The document discusses the management of community acquired pneumonia. It defines community acquired pneumonia and outlines its typical clinical features. Several severity assessment scores for pneumonia are described, including CURB-65 and Pneumonia Severity Index. Common causative agents are noted. Investigations and treatment principles are outlined, with betalactam antibiotics, macrolides, and fluoroquinolones discussed in detail regarding their mechanisms of action, resistance, indications, and adverse effects. Prevention methods like influenza and pneumococcal vaccines are also mentioned.
Community-acquired pneumonia (CAP) is a common infectious disease worldwide and a major cause of mortality and morbidity. The document discusses definitions, etiology, risk factors, diagnosis, and treatment recommendations for CAP according to guidelines from IDSA/ATS. Key points include common bacterial and atypical pathogens causing typical and atypical CAP; use of severity assessment scores to determine hospitalization and ICU needs; recommendations for empirical antibiotic therapy based on patient factors; and considerations for MRSA coverage and broad-spectrum therapy.
This 67-year-old woman with mild Alzheimer's disease presents with community-acquired pneumonia based on symptoms of productive cough, fever, confusion and exam findings of crackles in both lower lung fields and CXR infiltrates. She meets 3 CURB-65 criteria (confusion, RR≥30, age≥65) and 4 IDSA-ATS minor criteria (RR≥30, confusion, BUN>20, PaO2/FiO2<250) warranting consideration of ICU admission given risk of deterioration. Based on her nursing home residence and recent hospitalization, she also meets criteria for possible healthcare-associated pneumonia and should receive broad-spectrum antibiotics with MRSA and Pseudomonas coverage along with diagnostic
Although there are no large epidemiological studies from India, mortality data on total number of deaths from lower respiratory tract infection are available. Whereas the world wide mortality of CAP in hospitalised patients varies from 14%–50%, the reported mortality in India varies from 3.3% to 40% with higher rates in elderly & in those requiring intensive care unit (ICU) care. Use of clinical scores like CURB-65, & CRB 65 help to stratify risk of severe disease & need for hospitalisation & ICU care. Early initiation of appropriate antibiotic based upon the knowledge of local resistant patterns of existing pathogens is the key for successful treatment.
The document discusses the use of anti-inflammatory drugs to treat COVID-19. It explains that early in the infection, the disease is driven by viral replication, while later it is driven by an exaggerated immune response causing tissue damage. Anti-inflammatory therapies are likely more beneficial in later stages. Tocilizumab, an IL-6 inhibitor, is discussed as a potential treatment for its "cytokine storm". Studies on tocilizumab show mixed results, with some trials like REMAP-CAP showing reduced need for ventilation and others like COVACTA not meeting primary endpoints. The document provides dosage recommendations and warnings for tocilizumab use in COVID-19 patients.
This document provides an overview of pneumonia, including its definition, epidemiology, etiology, clinical features, diagnosis, severity assessment, management, and treatment guidelines. It discusses community-acquired pneumonia and outlines 4 patient categories based on risk factors and symptoms. Key points include that pneumonia has many potential causes, symptoms often include cough and fever, and treatment involves antibiotics with consideration of atypical pathogens and severity of illness. Hospitalization is recommended for higher-risk patients or those not improving after 2 days.
This document discusses the role of anti-IL6 medications like tocilizumab in treating the cytokine storm seen in severe COVID-19 cases. It notes that cytokine storm can lead to multi-organ failure if left untreated. Tocilizumab works by inhibiting IL-6 receptors to mitigate the cytokine release syndrome. The document reviews several clinical trials that show tocilizumab may reduce mortality and decrease the need for mechanical ventilation in hospitalized COVID-19 patients experiencing severe pneumonia. It provides guidelines on patient selection, dosage, contraindications, and monitoring for safe administration of tocilizumab. The key takeaway is that anti-IL6 medications could benefit severe COVID-19 patients if given early before organ failure,
This document provides guidelines for the diagnosis, treatment, and prevention of community-acquired pneumonia (CAP) in immunocompetent adults. It discusses CAP definitions, epidemiology, risk factors, clinical presentation, diagnostic testing including chest x-rays and microbiological studies, site of care decisions, and treatment recommendations. The guidelines outline criteria for hospital admission and recommend empiric antibiotic therapy based on a patient's risk level, with combinations of beta-lactams, macrolides, or fluoroquinolones depending on severity of illness.
Mucormycosis is a serious fungal infection caused by exposure to mucor mold spores, usually through inhalation. It most often affects people who have health problems that weaken the immune system, such as diabetes, cancer, or those taking immunosuppressive drugs. The infection can cause sinus, lung, or brain infections and is life-threatening without prompt treatment with antifungal drugs and sometimes surgery. Managing any underlying health conditions contributing to a weakened immune system is also important for treatment. Prognosis depends on early diagnosis and treatment as well as the patient's overall health status.
Community-acquired pneumonia (CAP) is a common infectious disease worldwide and a major cause of mortality and morbidity. The document discusses definitions, etiology, risk factors, diagnosis, and treatment recommendations for CAP according to guidelines from IDSA/ATS. Key points include common bacterial and atypical pathogens causing typical and atypical CAP; use of severity assessment scores to determine hospitalization and ICU needs; recommendations for empirical antibiotic therapy based on patient factors; and considerations for MRSA coverage and broad-spectrum therapy.
