13_Respiratory_distress_16-Sep-09[1].ppt
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This document provides guidance on assessing and treating a child presenting with respiratory distress. It outlines the key signs that determine severity, including inability to drink, reduced consciousness, grunting, and fast breathing rates. The most common causes of respiratory distress in children are pneumonia, malaria, asthma, anaemia, and dehydration. The document provides a decision tree to systematically evaluate the child, identify the most likely causes based on presenting signs, and determine the appropriate treatment and level of care needed.
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Cancer remains one of the leading causes of death worldwide, prompting the need for innovative treatment methods. Nanotechnology offers promising new approaches, including the use of gold nanoparticles (nanogold) for targeted cancer therapy. Nanogold particles possess unique physical and chemical properties that make them suitable for drug delivery, imaging, and photothermal therapy.
The Nervous and Chemical Regulation of Respiration
These lecture slides, by Dr Sidra Arshad, offer a simplified look into the mechanisms involved in the regulation of respiration:
Learning objectives:
1. Describe the organisation of respiratory center
2. Describe the nervous control of inspiration and respiratory rhythm
3. Describe the functions of the dorsal and respiratory groups of neurons
4. Describe the influences of the Pneumotaxic and Apneustic centers
5. Explain the role of Hering-Breur inflation reflex in regulation of inspiration
6. Explain the role of central chemoreceptors in regulation of respiration
7. Explain the role of peripheral chemoreceptors in regulation of respiration
8. Explain the regulation of respiration during exercise
9. Integrate the respiratory regulatory mechanisms
10. Describe the Cheyne-Stokes breathing
Study Resources:
1. Chapter 42, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 36, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 13, Human Physiology by Lauralee Sherwood, 9th edition
Top Travel Vaccinations in Manchester
Travel vaccination in Manchester offers comprehensive immunization services for individuals planning international trips. Expert healthcare providers administer vaccines tailored to your destination, ensuring you stay protected against various diseases. Conveniently located clinics and flexible appointment options make it easy to get the necessary shots before your journey. Stay healthy and travel with confidence by getting vaccinated in Manchester. Visit us: www.nxhealthcare.co.uk
STUDIES IN SUPPORT OF SPECIAL POPULATIONS: GERIATRICS E7
Unit 4: MRA 103T Regulatory affairs
This guideline is directed principally toward new Molecular Entities that are
likely to have significant use in the elderly, either because the disease intended
to be treated is characteristically a disease of aging ( e.g., Alzheimer's disease) or
because the population to be treated is known to include substantial numbers of
geriatric patients (e.g., hypertension).
Breast cancer: Post menopausal endocrine therapy
Breast cancer in postmenopausal women with hormone receptor-positive (HR+) status is a common and complex condition that necessitates a multifaceted approach to management. HR+ breast cancer means that the cancer cells grow in response to hormones such as estrogen and progesterone. This subtype is prevalent among postmenopausal women and typically exhibits a more indolent course compared to other forms of breast cancer, which allows for a variety of treatment options.
Diagnosis and Staging
The diagnosis of HR+ breast cancer begins with clinical evaluation, imaging, and biopsy. Imaging modalities such as mammography, ultrasound, and MRI help in assessing the extent of the disease. Histopathological examination and immunohistochemical staining of the biopsy sample confirm the diagnosis and hormone receptor status by identifying the presence of estrogen receptors (ER) and progesterone receptors (PR) on the tumor cells.
Staging involves determining the size of the tumor (T), the involvement of regional lymph nodes (N), and the presence of distant metastasis (M). The American Joint Committee on Cancer (AJCC) staging system is commonly used. Accurate staging is critical as it guides treatment decisions.
Treatment Options
Endocrine Therapy
Endocrine therapy is the cornerstone of treatment for HR+ breast cancer in postmenopausal women. The primary goal is to reduce the levels of estrogen or block its effects on cancer cells. Commonly used agents include:
Selective Estrogen Receptor Modulators (SERMs): Tamoxifen is a SERM that binds to estrogen receptors, blocking estrogen from stimulating breast cancer cells. It is effective but may have side effects such as increased risk of endometrial cancer and thromboembolic events.
