Toilet Paper Attack!
Toilet Paper Attack!
You’re considered a beginner for the first 10 years of your yoga practice.
It’s a very humbling experience to say the least.
Yoga is about enjoying the gradual unfolding process and being aware of how each pose affects the relationship to your breathing. We tend to hold our breath when we are in a stressful situation. Letting go your tension and just maintaining the flow of breathing helps you get deeper into the pose and quiet your mind.
Everybody is different. There’s nothing “messed up” about your back just because it’s more rounded than others. It doesn’t matter that your heels can’t reach the ground when you’re in Downward Dog. I repeat, every-body is different and we are all on our own journey.
Your pose doesn’t have to look like the perfection in the drawings or books. Don’t worry about doing everything perfectly. There is no perfect pose. Alignment is important but yoga isn’t about reaching a perfect pose. Be gentle with yourself and don’t try to make your pose pretty.
How you treat yourself during your yoga session is how you treat yourself outside of it.
Related: How you do anything is how you do everything. Life is one big pose.
Strive to be more ambidextrous from the get-go. You’ll notice one side of your body is sometimes stronger or more flexible than the other. The side that is weaker is the one that needs more time and attention! Note: Practicing ambidexterity is key to making you a better athlete in any sport!
Related: Stand Evenly on Both Feet
Growth is infinite. No matter if it’s your tenth time doing downward-dog or your thousandth time, you will always discover something new about that stretch. In other words, you could get something out of each pose, no matter what level you are at. As you progress deeper into a pose, it transforms into a different stretch and this process is infinite.
Let go your head! When you’re in downward dog, or standing forward bend, simply nod or shake your head to let it fall! Shaking or nodding your head makes your neck immediately surrender to gravity.
When you’re in Warrior 1, if your left foot is in the front, your bum will tend to go out toward the left. Move it to the right, draw the inner thighs closer together and you’ll feel a new stretch (possibly the hip flexors). Conversely, if your right foot is the front one, move your butt to the left (toward the midline).
When you’re in Warrior 2, look over your fingers and SMILE! This makes any distressful pose become ridiculous.
Little earthquakes (tremors) are there to remind you that you are alive when you’re being pushed to the edge.
Be Here Now… On Vacation! You may have to do things later but when you’re doing your practice, don’t worry about it. Let your thoughts roll by as you just focus on your breath and stay in the present moment. Treat this hour or two in the studio as a vacation.
Yoga Straps are a godsend for beginners. Yoga belts/straps (pictured on the right) allow you to grasp limbs that you couldn’t normally reach and help you hold the pose longer. You get much deeper into a pose and stretch much more effectively with them. I recommend Yoga Accessories 8′ Cotton Straps because they’re long enough for nearly everyone!
Over the past year, I have been passively rating my music library on iTunes (or my iPhone) as I listen to them. I have finally rated my entire library and it feels good, really, really good.
Maybe you’re the type of guy who downloads a terabyte of music and brags about how much music you have. But what good is it if it’s mostly SHIT? Quality over quantity.
In iTunes, you have the option of rating something from 1 to 5 stars.
Here’s how I go about it:
1 star: I’m going to delete it. Why would I ever listen to something that I think is that shitty?
2 stars: Marked for deletion.
3 stars: Normally I would delete this (and I probably will), but the ONLY reason I’m keeping it is because it has sentimental value.
4 stars: It’s really, really good, but it’s not the BEST.
5 stars: The cream of the crop. The BEST of that genre. It’s TIMELESS. Meaning you could play this track 5, 10, 20 years from now and you couldn’t tell if it was made yesterday.
I looked at my brothers iTunes library one day and noticed it was full of either 5-star rated tracks or unrated tracks, with nothing in between. He told me he deletes music that he considers 4.9 out of 5 stars or lower.
I was astounded when he told me that and in disbelief immediately asked him, “You even delete something you think is 4 out of 5?!”