This 67-year-old woman with mild Alzheimer's disease presents with community-acquired pneumonia based on symptoms of productive cough, fever, confusion and exam findings of crackles in both lower lung fields and CXR infiltrates. She meets 3 CURB-65 criteria (confusion, RR≥30, age≥65) and 4 IDSA-ATS minor criteria (RR≥30, confusion, BUN>20, PaO2/FiO2<250) warranting consideration of ICU admission given risk of deterioration. Based on her nursing home residence and recent hospitalization, she also meets criteria for possible healthcare-associated pneumonia and should receive broad-spectrum antibiotics with MRSA and Pseudomonas coverage along with diagnostic
Although there are no large epidemiological studies from India, mortality data on total number of deaths from lower respiratory tract infection are available. Whereas the world wide mortality of CAP in hospitalised patients varies from 14%–50%, the reported mortality in India varies from 3.3% to 40% with higher rates in elderly & in those requiring intensive care unit (ICU) care. Use of clinical scores like CURB-65, & CRB 65 help to stratify risk of severe disease & need for hospitalisation & ICU care. Early initiation of appropriate antibiotic based upon the knowledge of local resistant patterns of existing pathogens is the key for successful treatment.
The document discusses the use of anti-inflammatory drugs to treat COVID-19. It explains that early in the infection, the disease is driven by viral replication, while later it is driven by an exaggerated immune response causing tissue damage. Anti-inflammatory therapies are likely more beneficial in later stages. Tocilizumab, an IL-6 inhibitor, is discussed as a potential treatment for its "cytokine storm". Studies on tocilizumab show mixed results, with some trials like REMAP-CAP showing reduced need for ventilation and others like COVACTA not meeting primary endpoints. The document provides dosage recommendations and warnings for tocilizumab use in COVID-19 patients.
This document provides an overview of pneumonia, including its definition, epidemiology, etiology, clinical features, diagnosis, severity assessment, management, and treatment guidelines. It discusses community-acquired pneumonia and outlines 4 patient categories based on risk factors and symptoms. Key points include that pneumonia has many potential causes, symptoms often include cough and fever, and treatment involves antibiotics with consideration of atypical pathogens and severity of illness. Hospitalization is recommended for higher-risk patients or those not improving after 2 days.
This document discusses the role of anti-IL6 medications like tocilizumab in treating the cytokine storm seen in severe COVID-19 cases. It notes that cytokine storm can lead to multi-organ failure if left untreated. Tocilizumab works by inhibiting IL-6 receptors to mitigate the cytokine release syndrome. The document reviews several clinical trials that show tocilizumab may reduce mortality and decrease the need for mechanical ventilation in hospitalized COVID-19 patients experiencing severe pneumonia. It provides guidelines on patient selection, dosage, contraindications, and monitoring for safe administration of tocilizumab. The key takeaway is that anti-IL6 medications could benefit severe COVID-19 patients if given early before organ failure,
This document provides guidelines for the diagnosis, treatment, and prevention of community-acquired pneumonia (CAP) in immunocompetent adults. It discusses CAP definitions, epidemiology, risk factors, clinical presentation, diagnostic testing including chest x-rays and microbiological studies, site of care decisions, and treatment recommendations. The guidelines outline criteria for hospital admission and recommend empiric antibiotic therapy based on a patient's risk level, with combinations of beta-lactams, macrolides, or fluoroquinolones depending on severity of illness.
Mucormycosis is a serious fungal infection caused by exposure to mucor mold spores, usually through inhalation. It most often affects people who have health problems that weaken the immune system, such as diabetes, cancer, or those taking immunosuppressive drugs. The infection can cause sinus, lung, or brain infections and is life-threatening without prompt treatment with antifungal drugs and sometimes surgery. Managing any underlying health conditions contributing to a weakened immune system is also important for treatment. Prognosis depends on early diagnosis and treatment as well as the patient's overall health status.
Community acquired pneumonia by dr md abdullah saleemsaleem051
This document provides information on community-acquired pneumonia (CAP), including epidemiology, risk factors, presentation, diagnosis, treatment recommendations, and prevention strategies. It notes that CAP is one of the most common infectious diseases worldwide, with higher rates among the elderly. Common bacterial causes are Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis. Clinical assessment and chest imaging are important for diagnosis and management. Antibiotic treatment should be based on likely pathogens and severity of illness. Immunization can help prevent CAP in high-risk groups.
Sepsis is a life-threatening condition that arises from the body's response to infection. It can cause tissue damage and organ failure. Signs of sepsis include fever, rapid breathing and heart rate, low blood pressure, and confusion. Sepsis is diagnosed based on signs of infection along with indicators of organ dysfunction. Common causes are bacterial and fungal infections. Treatment involves timely administration of antibiotics, IV fluids, and organ support such as ventilation or dialysis. Antibiotic therapy, source control, fluid therapy, and hemodynamic management are key to treatment. Early recognition and treatment improve outcomes for sepsis patients.
