medical Center(00:02:11) Evolution of Jeff's vestibular specialization(00:03:12) Overview: tips for clinicians with foundational vestibular knowledge(00:04:42) Sidelying test: what it is and why to use it(00:06:54) How to perform the sidelying test with exact head positioning cues(00:08:21) Embedding the sidelying test into functional mobility assessments(00:11:55) Splinting the patient's head: comfort and compliance tips(00:13:21) Half Dix-Hallpike: identifying short-arm posterior canal BPPV(00:16:40) Flashlight fixation-blocking: a goggle-free nystagmus test(00:18:11) When to use it and how to prep the patient(00:25:10) Mastoid vibration test: screening for vestibular hypofunction(00:26:00) Interpretation: direction-fixed nystagmus and its implications(00:26:40) When and why to use mastoid vibration (TBI, falls, etc.)(00:34:04) Gentamicin injections: managing Meniere's-related vertigo(00:40:00) Vestibular drop attacks (Tumarkin events): signs and screening tips(00:42:30) Real-life example and how to follow up when falls are unexplained(00:46:00) Vibrotactile belt: a future-forward sensory substitution device(00:47:00) Who it's for, how it works, and early user feedback(00:52:50) Wrapping up: Jeff's top takeaways for novice and experienced physical and occupational therapy practitioners(00:56:25) Superpower time: Jeff's vestibular-themed wishes(00:58:00) Closing remarks and where to listen to Episode 1Resources Mentioned in EpisodeAlonso, S. M., & Caletrío, Á. B. (2024). Clinical Advancements in Skull Vibration-Induced Nystagmus (SVIN) over the Last Two Years: A Literature Review. Journal of Clinical Medicine, 13(23), 7236.Neuro Naviagators is brought to you by Medbridge. If you'd like to earn continuing education credit for listening to this episode and access bonus takeaway handouts, log in to your Medbridge account and navigate to the course where you'll find accreditation details. If applicable, complete the post-course assessment and survey to be eligible for credit. The takeaway handout on Medbridge gives you the key points mentioned in this episode, along with additional resources you can implement into your practice right away.To hear more episodes of Neuro Naviagators, visit https://www.medbridge.com/neuro-navigatorsIf you'd like to subscribe to Medbridge, visit https://www.medbridge.com/pricing/

Vi har vært på konferanse og intervjuet professor Jan Kristian Damås om gentamicin – et effektivt og i skandinavisk sammenheng hyppig brukt antibiotikum - men internasjonalt også mye debattert legemiddel.Referanser: Ritchie ND, Irvine SC, Helps A, Robb F, Jones BL, Seaton RA. Restrictive antibiotic stewardship associated with reduced hospital mortality in gram-negative infection. Qjm. 2017;110(3):155-61.McDermott JH, Mahaveer A, James RA, Booth N, Turner M, Harvey KE, et al. Rapid Point-of-Care Genotyping to Avoid Aminoglycoside-Induced Ototoxicity in Neonatal Intensive Care. JAMA Pediatrics. 2022;176(5):486-92.Grønmo M, Møller-Stray J, Akselsen PE, Lindemann PC, Fostervold A, Vestby Knudsen C, Knudsen PK, Lindbæk M, Tonby K, Sundsfjord A. Gentamicin bør fortsatt inngå i empirisk sepsisregime hos voksne. Tidsskr Nor Legeforen. 2024.Vidal L, Gafter-Gvili A, Borok S, Fraser A, Leibovici L, Paul M. Efficacy and safety of aminoglycoside monotherapy: systematic review and meta-analysis of randomized controlled trials. J Antimicrob Chemother. 2007 Aug;60(2):247-57. Hosted on Acast. See acast.com/privacy for more information.

On this podcast episode, I discuss gentamicin pharmacology, adverse effects, monitoring, drug interactions and much more! Drug monitoring is critical with gentamicin. Trough and peak concentrations can guide therapy and identify someone at risk of toxicity. Nephrotoxicity is a major concern with gentamicin. There are numerous nephrotoxic agents that can increase this risk. I discuss them on the podcast. Ototoxicity is another risk associated with gentamicin. Loop diuretics like furosemide can increase this risk. Learn more on this podcast episode.

Visit: https://nursing.com/140meds to request your free copy of "140 Must Know Meds" Generic Name Gentamicin Trade Name Cidomycin Indication Treatment of gram negative infections when penicillin is ineffective Action Inhibits bacterial protein synthesis Therapeutic Class Anti-infectives Pharmacologic Class Aminoglycoside Nursing Considerations • Causes tinnitus-hearing loss/do not administer with penicillin • Use caution in renal impairment • Assess for infection • Obtain cultures prior to therapy • Monitor liver function tests • Monitor blood levels of drug

For most of our lives, we've been taught that viruses make us sick. But there is important evidence that has been overlooked by both virologists and the public. Today, Alec Zeck, the Executive Director and Founder of the Way Forward, breaks down viruses. He reviews the history of virology, the assumptions behind the science, and explains where we've gone wrong in our understanding of what causes ill health. His conclusions, based on his extensive research, paint a very different picture of the "pandemic" of recent years and offer insights for the days ahead. This is an episode that may challenge what many of us thought we knew about viruses. Visit Alec's website: The Way Forward Become a member of the Weston A. Price Foundation Check out our sponsors: Serenity Farm Bread, Paleo Valley,  Optimal Carnivore For more resources on viruses: Study on Amphotericin B:  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3194987/ Study on Gentamicin toxicity: https://sciendo.com/downloadpdf/journals/arls/1/1/article-p111.pdf Study on COVID death risk factors: https://www.cdc.gov/pcd/issues/2021/pdf/21_0123.pdf?fbclid=IwAR2p5g4KXqdUY948K7YxZhc3X2A3PFA_j3tYqxhaYRVN2vZKQijGzpF_KBs Study on COVID hospitalizations:  https://www.cdc.gov/mmwr/volumes/70/wr/mm7010e4.htm?s_cid=mm7010e4_w&fbclid=IwAR2h17JKDqYLejoonQj_H7bXtu8-PGDlMnWA8Tym8ZfI5GugRx6QgkxvoiA COVID data on comorbidities:  https://www.cdc.gov/nchs/nvss/vsrr/covid_weekly/index.htm?fbclid=IwAR2KYI1QdB5uoE6Shgv0B-a3YrNfuchCxf85UbysPxk4KKUvKkvpzAowQVQ Alec's presentation, Debunking the Nonsense:  https://www.youtube.com/watch?v=nPSViaPCGrM&t=2776s Amazing resource on all things virology: https://viroliegy.com/

Let's revive an old practice that may one day help you treat uncomplicated cystitis without having to admit your patient to the hospital Click HERE to leave a review of the podcast!Subscribe HERE!References:All references for Episode 80 are found on my Read by QxMD collectionDisclaimer: The information contained within the  ER-Rx podcast episodes, errxpodcast.com, and the @errxpodcast Instagram page is for informational/ educational purposes only, is not meant to replace professional medical judgement, and does not constitute a provider-patient relationship between you and the authors. Information contained herein may be accidentally inaccurate, incomplete, or outdated, and users are to use caution,  seek medical advice from a licensed physician, and consult available resources prior to any medical decision making. The contributors of the ER-Rx podcast are not affiliated with, nor do they speak on behalf of,  any medical institutions, educational facilities, or other healthcare programs.Support the show

Join host Mr. Jamie Ferguson from Oxford Bone Infection Unit, as he chats with guests Mr. Alex Wee and Mr. Anand Pillai about their clinical experiences in treating bone infections with CERAMENT G. Sponsored by BONESUPPORT. For case studies and more information on CERAMENT G, visit: https://www.bonesupport.com/en-eu/ For the CERAMENT G IFU, please visit: https://bit.ly/3RKYqka This is an orthopedic expert discussion on the use of BONESUPPORT's product CERAMENT G. Some of the uses discussed here may not be approved or cleared by FDA. The experts are independent, and the content is not in any way influenced by BONESUPPORT. Please refer to the Instructions for Use document for official indications, contraindications, and mixing information.  

Join host Mr. Jamie Ferguson from Oxford Bone Infection Unit, as he chats with guests Mr. Alex Wee and Mr. Anand Pillai about their clinical experiences in treating bone infections with CERAMENT G.  Sponsored by BONESUPPORT. For shownotes including case studies and CERAMENT G product information, download the ConveyMED Podcast App: Apple Store click here  Google Play click here or visit: https://www.bonesupport.com/en-eu/  For the CERAMENT G IFU, please visit: https://bit.ly/3RKYqka  This is an orthopedic expert discussion on the use of Bonesupport's product CERAMENT G. Some of the uses discussed here may not be approved or cleared by FDA. The experts are independent, and the content is not in any way influenced by Bonesupport. Please refer to the Instructions for Use document for official indications, contraindications, and mixing information. 

