- Bronchiolitis is a common respiratory condition in infants caused by viral infections like respiratory syncytial virus (RSV). It involves inflammation of the smallest air passages in the lungs called bronchioles.
- Symptoms include cough, wheezing, difficulty breathing and feeding. Risk factors for severe disease include age under 6 months, prematurity, and exposure to tobacco smoke. Diagnosis is clinical based on symptoms and signs. Treatment is supportive with oxygen, fluids, and nasal suctioning. Antibiotics and bronchodilators are not recommended. Parents should monitor for worsening symptoms.
This presentation was done by Dr. Julius P. Kessy,MD. An intern Doctor at Dodoma Regional Referral Hospital (DRRH) during pediatrics unit clinical meeting and supervised by Dr. Christina K. Galabawa,MD,Mmed2, Pediatrics and Child Health, University of Dodoma (UDOM) in November, 2017.
This presentation was done by Dr. Julius P. Kessy,MD. An intern Doctor at Dodoma Regional Referral Hospital (DRRH) during pediatrics unit clinical meeting and supervised by Dr. Christina K. Galabawa,MD,Mmed2, Pediatrics and Child Health, University of Dodoma (UDOM) in November, 2017.
What is bronchiolitis and its definition, the age group, signs and symptoms and clinical presentation The clinical practice guidelines, how to diagnosis, clinical criteria, what are the severity degrees and How to assess the severity, what are the investigations that may be needed, Is there any diagnostic test, what is the prognosis
What is the management,
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What is bronchiolitis and its definition, the age group, signs and symptoms and clinical presentation The clinical practice guidelines, how to diagnosis, clinical criteria, what are the severity degrees and How to assess the severity, what are the investigations that may be needed, Is there any diagnostic test, what is the prognosis
What is the management,
simlpe approach to anemia in children , how to diagnose anemia in kids ,types of anemias ,causes of anemia , iron deficeincy anemia, hemolytic anemias , laboratory tests in anemia ,
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An old presentation that I made when I was an Intern in Pediatric department.
The presentation contains 71 slides. It discusses bronchial asthma in pediatric age group starting from the definition of bronchial asthma and its pathophysiology and ending by the management of acute attacks of asthma and long-term management of bronchial asthma patients.
These lecture notes were prepared by Dr. Hamdi Turkey- Pulmonologist- Department of internal medicine - Taiz university
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i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
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These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
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Bronchiolitis of infancy is a clinically diagnosed respiratory
condition presenting with breathingdifficulties cough, poor feeding,
irritability and, in the very young, apnoea. These clinical features,
together with wheeze and/or crepitations on auscultation combine to
make the diagnosis. Bronchiolitis most commonly presents in infants
aged three to six months.
Bronchiolitis occurs in association with viral infections (respiratory
syncytial virus; RSV, in around 75% of cases)2 and is seasonal, with
peak prevalence in the winter months (November to March) when
such viruses are widespread in the community. Re-infection during a
single season is possible
Background
4. RSV:
is highly infectious
is transmitted mainly through contagious secretions or
via environmental surfaces (skin,cloth and other objects)
in respiratory droplets produced during coughing or
sneezing can spread up to two metres
enters the body via the mucous membranes of the eyes,
nose or mouth
can survive 6-12 hours on environmental surfaces
may be transferred on the hands to the eyes or nose
is destroyed by soap and water/alcohol gel
may be shed for up to three weeks and longer if a child is
immuno-compromised.08/27/13 SHO INDUCTION/DR.S.SEN 4
5. Diagnosis
1- clinical definition:
The diagnosis of bronchiolitis is a clinical one based on
typical history and findings on physical examination.
2-diagnostic value of clinical characteristics:
Age:
Bronchiolitis mainly affects infants under two years of
age. Ninety percent of cases requiring hospitalisation
occur in infants under twelve months of age.4 Incidence
peaks at age three to six months.
Fever:
Infants with bronchiolitis may have fever or a history of
fever.high fever is uncommon in bronchiolitis.SHO INDUCTION/DR.S.SEN
6. 08/27/13 SHO INDUCTION/DR.S.SEN 6
Rhinorrhoea:
Nasal discharge often precedes the onset of other symptoms such
as cough, tachypnoea, respiratory distress and feeding
difficulties. Cough:
a dry, wheezy cough is characteristic of bronchiolitis.Cough, along
with nasal symptoms, is one of the earliest symptoms to occur
in bronchitis.
Respiratory Rate:
Increased respiratory rate is an important symptom in lower
respiratory tract infection (LRTI) and particularly in bronchiolitis and
pneumonia.