This document discusses fever in the intensive care unit. It begins with definitions of terms like fever and hypothermia. It then discusses the pathogenesis and significance of fever. Fever can both enhance immune function but also lead to poor outcomes in some cases like stroke patients. In the ICU, fever often complicates many admissions and can be caused by infectious or non-infectious etiologies. Common infectious causes are discussed like ventilator-associated pneumonia, catheter-associated bloodstream infections, and urinary tract infections. Non-infectious causes such as drug reactions, adrenal crisis, and blood transfusions are also outlined. The document concludes with a discussion of antibiotic use and strategies to optimize treatment in the ICU.
abscess advanced trauma life support anterior open bite antibiotics braces csf leaks dental diseases doxycycline dr dr shabeel drshabeel’s face eye trauma gingival infection medical medicine periodontal gum surgery pharmacy pn
BACTERIAL SEPSIS AT THE PEDATRIC INTENSIVE CARE UNITJohannaLomuljo1
Bacterial sepsis is a common reason for children requiring intensive care. It occurs when a systemic inflammatory response develops in response to a suspected or proven bacterial infection. Early and aggressive fluid resuscitation and antibiotic treatment are important for management. Antibiotic selection should consider likely pathogens, resistance patterns, and individual patient risk factors. Ongoing monitoring and potential escalation of care is often needed to support organ function and reverse shock in severe cases of sepsis.
Tuberculosis is a bacterial infection that primarily affects the lungs and is spread through inhaling droplets from infected individuals. It is a global health problem that kills over 5,000 people per day. Risk factors include immunocompromised status, drug/alcohol abuse, lack of healthcare, and living in close quarters with an infected individual. Symptoms can include cough, weight loss, fever, and night sweats. Diagnosis involves tests of sputum, skin, blood, and imaging. Treatment requires a multi-drug regimen over a period of 6-12 months under direct observation to prevent drug resistance.
Room a a07. mcgee-procalcitonin to predict ss and guide therapy_(en)SoM
This case involves a 78-year-old female who presented with respiratory distress and was intubated. Her initial labwork showed an elevated white blood cell count, bands, and procalcitonin of 2.7 ng/mL, suggesting possible sepsis. She had multiple comorbidities including diabetes, hypertension, prior UTIs, and received TPN through a port. Her clinical picture and labs were concerning for sepsis possibly related to her port. Close monitoring of her procalcitonin and other markers over subsequent days would help guide management and predict her clinical course.
This document discusses maternal sepsis. It begins with an introduction on maternal health and mortality rates. It then discusses why sepsis is an important cause of maternal mortality, accounting for up to 15% globally. The Surviving Sepsis Campaign is described as an initiative to reduce sepsis mortality through protocolized care bundles. The 6-hour and 24-hour bundles are summarized, focusing on early antibiotics, lactate measurement, fluid resuscitation, and glucose control. Empiric antibiotic selection and considering additional interventions like surgery are also mentioned.
This document discusses antibiotic strategy in community-acquired pneumonia (CAP). It begins by classifying different types of pneumonia, such as CAP, HCAP, HAP, ICUAP, and VAP. It then discusses definitions, clinical diagnosis, bacteriological diagnosis, pathogenesis, severity scoring using PSI and CURB-65, treatment recommendations based on location and severity, special considerations, treatment duration, and prevention strategies for CAP. The overall document provides guidance on evaluating and managing antibiotic treatment for CAP.
This document discusses febrile neutropenia, which is a common complication of chemotherapy that often requires hospitalization. It defines febrile neutropenia and grades of neutropenia. Prevention is important as it can lead to significant morbidity and mortality if treatment is delayed. The use of colony stimulating factors and antibiotics are discussed for prevention and treatment. Hospitalization is usually required for high risk patients while low risk patients may be treated as outpatients.
Contrast Simulation Study material 20150509.pptAIDA BORLAZA
This document provides guidelines for contrast reactions and their management from the American College of Radiology (ACR). It discusses various types of intravenous contrast media and their risks. Adverse reactions can range from mild to severe/life-threatening and include contrast-induced nephrotoxicity and nephrogenic systemic fibrosis. The document outlines Boston Medical Center's premedication regime using steroids and antihistamines to reduce reaction risk. It also provides guidance on assessing and treating acute contrast reactions according to their severity per ACR guidelines.
Community Acquired Pneumonia can be caused by various pathogens including bacteria, viruses, and fungi. The document discusses classifications of pneumonia based on location and acquisition. It focuses on community acquired pneumonia, describing the most common pathogens such as Streptococcus pneumoniae. Severity assessment is important for determining appropriate treatment setting and prognosis. Several prognostic severity scales are discussed including the Pneumonia Severity Index (PSI), CURB-65, and CRB-65, which stratify patients into risk groups to help decide between outpatient or inpatient care.
Antibiotic Strategy in Lower Respiratory Tract Infections (part 1)Gamal Agmy
This document summarizes guidelines for empiric antibiotic treatment of lower respiratory tract infections such as community-acquired pneumonia. It recommends using a clinical prediction rule like the Pneumonia Severity Index in addition to clinical judgment to determine whether patients should be treated as outpatients or inpatients. For outpatient treatment of CAP, it recommends amoxicillin, doxycycline, or macrolides depending on patient risk factors and local resistance patterns. For inpatient treatment of non-severe CAP without risk of MRSA or Pseudomonas, it recommends beta-lactam plus macrolide or fluoroquinolone monotherapy. It does not recommend routinely adding anaerobic coverage or extended-spectrum antibiotics without
Tuberculosis is a chronic bacterial infection caused by Mycobacterium tuberculosis that primarily affects the lungs. It spreads through inhaling droplets from an infected person when they cough, sneeze or laugh. Common symptoms include cough, weight loss, fever and night sweats. TB can spread to other organs if not treated properly. Diagnosis involves tests such as chest x-rays, sputum smear and culture, and tuberculin skin tests. Treatment requires taking multiple antibiotics daily for 6-12 months. Directly observed treatment is important to ensure compliance and prevent drug resistance.