Download the cheat: https://bit.ly/50-meds  View the lesson: https://bit.ly/GentamicinGaramycinNursingConsiderations    Generic Name Gentamicin Trade Name Cidomycin Indication Treatment of gram negative infections when penicillin is ineffective Action Inhibits bacterial protein synthesis Therapeutic Class Anti-infectives Pharmacologic Class Aminoglycoside Nursing Considerations • Causes tinnitus-hearing loss/do not administer with penicillin • Use caution in renal impairment • Assess for infection • Obtain cultures prior to therapy • Monitor liver function tests • Monitor blood levels of drug

Gentamicin over a best-a-lactam?!  Listen in as Jame & Callum from the https://idiotspodcasting.buzzsprout.com/ (ID:IOTS) podcast extoll the virtues of aminoglycosides in empiric therapy…and teach Sara some Scottish slang https://febrilepodcast.com/episodes/ (Episodes) |https://febrilepodcast.com/consult-notes/ ( Consult Notes) |https://febrilepodcast.captivate.fm/listen ( Subscribe) |https://twitter.com/febrilepodcast ( Twitter) |https://febrile.bigcartel.com/ ( Merch) | febrilepodcast@gmail.com

In this episode, Xtalks is marking World Parkinson's Day (April 11) and Parkinson's Awareness Month, which are observed every year to help raise awareness about the disease and the individuals living with it. To learn more about new Parkinson's disease research, Ayesha discussed a new study by researchers at Rush University Medical Center that shows statins may help decrease the risk of parkinsonism in older adults. Hear about how parkinsonism relates to Parkinson's disease and how the neuroprotective effects of statins could prevent Parkinson's and related conditions.The editorial team also discussed a new rapid molecular test developed by UK-based Genedrive PLC that can help physicians select the best antibiotic to treat babies with to prevent hearing loss. Gentamicin is the preferred treatment for newborns with infections like sepsis but about one in 500 babies have a genetic variant that makes them susceptible to gentamicin-induced hearing loss. Find out how the new genetic test can produce results in less than half an hour to help clinicians quickly determine the best course of treatment, and its rollout across a couple of NICUs in England.Read the full articles here: Parkinson's Awareness Month: Statins May Lower Parkinsonism Risk in Older Adults Genedrive's Genetic Test Can Prevent Hearing Loss in Babies Through Personalized Treatment For more life science and medical device content, visit the Xtalks Vitals homepage.Follow Us on Social MediaTwitter: @Xtalks Instagram: @Xtalks Facebook: https://www.facebook.com/Xtalks.Webinars/ LinkedIn: https://www.linkedin.com/company/xtalks-webconferences YouTube: https://www.youtube.com/c/XtalksWebinars/featured

Welcome to another episode of Pediatric Meltdown. My guest for today is Dr. Lisa Namerow, a Board-certified psychiatrist triple-boarded in pediatrics, child psychiatry, and general psychiatry. She has been in the pediatric healthcare space for almost 30 years, directing the consultation services to in-patient pediatrics, and the access to mental health programs for pediatricians.  Her areas of research have been pharmacogenetics, and the impact of clinical pathways and standardized care for eating disorders, somatic symptoms, and related disorders, and delirium, and serves on the American Academy of Child and Adolescent Psychiatry Committee on the physically ill child. [00:01] Dr. Lisa Namerow Shares Her Story With Us  Dr. Namerow shares how she became a child and adolescent psychiatrist  She introduces the field of Pharmacogenomics Pharmacogenomics vs. Pharmacogenetics  [06:12] Genetics 101  Myths about Pharmacogenomics Pharmacodynamic Genes and Pharmacokinetic Genes What we need to know Dr. Namerow's analogy for genes  The relationship between medicines and gene findings  [16:19] Deciding if Gene Testing Can Be Helpful What oncologists should know about prescribing medicines How a pediatrician can utilize genetic testing  The screening questions to help pediatricians decide on genetic testing [26:37] Genetic Testing in ADHD, Depression, and Anxiety Talking with parents about genetic testing How the serotonin transporter works in the body  Genetics in the context of ADHD, depression, and anxiety  [36:10] The Best References for Primary Care  Dr. Namerow's interesting insights about primary care Her message for clinicians that you should not miss  Dr. Namerow's message for her younger self   [46:10] Closing Segment   Our advice for all working moms out there Final takeaways: The role of certain relevant genes in drug response The industry's detailing can be misleading There are some very relevant gene medication pairs An analogy about Gentamicin you should not miss Using Venlafaxine  Facts about Cytochrome P450 Screening questions to decide if genetic testing can be helpful Select medications based on evidence and guidelines Key Quotes: “What is true is that genes do code for both the enzymes that metabolize medicines, and they also code for the proteins that are the site of the action of medication.” - Dr. Lisa Namerow “[It's] heartbreaking that we don't have a system that cares for these kids in the way that they should be cared for, and that it falls on primary care.” - Dr. Lisa Namerow Email lnamerow@connecticutchildrens.org to connect with Dr. Namerow or check out https://www.connecticutchildrens.org (Connecticut Children's Medical Center) to know more about her work.  Resources Mentioned: https://bit.ly/3jIxpQf (Pharmacogenomics: An Update for Child and Adolescent Psychiatry) https://www.nncpap.org/map (Child Psychiatry Access Programs by state) https://ki.se/en (Karolinska Institutet) https://www.cincinnatichildrens.org/bio/S/jeffrey-strawn (Dr. Jeffrey R. Strawn) If you'd like to connect with me, you can find me on https://www.linkedin.com/in/dr-lia-gaggino-80322a31/ (LinkedIn), https://www.facebook.com/DrLiaGaggino/ (Facebook), and https://twitter.com/gagginol?lang=en (Twitter) or email me at gagginol@yahoo.com. To learn more about me visit https://www.medicalbhs.com/ (https://www.medicalbhs.com/) LOVE WHAT YOU HEARD? Leave us a 5-star review so we can continue to provide you with great content. Share this episode and help people know more about children's health and well-being.

In this week’s episode we are joined by Dr Qureshi, a consultant microbiologist who shares with us his story. We discover his unusual journey as a computer science graduate transitioning from GP to core surgical trainee before settling for a career in microbiology. Imran shares the obstacles and challenges he has faced so far in his career and his ethos in life of being authentic. We discuss the evolving role of technology in healthcare, the story behind creating and selling the first comprehensive Gentamicin calculator and his new found initiative Code Med.  We discuss why he became extremely passionate about microbiology and explore his relationship with patient safety and quality improvement. Imran tells us about the importance of healthy workplace cultures and supportive leadership in his role as Foundation Programme Director. Dr Imran Qureshi is a Consultant microbiologist at Croydon University Hospital, he is a Foundation Programme Director and more recently Associate Medical Director.  His is passionate about Patient Safety and Quality Improvement which led to setting up DAPS Global, then became the first clinical lead for BMJ Quality then an Honorary Clinical Associate Professor for UCL. He co-founded Code Med, an organisation which is dedicated to teaching coding to healthcare professionals as well as developing apps and providing consulting services.  Twitter: @reachimyq --------------------------------- Episode sponsored by MySuture  MySuture™  is an all in one suture practice kit and digital learning platform with direct access to Surgeon advice & training. With this all in one suture practice kit and the MySkills™ digital learning platform, you can learn to suture anytime, anywhere.    MySuture™  is here to share your journey in medical education by helping you learn the art of suturing and provide you with access to training and advice for your career in healthcare.  The all in one suture simulation kit includes high quality silicone made of advanced nontoxic materials, with height simulation skin, 14 pre cut wounds, 3 layers including skin, subcutaneous fat and muscle with a mesh reinforcement to provide suture retention, mimic natural anatomy and create a true to life texture.  Buy your suture kit now at: mysuture.com  MySuture Socials: Twitter | Instagram --------------------------------- Learn more about Scrubbed In: Twitter - @ScrubbedIn_ Instagram - @Scrubbedin_ Download the PodCases Mobile app Now - iOS (App Store) or Android (Google Play) PodCases lets you Step into the shoes of Doctors to experience medicine. Listen to high quality audio cases and reinforce your learning with interactive quizzes.  www.scrubbedin.co.uk Hello@scrubbedin.co.uk

In this VETgirl online veterinary continuing education podcast, we discuss different treatment protocols for canine Bordetella bronchiseptica (Bb), including the use of aerosolized antimicrobial therapy, specifically the aminoglycoside, gentamicin. In a study by Canonne et al, the authors wanted to evaluate the clinical response in dogs affected by Bb when administered 2 distinct protocols of aerosolized gentamicin.

In this episode, a recent study showed that aloe vera can be more effective on staph in dogs than the commonly prescribed topical antibiotic, Gentamicin. Dr. Becker also shares how to use aloe vera to relieve hot spots and sores in dogs and cats. Also discussed, the benefits and effects that a ketogenic MCT diet has on your dog's microbiome, behavior, and GI issues. Plus listener questions and much more! Every week in the Planet Paws Facebook subscription group, Inside Scoop, Rodney & Dr. Becker go Live to discuss some of the latest research and studies on nutrition and health.  To subscribe & watch the full video podcast plus take part in the LIVE comments & questions: Inside Scoop Full show notes: Mind-Jam|FB Live Jan. 3, 2021

We're back on the narrow therapeutic index drugs! This week, we talk about theophylline and gentamicin, and how to manage toxicity. These two drugs are so commonly tested in the exam and pharmacists are always heavily involved in the prescription of these medicines. Have a listen, let me know what you think!