Poor feeding:
Many infants with bronchiolitis have feeding difficulties due to
dyspnoea but poor feeding is not essential for the diagnosis of
bronchiolitis. Feeding problems are often the reason for hospital
admission.
7. 08/27/13 SHO INDUCTION/DR.S.SEN 7
Increased work of breathing and recession:
Dyspnoea and subcostal,intercostal and supraclavicular recessions
are commonly seen in infants with acute bronchiolitis.
Crackles /crepitation:
Fine inspiratory crackles in all lung fields are a common (but not
universal) finding in acutebronchiolitis.
Wheeze:
high pitched expiratory wheeze as a common but not universal
examination finding.
Apnea:
Apnoea can be the presenting feature of bronchiolitis, especially in
the very young and in premature or low birthweight infants.
8. Summary of diagnostic characteristics
diagnosis of acute bronchiolitis should be considered in
an infant with nasal discharge and a wheezy cough, in
the presence of fine inspiratory crackles and/or high
pitched expiratory wheeze. Apnoea may be a presenting
feature.
08/27/13 SHO INDUCTION/DR.S.SEN 8
9. Risk factors for severe disease
Age:
Younger infants have a higher risk of hospital admission
with bronchiolitis than older infants.
Significant comorbidities:
Prematurit y:
Infants born prematurely have a modestly higher rate of
RSV-associated hospitalisation compared with full-term
healthy babies.
Congenital heart disease.
Chronic lung disease of prematurit y: bronchopulmonary
dysplasia
08/27/13 SHO INDUCTION/DR.S.SEN 9
10. 08/27/13 SHO INDUCTION/DR.S.SEN 10
Social factors:
Breast feeding:
Breast feeding reduces the risk of RSV-related
hospitalisation and should be encouraged and supported.
Parental smoking:
Parental smoking is associated with an increased risk of
RSV-related hospitalisation of infants when
compared with non- smoking families.
Number of sibilings.
Socioecnomic deprivation.
11. Assessment and referral
Assessment:
Sever disease:
• poor feeding (<50% of usual fluid intake in preceding 24 hours)
• lethargy
• history of apnoea
• respiratory rate >70/min
• presence of nasal flaring and/or grunting
• severe chest wall recession
• Cyanosis
Clinical scoring system:
• No good quality evidence on the use of formal clinical scoring
systems in infants with acute bronchiolitis was identified.
08/27/13 SHO INDUCTION/DR.S.SEN 11
12. 08/27/13 SHO INDUCTION/DR.S.SEN 12
Referral:
Most infants with acute bronchiolitis will have mild disease and can
be managed at home with primary care support. Parents/care givers should be
given information on how to recognise any deterioration in their infant’s
condition ,asked to bring them back for reassessment should this occur.
Any of the following indications should prompt hospital referral/acute
paediatric assessment in an infant with acute bronchiolitis or suspected acute
bronchiolitis:
•poor feeding (<50% of usual fluid intake in preceding 24 hours)
•lethargy
•history of apnoea
•respiratory rate >70/min
•presence of nasal flaring and/or grunting
•severe chest wall recession
•cyanosis
•oxygen saturation ≤94%
•uncertainty regarding diagnosis.
13. 08/27/13 SHO INDUCTION/DR.S.SEN 13
Indications for high dependency/intensive care unit
consultation include:
•failure to maintain oxygen saturations of greater than 92% with
increasing oxygen therapy.
•deteriorating respiratory status with signs of increasing respiratory
distress and/orexhaustion
•recurrent apnoea.
14. oxygen saturation:
Pulse oximetry should be performed in every child who attends
hospital with acute bronchiolitis.
Infants with oxygen saturation ≤92% require inpatient care.
Decision making around hospitalisation of infants with oxygen
saturations between 92% and 94% should be supported by detailed
clinical assessment, consideration
of the phase of the illness and take into account social and
geographical factors.
Infants with oxygen saturations >94% in room air may be
considered for discharge.
08/27/13 SHO INDUCTION/DR.S.SEN 14
Investigations:
15. 08/27/13 SHO INDUCTION/DR.S.SEN 15
Blood Gases:
Blood gas analysis (capillary or arterial) is not usually indicated in
acute bronchiolitis.It may have a role in the assessment of infants
with severe respiratory distress or who are tiring and may be
entering respiratory failure. Knowledge of arterialised carbon dioxide
values may guide referral to high dependency or intensive care.
Chest x-ray:
Chest X-ray should not be performed in infants with typical acute
bronchiolitis.