Armand replied with, “Yup. There is so much music out there that I have no reason to keep the songs that are not the absolute best.”
That made a lot of sense, but it was still a difficult thing to process and accept, let alone actually put into practice. I find it hard to get rid of 3-star rated songs, let alone 4, so that’s quite the standard Armand is holding onto. It makes sense though, especially for a DJ like himself. It’s definitely one of the assets that sets him apart in such an over-saturated field.
It took me over a year to actually rate my music and I find myself NEVER listening to the 3-star rated crap. If a 3-star rated song goes on, I don’t even let it play for more than 20 seconds before changing it. So I’m ready to delete them, despite their sentimental value. It took me months to realize this and I never would have been aware of this trend if I hadn’t rated my library so thoroughly. I just don’t know if I have the balls to delete the 4-star tracks. Not yet anyway.
Not sure? Well, start rating your songs and start that cleansing process!
Update: There’s a part 2 to this article, made exactly 3 months later. It involves a new development where I essentially want to rate some songs as 6-stars, haha.
I highly recommend you work the knots out of your muscles using a foam roller, especially if you’re an active individual. I had been bicycling for years and didn’t even realize the hundreds of knots that had accumulated in my quadriceps and calves until I tried this for the first time. Not to mention the amount of relief and release it created in the mid to upper back!
A muscle knot is technically known as a trigger point. It’s a small group of muscle fibers that have contracted locally in one spot amidst a much larger muscle bundle or muscle spindle. It usually occurs from chronically overusing a muscle.
What’s the problem with knots? Anytime there is any compression of a muscle, the blood vessels compress and that shuts the flow of blood (and oxygen). That’s why you can’t indefinitely keep lifting something up with your arm and eventually need to relax. Wherever there is a knot, the muscle fiber is chronically constricted, consuming energy and the lack of oxygenated blood flow causes waste products such as lactic acid to build up and the waste products cannot leave since the blood flow is decreased. This causes knots/trigger points to remain very tight and painful when massaged.
The problem with these knots is that stretching may not get rid of all these knots as effectively as we would like. Deep Tissue Massage works best but most people can’t afford a massage regularly! Luckily, there is a form of self-myofascial release that you could do yourself using a foam roller that is actually quite inexpensive and incredibly effective!
You see this foam roller on the right? This thing is absolutely ridiculous. It’s called the Trigger Point Grid Foam Roller and for $40-shipped, I got rid of all the knots on my entire upper back and legs. I feel so incredibly loose afterwards. It’s like giving yourself a massage every time. It’s painful at first, but the pain lessens with each subsequent session and the areas feel so much more flexible.
Note: When I first ran the foam roller along my back for the first time, it got rid of so many knots I didn’t even know existed. Being a regular cyclist for over five years now, the amount of knots I had built up in my quadriceps were innumerable and I had no idea.
I’ve tried this j/fit foam roller as it was only $20 instead of the $33 but it wasn’t very good, at all. I wouldn’t be impressed with foam rollers if this is what they were like. It barely works and it’s absolutely nothing like the trigger point brand.
I found this manual online that explains in detail how to perform Self Myofascial Release for every muscle and what tool to use. Most of them call for a foam roller but some of them can also be done with a lacrosse ball or a stick, which I will make videos for in the future as well.
Hope that helps!
People don’t seem to be aware of the importance of doing nothing but lying on their back on the floor to allow their back to relax. That’s right, the floor. Not the mattress. When you are on the mattress, you literally slouch just like when you are sitting on a chair or couch. Even on a new, firm mattress, your hips and shoulders sink in and your lower back collapses, causing your spine to go out of alignment.
You may think that lying on your back on the floor would be a terrible way to relax, because it contradicts all your ideas about relaxation, but when you feel that Earth supporting you underneath, only then will you truly be able to relax because none of your muscles are being used to support yourself.
