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https://graduate.uofk.edu/user/diploma.php?sep=best-custom-essay-service-reviews best custom essay service reviews Aggressive antibiotic therapy (including high-dose iv antibiotic therapy plus intraventricular vancomycin and/or tobramycin) may be effective for patients in whom hardware removal is not possible. 34 if methicillin-resistant s. Aureus is identified as the causative organism, daptomycin may be considered an alternative therapy. 35 the use of prophylactic antibiotics against meningitis postcraniotomy remains controversial. 36,37 one meta-analysis suggests that prophylaxis reduces rates of postoperative meningitis by nearly one-half. 36 breakthrough meningitis that does occur may be a result of drug-resistant pathogens. 37 brain abscesses are localized collections of pus within the cranium. These infections are difficult to treat due to the presence of walled-off infections in the brain tissue reducing antibiotic penetration. In addition to appropriate antimicrobial therapy (a discussion of which is beyond the scope of this chapter), surgical debridement is often required as an adjunctive measure. Surgical debridement may also be required in the management of neurosurgical postoperative infections. »» viral encephalitis and meningitis viral encephalitis and meningitis may mimic bacterial meningitis on clinical presentation but often can be differentiated by csf findings (see table 70–2). The most common viral pathogens are enteroviruses, which cause approximately 85% of cases of viral cns infections. 7 other viruses that may cause cns infections include arboviruses, hsv, cytomegalovirus, varicella-zoster virus, rotavirus, coronavirus, influenza viruses a and b, west nile virus, and epstein-barr virus. Viral cns infections are acquired through hematogenous or neuronal spread. 7 most cases of enteroviral meningitis or encephalitis are self-limiting with supportive treatment. 38 however, arbovirus, west nile virus, and eastern equine virus infections are associated with a less favorable prognosis. In contrast to other viral encephalitides, hsv type 1 and 2 encephalitis are treatable. Although rare (one case per 250,000 population per year in the united states), hsv encephalitis is a serious, life-threatening infection. 39 more than 90% of hsv encephalitis in adults is due to hsv type 1, whereas hsv type 2 predominates in neonatal hsv encephalitis (greater than 70%). 40 hsv encephalitis is the result of reactivation of a latent infection (two-thirds of cases) or a severe case of primary infection (one-third).

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bad of smoking essay Plex, which removes immunoglobulins and antibodies rom the serum, is a well-established treatment or patients with severe exacerbations. Plexs are usually done 3 times per week up to 5–6 exchanges. Patients may respond rapidly as early as 2–3 days but this may be delayed or about 2 weeks. Plex is the treatment o choice or patients with myasthenic crisis, since its action is usually more rapid than ivig. Plex is rarely used as maintenance therapy via peripheral veins, but using large-bore intravenous catheters may trigger serious in ections. Ivig, which probably binds and neutralizes antiidiotypic antibodies, is also e ective and is an alternative therapy to plasma exchange. T e usual total dose is 2 g/kg divided over 2–5 days. T e therapeutic benef t is typically 3 weeks a er in usion. Maintenance therapy is probably e ective, but this therapy has not been studied vigorously. Key points t e diagnosis o myopathy, channelopathy, or nmj disorder cannot be adequately assessed without considering a di erential diagnosis or the weakness ( able 42-1). Physical examination f ndings suggesting an alternative source o symptoms in the central nervous system should be sought. Nerve conduction studies and needle emg are crucial tools. T e most common causes o weakness in the critically ill patient are cim and cip. Myopathy is unlikely to be the cause o vague complaints o weakness i muscle strength examination and laboratory testing are normal. Muscle biopsy is required i a patient with suspected statin-associated myopathy ails to improve a er statins are discontinued. T e patient may have a progressive, autoimmune necrotizing myopathy that requires immunotherapy. Muscle biopsy is required or the diagnosis o in ammatory myopathy.

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helping the disabled essay 1 when these requirements cannot be achieved by diet alone, appropriate calcium supplementation is recommended. Intakes over 1200 to 1500 mg/day may increase the risk of developing kidney stones,1 and supplementation greater than 2500 mg/day may lead to hypercalciuria and hypercalcemia. Additionally, excessive calcium supplementation may be associated with an increased risk of cardiovascular events. 7,8 calcium supplements are available in a variety of calcium salts and dosage forms. Daily calcium requirements are reported as elemental calcium. However, many product labels list calcium content in the salt form, so the percentage of elemental calcium must be known to calculate the elemental calcium content per tablet. A number of factors, including a single large intake of calcium, can limit calcium absorption, and special consideration must be given to calcium dosing to maximize absorption. Supplement doses should be limited to 500 to 600 mg of elemental calcium per dose, and absorption parameters, elemental calcium content, and adherence should be considered when choosing an appropriate supplement (table 56–5). Calcium carbonate should be taken with food to maximize absorption. Elderly patients or patients receiving proton pump inhibitors or h2-receptor antagonists may have difficulty absorbing calcium supplements due to reduced stomach acidity.

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