Chest X-ray should be considered in those infants where there is
diagnostic uncertainty or an atypical disease course
Haematology:
Full blood count is not indicated in assessment and management of
infants with typical acute bronchiolitis
16. 08/27/13 SHO INDUCTION/DR.S.SEN 16
virological testing:
rapid testing for RSV is recommended in infants who require
admission to hospital with acute bronchiolitis.
Bacteriological testing:
Routine bacteriological testing (of blood and urine) is not indicated
in infants with typical acute bronchiolitis. Bacteriological testing
of urine should be considered in febrile infants less than 60 days old.
Biochemistry:
Urea and electrolytes:
Measurement of urea and electrolytes is not indicated in the routine
assessment and management of infants with typical acute
bronchiolitis but should be considered in those with severe disease.
C-Reactive protien.
17. Treatment
Antivirals:
• Nebulised ribavirin is not recommended for treatment of
acute bronchiolitis in infants.only can reduce admission
period.
Antibiotics:
• Antibiotic therapy is not recommended in the treatment
of acute bronchiolitis in infants.
Nebulised epinephrine:
• Nebulised epinephrine is not recommended for the
treatment of acute bronchiolitis in infants.
08/27/13 SHO INDUCTION/DR.S.SEN 17
18. 08/27/13 SHO INDUCTION/DR.S.SEN 18
anti-inflammatories:
•Inhaled corticosteroids&oral systemic corticosteroids:are
not recommended for the treatment of acute bronchiolitis
in infants.
inhaled bronchodilators:
•Beta 2 agonists&Anticholenergic:are not recommended for
the treatment of acute bronchiolitis in infants.
Hospital based supplementary therapies:
•Physiotherapy:
chest physiotherapy using vibration and percussion is not
recommended in infants hospitalised with acute
bronchiolitis who are not admitted to intensive care.
19. 08/27/13 SHO INDUCTION/DR.S.SEN 19
•Nasal suction:
Nasal suction should be used to clear secretions in
infants hospitalised with acutebronchiolitis who exhibit
respiratory distress due to nasal blockage.
•Maintaining fluid balance /hydration:
Common strategies are to commence small frequent
feeds, nasogastric or orogastric feeding or intravenous
fluids.
•Oxygen:
Infants with oxygen saturation levels ≤92% or who have
severe respiratory distress or cyanosis should receive
supplemental oxygen by nasal cannulae or facemask.
20. 08/27/13 SHO INDUCTION/DR.S.SEN 20
•Continuous Positive Airwa y Pressure and Negative
Pressure Ventilation:
Early discussion with a paediatric intensive care unit and
introduction of respiratory support should be considered in
all patients with severe respiratory distress or apnoeas.
21. Information about bronchiolitis for
parents and carers
What is bronchiolitis?
• Bronchiolitis is when the tiniest air passages in your
baby’s lungs become swollen. This can make it more
difficult for your baby to breathe. Usually, bronchiolitis is
caused by a virus called respiratory syncytial virus
(known as RSV).
Can I prevent bronchiolitis?
• No. The virus that causes bronchiolitis in babies also
causes coughs and colds in older children and adults so
it is very difficult to prevent.08/27/13 SHO INDUCTION/DR.S.SEN 21
22. 08/27/13 SHO INDUCTION/DR.S.SEN 22
What are the symptoms?
• Bronchiolitis starts like a simple cold. Your baby may
have a runny nose and sometimes a temperature and a
cough.
•After a few days your baby’s cough may become worse.
• Your baby’s breathing may be faster than normal and it
may become noisy. He or she may need to make more
effort to breathe.
•Sometimes, in very young babies, bronchiolitis may cause
them to have brief pauses in their breathing.
•As breathing becomes more difficult, your baby may not
be able to take the usual amountof milk by breast or bottle.
You may notice fewer wet nappies than usual.
•Your baby may be sick after feeding and become irritable.
23. 08/27/13 SHO INDUCTION/DR.S.SEN 23
How can I help my baby?
•If feeding is difficult, try breastfeeding more often or
offering smaller bottle feeds moreoften.
•If your baby has a temperature, you can give him or her
paracetamol .
•If your baby is already taking any medicines or inhalers,
you should carry on using these. If you find it difficult to
get your baby to take them, ask your doctor for advice.
•Bronchiolitis is caused by a virus so antibiotics won’t help
•How long does bronchiolitis last?
Most babies with bronchiolitis get better within about two
weeks. They may still have a cough for a few more weeks.
24. 08/27/13 SHO INDUCTION/DR.S.SEN 24
When should I get advice?
•you are worried about your baby;
•your baby is having difficulty breathing;
•your baby is taking less than half his or her usual feeds
over two to three feeds, or has no wet nappy for 12 hours;
•your baby has a high temperature; or your baby seems
very tired or irritable