Acute bronchiolitis is a common lower respiratory tract viral infection in infants under 2 years old, often caused by respiratory syncytial virus. It involves inflammation of the bronchioles and leads to respiratory distress. Management focuses on supportive care through hydration, oxygen therapy, and monitoring for complications like pneumonia or respiratory failure. Prevention emphasizes hand hygiene and palivizumab prophylaxis for high-risk infants.
Module: Pharmacology and Therapeutics III, (Therapeutics part)
Coordinator: Dr. Arwa M. Amin Mostafa
Academic Level: Undergraduate, B.Pharmacy
School: Dubai Pharmacy College
Year of first presented in Class: 2018
This Presentation is for Educational Purpose. It has no commercial value associated with it.
Module: Pharmacology and Therapeutics III, (Therapeutics part)
Coordinator: Dr. Arwa M. Amin Mostafa
Academic Level: Undergraduate, B.Pharmacy
School: Dubai Pharmacy College
Year of first presented in Class: 2018
This Presentation is for Educational Purpose. It has no commercial value associated with it.
The lower respiratory system, or lower respiratory tract, consists of the trachea, the bronchi and bronchioles, and the alveoli, which make up the lungs. These structures pull in air from the upper respiratory system, absorb the oxygen, and release carbon dioxide in exchange.
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The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
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NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
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.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
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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
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
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
3. Introduction
• Acute bronchiolitis is a diagnostic term used to describe the clinical
picture produced by several different viral lower respiratory tract
infections in infants and very young children.
• It is as a result of an acute inflammatory injury to the bronchioles that
as caused by a viral infection.
• It is the commonest lower respiratory tract infection in children less
than 1 year of age.
4. Epidemiology
• According to the WHO bulletin, an estimated 150 million new cases
occur annually.
• Over 100,000 young children are hospitalized annually in the United
States with the diagnosis of bronchiolitis,
• About 75% of cases occur in children younger than 1 year, and 95% in
children younger than 2 years.
• Incidence peaks in those aged 2-8 months (3-6months crescendo).
• Male to female ratio – 1.25-2 : 1
• Death is 1.5 times more likely in males.
6. Pathophysiology
• Bronchiolar injury and the consequent interplay between inflammatory
and mesenchymal cells can lead to diverse pathologic and clinical features:
Day 0 – 2 (upper respiratory tract): Virus damages the upper respiratory
tract epithelial cells which are sloughed to the lower respiratory tract, thus
constituting cellular debris.
Day 3 – 10 (lower respiratory tract): Further epilethial cell invasion.
Increased mucus production. Mucosal edema. Ciliary function impairment.
Proliferation and infiltration of polymorphonuclear cells and lymphocytes.
Air trapping. Atelectasis and ventilation-perfusion mismatch.
The above lead to significant narrowing of the bronchioles.
Day 11 – 22 (upper and lower respiratory tracts): Epithelial regeneration.
7. Risk Factors
• Low birthweight
• Age less than 3 months.
• Low socioeconomic group
• Chronic lung diseases e.g BPD
• Congenital heart or neurological diseases
• Exposure to second-hand tobacco smoke.
• Those who have not been breastfed
• crowded living conditions, daycare centers.
• Risk is also higher for infants with mothers who smoked during pregnancy.
• Older family members, including older siblings with respiratory tract
infection.
9. Clinical Manifestations
• Day 3 – 10
Wheezing
Subcostal and intercostal retractions
Cough
Impaired feeding
Cyanosis, apnea
Rhonchi, crackles
10. Management
• Management of a child presenting with features suggestive of acute
bronchiolitis entails detailed history, physical examination, diagnostic
evaluation, treatment and follow-up.
11. Management
• History
usually preceded by exposure to contacts with a minor respiratory
illness within the previous week
The infant first develops signs of upper respiratory tract infection
with sneezing and clear rhinorrhea. This may be accompanied by
diminished appetite and fever. Gradually, respiratory distress ensues,
with paroxysmal cough, dyspnea, and irritability. The infant is often
tachypneic, which can interfere with feeding. Apnea may precede
lower respiratory signs early in the disease, particularly with very
young infants.
12. Management
• History
Birth history includes weeks of gestation, neonatal complications
including history of intubation or oxygen requirement, maternal
complications, and prenatal smoke exposure.
Past medical history includes any comorbid conditions.
Family history of cystic fibrosis, immunodeficiencies, asthma in a first-
degree relative, or any other recurrent respiratory conditions in
children should be obtained.
13. Management
• History
Social history should include any second-hand tobacco or other
smoke exposure, daycare exposure, number of siblings, pets, and
concerns regarding home environment (e.g., dust mites, construction
dust, heating and cooling techniques, mold, cockroaches).
The patient's growth chart should be reviewed for signs of failure to
thrive
14. Management
• Physical examination
Respiratory rate and oxygen saturation is an important initial step.
Wheezing and crackles.
Expiratory time may be prolonged.
Work of breathing may be markedly increased, with nasal flaring and
retractions.
Complete obstruction to airflow can eliminate the turbulence that causes
wheezing; thus the lack of audible wheezing is not reassuring if the infant
shows other signs of respiratory distress.
