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Medical uses[ edit ] The original indication of chloramphenicol was in the treatment of typhoid , but the now almost universal presence of multiple drug-resistant Salmonella typhi has meant it is seldom used for this indication except when the organism is known to be sensitive. In low-income countries, the WHO no longer recommends oily chloramphenicol as first-line to treat meningitis, but recognises it may be used with caution if there are no available alternatives. It is not effective against Pseudomonas aeruginosa. The following susceptibility data represent the minimum inhibitory concentration for a few medically significant organisms. Some strains of E. It is easy to select for reduced membrane permeability to chloramphenicol in vitro by serial passage of bacteria, and this is the most common mechanism of low-level chloramphenicol resistance. High-level resistance is conferred by the cat-gene; this gene codes for an enzyme called chloramphenicol acetyltransferase , which inactivates chloramphenicol by covalently linking one or two acetyl groups, derived from acetyl-S-coenzyme A, to the hydroxyl groups on the chloramphenicol molecule. The acetylation prevents chloramphenicol from binding to the ribosome. Resistance-conferring mutations of the 50S ribosomal subunit are rare. Chloramphenicol resistance may be carried on a plasmid that also codes for resistance to other drugs. As of some Enterococcus faecium and Pseudomonas aeruginosa strains are resistant to chloramphenicol. Some Veillonella spp. This effect is rare and sometimes fatal. The risk of AA is high enough that alternatives should be strongly considered. Treatments are available but expensive.

Gray baby syndrome[ edit ] Intravenous chloramphenicol use has been associated with the so-called gray baby syndrome. UDP-glucuronyl transferase , so chloramphenicol remains unmetabolized in the body.

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The condition can be prevented by using the drug at the recommended doses, and monitoring blood levels. Herxheimer's reactions have occurred during therapy for typhoid fever.

Optic and peripheral neuritis have been reported, usually following long-term therapy. If this occurs, the drug should be promptly withdrawn.

It has a large apparent volume of distribution and penetrates effectively into all tissues of the body, including the brain. Distribution is not uniform, with highest concentrations found in the liver and kidney, with lowest in the brain and cerebrospinal fluid. Chloramphenicol increases the absorption of iron. In liver impairment, the dose of chloramphenicol must therefore be reduced. No standard dose reduction exists for chloramphenicol in liver impairment, and the dose should be adjusted according to measured plasma concentrations.

The majority of the chloramphenicol dose is excreted by the kidneys as the inactive metabolite, chloramphenicol glucuronate. Only a tiny fraction of the chloramphenicol is excreted by the kidneys unchanged.

Plasma levels should be monitored in patients with renal impairment, but this is not mandatory.

Chloramphenicol succinate ester an intravenous prodrug form is readily excreted unchanged by the kidneys, more so than chloramphenicol base, and this is the major reason why levels of chloramphenicol in the blood are much lower when given intravenously than orally.

Plasma levels should be monitored in all children under the age of four, the elderly, and patients with renal failure. It prevents protein chain elongation by inhibiting the peptidyl transferase activity of the bacterial ribosome. It specifically binds to A and A residues [36] in the 23S rRNA of the 50S ribosomal subunit, preventing peptide bond formation.

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Non-public partner denotes a cell This paper is organised as follows: Section II presents the receiving traffic from one hot-spot cell. Assuming Cellh has N system model. Simulation results and Lnode : Actual load. The modified soft M node frequency reuse technology [8] is employed.

The total spectrum is fully reused in all cells.

According to [11], in Section MRS2…. MRS6 , respectively. RSsev,h is located in hot-spot Cellh.

RSt,j : RSt in partner Cellj. Layout and frequency planning in relay cellular networks CMLB scheme employs the user-vote assisted partner selection mechanism. For the edge user, the downlink transmission is Then, it is modified to fit in relay cellular networks. This split into two consecutive time slots. In the second time cells. Uk is served by RSsev,h. The definitions and system parameters are shown in Table I.

Similar as our previous partner selection mechanism in Cellj: Partner Cellj. RSs in neighbouring Celli. R1,h…Rp,h…RP,h : Relative load of public partners. In order to choose appropriate partner cells, the hot-spot Cellh also considers the actual load of neighbouring Celli.

In the modified user-vote assisted partner, in order to minimise the load difference among Cellh partner selection mechanism, the above two factors, including and its partners, as shown in 4. Then, hot-spot objective, the amount of shifting traffic from Cellh to non- Cellh selects the high priority neighbouring cells as partners. Similarly, the Finally, Cellh sends a request message to partner cells.

The amount of shifting traffic from Cellh to public partner p is partner cells will respond with a confirmation message. Mn and Mp are the total number of pre-allocated subcarriers in non-public partner n and public partner p, respectively. Relay-Level User Shifting According to the amount of the required shifting traffic, the hot-spot cell tries to offload edge users to partner cells.

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This may result in the heavily loaded RS, especially under public RS scenario, in which the RS receives shifted users from multiple hot-spot cells as illustrated in Fig.

Negotiation process of cooperative traffic shifting algorithm Therefore, the relay-level user shifting aims at: 1 Shift appropriate users, which have good channel condition in A.

The cell-level shifting traffic calculation stage refers to our As shown in Fig.

Specifically, since multiple hot-spot cells steps. The first step is on the side of hot-spot cell, it selects part may select a lightly loaded cell as partner, and then this cell of edge users as possible shifted users, in order to satisfy the becomes public partner. As introduced in [9], the public amount of the required shifting traffic to each partner.

Then the partner responds a relative load to each hot-spot cell. Thus, each hot-spot cell will transfer handover users. Finally, the partner and the hot-spot cell adjust appropriate and less traffic to the public partner. This response process can ensure t, j estimated SINR.

Then, partner Cellj is depicted in Fig. Otherwise, RSt,j will A downlink system-level simulation platform of relay t, j become heavily loaded and suffer the aggravating load problem.

As shown in Fig. Ada pula kisah tentang rumah permintaan yang bisa mengabulkan apa saja untuk sebuah harga tinggi. Ada kisah tentang kakak-beradik yang terjebak di ruko tua. Ada kisah tentang pacar lama yang menagih janji. Ada kisah tentang seorang cewek yang sakit hati karena dijadikan taruhan.

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Dan ada kisah tentang sebuah keluarga misterius yang terlalu bersemangat membuat kostum Halloween. Pernahkah kalian dikuntit oleh perempuan berponi dengan rambut panjang? Pernahkah kalian mendapat hadiah-hadiah aneh yang semakin lama semakin mengerikan? Pernahkah kalian menjanjikan sesuatu pada orang yang baru dikenal?

Dan pernahkah kalian bertanya-tanya, apakah rahasia yang selalu disembunyikan sahabat terdekatmu?

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