Chapter 992: Millions for treatment costs! A miracle that cannot be replicated!
Azithromycin is indeed metabolized by the liver, so it places high demands on the patient's liver function.
But the patient recovered well after the liver transplant, so he was not unable to use azithromycin.
Secondly, changing the dosage of immunosuppressants again at the risk of taking risks, although it is not as exaggerated as stopping the use of the whole line, but just adjusting the dosage of cyclosporine and controlling the number of CD4+ T cells... What is the use of restoring such a little immune function?
This is no different from pouring a bucket of water into a raging fire.
In other words, whether to use azithromycin involves two issues.
One is the cost, and the other is the benefit.
As long as the latter can exceed the former, there is no reason to judge azithromycin wrong.
…
Liu Si and others frowned, looking at the main judge, waiting for the answer.
The latter seemed to see the doubts of most people.
He couldn't help but look in the direction of the clinical doctor... To be honest, they didn't expect that someone could really give this answer.
Even if there is, it should be a doctor from Union Hospital or West China.
No one expected that this year's competition would have a dark horse, a clinical doctor, and a close connection with Xu Qiu.
Shi Lian, Jiang Mai, Yang Yuen... all of these contestants are doctors who studied under Xu Qiu.
In other words, this is a team trained by Xu Qiu.
And this team really beats top hospitals such as Union Hospital!
The chief judge had a complicated look in his eyes. He retracted his gaze, suppressed his surprise and said:
"Let's talk about why azithromycin is not used first...
In fact, after the expert consultation and discussion of the patient's diagnosis hospital, the treatment plan based on azithromycin was obtained, that is, azithromycin combined with allicin!
This treatment lasted for a week, and the patient's diarrhea did improve..."
Hearing this, Liu Si and others nodded slowly.
The chief judge continued: "However, the patient's liver and kidney function deteriorated again, and the hospital had to re-enable CRRT treatment.
On the tenth day, the patient's glutamyl transpeptidase and alkaline phosphatase rose to an unimaginable high value... The patient had a retrograde biliary infection of Cryptosporidium!"
After saying this, Liu Si and others suddenly raised their heads, with a solemn look and a hint of fear.
The patient's liver function has almost recovered, but he still can't tolerate azithromycin? !
Moreover, the subsequent increase in glutamyl transpeptidase and alkaline phosphatase directly means that the anti-Cryptosporidium treatment plan has completely failed... What's the problem!
The chief judge did not give a direct answer, but said: "Why can't azithromycin be used? Let's put it aside for now. The hospital changed the medication plan later... because the patient's family bought nitazoxanide from overseas.
Let's talk about the medication guide of nitazoxanide first.
Although the drug is not recommended for people with immune deficiency, this rule is based on the fact that the patient does not have normal immune function.
But the patient is very special. He has artificially intervened immune deficiency, and the immune function is reversible!
And the reason why nitazoxanide needs to be used in people with immune function is that the drug needs to rely on the amplification effect of immune cells themselves to fight Cryptosporidium...
To put it bluntly, immune function is a magnifying glass for the efficacy of nitazoxanide!"
Magnifying glass...
As soon as these words came out, Liu Si and others finally showed a look of surprise on their faces.
Their previous thinking was that immune function directly fights Cryptosporidium infection.
Therefore, it is believed that changing immunosuppressants and slightly adjusting the number of immune cells is of little use.
But what if immune cells act as a magnifying glass?
Nitazoxanide is a specific drug for Cryptosporidium infection, and its therapeutic effect is quite significant. If quantified by numbers, it is about 10,000.
Previously, Liu Si and others believed that it was a direct confrontation of immune cells, and the therapeutic effect of the program was naturally addition. Ten thousand plus one is only one thousand and one.
But if it is the effect of a magnifying glass, then multiplication should be used.
Even if it can only increase by 0.1, for the already huge base number, the improvement in effect is quite amazing... The insecticidal effect of nitazoxanide will exceed imagination under the magnification!
After the chief judge finished speaking, he changed his tone and said, "Back to the original question, why can't azithromycin be used...
Because for this patient, in addition to controlling the infection, it is also necessary to curb the reproduction of Cryptosporidium.
Azithromycin can do the former, so the symptoms can be relieved.
But it further increases the burden on the liver and kidneys, making the patient's already fragile immune system even more unbearable. Cryptosporidium has obtained an excellent growth and reproduction environment, and it has become more rampant.
And allicin cannot suppress the almost crazy Cryptosporidium infection.
The only thing that can simultaneously complete anti-infection and destroy the growth environment of Cryptosporidium is nitazoxanide."
After speaking, the chief judge glanced at the whole audience. Liu Si, Shi Feng and others were already stunned in place, seemingly unable to accept this fact.
In fact, their diagnostic thinking is already very mature, and even the answers obtained by the hospital expert group after multiple consultations are exactly the same.
This is enough to show their talent.
However, top doctors are not only meticulous diagnostic logic, not only the application of drugs in accordance with the rules, but also need spirituality and fine-tuning of individualized treatment for patients!
Currently, only the Linyi team has achieved this.
"By the way."
Taking advantage of the silence in the conference hall, the chief judge added: "After switching to nitazoxanide, the patient's condition improved rapidly. Two days later, liver and kidney functions began to recover. Nine days later, CRRT was discontinued, and the patient was taken off the ventilator on the thirteenth day.
It took only two weeks, and Cryptosporidium could no longer be found in the patient's fecal acid-fast staining."
This case is already a miracle in the field of clinical medicine.
And it is almost impossible to replicate it.
First, it is difficult to encounter patients infected with Cryptosporidium, let alone such a serious case.
Second, this patient stayed in the ICU for nearly a month, and the total cost has reached the million level. The final special medicine Nitazoxanide was purchased overseas.
This economic condition alone is beyond the reach of most people.
Many experts almost made mistakes. If they were transferred to other hospitals, the patient would basically have no way out...
...
At about two o'clock in the afternoon, the second round of assessment finally ended.
Shi Lian left the crowd who came to talk, found a secluded corner, and sent a message to Xu Qiu.
"Teacher, today's competition is over, and our Linyi is the first again!"
"..."
After waiting for a long time, there was no reply, so Shi Lian had to put away his phone. At this time, the teacher was probably on the operating table again... Suddenly I felt that the famous knife competition was boring, and it was better to do surgery beside the teacher.
As his teacher became more and more famous, the patients who came to Linyi became more and more tricky, and he could encounter some rare cases from time to time.
Many doctors may not hear about cases once in their lives. In Xu Qiu's case, it is not rare, although it can be seen everywhere.
And this is also the key to Shi Lian and others' rapid growth.
The so-called talent, unless it is directly opened, is not as good as personal experience over and over again.
What's more, Shi Lian and others have full medical talents.
...
At this time, in the operating room of Linyi.
In the rest room, a buzzing sound was heard.
The circulating nurse glanced sideways and saw the phone screen suddenly lit up. The originally calm expression was suddenly startled, and the pupils shrank immediately.
