This document discusses neonatal sepsis, including its definition, types (early vs late onset), symptoms, risk factors, diagnosis, treatment and prevention. It notes that neonatal sepsis is a systemic bacterial infection occurring in the first 4 weeks of life. Early onset sepsis occurs within 72 hours of birth and is usually caused by maternal genital tract bacteria. Late onset sepsis occurs after 72 hours and is often hospital-acquired. Diagnosis involves blood, CSF and other cultures as well as sepsis screening tests. Treatment involves supportive care and parenteral antibiotics, with antibiotic choices dependent on the suspected site of infection. Handwashing and other infection control practices are emphasized for prevention.
During the last decades advances in neonatal intensive care have led to an impressive decrease of neonatal mortality and morbidity. However, infectious episodes in the early postnatal period still remain serious and potentially life-threatening events with a mortality rate of up to 50% in very premature infants. [1, 2] The signs and symptoms of neonatal sepsis can be clinically indistinguishable from various noninfectious conditions such as respiratory distress syndrome or maladaptation. Therefore rapid diagnosis is crucial for preventing the child from an adverse outcome. The current practice of starting empirical antibiotic therapy in all neonates showing infection-like symptoms results in their exposure to adverse drug effects, nosocomial complications, and in the emergence of resistant strains. [3] Sepsis results from the complex interaction between the invading microorganism and the host immune, inflammatory, and coagulation response. [4, 5] Inflammatory cytokines (TNF-α, IL-1β, IL-6, IL-8, IL-15, IL-18, MIF) and growth factors (IL-3, CSFs), and their secondary mediators, including nitric oxide, thromboxanes, leukotrienes, platelet-activating factor, prostaglandins, and complement, cause activation of the coagulation cascade, the complement cascade, and the production of prostaglandins, leukotrienes, proteases and oxidants. [6] Laboratory sepsis markers represent a helpful tool in the evaluation of a child with clinical signs and complement the evaluation of a neonate with a potential infection. During the last decades efforts were done to improve laboratory sepsis diagnosis and a variety of the above mentioned markers and more were studied with different success. Despite the promising results for some of them current evidence suggests that none of them can consistently diagnose 100% of infected cases. C-reactive protein (CRP) is the most extensively acute phase reactant studied so far and despite the ongoing rise (and fall) of new infection markers it still remains the preferred index in many neonatal intensive care units.
During the last decades advances in neonatal intensive care have led to an impressive decrease of neonatal mortality and morbidity. However, infectious episodes in the early postnatal period still remain serious and potentially life-threatening events with a mortality rate of up to 50% in very premature infants. [1, 2] The signs and symptoms of neonatal sepsis can be clinically indistinguishable from various noninfectious conditions such as respiratory distress syndrome or maladaptation. Therefore rapid diagnosis is crucial for preventing the child from an adverse outcome. The current practice of starting empirical antibiotic therapy in all neonates showing infection-like symptoms results in their exposure to adverse drug effects, nosocomial complications, and in the emergence of resistant strains. [3] Sepsis results from the complex interaction between the invading microorganism and the host immune, inflammatory, and coagulation response. [4, 5] Inflammatory cytokines (TNF-α, IL-1β, IL-6, IL-8, IL-15, IL-18, MIF) and growth factors (IL-3, CSFs), and their secondary mediators, including nitric oxide, thromboxanes, leukotrienes, platelet-activating factor, prostaglandins, and complement, cause activation of the coagulation cascade, the complement cascade, and the production of prostaglandins, leukotrienes, proteases and oxidants. [6] Laboratory sepsis markers represent a helpful tool in the evaluation of a child with clinical signs and complement the evaluation of a neonate with a potential infection. During the last decades efforts were done to improve laboratory sepsis diagnosis and a variety of the above mentioned markers and more were studied with different success. Despite the promising results for some of them current evidence suggests that none of them can consistently diagnose 100% of infected cases. C-reactive protein (CRP) is the most extensively acute phase reactant studied so far and despite the ongoing rise (and fall) of new infection markers it still remains the preferred index in many neonatal intensive care units.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
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micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
2. 03/11/2023 2
Neonatal Sepsis
Clinical syndrome of bacteraemia
characterized by systemic signs and symptoms of
infection in the first four weeks of life
3. 03/11/2023 3
Early vs Late onset sepsis
Early onset Late onset
Age <72 hours >72 hours
Risk factor Prematurity Prematurity
Amnionitis,
Maternal infection
Source Maternal genital Environmental
