Doctor: It's reasonable to perform surgery on yourself.

Jiang Mai's face almost turned into a bitter melon: "The terrible thing is, I remember that this medicine has a special note: It is not recommended for people with immune deficiency."

As soon as these words came out, the examination field was instantly quiet.

All the clinical doctors felt that they were being fooled... Damn, immunosuppressants must be used after liver transplantation, but at the same time, they are infected with Cryptosporidium. As a result, the only new drug that can treat the disease is not allowed to be used for people with immune deficiency?

This is a logical dead loop.

If the patient's immunity is not defective, the other party's infection will not be so serious...

"Are you here to make fun of me?" Even though time is so precious, Yang Yuen couldn't help but complain.

If it's not immunodeficiency, who is afraid of a self-limiting disease?

But Shi Lian was relieved.

This difficulty is in line with the tone of the famous sword competition assessment.

If you can directly give a treatment plan by locking in Cryptosporidium infection, it would be too simple.

"Remember the mechanism of action?" Shi Lian asked quickly.

The so-called suitable population and unrecommended suitable population are for laymen and semi-laymen who are looking for convenience.

Shi Lian and others have been working under Xu Qiu for such a long time and have learned a lot. Under the influence of what they have seen and heard, they have naturally abandoned the habit of ordinary doctors who follow the guidelines in a muddle.

They not only know what to do, but also understand why they should do it.

Therefore, at present, the indication of the drug is not the key. Whether the drug can be used depends on the drug's mechanism of action.

Jiang Mai recalled it carefully.

Fortunately, he has been interested in parasites since he was a child, so he has paid extra attention to special drugs such as nitazoxanide, and he really remembered it.

Jiang Mai said: "There is no conclusion, but the mainstream theory is to inhibit the pyruvate ferredoxin oxidoreductase reaction."

Shi Lian was a little puzzled: "What does this have to do with the immune system?"

Looking at the mechanism of action of nitazoxanide, it seems to inhibit Cryptosporidium infection by interfering with the activity of key enzymes in the anaerobic metabolism of parasites.

This does not seem to involve the immune system.

Theoretically, it should not indicate that "it is not recommended for people with immune deficiency."

Jiang Mai shook his head and added: "The problem is that this mechanism itself is not perfect. It must be amplified by the normal human immune system to eliminate Cryptosporidium."

Hearing this, Shi Lian finally figured it out.

That is to say, inhibiting pyruvate is the core, but the effect is too weak. At most, it can fight the trend of Cryptosporidium deterioration, but it cannot achieve the effect of treatment.

The body's immune system is like a magnifying glass that can magnify the process.

Without a magnifying glass, the drug itself will not have much effect.

Shi Lian thought and said: "According to the original medication plan, azithromycin must be retained. It should be effective against infection... Maybe allicin can be used instead of nitazoxanide?"

Allicin has a good effect on many parasitic infections, such as Pneumocystis carinii pneumonia and Toxoplasma gondii, and there are examples of allicin working wonders.

Jiang Mai shook his head, "If used alone, it may not work. Allicin mainly destroys ultrastructure, which is different from the mechanism of action of nitazoxanide."

At this time, the invigilator looked at his watch and reminded, "There is one last minute."

The examination room was quiet for a moment, and everyone's backs straightened unconsciously. Although they were nervous, everyone was restraining their emotions and trying to stay calm.

To be selected by Xu Qiu, they are already outstanding, and their psychological quality cannot be weak.

"Wait, azithromycin cannot be used."

Suddenly, Yang Yuen stood up.

Shi Lian and others looked over at the same time.

Without waiting to ask questions, Yang Yuen said quickly: "The patient's liver function indicators are abnormal, and azithromycin has certain requirements for the patient's liver function... If it is used, it is hard to guarantee that jaundice will not occur. If the parasites are not cured, liver damage may kill the patient first!"

Shi Lian also reacted immediately.

So after all the twists and turns, nitazoxanide is still needed?

But nitazoxanide is completely ineffective for immunodeficient patients...

At this moment, Shi Lian suddenly realized that something was wrong...Immunodeficient people are different from immunodeficient people after organ transplantation.

The former is due to abnormalities in the immune system itself, in other words, it is an original defect.

This patient is special. It is an immunodeficiency caused by human intervention after taking immune preparations.

Since it is acquired, it can be reversed.

Doctors can even control the magnification of immune cells by controlling the immunosuppressant regimen.

Of course, it is a bit exaggerated to say that the magnification can be controlled, but according to existing research in the literature, it is completely feasible to determine what dose can be used to control the number of CD4+ T cells.

Theoretically, it is completely possible...

Shi Lian no longer hesitated and immediately explained his ideas.

Jiang Mai and others thought for a few seconds and nodded immediately.

Garlicin alone is definitely not able to treat Cryptosporidium infection, but it also has a certain insecticidal and sterilizing effect.

If allicin and nitazoxanide with a smaller magnification are used in combination, perhaps Cryptosporidium can be eliminated under immunosuppression?

At this time, there were only 30 seconds left before the end of the assessment.

Shi Lian looked around, and all the doctors gave her a look of approval.

She took a deep breath and said:

"For the first question, we need to perform a gastrointestinal endoscopy to identify the infected fragments in the patient's intestines. Then we will perform high-throughput sequencing of blood samples and modified acid-fast staining of stool.

The preliminary diagnosis is Cryptosporidium infection!

For the second question, the treatment plan is to take 500mg tid of nitazoxanide and 500mg tid of allicin orally.

In addition, the most critical point is that the patient's immunosuppressant is adjusted to cyclosporine, and through dosage control, the patient's CD4+ T cells are controlled at 100-300/mm3!"

Tid means three times a day.

The use of nitazoxanide and allicin is no different from general medicines, and can be taken with three meals a day.

The key is to control the immune ability within a certain range.

It can not only ensure immunosuppression after organ transplantation, but also ensure that nitazoxanide plays a certain clearance role...

The normal CD4 cells in the human body are generally around 500 to 1,600.

Many asymptomatic AIDS patients have a CD4+ T lymphocyte count of around 350.

Shi Lian controlled the value to around 300, so that the patient could maintain the most basic immune ability to deal with the subsequent Cryptosporidium sweep.

After answering clearly, the invigilator looked at his watch and saw that there were only ten seconds left.

He did not express his opinion. There was a recording device in the examination room, and Shi Lian's answer just now had been heard by the judges.

As for the result, he was just an invigilator...

In fact, in order to prevent the leakage of questions, the invigilators present did not know the real answer.

But they were all extremely experienced doctors, and they were inevitably itchy and followed the questions in their minds.

He could still see some clues in the first few questions.

But the invigilator was really confused in the last two questions... Ordinary hospitals can't stick to this step at all. Even if the hospital has this ability, the patient is the biggest challenge.

All the way to diagnosis, the patient is almost on CRRT and ventilator every day, and antibiotics are used like drinking water, and the cost of one day is at least 30,000 or 40,000.

After a set of treatment, the medical expenses of one million are guaranteed.

And many of them cannot be reimbursed, such as nitazoxanide... This even requires family members to use their connections to buy drugs overseas!

The patient's life is hanging by a thread... If it were an ordinary family, they might not even get to the stage of explosive watery diarrhea and would have to give up.