Ten quickfire questions on Gentamicin

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Show notes at pharmacyjoe.com/episode471. In this episode, I ll discuss whether to use actual, ideal, or adjusted body weight when dosing gentamicin in pregnant patients. The post 471: What dosing weight is used for gentamicin in pregnant patients? appeared first on Pharmacy Joe.

We discuss innovative approaches to gentamicin prescribing for sepsis with Dr Tom Lewis and learn the importance of approaching improvement from the patient perspective.

In this episode, Dr. Vincent DeLeo talks to Dr. Shari Lipner about nail education gaps in the American Academy of Dermatology Basic Dermatology Curriculum. Although the curriculum is designed to introduce medical students to essential concepts in dermatology, nail-related topics such as diagnostic techniques, biopsy procedures, and skin cancers of the nail unit are inadequately covered. Dr. Lipner discusses strategies to close these gaps and improve nail education for medical students and dermatology residents. She also breaks down the mnemonic for identifying nail melanomas. We also bring you the latest in dermatology news and research: 1. Gentamicin restores wound healing in hereditary epidermolysis bullosa. 2. Measles complications in the U.S. unchanged in posteradication era. 3. Dr. Adam Friedman outlines oral treatment options for hyperhidrosis. Things you will learn in this episode:  A thorough full-body skin examination should include the skin, hair, and scalp, as well as the nails. Even while the patient is initially speaking, pay attention to the nails. Many dermatology residents and attendings are not familiar with the ABCDEF nail melanoma mnemonic, which is more complex than the mnemonic for cutaneous melanoma. There is a gap in educating dermatology residents on nail biopsies and surgical procedures. Nail education can be improved by encouraging medical students and residents to be aware of the nails, get comfortable with the nails, and incorporate nails into the didactics during medical school and training. More lectures at national and local conferences and hands-on learning also are helpful. “By understanding nails, both diagnosis and management, potentially we can improve patients' quality of life, and it can also be lifesaving in the case of malignancies.” Hosts: Elizabeth Mechcatie; Terry Rudd; Vincent A. DeLeo, MD (Keck School of Medicine of University of Southern California, Los Angeles)  Guest: Shari R. Lipner, MD, PhD (Weill Cornell Medicine, New York, New York)  Show notes by Alicia Sonners, Melissa Sears, and Elizabeth Mechcatie. Contact us: podcasts@mdedge.com Twitter: @MDedgeDerm Rate us on iTunes!

On this episode, I will discuss aminoglycoside pharmacology.  Gentamicin and tobramycin are the two classic examples of aminoglycosides.  We will review how these medication work in the body, adverse effects, and the importance of pharmacokinetics and laboratory monitoring. All subscribers to the website/podcast will get access to a FREE Top 200 Drug Study Guide where I highlight the 3 most highly testable pearls from each medication (this is a 31 page PDF!)  In addition, you'll get a free 100 question pharmacology test.  Both resources are free, simply for following the podcast!  What are you waiting for? Click Here to Subscribe

PSA:  Please don't stick things in your ear any larger than your elbow...and that includes your finger. Review Outer ear = the part that you can touch Middle ear = the area being the ear drum Inner ear = the cochlea and area responsible for your balance 3 common ear problems Ear infections (otitis media) Vertigo (and motion sickness) Tinnitus (ringing in your ear) Callback *Ear wax Ear Infections The area behind your ear drum has air in it and that pressure is equalized through the eustachian tube.  If that area gets fluid in it, that fluid can grow bacteria and that leads to infection.  The natural motion of opening and closing your jaw helps massage the eustachian tubes and moves air in and out (like when you fly or drive in the mountains and you chew gum or yawn). Cold and allergies can be the source of the fluid build up that leads to ear infection.  You may have decreased hearing, pain, decreased balance - infection can require antibiotics. Vertigo This is the sensation of spinning, dizziness, being off balance The semi-circular canals are responsible for your balance.  If it get sloshed too much, or doesn't level out exactly right, then the signals sent to the brain may translate to being off balance even though your body is upright.  The signal confusion is what can lead to nausea (it's not actually happening in your stomach - at least not until you vomit!) The fluid moving around in these canals are why kids can induce dizziness when they spin around in circles (think about the clothes in your washer during the spin cycle - they get pushed to the outside). Medications  for vertigo are the same as some medications for nausea - plus they have drowsy side effects, so maybe you just sleep it off. There are many suspected causes, but nothing definite or proven. Tinnitus Defined as ringing, buzzing, roaring, whooshing sound when nothing is actually making that noise. Causes: hearing loss (either due to aging or exposure to loud noises); high blood pressure (pulsating); medications One theory: the hairs in the cochlea are damaged so those frequencies of sound (usually high pitched sounds) can't be picked up anymore; the brain fills in the gaps with "made up sound".  This is NOT PROVEN! High blood pressure can cause you to hear the blood pulsing through the blood vessels in your ears. Medications that causing ringing in the ears Aspirin (acute over-use) Aminoglycosides (i.e. Gentamicin = antibiotic) - it has a small therapeutic window, too much can lead to ear damage, it stopped in time, permanent ear damage can be avoided Quinine = usually asked for to help leg cramps, also medically prescribed to prevent malaria.  Can only be readily consumed by drinking tonic water. Flavonoids are put in vitamins and advertised to help tinnitus.  Flavonoids are phytonutrients (nutrients you get from plants).  These nutrients can't grow the hairs back in the cochlea.  Most of the vitamins and nutrients in the flavonoid vitamins have anti-oxidative properties, but I doubt that tinnitus is a major oxidation problem. Audience Question Can being slapped over time cause ringing in the ears? Being bopped in the face and head can probably cause permanent damage to the structures on the inside and outside of your head.  Being hit in the side of the head can cause pressure build-up in the ear where the air causes the ear drum to rupture (like "boxing" the ears). Slaps to the face (like "you jerk!" kind of slaps) don't usually cause ear problems, but punches or slaps to the side of the head near or on the ears can possibly cause damage. Prevent ear problems: be nice to your ears! Connect with me Support us on Patreon *NEW* Join the Pharmacist Answers Podcast Community on Facebook Subscribe: iTunes, Stitcher, GooglePlay, TuneIn Radio Like the Facebook page Music Credits:  “Radio Martini” Kevin MacLeod (incompetech.com)  Licensed under Creative Commons: By Attribution 3.0  http://creativecommons.org/licenses/by/3.0/

Gareth discusses aspects of starting antibiotics and focussing them in line with principles of antibiotic stewardship with Joy Nicholls, an Antibiotic Specialist Pharmacist at Chester Hospital. also up for discussion are the particulars of prescribing Gentamicin and Vancomycin and how to manage the ongoing treatment and when to take serum drug levels. @FOAMdation @garEMlyn foamdation@gmail.com www.foamdation.com

The post Gentamicin (Cidomycin) appeared first on NURSING.com.