Tuberculosis is a bacterial infection that primarily affects the lungs and is caused by Mycobacterium tuberculosis. It spreads through inhaling droplets from the coughs or sneezes of an infected individual. Common symptoms include cough, weight loss, and fever. Diagnosis involves tests such as chest x-rays, sputum smear and culture, and tuberculin skin tests. Treatment consists of a multi-drug regimen over a period of 6-12 months to prevent drug resistance. Patient education and directly observed treatment are important for ensuring adherence and controlling the spread of the disease.
Ventilator-associated pneumonia (VAP) is a common infection in mechanically ventilated patients. The risk of developing VAP increases the longer a patient requires ventilation. Early-onset VAP is usually caused by bacteria that normally inhabit the mouth and throat, while late-onset VAP is often caused by more resistant bacteria. Diagnosis of VAP requires evaluating clinical signs along with testing lower respiratory tract secretions. Prevention strategies aim to reduce bacterial contamination and aspiration, including oral care, elevation of the head, and careful management of tubes.
Legionnaires' disease is a form of atypical pneumonia caused by Legionella bacteria, mainly L. pneumophila. It is contracted through inhalation of contaminated aerosolized water droplets. Risk factors include smoking, immunosuppression, and age over 50. Symptoms include fever, cough, shortness of breath, and confusion. Diagnosis involves urine antigen testing, culture, or PCR. Treatment guidelines recommend macrolides or fluoroquinolones. Prevention focuses on maintaining cooling towers and water systems to avoid bacterial growth.
The document provides information on sepsis definitions, pathophysiology, and assessment tools. It discusses:
1) The 1992 and 2001 consensus definitions of sepsis, severe sepsis, and septic shock based on SIRS criteria and organ dysfunction.
2) The key pathophysiological processes in sepsis including dysregulated inflammation, coagulation, fibrinolysis and endothelial dysfunction which can lead to organ failure.
3) Limitations of the SIRS criteria and introduction of newer assessment tools like qSOFA and SOFA score which include clinical variables and lab markers to better predict patient outcomes.
Principle of antibiotic use in pulmonary infectionsSami Eldahdouh
This document provides guidelines for the appropriate use of antibiotics in pulmonary infections. It discusses the importance of selecting the correct antibiotic as well as optimal dosing and route of administration. Certain properties of antibiotics, such as tissue concentration, mechanism of action, and time-dependent versus concentration-dependent killing, should be considered when selecting a dosing regimen. Community-acquired pneumonia can usually be treated as an outpatient, but inpatient treatment may be required for more severe cases or those with risk factors. Initial treatment depends on severity and risk of drug-resistant pathogens. Duration of therapy is typically 5 days but may be longer for complicated cases.
This presentation by Professor Alex Robson, Deputy Chair of Australia’s Productivity Commission, was made during the discussion “Competition and Regulation in Professions and Occupations” held at the 77th meeting of the OECD Working Party No. 2 on Competition and Regulation on 10 June 2024. More papers and presentations on the topic can be found at oe.cd/crps.
This presentation was uploaded with the author’s consent.
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Community acquired pneumonia by dr md abdullah saleemsaleem051
This document provides information on community-acquired pneumonia (CAP), including epidemiology, risk factors, presentation, diagnosis, treatment recommendations, and prevention strategies. It notes that CAP is one of the most common infectious diseases worldwide, with higher rates among the elderly. Common bacterial causes are Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis. Clinical assessment and chest imaging are important for diagnosis and management. Antibiotic treatment should be based on likely pathogens and severity of illness. Immunization can help prevent CAP in high-risk groups.
Sepsis is a life-threatening condition that arises from the body's response to infection. It can cause tissue damage and organ failure. Signs of sepsis include fever, rapid breathing and heart rate, low blood pressure, and confusion. Sepsis is diagnosed based on signs of infection along with indicators of organ dysfunction. Common causes are bacterial and fungal infections. Treatment involves timely administration of antibiotics, IV fluids, and organ support such as ventilation or dialysis. Antibiotic therapy, source control, fluid therapy, and hemodynamic management are key to treatment. Early recognition and treatment improve outcomes for sepsis patients.
This document discusses fever in the intensive care unit. It begins with definitions of terms like fever and hypothermia. It then discusses the pathogenesis and significance of fever. Fever can both enhance immune function but also lead to poor outcomes in some cases like stroke patients. In the ICU, fever often complicates many admissions and can be caused by infectious or non-infectious etiologies. Common infectious causes are discussed like ventilator-associated pneumonia, catheter-associated bloodstream infections, and urinary tract infections. Non-infectious causes such as drug reactions, adrenal crisis, and blood transfusions are also outlined. The document concludes with a discussion of antibiotic use and strategies to optimize treatment in the ICU.
abscess advanced trauma life support anterior open bite antibiotics braces csf leaks dental diseases doxycycline dr dr shabeel drshabeel’s face eye trauma gingival infection medical medicine periodontal gum surgery pharmacy pn
BACTERIAL SEPSIS AT THE PEDATRIC INTENSIVE CARE UNITJohannaLomuljo1
Bacterial sepsis is a common reason for children requiring intensive care. It occurs when a systemic inflammatory response develops in response to a suspected or proven bacterial infection. Early and aggressive fluid resuscitation and antibiotic treatment are important for management. Antibiotic selection should consider likely pathogens, resistance patterns, and individual patient risk factors. Ongoing monitoring and potential escalation of care is often needed to support organ function and reverse shock in severe cases of sepsis.
