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    Medicine and Allied Phase-A Curriculum

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    Medicine and Allied Phase-A Curriculum

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    Zarin Tasnim
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    Medicine and Allied Phase-A Curriculum

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    Medicine and Allied Phase-A Curriculum

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    6 views14 pages

    Medicine and Allied Phase-A Curriculum

    Uploaded by

    Zarin Tasnim
    Medicine and Allied Phase-A Curriculum

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    © All Rights Reserved
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    Pose Ne.| ‘Admiion Phase A (Core Medial Taning Domains of Learning “Teaching and ering toe Record of aining Aseserens| Superson and Tamang Monto ‘Caeulum ingiementtion, Review and UpSaing lalsfe|sie|a|sielala. Sila Resideney Proaram 1. Introduction Medical education is @ continuum from Undergraduate through internship to Postgraduate Medical Training, which is further vided into two stages: basic and higher profesional taining Universally postgraduate medical training is competency-based and structured. In fact, sll-eaming aided by Continued Medical ‘Education (CME) programs, should continue throughout the career of @ medical practioner and retraining is desirable whether r-cerification is mandatory or not. This should not be construed to mean that doctors are not adequately trained for thelr job at graduation or on exit fiom higher professional ‘raining, but that Mediine is complex and evolving, therfore, continued update, review and re-education are mandatory in the Medical Profession. Recently ESMMU has introduced ils competency-based Residency Program. Phase A training ofthe program, which lasts for two years, aims ata broad-based training in General Internal Medicine, 2. Objectives a) To provide @ broad experience in General Intemal Medicine, Including its interelationship with other disciplines. b) To enhance medical knowledge, clinical skis, and ompetence in bedside diagnostic and therapeutic procedures ‘To achieve the professional equlrements fr specialty specific traning (Phase B) 4) To cultivate the corect professional atitule and enhance ‘communication skill towards patiens, thelr families and ‘other bealincare professional 2) To enhance sensitivity and responsiveness to community noeds and the economics of health care delivery. To enhance critical thinking, seeaming, and interest in research and development of patient-care sevice. 3 Medicine & Aled 4) To calivate the pracice of evidence-based medicine and cxtcal appraisal sls. h) To inculcate a commitment to continuous medical education and professional development 3. Admission Requirements: Medical graduate with successful completion of internship and ‘with full registration with the BMDC will be seleced by competitive admission test. ‘A. Prexequisites for admission In Phase-A, B. The applicants should not be above 45. years of age on enrolment. {a} MBBS or equivalent degree as recognized by BMDC 1). One year of internship in-service trainina ©) Completion of one year after intemship / inservice traning 4) BMDC registration C. Candidates fr reskiency have to si fora written MOQ-baced ‘admission test on Basie Medical Sciences and Faculy-based topics. 4. Phase A (Core Medical) Training: “The two-year Core Medical Training provides foundation training in. General Internal Medicine which includes ‘components of educational (academe) and traning program in relevant fields of ‘Applied Medical Sciences and General Internal Medicine, This training program wil focus on developing core knowledge and skills, providing a foundation for consolidation and further sd within advanced specialty-specific raining. 4.1. Expected outcomes at the completion of Phase A Training Program + At the completion of Phase A taining, itis expected that Residents wil have * Built on the knowledge and sklls acquired during mesic CColege and the internship yeas. 4 Mescine & ied ‘= Gained experience in, and hed the opportunity to develop and demonstrate competency in, o comprehensive range of "core’ generic and disciplin-spectic knowledge, clinical skils ‘and atiudes ‘= Aout the sills tobe able to work within, and fully tiie rmultidiscpinary team-based approaches to the assessment, management and care of ther patents ‘= Implemented their future careerplanning and decison ‘making processes based on a more informed level of Jnowkedge and understanding 4.2. Structure of Training: 1. The cor program consists of two years of supervised training with formative assessment and feedback ‘The Residents should have at leat seven months of training in units dealing with general madical problems. The residentihe respective department then will have to choose 4 rotations, each ‘comprising tree & hall months out of 9 rotations to complete 221 months of raining. The last 3 months wil be placed in the respective department, preparing themselves forthe phase A Final examination, 2 Residents should acquire competence through supervised performance of the tequived numbers of diagnostic and therapeutic procedures during thei Phase A Training. 