When you lie on the floor, those muscles finally get to rest and relax at a proper length. Even when you lay down on a supposedly firm mattress, not every muscle relaxes like it does with the floor. In short, being supported by the Earth underneath you feels really, really good .
Mattress vs Floor
This is similar to how a very hard bicycle seat (such as one made only of leather and no padding) is better for you than a soft/gel one. The soft one will cause your soft tissues to bruise after 10 miles, while the hard one allows the support to remain solely on the pubic bones (seat bone) and not squash the soft tissues around it.
Note: When you are lying down on the floor, is your lower back in the air? What size animal can fit under there? The lower back has a natural inward curve, but fat or pregnant people have a curve that is too inward (lumbar hyperlordosis) and may be associated with pain in that area. If you keep relaxing on the ground like this, your curve will get more aligned than any mattress ever would.
While you’re down there, stretch yourself horizontally as much as you can. When you first get up in the morning, it feels good to get on your tippy-toes and reach for the sky. Try to do the same, but horizontally on the ground. Roll around if you have the room to.
While you’re down there, do the russian twist! Probably the nicest stretches ever. Here’s a video I made from a previous blog post on how to do it.
Once you are down there, why not also do some yoga?! Discover the joy of stretching. There’s a video you could download in that blog post that could get you started. Yoga is not about achieving the perfect pose but about the entire process itself.
Here’s another benefit of lying on your back… trees and clouds…
Near sunset time, I look at my shadow and pretend I’m riding a high wheel penny farthing.
Midnight Ridazz is holding a “Midnight Drag Race” on July 28, 2012.
The 2nd St. tunnel in downtown will be closed down to the public at night for this race. You know which tunnel this is if you’ve ever been in it. It’s really long and enchanting. It’s lined with white glossy tiles everywhere that makes it seem like you’re in one big light box. You could participate in this event for $10.
You’ll have a timer on you and if you are in the top 16 of the qualifying races, you will go head to head until you’re eliminated or you win. 1st and 2nd places get STUFF.
I believe this will be for single-speed bikes only (fixed or single speed), with Men and Women divisions. There may be a freak-bike section and unicycle section as well.
Should be a fun night. I want to try it!
Video of the last race of this nature from 2007: The Midnight Drag Race
Pharmacology refers to drug administration (including dosage) and distribution in the body (pharmacokinetics). The area under the curve includes T half-life, peak concentration, time to achieve peak, elimination and protein binding. It’s one of the most important aspects of drug study, including antibiotics.
Peak and Trough
Let’s look at the peak and trough of gentamycin, which is an aminoglycoside. If the concentration is too high, the peak could lead to ototoxicity and nephrotoxicity. So it’s essential you measure peak and trough. If the peaks are exceeded, their middle ear apparatus are destroyed so they can’t tell their position and they could have kidney failure.
The normal peak and trough are 10-12ug/ml and 1-2ug/ml, respectively. The blue line shows the appropriate administered dose while the black line shows one that is excessive.
The route of administration is determined by the site of infection, the level of antibiotic required at that site, and the patients status and the urgency of appropriate treatment.
For seriously ill patient with SIRS and a gram positive gram stain from the C&S, what route of antibiotic administration do you recommend?
IV because it’s the fastest possible.
Bioavailability affects the concentration of availability of the active drug in the systemic circulation because the drug must succumb to the gastrointestinal tract. It’s also influenced by solubility, which relates to the excipients (vehicle; tablets and capsules for oral, suppositories for rectal) in which the material is in. In regards to the question of generics, the FDA regulates the generics so they are the same as the proprietary versions (at least for those manufactured in the USA).
An example of bioavailability are the Fluoroquinolones (Ciprofloxacin, Levofloxacin and so forth). It’s recommended that you should avoid taking it 2 hours before a meal or 4 hours after a meal and also avoid antacids.
LOOK AT PAGE 493 FIGURE 21.3.
