Sam Kocoshis
33 statements · 3 topics · summaries given as host listed separately
Featured statements
Metronidazole is absolutely the wrong choice. It has a limited spectrum. It knocks off your anaerobes and facilitates the growth of aerobes.
quote ·
Gastroschisis
We need to discourage putrefactive bacteria such as E. coli, Klebsiella, and the like, and we want to encourage the anaerobes.
quote ·
Gastroschisis
Prebiotics (oligosaccharides) induce a more healthful flora; probiotics are not routinely recommended due to case reports of central line infections, though these likely occurred through direct line contamination rather than translocation.
opinion ·
Intestinal Failure
Metronidazole is the wrong choice for bacterial overgrowth because it has limited spectrum, knocks off anaerobes, and facilitates aerobic overgrowth; 2/3 of bloodstream infections were seen in patients on prophylactic Flagyl.
clinical ·
Intestinal Failure
Donor breast milk is less advantageous than maternal breast milk because it is usually from mothers 10-14 months postpartum, has lower caloric density and protein, and freezing may inactivate trophic factors.
clinical ·
Intestinal Rehab
Cholestyramine in effective doses will bind nutrients, fat-soluble vitamins, and fats, with risk of hyperchloremic acidosis and bezoars; homeopathic doses may improve stool appearance but not reduce volume.
clinical ·
Intestinal Rehab
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Sam's statements about Gastroschisis 11 statements
Open the Gastroschisis collection →
Intestinal Failure - Feeding Access and Nutrition
Statement
Since developing a mature multidisciplinary intestinal rehabilitation program, internal transplant candidates have declined by 75%, and intestinal transplants are almost non-existent.
Open
Statement
Donor breast milk is less advantageous than maternal breast milk because it is usually from mothers 10-14 months postpartum, has lower caloric density and protein, and freezing may inactivate trophic factors.
Open
Statement
About 60% of patients weaned off TPN have deficiencies in one micronutrient or another.
Open
Quotation
The older I get, and I'm pretty old, the more I recommend prebiotics and the less I recommend antibiotics.
Open
Statement
Prebiotics (oligosaccharides) induce a more healthful flora; probiotics are not routinely recommended due to case reports of central line infections, though these likely occurred through direct line contamination rather than translocation.
Open
Quotation
We need to discourage putrefactive bacteria such as E. coli, Klebsiella, and the like, and we want to encourage the anaerobes.
Open
Statement
Metronidazole is the wrong choice for bacterial overgrowth because it has limited spectrum, knocks off anaerobes, and facilitates aerobic overgrowth; 2/3 of bloodstream infections were seen in patients on prophylactic Flagyl.
Open
Quotation
Metronidazole is absolutely the wrong choice. It has a limited spectrum. It knocks off your anaerobes and facilitates the growth of aerobes.
Open
Statement
If using antibiotics for bacterial overgrowth, selective decontamination with non-absorbable aminoglycosides (tobramycin) and colistin may be preferable to metronidazole.
Open
Statement
Cholestyramine in effective doses will bind nutrients, fat-soluble vitamins, and fats, with risk of hyperchloremic acidosis and bezoars; homeopathic doses may improve stool appearance but not reduce volume.
Open
Statement
In infants, only pancreatic proteases are present in adult quantities; amylases appear between 6-12 months and lipase reaches adult levels by end of first year.
Open
Sam's statements about Intestinal Failure 11 statements
Open the Intestinal Failure collection →
Intestinal Failure - Feeding Access and Nutrition
Statement
Since developing a mature multidisciplinary intestinal rehabilitation program, internal transplant candidates have declined by 75%, and intestinal transplants are almost non-existent.
Open
Statement
Donor breast milk is less advantageous than maternal breast milk because it is usually from mothers 10-14 months postpartum, has lower caloric density and protein, and freezing may inactivate trophic factors.
Open
Statement
About 60% of patients weaned off TPN have deficiencies in one micronutrient or another.
Open
Quotation
The older I get, and I'm pretty old, the more I recommend prebiotics and the less I recommend antibiotics.
Open
Statement
Prebiotics (oligosaccharides) induce a more healthful flora; probiotics are not routinely recommended due to case reports of central line infections, though these likely occurred through direct line contamination rather than translocation.
Open
Quotation
We need to discourage putrefactive bacteria such as E. coli, Klebsiella, and the like, and we want to encourage the anaerobes.
Open
Statement
Metronidazole is the wrong choice for bacterial overgrowth because it has limited spectrum, knocks off anaerobes, and facilitates aerobic overgrowth; 2/3 of bloodstream infections were seen in patients on prophylactic Flagyl.