13. Residents should attend the mandatory courses, workshops, tc as per curricular requirments 5. Domains of Learning 5:1. Knowledge 1 Bticlogy, linia! manifestation, disease course and prognosis, Investigation and management of common medical diseases. 2. Scientific basis and recent advances in path physiology, fiagnosis and management of medical diseases, 3 Spectrum of cinieal manifestations and interaction of multiple medical diseases in the same patent, 4, Paychological and social aspects of medical linesses. 5 Residency Program 5, Costetlecive use and interpretation of investigations and special diagnostic procedures. 6, Citical analsis of the efficacy, costeffectivaness and cos uly of treatment modaltes. 7, Patient safety and risk management 8. Modical audit and quay assurance 9. Ethical principles and medicolegal sues related to medical nesses. 5.2. Skills 1. Abily to take a detailed history. gathers relevant data from patient and. assimilates the information to develop sfagnoste and management plans. 2, Competence in. eicting abnormal physical signs and interpreting their significance. Ability to relate clinical abnormalities with pathophysiologic states ond diagnosis of diseases. Abily to select appropriate investigation and diagnostic procedures for confirmation of diagnosis and patent ‘management. ‘Shils in performing important bedside diagnostic and therapeutic procedures and of thelr indications. Residents should acquire competence through supervised performance ofthe required number of procedures during the 2-year training period and should record them inthe Logbook. Abily 10 present clinical problems and lieature review in ‘grand rounds, journal cub and seminars. Good communication skills and interpersonal relationship with patients, families, medical colleagues, nursing and ald health professionals Abily to mobilize appropriate resources for management of pallents at diferent siages of medical illnesses, including cextcal care, contuitation of other specialties and disciplines, ambulatory and rehabilitative services, and community 6 Resideney Program 5.3, Auitudes 1. The wellbeing and restoration of health of patients must be ‘of paramount consideration. 2. Empathy and good rapport with patient and relatives are essential atributes, 3. An aspiration to be the teamleader in total patent care Involving nursing and aed healthcare professionals should be developed 4. The costeffectveness of various investigations and treatments in patient care shouldbe recognize. 5, The privacy and confidentiality of patents and the sancity of| life ust be respecte Mecicine & Abed 6. Teaching and Learning Methods: For trainees to maximize their learning opportunities i is Important that they workin ‘a good learning environment. Tis Includes encouragement for self-directed leaming as well as recognizing the learning potential in all spect of day to day work ‘The bulk of leaning occurs as a result of clinical experiences (experiential learina, on-thejob teaming) and seltdiected study, The degree of self-directed learning will increase as trainees became more experienced. Teaching and leaming occurs using several methods that range from formal didactic lectures to planned clinical experiences. Aspects covered will incude nouedge, skis and practices relevant to General Medicine in fonder to achieve specific learning eutcomes and. competencies. ‘The theoretical part ofthe cuniculum presents the curent body of knowledge necessary for practice as an Internist. In this rogram this wil be imparted using lectures, grand teaching rounds, clinco-pathological meetings, morbidity/moraliy review meetings, erature reviews and presentations, oumal cubs, sel directed learning, conferences and seminars, 7 Reser Proven 6.1. Training Rotations Residents wll undergo taining roaton in aire inkl sence ding ft 21 months andthe a 3 month or lity acest and Phase Final Examination, Phose A troirna rotations ull be o flu: 1. Ine Medicine = OT mont 2. Thee and haf mothin