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Spread to adjacent pelvic organs Spread to distant organs Adapted from FIGO staging for carcinoma of the vulva, cervix, and corpus uteri. Int J Gynaecol Obstet ; 2:

301 mcq of sm

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Figure 1 Algorithm for giving pneumococcal vaccine. Mechanical interventions include tooth brushing and rinsing of the oral cavity to remove dental plaque; pharmacological interventions involve the use of antimicrobial agents.

Both of these interventions decrease the likelihood of colonization of the oropharynx. Pharmacological interventions include twice-a-day use of chlorhexidine oral rinse.

In a study 24 of patients undergoing cardiac surgery, use of chlorhexidine decreased the incidence of VAP by decreasing colonization. Unfortunately, except for patients undergoing cardiac surgery, no evidence-based protocols for oral care have been tested and confirmed to decrease the incidence of VAP in patients receiving mechanical ventilation.

Bacterial colonization of the stomach can lead to aspiration and colonization of the respiratory tract. Most patients receiving mechanical ventilation are given stress ulcer prophylaxis, often with medications that increase the gastric pH. A study 25 in the s indicated that pathogens multiply in an alkaline gastric environment.

In the largest study 26 on the risk for VAP with stress ulcer prophylaxis, ranitidine, an H2-receptor blocker, significantly reduced the risk of clinically important bleeding without increasing the risk of VAP or mortality. In another large study, 27 mechanical ventilation for greater than 48 hours was associated with a fold increase in the risk for gastrointestinal bleeding.

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In research 28 conducted in a pediatric intensive care unit, VAP rates did not differ between patients receiving ranitidine, omeprazole, or sucralfate for stress ulcer prophylaxis. Unfortunately, as the use of proton pump inhibitors for stress ulcer prophylaxis has increased, few studies have been conducted in adults to address whether the incidence of VAP is affected by the use of these inhibitors.

In summary, according to the studies done so far, stress ulcer prophylaxis does not play a significant role in the development of VAP but may prevent the serious complication of gastrointestinal bleeding.

Mucus in the airways can become stagnant and serve as a medium for bacterial growth. Maintenance of aseptic technique when performing endotracheal suctioning is essential to prevent contamination of the airways. No difference has been found in the incidence of VAP with open versus closed suction systems.

Furthermore, saline lavage of endotracheal tubes before suctioning dislodges bacteria from the endotracheal tube into the lower airways, increasing the risk for VAP.

Ventilator-Associated Pneumonia

However, in one study, 31 saline instillation did not thin secretions; rather it reduced the amount of oxygen that reached the lungs and increased blood pressure, heart rate, intracranial pressure, and the risk for VAP.

Maintaining adequate hydration, ensuring proper humidification of the ventilatory circuit, and using nebulizer or mucolytic agents can help decrease the viscosity of secretions and eliminate the need for saline lavage.

Use of beds capable of continuous lateral rotation can decrease the incidence of pneumonia but do not decrease mortality or duration of mechanical ventilation.

Colonization of the ventilator circuit can also play a role in the development of VAP. Daily changes of the ventilator circuit do not seem to decrease the incidence of VAP. It is recommended that the ventilator circuit be changed when visibly soiled. The results were inconclusive as to which form of humidity is associated with a higher incidence of VAP.

In addition to strategies to prevent colonization, strategies to prevent aspiration can also be used to decrease the risk for VAP. Because the presence of an endotracheal tube predisposes patients to VAP, patients should be assessed on a daily basis for potential weaning and extubation from mechanical ventilation.

Several methods of assessing readiness for extubation exist. These include T-piece trials, weaning intermittent mandatory ventilation, and pressure-support ventilation.Encephalitis is a severe inflammatory disorder of the brain with many possible causes and a complex differential diagnosis.

Advances in autoimmune encephalitis research in the past 10 years have led to the identification of new syndromes and biomarkers that have transformed the .

Output: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 Hammer SM, Squires KE, Hughes MD, Grimes JM, Demeter LM, Currier JS, Eron JJ, Jr., Feinberg JE, Balfour HH, Jr., Deyton LR, Chodakewitz JA, Fischl MA.

A controlled trial of two nucleoside analogues plus indinavir in persons with human immunodeficiency virus infection and CD4 cell counts of per cubic millimeter or less.

301 mcq of sm

Shop , Cityplaza, 18 Taikoo Shing Road, Taikoo Shing, Island East, H.K Typical sites of polymicrobial infections involving Bacteroides include the abdomen and pelvis, perirectal, skin and soft tissue, and solid organs. Although isolation of Bacteroides spp as the sole pathogen can occur, it is unusual.

Mar 12,  · Pretorius MA, Madhi SM, Cohen C, Naidoo D, Groome M, After reading the article, you should be able to answer the following, related, multiple-choice questions.

To complete the questions (with a minimum 75% passing score) and earn continuing medical education (CME).

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