Drug distribution in body tissues should be considered in pharmacology/pharmacokinetics. IM/IV/Oral, it doesn’t matter, the drugs all get to the blood/systemic circulation. Even the nasal cavities are highly vascular and it has been shown (chinese showed this for centuries, long before jenner formulated it). Sometimes, you want the drug to be concentrated in the lungs sometimes, but with a pill taken by mouth, it has to cross into the blood stream. If it’s bound to protein, it can’t cross because the sheer size of it prohibits crossing. This is something the drug manufacturer has to document that protein binding is not significant or there is some mechanism where the drug can be freed by the protein.
If the drug binds to protein it will not cross into the tissue. (In other words, protein-bind = cannot cross)
Not protein bound (unbound drug) means it crosses by…
One of the quintessential antifungals: Amphotericin B, used widely for systemic fungal infections, is extremely toxic. And why would that be an issue? Both fungi and your cells are eukaryotic. In the business this is known as amphoterrible. Some patients rather die than take it because if they do take it they get this metallic taste in their mouth, persistent ear ringing, nausea, upset GI and vomiting.
Part of the toxicity can be overcome and reduced by targeting delivery. Amphotericin B is now encapsulated in liposomes (now known by the market name: ambisome). A liposome is a fat globule (lip=lipid=fat), and inside of it is amphotericin B. It will dissolve in the lipid membrane due to the similar structure and that will ensure that the delivery to the tissues is much more facile rather than circulating ad libitum (freely) throughout the body. Amphotericin B is now marketed as Ambisome because it’s in this lipid vesicle.
Reference Page 494: Read “Drug Distribution” section to get a fuller idea.
Ciprofloxacin has an extended preparation of cipro. There are several coatings so there’s an extended release of the drug (by dissolving the layers slowly), that allows a different dosing regimen.
Spectrum of activity
Antibiotic: Only refers to drugs that are effective against bacteria.
Antimicrobial: Includes antiparasitic, antifungal, antiviral. An antiviral drug is commonly referred to as an antibiotic but it’s not an antibiotic.
The range refers to the number and variety of organisms that can be covered. When we talk about any antimicrobial agent, we talk about whether it’s a broad spectrum (covers a wide range of organisms) or narrow spectrum (covers a narrow range of organisms; generally one type of bacteria).
Turn to page 495, figure 21.5: YOU MUST KNOW THIS CHART. Know which antibiotic is used against what type of bacteria
Pencillin: When asked for a narrow spectrum antibiotic on the test, DO NOT say penicillin, as it can be used against outside of its spectrum of gram positive activity, even though the table in the book says it’s a narrow spectrum. Ampicillin is a variation of penicillin. Up to 15-20 years ago, penicillin was the treatment of choice for N. gonorrhoea and it’s not anymore due to resistance.
Isoniazid/Ethambutol: Narrow spectrum, effective against mycobacteria.
Polymyxin B: Narrow spectrum: effective against gram negative bacteria.
What is the significance of using broad versus narrow?
1. Broad spectrum gives greater perturbations to normal flora so it leads to secondary infections (pseudomembranous colitis; antibiotic associated colitis).
2. The possibility of resistance will be increased with broad spectrum because it’s used against a wider variety of organisms. In other words, the chances of resistance developing are more likely with the broad spectrum antibiotic because it covers such a wide range of organisms so there’s a greater potential for resistance.
Some antibiotics are classically associated with this: Clindomycin, for example, in the early days had an unsavory reputation for an increased incidence for pseudomembranous colitis and it was particularly useful against anaerobic bacteria. The broader the spectrum, the more likely it is to perturb normal flora.
You will be asked a question on fecal transplant (aka fecal bacteriotherapy):
Resistance to Antibiotics/Antimicrobial agents
Factors influencing resistance:
Bacteria can adapt so quickly to changes, it surpasses anything we are capable of. Every single antibiotic discovered to date has been shown to be associated with resistance in target organisms, even in circumstances where there is no evidence of prior exposure.