Poorly audible breath sounds suggest severe disease with nearly complete
bronchiolar obstruction
15. Management
• Diagnostic evaluation
Acute bronchiolitis is a clinical diagnosis and thus investigations to confirm the
diagnosis are seldom needed.
CBC: white blood cell and differential counts are usually normal and are not
predictive of bacterial superinfection, However, may show lymphocytosis
ABG: hypoxia and hypercapnia
Chest X-ray: might show findings misconstrued for bronchopneumonia thus
encouraging the unnecessary use of antibiotics.
Rapid antigen detection for RSV, parainfluenza, influenza and adenovirus
(sensitivity 80=90%)
Immunofluorescence, viral culture and PCR
17. Management
• Admission Criteria
SPO2 below 92% in room air
Markedly elevated respiratory rate (>70cpm)
Respiratory distress
Chronic lung disease
Congenital heart disease
Prematurity
Age <3 months
Inability or difficulty with feeding
Parental anxiety
18. Management
• Treatment
Among the many medications and interventions used in the
management of bronchiolitis, only oxygen appreciably improves the
condition of the ailing child.
Healthy children with bronchiolitis usually have limited disease and
do well with supportive care only.
Therapy is directed towards symptomatic relief and maintenance of
hydration and oxygenation.
19. Management
• Treatment
Supportive care includes:
Supplemental humidified oxygen
Maintenance of hydration
Nasal and oral suctioning
Apnea and cardiorespiratory monitoring
Thermoregulation
Mechanical ventilation.
20. Management
• Guidelines for treatment
• In 2006, the American Association of Paediatricians in conjunction
with the America College of Chest Physicians, American Thoracic
Society and American Academy of Family Physicians published the
following recommendations as guideline for the treatment of acute
bronchiolitis.
21. Management
• Treatment guidelines
Diagnosis and severity should be based on history and physical
findings.
Bronchodilators should not be routinely used.
Corticosteroids should not be routinely used.
Ribavirin should not be routinely used.
Antibiotics should be used only upon proven bacterial co-infection,
Hydration and the ability to take oral fluids should be assessed.
22. Management
• Treatment guidelines
Supplemental oxygen should be supplied for saturations below 90% on
pulse oximetry.
Palivizumab prophylaxis should be administered to selected children.
Hand decontamination is indicated to prevent nosocomial spread.
Infants should not be exposed to secondary smoking, and breastfeeding is
recommended.
Clinicians should inquire about use of complementary and alternative
medicine therapies.
23. Complications
• Otitis media
• Pneumonia
• Pneumothorax
• Dehydration
• Respiratory acidosis
• Respiratory failure
• Heart failure
• Prolonged apneic spells leading to death
24. Prognosis
• Infants with acute bronchiolitis are at highest risk for further respiratory
compromise in the first 72 hours after onset of cough and dyspnea.
• The case fatality rate is <1% in developed countries, with death attributable
to respiratory arrest and/or failure or severe dehydration and electrolyte
disturbances.
• A majority of deaths due to bronchiolitis occur in children with complex
medical conditions or comorbidities such as bronchopulmonary dysplasia,
congenital heart disease, or immunodeficiency.
• The median duration of symptoms in ambulatory patients is approximately
14 days; 10% may be symptomatic for 3 weeks.
25. Prevention
• Meticulous hand hygiene is the best measure to prevent transmission
of the viruses responsible for bronchiolitis.
• For high-risk populations, palivizumab, an intramuscular monoclonal
antibody to the RSV F protein, may be given as a prophylactic agent.
• Palivizumab has been demonstrated to reduce risk of hospitalization
due to RSV bronchiolitis in certain populations.
• It has not been shown to decrease mortality and does not protect
against bronchiolitis caused by other viruses and is also quite costly.
As a result, there is some controversy surrounding which populations
should receive palivizumab.
26. Prevention
• U.S. guidelines suggest use for children born at <29 weeks completed
gestation,
• those with significant heart disease or chronic lung disease of
prematurity, through the 1st or 2nd (for those with persistent chronic
lung disease of prematurity) year of life.
• Prophylaxis may be considered in infants with neuromuscular disease
and immunocompromised states.
27. Conclusion
• Acute bronchiolitis is a viral lower respiratory tract infection
commonest in under-2s which frequently presents with cough,
wheezing, respiratory distress, fever and impaired feeding. It is
usually preceded by rhinorrhea.
• RSV is implicated in more than 50% of cases of acute bronchiolitis.
• Hydration, oxygen optimization and other supportive care targeted
towards symptomatic relief are the main stay of management.
• Meticulous hand hygiene remains the best measure to prevent
transmission of the viruses responsible for bronchiolitis.
28. References
• Kliegman, R. (2020). Nelson textbook of pediatrics (Edition 21.).
Philadelphia, PA: Elsevier.
• Kumar, V., Abbass, A. K., & Aster, J. C. (2015). Robbins and Cotran
pathologic basis of disease (9th Edition.). Philadelphia, PA:
Elsevier/Saunders.
• Medscape