any 4 ou of teow dearer: Corts Exdocnolgy, Gavteetrlogy, Hepatology, Hemasey,Nepvloy Nels _ Hamenths Feumatlog, ard Piondogy ‘Eligibility assessment and Phase Final Exam - 03 months 6.2. Teaching and training program in internal Medicine ‘At the end of the training program in Internal Medicine, the residents wil beable to lear to “Take history propery = Examine the patients meticulously but must be relevant and pertinent Ener the information comectiy in the history sheet Critically analyze the case Formulate acinical diagnesis and differential diagnoses Know formuiating fis line and second line investigations “To interpret the investigations and lab reports cared with the patients + Have practical and working knowledge to interpret the investigations done ina patient or diagnosis Manage all emergency medical cases = Manage cormmon medical problems *Iniate management in all other medical problems = Know to diagnose ond manage patients coming with ‘mulliple medical probleme/diagnoses Know when to reer, how to refer an whom to refer + The resents wil be responsible for admitted patient as per liguibution and will present the case during ward round or ‘ase dlscusson schedule. Residency Progem Mediine & Ales + "They will attend OPD, evening, night or other duties es assigned bythe departmentiunits ‘+ They wil attended scheduled lecture clases, tutorials, journal ‘dubs, grand round, elnical meeting and other deparimental ‘academic and taining activities + During the rotation in Internal Medicine they wil perform the ‘rocedires as much as posible as mentioned inthe logbook 6.3. Teaching and learning program in the rotations other than Internal Medicine + At the end ofthe training program in a specific rotation, the ‘residents will be competent enough to cary out diagnostic workup and day-to-day management of the common problems encountered inthe respective specialty + They will attend OPD, specially clinics, evening, night or ther duties as asigned by the departmentunis + They wil atended schediledlectre classes, tutorials, Journal clubs, grand round, clinical meeting and other departmental academic and taining activities + They will have practical and working knowledge and be able to interpret the investigations necessary for diagnosing 9 patient relevant tothe specialty + During the rotation in 2 specie specially they wil perform the relevant procedures 8 much as possible covering the schedule in the labook Nate: The teaching leoming proarom contained inthe curl net ‘covered nthe scheduled raion wil be covered by se learning by he test 7. Record of Training: The evidence requires confirming progress through ‘raining includes: + Detals of the taining rotations, weekly timetables and duty rosters; ease-mixes and numbers of practical procedures and Residency Program Medicine & Aled + Confirmations of attendance at events in the educational rogram, at departmental and iterdepartmental meetings ‘and other (optional) educational evens + Confirmation (ceificates) of attendance at subject- ‘based/sklls-raininglinsbuctional courses ‘Recorded attendance at conference ané meetings + A properly completed logbook with enties capable of testifying to the taining ebjectives which have been attained ‘and the Level of performance achieved, = OME activity, ‘+ Supervisor's’ seporis on served performance in the ‘workplace 7.1. Loghook: Residents ae required to maintain 2 logbook in which enties of academiciprofessional work done during the period of training should be made on a daily bass. and signed by the supervisor. Completed and duly certiied logbook will form a part of the application for appearing in Phase Final Examinations. 7.2. Portfolio: “This isa collection of evidence documenting trainee's learning ‘and achievements during their taining. The trainee takes ‘esponsitiltes fr the portflio’s creation and maintenance Iwill form the basis of asestment of progression, 8. Assessment: ‘The assessment method is comprehensive, integrated and phase- centered attempting to idently attrbutes expected of specialists for independent practice and lifelong leaming and covers cognitive, psychomotor and affecive domains. It keeps srct reference tothe components, the contents, the competencies and the erteria laid down in the curriculum. Assessment includes both Formative Assessment and Summative (Phase final) Examinations, ty Residency Prostar Mecicine & Aled 4.1. Formative Assessment: Formative assessment will be conducted throughout the traning phases. It wil be carried out for tacking the of residents, providing feedback, and preparing them for final assessment {Phase campletion exams). ‘There will be continuous (day-to-day) and periodic type of formative assessment, * Continuous (day-to-day) formative assessment in classroom and. workplace stings provides guide to 2 resident's learning and a faculty's teaching /leaming straagis to ensure formative leston / training outcomes, + Periodic formative assessment is quast-formel and is directed to assessing the outcome of a block placement or academic module completion. It is held at the end of Block Placement and Academic Module completion. The contents of such examinations inde Block Unite of the ‘Training Curriculum and Academie Module Units of the ‘Academic Curicurn, + End of Block Assessment (EBA): End of Block ‘Assessment (EBA) isa Periodic Formative Assessment and is ‘undertaken after completion of each training block, assessing knowledge, sis and atttude of the residents, Components of EBA are wnitten examination, Structured Clinical Assessment (SCA), medical record review, logbook review and porto assessment. Incomplete block taining must be satisfactorily completed by undergoing further raining forthe block to be tile for "appearing inthe nex phase compieton examination. 8.2. Summative (Phase A Final) Examination: Phase A Final examination vill be common for Medicine and Allied and wall have following components: * Writen examination (SAQ’SEQ) + Clinical examination: = Long ease (1) + Short cases (4) + Structured Clinical Assessment (SCA-10) n Resideney Progom Medicine & Aited 9, Supervision and Training Monitoring “The training will incorporate the principle of gradually increasing responsibly, and provide each trainee with a sufiient scope, volume and vanety of experience in a range of settings that Include Iepatiens, outpatients, emergency and intensive cae. All ‘laments of work in training rotation willbe supervised with the level of superaision varying depending on the experience of the Resident and the cltical exposure. Outpatient and referal supervision must routinely indude the opportunity to personally iscus all cass. As traning progresses the Resident should have the opportunity for increasing autonomy, consistent with safe and effective care forthe patient. Residents wil af all ines have a ‘Supervisor, responsible for overseeing their education and sraining Supervisors are responsible for supervision of learning throughout the program to ensure patient safety, service delivery fs well a6 the progess of the resident wlth leaming and performance. They set the lesson plans based on the curriculum, "undertake appraisal, review progress agains the curriculum, give feedback on both formative and summative assessments, and ‘ensures proper recording of the and signing the logbook, The residents are made aware of their liittions and are encouraged toseek advice and receive help at al ies. ‘The Course Coordinator of each department coorinates all training and academic activities of the progam in collaboration With the Course Manager(s), The Course Director of each facully dees, guides and manages euricular activities under his / be jursdicion ad isthe person to be reported to fora events ‘and performances ofthe residents and the supervisors, 10. Curriculum Implementation, Review and Updating: Both Supervisors and Residents are expected to have a good koowledge of the curriculum and should use it as a guide for 2 i Residency Program thetr training. program. rapidly changing specially, the need for review and up-dating of curricula is evident. The Curiculum is specifically designed to guide an educational process and will continue to be the subject fof active redrafting, to reflect changes in both Medicine and educational theory and practice. Residents and Supervisors are encouraged to discuss the curiculum and to feedback on content and isue regarding implementation with the Course Director. Review willbe time tabled to eccur annually for any ‘minor changes tothe eurculum, 11. Syllabus “The alm of the sylabus for Phase A training i to guide the Residents to acquite broad! based knowledge on Medicine belore ‘entering the Phase B spectlly specific traning. Patients present themselves with problems and itis the problem that needs solving. A specialist who hes brosd based knowledge of Medicine wil be able to salve the problem in a better way. So the ultimate objective of Phase A traning is to produce 9 knowledgeable, competent, alist spedialst with up to date background knowledge of Medicine. Emphasis has been laid on common Aisoases frequently encountered in this part ofthe world By the end of Phase A Training (Core Medical Training) the Resident should be able to: Assess presenting symptoms and signs b. Formulete appropriate investigations