Since bacteria have such a wonderful adaptive capability and can multiply so rapidly, that one in a million or billion chance creates naturally occurring resistant organisms. You start off with a mixed population of resistant and susceptible organisms. You treat with antibiotics and the susceptible ones will be eliminated and you’re left with a resistant population which will multiply like crazy and that drug no longer become effective.
For this reason, the CDC launched an antibiotic tracking system for hospitals. Antibiotic use can lead to antibiotic resistance which can increase the risk of hospitalization or lead to treatment failure in sick patients, according to the CDC.
Antibiotic-resistant infections are likely to require longer and more costly hospital stays and have higher mortality rates. If first-line drugs don’t clear up the infection, second or third-line drugs may be even less effective, more toxic, and more expensive.
Real threat of returning to a pre-antibiotic era: Drugs no longer useful because organisms are resistant to everything we have come up with.
With every single antibiotic noted to date, within 6 months of use, antibiotic resistance has been documented. So there’s no antibiotic which bacteria have not developed resistance. It’s microbial survival of the fittest.
*T/F Question! – Emerging resistance to N. Gonnorhea is developing. (true)
Basic mechanisms of resistance
One single organism may have several different mechanisms to several drugs. The bacteria can either destroy the drug or alter the drug or inhibit the drug or do all of them.
Reference: pg. 496 Table 21.2
This isn’t an exhaustive list, there’s many variations of each theme. Know the 3 primary mechanisms and one antibiotic associated with each one. These are all ways that bacteria can destroy/alter/inhibit the drug (antibiotic).
Increasing the number of different mechanisms of resistance increases the likelihood of resistance.
T/F Question – Bacteria are conscious or sentient entities. (true)
What evidence is there that bacteria are conscious or sentient entities?
Capsule, spore , nutrition, temperature, adaptive, listeria cold enrichment.
Evaluation of Efficacy
How do you know if antibiotics are going to work? It’s the S in C&S (Sensitivity).
Susceptibility testing (for lab practicum).
Question on exam You have a plate with antibiotics, and you look for the zone of inhibition. This zone is arbitrary and has no significance until you refer to the NCLS Chart. If the chart says that 12mm or more is equivalent to susceptibility, whereas 10 or less is resistant, and you have 12 or more, it means it’s susceptible and so forth
If control zones are not within acceptable limits or if the identity of the organism is unknown, the data from the test is invalid and must be discarded necessitating that the test be repeated.
A high M.I.C. (minimum inhibition concentration) typically indicates resistance. (on the KB chart) I’ll give you zone sizes, the results of the test and ask you whether it’s R or S or I
Now turn to pg. 500 – dilution of antibiotics.
You have different graded concentrations, all tubes inoculated with the same organism. The tubes with no antibiotics are control. If the control tubes have no growth, they are dead. (HE WILL ASK THIS). 2 mg/mL has no growth, so the MIC is the lowest concentration that inhibits the growth of the bacteria. I could give you the results like this or a chart and ask you where the MIC is.
To determine the bactericidal concentration, take all the negative tubes and put them on plates. If they grow, they are not totally inhibited. The MBC in this case is 8 mg/ml. The MBC is the minimum bactericidal concentration: the lowest concentration that KILLS the organism, established by taking cultures with no obvious growth, to antibiotic-free media and looking for growth. If the subculture in the antibiotic-free media grows, the bacteria were inhibited but not killed; The MBC is equated by those negative cultures that do not grow on the antibiotic-free media, documenting that the bacteria were killed.
Uses/Applications of MIC/MBC Data: This is a guide to the choice of therapy.
1. If the MBC 64x times greater than the MIC, that indicates TOLERANCE which means the antibiotic is not likely to be effective for treatment. You have to use so much of the antibiotic to kill the organism that you exceed the therapeutic ratio or range and you can harm the patient.