Tuberculosis is a bacterial infection that primarily affects the lungs and is spread through inhaling droplets from infected individuals. It is a global health problem that kills over 5,000 people per day. Risk factors include immunocompromised status, drug/alcohol abuse, lack of healthcare, and living in close quarters with an infected individual. Symptoms can include cough, weight loss, fever, and night sweats. Diagnosis involves tests of sputum, skin, blood, and imaging. Treatment requires a multi-drug regimen over a period of 6-12 months under direct observation to prevent drug resistance.
Room a a07. mcgee-procalcitonin to predict ss and guide therapy_(en)SoM
This case involves a 78-year-old female who presented with respiratory distress and was intubated. Her initial labwork showed an elevated white blood cell count, bands, and procalcitonin of 2.7 ng/mL, suggesting possible sepsis. She had multiple comorbidities including diabetes, hypertension, prior UTIs, and received TPN through a port. Her clinical picture and labs were concerning for sepsis possibly related to her port. Close monitoring of her procalcitonin and other markers over subsequent days would help guide management and predict her clinical course.
This document discusses maternal sepsis. It begins with an introduction on maternal health and mortality rates. It then discusses why sepsis is an important cause of maternal mortality, accounting for up to 15% globally. The Surviving Sepsis Campaign is described as an initiative to reduce sepsis mortality through protocolized care bundles. The 6-hour and 24-hour bundles are summarized, focusing on early antibiotics, lactate measurement, fluid resuscitation, and glucose control. Empiric antibiotic selection and considering additional interventions like surgery are also mentioned.
This document discusses antibiotic strategy in community-acquired pneumonia (CAP). It begins by classifying different types of pneumonia, such as CAP, HCAP, HAP, ICUAP, and VAP. It then discusses definitions, clinical diagnosis, bacteriological diagnosis, pathogenesis, severity scoring using PSI and CURB-65, treatment recommendations based on location and severity, special considerations, treatment duration, and prevention strategies for CAP. The overall document provides guidance on evaluating and managing antibiotic treatment for CAP.
This document discusses febrile neutropenia, which is a common complication of chemotherapy that often requires hospitalization. It defines febrile neutropenia and grades of neutropenia. Prevention is important as it can lead to significant morbidity and mortality if treatment is delayed. The use of colony stimulating factors and antibiotics are discussed for prevention and treatment. Hospitalization is usually required for high risk patients while low risk patients may be treated as outpatients.
Contrast Simulation Study material 20150509.pptAIDA BORLAZA
This document provides guidelines for contrast reactions and their management from the American College of Radiology (ACR). It discusses various types of intravenous contrast media and their risks. Adverse reactions can range from mild to severe/life-threatening and include contrast-induced nephrotoxicity and nephrogenic systemic fibrosis. The document outlines Boston Medical Center's premedication regime using steroids and antihistamines to reduce reaction risk. It also provides guidance on assessing and treating acute contrast reactions according to their severity per ACR guidelines.
Community Acquired Pneumonia can be caused by various pathogens including bacteria, viruses, and fungi. The document discusses classifications of pneumonia based on location and acquisition. It focuses on community acquired pneumonia, describing the most common pathogens such as Streptococcus pneumoniae. Severity assessment is important for determining appropriate treatment setting and prognosis. Several prognostic severity scales are discussed including the Pneumonia Severity Index (PSI), CURB-65, and CRB-65, which stratify patients into risk groups to help decide between outpatient or inpatient care.
Antibiotic Strategy in Lower Respiratory Tract Infections (part 1)Gamal Agmy
This document summarizes guidelines for empiric antibiotic treatment of lower respiratory tract infections such as community-acquired pneumonia. It recommends using a clinical prediction rule like the Pneumonia Severity Index in addition to clinical judgment to determine whether patients should be treated as outpatients or inpatients. For outpatient treatment of CAP, it recommends amoxicillin, doxycycline, or macrolides depending on patient risk factors and local resistance patterns. For inpatient treatment of non-severe CAP without risk of MRSA or Pseudomonas, it recommends beta-lactam plus macrolide or fluoroquinolone monotherapy. It does not recommend routinely adding anaerobic coverage or extended-spectrum antibiotics without
Tuberculosis is a chronic bacterial infection caused by Mycobacterium tuberculosis that primarily affects the lungs. It spreads through inhaling droplets from an infected person when they cough, sneeze or laugh. Common symptoms include cough, weight loss, fever and night sweats. TB can spread to other organs if not treated properly. Diagnosis involves tests such as chest x-rays, sputum smear and culture, and tuberculin skin tests. Treatment requires taking multiple antibiotics daily for 6-12 months. Directly observed treatment is important to ensure compliance and prevent drug resistance.
Tuberculosis is a bacterial infection that primarily affects the lungs and is caused by Mycobacterium tuberculosis. It spreads through inhaling droplets from the coughs or sneezes of an infected individual. Common symptoms include cough, weight loss, and fever. Diagnosis involves tests such as chest x-rays, sputum smear and culture, and tuberculin skin tests. Treatment consists of a multi-drug regimen over a period of 6-12 months to prevent drug resistance. Patient education and directly observed treatment are important for ensuring adherence and controlling the spread of the disease.