and accurately interpret Investigation reports ‘© Communicate the diagnosis and prognosis 4 Institute appropriate treatment recognizing indications, contraindications and side oflects of common clnical conditions (On this background, it is expocie that Residents wil be able to (i) acquire “knowledge [of common medical conditions, emergencies, & rehabilations), (i) acquire skis. (dlsgnosi B Resdency Program Medicine & Aled ‘nical and decision making] and (i) develop attiude (caving learning, ethical, 11.1. Learning Objectives: A. CLINICAL SKILLS 1. litte history and obtain thor relovant data 2. Conduct an appropriate physical examination 3. Syrtheste findings from history and physical examination to Gevelop diferent diagnoses, identify problems, make ‘problem lst and formulate management plan Plan and arrange investigations appropriately PATIENT CARE AND THERAPEUTICS Manage general care in the unwell patient Prescribe apmropriate and safe pharmacotherapy Incorporate health and wellness promotion in cinial practice “Manage patients with surgical problems Facilitate ongoing eave planning Know his imitations and seeks appropriate consultation PROCEDURAL SKILLS Prepare patent for procedure CCompetently perform procedures relevant to General intemal Medicine Provide care folowing procedure Bre pwreyee ). MANAGEMENT OF ACUTE MEDICAL PROBLEMS Recognize and manage the cecal il patient ‘Manage specific acute medical problems ‘Communicate with patients and their familes in an emergency situation spre E, MANAGE PATIENTS WITH UNDIFFERENTIATED PRESENTATIONS 1, Manage patients with undiferentated presentations (eg, Chest pain, cough, weight los, ez) 4 siden mo Medicine & Aled F. MANAGE PATIENTS WITH COMMON DISORDERS OF ORGANS 1. Disorders ofthe cardiovascular sytem 2. Endocrine and metabolic disorders 13. Disorders of the gastointstnal system 4. Disorders ofthe haemopoetic system, ‘5. Mental health disorders 6. Disorders of the musculoskeletal system 7. Disorders of the neurlogical system Disorders ofthe renal and genitourinary systems 9. Disorders ofthe respiratory system 10. Skin disorders G, MANAGE PATIENTS WITH DEFINED DISEASE PROCESSES 1, Manage patiens with neoplastic diseases 2. Manage patients with genetic dicorders 3. Manage patients with infectious diseases 4. Manage patents with electrolytes and acid base disorders H. MEDICINE THROUGHOUT THE LIFESPAN’ GROWTH AND DEVELOPMENT |. Manage common presentations in adolescents Manage common presentations in pregnancy Manage common problems associated with the menopause Manage problems in the older patient Manage patients atthe end of ite 11.2, Outline of Core Syllabus: Core Sylabus in which the Resident should acquire good Fnowedge, dinical competence including appropriate technical abilities is outlined below. Respective applied basic sciences ul be Integrated with the clinical science content 15 Medicine & Alles Residency Program 1. Disorders of Cardiovascular System: Applied Basic science: Regional anatomy: fetal circulation, principal blood vessel, coronary anatomy and circulation; conducting system of the heart, Cardiac cycle; Carine performance Core Clinical knowledge Medicine & Aled > Coal cannon + Tangosaohy | + Echocardiography 2, Endocrine and Metabolic Disorders Applied Basic Science Symptoms and signs of] » Infecive endocardis ‘> Giassifcation of hormones [+ Adrenal cortex heart and vascular |e Myocarditis a '* Mechanisms of hormone |* Adrenal media + diseases + Pericarditis with y action + Thysoid + Ischemic heart disease: | pericardial effusion + Hypothalamicregulatory |+ Pancreas stable angina, ACS ‘Caxdiomyopathies hormones ‘+ Physiological response 1+ Arhythmias one + Peripheral vascular Anterior pituitary in Pregnancy ‘conduction defects disease hormones © Hear failure ‘+ Congenital heat disease Posterior pituitary "© Gardiogenic shock |» Systemic disease and hormones + Hypertension cardiology + Dyslipidemia Core Ctneat routed Valvar heart dscase ‘Sumploms and signs of |» Muliple endosrine endocrine disorders neoplasia + Diabetes meltus + Obesity + Hypogycemia ‘+ Polyeytic ovary syndrome + Hypo: and + Hypogonadism hyperthyroidism Menopause + Hypo: and Male senual dysfunction hhyperealcernia Hypo and © Thyroid podules and hhyperadrenalism cancer ‘+ Phacochromocytoma » ‘+ Autoimmune thyroiditis |* Hyperaldosteronism, ‘+ Hypopituitarism hhypoaldosteronism Shock tate ‘+ Palpitations ) ‘Pituitary tumors + Acute pulmonary edema |» Edema + Cjanosis | Emergency management Investigations, procedures, and interpretation "Diabetic hetoacidoss| © Thyroionie css + Hyperosmolarnon-ketaticcoma | + Tetany + ECG interpretation |e Cardiac