2. Efficacy is mandatory data for FDA approval and essential documentation.
3. Comparative efficacy. In other words, the FDA is not necessarily concerned with proving just another drug without a significant advantage, unless it’s a generic, which the data would have been established by the proprietary brand name. So this is one of the major planks in the approval process so they have to demonstrate that the drug actually works.
4. Even more importantly, it monitors the development of resistance, or changes in susceptibility patterns/response.
You’ll typically see:
MIC50 means ½ of the isolates tested are inhibited (which means they are susceptible).
MIC90 means 90% (9/10) are inhibited.
MBC50 means ½ of the isolates are killed by the concentration.
MBC90 means 90% of the isolates are killed by the concentration.
YOU’LL NEVER SEE MBC 100. There’s always going to be an organism that is going to be resistant, given the fact that antibiotic resistant can be documented without prior exposure and within 6 months of introduction of any antibiotic.
If you require an increase of concentration, it’s indicative of an increase in resistance, you need a greater concentration of antibiotics.
↑ [C] = ↑[R] (C=concentration, R=resistance)
In the year 2000, MIC50 = 1ug/ml
In the year 2010, MIC50 = 5ug/ml
Let’s look at ciprofloxacin… If an effective dose is achieved at 5ug/ml, and you have MIC50 but years down the line 50% of your isolates may require 10ug/ml. If you have an organism that requires TWICE the concentration to be inhibited, it means 5ug/ml is not going to be effective anymore. You can’t just double the dose cause then you have toxicity.
Be familiar with why an organism showing tolerance is not effective to that treatment.
Agar dilution: Rather than having a bunch of tubes for the MIC/MBC, the tubes are replaced by agar, with varying concentrations of antibiotic or antimicrobial agent.
Neutropenics. The big problem is neutropenics are treated with antifungal treatments like Nystatin Px but a lot of those patients end up with fatal fungal infections. So the question is… are the deaths due to antifungal failure? In other words, were the organisms resistant to nystatin? The failure of treatment was not due to the resistance of the organisms.. none of the fungi were resistance. The failure was due to the neutrophil count not being increased.
Fungi are not tested routinely for susceptibilities, although several experts are recommending that this be done. For the most part, the responses are predictable. What is done instead is the tests are done in pools of isolates and they are periodically tested with the agar dilution or now they have modifications with respect to instrumentations that allow you to detect growth dependent on the concentrations
The E test is not as widely accepted in America because here’s a bit of jingoism since it wasn’t developed in the USA. It’s slowly gaining acceptance and becoming more routine now.
The E test is useful because you have a lawn of bacteria and you could put several different antibiotic strips that could be vancomycin, penicillin, gentamycin, tobramycin. Whoever came up with this is certifiably genius.
The concentrations of the antibiotics are layered sequentially and sold commercially. You put this strip on the lawn and you end with growth or no growth or a zone of inhibition.
The point of intersection where the point of inhibition coincides with the level marked on the strip is the MIC. The beauty of this is you could test 4-5 different antibiotics separately and you could get break-point MICs. You will indubitably get questions on the exams with this.
The E test, a gradient diffusion method that determines antibiotic sensitivity and estimates minimal inhibitory concentration. The plastic strip, which is placed on an agar surface inoculated with test bacteria, contains an increasing gradient of the antibiotic. The MIC in ug/ml is clearly shown.
Reference page 501, figure 21.10
You see prokaryotes and eukaryotes. There’s a clinically significant difference between the two. This is a prime example. Not only do these differences reflect specificity of action but explain the toxicity associated with antimicrobial agents.
How is toxicity of antibiotics and adverse drug reactions related to the differences of eukaryotes and prokaryotes?
The specificity of microbial action is related to the structural, physiological and metabolic differences that differentiate microbes from the human body.
You must be familiar with ALL of these sites and the relevant antibiotics that target those specific sites. Any part of the bacteria is fair-game.
What antibiotics inhibit the bacterial cell wall?