Ventilator-associated pneumonia (VAP) is a common infection in mechanically ventilated patients. The risk of developing VAP increases the longer a patient requires ventilation. Early-onset VAP is usually caused by bacteria that normally inhabit the mouth and throat, while late-onset VAP is often caused by more resistant bacteria. Diagnosis of VAP requires evaluating clinical signs along with testing lower respiratory tract secretions. Prevention strategies aim to reduce bacterial contamination and aspiration, including oral care, elevation of the head, and careful management of tubes.
Legionnaires' disease is a form of atypical pneumonia caused by Legionella bacteria, mainly L. pneumophila. It is contracted through inhalation of contaminated aerosolized water droplets. Risk factors include smoking, immunosuppression, and age over 50. Symptoms include fever, cough, shortness of breath, and confusion. Diagnosis involves urine antigen testing, culture, or PCR. Treatment guidelines recommend macrolides or fluoroquinolones. Prevention focuses on maintaining cooling towers and water systems to avoid bacterial growth.
The document provides information on sepsis definitions, pathophysiology, and assessment tools. It discusses:
1) The 1992 and 2001 consensus definitions of sepsis, severe sepsis, and septic shock based on SIRS criteria and organ dysfunction.
2) The key pathophysiological processes in sepsis including dysregulated inflammation, coagulation, fibrinolysis and endothelial dysfunction which can lead to organ failure.
3) Limitations of the SIRS criteria and introduction of newer assessment tools like qSOFA and SOFA score which include clinical variables and lab markers to better predict patient outcomes.
Principle of antibiotic use in pulmonary infectionsSami Eldahdouh
This document provides guidelines for the appropriate use of antibiotics in pulmonary infections. It discusses the importance of selecting the correct antibiotic as well as optimal dosing and route of administration. Certain properties of antibiotics, such as tissue concentration, mechanism of action, and time-dependent versus concentration-dependent killing, should be considered when selecting a dosing regimen. Community-acquired pneumonia can usually be treated as an outpatient, but inpatient treatment may be required for more severe cases or those with risk factors. Initial treatment depends on severity and risk of drug-resistant pathogens. Duration of therapy is typically 5 days but may be longer for complicated cases.
This presentation by Professor Alex Robson, Deputy Chair of Australia’s Productivity Commission, was made during the discussion “Competition and Regulation in Professions and Occupations” held at the 77th meeting of the OECD Working Party No. 2 on Competition and Regulation on 10 June 2024. More papers and presentations on the topic can be found at oe.cd/crps.
This presentation was uploaded with the author’s consent.
Suzanne Lagerweij - Influence Without Power - Why Empathy is Your Best Friend...Suzanne Lagerweij
This is a workshop about communication and collaboration. We will experience how we can analyze the reasons for resistance to change (exercise 1) and practice how to improve our conversation style and be more in control and effective in the way we communicate (exercise 2).
This session will use Dave Gray’s Empathy Mapping, Argyris’ Ladder of Inference and The Four Rs from Agile Conversations (Squirrel and Fredrick).
Abstract:
Let’s talk about powerful conversations! We all know how to lead a constructive conversation, right? Then why is it so difficult to have those conversations with people at work, especially those in powerful positions that show resistance to change?
Learning to control and direct conversations takes understanding and practice.
We can combine our innate empathy with our analytical skills to gain a deeper understanding of complex situations at work. Join this session to learn how to prepare for difficult conversations and how to improve our agile conversations in order to be more influential without power. We will use Dave Gray’s Empathy Mapping, Argyris’ Ladder of Inference and The Four Rs from Agile Conversations (Squirrel and Fredrick).
In the session you will experience how preparing and reflecting on your conversation can help you be more influential at work. You will learn how to communicate more effectively with the people needed to achieve positive change. You will leave with a self-revised version of a difficult conversation and a practical model to use when you get back to work.
Come learn more on how to become a real influencer!
This presentation by Juraj Čorba, Chair of OECD Working Party on Artificial Intelligence Governance (AIGO), was made during the discussion “Artificial Intelligence, Data and Competition” held at the 143rd meeting of the OECD Competition Committee on 12 June 2024. More papers and presentations on the topic can be found at oe.cd/aicomp.
This presentation was uploaded with the author’s consent.
This presentation by OECD, OECD Secretariat, was made during the discussion “Pro-competitive Industrial Policy” held at the 143rd meeting of the OECD Competition Committee on 12 June 2024. More papers and presentations on the topic can be found at oe.cd/pcip.
This presentation was uploaded with the author’s consent.
This presentation by OECD, OECD Secretariat, was made during the discussion “Artificial Intelligence, Data and Competition” held at the 143rd meeting of the OECD Competition Committee on 12 June 2024. More papers and presentations on the topic can be found at oe.cd/aicomp.
This presentation was uploaded with the author’s consent.
This presentation by Thibault Schrepel, Associate Professor of Law at Vrije Universiteit Amsterdam University, was made during the discussion “Artificial Intelligence, Data and Competition” held at the 143rd meeting of the OECD Competition Committee on 12 June 2024. More papers and presentations on the topic can be found at oe.cd/aicomp.
This presentation was uploaded with the author’s consent.
This presentation by OECD, OECD Secretariat, was made during the discussion “Competition and Regulation in Professions and Occupations” held at the 77th meeting of the OECD Working Party No. 2 on Competition and Regulation on 10 June 2024. More papers and presentations on the topic can be found at oe.cd/crps.
This presentation was uploaded with the author’s consent.
Collapsing Narratives: Exploring Non-Linearity • a micro report by Rosie WellsRosie Wells
Insight: In a landscape where traditional narrative structures are giving way to fragmented and non-linear forms of storytelling, there lies immense potential for creativity and exploration.