Laura Martin. Photo courtesy of Laura Martin. Episode 6 features Laura Martin, expert parent, mom blogger at Joseph at Home, and the Director of Parent Communication and Engagement at Graham’s Foundation—a non-profit organization that supports parents of premature infants. During the episode, Laura shares her son Joseph’s story of prematurity and survival including his near fatal bout of late-onset NEC and the multitude of life-long complications that have resulted. She discusses: The extremely premature birth of her twin sons, Joseph and Campbell, at 24 weeks—four months early, and Campbell’s passing at 23 days of life, How Joseph developed late-onset NEC and lost two-thirds of his small intestine, Several of Joseph’s secondary diagnoses including Short Bowel Syndrome, Auditory Neuropathy Spectrum Disorder, Eosinophilic Esophagitis, and multiple food allergies—all resulting from NEC, How hers and her family’s experience with prematurity led to her work at Graham’s Foundation, Her personal blog where she documents her daily life as an expert parent of a child with special needs. Copyright © 2015 The Morgan Leary Vaughan Fund, Inc. This episode was produced in part by the TeacherCast Educational Broadcasting Network. [powerpress] STEPHANIE VAUGHAN, HOST: Welcome to Episode 6 of Speaking of NEC—a free, audio podcast series about Necrotizing Enterocolitis. Produced by The Morgan Leary Vaughan Fund, and funded by The Petit Family Foundation, Speaking of NEC is a series of one-on-one conversations with relevant NEC experts—neonatologists, clinicians and researchers—that highlights current prevention, diagnosis, and treatment strategies for NEC, and the search for a cure. For more information about this podcast series or The Morgan Leary Vaughan Fund, visit our website at morgansfund.org. Hello, my name is Stephanie Vaughan. Welcome to the show. I’m the Co-founder and President of The Morgan Leary Vaughan Fund. NEC is the leading cause of Short Bowel Syndrome or Short Gut Syndrome. The amount and location of intestine lost can result in life-long medical complications. Up to now, we’ve discussed NEC and its most common complication from the perspective of the neonatologist or surgeon. However, I feel that it is equally important to share the parent’s perspective. I’m privileged to have one such expert parent as my guest today. Laura Martin is the mom blogger at Joseph at Home, and the Director of Parent Communication and Engagement at Graham’s Foundation. She is also the parent of a fellow surgical NEC survivor. Laura will share with me today her son Joseph’s story of prematurity and survival including his near fatal bout of late-onset NEC and the multitude of life-long complications that have resulted. During our conversation, she will discuss in varying degrees: The extremely premature birth of her twin sons, Joseph and Campbell, at 24 weeks—four months early, and Campbell’s passing at 23 days of life, How Joseph developed late-onset NEC and lost two-thirds of his small intestine, Several of Joseph’s secondary diagnoses including Short Bowel Syndrome, Auditory Neuropathy Spectrum Disorder, Eosinophilic Esophagitis, and multiple food allergies—all resulting from NEC, How hers and her family’s experience with prematurity led to her work at Graham’s Foundation, Her personal blog where she documents her daily life as the parent of a child with special needs. With that in mind, let me introduce my guest today. This is Laura. Hi, how are you? LAURA MARTIN, GUEST: Hey, good. How are you? STEPHANIE: Good. Thank you for joining us. And Laura is a blogger at Joseph at Home and the Director of Parent Communication and Engagement at Graham’s Foundation. So I will let you introduce yourself and talk to me a little bit about your experience with prematurity and Necrotizing Enterocolitis. LAURA: Yeah. Our twin boys were born at 24 weeks gestation on Halloween morning in 2009. It came as a big surprise. It had been a perfectly clean, normal pregnancy. I had just had an appointment three days before, woke up with a dull backache about midnight. And Joseph was born first at 7:41 and his twin brother Campbell at 7:42. No rhyme or reason for the prematurity. It just happened. Campbell, unfortunately lost his battle to prematurity after 23 days of life. He just had a lot of complications from prematurity that he just couldn’t have overcome. Joseph went on to spend 228 days in the neonatal intensive care unit before he came home. He is now five and a half. He just started kindergarten. But it’s been a long journey to get here. We were two days from coming home when he was 5 and a half months old. He was about eight weeks adjusted. We had everything set up at home. We had oxygen. We had G-tube equipment. We had everything. We were ready. His room was ready. All of the clothes were washed. Two days before discharge, we got a call from the NICU that he was gray and bloated. And they were putting him on a ventilator. Let me back up a little bit. A few days prior to that, he had been showing some signs of infection. But nobody really knew what it was. He just had vaccines. He was running a little bit of fever. We contributed it to that. This pushed discharge back a little bit. But just two days before the initial discharge, when they called and said he’s gray and bloated, and they were putting him on a ventilator. You need to get here immediately. Our world kind of turned upside down, because we thought we were two days from home. And here we were not knowing what was going to happen. This was a Saturday, the day before Palm Sunday, 2010. And we didn’t know what was going to happen. The doctors kind of watched him throughout the Saturday, were taking X-rays every few hours. A little bit after lunch that day, one nurse practitioner came and said, his X-ray looks a little bit like NEC. Do you know what that is? And we said, of course, we know what that is. We’ve been in the NICU five and a half months. But he’s eight weeks adjusted. Why would be looking at NEC? We’ve been told once you get to your due date, you cross that off your list of things to worry about. And so, as the day went on, the night went on, it became very evident that he had Necrotizing Enterocolitis. They had seen this one other time in the NICU with a baby this old. He went through Saturday night. Things were not looking good. And on Sunday morning, the surgeon came to us and said, I’m going to take him to the OR. I’m going to open him up. And I’m going to see what happens. We don’t know what we’re going to find. So, on Palm Sunday, 2010, the surgeon took him to the OR. He was gone for several hours and came back halfway through surgery and sat us down in a room and said, here’s what I found. He has 41 centimeters (16 inches) of salvageable intestine. He said, he has 28 centimeters (11 inches) below his stomach, and he has 13 (5 inches) above his colon. Everything else in the middle is completely gangrenous. He said, we can take out the gangrenous intestine. And he’ll have two stomas for a while. Then we’ll go back in and reconnect. But he also looked at us and said, we don’t know what life for him is going to be like. It’s probably going to be very rocky. He may die before the age of two waiting on a liver transplant, because he’s going to be TPN dependent. If you want to close him up and let him go, I’ll respect your wishes. And, of course, we looked at him and said, no way, we’ve gotten this far. We’ve already lost one kid. We’re not doing this again. Go in there. Do what you have to do and save his life. So he went back. He was gone for several hours, came back to us. We saw Joseph, and it was amazing. Even though he had stomas, and he had just lost two thirds of his small intestine, he looked so much better than he had right before he went, because the infection was gone. A few days after that, they went in and placed a central line, because he was, of course, totally TPN dependent. He already had a G-tube before NEC, because of aspiration to his lungs. So we were fortunate with that that he already had the G-tube. But, as the weeks wore on, they were able to slowly decrease TPN, increase feeds, and decided after four weeks, he was ready for intestine reconnect, which was shocking. Nobody expected after four weeks he would be ready for intestine reconnect. So four weeks later, they went in, reconnected the intestines, told us we would probably be in another two to three months. He again amazed everybody—came off TPN very quickly, increased G-tube feeds to the point that they pulled his port before he came home. He never came home with a central line. And four weeks after his reconnect surgery, he came home—after 220 days in the NICU. STEPHANIE: That’s amazing. LAURA: So that’s how NEC came to be. Again, the hospital had seen one case of that. And it had been years and years and years. And people say, are you sure it’s NEC? Are you sure it was NEC? Yes, pathology confirmed that it was NEC. But who knows? Who knows why he had it at five and a half months old. STEPHANIE: Right, right. So just to back up, I’m curious what you knew about NEC before his surgery. You know, you had said that you had been in the NICU for now almost five months. And he reached his due date, so you were crossing it off the list. So I’m just curious, in general terms, what you knew up to that point. LAURA: NEC was one of those things that I remember learning about really early on in our NICU stay. Having 24-week twins, we knew that it was a very rocky journey. They both had less than 50% chance of survival. But my husband and I were the type that we wanted to know everything. We wanted to know what are things we have to look out for. What are things we need to be worried about? What are things that we don’t have to worry about? And it was within the first 24 to 48 hours that the nurse said there’s a thing called Necrotizing Enterocolitis. It doesn’t happen a lot. But it’s one of these things we watch for. We stay on top of it. So we knew about it from the beginning, but we had always been told that once you reach the gestational due date, you didn’t have to worry about it anymore. And while that is so true 99.999% of the time, there is a very small chance that it can happen later. And it’s almost one of those things I wish we had never been told—oh, yeah, you don’t have to worry about it when you hit 40 weeks. Because we did—we had completely crossed it off Right. So we know about it. And we knew what the warning signs were. We knew what to look for. Yet, again, when we look back on it, he had some of these warning signs two to three days before he got really, really sick. But why would—none of us thought it could be NEC. We thought, well, he’s had some GI issues. He has the feeding tube. He’s had his vaccines. It could be any other bug he’s picked up. He’s still in the NICU. But we knew what it was, but it was still just a huge shock that—I mean, he was 13 pounds at that point. He was a big kid, you know, for being in the NICU. STEPHANIE: Right, right. So he came home now, you said, four weeks after he had been reconnected. So talk to me a little bit about, I guess, those first days and first months when he was coming home—you know, again, sort of thinking from the perspective of things that we want to let parents and caregivers know, questions to ask, sort of things to look out for—so anything that you want to talk about, you know, his transition home and getting settled. LAURA: Yeah, he came home on complete continuous feeds via G-tube. So he was on feeds 24 hours a day because, of course, having NEC left him with short bowel syndrome. So he had a lot of dumping episodes, where it was out of control at times. We couldn’t really go anywhere because of the dumping syndrome. As the days went on, the weeks went on, the months went on, that got a little bit better. We were in and out of GI every 8 to 12 weeks, just checking in, making sure he was gaining weight. But a lot of doctors also didn’t really know what to do because he wasn’t TPN dependent. A lot of kids who come home with short bowel syndrome are TPN dependent. But here you have this kid who has only a third of his small intestine, but for the most part he’s tolerating formula well. He’s tolerating G-tube feeds. He’s gaining weight. He’s not going to need a port. Everybody was convinced he would have to have his port put back in. He never did. So that was actually, to be honest, a frustration for the first several years, is finding doctors who understood that, yeah, he is doing well. But he’s also not doing well. He only has a third of his small intestine. His weight gain is very slow. He still has periods of severe pain even today, from school. He still has periods where his belly is very distended. It took some time to find doctors who really wanted to help and say, yes, there really is still a problem here—with a kid who only has a third of his small intestine. That first year that he was home, he was rehospitalized five or six times, most of those with a GI bug. If he got any sort of stomach bug, we were in the hospital, because his body just couldn’t handle it. And so we were back in. Usually it would lead to a respiratory infection. He would spend a good week, 10 days, in the hospital. That was the first year. After that, I quit my job teaching, because we knew he had to stay home. He had to be healthy. And he had to grow. And as he’s gotten bigger, he’s gotten healthier. He has not been in the hospital for a GI bug in 3 and 1/2, 4 years. It’s been awhile. STEPHANIE: Oh, that’s great. LAURA: Yeah, now his body can tolerate it. You know, it’s not pleasant still. But we know what to do. But, as he’s gotten bigger, it’s gotten better. So, yeah, that was the first few years out of the hospital. STEPHANIE: We don’t have nearly the after-effects, but I remember Morgan’s transition home was pretty chaotic. LAURA: Yeah. STEPHANIE: His brother came home after 85 days, and I’m guessing was a much simpler transition, even just holding him in hands-on care and changing diapers. Morgan was very traumatized, I think, from being in the hospital and having the surgery. And we saw a big, big difference between him and his brother. So it was very scary as a parent that even simple things that you have to do was traumatizing to him. LAURA: Right. And then they can’t communicate with you to tell you that. And that’s what was so hard to watch early on, was you knew he was hurting. You knew he was in pain. But I didn’t know what to do to help, you know. So that was hard. Yeah. STEPHANIE: So, I guess, now that he’s getting a little bit older—you said he started kindergarten. That’s great. So how is he doing, I guess, developmentally? And are you seeing anything—you know, secondary diagnoses, I guess, maybe, strictly because of NEC or because of the short bowel or other issues that he’s having? LAURA: Yeah, he has several things that are going on. He did just start kindergarten. He’s in a special needs kindergarten. As a result—well, when he had NEC, he had to receive Gentamicin, which of course is an ototoxic drug. And the surgeon said, if we give this to him, he will probably lose all of his hearing. But if we don’t give this to him, he’s not going to live. Well, of course, it was a no-brainer decision. Before that, he had not passed his newborn hearing screening. But a lot of preemies don’t. So we kind of thought, well, we’ll get out of the NICU, he’ll pass it. He never did. While he was still in the NICU—this was in between NEC and the reconnect surgery—he was diagnosed with Auditory Neuropathy Spectrum Disorder, which is a hearing loss that comes and goes. It’s almost like you’re trying to tune a radio and there’s static. And that was what his hearing was like. So he received his first cochlear implant when he was three—three months after he turned three—because his hearing was rapidly deteriorating in his left ear. Just, not even two weeks ago, he received his second cochlear implant in his right ear. And we always go back to say, his hearing probably would have never been that great. But it’s definitely a lot worse post-NEC, because he had to receive the Gentamicin, the ototoxic drug, in order to kill the bacteria. Some other things that he has—July of 2014, he was diagnosed with Eosinophilic Esophagitis, which has been in question for several years. And we could not get the GI doctor to agree to do an endoscopy. He hated to do the endoscopy, because it meant putting him under sedation. Due to asthma, he didn’t want to do that. But at the same time, we’re battling with this increased amount of food allergies, knowing that that has to be a problem. Finally, they agreed to do the endoscopy. And it was clear that he had Eosinophilic Esophagitis. As a result of that, he has 15 food allergies. I’m happy to list them all if you want. But it includes all of the top 8 plus beef, chicken, rice, potatoes, watermelon, strawberry, pineapple, and a whole slew of medications. And I always tell people asking—it’s hard to know whether he would have had that regardless. Probably not. But having the Short Bowel Syndrome made it worse. He would not have had Short Bowel Syndrome if he didn’t have Necrotizing Enterocolitis. So to me it’s all sort of related. STEPHANIE: Right. Right. There’s definitely a domino effect. LAURA: It’s a domino effect. One thing has led to the other, which has led to the other. So it’s hard to know, some days, if you’re battling GI issues because of Short Bowel Syndrome. Or are you battling GI issues because of the Eosinophilic Esophagitis? Or are the white blood cells growing because he’s eating something he’s allergic to? Is there a new allergy? So some days we really struggle knowing what is what. And then you’ll have periods where he does great. And he’s like a normal kid. He does still have a G-tube. We were told he would lose the G-tube by two. But here we are almost six, and we still have the G-tube. Many days I wish we didn’t. But there are many days we couldn’t do without it. And if he doesn’t feel like eating or he’s in pain, we have the G-tube. And it’s literally been a lifesaver. And if he’s been sick, we can always get fluids in him. I would love to see it go. But I don’t see it going any time in the future. He doesn’t know life without it. He’s had it since he was four months old. To him it’s second nature. He gets his G-tube feeds at school. He gets them at home. They travel with us. But it’s truly a lifesaver for him. But it helps him gain weight. It’s what helps him actually be on the growth chart as a short-bowel kid. Many short-bowel kids, I think, are failure-to-thrive. He has never even been remotely considered failure-to-thrive, which is huge. So, yeah, there’s a lot of complications as a result—what I feel like, had he not had NEC, wouldn’t have led to X, Y, and Z probably. He does have development delays. But a lot of it is that he spent so much time in