Aromatase Inhibitors (AIs): These drugs, including anastrozole, letrozole, and exemestane, lower estrogen levels by inhibiting the aromatase enzyme, which converts androgens to estrogen in peripheral tissues. AIs are generally preferred in postmenopausal women due to their efficacy and safety profile compared to tamoxifen.
Selective Estrogen Receptor Downregulators (SERDs): Fulvestrant is a SERD that degrades estrogen receptors and is used in cases where resistance to other endocrine therapies develops.
Combination Therapies
Combining endocrine therapy with other treatments enhances efficacy. Examples include:
Endocrine Therapy with CDK4/6 Inhibitors: Palbociclib, ribociclib, and abemaciclib are CDK4/6 inhibitors that, when combined with endocrine therapy, significantly improve progression-free survival in advanced HR+ breast cancer.
Endocrine Therapy with mTOR Inhibitors: Everolimus, an mTOR inhibitor, can be added to endocrine therapy for patients who have developed resistance to aromatase inhibitors.
Chemotherapy
Chemotherapy is generally reserved for patients with high-risk features, such as large tumor size, high-grade histology, or extensive lymph node involvement. Regimens often include anthracyclines and taxanes.
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PGx Analysis in VarSeq: A User’s Perspective
Since our release of the PGx capabilities in VarSeq, we’ve had a few months to gather some insights from various use cases. Some users approach PGx workflows by means of array genotyping or what seems to be a growing trend of adding the star allele calling to the existing NGS pipeline for whole genome data. Luckily, both approaches are supported with the VarSeq software platform. The genotyping method being used will also dictate what the scope of the tertiary analysis will be. For example, are your PGx reports a standalone pipeline or would your lab’s goal be to handle a dual-purpose workflow and report on PGx + Diagnostic findings.
The purpose of this webcast is to:
Discuss and demonstrate the approaches with array and NGS genotyping methods for star allele calling to prep for downstream analysis.
Following genotyping, explore alternative tertiary workflow concepts in VarSeq to handle PGx reporting.
Moreover, we will include insights users will need to consider when validating their PGx workflow for all possible star alleles and options you have for automating your PGx analysis for large number of samples. Please join us for a session dedicated to the application of star allele genotyping and subsequent PGx workflows in our VarSeq software.
Pharmacology of 5-hydroxytryptamine and Antagonist
5-hydroxytryptamine or 5-HT or Serotonin is a neurotransmitter that serves a range of roles in the human body. It is sometimes referred to as the happy chemical since it promotes overall well-being and happiness.
It is mostly found in the brain, intestines, and blood platelets.
5-HT is utilised to transport messages between nerve cells, is known to be involved in smooth muscle contraction, and adds to overall well-being and pleasure, among other benefits. 5-HT regulates the body's sleep-wake cycles and internal clock by acting as a precursor to melatonin.
It is hypothesised to regulate hunger, emotions, motor, cognitive, and autonomic processes.
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13_Respiratory_distress_16-Sep-09[1].ppt
- 1. The child with respiratory distress and an acute illness
- 2. What is this child’s problem?