'Collapsing Narratives: Exploring Non-Linearity' is a micro report from Rosie Wells.
Rosie Wells is an Arts & Cultural Strategist uniquely positioned at the intersection of grassroots and mainstream storytelling.
Their work is focused on developing meaningful and lasting connections that can drive social change.
Please download this presentation to enjoy the hyperlinks!
This presentation by Yong Lim, Professor of Economic Law at Seoul National University School of Law, was made during the discussion “Artificial Intelligence, Data and Competition” held at the 143rd meeting of the OECD Competition Committee on 12 June 2024. More papers and presentations on the topic can be found at oe.cd/aicomp.
This presentation was uploaded with the author’s consent.
This presentation by Nathaniel Lane, Associate Professor in Economics at Oxford University, was made during the discussion “Pro-competitive Industrial Policy” held at the 143rd meeting of the OECD Competition Committee on 12 June 2024. More papers and presentations on the topic can be found at oe.cd/pcip.
This presentation was uploaded with the author’s consent.
Why Psychological Safety Matters for Software Teams - ACE 2024 - Ben Linders.pdfBen Linders
Psychological safety in teams is important; team members must feel safe and able to communicate and collaborate effectively to deliver value. It’s also necessary to build long-lasting teams since things will happen and relationships will be strained.
But, how safe is a team? How can we determine if there are any factors that make the team unsafe or have an impact on the team’s culture?
In this mini-workshop, we’ll play games for psychological safety and team culture utilizing a deck of coaching cards, The Psychological Safety Cards. We will learn how to use gamification to gain a better understanding of what’s going on in teams. Individuals share what they have learned from working in teams, what has impacted the team’s safety and culture, and what has led to positive change.
Different game formats will be played in groups in parallel. Examples are an ice-breaker to get people talking about psychological safety, a constellation where people take positions about aspects of psychological safety in their team or organization, and collaborative card games where people work together to create an environment that fosters psychological safety.
XP 2024 presentation: A New Look to Leadershipsamililja
Presentation slides from XP2024 conference, Bolzano IT. The slides describe a new view to leadership and combines it with anthro-complexity (aka cynefin).
Mastering the Concepts Tested in the Databricks Certified Data Engineer Assoc...SkillCertProExams
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2. 9/18/2023 Dr Fizzah Ali
Objectives
Discuss the management of community acquired pneumonia
Betalactam antibiotics in detail
Macrolides in detail
Fluoroquinolones in detail
3. 9/18/2023 Dr Fizzah Ali
Definition
An acute respiratory illness characterized by clinical and/or
radiological signs of consolidation of a part or parts of one
or both lungs.
4. 9/18/2023 Dr Fizzah Ali
Clinical Definition
Symptoms of acute LRT infection
a) Cough, sputum,chest pain
b) Fever,sweating,shiver, aches and pains
New focal chest signs on examination
OR
New radiographic pulmonary infiltrates
6. 9/18/2023 Dr Fizzah Ali
Types of pneumonia
Community acquired pneumonia
Hospital acquired pneumonia
Supprative or aspirational pneumonia
Pnemonia in Immunocompromised patients
7. 9/18/2023 Dr Fizzah Ali
Typical or Atypical CAP ?
Difficult to differentiate on clinical grounds alone
The term ‘atypical’ is used to refer to a group of organisms
rather than a clinical picture
12. 9/18/2023 Dr Fizzah Ali
CURB 65
CURB-65,, is a clinical prediction rule that has been validated
for predicting mortality in community-acquired pneumonia
Core’ clinical adverse prognostic features
(CURB)
• Confusion mental test ≤ 8
• Urea > 7 mM (>19.1 mg/dL)
• Resp.rate >30 /min
• Blood Pressure: Systolic BP < 90 mm Hg and/or diastolic BP
≤ 60 mmHg
• Age < 65
NOTE: Patients with 2 or more CURB are at high risk of death
13. 9/18/2023 Dr Fizzah Ali
Severity assessment in CAP in the
community (CRB-65 score)
1-2 suitable for home
treatment
3-4 Needs hospital referral
14. 9/18/2023 Dr Fizzah Ali
Pneumonia Severity Index (PSI)
Class I is determined by absence of the following risk factors:
• Age > 50 or temperature > 40°C
Class II - V is determined by a patient’s total risk score, which
in addition to the risk factors above, include
Demographic factors (male sex and nursing home residence)
and seven laboratory or radiographic findings:
• BUN concentration >30 mg/dL
• Glucose concentration >250 mg/dL
• Hematocrit <30%
• Sodium concentration <130 mmol/L
• Partial pressure of oxygen <60 mmHg
• Arterial pH <7.35
• Pleural effusion
Class IV/V suggests severe/life-threatening CAP.