the hospital. Then there was the hearing issue, but he could not get a cochlear implant because he wasn’t healthy enough to have surgery. So it was just sort of this domino effect, and a spiral of getting out of it, and getting him healthy enough to be able to have surgery. And then you’re trying to catch up. You’re trying to catch up with language, fine motor, gross motor, it all, as well. But the kid we were told would never walk or talk, walked into kindergarten last week. So there’s so many things to be thankful for, and so many things that he’s doing so well on, that those are the days you really have to hold onto on the days he’s feeling really, really bad. You have to know that he’s going to get through it. Life will turn around, and it will get better. It’s just going to be interesting to see as he continues to grow, how much of this is just going to continue to get better. Will there be a decline at some point? We don’t know. Nobody really thought he would even make it to this point. STEPHANIE: Now, I’m just curious, sort of, personally, but also as a fellow parent of a NEC baby, have you talked to him at all about being in the NICU? Has any of that come up yet? I mean, I know he’s still sort of young. But I’m just curious. LAURA: Yeah, he knows he was in the hospital. When we drive by the hospital where he was born, he’ll say, that’s where I was born. That’s where my sister was born. He has seen pictures. He’s seen videos. But I don’t think he quite cognitively wraps his head around it. When he had a cochlear implant put in 10 days ago, it was at the hospital where he had NEC. And so we were able to kind of say, you were in the hospital here when we are a baby. A couple of the nurses stopped by to see him—they took care of you when you were a baby. But the cognition is just not quite there too. He sees his pictures. And he’ll say, I was very sick. And, yes, you were very sick—because he knows that his baby pictures look very different from his sister who was born full term. So he knows. He knows he has a G-tube. She does not. And so he’s starting to really realize those differences. STEPHANIE: Right. Yeah, I don’t think we’ve quite reached that yet. Shaymus deals with asthma. So he gets his puffs and he has, you know, different things. But I don’t think they’ve really lined up and taken notes on, you know, your picture has this. And my picture has that. Or you have this and I have that. But, yeah, sort of, it’ll be interesting to talk to them about it when they start to ask. Like, they just figured out that they’re twins this year. LAURA: Oh, that’s so funny. And my husband and I have talked about it. Gee, at what point in their life are they going to realize everything that they went through as a baby. And all these odds that were stacked against them. And all the times that they shouldn’t have lived. And will they be teenagers? Will they be adults? Will it be when they have their own children? My husband and I talk about this a lot. It’s just going to be interesting to see at what point do they kind of go, oh, wow, yeah, that really was what mom and dad went through and what I went through. It’s just fascinating. STEPHANIE: Yeah. So I would also like to let you talk about the work that you’ve done now because of having preemies and Joseph’s diagnosis. So you are the Director of Parent Communication and Engagement at Graham’s Foundation. So I’m happy to let you plug them away, and also to talk about your blog, which is Joseph at Home. LAURA: Yeah, I'll start with Graham’s Foundation first. I started working for them, gosh, about three and a half years ago in a different capacity. And it was one of those things that I was staying home with Joseph. And I was trying to figure out a way that I could give back to the preemie community. But I knew I couldn’t go into the NICU, because here I was with this child who got sick easily. And I knew that that couldn’t happen. So I started working for Graham’s Foundation, which was such a great outlet to be able to connect with other preemie parents, and sort of share stories—share stories with families who lost their child, with families who went through a long-term NICU stay, families who went through a short-term NICU stay. People will say, well I was only in the NICU 10 days. You were in seven and a half months. One day is one day too long for anybody to be in the NICU. And that’s what I always say to people. Nobody should have to go there. And if I can provide any sort of “it’s going to be OK,” I would love to do that. And so now, I serve as the Director of Parent Communication and Engagement. I do a lot of the writing for the blog for Graham’s Foundation, which is something we’re really trying to get off the ground. And through that, I also serve as a NEC mentor. So if parents come across our website and are looking to talk with someone who has experienced NEC, in no way am I a medical professional but I'm able to say: This is what we experienced. This is what we’re experiencing now. These are some questions you might be able to ask the doctor. And it’s been really nice to connect with people. Also, being five years out, to say, I promise you are going to get through this. When you’re dealing with, all along, doctor’s appointments, and you feel like you’ve got 18,000 things going on in one week. I’m here to tell you that I promise you, it gets better. The appointments get less and less and less. And it’s been so nice to connect with parents, and to offer that support from home, while I can still stay home with my kids and be able to work from home. And then also I have my personal blog, josephathome.com, which I started when I found I was pregnant with twins. I didn’t even share the blog address with anybody. My husband and I thought, oh, this will be great. We’ll update it. We’ll send it to friends and family. So as the pregnancy rocked along, I would sort of update it. I could never send out to anybody. And then when they were born Halloween morning, 2009, at 24 weeks gestation, I knew I didn’t have the energy to tell the same story over and over and over about what was happening. The texts were too long to send the information of what was going on. We had two of them, and I just couldn’t do it. And I was, like, oh, I’ve got this blog. This will be a great way to update people, so the long days of sitting in a hospital, my husband worked on our family tree. And I worked on the blog. That is just what we each sort of did to take our mind off of what was going on. And it was a great way, if somebody asked me a question, I would just say, read the blog. It’s on the blog. Just read the blog. I could share pictures—it just—because I wasn’t really in the mood to talk. We would talk to family, immediate family, and share with them what was going on. But it was just—it was so draining to tell the same story over and over and over. And if I just wanted to get something out there quickly, I would put it up. So, when Joseph came home, and I thought, well, I’ll keep it going. We’ll see what happens. It’ll probably die by the wayside. Well, five and a half years later—it’s almost six years later—it’s still going. And I write a lot now just about, of course, about prematurity, but also raising a special needs child and what that looks like, because we’re in this short-bowel world. We’re in the eosinophilic world. We’re in this hearing-loss world. We’re in the cochlear-implant world. We’re in the vision-impaired world. We’re in the mild cerebral palsy world, food-allergy world. And it’s just been nice to be able to connect with other parents and just to write about our real life and what it’s like. What it’s like. How do we deal with insurance? How do we deal with medical supplies? How do we travel? How do we do this, that, and the other? And it’s just a great outlet, too, just for venting, you know. And if I don’t want to talk about it, I can write about it. So we’ll see where it goes. It’s been a really nice outlet. But it’s also a great way to show Joseph, hey, this is where you started. This is where you are now. And it’s almost like a scrapbook, really, of his entire life, because it started the day he was born, and has everything. I just hit my—over 1,100 entries on it. STEPHANIE: That’s great. I commend you on that. I attempted, when I first came home from the hospital, to start recording things. And, I think, honestly, it was just too hard. I sort of thought to myself, I don’t want to remember this piece of it, so I sort of stopped. And I had scraps of paper where I would write down stats every day. You know, they gained this, and literally had, like, a pile two inches thick, by the time they came home, of daily weights and charts and things. Yeah, I mean, I’ve seen many of your posts. And I think they’re great. And I think it’s a great outlet. And, again, sort of that you’re not alone. And, you know, people are better off than you. People are worse off than you. And everybody’s sort of on their own journey. And I know preemie parents tend to minimize amongst other people, but your struggle is really your struggle and your family’s struggle. And no one should have to struggle. LAURA: No. And that’s what I’ve always said to people is, somebody out there always has something worse going on. Like, on Joseph’s worst day, somebody else has something worse going on. And that’s what I always say to people is, yeah, this is just our life in a little nutshell. But we’re so thankful for what we have. And, again, it could always be worse. You can just turn on the news every day and see that. But if it’s just, you know, if it can help one parent to say—and even sometimes I think people don’t like to say, well, this is not fair. You know what, sometimes it’s not fair. And it’s OK to say that and have a little pity party and then move on. And I enjoy being able to say to people sometimes. STEPHANIE: That’s great. So, I guess, is there anything else that you would want to mention if you had somebody in your position, however many years back, thinking to ask the doctors about, or transitioning home—coming home—how you sought out your specialists, if you’re not getting the answers that you think you should, how you proceeded, any sort of big-sisterly advice. LAURA: Yeah, I know, really. I think the big thing is to trust your instincts if you know that there’s something not right. We’ve gone through our fair share of doctors. Because if I feel like my child’s not getting the care that they need—and any parent would feel this way—I’m not going to settle for mediocre. I’m not going to settle for “he’s going to be fine” when you know in your heart that there’s still a problem. We were having some issues last year around the whole eosinophilic diagnosis. And I felt like we had run out of options where we live. And so I reached out to a doctor eight hours away. And he said, if you’re willing to travel, I’m willing to see him. I said, of course, we’re willing to travel. And so we did. He got us in. And we made the trip. And it was so nice to just connect with somebody who was a specialist in that field of Short Bowel Syndrome, to be able to say, yeah, he’s doing OK. I see that there are some problems. But you’re doing the right thing. And I think that’s become sort of my mantra is, don’t stop until you have the answers that you need. And there may not be answers. But I am not going to rest until I know that we have the answers we need. Like, we’re having some eosinophilic issues, so we’re working on getting into a top eosinophilic clinic. I don’t care how far we have to travel, because that’s what Joseph needs and it’s what’s best for him. And that’s what matters. It matters him feeling good. It matters him being healthy. It matters him growing. And he deserves to have the best life absolutely possible. And that’s what I would tell somebody if you’re just coming home. If you feel like something is not right, keep going and keep going and keep going. Yes, it’s exhausting. I think there are many days I’m asleep before my head even hits the pillow. But you have to do what’s best for your kid, because they can’t do it for themselves. You are their advocate. And that’s one thing that the NICU nurses taught us really, really early on—is you have to advocate for your child. Nobody else is going to do it for you. They can’t do it for themselves. You just have to keep going. And, again, it’s hard. You may hit brick walls here and there. Because goodness knows we’ve had our fair share with doctors. And it’s OK with doctors to speak your mind and say, you know, I don’t think you’re right on this. I think there’s more to it. You may upset them a little bit, because there’s no doubt I’ve upset a few. But it’s OK. It’s OK. Yes, they’re doctors. But they don’t have all the answers. You’re the parent. You live with your child day in and day out. You know their idiosyncrasies. You know what’s right and what’s wrong with them. And I think standing up for yourself is so important. And that’s what I would tell somebody coming out. You can’t be shy when it comes to advocating for your child who has special needs. STEPHANIE: I would agree. Yeah, we’re transitioning through preschool. And the boys were kindergarten eligible this year. But they’re actually being given an extra year of pre-K. And we had sort of that, uh, I’m not sure about this. I’m really not sure about it. I’m really not sure about it. And in the end they saw that—their teachers agreed with us. And the educational system agreed that, yeah, they’re a little bit immature. And probably going to kindergarten isn’t the best idea for them. And they really need the extra year. You know, they’re smart. Yes. But good enough isn’t good enough. We don’t want them to sort of eke by. We want to give them the best opportunities that they can have. So I agree with you wholeheartedly. LAURA: And it’s tough as a parent. I’ve had this conversation with a lot of people. My husband’s a teacher. I’m a teacher also. I’m not teaching right now. Hopefully one day I will be again. But it’s hard as a parent. It’s hard as a parent-teacher to have a child who has special needs and who needs that IEP (Individualized Education Program). It’s tough to sit on that end of the table as a parent. I mean, I’ve sat on the other end of the table as a teacher countless times. But, as a parent, it’s a tough pill to swallow, to say—and we know—I mean, Joseph started kindergarten. But we know full well he may need to repeat kindergarten. And while that’s tough to say, it’s a reality. We hope that he does great. But he may need to repeat. And if that’s what’s best for him, then that’s going to be what’s best for him. It’s tough to sit in an IEP meeting and hear how far behind he is. Or these are all the goals. And up to 21 pages now of his IEP. But it’s what he needs. And it’s what’s best for him. But I always go back to the day when one of our favorite NICU nurses—this was a long time ago—said, you know, one day he’s going to pull out a picture of him with all those tubes and wires and on a ventilator and say, see, mom, you remember this. And I have to think back to that, because, yes, it’s hard. And I kind of want to wallow in self-pity about, oh, I wish he was just in a regular ed class. He shouldn’t even be here. And that’s what I have to remind myself is, we had many days where we weren’t even sure we would see pre-K. And I know you’re the same way. We weren’t even sure he would see kindergarten. But here we are. And let’s just make the most of it. He’s loving every second of it. And that’s what matters. And so, being a preemie parent, as you know, it’s a journey that I never expected. But at the same time, I’m grateful for it, because it’s opened my eyes to a whole new area of life. STEPHANIE: Right. Well, I really appreciate you talking to me. And I think you’ve given some great advice—preemie parents or not, and NECs parents or not—on advocating for your child, and in every facet. So I really appreciate your time. And thank you so much. And if there’s anything else that you want to add, feel free. LAURA: If anyone wants to contact me personally, I’m happy to answer questions if there’s something that anybody wants to know more about. STEPHANIE: So great. Thank you. Thank you so much. LAURA: Thank you. STEPHANIE: For more information about Laura or to follow her blog, visit: josephathome.com. A direct link can also be found in this episode’s show notes. You can also email Laura directly at: laura [at] grahamsfoundation [dot] org. In closing, I’d like to share a few thoughts about today’s conversation with Laura. According to Dr. Besner, with whom I spoke about Short Bowel Syndrome in Episode 1, “if we estimate that a newborn baby has approximately 200 centimeters (78.74 inches) of intestine, they have to be left with at least 40 centimeters (15.75 inches) in order to be able to nourish themselves and get off TPN.” As a result of his bout with NEC, Joseph had only one centimeter (0.4 inches) more remaining. So first, I would like to take a moment to celebrate Joseph’s survival, courage, and strength. And that of his family. Both Joseph and his parents have shown remarkable resiliency while dealing with the daily effects of his bout with NEC. Second, I would like to reiterate that I strongly believe that a cure for NEC, once found, will have a far reaching impact not only on Gastroenterology (the digestive system and its disorders) as a whole, but also all of the patients like Joseph, and families like Laura’s. Show your support for our smallest and most fragile babies, those who have the greatest risk for developing NEC. Show your support for continued research in NEC. And join our effort to raise awareness about, and funds for research in NEC by making a donation to Morgan’s Fund at morgansfund.org/donate. If you’ve had a personal experience with NEC and would like to share your story, or have a question or topic that you’d like to hear addressed on our show, e-mail us at feedback@morgansfund.org. We’d love to hear from you! Copyright © 2015 The Morgan Leary Vaughan Fund, Inc. The opinions expressed in Speaking of NEC: Necrotizing Enterocolitis (the Podcast series) and by The Morgan Leary Vaughan Fund are published for educational and informational purposes only, and are not intended as a diagnosis, treatment or as a substitute for professional medical advice, diagnosis and treatment. Please consult a local physician or other health care professional for your specific health care and/or medical needs or concerns. The Podcast series does not endorse or recommend any commercial products, medical treatments, pharmaceuticals, brand names, processes, or services, or the use of any trade, firm, or corporation name is for the information and education of the viewing public, and the mention of any of the above on the Site does not constitute an endorsement, recommendation, or favoring by The Morgan Leary Vaughan Fund.