catheteration s epeeom S Hopercaloenic Cie + Ambulstoy Cardiac pacing + _Addisonian eis 16 "7 Reseny Progra Medcine & Aled ‘Common clinical seenarios ‘+ Thint, pola smndrome[» Seal dystuncion ‘+ Hyperpigrentation + Appetite and weight + Wealeess, fatigue symptoms + Hirsutism Investigations and procedures * CT and MRI piitary and [> Fine needle aspiration adrenals ‘of thyroid nodules ‘+ Radionuclide sean of |» Oral ghicose tolerance thyroid & RAIU test ‘+ Ulrasound of thyroid |e Thyroid function tests! + Short Synacthin Test TS, FT4, TSH_ + Xray sal + Thyroid auto antibedies 3. Disorders of Gastrointestinal and Hepatopancreatic System: Applied Basic science ‘+ Regione! anatomy: surface markings, diaphragm, thoracic duc, esophagus, stomach, duodenum, tver ‘+ Physiology of stomach, pancreas, bilary system, small intestine, colon Core Clinical knowledge ‘+ Symptoms and signs of |» Galstone dieases gasiointesinal and | + Aleoholilive disease hepatobiliary diseases | Acute viral hepatitis © Oral Medicine ‘Chronic vial hepatitis + Exophaits, Cinosis of liver with ‘esophageal motility ‘portal hypertension disorders & dysphagia, ‘esophageal cancer Peptic ulcer disease Coolie disease Reetdeney Progam Medicine & Aled [eeeraive Gata Yo Hepa cancer Crohns decane Gosto testinal © Gekreeancer hemo 2 Functional bowel 6 lchemic bowel disease lenders Acute abdomen + Malabsorption Uber transplantation S prcatccat |e. femecmantalrans 2 Pancreatitis aciie®& |= Hepalcamoctiesstver wonie shee + Colorectal cancer| Intestinal & hepatic 2 Divertelar deste helintios Emergency management om + Upper gstroniesinal |» Acute abdomen tenonbege + Falminant hepatic _ fete nests fake Common presentation scenerios + Diarhen: Ace * dande Chronic Dysentery | + Abdominal distension + Asdomina pain Induding aes and c + _Anorena and welt ost Investigations and procedures > Upper gastobtesinal |» Uver Wopay endoscony {Abdominal pracentess + Ines! bopsy 2 Pain adology ence MRCP + Ulrasonegraphy of the © Sipnaliceony end hepatobiliary stem Coes + Ablominal CF MR 4. Disorders of Haemopoetic System: Applied Basic science ‘+ Hematopoiesis and hematopoietic growth factors = Hoemostasis 19 Residency Program re deine & Alt ‘= Iemunohematology; HLA ping " Medicine & Aled {+ Maeclr bos of malign! blood daordrs 7 Deena inrovesar cotton Core eneat knowledge + Bleting due to > Thgnoeries [> fate Laie] hererhia honey Anemia | Rete Myc saute TP = Megat Anemia Letemia = © Aeemia ot "Conc | Ace Common presentation scenarlos aon Lamphote Bosra, aren, + PamayandSecondoy |» Cheon Leeria pers pnd Exocytosis = Chronie Myeloid eee | + Hence Aner Leela Lynphadenopaty Congenital and Aequed Chronic + on Overload Dsrrs Limphocaic Insestigetins ond procedures + lnmunobematlog HLA Lami nd + Iterenition of CRC rete ire pe + ntepeition of blo ins « Reoncanat Je iwmarecnnd {Bone mano expition and tehine biopsy Hemoxisin Relaled Monodonal "Inerwetation of bone maow eptaton and tephine eps + Pallet Diodes Ganmepahies BT, C1, PT, APTT Heredity ond Aeubed |» Limphorae + imminophenotping + Mydoprelleaive Dseses Hdl’: Mylonas Syndromes Dhesse 5. Infectious Diseases and Tropical Medicine 2 Cylogeneia end Molsalar Non Hedgn's Applied Base sclence Bnd ofLedhemia and Lumphome Clascaon of ici [> Parse and nips Imei + Hemost oie chemotherapy Homontagic and enonhage and + Bade chretrscs, |» Opporiise pathogens , tiation reseworsofinfectone | + newbaton periods Trans «+ Endotodns exeerns | + Vacdnes nd en Sa Anbar srmzation hes Cat Se chemoterapy + Staion and fees Struc of ves dintecion taneiee Vis repseaion + munciogy: ce + Stance {Antu chemetherapy |" ied nthe mune Tarlton Stow ves teponee olen, a Mediine & Aled Medicine & Altes ‘@cnes, heat shock Proteins, re radicals irc oxide, pathology of septic shock, basis of Immunodeficiency states + Pathophysiology of fever * Brood knowledge of bacterial, vial, fungal diseaces + Major infections of the subspecies. of Medieine 1+ Major infections of other Discpines (surgery. ‘obsctries,imtensive care ec} + Stoplylococca, streptococcal discases + Typhoid + Malaria + Bacterial meningitis + Viral meningitis + Pulmonary tuberculosis + Extrpulmonary tuberculosis + Brucellosis + Infectious mononucleosis Tetanus Core Clinical Knowledge chilamyial and rickets | « Vorcl-zoster + Aste ofectous Major diseases of gasto- |” newologe syndrome entero-clt rs) Sslmoneloss, + Herorthagl fever Campslobactenoss syriiome (HES) {_shigeoss, yesinios, | Systemic inlammatory | + Hiv intecion + Cryptococcosis ‘Systemic nosocomial Invasive mycoses Including Aspergiosis and Candidiasis + Antimicobials

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