16. Infectious Diseases Society of America/American Thoracic Society
Criteria for Defining Severe Community-acquired Pneumonia
Validated definition includes either one major criterion or three or more minor criteria
Minor criteria
Respiratory rate ≥ 30 breaths/min
PaO2/FIO2 ratio ≤ 250
Multilobar infiltrates
Confusion/disorientation
Uremia (blood urea nitrogen level ≥ 20 mg/dl)
Leukopenia* (white blood cell count < 4,000 cells/μl)
Thrombocytopenia (platelet count < 100,000/μl)
Hypothermia (core temperature < 36°C)
Hypotension requiring aggressive fluid resuscitation
Major criteria
Septic shock with need for vasopressors
Respiratory failure requiring mechanical ventilation
9/18/2023 https://www.atsjournals.org/doi/full/10.1164/rccm.201908-1581ST
17. Infectious Diseases Society of America/American Thoracic Society Criteria for Defining Severe Community-acquired
Pneumonia
Validated definition includes either one major criterion or three or more minor criteria
Minor criteria
Respiratory rate ≥ 30 breaths/min
PaO2/FIO2 ratio ≤ 250
Multilobar infiltrates
Confusion/disorientation
Uremia (blood urea nitrogen level ≥ 20 mg/dl)
Leukopenia* (white blood cell count < 4,000 cells/μl)
Thrombocytopenia (platelet count < 100,000/μl)
Hypothermia (core temperature < 36°C)
Hypotension requiring aggressive fluid resuscitation
Major criteria
Septic shock with need for vasopressors
Respiratory failure requiring mechanical ventilation
9/18/2023 https://www.atsjournals.org/doi/full/10.1164/rccm.201908-1581ST
21. 9/18/2023 Dr Fizzah Ali
Therapy Principles
All admitted patients should receive first antibiotic
dose within 8 hours of arrival to the hospital
All populations should be treated for the possibility of
atypical pathogens
Upto 10% of all CAP patients will not respond to
initial therapy. A diagnostic evaluation is mandatory
26. 9/18/2023 Dr Fizzah Ali
Mechanism of Action
Inhibit cell wall synthesis by binding of the drug to specific
enzymes (penicillin-binding proteins [PBPs]) located in the
bacterial cytoplasmic membrane;
Inhibition of the transpeptidation reaction that cross-links
the linear peptidoglycan chain constituents of the cell wall;
Activation of autolytic enzymes that cause lesions in the
bacterial cell wall.
Enzymatic hydrolysis of the beta-lactam ring results in loss of
antibacterial activity ..
29. 9/18/2023 Dr Fizzah Ali
Resistance
Inactivation of antibiotic by beta lactamases
Modification of target PBPs.
Impaired penetration of drug to target PBPs.
Efflux
30. 9/18/2023 Dr Fizzah Ali
Penicillins indication
The indications for penicillins vary depending on penicillins group.
Natural penicillins are used in:
Infections caused by S.pyogenes, and their consequences:
tonsilopharyngitis
scarlet fever
erysipelas
year-round rheumatism prevention.
Infections caused by S.pneumoniae:
community-acquired pneumonia
meningitis
sepsis
Infections caused by other streptococci:
Infective endocarditis (in combination with gentamicin or
streptomycin);
Meningococcal infections (meningitis)
Syphilis
Leptospirosis
Tick-borne borreliosis (Lyme disease)
Gangrenous emphysema
Actinomycosis
31. 9/18/2023 Dr Fizzah Ali
PHARMAKOKINETICS
Except for oral amoxicillin
Penicillin should be given 1-2 hrs before meal.
Amoxicillin is well absorbed orally
Penicillin is xcreated by kidneys
Naficillin is cleared by biliary excretion
37. 9/18/2023 Dr Fizzah Ali
Cephalosporin
They are beta lactam antibiotics
Chemically similar to penicillin, so it shares the mechanism of
action and adverse effects with that
40. 9/18/2023 Dr Fizzah Ali
Macrolides
Azithromycin
Clarithromycin
Erythromycin
Mechanism of action:
Macrolides bind irreversibly to a site on the 50S subunit of the
bacterial ribosome thus inhibiting translocation steps of protein
synthesis.
They also interefere with transpeptidation
42. 9/18/2023 Dr Fizzah Ali
Resistance:
by post-transcriptional methylation of the 23S bacterial
ribosomal RNA
production of drug-inactivating enzymes (esterases or kinases)
production of active ATP-dependent efflux proteins that
transport the drug outside of the cell.
43. 9/18/2023 Dr Fizzah Ali
Adverse Effects
Gastric distress
May prolong the QT interval
Ototoxicity
Cholestatic jaundice
Combination of some macrolides and statins is not advisable and
can lead to debilitating myopathy.
This is because some macrolides (clarithromycin and
erythromycin, not azithromycin) are potent inhibitors of the
cytochrome P450 system, particularly of CYP3A4.
45. Fluoroquinolones
Fluoroquinolones are a class
of antibiotics approved to treat bacterial
infection.
The fluoroquinolone antibiotics
include ciprofloxacin, gemifloxacin, levofloxac
in, moxifloxacin, and ofloxacin
9/18/2023 Dr Fizzah Ali
46. Mechanism of action
Fluoroquinolones act by inhibiting two
enzymes involved in bacterial DNA synthesis,
both of which are DNA topoisomerases that
human cells lack and that are essential for
bacterial DNA replication, thereby enabling
these agents to be both specific and
bactericidal.
9/18/2023 Dr Fizzah Ali
49. 9/18/2023 Dr Fizzah Ali
Prevention
Influenza vaccine
Younger patients at risk
- Chronic cardiovascular and pulmonary diseases
- Renal and metabolic disease
- Immune deficiency
- Nursing home residents and health care workers
51. 9/18/2023 Dr Fizzah Ali
Prevention
23-valent polysaccharide pneumococcal vaccine
90 percent of the serotypes are included in the 23
valent vaccine
70 % response in the general population
Lower in immunocompromised patients and those
on maintenance dialysis