Read the “Cell Wall” paragraph. You only find peptidoglycan in bacteria. These agents have no effect on eukaryotic cells because all eukaryotic cells lack peptidoglycan.
Question on test: What is the treatment of choice for L forms and why? An agent that inhibits protein synthesis (gentamycin) and penicillin that inhibits the reformation of the cell wall. Some L forms can reform the wall, so if they reform the wall, you use penicillin to inhibit the cell wall and the gentamycin to inhibit protein synthesis, so that’s a synergistic example of antibiotics. (Synergy = 1+1=11).
Beta-lactam ring -> Penicillinase (beta-lactamase) -> Produces penicilloic acid, which inactivates the penicillin. The penicilloic acid is also a product that can trigger allergic/hypersensitive reactions.
What antibiotics inhibit the bacterial cell membrane?
What antibiotics inhibit the Nucleic Acid synthesis?
The product monograph is a quasilegal guideline document. As a patient you might get a package insert that gives you the adverse side effects and how you should take the dose and whatever else. First thing is shows is the warning. FQ’s are associated with an increased risk of tendinitis and tendon rupture (Is your ACL a tendon or ligament? It’s a ligament. Tendons are muscle to bone. What are ligaments? Bone to bone connective tissue. What’s the similarity? They’re both dense connective tissue).
What antibiotics inhibit Protein synthesis?
These antibiotics require monitoring. The therapeutic acceptable peak levels of these are 10-12ug/ml and the trough is 1-2ug/ml. The peak is usually 2 hours and the trough is 4 hours after administration. Peak and trough levels are a guide to the effective levels which are not to be exceeded to avoid toxicity. This is particularly important in patients with deficient kidney function. What would you do if levels exceeded peak and trough? You could lengthen the dosage frequency or lower the dose but you can’t arbitrarily do that because you have to consider the concentration achieved at the site of infection. If you need 5ug/ml in the CSF and you’re only getting 2ug/ml, is it going to be effective? NO. So you need to consider MIC, MBC and the concentration achieved at the site of infection.
Side effects: Ototoxicity and nephrotoxicity (middle ear damage and kidney damage) are the two primary consequences of aminoglycoside if peak and trough levels are exceeded, especially in elderly.
What antibiotics inhibit Folic Acid Synthesis? (page 502)
In this case we are looking at metabolism. FA is a precursor to the biosynthesis of nucleic acids. Trimethoprim blocks the pathway in which folic acid is converted into nucleic acids in bacteria but not in humans because humans use a different pathway to utilize that folic acid.
UTI: One of the most widely used antibiotics for treatment of UTI. Where do the bacteria primarily come from that cause UTI? The area between the genitalia and the rectum. Also, honeymoon cystitis is excessive sexual intercourse which predisposes to UTI.
Cranberry juice does not treat UTI’s, it reduces the incidence rate.
Pneumocystosis / Pneumocystic pneumonia is a form of pneumonia caused by a yeast-like fungus.
Folic acid synthesis
Nucleic acid synthesis
In Table 21.5: Remember Malarone for Malaria:
Malarone is the synergistic combination of 2 drugs: atovaquone and proguanil (he will probably ask this!)
Know how Acyclovir works!
Acyclovir is structurally similar to the nucleotide guanosine. An enzyme, found only in virus-infected cells converts acyclovir to acyclovir triphosphate, the actual antiviral drug. This false nucleotide competes with GTP to incorporate into DNA, leading to chain termination and stops DNA replication.
What is the major contraindication associated with antibiotic use? An indication is a circumstance of an infectious disease with characteristic etiology that warrants use of an antibiotic. Contraindications preclude to negate indications.
1. A history of allergic response or hypersensitivity is a contraindication, including anaphylactic shock which can be fatal.
2. Synergy: an amplified effect beyond an additive. The sum of the parts are more effective than their individual selves (1 plus 1 = 11). (malarone = atovaquone and proguanil synergistic combination)
Toxic effects of fluoroquinolones?