tract (nosocomial)
Presentation Fulminant slowly progressive
Multisystem focal
Pneumonia frequent Meningitis frequent
Mortality 5-50% 10-15%
4. 03/11/2023 4
Natural course of sepsis
Bacteria
Focal infection Bacteraemia
sepsis
Sepsis syndrome
Early septic shock
Refractory septic shock
MODS
DEATH
5. 03/11/2023 5
Incidence
In India
- 3.9 % of all imtramural births
- 20 – 30 % develop meningitis
In developed countries
- 1 in 1000 live births - Term
- 4 in 1000 live births - Preterm
- 300 in 1000 VLBW babies
11. 03/11/2023 11
Laboratory Diagnosis of Neonatal Sepsis
1. Direct methods
- Blood culture
- CSF culture
- Urine culture
2. Indirect methods
- Total leucocyte count
- Absolute neutrophil count
- Total immature neutrophils
- Immature to total neutrophols
- Neutrophil Morphology
- Platelet count
- Micro ESR
- Acute phase reactants
- Buffy coat examination
- Smear of gastric aspirate / External ear canal fluid
- C3d
12. 03/11/2023 12
SEPSIS SCREEN
At Birth
Major risk factors
1. Rupture of membranes > 24 hours
2. Maternal intrapartum fever > 100.40 F
3. Chorioamninitis
Minor risk factors
1. Rupture of membrane > 12 hours
2. Maternal intrapartum fever > 99.50 F
3. Maternal WBC > 15000 / mm3
4. Low apgar score(< 5 at 1 min, < 7 at 5 min)
5. LBW ( < 1500 g )
6. Preterm labour ( < 37 weeks)
13. 03/11/2023 13
SEPSIS SCREEN
1. Leucopenia (TLC < 5000 / mm3)
2. Neutropenia (ANC <1800 / mm3)
3. Immature neutrophil to total neutrophil
( I / T) ratio ( > 0.2)
4. Micro – ESR ( > 15 mm / 1st hour )
5. CRP - positive
14. 03/11/2023 14
Approach to Neonatal Sepsis
Antenatal Postnatal
Mothers with risk factors
Symptomatic Asymptomatic
infants infant with risk
factors
Term Preterm
15. 03/11/2023 15
Evaluation of symptomatic infant for sepsis
- Sepsis screen
- Chest X-ray
- Lumbar puncture
- Blood culture
Begin Antibiotics
Culture positive No risk factors for sepsis
Presence of focal infection Culture negative
Sepsis screen positive Sepsis screen negative
LP abnormal Symptoms resolve by 24 hrs
Symptoms persists 72 hrs
Treat pneumonia 7-10 days Treat for 48-72 hrs
Septicaemia 10-14 days and discharge
Meningitis 14-21 days
16. 03/11/2023 16
Evaluation of asymptomatic infant for sepsis
Sepsis screen
Sepsis screen Sepsis screen Blood culture, LP
negative positive
Begin Antibiotics
Observe for 48-72 hrs Culture positive Culture negative
and discharge LP abnormal LP normal
Treat septicaemia 10-14 days Treat for 48-72 hr
Meningitis for 14-21 days and discharge
17. 03/11/2023 17
Supportive Care
- Keep the neonate warm
- Start IV Fluid, Infuse 10% Dextrose 2ml / Kg
stat to maintain normoglycaemia
- Maintain fluid and electrolyte balance and
tissue perfusion
If CRT > 3 sec infuse 10 ml / Kg normal
saline
18. 03/11/2023 18
Supportive Care
- Avoid enteral feed, if sick
- Start oxygen by hood, if cyanosed
and support breathing
- Consider exchange blood transfusion,
if there is sclerema, DIC, Neutropenia
19. 03/11/2023 19
Choice of Antibiotics
Pneumonia or Sepsis
Penicillin + Aminoglycoside
(Ampicillin or Cloxacillin) (Gentamicin or Amikacin)
Meningitis
Ampicillin + Gentamicin
or
Cefotaxime + Gentamicin or Amikacin
20. 03/11/2023 20
Superficial Infections
- Pustules - After puncturing, clean with
betadine and apply antimicrobial
- Conjunctivitis- Chloramphenicol eye drops
- Oral thrush - Local application of Nystatin
or Clotrimazole
21. 03/11/2023 21
Prevention of Infection
- Exclusive breastfeeding
- Keep cord dry
- Hand washing by care givers
- Hygiene of Baby
- No unnecessary intervention
- Better management of IV Lines
- Disinfection of Equipments
22. 03/11/2023 22
Hand Washing
- Single most important means of
preventing nosocomial infections
- Very Simple
- Cheap
23. 03/11/2023 23
Hand Washing
- Two minutes, hand washing to be done
before entering baby care area
- 10 seconds hand washing to be done before
and after touching every baby, and after
touching unsterile surfaces and fomites
24. 03/11/2023 24
Steps of effective hand washing
- Roll sleeves above elbow
- Remove wrist watch, bangles, ring etc
- Using plain water and soap, wash parts of the
hand in the following sequence
- Palm and fingers (web spaces)
- Back of hands
- Fingers and Knuckles
- Thumbs
- Finger tips
- Wrists and forearm up to elbow
25. 03/11/2023 25
Steps of Effective Hand Washing
- Keep elbow always dependent
- Close the tap using elbow
- Dry hands using single use sterile
paper / napkin
- Do not keep long or polished nails
Rinsing hands with alcohol is
NOT A SUBSTITUTE for PROPER HAND WASHING
26. 03/11/2023 26
Medication preparation
( Prepare IV fluid under aseptic conditions )
- Never use stock solution for flushing
- Do not use a single bottle for > 24 hrs
- Label bottle with date / time
- After seal is removed, use betadine soaked
sterile cotton to cover the stopper of bottle
- Use disposable needle each time
27. 03/11/2023 27
Better management of IV Lines
- Thorough hand washing
- Wear gloves
- Use disposable IV cannula
- Thorough skin preparation
- All IV ports should be wiped with alcohol
- Early identification of extravasation
- Avoid unnecessary IV infusion
28. 03/11/2023 28
Conclusion
- High index of clinical suspicion
- Look for Lab evidence of sepsis
- Start parenteral antibiotics (intravenous)
- Provide supportive care
- Review culture reports
- Practise barrier nursing to prevent
Cross–infection