- 3. Respiratory Distress Lung / Airway Disease • Acute Pneumonia • PTB • HIV • Stridor: – Croup (LTB) – Epiglottitis Systemic Disease • Malaria • Severe Anaemia • Severe dehydration • Heart Disease • Renal Disease
- 4. How severe is respiratory distress – Cough or Difficult Breathing 1 Cyanosed? Unable to drink? Reduced level of consciousness? Grunting (infants)? Lower chest wall indrawing? RR ≥ 50 aged 2 –11 months? RR ≥ 40 aged 1 – 4 yrs? Very Severe Pneumonia Severe Pneumonia Pneumonia None of the above? No Pneumonia Y Y Y Y
- 5. How severe is respiratory distress – Cough or Difficult Breathing 2 Cyanosed? Unable to drink? Reduced level of consciousness? Grunting (infants)? Very Severe Pneumonia Y High Risk of Death High Risk of Hypoxaemia = Need Oxygen May need fluid / feeding support Require Broad Spectrum Antibiotics
- 6. How severe is respiratory distress – Cough or Difficult Breathing 3 Lower chest wall indrawing? Severe Pneumonia Y Some Risk of Death = Need Admission Can feed orally Require Simple Antibiotics = Penicillin, and Observe for improvement / deterioration
- 7. How severe is respiratory distress – Cough or Difficult Breathing 4 RR ≥ 50 aged 2 –11 months? RR ≥ 40 aged 1 – 4 yrs? Pneumonia Y Not severely ill = Outpatient care Can feed orally Require Simple Antibiotics = Co-trimoxazole (Amoxicillin), and Review in 2-3 days for improvement / deterioration
- 8. Cause of Respiratory Distress 1? 12 months Difficult Breathing, AVPU = P RR = 43/min Indrawing +ve Blood Slide
- 9. Cause of Respiratory Distress 2? 12 months Difficult Breathing, AVPU = P RR = 43/min Indrawing +ve Blood Slide Very Severe Pneumonia Difficult breathing and AVPU = P
- 10. Cause of Respiratory Distress 3? 12 months Difficult Breathing, AVPU = P RR = 43/min Indrawing +ve Blood Slide Very Severe Pneumonia Difficult breathing and AVPU = P Severe Malaria with Respiratory Distress Difficult breathing, Indrawing AVPU = P, and +ve Blood Slide
- 11. Cause of Respiratory Distress 4? 12 months Difficult Breathing, AVPU = P Indrawing +ve Blood Slide Severe Pallor Very Severe Pneumonia Difficult breathing and AVPU = P Severe Malaria with Respiratory Distress Difficult breathing, Indrawing, AVPU = P, and +ve Blood Slide
- 12. Cause of Respiratory Distress 5? 12 months Difficult Breathing, AVPU = P Indrawing +ve Blood Slide Severe Pallor Very Severe Pneumonia Difficult breathing and AVPU = P Severe Malaria with Respiratory Distress Difficult breathing, Indrawing, AVPU = P, and +ve Blood Slide Severe Anaemia Respiratory distress plus severe pallor
- 13. Cause of Respiratory Distress 6? 12 months Difficult Breathing, Cannot drink Indrawing Wheeze ++ -ve Blood Slide Very Severe Pneumonia Difficult breathing, cannot drink and indrawing Very Severe Asthma Difficult breathing, Indrawing, Wheeze, and Cannot drink.
- 14. Wheeze – how severe is the asthma? Cyanosed? Unable to drink? Reduced level of consciousness? Grunting (infants)? Lower chest wall indrawing? RR ≥ 50 aged 2 –11 months? RR ≥ 40 aged 1 – 4 yrs? Very Severe Asthma Severe Asthma Mild Asthma Y Y Y
- 15. Causes of respiratory distress Pneumonia Malaria Anaemia Asthma Dehydration Acidosis Blood Film Pallor / Hb Acidosis Sunken Eyes, Skin Turgor, Acidosis Wheeze Crackles
- 16. Causes of respiratory distress Pneumonia Malaria Anaemia Asthma Dehydration Acidosis Blood Film Pallor / Hb Acidosis Sunken Eyes, Skin Turogor, Acidosis Wheeze Crackles Difficulty Breathing Indrawing Tachypneoa Consciousness?
- 17. Respiratory distress & Malaria Conscious level OK Deep / acidotic breathing Indrawing / Deep acidotic breathing PLUS severe pallor or Hb <5g/dl? Severe Malaria Life threatening anaemia plus malaria Y Y
- 18. Questions?
- 19. Summary • Key clinical signs define the severity of respiratory distress • There are several common causes that are hard to distinguish • Define severity and treat appropriately ALL likely problems.