Im Rahmen der vorliegenden Arbeit wurde das Vorkommen von Bakterien im unteren Respirationstrakt von Hunden mit Atemwegserkrankungen und deren Resistenzverhalten gegenüber klinisch relevanten Antibiotika untersucht. Hierfür wurden die Ergebnisse der bakteriologischen Untersuchungen und Resistenztests von 502 Proben von 493 Hunden retrospektiv ausgewertet, die im Zeitraum von 1989 bis 2011 an der Medizinischen Kleintierklinik der Ludwig-Maximilians-Universität München mit respiratorischen Symptomen vorgestellt wurden. Aerobe Bakterien wurden aus 65 % der Proben isoliert, wobei in 47 % der positiven Kulturen mehrere Isolate nachgewiesen wurden. Grampositive Bakterien wurden aus 52 % und gramnegative Bakterien aus 77 % der Proben mit bakteriellem Wachstum kultiviert. Die häufigsten Isolate umfassten Spezies der Gattungen Streptococcus (31 %), Staphylococcus (19 %), Pasteurella (16 %) und Pseudomonas (14 %). Weiterhin konnten Enterobakterien in 30 % der positiven Proben nachgewiesen werden, bei denen es sich in der Hälfte der Fälle um Escherichia coli (15 %) handelte. Bordetella bronchiseptica als primär pathogenes Bakterium wurde in 8 % der positiven Fälle vergleichsweise selten isoliert. Im zweiten Teil der Arbeit wurde anhand der Ergebnisse des Agardiffusionstests die in-vitro-Sensibilität der häufigsten bakteriellen Isolate gegenüber den antibiotischen Wirkstoffen Enrofloxacin, Gentamicin, Cefalexin/Cefalotin, Amoxicillin-Clavulansäure, Sulfonamid/Trimethoprim, Cefotaxim, Doxycyclin und Ampicillin ausgewertet. Enrofloxacin zeigte die höchste Gesamtwirksamkeit aller getesteten antibiotischen Wirkstoffe gegenüber 86 % aller Keime, darunter 87 % der gramnegativen Isolate. Hochwirksam gegenüber grampositiven Bakterien erwiesen sich Amoxicillin-Clavulansäure (92 %) und Cephalosporine der ersten Generation (86 %), wobei 40 % der gramnegativen Isolate resistent gegenüber diesen Wirkstoffen waren. Ausgedehnte Resistenzen zeigten sich vor allem unter gramnegativen Spezies gegenüber Beta-Laktam-Antibiotika, potenzierten Sulfonamiden und Doxycyclin. Sehr hohe Resistenzraten wurden für Escherichia coli und Pseudomonas spp. nachgewiesen. Lediglich Enrofloxacin und Gentamicin wiesen eine Wirksamkeit gegenüber 70 bis 73 % dieser Isolate auf. Am empfänglichsten zeigten sich Pasteurella spp. mit weniger als 15 % Resistenzen gegenüber den meisten Antibiotika. Eine günstige Resistenzlage konnte auch für Bordetella bronchiseptica nachgewiesen werden. Hier lagen über 90 % sensible Isolate gegenüber Enrofloxacin, Gentamicin, Amoxicillin-Clavulansäure und Doxycyclin vor. Im Verlauf des Studienzeitraums konnte eine signifikante Abnahme der in-vitro-Wirksamkeit von Enrofloxacin gezeigt werden. Insbesondere für Escherichia coli konnte in der zweiten Hälfte des Untersuchungszeitraums ein signifikanter Anstieg des Anteils Enrofloxacin-resistenter Isolate nachgewiesen werden. Die Ergebnisse der vorliegenden Untersuchung unterstreichen aufgrund des nicht exakt vorhersehbaren Resistenzverhaltens der isolierten Bakterien die Notwendigkeit zur routinemäßigen Durchführung von bakteriologischen Untersuchungen und antibiotischen Resistenztests bei Hunden mit bakteriellen Atemwegsinfektionen. Anhand der erhobenen Daten kann Enrofloxacin zur empirischen antibiotischen Behandlung oder zur Initialen Therapie bis zum Vorliegen der Ergebnisse aus Erregerkultivierung und Resistenztests bei Infektionen mit gramnegativen oder unbekannten Erregern eingesetzt werden, während Amoxicillin-Clavulansäure zur Behandlung von Infektionen mit grampositiven Bakterien geeignet erscheint.