Arthrotopy, rupture of the ACL, tendinitis, bursitis, photosensitivity, photo-mutagenicity. The major problem is arthrotopy in every age group but particularly children. While you’re on fluoroquinolones, you have to avoid direct light.
ESBL = Extended spectrum beta-lactamase bacteria (beta lactamase 2.0)
With ESBL’s, if the organism is resistant to penicillin then it’s going to be resistance to beta lactam antibiotics because it means it has beta lactamase.
“The devilishly clever bacteria met our challenge by creating beta lactamase, an enzyme that grants many bacteria immunity to penicillin-type antibiotics. In turn, we upped the ante by developing new kinds of antibiotics that trounced these beta lactamase-producing pathogens.
But the bacteria weren’t done yet. Some tricky little bugs had a trick up their metaphorical sleeves: Beta Lactamase model 2.0, known to us as extended-spectrum beta lactamase, or ESBL. This enzyme not only chops apart penicillins, but cephalosporin antibiotics, too (all of the antibiotics whose generic names begin with “Cef-”).”
Page 278… Table 1.4, Know the problems associated with atypical bacteria.
The part about chlamydia.. they are atypical because they don’t have a cell wall … you can’t grow chlamydia on blood agar, it is an obligate intracellular pathogen so it must grow on tissue culture.
What are the 3 species of chlamydia that infect humans? Chlamydia pneumoniae, trachomatis (blindness, STD), and psittaci (causes ornithosis or psittacosis; parrot fever)
Chlamydia pneumonia. What is the primary significance? It causes pneumonia! Secondary significance: Coronary artery disease; myocardial infarction due to high antibody levels. People who have had heart attacks have high levels of antibodies which means they have been exposed to the bacteria.
Rickettsia: What is the only rickettsia that is able to survive outside the living host? Coxiella burnetii is the only rickettsia that could survive outside of the living host. It forms a spore like entity which isn’t equal to the bacterial endospore but can survive in soil, feces, etc for an extended period of time. It’s the only rickettsia that can do that and the etiology of Q fever.
Microscopy: Know the limits of resolution, the various types of microscopes (brightfield is the most common, electron microscopy is used for viruses, fluorescent is used for identifying antigens/antibodies and you don’t need isolation in pure culture to do fluorescent marking).
You will be asked something like: How many times smaller of an object can be seen with a scanning electron microscope than the naked eye? Convert everything to nanometers to find out.
Review previous tests. Review those god damned presentation sheets. Review fucking everything. Good luck.
When I was a teenager and looking for some new music, I discovered this romantic song called “Al di là” being sung by Emilio Pericoli. I liked it immediately. Turns out it’s a very popular Italian song. Maybe you’ll like it too.
Below,on the left, you could follow the lyrics and pretend you know Italian.
On the right, you could see what those lyrics mean, so you’re not pretending anymore.
|Italian lyrics: Non credevo possibile, se potessero dire queste parole:Al di là del bene più prezioso, ci sei tu.Al di là del sogno più ambizioso, ci sei tu.Al di là delle cose più belle.Al di là delle stelle, ci sei tu.
Al di là, ci sei tu per me, per me, soltanto per me.
Al di là del mare più profondo, ci sei tu.
Al di là dei limiti del mondo, ci sei tu.
Al di là della volta infinita, al di là della vita.
Ci sei tu, al di la, ci sei tu per me.
|English Translation: I did not believe I could ever say these words:Beyond the most precious, that’s where you are.Beyond the most ambitious, that’s where you are.Beyond the most beautiful,Beyond the stars, that’s where you are.
Beyond everything, that’s where you are for me, for me, just for me.
Beyond the deepest sea, that’s where you are.
Beyond the limits of the world, that’s where you are.
Beyond infinite time, beyond life.
That’s where you are, beyond everything, that’s where you are for me.