Open
Quotation
Metronidazole is absolutely the wrong choice. It has a limited spectrum. It knocks off your anaerobes and facilitates the growth of aerobes.
Open
Statement
If using antibiotics for bacterial overgrowth, selective decontamination with non-absorbable aminoglycosides (tobramycin) and colistin may be preferable to metronidazole.
Open
Statement
Cholestyramine in effective doses will bind nutrients, fat-soluble vitamins, and fats, with risk of hyperchloremic acidosis and bezoars; homeopathic doses may improve stool appearance but not reduce volume.
Open
Statement
In infants, only pancreatic proteases are present in adult quantities; amylases appear between 6-12 months and lipase reaches adult levels by end of first year.
Open
Sam's statements about Intestinal Rehab 11 statements
Open the Intestinal Rehab collection →
Intestinal Failure - Feeding Access and Nutrition
Statement
Since developing a mature multidisciplinary intestinal rehabilitation program, internal transplant candidates have declined by 75%, and intestinal transplants are almost non-existent.
Open
Statement
Donor breast milk is less advantageous than maternal breast milk because it is usually from mothers 10-14 months postpartum, has lower caloric density and protein, and freezing may inactivate trophic factors.
Open
Statement
About 60% of patients weaned off TPN have deficiencies in one micronutrient or another.
Open
Statement
Prebiotics (oligosaccharides) induce a more healthful flora; probiotics are not routinely recommended due to case reports of central line infections, though these likely occurred through direct line contamination rather than translocation.
Open
Quotation
The older I get, and I'm pretty old, the more I recommend prebiotics and the less I recommend antibiotics.
Open
Quotation
We need to discourage putrefactive bacteria such as E. coli, Klebsiella, and the like, and we want to encourage the anaerobes.
Open
Statement
Metronidazole is the wrong choice for bacterial overgrowth because it has limited spectrum, knocks off anaerobes, and facilitates aerobic overgrowth; 2/3 of bloodstream infections were seen in patients on prophylactic Flagyl.
Open
Quotation
Metronidazole is absolutely the wrong choice. It has a limited spectrum. It knocks off your anaerobes and facilitates the growth of aerobes.
Open
Statement
If using antibiotics for bacterial overgrowth, selective decontamination with non-absorbable aminoglycosides (tobramycin) and colistin may be preferable to metronidazole.
Open
Statement
Cholestyramine in effective doses will bind nutrients, fat-soluble vitamins, and fats, with risk of hyperchloremic acidosis and bezoars; homeopathic doses may improve stool appearance but not reduce volume.
Open
Statement
In infants, only pancreatic proteases are present in adult quantities; amylases appear between 6-12 months and lipase reaches adult levels by end of first year.
Open
Summaries Sam gave as host · 6 summaries
Recaps of other experts' statements, not Sam's own clinical position.
Summaries Sam gave as host · Gastroschisis 2 summaries
Open the Gastroschisis collection →
Intestinal Failure - Feeding Access and Nutrition
Host summary
Sam Kocoshis summarizing the discussion: In a classic French study by Jolie, adults with short bowel syndrome had 60% absorption with ad lib feeding, 85% with continuous drip feeds, and 75% with half calories by mouth plus overnight drip feeds.
Open
Host summary
Sam Kocoshis summarizing the discussion: GLP-2 analog can reduce fecal output such that TPN can be reduced by about 20% in 60-70% of adult patients, and totally emancipate about 20% from TPN in extension studies.
Open
Summaries Sam gave as host · Intestinal Failure 2 summaries
Open the Intestinal Failure collection →
Intestinal Failure - Feeding Access and Nutrition
Host summary
Sam Kocoshis summarizing the discussion: In a classic French study by Jolie, adults with short bowel syndrome had 60% absorption with ad lib feeding, 85% with continuous drip feeds, and 75% with half calories by mouth plus overnight drip feeds.
Open
Host summary
Sam Kocoshis summarizing the discussion: GLP-2 analog can reduce fecal output such that TPN can be reduced by about 20% in 60-70% of adult patients, and totally emancipate about 20% from TPN in extension studies.
Open
Summaries Sam gave as host · Intestinal Rehab 2 summaries
Open the Intestinal Rehab collection →
Intestinal Failure - Feeding Access and Nutrition
Host summary
Sam Kocoshis summarizing the discussion: In a classic French study by Jolie, adults with short bowel syndrome had 60% absorption with ad lib feeding, 85% with continuous drip feeds, and 75% with half calories by mouth plus overnight drip feeds.
Open
Host summary
Sam Kocoshis summarizing the discussion: GLP-2 analog can reduce fecal output such that TPN can be reduced by about 20% in 60-70% of adult patients, and totally emancipate about 20% from TPN in extension studies.
Open