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Purpose: The purpose of this preliminary and descriptive study was toevaluate a biodegradable drug delivery system in combination with aninnovative ceramic implant. Methods: The delivery of gentamicin ofstandardized samples was measured in the laboratory usingultra-high-performance liquid chromatography. Biocompatibility andbiodegradation of the materials was investigated in an animal experimentin sheep up to 14 months. As carrier epsilon-caprolactone, 1:1 mixedwith gentamicin, intruded into micro-chambered beta-tricalcium-phosphatebeads (MCB (R)) was studied. Results and Discussion: Gentamicin wasreleased in calculable concentrations during the first 30 days. Therelease from epsilon-caprolactone was higher than that frompolymethylmethacrylate and more predictable. The caprolactone carrierwas reabsorbed by osteoclasts.

Enteric pathogens need to grow efficiently in the gut lumen in order to cause disease and ensure transmission. The interior of the gut forms a complex environment comprising the mucosal surface area and the inner gut lumen with epithelial cell debris and food particles. Recruitment of neutrophils to the intestinal lumen is a hallmark of non-typhoidal Salmonella enterica infections in humans. Here, we analyzed the interaction of gut luminal neutrophils with S. enterica serovar Typhimurium (S. Tm) in a mouse colitis model.Upon S. Tm(wt) infection, neutrophils transmigrate across the mucosa into the intestinal lumen. We detected a majority of pathogens associated with luminal neutrophils 20 hours after infection. Neutrophils are viable and actively engulf S. Tm, as demonstrated by live microscopy. Using S. Tm mutant strains defective in tissue invasion we show that pathogens are mostly taken up in the gut lumen at the epithelial barrier by luminal neutrophils. In these luminal neutrophils, S. Tm induces expression of genes typically required for its intracellular lifestyle such as siderophore production iroBCDE and the Salmonella pathogenicity island 2 encoded type three secretion system (TTSS-2). This shows that S. Tm at least transiently survives and responds to engulfment by gut luminal neutrophils. Gentamicin protection experiments suggest that the life-span of luminal neutrophils is limited and that S. Tm is subsequently released into the gut lumen. This "fast cycling" through the intracellular compartment of gut luminal neutrophils would explain the high fraction of TTSS-2 and iroBCDE expressing intra- and extracellular bacteria in the lumen of the infected gut. In conclusion, live neutrophils recruited during acute S. Tm colitis engulf pathogens in the gut lumen and may thus actively engage in shaping the environment of pathogens and commensals in the inflamed gut.

It's no secret that millions of Americans depend on pharmaceutical drugs and medical devices to improve their health and quality of life. Unfortunately, sometimes medications come with side effects and each year, over a quarter of a million side effects related to prescription drugs are reported. Ringler Radio host, Larry Cohen and co-hosts, Mike Casey, Chairman of the Board of Directors and Head of Midwest Operations for Ringler and Brad Mathers from the Dublin, Ohio office, welcome Attorney John A. Lancione, Jr. from the firm Lancione & Lancione, to talk about pharmaceutical and medical device litigation. They will explore the role of the FDA, highlight the drug Gentamicin and see what needs to be done to stop the side effects from medications and defects from devices.

