ICH 2010年 guidelines

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https://docs.google.com/fileview?id=0B278nGJMQBk7Zjc4YzA2OTAtMzNkYi00NzBjLTllMjctMDE0ZDE2MTgzMTU2&hl=zh_TW

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即便是用IGRA, 有時也要等大於三個月才能決定TB contact

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接觸TB後，TST大抵上2-12週轉陽，IGRA大抵上6-10週，但IGRA可以長到3個月以上 TB Tests Can Have a Lengthy Window Period Two studies suggest that interferon- release assay conversion sometimes occurs more than 3 months after exposure to active tuberculosis. Increasingly, interferon- release assays (IGRAs) are being used for diagnosing latent tuberculosis (TB). Although the tuberculin skin test (TST) traditionally used for this purpose converts to positive within 2 to 12 weeks after an individual is exposed to someone with active TB, the interval for IGRA conversion has remained unclear. Current guidelines recommend repeating an initially negative IGRA after 6 to 10 weeks, but this recommendation is not based on controlled studies. Two recent investigations address this issue. Anibarro and colleagues conducted a longitudinal prospective analysis among contacts of TB patients in Spain. The 152 contacts received a TST and an IGRA at first visit; for individuals with negative or conflicting results, t...
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medscape 討論NDM-1

http://www.medscape.com/viewarticle/728118_3 carbapenem resistant enterobacteriae 已經在美國很多了，要通報 但是NDM-1之所以引人注意是因為他和之前的carbapenemase不同來源 而且他可以在許多種plasmids上傳來傳去，傳得快 預計會造成Healthcare associated infection, 也可以造成community infection From Medscape Internal Medicine NDM-1 -- Making Resistant Bugs in New Ways Carol Peckham Posted: 09/13/2010 Introduction A report in Lancet Infectious Disease has described the New Delhi metallo-beta-lactamase 1 (NDM-1), a unique genetic mechanism identified in India, Pakistan, and the United Kingdom that has produced antibiotic-resistant gram-negative Enterobacteriaceae. [1] The strain was identified by the Centers for Disease Control and Prevention (CDC) in 3 isolates in the United States. To determine what threat this might pose, Medscape interviewed Alex Kallen, MD, and Brandi M. Limbago, PhD, both in the Division of Healthcare Quality Promotion, who provided perspective from Centers for Disease Control and Prevention (CDC). Alex Kallen, MD, is a Medical Office...
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