ZUSAMMENFASSUNG Die Anwendung antimikrobieller Wirkstoffe in der Human- und Veterinärmedizin hat zu einer Selektion und Anreicherung antibakteriell resistenter Mikroorganismen geführt. Die Bedeutung tierischer Lebensmittel bei der Übertragung von Bakterien auf den Menschen wurde bereits des öfteren beschrieben. In Europa sind die meisten Y. enterocolitica-Stämme, die bei humanen Gastroenteritiden isoliert werden, vom Bioserotyp 4/O:3. Für menschliche Infektionen stellen symptomlos infizierte Schweine das wichtigste Erregerreservoir dar, dabei gilt Schweinefleisch als wichtigste Kontaminationsquelle. In der Literatur wurde bisher nur über eine Empfindlichkeitsbestimmung von Y. enterocolitica 4/O:3 in Deutschland berichtet. Aus diesem Grund befasste sich diese Studie mit dem Resistenzverhalten dieser Bakterien unter Anwendung zweier unterschiedlicher Methoden. Mittels Agardiffusionsverfahren wurden 200 Stämme (60 humane und 140 porcine) auf die antimikrobiellen Wirkstoffe Ampicillin, Amoxicillin/Clavulansäure, Cefotaxim, Aztreonam, Chloramphenicol, Colistin, Erythromycin, Gentamicin, Streptomycin, Nalidixinsäure, Ciprofloxacin, Tetracyclin, Sulphamethoxazol, Sulphamethoxazol/Trimethoprim und Trimethoprim getestet. Im Anschluss wurden 110 der gleichen Stämme (31 humane und 79 porcine) mittels Bouillon-Mikrodilutionsverfahren untersucht. Die im Handel erhältlichen Mikrotiterplatten wurden vom Nationalen Veterinärinstitut Schwedens bezogen und enthielten die antimikrobiellen Wirkstoffe Ampicillin, Cefotaxim, Ceftiofur, Chloramphenicol, Florfenicol, Gentamicin, Kanamycin, Streptomycin, Nalidixinsäure, Ciprofloxacin, Tetracyclin, Sulfamethoxazol und Trimethoprim. Mittels Agardiffusionstest wurden gegen fünf Wirkstoffe Resistenzen ermittelt. 98,0 % der untersuchten Yersinien waren gegen Ampicillin, 92,5 % gegen Erythromycin, 7,0 % gegen Streptomycin, 2,0 % gegen Sulphamethoxazol und nur 1 Stamm (0,5 %) war gegen den Kombinationswirkstoff Sulphamethoxazol/Trimethoprim resistent. Mittels Mikrodilutionsverfahren wurden bei drei von 13 getesteten Wirkstoffen Resistenzen ermittelt. So waren 97,2 % gegen Ampicillin, 15,5 % gegen Streptomycin sowie 1 Stamm (0,9 %), aus einer humanen Stuhlprobe, gegen Sulphamethoxazol resistent. Dieser Stamm war sowohl mittels Agardiffusions- als auch mittels Mikrodilutionsverfahren multiresistent. Es konnte kein wesentlicher Unterschied zwischen den Resistenzergebnissen humaner und porciner Stämme festgestellt werden. Von den 110 Yersinien waren die Ergebnisse von 82 Stämmen, mittels Agardiffusions- und Bouillon-Mikrodilutionsverfahren, übereinstimmend. Bei 28 Y. enterocolitica-Stämmen wurden unterschiedliche Resultate ermitelt. In 6 Fällen handelte es sich um größtmögliche Fehler, 4 mal sind große und 18 mal geringfügige Fehler aufgetreten. Dabei ist bei dem Vergleich der Ergebnisse der MHK-Wert als der verlässlichere anzusehen. Aus diesem zuletzt genannten Grund und da die Mikrodilution im Gegensatz zur Agardiffusion quantitative Ergebnisse liefert, was für eine effektive Therapie von Bedeutung ist, sollten Empfindlichkeitsbestimmungen mittels Mikrodilution durchgeführt werden. Insgesamt betrachtet, zeigen die Ergebnisse dieser Studie, dass Y. enterocolitica- Stämme 4/O:3 gegenüber den meisten antibakteriellen Wirkstoffen empfindlich sind und nur vereinzelt Resistenzen gegen antimikrobielle Wirkstoffe aufweisen. Des Weiteren ist zu sagen, dass bei Y. enterocolitica-Stämmen 4/O:3, die im süddeutschen Raum isoliert wurden, die Resistenzsituation zum derzeitigen Zeitpunkt nicht problematisch ist und mit den Ergebnissen anderer weltweit durchgeführten Untersuchungen übereinstimmt.

Epithelzellen spielen im Immunsystem eine wichtige Rolle als Vermittler zwischen äußerem Milieu und darunterliegender Mukosa. Epithelzellen treten als Erste mit potentiellen Pathogenen in Kontakt: durch die Sekretion von Zytokinen als Warnsignale an umliegende Zellen können sie eine Entzündungsreaktion einleiten. Yersinia enterocolitica ist ein enteropathogener, vorwiegend extrazellulär lokalisierter Erreger, der eine akute Enterokolitis, Sepsis und immunologische Folgeerkrankungen verursacht. Die Rolle der intestinalen Epithelzellen bei der Infektion mit Y. enterocolitica ist bisher nicht ausreichend erörtert. Ziel dieser Arbeit war zum einen die Untersuchung des von Epithelzellen initiierten Zytokin-Netzwerks während der frühen Phase der Y. enterocolitica- Infektion. Hierzu wurden HeLa-Zell-Monolayer mit verschiedenen Y. enterocolitica- Stämmen infiziert und mittels Reverser Transkriptions (RT)-PCR zunächst wichtige Zytokine identifiziert. Die Kinetik der Zytokin-Produktion wurde durch semiquantitative RT-PCR analysiert sowie die intra- oder extrazelluläre Lokalisation der Zytokine mittels ELISA quantitativ erfasst. Die Stimulation von epithelialen Zellen mit rekombinanten humanen Zytokinen lieferte weitere Informationen über die Funktion der einzelnen Zytokine. Zum anderen wurden die Mechanismen der Wirt-Pathogen- Interaktion analysiert, die das Zytokin-Netzwerk während der initialen Phase der Y. enterocolitica-Infektion auslösen. Die Auswirkungen der Hemmung der bakteriellen Invasion (durch PI3-Kinase-Inhibitoren) sowie der bakteriellen Proteinsynthese (mittels Antibiotika) wurden untersucht. Durch die Infektion von Epithelzellen mit verschiedenen bakteriellen Mutantenstämmen gelang es, die Bedeutung des chromosomal kodierten Oberflächenproteins Yersinia Invasin zu charakterisieren. Folgende Ergebnisse wurden im Rahmen dieser Arbeit erzielt: 1. Y. enterocolitica pYV– induziert eine Stunde nach Infektion von HeLa-Zellen die de novo-Synthese von IL-8-, IL-1a-, MCP-1-, IL-1b-, GM-CSF- und TNF-a- mRNA. Y. enterocolitica pVY+ hemmt durch bestimmte Yersinia outer proteins die de novo-Synthese aller untersuchten Zytokine in HeLa-Zellen. 2. Die Zytokin-mRNA-Produktion in HeLa-Zellen nach Y. enterocolitica pYV–-Infektion erreicht nach 3 h ihr Maximum, um 5–6 h nach Infektion wieder auf Normalwerte abzufallen. IL-8 wird hierbei als Erstes und in den größten Mengen produziert. Diese pro-inflammatorische Zytokin-Antwort ist wahrscheinlich verantwortlich für den histopathologisch beobachteten massiven Einstrom von Immunzellen in infizierte Peyer’sche Plaques, was deren Zerstörung zur Folge hat. 3. Nur IL-8, MCP-1 und GM-CSF werden von HeLa-Zellen sekretiert, IL-1a und IL-1b verbleiben intrazellulär. IL-1a stimuliert bei HeLa-Zellen eine proinflammatorische Zytokin-Antwort, nicht jedoch IL-8, MCP-1 oder GM-CSF. Dies spricht für eine spezielle Rolle von IL-1: es könnte als ‚Verstärker-Zytokin’ dienen, das erst im späteren Verlauf der Infektion, nach Lyse der infizierten Zellen, freigesetzt wird und eine erneute Zytokin-Produktion verursacht. 4. Die Zytokin-Induktion nach Y. enterocolitica-Infektion von HeLa-Zellen ist wahrscheinlich nicht LPS-vermittelt. 5. Auch nach Hemmung der bakteriellen Invasion durch Wortmannin, einem PI3- Kinase-Inhibitor, beobachtet man die gleichen Zytokin-Antwort: schon die Adhäsion der Bakterien an die Wirtszelle genügt, um eine inflammatorische Zytokin- Reaktion auszulösen. 6. Wir zeigten, dass die Zytokin-Induktion durch die Bindung von Yersinia Invasin an b1-Integrine der Wirtszelle vermittelt wird: Eine Invasin-defiziente Y. enterocolitica- Mutante löst (ebenso wie ein nicht-invasiver E. coli-Stamm) keine Zytokin- Reaktion in HeLa-Zellen aus. Der Transfer des Invasin-Gens in E. coli hingegen vermittelt diesem die Fähigkeit, eine inflammatorische Zytokin-Antwort auszulösen. 7. Die Invasin-induzierte Zytokin-Antwort nach Y. enterocolitica pYV– ist unabhängig von bakterieller Proteinbiosynthese oder einem intakten Typ III-Sekretionssystem: auch Gentamicin- oder Hitze-getötete Yersinien induzieren eine inflammatorische Zytokin-Antwort wie metabolisch aktive Yersinien. Diese Ergebnisse verdeutlichen zum einen die wichtige Rolle von Epithelzellen bei der Generierung von Signalen zur Initiation der Abwehrreaktion des Immunsystems gegen Y. enterocolitica. Zum anderen wurde Yersinia Invasin als Pathogenitätsfaktor charakterisiert, der gezielt eine zelluläre Entzündungsreaktion der Darmmukosa auf eine Y. enterocolitica-Infektion initiiert.